10 Common Symptoms of Ascariasis You Should Know

Ascariasis is one of the most common parasitic infections worldwide, caused by the roundworm Ascaris lumbricoides. This intestinal parasite affects millions of people globally, particularly in regions with poor sanitation. While many cases may be mild or asymptomatic, understanding the symptoms of worms in stomach in adults is crucial for early detection and proper management. This comprehensive guide explores the key signs and symptoms that may indicate an ascariasis infection.

1. Abdominal Pain and Discomfort

One of the most frequently reported symptoms of ascariasis is abdominal pain, which can range from mild discomfort to severe cramping. This pain typically occurs in the upper abdomen or around the navel area.

The discomfort arises when adult worms migrate through the intestines or when they accumulate in large numbers, causing blockages. Patients often describe the sensation as:

• Intermittent cramping that comes and goes
• A dull, persistent ache in the stomach region
• Increased discomfort after eating
• Bloating sensations accompanied by pain

The intensity of abdominal pain often correlates with the worm burden—the higher the number of parasites, the more pronounced the symptoms tend to be.

2. Nausea and Vomiting

Nausea and vomiting are common gastrointestinal symptoms associated with ascariasis, particularly when the infection involves a significant number of worms. These symptoms occur due to intestinal irritation and obstruction caused by the parasites.

In severe cases, individuals may actually vomit up worms, which can be extremely distressing but serves as a definitive sign of infection. The nausea tends to be:

• More pronounced in the morning or on an empty stomach
• Accompanied by loss of appetite
• Persistent and not relieved by typical anti-nausea remedies
• Sometimes triggered by the movement of worms in the digestive tract

Chronic nausea can lead to reduced food intake, contributing to nutritional deficiencies over time.

3. Diarrhea or Loose Stools

Digestive disturbances, including diarrhea and loose stools, frequently occur in individuals with ascariasis. The presence of worms in the intestines disrupts normal digestive processes and can damage the intestinal lining.

The diarrhea associated with this condition typically presents as:

• Watery or loose bowel movements that may occur multiple times daily
• Stools that may contain mucus
• Irregular bowel patterns alternating between diarrhea and constipation
• Occasional presence of visible worms in stool, appearing as long, white or pink threadlike creatures

The persistent diarrhea can lead to dehydration and electrolyte imbalances if not properly managed, making it important to maintain adequate fluid intake.

4. Unexplained Weight Loss and Malnutrition

Progressive weight loss despite adequate food intake is a significant indicator of ascariasis, especially in chronic infections. The parasites compete with the host for nutrients, literally stealing nutrition from the food consumed.

This symptom manifests through several mechanisms:

• Direct consumption of nutrients by the worms, particularly proteins and vitamins
• Reduced appetite due to gastrointestinal discomfort
• Malabsorption of nutrients due to intestinal damage
• Increased metabolic demands as the body fights the infection

Children are particularly vulnerable to growth retardation and developmental delays due to the nutritional deficiencies caused by chronic ascariasis. Adults may notice clothes fitting more loosely and a general decline in energy levels.

5. Respiratory Symptoms and Coughing

During the early stages of infection, ascariasis can cause respiratory symptoms as larvae migrate through the lungs. This phase, known as the pulmonary phase, occurs approximately 10-14 days after ingesting infectious eggs.

Respiratory manifestations include:

• Persistent dry cough that may become productive
• Wheezing and shortness of breath
• Chest discomfort or tightness
• Low-grade fever accompanying respiratory symptoms
• In severe cases, coughing up blood-tinged sputum

These symptoms result from the larvae breaking through the alveolar walls to reach the airways, causing inflammation and triggering an immune response. The condition may be mistaken for asthma, bronchitis, or pneumonia, making proper diagnosis essential.

6. Visible Worms in Stool or Vomit

Perhaps the most definitive and alarming symptom of ascariasis is the actual sighting of worms. Adult Ascaris lumbricoides are large roundworms that can measure 15-35 cm in length, making them visible to the naked eye.

These parasites may be observed:

• In stool during bowel movements, appearing as long, pale, pinkish-white worms
• In vomit, which is particularly distressing but indicates heavy infection
• Occasionally emerging from the nose or mouth, especially during sleep

The worms are typically round in cross-section with tapered ends. While seeing a worm is undoubtedly disturbing, it provides clear confirmation of infection and should prompt immediate medical attention for proper treatment and prevention of complications.

