Fig. 1. Surgery to remove ascaris from the intestine.

Remove ascaris from the intestines.

Diagnosis Methods for Ascariasis

There are many methods for the diagnosis of ascariasis. They are divided into laboratory and instrumental.

Laboratory diagnostic methods for ascariasis:

• Coprological study.
• Analysis of feces on the eggs of the worm.
• Sputum analysis for the detection of helminth larvae.
• General blood analysis.
• Biochemical study of blood.
• Serological methods of research.
• Histological examination.

Instrumental methods of diagnosis of ascariasis:

• X-ray examination of the esophagus, organs abdominal cavity   and light.
• Endoscopic examination.
• Diagnostic laparotomy and laparoscopy.

Diagnosis of ascariasis in the intestinal stage

The intestinal stage of ascariasis begins 14 to 15 days after infection with helminth eggs. During this period, mature individuals, which are able to fertilize and release eggs, grow from the larvae. Its duration is 2.5 - 3 months. Therefore, if ascariasis is suspected, an analysis of feces on ascaris eggs is carried out precisely after this period of time, as well as after diagnostic deworming.

From the moment of infection with Ascaris eggs to the appearance of eggs in the fecal masses, 2.5 - 3 months pass. The larvae migrate for 14-15 days. In the patient's body, roundworm does not live for more than a year.

Fig. 3. Roundworm in gallbladder   and liver.

Surgery to remove ascaris from the child's gallbladder and liver.

Diagnosis of ascariasis on the basis of clinical and epidemiological data

Symptoms of ascariasis are numerous and varied. In the migration period, the symptoms of toxicosis and allergic reactions come to the fore. The release of larvae into the respiratory tract is accompanied by pulmonary complaints. Particular attention should be paid to the collection of epidemiological history: season of the year, participation in gathering berries, vegetables and greens, staying in rural areas, etc. It should be remembered that children suffer from ascariasis 3.5 times more often, which is associated with insufficient personal hygiene.

At a certain stage of migration, the ascaris larvae penetrate the patient's airway and then go up to the pharynx with phlegm and are swallowed. Detection of Ascaris larvae in sputum is an unconditional confirmation of the diagnosis, but this is a rare finding. A small amount of   Ascarid larvae in sputum oblige to conduct research multiple times.

Fig. 4. In the photo to the left is the roundworm larva in the egg, on the right - the release of the larva from the egg.

Histological examination

In the course of migration, the larvae destroy the vessels and can penetrate into any organs: the liver, eyes, brain, etc. In the organs, the larvae lose the ability to destroy the walls of the capillaries, encapsulate and die. In order to detect the larvae in the tissues of the affected organs, the method of histological examination is used. A biopsy biopsy is taken from the affected organ — a piece of tissue that is further examined using microscopy. Biopaths are taken from a variety of tissues of the human body.

Fig. 6. Histological preparation of lung tissue and liver of a patient with ascariasis: on the left is the helminth larva in the lungs, on the right in the liver.

Ascaris eggs in feces

Detection of helminth eggs or adults in the feces and after diagnostic deworming is a reliable sign of ascariasis. However, it should be borne in mind that ascaris eggs are not detected:

• during the migration of Ascaris larvae;
• in the first 3 - 3.5 months after infection. In the months of May and September that have been infested, ascaris eggs will begin to appear in the feces in 3–3.5 months — that is, from December to February;
• with a low intensity of invasion;
• in the presence in the intestines of some males, old or insufficiently mature females.

The analysis of feces for ascarids is used to diagnose the chronic stage of ascariasis.

In order to identify ascaris eggs in feces, the method of simple microscopy and a thick smear (Kato method) is used.

The analysis of feces for ascaris should be repeated several times. A negative result of the analysis does not indicate the absence of ascaris in the intestine.

Fig. 7. Tanks for collecting feces for analysis.

Fig. 8. In order to identify ascaris eggs in feces, the method of simple microscopy and thick smear (Kato method) is used.

Fig. 9. When ascaris eggs are detected, the thick smear method (Kato method) is used. Smear tinted malachite green.

Fig. 10. Eggs of Ascaris in feces.

