Ascaris Lumbricoides Treatment & Management

Updated: Jan 15, 2019
  • Author: Aaron Dora-Laskey, MD, MS; Chief Editor: Jeter (Jay) Pritchard Taylor, III, MD  more...
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Treatment

Emergency Department Care

Early infection (larval migration)

Inhaled beta-agonists may be indicated.

Steroids for pulmonary symptoms are controversial.

Whether anthelmintic therapy is effective against larval stages is unclear. (Stool ova microscopy will likely be negative at this phase). Because infection in the early phase is rarely serious, generally treatment is delayed until definitive diagnosis can be made.

Established infection (adult phase)

Benzimidazoles are the mainstay of treatment of symptomatic and asymptomatic infections. They are poorly systemically absorbed and thus have low human toxicity and exert their action directly on worms. The most common members of this family are albendazole and mebendazole.

Treatment of bowel obstruction includes intravenous hydration, nasogastric suctioning, electrolyte monitoring, and laparotomy if conservative measures fail. Colonoscopy and esophagogastroduodenoscopy (EGD) may be useful in removing obstructing masses of worms.

Piperazine citrate, a helminth paralytic, has been suggested in cases of obstruction; however, it is no longer commercially available in the United States.

Hepatobiliary ascariasis typically responds to similarly conservative therapy, but it may require invasive intervention (eg, ERCP) should this fail, or if there are coexisting stones or strictures. It may also be indicated in cases of pyogenic cholangitis and acute pancreatitis.

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Consultations

Bowel or hepatobiliary obstruction may require surgical or gastroenterologic consultation.

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Prevention

Screening programs for the carrier state may assist in eradication in endemic areas.

Given the association with poverty and malnutrition, long-term control will require sustained economic growth in developing countries and the creation of sanitation and education systems including those to reduce the use of human feces for fertilizer.

Many nations have such high rates of Ascaris infection that they empirically treat some age groups without testing. Medication choices and the frequency of testing vary from country to country, but data are favorable for reducing the load of parasites in the community and as well for reducing individual morbidity and mortality associated with infection.

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Further Outpatient Care

Primary care follow up is suggested to confirm cure.

Presumptive administration of albendazole to all immigrants at risk for parasitosis has been suggested and shown to save lives and money. However, current recommendations do not include its implementation.

Follow-up stool ova and parasite microscopic testing is warranted post treatment to ensure clearance of parasite infection and as well to monitor for re-infection, which can be common.

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Further Inpatient Care

Further inpatient care is warranted for patients with complications due to worm migration.

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