Intestinal capillariasis in the 21st century: clinical presentations and role of endoscopy and imaging

BMC Gastroenterology

Sathaporn Manatsathit¹  Piyaporn Apisarnthanarak²  Supot Pongprasobchai¹  Julajak Limsrivilai¹ 

[1] Division of Gastroenterology, Faculty of Medicine, Siriraj Hospital, Mahidol University, Bangkok, Thailand;Division of Diagnostic Radiology, Faculty of Radiology, Siriraj Hospital, Mahidol University, Bangkok, Thailand

关键词: Treatment;    Imaging;    Video capsule endoscopy;    Enteroscopy;    Clinical presentation;    Intestinal capillariasis;   

Others  :  1121744
DOI  :  10.1186/s12876-014-0207-9

 received in 2014-08-23, accepted in 2014-11-27,  发布年份 2014

【 摘 要 】

Background

Intestinal capillariasis is one of the common causes of malabsorption in the East. Reports emphasizing the roles of clinical, endoscopic and radiologic findings of intestinal capillariasis are limited.

Methods

Retrospective review of medical records of 26 patients diagnosed with intestinal capillariasis at Siriraj Hospital, Bangkok, Thailand between 2001- 2013.

Results

Clinical manifestations were chronic watery diarrhea (93%), chronic abdominal pain (70%), significant weight loss (92%), hypoalbuminemia (100%; 85% lower than 2.0 g/dL), and anemia (50%). The median duration of symptoms was 5.5 months (1-60 months). Parasites were found in stool in 15 patients (57%). In patients whose stool tests were initially negative, parasites were discovered in tissue biopsy from endoscopy in 1 from 10 esophagogastroduodenoscopies (EGD), 0 from 7 colonoscopies, 3 from 5 push enteroscopies, and 3 from 5 balloon-assisted enteroscopies (BAE). Endoscopic findings included scalloping appearance, mucosal cracking, and redness of mucosa. These endoscopic findings affected mostly at jejunum and proximal ileum. They were similar to celiac disease except duodenal involvement which is uncommon in capillariasis. Three patients underwent video capsule endoscopy (VCE) and typical abnormal findings were observed in all patients. Small bowel barium study showed fold thickening, fold effacement, and increased luminal fluid in 80% of patients, mainly seen at distal jejunum and ileum. CT findings were long segment wall thickening, enhanced wall, and fold effacement. Treatment with either albendazole or ivermectin cured all patients with most responding within 2 months.

Conclusions

In endemic area, intestinal capillariasis should be considered if patients develop chronic watery diarrhea accompanied by significant weight loss and severe hypoalbuminemia. Stool examination had quite low sensitivities in making diagnosis in our study. Deep enteroscopy with biopsy guided by imaging or VCE may improve diagnostic yield. Empirical therapy may also be justifiable due to the very good response rate and less side effects.

