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PubMed2002

Biliopancreatic ascariasis: endoscopic approach.

From June 1985 to June 1999, 120 patients were diagnosed by means of panendoscopy, choledocoscopy, and endoscopic retrograde cholangiopancreatography as having biliary and pancreatic ascariasis. All duodenoscopic procedures were performed under fluoroscopic control. Endoscopic extraction was successful in 99 of 108 (92%) patients, some of whom had had previous endoscopic sphincterotomy. The endoscopic accessories used were a basket catheter, polypectomy snare, and balloon catheter. Because no significant complications were observed after this endoscopic treatment, we recommend endoscopic extractions for biliary ascariasis.

Adolescent↗
PubMedDate not supplied

Ultrasound appearances of intra- and extrahepatic biliary ascariasis.

BACKGROUND: To determine the range of ultrasonographic (US) appearances of Ascaris lumbricoides roundworms in the biliary system, their distribution in the intra- and extrahepatic parts of the system, and associated features. METHODS: All cases of biliary ascariasis during a 10-year period were reviewed. There were 42 cases in which diagnosis was based on established US criteria, and 2 cases diagnosed surgically in which US had been negative. These 44 cases occurred in 36 patients. RESULTS: In the US-diagnosed cases, worms were present in intrahepatic ducts in 32 cases, in the main duct in 37, and in the gallbladder in eight. In six cases, the liver was lifted off the main portal vein by a bundle of worms obliterating the lumen of the main bile duct. Worms packing and dilating intrahepatic ducts produced pseudotumorous appearances in the liver in four cases and bundlelike appearances in three. Worms were also seen in the pancreatic duct in two cases. Stones in intrahepatic ducts were present in 12 patients. CONCLUSION: Biliary ascariasis should be searched for inside and outside the liver. The appearances of bundles and boluses are different from those of single worms. Intra- and extrahepatic biliary stones may be present.

Adolescent↗
PubMed2004

Endoscopic management of early postoperative biliary ascariasis in patients with biliary tract surgery.

Bile leak and residual stones are well known complications of biliary tract surgery. In endemic areas of ascariasis, invasion of the biliary tract by roundworms during the early postoperative period is an infrequent but serious complication. The present study describes the endoscopic management of postoperative biliary ascariasis in 19 consecutive patients. There were 5 men and 14 women with a mean age of 33.3 +/- 6.3 years. All patients had undergone cholecystectomy, with choledocholithotomy and placement of a T-tube in 13 (68.4%) patients. Eight (42.1%) patients including two with T-tubes were acutely sick at referral. Altogether, 16 (84.2%) patients had widened papillae due to previous endoscopic sphincterotomy (3 patients) or recent dilatation of the sphincter of Oddi by Bake's dilators (13 patients). All patients with a T-tube in situ had undergone unsuccessful attempts to remove the worms by flushing saline through the T-tube. Endoscopic retrograde cholangiopancreatography was performed 4 to 16 days after biliary tract surgery and revealed roundworms in the common bile duct in 10 patients, in the hepatic ducts in 2, or in both ducts in 7. Three patients had coexisting biliary leakage: from the cystic duct stump in two and from a T-tube track in one. Endoscopic treatment consisted of extracting the worms from the biliary tree and placing stents in those with coexisting leakage. Endoscopic success was defined as complete worm extraction and resolution of biliary leakage and was achieved in all patients. Complications occurred in one (5.3%) patient. We concluded that endoscopic management is an effective, safe approach for extracting ascarids from the biliary tree during the early postoperative period. It reduces the hospital stay, avoids T-tube-related complications, and permits a postoperative complication to be treated using a nonsurgical method.

Adult↗
PubMed1998

Biliary ascariasis associated with cholangiocarcinoma: ultrasonographic and percutaneous transhepatic cholangiographic findings.

