Ascariasis (Minyoo)

Ascariasis is a type of roundworm infection. These worms are parasites that use your body as a host to mature from larvae or eggs to adult worms. Adult worms, which reproduce, can be more than a foot (30 centimeters) long.

One of the most common worm infections in people worldwide, Most infected people have mild cases with no symptoms. But heavy infestation can lead to serious symptoms and complications.

Ascariasis occurs most often in children in tropical and subtropical regions of the world — especially in areas with poor sanitation and hygiene.

Symptoms of Round worm infection

Most people infected with ascariasis have no symptoms. Moderate to heavy infestations cause various symptoms, depending on which part of your body is affected.

In the lungs
After you ingest the microscopic ascariasis eggs, they hatch in your small intestine and the larvae migrate through your bloodstream or lymphatic system into your lungs. At this stage, you may experience signs and symptoms similar to asthma or pneumonia, including:

Persistent cough
Shortness of breath
Wheezing
After spending six to 10 days in the lungs, the larvae travel to your throat, where you cough them up and then swallow them.

In the intestines
The larvae mature into adult worms in your small intestine, and the adult worms typically live in the intestines until they die. In mild or moderate ascariasis, the intestinal infestation can cause:

Vague abdominal pain
Nausea and vomiting
Diarrhea or bloody stools
If you have a large number of worms in your intestine, you might have:

Severe abdominal pain
Fatigue
Vomiting
Weight loss or malnutrition
A worm in your vomit or stool
When to see a doctor
Consult your doctor if you have persistent abdominal pain, diarrhea or nausea.

Causes

Ascariasis isn’t spread directly from person to person. Instead, a person has to come into contact with soil mixed with human feces that contain ascariasis eggs or infected water. In many developing countries, human feces are used for fertilizer, or poor sanitary facilities allow human waste to mix with soil in yards, ditches and fields.

Small children often play in dirt, and infection can occur if they put their dirty fingers in their mouths. Unwashed fruits or vegetables grown in contaminated soil also can transmit the ascariasis eggs.

Life cycle of a worm
Ingestion. The microscopic ascariasis eggs can’t become infective without coming into contact with soil. People can accidentally ingest contaminated soil through hand-to-mouth contact or by eating uncooked fruits or vegetables that have been grown in contaminated soil.
Migration. Larvae hatch from the eggs in your small intestine and then penetrate the intestinal wall to travel to your lungs via your bloodstream or lymphatic system. After maturing for about a week in your lungs, the larvae break into your airway and travel up your throat, where they’re coughed up and swallowed.
Maturation. Once back in the intestines, the parasites grow into male or female worms. Female worms can be more than 15 inches (40 centimeters) long and a little less than a quarter inch (6 millimeters) in diameter. Male worms are generally smaller.
Reproduction. Male and female worms mate in the small intestine. Female worms can produce 200,000 eggs a day, which leave your body in your feces. The fertilized eggs must be in soil for at least 18 days before they become infective.
The whole process — from egg ingestion to egg deposits — takes about two or three months. Ascariasis worms can live inside you for a year or two.

Risk Factors

Age. Most people who have ascariasis are 10 years old or younger. Children in this age group may be at higher risk because they’re more likely to play in dirt.
Warm climate. In the United States, ascariasis is more common in the Southeast, but it’s more prevalent in developing countries with warm temperatures year-round.
Poor sanitation. Ascariasis is widespread in developing countries where human feces are allowed to mix with local soil.

Complications of Round worm infection

Mild cases of ascariasis usually don’t cause complications. If you have a heavy infestation, potentially dangerous complications may include:

Slowed growth. Loss of appetite and poor absorption of digested foods put children with ascariasis at risk of not getting enough nutrition, which can slow growth.
Intestinal blockage and perforation. In heavy ascariasis infestation, a mass of worms can block a portion of your intestine, causing severe abdominal cramping and vomiting. The blockage can even perforate the intestinal wall or appendix, causing internal bleeding (hemorrhage) or appendicitis.
Duct blockages. In some cases, worms may block the narrow ducts of your liver or pancreas, causing severe pain.

Tests and Diagnosis

In heavy infestations, it’s possible to find worms after you cough or vomit, and the worms can come out of other body openings, such as your mouth or nostrils. If this happens to you, take the worm to your doctor to identify it and prescribe the proper treatment.

