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.

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 ^{[19, 20]}

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) ^[21]

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.

Treatment & Management

Bethony J, Brooker S, Albonico M, et al. Soil-transmitted helminth infections: ascariasis, trichuriasis, and hookworm. Lancet. 2006 May 6. 367(9521):1521-32. [QxMD MEDLINE Link].
Crompton DW. Ascaris and ascariasis. Adv Parasitol. 2001. 48:285-375. [QxMD MEDLINE Link].
Lynch NR, Hagel IA, Palenque ME, Di Prisco MC, et al. Relationship between helminthic infection and IgE response in atopic and nonatopic children in a tropical environment. J Allergy Clin Immunol. 1998 Feb. 101(2 Pt 1):217-21. [QxMD MEDLINE Link].
Pinelli E, Willers SM, Hoek D, et al. Prevalence of antibodies against Ascaris suum and its association with allergic manifestations in 4-year-old children in The Netherlands: the PIAMA birth cohort study. Eur J Clin Microbiol Infect Dis. 2009 Nov. 28(11):1327-34. [QxMD MEDLINE Link].
Dold S, Heinrich J, Wichmann HE, Wjst M. Ascaris-specific IgE and allergic sensitization in a cohort of school children in the former East Germany. J Allergy Clin Immunol. 1998 Sep. 102(3):414-20. [QxMD MEDLINE Link].
Leonardi-Bee J, Pritchard D, Britton J. Asthma and current intestinal parasite infection: systematic review and meta-analysis. Am J Respir Crit Care Med. 2006 Sep 1. 174(5):514-23. [QxMD MEDLINE Link].
Hunninghake GM, Soto-Quiros ME, Avila L, et al. Sensitization to Ascaris lumbricoides and severity of childhood asthma in Costa Rica. J Allergy Clin Immunol. 2007 Mar. 119(3):654-61. [QxMD MEDLINE Link].
Cooper PJ, Chico ME, Rodrigues LC, et al. Reduced risk of atopy among school-age children infected with geohelminth parasites in a rural area of the tropics. J Allergy Clin Immunol. 2003 May. 111(5):995-1000. [QxMD MEDLINE Link].
Schafer T, Meyer T, Ring J, Wichmann HE, Heinrich J. Worm infestation and the negative association with eczema (atopic/nonatopic) and allergic sensitization. Allergy. 2005 Aug. 60(8):1014-20. [QxMD MEDLINE Link].
Notes from the Field: Ascariasis Associated with Pig Farming — Maine, 2010–2013. MMWR. May 24, 2013. 62(20):413-413.
Albonico M, Bickle Q, Ramsan M, Montresor A, Savioli L, Taylor M. Efficacy of mebendazole and levamisole alone or in combination against intestinal nematode infections after repeated targeted mebendazole treatment in Zanzibar. Bull World Health Organ. 2003. 81(5):343-52. [QxMD MEDLINE Link]. [Full Text].
Hesham Al-Mekhlafi M, Surin J, Atiya AS, Ariffin WA, Mohammed Mahdy AK, Che Abdullah H. Pattern and predictors of soil-transmitted helminth reinfection among aboriginal schoolchildren in rural Peninsular Malaysia. Acta Trop. 2008 Aug. 107(2):200-4. [QxMD MEDLINE Link].
Luoba AI, Wenzel Geissler P, Estambale B, et al. Earth-eating and reinfection with intestinal helminths among pregnant and lactating women in western Kenya. Trop Med Int Health. 2005 Mar. 10(3):220-7. [QxMD MEDLINE Link].
Clarke NE, Clements AC, Doi SA, Wang D, Campbell SJ, Gray D, et al. Differential effect of mass deworming and targeted deworming for soil-transmitted helminth control in children: a systematic review and meta-analysis. Lancet. 2017 Jan 21. 389 (10066):287-297. [QxMD MEDLINE Link].
Sandouk F, Haffar S, Zada MM, Graham DY, et al. Pancreatic-biliary ascariasis: experience of 300 cases. Am J Gastroenterol. 1997 Dec. 92(12):2264-7. [QxMD MEDLINE Link].
Khuroo MS, Zargar SA, Mahajan R. Hepatobiliary and pancreatic ascariasis in India. Lancet. 1990 Jun 23. 335(8704):1503-6. [QxMD MEDLINE Link].
