BY: ANTOLIN, Shelila Hope

D.
ZETA, Jamaica Mae
BSN3-A
ASCARIASI
S
An infection caused by parasitic
roundworm. Ascaris lumbricoides.
Ascariasis is particularly prevalent in
tropical and sub-tropical regions where
hygiene is poor.
The geographic distributions of Ascaris
are worldwide in areas with warm, moist
climates and are widely overlapping.



Once consumed, the eggs hatch and
release immature roundworms called
larvae within the small intestine. Within a
few days, the larvae then move through
the bloodstream to the lungs, exit up
through the large airways of the lungs, and
are swallowed back into the stomach and
reach the small intestine.
During movement through the lungs the
larvae may produce an uncommon form of
pneumonia called eosinophilic pneumonia.
Once they are back in the small intestine,
the larvae mature into adult roundworms.
Adult worms live in the small intestine
where they lay eggs that are present in
feces. They can live 10 24 months.
It is estimated that 1 billion people are
infected worldwide. Ascariasis occurs in
people of all ages, though children are
affected more severely than adults.

Most of the time, there are no symptoms. If there are
symptoms, they may include;
Nausea and Vomiting
Diarrhea
Vomiting worms
Bloody Sputum
Cough
Low-grade fever
Passing worm in stool
Shortness of breath
Skin rash
Stomach pain
Wheezing
Worms exiting through the nose or mouth

Life Cycle
Of ascaris:
Embryonated
ova

Larval stage

Adult


1. EMBRYONATED OVA
- Soil contamination with human
excreta
- Contamination of food, water and
other objects
-Ingested to intestine

2. LARVAL STAGE
- The larvae penetrate the walls of
the intestine (duodenum)
- The larvae are picked up by
lymphatics or bloodstream.
- They are carried to the liver.
- Some larvae may reach the heart.
- Sometimes they are carried to the
biliary tract.









- Nausea and vomiting, poor
appetite
- Periumbilical pain

- Right upper quadrant pain



DEVELOPMENTAL STAGE SYMPTOMATOLOGY
- They may reach the
stomach, esophagus, and
then the upper respiratory
tract.
- They may stay in the
capillaries of the lungs, and
then reach the alveoli,
where they grow and molt
for ten days.
- From the alveoli, they
migrate to the bronchioles,
bronchi, trache, and
epiglottis.
- Ascaris in the larvae stage
may be swallowed or
ingested.




- Cough, fever, rales, blood-
tinged sputum



- Nasal pruritus if larvae reach
the nose
3. ADULT
-Adult ascaris stays in the
small intestine.

-At times they become
erratic that they go to the
stomach to the esophagus,
and sometimes to the
common bile duct and the
gall bladder.

- in the GI tract, they
copulate. The female lay
eggs about 2-3 months after
embryonated eggs are
ingested.



- Colicky, periumbilical pain
aggravated by cold stimulation
(Nakamura sign)

- Intestinal obstruction may
be caused by a bolus of
entangled worms which may
be palpable



- Severe abdominal pain
associated with vomiting
Risk factors for ascariasis include:
Age. Most people who have
ascariasis are 10 years old or
younger. Children in this age group
may be at higher risk because
they're more likely to play in dirt.

Warm climate. Ascariasis worms thrive in
mild climates. In the United States,
ascariasis is more common in the
Southeast. But it's more prevalent in
developing countries with warm
temperatures year-round.
Poor sanitation. Ascariasis is widespread
in developing countries where human
feces are allowed to mix with local soil.


Malabsorption -The malabsorption may
be due to a loss of brush border
enzymes, erosion and flattening of the
villi, and inflammation of the lamina
propia (a thin layer of loose connective
tissue which lies beneath the epithelium
and together with the epithelium
constitutes the mucosa).
Blockage in the intestine
Malnutrition -The worms in the intestine
cause malabsorption and anorexia which
contribute to malnutrition.



The lifecycle requires four to eight weeks
to complete. Ascaris eggs are
unsegmented when passed and require
a period of two or three weeks outside
the host to develop to the infective
stage. Mature female worms have been
estimated to produce an average of 200,
000 eggs per day.
Stool for ova demonstration of
fertilized or unfertilized eggs in the stools
(Kato-Katz technique)
Abdominal x-ray densed shadow of
adult ascaris which looks like strands of
spaghetti (dot sign)
- Signs of intestinal obstruction if bolus is big
enough to cause a mechanical ileus.
Routine blood counts significant
eosinophelia

Albendazole or mebendazole 15 cc as a
single dose
- Causes slow immobilization and death of the
worms by selectively and irreversibly blocking
uptake of glucose and other nutrients in susceptible
adult intestine where helminths dwell.
Piperazine citrate- 75 mg/kg twice daily, orally
- A flaccid paralyzing agent that causes a
blocking response of ascaris muscle to
acetylcholine. The narcotizing effect immobilizes
the worm, which prevents migration when
treatment is accomplished with weak drugs such
as thiabendazole. If used by itself it causes the
worm to be passed out in the feces.
-
Pyrantel pamoate- 1mg/kg as a single
dose, orally
- Depolarizes ganglionic block of nicotinic
neuromuscular transmission, resulting in
spastic paralysis of the worm. Spastic
(tetanic) paralyzing agents, in particular
pyrantel pamoate, may induce complete
intestinal obstruction in a heavy worm
load.


Altered nutrition: less than body
requirement
Knowledge deficit
Alteration in bowel elimination
Fluid volume deficit
Anxiety
Sleep pattern disturbance
Improve the nutritional status of the patient
by letting the patient eat nutritious foods that
are washed well with clean water, and they
should minimize eating foods that are raw
because embryonated eggs may be present,
especially in areas where hygiene is poor.
Preventive measures in each home and in the
community should be enforced.
All members of the family must be taught on
sanitary practices such as washing of hands
before handling food, washing of all fruits
and vegetables that are eaten raw, and
effective sewage disposal.

Availability of toilet facilities must be ensured.
Importance of personal hygiene should be
explained.
Proper disposal of diapers should be
emphasized to mothers.
Explain to the family the importance of
increase in fluid intake (esp. safe drinking
water)
Explain to the patient that isolation is not
needed; show support, provide comfort,
assistance or encouragement to the patient.
Maintain a supportive, calm, confident methods
to interact with the patient all the times
Allow client to continue usual sleep practices
(e.g. position; time; presleep routines such as
reading, watching television, listening to
music, ) whenever possible; satisfy basic
needs such as comfort and warmth before
sleep.

Improved sanitation and hygienic practices
Improved nutrition
Deworming may be advised.
When travelling to areas where sanitation
and hygiene are poor, avoid water or food
that may be contaminated.