Fig. 11. Ascaris in feces.

Identification of adult Ascaris

Fig. 12. Male and female Ascaris (photo left). On the photo to the right is a live roundworm.

Diagnosis of ascariasis using instrumental methods of research

Diagnosis of ascariasis with the use of an X-ray method of examination, endoscopy and an ultrasound scan takes place with no identified causes of the disease and negative scars of the research.

Fig. 13. Diagnosis of ascariasis with the use of X-ray studies using barium. Helminths in the picture are tape-like enlightenments located in the loops of the small intestine.

Fig. 15. Diagnosis of ascariasis using ultrasound. Roundworm in the stomach cavity.

Blood test for ascariasis

• The number of eosinophils rises to 20% - 60%.
• Erythrocyte sedimentation rate rises to 50 mm / hour.
• Erythrocyte count and hemoglobin level are reduced.
• The number of leukocytes increases.

Fig. 16. Ascaris in the eyes and heart.

Surgery to remove ascaris from the eyes.

Antibodies to Ascaris

Antibodies to ascaris of the IgG class in the patient's bloodline appear after 5–10 days from the moment of invasion. They are detected using the enzyme immunoassay (ELISA) method and latex agglutination reaction (RLA). Serological methods today are not widely used because of the difficulty in interpreting the results. They are used as additional methods   in combination with other techniques and clinical data.

Illegals inside us: roundworm worms.

Ascariasis is difficult to identify, and it is important to identify the invasion in its early stages. The main diagnostic method is blood test for roundworm. The answer to the question of how to identify chronic ascariasis, as a rule, offer less complex and costly methods.

The main groups of diagnostic methods for ascariasis

The primary diagnosis of infection with ascaris makes the doctor. Without examining and interviewing the patient, without taking into account the history, it is impossible to establish the time and reason for the appearance of worms.

Depending on the stage life cycle Ascaris in the body Negative decoding of one of the diagnostic methods does not guarantee the absence of a threat. worm infestation. At the same time ascariasis:

• at the migration stage is diagnosed using specific and serological analyzes. Laboratory diagnosis   specified instrumentally: radiographically, by ultrasound, CT or endoscopy;
• at the intestinal stage, a normal coprogram or coproovoscopy gives positive results. Usually, blood is analyzed for clarification, including for antibodies, the results of which are also confirmed by instrumental examinations: ultrasound, x-rays, less often others.

Types of diagnosis of the disease

Considering that during the migration phase and during the intestinal, it strongly intersects with diseases of the organs of localization, the diagnosis based on the use of any particular method is counterproductive.

Therefore, when setting ascariasis as the main diagnosis, it is necessary to use differential diagnostic methods.

At the chronic stage, which is necessarily diagnosed on ultrasound or radiography of the abdominal cavity, for consultation it is necessary to involve a surgeon and comprehensively examine the small and large intestines.

Immunoassay method of analysis (ELISA)

One of the most effective survey methods is ELISA. Despite certain specificity of the production of antibodies in the body of an adult, it shows a positive or negative result when making a diagnosis of ascariasis.

Features of the change

Resisting the antigens that are inevitably produced by ascaris, the immune system in the human body generates specific antibodies (immunoglobulins, for example, IgG to ascarids or IgM) to eliminate the toxic effects of worms on the body. The concentration and quality of antibodies in the blood is the basis for determining not only ascariasis directly, but also the time and extent of invasion.

There are different types that correspond to different terms of damage, namely antibodies to ascarid antigens: A, G, M and common: D, E. By the presence of one or another immunoglobulin, you can reliably know the time of infection: a positive IgG indicator manifests itself from the third to the sixth week of ascariasis , and IgM - already on the fifth day.

When is held

Blood for ascaris is given after simpler diagnostic procedures are passed, for example, general clinical tests in combination with X-ray. Provided that the symptoms are pronounced, and previous studies have not yielded results, it makes sense to use Ig markers.

• in mixed infections, the pathogen is precisely detected and identified;
• at critical values ​​in relation to the standards of other blood tests;
• to observe the results of treatment in dynamics.

