Case history
Case history #1
A 3-year-old male Chinese adoptee presents for a routine physical exam shortly after arrival in the US. His mother states that he sometimes complains that his "tummy hurts." Physical findings are notable for height and weight less than the third percentile. The stool is examined for ova and parasites.
Case history #2
A 29-year-old male traveler noted passage of a large worm in his stool. Six months earlier, after returning from Cuba, he had unexplained cough and wheezing.
Other presentations
While most intestinal infections with Ascaris lumbricoides are inapparent and uncomplicated, some patients have gastrointestinal symptoms ranging from mild abdominal discomfort, anorexia, nausea, and diarrhea to distension and pain. During larval migration, A lumbricoides can also produce allergic and respiratory symptoms, including cough, wheezing, dyspnea, and urticaria.[1] Other presentations include malabsorption, growth retardation, and cognitive delay, and, especially during times of physiologic stress, ectopic migration of adult worms to the hepatobiliary tree, appendix, pancreas, and other sites. One case of an adult worm causing airway obstruction in a burn patient has been reported.[5][6] Cases of pharyngeal ascariasis (causing dysphagia) and esophageal ascariasis (causing retrosternal chest discomfort) have been reported.[7][8] It has been estimated that 2 in 1000 cases of ascariasis develop intestinal obstruction, sometimes leading to peritonitis from a perforated bowel.[9] Hepatobiliary and pancreatic complications are more common in adults.[1] Rarely, a single adult worm may be incidentally visualized in the small intestine during or after a barium x-ray.
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