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Hon KL, Leung AKC. An update on the current and emerging pharmacotherapy for the treatment of human ascariasis. Expert Opin Pharmacother 2024. [PMID: 38372051 DOI: 10.1080/14656566.2024.2319686] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/29/2023] [Accepted: 02/13/2024] [Indexed: 02/20/2024]
Abstract
INTRODUCTION Globally, Ascaris lumbricoides is the commonest helminthic infection that affects people in underdeveloped countries and returning immigrants in industrialized nations. This article aims to provide latest updates on the epidemiology, clinical manifestations, and pharmacotherapy of ascariasis. AREAS COVERED A PubMed search was conducted using Clinical Queries and the key terms 'human ascariasis' OR 'Ascaris lumbricoides.' Ascaris lumbricoides is highly endemic in tropical and subtropic regions and among returning immigrants in industrialized nations. Predisposing factors include poor sanitation and poverty. The prevalence is greatest in young children. Most infected patients are asymptomatic. Patients with A. lumbricoides infection should be treated with anti-helminthic drugs to prevent complications from migration of the worm. Mebendazole and albendazole are indicated for children and nonpregnant women. Pregnant individuals should be treated with pyrantel pamoate. EXPERT OPINION Cure rates with anthelmintic treatment are high. No emerging pharmacotherapy can replace these existing drugs of good efficacy, safety profile and low cost for public health. It is opinioned that advances in the management of ascariasis include diagnostic accuracy at affordable costs, Emodepside is highly effective in single doses against ascarids in mammals and in human trials. The drug could be registered for human use in multiple neglected tropical diseases.
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Affiliation(s)
- Kam Lun Hon
- Department of Paediatrics, The Chinese University of Hong Kong, and Department of Paediatrics and Adolescent Medicine, Hong Kong Children's Hospital, Hong Kong, China
| | - Alexander K C Leung
- Department of Pediatrics, The University of Calgary and the Alberta Children's Hospital, Calgary, Alberta, Canada
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Muacevic A, Adler JR, George K, Poudel P, Chalasani R, Goonathilake MR, Waqar S, George S, Jean-Baptiste W, Yusuf Ali A, Mohammed L. An Overview of Ascariasis Involvement in Gallbladder Disease: A Systematic Review of Case Reports. Cureus 2022; 14:e32545. [PMID: 36654632 PMCID: PMC9840414 DOI: 10.7759/cureus.32545] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/10/2022] [Accepted: 12/15/2022] [Indexed: 12/23/2022] Open
Abstract
Ascaris lumbricoides is the most common type of helminth infection in humans. It affects more than one billion of the world's population. Children living in developing nations are prone to ascariasis, presenting with obstructive biliary illnesses. Migration of Ascaris worms through the major duodenal papilla to the hepatobiliary system leads to symptoms of biliary colic and complications along the biliary tree. In April 2022, we performed a systematic review of case reports to identify and examine cases of gallbladder ascariasis worldwide. A methodical search using PubMed, Semantic Scholar, ScienceDirect, and Directory of Open Access Journals yielded 2773 studies. After duplicate removal, title, abstract, and content screening, retrieval, and quality assessment, 13 studies met the criteria for this systematic review of case reports. The cases and results from these 13 studies revealed gallbladder ascariasis in different age groups worldwide. This systematic review discusses ascariasis, explicitly highlighting its presence in the gallbladder, symptomatic presentation, laboratory/imaging findings, complications, and approach to management.
