Ascaris is a worm that infects the small intestine, but its life cycle includes migration through the circulation to the heart and lungs, and into the oropharynx. Infection is acquired through the ingestion of embryonated eggs in contaminated soil or water. Ascariasis is the most prevalent intestinal helminth infection in the world; current estimates suggest that more than 1 billion persons are infected. In the US, infection is more common in rural parts of the southeast.
Most individuals have no noticeable symptoms. Migrating larvae may produce “verminous pneumonia”. However, heavy infection, especially in children, may produce abdominal cramps, and a mass of tangled worms may cause intestinal obstruction. Aberrant migration of individual adult worms occasionally leads to obstructions resulting in cholangitis, cholecystitis, liver abscess, pancreatitis, appendicitis, or peritonitis.
Passage of an adult worm by mouth or rectum is possible. All Ascaris infections should be treated. If other intestinal helminths are present, Ascaris must be treated first to prevent aberrant migration of worms. Treat adults with mebendazole (200 mg bid x 20 days) or albendazole (400 mg x 1 dose).
Repeat stool exam 1-2 weeks after therapy. Garlic, onion, wormwood, black walnut, quassia, and pumpkin seeds may be effective natural agents. Minimize meat, dairy, and refined carbohydrates while increasing fiber in the diet.
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