Ascariasis is a type of infection caused by Ascaris lumbricoides or roundworms. This worm is a parasite that uses the human body as a host for growth from larvae or eggs to adult worms. In the human body, adult roundworms that reproduce can be up to more than 30 centimeters long.
Ascariasis is also recorded as one of the most common worm infections worldwide. Unfortunately, most people who are infected have a mild case without symptoms. However, heavy infestations can cause serious symptoms and complications.
Ascariasis occurs most frequently in children in tropical and subtropical regions of the world, especially in areas with poor sanitation and hygiene.
Symptoms of Ascariasis
Most people infected with ascariasis have no signs or symptoms. Moderate to severe infestations cause a variety of signs or symptoms, depending on which part of the body is affected.
In the lungs
After a person swallows tiny Ascaris lumbricoides eggs, they hatch in the small intestine and the larvae migrate through the bloodstream or lymphatic system to the lungs. At this stage, a person may experience signs and symptoms similar to asthma or pneumonia, including:
- Continuous cough.
- Hard to breathe.
- Wheezing.
After spending 10-14 days in the lungs, the larvae travel to the throat, where a person will cough them up and then swallow them.
In the intestines
The larvae mature into adult worms in the small intestine, and the adult worms usually live in the intestine until they die. In mild or moderate ascariasis, intestinal infestation can cause:
- Unexplained stomach ache.
- Nausea and vomiting.
- Diarrhea or bloody stools.
If a person has a lot of worms in their intestines, they may experience:
- Severe stomach ache.
- Fatigue.
- Nausea and vomiting.
- Weight loss or malnutrition.
- There are worms in the vomit or feces.
Causes of Ascariasis
Ascariasis is not spread directly from person to person. Instead, a person must come into contact with soil mixed with human or pig feces containing Ascaris lumbricoides eggs or contaminated water.
In some developing countries, human waste is used for fertilizer or poor sanitation facilities allow human waste to mix with the soil in yards, ditches, and fields. A person can also get it from eating infected raw pork or chicken livers.
Young children often play in the dirt, and they can get worms if they put dirty fingers in their mouths. Unwashed fruits or vegetables grown in contaminated soil can also transmit ascariasis eggs.
This is the life cycle of the roundworm:
- Ingestion. The small (microscopic) eggs of Ascaris lumbricoides cannot become infective without contact with soil. People can accidentally ingest contaminated soil through hand-to-mouth contact or by eating raw fruits or vegetables grown in contaminated soil.
- Migration. Larvae hatch from eggs in the small intestine and then pass through the intestinal wall to travel to the heart and lungs via the bloodstream or lymphatic system. After maturing for about 10-14 days in the lungs, the larvae enter the respiratory tract and ascend into the throat.
- Maturation. Once they return to the intestines, the parasites grow into either male or female worms. Female worms can be more than 40 centimeters long with a diameter of about 6 millimeters. While male worms are generally smaller.
- Reproduction. Female worms can produce 200,000 eggs a day if both female and male worms are present in the intestine, and the eggs leave the body in the feces. Fertilized eggs must remain in the soil for at least two to four weeks before they become infective.
The entire process, from ingesting the eggs to depositing the eggs, will take about two or three months. Ascaris lumbricoides worms can live in the body for one to two years.
Risk Factors for Ascaris lumbricoides Infection
There are several risk factors that cause a person to experience ascariasis more easily, including:
- Age. Most people who get this infection are 10 years old or younger. Children in this age group may be at higher risk because they play in the dirt more often. Parents, pay attention to whether your child has these 5 habits. Beware of roundworm infection.
- Warm climate. Countries with warm climates like Indonesia are more susceptible to this roundworm disease.
- Poor sanitation. Ascariasis will be more widespread in developing countries where human waste is allowed to mix with local soil.
Diagnosis of Ascaris lumbricoides Infection
To diagnose ascariasis, a doctor will likely review the symptoms and have a person undergo several tests. In heavy infestations, worms may be found after coughing or vomiting. Worms may come out of other body openings, such as the mouth or nostrils. If this happens, bring the worms to your doctor so they can identify them and prescribe the right treatment.
Stool examination
Adult female ascariasis worms in the intestines begin to lay eggs. These eggs travel through the digestive system and can eventually be found in the stool.
To diagnose ascariasis, your doctor will check your stool for eggs and tiny (microscopic) larvae. However, eggs will not appear in your stool until at least 40 days after infection. If a person is infected with only male worms, they will not have eggs.
Blood test
A blood test to check for an increase in a certain type of white blood cell called eosinophils. Ascariasis can increase eosinophils, but so can other types of health problems.
Imaging tests
There are several imaging tests that can be done:
- X-ray. If a person has worms, masses of worms may be visible on an abdominal x-ray. In some cases, a chest x-ray may reveal larvae in the lungs.
- Ultrasound. Ultrasound can show worms in the pancreas or liver. This technology uses sound waves to create images of internal organs.
- CT scan or MRI. Both types of tests create detailed images of internal structures, which can help doctors detect worms blocking ducts in the liver or pancreas. A CT scan combines X-ray images that doctors can take from many angles. An MRI uses radio waves and a strong magnetic field.
Ascariasis Treatment
Usually, only the infection causes symptoms that you don’t need to treat. In some cases, ascariasis will clear up on its own.
1. Medicines
Antiparasitic drugs are the first-line treatment for ascariasis. The most common drugs are:
- Albendazole.
- Ivermectin.
- Mebendazole.
These drugs can be taken for one to three days to kill adult worms. Side effects include mild stomach upset or diarrhea. Meanwhile, pregnant women can take pyrantel pamoate.
2. Surgery
In severe cases of infestation, surgery may be required to remove the worms and repair the damage they cause. Bowel obstruction or perforation, bile duct obstruction, and appendicitis are complications that may require surgery.
Complications of Ascaris lumbricoides Infection
Mild cases of ascariasis usually do not cause complications. If a person has a heavy infestation, potentially dangerous complications may include:
- Slowed growth. Loss of appetite and poor absorption of digested food put children with ascariasis at risk of not getting enough nutrients, which can slow growth.
- Intestinal obstruction and perforation. In severe ascariasis infestations, large numbers of worms can block part of the intestine. This can cause severe abdominal cramps and vomiting. The obstruction can even create a hole in the wall of the intestine or appendix, causing internal bleeding (hemorrhage) or appendicitis.
- Duct blockage. In some cases, worms can block the narrow ducts of the liver or pancreas, causing severe pain.
Prevention of Ascariasis
The best defense against ascariasis is good hygiene. Here are some tips to avoid infection:
- Practice good hygiene. Always wash your hands with soap and water before handling food. Wash fresh fruits and vegetables thoroughly.
- Be careful when traveling. Use only bottled water, and avoid raw vegetables unless you can peel and wash them.
However, if you have already been infected with Ascaris lumbricoides worms, immediately contact doctor to get the right treatment.
When to See a Doctor?
Consult a doctor immediately if you feel the symptoms. Remember, proper treatment can minimize the consequences, so that treatment can be done faster.