Parasitic appendicitis, what do we know?-a literature review

Acute appendicitis (AA) is a leading cause of emergency abdominal surgery worldwide, with surgical intervention as its mainstay of treatment. As a primarily clinical diagnosis, it is important for physicians to have ample information to diagnose cases accurately. Given the high rates of negative appendectomies, robust diagnostic workups are crucial to minimize unnecessary surgeries and consider adjunct therapy. Various etiologies, including parasitic infections, are associated with AA. In this review, we report that Schistosoma spp., Enterobius vermicularis (E. vermicularis), Taenia spp., and Ascaris lumbricoides (A. lumbricoides) contribute to or mimic AA. As globalization expands, areas once considered "safe zones" for parasites now face higher risks. It is therefore increasingly important for physicians in all countries to recognize the association between parasites and AA and include proper investigations for high-risk patients. Our findings aim to assist physicians on when to consider a parasitic infection and AA, potentially reducing the number of negative appendectomies, as some parasitic infections can be treated with medication alone.

To our knowledge, this narrative review incorporating three databases (PubMed, Ovid and Embase), is the first to synthesize research on the relationship between parasites and AA. Articles were screened using Covidence, and inclusion criteria required references to Schistosoma spp., E. vermicularis, Taenia spp., and A. lumbricoides. We limited results to English and French manuscripts published between 1949 and 2023. Two independent reviewers performed title and abstract screening, followed by full-text analysis, ultimately selecting 71 studies that met the inclusion criteria.

Our analysis identifies four parasitic organisms strongly associated with AA-Schistosoma spp., E. vermicularis, Taenia spp., and A. lumbricoides-and highlights countries where these infections are most prevalent. Furthermore, it highlights the need for more research in this area as causal relationships are still yet to be made.

While strong associations exist between parasitic infections and AA, further research is needed to establish a causal relationship.