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PubMed2004

Biliary ascariasis as a cause of post-cholecystectomy syndrome in an endemic area.

BACKGROUND: Post-cholecystectomy syndrome encompasses numerous biliary, pancreatic and other entities. Biliary ascariasis is a common cause of adult biliary disease in an endemic area. Post-cholecystectomy biliary ascariasis, a cause of post- cholecystectomy syndrome although not yet defined is frequently seen in this part of the world. METHOD: Between Jan. 1990 and Jan. 2001, 104 cases of post-cholecystectomy biliary ascariasis were seen. Ultrasonography was found to be an excellent tool for diagnosing and monitoring of the worms inside the biliary tract. Endoscopic retrograde cholangiopancreatography had both diagnostic and therapeutic value. RESULTS: The majority (68.2%) of patients responded to conservative treatment. Surgical treatment was advocated in 18.2%, which included 2 patients with liver abscesses. Endoscopic extraction of worms was successful in 48.2%. CONCLUSION: Post-cholecystectomy biliary ascariasis as a cause of post-cholecystectomy syndrome needs to be included in the list of causes for post-cholecystectomy syndrome. Although the majority of patients respond to conservative treatment but endoscopic extraction or surgical intervention may be needed. Routine deworming of patients undergoing cholecystectomy both preoperatively and postoperatively should be done in all patients in endemic areas of ascariasis. Although this entity is rare in Europe and United States, due to population migration and increased travel, it is necessary for surgeons in these countries to be aware of this condition.

Adolescent↗

PubMedDate not supplied

[Asthma and ascariasis in children aged two to ten living in a low income suburb].

OBJECTIVE: To assess the relation between children with asthma and ascariasis in the low income neighborhood of Pedregal, in Campina Grande (Paraíba, Brazil). MATERIAL AND METHOD: The International Study of Asthma and Allergies in Childhood (ISSAC) standard questionnaire was distributed to 1,095 children but only 742 of them answered it and provided stool samples for parasite examination. The cross-sectional study included those 742 children, whose age ranged from 2 to 10 years. The association between asthma and ascariasis was studied through Kappa rating. Demographic and clinic variants comparing the two groups were analyzed by chi-square test (chi(2)) or t Student test. RESULTS: Among the 742 children analyzed, 51.9% (385) were males and 48.1% (357) females. The prevalence of asthma was 59.7% (443) and that of ascariasis was 56.3% (418). The frequency of asthma in the ascariasis group (60.5%) was similar (chi(2)) = 0.27, p > 0.06) to the frequency of asthma in the non-infected group (58.6%). CONCLUSION: Despite the high prevalence of the diseases studied, there is no apparent relation between asthma and ascariasis in the population studied.

Ascariasis↗

PubMed2000

Epidemiology of human geohelminth infections (ascariasis, trichuriasis and necatoriasis) in Lushui and Puer Counties, Yunnan Province, China.

Between April and June of 1998, the prevalence and intensity of geohelminth infections caused by hookworm, Ascaris and Trichuris were investigated in two rural Yunnan villages. In Liuku, a village of Lisu indigenous people in Lushui County, there was an overall geohelminth prevalence of 72% (48%, 43% and 16% for hookworm infection, ascariasis, and trichuriasis, respectively). The prevalence of ascariasis was greatest among preschool and school aged children, whereas the prevalence of trichuriasis was greatest among teenagers and the prevalence of hookworm increased until the age of 10-15 and then remained high throughout adulthood. In Linger, a village of Han Chinese, located in Puer County, there was an overall geohelminth prevalence of 77% (30%, 60% and 36% for hookworm infection, ascariasis, and trichuriasis, respectively). The differences in prevalence for hookworm and ascariasis were statistically significant. The prevalence of hookworm in Linger increased steadily with age and did not plateau, but there were no discernible patterns of prevalence versus age for either ascariasis or trichuriasis. Heavy trichuriasis infections were noted to occur in Linger. In both villages, more than 98% of the hookworm infections were of light and moderate intensity. Both by morphologic identification of third-stage infective larvae (L3) from eggs as well as identification of adult hookworms recovered from adult residents after treatment with quantrel, Necator americanus was identified as the exclusive hookworm in each village. Geohelminth infections caused by Ascaris, Trichuris and hookworm remain highly endemic to the rural areas of Yunnan Province in southwestern China.