Stool tests
Mature female ascariasis worms in your intestine begin laying eggs. These eggs travel through your digestive system and eventually can be found in your stool.

To diagnose ascariasis, your doctor will examine your stool for the microscopic eggs and larvae. But eggs won’t appear in stool until at least 40 days after you’re infected. And if you’re infected with only male worms, you won’t have eggs.

Blood tests
Your blood can be tested for the presence of an increased number of a certain type of white blood cell, called eosinophils. Ascariasis can elevate your eosinophils, but so can other types of health problems.

Imaging tests
X-rays. If you’re infested with worms, the mass of worms may be visible in an X-ray of your abdomen. In some cases, a chest X-ray can reveal the larvae in your lungs.
Ultrasound. An ultrasound may show worms in your pancreas or liver. This technology uses sound waves to create images of internal organs.
CT scans or MRIs. Both types of tests create detailed images of your internal structures, which can help your doctor detect worms that are blocking ducts in your liver or pancreas. CT scans combine X-ray images taken from many angles; MRI uses radio waves and a strong magnetic field.

Treatment and Drugs

Typically, only infections that cause symptoms need to be treated. In some cases, ascariasis will resolve on its own.

Medications
Anti-parasite medications are the first line of treatment against ascariasis. The most common are:

Albendazole (Albenza)
Ivermectin (Stromectol)
Mebendazole
These medications, taken for one to three days, kill the adult worms. Side effects include mild abdominal pain or diarrhea.

Nocturnal Enuresis (Bed Wetting)

Bed-wetting is also known as nighttime incontinence or nocturnal enuresis. Generally, bed-wetting before age 7 isn’t a concern. At this age, your child may still be developing nighttime bladder control. If bed-wetting continues, treat the problem with patience and understanding. Bladder training, moisture alarms or medication may help reduce bed-wetting.

Symptoms of Bed Wetting

Bed-wetting is involuntary urination while asleep after the age at which staying dry at night can be reasonably expected.

Most kids are fully toilet trained by age 5, but there’s really no target date for developing complete bladder control. Between the ages of 5 and 7, bed-wetting remains a problem for some children. After 7 years of age, a small number of children still wet the bed.

When to see a doctor

Most children outgrow bed-wetting on their own — but some need a little help. In other cases, bed-wetting may be a sign of an underlying condition that needs medical attention.

Causes

No one knows for sure what causes bed-wetting, but various factors may play a role:

A small bladder. Your child’s bladder may not be developed enough to hold urine produced during the night.
Inability to recognize a full bladder. If the nerves that control the bladder are slow to mature, a full bladder may not wake your child — especially if your child is a deep sleeper.
A hormone imbalance. During childhood, some kids don’t produce enough anti-diuretic hormone (ADH) to slow nighttime urine production.
Stress. Stressful events — such as becoming a big brother or sister, starting a new school, or sleeping away from home — may trigger bed-wetting.
Urinary tract infection. This infection can make it difficult for your child to control urination. Signs and symptoms may include bed-wetting, daytime accidents, frequent urination, red or pink urine, and pain during urination.
Sleep apnea. Sometimes bed-wetting is a sign of obstructive sleep apnea, a condition in which the child’s breathing is interrupted during sleep — often due to inflamed or enlarged tonsils or adenoids. Other signs and symptoms may include snoring, frequent ear and sinus infections, sore throat, or daytime drowsiness.
Diabetes. For a child who’s usually dry at night, bed-wetting may be the first sign of diabetes. Other signs and symptoms may include passing large amounts of urine at once, increased thirst, fatigue and weight loss in spite of a good appetite.
Chronic constipation. The same muscles are used to control urine and stool elimination. When constipation is long term, these muscles can become dysfunctional and contribute to bed-wetting at night.
A structural problem in the urinary tract or nervous system. Rarely, bed-wetting is related to a defect in the child’s neurological system or urinary system.

Risk Factors of Bed Wetting

Several factors have been associated with an increased risk of bed-wetting, including:

Being male. Bed-wetting can affect anyone, but it’s twice as common in boys as girls.
Family history. If one or both of a child’s parents wet the bed as children, their child has a significant chance of wetting the bed, too.
Attention-deficit/hyperactivity disorder (ADHD). Bed-wetting is more common in children who have ADHD.

