Pediatric Ascariasis Workup

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

Laboratory Studies

Adult worms may be coughed out, vomited, or passed via the rectum and studied.

A microscopic examination finding of eggs in the feces confirms the diagnosis. This is performed using a direct method (stool mixed with saline) or after concentrating the stool. The Kato-Katz method is the preferred method. Fertilized eggs are easier to identify than unfertilized eggs and decorticate eggs, which are infrequently produced and lack the outer covering. Male-only ascaris infections produce no eggs. Microscopic examination of gastric contents may reveal larvae and eggs. Microscopic examination of sputum may reveal larvae.

Eosinophilia (5-12%) may occur, particularly during the lung migration phase, and can be as high as 50% in ascaris pneumonia.

Serology is used for epidemiological purposes and is not useful for diagnostic purposes.

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Imaging Studies

Chest radiography

According to Löeffler, "The x-ray shadows are variable, unilateral or bilateral, fleecy or dense and small and round or big and irregular; they may be very extensive. They usually appear within three days and disappear in about 10-12 days." Follow-up radiography several months after the acute illness reveals no residual abnormalities.

Abdominal ultrasonography

This is the study of choice for imaging Ascaris worms in the biliary tree. Worms may be single, multiple, in bundles, and moving during the examination.

Abdominal CT scanning [15] {Ref39}

An alternative study to abdominal ultrasonography. A thin line of dye is occasionally seen within the corpus of a worm that has swallowed dye. Within the biliary tree, the worm is more easily visualized on an unenhanced scan. Double-contrast abdominal CT scanning is an excellent study for the evaluation of a patient who presents with acute abdominal symptoms suggestive of intestinal obstruction or another surgical emergency.

Magnetic resonance cholangiopancreatography (MRCP) [16]

This is an alternative to abdominal ultrasonography when it is not feasible, as is the case in some pregnant women. It is good for a general evaluation of the pancreatobiliary organs. It is an alternative to abdominal CT scanning when radiation exposure is to be avoided.

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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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