Ascaris: symptoms and treatment in adults and children

Ascaris: symptoms and treatment in adults and children

Ascaris are roundworm parasites Ascaris lumbricoides. The carrier, or the only host of this species of ascaris, is a human: the parasite matures and multiplies in the human body, without requiring for the development of the presence in the bodies of other mammals.

When an early stage invasion occurs, ascaris eggs trapped in the gastrointestinal tract, under the influence of enzymes lose their membranes, and the released larvae spread to various organs: the liver, heart, lungs. Upon further migration, the ascaris larvae enter the oral cavity through the respiratory tract, from where they return to the intestine along with saliva and swallowed food for further existence and reproduction in the chronic stage of ascarisosis.

Symptoms of ascariasis depend on the stage of the disease, the number of parasites and the response of the immune and other systems, and can manifest themselves in a wide range. In the diagnosis of ascaris, treatment is carried out antihelmintic drugs, as well as symptomatic drugs aimed at reducing intoxication, and the appointment of adherence to a particular diet.

What does a roundworm look like?

An adult roundworm looks like a reddish spindle worm (after death, the body color changes to yellowish white). The length of the mature helminth depends on age and sex: males can reach lengths of 25 cm, widths of 4 mm, females up to 40 cm and up to 6 mm.

What does a roundworm look like?
Photo: Rattiya Thongdumhyu /

Ascaris eggs cannot be seen with the naked eye. Depending on the presence of a factor of fertilization, they differ in size and shape, but even the largest of them do not exceed the size of 100 x 45 microns.

Ascaris – exclusively fertile worms, the body of a female can contain up to 27 million eggs in different stages of formation. One adult female is able to lay up to 240 thousand eggs per day, up to 64 million per year, as a result of which roundworm is the most common type of helminth with a type of infection through the soil. Ascarid carriers are estimated to be almost 1.2 billion people, in some countries the percentage of patients with ascariasis reaches 20.

The high fecundity of these worms is due to the rather low compared with the number of eggs laid, survival in the environment: for further maturation, the eggs must be in the soil, passing the biological cycle of invasive larva formation. At the same time, the temperature of the soil should remain in the range from 13 to 26 ° C, and the humidity of the environment should be from 4 to 8%.

With such limitations, temperature parameters of ascaris is considered a typical geohelminth parasite, depending on the natural and climatic habitat conditions. The most contaminated habitat is in Africa, Asia, and Latin America. In the middle lane, the biological cycle of larval formation is possible only during warm periods, and the summer – autumn seasonality of ascaris infection is caused by the consumption of insufficiently clean root crops, berries, and greens. Winter cases of infection are caused by the storage of vegetables in cellars and storehouses with an average temperature that supports the activity of the larvae.

Ways of Ascariasis Infection

Ascariasis – a disease with an oral route of infection. Roundworms are helminths that go through a developmental stage inside and outside a person. A patient with ascariasis, in the presence of different-sex adult individuals in the body, together with feces, distributes eggs to ascaris. After a period of development in the soil, microscopic Ascaris larvae, along with the earth, plants or water, fall on the hands of a person or directly in the mouth.

Ways of Ascariasis Infection
Photo: MIA Studio /

Eggs are quite easily removed during hygienic procedures (washing hands, vegetables, and greens) or pre-treating food and heating above 50 ° C or boiling water, which causes a pronounced difference in the number of infections among different age and social groups. Ascariasis is most often diagnosed in children who are actively in contact with nature and do not have the skills to follow the rules of hygiene due to age, as well as among people in rural areas with unfavorable sanitary and hygienic living conditions. Occupational hazards include ascariasis in wastewater treatment facilities and excavators.

After swallowing the larvae of Ascaris in the intestinal environment, they lose the egg’s shell and begin to migrate through the body. The purpose of migration is to reach the oral cavity and then transport it to the intestine. However, with the flow of blood, the larvae can spread through different organs and tissues, settling in the veins, liver, heart, and forming inflammatory infiltrates with a high content of eosinophils. A full-fledged formation of an adult helminth in such cases does not occur, but significant harm is caused to the body.

On average, the early stage of development of the larvae and their achievement of the oral cavity lasts about 3 months. After secondary ingestion, the late intestinal stage of development of a mature individual in the small intestine begins.

The lifespan of an adult roundworm is on average 12 months, after which the helminth dies and is excreted from the intestine with stool masses.