Nikolic H, Palcevski G, Saina G, Peršic M. Chronic intussusception in children caused by Ascaris lumbricoides. Wien Klin Wochenschr. 2011 May. 123(9-10):294-6. [QxMD MEDLINE Link].
Hesse AA, Nouri A, Hassan HS, Hashish AA. Parasitic infestations requiring surgical interventions. Semin Pediatr Surg. 2012 May. 21(2):142-50. [QxMD MEDLINE Link].
Sherman SC, Weber JM. The CT diagnosis of Ascariasis. J Emerg Med. 2005 May. 28(4):471-2. [QxMD MEDLINE Link].
de Silva NR, Brooker S, Hotez PJ. Soil-transmitted helminth infections: updating the global picture. Trends Parasitol. 2003 Dec. 19(12):547-51. [QxMD MEDLINE Link].
Arya PK, Kukreti R, Arya M, Gupta SN. Magnetic resonace appearance of gall bladder ascariasis. Indian J Med Sci. 2005 May. 59(5):208-10. [QxMD MEDLINE Link].
World Health Organization. Report of the third global meeting on the partners for parasite control: Deworming for health and develpment. November 2004. Available at http://whqlibdoc.who.int/hq/2005/WHO_CDS_CPE_PVC_2005.14.pdf.
World Health Organization. Report of the WHO informal consultation on the use of praziquantel during pregnancy/lactation and albendazole/mebendazole in children under 24 months. April 2002. Available at http://www.who.int/wormcontrol/documents/en/pvc_20024full.pdf.
Albonico M, Stoltzfus RJ, Savioli L. A controlled evaluation of two school-based anthelminthic chemotherapy regimens on intensity of intestinal helminth infections. Int J Epidemiol. 1999 Jun. 28(3):591-6. [QxMD MEDLINE Link].
Fallah M, Mirarab A, Jamalian F. Evaluation of two years of mass chemotherapy against ascariasis in Hamadan, Islamic Republic of Iran. Bull World Health Organ. 2002. 80(5):399-402. [QxMD MEDLINE Link].
Abebe W, Tsuji N, Kasuga-Aoki H. Species-specific proteins identified in Ascaris lumbricoides and Ascaris suum using two-dimensional electrophoresis. Parasitol Res. 2002 Sep. 88(9):868-71. [QxMD MEDLINE Link].
Akgun Y. Intestinal obstruction caused by Ascaris lumbricoides. Dis Colon Rectum. 1996 Oct. 39(10):1159-63. [QxMD MEDLINE Link].
American Academy of Pediatrics. Ascaris lumbricoides infections. Peter G, ed. Red Book: Report of the Committee on Infectious Diseases. 24th ed. Elk Grove Village, IL: AAP; 1997. 142-3.
Ash LR. Ascaris lumbricoides?. South Med J. 2003 Jan. 96(1):101-2. [QxMD MEDLINE Link].
Bapat SS, Pulikot AM. Hepato-cerebral complications in ascariasis. Indian Pediatr. 2001 Apr. 38(4):431-2. [QxMD MEDLINE Link].
Beckingham IJ, Cullis SN, Krige JE. Management of hepatobiliary and pancreatic Ascaris infestation in adults after failed medical treatment. Br J Surg. 1998 Jul. 85(7):907-10. [QxMD MEDLINE Link].
Beitia AO, Haller JO, Kantor A. CT findings in pediatric gastrointestinal ascariasis. Comput Med Imaging Graph. 1997 Jan-Feb. 21(1):47-9. [QxMD MEDLINE Link].
Bennett A, Guyatt H. Reducing intestinal nematode infection: efficacy of albendazole and mebendazole. Parasitol Today. 2000 Feb. 16(2):71-4. [QxMD MEDLINE Link].
Bergler-Czop B, Lis-Swiety A, Kaminska-Winciorek G, Brzezinska-Wcislo L. Erythema nodosum caused by ascariasis and Chlamydophila pneumoniae pulmonary infection--a case report. FEMS Immunol Med Microbiol. 2009 Dec. 57(3):236-8. [QxMD MEDLINE Link].
Borges CA, Costa-Cruz JM, Paula FM. Intestinal parasites inside public restrooms and buses from the city of Uberlândia, Minas Gerais, Brazil. Rev Inst Med Trop Sao Paulo. 2009 Jul-Aug. 51(4):223-5. [QxMD MEDLINE Link].
Brooker S, Clements AC, Bundy DA. Global epidemiology, ecology and control of soil-transmitted helminth infections. Adv Parasitol. 2006. 62:221-61. [QxMD MEDLINE Link].
