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Wednesday, March 30, 2011

ASCARIS LUMBRICOIDES ('ROUND WORM')

This pale-yellow worm is 20-35 cm long. Man is infected by eating food contaminated with mature ova.
These hatch in the duodenum and the larvae migrate through the lungs, where they moult, ascend the bronchial tree and trachea and are swallowed. They mature in the small intestine. In heavy infections, larvae in the lung may cause pulmonary eosinophila
Clinical features
Adult worms commonly cause abdominal discomfort or colic. Sometimes a worm is vomited or passed per rectum. A tangled mass of worms may cause intestinal obstruction in children with severe infections. Heavy infestation will compete with the child nourishment and contribute to malnutrition. Other complications include blockage of the bile or pancreatic duct and obstruction of the appendix by adult worms.
Diagnosis
The diagnosis is made microscopically by finding ova in the faeces or by observing an adult worm. A solely male infection is usually revealed only after the giving of an antihelminthic to a patient with an unexplained eosinophilia. Occasionally the worms are demonstrated radiographically by barium examination.
Management
The appropriate drugs are Piperazine salts 100mg/kg. Pyrantel pamoate 10mg/kg, Mebendazole 100mg, Albendazole 400 mg and Levamisole 5mg/kg. Surgery is required if obstruction occurs and fails to respond to nasogastric suction and sedation; worms are 'milked' past the obstruction , or removed by enterostomy.

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