Ascariasis

　　Traditional Chinese medicine believes that ascariasis is caused by unclean diet, or eating unclean raw and cold fruits and vegetables, and excessive intake of sweet and greasy foods, which accumulate dampness and generate heat. If these unhealthy and unclean things, some of which even carry viruses, are ingested, they will grow in the human body, gradually forming ascaris, and thus causing ascariasis.

　　The common complications in clinical practice are cholangioascaris, intestinal obstruction, cholangitis, cholecystitis, cholecystolithiasis, pancreatitis, liver abscess, appendicitis, intestinal perforation, and peritonitis, etc.

　　1. Intestinal obstruction: It refers to the obstruction of the passage of intestinal contents, commonly known as the unsmoothness of the intestines. Here, the intestines usually refer to the small intestine (jejunum, ileum) and colon (ascending colon, transverse colon, descending colon, sigmoid colon). It is mostly early onset, with abdominal pain as the main symptom, accompanied by vomiting, constipation, abdominal distension, and no flatus, which are common symptoms of intestinal obstruction. The abdominal muscles are usually soft, and one or more movable, painless masses can often be felt around the umbilicus, and the bowel sounds are usually normal or slightly hyperactive.

　　2. Cholangioascaris: The term cholangioascaris refers to acute abdominal symptoms caused by ascaris entering the common bile duct, intrahepatic bile ducts, and gallbladder. The deep-seated location is often in the common bile duct, less frequently in the bile duct, and occasionally in the gallbladder. The symptoms are sudden, severe pain under the xiphoid process or on the right side, which is difficult to bear, accompanied by nausea and vomiting, and radiation to the right shoulder, back, or lower abdomen.

　　3. Cholangitis: Cholangitis refers to cholangitis with inflammation of the bile ducts as the main manifestation, while cholecystitis refers to cholangitis with inflammation of the gallbladder as the main manifestation.

　　4. Cholecystolithiasis: It refers to the disease caused by gallstones occurring in the gallbladder.

　　5. Pancreatitis: It is a disease caused by the autodigestive action of trypsin in the pancreas.

　　6. Liver abscess: It is a suppurative lesion of the liver caused by various microorganisms such as bacteria, fungi, or tissue-invasive amebae.

　　7. Appendicitis: It refers to the inflammatory changes of the appendix caused by various factors, a surgical disease of the abdomen.

　　8. Intestinal perforation: It refers to the process in which the intestinal lesions penetrate the intestinal wall, causing the intestinal contents to overflow into the peritoneal cavity, which is one of the severe complications of many intestinal diseases.

　　9. Peritonitis: It is a common serious surgical disease caused by bacterial infection, chemical irritation, or injury.

　　Ascariasis has a certain development time in the human body. When it is still a larva, it can cause ascariasis asthma and ascariasis pneumonia, with an abrupt onset, and the patient may experience fever and dry cough. Symptoms such as asthma, a sensation of foreign body in the throat, chest pain, expectoration, or hemoptysis may occur, and even respiratory distress and cyanosis. In severe infections, the lungs may bleed, swell, and become solidified. The body temperature may rise to 38°C, even reaching 40°C. The larvae can also enter the great circulation through the pulmonary capillaries and left ventricle, invade the intestinal wall, liver, and other organs, causing ectopic lesions. Most cases recover spontaneously without treatment within 5 to 14 days. As the larvae gradually transform into adults, the clinical manifestations of the disease caused by adults are gastrointestinal symptoms: disordered digestive function and malnutrition; systemic toxic symptoms, and toxins acting on the nervous system can cause ascariasis toxic encephalopathy, presenting with headache, insomnia, epilepsy, meningeal irritation sign, and in severe cases, seizures, convulsions, and coma.

　　Other symptoms of ascariasis: recurrent umbilical paroxysmal or hidden pain, good appetite but emaciated, or loss of appetite, restless sleep at night, palpable worms or masses in the abdomen; mild increase in eosinophils in peripheral blood, finding worm eggs in stool examination; may be complicated with cholangitis ascariasis, intestinal obstruction, liver abscess, etc., may have corresponding symptoms, mainly manifested by loss of appetite, umbilical pain, or even emaciated abdomen, defecating worms or finding worm eggs in examination. Children may also cause nervous symptoms, such as convulsions, night terrors, grinding teeth, pica, etc.

　　General ascariasis: manifested as recurrent paroxysmal umbilical pain or recurrent umbilical pain, with a desire to rub and press, varying appetite, or eating foreign objects, restless sleep at night, grinding teeth, picking nose, biting nails, with a history of vomiting worms or defecating worms, or even eating soil, uncooked rice, charcoal ash, and other substances.

　　Ascariasis syndrome: There is a history of vomiting or defecating worms, there are occasional umbilical or abdominal pain, sudden severe abdominal pain, abdominal mass bulging, or may be palpable to a mass, soft and movable when pressed, vomiting, constipation, pale complexion, and wiry pulse.