Bude RO, Bowerman RA. Case 20: Biliary ascariasis. Radiology. 2000 Mar. 214(3):844-7. [QxMD MEDLINE Link].
Carneiro FF, Cifuentes E, Tellez-Rojo MM, Romieu I. The risk of Ascaris lumbricoides infection in children as an environmental health indicator to guide preventive activities in Caparao and Alto Caparao, Brazil. Bull World Health Organ. 2002. 80(1):40-6. [QxMD MEDLINE Link].
Cooper PJ, Chico M, Sandoval C, Espinel I, Guevara A, Levine MM. Human infection with Ascaris lumbricoides is associated with suppression of the interleukin-2 response to recombinant cholera toxin B subunit following vaccination with the live oral cholera vaccine CVD 103-HgR. Infect Immun. 2001 Mar. 69(3):1574-80. [QxMD MEDLINE Link].
Crompton DWT, Nesheim MC, Pawlowski ZS. Ascariasis and Its Prevention and Control. London, England: Taylor & Francis; 1989.
de Silva NR, Chan MS, Bundy DA. Morbidity and mortality due to ascariasis: re-estimation and sensitivity analysis of global numbers at risk. Trop Med Int Health. 1997 Jun. 2(6):519-28. [QxMD MEDLINE Link].
Gelpi AP, Mustafa A. Ascaris pneumonia. Am J Med. 1968 Mar. 44(3):377-89. [QxMD MEDLINE Link].
Gelpi AP, Mustafa A. Seasonal pneumonitis with eosinophilia. A study of larval ascariasis in Saudi Arabs. Am J Trop Med Hyg. 1967 Sep. 16(5):646-57. [QxMD MEDLINE Link].
Hui JY, Woo PC, Kan PS, Tang AP. A woman with ascites and abdominal masses. Lancet. 2000 Feb 12. 355(9203):546. [QxMD MEDLINE Link].
Inatomi Y, Murakami T, Tokunaga M, Ishiwata K, Nawa Y, Uchino M. Encephalopathy caused by visceral larva migrans due to Ascaris suum. J Neurol Sci. 1999 Apr 1. 164(2):195-9. [QxMD MEDLINE Link].
Ishiwata K, Shinohara A, Yagi K. Identification of tissue-embedded ascarid larvae by ribosomal DNA sequencing. Parasitol Res. 2004 Jan. 92(1):50-2. [QxMD MEDLINE Link].
Jat KR, Marwaha RK, Panigrahi I, Gupta K. Ascariasis-associated worm encephalopathy in a young child. Trop Doct. 2009 Apr. 39(2):113-4. [QxMD MEDLINE Link].
Jones JL, Schulkin J, Maguire JH. Therapy for common parasitic diseases in pregnancy in the United States: a review and a survey of obstetrician/gynecologists' level of knowledge about these diseases. Obstet Gynecol Surv. 2005 Jun. 60(6):386-93. [QxMD MEDLINE Link].
[Guideline] Keiser J, Utzinger J. Efficacy of current drugs against soil-transmitted helminth infections: systematic review and meta-analysis. JAMA. 2008 Apr 23. 299(16):1937-48. [QxMD MEDLINE Link].
Khuroo MS. Ascariasis. Gastroenterol Clin North Am. 1996 Sep. 25(3):553-77. [QxMD MEDLINE Link].
Kiafar C, Shah D, Wadas D, Gilani N. Intermittent obstruction of jejunostomy tube due to Ascaris lumbricoides infection. South Med J. 2008 Jun. 101(6):654-6. [QxMD MEDLINE Link].
Knopp S, Mohammed KA, Simba Khamis I, et al. Spatial distribution of soil-transmitted helminths, including Strongyloides stercoralis, among children in Zanzibar. Geospat Health. 2008 Nov. 3(1):47-56. [QxMD MEDLINE Link].
Knopp S, Mohammed KA, Simba Khamis I, et al. Spatial distribution of soil-transmitted helminths, including Strongyloides stercoralis, among children in Zanzibar. Geospat Health. 2008 Nov. 3(1):47-56. [QxMD MEDLINE Link].
Larrubia JR, Ladero JM, Mendoza JL, Morillas JD, Diaz-Rubio M. The role of sonography in the early diagnosis of biliopancreatic Ascaris infestation. J Clin Gastroenterol. 1996 Jan. 22(1):48-50. [QxMD MEDLINE Link].
Loreille O, Bouchet F. Evolution of ascariasis in humans and pigs: a multi-disciplinary approach. Mem Inst Oswaldo Cruz. 2003. 98 Suppl 1:39-46. [QxMD MEDLINE Link].
Mao XQ, Sun DJ, Miyoshi A, Feng Z, Handzel ZT, Hopkin JM. The link between helminthic infection and atopy. Parasitol Today. 2000 May. 16(5):186-8. [QxMD MEDLINE Link].
