ZyraDoc #49 - September 19, 2026

A 9-year-old child from a rural agricultural area presents with intermittent, vague mid-abdominal cramps, loss of appetite, and a history of coughing up blood-tinged sputum 2 weeks prior.

Physical examination reveals a mildly distended, non-tender abdomen, and his parent brings a large, smooth, cylindrical reddish-white worm (22 cm in length) passed in the child's stool this morning.

Microscopic stool evaluation demonstrates characteristic thick-shelled, knobby, golden-brown embryonated eggs, and a complete blood count shows marked peripheral eosinophilia.

Case Summary

Clinical Focus:

The diagnosis is Ascariasis.

Aetiology/Cause:

Infection by the giant intestinal roundworm Ascaris lumbricoides.
Fecal-oral transmission occurring via ingestion of food, water, or soil contaminated with embryonated eggs.
Larval migration pathway: ingested eggs hatch in the small intestine, cross the intestinal mucosa into the portal system, migrate through the pulmonary circulation into alveoli, ascend the bronchial tree, and are swallowed back into the GI tract to mature into adult worms.

Clinical Features:

Pulmonary phase (Löffler syndrome) characterized by transient dry cough, wheezing, dyspnea, substernal chest discomfort, and eosinophilic pneumonitis during larval lung migration.
Intestinal phase featuring vague abdominal pain, nausea, anorexia, diarrhea, and abdominal distension.
Nutritional impairment, growth faltering, and vitamin A/C deficiencies in heavily infected pediatric populations.
Passage of large adult worms (15–35 cm in length) through the mouth, nares, or rectum.

Diagnosis and Investigations:

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