Ascariasis - Clinicals, Diagnosis, and Management

Infectious diseases

Clinicals - History

Fact Explanation
Cough, dyspnoea, wheeze and chest pain. When migrating through the lungs, Ascaris larvae secrete allergenic substances which stimulate the activation of the IgE mediated immune response which in turn lead to pathophysiological changes in the lung such as airway inflammation and bronchial hyper reactivity . Cough, dyspnoea, wheeze and chest pain.
When migrating through the lungs, Ascaris larvae secrete allergenic substances which stimulate the activation of the IgE mediated immune response which in turn lead to pathophysiological changes in the lung such as airway inflammation and bronchial hyper reactivity .
Colicky abdominal pain, abdominal distension, nausea and intermittent diarrhoea. Due to small bowel obstruction, commonly as a result of large numbers of entangled worms. A worm bolus could also result in volvulus and intussusception which could cause bowel ischemia and infarction . Colicky abdominal pain, abdominal distension, nausea and intermittent diarrhoea.
Due to small bowel obstruction, commonly as a result of large numbers of entangled worms. A worm bolus could also result in volvulus and intussusception which could cause bowel ischemia and infarction .
Dark urine, pale stools, yellowish discoloration of eyes, radiating right hypochondrial and epigastric pain, and fever. Due to invasion of the biliary tree by the adult worm causing biliary colic, pyogenic cholangitis, chloecystitis, pancreatitis and formation of biliary stones . Dark urine, pale stools, yellowish discoloration of eyes, radiating right hypochondrial and epigastric pain, and fever.
Due to invasion of the biliary tree by the adult worm causing biliary colic, pyogenic cholangitis, chloecystitis, pancreatitis and formation of biliary stones .

Clinicals - Examination

Fact Explanation
Tachypnoea; rhonchi and crepitations on auscultation of the lungs. Due to the pathophysiological changes of the lung similar to asthma, as result of Ascaris larvae migrating through the lung . Tachypnoea; rhonchi and crepitations on auscultation of the lungs.
Due to the pathophysiological changes of the lung similar to asthma, as result of Ascaris larvae migrating through the lung .
Urticaria Due to the IgE mediated allergic response brought about by the parasite . Urticaria
Due to the IgE mediated allergic response brought about by the parasite .
Fever; right hypochondrial and epigastric tenderness; icterus Due to parasitic invasion of the biliary tree . Fever; right hypochondrial and epigastric tenderness; icterus
Due to parasitic invasion of the biliary tree .
Abdominal distension Due to partial or complete intestinal obstruction caused by the parasite . Abdominal distension
Due to partial or complete intestinal obstruction caused by the parasite .
Bitot spots (vitamin A deficiency), gum bleeding (vitamin C deficiency), low lean body mass (protein deficiency) and other features of nutritional deficiency. Due to nutrient absorption and blocking of the absorbing surface of the intestinal mucosa by Ascaris worms as well as reduced voluntary food intake . Bitot spots (vitamin A deficiency), gum bleeding (vitamin C deficiency), low lean body mass (protein deficiency) and other features of nutritional deficiency.
Due to nutrient absorption and blocking of the absorbing surface of the intestinal mucosa by Ascaris worms as well as reduced voluntary food intake .

Investigations - Diagnosis

Fact Explanation
Stool examination for fertilized ova. Fertilized ova of the adult worm are unequally excreted over days and patchily distributed in stool, so stool smears should be examined over several days . Stool examination for fertilized ova.
Fertilized ova of the adult worm are unequally excreted over days and patchily distributed in stool, so stool smears should be examined over several days .
Full blood count revealing eosinophilia. Secondary eosinophilia due to tissue invasive parasitosis . Full blood count revealing eosinophilia.
Secondary eosinophilia due to tissue invasive parasitosis .
Ascaris larvae in sputum. Due to migration of larvae through the lungs in the pulmonary phase . Ascaris larvae in sputum.
Due to migration of larvae through the lungs in the pulmonary phase .
Transient pulmonary infiltrates on chest X ray. Occurs during pulmonary migration of Ascaris larvae . Transient pulmonary infiltrates on chest X ray.
Occurs during pulmonary migration of Ascaris larvae .
Multiple air fluid levels on erect abdominal X ray. Due to intestinal obstruction caused by the worms . Multiple air fluid levels on erect abdominal X ray.
Due to intestinal obstruction caused by the worms .
Ultrasound scanning of the biliary tree. It has the ability to demonstrate the presence of biliary ascariasis with findings such as bile duct dilatation and by directly visualizing worms within the biliary tree . Ultrasound scanning of the biliary tree.
It has the ability to demonstrate the presence of biliary ascariasis with findings such as bile duct dilatation and by directly visualizing worms within the biliary tree .

Investigations - Management

Fact Explanation
CT scan of the abdomen. To identify complications of biliary ascariasis such as cholangitis and hepatic abscesses . CT scan of the abdomen.
To identify complications of biliary ascariasis such as cholangitis and hepatic abscesses .

Management - Supportive

Fact Explanation
Bronchodilator therapy. This reduces the bronchospasm brought about by the hypersensitivity reaction towards the Ascaris larvae which occurs during the pulmonary larval migration phase . Bronchodilator therapy.
This reduces the bronchospasm brought about by the hypersensitivity reaction towards the Ascaris larvae which occurs during the pulmonary larval migration phase .
Nutritional supplimentation. Due to nutrient absorption and blocking of the absorbing surface of the intestinal mucosa by Ascaris worms as well as reduced voluntary food intake . Nutritional supplimentation.
Due to nutrient absorption and blocking of the absorbing surface of the intestinal mucosa by Ascaris worms as well as reduced voluntary food intake .

Management - Specific

Fact Explanation
Albendazole 400mg single oral dose. It is a benzimidazole and acts by binding to parasite beta tubulin inhibiting its polymerization and impairing glucose uptake . Albendazole 400mg single oral dose.
It is a benzimidazole and acts by binding to parasite beta tubulin inhibiting its polymerization and impairing glucose uptake .
Pyrantel pamoate. Non-benzimidazole anthelminthics act on the parasite neuromuscular pathways and paralyze them . Pyrantel pamoate.
Non-benzimidazole anthelminthics act on the parasite neuromuscular pathways and paralyze them .
Endoscopic retrograde cholangiopancreatography (ERPC). For the endoscopic removal of worms in diagnosed biliary ascariasis . Endoscopic retrograde cholangiopancreatography (ERPC).
For the endoscopic removal of worms in diagnosed biliary ascariasis .

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