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Freeman M, Kc M, Amateau SK. Identification of Ascaris lumbricoides Eggs within the Pancreas Using Endoscopic Ultrasound. Am J Trop Med Hyg 2022; 107:tpmd220145. [PMID: 36067992 PMCID: PMC9651514 DOI: 10.4269/ajtmh.22-0145] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/22/2022] [Accepted: 06/20/2022] [Indexed: 11/07/2022] Open
Affiliation(s)
- Morgan Freeman
- Department of Medicine, University of Minnesota, Minneapolis, Minnesota
| | - Mandip Kc
- Division of Gastroenterology, Hepatology and Nutrition, Department of Medicine, Minneapolis, Minnesota
| | - Stuart K. Amateau
- Division of Gastroenterology, Hepatology and Nutrition, Department of Medicine, Minneapolis, Minnesota
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Barkhatova NA, Peshikova MV, Shlepotina NM, Barkhatova EI, Peshikov OV. [Ascaris lumbricoides-induced pancreatic lesion]. Khirurgiia (Mosk) 2022:71-76. [PMID: 35775847 DOI: 10.17116/hirurgia202207171] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/15/2023]
Abstract
Ascaris lumbricoides is nematode localized in human small bowel in most cases. This nematode is capable for migration. Pancreatitis is one of the most common surgical diseases. One of the causes of this pancreatitis may be migration of Ascaris lumbricoides from small bowel through the major duodenal papilla to the pancreatic ducts. This migration is provided by complex of morphological and functional disorders of digestive system associated with this helminthiasis, as well as certain risk factors. These are previous cholecystectomy, sphincterotomy, living in endemic areas, massive Ascaris lumbricoides invasion, pregnancy. Damage of the pancreas develops due to direct mechanical effect of nematodes and allergic reactions, papillitis and functional disorders of digestive tract. Pancreatitis is usually mild, but severe course of disease is also possible. A typical symptom of pancreatitis caused by Ascaris lumbricoides is helminths in vomit and/or feces.
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Affiliation(s)
- N A Barkhatova
- South Ural State Medical University, Chelyabinsk, Russia
| | - M V Peshikova
- South Ural State Medical University, Chelyabinsk, Russia
| | - N M Shlepotina
- South Ural State Medical University, Chelyabinsk, Russia
| | - E I Barkhatova
- South Ural State Medical University, Chelyabinsk, Russia
| | - O V Peshikov
- South Ural State Medical University, Chelyabinsk, Russia
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Leung AK, Leung AA, Wong AH, Hon KL. Human Ascariasis: An Updated Review. ACTA ACUST UNITED AC 2021; 14:133-145. [DOI: 10.2174/1872213x14666200705235757] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/22/2020] [Revised: 05/25/2020] [Accepted: 06/11/2020] [Indexed: 11/22/2022]
Abstract
Background:
Ascaris lumbricoides is the most common helminthic infection. More than
1.2 billion people have ascariasis worldwide.
Objective:
This article aimed to provide an update on the evaluation, diagnosis, and treatment of ascariasis.
Methods:
A PubMed search was conducted in February 2020 in Clinical Queries using the key
terms “ascariasis” OR “Ascaris lumbricoides”. The search strategy included meta-analyses, randomized
controlled trials, clinical trials, observational studies, and reviews published within the
past 10 years. The search was restricted to English literature. The information retrieved from the
above search was used in the compilation of the present article. Patents were searched using the
key term “ascariasis” OR “Ascaris lumbricoides” in www.freepatentsonline.com.
Results:
Ascaris lumbricoides is transmitted through the ingestion of embryonated eggs from fecal-
contaminated material. Ascariasis has high endemicity in tropical and subtropical areas. Predisposing
factors include poverty, poor sanitation, inadequate sewage disposal, and poor personal hygiene.
The prevalence is greatest in children younger than 5 years of age. The majority of patients
with intestinal ascariasis are asymptomatic. For those with symptoms, anorexia, nausea, bloating,
abdominal discomfort, recurrent abdominal pain, abdominal distension, and intermittent diarrhea
are not uncommon. Other clinical manifestations vary widely, depending on the underlying complications.
Complications include Löeffler syndrome, intestinal obstruction, biliary colic, recurrent
pyogenic cholangitis, cholecystitis, acalculous cholecystitis, obstructive jaundice, cholelithiasis,
pancreatitis, and malnutrition. The diagnosis is best established by microscopic examination of fecal
smears or following concentration techniques for the characteristic ova. Patients with A. lumbricoides
infection warrant anthelminthic treatment, even if they are asymptomatic, to prevent complications
from migration of the parasite. Albendazole and mebendazole are the drugs of choice for
children and nonpregnant individuals with ascariasis. Pregnant women with ascariasis should be
treated with pyrantel pamoate. Recent patents related to the management of ascariasis are also discussed.
