An estimated 807 million–1.2 billion people in the world are infected with Ascaris lumbricoides (sometimes called just ascariasis). Patients infected with ascariasis can be asymptomatic or symptoms like, abdominal pain, bloating, nausea, vomiting, anorexia, intermittent diarrhea, Atopic dermatitis may be seen. Ascariasis is caused by ingesting infective eggs of ascaris. This can happen when hands or fingers that have contaminated dirt on them are put in the mouth or by consuming vegetables or fruits that have not been carefully cooked, washed or peeled.

A. lumbricoide’s eggs are one of the most difficult pathogens to kill (second only to prions), and the eggs commonly survive 1–3 years. Ascaris eggs can be inactivated in minutes by temperatures above 60ËšC, they can survive for more than 1 year at 40ËšC. 

I have encountered two laboratory proven ascariasis cases which came to us with totally different presentation. First case was young lady presented with atopic dermatitis which involved areas on the insides of the knees and folds of the elbows and around the neck.

Second case was 58 year old diabetic female who presented with intermittent diarrhea and mild abdominal pain in the periumbilical region. 

First case was empirically treated for dermatitis with oral betamethasone and topical pimecrolimus with little benefit.

Second case was initially treated for irritable bowl disease but later in both the cases Complete blood count shown eosinophilia. Finding out eosinophilia stool routine and microscopy ordered suspecting parasitic infection. 

Stool report in both the cases documented ascaris lumbricoides helminthic ova. Albendazole 400mg two courses was given four weeks apart with supportive medicines. Both patients improved symptomatically with decreased eosinophil count after a month. 

Ascariasis is common parasitic infection and it is affecting both children and adult population. It is advisable to keep a doubt about these kind of parasitic infection if patient is showing any related symptoms.