Among the individual measures for the prevention of helminth infection are the need for such as mandatory hand washing before eating, using hand protection (rubber gloves) when working with the soil, careful processing of vegetables, fruits and berries.

Places of probable ascaris eggs (country, country toilets equipped with cesspools) should be neutralized by backfilling the feces with soil for at least 2 years, after which the compost can be used to fertilize the soil. Otherwise, neutralizing chemicals are used.

Symptoms of the disease at different stages

The symptoms of ascariasis vary depending on the magnitude of the invasion, the localization of the parasites, the individual characteristics of the patient and the stage of development of the disease. The clinical pictures of the early migratory and late intestinal stages have marked differences.

Symptoms of early ascariasis: the first signs of infection

How and when can you detect the presence of worms of this species in the body? After penetration, the first clinical manifestations of the disease occur in 1-2 months. Noninvasive invasion may be asymptomatic or subclinical.

With a pronounced reaction of the body, symptoms such as headache, general weakness, fatigue, fever to subfebrile parameters, allergic manifestations (itching, skin rash) prevail. Less commonly, infection is accompanied by a clinical picture of pulmonary pathologies, expressed by cough, sputum separation (bloody inclusions are possible), shortness of breath, chest pains, during examination, signs of exudative pleurisy, eosinophilic infiltrates of lung tissue, bronchi can be detected. There is also an increase in lymph nodes, spleen, liver. Migration of larvae can cause the development of pneumonia and bronchitis, as well as signs of impaired activity of the cardiovascular system and liver.

Intestinal Stage

The late phase of the disease can be manifested by various symptoms and the severity of the course. In adults, ascariasis may be mild or asymptomatic. In a clinically severe case, frequent complaints relate to impaired gastrointestinal function and asthenic syndrome. Accelerated transportation of food mass in the intestines, damage to the mucous membrane, reduced digestibility of nutrients, vitamins, as well as the constant presence of toxins secreted by parasites in the body lead not only to morphological and functional disorders in the small intestine, but also to asthenic conditions and various nervous symptoms. systems.

Ascaris: symptoms in children

The most pronounced symptom, manifested in the presence of roundworm in children, is intestinal dyspepsia: stool disorders (diarrhea, constipation, often – alternating), may develop progressive enteritis. Note the presence of cramping pain in the abdomen, arising arbitrarily or with palpation. At the same time, the pain in children is not localized and can cover the entire peritoneal region, in adults they are limited and localized in the upper right quarter.

Roundworm in children also cause appetite disorders, more often – its steady decline, “whims” when eating, nausea, increased salivation, and can also cause the development of intolerance to some foods (in most cases – dairy).

Ascaris: symptoms in children
Photo: Evgeny Atamanenko /

On the part of the nervous system, ascariasis in childhood manifest asteno-neurotic syndrome, weakness, fatigue, headaches, confusion, decreased concentration, irritability. Sleep disturbances (anxiety, fears, physical activity during sleep), as well as a decrease in the level of intelligence, hysterical seizures, and epileptiform convulsions and the occurrence of Meniere’s symptom complex are included in the clinical picture of severe ascariasis.

Just as at the migration stage, allergic reactions in the form of urticaria can occur.

Roundworm in children is much more pronounced than in adults, affecting the immune system and may be accompanied by frequent colds, viral and fungal infections (oral stomatitis), inflammatory processes of the mucous membranes and skin of bacterial etiology.

Roundworm: symptoms in adults

in adults, it proceeds with less severe symptoms than in the clinical picture of the parasitism of roundworm in children, but the general direction of the manifestations remains unchanged: intestinal dyspepsia, neuroastenica. It is also possible the development of hypotension (lower blood pressure).

In the formation of complications caused by the number or migration of mature ascaris, the children’s body can suffer much more. Fatal complications of ascariasis in children are recorded more often than in adults.

Diagnosis of Ascariasis

When invading the body ascaris in adults and children, the symptoms and signs of the disease are variable, diagnosis and treatment on the basis of only manifestations is not set. Diagnosis is carried out by several methods.

Coprological Studies

The most common method of detecting ascaris is the analysis of feces on the eggs of the worm. This diagnosis is effective only in the late phase of the disease, when the mature individual is in the intestinal cavity, scrology is ineffective at the migration stage.

The effectiveness of coproovoscopy is also limited by a temporary factor: if the analysis is carried out at a time when the female roundworm does not lay eggs, they will not be detected in the laboratory. To confirm the absence of ascaris in the presence of a clinical picture, it is recommended to conduct a series of studies with an interval of 10-14 days.
When parasitizing only the male specimen, feces for the eggs of the worm will be negative.

