Ascariasis

Abstract

Ascariasis is a helminthic infection of global distribution with more than 1.4 billion persons infected throughout the world. The majority of infections occur in the developing countries of Asia and Latin America. Of 4 million people infected in the United States, a large percentage are immigrants from developing countries. Ascaris-related clinical disease is restricted to subjects with heavy worm load, and an estimated 1.2 to 2 million such cases, with 20,000 deaths, occur in endemic areas per year. More often, recurring moderate infections cause stunting of linear growth, cause reduced cognitive function, and contribute to existing malnutrition in children in endemic areas. Ascaris infection is acquired by the ingestion of the embryonated eggs. The larvae, while passing through the pulmonary migration phase for maturation, cause ascaris pneumonia. Intestinal ascaris is usually detected as an incidental finding. Ascaris-induced intestinal obstruction is a frequent complication in children with heavy worm loads. It can be complicated by intussusception, perforation, and gangrene of the bowel. Acute appendicitis and appendicular perforation can occur as a result of worms entering the appendix. HPA is a frequent cause of biliary and pancreatic disease in endemic areas. It occurs in adult women and can cause biliary colic, acute cholecystitis, acute cholangitis, acute pancreatitis, and hepatic abscess. RPC causing hepatic duct calculi is possibly an aftermath of recurrent biliary invasion in such areas. Ultrasonography can detect worms in the biliary tract and pancreas and is a useful noninvasive technique for diagnosis and follow-up of such patients. ERCP can help diagnose biliary and pancreatic ascariasis, including ascaris in the duodenum. Also, ERCP can be used to extract worms from the biliary and pancreatic ducts when indicated. Pyrantel pomoate, mebendazole, albendazole, and levamisole are effective drugs and can be used for mass therapy to control ascariasis in endemic areas.

Ultrasonography findings of biliary ascariasis as a rare cause of acalculous cholecystitis

“…The biliary ascariasis may be complicated or uncomplicated [2]. In uncomplicated biliary ascariasis, the clinical picture merges with that of acute acalculous cholecystitis with lowgrade fever, upper abdominal colic, associated tenderness, muscle guarding in right upper quadrant with a gallbladder mass.…”

“…Adult worms can migrate through the biliary tract reaching the intra-hepatic ducts and the gallbladder, causing acute cholecystitis, cholangitis, biliary colic, obstructive jaundice, and hepatic abscesses. Ultrasound (US) of the abdomen has been advocated as a quick, safe, noninvasive, and relatively inexpensive modality for suspected biliary ascariasis and various appearances of roundworms in the biliary tract and gallbladder have been described [1][2][3][4]. In this report, the clinical manifestations, diagnostic procedures, and ultrasonographic appearance of gallbladder ascariasis in two patients are presented.…”

Ultrasonographic Diagnosis of Isolated Jejunal Ascaris Lumbricoides

“…Ascaris-induced intestinal obstruction is a frequent complication in children with heavy worm loads in endemic areas. It constitutes 5% to 35% of all cases of bowel obstruction in such regions (7). Ochoa B. has demonstrated surgical complications of ascariasis (Table 1) …”

Hepato- Biliary Ascariasis- Experience from a Tertiary Care Hospital in North East India

“…It infects 25% of the world's population (2). In the Indian subcontinent, ascariasis is highly endemic in Kashmir (70%), Bangladesh (82%), Central and Southwest India (20% to 49%) [3].…”