Capillaria Philippinensis Mohamed Seif

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Information about Capillaria Philippinensis Mohamed Seif
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Published on August 5, 2008

Author: drmdarif

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Capillariasis : Capillariasis By Mohamed Seif Capillaria species parasitize many classes of vertebrates, although only 4 species have been found in humans, namely:Capillaria philippinensis (Intestinal capillariasis)Capillaria plica (Urinary capillariasis)Capillaria aerophila (Pulmonary capillariasis)Capillaria hepatica (Hepatic capillariasis) : Capillaria species parasitize many classes of vertebrates, although only 4 species have been found in humans, namely:Capillaria philippinensis (Intestinal capillariasis)Capillaria plica (Urinary capillariasis)Capillaria aerophila (Pulmonary capillariasis)Capillaria hepatica (Hepatic capillariasis) Intestinal capillariasis is a wasting and sometimes fatal disease of man caused by the nematode, Capillaria philippinensisSynonyms include Capillariasis philippinensisWasting disease Pudoc (Local) mystery disease : Intestinal capillariasis is a wasting and sometimes fatal disease of man caused by the nematode, Capillaria philippinensisSynonyms include Capillariasis philippinensisWasting disease Pudoc (Local) mystery disease Intestinal capillariasis Epidemiology and Geographic Distribution : C. philippinensis is a tiny nematode first described in the 1962 in the Philippines as a pathogen inducing severe diarrheal syndromes in humans. There was an epidemic of the disease in the Philippines from 1967 to 1968, where more than 1300 persons acquired the illness, and 90 patients died. In 1978, another small outbreak was identified with about 50 persons infected. Epidemiology and Geographic Distribution Slide 5: The disease is endemic in Thailand, where it was first reported in 1973. Sporadic cases have also been found in Iran, Egypt, Taiwan, Japan, Indonesia, Korea, Spain, and Italy. The parasite thus appears to be widespread. Morphology : Morphology The adult is a small slender nematode or roundworm. Male worms are 2.6 mm in length; the female worms are 3.6 mm in length. The eggs are ovoid or peanut-shaped , operculated with flattened bipolar plugs , broad shoulders and a striated shell. J. Cross, Pathology of Infectious Diseases. 1997 Life Cycle : Life Cycle Slide 8: After 2 months of ingestion, adult worms are found partially embedded in the mucosa of the small intestine, not penetrating beyond the muscularis mucosa. They may be present in enormous numbers, with 40,000 worms found at autopsy in one patient. The intestinal villi become flattened and the crypts of Lieberkühn atrophy. The parasites cause a mild inflammatory response with edema of the basement membrane, distention of mucous glands, and infiltration of the lamina propria with plasma cells, lymphocytes, and occasional eosinophils. Pathology Slide 9: In severe infections the small bowel wall is thickened indurated and the bowel becomes distended . Occasionally parasites have been noted in the lumen of the larynx, esophagus, stomach and colon, and rarely near the portal triads of the liver. Pathological changes may occur in distant parts of the body, primarily due to the effects of malnutrition and electrolyte depletion. Severe diarrhoea may lead to lactic acidosis which might lead to hepatic steatosis. Lobar pneumonia, lung abscesses, congested spleen, and damaged kidneys have been reported. Slide 10: The disease is seen most commonly in men between 20 and 45 years of age, but it occurs in both genders and all age groups. It causes a severe protein-losing enteropathy and malabsorption syndrome, with a relatively high mortality unless appropriate therapy is instituted. The syndrome resembles disseminated strongyloidiasis with autoinfection. Clinical Features Slide 11: Initial symptoms of the disease are mild and consist of borborygmi and vague abdominal pain. Diarrhea develops within 2-6 weeks; first it is intermittent then becomes persistent, watery, and voluminous. There is associated weight loss, malaise, anorexia, nausea, and vomiting. Patients with more advanced disease show cachexia and weakness, with diminished reflexes, profound muscle wasting, anasarca, and dehydration. Death may follow rapidly in severely infected individuals. Diagnosis : Diagnosis Because infection may result in severe disease with a high mortality when untreated, early diagnosis is very important. Laboratory Diagnosis : Laboratory Diagnosis Stool analysis: The stools are bulky with an elevated fecal fat content and an average daily stool weight of 1200 g (versus controls of 170 g). Protein loss in the stools may be 15 times that seen in controls. The specific diagnosis is established by finding unembryonated eggs, even larvae and/or adult worms in severe infection.  