The combination of biliary ascariasis and cholangiocarcinoma is rare. A 56-year-old female presented with progressive jaundice. Ultrasonography revealed a curvilinear structure with anechoic center consistent with ascariasis within the dilated common bile duct. Ultrasonography also demonstrated that a slightly echogenic soft tissue mass projecting into the mid segment of the common bile duct proved to be coexistent cholangiocarcinoma. Percutaneous transhepatic cholangiography did not confirm the presence of worm. In this report ultrasonographic and percutaneous transhepatic cholangiographic findings of the case are described and the relative merits of these two techniques are discussed.

Animals↗
PubMed1999

Radiological findings of intraparenchymal liver Ascaris (hepatobiliary ascariasis).

Ascariasis is a well-known cause of acute cholangitis and cholecystitis; however, very rarely do worms penetrate and colonize the liver parenchyma. Here we present the unique radiological demonstration (US, CT and ERCP) of hepatobiliary ascariasis in which worm was first alive in the parenchyma of the liver and subsequently died and formed liver abscess.

Aged↗
PubMed2006

Ascariasis infection of the colon: MDCT evaluation.

Ascariasis is the most common helminth infection in the world and is a common cause of abdominal symptoms worldwide. Although rare in the United States, isolated cases do occur in the Southwestern States. We present a case of a 34-year-old woman who presented to the emergency room with abdominal pain and diarrhea. The diagnosis of ascariasis was made on CT scan.

Adult↗
PubMed2002

Ascariasis-induced empyema of gallbladder: report of a case.

A rare case of a 52-year-old woman with empyema of the gallbladder due to ascariasis causing an obstruction in the cystic duct is presented. She was admitted on September 20, 2000, and on September 23 an emergency cholecystectomy was performed. Ultrasonography is a highly sensitive and specific method for diagnosing gallbladder ascariasis, and a cholecystectomy is considered mandatory for the treatment of empyema of the gallbladder.

Ascariasis↗
PubMed1988

Intraperitoneal ascariasis.

Seven children with intraperitoneal ascariasis are reported. One of them had two episodes. There were four instances of free worms in the peritoneal cavity, whereas others had peritoneal abscesses containing round worms. It is suggested that peritoneal ascariasis should be suspected whenever a child presents with peritonitis and/or an inflammatory abdominal mass having evidence of ascarial infestation.

Ascariasis↗
PubMed1997

Management of intestinal obstruction caused by ascariasis.

A retrospective clinical study to evaluate the effects of paralyzing vermifuges on the course of intestinal obstructions complicating ascariasis was performed. Forty-two patients, 26 patients with partial and 16 patients with complete intestinal obstructions, were treated over 7 years. Although 24 patients have not received any medications two patients with partial obstructions received flaccid paralyzing agent before referral. However, 12 of 16 patients with complete obstruction received spastic paralyzing agent, and the remaining patients received flaccid paralyzing agent before referral. Paralyzing agents, especially those causing spastic paralysis, should be avoided in patients with abdominal symptoms presumed to be related to ascariasis because of the risk of causing complete obstruction and making surgery more complex.

Anthelmintics↗
PubMedDate not supplied

Serodiagnosis of ascariasis with specific IgG4 antibody and its use in an epidemiological study.

