17 september 2018

• 6 year old daughter of a seasonal farm worker

• Presents with malnourishment, abdominal swelling,
cough, wheeze and fever.
• CXR reveals a lobar pneumonia
• X-Ray plain abdomen revealed suspicion of worms
• Admitted for initial antibiotic therapy
• After 2 days of antibiotic, worm was found in her bed
• Common Roundworm that is parasitic in the
intestines of humans
• Most common helminthic human infection
• Largest nematode to infect the human intestine
• An estimated 807-1,221 million people in the
world are infected (according to CDC)
• Ascaris, hookworm, and whipworm are known
as soil-transmitted helminths
• Worldwide
• High prevalence in underdeveloped countries that
have poor sanitation (parts of Asia, South America
and Africa)
• Occurs during rainy months, tropical and
subtropical countries
• ADULT WORM- lumen of small intestine mainly the
jejunum
• Egg:
- three kinds of the eggs
- fertilized eggs, unfertilized eggs and
decorticated eggs.
- 5 aspects: size, color, shape, shell and
content.
 1. Fertilized eggs:
- broad round to oval in shape, brown to golden
brown in color, an average size 60- 75× 40-
50µm.
- The shell-thick, smooth, translucent with an outer
mammillated albuminous coat stained brown by
bile.
2.Unfertilized egg:

• Longer and slender 80 x 55μm

• Thin shelled- ranges from irregular mammilations to a
relatively smooth layer completely lacking the rugosities.
• 3. Decorticated eggs: Both fertilized
and unfertilized eggs sometimes may
lack their outer albuminous coats and
are colorless.
• can survive for prolonged periods as long as
warm, shade, moist conditions are available
• can live up to 10 years
• Resistant to low temperatures, desiccation and
chemicals
• removed by filtration and are killed by
boiling.
• Eggs embryonate but do not hatch until
ingested by man
• developing larvae are destroyed by sunlight,
high temperature and desiccation.
• ADULT WORM
- Light brown or pink to white
in color
- Mouth opens at anterior end;
possesses 3 finely toothed
lips
- Female (25-40cm) longer
and stouter than the male
(15-25 cm)
- Ovaries are extensive;
contain upto 27 million eggs
at a time
 HOST-
• Definitive host : Man

• Intermediate Host : -none-

INFECTING AGENT-
• embryonated egg
• ingestion of water or food (raw vegetables or fruit in
particular) contaminated with embryonated
A.lumbricoides eggs.

• Children playing in contaminated soil may acquire the

parasite from their hands

• Occasionally inhalation of contaminated dust

After 17 September 2018
 II Life Cycle
 1. Site of inhabitation: small intestine
2. Infective stage: embryonated eggs
3. Route of infection: by mouth
4. No intermediate and reservoir hosts
5. Life span of the adult: about 1 year
 II Life Cycle
 This worm lives in the lumen of small
intestine, feeding on the intestinal contents,
where the fertilized female lays eggs. An
adult female can produce approximately
240,000 eggs per day, which are passed in
feces. When passed, the eggs are
unsegmented and require outside
development of about three weeks until a
motile embryo is formed within the egg.
 After the ingestion of embryonated eggs in
contaminated food or drink or from contaminated
fingers, host digestive juices acts on the egg shell
and liberate the larva into the small intestine.
These larvae penetrate the intestinal mucosa and
enter lymphatics and mesenteric vessels. They are
carried by circulation to the liver, right heart and
finally to the lungs where they penetrate the
capillaries into the alveoli in which they molt
twice and stay for 10-14days and then they are
carried, or migrate, up the bronchioles, bronchi,
and trachea to the epiglottis.
When swallowed, the larvae pass down
into the small intestine where they
develop into adults. The time from the
ingestion of embryonated eggs to
oviposition by the females is about 60-
75 days. The adult worms live for about
one year. The ascarid life cycle is as the
following diagram.
Symptoms are due to 

1. The migrating larva –

a) Larva in the lungs : condition known as
Ascaris pneumonia (Loeffler’s
syndrome) characterized by low
grade fever, cough, urticarial rashes,
eosinophilia & blood tinged sputum
which may contain larvae
• Albendazole - single oral dose of
400mg
• Mebendazole- 100mg orally twice
daily for 3 days

• Pyrantel pamoate – single dose

10mg/kg
• Good hygiene; hand washing

• Proper disposal of human excreta

• Treatment of parasitized individuals

• Avoid contaminated food and water
especially in areas of poor sanitation
• Wash, peel or cook all raw vegetables and
fruits
• Periodic mass treatment of children with
single doses of Albendazole or
Mebendazole – helps reduce transmission
in community
• Environmental sanitation
• Limit/stop using human faeces as fertilizer
• Health education
• Write an essay on life cycle ,pathogenesis laboratory diagnosis
of Ascariasis ?
• Write difference between fertilized and unfertilized egg of
A.lumbricoides
• Draw labelled diagram of Ascaris eggs