Conclusion:
The average cure rate with anthelminthic treatment is over 95%. Unfortunately, most
treated patients in endemic areas become re-infected within months. Health education, personal hygiene,
improved sanitary conditions, proper disposal of human excreta, and discontinuing the use
of human fecal matter as a fertilizer are effective long-term preventive measures. Targeting deworming
treatment and mass anthelminthic treatment should be considered in regions where A. lumbricoides
is prevalent.
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Affiliation(s)
- Alexander K.C. Leung
- Department of Pediatrics, The University of Calgary, Alberta Children’s Hospital, Calgary, Alberta, Canada
| | - Amy A.M. Leung
- Department of Family Medicine, The University of Alberta, Edmonton, Alberta, Canada
| | - Alex H.C. Wong
- Department of Family Medicine, The University of Calgary, Calgary, Alberta, Canada
| | - Kam L. Hon
- Department of Paediatrics, The Chinese University of Hong Kong, and Department of Paediatrics and Adolescent Medicine, Hong Kong Children’s Hospital, Shatin, Hong Kong
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Hussain T, Walizada K, Khan T, Khan R, Mushtaq Z. Ascaris Lumbricoides Infestation as an Unexpected Cause of Acute Pancreatitis. Cureus 2020; 12:e12103. [PMID: 33489520 PMCID: PMC7805493 DOI: 10.7759/cureus.12103] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022] Open
Abstract
Ascariasis is the most common helminthic infection. It is most common in children of tropical and developing countries where the transmission is by contamination of soil by human feces or use of untreated feces as fertilizer. Transmission in most endemic areas is via person to person contact. We hereby present a case report of acute pancreatitis due to ascariasis. Twenty-five-year-old male patient presented to us with chief complaint of acute epigastric pain radiating to back and associated with vomiting. Initial lab investigations revealed increased serum amylase and lipase. Probable diagnosis of acute pancreatitis was made. CT scan was done and report revealed bulky pancreas, and significant peri-pancreatic fat stranding. He was managed symptomatically with intravenous fluids, analgesics, anti-emetics and enteral nutrition. However, the cause remained undetermined as we ruled out the possible etiologies of acute pancreatitis until one day the patient vomited a 15-cm round worm. Thereafter, his condition improved dramatically. This is one of the first few case reports of ascariasis-induced pancreatitis from Pakistan and the first one from Baluchistan province of Pakistan. Thus it highlights ascariasis as possible etiology of acute pancreatitis in regions where ascariasis is geographically endemic.
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Affiliation(s)
| | | | - Tuba Khan
- Medicine and Surgery, Ziauddin Medical College, Karachi, PAK
| | - Rajeswari Khan
- Medicine and Surgery, College of Medicine & Sagore Dutta Hospital, Kolkata, IND
| | - Zahra Mushtaq
- Internal Medicine, Sandeman Provincial Hospital, Quetta, PAK
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Zahida K, Joseph P, Balaraju G, Al Kaabi SRM, Naushad VA. Hidden Nematode Causing Recurrent Pancreatitis: A Case Report. Cureus 2020; 12:e11835. [PMID: 33409075 PMCID: PMC7781542 DOI: 10.7759/cureus.11835] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022] Open
Abstract
Even though hepatobiliary ascariasis has been found to cause pancreatitis, it is rare in Qatar and other countries in the Middle East. In this report, we present a case of biliary duct ascariasis causing recurrent pancreatitis. A 46-year-old woman from the Philippines presented with recurrent clinical and biochemical features of acute pancreatitis and was found to have hepatobiliary ascariasis. She was successfully treated with endoscopic retrograde cholangiopancreatography (ERCP) and antihelminthic medication. Although hepatobiliary ascariasis as a cause of pancreatitis is rare, it should be considered in patients with recurrent pancreatitis without an obvious cause, especially in those from endemic areas or those who have visited endemic areas.
