What is the recommended treatment for a patient with abdominal ascariasis and worms in vomit?

Treatment of Abdominal Ascariasis with Worms in Vomit

For patients with abdominal ascariasis and worms in vomit, a single dose of albendazole 400 mg orally is the recommended first-line treatment. 1

Diagnosis Confirmation

The presence of worms in vomit provides direct visual confirmation of ascariasis infection. Additional diagnostic steps may include:

• Concentrated stool microscopy or fecal PCR to confirm the diagnosis 1
• Multiple stool samples (2-3) to increase diagnostic sensitivity 2
• Examination for other clinical manifestations:
  • Abdominal pain (present in 80.12% of cases) 3
  • Palpable worm bolus (present in 46.47% of cases) 3

Treatment Algorithm

First-line Treatment:

• Albendazole 400 mg orally as a single dose 1, 2

Alternative Treatment Options:

• Mebendazole 500 mg orally as a single dose 1
• Ivermectin 200 μg/kg orally as a single dose 1

For Severe Cases or Complications:

• If intestinal obstruction is present:
  • Initial conservative management with IV fluids, nasogastric decompression, and antispasmodics 3
  • Surgical intervention if conservative management fails:
    • Enterotomy and evacuation of worms
    • Laparotomy with milking of worms into colon
    • Resection anastomosis in cases of bowel necrosis or perforation 3, 4

Follow-up and Monitoring

• Clinical follow-up in 2-4 weeks 2
• Consider a second dose of anthelmintic medication at follow-up visit 3
• For persistent symptoms or suspected treatment failure:
  • Repeat stool examination
  • Consider alternative treatment 2

Prevention of Reinfection

• Frequent handwashing with soap, especially before eating and after using the toilet 2
• Daily changing of underwear and keeping fingernails short and clean 2
• Environmental cleaning measures including washing bed linens in hot water 2
• Treatment of all household members simultaneously 2

Treatment Efficacy and Considerations

• Albendazole has a 98% cure rate for Ascaris lumbricoides infections 5, 6
• A single dose of albendazole is ovicidal against Ascaris eggs, preventing further transmission 7
• In endemic areas, consider repeated dosing (three doses at 6-week intervals) for complete eradication 6

Potential Pitfalls

• Inadequate diagnosis or incomplete treatment may lead to recurrent infections 2
• Emerging resistance has been documented in some helminth species, highlighting the need for proper dosing and follow-up 2
• For prolonged treatment courses (>14 days), monitor for potential hepatotoxicity and leukopenia 2
• Failure to treat all household members may result in reinfection 2

Special Populations

• Children ≥2 years should receive the same dose as adults (albendazole 400 mg) 2
• For pregnant women, treatment should be deferred until after the first trimester unless benefits outweigh risks 2