ASCARIASIS

ASCARIASISBY: ANTOLIN, Shelila Hope D.ZETA, Jamaica MaeBSN3-AEtiologic Agent:Ascaris lumbricoides

ASCARIASIS

An infection caused by parasitic roundworm. Ascaris lumbricoides.Ascariasis is particularly prevalent in tropical and sub-tropical regions where hygiene is poor. The geographic distributions of Ascaris are worldwide in areas with warm, moist climates and are widely overlapping.

Once consumed, the eggs hatch and release immature roundworms called larvae within the small intestine. Within a few days, the larvae then move through the bloodstream to the lungs, exit up through the large airways of the lungs, and are swallowed back into the stomach and reach the small intestine.During movement through the lungs the larvae may produce an uncommon form of pneumonia called eosinophilic pneumonia. Once they are back in the small intestine, the larvae mature into adult roundworms. Adult worms live in the small intestine where they lay eggs that are present in feces. They can live 10 24 months.It is estimated that 1 billion people are infected worldwide. Ascariasis occurs in people of all ages, though children are affected more severely than adults.

SYMPTOMS

Most of the time, there are no symptoms. If there are symptoms, they may include;Nausea and VomitingDiarrhea Vomiting wormsBloody SputumCough Low-grade feverPassing worm in stoolShortness of breathSkin rashStomach painWheezingWorms exiting through the nose or mouth

Life CycleOf ascaris:Embryonated ova

Larval stage

Adult

LIFE CYCLE OF ASCARIS:

1. EMBRYONATED OVA- Soil contamination with human excreta- Contamination of food, water and other objectsIngested to intestine

2. LARVAL STAGE - The larvae penetrate the walls of the intestine (duodenum)- The larvae are picked up by lymphatics or bloodstream.- They are carried to the liver.- Some larvae may reach the heart.- Sometimes they are carried to the biliary tract.

- Nausea and vomiting, poor appetite- Periumbilical pain- Right upper quadrant pain

DEVELOPMENTAL STAGESYMPTOMATOLOGY- They may reach the stomach, esophagus, and then the upper respiratory tract.- They may stay in the capillaries of the lungs, and then reach the alveoli, where they grow and molt for ten days.- From the alveoli, they migrate to the bronchioles, bronchi, trache, and epiglottis.- Ascaris in the larvae stage may be swallowed or ingested.- Cough, fever, rales, blood-tinged sputum

- Nasal pruritus if larvae reach the nose3. ADULT-Adult ascaris stays in the small intestine.

At times they become erratic that they go to the stomach to the esophagus, and sometimes to the common bile duct and the gall bladder.

- in the GI tract, they copulate. The female lay eggs about 2-3 months after embryonated eggs are ingested.

- Colicky, periumbilical pain aggravated by cold stimulation (Nakamura sign)

- Intestinal obstruction may be caused by a bolus of entangled worms which may be palpable

- Severe abdominal pain associated with vomitingRisk factorsRisk factors for ascariasis include: Age. Most people who have ascariasis are 10 years old or younger. Children in this age group may be at higher risk because they're more likely to play in dirt.

Warm climate. Ascariasis worms thrive in mild climates. In the United States, ascariasis is more common in the Southeast. But it's more prevalent in developing countries with warm temperatures year-round. Poor sanitation. Ascariasis is widespread in developing countries where human feces are allowed to mix with local soil.

POSSIBLE COMPLICATIONS:

Malabsorption -The malabsorption may be due to a loss of brush border enzymes, erosion and flattening of the villi, and inflammation of thelamina propia (a thin layer ofloose connective tissue which lies beneath the epithelium and together with the epithelium constitutes themucosa).Blockage in the intestineMalnutrition -The worms in the intestine causemalabsorptionandanorexia which contribute to malnutrition.

INCUBATION PERIOD:The lifecycle requires four to eight weeks to complete. Ascaris eggs are unsegmented when passed and require a period of two or three weeks outside the host to develop to the infective stage. Mature female worms have been estimated to produce an average of 200, 000 eggs per day.MODE OF TRANSMISSIONAscaris lumbricoides is transmitted through: 1. contaminated fingers put into the mouth.2. ingestion of food and drinks contaminated with embryonated eggs can transmit ascariasis.

DIAGNOSTIC EXAM:

Stool for ova demonstration of fertilized or unfertilized eggs in the stools (Kato-Katz technique)Abdominal x-ray densed shadow of adult ascaris which looks like strands of spaghetti (dot sign)- Signs of intestinal obstruction if bolus is big enough to cause a mechanical ileus.Routine blood counts significant eosinophelia

TREATMENT:

Albendazole or mebendazole 15 cc as a single dose- 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.Piperazine citrate- 75 mg/kg twice daily, orally- 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. -Pyrantel pamoate- 1mg/kg as a single dose, orally- 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.

COMMON NURSING DIAGNOSES:

Altered nutrition: less than body requirementKnowledge deficit Alteration in bowel eliminationFluid volume deficitAnxietySleep pattern disturbanceNURSING INTERVENTIONS:

Improve the nutritional status of the patient by letting the patient eat nutritious foods that are washed well with clean water, and they should minimize eating foods that are raw because embryonated eggs may be present, especially in areas where hygiene is poor.Preventive measures in each home and in the community should be enforced.All members of the family must be taught on sanitary practices such as washing of hands before handling food, washing of all fruits and vegetables that are eaten raw, and effective sewage disposal.

Availability of toilet facilities must be ensured.Importance of personal hygiene should be explained.Proper disposal of diapers should be emphasized to mothers.Explain to the family the importance of increase in fluid intake (esp. safe drinking water)Explain to the patient that isolation is not needed; show support, provide comfort, assistance or encouragement to the patient.Maintain a supportive, calm, confident methods to interact with the patient all the timesAllow client to continue usual sleep practices (e.g. position; time; presleep routines such as reading, watching television, listening to music, ) whenever possible; satisfy basic needs such as comfort and warmth before sleep.

PREVENTION:

Improved sanitation and hygienic practicesImproved nutritionDeworming may be advised.When travelling to areas where sanitation and hygiene are poor, avoid water or food that may be contaminated.