Pediatric Ascariasis Follow-up

  • Author: William H Shoff, MD, DTM&H; Chief Editor: Russell W Steele, MD   more...
 
Updated: Sep 27, 2010
 

Deterrence/Prevention

Prevention consists of improved sanitation and education about the disease. In endemic areas, school screening has demonstrated effectiveness in detection and early treatment of asymptomatic carriers.[19] Benefits in health and educational performance have been reported with large-scale treatment of school-aged children every 6 months in countries where ascariasis is a public health problem.

The WHO ranks STH infections as the prime cause of infectious disease in children aged 5-14 years. Three strategies have been identified to control STH infections: chemotherapy, health education, and sanitation. Sanitation in developed countries is currently too expensive to be provided to the more than 2 billion people who lack safe disposal of their feces. In terms of education, better-educated households have better health. Specifically regarding STH, studies in Sri Lanka demonstrate that the more education mothers receive, the lower the prevalence of STH infection in their children. The challenge is to educate communities without clashing with local customs and cultures.

That leaves chemotherapy as the current mainstay for control of STH infection, although this strategy is limited by the enormous ongoing burden of environmental contamination. The goal is to reduce the intensity of STH infections in the community. Three chemotherapy strategies have been field tested for reducing the intensity of STH infections in the community: universal/mass treatment (all ages, both sexes, no exceptions),[20] targeted treatment (defined age, sex, or other identifier), and selected treatment (current diagnosis of STH infection). Only universal and targeted treatments are effective. Selected treatment does have a role, although it does not reduce community STH infection intensity. Treatment delivered to children through the schools at intervals of a year, 6 months, 4 months, or 3 months has been shown to be effective. When given every 3 months to children in one study, a significant decrease in adult intensity was noted, as well.

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Complications

Complications include the following:

  • Intestinal obstruction: In some instances, treatment that involves an antihelminthic in an asymptomatic individual who is passing Ascaris eggs or who is involved in a mass treatment program precipitates partial or complete bowel obstruction. This situation cannot be predicted. If the patient has abdominal (nonsurgical) pain that may be related to ascariasis, conservatively treating the patient without administering an antihelminthic until the symptoms abate and then treating with antihelminthics under close observation is judicious (see Medical Care). Untreated intestinal obstruction may lead to bowel necrosis, peritonitis, sepsis, and death.
  • Volvulus
  • Intussusception
  • Hepatobiliary disease
  • Pancreatitis
  • Appendicitis
  • Bowel perforation
  • Peritonitis
  • Sepsis, sepsis syndrome, septic shock
  • Ascaris pneumonia
  • Löeffler syndrome
  • Asthma exacerbation
  • Encephalitis
  • Other ectopic migration (see Mortality and Morbidity)
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Prognosis

Prognosis is excellent for the treatment of asymptomatic ascariasis. In some instances, a second treatment may be necessary to completely clear the worms. This has been demonstrated to significantly reduce the number of complications. The concern in endemic countries is that reinfection will occur.

In children in endemic countries, treatment results in demonstrated improvement in cognitive development, school performance, and weight gain.

The prognosis is good for patients with partial bowel obstruction who do not have toxicity and who are nonseptic, provided the patient is treated early with conservative management (see Medical Care).

The prognosis in patients with bowel obstruction who do not have toxicity or sepsis is good if the patient is treated early with appropriate surgical intervention (see Surgical Care).

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Contributor Information and Disclosures
Author

William H Shoff, MD, DTM&H  Director, PENN Travel Medicine, Associate Professor, Department of Emergency Medicine, Hospital of the University of Pennsylvania

William H Shoff, MD, DTM&H is a member of the following medical societies: American College of Physicians, American Society of Tropical Medicine and Hygiene, International Society of Travel Medicine, Society for Academic Emergency Medicine, and Wilderness Medical Society

Disclosure: Glaxo Smith Kline None None; Glaxo Smith Kline Honoraria Speaking and teaching

Coauthor(s)

Catherine T Shoff, DO  Staff Physician, Departments of Pulmonary, Critical Care and Sleep Medicine, Director, Tri-Services Adult Cystic Fibrosis Ctr, Wilford Hall Medical Center, Assistant Professor of Medicine, Uniformed Services University of the Health Sciences

Catherine T Shoff, DO is a member of the following medical societies: American Academy of Sleep Medicine and American College of Chest Physicians

Disclosure: Nothing to disclose.

Michael E Greenberg, MD  MPH, Clinical Instructor, Department of Pediatrics, University of California at San Francisco

Michael E Greenberg, MD is a member of the following medical societies: Alpha Omega Alpha, Ambulatory Pediatric Association, American Academy of Pediatrics, and American Public Health Association

Disclosure: Nothing to disclose.

