Ascariasis Clinical Presentation

Updated: Oct 01, 2021
  • Author: Amber Mahmood Bokhari, MBBS; Chief Editor: Pranatharthi Haran Chandrasekar, MBBS, MD  more...
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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.



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 duodenaleNecator 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 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]