Final Diagnosis

Final laboratory identification of the organism confirmed an Ascaris lumbricoides adult worm. The mother was contacted, and mebendazole 100 mg by mouth BID for 3 days was prescribed. The mother was educated on the life cycle of the A. lumbricoides and was also informed that other family members should have their stool tested, as there is an increased risk of contraction in family members of someone with the parasitic infection.

The mother was informed of the need for follow-up stool testing in 3 months, as antiparasitic therapy acts on the adult worm and not the larvae that may remain in the intestine.



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Table 1: Common soil-transmitted helminths

Parasite* Disease Prevalence
Ascaris lumbricoides Common roundworm infection, ascariasis 800 million to 1.4 billion
Trichuris trichiura Whipworm infection, trichuriasis 600 million to 1 billion
Necator americanus and Ancylostoma duodenale Hookworm infection 580 million to 1.2 billion
Strongyloides stercoralis Threadworm infection, strongyloidiasis 30 to 300 million
Enterobius vermicularis Pinworm infection 4% to 28% of children
Toxocara canis and Toxocara cati Visceral larva migrans and ocular larva migrans 2% to 80% of children
*All major parasites are found in tropical, subtropical, and temperate climates. Adapted from Bethony et al, 2006.

Conclusion

The CDC has identified ascariasis as one of the more common intestinal infections and can be found in areas with poor sanitation, poor personal hygiene, and in locations where human feces is used as fertilizer. It can also be more prevalent in travelers to or from endemic regions. This makes getting a thorough history critical to accurately placing ascariasis on the list of differential diagnoses.

All advanced practice providers should be cautious when deciding to initiate treatment of any diagnosis based on symptoms alone. Be mindful of treating pediatric patients, as they are not always good historians, and therefore practitioners are forced to rely on the history of others.

 
Helpful ascariasis websites for advanced practice providers

www.cdc.gov/parasites/ascariasis/gen_info/index.html
www.cdc.gov/parasites/ascariasis/health_professionals/
www.nlm.nih.gov/medlineplus/ency/article/000628.htm
www.who.int/water_sanitation_health/diseases/ascariasis/en/

This may not always be accurate or contain the detail that allows the provider to ultimately make the right diagnosis. Be mindful of risks versus benefits of the treatments associated with disease. Waiting a little longer can allow for confirmation of your diagnosis and prevent unnecessary complications from the pharmacologic and nonpharmacologic management that you would otherwise prescribe and recommend.

Christine Verni, MSN, FNP-BC, APRN, is an Assistant Professor, School of Nursing, D’Youville College in Buffalo, N.Y.


References


  1. Bari S, Sheikh KA, Ashraf M, et al. Ascaris liver abscess in children. 
J Gastroenterol. 2007;42(3):236-240.

  2. Bethony J, Brooker S, Albonico M, et al. Soil-transmitted helminth infections: 
ascariasis, trichuriasis, and hookworm. Lancet. 2006;367(9521):1521-1532.

  3. Butts C, Henderson SO. Ascariasis. Top Emerg Med. 2003;25(1):38-43.

  4. Cardenas VM, Mena KD, Ortiz M, et al. Hyperendemic H. pylori and tapeworm infections in a U.S.-Mexico border population. Public Health Rep. 2010;125(3):441-447. 

  5. Centers for Disease Control and Prevention. (2013). Parasites-Ascariasis. Retrieved from http://www.cdc.gov/parasites/ascariasis/epi.html
  6. Leder K, Weller P. Ascariasis. In Rose B (Ed): UpToDate. 2011. Retrieved from http://www.uptodate.com/contents/ascariasis?source=search_result&search=Ascariasis&selectedTitle=1~34
  7. Shoff, WH, Schoff CT, Greenberg, MT. Pediatric Ascariasis. Nov 16, 2012. Retrieved from https://www.clinicalpainadvisor.com/home/topics/abdominal-pelvis-pain/

All electronic resources were accessed on February 4, 2015.

This article originally appeared on Clinical Advisor