Complications

Although frustrating, bed-wetting without a physical cause doesn’t pose any health risks. However, bed-wetting can create some issues for your child, including:

Guilt and embarrassment, which can lead to low self-esteem
Loss of opportunities for social activities, such as sleepovers and camp
Rashes on the child’s bottom and genital area — especially if your child sleeps in wet underwear

Tests and Diagnosis

Your child will need a physical exam. Depending on the circumstances, your doctor may recommend:

Urine tests to check for signs of an infection or diabetes
X-rays or other imaging tests of the kidneys or bladder, if the doctor suspects a structural problem with your child’s urinary tract or another health concern
Other types of tests or assessments, if other health issues are suspected

Treatment and Management

Most children outgrow bed-wetting on their own. If there’s a family history of bed-wetting, your child will probably stop bed-wetting around the age the parent stopped bed-wetting.

If your child isn’t especially bothered or embarrassed by an occasional wet night, traditional home remedies may work well. However, if your grade schooler is terrified about wetting the bed during a sleepover, he or she may be more motivated to try additional treatments. The child’s and parents’ motivation can impact the selection of treatment and its success.

If found, underlying causes of bed-wetting, such as constipation or sleep apnea, should be addressed before other treatment.

Moisture alarms: These small, battery-operated devices — available without a prescription at most pharmacies — connect to a moisture-sensitive pad on your child’s pajamas or bedding. When the pad senses wetness, the alarm goes off.

Ideally, the moisture alarm sounds just as your child begins to urinate — in time to help your child wake, stop the urine stream and get to the toilet. If your child is a heavy sleeper, another person may need to listen for the alarm and wake the child.

If you try a moisture alarm, give it plenty of time. It often takes at least two weeks to see any type of response and up to 16 weeks to enjoy dry nights. Moisture alarms are effective for many children, carry a low risk of relapse or side effects, and may provide a better long-term solution than medication does. These devices are not typically covered by insurance.

Medication
As a last resort, your child’s doctor may prescribe medication to stop bed-wetting. Certain types of medication can:

Slow nighttime urine production. The drug desmopressin (DDAVP, others) boosts levels of a natural hormone (anti-diuretic hormone, or ADH) that forces the body to make less urine at night. But drinking too much liquid with the medication can cause problems with low sodium levels in the blood and the potential for seizures. So drinking only 8 ounces (237 milliliters) of fluids with and after the medication is recommended. Don’t give your child this medication if he or she has a headache, has vomited or feels nauseated. Desmopressin also may be used in short-term situations, such as going to camp.

According to the Food and Drug Administration, nasal spray formulations of desmopressin (DDAVP Nasal Spray, DDAVP Rhinal Tube, others) are no longer recommended for treatment of bed-wetting due to the risk of serious side effects.

Calm the bladder. If your child has a small bladder, an anticholinergic drug such as oxybutynin (Ditropan XL) may help reduce bladder contractions and increase bladder capacity. This medication is usually used in combination with other medications and is generally recommended only when other treatments have failed.

Sometimes a combination of medications is most effective. There are no guarantees, however, and medication doesn’t cure the problem. Bed-wetting typically resumes when medication is stopped.

Pelvic Inflammatory Disease

This is an infection of the female reproductive organs. It usually occurs when sexually transmitted bacteria spread from your vagina to your uterus, fallopian tubes or ovaries. Many women who develop pelvic inflammatory disease either experience no signs or symptoms or don’t seek treatment. Pelvic inflammatory disease may be detected only later when you have trouble getting pregnant or if you develop chronic pelvic pain.

Symptoms

Signs and symptoms of pelvic inflammatory disease may include:

Pain in your lower abdomen and pelvis
Heavy vaginal discharge with an unpleasant odor
Irregular menstrual bleeding
Pain during intercourse
Fever
Painful or difficult urination
PID may cause only minor signs and symptoms or none at all. PID with mild or no symptoms is especially common when the infection is due to chlamydia.