7. Fatigue and General Weakness

Chronic fatigue and persistent weakness are subtle yet significant symptoms of ascariasis that often develop gradually over time. These symptoms result from the cumulative effects of the infection on the body.

The fatigue associated with ascariasis stems from multiple factors:

• Anemia caused by nutritional deficiencies, particularly iron and vitamin B12
• The body’s continuous energy expenditure in mounting an immune response
• Poor sleep quality due to discomfort and nausea
• Reduced oxygen-carrying capacity during the pulmonary phase
• General malaise from the toxic metabolic products released by the worms

Individuals may find it difficult to complete daily activities, experience reduced work productivity, and feel constantly tired even after adequate rest.

8. Loss of Appetite

A decreased desire to eat is a common but often overlooked symptom of ascariasis. This loss of appetite, medically termed anorexia, can contribute significantly to weight loss and malnutrition.

Several mechanisms contribute to reduced appetite:

• Nausea and abdominal discomfort that make eating unappealing
• A feeling of fullness due to worms occupying space in the intestines
• Altered taste perception caused by the infection
• Generalized feeling of unwellness that suppresses hunger signals

Children with ascariasis may become picky eaters or refuse meals entirely, which can alarm parents and lead to family stress. The appetite typically improves after successful treatment of the infection.

9. Abdominal Swelling and Distention

Visible swelling or distention of the abdomen is another notable symptom, particularly in cases involving heavy worm burdens. The abdomen may appear bloated and feel tight to the touch.

This distention results from:

• The physical space occupied by numerous worms in the intestinal tract
• Gas accumulation due to disrupted digestive processes
• Intestinal obstruction caused by worm masses
• Fluid retention in the abdominal cavity in severe cases

The swelling may be more noticeable in children with smaller body frames and can be accompanied by a sensation of pressure or tightness. Severe abdominal distention requires immediate medical evaluation as it may indicate intestinal obstruction, a serious complication requiring urgent intervention.

10. Fever and Night Sweats

Low-grade fever and night sweats can occur during both the early larval migration phase and in established intestinal infections. These symptoms reflect the body’s immune response to the parasite.

Temperature-related symptoms include:

• Intermittent low-grade fever, typically below 38.5°C (101.3°F)
• Night sweats that may require changing sleepwear or bedding
• Chills alternating with feeling warm
• General feeling of being feverish without consistently high temperature readings

The fever is usually not high enough to cause serious concern but indicates active infection. During the pulmonary migration phase, fever may be accompanied by respiratory symptoms, while in intestinal phase infections, it may occur alongside gastrointestinal complaints.

Main Causes of Ascariasis

Ascariasis is caused by ingestion of infectious Ascaris lumbricoides eggs. Understanding how transmission occurs is essential for prevention. The primary causes and risk factors include:

Contaminated Food and Water

The most common route of infection is through consuming food or water contaminated with Ascaris eggs. These microscopic eggs can survive in soil for years and easily contaminate fresh produce, particularly vegetables grown in soil fertilized with human feces.

Poor Sanitation and Hygiene

Inadequate sanitation facilities and poor handwashing practices significantly increase infection risk. The eggs are transmitted through the fecal-oral route, meaning anything contaminated with infected feces can serve as a transmission vehicle.

Soil Contamination

In areas where human feces are used as fertilizer or where open defecation is practiced, soil becomes heavily contaminated with Ascaris eggs. Children playing in contaminated soil and adults working in agriculture are particularly at risk.

Person-to-Person Transmission

While less common than environmental contamination, direct transmission can occur through contaminated hands, especially in settings with poor hygiene practices such as crowded living conditions or inadequate handwashing facilities.

Environmental and Geographic Factors

Ascariasis is more prevalent in tropical and subtropical regions with warm, moist climates that favor egg survival and maturation. Rural areas with limited access to clean water and sanitation infrastructure have higher infection rates.

Prevention of Ascariasis

Preventing ascariasis requires a multi-faceted approach focusing on hygiene, sanitation, and food safety. The following measures can significantly reduce infection risk:

Practice Good Hand Hygiene

Regular and thorough handwashing is the single most effective prevention method. Wash hands with soap and clean water:

• Before preparing or eating food
• After using the toilet
• After working with soil or gardening
• After changing diapers or helping children with toileting

Ensure Food Safety

Proper food handling and preparation can eliminate infectious eggs:

• Thoroughly wash all fruits and vegetables, especially those eaten raw
• Peel fruits and vegetables when possible
• Avoid eating uncooked vegetables in areas where human feces are used as fertilizer
• Use safe, clean water for washing produce
• Cook food to appropriate temperatures

Drink Safe Water

Only consume water from safe sources. If uncertain about water quality, boil water for at least one minute or use appropriate filtration systems. Avoid ice made from untreated water in endemic areas.

