Capillaria Philippinensis (Paracapillaria Philippinensis)

Capillaria philippinensis
(Paracapillaria
philippinensis)
Ian Loon Genaldo, MD
Chairman Microbiology and Parasitology Department
UV – Gullas College of Medicine
GENERAL CHARACTERISTICS (ADULT
MORPHOLOGY)
• Order: Trichinellida (Trichuris, Capillaria, Trichinella)
• Super family: Trichinelloidea
• SIMILAR MORPHOLOGY
Parasite Biology:
• Super family: Trichinelloidea ( e.g. C. philippinensis, Trichuris,
Trchinella )
- have thin filamentous anterior end and slightly thicker
shorter posterior end
THE DIFFERENTIATION
• Capillaria philippinensis adult • Trichuris trichiura adult
Parasite Biology
• Male worms: • Female worms:
- 1.5 to 3.9 mm length - 2.3 to 5.3 mm long
Parasite Biology
• Male spicule: • Vulva ( Female worm ):
- 230 to 300 um long and has - Located at the junction at
an unspined sheat. the anterior and middle thirds.
Parasite Biology
• Female worms: • Egg of C. philippinensis in an
- Produce characteristic eggs unstained wet mount of stool.g
which are peanut – shaped with of C. philippinensis in an
striated shells and flattened unstained wet mount of
bipolar plugs. stool.
- measures:
- 36 to 45 um X 20 um
COMPARISON OF THE OVA
Trichuris trichiura ovum Capillaria philippinensis ovum

LIFE CYCLE
Life cycle:
• Unembryonated, thick-shelled eggs are passed in the human stool
become embryonated in the external environment in 5—
10 days after ingestion by freshwater fish, larvae hatch,
penetrate the intestine, and migrate to the tissues Ingestion of
raw or undercooked fish results in infection of the human host.
The adults of Capillaria philippinensis are very small (males:
2.3 to 3.2mm; females: 2.5 to 4.3 mm) and reside in the human small
intestine, where they burrow in the mucosa.
Life cycle:
• In addition to the unembryonated, shelled eggs which pass into the
environment, the females can also produce eggs lacking shells
(possessing only a vitelline membrane) which become embryonated
within the female’s uterus or in the intestine The released
larvae can re-invade the intestinal mucosa and cause internal
autoinfection This process may lead to hyperinfection (a
massive number of adult worms).
PATHOGENESIS
Human intestinal capillariasis is caused by
Capillaria philippinensis.
Let’s investigate..
• Human intestinal capillariasis from India and the first case from
Andhra Pradesh, which is a non-endemic area.
• A 40-year-old female presented with diarrhoea, vomiting, decreased
urinary output, ascitis, pedal oedema, hypoalbuminemia, and
electrolyte imbalance.
• Microscopic examination of stool sample revealed the presence of
ova, larvae, and adult worms of C. philippinensis.
• Patient recovered from the disease after taking albendazole 400 mg
daily for 1 month along with supportive treatment.
Let’s investigate..
• 29 year old, male from Northern Luzon
• Abdominal pain ( P.E. Abdomen – ( + ) Borborygmi )
• Initially: experience intermittent diarrhea and progress to passing out
8 to 10 voluminous stools per day, for 5 weeks
• After a few weeks - weight loss, malaise, anorexia, vomiting, EDEMA
Hypoalbuminemia - EDEMA
• Low level of albumin due to combined loss of blood, lymph and
protein.
• Albumin is a protein made by the liver. Will induced Oncotic pressure.
Hypoalbuminemia - EDEMA
• Oncotic Pressure:
- a.k.a colloid osmotic pressure
- is a form of osmotic pressure
induced by proteins ( albumin ) in a
blood vessels plasma ( blood/liquid)
that displaces water molecules
moving back to the circulatory
system
Pathogenesis:
• Parasites do not invade • Malabsorption of fluids,
intestinal tissues but responsible proteins and electrolytes (low
micro-ulcers in the epithelium serum electrolyes – K, Ca, Na).
and compressive degeneration • Fat and sugar malabsorption –
and mechanical compression of decrease excretion of xylose
cells.
• Ulcerative and Degenerative
lesions in the intestinal mucosa
Pathogenesis:
• Endoscopic Findings • Nonspecific, segmental erythematous
inflammation in the small bowel with
superficial erosions with exudation
• Histologically
- The intestines also show flattened
and denuded villi and dilated mucosal
glands.
- Lamina propria is infiltrated with
plasma cells, lymphocytes macrophages
and neutrophils.
DIAGNOSIS
Diagnosis:
• Basis of Diagnosis: • Based on finding characteristic
eggs in the feces by – DIRECT
SMEAR OR WET MOUNT AND
STOOL CONCENTRATION
METHODS
Diagnosis
• Parasites can be also recovered • Duodenal aspiration
from small intestine
Diagnosis:
• ELISA – Enzyme Link • Detection of coproantigen
Immunosorbent Assay prepared from stool samples of
patient with capillariasis
• This technique did not show cross
reaction with coproantigens from
patients with Fasciola gigantica and
Schistosoma mansoni
Diagnosis:
• Immunodiagnosis ( Immunoblot ) • Cross reaction of capillariasis
patient antibodies with Trichella
spiralis antigen.
- suggesting the prospective
use of Trichenella spiralis antigen.
TREATMENT
• Electrolyte replacement, high protein diet – severe cases
• Mebendazole 200 mg BID x 20 days --- DOC
• Albendazole 400 mg OD x 10 days - ALTERNATIVE DRUGS
• Relapse – may occur if treatment regimen is not followed or

completed.
Human Intestinal Capillariasis
PREVENTION AND
CONTROL
Prevention and Control
• Improve sanitation / Health educational program
- Proper waste disposal of human waste
- Discourage eating raw fish
- Improve patient health seeking behaviors
• Capacity building – for health personnel in the field ( e.g. laboratory
staff ) - for early detection and treatment is important in preventing
mortality
EPIDEMIOLOGY
Epidemiology
• 1963, first case in Northern Luzon
• 1966 epidemic at Pudoc West, Ilocos Sur (“Pudoc Worm”)
• 1966-1990: 2,000 cases, Northern Luzon Provinces
• 1998: Monkayo, Compostela Valley (“mystery disease”)
• Other countries: Thailand, Iran, Japan, Indonesia, United Arab
Emirates, South Korea, India, Taiwan, Egypt and Lao People’s
Democratic Republic
References
• Medical Parasitology in the Philippines by Vicente Y. Belizario Jr. and
Winifreda U. de Leon
• Foundations of Parasitology by Roberts and Janovy, Jr.
• Center for Disease Control and Prevention (CDC)
We hope you enjoyed. Any questions?
But wait..
Always remember these
truths..
1. We are capable.
2. We are loved.
3. We can always be
forgiven.
Referrences:
• Medical Parasitology in the Philippines by Vicente Belizario Jr,
Winifreda U. de Le-on, 3rd edition 2015.
• CDC.
https://www.cdc.gov/dpdx/diagnosticprocedures/blood/specimenpro
c.html.
https://www.cdc.gov/dpdx/diagnosticprocedures/index.html
God gave every person some talents.
Talents are to be shared. What talent
can you share with others today? 
Gratias tibi!

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Capillaria philippinensis

Trichuris trichiura ovum Capillaria philippinensis ovum

• Relapse – may occur if treatment regimen is not followed or

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