Ascariasis & Giardiasis

Dr. Shahjahan Ahmed Chowdhury

Associate Professor
Department of Community Medicine
Ascariasis
Definition

An infection of the intestinal tract

caused by the adult, Ascaris
Lumbricoids and clinically manifested
by vague symptoms of nausea,
abdominal pain and cough.
 Occurrence &Geographic
distribution

Cosmopolitan in distribution
Most common helminthic infestation
About 1.3 billion infected worldwide
Prevalence was about 250 million in 1997
 Epidemiological Determinants

1. Agent 5. Environment
2. Reservoir of infection 6. Human habits
3. Infective material 7. Period of
4. Host communicability
Agent- Ascaris Lumbricoides
The adult worms are cylindrical in shape,
creamy-white or pinkish in color. The female
averages 20-35cm in length, the largest 49cm.
The male is smaller, averaging 15-31cm in
length and distinctly more slender than the
female. They have a complete digestive tract.
Reproductive organs are tubular, male has a
single reproductive tubule. The female has two
reproductive tubules and the vulva is ventrally
located at the posterior part of the anterior 1/3 of
the body.
Reservoir of infection

Man is the only

reservoir
Infective material

Feaces containg
fertilized eggs
 Host

Children are more Adults are less

common common
 Environment

Soil transmitted helminth

Eggs remain viable in the soil for
months/years
Clay soils are most favourable for the
development of ascaris eggs
 Human habits

Open air defecation is the most important

factor for soil pollution
Infective eggs from soil can easily
contaminate human hands and foods
 Period of communicability

Until all fertile females are destroyed and

stools are negative
Mode of transmission

By faecal-oral route

Incubation period

About 2 months
Life cycle
Man is the only definitive host
Eggs in feces
Development in soil
Rhabditiform larva forms
Infection by ingestion and
liberation of larvae
Migration through the lungs
Re-entry in the stomach and
small intestine
Sexual maturity and egg
liberation
Cycle again repeats
Four moultings of larvae
One (outside), two (lungs) and
one (intestine)
Factors favoring transmission:

1. Simple life cycle.

2. Enormous egg production ( 240,000 eggs/
day/ female ).
3.These eggs are highly resistant to ordinary
disinfectants( due to the ascroside). The
eggs may remain viable for several years.
4. Unhealthy social customs and living
habits.
5. Unhygienic disposal of feces.
 Pathogenesis
There are two phase in ascariasis:
1. The blood-lung migration phase of the
larvae: During the migration through the lungs,
the larvae may cause a pneumonia. The
symptoms of the pneumonia are low fever,
cough, blood-tinged sputum, asthma. Large
numbers of worms may give rise to allergic
symptoms. Eosionophilia is generally present.
These clinical manifestation is also called
Loefflers syndrome.
 Pathogenesis (cont.)
2. The intestinal phase of the adults: The
presence of a few adult worms in the lumen of
the small intestine usually produces no
symptoms, but may give rise to vague
abdominal pains or intermittent colic, especially
in children. A heavy worm burden can result in
malnutrition. More serious manifestations have
been observed. Wandering adults may block the
appendical lumen or the common bile duct and
even perforate the intestinal wall. Thus
complications of ascariasis, such as intestinal
obstruction, appendicitis, biliary ascariasis,
perforation of the intestine, cholecystitis,
pancreatitis and peritonitis, etc., may occur.
 Diagnosis
The confirmative diagnosis depends on the recovery and
identification of the worm or its egg.
1. Ascaris pneumonitis: examination of sputum for
Ascaris larvae is sometimes successful.
2. Intestinal ascariasis: feces are examined for the
ascaris eggs.
(1) direct fecal film: it is simple and effective. The
eggs are easily found using this way due to a large
number of the female oviposition, approximately 240,000
eggs per worm per day. So this method is the first
choice.
(2) brine-floatation method:
(3) recovery of adult worms: when adults or
adolescents are found in feces or vomit and tissues and
organs from the human infected with ascarids , the
diagnosis may be defined.
 Prevention and Control
Primary prevention
sanitary disposal of human excreta
Provision of safe drinking water
Food hygiene habits
Health education in use of sanitary latrine
Personal hygiene and changing
behavioural pattern
 Prevention and Control (cont.)
Secondary prevention- by drugs
Piperazine
Mebandazole
Levamisole
Pyrantel pamoate
 Prevention and Control (cont.)
Mass treatment
Periodic deworming at intervals of 2 to 3
months, along with improved sanitation.
Giardiasis
 Giardia: Human Disease
Incubation period of 1-25 days (average 7
days)
Infectious dose is low (10 cysts)
Excreted in the stool intermittently for
weeks or months
Asymptomatic infections can occur
Duration of illness 1 to 3 weeks
 Protozoan flagellate
Global distribution
Two-stage life cycle - trophozoite and
cyst
Reservoirs: domestic and wild
animals
Giardia life cycle
Ingestion of cysts
Cysts hatches to
trophozoites
In the trophozoite
stage parasite
multiplies in the
intestine by binary
fission in dudenum
and biliary tract.
Giardia - cysts
 Giardia: Transmission to Humans
Oral ingestion of cysts
Fecal-oral transmission
Contamination of water
Food borne transmission
Zoonotic transmission from pets and
livestock may be important
 Direct Contact Transmission
Person-to-person is 2nd most commonly
identified mode of transmission
Poor fecal-oral hygiene
Children in daycare centers
Cyst passage as high as 20-50%
Spread the disease within center, homes, and
communities
Men who have sex with men (MSM)
Cyst passage as high as 20%
Persons in custodial institutions
 Giardia: Clinical signs
Diarrhoea
Other symptoms: flatulence, bloating, weight
loss, abdominal cramping, nausea, mal
absorption, foul-smelling stools, steatorrhoea,
fatigue, anorexia, and chills
Chronic disease
recurrent symptoms
Mal absorption and debilitation may occur
 Giardia: Diagnosis
Microscopic visualization
via wet mount
staining (trichrome or iron hematoxylin)
Direct fluorescent antibody detection
ELISA
Alternative - samples of duodenal fluid
(e.g., Enterotest) or duodenal biopsy may
demonstrate trophozoites
 Giardia: Treatment
Many effective treatment alternatives
Metronidazole first choice
Alternatives: Nitazoxanide, Furazolidone,
Quinacrine, Tinidazole, Albendazole, and
Paromomycin
 Prevention and Control
Proper handling and treatment of water
Travelers to developing world or wilderness should
boil or treat surface water
Good personal hygiene
Daycare center foci are a problem
Some recommend only symptomatic children be
treated
However, asymptomatic passers may infect others
If strict hand washing and treatment of symptomatic
children does not control outbreak, treating all
infected should be considered
Thank you