Adolescent↗

PubMed2001

[Epidemiological study on the influence of pig-derived Ascaris to the transmission of human ascariasis].

OBJECTIVE: An experimental epidemiological study was designed to investigate possible relations of pig-derived Ascaris to the transmission of human ascariasis which might be caused by cross-infection between the pig and humans. METHODS: In Xinjian County, Jiangxi province, two adjacent villages, Laozhi and Panzhi, with similar baseline of ascariasis in pig and human populations were selected as the study sites with a one-year longitudinal epidemiological follow-up study. People in the two villages received mass chemotherapy. Pigs received mass chemotherapy only in Panzhi village and was twice repeated with two months interval, while pigs in Laozhi village were not treated at all. In the following year after treatment on humans, ascariasis among villagers was studied cross-sectionally five times with Kato-katz technique. RESULTS: No significant difference of the re-infection patterns of human ascariasis was found between the two villages in terms of prevalence and intensity during the following year in all the five surveys (chi(2) < 0.658, F < 1.658 and P > 0.1). CONCLUSION: The results suggested that pig-derived Ascaris were mainly transmitted among pigs but had no important role on the transmission of human ascariasis. The results were in good accordance with the findings through a recent molecular genetic research on the local human-and pig-derived Ascaris worms. Possible confounding factors were discussed.

Animals↗

PubMed2002

Human toxocariasis and ascariasis: concomitant parasitism in Srinagar, Kashmir, India.

Human toxocariasis caused by Toxocara canis is common in both developing and developed countries and leads to visceral larva migrans with high morbidity and mortality. Ascariasis caused by Ascaris lumbricoides, too has global distribution and in India, high prevalence rate has been reported in Kashmir (J & K State). Both nematode parasites, Toxocara canis and A. lumbricoides require similar biological and environmental conditions for the development of eggs in soil. Therefore, the present study was attempted to detect the antibody response to T. Canis excretory-secretory (ES) antigen by enzyme linked immunosorbent assay in patients attending Sher-I-Kashmir Institute of Medical Sciences, Soura, Srinagar, Kashmir to assess the magnitude of human toxocariasis in Kashmir, the highly endemic area of ascariasis. Interestingly, it was observed that 38 (82.60%) out of 46 patients harbouring Ascaris Iumbricoides had positive antibody response to T. Canis ES antigen while none of the 15 normal healthy subjects from the same endemic zone, 25 from low endemic zone Chandigarh and 15 from other parasitic infections (hookworm, hydatidosis, cysticercosis) indicated detectable positive response. Majority of the ascariasis positive patients studied were in the age group of 21-40 years. However, one ascariasis patient studied in the age group of 1-10 years (4 years old) had also positive antibody response to T. Canis antigen. This study is the first report of human toxocariasis in Kashmir, India, an endemic zone for ascariasis and emphasizes the need for detailed epidemiological study for the ultimate prevention and control of this disease

Adolescent↗

PubMed1987

A profile of ascariasis morbidity in Rangoon Children's Hospital, Burma.

The Rangoon Children's Hospital (RCH) inpatient summary returns from hospital wards from 1981 to 1983 and the surgical operation registers from 1983 to 1984 were studied and analysed in relation to ascariasis morbidity. The majority (57.7%) of clinical manifestations of ascariasis responsible for hospital admission were due to intestinal obstruction, the next most common manifestation was intestinal colic (33.0%). Mean ages for the two conditions were 5.9 years and 7.6 years, respectively. Hospital admissions due to ascariasis varied greatly by season and were significantly higher in the months of May, June and July. Ascariasis was responsible for about 3% of admissions to the hospital. Of the total ascariasis cases, 61.6% were treated in the surgical wards. Moreover, 57.6% of all the acute abdominal cases in the surgical wards were clinically diagnosed to be due to Ascaris lumbricoides infection. In 1983 and 1984, 43 cases of abdominal surgery were performed due to adult Ascaris worms, representing 16.7% of all the acute abdominal conditions operated. Of these 43 cases, intestinal obstruction constituted 65.1%, followed by appendicitis at 20.9%. The mean age of those undergoing surgery for Ascaris-induced abdominal complications was 6.8 years. The validity of some of the clinical data and the public health significance of this study are briefly discussed. The findings are also compared with those of other hospital-based studies.

