Capillariasis

Capillariasis General Information

Capillariasis Symptoms

Responsible for the transmission of Capillariasis are the improper eating habits of many people around the world.  In Philippines, for example, the disease appears mainly because of the patients’ preference for a variety of improperly cooked meals. Raw shrimps, snails, goat, clams, crabs, and squid are eaten as well as a multitude of small brackish-water and freshwater fish found in lagoons along coasts. Capillariasis usually appears because the fish are too small to be eviscerated before eating them, so that they are consumed whole. In other parts of the world, the occurrence of this disease is associated mostly with raw fish. When the disease is caused by C. hepatica, the patient may suffer from eosinophila with a sub acute or acute hepatitis that could disseminate to other organs. When dealing with an intestinal Capillariasis caused by C. philippinensis, intermittent or chronic diarrhea (that could last more than three weeks), borborygmus (gurgling stomach) and abdominal pain could appear. If the proper treatment is not given in time, it could become really severe because of autoinfection. For example, the developing of a protein losing enteropathy can be observed; this leads to cachexia (regression), and eventually, to death. Other cases can be: malabsorption of sugar or fats, low levels of potassium, calcium, sodium and carotene, decreased excretion of xylose. In the case of C. aerophila, pulmonary problems could appear, for example pneumonia, cough, asthma and fever that prove to be really dangerous. Other general symptoms are: the loss of appetite that ends with severe weight loss as a result of even ten voluminous stools per day, anorexia, muscle wasting, malaise, swellings of parts of the body and vomiting. Studies have shown weakness of the muscles, edema, hypotension, distant heart sounds, hyporeflexia, tenderness and abdominal distention.

Capillariasis Treatment

The right diagnosis for Capillariasis philippinensis is put after larvae, eggs or adult worms are found in intestinal biopsies or in the stools. Usually, in the feces, the most common stage found is that of unembryonated eggs. When dealing with more severe forms of Capillariasis, along with these unembryonated eggs, larvae and adult worms can be revealed in the feces. In the case of C. hepatica the diagnosis is put after a necropsy or a biopsy that shows eggs or adult worms in the tissues of the liver. Usually, this finding is a spurious one because it does not come from an infection of the human host, but from the ingestion of livers belonging to the infected animals by the respective host. C. aerophila is discovered either after the presence of eggs in stools or in biopsies of the lungs. In some patients, multiple stools need to be tested. Only after these tests are done and the right diagnosis of Capillariasis is put, in any of its forms, the doctor can proceed with the adequate treatment.

When it first appeared, the infected persons received anthelminthic agents. Eventually, the main choice for the drug treatment became that with thiabendazole, given in the following dosage: 1 g/day for 30 days or 25 mg/kg/day. The majority of patients had a good response to the treatment, although some of them complained of relapses and side effects. After some years of the epidemic, the number of relapses becomes bigger than the number of new infections. In the cases of severe Capillariasis, the patient usually receives a replacement therapy with electrolytes, antidiarrheal agents and is advised to follow a high protein diet. Nowadays, the doctors prefer as drug of choice mebendazole with a dosage of 450mg/day divided into doses for 25 days for the new patients and for 35 days for the patients who relapsed. Then, this drug is replaced with thiabendazole. Albendazole proved to be very efficient against intestinal Capillariasis and it is now the alternative treatment and is given in similar doses to those for mebendazole, but it is only administered for ten days. It seems that Albendazole acts both on the larvae, as well as in the adults stages. If these ten days are not respected, the therapy results in recent relapses in many patients. The relapses are considered to be caused by the impossibility of mebendazole and thiabendazole to fight against the larval stages. Usually, once the adults affected and as the maturation of larvae proceeds, they become susceptible to these drugs. After the five days of strict treatment with most drugs, the worms are not found anymore in the feces, although the symptoms disappear within a week. Some patients do the wrong thing to stop the treatment at this time; but hardly after 25 or 30 days, the parasite and its eggs reappear. This disease usually appears because the fish are too small to be eviscerated before eating them, so that they are consumed whole. This disease can easily be prevented and controlled, usually by avoiding eating raw fish, by adequate cooking of the fish thoroughly before eating it and by using sanitary toilets for disposal of the human wastes.