The ova must be distinguished from those of Trichuris trichiura which they superficially resemble. The eggs are 40 µm in length by 20 µm in width, ovoid or peanut-shaped , operculated with flattened bipolar plugs, broad shoulders and a striated shell : The eggs are 40 µm in length by 20 µm in width, ovoid or peanut-shaped , operculated with flattened bipolar plugs, broad shoulders and a striated shell Other investigations : Other investigations Intradermal tests employing antigen prepared from extracts of the adult worms have been useful epidemiologically. There is marked hypoproteinemia with low serum albumin levels. lmmunoglobulin studies show normal IgA values but diminished IgM and IgG values. There is malabsorption of sugars (xylose) and fats, and low serum levels of potassium, sodium, calcium, and carotene. Imaging Diagnosis (BMFT) : Imaging Diagnosis (BMFT) Bowel Dilatation (usually a short segment). Segmentation (commonly in the ileum). Fragmentation of the barium column (the most common radiographic abnormality). Hypersecretion (Increased fluid in the small bowel). Interestingly all of the various abnormal radiographic signs are seen in the mid- and distal jejunum and proximal ileum. The area in which the worm burden is highest and the associated histological changes are most advanced, thus providing a striking radiological-pathological correlation. BMFT : BMFT Slide 18: Endoscopic biopsy and histopathology specimen of human intestine showing numerous sections of C. philippinensis (arrows) and debris Differential Diagnosis : Differential Diagnosis Capillariasis must be considered in the differential diagnosis of the malabsorption pattern. Differential diagnosis should also include other parasitic diseases, such as giardiasis, strongyloidiasis, and hookworm disease. Treatment : Treatment Hospitalization Resuscitation Fluid and electrolytes (specially K) replacement Antidiarrhoeal agents. High protein diet Specific Treatment : Specific Treatment The treatment of choice is 200 mg of albendazole BID for 10 days. It is effective against eggs, larvae, and adult worms. Another alternative is 200 mg of mebendazole BID for 20 days. The pediatric dose is the same. Thiabendazole, 25 mg/kg per day given in two dosages for 30 days, is a less effective alternative. C. philippinensis can be prevented by avoiding the ingestion of raw or partially cooked freshwater fish, snails, and crustaceans. Slide 22: C. hepatica adult worms reside in the liver of various animals, especially rats.  The females produce eggs that are retained in the liver parenchyma.  The infected animal either die and decompose with the release of eggs in the soil or is eaten by another animal, the eggs are released by digestion, excreted in the feces of the second animal, and become embryonated in the soil.   Following ingestion, these infective eggs release larvae in the intestine that migrate through the portal circulation to the liver, where they develop into adults. Hepatic capillariasis Slide 23: C. hepatica will elicit granuloma formation and fibrosis in the liver parenchyma. Clinically it manifests as an acute or subacute hepatitis with eosinophilia, with possible dissemination to other organs.  It may be fatal.  The characteristic triad of this type of infection is persistent fever, hepatomegaly, and eosinophilia. Slide 24: The specific diagnosis of C. hepatica infection is based on demonstrating the adult worms and/or eggs in liver tissue at biopsy.  (Note: identification of C. hepatica eggs in the stool is a spurious finding, which does not result from infection of the human host, but from ingestion by that host of livers from infected animals.) C.Hepatica egg has a typically striated shell and shallow polar prominences : C.Hepatica egg has a typically striated shell and shallow polar prominences Slide 26: C. aerophila adult worms reside in the epithelium of the tracheo-bronchial tract of various animals.  Eggs are produced, coughed up, swallowed by the animal, and excreted in its feces.  The eggs become embryonated in the soil.  Ingestion of infective eggs completes the cycle. Ten human infections had been reported.   Pulmonary capillariasis may present with fever, cough, asthma, and pneumonia, and also may be fatal. Pulmonary capillariasis Chest X-Ray : Chest X-Ray The lungs may show hyperventilation from an acute obstructive airway process (bronchiolitis) as well as diffuse perihilar infiltrates and a reticulonodular pattern. Bilateral hilar lymph node enlargement may be present The specific diagnosis of C. aerophila is based on demonstrating eggs in stool or in lung biopsy. : The specific diagnosis of C. aerophila is based on demonstrating eggs in stool or in lung biopsy. Capillaria aerophila, egg. Courtesy of Merial Egyptian publications : Egyptian publications Capillaria philippinensis: a cause of fatal diarrhea in one of two infected Egyptian sisters. J Trop Pediatr.  2004; 50(1):57-60  el-Karaksy H; el-Shabrawi M; Mohsen N; Kotb M; el-Koofy N; el-Deeb NDepartment of Pediatrics, Faculty of Medicine, Cairo University, Egypt. Capillaria philippinensis: an emerging parasite causing severe diarrhoea in Egypt. J Egypt Soc Parasitol.  1999; 29(2):483-93  Ahmed L; el-Dib NA; el-Boraey Y; Ibrahim MDepartment of Tropical Medicine, Faculty of Medicine, Cairo University, Egypt Intestinal capillariasis as a cause of chronic diarrhoea in Egypt.J Egypt Soc Parasitol. 1998 Apr;28(1):143-7. Anis MH, Shafeek H, Mansour NS, Moody A. Slide 30: Evaluation of Capillaria philippinensis coproantigen in the diagnosis of infection.J Egypt Soc Parasitol. 2004 Apr;34(1):97-106. El Dib NA, Sabry MA, Ahmed JA, El-Basiouni SO, El-Badry AA Parasitological aspects of Capillaria philippinensis recovered from Egyptian patients.J Egypt Soc Parasitol. 1999;29(1):139-47. El-Dib NA, Ahmed JA, El-Arousy M, Mahmoud MA, Garo K. Thank You : Thank You

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