Norhayati M, Oothuman P, Azizi O, Fatmah MS. Efficacy of single dose albendazole on the prevalence and intensity of infection of soil-transmitted helminths in Orang Asli children in Malaysia. Southeast Asian J Trop Med Public Health. 1997 Sep. 28(3):563-9. [QxMD MEDLINE Link].
Norhayati M, Oothuman P, Azizi O, Fatmah MS. Efficacy of single dose albendazole on the prevalence and intensity of infection of soil-transmitted helminths in Orang Asli children in Malaysia. Southeast Asian J Trop Med Public Health. 1997 Sep. 28(3):563-9. [QxMD MEDLINE Link].
O'Lorcain P, Holland CV. The public health importance of Ascaris lumbricoides. Parasitology. 2000. 121 Suppl:S51-71. [QxMD MEDLINE Link].
Ochoa B. Surgical complications of ascariasis. World J Surg. 1991 Mar-Apr. 15(2):222-7. [QxMD MEDLINE Link].
Ozturk H, Ozturk H, Duran H, Otcu S. [Biliary ascaris-induced obstructive jaundice: a case of acute abdomen]. Ulus Travma Acil Cerrahi Derg. 2009 Jan. 15(1):88-90. [QxMD MEDLINE Link].
Reeder MM. The radiological and ultrasound evaluation of ascariasis of the gastrointestinal, biliary, and respiratory tracts. Semin Roentgenol. 1998 Jan. 33(1):57-78. [QxMD MEDLINE Link].
Rodriguez EJ, Gama MA, Ornstein SM, Anderson WD. Ascariasis causing small bowel volvulus. Radiographics. 2003 Sep-Oct. 23(5):1291-3. [QxMD MEDLINE Link].
Salman AB. Management of intestinal obstruction caused by ascariasis. J Pediatr Surg. 1997 Apr. 32(4):585-7. [QxMD MEDLINE Link].
Sandouk F, Anand BS, Graham DY. The whirlpool jet technique for removal of pancreatic duct ascaris. Gastrointest Endosc. 1997 Aug. 46(2):180-2. [QxMD MEDLINE Link].
Sarinas PS, Chitkara RK. Ascariasis and hookworm. Semin Respir Infect. 1997 Jun. 12(2):130-7. [QxMD MEDLINE Link].
Schulman A. Ultrasound appearances of intra- and extrahepatic biliary ascariasis. Abdom Imaging. 1998 Jan-Feb. 23(1):60-6. [QxMD MEDLINE Link].
Selimoglu MA, Ozturk CF, Ertekin V. A rare manifestation of ascariasis: encephalopathy. J Emerg Med. 2005 Jan. 28(1):87-8. [QxMD MEDLINE Link].
St Georgiev V. Pharmacotherapy of ascariasis. Expert Opin Pharmacother. 2001 Feb. 2(2):223-39. [QxMD MEDLINE Link].
Stephenson LS, Latham MC, Ottesen EA. Malnutrition and parasitic helminth infections. Parasitology. 2000. 121 Suppl:S23-38. [QxMD MEDLINE Link].
Tiyo R, Guedes TA, Falavigna DL, Falavigna-Guilherme AL. Seasonal contamination of public squares and lawns by parasites with zoonotic potential in southern Brazil. J Helminthol. 2008 Mar. 82(1):1-6. [QxMD MEDLINE Link].
Tondon A, Choudhury SP, Sharma D. Hypertonic saline enema in gastrointestinal ascariasis. Indian J Pediatr. 1999 Sep-Oct. 66(5):675-80. [QxMD MEDLINE Link].
van Riet E, Wuhrer M, Wahyuni S, Retra K, Deelder AM, Tielens AG. Antibody responses to Ascaris-derived proteins and glycolipids: the role of phosphorylcholine. Parasite Immunol. 2006 Aug. 28(8):363-71. [QxMD MEDLINE Link].
Villamizar E, Mendez M, Bonilla E, et al. Ascaris lumbricoides infestation as a cause of intestinal obstruction in children: Experience with 87 cases. J Pediatr Surg. 1996 Jan. 31(1):201-4; discussion 204-5. [QxMD MEDLINE Link].
World Health Organization. Control of Ascariasis. 1967. Available at http://dosei.who.int/uhtbin/cgisirsi/Sun+Nov+12+06:08:35+MET+2006/0/49.
World Health Organization. Prevention and control of schistosomiasis and soil-transmitted helminths. 2002. Available at http://whqlibdoc.who.int/trs/WHO_TRS_912.pdf.
Zargar SA, Khuroo MS. Management of biliary ascariasis in children. Indian J Gastroenterol. 1990 Oct. 9(4):321. [QxMD MEDLINE Link].

