Pneumoascariasis: An Unusual Pulmonary Manifestation of Ascaris lumbricoides Infection

Pneumoascariasis: An Unusual Pulmonary Manifestation of Ascaris lumbricoides Infection | Research Square window.SnipcartSettings = { analytics: { enabled: false } }; (function() { var accessVector = localStorage.getItem('access_vector') || ''; window.dataLayer = window.dataLayer || []; if (accessVector) { window.dataLayer.push({ user: { profile: { profileInfo: { snid: accessVector } } } }); } })(); (function(w,d,s,l,i){w[l]=w[l]||[];w[l].push({'gtm.start':new Date().getTime(),event:'gtm.js'});var f=d.getElementsByTagName(s)[0],j=d.createElement(s),dl=l!='dataLayer'?'&l='+l:'';j.async=true;j.src='https://www.googletagmanager.com/gtm.js?id='+i+dl;f.parentNode.insertBefore(j,f);})(window,document,'script','dataLayer','GTM-K279D39R'); Browse Preprints In Review Journals COVID-19 Preprints AJE Video Bytes Research Tools Research Promotion AJE Professional Editing AJE Rubriq About Preprint Platform In Review Editorial Policies Our Team Advisory Board Help Center Sign In Submit a Preprint Cite Share Download PDF Case Report Pneumoascariasis: An Unusual Pulmonary Manifestation of Ascaris lumbricoides Infection Vennela Pallem, Shaik Mohammed Aslam, Ashwin Kulkarini, Mohammed Suhail, and 1 more This is a preprint; it has not been peer reviewed by a journal. https://doi.org/ 10.21203/rs.3.rs-7565790/v1 This work is licensed under a CC BY 4.0 License Status: Under Review Version 1 posted 12 You are reading this latest preprint version Abstract Background Pneumoascariasis, a pulmonary manifestation of Ascaris lumbricoides infection, is infrequently recognized in clinical practice despite the global prevalence of ascariasis. The symptoms often mimic community-acquired pneumonia or bronchial asthma, leading to diagnostic challenges. We present an unusual case of pneumoascariasis in an elderly female who presented with respiratory symptoms and was found to have worm migration through multiple body sites. Case Presentation A 70-year-old female with no known comorbidities presented with fever, productive cough, and dysphagia for 3 days. Physical examination revealed tachycardia, tachypnea, hypoxia and pallor. Respiratory examination showed bilateral basal crepitations. On day 2 of hospitalization, creamy-colored worms were observed in the patient’s stool, nasal cavity, and oral cavity. Stool examination confirmed Ascaris lumbricoides infection, and radiological findings revealed bilateral lower zone pneumonitis. The patient was diagnosed with pneumoascariasis (post-lung phase) and was successfully treated with anti-helminthic therapy, antibiotics, and corticosteroids. Conclusion This case highlights the importance of considering parasitic infections in the differential diagnosis of respiratory symptoms, particularly in endemic regions. Pulmonary symptoms may be the predominant manifestation of ascariasis, necessitating a high index of clinical suspicion for timely diagnosis and appropriate management. Pneumoascariasis Ascaris lumbricoides pulmonary migration helminthic infection respiratory symptoms Figures Figure 1 Figure 2 Figure 3 Figure 4 Figure 5 Figure 6 Introduction Ascariasis is one of the most prevalent helminthic infections globally, affecting approximately 800–1200 million people worldwide, with the highest burden in tropical and subtropical regions with inadequate sanitation and hygiene practices.^1,2^ The infection is caused by the parasitic roundworm Ascaris lumbricoides, which exhibits a complex life cycle involving the intestinal and pulmonary systems. Ascaris infection predominantly involves the intestines; however, during its life cycle, larvae migrate through the liver and lungs before settling in the small intestine as adult worms.^3^ This migratory phase through the lungs can cause respiratory symptoms known as pneumoascariasis. The global prevalence of ascariasis has declined over time due to improved sanitation and public health measures, leading to reduced recognition and potential underdiagnosis of this condition in clinical practice.^4^ Pneumoascariasis can mimic common respiratory conditions such as community-acquired pneumonia, bronchial asthma, or Löffler’s syndrome, posing diagnostic challenges for clinicians.^5^ The condition typically manifests with cough, dyspnea, wheezing, and occasionally hemoptysis, with or without peripheral eosinophilia.^6^ Recognizing pneumoascariasis is crucial for appropriate management and to prevent potential complications. We report an unusual case of pneumoascariasis in an elderly female who presented with respiratory symptoms and was subsequently found to have evidence of Ascaris lumbricoides migration through multiple body sites, including the respiratory, gastrointestinal, and nasopharyngeal tracts. Case Presentation A 70-year-old female with no known comorbidities presented to our hospital with complaints of fever, cough with expectoration, and difficulty in swallowing for 3 days. The patient reported a gradual onset of symptoms with progressive worsening over the preceding days. There was no history of recent travel, known tuberculosis exposure, or prior episodes of similar symptoms. On physical examination, the patient appeared ill and was in moderate respiratory distress. Vital signs revealed tachycardia (heart rate 110 beats/minute), tachypnea (respiratory rate 28 breaths/minute), and hypoxia (oxygen saturation 92% on room air). She was febrile with a temperature of 38.2°C. General examination showed pallor. Respiratory examination revealed bilateral basal crepitations in the infrascapular and interscapular areas. The rest of the physical examination was unremarkable. On day 2 of hospitalization, creamy-colored worms[Picture - 1] were observed in the patient’s stool[Picture -5 & 6], nasal cavity[Picture – 2&4], and oral cavity[Picture - 3 ]. These specimens were collected and sent for parasitological evaluation. Laboratory investigations [Investigations – Table 1 to be inserted here] during the hospital stay revealed normal hemogram , normal Renal and liver function tests. Stool examination revealed ova of ascariasis lumbricoides. Chest X-ray: Bilateral lower zone infiltrates consistent with pneumonia.