ASCARIS LUMBRICOIDES

A. Causal Agent

Ascaris lumbricoides is the largest nematode (roundworm) parasitizing the human

intestine. (Adult females: 20 to 35 cm; adult male: 15 to 30 cm.)

B. Geographic Distribution

The geographic distributions of Ascaris lumbricoides are worldwide in areas with warm,

moist climates and are widely overlapping. Infection occurs worldwide and is most common
in tropical and subtropical areas where sanitation and hygiene are poor. Ascaris suum can be
found wherever pigs are found.

C. Cycle Life

The diagram above reflects only the life cycle of Ascaris lumbricoides. Ascaris suum, the
species of roundworm found in pigs, in rare cases may also cause human infection.
Adult worms   live in the lumen of the small intestine. A female may produce
approximately 200,000 eggs per day, which are passed with the feces  . Unfertilized eggs
may be ingested but are not infective. Fertile eggs embryonate and become infective after 18
days to several weeks  , depending on the environmental conditions (optimum: moist,
warm, shaded soil). After infective eggs are swallowed  , the larvae hatch  , invade the
intestinal mucosa, and are carried via the portal, then systemic circulation to the lungs  . The
larvae mature further in the lungs (10 to 14 days), 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.

D. Pathogenesis
Pathogenesis caused by Ascaris infections is attributed to (1) the host's immune response,
2) effects of larval migration, (3) mechanical effects of the adult worms, and (4) nutritional
deficiencies due to the presence of the adult worms. Although the initial passage of larvae
through the liver and lungs usually elicits no symptoms, there can be signs of pneumonitis if
the number of larvae is quite large. When the larvae break out of the lung tissue and into the
alveoli, there may be some bronchial epithelium damage. With reinfection and subsequent
larval migrations, there may be intense tissue reactions, even with small numbers of larvae.
There may be pronounced tissue reaction around the larvae in the liver and lung with
infiltration of eosinophils, macrophages, and epithelioid cells. This has been called Ascaris
pneumonitis and is accompanied by an allergic reaction consisting of dyspnea, a dry or
productive cough, wheezing or coarse rales, fever (39.9-40.0°C), transient eosinophilia, and a
chest x-ray suggestive of viral pneumonia. This picture of transient pulmonary infiltrates,
clearing within a couple of weeks, and associated with peripheral eosinophilia is frequently
called Loeffler's syndrome. In addition to eosinophils and Charcot-Leyden crystals, the
sputum may also contain larvae. Asthma and urticaria may continue during the intestinal
phase of ascariasis.
The presence of the adult worms in the intestine usually causes no difficulties unless the
form burden is very heavy; however, due to the tendency of the adult worms to migrate, even
a ingle worm can cause serious squeal. Worm migration may occur as a result of stimuli such
as fever (usually over 38.9 °C), the use of general anesthesia, or other abnormal conditions.
This migration may result in intestinal blockage; entry into the bile duct, pancreatic duct, or
other small spaces; or entry into the liver or peritoneal cavity. They can also migrate out of
the anus or come out the mouth or nose. Other body sites have been involved such as the
kidney, appendix, or pleural cavity. In children, particularly those under the age of 5, there
may be severe nutritional impairment related to the worm burden. Directly measurable effects
would include increased fecal nitrogen and fecal fat, and impaired carbohydrate absorption,
all of which would return to normal with elimination of the adult worms. Worms can also be
spontaneously passed without any therapy.
E. Diagnose
In the larval migration phase of the infection, diagnosis can be made by finding the larvae
in sputum or in gastric washings. The typical Loeffler's syndrome is more likely to be seen in
areas where transmission is highly seasonal.
During the intestinal phase, the diagnosis can be made by finding the eggs (unfertilized or
fertilized) or adult worms in the stool. The eggs are most easily seen on a direct wet smear or
a wet preparation of the concentration sediment. Unfertilized Ascaris eggs will not float using
the zinc sulfate flotation concentration method (eggs too heavy). Also, if too much iodine is
added to the wet preparations, the eggs may look like very dark debris. Eggs may be very
difficult to identify on a permanent stained smear due to stain retention and asymmetrical
shape. Intestinal disease can often be diagnosed from radiographic studies of the
gastrointestinal tract where the worm intestinal tract may be visualized. This may be
particularly obvious when two worms are lying parallel, like "trolly car lines". Other involved
body sites would present specific symptoms indicative of bowel obstruction, biliary or
pancreatic duct blockage, appendicitis, or peritonitis. Therapeutic measures would be related
to specific symptoms and involved areas.

F. Treatment

The treatment of ascariasis can be divided into two, namely drug therapy and surgery.
Drug therapy that can be used include albendazole (400 mg) and mebendazole (500 mg)
single dose. Can also be used levamisole (2.5 mg / kgBB) or pirantel pamoat (10 mg / kgBB),
otherwise it can be given nitazoxanide (500 mg per day for three days). The surgical action
that can be performed is laparotomy. The surgical action is given to the situation in which the
patient does not respond to treatment..

G. Prevention and control

The best way to prevent people from getting ascariasis from humans or pigs is to always
do the following:

 Avoid ingesting soil that may be contaminated with human or pig feces, including
where human fecal matter (“night soil”), wastewater, or pig manure is used to fertilize
crops.
 Wash your hands with soap and  water before handling food.
 Wash your hands with soap and water after touching or handling pigs, cleaning pig
pens, or handling pig manure.
 Teach children the importance of washing hands to prevent infection.
 Supervise children around pigs, ensuring that they do not put unwashed hands in their
mouths.
 Wash, peel, or cook all raw vegetables and fruits before eating, particularly those that
have been grown in soil that has been fertilized with manure.

Transmission of Ascaris lumbricoides infection to others in a community setting can be

prevented by:

 Not defecating outdoors.

 Effective sewage disposal systems.

Ascaris suum eggs left in the soil from pigs can survive for up to 10 years. The eggs are
very hardy and can survive extreme environmental conditions like freezing and extreme heat.
It is virtually impossible to completely remove Ascaris suum eggs from the environment
where an infected pig has been present. Consult a veterinarian for recommendations on
preventing and controlling Ascaris suum in your pigs.