Symptoms of Ascariasis
The clinical manifestations of the early phase of ascariasis caused by the migration of ascaris larvae in the bloodstream are varied in severity. Often, with low-intensity infection, this phase is subclinical or asymptomatic.
In clinically severe cases, complaints of general weakness, malaise, headaches, fatigue, disability, sometimes fever, the appearance of itchy rashes such as urticaria on the skin prevail. Less often, usually with intense infections, a picture of pulmonary pathology appears in the form of a cough, sometimes with sputum mixed with blood, with an asthmatic component, shortness of breath, chest pains. Auscultation is determined by wheezing, pleural friction noise, and exudative pleurisy. X-ray follow-up in the lungs reveals eosinophilic infiltrates described by Leffler in 1932, characterized by variability in their size, configuration, position – “volatile infiltrates”. As a rule, focal infiltration of the lungs is accompanied by blood eosinophilia, sometimes the number of blood eosinophils reaches 35-60%.
Migrating ascaris larvae can cause severe pulmonary events – acute pneumonia and bronchitis, as was shown in Koino’s self-experiment (Koino, 1922), who swallowed 2,000 mature ascaris eggs. In severe pneumonia of ascariasis etiology, accompanied by allergy, an important role in the development of the disease is played by extensive hemorrhages caused by the rupture of the capillaries of the lungs by migrating larvae with the subsequent development of inflammatory phenomena.
These clinical manifestations of the early phase are supplemented in some patients with symptoms of impaired function of the cardiovascular system and liver.
The second – the intestinal phase of ascariasis – is also characterized by a variety of pathology and severity of the course. The invasion can be mild or even asymptomatic. In clinically severe cases, gastrointestinal pathology and often asthenic syndrome prevail. Frequent complaints of patients are such as appetite disorder, its decrease, “capricious appetite” in children, nausea, increased salivation, “saliva rolls like a club” more often in the morning on an empty stomach, etc.
In some cases, there is a tendency to diarrhea or constipation, more often they alternate, and progressive enteritis is less common. In children, dyspeptic symptoms prevail, accompanying abdominal pain, often cramping and quite strong, arising spontaneously or on palpation. Functional and morphological abnormalities in the small intestine were detected radiographically in the form of a change in the relief of the mucous membrane, etc. Sometimes there are unpleasant sensations of movement of something in the intestine, bloating.
Soreness to palpation of the abdomen during the intestinal phase of ascariasis is often found, and in children it is most often diffused, in adults – local – along the midline above the navel, and to the right of the midline. Gastric secretion in the invasive is often reduced.
In almost all cases of ascariasis in children, symptoms from the nervous system, asthenic manifestations such as weakness, poor health, irritability, headaches, often absent-mindedness, memory loss, restless sleep, night fears, twitching, less often hysterical and epileptic seizures, symptom complex are observed Meniere, decrease in intelligence.
Sometimes it is these asthenic phenomena that prevail over the rest.
In the phase of intestinal ascariasis, sometimes, as in the first phase, allergic phenomena are observed, such as: a rash such as nettle fever, eosinophilia, although less pronounced. In the blood, especially in children, moderate hyprochromic anemia is a frequent companion of ascariasis.
On the part of the cardiovascular system, a decrease in arterial and venous pressure was noted.
In the intestinal phase of ascariasis, both intestinal and extraintestinal complications can occur. Most of them are associated with increased motor activity of adult ascaris: intestinal obstruction, perforated peritonitis, ascariasis of the liver, ascariasis of the pancreas, respiratory tract, etc.
Ascariasis invasion in the obstetric clinic also does not remain without consequences. The negative effect of ascariasis on the course of pregnancy has been proven. In invasive pregnant women, toxicosis, fetal development disorders are more often recorded, the course of childbirth and the postpartum period becomes more complicated.
A frequent complication of ascariasis is intestinal obstruction, which is caused by the closure of the intestinal lumen with a ball of ascaris or due to a violation of the neuromuscular regulation of intestinal tone. On palpation of the abdomen in patients with similar complications, it is possible to palpate a round, doughy consistency tumor-ball of ascaris, which can be localized in any segment of the intestine. In some cases, with a thin abdominal wall, you can feel the bodies of individual helminths in the intestinal lumen.
A serious complication of ascariasis is the penetration of helminths into the bile ducts and gallbladder. In these cases, severe pain occurs that cannot be relieved even by narcotic analgesics. Against the background of these attacks, vomiting often occurs, and helminths are sometimes excreted with vomit. In cases of cholangiohepatitis and mechanical blockage of the common bile duct with roundworms, jaundice occurs. The temperature during the development of complications can be septic in nature with tremendous chills. As a result of the addition of a bacterial infection, purulent cholangitis and multiple liver abscesses often occur, which in turn can be complicated by peritonitis, purulent pleurisy, sepsis, abscesses in the abdominal cavity.
Ascaris penetration into the pancreatic ducts causes acute pancreatitis. Getting them into the appendix causes appendicitis or appendicular colic without inflammatory manifestations.
