Internal Medicine

P1: SBT

0521779407-04 CUNY1086/Karliner 0 521 77940 7 June 13, 2007 7:8

Ascariasis 161

tests

■Basic tests: blood: eosinophilia present in migration phase

■Basic tests: urine: normal

■Specific tests: Stool for O&P will diagnose all but single male infec-

tions. Identification of passed worm is diagnostic.

■Other tests: In migration phase, chest X-ray may show patchy infil-

trates (Loeffler’s syndrome). Worms may be seen on upper GI series,

and ultrasound will usually detect worms in biliary tree.

differential diagnosis

■In migratory phase, a similar syndrome is seen with hookworm,

strongyloidiasis, and schistosomiasis in their migratory phases.

Other causes of Loeffler’s syndrome, asthma, industrial exposures,

etc., can be confused with pulmonary ascariasis.

■In intestinal phase, mild symptoms mimic almost any mild GI dis-

order.

management

What to Do First

■Assess severity of infection, look for worms in ectopic positions.

General Measures

■Find source of infection. Instruct on hygiene.

specific therapy

Indications

■Probably all patients should be treated, as the worms may migrate,

leading to complications.

Treatment Options

■Mebendazole for 3 days

■Pyrantel pamoate

■Albendazole

Side Effects & Complications

■Mild nonspecific intestinal complaints may occur, and pyrantel

pamoate may rarely cause headache, dizziness, rash. Occasionally a

worm will migrate during treatment.

■Contraindications: First-trimester pregnant women. Treat them later

in pregnancy, preferably with pyrantel pamoate.