It is extremely rare, but ELISA is used when the epidemiological situation among the population is exceeded. Because it is impossible to determine the degree of diagnosis in less costly ways.

How to prepare for delivery

For the detection of ascaris in the human body in adults, venous blood is collected, and in children - capillary blood.

For two days it is better not to take medicine. If it is not possible to interrupt treatment, the laboratory technician must be notified without fail.

In addition, adults have additional restrictions: about a day before donating blood, it is better for them to refrain from cigarettes and alcohol.

Benefits

An analysis to detect antibodies to ascaris in the blood is expensive. Yes, and the technique of conducting research is difficult, however, these difficulties are leveled by obvious advantages:

• high reliability of the method - approximately 90%;
• possibility of early diagnosis;
• informative dynamics of ascariasis. Allows adjustment of therapy during treatment;
• the speed of obtaining results of tests for roundworm.

Feces test

The classic method for the detection of ascariasis in adults and children is stool analysis. A simple coprogram and coproovoscopy is effective, provided that there are ascaris eggs in the intestine. High reliability is possible only at the stage of chronic infection, since the diagnosis of ascariasis has certain disadvantages.

If the intestine is old, immature, or adult of the same sex, a study for roundworm in the feces will not produce results. In this case, it is advisable to carry out PCR fecal masses. The analysis makes it possible to identify not traces of ascaris, but fragments of their DNA.

How many times to take feces to be sure of the diagnosis?

Depending on the results of the first fecal examination, follow-ups are recommended to be performed in succession from 3 to 6 times. The interval of the material intake is 1-2 days. At the same time, it is enough to pass a PCR stool twice with an interval of two to three weeks.

X-ray in the diagnosis of ascariasis

Despite the fact that radiography with contrast staining and ultrasound is actively used during the intestinal stage of infection, chronic ascariasis is fairly easy to detect using laboratory methods.

The use of X-rays is most justified in the early stages of ascariasis-diagnosis. To do this, a snapshot of the lungs is taken, in which, during the migration phase of the disease, worm infiltrates with lymph and blood are seen.

Deciphering the results of analysis for ascariasis

Despite the high accuracy of the method, it is recommended to donate blood for ascariasis several times. Conclusions can be only of three types:

• a positive result confirms the diagnosis of ascariasis. It should be borne in mind that antibodies are produced for some time. immune system   in patients who have recently had an invasion;
• negative. Indicate the absence of worms. May be erroneous at the onset of the illness;
• questionable (doubtful), when the values ​​are borderline to normal. It is mandatory to be checked again, and when receiving the same result, it is treated as negative.

All laboratories work on different equipment, use completely different reagents in quality and sometimes composition, and moreover, the samples are also different. That is why on the sheets with the results of the analyzes, all give their norms for decoding. Almost without exception.

Reference Values ​​- Norm

In ascariasis, the blood test shows an increase in the number of total immunoglobulins, namely, IgD and IgE, while the standard content of antibodies to ascaris in serum is respectively<0,15г/л и <0,3мг/л.

Specific immunoglobulins are strongly differentiated depending on the patient's age, for adults, each indicator is normally:

Often, diagnosis of ascaris is based on the IgG antibody titer. The rate is 1/100. Usually, experts recommend this indicator.

Frequently asked Questions

Complicated and costly analyzes raise many questions for patients who, if they suspect ascariasis, are forced to undergo a comprehensive diagnosis.

Blood test for antibodies to ascaris - a divorce for money?

ELISA gives almost unambiguous results at an early stage of infection. Maximum confidence from 10 to 30 days. If the invasion lasts more than three months, is accompanied by the patient's immunodeficiency, the examination is carried out in newborns, then characteristic antibodies in the blood serum are difficult to detect or their value will be threshold with a high probability of error.

Which analysis is more accurate?

If the primary diagnosis calls into question ascariasis, then the study should be complex, since on different, they can be detected by fundamentally different methods.

What is the probability of error when analyzing ascariasis?

