Ascaridosis in children

Ascariasis is an invasion by the roundworm Ascaris. It may initially occur as an allergic disease with fever, skin rashes, "flying" eosinophilic infiltrates in the lungs, hypereosinophilia of the blood; in the chronic stage, ascariasis is usually accompanied by moderate abdominal pain, dyspeptic disorders, and sometimes asthenia.

ICD-10 code

• B77.0 Ascariasis with intestinal complications.
• 877.8 Ascariasis with other complications.
• 877.9 Ascariasis, unspecified.

Epidemiology

Ascariasis is common in all climate zones of the globe, with the exception of permafrost regions, highlands, and deserts. The population of humid tropical and subtropical climate zones is most affected.

Ascariasis is classified as a geohelminthiasis. Eggs excreted with feces enter the soil, where they mature within 2-3 weeks, depending on the ambient temperature, humidity, and aeration. Infection occurs when consuming vegetables, fruits, and drinking water contaminated with parasite eggs. Ascaris eggs are sensitive to high temperatures and drying; in moist soil, they can remain viable for up to 6 years. Transmission of ascariasis in the middle zone occurs from April to October, and in tropical climates - throughout the year. Children aged 5-10 years are most affected by ascariasis due to their activity, poor hygiene skills, and lack of immunity to the invasion.

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Cause of ascariasis

Ascaris is a large, spindle-shaped, pale pink worm. The female is 25-40 cm long, the rear end of the body is straight and pointed, the male is 15-20 cm long, the tail end is hooked onto the ventral side. The body of the helminth is covered with a thick, transversely striated cuticle. The female lays more than 200 thousand fertilized and unfertilized eggs per day in the intestinal lumen. The eggs are excreted with feces into the environment. The lifespan of an ascaris is about 1 year.

What causes ascariasis?

Symptoms of ascariasis

The incubation period for ascariasis is 2-3 weeks. With low-intensity invasion, the early stage of the disease is subclinical. In preschool and early school-age children, the acute phase of the disease usually manifests itself as fever or high subfebrile temperature, skin exudative rashes, sometimes pain throughout the abdomen, nausea, and bowel disorder. Most often, pulmonary syndrome is noted in the form of a dry or wet cough with the development of "flying" infiltrates, less often - pneumonic foci, blood eosinophilia up to 20-40% against the background of leukocytosis up to 12-15 x 10 ⁹ /l. In case of particularly massive invasion, in addition to pneumonia and pleuropneumonia, granulomatous hepatitis with hepatosplenomegaly, moderate jaundice, increased serum transaminase activity, alkaline phosphatase, bilirubin level, all globulin fractions and changes in sedimentation test parameters may develop. Heart damage with tachycardia, muffled heart sounds, signs of dystrophic changes in the myocardium are not excluded.

Symptoms of ascariasis

Diagnosis of ascariasis

The diagnosis in the acute stage is established on the basis of the epidemiological anamnesis, clinical picture of febrile disease with skin, pulmonary syndromes, hypereosinophilia, transient dyspeptic phenomena. To confirm the diagnosis, a serological study is carried out with ascariasis diagnosticum (RNGA, ELISA), which gives positive results already 2-3 weeks after infection. It is rarely possible to detect larvae in sputum, but a naturally large number of eosinophils is noted, sometimes Charcot-Leyden crystals are visible. After 2-2.5 months after infection, the diagnosis of ascariasis is confirmed by detecting parasite eggs in feces. Ascaris eggs are 0.05-0.1 x 0.1-0.04-0.06 mm in size. oval, with a double-contour shell, which in fertilized eggs is usually surrounded by a scalloped protein shell, colored yellow or brownish by the pigments of the intestinal contents. Unfertilized eggs are irregular, spherical or even triangular in shape, rarely surrounded by a protein shell, filled with large irregularly shaped yellow bodies. The Kato method is used, and for enrichment - the ether-formaldehyde method. Currently, non-invasive methods for detecting ascaris antigens in feces, urine, sputum are being developed.

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Treatment of ascariasis

In the acute stage of ascariasis, treatment is carried out with antihistamines. Calcium chloride, calcium gluconate, and ascorbic acid solutions are taken orally; in severe cases of the disease, parenteral administration is used. The larval stage of ascarids is treated with a thiazolyl-benzimidazole derivative, mintezole (thiabendazole), at a dose of 25 mg/kg per day in 3 doses after meals for 5 days. Treatment can cause an increase in allergic reactions, so it must be carried out in a hospital against the background of desensitizing therapy up to the administration of glucocorticoids in moderate doses for 5-7 days.

Treatment of ascariasis

Prevention of ascariasis

Consists, first of all, in developing children's hygiene skills: washing hands after using the toilet, before eating, consuming only thoroughly washed fruits and vegetables, boiled water. Environmental protection from contamination by ascaris eggs is achieved by neutralizing sewage using settling tanks and filtration, chlorination and filtration of tap water. In rural areas, proper and timely cleaning of cesspools to prevent sewage from entering water sources, and the use of feces for fertilizing gardens and vegetable gardens only after 4 years of composting are of great importance.