　　Prevention of ascariasis should start with hygiene, popularize health knowledge, pay attention to personal hygiene and dietary hygiene, wash hands frequently, do not eat unclean and unhygienic food, do not drink unclean water, prevent the ingestion of worm eggs, reduce the chance of infection; use harmless fertilizers, such as human feces, prevent the pollution of feces and prevent the spread of ascariasis, building healthy toilets, and also prevent the occurrence of ascariasis from the source, which is deworming, removing worms in the human intestines including patients and carriers.

　　1. Ultrasound examination: In some cases, abdominal ultrasound examination in patients with cholangiocystis can sometimes detect the location of the worm in the dilated common bile duct, and it can move inside, but the positive rate is not high.

　　2. Stool examination: The presence of worm eggs in the stool of the infected person can be diagnosed. Due to the large egg production of the female worm, the direct smear method is used, with an detection rate of about 80%, and three smears can reach 95%.

　　1. Eat light and less spicy, roasted, and greasy foods, avoid aiding heat and dampness.

　　2. For patients with ascariasis, deworming drugs should be taken, and attention should be paid to rest and diet after taking the medicine, maintain smooth defecation, and pay attention to the reaction and defecation after taking the medicine. When there is ascariasis, take 60~100ml of vinegar orally, which has the effect of calming the worm and relieving pain.

　　Deworming treatment

　　1. Benzimidazole drugs: Albendazole, dosage of 400mg, taken all at once. It can be repeated once every 10 days after deworming.

　　2. Thiabendazole (also known as prothiabendazole, Purvalban): Dosage: 400mg for adults, taken all at once, with a negative conversion rate of 100%. For children under 12 years old, the dosage is halved, and the method of administration is the same as for adults. This is a highly effective broad-spectrum anthelmintic new drug, which can bind to the microtubule protein of the worm, hinder the polymerization of microtubule protein; inhibit the absorption of glucose by the worm body, leading to the exhaustion of glycogen; inhibit the fumarate reductase system, prevent the production of adenosine triphosphate, causing the worm body to be unable to survive and reproduce.

　　3. Tetrachloromethane (also known as Tetrachloromethane): Dosage: Adults take 100-200mg per day, children take 2-3mg/kg per day, taken at one time one hour after a meal. Side effects are mild, but those in the early stages of pregnancy, with abnormal liver function, and those with decreased renal function should use it with caution. It is contraindicated during the active stage of hepatitis. This is a broad-spectrum anthelmintic that can directly inhibit the intake of glucose by nematodes, causing nematodes to be unable to survive, and has the effects of inhibiting the development of nematode embryos and killing adult worms.

　　4. Levamisole: Dosage: Adults take 100-200mg per day, children take 2-3mg/kg per day, taken at one time one hour after a meal. Side effects are mild, but those in the early stages of pregnancy, with abnormal liver function, and those with decreased renal function should use it with caution. It is contraindicated during the active stage of hepatitis. This is a broad-spectrum antihelmintic that can selectively inhibit the succinate dehydrogenase in the muscle of the worm body, preventing fumarate from being reduced to succinate, thereby affecting the anaerobic metabolism of the worm body, reducing energy production, and causing paralysis of the worm body. It is excreted from the body through feces. It is also an immunomodulator that can restore the cell immunity of those with low immunity.

　　5. Piroxicam (Oxepamidazole): Dosage: Adults take 400mg per day, taken once on an empty stomach, for 2-3 days. Side effects include dizziness and fatigue, which are usually mild and transient and generally do not require treatment. This is a broad-spectrum anthelmintic, especially suitable for mixed infections of Ascaris, hookworms, and whipworms.

　　6. Thiabendazole (Antidote to Worms): Dosage: Adults take 1.2-1.5g of hydroxyquinazolone thiabendazole at one time, taken at bedtime, for a course of 1-2 days. Side effects are mild, and pregnant women, those with coronary heart disease, and those with a serious history of peptic ulcer disease should use it with caution. This is a broad-spectrum anthelmintic, which exerts a blocking action on the neuromuscular system by inhibiting the cholinesterase in the worm body, causing paralysis and excretion of the worms from the body.

　　7. Praziquantel (Deworming Agent): Oral absorption is rapid, mainly excreted through the bile duct. Adults take 3-3.5g per day, taken at bedtime, for 2 consecutive days. For children, calculate 100-150ml/kg per day, with a total dose not exceeding 3g, taken at bedtime or in 1-2 doses, and for those prone to constipation, a mild laxative can be added. The mechanism of action is the same as that of Thiabendazole.

　　8. Oxygen: Dosage: 100-150ml per child per year, injected into the gastric tube, and 1 dose of laxative is given after treatment, which can relax the roundworms and paralyze them for excretion.