Introduction 

Ascariasis is caused by Ascaris lumbricoides, the most common intestinal helminth and the largest intestinal nematode 

-it can reach up to 40 cm in length 

-it is particularly common in the Far East, India, and South Africa

-it is seen following ingestion of foods or vegetables fertilized by ‘night soil’ (human feces) or playing in the infected soil 

Life cycle: Humans ingest eggs, which form larvae in the gut, where after hatching, they migrate through the blood to the lungs, where they enter the alveoli,ascend the bronchial tree, and are swallowed. In the gut, they become adults and lay eggs that are passed in the feces. Adult worms can migrate to the appendix, bile duct or pancreatic duct, causing obstruction and inflammation 

Symptoms & Signs 

Most persons with Ascaris infection are asymptomatic

Lungs: migrating worms can cause fever, cough, chest pain, dyspnea, eosinophilia, or  “Löffler syndrome”

Gastrointestinal: Abdominal pain, obstruction, volvulus, perforation, appendicitis 

Biliary: Cholangitis, cholecystitis, obstructive jaundice, pancreatitis 

Diagnosis 

Adult worms: can be seen emerging from the mouth, nose, or anus or in stools 

Chest X ray: migratory pulmonary infiltrates 

ERCP: linear filling defects within the bile ducts 

Eggs in stool: egg is oval with an irregular surface with a typical “scalloped” edge 

Treatment 

Effective agents: Albendazole, mebendazole, ivermectin, or pyrantel pamoate