[Investigations – Table 2 to be inserted here] Peripheral smear revelaed normoctic normochromic blood picture . Absolute eosinophilic count was normal . Differential Diagnosis The primary differential diagnoses considered in this case included: 1. Community-acquired pneumonia: The patient’s presenting symptoms of fever, cough, and respiratory distress with radiological evidence of bilateral infiltrates initially suggested community-acquired pneumonia. However, the subsequent identification of worms in multiple body sites necessitated consideration of alternative diagnoses. 2. Löffler’s syndrome: This condition, characterized by transient pulmonary infiltrates and peripheral eosinophilia, is frequently associated with the larval migration phase of parasitic infections, including ascariasis.^6,9^ However, in our patient, the absolute eosinophil count and peripheral smear were normal, making this diagnosis less likely. 3. Bronchial asthma with secondary infection: The presence of wheezing and respiratory distress could suggest an acute exacerbation of bronchial asthma. However, the absence of a prior history of asthma and the presence of fever made this diagnosis less probable. 4. Pneumoascariasis: The combination of respiratory symptoms, radiological findings, and the detection of Ascaris lumbricoides in the stool, along with the unusual finding of worms in the nasal and oral cavities, supported the diagnosis of pneumoascariasis.^8^ Based on the clinical presentation, laboratory findings, and parasitological examination, the patient was diagnosed with pneumoascariasis in the post-lung phase of Ascaris lumbricoides infection. Treatment The patient was initially started on empirical treatment for community-acquired pneumonia with intravenous ceftriaxone (1 gram twice daily) and oral azithromycin (500 mg once daily). Supportive measures including oxygen supplementation, antipyretics, and intravenous fluids were provided. Upon confirmation of Ascaris lumbricoides infection, the treatment regimen was modified to include: 1. Anti-helminthic therapy: Albendazole 400 mg as a single dose administered via nasogastric tube 2. Corticosteroids: Intravenous hydrocortisone 100 mg three times daily, gradually tapered over subsequent days 3. Continuation of antibiotics: To address potential secondary bacterial infection 4. Supportive care: Oxygen therapy, intravenous fluids, and chest physiotherapy Outcome and Follow-up Following the initiation of anti-helminthic therapy and corticosteroids, the patient showed significant clinical improvement. Her respiratory symptoms improved, and she was successfully weaned off oxygen supplementation. Subsequent stool examinations showed clearance of Ascaris ova, and no further worm migration was observed. The patient was discharged in stable condition with prescriptions for oral medications and recommendations for chest physiotherapy. At the initial follow-up visit, she reported continued improvement in her symptoms without any recurrence. Unfortunately, the patient was lost to further follow-up after the initial post-discharge visit. Discussion Ascariasis is the most common helminthic infection globally, with an estimated prevalence of over 800 million cases.^1^ The infection is particularly endemic in tropical and subtropical regions with poor sanitation, where the warm, moist environment favors egg survival.^7^ While the majority of infections are asymptomatic or manifest with mild gastrointestinal symptoms, pulmonary involvement during the larval migration phase can lead to pneumoascariasis. Pulmonary ascariasis, or pneumoascariasis, occurs during the larval migratory phase of the Ascaris life cycle. Following ingestion of embryonated eggs, larvae hatch in the small intestine and penetrate the intestinal mucosa to enter the portal circulation. They subsequently migrate through the liver and reach the lungs via the pulmonary circulation. Within the alveoli, larvae mature further before ascending the bronchial tree, being swallowed, and finally developing into adult worms in the small intestine.^3,8^ This pulmonary migration typically occurs 4-16 days after ingestion of eggs and can cause symptoms such as cough, dyspnea, wheeze, and occasionally hemoptysis. Radiological findings during this phase may include transient pulmonary infiltrates, often described as Löffler’s syndrome when accompanied by peripheral eosinophilia.^9^ In our case, the patient presented with respiratory symptoms consistent with pneumoascariasis, although notably without the characteristic eosinophilia. An unusual aspect of our case was the observation of worms in the nasal and oral cavities, in addition to stool. This suggests an aberrant migration pattern of adult worms, possibly due to the heavy worm burden or the elderly age of the patient. Adult Ascaris worms can occasionally migrate from their usual habitat in the small intestine to ectopic sites, including the biliary tract, pancreatic duct, or even the respiratory tract, especially during febrile illnesses or following administration of certain medications.^10^ The diagnosis of pneumoascariasis requires a high index of suspicion, particularly in endemic regions. Diagnostic approaches include identification of eggs or adult worms in stool samples, imaging studies to detect pulmonary infiltrates, and occasionally examination of sputum for larvae during the pulmonary phase. In our patient, the diagnosis was established through the visualization of adult worms and the identification of characteristic Ascaris ova in stool examination. Treatment of pneumoascariasis involves anti-helminthic medications, most commonly albendazole or mebendazole, which are effective against both intestinal and tissue-migrating stages of the parasite.^11^ In patients with significant pulmonary symptoms, corticosteroids may be considered to reduce inflammation associated with the immune response to migrating larvae.^12^ Our patient received albendazole for parasite eradication, along with corticosteroids to address the inflammatory component of her respiratory symptoms. It is worth noting that anti-helminthic therapy during the pulmonary phase of ascariasis has been a subject of debate, as killing larvae in the lungs may potentially exacerbate the inflammatory response. However, in cases with significant symptoms, the benefits of parasite eradication often outweigh this theoretical risk, particularly when combined with anti-inflammatory therapy.