[Ascariasis; portal vein migration of numerous adult worms; necrotic foci of the liver of peculiar morphology; review of ascariasis, with special reference to the liver].
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Adult↗
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[Pulmonary ascariasis with eosinophilia in a case of ascariasis].
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Ascariasis↗
Control of the action of diguanyl, an alantic lactone, piperazine hydrate and piperazine phenylacetate in ascariasis; papa control activated in ascariasis and trichocephalosis.
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Anthelmintics↗
Ascariasis complicating a gunshot wound: case report and review of the complications of ascariasis.
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Ascariasis↗
Reduction in the incidence of biliary and other surgical complications of ascariasis according to the decrease of its national egg prevalence in Korea.
While various examples of rationale or benefits of ascariasis control could justify a necessity of control activity in a community, few practical index other than the egg prevalence or intensity of infection has been used to evaluate the efficacy obtained by the control activity. A literature-based retrospective study was undertaken to provide some numerical data on the decreasing morbidity of surgical ascariasis as a consequence of ascariasis control in Korea. A thorough review of literatures (1959-1990) on biliary and other surgical complications of ascariasis reported from general hospitals revealed that their incidence has been decreasing very proportionally to the national figures of its egg prevalence and worm burden. For example, according to the remarkable decreases of the prevalence of ascariasis, there is an evident decreasing tendency of the proportion (%) of biliary ascariasis cases among all biliary surgical patients and the proportion of biliary ascariasis cases among all biliary stone patients in general hospitals. It is highly suggested that the Korean people have been much benefited by the control activity of ascariasis executed at a national scale since 1960s, especially in terms of incidence of biliary and other surgical complications of ascariasis.
Ascariasis↗
Management of biliary ascariasis in pregnancy.
Ascariasis is a helminthic infection of humans caused by the nematode Ascaris lumbricoides. Biliary ascariasis is one of the most common and well described entities caused by ascaris. In endemic areas pregnant women are prone to develop biliary ascariasis. Its management poses a great challenge to both the attending surgeon and the endoscopist. Between January 1993 and March 2003, 15 cases of biliary ascariasis were seen in pregnant patients in our institution. Ultrasonography was used as the main investigative tool. Treatment involved management by conservative, endoscopic, and surgical methods, taking due care of both the mother and the fetus. Ten patients (66.6%) were in the third trimester of pregnancy, and 10 (66.6%) patients were in their third pregnancy. Ultrasonography proved to be the best tool for diagnosing and monitoring worms inside the biliary ductal system. Nine (60%) patients responded to the conservative treatment; endoscopic extraction was successful in 4 (66.6%) patients. Surgical treatment was required in 2 (13.3%) patients. One (6.6%) patient had had spontaneous abortion at 12 weeks gestation, and one (6.6%) patient had a premature labor. The remaining patients had normal pregnancies. Management of biliary ascariasis in pregnancy is a challenge for both the attending surgeon and the endoscopist. Safe and effective management requires special attention to the gestational age and accurate recognition of the specific pathology in the patient. The majority of patients respond to conservative treatment, but endoscopic extraction may be needed in nonresponsive cases. Lead shielding of the fetus and limitation of the total fluoroscopic exposure during therapeutic endoscopy can minimize the teratogenic risk of ionizing radiation. Failures of endoscopic extraction may lead to surgical intervention, which carries risks of fetal wastage and premature labor. Routine worming of women in the child-bearing years is recommended in endemic areas of ascariasis. Though ascariasis is a problem in developing countries, because of increased travel and population migration, clinicians elsewhere should be aware of the problems associated with ascariasis.
Adult↗
Serum cytokine levels in human ascariasis and toxocariasis.
Cytokine-mediated regulation of chronic intestinal helminth infections is well documented. The present study reports the serum cytokine responses in 38 ascariasis (stool samples positive for Ascaris lumbricoides ova) and toxocariasis (seropositive) patients, 8 ascariasis-positive and toxocariasis-seronegative patients, 22 endemic, normal, healthy subjects residing in areas hyperendemic for ascariasis and 16 normal healthy subjects residing in a low-endemic area in India. The results indicated T-helper type-2-type cytokine responses in ascariasis and toxocariasis (seropositive) and ascariasis-positive and toxocariasis-seronegative patients. The important observation was that both patients and healthy individuals in ascariasis-hyperendemic areas had significantly higher interleukin-5 (IL-5) responses than non-endemic control subjects. The altered immune responses of patients in areas hyperendemic of ascariasis may have further implications. Earlier reports suggest that the geohelminth parasites in endemic areas may modulate the immune response to oral vaccines. A critical role for IL-5 in the immune response against challenge infection consistent with the association of type-2 cytokines with vaccine-mediated protection has been reported. Furthermore, co-infection by pathogens that elicit opposing immune responses, particularly helminths vs HIV and tuberculosis, could influence the infection dynamics, progression and immunoprophylaxis of the diseases they cause. Further studies are warranted to ascertain these findings.