Abdomen, Acute↗

PubMed1982

Biliary ascariasis in children.

In the Cape Town Children's Hospital ascariasis is the commonest cause for an acute abdominal emergency; over a thousand cases have been admitted with ascariasis to the paediatric surgical wards. There was a high incidence of biliary ascariasis (424 cases) and routine intravenous cholangiography should be performed in all children with abdominal pain where ascariasis is suspected. The normal host/parasite relationship is described and the frequent invasion of the ampulla of Vater by the worm is discussed. The typical worm biliary colic is described and the classical surgical findings reported. The radiographic, ultrasonic and duodenoscopic diagnoses of the disease are evaluated. The management of the patient is described. Ninety-five percent of them were uncomplicated cases, but in 20 or 5% of the patients complications arose, the most important of them being ascariasis cholangitis, pyogenic cholangitis, perforation of the bile duct, cholecystitis and pancreatitis. The diagnosis and surgical management of these complications are described in some detail.

Abdomen, Acute↗

PubMed1993

[Biliary ascariasis].

From January 1982 to September 1987, ten diagnosed cases of biliary ascariasis were collected among 8,160 cases who were admitted for biliary tract diseases in our hospital. It represented an incidence of 0.12% in our hospital. In our series, the patients' ages ranged from 33 to 68 years old, with a female predominances. The clinical impression on admission were those of biliary tract stone, infection or pancreatitis. Signs and symptoms of biliary ascariasis were abdominal pain, fever, jaundice, vomiting of round worms and distended gallbladder. Laboratory findings disclosed leukocytosis, mildly elevated alkaline phosphatase, transaminase and bilirubin. There was a relatively high incidence of positive bile culture for bacteria. The reliable diagnostic tools for biliary ascariasis were abdominal real-time ultrasonography and endoscopic retrograde cholangiopancreatography (ERCP). They yielded a diagnostic rate of 40% and 87.5% respectively in our series. The principles of management of biliary ascariasis were conservative treatments including intravenous fluids, nasogastric decompression, antibiotics and antihelmintic agents. Other treatments that were also tried included endoscopic removal of round worms through a T-tube, or nasobiliary drainage. Surgery was considered when there were signs of complications, such as uncontrolled sepsis or suppurative cholangitis. The prognosis of biliary ascariasis was good if patients were diagnosed and treated properly. Regular follow-up with antihelmintic agents is also recommended to avoid reinfection.

Adult↗

PubMed2006

Biliary ascariasis: a review.

Ascariasis, a helminthic infection of humans, is the most common parasitic infestation of the gastrointestinal tract. It infects about 25% of the world's population; around 20 thousand deaths occur per year from an adverse clinical course of the disease. This review is focused on biliary ascariasis, examining in some detail the pathogenesis of the disease with special reference to postcholecystectomy ascariasis and related issues. Although an endemic disease of tropical and subtropical countries, increasing population migration facilitated by fast improving communication facilities demands that clinicians everywhere be familiar with the clinical profile and management of biliary ascariasis.

Ascariasis↗

PubMed2001

Ascaris and ascariasis.

In recent years much new information has been obtained about the epidemiology, population biology and public health significance of infections of Ascaris lumbricoides in humans. Results from experimental infections of A. suum in pigs have helped to elucidate the observations made in the community on human ascariasis. The main purpose of the review is to see how new information may contribute to further acceptance of ascariasis as a serious contributor to ill-health and so to the design and implementation of sustainable control programmes intended to reduce the morbidity due to infection with A. lumbricoides. Eradication is neither a realistic nor prudent aim given the current shortage of appropriate sanitation in many countries where ascariasis is endemic. A substantial body of evidence shows that for the four common species of soil-transmitted nematode, including A. lumbricoides, regular administration of broad-spectrum anthelminthic drugs to children attending primary schools is a cost-effective means of controlling the infections. Anthelminthic drugs must be of proven quality and efficacy and health professionals should be prepared to detect and manage drug resistance should that emerge. Despite a deeper understanding of the immune response of a variety of hosts to infections with either A. lumbricoides or A. suum there is at present little prospect of an effective vaccine against ascariasis. The relationship between A. lumbricoides and A. suum is addressed, particularly since both species, if they are indeed separate species, occur in people and their pigs in many communities.