^13^ Prevention of ascariasis and its pulmonary manifestations relies on improved sanitation, access to clean water, proper disposal of human waste, and health education. In endemic regions, periodic mass drug administration has been implemented as a public health strategy to reduce worm burden and transmission.^14^ Learning Points 1. Pulmonary ascariasis should be considered in the differential diagnosis of respiratory symptoms, particularly in patients from endemic regions, even in the absence of peripheral eosinophilia.^5,6^ 2. The migration of Ascaris lumbricoides can involve multiple body sites beyond the typical intestinal and pulmonary locations, including unusual sites such as the nasal and oral cavities.^10^ 3. Radiological findings in pneumoascariasis may be non-specific; hence, a high index of suspicion is needed, particularly in endemic areas.^7,8^ 4. Treatment with anti-helminthic agents is effective and should be timed appropriately to avoid exacerbating the pulmonary response. Corticosteroids may be beneficial in cases with significant respiratory symptoms.^11,12^ 5. The diagnosis of pneumoascariasis may be overlooked due to its similarity to more common respiratory conditions such as community-acquired pneumonia or bronchial asthma.^5,9^ Declarations Author Contribution Shaik Mohammed Aslam: Conceptualization, data collection, clinical management of the patient, manuscript drafting, and final approval of the version to be submitted.Vennela Pallem: Literature review, preparation of case presentation details, and drafting of the discussion section.Ashwin Kulkarni: Critical revision of the manuscript for important intellectual content and supervision.Mohammed Suhail: Radiological interpretation, preparation of figure(s), and assistance with discussion of differential diagnoses.Harshith N: Supervision, overall guidance, editing for clarity and accuracy, and approval of the final manuscript. References Bethony J, Brooker S, Albonico M, Geiger SM, Loukas A, Diemert D, et al. Soil-transmitted helminth infections: ascariasis, trichuriasis, and hookworm. Lancet. 2006;367(9521):1521–32. GBD 2019 Diseases and Injuries Collaborators. Global burden of 369 diseases and injuries in 204 countries and territories, 1990–2019: a systematic analysis for the Global Burden of Disease Study 2019. Lancet. 2020;396(10258):1204–22. Dold C, Holland CV. Ascaris and ascariasis. Microbes Infect. 2011;13(7):632–7. Pullan RL, Smith JL, Jasrasaria R, Brooker SJ. Global numbers of infection and disease burden of soil transmitted helminth infections in 2010. Parasit Vectors. 2014;7:37. Ozdemir O. Loeffler’s syndrome: a type of eosinophilic pneumonia mimicking community-acquired pneumonia and asthma that arises from Ascaris lumbricoides in a child. J Pediatr Infect Dis. 2020;15(04):193–6. Spener R, Safe I, Baia-da-Silva DC, Sampaio VS, Borba MGS, Cordeiro-Santos M, et al. Löeffler’s syndrome. Int J Infect Dis. 2019;89:79–80. Schindler-Piontek M, Chaubal N, Dehmani S, Streba CT, Sirli R, Burta OL, et al. Ascariasis, a review. Med Ultrason. 2022;24:329–38. Widiastara AA, Ferreira E, Basuki S. Pneumoascariasis: Ascaris worm infestation in the lungs. Jurnal Respirasi. 2024;10(1):69–75. Cheema HA, Waheed N, Saeed A. Rare presentation of haemobilia and Loeffler’s pneumonia in a child by Ascaris lumbricoides. BMJ Case Rep. 2019;12:e230150. Khuroo MS, Rather AA, Khuroo NS, Khuroo MS. Hepatobiliary and pancreatic ascariasis. World J Gastroenterol. 2016;22(33):7507–17. World Health Organization. Preventive chemotherapy to control soil-transmitted helminth infections in at-risk population groups. Geneva: World Health Organization; 2017. Tran KH, Nguyen-Thi KH, Pham NC, Le HT, Pham TC, Nguyen NL, et al. Loeffler’s syndrome in a child: a rare radiological and histopathological diagnosis. Radiol Case Rep. 2022;17:245–9. Son BB, Kim-Hoa NT, Tuy NV, Binh MH, Anh TD, Ha DT, et al. Loeffler’s syndrome mimicking lung tumor and pneumonia in a child: a case report. Respir Med Case Rep. 2022;37:101638. Betson M, Nejsum P, Bendall RP, Deb RM, Stothard JR. Molecular epidemiology of ascariasis: a global perspective on the transmission dynamics of Ascaris in people and pigs. J Infect Dis. 2014;210(6):932–41. Tables Table 1. Investigations done during hospitalisation. Laboratory Results Test Result Reference Range White blood cell count 4,120 cells/μL 4,000-11,000 cells/μL Hemoglobin 13.8 g/dL 12.0-16.0 g/dL Platelet count 177,000/μL 150,000-450,000/μL Absolute eosinophil count 0.01 × 10³/μL 0.0-0.5 × 10³/μL (approx) Total bilirubin 0.85 mg/dL 0.1-1.2 mg/dL Direct bilirubin 0.40 mg/dL 0.0-0.3 mg/dL Aspartate aminotransferase (AST) 59 U/L 5-40 U/L Alanine aminotransferase (ALT) 20 U/L 5-40 U/L Alkaline phosphatase 31 U/L 35-129 U/L Albumin 2.3 g/dL 3.5-5.0 g/dL Prothrombin time 13.3 sec 11-15 sec International Normalized Ratio (INR) 0.95 0.8-1.2 Table 2. Microbiological and Radiological investigations done during hospitalisation Microbiological and Imaging Studies Investigation Findings Blood cultures No growth Urine cultures No growth Stool examination Ova of Ascaris lumbricoides identified Chest X-ray Bilateral lower zone infiltrates consistent with pneumonia 2D Echocardiography Tachycardia, concentric LV hypertrophy, no RWMA, normal IVC with partial collapse Abdominal ultrasonography Normal, no hepatobiliary involvement Additional Declarations No competing interests reported. Cite Share Download PDF Status: Under Review Version 1 posted Editorial decision: Revision requested 17 Oct, 2025 Reviews received at journal 17 Oct, 2025 Reviews received at journal 10 Oct, 2025 Reviewers agreed at journal 10 Oct, 2025 Reviewers agreed at journal 06 Oct, 2025 Reviews received at journal 25 Sep, 2025 Reviewers agreed at journal 23 Sep, 2025 Reviewers agreed at journal 20 Sep, 2025 Reviewers invited by journal 18 Sep, 2025 Editor assigned by journal 18 Sep, 2025 Submission checks completed at journal 18 Sep, 2025 First submitted to journal 08 Sep, 2025 You are reading this latest preprint version Research Square lets you share your work early, gain feedback from the community, and start making changes to your manuscript prior to peer review in a journal. As a division of Research Square Company, we’re committed to making research communication faster, fairer, and more useful. 