Ascaris lumbricoides

Common name: large intestinal roundworm

Ascaris lumbricoides is the largest of the intestinal nematodes
parasitizing humans. It is the most common and most prevalent of the parasitic
intestinal worms; an estimated 1.4 billion people are infected worldwide, mostly in developing
countries. An adult female ascaris can lay up to 200,000 eggs per day.The average life span of an
ascaris is 10-24 months while its egg can last up to 3-10 years.

Male and Female

Both sexes are creamy white, sometimes with a pinkish cast, and the cuticle has fine circular striations. Large adult
worms develop in the gut, female worms measuring 20-50cm long by 3-6mm wide, while males are smaller,
measuring 15-30cm long by 2-4mm wide with two simple spicules 2.0-3.5mm long. The female worms may be as
thick as a lead pencil; the males are definitely more slender. Adults have three small, but conspicuous, lips around
the apical mouth each equipped with small papillae. The posterior extremity is conical and straight in a female
worm while the posterior end of a male worm is curved ventrally in the form of a hook having conical tip

Distinct Characteristics of ova:

Fertilized Egg: Undeveloped eggs are unicellular

and are passed in the stool. The outer surface is
mamillated (rough, bumpy) and stained brown
from bile. Size is about 40 x 60 um.

Unfertilized and Fertilized Eggs:

Females will release unfertilized eggs, which are more elongated
(left) than fertilized eggs (right). Unfertilized eggs may also have a
very thin mammillated layer (albuminous coat). They are about 90 m x
40 m in size.

Decorticated Eggs

Both fertilized and unfertilized eggs

sometimes may lack their outer albuminous
coats and are colorless.

Developed Egg: This egg contains an infective

larvae (L2) that could infect a person if ingested.
The larvae develops inside the egg about 3 weeks
before becoming infective.

Adult worms inhabit the lumen of the small intestine, usually in the jejunum or
ileum. They have a life span of 10 months to 2 years and then are passed in the
stool. When both female and male worms are present in the intestine, each female
worm produces approximately 200,000 fertilized ova per day. When infections with
only female worms occurs, infertile eggs that do not develop into the infectious
stage are produced. With male-only worm infections, no eggs are formed.

The ova are passed out in the feces, and embryos develop into infective secondstage larvae in the environment in two to four weeks (depending upon
environmental conditions). When ingested by humans, the ova hatch in the small
intestine and release larvae, which penetrate the intestinal wall and migrate
hematogenously or via lymphatics to the heart and lungs. Occasionally, larvae
migrate to sites other than the lungs, including to the kidney or brain.

Larvae usually reach the lungs by four days after ingestion of eggs. Within the
alveoli of the lungs, the larvae mature over a period of approximately 10 days, then
pass up via bronchi and the trachea, and are subsequently swallowed. Once back in
the intestine, they mature into adult worms. Although the majority of worms are
found in the jejunum, they may be found anywhere from the esophagus to the
rectum. After approximately two to three months, gravid females will begin to
produce ova which, when excreted, complete the cycle.
Modes of Transmission
Transmission occurs mainly via ingestion of water or food (raw vegetables or fruit in
particular) contaminated with A. lumbricoides eggs and occasionally via inhalation
of contaminated dust. Children playing in contaminated soil may acquire the
parasite from their hands. Transplacental migration of larvae has also occasionally
been reported.
Habitat and World Distribution
Ascariasis tends to occur more commonly in places where sanitation is minimal and
human feces is used to fertilize crops. As a result, the majority of Ascaris infections
are concentrated in the developing world.
Ascariasis plagues more people in the world than any other parasitic infection.
Some estimate that as many as 1-1.5 billion people or approximately 1 out of 4
people are infected with Ascaris. In some tropical areas, 100% of the population
have Ascaris.

Ascariasis
Ascariasis is the most common helminthic infection caused by Ascaris lumbricoides

Small burdens of worms in the intestine may cause no symptoms. The patient may have
symptoms of pneumonitis with cough and low grade fever during the migration of the
larvae through the liver and lungs. This can be accompanied by wheezing, coughing
and eosinophilia.
In heavy worm burdens the adult worms actively migrate in the intestine resulting in
intestinal blockage, vomiting and abdominal pain but infections may also be
asymptomatic. The worms can penetrate through the wall of the intestine, or into the
appendix, travel up the common bile duct, which may become blocked or they may then
enter the gal bladder or liver.
Medications:

albendazole

ivermectin

mebendazole