Visible worms in the stool is a common presentation in many children which worries parents and leading to OPD or ER visits. It is a very common presentation in third world countries and developing countries like the Indian subcontinent. It is very common in people of low socioeconomic status with poor people and unhygienic conditions. Today let us discuss this common problem which is easily preventable and treatable with simple measures, but if not prevented and treated it takes a heavy toll on the health of individuals and society. 

What causes ascariasis?

  • Ascariasis as its name indicates it is an infection by Ascaris lumbricoides.
  • It is a nematode, a roundworm. 

About Ascaris lumbricoides?

  •  Ascaris lumbricoides is a nematode, a round worm.
  •  It inhabits the lumen of the small intestine.
  •  It is also called a giant worm as females can grow up to 20-49 cm in length and males up to 30 cm in length.       
  • Ascaris lumbricoides normal life span is around 10-24 months.       
  • The female worm can produce about 2 lakh eggs per day.      
  • These eggs can remain viable at 5-10 degrees centigrade for up to 2 years.
  • These eggs are released in the feces of infected animals or human beings.       
  • In a suitable environment, these eggs are ready to infect a new individual human or another mammal in 10-12 days.       
  • When ready and ingested by other susceptible animals or humans it infects that person or animal. 

Ascariasis the magnitude of the problem:

  • Nearly 1 billion people in the entire world are estimated to be infected by Ascaris lumbricoides having the disease ascariasis.
  • The infection rate is highest in preschool and school children.
  • The infection can occur at any age mainly by the 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 the main contributors to the spread of disease. 

How does Ascaris affect your health, Pathogenesis?

  •  When ingested eggs unknowingly they gain entry to the mouth.
  •  From there they travel to the stomach and then to the small intestine.
  •  In the small intestine, they penetrate the intestinal wall and get into the bloodstream.
  •  Through the bloodstream, they reach the lungs of the individual.
  •  They come to the alveoli of the lung from there they travel to the bronchi and trachea and throat.
  •  Then they are swallowed back to the stomach then small and large intestine where they get attached to the lumen of the intestine.
  •  They get feed there and they get mature into the 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 the clinical presentation of ascariasis?  

  • The clinical presentation depends on the intensity of involvement and age of the host.
  •  The main complications are lung disease and obstruction of the intestine and biliary tract.
  •  Larva when migrating bloodstream and these organs may cause allergic symptoms like fever and urticaria.
  •  Lung manifestations are similar to Loffler's syndrome and include cough and dyspnea.
  •  The larvae may be found in the sputum.
  •  Vague abdominal pain and abdominal symptoms may occur in presence of the adult worms in the intestines.
  •  Large worm load may lead to intestinal obstruction these children may show symptoms of abdominal cramps and vomiting.
  •  Sometimes these worms migrating to the biliary tract can cause biliary tract obstruction and pancreatitis and cholecystitis.
  •  The invasion of the intestinal wall and worms migrating to the peritoneal cavity can cause peritonitis.      
  •  Chronic infection with ascariasis is associated usually with other helminthic infections.
  •  Heavy worm load can cause physical and cognitive growth impairment. 

How is it diagnosed?   

  • The obvious appearance of worms in stool.
  • Microscopy examination of stool can reveal worms and eggs.
  •  Sputum can reveal larvae on microscopic examination.
  • A high index of suspicion is needed to diagnose as many times worms may not be visible naked eyes. 

What is the treatment?

  • It can be easily treated with the anti-parasite drug albendazole.
  • Generally, all family members should be treated together.
  • Treatment in an infected person also prevents spread to other persons.
  • Other drugs like mebendazole, 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 a high frequency of infection, such as children attending primary school.
  • Offering individual treatment based on the 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 is the most effective long-term preventive measure.