Media Gallery

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.

of 1

Table 1. Major Soil-Transmitted Helminths ^{[1, 2]}

Parasite*	Disease	Prevalence
A lumbricoides	Common roundworm infection, ascariasis	800 million to 1.4 billion
T trichiura	Whipworm infection, trichuriasis	600 million to 1 billion
Necator americanus and Ancylostoma duodenale	Hookworm infection	580 million to 1.2 billion
Strongyloides stercoralis	Threadworm infection, strongyloidiasis	30-300 million
Enterobius vermicularis	Pinworm infection	4-28% of children
Toxocara canis and Toxocara cati	Visceral larva migrans and ocular larva migrans	2-80% of children
*All major parasites are found in tropical, subtropical, and temperate climates.

Table 2. Minor Soil-Transmitted Helminths ^{[1, 2]}

Minor Parasite	Disease	Distribution
Ancylostoma braziliense	Cutaneous larva migrans	Costal regions worldwide
Uncinaria stenocephala	Cutaneous larva migrans	Costal regions worldwide
Ancyclostoma canium	Eosinophilic enteritis	Australia
Ancylostoma ceylanicum	Hookworm infection	Asia
Oesophagostomum bifurcum	Nodular worm infection	North America
Strongyloides fuelleborni	Swollen belly syndrome	West Africa
Ternidens diminutus	False hookworm infection	Southern Africa

Back to List

Author

William H Shoff, MD, DTM&H Former Director, PENN Travel Medicine; Former Associate Professor, Department of Emergency Medicine, Hospital of the University of Pennsylvania, University of Pennsylvania School of Medicine

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, Wilderness Medical Society

Disclosure: Nothing to disclose.

Coauthor(s)

Catherine T Shoff, DO Staff Physician, Departments of Pulmonary, Critical Care and Sleep Medicine, Director, Tri-Services Adult Cystic Fibrosis Center, 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 College of Chest Physicians, American Academy of Sleep Medicine

Disclosure: Nothing to disclose.

Specialty Editor Board

Mary L Windle, PharmD Adjunct Associate Professor, University of Nebraska Medical Center College of Pharmacy; Editor-in-Chief, Medscape Drug Reference

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: Academic Pediatric Association, American Academy of Pediatrics, Pediatric Infectious Diseases Society

Disclosure: Nothing to disclose.

Chief Editor

Russell W Steele, MD Clinical Professor, Tulane University School of Medicine; Staff Physician, Ochsner Clinic Foundation

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, Southern Medical Association

Disclosure: Nothing to disclose.

Additional Contributors

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 is a member of the following medical societies: American Academy of Pediatrics, Royal College of Pathologists of Australasia, Royal Australasian College of Physicians, American Society for Microbiology, Pediatric Infectious Diseases Society

Disclosure: Nothing to disclose.

Acknowledgements

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.