History

Early symptoms of ascariasis, during the initial lung migration (first 10-14 days after ingestion) include cough, dyspnea, wheezing, urticaria, hemoptysis, and chest pain.^[2]This may be seasonal after rains in some countries, such as Saudi Arabia. Returning travelers could also present with Loeffler syndrome of eosinophilic pneumonia if exposed in a high-risk environment.

Abdominal pain or discomfort, distension, colic, nausea, anorexia, and intermittent diarrhea may be manifestations of partial or complete intestinal obstruction by adult worms during the late phase of infection six to eight weeks after egg ingestion. Adult worms are passed in the stool and can be seen on stool examination.

Jaundice, nausea, vomiting, fever, and severe or radiating abdominal pain may suggest cholangitis, pancreatitis, hepatic abscess, or appendicitis.

Physical

Within 1 to 2 weeks of new infection following egg ingestion, Ascaris larvae migrate through lungs causing eosinophilic pneumonitis. This is known as the Loeffler syndrome. Parasitic infections with Strongyloides stercolis, Ancylostoma duodenale, Necator americanus, Toxocara, schistosomiasis, and lymphatic filariasis can present with a similar pathological presentation. Patients may present with fever, dry cough, dyspnea, wheezing, and urticaria that subsides within 5 to 10 days. Rales, wheezes, and tachypnea may develop during pulmonary migration, particularly in persons with a high worm burden. Urticaria and fever may also develop late in the migratory phase.

Abdominal distension is nonspecific, but is common in children with ascariasis.

Abdominal tenderness, especially in the right upper quadrant, hypogastrium, or right lower quadrant, may suggest complications of ascariasis.

Evidence for nutritional deficiency due to ascariasis is strongest for vitamins A and C, as well as for protein, as indicated by albumin and growth studies in children observed prospectively. Some studies have not confirmed nutritional or developmental delay due to ascariasis.

Complications

Complications of ascariasis are related to worm burden and location of the relatively large nematode. They include acute abdomen, upper GI bleeding, small-bowel obstruction, volvulus and intussusception, peritonitis, biliary colic, acute cholecystitis, acute pancreatitis, acute cholangitis, and hepatic abscess. As such, ascariasis could be considered a potential cause of surgical emergency in endemic areas.^[2]

Differential Diagnoses

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Media Gallery

Adult Ascaris lumbricoides.
Life cycle of Ascaris lumbricoides.
Ascaris lumbricoides egg.
Adult Ascaris lumbricoides in biliary system.
Life cycle of Ascaris lumbricoides. Courtesy of the Centers for Disease Control and Prevention (CDC) [https://www.cdc.gov/dpdx/ascariasis/index.html].
Larva of A lumbricoides hatching from an egg. Courtesy of the Centers for Disease Control and Prevention (CDC) [https://www.cdc.gov/dpdx/ascariasis/index.html].

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Author

Amber Mahmood Bokhari, MBBS Assistant Professor, Department of Infectious Disease, University of South Alabama College of Medicine

Amber Mahmood Bokhari, MBBS is a member of the following medical societies: American Medical Association, Infectious Diseases Society of America

Disclosure: Nothing to disclose.

Coauthor(s)

John A Vande Waa, DO, PhD Professor of Medicine and Director, Division of Infectious Diseases, Adjunct Associate Professor, Department of Microbiology and Immunology, University of South Alabama College of Medicine

John A Vande Waa, DO, PhD is a member of the following medical societies: American Federation for Medical Research, American Society of Tropical Medicine and Hygiene, Infectious Diseases Society of America

Disclosure: Nothing to disclose.

Specialty Editor Board

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

Disclosure: Received salary from Medscape for employment. for: Medscape.

Richard B Brown, MD, FACP Chief, Division of Infectious Diseases, Baystate Medical Center; Professor, Department of Internal Medicine, Tufts University School of Medicine

Richard B Brown, MD, FACP is a member of the following medical societies: Alpha Omega Alpha, American College of Chest Physicians, American College of Physicians, American Medical Association, American Society for Microbiology, Infectious Diseases Society of America, Massachusetts Medical Society

Disclosure: Nothing to disclose.

Chief Editor

Pranatharthi Haran Chandrasekar, MBBS, MD Professor, Chief of Infectious Disease, Department of Internal Medicine, Wayne State University School of Medicine

Pranatharthi Haran Chandrasekar, MBBS, MD is a member of the following medical societies: American College of Physicians, American Society for Microbiology, International Immunocompromised Host Society, Infectious Diseases Society of America

Disclosure: Nothing to disclose.

Additional Contributors

David R Haburchak, MD, FACP Key Faculty, Wellstar Kennestone Internal Medicine Residency Program, Wellstar Health System

David R Haburchak, MD, FACP is a member of the following medical societies: American College of Physicians, American Osler Society, American Society for Microbiology, Christian Medical and Dental Associations, Infectious Diseases Society of America

Disclosure: Nothing to disclose.

Jeffrey D Band, MD, FACP, FIDSA Professor of Medicine, Oakland University William Beaumont School of Medicine; Health System Chair, Healthcare Epidemiology and International Medicine, Beaumont Health System; Former Chief of Infectious Diseases, Beaumont Hospital; Clinical Professor of Medicine, Wayne State University School of Medicine

Disclosure: Nothing to disclose.

Ascariasis Clinical Presentation

History

Physical

Complications

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