Blood and body fluids

Although in the early stages of excess of the norm of leukocytes and eosinophils in the blood serve as one of the signs of helminthic invasion, the classical blood test does not provide an opportunity to draw definite conclusions about the diagnosis, as the presence of anemia, leukocytosis, and eosinophilia may not accompany the disease during adaptation. body or to testify about other reasons.
Several methods of serological research have been developed, but they are not widely used in the laboratory. In most cases, larvae may be detected 2-3 months after infection in the secreted sputum, but this type of analysis is quite rare.

X-ray and operative methods

At the migration stage, fluoroscopy can be used to detect volatile infiltrates in the lungs. For the diagnosis, several pictures of the lungs are taken, examining the presence and changing of the position of infiltrates indicating the migration of larvae.

If there are adult ascarids in the small intestine, radiology allows to determine changes in the relief of the mucous membranes of the intestines, periodically the parasites themselves. It is also possible to determine the presence of helminths during surgical operations, however, this method is for obvious reasons not attributed to the prescribed diagnostic procedures.

If there is a likelihood of infection, a general clinical picture and the absence of confirmation of infection with several consecutive coproovoscopies, prophylactic treatment is prescribed and its effect on the body is evaluated.

Ascaris: treatment of ascariasis

If ascaris is suspected or confirmed, treatment is prescribed primarily as a drug, if the complications of the disease do not require a different topical treatment.

The modern choice of antihelminthic drugs allows you to achieve rapid recovery in 80% of cases after the first course of treatment. To determine the dose and the choice of drug, it is necessary to consult a specialist: the choice of the active substance and features of the intake are calculated depending on the age, body weight, severity of the invasion, as well as the characteristics of the patient’s physiological periods. Thus, ascariasis, detected during the gestational period, can negatively affect the development of the fetus. However, treatment with medications is possible not earlier than the second trimester, although this period also depends on the woman’s well-being.

In the migration phase, the first choice drugs are broad-spectrum anthelmintic drugs based on levamisole (Decaris), mebendazole (Vermox, Termox, etc.), thiabendazole (Mertect, Tekto, Tetusim, etc.).

The following drugs are used in the intestinal stage: Dekaris, Pyrantel (and its analogues), Piperazine, Vermox (and analogues).

If the disease is accompanied by symptoms of bronchopulmonary obstruction, exudative pleurisy, symptomatic treatment with corticosteroids and bronchodilator drugs is carried out.

Ascaris: treatment of ascariasis
Photo: anatolypareev /

In the treatment of the intestinal stage, an additional diet with increased protein content is prescribed. After taking antihelminthic drugs, it is recommended that antihistamine desensitizing agents and enterosorbents (activated carbon, Polysorb, Polyphepan, etc.) be taken 3-4 days after the course of therapy to reduce the amount of decay products of dead parasites.

During the severe stages of the disease or when there are contraindications to drug therapy, oxygen is introduced through a tube into the stomach cavity by a course of 2-3 times (once a day, daily). This method is not suitable in the presence of peptic ulcers or inflammatory processes in the organs of the gastrointestinal tract.
With complications, symptomatic and / or surgical treatment is indicated.

During the recovery period after the disease, the intake of vitamin-mineral complexes, enzyme preparations (Mezim, Creon) is recommended. It should be remembered that the anthelmintic drugs are toxic, causing the death of roundworm, they also have a negative effect on the human body. When detecting the presence of ascaris, symptoms, treatment is prescribed by a specialist. Do not use antiparasitic drugs “for prevention” without evidence.

Complications of Ascariasis

Complications of the disease occur when the larvae migrate ascarids to various organs and tissues, as well as with a large number and / or active movement of mature specimens in the intestinal region and their movements along the gastrointestinal tract. Lack of therapy or independent, especially alternative “popular” treatment also leads to this: roundworms can not only significantly harm health, but also cause a fatal outcome.

Among the most frequent complications of the disease will highlight:

  • intestinal obstruction;
  • perforated peritonitis;
  • acute pancreatitis;
  • acute appendicitis;
  • development of liver abscesses;
  • acute cholecystitis and inflammation of the biliary tract;
  • choking when adults enter the airways;
  • purulent pleurisy, pneumonia;
  • tissue sepsis;
  • complicated during pregnancy and childbirth, fetal malformations;
  • pronounced decrease in immunity, etc.
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