Improve Sanitation

Community-level improvements in sanitation infrastructure dramatically reduce transmission:

• Use proper toilet facilities rather than practicing open defecation
• Ensure proper disposal of human waste
• Avoid using human feces as fertilizer, or ensure it is properly treated before agricultural use
• Maintain clean living environments

Educate Children

Teach children about proper hygiene practices early, including not putting hands or objects from the ground in their mouths, washing hands regularly, and avoiding eating dirt or soil.

Regular Deworming in Endemic Areas

In regions where ascariasis is common, periodic deworming programs recommended by health authorities can help reduce the prevalence of infection in the community. Consult with local health services about appropriate prevention strategies for your area.

Frequently Asked Questions

Can ascariasis go away on its own?

While adult worms have a lifespan of 1-2 years and will eventually die without reinfection, it is not advisable to wait for spontaneous resolution. Untreated infections can cause serious complications including intestinal obstruction, malnutrition, and organ damage. Medical treatment is safe, effective, and recommended for all diagnosed cases.

How long does it take for symptoms to appear after infection?

The timeline varies by stage. Respiratory symptoms may appear 10-14 days after ingesting eggs, when larvae migrate through the lungs. Intestinal symptoms typically develop 6-8 weeks post-infection, once worms mature in the intestines. Some people remain asymptomatic throughout the infection.

Are ascariasis symptoms different in adults and children?

The fundamental symptoms are similar, but children often experience more severe effects, including growth retardation, cognitive impairment, and more pronounced malnutrition. Children are also more likely to develop intestinal obstruction due to their smaller intestinal diameter. Adults may have milder symptoms, especially with light infections.

Can you have ascariasis without any symptoms?

Yes, many people with light infections remain completely asymptomatic. Studies suggest that up to 85% of infected individuals show no obvious symptoms. However, even asymptomatic infections can cause subclinical nutritional deficiencies and may worsen over time if reinfection occurs.

How is ascariasis diagnosed?

Diagnosis typically involves stool examination to identify Ascaris eggs under a microscope. Sometimes worms are visible in stool or vomit. Imaging studies like X-rays or ultrasound may reveal worms in the intestines or bile ducts. Blood tests may show eosinophilia, indicating parasitic infection. During the pulmonary phase, chest X-rays may show characteristic infiltrates.

Is ascariasis contagious from person to person?

Ascariasis is not directly contagious in the typical sense. You cannot catch it from casual contact with an infected person. However, if someone infected with ascariasis does not practice good hygiene, they can contaminate their environment with eggs, which can then infect others who come into contact with contaminated surfaces, soil, food, or water.

Can pets transmit ascariasis to humans?

No, the species of Ascaris that infects humans (Ascaris lumbricoides) is different from those that infect dogs (Toxocara canis) and cats (Toxocara cati). While pets have their own species of roundworms that can occasionally cause disease in humans (toxocariasis), they do not transmit human ascariasis.

What complications can arise from untreated ascariasis?

Untreated ascariasis can lead to several serious complications including intestinal obstruction from worm masses, bile duct blockage causing jaundice and pancreatitis, appendicitis if worms enter the appendix, peritonitis if worms perforate the intestinal wall, and chronic malnutrition leading to developmental delays in children.

When should I see a doctor if I suspect ascariasis?

Seek medical attention if you experience persistent abdominal pain, unexplained weight loss, visible worms in stool or vomit, or respiratory symptoms that don’t improve. Immediate medical care is necessary for severe abdominal pain with swelling, vomiting worms, high fever, or signs of intestinal obstruction such as inability to pass stool or gas.

Can ascariasis be prevented by vaccines?

Currently, there is no vaccine available for ascariasis. Prevention relies entirely on improved sanitation, hygiene practices, safe food and water, and in some endemic areas, periodic preventive treatment programs. Research into vaccine development is ongoing, but practical implementation remains years away.

References:

• Centers for Disease Control and Prevention – Ascariasis
• World Health Organization – Soil-transmitted helminth infections
• Mayo Clinic – Ascariasis
• National Center for Biotechnology Information – Ascariasis
• MedlinePlus – Ascariasis