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{{Ascariasis}}
{{Ascariasis}}
{{CMG}}; '''Associate Editor-In-Chief:''' Imtiaz Ahmed Wani, [[M.B.B.S]]
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==Overview==
==Overview==
Antimicrobial therapy with [[albendazole]] is usually the treatment of choice for ascariasis, although other antihelminthic medications can effectively eradicate the parasite.<ref name="Murray and Nadel's Textbook of Respiratory Medicine">Kim, Kami; Weiss, Louis; Tanowitz, Herbert (2016). "Chapter 39:Parasitic Infections". Murray and Nadel's Textbook of Respiratory Medicine Sixth Edition. Elsevier. pp. 682–698. ISBN 978-1-4557-3383-5.</ref>
==Medical Therapy==
==Medical Therapy==
Pharmaceutical treatments include:
All ascariasis infection (symptomatic and asymptomatic) should be treated with antimicrobial therapy.<ref name="Principles and Practice">{{cite book |last=Durand |first1=Marlene |title=Mandell, Douglas, and Bennett's Principles and Practice of Infectious Diseases Updated Edition, Eighth Edition |publisher=Elsevier |date=2015 |pages=3199-3207 |chapter=Chapter 288:Intestinal Nematodes (Roundworms) |isbn=978-1-4557-4801-3}}</ref> Due to the high rate of reinfection, it is sometimes necessary to repeat antimicrobial therapy.<ref name="Nelson Textbook of Pediatrics">Kliegman, Robert; Stanton, Bonita; St. Geme, Joseph; Schor, Nina (2016). "Chapter 291:Ascariasis (Ascaris lumbricoides)". Nelson Textbook of Pediatrics Twentieth Edition. Elsevier. pp. 1733–1734. ISBN 978-1-4557-7566-8.</ref> 
* [[Mebendazole]] (Vermox) (C<sub>16</sub>H<sub>13</sub>N<sub>3</sub>O<sub>2</sub>).  Causes slow immobilization and death of the worms by selectively and irreversibly blocking uptake of glucose and other nutrients in susceptible adult intestine where helminths dwell.  Oral dosage is 100 [[milligram|mg]] 12 hourly for 3 days.
* [[Piperazine]] (C<sub>4</sub>H<sub>10</sub>N<sub>2</sub>.C<sub>6</sub>H<sub>10</sub>O<sub>4</sub>).  A flaccid paralyzing agent that causes a blocking response of ascaris muscle to acetylcholine.  The narcotizing effect immobilizes the worm, which prevents migration when treatment is accomplished with weak drugs such as thiabendazole.  If used by itself it causes the worm to be passed out in the feces. Dosage is 75 mg/kg (max 3.5 g) as a single oral dose.
* [[Pyrantel pamoate]] (Antiminth, Pin-Rid, Pin-X) (C<sub>11</sub>H<sub>14</sub>N<sub>2</sub>S.C<sub>23</sub>H<sub>16</sub>O<sub>6</sub>)  Depolarizes ganglionic block of nicotinic neuromuscular transmission, resulting in spastic paralysis of the worm. Spastic (tetanic) paralyzing agents, in particular pyrantel pamoate, may induce complete intestinal obstruction in a heavy worm load.  Dosage is 11 mg/kg  not to exceed 1 g as a single dose.
* [[Albendazole]] (C<sub>12</sub>H<sub>15</sub>N<sub>3</sub>O<sub>2</sub>S) A broad-spectrum antihelminthic agent that decreases [[Adenosine triphosphate|ATP]] production in the worm, causing energy depletion, immobilization, and finally death. Dosage is 400 mg given as single oral dose (contraindicated during pregnancy and children under 2 years).
* [[Thiabendazole]]. This may cause migration of the worm into the [[esophagus]], so it is usually combined with piperazine.
* [[Hexylresorcinol]] effective in single dose, mentioned in : Holt, Jr Emmett L, McIntosh Rustin: Holt's Diseases of Infancy and Childhood: A Textbook for the Use of Students and Practitioners. Appleton and Co, New York,11th edition
* [[Santonin]], more toxic than [[hexylresorcinol]], mentioned in : Holt, Jr Emmett L, McIntosh Rustin: Holt's Diseases of Infancy and Childhood: A Textbook for the Use of Students and Practitioners. Appleton and Co, New York,, 11th edition
* Oil of ''Chenopodium'', more toxic than [[hexylresorcinol]], mentioned in : Holt, Jr Emmett L, McIntosh Rustin: Holt's Diseases of Infancy and Childhood: A Textbook for the Use of Students and Practitioners. Appleton and Co, New York, 11th edition