In an earlier study Ascaris-specific IgG4 antibody was found to be elevated in cases of ascariasis. However, the usefulness of the elevated levels of this antibody in Ascaris infection as a diagnostic marker has not been well established. In India, in early 1999, blood samples of 83 cases of Ascaris infection, 35 cases of other nematode infection and 53 control subjects (without any helminth infection) were tested for anti-Ascaris IgG4 by ELISA. Further anti-Ascaris IgG4 levels in the blood of Ascaris-infected patients were determined, after eradication of the worms with drugs, at regular intervals to ascertain the duration of elevation of titre of the serological marker following initial infection. This information would indicate the sensitivity of the test as a diagnostic marker for recent infection. Blood samples of 422 rural people were also tested for anti-Ascaris IgG4 titre to ascertain the prevalence of ascariasis in the community. High levels of anti-Ascaris IgG4 antibody (OD 1.246 +/- 0.212) were found in all the 83 Ascaris-infected subjects compared to controls (OD 0.158 +/- 0.047). Anti-Ascaris IgG4 antibody levels of other nematode-infected subjects were comparable to the controls. Anthelmintic treatment of 8 Ascaris-infected subjects caused sequential fall of IgG4 level in their blood, and its titre reached control level within 6 months of deworming. Of 422 individuals from the rural community 229 (54.3%) had significantly high levels of specific IgG4 antibody against Ascaris excretory-secretory antigen, suggesting that they were infested with Ascaris. Thus, this study demonstrated that anti-Ascaris IgG4 antibody is a very sensitive and specific marker for the diagnosis of Ascaris infection. Utilizing this test, a significant number of a rural population could be diagnosed with Ascaris infection in West Bengal, India.

Adolescent↗
PubMedDate not supplied

Comparative clinical studies of nitazoxanide, albendazole and praziquantel in the treatment of ascariasis, trichuriasis and hymenolepiasis in children from Peru.

Three randomized clinical studies were conducted in 2000 to evaluate the efficacy of nitazoxanide paediatric suspension compared to albendazole in the treatment of ascariasis and trichuriasis and praziquantel in the treatment of hymenolepiasis in children from Cajamarca, Peru. Nitazoxanide was administered at a dose of 100 mg (age 1-3 years) or 200 mg (age 4-11 years) twice daily for 3 days, albendazole as a 400-mg single dose and praziquantel as a 25-mg/kg single dose. Post-treatment parasitological examinations were carried out on 3 faecal samples, each collected on a different day between 21 and 30 days following initiation of treatment. Nitazoxanide cured 89% (25/28), 89% (16/18) and 82% (32/39) of the cases of ascariasis, trichuriasis and hymenolepiasis respectively compared with 91% (32/35), 58% (11/19) and 96% (47/49) for the comparator drugs. Each of the drugs produced egg reduction rates in excess of 98%. There were no significant adverse events or abnormalities in haematology or clinical chemistry values or urinalysis.

Albendazole↗
PubMedDate not supplied

CT findings in pediatric gastrointestinal ascariasis.

We present a case of a 9-yr-old child with gastrointestinal ascariasis. Computed tomography of the abdomen demonstrates the Ascaris roundworms as cylindrical filling defects within contrast filled bowel loops. In addition, the intestinal tract of the roundworm itself is seen as a thin thread of oral contrast within the tubular filling defect. To our knowledge, this is the first reported description of the CT findings of intestinal ascariasis in a pediatric patient.

Abdominal Pain↗
PubMed1993

Ascariasis and childhood malnutrition.

The present review will examine epidemiological perspectives and be confined mainly to the results of those field studies published since 1975 in order to provide concrete scientific evidence of the effect of ascariasis on childhood malnutrition, particularly on growth. The field studies were done in many developing countries from Africa, Asia and Latin America, using cross-sectional and intervention studies in which anthelmintics were employed, with different dosing frequency and follow-up periods ranging from 33 days to 2 years. In general, a better nutritional status in terms of growth, lactose tolerance, vitamins A and C, and albumin levels were observed among Ascaris-free or treated than among Ascaris-infected or untreated children even in cross-sectional or non-randomized studies. More importantly, the improvement in weight or height after chemotherapeutic treatment was found to be significant particularly in those randomized controlled studies with an initially high prevalence of ascariasis and malnutrition, a low prevalence of other intestinal parasites, repetitive and regular treatments of children with tetramisole, levamisole or pyrantel, within a period of 12 or 24 months. Reasons for failures to detect improved growth in some studies are provided. This review strongly indicates that A. lumbricoides infection definitely retards childhood growth.

Animals↗
PubMed2000

Biliary ascariasis after Roux-en-Y hepaticojejunostomy.