Ascariasis↗
Role of ascariasis in surgical abdominal emergencies in the Rangoon Children's Hospital, Burma.
Patients aged 1 month to 12 years admitted with an acute abdominal surgical condition comprising 226 cases with and 206 cases without ascariasis, recorded in the operation theatre registers and in-patients clinical sheets, were studied in relation to morbidity, duration of operation and hospital stay and mortality. Annually, 7.5% of laparotomies were due to complications of ascariasis. Operations for ascariasis accounted for 10.6% of all hospital admissions for an acute abdominal emergency. Also, ascariasis accounted for 26.3% of emergency operations. All operated biliary obstruction cases were due to ascariasis. Moreover, 20.4% of all cases of ascariasis with abdominal complications required operation. The mean ages at operation were higher in Ascaris-induced than in non-Ascaris-induced intestinal obstruction (5.1 vs 3 yr), intussusception (3.5 vs 1.2 yr) and volvulus (4.8 vs 1.7 yr). The durations of operation and hospital stay were longer and case fatality rates higher in Ascaris-induced than in non-Ascaris-induced cases. The importance of this study in relation to the socio-economic benefits of controlling ascariasis is discussed.
Abdomen, Acute↗
Spatial ascariasis risk estimation using socioeconomic variables.
Frequently, disease incidence is mapped as area data, for example, census tracts, districts or states. Spatial disease incidence can be highly heterogeneous inside these areas. Ascariasis is a highly prevalent disease, which is associated with poor sanitation and hygiene. Geostatistics was applied to model spatial distribution of Ascariasis risk and socioeconomic risk events in a poor community in Rio de Janeiro, Brazil. Data were gathered from a coproparasitologic and a domiciliary survey in 1550 children aged 1-9. Ascariasis risk and socioeconomic risk events were spatially estimated using Indicator Kriging. Cokriging models with a Linear Model of Coregionalization incorporating one socioeconomic variable were implemented. If a housewife attended school for less than four years, the non-use of a home water filter, a household density greater than one, and a household income lower than one Brazilian minimum wage increased the risk of Ascariasis. Cokriging improved spatial estimation of Ascariasis risk areas when compared to Indicator Kriging and detected more Ascariasis very-high risk areas than the GIS Overlay method.
Adolescent↗
Clinical features and management of biliary ascariasis in a non-endemic area.
Biliary ascariasis is common in certain geographical areas of the world. In India, it is common in the Kashmir valley and only stray cases have been reported from other parts of the country. Between January 1995 and May 1997, 14 patients with biliary ascariasis were seen at our centre, which is more than 1000 km from the Kashmir valley. The mean (+/- SD) age of the patients was 31.7 (+/- 6.1) years and all were females. None of them had been to a place known to be endemic for biliary ascariasis. Four patients presented with acute cholangitis, eight with acute abdominal pain and vomiting, and the remaining two were diagnosed incidentally during surgery for gallstone disease. Barring these two patients, ultrasound examination of the abdomen diagnosed the condition accurately. In 10 patients, a part of the worm was visible outside the papilla of Vater. The roundworm was caught in a Dormia basket and could be extracted in nine patients. In one patient the worm migrated inside the bile duct while it was being caught in a Dormia basket. In this and two other patients, in whom the worm had migrated completely inside the bile duct, worms were removed with the help of a Dormia basket after endoscopic sphincterotomy. There were no complications of endoscopic therapy. In the two patients in whom biliary ascariasis was detected during surgery, the worms were removed after choledocholithotomy. On a mean follow-up of 13.8 months, only one patient had a recurrence of biliary ascariasis. It is concluded that biliary ascariasis is not an uncommon disease and must be considered as a possibility in patients presenting with acute cholangitis and biliary pain even in a non-endemic area. Ultrasonography is an excellent diagnostic tool and endoscopic management is very effective and safe in the treatment of these patients.
Abdominal Pain↗
Magnetic resonace appearance of gall bladder ascariasis.
Ascariasis is a common disease in many developing countries and is a common cause of biliary and pancreatic diseases in endemic areas. Numerous studies have been published on biliary tract ascariasis. All these have documented ultrasonography as the primary imaging modality for biliary tract ascariasis. Magnetic Resonance Cholangiopancreatography (MRCP) has been the latest entrant for the study of bilary tract. MRCP findings of biliary tract ascariasis have been scarcely documented. MRCP is a unique non-invasive investigation for demonstrating ascariasis in gall bladder and bilary tract clearly. We present MR appearances of gall bladder and biliary tract in a proven case of biliary ascariasis.