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5","display":"","copyAsset":false,"role":"figure","size":627821,"visible":true,"origin":"","legend":"\u003cp\u003eSee image above for figure legend\u003c/p\u003e","description":"","filename":"AscarisCaseImages5.jpg","url":"https://assets-eu.researchsquare.com/files/rs-7565790/v1/7d57613211dc16760e45cfac.jpg"},{"id":92615399,"identity":"c7104fab-c052-41ff-9e03-61aaf5055bf6","added_by":"auto","created_at":"2025-10-01 17:33:14","extension":"jpg","order_by":6,"title":"Figure 6","display":"","copyAsset":false,"role":"figure","size":472494,"visible":true,"origin":"","legend":"\u003cp\u003eSee image above for figure legend\u003c/p\u003e","description":"","filename":"AscarisCaseImages6.jpg","url":"https://assets-eu.researchsquare.com/files/rs-7565790/v1/4f4e7fdc44506c2a91924dd8.jpg"},{"id":92617991,"identity":"861c1f79-3ae9-479e-97fe-4e24a14cfb32","added_by":"auto","created_at":"2025-10-01 17:57:15","extension":"pdf","order_by":0,"title":"","display":"","copyAsset":false,"role":"manuscript-pdf","size":4135886,"visible":true,"origin":"","legend":"","description":"","filename":"manuscript.pdf","url":"https://assets-eu.researchsquare.com/files/rs-7565790/v1/5643c9f6-0a0c-4d6d-ab86-2c5d2c36ac56.pdf"}],"financialInterests":"No competing interests reported.","formattedTitle":"Pneumoascariasis: An Unusual Pulmonary Manifestation of Ascaris lumbricoides Infection","fulltext":[{"header":"Introduction","content":"\u003cp\u003eAscariasis is one of the most prevalent helminthic infections globally, affecting approximately 800\u0026ndash;1200\u0026nbsp;million people worldwide, with the highest burden in tropical and subtropical regions with inadequate sanitation and hygiene practices.^1,2^ The infection is caused by the parasitic roundworm Ascaris lumbricoides, which exhibits a complex life cycle involving the intestinal and pulmonary systems.\u003c/p\u003e\u003cp\u003eAscaris infection predominantly involves the intestines; however, during its life cycle, larvae migrate through the liver and lungs before settling in the small intestine as adult worms.^3^ This migratory phase through the lungs can cause respiratory symptoms known as pneumoascariasis. The global prevalence of ascariasis has declined over time due to improved sanitation and public health measures, leading to reduced recognition and potential underdiagnosis of this condition in clinical practice.^4^\u003c/p\u003e\u003cp\u003ePneumoascariasis can mimic common respiratory conditions such as community-acquired pneumonia, bronchial asthma, or L\u0026ouml;ffler\u0026rsquo;s syndrome, posing diagnostic challenges for clinicians.^5^ The condition typically manifests with cough, dyspnea, wheezing, and occasionally hemoptysis, with or without peripheral eosinophilia.^6^ Recognizing pneumoascariasis is crucial for appropriate management and to prevent potential complications.\u003c/p\u003e\u003cp\u003eWe report an unusual case of pneumoascariasis in an elderly female who presented with respiratory symptoms and was subsequently found to have evidence of Ascaris lumbricoides migration through multiple body sites, including the respiratory, gastrointestinal, and nasopharyngeal tracts.\u003c/p\u003e"},{"header":"Case Presentation","content":"\u003cp\u003eA 70-year-old female with no known comorbidities presented to our hospital with complaints of fever, cough with expectoration, and difficulty in swallowing for 3 days. The patient reported a gradual onset of symptoms with progressive worsening over the preceding days. There was no history of recent travel, known tuberculosis exposure, or prior episodes of similar symptoms.\u003c/p\u003e\n\u003cp\u003eOn physical examination, the patient appeared ill and was in moderate respiratory distress. Vital signs revealed tachycardia (heart rate 110 beats/minute), tachypnea (respiratory rate 28 breaths/minute), and hypoxia (oxygen saturation 92% on room air). She was febrile with a temperature of 38.2\u0026deg;C. General examination showed pallor. Respiratory examination revealed bilateral basal crepitations in the infrascapular and interscapular areas. The rest of the physical examination was unremarkable.\u003c/p\u003e\n\u003cp\u003eOn day 2 of hospitalization, creamy-colored worms[Picture - 1] were observed in the patient\u0026rsquo;s stool[Picture -5 \u0026amp; 6], nasal cavity[Picture \u0026ndash; 2\u0026amp;4], and oral cavity[Picture - 3 ]. These specimens were collected and sent for parasitological evaluation.\u003c/p\u003e\n\u003cp\u003eLaboratory investigations [Investigations \u0026ndash; Table 1 to be inserted here] during the hospital stay revealed normal hemogram , normal Renal and liver function tests. Stool examination revealed ova of ascariasis lumbricoides. Chest X-ray: Bilateral lower zone infiltrates consistent with pneumonia.[Investigations \u0026ndash; Table 2 to be inserted here] Peripheral smear revelaed normoctic normochromic blood picture . Absolute eosinophilic count was normal .\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eDifferential Diagnosis\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThe primary differential diagnoses considered in this case included:\u003c/p\u003e\n\u003cp\u003e\u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp;\u0026nbsp;1.\u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp;Community-acquired pneumonia: The patient\u0026rsquo;s presenting symptoms of fever, cough, and respiratory distress with radiological evidence of bilateral infiltrates initially suggested community-acquired pneumonia. However, the subsequent identification of worms in multiple body sites necessitated consideration of alternative diagnoses.\u003c/p\u003e\n\u003cp\u003e\u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp;\u0026nbsp;2.\u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp;L\u0026ouml;ffler\u0026rsquo;s syndrome: This condition, characterized by transient pulmonary infiltrates and peripheral eosinophilia, is frequently associated with the larval migration phase of parasitic infections, including ascariasis.^6,9^ However, in our patient, the absolute eosinophil count and peripheral smear were normal, making this diagnosis less likely.\u003c/p\u003e\n\u003cp\u003e\u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp;\u0026nbsp;3.\u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp;Bronchial asthma with secondary infection: The presence of wheezing and respiratory distress could suggest an acute exacerbation of bronchial asthma. However, the absence of a prior history of asthma and the presence of fever made this diagnosis less probable.