Ascariasis, caused by the roundworm Ascaris lumbricoides, is among the most common parasitic infections worldwide, yet it remains underappreciated in pediatric healthcare despite its significant impact.
Children are particularly vulnerable because of their behaviors, such as hand-to-mouth activity and playing in contaminated soil, which increase their exposure to the worm's eggs.
Transmission Pathways and Life Cycle
Human infection begins with ingestion of viable eggs, typically contaminating soil or unwashed produce in environments with poor sanitation. Once swallowed, the eggs hatch in the small intestine, releasing larvae that enter the bloodstream. They are transported to the lungs, where they mature further, sometimes causing respiratory symptoms during this migration phase.
Clinical Manifestations in Children
Many children with light worm burdens show no symptoms, which contributes to the underreporting of ascariasis. For those with substantial infestations, symptoms span gastrointestinal and respiratory systems. Gastrointestinal complaints include abdominal pain, distension, nausea, intermittent diarrhea, and loss of appetite.
In severe cases, large worm loads may cause intestinal obstruction, a medical emergency marked by vomiting, severe pain, and potentially the need for surgical intervention.
Diagnostic Approaches
Diagnosis primarily depends on microscope identification of Ascaris eggs in stool samples, which confirms intestinal infection. However, eggs appear only several weeks post-infection and may be absent if only male worms are present or during early stages. Multiple stool examinations may be necessary due to intermittent egg shedding.
When complications arise, imaging modalities such as abdominal ultrasound, X-rays, and computed tomography (CT) scans provide valuable insights. These can visualize intestinal obstruction caused by worms or identify parasites migrating into biliary and pancreatic ducts. Chest X-rays reveal transient pulmonary infiltrates during larval lung migration phases.
Management and Treatment Strategies
Antiparasitic medications form the cornerstone of ascariasis treatment in children. Albendazole administered as a single dose shows high efficacy in eradicating worms, with alternatives including mebendazole and ivermectin.
Treatment often requires repetition after one to three months to target newly matured worms that escaped initial therapy as larvae. Symptomatic management focuses on hydration and nutritional support, often incorporating vitamin supplementation such as vitamin A to address deficiencies linked to chronic infection and malnutrition.
Prevention and Community Health Perspectives
Ascariasis control hinges on improving sanitation infrastructure to interrupt transmission, including constructing latrines and ensuring safe disposal of human waste. Educating caregivers and children about hand hygiene and discouraging geophagia behaviors significantly reduce infection risk.
Food safety measures, such as thoroughly washing and peeling fruits and vegetables, decrease the possibility of ingesting infective eggs. In endemic areas, periodic deworming programs targeting children serve as effective public health strategies to lessen the parasite burden and limit reinfections.
Dr. Daniel S. Caplivski, a recognized expert in infectious diseases and tropical medicine, "Ascaris is a very large round worm (nematode) that is carried into the GI tract. It's transmitted from person to person by consuming the microscopic eggs that contaminate food and water in poor-hygiene countries."
Ascariasis continues to be a pervasive but frequently overlooked parasitic infection among children, primarily due to its asymptomatic nature in mild cases and the lack of awareness in many affected regions. Prompt detection through stool examination and imaging, combined with effective antiparasitic treatments and supportive care, can prevent serious complications such as intestinal obstruction and malnutrition.
