eMedicine Specialties > Emergency Medicine > Infectious Diseases
Ascaris Lumbricoides: Treatment & Medication
Updated: Jul 30, 2009
- Overview
- Differential Diagnoses & Workup
- Treatment & Medication
- Follow-up
- Multimedia
Treatment
Emergency Department Care
- Early infection (larval migration)
- Inhaled beta-agonists may be indicated.
- Steroids for pulmonary symptoms are controversial.
- Whether anthelmintic therapy is effective against larval stages is unclear. (Stool ova microscopy will likely be negative at this phase). Because infection in the early phase is rarely serious, generally treatment is delayed until definitive diagnosis can be made.
- Established infection (adult phase)
- Benzimidazoles are the mainstay of treatment of symptomatic and asymptomatic infections. They are poorly systemically absorbed and thus have low human toxicity and exert their action directly on worms. The most common members of this family are albendazole and mebendazole.
- Treatment of bowel obstruction includes intravenous hydration, nasogastric suctioning, electrolyte monitoring, and laparotomy if conservative measures fail. Colonoscopy and esophagogastroduodenoscopy (EGD) may be useful in removing obstructing masses of worms.
- Piperazine citrate, a helminth paralytic, has been suggested in cases of obstruction; however, it is no longer commercially available in the United States.
- Hepatobiliary ascariasis typically responds to similarly conservative therapy, but it may require invasive intervention (eg, ERCP).
Consultations
Bowel or hepatobiliary obstruction may require surgical or gastroenterologic consultation.
Medication
Benzimidazoles are effective for the treatment of intestinal ascariasis, although some authors recommend against their use in the first year of life and during pregnancy due to their teratogenic effects in animal studies. The most commonly recommended agents are albendazole and mebendazole. Ivermectin and pyrantel pamoate are alternatives, the latter having been suggested for pregnant patients in whom benzimidazoles are contraindicated. An anthelmintic agent from China, tribendimidine (at a dose of 300 mg), has been shown to be as efficacious as albendazole.9,10Anthelmintics
Parasite biochemical pathways are sufficiently different from the human host to allow selective interference by chemotherapeutic agents in relatively small doses.
Albendazole (Albenza)
Decreases ATP production in worm, causing energy depletion, immobilization, and finally death.
Adult
400 mg/d PO single dose; repeat in 3 wk if not cured
Pediatric
<2 years: 200 mg/d PO single dose; repeat in 3 wk if not cured
>2 years: Administer as in adults
Coadministration with carbamazepine may decrease efficacy; dexamethasone and praziquantel may increase toxicity
Documented hypersensitivity
Pregnancy
C - Fetal risk revealed in studies in animals but not established or not studied in humans; may use if benefits outweigh risk to fetus
Precautions
Discontinue use if LFT values increase significantly (resume when levels decrease to pretest values); GI symptoms (nausea, vomiting, diarrhea) or CNS symptoms (dizziness, headache, meningeal signs) may occur; granulocytopenia, thrombocytopenia, and pancytopenia have been reported
Mebendazole (Vermox)
Causes worm death by selectively and irreversibly blocking uptake of glucose and other nutrients in susceptible adult intestine where helminths dwell.
Adult
100 mg PO bid on 3 consecutive days
Administer second course if not cured within 3-4 wk
Pediatric
<2 years: Not established
>2 years: Administer as in adults
Carbamazepine and phenytoin may decrease effects
Documented hypersensitivity
Pregnancy
C - Fetal risk revealed in studies in animals but not established or not studied in humans; may use if benefits outweigh risk to fetus
Precautions
Adjust dose in hepatic impairment; GI symptoms (nausea, vomiting, abdominal pain, diarrhea) and CNS symptoms (headache, dizziness) are common; alopecia may be associated with high doses; rare reactions include angioedema, seizures, and agranulocytosis
Piperazine citrate
Recommend for GI or biliary obstruction secondary to ascariasis; causes flaccid paralysis of the helminth by blocking response to worm muscle to acetylcholine.