In some cases, roundworms, going up the digestive tract, reach the pharynx and from there crawl into the respiratory tract, which causes death from asphyxia.
In rare cases, roundworms are found in the urogenital organs, the nasolacrimal canal, the Eustachian tube, the middle ear, the external auditory canal, and perirenal tissue.
Invasion of roundworms aggravates the course of various infectious and non-infectious diseases, disrupts immunogenesis in infectious diseases.
Diagnosis of Ascariasis
The basis for the diagnosis of the early phase of ascaris is clinical and epidemiological data. Acute clinical symptoms of broncho-pulmonary pathology (fever, cough, chest pains, blood eosinophilia, volatiles and filtrates in the lungs, etc.) in the season of the year not typical for colds, stay in foci of ascariasis, participation (especially children) in picking berries strawberries, early vegetables – are the basis for a presumptive diagnosis.
The unconditional confirmation of the diagnosis is the detection of larvae in sputum, however, these are very rare findings, therefore, are of little practical importance.
Serological diagnostic methods are proposed: the reaction of precipitation on live larvae of ascaris (E.S. Leikina), the reaction of indirect hemagglutination, latexagglutination, the reaction of accelerated erythrocyte sedimentation (according to Krotov). The methods based on the detection of volatile fatty acids in saliva and urine according to N. Ya. Soprunova were encouraging.
However, having a very important scientific value (the study of immunity, epidemiology, pathogenesis), serological methods have not entered widespread practice. Therefore, if there is a presumptive diagnosis, it is necessary after 3 months (when roundworms reach puberty and begin to release eggs) to conduct a scatological study using the methods of a thick smear according to Kato or the enrichment method (Fulleborn, Kalantaryan, etc.).
Considering the possibility of parasitizing only males, which indicates a non-intensive invasion, when coproovoscopy is negative, diagnostic deworming is recommended.
Treatment of Ascariasis
To expel ascaris, Piperazine adipate, Pirantel and Levamisole (Decaris) are used.
An effective remedy for ascariasis is oxygen, it is administered through a gastric tube in the morning on an empty stomach or 3-4 hours after breakfast for 2-3 days in a row. The amount of oxygen for one session is 1500 ml, after the introduction of oxygen, the patient must lie for 2 hours. Oxygen is contraindicated in peptic ulcer and inflammatory diseases in the abdominal cavity.
Piperazine adipate is prescribed 2 times a day 1 hour before or 30-60 minutes after meals for 2 days in a row at a dose of 1.5-2 g per dose, the daily dose is 3-4 g.
Prevention of Ascariasis
The complex of preventive measures for ascariasis is aimed at:
- identification and treatment of infested;
- protection of soil from fecal contamination;
- carrying out sanitary and educational work among the population.
The volume and nature of the activities carried out is determined by the level of the affected population, the characteristics of the life and economic activity of people and the epidemic process. This is established and regulated by the territorial sanitary and epidemiological service, depending on the type of outbreak: intensive (20-30% of infested), medium intensity (6-20%) and non-intensive (with an incidence below 6%).
In intensive outbreaks, mass deworming of the population is carried out 2 times a year. In medium-intensity foci, deworming is carried out according to the micro-focal principle (on estates where there is an invasive one).
The first deworming is carried out in late spring – early summer (in order to get rid of ascaris people who became infected last year and this spring), the second – in late autumn or early winter (in order to get rid of all roundworms infected in this season).
In the current true micro-foci of ascariasis (a farmstead where there is an invasive and possible transmission of the invasion), the period of clinical examination is 3 years, during which scrological examinations of all family members are carried out twice a year (in spring and autumn). After three years, with a threefold negative result of the examination, the micro focus is removed from the register.
The improvement of the outbreaks is under the control of the results of the sanitary-helminthological study of the soil of the backyard plots and gardens.
With a decrease in the incidence of up to 3 – 5% and below, only those infected are subject to treatment as they are detected.
Measures aimed at protecting the external environment, especially vegetable gardens, berry plots from contamination with non-neutralized feces, are of great importance (especially in healed foci).
Feces can be neutralized by keeping them in latrines for 2 years: the filled latrine cesspool of the personal plot is closed and buried, the frame is transferred to another pit. The sewage in the first pit, remaining in it for 2 years, during which the eggs of helminths almost completely die, can be used as fertilizers.
This method is simple, cheap, and can be recommended for country estates that are not routinely cleaned.
Measures providing for sanitary improvement, such as: sewerage, construction of yard latrines, dry closets, regular cleaning, as well as the use of various chemicals to neutralize the soil (carbation 3% solution 4 liters per 1 m2), polycarbacin (30-40 g in 5 l of water per 1 m2), thiozone (200 g per 1 m2), etc. are the basis for the prevention of ascariasis.
Of great importance is sanitary propaganda, explaining to people the inadmissibility of using feces as fertilizers, the need to follow the rules of personal prevention: washing hands before eating, eating only well-washed fruits, berries, vegetables that are not heat-treated.
The sanitary culture of the population determines the success of preventive work.