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Laboratory Diagnosis

Definitive diagnosis of C. philippinensis is made by identifying the characteristic ova in the stool. The ova must be distinguished from those of Trichuris trichiura which they superficially resemble. Occasionally adult worms and larvae may be found in feces or on jejunal biopsy. Intradermal tests employing antigen prepared from extracts of the adult worms have been useful epidemiologically.

Marked hypoproteinemia with low serum albumin levels is a constant finding. The stools are bulky with an elevated fecal fat content and an average daily stool weight of 1200 g (versus controls of 170 g). Protein loss in the stools may be 15 times that seen in controls. lmmunoglobulin studies show normal IgA values but diminished IgM and IgG values. There is malabsorption of sugars (xylose) and fats, and low serum levels of potassium, sodium, calcium, and carotene.

Clinical Characteristics

Intestinal capillariasis is seen most commonly in men between 20 and 45 years of age, but the disease occurs in both sexes and all age groups. It causes a severe protein-losing enteropathy and malabsorption syndrome, with a relatively high mortality unless appropriate therapy is instituted. This will include antihelminthic therapy with mebendazole, use of an antidiarrheal drug, replacement of fluids and electrolytes, and a high protein diet.

The syndrome resembles disseminated strongyloidiasis with autoinfection. The initial symptoms of the disease are mild and consist of borborygmi and vague abdominal pain. Diarrhea develops within 2-6 weeks; at first it is intermittent but it then becomes persistent with passage of five to ten or more watery, voluminous, sprue-like stools per day. There is associated weight loss, malaise, anorexia, nausea, and vomiting. Patients with more advanced disease show cachexia and weakness, with absent or diminished reflexes, profound muscle wasting, and loss of subcutaneous fat, anasarca, and dehydration. The patient may have weak heart sounds, hypotension, and gallop rhythm suggesting a myocardiopathy. The abdomen is distended and there is epigastric tenderness. The protein-losing enteropathy results in severe hypoproteinemia and peripheral edema. Extreme weight loss, emaciation and death may follow rapidly in severely infected individuals.

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