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ID: Ascariasis
LTC Glenn Wortmann, MC, USAIntroduction: The most common intestinal worm, Ascaris infects more than 1 billion people worldwide, who
ingest eggs in contaminated food and drink. The eggs hatch in the small intestine, penetrate the intestinal wall
and travel by venous circulation to the lungs. The larvae then pass into the trachea and are swallowed. They
migrate through the GI tract becoming mature worms in the small intestine. Incubation period is 4-8 weeks.
Ascaris is also known as roundworm, and is large enough to easily see without magnification.
Subjective: Symptoms
Abdominal pain (obstruction of bowel or bile ducts [biliary colic] with worms); wheezing and coughing
(pneumonitis [Loeffler’s syndrome]); occasional liver enlargement; fever. Worms (some larger than earthworm)
pass from the anus, nose and mouth and are often brought for diagnosis.
Focused History: Have you noted the presence of a worm in your stool? (occasionally migrate out of the
intestine) How large was the worm? (often the size of an earthworm)
Objective: Signs
Using Basic Tools: Cough and occasionally hepatomegaly; abdominal tenderness; decreased bowel sounds
Using Advanced Tools: Lab: Stool O&P (identify eggs or the adult worm); CBC (nutritional anemia)
Assessment:
Differential Diagnosis
Worm in stool - the presence of a visible worm in the stool is usually diagnostic.
Cough/wheezes - asthma and pneumonia can cause similar findings.
Plan:
Treatment:
Primary: Albendazole 400 mg once
Alternative: Mebendazole 100 mg bid for one day.
Patient Education
General: Wash hands thoroughly.
Activity: As tolerated
Diet: As tolerated
Medications: Occasional gastrointestinal side-effects
Prevention and Hygiene: Hand washing
No Improvement/Deterioration: Refer for evaluation
Follow-up Actions
Return evaluation: As needed
Consultation Criteria: Failure to improve.
ID: Babesiosis
LTC Glenn Wortmann, MC, USAIntroduction: Babesiosis is caused by Babesia species protozoa and is transmitted by deer tick bites.
Infection is most commonly reported in the Northeastern U.S., but has also occurred in Europe. It is typically
a mild illness in healthy people but it can be fatal, particularly in immunocompromised patients (especially
splenectomized patients). Incubation period is a few days to weeks.