【 授权许可】

   
2014 Limsrivilai et al.; licensee BioMed Central Ltd.

【 图 表 】

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【 参考文献 】

• [1]Chitwood MBVC, Salazar NG: Physiologic changes in a species of Capillaria (Trichuroidae) causing a fatal cases of human intestinal capillariasis. Proc 1st Int Congr Parasitol 1964, 2:797.
• [2]Cross JHBT, Murrell KD, Watten RH, Dizon JJ: A new epidemic diarrheal disease caused by the neatode Capillaria philippinensis. Ind Trop Health 1970, 7:124-131.
• [3]Brandatsundarasar APK, Chintanawongs C, Ungthavorn D: The first case of intestinal capillariasis in Thailand. Southeast Asian J Trop Med 1973, 4:131-134.
• [4]Sanpakit SSS, Bhaibulaya M: Intestinal capillariasis from Saraburi province, Thailand: report of the second case. J Med Assoc Thai 1974, 57:453-460.
• [5]Muangmanee LAN, Vanasin B: Intestinal capillariasis. Report of the fourth case in Thailand. Siriraj Hosp Gaz 1977, 29:439-449.
• [6]Bhaibulaya MBW, Noeypatimanond S: Infection of Capillaria phillippinensis in man from Petchabun province, Northern Thailand: a report of the fifth case. J Med Assoc Thai 1977, 60:507-509.
• [7]Pathnacharoen STS, Manutstitt S, Thanangkul B: Intestinal capillariasis. Ramathibodi Med J 1983, 6:277-283.
• [8]Chunlertrith K, Mairiang P, Sukeepaisarnjaroen W: Intestinal capillariasis: a cause of chronic diarrhea and hypoalbuminemia. Southeast Asian J Trop Med Public Health 1992, 23:433-436.
• [9]Thewjitcharoen YMS, Sanprasert V, Saksirisampant W, Nuchprayoon S: A fatal case of intestinal capillariasis due to misleading investigations. Asian Biomed 2012, 6:781-785.
• [10]Kunaratanapruk SI-OS, Chatsirimongkol C, Dhirasut C, Laohanuwat C: Intestinal Capillariasis in Sisaket Province: a report of 100 cases. Ramathibodi Med J 1983, 6:253-258.
• [11]Cross JHBT, Murrell KD, Watten RH, Dizon JJ: Intestinal Capillariasis. Clin Microbiol Rev 1992, 5:120-129.
• [12]Jung WT, Kim HJ, Min HJ, Ha CY, Ko GH, Na BK, Sohn WM: An indigenous case of intestinal capillariasis with protein-losing enteropathy in Korea. Korean J Parasitol 2012, 50:333-337.
• [13]Fan Z, Huang Y, Qian S, Lv G, Chen Y, Yang B, Zhong S, Lin G, Yan G: Serious diarrhea with weight loss caused by Capillaria philippinensis acquired in China: a case report. BMC Res Notes 2012, 5:554. BioMed Central Full Text
• [14]Rana SS, Bhasin DK, Bhatti HS, Gupta K, Gupta R, Nada R, Nagi B, Sinha SK, Singh K: Human intestinal capillariasis: diagnosis by jejunal fluid analysis obtained at enteroscopy and reversal of subtotal villous atrophy after treatment. Endoscopy 2009, 41(Suppl 2):E102-E103.
• [15]Wongsawasdi L, Ukarapol N, Lertprasertsuk N: The endoscopic diagnosis of intestinal capillariasis in a child: a case report. Southeast Asian J Trop Med Public Health 2002, 33:730-732.
• [16]Sangchan A, Wongsaensook A, Kularbkaew C, Sawanyawisuth K, Sukeepaisarnjaroen W, Mairiang P: The endoscopic-pathologic findings in intestinal capillariais: a case report. J Med Assoc Thai 2007, 90:175-178.
• [17]Lu LH, Lin MR, Choi WM, Hwang KP, Hsu YH, Bair MJ, Liu JD, Wang TE, Liu TP, Chung WC: Human intestinal capillariasis (Capillaria philippinensis) in Taiwan. Am J Trop Med Hyg 2006, 74:810-813.
• [18]Bair MJ, Hwang KP, Wang TE, Liou TC, Lin SC, Kao CR, Wang TY, Pang KK: Clinical features of human intestinal capillariasis in Taiwan. World J Gastroenterol 2004, 10:2391-2393.
• [19]Attia RA, Tolba ME, Yones DA, Bakir HY, Eldeek HE, Kamel S: Capillaria philippinensis in Upper Egypt: has it become endemic? Am J Trop Med Hyg 2012, 86:126-133.
• [20]Apisarnthanarak P, Apisarnthanarak A, Pongpaibul A, Roongruangchai K, Charatcharoenwitthaya P, Teerasamit W, Mundy LM: Four Thai patients with chronic diarrhea, malabsorption, and weight loss. Diagnosis: Capillariasis associated with tubular narrowing of multiple small-bowel loops with fold effacement. Clin Infect Dis 2013, 56(1147-8):83-85.