eMedicine Specialties > Emergency Medicine > Infectious Diseases

Ascaris Lumbricoides: Differential Diagnoses & Workup

Author: Aaron Dora-Laskey, MD, Emergency Physician, Physician Management Group, Dayton, Ohio
Coauthor(s): Ugo Anthony Ezenkwele, MD, MPH, Assistant Professor of Emergency Medicine, Department of Emergency Medicine, New York University School of Medicine/Bellevue Hospital Center; Eric L Weiss, MD, DTM&H, Director of Stanford Travel Medicine, Medical Director of Stanford Lifeflight, Assistant Professor, Departments of Emergency Medicine and Infectious Diseases, Stanford University School of Medicine
Contributor Information and Disclosures

Updated: Jul 30, 2009

Differential Diagnoses

Appendicitis, Acute
Obstruction, Large Bowel
Ascending cholangitis
Obstruction, Small Bowel
Asthma
Pancreatitis
Cholangitis
Strongyloides Stercoralis
Cholecystitis and Biliary Colic
Hookworm

Other Problems to Be Considered

Hepatic abscess
Tropical pulmonary eosinophilia
Visceral larva migrans

Workup

Laboratory Studies

  • Early infection (larval migration)
    • Complete blood count (CBC) may show eosinophilia.
    • Sputum analysis may reveal larvae or Charcot-Leyden crystals.
    • Stool examination findings are typically normal in absence of previous infection (during the first 40 d).
    • Ascaris specific antibodies (not useful in acute infection and not protective)
    • Increases in IgE and later IgG 
  • Established infection (adult phase): Stool examination findings include characteristic eggs. Adult females lay about 200,000 eggs per day, aiding microscopic identification of characteristic eggs.


<EM>Ascaris lumbricoides</EM> egg.

Ascaris lumbricoides egg.

<EM>Ascaris lumbricoides</EM> egg.

Ascaris lumbricoides egg.



Adult <em>Ascaris lumbricoides</EM> in biliary sy...

Adult Ascaris lumbricoides in biliary system.

Adult <em>Ascaris lumbricoides</EM> in biliary sy...

Adult Ascaris lumbricoides in biliary system.



<EM>Ascaris lumbricoides</EM> egg in feces (forma...

Ascaris lumbricoides egg in feces (formalin-ethyl acetate sedimentation method).

<EM>Ascaris lumbricoides</EM> egg in feces (forma...

Ascaris lumbricoides egg in feces (formalin-ethyl acetate sedimentation method).

Imaging Studies

  • Early infection (larval migration): Chest radiography may reveal patchy infiltrates of eosinophilic pneumonia.
  • Established infection (adult phase)
    • Abdominal radiography may reveal adult worms (especially with contrast). 
    • Obstructing Ascaris lesions cause cylindrical filling defects on contrast computed tomography (CT) scans.
    • Cholangiopancreatography by endoscopy (ERCP) or magnetic resonance imaging (MRCP, or magnetic resonance cholangiopancreatography) may detect adult worms in bile or pancreatic ducts.8
    • Ultrasonography may detect worms in the gallbladder.

More on Ascaris Lumbricoides

Overview: Ascaris Lumbricoides
Differential Diagnoses & Workup: Ascaris Lumbricoides
Treatment & Medication: Ascaris Lumbricoides
Follow-up: Ascaris Lumbricoides
Multimedia: Ascaris Lumbricoides
References

References

  1. Albonico M, Ramsan M, Wright V, et al. Soil-transmitted nematode infections and mebendazole treatment in Mafia Island schoolchildren. Ann Trop Med Parasitol. Oct 2002;96(7):717-26. [Medline].

  2. Luoba AI, Wenzel Geissler P, Estambale B, et al. Earth-eating and reinfection with intestinal helminths among pregnant and lactating women in western Kenya. Trop Med Int Health. Mar 2005;10(3):220-7. [Medline].

  3. Williams-Blangero S, Subedi J, Upadhayay RP, et al. Genetic analysis of susceptibility to infection with Ascaris lumbricoides. Am J Trop Med Hyg. Jun 1999;60(6):921-6. [Medline].

  4. Mwanza JC. Lacrimal drainage obstruction by Ascaris lumbricoides. Bull Soc Belge Ophtalmol. 2004;71-3. [Medline].

  5. Karatepe O, Tukenmez M, Salmashogul A, et al. Ascaris as a leading point for small-bowel intussusception in an adult: a rare cause of intussusception. Am J Emerg Med. Mar 1 2008;26(3):381.e3-381.e4.

  6. Jung O, Ditting T, Grone HJ, Geiger H, Hauser IA. Acute interstitial nephritis in a case of Ascaris lumbricoides infection. Nephrol Dial Transplant. Jun 2004;19(6):1625-8. [Medline].

  7. Selimoglu MA, Ozturk CF, Ertekin V. A rare manifestation of ascariasis: encephalopathy. J Emerg Med. Jan 2005;28(1):87-8. [Medline].

  8. Arya PK, Kukreti R, Arya M, Gupta SN. Magnetic resonace appearance of gall bladder ascariasis. Indian J Med Sci. May 2005;59(5):208-10. [Medline].

  9. Xiao SH, Hui-Ming W, Tanner M, Utzinger J, Chong W. Tribendimidine: a promising, safe and broad-spectrum anthelmintic agent from China. Acta Trop. Apr 2005;94(1):1-14. [Medline].

