Communicable Diseases - Ascariasis uploaded by Mr. MOHIT DWIVEDI ,King George Medical University , Institute Of Nursing

1. Mr.Mohit Dwivedi
B.sc.(N) 2nd
Year
King George Medical University
Institute of Nursing

2. What is Ascariasis?
• Definition - Infection of the intestine with
Ascaris(Parasitic nematodes worms)
• Most common helminthic disease
– Estimated worldwide prevalence of 25%
– 0.8-1.22 billion people
• Usually asymptomatic
• Most prevalent in children
– Highest prevalence = 2 to 10 year olds
– Highest intensity = 5 to 15 year olds

4. Geographical Distribution
•Climate is an important factor
Warm and moist climates
–Latin America and Caribbean
–Sub-Saharan Africa
–Middle East and north Africa
–India
–South Asia
–East Asia and Pacific Islands
–China
–and areas with inadequate sanitation.

5. Ascaris lumbricoides
• Largest of nematodes
infecting humans
• Highest daily egg output
• Shortest lifespan

6. INFECTION TO MAN
It occurs when the man swallows the infective eggs
of Ascaris with contaminated food or water.
• Ascariasis can occur by way of trasnplacental
transmission, since many neonatal cases have been
documented.
Agent
Ascaris lumbricoides
M-20cm F-30cm
Reservoir of infection
Man

7. Period of communicability
Until all the stools are negative for the ascaris eggs
Environmental factors
Soil transmitted
For years eggs can survive under favourable conditions
Clay soils and low temperature are favourable
Open air defecation
Mode of transmission
Faeco-oral (food,water,pica)
Human to human direct transmission is impossible*
Incubation period
after ingestion of the eggs 4days -2 months

8. Ascaris lumbricoides life cycle
200,000 eggs/day
Embryonated egg
larva
Stage 2-3: 2-3 weeks, Stage 7-1: 2-3 months

9. Egg shed facts:
• Humans with ascariasis can shed in their faeces
– Fertilized eggs only
• 45% of infected persons
– Unfertilized eggs only
• 20% of infected persons
– Or fertilized and unfertilized eggs
• 40% of infected persons

10.  Adult worms live in the lumen of the small intestine.
A female may produce approximately 200,000 eggs
per day, which are passed with the faeces .
 Unfertilized eggs may be ingested but are not
infective. Fertile eggs embryonate and become
infective after 18 days to several weeks.
 After infective eggs are swallowed , the larvae hatch ,
invade the intestinal mucosa.
 Carried via the portal, then systemic circulation to
the lungs. larvae mature further in the lungs (10 to 14
days), penetrate the alveolar walls, ascend the
bronchial tree to the throat, and are swallowed.
 Upon reaching the small intestine, they develop into
adult worms. Between 2 and 3 months are required
from ingestion of the infective eggs to oviposition by
the adult female. Adult worms can live 1 to 2 years.

11. Symptoms of Ascariasis
 No symptoms
 Stage 1: worm larvae in the bowels attach to bowel walls
 Stage 2: worm larvae migrate into the lungs:
 Fever and breathing difficulty
 Coughing and pneumonia
 Stage 3: worms enter the small intestine and mature into worms
and remain there to feed
 Abdominal symptoms
 Abdominal discomfort
 Intestinal blockage - may be partial or complete
 Partial intestinal blockage
 Total intestinal blockage
 Severe abdominal pain
 Vomiting
 Restlessness
 Disturbed sleep
 Worm in stool
 Worm in vomit

12. Clinical features of
ascaris infection
Nausea, abdominal pain, cough
In severe cases:
Intestinal obstruction
May manifest into
– Growth retardation
– Pneumonitis/ verminous pneumonia
– Hepatobiliary and pancreatic injury

13. Diagnosis
Stool examination
Kato-Katz fecal smear
McMaster method
Ultrasonography and
endoscopy
ECRP(Endoscopic Retrograde
Cholangio Pancreatography)

14. o Abdominal x-ray or other
imaging tests
o Complete blood count
o Eosinophil count
oLiver Function Test may
reveal liver damage or low
protein state.
o Sputum for larva and
eosinophil count.

