24.6 Helminthic infections of the gastrointestinal tract

Learning objectives

• Identify the most common helminths that cause infections of the GI tract
• Compare the major characteristics of specific helminthic diseases affecting GI tract

Helminths are widespread intestinal parasites. These parasites can be divided into three common groups: round-bodied worms also described as nematodes , flat-bodied worms that are segmented (also described as cestodes ), and flat-bodied worms that are non-segmented (also described as trematodes ). The nematodes include roundworms , pinworms , hookworms , and whipworms . Cestodes include beef, pork, and fish tapeworms . Trematodes are collectively called flukes and more uniquely identified with the body site where the adult flukes are located. Although infection can have serious consequences, many of these parasites are so well adapted to the human host that there is little obvious disease.

Ascariasis

Infections caused by the large nematode roundworm Ascaris lumbricoides , a soil-transmitted helminth, are called ascariasis . Over 800 million to 1 billion people are estimated to be infected worldwide. Centers for Disease Control and Prevention. “Parasites–Ascariasis.” Updated May 24, 2016. http://www.cdc.gov/parasites/ascariasis/index.html. Infections are most common in warmer climates and at warmer times of year. At present, infections are uncommon in the United States. The eggs of the worms are transmitted through contaminated food and water. This may happen if food is grown in contaminated soil, including when manure is used as fertilizer.

When an individual consumes embryonated eggs (those with a developing embryo), the eggs travel to the intestine and the larvae are able to hatch. Ascaris is able to produce proteases that allow for penetration and degradation of host tissue. The juvenile worms can then enter the circulatory system and migrate to the lungs where they enter the alveoli (air sacs). From here they crawl to the pharynx and then follow the gut lumen to return to the small intestine, where they mature into adult roundworms . Females in the host will produce and release eggs that leave the host via feces. In some cases, the worms can block ducts such as those of the pancreas or gallbladder .

The infection is commonly asymptomatic. When signs and symptoms are present, they include shortness of breath, cough, nausea, diarrhea, blood in the stool, abdominal pain, weight loss, and fatigue. The roundworms may be visible in the stool. In severe cases, children with substantial infections may experience intestinal blockage.

The eggs can be identified by microscopic examination of the stool ( [link] ). In some cases, the worms themselves may be identified if coughed up or excreted in stool. They can also sometimes be identified by X-rays, ultrasounds, or MRIs.

Ascariasis is self-limiting, but can last one to two years because the worms can inhibit the body’s inflammatory response through glycan gimmickry (see Virulence Factors of Eukaryotic Pathogens ). The first line of treatment is mebendazole or albendazole . In some severe cases, surgery may be required.