Ascaris lumbricoides (Parasitic Roundworms) – Overview & Testing

Do you plan to travel this summer? Are you worried about what might be lurking in the food and environment while you travel? Then, you will enjoy this educational blog post!

Currently, Ascaris lumbricoides is the most common helminthic (parasitic worm) infection worldwide. More than a billion people are infected with Ascaris lumbricoides in the world right now, and it is more common in areas with poor sanitation.¹

Ascaris lumbricoides is the Latin name for a parasitic roundworm. While the eggs are microscopic, the mature, adult roundworm is large enough to be seen with the naked eye. The adult female worm can grow up to 20-35 cm in length, which is over 13 inches long. The adult male worm can grow up to 15-30 cm in length or nearly a foot long.¹

How Common Are Infections with Ascaris lumbricoides (and other Parasites) in the United States?

Populations in the United States have not been thoroughly tested for Ascaris lumbricoides infections in recent years. A systematic review published in 2011 noted that high-quality studies performed between 1942 and 1982 concluded parasitic infection was highly prevalent throughout the southern US.²

One of the most recent studies included in the review was performed in the Southeastern United States in the 1980s. The study determined over 55% of participants were infected with whipworm, almost 20% had a hookworm infection, and nearly 50% were infected with Ascaris lumbricoides. Therefore, as recently as the 1980s, there is evidence over half of people living in the southern US had a parasitic infection. Even with improvements in sanitation and agriculture methods, it is possible those living in the US could be infected with a parasite.^2,3

A case study published this year, in 2024, describes the case of a 2-year-old girl in Mississippi who recently expelled a large adult Ascaris lumbricoides worm into her diaper. She never traveled outside the United States but did live on a farm.⁴

The Unusual Life Cycle of the Parasite Ascaris lumbricoides

The life cycle of Ascaris lumbricoides begins in the intestines, where an adult female worm can lay approximately 200,000 eggs per day. The sticky eggs are then excreted in the stool and can infect others if fertilized. The eggs can be on surfaces in the home environment, on hands after using the restroom, or in soil where plumbing is not readily available. Eggs in the soil can contaminate fruits, vegetables, herbs, animals, and humans that touch or eat the soil.¹

Once eggs are swallowed via food contamination, exposure to fecal matter, or hand-to-mouth contact with a contaminated substance or surface, the eggs hatch in the intestine. After hatching, the larvae migrate to the liver and the lungs within the first week of infection. The larvae then mature in the lungs and climb into the throat, where they are swallowed to travel back into the intestines. They then become adult worms in the intestine and begin producing more eggs.¹

An adult worm can live in the intestines for up to approximately two years, while the eggs can remain viable and infectious in soil for up to 10 years despite freezing temperatures and extreme heat.^4,5

What are the Symptoms of an Infection with Ascaris lumbricoides (Ascariasis)?

An infection with the parasite Ascaris lumbricoides is known as ascariasis. Those with ascariasis often have no symptoms. But, since the larvae travel throughout the body, from the intestines to the liver, to the lungs, and then back to the intestines, several symptoms are possible.¹

Signs & symptoms of ascariasis can include:

• Abdominal pain
• Anorexia
• Appendicitis
• Asthma
• Atopic Dermatitis
• Bloating
• Cough
• Cholangitis (inflammation of the bile ducts)
• Cholecystitis (inflammation of the gallbladder)
• Diarrhea
• Eosinophilia - elevated eosinophil count in the blood
• Fever
• Hemoptysis (Coughing up blood)
• Hives
• Intestinal obstruction
• Intestinal perforation
• Liver abscess
• Nausea
• Nutrient deficiencies
• Pancreatitis
• Pneumonia
• Pneumonitis
• Shortness of breath
• Vomiting
• Wheezing^1,6-9

How Do You Test for Ascaris lumbricoides and other Parasites?

The gold standard method of diagnosing an Ascaris lumbricoides infection is stool microscopy.¹ For a stool microscopy test, a stool sample is collected and sent to the laboratory. The sample is inspected under the microscope for Ascaris lumbricoides eggs and worms. When an egg or a worm is present in the stool, an Ascaris lumbricoides infection is confirmed.¹⁰

But - eggs and worms are not necessarily expelled or shed with every bowel movement. Therefore, the Centers for Disease Control (CDC) in the US recommends the collection of three or more stool samples, each collected on a different day, for analysis.¹⁰

While the test is not perfect, stool microscopy is the preferred diagnostic test since mature adult females lay so many eggs, approximately 200,000 per day. Please note the stool microscopy test will be negative during migration and maturation of the worm(s), which takes approximately one month to 70 days.^11,12 This is another reason why multiple samples could be required to confirm an active infection via stool microscopy testing.¹¹

Imaging and blood tests may also be ordered by your doctor to diagnose a parasitic infection.^10,11

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References:

1. Ahmed M. Intestinal Parasitic Infections in 2023. Gastroenterology Res. 2023;16(3):127-140. doi:10.14740/gr1622
2. Starr MC, Montgomery SP. Soil-transmitted Helminthiasis in the United States: a systematic review--1940-2010. Am J Trop Med Hyg. 2011;85(4):680-684. doi:10.4269/ajtmh.2011.11-0214
3. Miswan N, Singham GV, Othman N. Advantages and Limitations of Microscopy and Molecular Detections for Diagnosis of Soil-transmitted Helminths: An Overview. Helminthologia. 2022;59(4):321-340. Published 2022 Dec 30. doi:10.2478/helm-2022-0034
4. Hobbs CV, Rhinewalt JM, Arguello I, et al. Autochthonous Ascariasis, Mississippi, USA. Emerg Infect Dis. 2024;30(4):821-823. doi:10.3201/eid3004.240176
5. CDC - Ascariasis - Prevention & Control. Centers for Disease Control and Prevention. February 15, 2018. Accessed May 13, 2024. https://www.cdc.gov/parasites/ascariasis/prevent.html.
6. Bethony J, Brooker S, Albonico M, et al. Soil-transmitted helminth infections: ascariasis, trichuriasis, and hookworm. Lancet. 2006;367(9521):1521-1532. doi:10.1016/S0140-6736(06)68653-4
7. Cheema HA, Waheed N, Saeed A. Rare presentation of haemobilia and Loeffler's pneumonia in a child by ascaris lumbricoides. BMJ Case Rep. 2019;12(8):e230198. doi:10.1136/bcr-2019-230198
8. Buendía E, Zakzuk J, Mercado D, et al. The IgE response to Ascaris molecular components is associated with clinical indicators of asthma severity. World Allergy Organ J. 2015;8(1):8. doi:10.1186/s40413-015-0058-z
9. Qualizza R, Losappio LM, Furci F. A case of atopic dermatitis caused by Ascaris lumbricoides infection. Clin Mol Allergy. 2018;16:10. doi:10.1186/s12948-018-0088-5
10. CDC - Parasites - resources - diagnosis. Centers for Disease Control and Prevention. October 5, 2023. Accessed May 13, 2024. https://www.cdc.gov/parasites/references_resources/diagnosis.html.
11. de Lima Corvino DF, Horrall S. Ascariasis. In: StatPearls. Treasure Island (FL): StatPearls Publishing; July 17, 2023.
12. Braseth AL, Elliott DE, Ince MN. Parasitic Infections of the Gastrointestinal Track and Liver. Gastroenterol Clin North Am. 2021;50(2):361-381. doi:10.1016/j.gtc.2021.02.011