Adult↗

PubMed2001

Three common presentations of ascariasis infection in an urban Emergency Department.

In the United States, approximately 4 million people per year are infected with Ascaris lumbricoides. We reviewed the common presentations of complications of Ascariasis infection in the Emergency Department (ED) and the diagnostic tools and treatment available. This was a retrospective case review conducted on all patients diagnosed with Ascariasis (using ICD-9 codes) over a 6-year period at Los Angeles County and University of Southern California Medical Center. Three patients with distinct complications secondary to Ascariasis were chosen, and all ED and inpatient records were reviewed. The patient's age, sex, race, presenting symptoms, data, outcome, and ED course and diagnosis were recorded. The three cases included a periappendiceal abscess, Loeffler's syndrome, and biliary colic/choledocholithiasis. The first patient underwent a computed tomography-guided drainage of the abscess. The second patient received supportive care and antibiotic therapy secondary to a superimposed bacterial pneumonia. The third patient underwent endoscopic retrograde cholangiopancreatography with sphincterotomy. All three patients had a stool ova and parasites positive for A. lumbricoides, and all received a 3-day course of mebendazole. Symptomatic cases of Ascariasis may present to EDs in the United States. Important diagnostic tools for the ED include chest X-ray, X-ray of the kidney-ureter-bladder and ultrasonography. Single-dose medications given in the ED are very effective in eradicating A. lumbricoides infection, thus avoiding hospitalization.

Abdominal Abscess↗

PubMed1987

Contributions of ascariasis to poor nutritional status in children from Chiriqui Province, Republic of Panama.

Relationships between ascariasis and lactose digestion and between ascariasis and food transit time from mouth to caecum were investigated in young children from Chiriqui Province, Republic of Panama. The breath hydrogen method was used in both studies. Ascaris-infected children showed a significantly poorer degree of lactose digestion following a test oral load than uninfected children. Recovery of the capacity of the children to digest lactose was still not fully complete for at least 3 weeks following anthelmintic treatment. On average, the mouth-to-caecum transit time was similar in infected and uninfected children, but among the Ascaris-infected children the transit time tended to be shorter in relation to the intensity of infection. Evidence from a cross-sectional survey indicated that ascariasis was significantly associated with reduced plasma vitamin A and carotenoid concentrations. This relationship remained after controlling for a range of socio-economic variables. Ascaris-infected children were frequently found to have lower haematocrits and blood haemoglobin concentrations than uninfected children, but these relationships could not be attributed to ascariasis alone.

Anthropometry↗

PubMed1996

Endoscopy-assisted emergency treatment of gastroduodenal and pancreatobiliary ascariasis.

Five patients with gastrointestinal tract and pancreatobiliary ascariasis presenting as emergency cases are reported here. Two patients presented with hematemesis due to gastric ascariasis, one with abdominal pain due to duodenal ascariasis, and one each with biliary and pancreatic ascariasis manifesting as acute cholangitis and acute pancreatitis, respectively. Endoscopy-assisted management consisted of roundworm removal using a Dormia basket, insertion of a biliary endoprosthesis, and carrying out endoscopic sphincterotomy alone or in combination, and was successful in all cases, with administration of albendazole. The condition of all the patients improved, and they have been asymptomatic on follow-up (2-12 months).

Acute Disease↗

PubMedDate not supplied

Ascariasis: nutritional implications.

Ascaris lumbricoides, the roundworm, is one of the largest parasites of man and probably infects one in four persons in the world. Despite its prevalence, ascariasis is a largely neglected public health problem that has attracted relatively little scientific inquiry. Frequently, a number of biases contribute to the uncritical conclusion that infection with A. lumbricoides adversely affects the nutritional status of the host. This situation is exacerbated by number of studies that have confirmed these biases but have employed questionable methods, such as the use of small samples and indistinct categories, the neglect of the double-blind safeguard, the selection of inadequate controls, and the performance of experiments that are not reproducible in a variety of circumstances. It is interesting to note that studies claiming positive correlation between ascariasis and protein energy malnutrition have not found a significant difference in weight between infected and uninfected children before intervention. Furthermore, several recent studies have shown no significant improvement in nutritional status after intervention. Thus, the causal relationship between ascariasis and protein energy malnutrition is not clearly proved, and it is premature to advocate mass treatment of children in ascariasis-endemic areas as a method to enhance their growth and development.

