Erbil polytechnic University

Erbil Technical Health College

MLT Department
Stage: third

Subject: practical helminthology

Report 1:
(Ascaris lumbricoides)

Prepared by:

‫عمر فاریق محمد‬ ‫هاورێ نجم الدین سعید‬

‫بلیمەت کامران صدیق‬ ‫بوشراطارق عفان‬
‫زەهرا گۆڤەند رەسول‬ ‫ریان مغدید خورشید‬

Supervisor: Mr. Hawri H. Mohammed

H.D., M.Sc. Parasitology
Date: 8/10/2021

Ascaris lumbricoides
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Ascaris lumbricoides is the largest nematode parasitizing the human intestine. Th e name is derived
from Askaris means intestinal worm and Lumbricus means resembling with common earthworm. It
is commonly called as round worm.
• COMMON NAME
Roundworm.

• HISTORY AND DISTRIBUTION

Ascaris lumbricoides has been observed and described from very ancient times, when it was
sometimes confused with the earthworm.
• Its specific name lumbricoides is derived from its resemblance with earthworm (Lumbricus,
meaning earthworm in Latin).
• It is the most common of human helminths and is distributed worldwide. A billion people are
estimated to be infected with roundworms. The individual worm burden could be very high, even up
to over a thousand. An editorial in the Lancet in 1989 observed that if all the roundworms in all the
people worldwide were placed end-to-end they would encircle the world 50 times.
• The incidence may be as high as 80- 100% in rural areas with poor sanitation.

• HABITAT
Adult worms live in the small intestine (85% in jejunum and 15% in ileum). The roundworm,
Ascaris lumbricoides is the largest nematode parasite in the human intestine.

Epidemiology
A. lumbricoides is cosmopolitan in distribution, mainly affecting tropical countries including India.
z It is estimated that, 1470 million people are infected globally out of which around 120–250 million
of people are symptomatic
z Transmission typically occurs through fecally contaminated soil and is due to either lack of
sanitary facilities or use of human feces as fertilizer
z Clay soils are the most favorable for the development of Ascaris egg (in contrast to moist porous
soil required for hookworm)
z Risk factors: Children (most important disseminator of the disease) and malnutrition.

Morphology
Adult worm
z Appearance: Pinkish creamy in color when freshly passed from intestine, but gradually fades
color and looks whitish
z Size: Female worms (20–35 cm) are longer than male worms (15–31 cm). Adult worms life span is
1–2 years
z Shape: Cylindrical (hence called as round worm); with tapering ends (tapering is more anteriorly)
z Mouth part: Th e mouth opens anteriorly and bears three characteristic toothed lips (one dorsal
and two ventral). Th e character of the toothed lip is used to diff erentiate A. lumbricoides and A.
suum
z Body cavity: Filled with a characteristic fluid called as ascaron or ascarase in which the intestine

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and genital organs float. Th is fluid is irritant in nature and if leaked, then can cause allergic
manifestations
z Male: The posterior end is curved and

pointed bearing two spicules. Rectum and genital duct open together at cloaca near the posterior end (Fig. 12.15 A)
z Females: Posterior end is straight and pointed. Anus is subterminal and situated posteriorly while
the vulva is situated at the junction of anterior and middle third of the body (on the ventral surface).
This portion of the worm is narrower and referred to as vulvar waist (Fig. 12.15B)
z Other features are similar to any nematode described in the beginning of the chapter.

Egg
Two types of eggs are liberated from the female
worm of A. lumbricoides—(1) fertilized and (2) unfertilized eggs (Table 12.10) Sometime, the
fertilized eggs may lose the thick mamillated albuminous coat. Such types of eggs are called as
decorticated eggs.

Larva
There are four stages of Ascaris larvae (L1 to L4).

Life Cycle (Fig. 12.16)

Host: Involves only one host (man).
Infective stage: Embryonated eggs containing the L2 larvae.
Mode of transmission: Ingestion of embryonated eggs from the contaminated soil, food and water.

Migratory Phase
Following ingestion, the eggs hatch out to liberate the L 2 larvae (250 µm long) in the duodenum.
z The L 2 larvae molt once (L3)and penetrate the intestine, reach right side of heart via portal
circulation and finally enter the lungs via pulmonary capillaries
z Within 6–10 days in lungs, the larvae mature to become 550 µm long, molt to form next stage
larvae (L4)
z The larvae break up into the alveoli, migrate via bronchi, trachea and pharynx and finally
swallowed to reach intestine.
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intestinal Phase
The larvae undergo final molt to develop into adult worms in the small intestine. Adults become
sexually mature, fertilize and the female worms start laying the fertilized eggs which are passed in
the feces. Sometime, before mating, the female worms may directly lay the unfertilized eggs.
Pre-patent period: It is the time from egg ingestion to egg passage in the feces and is around 8–12
weeks.

Development in Soil

The fertilized egg passed in feces is not immediately infective. It has to undergo a period of
incubation in soil before acquiring infectivity.
• The eggs are resistant to adverse conditions and can survive for several years.
• The development of the egg in soil depends on the nature of the soil and various environmental
factors. A heavy clayey soil and moist shady location, with temperature between 20°c and 30°Care

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optimal for rapid development of the embryo.
• The development usually takes from J0-40 days, during which time the embryo moults twice and
becomes the infective rhabditiforrn larva, coiled up within the egg.