A positive or negative result in the acute stage of development gives an error of only 10%. The accuracy of the determination of individual antibodies, for example, IgG to Ascaris is at least 94%. Questionable analyzes are subject to clarification. About a month after the first study, repeated results are analyzed in dynamics, and with a decrease or increase in titer, respectively, a negative or a positive conclusion is given.

Can ascariasis be asymptomatic?

At the early stage of the life cycle of ascaris, in particular during migration through the body, especially with a minor lesion, ascariasis is almost asymptomatic.

Helminth eggs enter the body by the alimentary route, after which they migrate to the respiratory organs with blood flow. There, the larvae go through the first stage of development, after which they cause a cough in an infected person, due to which they enter the oral cavity. After that, the person swallows them with saliva at the first swallowing effect.

It is possible to become infected with ascariasis by eating poorly washed vegetables, berries and fruits.. Infection can also occur through contact with the soil. When eating food with insufficiently hand-treated disinfectants can lead to the ingress of eggs into the gastrointestinal tract, which leads to the development of helminthiasis.

The manifestation of helminthiasis

An ascariasis test should be taken when the following symptoms appear:

• pain in the abdomen;
• headaches;
• feeling nauseous;
• constant weakness;
• sleep disturbance.

When ascariasis often occurs a malfunction of the gastrointestinal tract, which leads to diarrhea or, conversely, constipation.

Danger of ascariasis

   The activity of ascaris with a high degree of development of invasion can lead to anemia, intestinal obstruction, enterocolitis and the development of permanent dyspeptic syndrome.

Preventing such complications with health will help time the analysis of roundworm and properly conducted treatment.

Diagnostic methods

  Results Decoding Table

A stool analysis is also prescribed to help identify helminthiasis, but only at a later stage due to the eggs that can be found in the biomaterial.

Blood tests are sometimes the most informative, which are divided into general, biochemical and enzyme immunoassay.

Also, special decoding is not required: it is either negative or positive.

How to overcome ascariasis?

If the results are positive, the doctor prescribes treatment with one of the following drugs:

  Pyrantel - one of the most popular anthelmintic drugs

"Pirantel" is considered one of the most prescribed anthelmintics for ascariasis. It can be used in infants in the form of a suspension, and in the form of tablets, the drug is prescribed only from the age of three. The active substance of the drug kills the larvae, eggs and adults.

In severe pathological processes occurring in the liver, "Pirantel" is contraindicated.

  Vermox is prescribed quite often

"Vermox" refers to anthelmintic drugs, which is effective against all known roundworms, including ascaris. At the same time, the medication has many contraindications, including various pathologies of the digestive system. Children under three years of age and pregnant antihelminthic drugs can not be used.

"Vermox" is able to enter into drug interactions with certain groups of drugs, so before taking it is necessary to carefully read the instructions.

Antihelmintic therapy is carried out for three days. With a strong infection, the course is repeated after a few weeks.

Replace "Vermox" can be "Mebendazole" or "worm", which have a similar composition.

  Piperazin treats ascariasis and enterobiasis

"Piperazine" is considered a less effective drug, but it is also prescribed for ascariasis if it is impossible to take other drugs. Since it is considered to be slightly toxic, it is often prescribed to patients in the position after the first trimester of pregnancy.

With caution used "Piperazin" in liver failure. The duration of treatment depends on the neglect of the invasion, as well as the age and weight category of the patient.

In most cases, this anthelmintic does not contribute to the occurrence of side effects under the condition of good tolerance of piperazine and compliance with therapeutic dosage.

  Dekaris - an effective tool

A single dose of the drug is enough to completely. In the case of neglect of the disease after a week, repeat the anthelmintic therapy.

Compliance with the dosage will avoid the side effects that levamisole can cause.

When liver and kidney failure drug is not prescribed.

  Nemozol refers to drugs of broad anthelmintic action

Nemozol is a universal anthelmintic used not only for ascariasis. It is also prescribed for mixed types of gelintosis.

Like many anthelmintic drugs, due to the toxic property, Nemozol is not prescribed for abnormal liver function.

“Worm” refers to preparations of a broad spectrum of action in relation to many types of worms.

