Ascaris lumbricoides: To Expect the Unexpected during a Routine Colonoscopy

Abstract

Ascaris lumbricoides is a common nematode infecting humans worldwide with increased prevalence in tropical and subtropical areas of less developed countries. Recently, it has been estimated that over one billion individuals are infected with ascariasis worldwide with 7% in USA. Although most of these cases are due to increasing immigration and travel outside America it is worth recognizing that prevalence of ascariasis is high in southeastern parts of USA due to their temperate climate. Infections of A. lumbricoides are largely asymptomatic, and hence a large population of people carrying this worm remains undetected for years until they develop some symptoms. Due to a large group of asymptomatic individuals with intestinal ascariasis, these worms are occasionally and unexpectedly identified during routine endoscopic procedures. Here, we present a case of an intestinal ascariasis found during routine colonoscopy in an African-American man from the Bronx with perianal itching. He denied any history of travel outside USA but reported frequent visits to South Carolina. This case illustrates the fact that ascariasis should be suspected even if immigration or travel outside USA is not involved. It should be suspected even in cases of travel within USA to the south east where endemic cases are reported.

To Assess the Efficacy and Safety of Various Anti-heliminthics against Ascariasis Lumbricoides among a Study Population in North India

“…Due to a large group of asymptomatic individuals with intestinal ascariasis, these worms are occasionally and unexpectedly identified during routine endoscopic procedures. [10] It is estimated that more than 1.4 billion people are infected with A. lumbricoides, representing 25% of the world population. A number of features account for its high prevalence including a ubiquitous distribution, the durability of eggs under a variety of environmental conditions, the high number of eggs produced per parasite and poor socioeconomic conditions that facilitate its spread.…”

“…[9] Due to a large group of asymptomatic individuals with intestinal ascariasis, these worms are occasionally and unexpectedly identified during routine endoscope procedures. [10] Hepatobiliary pancreatic Ascariasis (HPA) is a frequent cause of biliary and pancreatic disease in endemic areas. It occurs in all age groups and can cause biliary colic, acute cholecystitis, acute cholangitis, acute pancreatitis and hepatic abscesses.…”

Diagnosis of intestinal ascariasis in modern era

“…Most patients are asymptomatic, hence it can be undetected for years until they develop some symptoms 1 2. Diagnosis is usually made through a combination of blood counts showing marked leucocytosis with eosinophilia, stool studies and radiographic imaging.…”

“…Diagnosis is usually made through a combination of blood counts showing marked leucocytosis with eosinophilia, stool studies and radiographic imaging. Complications can range from nutritional deficiency to obstruction of the bowel lumen, the bile or pancreatic duct, perforation, volvulus, intussusception, appendicitis, cholecystitis, biliary colic, cholangitis, hepatic abscess and pancreatitis depending on the site and severity of infestation 1 3. Antihelminthic therapy is usually sufficient except in few cases where surgical interventions might be needed 4…”

Respiratory Failure Associated with Ascariasis in a Patient with Immunodeficiency

“…Skin urticarial rash may also accompany these symptoms. Chest X-rays reveal rounded infiltrates with peripheral eosinophilia [10]. Occasionally, A. lumbricoides may pass from the nose or the mouth during vomiting [11].…”