Definition

Ascariasis is a common worm infection worldwide. Worms need the human intestine to grow from larvae or eggs into adult worms, which can reproduce and reach lengths up to 30 centimeters. Most people have minor infections with no signs or symptoms. On the other hand, a severe infection may result in a wide range of signs, symptoms, and complications. It is more common for child populations in tropical and subtropical regions to be affected, especially in areas with inadequate sanitation and hygiene facilities.

Causes

Ascariasis is not transmitted by person-to-person contact. It is spread through soil contaminated with human feces or water. The use of human feces as fertilizer persists in numerous developing countries. Inadequate sanitation can also contribute to transmission, as human feces may contaminate soil in open areas.

Children are at risk of ascariasis if they engage in the following activities:

• Playing in dirt
• Barefooting on roundworm egg-contaminated soil
• Touching egg-contaminated surfaces

These objects can cause infections if someone touches them and doesn't wash their hands.

Other potential transmissions include:

• Eat unwashed fruits and vegetables cultivated on polluted soil
• Consume uncooked meat, pork, or freshwater fish

Risk factor

The following factors may increase the risk of ascariasis:

• Age

Ascariasis affects mostly children under 10. Children in this age group may be at a higher risk since they are more exposed to dirt.

• Warm conditions

Ascariasis is more prevalent in developing nations with year-round warmth.

• Poor sanitation

Ascariasis is common in impoverished nations where human waste is used as fertilizer.

• Places with a high population density

Symptoms

Most patients with ascariasis have no symptoms. However, mild to severe infections might cause different symptoms. The possible symptoms are the following:

• Abdominal
• Nausea and vomiting
• Bloody diarrhea

Severe abdominal pain, lethargy, persistent vomiting, loss of weight, and worms in the stool or vomit are all symptoms of an overabundance of worms in the intestines.

Worms can hatch in the small intestine after being swallowed in their tiny form. The larvae enter the lungs via the circulatory or lymphatic systems. At this stage, the infected person may have respiratory tract symptoms like:

• Cough
• Difficulty breathing
• An acute wheeze sounds like asthma.

The larvae can climb into the throat in the lungs after 6–10 days. It will be coughed up and swallowed back into the digestive tract. Swallowed larvae can become small intestine adult worms and remain alive.

Diagnosis

A comprehensive interview (anamnesis) concerning the following is necessary to confirm a diagnosis of ascariasis:

• Patient symptoms
• Progressivity of the disease
• History of the patient's disease-related habits, such as barefooting
• Sanitation of the living environment

The doctor will then examine your digestive organs and anus. Worms can be found in severe infections when coughing, vomiting, or defecating. If needed, the doctor will suggest additional tests, such as:

• Fecal analysis. Female intestinal worms hatch eggs that can be seen in feces under a microscope. The feces do not contain eggs until 40 days after the infection.
• Blood test. Blood testing can detect eosinophil white blood cell growth. Ascariasis can raise eosinophils, but other illnesses can also.
• Imaging. Abdominal worms can be seen on X-rays.

In some cases, chest X-rays may show worm larvae in the lungs. Ultrasound examination (USG) can reveal liver or pancreatic worms. CT scans and MRIs may also help observe these worms.

Management

Ascariasis infections can recover spontaneously, but in most cases, ascariasis infections require treatment. The primary therapy for ascariasis involves the use of antiparasitic medicines. Albendazole, ivermectin, and mebendazole are the selected antiparasitic medications for roundworm infections. The drug can be used for one to three days to eradicate developed worms. In some severe cases, surgical intervention may be conducted to remove the mature worms and restore the affected tissues caused by this parasite. Typically, a doctor will advise surgical intervention in cases where there is an obstruction or perforation in an organ, as these conditions can be life-threatening.

Complications

One of the complications that might result from an ascariasis infection is intestinal obstruction.  This complication can occur when several worms block the intestines, producing abdominal discomfort and vomiting. Due to their smaller intestines, children are more susceptible to this condition. Liver or pancreatic duct blockages cause appetite loss and inadequate nutrient absorption. Thus, children may have dietary deficits that may impact their growth. High pressure from the obstruction may destroy organ walls, known as perforation. This is a medical emergency that requires immediate treatment.

Prevention

An effective way to prevent ascariasis is by maintaining high personal hygiene, such as:

• Maintain hand hygiene. Wash your hands with soap and clean water before touching food.
• Wash fruits and vegetables before consuming them. Avoid raw vegetables.
• Maintain cleanliness while traveling, especially in endemic areas. If you are unsure about the cleanliness of the water in the area, use bottled water.
• Eat only warm, cooked food
• Take a shower regularly. This may remove attached roundworm eggs
• Change clothes every day
• Wash contaminated clothes, sheets, and towels with hot water
• Keep the room bright during the day. Worm eggs are susceptible to sunlight
• Cut your nails regularly, as nails are also a source of infection

When to see a doctor?

If your children have persistent symptoms like nausea, vomiting, stomach discomfort, swelling, worms in the feces, diarrhea, and weight loss, visit your doctor. Treating worm infections as soon as possible will help prevent growth abnormalities in children.

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