Suzanne Moore Shepherd, MD, MS, DTM&H, FACEP, FAAEM  Associate Professor, Education Officer, Department of Emergency Medicine, Hospital of the University of Pennsylvania; Director of Education and Research, PENN Travel Medicine

Suzanne Moore Shepherd, MD, MS, DTM&H, FACEP, FAAEM is a member of the following medical societies: Alpha Omega Alpha, American Academy of Emergency Medicine, American Society of Tropical Medicine and Hygiene, International Society of Travel Medicine, Society for Academic Emergency Medicine, and Wilderness Medical Society

Disclosure: Nothing to disclose.

Specialty Editor Board

Michael D Nissen, MBBS, FRACP, FRCPA  Associate Professor in Biomolecular, Biomedical Science & Health, Griffith University; Director of Infectious Diseases and Unit Head of Queensland Paediatric Infectious Laboratory, Sir Albert Sakzewski Viral Research Centre, Royal Children's Hospital

Michael D Nissen, MBBS, FRACP, FRCPA is a member of the following medical societies: American Academy of Pediatrics, American Society for Microbiology, Pediatric Infectious Diseases Society, Royal Australasian College of Physicians, and Royal College of Pathologists of Australasia

Disclosure: Nothing to disclose.

Mary L Windle, PharmD  Adjunct Associate Professor, University of Nebraska Medical Center College of Pharmacy; Pharmacy Editor, eMedicine

Disclosure: Nothing to disclose.

Martin Weisse, MD  Program Director, Associate Professor, Department of Pediatrics, West Virginia University

Martin Weisse, MD is a member of the following medical societies: Ambulatory Pediatric Association, American Academy of Pediatrics, and Pediatric Infectious Diseases Society

Disclosure: Nothing to disclose.

Robert W Tolan Jr, MD  Chief, Division of Allergy, Immunology and Infectious Diseases, The Children's Hospital at Saint Peter's University Hospital; Clinical Associate Professor of Pediatrics, Drexel University College of Medicine

Robert W Tolan Jr, MD is a member of the following medical societies: American Academy of Pediatrics, American Medical Association, American Society for Microbiology, American Society of Tropical Medicine and Hygiene, Infectious Diseases Society of America, Pediatric Infectious Diseases Society, Phi Beta Kappa, and Physicians for Social Responsibility

Disclosure: GlaxoSmithKline Honoraria Speaking and teaching; MedImmune Honoraria Speaking and teaching; Merck Honoraria Speaking and teaching; Sanofi Pasteur Honoraria Speaking and teaching; Baxter Healthcare Honoraria Speaking and teaching; Novartis Honoraria Speaking and teaching

Chief Editor

Russell W Steele, MD  Head, Division of Pediatric Infectious Diseases, Ochsner Children's Health Center; Clinical Professor, Department of Pediatrics, Tulane University School of Medicine

Russell W Steele, MD is a member of the following medical societies: American Academy of Pediatrics, American Association of Immunologists, American Pediatric Society, American Society for Microbiology, Infectious Diseases Society of America, Louisiana State Medical Society, Pediatric Infectious Diseases Society, Society for Pediatric Research, and Southern Medical Association

Disclosure: Nothing to disclose.

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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.
Table 1. Major Soil-Transmitted Helminths[1, 2]
Parasite*DiseasePrevalence
A lumbricoidesCommon roundworm infection, ascariasis800 million to 1.4 billion
T trichiuraWhipworm infection, trichuriasis600 million to 1 billion
Necator americanus and



Ancylostoma duodenale



Hookworm infection580 million to 1.2 billion
Strongyloides stercoralisThreadworm infection, strongyloidiasis30-300 million
Enterobius vermicularisPinworm infection4-28% of children
Toxocara canis and



Toxocara cati



Visceral larva migrans and ocular larva migrans2-80% of children
*All major parasites are found in tropical, subtropical, and temperate climates.
Table 2. Minor Soil-Transmitted Helminths[1, 2]
Minor ParasiteDiseaseDistribution
Ancylostoma brazilienseCutaneous larva migransCostal regions worldwide
Uncinaria stenocephalaCutaneous larva migransCostal regions worldwide
Ancyclostoma caniumEosinophilic enteritisAustralia
Ancylostoma ceylanicumHookworm infectionAsia
Oesophagostomum bifurcumNodular worm infectionNorth America
Strongyloides fuelleborniSwollen belly syndromeWest Africa
Ternidens diminutusFalse hookworm infectionSouthern Africa
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