Ascariasis: visible Worms in stool
Visible worms in stool is a common presentation in many children which worries parents and leading to OPD or ER visits. It is very common presentation in third world countries and developing countries like Indian subcontinent. It is very common in people of low socioeconomic status with poor people and un-hygienic conditions. Today let us discuss regarding this common problem which is easily preventable and treatable with simple measures, but if not prevented and treated it takes heavy toll on health of individual and society.
What causes ascariasis?·
Ascariasis as its name indicates it is a infection by Ascaris lumbricoides.· It is nematode, a round worm.
About Ascaris lumbricoides?·
Ascaris lumbricoides is a nematode, a round worm.· It inhabits the lumen of the small intestine.· It is also called giant worm as females can grow up to 20-49 cm length and males up to 30 cm in length.· Ascaris lumbricoides normal life span is around 10-24 months.· Female worm can produce about 2 lakh eggs per days.· These eggs can remain viable at 5-10 degree centigrade up to 2 years.· These eggs are released in feces of infected animal or human beings.· In suitable environment these eggs are ready to infect new individual human or other mammal in 10-12 days.· When ready and ingested by other susceptible animal or human it infect that person or animal.
Ascariasis the magnitude of problem:·
Nearly 1 billion people in entire world is estimated to be infected by Ascaris lumbricoides having disease ascariasis.· The infection rate is highest in preschool and school children.· The infection can occur at any age mainly by feco-oral route.· One of the main causes of malnutrition and anemia in the world is ascariasis.· Poor socioeconomic status, use of human feces as fertilizer and geophagia are common risk factors.· Eating raw fruits and vegetables are main contributors for the spread of disease.
How does Ascaris affects you, Pathogenesis?·
When ingested eggs unknowingly they gain entry to mouth.· From there they travel to stomach and then to small intestine.· At small intestine they penetrate the intestinal wall and get into the blood stream.· Through blodd stream they reach to the lungs of individual.· They come to alveoli of lung from there they travel to bronchi and trachea and throat.· Then they are swallowed back to stomach then small and large intestine where they get attached into the lumen of the intestine.· They get feed there and they get mature into adult form there to produce millions and billions of eggs per day to be excreted into the fecal matter into the environment.· Female worms begin producing eggs in 8-10 weeks.
What is clinical presentation of ascariasis?·
The clinical presentation depends on the intensity of involvement and age of the host.· Main complications are lung disease and obstruction of intestine and billiary tract.· Larva when migrate blood stream and these organs may cause allergic symptoms like fever and urticaria.· Lung manifestations are similar to loffler’s syndrome and include cough, and dyspnoea.· The larvae may be found in sputum.· Vague abdominal pain and abdominal symptoms may occur in presence of adult worm in intestines.· Large worm load may lead to intestinal obstruction these children may show symptoms of abdominal cramps and vomiting.· Sometimes these worms migrating to billiary tract can cause billiary tract obstruction and pancreatitis and cholecystitis.· The invasion of instestinal wall and worms migrating to peritoneal cavity can cause peritonitis.· Chronic infection with ascariasis is associated usually with other helminthes infections.· Heavy worm load can cause can cause physical and cognitive growth impairment.
How is it diagnosed?·
Obvious appearance of worms in stool.· Microscopy examination of stool can reveal worms and eggs.· Sputum can reveal larvae on microscopic examination.· High index of suspicion is needed to diagnose as many times worms may not be visible naked eyes.
What is treatment?·
It can be easily treated with anti parasite drug albendazol.· Generally all family members should be treated together.· Treatment in infected person also prevents spread to other persons.· Other drugs like mebendazol, ivermectin and nitazoxanide are effective too.
How to prevent the infection?·
Offering universal treatment to all individuals in an area of high endemicity.· Offering treatment targeted to groups with high frequency of infection, such as children attending primary school.· Offering individual treatment based on intensity of current or past infection. · Improving education about and practices of sanitary conditions and sewage facilities.· Discontinuing the practice of using human feces as fertilizer.· Education are the most effective long-term preventive measures.