Adolescent↗
Management of hepatobiliary and pancreatic ascariasis in children of an endemic area.
Ascariasis is the most common parasitic infestation in endemic areas and accounts for 50-60% of pediatric admissions in the surgical emergency department. Hepatobiliary and pancreatic ascariasis accounts for about 10% of such admissions. The present study was undertaken to evaluate the clinical features, investigations, and management of hepatobiliary and pancreatic ascariasis. The study was conducted in the endemic areas of Kashmir in northern India over a period of 3 years. During the study period (May 2001 to April 2004), 214 children with hepatobiliary and pancreatic ascariasis were admitted in the department. These children underwent complete clinical evaluation, investigation including ultrasound, and ERCP when required. Surgical intervention was done in patients who failed to settle with medical treatment. Ninety percent of our admissions were from rural areas and 86% of the children presented with pain in the right hypochondrium. Twenty-two percent of patients presented with cholangitis, whereas 39% of the children had mild icterus at presentation. Thirty-eight percent of the children had vomited worms during the episode of illness. Ultrasound was the diagnostic method of choice, which revealed the worms in the CBD in 80% of the patients, and in gall bladder in 16% of the children. Eight patients had worms in the main pancreatic duct while seven (4%) had multiple small liver abscesses. Serum alkaline phosphatase was raised in majority of children (80%). Twenty (9%) children were referred for ERCP. Medical treatment including endoscopic management was successful in 97% of the children. Seven (4%) children had to be operated upon due to complications of the disease. We conclude that the majority of the children with hepatobiliary and pancreatic ascariasis respond to conservative treatment, and surgical treatment is rarely needed.
Adolescent↗
Sonographic appearances in biliary ascariasis.
Biliary ascariasis is as frequent a cause of adult biliary disease as gallstones in Kashmir Valley, India. In the present study, we prospectively evaluated the role of sonography in the diagnosis of biliary ascariasis and its utility in monitoring the exit of worms from the bile duct. Sonography was performed on 28 patients with biliary ascariasis proven by endoscopic retrograde cholangiopancreatography. The bile ducts were dilated on sonography in 26 patients. The characteristic sonographic features of worms in the bile duct were as follows: (a) a single, long, linear or curved echogenic structure without acoustic shadowing (2 patients); (b) multiple, long, linear, parallel echogenic strips, usually without acoustic shadowing (15 patients); (c) a thick, long, linear or curved, nonshadowing echogenic strip containing a central, longitudinal anechoic tube, probably representing the digestive tract of the worm (7 patients); and (d) characteristic movement of these long echogenic structures within the bile duct (8 patients). One patient with pancreatic ascariasis exhibited long, linear, nonshadowing echogenic strips in a dilated pancreatic duct. Other sonographic changes observed in these patients were (a) gallbladder distention (10 patients), edema of the gallbladder wall (8 patients), sludge within the gallbladder (11 patients), a coiled echogenic structure within the gallbladder (1 patient); (b) multiple liver abscesses (1 patient); and (c) edematous pancreatitis (4 patients). Sonography detected worms in the biliary tree in 24 of 28 patients (85.7%). Serial sonograms accurately demonstrated the spontaneous exit of worms in 18 patients and the persistence of worms in 3 patients. Sonography is a simple, rapid, and noninvasive method for diagnosis and follow-up of patients with biliary ascariasis.
Adolescent↗
Hepatobiliary and pancreatic ascariasis in India.
500 patients with hepatobiliary and pancreatic disease due to Ascaris lumbricoides infection were studied. 274 patients had duodenal ascariasis, 171 biliary ascariasis, 40 hepatic ascariasis, 8 gall bladder ascariasis, and 7 pancreatic ascariasis. Five clinical presentations were recognised: acute cholecystitis (64 patients), acute cholangitis (121), biliary colic (280), acute pancreatitis (31), and hepatic abscess (4). Ascarides in the duodenum (which were seen to invade only the ampullary orifice) induced either severe biliary colic or episodes of acute pancreatitis. 27 patients had pyogenic cholangitis and were managed by surgical (2) or endoscopic (25) biliary decompression and drainage. Removal of worms from the ampullary orifice and their extraction by mouth led to rapid relief of biliary colic (214 patients) and acute pancreatitis (16). 4 patients died (acute pancreatitis 2, pyogenic cholangitis 1, hepatic abscess 1). In 12 patients worms persisted in the biliary tree at 3 weeks; dead worms were removed from the biliary tree by surgery (5 patients) or with an endoscopic basket (7). Worms moved out of the ductal system in 211 patients. During a mean follow-up of 48 months (SD 14), 76 patients had worm re-invasion of the biliary tree due to ascaris re-infection. Intrahepatic duct and bile duct calculi developed in 7 patients in whom dead worms formed the nidus of stones.
