Ascaris Lumbricoides

● Most common intestinal nematode

● Giant roundworm
● A soil-transmitted helminth
● STH infections are diseases of poverty and contribute to malnutrition and reduce work
capacity and productivity of adults

Morphology:
Adult worm: smooth finely striated cuticle, conical ant./post. extremities
Male:
● 10-31cm, ventrally curved posterior end of male with 2 spicules, single
reproductive organs
Female
● 22-35cm, w/paired reproductive organs.
Eggs:
Fertile eggs: 45-70um by 35-50um ;The thick-shelled egg has an outer shell membrane
which is heavily mamillated (cortication) with delicate vitelline lipoidal inner membrane
(impermeable)
Infertile eggs: 88-94um by 39-44um with refractile granules

Mode of Transmission:

Occurs mainly via ingestion of water or food (raw vegetables or fruit in particular)
contaminated with A. lumbricoides eggs. Occasionally inhalation of contaminated dust. Children
playing in contaminated soil may acquire the parasite from their hands. Walking barefoot in the
soil or skin having contact with the soil

Infective Stage: Fully embryonated eggs (3rd stage)

Pathogenic Stage: Adult worms
Habitat: In the mucosa of the small intestine, specifically the jejunum
Type of Host: Human or pigs (definitive host)

Epidemiology

The annual global morbidity due to ascaris infections is estimated at 1.2 billion with a
mortality of 2,000. Ascariasis can occur at all ages, but it is more prevalent in the 5 to 15 years
age group. The incidence is higher in poor rural populations. Children are vulnerable since
they’re at risk of ingesting embryonated Ascaris eggs while playing in soil contaminated with
human feces.
Contribution to the transmission of Ascaris:
● High density of human population
● Involvement in agriculture (including use of night-soil as fertilizer)
● Illiteracy
● Poor sanitation
 ● Poor health education (on personal, family, community hygiene)

Life cycle
1. Adult worms live in the lumen of the small intestine.
2. A female may produce approximately 200,000 eggs per day, which are passed
with the feces .
3. Unfertilized eggs may be ingested but are not infective. Larvae develop to
infectivity within fertile eggs after 18 days to several weeks , depending on the
environmental conditions (optimum: moist, warm, shaded soil).
4. After infective eggs are swallowed,
5. The larvae hatch and invade the intestinal mucosa, then,
6. Are carried via the portal, then systemic circulation to the lungs . The larvae
mature further in the lungs (10 to 14 days)
7. Penetrate the alveolar walls, ascend the bronchial tree to the throat, and are
swallowed . Upon reaching the small intestine, they develop into adult worms.
Between 2 and 3 months are required from ingestion of the infective eggs to
oviposition by the adult female. Adult worms can live 1 to 2 years.

Pathogenesis

The reaction of tissues to invading larvae, irritation of the intestine by mechanical and
toxic action of adult worms, and complication arising from the parasite’s extraintestinal
migration.
Lung migration: causes host sensitization resulting in lung infiltration, asthmatic attacks,
edema of the lips
Moderate infections: lactose intolerance, Vitamin A malabsorption
Heavy infections: bowel obstruction, intussusception, intestinal perforation
Ascariasis - intestinal

Clinical presentation
1. Migrating larvae: lungs; loeffler’s pneumonitis; liver
2. Adult worm in small intestine
3. Allergic response
4. Complications: obstruction, intussusception, ectopic migration
*Loeffler’s syndrome: a group of signs and symptoms consist of cough, dyspnea, transient
eosinophilia in PBS, sputum; infiltration of the lungs.

Autoinfection
*Larvae hatch from the eggs in the small intestine, penetrate the intestine wall, enter the
bloodstream, migrate to the liver, travel to the lung via the bloodstream.
Larvae break out of lung capillaries into alveoli, travel to the bronchioles, and are coughed up to
the pharynx. They are swallowed and return to the intestine. Two molts to 4th stage larvae take
place in alveoli.
Drugs
● Albendazole: 400mg single dose
● Mebendazole: 500mg single dose
● Pyrantel palmoate: 10mg/kg
● Piperazine citrate; 150mg/kg initially, followed by 65mg/kg at 12hrs interval for erratic
worm migration

Complications

Severe abdominal cramping and vomiting. The blockage can even perforate the
intestinal wall or appendix, causing internal bleeding (hemorrhage) or appendicitis. Once the
parasite is eliminated is very good as long as reinfection can be prevented and transmission
risks are removed. Undiagnosed or untreated infections can result in multiple complications.
Complications such as intestinal blockage may require surgery.