\u003c/p\u003e\n\u003cp\u003e\u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; 4. \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; Pneumoascariasis: The combination of respiratory symptoms, radiological findings, and the detection of Ascaris lumbricoides in the stool, along with the unusual finding of worms in the nasal and oral cavities, supported the diagnosis of pneumoascariasis.^8^\u003c/p\u003e\n\u003cp\u003eBased on the clinical presentation, laboratory findings, and parasitological examination, the patient was diagnosed with pneumoascariasis in the post-lung phase of Ascaris lumbricoides infection.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eTreatment\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThe patient was initially started on empirical treatment for community-acquired pneumonia with intravenous ceftriaxone (1 gram twice daily) and oral azithromycin (500 mg once daily). Supportive measures including oxygen supplementation, antipyretics, and intravenous fluids were provided.\u003c/p\u003e\n\u003cp\u003eUpon confirmation of Ascaris lumbricoides infection, the treatment regimen was modified to include:\u003c/p\u003e\n\u003cp\u003e\u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp;\u0026nbsp;1.\u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp;Anti-helminthic therapy: Albendazole 400 mg as a single dose administered via nasogastric tube\u003c/p\u003e\n\u003cp\u003e\u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp;\u0026nbsp;2.\u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp;Corticosteroids: Intravenous hydrocortisone 100 mg three times daily, gradually tapered over subsequent days\u003c/p\u003e\n\u003cp\u003e\u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; 3. \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; Continuation of antibiotics: To address potential secondary bacterial infection\u003c/p\u003e\n\u003cp\u003e\u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; 4. \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; Supportive care: Oxygen therapy, intravenous fluids, and chest physiotherapy\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eOutcome and Follow-up\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eFollowing the initiation of anti-helminthic therapy and corticosteroids, the patient showed significant clinical improvement. Her respiratory symptoms improved, and she was successfully weaned off oxygen supplementation. Subsequent stool examinations showed clearance of Ascaris ova, and no further worm migration was observed.\u003c/p\u003e\n\u003cp\u003eThe patient was discharged in stable condition with prescriptions for oral medications and recommendations for chest physiotherapy. At the initial follow-up visit, she reported continued improvement in her symptoms without any recurrence. Unfortunately, the patient was lost to further follow-up after the initial post-discharge visit.\u003c/p\u003e"},{"header":"Discussion","content":"\u003cp\u003eAscariasis is the most common helminthic infection globally, with an estimated prevalence of over 800 million cases.^1^ The infection is particularly endemic in tropical and subtropical regions with poor sanitation, where the warm, moist environment favors egg survival.^7^ While the majority of infections are asymptomatic or manifest with mild gastrointestinal symptoms, pulmonary involvement during the larval migration phase can lead to pneumoascariasis.\u003c/p\u003e\n\u003cp\u003ePulmonary ascariasis, or pneumoascariasis, occurs during the larval migratory phase of the Ascaris life cycle. Following ingestion of embryonated eggs, larvae hatch in the small intestine and penetrate the intestinal mucosa to enter the portal circulation. They subsequently migrate through the liver and reach the lungs via the pulmonary circulation. Within the alveoli, larvae mature further before ascending the bronchial tree, being swallowed, and finally developing into adult worms in the small intestine.^3,8^\u003c/p\u003e\n\u003cp\u003eThis pulmonary migration typically occurs 4-16 days after ingestion of eggs and can cause symptoms such as cough, dyspnea, wheeze, and occasionally hemoptysis. Radiological findings during this phase may include transient pulmonary infiltrates, often described as L\u0026ouml;ffler\u0026rsquo;s syndrome when accompanied by peripheral eosinophilia.^9^ In our case, the patient presented with respiratory symptoms consistent with pneumoascariasis, although notably without the characteristic eosinophilia.\u003c/p\u003e\n\u003cp\u003eAn unusual aspect of our case was the observation of worms in the nasal and oral cavities, in addition to stool. This suggests an aberrant migration pattern of adult worms, possibly due to the heavy worm burden or the elderly age of the patient. Adult Ascaris worms can occasionally migrate from their usual habitat in the small intestine to ectopic sites, including the biliary tract, pancreatic duct, or even the respiratory tract, especially during febrile illnesses or following administration of certain medications.^10^\u003c/p\u003e\n\u003cp\u003eThe diagnosis of pneumoascariasis requires a high index of suspicion, particularly in endemic regions. Diagnostic approaches include identification of eggs or adult worms in stool samples, imaging studies to detect pulmonary infiltrates, and occasionally examination of sputum for larvae during the pulmonary phase. In our patient, the diagnosis was established through the visualization of adult worms and the identification of characteristic Ascaris ova in stool examination.\u003c/p\u003e\n\u003cp\u003eTreatment of pneumoascariasis involves anti-helminthic medications, most commonly albendazole or mebendazole, which are effective against both intestinal and tissue-migrating stages of the parasite.^11^ In patients with significant pulmonary symptoms, corticosteroids may be considered to reduce inflammation associated with the immune response to migrating larvae.^12^ Our patient received albendazole for parasite eradication, along with corticosteroids to address the inflammatory component of her respiratory symptoms.