Ascaris Lumbricoides Follow-up

  • Author: Aaron Dora-Laskey, MD; Chief Editor: Rick Kulkarni, MD   more...
 
Updated: Apr 4, 2012
 

Further Inpatient Care

Further inpatient care is warranted for patients with complications due to worm migration.

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Further Outpatient Care

  • Primary care follow up is suggested to confirm cure.
  • Presumptive administration of albendazole to all immigrants at risk for parasitosis has been suggested and shown to save lives and money. However, current recommendations do not include its implementation.
  • Follow-up stool ova and parasite microscopic testing is warranted post treatment to ensure clearance of parasite infection and as well to monitor for re-infection, which can be common.
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Deterrence/Prevention

  • Screening programs for the carrier state may assist in eradication in endemic areas.
  • Given the association with poverty and malnutrition, long-term control will require sustained economic growth in developing countries and the creation of sanitation and education systems including those to reduce the use of human feces for fertilizer.
  • Many nations have such high rates of Ascaris infection that they empirically treat some age groups without testing. Medication choices and the frequency of testing vary from country to country, but data are favorable for reducing the load of parasites in the community and as well for reducing individual morbidity and mortality associated with infection.
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Complications

  • Complications may be attributed to larval migration typically involving the lungs, and intestinal tract producing vague symptoms but may as well involve the kidneys, brain, and heart.
  • Severe complications later in disease are usually attributable to mechanical obstruction of intestines or biliary tree secondary to high worm burden.
  • Complications may arise early in disease due to allergic reaction to Ascaris infection (urticaria).
  • Malnutrition, anemia, growth, and developmental retardation (subject to some debate)
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Prognosis

The prognosis for ascariasis is excellent. However, in higher worm burden infections, serious complications such as obstruction are more common.

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Patient Education

Recommend good personal hygiene and food handling techniques: discriminate defecation, hand-washing, cleaning fruits and vegetables, and avoiding soil consumption. Educational programs should also address the use of human feces as fertilizer, a practice that persists in many communities internationally.

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Contributor Information and Disclosures
Author

Aaron Dora-Laskey, MD  Clinical Assistant Professor, Department of Emergency Medicine, Wright State University, Boonshoft School of Medicine

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  Medical Director, Office of Service Continuity and Disaster Planning, Fellowship Director, Stanford University Medical Center Disaster Medicine Fellowship, Chairman, SUMC and LPCH Bioterrorism and Emergency Preparedness Task Force, Clinical Associate Progressor, Department of Surgery (Emergency Medicine), Stanford University Medical Center

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.

Specialty Editor Board

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.

Francisco Talavera, PharmD, PhD  Adjunct Assistant Professor, University of Nebraska Medical Center College of Pharmacy; Editor-in-Chief, Medscape Drug Reference

Disclosure: Medscape Salary Employment

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.

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  Attending Physician, Department of Emergency Medicine, Cambridge Health Alliance, Division of Emergency Medicine, Harvard Medical School

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

Additional Contributors

The authors and editors of Medscape Reference gratefully acknowledge the medical review of this article by Joseph U Becker, MD.

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Adult Ascaris lumbricoides.
Life cycle of Ascaris lumbricoides.
Ascaris lumbricoides egg.
Adult Ascaris lumbricoides in biliary system.
The roundworm Ascaris lumbricoides causes ascariasis. Worms can reach 10-30 cm in length. Clinical disease results from effects of pulmonary larval migration, intestinal obstruction, or migration through the biliary tree.
Ascaris lumbricoides egg in feces (formalin-ethyl acetate sedimentation method).
Endoscopic retrograde cholangiogram shows long, linear, filling defect in common bile duct. Image courtesy of Medscape.com.
 
 
 
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