15. MANAGEMENT
Drug therapy
•Benzimidazole
anthelminthic drugs
– Albendazole
– Mebendazole
•During pregnancy
‾pyrantel pamoatepyrantel pamoate given as agiven as a
single dose ofsingle dose of 10 mg/kg10 mg/kg..
maximum of 1 g
Albendazole
http://commons.wikimedia.org/wiki/File:Albendazole_structure.png

16. Treatment
• Paralyzing vermifuges
– pyrantel pamoate
– Piperazine citrate —
Piperazine citrate (50 to
75 mg/kg QD up to a
maximum of 3.5 g for 2
days
– ivermectine
• Nitazoxanide
– Primariliy for protozoal
infection
• Vitamin A supplements
Pyrantel pamoate
http://commons.wikimedia.org/wiki/File:Pyrantel_pamoate.png

17. Drug Albendazole Mebendazole Levamisole Pyrantel
Dose 400 mg for 2
years and
above, 200mg
for 12-
24months.
single dose
500 mg
single dose
50-150 mg
or 2.5mg/kg
and 5 mg/kg
for children,
single dose
10 mg/kg
daily
for 3 days
C/I < 2 yr,
pregnancy
<2 yr,
pregnancy
<1 yr,
kidney
or
liver
disorder
<1 yr,
kidney
or
liver
disorder
Very common Treatment of ascaris infection

18. Surgery
• Deworming
– Should be done first
• Intestinal or Bilial
surgery
– ECRP
– Cholecystectomy
Photo extracted from http://www.medscape.com/viewarticle/451597_3

19. Prevention
• Community control
– Difficult to achieve
• Health education
– Along with sanitation programs
• Mass treatments
– They do not seem to decrease transmission rates
• Vaccine in progress
– Nasally administered 16-kd secretory protein

20. Prevention and control of ascaris infection
1.Sanitation
Prevent soil contact : Do not contact the soil
with bare hands in areas where ascariasis is common
Use of sanitary latrines
Do not use human excreta ,untreated sewage as manure in
agriculture
Vegetable should be thoroughly washed in a mild solution
of Pottasium permanganate and properly cooked before use.
Finger nails should be regularly cut to avoid the collection of
dirt and eggs below them.
Hands should be properly washed with some antiseptic soap
before touching edibles or eating

21. 2.Case finding, treatment, deworming
routine or preventive (prophylactic) treatment with
deworming medications.
o once/twice per year preschool and school-age children
women of childbearing age
3.Health Eduaction
use of saniatry latrine
prevention of soil pollution
diagnosis and treatment
deworming

22. NURSING CARE
Children and adults must be providedwith clean, comfortable toilets. Childrenmust be taught to use them for eachdefecation.
Wash hands after defecation andbefore feeding.
Careful washing of toy, rawvegetables.
All infected persons must receivetreatment.
In hospital, teach mother about:• Careful disposal of stools.
• Hygienic care and preventive measurs.• Avoid overdosage of Piperazine citratemay cause irritation to intestinalmucosa).
• Provide with

23. ANY QUESTIONANY QUESTION

24. REFERENCES
ONLINE RESOURCES-
o http://bestpractice.bmj.com/best-
practice/monograph/908/diagnosis/tests.htm
o https://en.wikipedia.org/wiki/Kato_technique
o http://www.rvc.ac.uk/review/parasitology/eggcount/Principle.
html
o https://www.ncbi.nlm.nih.gov/pubmed/16328339
o http://cal.vet.upenn.edu/projects/parasit06/website/mcmaster.
htm
o https://www.science.gov/topicpages/k/kato-
katz+thick+smears.html
o https://www.ncbi.nlm.nih.gov/pmc/articles/PMC2912565/
o http://www.healthline.com/health/ascariasis
o http://emedicine.medscape.com/article/212510-overview
o https://www.cdc.gov/parasites/ascariasis/
o http://www.mayoclinic.org/diseases-
conditions/ascariasis/basics/symptoms/con-20027084
o http://www.slideshare.net/search/slideshow?
searchfrom=header&q=Ascariasis
oBOOK-
o COMMUNITY MEDICINE WITH RECENT ADVANCES-4TH
EDITION ,PAGE NO.-434,WRITTEN BY – AH Suryakantha.
o THE SHORT TEXT BOOK OF COMMUNITY HEALTH