UMEM Educational Pearls

Category: Visual Diagnosis

Title: What's the Diagnosis? Image by Dr. Jason Adler

Posted: 10/7/2012 by Haney Mallemat, MD (Emailed: 10/8/2012) (Updated: 10/8/2012)
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26 year-old male from Indonesia presents with severe abdominal pain and weight loss for the past two months. He also states he found this "worm" in the toilet (see below) after a bowel movement. What is the medical treatment for this condition? 


Answer: Mebendazole or albendazole 

The image above shows an Ascaris Lumbricoides (AL), the most common intestinal roundworm infection in humans. It typically occurs in inhabitants of impoverished areas with poor sanitation. 

Humans acquire AL from ingesting eggs from infected food or soil. Eggs hatch into larvae within the small intestine and then migrate through the mucosa to vascular beds of the alveoli within the lung. Larvae then migrate up the respiratory tree and are swallowed into the GI tract where they mate and more eggs are laid, maturing here or migrating to other organs within the body. 

Most infections are asymptomatic, but signs and symptoms can range from nonspecific pulmonary (first two weeks secondary to larval migration into lungs) to severe (after six weeks secondary to the mechanical effects of high parasite load in the gut). Symptoms include: 

  • Dyspnea, cough, wheezing, fever, etc. (migration of larvae through the lungs)
  • Malnourishment, iron-deficiency anemia, weight loss, GI obstruction, etc. (mechanical effects of a large parasite load)

Treatment during early infection is challenging because AL is non-specific and difficult to diagnose; symptomatic and supportive care is required. When the diagnosis is made, medications such as mebendazole and albendazole can be used to eradicate AL directly within the gut. Situations where worms cause intestinal obstruction, require manual debulking using scopes (e.g., colonoscopy) or surgery.


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