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Capillariasis is an infection by Capillaria
philippinensis, C. hepatica, or C. aerophila.
In 1962, the first reported case
of human intestinal capillariasis occurred in a previously healthy
young man from Luzon in the Philippines, who subsequently died. At
autopsy, a large number of worms were found in the large and small
intestines.
C. philippinensis is a tiny
nematode first described in the 1960 s as a pathogen causing severe
diarrheal syndromes in humans.
C. Philippinesis causes
a malabsorption enteropathy that may be severe and even fatal.
Infection with C. hepatica presents the clinical picture of acute or subacute hepatitis with hypereosinophilia.
C. aerophila causes acute
bronchitis, bronchiolitis, asthma, and cough.
The life cycle of C. philippinensis is not
completely known, but infection is probably acquired by ingesting eggs
or infective larvae in small fish.
The organisms embed in the mucosa of the jejunum and interfere with
absorption.
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Fatal infections are caused by
extraordinarily heavy worm infestation.
Larvae released from the female cause
autoinfection.
In severe infections generalized abdominal pain,
diarrhea and pronounced borborygmi are followed by nausea and vomiting
and intractable diarrhea, leading to severe malabsorption, cachexia,
and death.
The combination of muscular wasting, and loss of body fat
makes intestinal peristalsis visible and outlines muscles and tendons
through the skin.
The mortality ranges from 7% to 20%.
At autopsy the
small intestine is indurated, thickened, and distended with fluid.
One
liter of fluid may contain 200,000 adults and larvae.
Adults, larvae
and eggs of C. philippinensis are in the crypts and lamina propria of
the duodenum, jejunum, and upper ileum.
The diagnosis is made by
identifying characteristic C. philippinensis eggs in the stool.
C. hepatica is
parasite of mammals. Adult worms in the definitive host (the rat)
deposit eggs in the liver. If this host is eaten by a cat or
dog, the eggs pass with the animal faeces. Eggs in the soil are eaten
by humans and hatch in the small intestine. The larvae penetrate the
intestinal wall and migrate to the liver, where they mature.
C. hepatica in adults are the
foci of intense granulomatous reactions.
The diagnosis is made by
identifying eggs or adult worms in the liver.
Mebendazole is the drug
of choice.
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