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Decorticated Eggs
Adult worms inhabit the lumen of the small intestine, usually in the jejunum or
ileum. They have a life span of 10 months to 2 years and then are passed in the
stool. When both female and male worms are present in the intestine, each female
worm produces approximately 200,000 fertilized ova per day. When infections with
only female worms occurs, infertile eggs that do not develop into the infectious
stage are produced. With male-only worm infections, no eggs are formed.
The ova are passed out in the feces, and embryos develop into infective secondstage larvae in the environment in two to four weeks (depending upon
environmental conditions). When ingested by humans, the ova hatch in the small
intestine and release larvae, which penetrate the intestinal wall and migrate
hematogenously or via lymphatics to the heart and lungs. Occasionally, larvae
migrate to sites other than the lungs, including to the kidney or brain.
Larvae usually reach the lungs by four days after ingestion of eggs. Within the
alveoli of the lungs, the larvae mature over a period of approximately 10 days, then
pass up via bronchi and the trachea, and are subsequently swallowed. Once back in
the intestine, they mature into adult worms. Although the majority of worms are
found in the jejunum, they may be found anywhere from the esophagus to the
rectum. After approximately two to three months, gravid females will begin to
produce ova which, when excreted, complete the cycle.
Modes of Transmission
Transmission occurs mainly via ingestion of water or food (raw vegetables or fruit in
particular) contaminated with A. lumbricoides eggs and occasionally via inhalation
of contaminated dust. Children playing in contaminated soil may acquire the
parasite from their hands. Transplacental migration of larvae has also occasionally
been reported.
Habitat and World Distribution
Ascariasis tends to occur more commonly in places where sanitation is minimal and
human feces is used to fertilize crops. As a result, the majority of Ascaris infections
are concentrated in the developing world.
Ascariasis plagues more people in the world than any other parasitic infection.
Some estimate that as many as 1-1.5 billion people or approximately 1 out of 4
people are infected with Ascaris. In some tropical areas, 100% of the population
have Ascaris.
Ascariasis
Ascariasis is the most common helminthic infection caused by Ascaris lumbricoides
Small burdens of worms in the intestine may cause no symptoms. The patient may have
symptoms of pneumonitis with cough and low grade fever during the migration of the
larvae through the liver and lungs. This can be accompanied by wheezing, coughing
and eosinophilia.
In heavy worm burdens the adult worms actively migrate in the intestine resulting in
intestinal blockage, vomiting and abdominal pain but infections may also be
asymptomatic. The worms can penetrate through the wall of the intestine, or into the
appendix, travel up the common bile duct, which may become blocked or they may then
enter the gal bladder or liver.
Medications:
albendazole
ivermectin
mebendazole