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Fertilized egg Ascaris or roundworm

Ascaris lumbricoides or roundworm fertilized egg in saline preparation of feces as shown above image.

Characteristic Features of a Fertilized Egg

• Round and oval in shape 60-75 um x 40-50 um
• Bile stained and golden brown in color
  Surrounded by the thick smooth translucent shell with an outer albuminous coat.
• Sometimes outer coat is lost called decorticated egg
• Contain very large conspicuous unsegmented ovum
• There is a clear crescentic area at the pole.
• Floats in sodium chloride ( NaCl) solution
• Narrow, longer ( 80 x 55 um) and more elliptical, brownish in color
• Irregular coating of albumin (thinner cell)
• Contain a small atrophied ovum with a mass of disorganized highly refractile granules of various size
• Does not float in NaCl solution (heaviest of all helminth egg)

Life cycle of Ascaris lumbricoides

Infective stage: embryonated egg
Fertilized egg-containing unsegmented ovum are passed with the feces. Rhabditiform larva is developed from an unsegmented ovum within the eggshell within 10-40 days depending on atmospherical temperature and humidity. The larva undergoes molting (1st molting in soil, called embryonated egg). Embryonated egg when ingested with food passes down to the duodenum where the digestive juices (trypsin) weakens the eggshell and stimulates the enclosed larva. Eggshell splits and larva are liberated in the upper part of the small intestine. The newly hatched larva burrows through the mucus membrane of the small intestine and is carried to the portal circulation to the liver. They live in the liver for 3-4 days and pass out of the liver to the right side of the heart to the pulmonary circulation. In the lungs, they grow bigger and molt twice (2nd,3rd). Breaking through the capillary wall they reach the lung alveoli (about 10-15 days). Larva crawl up bronchi and trachea and with the help of ciliated epithelium of the respiratory tract, they are propelled into the larynx and pharynx and are once more swallowed. Larva pass down the esophagus to the stomach and localized in the upper part of the intestine
4 th molting occurs between 25-29 days of infection (in the small intestine).
The larva grows and sexually matures in 6-10 weeks. The gravid female discharge within 2 months after the time of infection and the cycle repeats.
Egg-laying capacity is 2,00,000/day.

Moulting of Ascaris lumbricoides

The total number of moultings is four and they are-

1. First molting-within eggshell
2. Second  and third  moultings- in lungs
3. Fourth molting- in the intestine

Mode of infection

Ingestion of foods contaminated with embryonated egg
Inhalation of desiccated egg in the dust reaching the pharynx and swallowed

Pathogenesis and clinical symptoms

Infestation of Ascaris lumbricoides in man is known as ascariasis.
Symptoms due to migrating larva: Ascaris pneumonia (Loeffler’s syndrome) with symptoms of fever, cough, and dyspnea. Larva in general circulation filtrate out to various organs where they may cause unusual clinical symptoms of the brain, spinal cord, heart, and kidney.

Symptoms due to Adult Worm:

Incubation period 60-75 days, symptoms are manifested at this period mostly related to GI tract.

Lab diagnosis of Ascaris lumbricoides

1. Direct evidence
2.  Indirect evidence
   Direct evidence
   Finding of adult
   The adult worm may pass out spontaneously in the stool or per anum between stool, or be vomited or escape through nares.
   X-ray diagnosis: The presence of A. lumbricoides has been demonstrated by radiography with barium emulsion, which is ingested by the worm for 4-6 hours, casts an opaque shadow (string-like shadow).

Finding of eggs

In stool:
direct microscopic examination of a saline emulsion of the stool
Concentration methods may be used.
Note:
The fertilized egg floats in a salt solution.
Unfertilized eggs do not float.
In the bile: microscopic examination

Indirect evidence

Blood examination:
Eosinophilia at the early stage of invasion but if present in the intestinal phase suggests strongyloidiasis or toxocariasis.
Dermal reaction (allergic): Scratch test-variable result
Traditional allergy tests utilize the Skin Prick method (also known as a Puncture or Scratch test) to determine whether an allergic reaction will occur by inserting possible triggers into your skin using a needle prick. If you are allergic to the substance, you are forced to suffer through your body’s reaction to the allergen.
Serological tests
The epidemiological study, also useful in the diagnosis of extra-intestinal ascariasis (Loeffler’s syndrome). Larva may be found in the sputum during the stage of migration.

Bibliography

1. Merkell and Voge’s medical parasitology
   9th edition.
2. Parasitology: 12th edition
   By K. D. Chatterjee
3. District laboratory practice in Tropical countries –Part-I.
   By Monica Chesbrough.
4. Isenberg clinical microbiology procedures Handbook
   2nd edition. Vol. 2
5. Atlas of Medical Helminthology and protozoology -4th edn  -P.L.  Chiodini, A.H. Moody, D.W. Manser
6. Medical Parasitology by Abhay R. Satoskar, Gary L. Simon, Peter J. Hotez and Moriya Tsuji
7. Atlas of Human Parasitology, Lawrence R Ash, Thomas C. Orihel, 3 rd ed, Publisher ASCP Press, Chicago.
8. Molecular Medical Parasitology. Editors: J. Joseph Marr, Timothy W. Nilsen, and Richard W. Komuniecki, Publisher Academic Press, an imprint of Elsevier Science.
9. Topley & Wilsons’ Principle of parasitology. Editors: M.T. Parker & L.H. Collier, 8 th ed 1990, Publisher Edward Arnold publication, Londo