Pediatric Ascariasis Follow-up

Updated: Aug 27, 2018
  • Author: William H Shoff, MD, DTM&H; Chief Editor: Russell W Steele, MD  more...
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Follow-up

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. [24] 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), [25] 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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