The authors report on a 6-year-old girl with biliary ascariasis after surgical treatment of a choledochal cyst and biliary-digestive tract reconstruction by Roux-en-Y hepaticojejunostomy. A precise diagnosis can be obtained by ultrasonography. Surgical treatment is required when clinical and endoscopic treatments fail. In countries in which this disease is endemic, biliary ascariasis should be considered in the differential diagnosis of cholangitis after surgery for hepaticojejunostomy.

Anastomosis, Roux-en-Y↗
PubMed1976

A case of common bile duct ascariasis diagnosed by duodenoscopy.

A case of common bile duct ascariasis diagnosed by duodenoscopy is presented. At the admission, the patient, cholecystectomized for gallstones 13 years before, had been complaining of epigastric pain associated with post-prandial and nocturnal vomiting. Physical examination showed only slight tenderness in the epigastrium. Laboratory findings were within normal limits, with the exception of a moderate leukocytosis. Intravenous cholangiography showed the lack of visualization of the terminal common bile duct, but the flow of contrast medium was normal. Duodenoscopy, carried out without a specific clinical suspicion, revealed an ascaris lumbricoides inserted in the common bile duct and partially protruding from the papilla Vateri. The patient was treated by piperazine, intravenous fluids, antibiotics and a choleretic compound. After 24 hours an ascaris 33 cm long was excreted in the faeces and the patient became symptom-free. Some pathophysiological, clinical and epidemiological aspects of biliary ascariasis are discussed.

Aged↗
PubMed1990

Effect of ascariasis upon nutritional status of children.

One hundred children aged 24-72 months who had history of passing roundworms during the preceding 12 months were compared with 100 children without such history. The two groups were matched for age, sex, economic status, and birth order. Children who had ascaris were 2.1 cm shorter in height, 0.6 cm, thinner for mid-arm circumference, and 0.38 kg lighter in weight compared to the children who did not pass ascaris. The first two of these differences were statistically significant (P less than 0.005). It is concluded that: 1. ascariasis contributes significantly to malnutrition in communities where both coexist; 2. periodic deworming should form part of community nutrition programmes in areas where ascariasis is common; 3. future studies of a similar nature should include recording of height, arm circumference, and birth order.

Arm↗
PubMed1997

Sonographic evaluation of biliary ascariasis.

In a prospective 6-month study, sonographic diagnosis of biliary ascariasis was made in 14 patients; in nine patients, the diagnosis was confirmed by endoscopic retrograde cholangiopancreatography and bile analysis, while in five patients, confirmation was obtained by proven intestinal infestation. No false-positive or false-negative cases were encountered. Ascariasis of the biliary tract was seen on ultrasound as echogenic, non-shadowing images, either as single or multiple strips, with visualization of the digestive tract of the worm as an anechoic inner tube, or as amorphous fragments. Follow-up sonograms helped in detection of worm expulsion following medical therapy in five patients, while endoscopic extraction of the worm was performed in four patients. In three patients, disappearance of the worm from the biliary tract was noted following a therapeutic sphincterotomy, and two patients detected to have a worm within the gall-bladder were operated on. In all patients, serial sonograms revealed disappearance of the worm, and the regression of biliary tract dilatation.

Animals↗
PubMed1969

Levamisole in the treatment of ascariasis in children.

Levamisole (the laevorotatory isomer of tetramisole) is a new synthetic anthelmintic. A cure rate of 91% was obtained in a series of 111 ascariasis-infected children treated with a single oral dose of the drug. The failures, who were treated with the drug a second time one week later, were all cured. In a comparative study of levamisole and piperazine citrate in a series of 100 children with ascariasis a cure rate of 92% and 90% was obtained with a single dose of levamisole and piperazine respectively, indicating equal efficacy. Levamisole is better tolerated than piperazine citrate and is virtually free of toxic effects.

Anthelmintics↗