When to see a doctor

Go to the emergency room if you experience the following severe signs and symptoms of PID:

Severe pain low in your abdomen
Vomiting
Signs of shock, such as fainting
Fever, with a temperature higher than 101 F (38.3 C)

If your signs and symptoms aren’t severe, but they’re persistent, see your doctor as soon as possible. Vaginal discharge with an odor, painful urination or bleeding between menstrual cycles can be associated with a sexually transmitted infection (STI). If these signs and symptoms appear, stop having sex and see your doctor soon. Prompt treatment of an STI can help prevent PID.

Causes

Pelvic inflammatory disease can be caused by a number of bacteria but are most often caused by gonorrhea or chlamydia infections. These bacteria are usually acquired during unprotected sex.

Less commonly, bacteria may enter your reproductive tract anytime the normal barrier created by the cervix is disturbed. This can happen after intrauterine device (IUD) insertion, childbirth, miscarriage or abortion.

Risk Factors of Pelvic inflammatory disease

A number of factors may increase your risk of pelvic inflammatory disease, including:

Being a sexually active woman younger than 25 years old
Having multiple sexual partners
Being in a sexual relationship with a person who has more than one sex partner
Having sex without a condom
Having had an IUD inserted recently
Douching regularly, which upsets the balance of good versus harmful bacteria in the vagina and may mask symptoms that might otherwise cause you to seek early treatment
Having a history of pelvic inflammatory disease or a sexually transmitted infection

Complications

Untreated pelvic inflammatory disease may cause scar tissue and collections of infected fluid (abscesses) to develop in your fallopian tubes and damage your reproductive organs. Complications may include:

Ectopic pregnancy. PID is a major cause of tubal (ectopic) pregnancy. In an ectopic pregnancy, the fertilized egg can’t make its way through the fallopian tube to implant in the uterus. Ectopic pregnancies can cause massive, life-threatening bleeding and require emergency surgery.
Infertility. PID may damage your reproductive organs and cause infertility — the inability to become pregnant. The more times you’ve had PID, the greater your risk of infertility. Delaying treatment for PID also dramatically increases your risk of infertility.
Chronic pelvic pain. Pelvic inflammatory disease can cause pelvic pain that may last for months or years. Scarring in your fallopian tubes and other pelvic organs can cause pain during intercourse and ovulation.

Tests and Diagnosis

Doctors diagnose pelvic inflammatory disease based on signs and symptoms, a pelvic exam, an analysis of vaginal discharge and cervical cultures, or urine tests.

During the pelvic exam, your doctor uses a cotton swab to take samples from your vagina and cervix. The samples are sent to a lab for analysis to determine the organism that’s causing the infection.

To confirm the diagnosis or to determine how widespread the infection is, your doctor may recommend other tests, such as:

Ultrasound. This test uses sound waves to create images of your reproductive organs.
Endometrial biopsy. During this procedure, your doctor removes a small piece of your uterine lining (endometrium) for testing.
Laparoscopy. During this procedure, your doctor inserts a thin, lighted instrument through a small incision in your abdomen to view your pelvic organs.

Treatment and Drugs

Treatment for pelvic inflammatory disease may include:

Antibiotics. Your doctor may prescribe a combination of antibiotics to start taking right away. After receiving your lab test results, your doctor may adjust the medications you’re taking to better match what’s causing the infection.

Usually, your doctor will request a follow-up visit in three days to make sure the treatment is working. Be sure to take all of your medication, even if you start to feel better after a few days. Antibiotic treatment can help prevent serious complications but can’t reverse any damage that’s already been done.

Treatment for your partner. To prevent reinfection with an STI, advise your sexual partner or partners to be examined and treated. Partners can be infected and not have any noticeable symptoms.
Temporary abstinence. Avoid sexual intercourse until treatment is completed and tests indicate that the infection has cleared in all partners.
More-serious cases

Outpatient treatment is adequate for treating most women with pelvic inflammatory disease. However, if you’re seriously ill, pregnant or haven’t responded to oral medications, you may need hospitalization. At the hospital, you may receive intravenous (IV) antibiotics, followed by antibiotics you take by mouth.

Surgery is rarely necessary. However, if an abscess ruptures or threatens to rupture, your doctor may drain it.

In addition, surgery may be performed on women who don’t respond to antibiotic treatment or who have a questionable diagnosis, such as when one or more of the signs or symptoms of PID are absent.

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