Ascaris Lumbricoides Workup

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

Laboratory Studies

  • Early infection (larval migration)
    • Complete blood count (CBC) may show eosinophilia.
    • Sputum analysis may reveal larvae or Charcot-Leyden crystals (collections of crystalloid composed of eosinophilic proteins).
    • 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. Ascaris lumbricoides egg. Ascaris lumbricoides egg. Adult Ascaris lumbricoides in biliary system. Adult Ascaris lumbricoides in biliary system. Ascaris lumbricoides egg in feces (formalin-ethyl Ascaris lumbricoides egg in feces (formalin-ethyl acetate sedimentation method).
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Imaging Studies

  • Early infection (larval migration): Chest radiography may reveal patchy infiltrates of eosinophilic pneumonia.
  • Established infection (adult phase)
    • Abdominal radiographs or contrast computed tomography (CT) scans may reveal adult worms or cylindrical filling defects, respectively; however, these are usually discovered retrospectively.
    • Some authors have recommended ultrasonography as the initial imaging study of choice, especially when pretest suspicion of pancreatobiliary involvement is high. Diagnosis of Ascaris infection has been described using point-of-care emergency department ultrasound.[9] Sensitivity may be increased by left lateral decubitus positioning, oral fluids, and using gentle transducer pressure to induce worm movement.
    • Magnetic resonance cholangiopancreatography (MRCP) may detect adult worms in bile or pancreatic ducts, though its availability may be limited.[10]
    • Alternatively, endoscopic retrograde cholangiopancreatography (ERCP) has the advantage of being both diagnostic and therapeutic when pancreato-biliary complications are suspected.[11]
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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.

References

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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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