When ascariasis is usually prescribed a single dose of the drug, the dosage of which should correspond to the age and body weight of the patient. Repeated antihelminthic treatment is prescribed at the discretion of the physician, if after the first course the proper therapeutic effect has not been obtained.

In the absence of liver pathologies, the drug is well tolerated and rarely causes negative reactions from the organs.

How to prevent infection?

  To prevent infection, you must comply with preventive measures.

Avoiding infection is quite simple, observing the basic rules of sanitation. After each contact with the soil, doctors recommend washing your hands thoroughly with soap and water. Before eating any vegetable product for food, it should be thoroughly washed with soap or scalded with hot water.

In some cases, animals can become random carriers of ascariasis, if they have helminth eggs on their wool, so it is important that after each contact with the pet, also handle the hands accordingly.

Usually, this helminth infection occurs when eating unwashed berries, fruits and vegetables, or eating food with unwashed hands, or cooking food with poor quality water.

Ascaris is also present on most surfaces:

Symptomatology

Unfortunately, such a disease as ascariasis in the early stages is very difficult to diagnose, because At the beginning of its development, there is no obvious symptomatology. After 10-15 days, the roundworm enters the patient's lungs, then the patient may be tormented by a small but obsessive cough, and the following symptoms are normal:

• temperature rise;
• allergic rash of unknown nature;
• sharp decrease in body weight.

At more advanced stages, a person may experience difficulties with the work of the gastrointestinal tract (intestinal disorders, or, conversely, severe constipation). It is extremely important to diagnose ascaris infection in time, because the development of the disease is dangerous with a multitude of complications. The main pathologies, the development of which leads to ascariasis, include:

• severe intestinal obstruction;
• appendicitis;
• inflammation of the biliary tract;
• various lung diseases;
• kidney disease.

That is why it is so important to conduct a series of studies to identify the development of ascariasis in the early stages. Below we look at the main methods of diagnosis, and what is the decoding of blood tests for antibodies to ascaris antigens.

Diagnosing

This study can be carried out in the first days after infection, it is the most informative. First, experts consider such an indicator as the level of leukocytes, with their increase, a blood test for ascariasis is prescribed.

The essence of the study itself is that a small amount of the ascaris antigen is injected into the patient’s blood, if antibodies to this helminth are present in the body, then antibodies and antigens are combined. It is this analysis that is most effective in determining ascariasis and prescribing competent medical treatment.

The stage of preparation for the study

Immediately before giving a blood test, you must adhere to a few simple rules, the observance of which will help to get the most reliable result:

• blood is donated in the morning and on an empty stomach;
• before taking the material it is recommended not to eat fatty, salty or spicy foods;
• the last meal is 8 hours before analysis;
• it is forbidden to drink alcohol the day before the test;
• before the research it is better to drink only water without gas, sugary and carbonated drinks are prohibited.

Other blood parameters

The rate of performance:

• normal values ​​of leukocytes - 0-0.5%;
• hemoglobin - in an adult, 120-140 g / l;
• red blood cells - 3.5-5.5 million / ml.

But blood sampling and its analysis is not yet the main thing in the diagnosis of ascariasis, the main thing is that the expert should make a competent decoding of all indicators.

results

For the study in adult patients venous blood is used, in children - capillary blood. Doctors divide the results into three groups:

It is worth recalling that the price for this analysis is quite high, so the redelivery can be great to hit on the wallet.

Blood test benefits

• hypersensitivity to ascaris antigens;
• the possibility of detecting the development of ascariasis at the earliest stages;
• by re-testing, you can constantly monitor the dynamics of the disease and adjust the course of therapy with indicators;
• all research is done in hardware, so the error of the result has small deviations, because the human factor is excluded;
• analysis is carried out in a short time.

Preventive measures

Unfortunately, there are frequent cases of repeated infection with ascaris, so experts advise to periodically carry out disease prevention, as well as adhere to the basic rules of personal hygiene:

But the most important when infected with ascaris are diagnostics in the early stages of the disease. As mentioned above, ascariasis is dangerous due to the occurrence of various complications. Only early diagnosis, proper treatment and adherence to preventive measures can protect a person from possible complications and prevent re-infection with the indicated helminths.