Also, [[corticosteroids]] can treat some of the symptoms, such as inflammation.
===Antihelminthic Regimen for Ascariasis<ref name="Principles and Practice">Durand, Marlene (2015). "Chapter 288:Intestinal Nematodes (Roundworms)". Mandell, Douglas, and Bennett's Principles and Practice of Infectious Diseases Updated Edition, Eighth Edition. Elsevier. pp. 3199–3207. ISBN 978-1-4557-4801-3.</ref><ref name="cdc1">Centers for Disease Control and Prevention.https://www.cdc.gov/parasites/ascariasis/health_professionals/index.html#tx Accessed on the 6th of March, 2017.</ref><ref name="pmid9580117">{{cite journal| author=Romero Cabello R, Guerrero LR, Muñóz García MR, Geyne Cruz A| title=Nitazoxanide for the treatment of intestinal protozoan and helminthic infections in Mexico. | journal=Trans R Soc Trop Med Hyg | year= 1997 | volume= 91 | issue= 6 | pages= 701-3 | pmid=9580117 | doi= | pmc= | url=http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=9580117  }} </ref><ref name="pmid8863040">{{cite journal| author=Khuroo MS| title=Ascariasis. | journal=Gastroenterol Clin North Am | year= 1996 | volume= 25 | issue= 3 | pages= 553-77 | pmid=8863040 | doi= | pmc= | url=http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=8863040  }} </ref><ref name="Nelson Textbook of Pediatrics">Kliegman, Robert; Stanton, Bonita; St. Geme, Joseph; Schor, Nina (2016). "Chapter 291:Ascariasis (Ascaris lumbricoides)". Nelson Textbook of Pediatrics Twentieth Edition. Elsevier. pp. 1733–1734. ISBN 978-1-4557-7566-8.</ref>===


Native Americans have traditionally used [[epazote]] (''Chenopodium ambrisioides'') for treatment, which was not as powerful as pharmaceutical compounds, but spontaneous passage of Ascarids provided some proof of efficacy.
* Preferred regimen
# [[Albendazole]] 400 mg PO single dose. [[Albendazole]] dose for children between the ages of 1-2 years is 200 mg.
# [[Mebendazole]] 500 mg PO single dose or 100 mg bid for 3 days
* Alternative regimen
# [[Ivermectin]] 150 to 200 µg/kg PO single dose
# [[Nitazoxanide]] 500 mg bid for 3 days (adolescents and adults); 200mg bid for 3 days (children 4-11 yrs of age); 100mg PO bid for 3 days (children 1-3 yrs of age)
# [[Levamisole]] 150 mg PO single dose. The pediatric dose is 2.5 mg/kg PO daily
# [[Pyrantel pamoate]] 11 mg/kg single dose PO, maximum 1.0 g
# [[Piperazine citrate]] 75 mg/kg/day for 2 days, maximum 3.5 g/day


Some recent studies exist in the medical literature suggesting that sun-dried [[papaya]] and watermelon seeds may reduce infections by a large factor. The adult dosage is one tablespoon of the seed powder in a glass of [[sugar]] water once a week for two weeks. The sugar makes the bitter taste palatable and acts as a [[laxative]].
===Management of Intestinal obstruction===
[[Intestinal obstruction]] due to ascariasis should be managed conservatively by:<ref name="Principles and Practice">{{cite book |last=Durand |first1=Marlene |title=Mandell, Douglas, and Bennett's Principles and Practice of Infectious Diseases Updated Edition, Eighth Edition |publisher=Elsevier |date=2015 |pages=3199-3207 |chapter=Chapter 288:Intestinal Nematodes (Roundworms) |isbn=978-1-4557-4801-3}}</ref><ref name="Nelson Textbook of Pediatrics">Kliegman, Robert; Stanton, Bonita; St. Geme, Joseph; Schor, Nina (2016). "Chapter 291:Ascariasis (Ascaris lumbricoides)". Nelson Textbook of Pediatrics Twentieth Edition. Elsevier. pp. 1733–1734. ISBN 978-1-4557-7566-8.</ref>


===Antimicrobial Regimen===
* Nasogastric decompression
* Fluid and electrolyte repletion
* [[Antihelminthic therapy]] once bowel motility is restored. [[Piperazine]] causes [[flaccid paralysis]] of the worms and this can help relieve the obstruction through rapid expulsion of the worms. It is preferably administered as a syrup via a [[nasogastric tube]] when treating intestinal or [[biliary obstruction]] due to ascariasis.
* Complete obstruction with inadequate decompression, lack of response within an interval of 24-48 hrs, [[volvulus]], [[intussusception]] or perforation should be managed surgically.