\u003c/p\u003e\n\u003cp\u003eIt is worth noting that anti-helminthic therapy during the pulmonary phase of ascariasis has been a subject of debate, as killing larvae in the lungs may potentially exacerbate the inflammatory response. However, in cases with significant symptoms, the benefits of parasite eradication often outweigh this theoretical risk, particularly when combined with anti-inflammatory therapy.^13^\u003c/p\u003e\n\u003cp\u003ePrevention of ascariasis and its pulmonary manifestations relies on improved sanitation, access to clean water, proper disposal of human waste, and health education. In endemic regions, periodic mass drug administration has been implemented as a public health strategy to reduce worm burden and transmission.^14^\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eLearning Points\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003e\u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp;\u0026nbsp;1.\u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp;Pulmonary ascariasis should be considered in the differential diagnosis of respiratory symptoms, particularly in patients from endemic regions, even in the absence of peripheral eosinophilia.^5,6^\u003c/p\u003e\n\u003cp\u003e\u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp;\u0026nbsp;2.\u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp;The migration of Ascaris lumbricoides can involve multiple body sites beyond the typical intestinal and pulmonary locations, including unusual sites such as the nasal and oral cavities.^10^\u003c/p\u003e\n\u003cp\u003e\u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp;\u0026nbsp;3.\u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp;Radiological findings in pneumoascariasis may be non-specific; hence, a high index of suspicion is needed, particularly in endemic areas.^7,8^\u003c/p\u003e\n\u003cp\u003e\u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp;\u0026nbsp;4.\u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp;Treatment with anti-helminthic agents is effective and should be timed appropriately to avoid exacerbating the pulmonary response. Corticosteroids may be beneficial in cases with significant respiratory symptoms.^11,12^\u003c/p\u003e\n\u003cp\u003e\u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; 5. \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; The diagnosis of pneumoascariasis may be overlooked due to its similarity to more common respiratory conditions such as community-acquired pneumonia or bronchial asthma.^5,9^\u003c/p\u003e"},{"header":"Declarations","content":"\u003ch2\u003eAuthor Contribution\u003c/h2\u003e\u003cp\u003eShaik Mohammed Aslam: Conceptualization, data collection, clinical management of the patient, manuscript drafting, and final approval of the version to be submitted.Vennela Pallem: Literature review, preparation of case presentation details, and drafting of the discussion section.Ashwin Kulkarni: Critical revision of the manuscript for important intellectual content and supervision.Mohammed Suhail: Radiological interpretation, preparation of figure(s), and assistance with discussion of differential diagnoses.Harshith N: Supervision, overall guidance, editing for clarity and accuracy, and approval of the final manuscript.\u003c/p\u003e"},{"header":"References","content":"\u003col\u003e\u003cli\u003e\u003cspan\u003eBethony J, Brooker S, Albonico M, Geiger SM, Loukas A, Diemert D, et al. Soil-transmitted helminth infections: ascariasis, trichuriasis, and hookworm. Lancet. 2006;367(9521):1521\u0026ndash;32.\u003c/span\u003e\u003c/li\u003e\u003cli\u003e\u003cspan\u003eGBD 2019 Diseases and Injuries Collaborators. Global burden of 369 diseases and injuries in 204 countries and territories, 1990\u0026ndash;2019: a systematic analysis for the Global Burden of Disease Study 2019. Lancet. 2020;396(10258):1204\u0026ndash;22.\u003c/span\u003e\u003c/li\u003e\u003cli\u003e\u003cspan\u003eDold C, Holland CV. Ascaris and ascariasis. Microbes Infect. 2011;13(7):632\u0026ndash;7.\u003c/span\u003e\u003c/li\u003e\u003cli\u003e\u003cspan\u003ePullan RL, Smith JL, Jasrasaria R, Brooker SJ. Global numbers of infection and disease burden of soil transmitted helminth infections in 2010. Parasit Vectors. 2014;7:37.\u003c/span\u003e\u003c/li\u003e\u003cli\u003e\u003cspan\u003eOzdemir O. Loeffler\u0026rsquo;s syndrome: a type of eosinophilic pneumonia mimicking community-acquired pneumonia and asthma that arises from Ascaris lumbricoides in a child. J Pediatr Infect Dis. 2020;15(04):193\u0026ndash;6.\u003c/span\u003e\u003c/li\u003e\u003cli\u003e\u003cspan\u003eSpener R, Safe I, Baia-da-Silva DC, Sampaio VS, Borba MGS, Cordeiro-Santos M, et al. L\u0026ouml;effler\u0026rsquo;s syndrome. Int J Infect Dis. 2019;89:79\u0026ndash;80.\u003c/span\u003e\u003c/li\u003e\u003cli\u003e\u003cspan\u003eSchindler-Piontek M, Chaubal N, Dehmani S, Streba CT, Sirli R, Burta OL, et al. Ascariasis, a review. Med Ultrason. 2022;24:329\u0026ndash;38.\u003c/span\u003e\u003c/li\u003e\u003cli\u003e\u003cspan\u003eWidiastara AA, Ferreira E, Basuki S. Pneumoascariasis: Ascaris worm infestation in the lungs. Jurnal Respirasi. 2024;10(1):69\u0026ndash;75.\u003c/span\u003e\u003c/li\u003e\u003cli\u003e\u003cspan\u003eCheema HA, Waheed N, Saeed A. Rare presentation of haemobilia and Loeffler\u0026rsquo;s pneumonia in a child by Ascaris lumbricoides. BMJ Case Rep. 2019;12:e230150.\u003c/span\u003e\u003c/li\u003e\u003cli\u003e\u003cspan\u003eKhuroo MS, Rather AA, Khuroo NS, Khuroo MS. Hepatobiliary and pancreatic ascariasis. World J Gastroenterol. 2016;22(33):7507\u0026ndash;17.\u003c/span\u003e\u003c/li\u003e\u003cli\u003e\u003cspan\u003eWorld Health Organization. Preventive chemotherapy to control soil-transmitted helminth infections in at-risk population groups. Geneva: World Health Organization; 2017.\u003c/span\u003e\u003c/li\u003e\u003cli\u003e\u003cspan\u003eTran KH, Nguyen-Thi KH, Pham NC, Le HT, Pham TC, Nguyen NL, et al. Loeffler\u0026rsquo;s syndrome in a child: a rare radiological and histopathological diagnosis. Radiol Case Rep. 2022;17:245\u0026ndash;9.\u003c/span\u003e\u003c/li\u003e\u003cli\u003e\u003cspan\u003eSon BB, Kim-Hoa NT, Tuy NV, Binh MH, Anh TD, Ha DT, et al. Loeffler\u0026rsquo;s syndrome mimicking lung tumor and pneumonia in a child: a case report. Respir Med Case Rep. 2022;37:101638.\u003c/span\u003e\u003c/li\u003e\u003cli\u003e\u003cspan\u003eBetson M, Nejsum P, Bendall RP, Deb RM, Stothard JR. Molecular epidemiology of ascariasis: a global perspective on the transmission dynamics of Ascaris in people and pigs. J Infect Dis. 2014;210(6):932\u0026ndash;41.