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Abstract
Ascariasis is a frequent human gastrointestinal tract helminthic disease caused by Ascaris lumbricoide. It usually stays in the intestinal lumen and occasionally migrates into the biliary tract through ampulla of Vater. Biliary ascariasis is a critical complication of intestinal ascariasis with life-threatening manifestations. We report a case of a-38 year-old lady who presented with colicky type epigastric pain radiating to back with diffuse tenderness over abdomen on examination. Ultrasonography abdomen showed linear echogenic structure in common bile duct. Biliary ascariasis was noted on Endoscopic Retrograde Cholangio Pancreaticography following which extraction was done. Our report highlights the varied clinical features of biliary ascariasis.
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Affiliation(s)
- Nita Lohala
- Kathmandu University School of Medical Sciences, Dhulikhel, Kavre
| | | | - Ram Bhattarai
- Department of Internal Medicine, Dhulikhel Hospital, Dhulikhel, Kavre
| | - Anjila Lama
- Department of Internal Medicine, Dhulikhel Hospital, Dhulikhel, Kavre
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Serrano-Moliner M, Morales-Suarez-Varela M, Valero MA. Epidemiology and management of foodborne nematodiasis in the European Union, systematic review 2000-2016. Pathog Glob Health 2018; 112:249-258. [PMID: 29957154 PMCID: PMC6225410 DOI: 10.1080/20477724.2018.1487663] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022] Open
Abstract
BACKGROUND Foodborne nematodiasis are caused by the ingestion of food contaminated by helminths. In Europe, these diseases are present in all countries. OBJECTIVES To review the available data on epidemiology and management of foodborne nematodiasis in the European Union, detect any trends and determine the possible causes of the observed changes. METHODS A review of available literature published between 2000 and 2016 was conducted. RESULTS Out of 1523 cases described in the literature, 1493 cases were autochthonous and 30 cases were imported. The detected parasites were Toxocara spp (34.7%), Ascaris lumbricoides (27.1%), Trichinella spp (21.9%), Anisakis spp (15.5%) and Angiostrongylus cantonensis (0.8%). CONCLUSIONS Foodborne nematodiasis remains a public health challenge for the European Union. Autochthonous cases of nematodiasis present the greatest health risk within the European Union. Foodborne nematodes due to lack of hygiene in food processing are diseases that can be avoided by increasing.
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Affiliation(s)
- Marta Serrano-Moliner
- Department of Cellular Biology and Parasitology, University of Valencia, Burjassot, Spain
| | - María Morales-Suarez-Varela
- Department of Preventive Medicine and Public Health, Food Science, Toxicology and Legal Medicine, University of Valencia, Burjassot, Spain
- CIBER of Epidemiology and Public Health (CIBERESP), Centro de Investigacion Biomedica en Red (CIBER), Madrid, Spain
| | - M. Adela Valero
- Department of Cellular Biology and Parasitology, University of Valencia, Burjassot, Spain
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Chauhan U, Jain N, Kumar Puri S, Garg L, Singh M. Intrahepatic ascariasis – Common parasite at an uncommon site. ASIAN PACIFIC JOURNAL OF TROPICAL DISEASE 2016. [DOI: 10.1016/s2222-1808(16)61104-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
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Abstract
Ascariasis lumbricoides is one of the most common helminthic infestations in humans. Despite the fact that the prevalence of ascariasis in developed countries has been decreasing, biliary ascariasis can cause serious complications, such as acute cholangitis, pancreatitis, and liver abscess. Here we presented a rare ascariasis-related complication-hepatolithiasis.A 60-year-old female patient had symptoms of recurrent cholangitis. Abdominal computed tomography scan revealed left intrahepatic duct stones with left liver lobe atrophy. Endoscopic retrograde cholangiopancreatography was performed, but the stones could not be removed due to left main intrahepatic duct stenosis. The patient was treated with left hemi-hepatectomy. Unexpectedly, Ascaris ova were found on the histopathological examination. She received antihelminthic therapy orally and was on regular follow-up without any complications.Our study indicates that clinicians should be aware of biliary ascariasis in patients with hepatolithiasis, though not living in endemic areas.
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Affiliation(s)
- Chen-Fang Lee
- From the Department of Liver and Transplantation Surgery (C-FL, W-CL); and Department of Pathology (R-CW, T-CC), Chang Gung Memorial Hospital at Linkou, Chang Gung University College of Medicine, Taoyuan, Taiwan
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