*Ascariasis
===Management of Biliary ascariasis<ref name="Principles and Practice">Durand, Marlene (2015). "Chapter 288:Intestinal Nematodes (Roundworms)". Mandell, Douglas, and Bennett's Principles and Practice of Infectious Diseases Updated Edition, Eighth Edition. Elsevier. pp. 3199–3207. ISBN 978-1-4557-4801-3.</ref>===
:*Preferred regimen: [[Albendazole]] 400 mg PO single dose {{or}} [[Mebendazole]] 500 mg PO single dose or 100 mg twice daily for 3 days<ref>{{Cite web | title = Parasites - Ascariasis| url = http://www.cdc.gov/parasites/ascariasis/health_professionals/}}</ref>
* Conservative management
:*Alternative regimen: [[Ivermectin]] 150 to 200 µg/kg PO once<ref>{{Cite web | title = Parasites - Ascariasis| url = http://www.cdc.gov/parasites/ascariasis/health_professionals/}}</ref>
# NG suction
# [[Antispasmodics]]
# [[Analgesics]]
# [[Intravenous fluids]]
# Antibiotics if evidence of bacterial infection
# Antihelminthic therapy
* Endoscopic or surgical removal


==References==
==References==
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Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]Associate Editor(s)-in-Chief: Fatimo Biobaku M.B.B.S [2]

Overview

Antimicrobial therapy with albendazole is usually the treatment of choice for ascariasis, although other antihelminthic medications can effectively eradicate the parasite.[1]

Medical Therapy

All ascariasis infection (symptomatic and asymptomatic) should be treated with antimicrobial therapy.[2] Due to the high rate of reinfection, it is sometimes necessary to repeat antimicrobial therapy.[3]

Antihelminthic Regimen for Ascariasis[2][4][5][6][3]

  • Preferred regimen
  1. Albendazole 400 mg PO single dose. Albendazole dose for children between the ages of 1-2 years is 200 mg.
  2. Mebendazole 500 mg PO single dose or 100 mg bid for 3 days
  • Alternative regimen
  1. Ivermectin 150 to 200 µg/kg PO single dose
  2. Nitazoxanide 500 mg bid for 3 days (adolescents and adults); 200mg bid for 3 days (children 4-11 yrs of age); 100mg PO bid for 3 days (children 1-3 yrs of age)
  3. Levamisole 150 mg PO single dose. The pediatric dose is 2.5 mg/kg PO daily
  4. Pyrantel pamoate 11 mg/kg single dose PO, maximum 1.0 g
  5. Piperazine citrate 75 mg/kg/day for 2 days, maximum 3.5 g/day

Management of Intestinal obstruction

Intestinal obstruction due to ascariasis should be managed conservatively by:[2][3]

  • Nasogastric decompression
  • Fluid and electrolyte repletion
  • Antihelminthic therapy once bowel motility is restored. Piperazine causes flaccid paralysis of the worms and this can help relieve the obstruction through rapid expulsion of the worms. It is preferably administered as a syrup via a nasogastric tube when treating intestinal or biliary obstruction due to ascariasis.
  • Complete obstruction with inadequate decompression, lack of response within an interval of 24-48 hrs, volvulus, intussusception or perforation should be managed surgically.

Management of Biliary ascariasis[2]

  • Conservative management
  1. NG suction
  2. Antispasmodics
  3. Analgesics
  4. Intravenous fluids
  5. Antibiotics if evidence of bacterial infection
  6. Antihelminthic therapy
  • Endoscopic or surgical removal

References

  1. ↑ Kim, Kami; Weiss, Louis; Tanowitz, Herbert (2016). "Chapter 39:Parasitic Infections". Murray and Nadel's Textbook of Respiratory Medicine Sixth Edition. Elsevier. pp. 682–698. ISBN 978-1-4557-3383-5.
  2. ↑ 2.0 2.1 2.2 2.3 Durand, Marlene (2015). "Chapter 288:Intestinal Nematodes (Roundworms)". Mandell, Douglas, and Bennett's Principles and Practice of Infectious Diseases Updated Edition, Eighth Edition. Elsevier. pp. 3199–3207. ISBN 978-1-4557-4801-3.
  3. ↑ 3.0 3.1 3.2 Kliegman, Robert; Stanton, Bonita; St. Geme, Joseph; Schor, Nina (2016). "Chapter 291:Ascariasis (Ascaris lumbricoides)". Nelson Textbook of Pediatrics Twentieth Edition. Elsevier. pp. 1733–1734. ISBN 978-1-4557-7566-8.
  4. ↑ Centers for Disease Control and Prevention.https://www.cdc.gov/parasites/ascariasis/health_professionals/index.html#tx Accessed on the 6th of March, 2017.
  5. ↑ Romero Cabello R, Guerrero LR, Muñóz García MR, Geyne Cruz A (1997). "Nitazoxanide for the treatment of intestinal protozoan and helminthic infections in Mexico". Trans R Soc Trop Med Hyg. 91 (6): 701–3. PMID 9580117.
  6. ↑ Khuroo MS (1996). "Ascariasis". Gastroenterol Clin North Am. 25 (3): 553–77. PMID 8863040.


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