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 ASCARIS LUMBRICOIDES

COMMON NAME : The Common Round worm

GEOGRAPHICAL DISTRIBUTION

Worldwide distribution,

Specially tropical countries like India, China & South East Asia.

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 ASCARIS LUMBRICOIDES

COMMON NAME : The Common Round worm

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 Geographical Distribution (Continued)

Worldwide distribution,

Specially tropical countries like India, China & South East Asia.

25% of the world’s population is affected.

Highest prevalence in malnourished population of developing

countries.

Low incidence in developed countries

Due to modern water and waste treatment. 5

HABITAT

Small intestine of man, specially jejunum.

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MORPHOLOGY
a. Adult worm b. Eggs.

a.Adult worm

Cylindrical in shape, more so at the anterior end.

Pinkish creamy in colour,

White longitudinal streaks along the entire length.

Mouth consists of three finely toothed lips .

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Morphology (Continued)

MALE WORM:

Measures 15-30 cm long.

3-4 mm in diameter.

Posterior end is curved ventrally into a hook.

Ejaculatory duct opens into cloaca which gives rise to a pair of copulatory spicules.

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 Morphology (Continued)

FEMALE WORM:

Measures 25-40 cm long.

5 mm in diameter.

Tail is straight & conical.

Vulva opens at the junction of anterior & middle thirds of the body

called “Vulvar waist”, a constriction in the body.

Average life span of adult worm is 01 years

but may live as long as 20 months.

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Female Worm

Male Worm
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 Morphology (Continued)

B. EGGS

The female worm passes nearly 200,000 eggs/day.

Two types of eggs.

1. Fertilized eggs.

2. Unfertilized eggs.

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Morphology of Eggs

1. Fertilized Eggs

•Round or oval,
•Brown (Bile – stained)
•60-75µm long,
•40-50µm broad
•Thick transparent shell
1. Innermost vitelline membrane (made by Embryo) .
2. Middle layer.
3. Outermost, coarse, mammilated (rounded protuberances)
albuminoid layer
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 Continued
Morphology of Fertilized Eggs

•When outer mammilated coat is lost, “Decorticated eggs”.

•They carry large, unsegmented ovum

•A clear crescentic region at each pole.

•Float in saturated salt solution.

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2. Unfertilized (Infertile) Eggs
• When male worm is not available

• 90µm x 55 µm
• Brown (Bile-stained)

• Possess a small atrophied ovum.

• Thin shell covered by a thin irregular

coating of albumin.
• Innermost lipoidal vitelline membrane
absent.

• The infertile eggs are the heaviest

of all helminthic eggs 16
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 LIFE CYCLE
• Only one host, (i.e. man) no intermediate host.

• Adult worm lives in small intestine (specially Jejunum).

• Fertilized eggs ( unsegmented ova ) passed out in faeces.

• As such, immediately after being laid , they are Not infective.

• Become infective after spending the period of incubation in soil.

• Unsegmented ovum develops into Rhabditiform larva ( initial

developmental larval stage (first and second stage)

• First moulting within the shell in 10-40 days.

• These embryonated eggs having Rhabditiform larvae are

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Pathogenic to man.
 Life Cycle (Continued)

Man gets infection via contaminated food, water & raw vegetables.

Eggs hatch in duodenum & liberate larvae.

Liver:
Larvae penetrate through mucosa and enter portal circulation.---
Reside Liver for 3-4 days)

Lung:
Via hepatic vein, inferior vena cava, right heart , pulmonary artery.
In lungs moult twice (5th and 10th day).
Break the capillary wall enter alveoli.

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 Life Cycle (Continued)

Migration

Alveoli bronchus trachea larynx

over the epiglottis oesophagus small intestine

(habitat).

Moulting (25-29th day) adult worm.

Sexual maturity in 6-10 weeks.

Pass eggs by 12th weeks.

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PATHOGENCITY

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Pathogencity (Continued)

UPWARD MOVEMENT
Crawl out of mouth, nose
Eustachian tube--Midde ear-- tympanic membrane--External auditorymeatus.
Trachea ------ Choking.

DOWN-WARD MOVEMENT
Appendix, ------ appendicitis
Bile-duct ------- Obstructive Jaundice
Pancrease------ Acute hemorrhagic pancreatitis.
Perforation of gut wall (Old gut ulcers)

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Pathogencity (Continued)

Ascaron-induced-Allergic manifestations:-

Fever

Urticaria

Angioneurotic oedema

Bronchospasm

Conjunctivitis

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Pathogencity (Continued)

Pathogencity of Migrating Larvae

Loeffler’s Syndrome
A type of extra-intestinal ascariasis

Migrating larvae cause two types of reactions in the lungs.

Inflammatory reaction
Hypersensitivity reaction

Leading to

Granuloma formation
Eosinophillic infiltration.
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 Pathogencity (Continued)

Loeffler’s Syndrome (Continued)

Fever, cough, urticaria with rash.

Blood stained sputum.

Ascaris larvae

Charcot-Leyden crystals.

Allergic & inflammatory reactions to migrating larvae may involve other organs (Liver & kidneys).

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 LABORATORY DIAGNOSIS

a. Identification of Parasite /Ova in stool :

• Demonstration of adult worms.

• Demonstration of Larvae.

• Demonstration of eggs. (Fertilized & Unfertilized).

b. Blood Complete

Marked eosinophilia

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Laboratory Diagnosis
Continued

c. Serodiagnosis:
Serological tests are specially useful for the diagnosis of

extra-intestinal ascariasis like “Loeffler’s syndrome”.

Ascaris antibodies can be detected by:

• IHA test (Indirect haemagglutination)

• IFA test (Immuno-fluorescent antibody).

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 TREATMENT

1. Pyrantel pamoate (single dose)

11 mg per kg body weight (maximum=1 gram).

2. Mebendazole

100 mg twice daily for 3 days.

3. Piperazine citrate

75 mg per kg body weight daily for 2 days.

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 PROPHYLAXIS

1. Proper disposal of human faeces.

2. Avoiding eating contaminated raw vegetable and salads.

3. Avoidance of untreated water

4. Periodic treatment with an effective anthelminthic.

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 VISCERAL LARVA MIGRANS
A syndrome caused by ingestion of
embryonated eggs of Nematodes of animals like
Toxacara canis (dog-roundworm)
Toxocara cati (cat-roundworm)
Hatching of larvae in small intestine which penetrate the intestinal wall.
Migrate to liver, from liver to lungs and other parts.
The larvae are attacked by phagocytic cells
i.e. Eosinophils, Histiocytes & Giant cells leading to granulomatous
lesions.

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Visceral Larva Migrans Continued

Characterized by:
 Fever
 Marked eosinophilia (15-80%)
 Hepatomegaly
 Penumonitis,
 Hyper gammaglobulinemia
 Ophthalmitis (Ocular larva migrans endophthalmitis)

Diagnosis of Visceral larva migrans

 Biopsy
 Autopsy.

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THANK
YOU
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