Human intestinal capillariasis: diagnosis by jejunal fluid analysis obtained at enteroscopy and reversal of subtotal villous atrophy after treatment

High Prevalence of Intestinal Capillariasis in Chronic Diarrhea Patients in Thailand: Serological Screening Using a Rapid Lateral-Flow Immunochromatographic Assay

Intestinal capillariasis is an emerging fish-borne helminthic disease caused by the round worm Capillaria philippinensis. Chronic infection may lead to death if the disease is misdiagnosed and inappropriate treatment is given. We used a rapid lateral-flow immunochromatographic test for screening of intestinal capillariasis in patients with chronic diarrhea. We screened 292 chronic diarrhea patients who had visited hospitals in Thailand. Sixty-six (22.6%) cases were positive according to the kit. All positive patients received mebendazole at 200 mg twice per day for 30 consecutive days or albendazole at 200 mg twice per day for 10 consecutive days. Later, stool concentration techniques, used to examine stool samples from all serologically positive individuals on three consecutive days, revealed C. philippinensis eggs, larvae, and/or adults. The kit is useful for screening and rapid diagnosis of intestinal capillariasis in chronic diarrhea patients in an endemic area for prevention of serious disease and facilitates treatment.

Albendazole and Mebendazole as Anti-Parasitic and Anti-Cancer Agents: an Update

The use of albendazole and mebendazole, i.e., benzimidazole broad-spectrum anthelmintics, in treatment of parasitic infections, as well as cancers, is briefly reviewed. These drugs are known to block the microtubule systems of parasites and mammalian cells leading to inhibition of glucose uptake and transport and finally cell death. Eventually they exhibit ovicidal, larvicidal, and vermicidal effects on parasites, and tumoricidal effects on hosts. Albendazole and mebendazole are most frequently prescribed for treatment of intestinal nematode infections (ascariasis, hookworm infections, trichuriasis, strongyloidiasis, and enterobiasis) and can also be used for intestinal tapeworm infections (taeniases and hymenolepiasis). However, these drugs also exhibit considerable therapeutic effects against tissue nematode/cestode infections (visceral, ocular, neural, and cutaneous larva migrans, anisakiasis, trichinosis, hepatic and intestinal capillariasis, angiostrongyliasis, gnathostomiasis, gongylonemiasis, thelaziasis, dracunculiasis, cerebral and subcutaneous cysticercosis, and echinococcosis). Albendazole is also used for treatment of filarial infections (lymphatic filariasis, onchocerciasis, loiasis, mansonellosis, and dirofilariasis) alone or in combination with other drugs, such as ivermectin or diethylcarbamazine. Albendazole was tried even for treatment of trematode (fascioliasis, clonorchiasis, opisthorchiasis, and intestinal fluke infections) and protozoan infections (giardiasis, vaginal trichomoniasis, cryptosporidiosis, and microsporidiosis). These drugs are generally safe with few side effects; however, when they are used for prolonged time (>14-28 days) or even only 1 time, liver toxicity and other side reactions may occur. In hookworms, Trichuris trichiura, possibly Ascaris lumbricoides, Wuchereria bancrofti, and Giardia sp., there are emerging issues of drug resistance. It is of particular note that albendazole and mebendazole have been repositioned as promising anti-cancer drugs. These drugs have been shown to be active in vitro and in vivo (animals) against liver, lung, ovary, prostate, colorectal, breast, head and neck cancers, and melanoma. Two clinical reports for albendazole and 2 case reports for mebendazole have revealed promising effects of these drugs in human patients having variable types of cancers. However, because of the toxicity of albendazole, for example, neutropenia due to myelosuppression, if high doses are used for a prolonged time, mebendazole is currently more popularly used than albendazole in anti-cancer clinical trials.

A Hospital-Based Study of Intestinal Capillariasis in Thailand: Clinical Features, Potential Clues for Diagnosis, and Epidemiological Characteristics of 85 Patients

Intestinal capillariasis caused by Capillaria philippinensis, a fish-borne nematode, is an important, emerging zoonotic helminthiasis. Cases may be fatal if suitable treatment is not administered in time. We reported a hospital-based study of 85 cases in Thailand, most of which were in the northeast. All patients had a history of eating raw or insufficiently cooked fresh water fish or prawns. The clinical manifestations are characterized by chronic diarrhea, borborygmi, abdominal pain, marked weight loss, muscle weakness, fatigue, dizziness, anorexia, and edema, as well as protein and electrolyte loss. Fecal examination revealed C. philippinensis in all patients. Although 16 of the total of 85 (18.8%) cases were initially found to be negative for C. philippinensis using fecal examination, further examination using an immunoblotting technique found them to be positive for the IgG antibody against Trichinella spiralis larval antigen. One day after administration of 400 mg of albendazole, eggs and/or larvae and/or adult C. philippinensis were found in 16 fecal samples. After treatment with mebendazole (200 mg twice a day for 30 days) or albendazole (200 mg twice a day for 10 days), all 85 patients recovered. The potential clues for diagnosis are clinical manifestations, history of eating raw contaminated food, and positive serological test, and fecal examinations under professional. Administration of anthelminthic drugs stimulates the excretion of larvae, eggs, and/or adult worms and can be used as a supportive method for the diagnosis of intestinal capillariasis in areas where serological test is not available.

Development and evaluation of a rapid diagnostic immunochromatographic device to detect antibodies in sera from intestinal capillariasis cases

Intestinal capillariasis, a fish-borne nematodiasis, is an important emerging zoonotic disease. Patients present clinical symptoms of borborygmus chronic diarrhea, intermittent abdominal pain, weight loss, and several degrees of painless lower-leg edema. Death may occur in cases of misdiagnosis and improper treatment. Diagnosis is difficult because of the atypical clinical symptoms and diagnostic confusion with diarrhea caused by gastrointestinal cancer, opportunistic infections in human immunodeficiency virus patients, and hyperthyroidism. In addition, parasite eggs are not always found in stool examination. Serology can provide a supportive diagnostic tool. We have produced a rapid and simple immunochromatographic test (ICT) kit for diagnosis of intestinal capillariasis by detection of diagnostic antibodies in human sera. Serum samples from healthy volunteers and patients with proven intestinal capillariasis and other parasitic diseases were evaluated with the Trichinella spiralis larval extract antigen absorbed ICT strips. The diagnostic sensitivity, specificity, and positive and negative predictive values were 100, 96.6, 90.2, and 100%, respectively. The ICT kit is simple and rapid to use and can supplement stool examination in clinical diagnosis of intestinal capillariasis. The test can be completed in 15 min without a need for any sophisticated instruments or reagents.

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

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.

Human intestinal capillariasis: a rare case report from non-endemic area (Andhra Pradesh, India)

Human intestinal capillariasis is caused by Capillaria philippinensis. This disease is endemic in Philippines and Thailand. To the best of our knowledge, we report the third case of human intestinal capillariasis from India and the first case from Andhra Pradesh, which is a non-endemic area. A 40-year-old female presented with diarrhoea, vomiting, decreased urinary output, ascitis, pedal oedema, hypoalbuminemia, and electrolyte imbalance. Microscopic examination of stool sample revealed the presence of ova, larvae, and adult worms of C. philippinensis. Patient recovered from the disease after taking albendazole 400 mg daily for 1 month along with supportive treatment.