History and exam
Key diagnostic factors
common
travel to, or immigration from, endemic areas with poor sanitation, hygiene, and agricultural practices
Travel to endemic areas may increase the risk of exposure to Ascaris eggs. Travelers should be cautious about eating fresh produce, such as lettuce, which may be contaminated by Ascaris eggs.
Due to the prevalence of ascariasis in children from endemic areas, many international adoptees as well as refugees from Asia, Latin America, and sub-Saharan Africa are at increased risk for Ascaris infection.
Other diagnostic factors
common
asymptomatic
Most patients infected with Ascaris lumbricoides are asymptomatic.
co-infection with other parasites
Co-infection with other soil-transmitted helminths, such as hookworm and Trichuris, is common.[42]
uncommon
developmental delay
Worm burdens as low as 10-15 worms may contribute to delayed growth and development in children.[10][29] This is a particular problem in children who are already malnourished. Several studies have noted accelerated growth velocity and improved cognition in children treated for ascariasis and other parasites.[10][24][30]
malnutrition
Soil-transmitted helminths, including Ascaris, may contribute to malnutrition in children from endemic regions.
fever
Presenting sign of eosinophilic pneumonitis (Loeffler syndrome) caused by larval migration through the lungs.
cough
Presenting sign of eosinophilic pneumonitis (Loeffler syndrome) caused by larval migration through the lungs.[23]
wheezing
Patients may present with allergic symptoms depending on the burden of infection and their degree of allergic hyperreactivity.
dyspnea
Patients may present with allergic symptoms depending on the burden of infection and their degree of allergic hyperreactivity.
hemoptysis
Presenting sign of eosinophilic pneumonitis (Loeffler syndrome) caused by larval migration through the lungs. Occurs with particularly heavy worm burdens.
hypoxia
Presenting sign of eosinophilic pneumonitis (Loeffler syndrome) caused by larval migration through the lungs.
tachypnea
Presenting sign of eosinophilic pneumonitis (Loeffler syndrome) caused by larval migration through the lungs.
rhonchi, rales
Presenting sign of eosinophilic pneumonitis (Loeffler syndrome) caused by larval migration through the lungs.
retractions
Presenting sign of eosinophilic pneumonitis (Loeffler syndrome) caused by larval migration through the lungs.
urticarial skin lesions
Patients may present with allergic symptoms depending on the burden of infection and their degree of allergic hyperreactivity.
abdominal pain
If pain is mild and accompanied by other nonspecific gastrointestinal conditions, such as anorexia, dyspepsia, vomiting, and diarrhea, it may indicate a smaller worm burden. However, more severe pain could suggest small bowel obstruction or even bowel perforation.
anorexia
Nonspecific gastrointestinal sign that may occur with smaller worm burden.
dyspepsia
Nonspecific gastrointestinal symptom that may occur with smaller worm burden.
nausea
Nonspecific gastrointestinal symptom that may occur with smaller worm burden.
vomiting
Could be a nonspecific gastrointestinal sign or could suggest small bowel obstruction.
diarrhea
Nonspecific gastrointestinal symptom.
constipation
Nonspecific gastrointestinal symptom.
abdominal distension
Nonspecific gastrointestinal sign.
reduced or absent bowel sounds
Common presenting sign of small bowel obstruction.
hypotension
May be seen in bowel perforation.
RUQ tenderness
May be seen in hepatobiliary ascariasis.
hepatomegaly
May be seen in hepatobiliary ascariasis.
jaundice
May be seen in hepatobiliary ascariasis.
signs/symptoms of iron deficiency anemia or kwashiorkor
Although these signs and symptoms (e.g., listlessness, brittle hair, cracked skin, edema, conjunctival pallor) are not specific to ascariasis, their presence should encourage clinicians to look for ascariasis and additional intestinal helminths, especially hookworms, as possible contributing factors in children at risk.[16]
Risk factors
strong
history of travel to or residence in endemic areas
Travel to endemic areas may increase the risk of exposure to Ascaris eggs. Travelers should be cautious about eating fresh produce, such as lettuce, which may be contaminated by Ascaris eggs. Due to the prevalence of ascariasis in children from endemic areas, many international adoptees as well as refugees from Asia, Latin America, and sub-Saharan Africa are at increased risk for Ascaris infection.
children <14 years
The prevalence of ascariasis increases during the first 2-3 years of life, and remains elevated until the teenage years. In adulthood, due to a combination of acquired immunity and decreased exposure, prevalence decreases. Exposure among children in endemic regions is elevated due to playing in contaminated soil, as well as poor sanitation and hygienic practices.
poverty
Poverty is often linked to poor practices of sanitation and hygiene. Lack of resources prevents improvement of such facilities, and allows the continued spread of soil-transmitted helminths.
poor sanitation
Areas with endemic Ascaris lumbricoides often lack effective sanitation; thus, eggs shed in the stool of infected humans and pigs may contaminate crops such as lettuce, or the hands of children playing in contaminated soil.[12] In Asia, the use of human feces as fertilizer facilitates the dissemination of A lumbricoides eggs in vegetables and contaminates the hands of farmworkers.
poor hygiene
Ascaris eggs are hardy: they are resistant to high and low temperatures, and to chemicals and desiccants. Hand washing helps prevent transmission, but is not 100% effective.
warm climate
The warm soils of tropical and subtropical regions worldwide are a particularly good habitat for the survival and maturation of Ascaris eggs.
contact with pigs
Contact with pigs (or pig manure) increases the risk of ascariasis caused by A suum.[19]
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