3 GEOGRAPHIC DISTRIBUTION * Philippines * ThailandRare cases have been reported from other Asian countries, Iran, Middle East, Japan, Egypt and Colombia.
4 Interesting FactsFirst discovered in 1963 in Northern Luzon, PhilippinesAppearance in humans was sudden and unexpectedWitch Doctors hired to drive out curse placed on people by River GodRiver God was responsible for Capillaria philippinensis.
5 MORPHOLOGY Adult Male Adult Female Egg 2.3-3.2 mm long 23-28 μm wide Small caudal alaeSpineless spicule sheathAdult Femalemm long29-47 μm wideEsophagus is half as long as bodyProduce Capillaria-type eggs that lack pitsEgg36-45 μm long20 μm widePeanut shapedStriated shellCaudal alae - cuticular extensions on either side of, or surrounding, genital cavity that opens (blue arrow)Spicule – small, hard body that serve as the skeletal element
6 LIFE CYCLE DEFINITIVE HOST: INTERMEDIATE HOST: VECTOR: fish-eating birdsINTERMEDIATE HOST:FishVECTOR:NoneACCIDENTAL HOSTS:HumanAcquire by eating small species of raw infected fishDirect and Indirect Life CyclesMigratory birds (definitive host) are the reason for the spreading to Asian countries and Middle East.
7 LIFE CYCLE Unembryonated eggs are passed in human/bird stool. Unembryonated eggs become embryonated in the external environment.Fresh water fish ingest embryonated eggs, larvae hatch, penetrate the intestine, migrate to tissues.Ingestion of raw or undercooked fish results in infection of human host.Adult worms reside in human small intestine, burrow in mucosa.Female adult worms deposit unembryonated eggs.- Some eggs become embryonated in intestine, release larvae, cause autoinfection, leading to hyperinfectionParasite of fish-eating birds.- (Birds eat small fish)Hyperinfection – meaning a massive amount of adult worms
8 PATHOGENESIS In Humans Causes intestinal capillariasisDamages cells of intestinal wallWorms repeatedly penetrate mucosa of small intestine and reenter lumen (jejunum)Leads to progressive degeneration of mucosa and submucosaInterferes with absorption of nutrients (fats and sugars) and maintenance of proper electrolyte (potassium) balance
9 PATHOGENESIS In Humans SYMPTOMS:Watery diarrheaAbdominal painEdemaWeight lossWeaknessMalaiseAnorexiaEmaciationBorborygmus (stomach growling)Depressed levels of potassium and albumin in bloodMalaise - a condition of general bodily weakness or discomfort, vague or unfocused of mental uneasiness, lethargy, or discomfortEmaciation – abnormal thinness caused by lack of nutrition or by disease
10 DIAGNOSIS In Humans Finding eggs, larvae, and/or adults in: Stool samplesUnembryonated eggsSevere infections have eggs, larvae, and adultsIntestinal biopsiesOften fatal if left untreatedPatients die from:Loss of electrolytesHeart FailureSecondary Bacterial Infections
11 TREATMENT In Humans Anthelmintics - Mebendazole - Albendazole - ThiabendazolePrefer Albendazole and Mebendazole because it works better than Thiabendazole.
12 CONTROL For HumansAvoid eating small raw fish wholeEducation