Acute Disease↗
Gallbladder ascariasis: presentation and management.
BACKGROUND: As many as 1.5 billion people around the world harbour Ascaris lumbricoides in the digestive tract. Gallbladder ascariasis, although less common than bile duct ascariasis, is quite often seen in endemic areas. METHODS: Some 1300 patients with hepatobiliary ascariasis, admitted between October 1992 and June 1998, were analysed prospectively. The clinical features and outcome of 56 cases of gallbladder ascariasis are presented. RESULTS: Forty-seven patients were diagnosed by ultrasonography and nine were diagnosed at laparotomy. Only ten patients diagnosed by ultrasonography expelled the worms spontaneously, with resolution of symptoms and signs. The remaining 37 patients underwent cholecystectomy. CONCLUSION: Gallbladder ascariasis is a significant entity in endemic areas which usually requires cholecystectomy.
Ascariasis↗
The health effects of wastewater on the prevalence of ascariasis among the children of the discharge zone of El Jadida, Morocco.
Proximity to wastewater constitutes an infection hazard by ascariasis. This is supported by the results of an epidemiologic study of a group of children living near an area of wastewater effluents. The subjects of this study were schoolchildren from Sidi Daoui, a neighborhood located in the area of the main effluent of the city of El Jadida, Morocco. For a comparative approach, a control group was selected from Sidi Moussa, a neighborhood far from the discharge area. The incidence of ascariasis was 18.1% in the study group (Sidi Daoui) and 1% in the control group (Sidi Moussa). It was found that 71% of the exposed children were suffering from acute parasitic infections. The risk attributable to wastewater in transmitting ascariasis to examined children in Sidi Daoui was about 17%. Boys, particularly those aged 7 - 10, appeared to be the most vulnerable to contracting ascariasis. This study demonstrates the relationship between ascariasis in children and their proximity to wastewater effluents.
Adolescent↗
Ascariasis: host-pathogen biology.
Ascaris lumbricoides is one of the most common intestinal parasites in humans. Daily global contamination of the soil by A. lumbricoides eggs is enormous (approximately 9 x 10(14) eggs/day). Physical factors, particularly temperature and moisture, are critical in determining the maturation of eggs to the infective stage and their survival. Transmission of the infection to humans, on the other hand, depends more on various socioeconomic factors. In theory, ascariasis is preventable; it is indeed on the way to disappearing completely in developed societies where there is a high standard of sanitation. Ascariasis remains a problem in developing countries, however, where methods of disposal of human excreta are inadequate. The intensity of invasion is regulated by specific and nonspecific responses of the host to migrating A. lumbricoides larvae. Whether or not ascariasis becomes symptomatic depends on the intensity of the infection, the nutritional and immunologic status of the host, and the possible complications that may arise. Host responses to A. lumbricoides are brisk during the larval migratory stage in which hypersensitivity reactions may become clinically manifest, whereas people are rather tolerant of intestinal infections with adult worms. The role of ascariasis in the prevalence of allergic asthma still remains unclear. Complications due to migration of adult worms into the biliary duct system and to intestinal obstructions are the major causes of acute morbidity and mortality in ascariasis.
Animals↗
Non-western patterns of biliary stones and the role of ascariasis.
Biliary calculi of a non-Western pattern were detected in 15 patients on real-time sonography performed over a 3-year period in a center serving a predominantly "Cape colored" (mixed race) population in South Africa. In two patients definite calculi were detected only in the common bile duct or gallbladder, but there was strong imaging and clinical evidence that the calculi were secondary to ascariasis. Twelve patients had intrahepatic calculi, predominantly left-sided, and evidence of past or present ascariasis. In at least five of the 12, biliary ascariasis was found at sonography or surgery. These fourteen patients reported recurrent, acute attacks of pain and cholangitis over a period of years. The symptoms were often difficult to distinguish clinically from those of uncomplicated intestinal or biliary ascariasis. The 15th patient had no evidence of ascariasis. Intrahepatic calculi were evenly distributed throughout both lobes and were clinically silent. Only one of the 13 patients with definite intrahepatic calculi had evidence of gallbladder calculi.
Adolescent↗