eMedicine Specialties > Infectious Diseases > Parasitic Infections

Ascariasis: Differential Diagnoses & Workup

Author: David R Haburchak, MD, Program Director, Professor, Department of Internal Medicine, Division of Infectious Disease, Medical College of Georgia
Contributor Information and Disclosures

Updated: Sep 12, 2008

Differential Diagnoses

Biliary Colic
Colonic Obstruction
Pancreatitis, Acute
Pneumonia, Community-Acquired

Workup

Laboratory Studies

  • Stool examination for ova and parasites almost always discloses large, brown 60 µm X 50 µm trilayered eggs in persons with ascariasis. However, stool examination may be negative for ova for up to 40 days after infection because of the time needed for migration and maturation of the worm. The outer surfaces of fertilized eggs have an uneven mucopolysaccharide coat.
  • Ascaris larvae may be observed in microscopic wet preparations of sputum during the pulmonary migration phase.
  • CBC counts show eosinophilia during the tissue migration phase of the infection.
  • Serological tests are not clinically useful for ascariasis.

Imaging Studies

  • Chest radiographs may show fleeting opacities during pulmonary migration.
  • Abdominal radiographs may show a whirlpool pattern of intraluminal worms. Narrow-based air fluid levels without distended loops of bowel on upright plain films suggest partial obstruction. Wide-based air fluid levels with distended loops suggest complete obstruction.
  • Worms have been increasingly identified in the biliary duct or gallbladder with ultrasonography and CT scanning. Liver granulomata due to A suum infection have been described as ill-defined, 3- to 35-mm, nodular- or wedge-shaped lesions in the periportal or subcapsular regions.

Other Tests

Endoscopic retrograde cholangiopancreatography (ERCP) has become a commonly used procedure for both diagnosis of ascariasis and removal of worms from the biliary tract. The ease of diagnosis and therapy in the same setting makes ERCP particularly valuable when used with real-time ultrasonography. The combined procedures yield a sensitivity of nearly 100%.11

More on Ascariasis

Overview: Ascariasis
Differential Diagnoses & Workup: Ascariasis
Treatment & Medication: Ascariasis
Follow-up: Ascariasis
Multimedia: Ascariasis
References
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Further Reading

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Keywords

ascariasis, helminthic infection, Ascaris lumbricoides, A lumbricoides, nematodes, roundworm, chronic ascariasis, acute ascariasis, biliary ascariasis, ascarids, geophagy, night soil, Ascaris lumbricoides suum, A lumbricoides suum, A suum, pig manure

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Contributor Information and Disclosures

Author

David R Haburchak, MD, Program Director, Professor, Department of Internal Medicine, Division of Infectious Disease, Medical College of Georgia
David R Haburchak, MD is a member of the following medical societies: Infectious Diseases Society of America
Disclosure: Nothing to disclose.

Medical Editor

Jeffrey D Band, MD, Clinical Professor of Medicine, Wayne State University School of Medicine; Director, Division of Infectious Diseases and International Medicine, William Beaumont Hospital Corporation
Disclosure: Nothing to disclose.

Pharmacy Editor

Francisco Talavera, PharmD, PhD, Senior Pharmacy Editor, eMedicine
Disclosure: Nothing to disclose.

Managing Editor

Richard B Brown, MD, FACP, Chief, Division of Infectious Diseases, Baystate Medical Center; Professor, Department of Internal Medicine, Tufts University School of Medicine
Richard B Brown, MD, FACP is a member of the following medical societies: Alpha Omega Alpha, American College of Chest Physicians, American College of Physicians, American Medical Association, American Society for Microbiology, Infectious Diseases Society of America, and Massachusetts Medical Society
Disclosure: Nothing to disclose.

CME Editor

Eleftherios Mylonakis, MD, Clinical and Research Fellow, Department of Internal Medicine, Division of Infectious Diseases, Massachusetts General Hospital
Eleftherios Mylonakis, MD is a member of the following medical societies: American Association for the Advancement of Science, American College of Physicians, American Society for Microbiology, and Infectious Diseases Society of America
Disclosure: Nothing to disclose.

Chief Editor

Burke A Cunha, MD, Professor of Medicine, State University of New York School of Medicine at Stony Brook; Chief, Infectious Disease Division, Winthrop-University Hospital
Burke A Cunha, MD is a member of the following medical societies: American College of Chest Physicians, American College of Physicians, and Infectious Diseases Society of America
Disclosure: Nothing to disclose.

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