Ascariasis↗

PubMedDate not supplied

Selective alterations in mast cell subsets and eosinophil infiltration in two complementary types of intestinal inflammation: ascariasis and Crohn's disease.

OBJECTIVE: Numbers of mast cells (MCs) of different subpopulations and the extent of eosinophil infiltration were compared in Crohn's disease and ascariasis. These two types of intestinal inflammation are complementary with regard to T cell response (TH1 versus TH2), prevalence and environmental factors. METHODS: Histochemical, immunohistochemical and ultrastructural tools were applied to biopsies of morphologically uninvolved colon, ileum and duodenum from Crohn's and ascariasis patients, as well as resection margins and tissues from an experimental porcine ascariasis model. MC subsets were defined by their dye-binding properties, and their chymase content was analysed using biochemical tools. RESULTS: The TH2 (IgE-mediated) response in ascariasis was characterised by a dramatic increase in mucosal- type MCs (MMCs) and eosinophils in both the mucosa and the deeper layers of the intestinal wall and a simultaneous decrease of connective tissue-type MCs (CTMCs). Uninvolved intestine of Crohn's patients showed moderate proliferation of CTMCs in the deeper layers of the intestinal wall, but a significant decrease of the MMCs, associated with moderate eosinophilia in all layers of the gut. Similar changes were present in the uninvolved duodenum of Crohn's patients. Comparable amounts of chymase could be extracted from mucosal and submucosal duodenum, with similar proportions of its two principal isoforms in each. CONCLUSIONS: Our results indicate that T cell responses (TH1 or TH2) are associated with different MC subsets in intestinal inflammation. Changes remote from the focus of inflammation point to the systemic nature of the different MC responses.

Adult↗

PubMed2003

Hepatolithiasis with biliary ascariasis--a case report.

BACKGROUND: Biliary ascariasis is regarded as possible etiological factor for hepatolithiasis. Here we report one case of a patient with hepatolithiasis with biliary ascariasis who developed a liver abscess, which was treated with partial hepatectomy. CASE PRESENTATION: A young adult female presented with epigastric pain and vomiting with repeated attacks of cholangitis. ERCP showed evidence of multiple intrahepatic calculi with the development of abscess in the left lobe of liver. The patient underwent partial hepatectomy and was found to have biliary ascariasis on histology. She was treated with antihelmenthic therapy and has had an uneventful postoperative period of 2 years. CONCLUSION: Biliary ascariasis with hepatolithiasis, although rare, should be considered in endemic countries.

Adult↗

PubMed2001

Pharmacotherapy of ascariasis.

Ascaris lumbricoides, the most frequent human intestinal nematode, is the causative agent of ascariasis, with an estimated worldwide prevalence of over one billion people, especially in moist tropical and subtropical regions, but also in cooler climates. Although characterised with low morbidity and mortality rates, the global prevalence of ascariasis still results in approximately 20,000 deaths annually, primarily as a consequence of intestinal obstruction. In humans, transmission usually occurs by hand-to-mouth route by way of contaminated agricultural products and food, or from dirty hands. Three phases of ascariasis may be present, namely, the pulmonary, intestinal and the complications stage. Although generally asymptomatic, heavy infestation may cause serious pulmonary disease, or partial or complete obstruction of biliary or intestinal tracts. Anthelminthic chemotherapy is required to eradicate the parasites and prevent potentially serious complications. Mebendazole, albendazole and pyrantel pamoate are the most widely used agents to treat ascariasis. Preventive chemotherapy delivered to communities in endemic regions may serve as an affordable and cost-effective strategy to reduce the prevalence and morbidity in endemic regions. Under unusual circumstances, Ascaris suum, the cause of helminthic infection in pigs, may also cause disease in humans.

Animals↗

PubMed2000

Life table analysis of ascariasis in a rural community in Jiangxi Province, China.

The prevalence of ascariasis is very high in parts of rural areas in southern China. The high prevalence of ascariasis is one of the most neglected public health problems. A longitudinal investigation on the prevalence of ascariasis in a rural community in China was reported previously. In this article, we re-analyze the reported age specific prevalence of ascariasis using a life table method. The results from our analysis may provide a better summary of the impact of the disease on the studied population.

Adolescent↗