  10. Steinmann P, Zhou XN, Du ZW, Jiang JY, Xiao SH, Wu ZX, et al. Tribendimidine and Albendazole for Treating Soil-Transmitted Helminths, Strongyloides stercoralis and Taenia spp.: Open-Label Randomized Trial. PLoS Negl Trop Dis. 2008;2(10):e322. [Medline].

  11. Bell DR. Soil transmitted helminths. In: Lecture Notes on Tropical Medicine. Boston: Blackwell Science; 1985:167-192.

  12. Cappello M, Hotez PJ. Intestinal Nematodes. Philadelphia: Churchill-Livingstone; 2003:1331-1333.

  13. Freedman DO. Intestinal nematodes. In: Gorbach, ed. Infectious Diseases. Philadelphia: WB Saunders; 1992:2003-2008.

  14. Gilles HM. Intestinal nematode infections. In: GT Strickland, ed. Hunter's Tropical Medicine. Philadelphia: WB Saunders; 1984:620-644.

  15. Liu LX, Weller PF. Antiparasitic drugs. N Engl J Med. May 2 1996;334(18):1178-84. [Medline].

  16. Muennig P, Pallin D, Sell RL, Chan MS. The cost effectiveness of strategies for the treatment of intestinal parasites in immigrants. N Engl J Med. Mar 11 1999;340(10):773-9. [Medline].

  17. Talaat KR, Nutman TB. Parasitic Diseases. In: Mason, ed. Murray & Nadel's Textbook of Respiratory Medicine. Philadelphia: Saunders; 2003:1090-1092.

  18. Urbani C, Albonico M. Anthelminthic drug safety and drug administration in the control of soil-transmitted helminthiasis in community campaigns. Acta Trop. May 2003;86(2-3):215-21. [Medline].

Further Reading

Keywords

Ascaris lumbricoides, A lumbricoides, ascariasis, roundworm, intestinal parasite, roundworm treatment, roundworm symptoms, intestinal roundworm, human parasite, nematode infection, malnutrition, iron-deficiency anemia, bowel obstruction, Ascaris suum, eosinophilic pneumonia, Löffler syndrome

Contributor Information and Disclosures

Author

Aaron Dora-Laskey, MD, Emergency Physician, Physician Management Group, Dayton, Ohio
Aaron Dora-Laskey, MD is a member of the following medical societies: American Academy of Emergency Medicine
Disclosure: Nothing to disclose.

Coauthor(s)

Ugo Anthony Ezenkwele, MD, MPH, Assistant Professor of Emergency Medicine, Department of Emergency Medicine, New York University School of Medicine/Bellevue Hospital Center
Ugo Anthony Ezenkwele, MD, MPH is a member of the following medical societies: American Academy of Emergency Medicine, American College of Emergency Physicians, National Medical Association, and Society for Academic Emergency Medicine
Disclosure: Nothing to disclose.

Eric L Weiss, MD, DTM&H, Director of Stanford Travel Medicine, Medical Director of Stanford Lifeflight, Assistant Professor, Departments of Emergency Medicine and Infectious Diseases, Stanford University School of Medicine
Eric L Weiss, MD, DTM&H is a member of the following medical societies: American College of Emergency Physicians, American College of Occupational and Environmental Medicine, American Medical Association, American Society of Tropical Medicine and Hygiene, Physicians for Social Responsibility, Southeastern Surgical Congress, Southern Association for Oncology, Southern Clinical Neurological Society, and Wilderness Medical Society
Disclosure: Nothing to disclose.

Medical Editor

Mark Louden, MD, FACEP, Assistant Medical Director, Emergency Department, Duke Raleigh Hospital
Mark Louden, MD, FACEP is a member of the following medical societies: American Academy of Emergency Medicine and American College of Emergency Physicians
Disclosure: Nothing to disclose.

Pharmacy Editor

Francisco Talavera, PharmD, PhD, Senior Pharmacy Editor, eMedicine
Disclosure: eMedicine Salary Employment

Managing Editor

Jon Mark Hirshon, MD, MPH, Associate Professor, Department of Emergency Medicine, University of Maryland School of Medicine
Jon Mark Hirshon, MD, MPH is a member of the following medical societies: Alpha Omega Alpha, American Academy of Emergency Medicine, American College of Emergency Physicians, American Public Health Association, and Society for Academic Emergency Medicine
Disclosure: Nothing to disclose.

CME Editor

John D Halamka, MD, MS, Associate Professor of Medicine, Harvard Medical School, Beth Israel Deaconess Medical Center; Chief Information Officer, CareGroup Healthcare System and Harvard Medical School; Attending Physician, Division of Emergency Medicine, Beth Israel Deaconess Medical Center
John D Halamka, MD, MS is a member of the following medical societies: American College of Emergency Physicians, American Medical Informatics Association, Phi Beta Kappa, and Society for Academic Emergency Medicine
Disclosure: Nothing to disclose.

Chief Editor

Rick Kulkarni, MD, Medical Director, Assistant Professor of Surgery, Section of Emergency Medicine, Yale-New Haven Hospital
Rick Kulkarni, MD is a member of the following medical societies: Alpha Omega Alpha, American Academy of Emergency Medicine, American College of Emergency Physicians, American Medical Association, American Medical Informatics Association, Phi Beta Kappa, and Society for Academic Emergency Medicine
Disclosure: WebMD Salary Employment

 
 
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