Ascariasis

What are the symptoms of ascariasis?

You may not have symptoms if you only have a few roundworms. Or, you may experience abdominal pain that comes and goes. The first sign of an infection may involve seeing a live worm in your vomit or poop. A. lumbricoides looks like common earthworms. The worms are about 6 to 13 inches long and are about as thick as a pencil.

If you do have symptoms, they vary based on where the worms are in your body. They’re in different places at different parts of their life cycle.

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Infection in your lungs

Larvae (immature worms) can infect your lungs. At this early stage of the infection, you may have symptoms similar to pneumonia. Symptoms include:

• Wheezing.
• Cough.
• Shortness of breath.
• Fever.
• Hives (rare).

Symptoms are challenging to diagnose at this stage. They’re similar to symptoms of many other illnesses.

Infection in your intestines

Adult worms remain in your intestines. At this stage, you may experience mild or more intense abdominal symptoms depending on how many eggs you swallowed and where the adult worms end up. Symptoms include:

• Severe abdominal pain.
• Abdominal swelling.
• Nausea and vomiting.
• Occasional diarrhea.
• Loss of appetite.
• Unexplained weight loss.
• Restlessness.
• Trouble sleeping.

The more worms you have, the more severe your symptoms will be.

What causes ascariasis?

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You can develop ascariasis if you ingest (swallow) the eggs of the human roundworm A. lumbricoides. These worms rely on your body as a hospitable climate that allows them to mature, mate and lay more eggs. The species relies on human hosts to complete its life cycle.

How is ascariasis transmitted?

Ascariasis spreads through hand-to-mouth contact — when someone touches and swallows fertilized A. lumbricoides eggs.

In places without adequate sanitation, people infected with ascariasis may poop outside. In some areas, people use human poop as fertilizer. Contaminated poop containing A. lumbricoides eggs can lie in fields, streets and yards without anyone knowing the eggs are there.

People may accidentally swallow the tiny eggs (too small to see with the naked eye) when they:

• Touch contaminated soil and then put their hands in or near their mouths.
• Eat fruits and vegetables grown in contaminated soil without washing with clean water, peeling and cooking the produce.
• Drink water contaminated with parasite eggs.

What is the life cycle of A. lumbricoides?

After you swallow the eggs, they pass into your intestines. There, they hatch into larvae and begin to travel through your body:

1. The larvae travel via your bloodstream or lymphatic system until they reach your lungs. They remain there for about two weeks.
2. They pass through the air sacs in your lungs and into your throat, where you re-swallow them.
3. The worms travel to your small intestine, where they mature into adults, mate and lay eggs. An adult female can lay more than 200,000 eggs daily.
4. The eggs exit your body through your poop.

The whole process of the complete life cycle can take two to three months.

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After leaving your body through pooping, eggs take up to several weeks to become capable of infecting another person. The eggs can survive extreme weather and remain infective for up to 17 months.

If a new host ingests an egg during this time period, the cycle restarts in that person.

Who is at risk of ascariasis?

People at risk for ascariasis live in or visit places:

• With limited access to proper sanitation and hygiene (like toilets and clean water for handwashing).
• Where people use human poop (or pig poop with A. suum) as fertilizer.
• That are warm and humid, such as tropical and subtropical areas of Asia, sub-Saharan Africa and the Americas. Those weather conditions favor egg survival and transformation to an infective form.

Age is a risk factor, too. Children 8 years old or younger are more likely to get an infection. This is likely because it’s common for children to play outside in the dirt and then touch their mouths without washing their hands.

What are the complications of ascariasis?

Severe untreated infections can lead to complications, especially in children. Some are potentially fatal without treatment, but this is very rare.

• Bowel obstruction or a blockage in your ducts: Too many worms can partially or completely clog the passageways that move substances, like food and waste, through your digestive system. You may need emergency care to get rid of the blockage.
• Severe inflammation: Obstructions can lead to severe and even life-threatening inflammatory conditions. These include pancreatitis (inflammation in your pancreas), cholecystitis (inflammation in your gallbladder) and cholangitis (inflammation in your bile ducts).
• Malnutrition: An infection can prevent you from getting the nutrients you need. Children may experience growth problems because of nutritional deficiencies if they’re infected for a long time.

Diagnosis and treatment can prevent complications from ascariasis.

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