Adult
3.5 g PO qd for 2 d
Pediatric
75 mg/kg PO qd for 2 d; not to exceed 3.5 g/dose
Coadministration with chlorpromazine may increase toxicity
Documented hypersensitivity
Pregnancy
C - Fetal risk revealed in studies in animals but not established or not studied in humans; may use if benefits outweigh risk to fetus
Precautions
Most commonly reported reactions include GI and CNS effects; discontinue therapy if effects become significant; prolonged, repeated, or excessive therapy should be avoided because of potential neurotoxicity
Pyrantel pamoate (Antiminth)
Depolarizing neuromuscular blocking agent; inhibits cholinesterases, resulting in spastic paralysis of worm.
Adult
11 mg/kg/dose PO as single dose; not to exceed 1 g
Pediatric
Administer as in adults
Pyrantel and piperazine are mutually antagonistic and should not be used concomitantly
Documented hypersensitivity; hepatic disease
Pregnancy
C - Fetal risk revealed in studies in animals but not established or not studied in humans; may use if benefits outweigh risk to fetus
Precautions
Caution in liver impairment, anemia, and malnutrition; GI effects, headache, insomnia, rash, tenesmus, and elevated LFT values may occur
Ivermectin (Stromectol)
Binds selectively with glutamate-gated chloride ion channels in invertebrate nerve and muscle cells, causing cell death.
Adult
150-200 mcg/kg PO once
Pediatric
Administer as in adults
None reported
Documented hypersensitivity
Pregnancy
C - Fetal risk revealed in studies in animals but not established or not studied in humans; may use if benefits outweigh risk to fetus
Precautions
Serious reactions include Stevens-Johnson syndrome, asthma exacerbation, and vision loss (rare); common reactions include pruritus, rash, headache, myalgias, and elevated LFT values
Levamisole (Ergamisol)
May inhibit worm copulation via agonism of L-subtype nicotinic acetylcholine receptors in male nematode muscles.
Adult
2.5 mg/kg PO once
Pediatric
Administer as in adults
Increases toxicity and serum levels of phenytoin; causes disulfiram reactions when taken with alcohol
Documented hypersensitivity
Pregnancy
C - Fetal risk revealed in studies in animals but not established or not studied in humans; may use if benefits outweigh risk to fetus
Precautions
Agranulocytosis can occur asymptomatically
More on Ascaris Lumbricoides |
| Overview: Ascaris Lumbricoides |
| Differential Diagnoses & Workup: Ascaris Lumbricoides |
 Treatment & Medication: Ascaris Lumbricoides |
| Follow-up: Ascaris Lumbricoides |
| Multimedia: Ascaris Lumbricoides |
| References |
| « Previous Page | Next Page » |
References
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].
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].
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].
Mwanza JC. Lacrimal drainage obstruction by Ascaris lumbricoides. Bull Soc Belge Ophtalmol. 2004;71-3. [Medline].
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.
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].
Selimoglu MA, Ozturk CF, Ertekin V. A rare manifestation of ascariasis: encephalopathy. J Emerg Med. Jan 2005;28(1):87-8. [Medline].
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].
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].
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].
Bell DR. Soil transmitted helminths. In: Lecture Notes on Tropical Medicine. Boston: Blackwell Science; 1985:167-192.
Cappello M, Hotez PJ. Intestinal Nematodes. Philadelphia: Churchill-Livingstone; 2003:1331-1333.
Freedman DO. Intestinal nematodes. In: Gorbach, ed. Infectious Diseases. Philadelphia: WB Saunders; 1992:2003-2008.
Gilles HM. Intestinal nematode infections. In: GT Strickland, ed. Hunter's Tropical Medicine. Philadelphia: WB Saunders; 1984:620-644.
Liu LX, Weller PF. Antiparasitic drugs. N Engl J Med. May 2 1996;334(18):1178-84. [Medline].
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].
Talaat KR, Nutman TB. Parasitic Diseases. In: Mason, ed. Murray & Nadel's Textbook of Respiratory Medicine. Philadelphia: Saunders; 2003:1090-1092.
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