\u003c/span\u003e\u003c/li\u003e\u003c/ol\u003e"},{"header":"Tables","content":"\u003cp\u003e\u003cstrong\u003eTable 1.\u003c/strong\u003e Investigations done during hospitalisation.\u003c/p\u003e\n\u003ch3\u003eLaboratory Results\u003c/h3\u003e\n\u003ctable border=\"1\" cellspacing=\"0\" cellpadding=\"0\"\u003e\n \u003ctbody\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 33.3333%;\"\u003e\n \u003cp\u003eTest\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 33.3333%;\"\u003e\n \u003cp\u003eResult\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 33.3333%;\"\u003e\n \u003cp\u003eReference Range\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 33.3333%;\"\u003e\n \u003cp\u003eWhite blood cell count\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 33.3333%;\"\u003e\n \u003cp\u003e4,120 cells/\u0026mu;L\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 33.3333%;\"\u003e\n \u003cp\u003e4,000-11,000 cells/\u0026mu;L\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 33.3333%;\"\u003e\n \u003cp\u003eHemoglobin\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 33.3333%;\"\u003e\n \u003cp\u003e13.8 g/dL\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 33.3333%;\"\u003e\n \u003cp\u003e12.0-16.0 g/dL\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 33.3333%;\"\u003e\n \u003cp\u003ePlatelet count\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 33.3333%;\"\u003e\n \u003cp\u003e177,000/\u0026mu;L\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 33.3333%;\"\u003e\n \u003cp\u003e150,000-450,000/\u0026mu;L\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 33.3333%;\"\u003e\n \u003cp\u003eAbsolute eosinophil count\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 33.3333%;\"\u003e\n \u003cp\u003e0.01 \u0026times; 10\u0026sup3;/\u0026mu;L\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 33.3333%;\"\u003e\n \u003cp\u003e0.0-0.5 \u0026times; 10\u0026sup3;/\u0026mu;L (approx)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 33.3333%;\"\u003e\n \u003cp\u003eTotal bilirubin\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 33.3333%;\"\u003e\n \u003cp\u003e0.85 mg/dL\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 33.3333%;\"\u003e\n \u003cp\u003e0.1-1.2 mg/dL\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 33.3333%;\"\u003e\n \u003cp\u003eDirect bilirubin\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 33.3333%;\"\u003e\n \u003cp\u003e0.40 mg/dL\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 33.3333%;\"\u003e\n \u003cp\u003e0.0-0.3 mg/dL\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 33.3333%;\"\u003e\n \u003cp\u003eAspartate aminotransferase (AST)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 33.3333%;\"\u003e\n \u003cp\u003e59 U/L\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 33.3333%;\"\u003e\n \u003cp\u003e5-40 U/L\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 33.3333%;\"\u003e\n \u003cp\u003eAlanine aminotransferase (ALT)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 33.3333%;\"\u003e\n \u003cp\u003e20 U/L\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 33.3333%;\"\u003e\n \u003cp\u003e5-40 U/L\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 33.3333%;\"\u003e\n \u003cp\u003eAlkaline phosphatase\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 33.3333%;\"\u003e\n \u003cp\u003e31 U/L\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 33.3333%;\"\u003e\n \u003cp\u003e35-129 U/L\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 33.3333%;\"\u003e\n \u003cp\u003eAlbumin\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 33.3333%;\"\u003e\n \u003cp\u003e2.3 g/dL\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 33.3333%;\"\u003e\n \u003cp\u003e3.5-5.0 g/dL\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 33.3333%;\"\u003e\n \u003cp\u003eProthrombin time\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 33.3333%;\"\u003e\n \u003cp\u003e13.3 sec\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 33.3333%;\"\u003e\n \u003cp\u003e11-15 sec\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 33.3333%;\"\u003e\n \u003cp\u003eInternational Normalized Ratio (INR)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 33.3333%;\"\u003e\n \u003cp\u003e0.95\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 33.3333%;\"\u003e\n \u003cp\u003e0.8-1.2\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003c/tbody\u003e\n\u003c/table\u003e\n\u003cp\u003e\u003cbr\u003e\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eTable 2.\u0026nbsp;\u003c/strong\u003eMicrobiological and Radiological investigations \u0026nbsp;done during hospitalisation\u003c/p\u003e\n\u003ch3\u003eMicrobiological and Imaging Studies\u003c/h3\u003e\n\u003ctable border=\"1\" cellspacing=\"0\" cellpadding=\"0\"\u003e\n \u003ctbody\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 50%;\"\u003e\n \u003cp\u003eInvestigation\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 50%;\"\u003e\n \u003cp\u003eFindings\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 50%;\"\u003e\n \u003cp\u003eBlood cultures\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 50%;\"\u003e\n \u003cp\u003eNo growth\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 50%;\"\u003e\n \u003cp\u003eUrine cultures\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 50%;\"\u003e\n \u003cp\u003eNo growth\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 50%;\"\u003e\n \u003cp\u003eStool examination\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 50%;\"\u003e\n \u003cp\u003eOva of Ascaris lumbricoides identified\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 50%;\"\u003e\n \u003cp\u003eChest X-ray\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 50%;\"\u003e\n \u003cp\u003eBilateral lower zone infiltrates consistent with pneumonia\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 50%;\"\u003e\n \u003cp\u003e2D Echocardiography\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 50%;\"\u003e\n \u003cp\u003eTachycardia, concentric LV hypertrophy, no RWMA, normal IVC with partial collapse\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 50%;\"\u003e\n \u003cp\u003eAbdominal ultrasonography\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 50%;\"\u003e\n \u003cp\u003eNormal, no hepatobiliary involvement\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003c/tbody\u003e\n\u003c/table\u003e"}],"fulltextSource":"","fullText":"","funders":[],"hasAdminPriorityOnWorkflow":false,"hasManuscriptDocX":true,"hasOptedInToPreprint":true,"hasPassedJournalQc":"","hasAnyPriority":false,"hideJournal":false,"highlight":"","institution":"","isAcceptedByJournal":true,"isAuthorSuppliedPdf":false,"isDeskRejected":"","isHiddenFromSearch":false,"isInQc":false,"isInWorkflow":false,"isPdf":false,"isPdfUpToDate":true,"isWithdrawnOrRetracted":false,"journal":{"display":true,"email":"[email protected]","identity":"tropical-medicine-and-health","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":false,"externalIdentity":"tmah","sideBox":"Learn more about [Tropical Medicine and Health](https://tropmedhealth.biomedcentral.com/)","snPcode":"41182","submissionUrl":"https://submission.springernature.com/new-submission/41182/3","title":"Tropical Medicine and Health","twitterHandle":"","acdcEnabled":true,"dfaEnabled":true,"editorialSystem":"stoa","reportingPortfolio":"BMC/SO AJ","inReviewEnabled":true,"inReviewRevisionsEnabled":true},"keywords":"Pneumoascariasis, Ascaris lumbricoides, pulmonary migration, helminthic infection, respiratory symptoms","lastPublishedDoi":"10.21203/rs.3.rs-7565790/v1","lastPublishedDoiUrl":"https://doi.org/10.21203/rs.3.rs-7565790/v1","license":{"name":"CC BY 4.0","url":"https://creativecommons.org/licenses/by/4.0/"},"manuscriptAbstract":"\u003cp\u003e\u003cstrong\u003eBackground\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003ePneumoascariasis, a pulmonary manifestation of Ascaris lumbricoides infection, is infrequently recognized in clinical practice despite the global prevalence of ascariasis. The symptoms often mimic community-acquired pneumonia or bronchial asthma, leading to diagnostic challenges. We present an unusual case of pneumoascariasis in an elderly female who presented with respiratory symptoms and was found to have worm migration through multiple body sites.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eCase Presentation\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eA 70-year-old female with no known comorbidities presented with fever, productive cough, and dysphagia for 3 days. Physical examination revealed tachycardia, tachypnea, hypoxia and pallor. Respiratory examination showed bilateral basal crepitations. On day 2 of hospitalization, creamy-colored worms were observed in the patient’s stool, nasal cavity, and oral cavity. Stool examination confirmed Ascaris lumbricoides infection, and radiological findings revealed bilateral lower zone pneumonitis. The patient was diagnosed with pneumoascariasis (post-lung phase) and was successfully treated with anti-helminthic therapy, antibiotics, and corticosteroids.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eConclusion\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThis case highlights the importance of considering parasitic infections in the differential diagnosis of respiratory symptoms, particularly in endemic regions. Pulmonary symptoms may be the predominant manifestation of ascariasis, necessitating a high index of clinical suspicion for timely diagnosis and appropriate management.\u003c/p\u003e","manuscriptTitle":"Pneumoascariasis: An Unusual Pulmonary Manifestation of Ascaris lumbricoides Infection","msid":"","msnumber":"","nonDraftVersions":[{"code":1,"date":"2025-10-01 17:33:09","doi":"10.21203/rs.3.rs-7565790/v1","editorialEvents":[{"type":"communityComments","content":0},{"type":"decision","content":"Revision requested","date":"2025-10-17T09:10:32+00:00","index":"","fulltext":""},{"type":"editorInvitedReview","content":"","date":"2025-10-17T05:14:58+00:00","index":"hide","fulltext":""},{"type":"editorInvitedReview","content":"","date":"2025-10-11T02:24:43+00:00","index":"hide","fulltext":""},{"type":"reviewerAgreed","content":"31027127926546850345723514332955212373","date":"2025-10-11T02:06:52+00:00","index":"hide","fulltext":""},{"type":"reviewerAgreed","content":"11234908561367944136536410762708138393","date":"2025-10-07T02:25:01+00:00","index":"hide","fulltext":""},{"type":"editorInvitedReview","content":"","date":"2025-09-25T16:08:10+00:00","index":"hide","fulltext":""},{"type":"reviewerAgreed","content":"172921703535457719762910548803170935105","date":"2025-09-23T07:37:45+00:00","index":"hide","fulltext":""},{"type":"reviewerAgreed","content":"302638828677043180832041139325442904590","date":"2025-09-20T12:32:01+00:00","index":"hide","fulltext":""},{"type":"reviewersInvited","content":"","date":"2025-09-18T12:21:28+00:00","index":"","fulltext":""},{"type":"editorAssigned","content":"","date":"2025-09-18T12:01:38+00:00","index":"","fulltext":""},{"type":"checksComplete","content":"","date":"2025-09-18T12:01:09+00:00","index":"","fulltext":""},{"type":"submitted","content":"Tropical Medicine and Health","date":"2025-09-08T15:15:31+00:00","index":"","fulltext":""}],"status":"published","journal":{"display":true,"email":"[email protected]","identity":"tropical-medicine-and-health","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":false,"externalIdentity":"tmah","sideBox":"Learn more about [Tropical Medicine and Health](https://tropmedhealth.biomedcentral.com/)","snPcode":"41182","submissionUrl":"https://submission.springernature.com/new-submission/41182/3","title":"Tropical Medicine and Health","twitterHandle":"","acdcEnabled":true,"dfaEnabled":true,"editorialSystem":"stoa","reportingPortfolio":"BMC/SO AJ","inReviewEnabled":true,"inReviewRevisionsEnabled":true}}],"origin":"","ownerIdentity":"e5d76cf7-b752-4b68-90f3-1ec757de7325","owner":[],"postedDate":"October 1st, 2025","published":true,"recentEditorialEvents":[],"rejectedJournal":[],"revision":"","amendment":"","status":"under-review","subjectAreas":[],"tags":[],"updatedAt":"2025-12-29T03:53:47+00:00","versionOfRecord":[],"versionCreatedAt":"2025-10-01 17:33:09","video":"","vorDoi":"","vorDoiUrl":"","workflowStages":[]},"version":"v1","identity":"rs-7565790","journalConfig":"researchsquare"},"__N_SSP":true},"page":"/article/[identity]/[[...version]]","query":{"redirect":"/article/rs-7565790","identity":"rs-7565790","version":["v1"]},"buildId":"XKTyCvWXoU3ODBz1xrDgd","isFallback":false,"isExperimentalCompile":false,"dynamicIds":[84888],"gssp":true,"scriptLoader":[]}