Development in Man
When the swallowed eggs reach the duodenum, the larvae hatch out.

The rhabditlform larva, about 250 µm in length and 14 µm in diameter, are actively motile.
They penetrate the intestinal mucosa, enter the portal vessels and are carried to the liver.
They then pass via the hepatic vein, inferior vena cava, and the right side of the heart and in about 4
days reach
the lungs, where they grow and moult twice. After development in the lungs, in about 10-15 days,
the larvae pierce the lung capillaries and reach the alveoli.
They crawl up or are carried up the respiratory passage to the throat and are swallowed.
The larvae moult.finally and develop into adults in the upper part of the small intestine. They
become sexually mature in about 6-12 weeks and the gravid females start laying eggs to repeat the
cycle
The adult worm has a lifespan of 12-20 months

Pathogenesis and Clinical Feature

Affect Due to Migrating Larva
z Pulmonary symptoms: Observed in the
second week after ingestion of eggs. Migrating larvae in lungs provoke an immune mediated
hypersensitivity response. Common symptoms include a nonproductive cough, chest discomfort and
fever
z Eosinophilic pneumonia (Loeffler’s
syndrome): In severe cases, patients develop dyspnea and an transient patchy infiltrates seen on
chest Xray along with peripheral eosinophilia.

Affect Due to Adult worm

z Asymptomatic: Most people with mild Ascaris infections are asymptomatic
z Malnutrition and growth retardation: Robbing the nutrition from the host may result in chronic
malnutrition and growth retardation (in children)
z Intestinal complications: A large bolus
of entangled worms can cause acute pain abdomen due to smallbowel obstruction, rarely perforation,
intussusception, or volvulus
z Extraintestinal complications: Larger worms can enter and occlude the biliary tree, causing
biliary colic, cholecystitis, pancreatitis, or (rarely) intrahepatic abscesses. Wandering worms may
migrate to pharynx and can cause respiratory obstruction or may block the Eustachian tube
z Allergic manifestations like fever, urticaria,angioneurotic edema and conjunctivitis may occur
due to toxic fluid (ascaron or ascarase) released by the adult worm.

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Laboratory diagnosis
Detection of the Parasite
Egg detection
Both fertilized and unfertilized eggs can be detected by stool examination by saline and iodine wet
mount. (Refer Table 12.10). Concentration techniques by sedimentation method should be done if
direct stool microscopy is negative. Floatation method for stool concentration is not preferred as
unfertilized eggs don’t fl oat on saturated salt solution (Figs 12.16 and 12.17).
Adult worm detection
Occasionally, adult worms may be detected in stool or sputum of the patients by naked eye.

Barium meal Xray of the GIT may demonstrate the adult worms in the intestine. When two worms
are lying parallel, gives trolley car lines appearance in Xray. Ultrasound (USG) or
cholangiopancreatography should be done to detect the adult worm in extraintestinal sites.
Larva detection
During the early pulmonary migratory phase, larvae can be found in sputum or gastric aspirates
before the eggs appear in the stool.

Serology
Antibodies can be detected by methods such as:
z ELISA
z IFA (Indirect fl uorescent antibody test)
z IHA(Indirect hemagglutination test)
z Micro precipitation test using larva

Serology is useful:

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 z In pulmonary phase (In case stool miscoscopy fails)
z For seroepidemiological purpose

Other Methods
z Eosinophilia is prominent during the early lung stage, but disappears later
z Presence of charcot leyden crystals in sputum and stool.

Treatment
anti-parasitic d rugs
z Ascariasis should always be treated early to prevent potentially serious complications
z Albendazole (400 mg once), meben dazole (100 g twice daily for 3 days or 500 mg once) is eff
ective
z Alternate drugs like ivermectin (150–200 mg/kg once) and nitazoxanide are also effective
z In pregnancy, pyrantel pamoate is safe
Symptomatic treatment
z Partial intestinal obstruction should be managed with nasogastric suction, intravenous (IV) fluid
administration but complete obstruction and its severe complications like intussusception require
immediate surgical intervention.

References Used
1. Textbook of MEDICAL PARASITOLOGYSIXTH EDITION
JAYPEE BROTHERS MEDICAL PUBLISHERS (P) LTD
CK Jayaram Paniker MD Formerly Director and Professor of Microbiology
and Principal, Medical College Calicut Dean, Faculty of Medicine Calicut University Emeritus
Medical Scientist Indian Council of Medical Research,2007
2. Paniker's Textbook of MEDICAL PARASITOLOGY

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(late} CK Jayaram Paniker MD Formerly,Director and Professor, Department of Microbiology, Principal
government Medical College, India
Emeritus Medical Scientist Indian Council of Medical Research New Delhi, India
Revised and Edited by Sougata Ghosh MD ocH Professor ,Department of Microbiology
Government Medical College Kol kata, West Bengal, India Formerly Faculty Institute of
Postgraduate Medical Education and Research (IPGMER) and
Calcutta School ofTropical Medicine Kolkata, West Bengal, India
2018

3- https://www.cdc.gov/