Pulmonary ascariasis: two cases in Austria and review of the literature

Abstract

Ascariasis is the most common helminthic infection, with an estimated worldwide prevalence of 25%. The estimated mortality ranges from 0.8 to 1%. Second stage larvae pass through the intestinal wall and migrate via the portal vein system to the liver and then proceed to the lungs, where they may produce pneumonia and eosinophilia. Symptoms include wheezing, dyspnea, nonproductive cough, hemoptysis, and fever. Two cases of pulmonary ascariasis in Austrian males are reported. Both patients presented with dyspnea, nonproductive cough, fever, and eosinophilia (19 and 26%). One patient additionally had pulmonary infiltrates. Recent travel history was unremarkable in both individuals. Serology for Ascaris was positive twice in both patients, while microscopic examination of stool was negative for helminthic ova. Extensive diagnostic procedures were performed to rule out possible differentials for the patients symptoms. Both patients responded well to antiparasitic treatment with albendazole 400 mg and mebendazole 100 mg q12h for 3 days, respectively. This report highlights the importance of considering parasitic infection in patients presenting with eosinophilia and pulmonary symptoms also in Austria.

Respiratory Failure Associated with Ascariasis in a Patient with Immunodeficiency

“…In many cases, pulmonary ascariasis in chest X-rays shows fleeting infiltrates that may develop peripheral confluence and intra-alveolar hemorrhage, and exudate may also be present (associated with larvae migration) [9, 19, 20]. …”

“…One of the patients was in remission of b-cell non-Hodgkin lymphoma. Serology for Ascaris was positive twice in both patients, while microscopic examination of stool was negative for helminthic ova [9]. Ascaris worms may enter nasogastric and endotracheal tubes and block their lumen [13].…”

“…In Poland, human infection with A. suum and pig infection with A. lumbricoides are possible, and both these species are considered together in the epidemiological evaluation of the environment [28]. The prevalence of A. suum in pigs has declined over the last decades as well; infections in humans may now be more common in the western world as contact with pig feces (as manure spread) may occur frequently [9]. …”

“…Symptoms include wheezing, dyspnea, nonproductive coughing, hemoptysis, and fever. The respiratory distress experienced during pulmonary ascariasis, referred to as Löffler's syndrome, occurs 4 to 16 days after ingesting embryonated roundworm eggs [9]. Skin urticarial rash may also accompany these symptoms.…”

Evaluation of real‐time PCR assay for the detection of Ascaris suum contamination in meat and organ meats

“…The outbreak of VLM due to A. suum was firstly reported in Japan in 1996 (Maruyama, Nawa, Noda, Mimori, & Choi, ). Since then, patients diagnosed in VLM caused by A. suum have been frequently reported around the world (Hoenigl et al ., ; Izumikawa et al, ; Miller et al, ; Pinelli, Herremans, Harms, Hoek, & Kortbeek, , Sakakibara et al 2002). Humans get infection either by accidental ingestion of embryonated eggs in soil or contacted on raw vegetable that is grown in soil fertilized with A. suum contaminated‐swine excrement (Matsuyama, Mizoguchi, Iwami, Kawabata, & Osame, ; Tokojima, Ashitani, & Nakazato, ), or by eating raw or undercooked meat and organs that are parasitized by the parasite larvae (Izumikawa et al, ).…”