Capillaria philippinensis: a cause of chronic diarrhea in Upper Egypt

ABSTRACT

Capillaria philippinensis is a rare zoonotic intestinal parasite that is endemic in Philippines and Thailand. A few cases have been reported in Japan, Iran, Egypt, and Taiwan. The outcome of C. philippinensis may be fatal if untreated in due time. C. philippinensis is an emerging infection in Egypt as a cause of chronic diarrhea; thus, we carried out this study to determine the presence and frequency of C. philippinensis in patients with chronic diarrhea in Upper Egypt. The study included 113 patients with chronic diarrhea attending the Department of Tropical Medicine and Gastroenterology, Assiut University Hospital. All patients were subjected to full history taking, clinical examination, and laboratory investigations including stool examination, complete blood count, and assessment of blood urea and serum creatinine, serum albumin, and electrolytes [sodium, potassium, and calcium]. Also, gastroduodenoscopy, duodenal biopsy for histopathological examination, and colonoscopy were performed for every patient. C. philippinensis was reported in seven patients. All of them were young female patients with severe chronic diarrhea, associated with vomiting, abdominal pain, anorexia, borborygmi, weight loss, and ankle edema; three patients had mild ascites. The seven patients had hyponatremia, hypocalcemia, marked hyokalemia, and hypoalbuminemia. The diagnosis of C. philippinensis was established on finding the characteristic egg of C. philippinensis in the stool of all cases; histopathological examination of the duodenal biopsies indicated heavy cellular infiltration around the adult worm in one of them and larvae in another one. Six patients recovered completely with albendazole treatment 200 mg twice daily for 21 days, whereas one patient died of heart failure because of severe hypoalbuminemia and hypokalemia. Capillariasis is one of the parasitic causes of chronic nonbloody diarrhea in patients in Upper Egypt