CDC - DPDX - Intestinal Capillariasis

[Capillaria philippinensis]
Parasite Biology
Causal Agent
The nematode (roundworm) Capillaria (=Paracapillaria) philippinensis causes human intestinal capillariasis. Unlike C.
hepatica, humans are most likely the main definitive host. Transmission occurs primarily through eating
undercooked fish.
Life Cycle
Typically, unembryonated, thick-shelled eggs are passed in the human stool and 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 . 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).
Hosts
While piscivorous birds have been suggested as a wildlife reservoir of C. philippinensis, this has not been well
substantiated based on field observations. Experimental trials have established heavy patent infections in several
bird species (particularly herons, egrets, and bitterns), but extensive surveys of wild birds in endemic areas have
largely failed to detect infection. Many species of freshwater fish appear susceptible to infection and act as
intermediate hosts.
Geographic Distribution
As the name suggests, Capillaria philippinensis is endemic in the Philippines and epidemics have occurred in the
Northern Luzon region. The parasite is also endemic in Thailand, and sporadic cases have been reported from other
East and Southeast Asian countries. More recently, a number of cases have been identified in northern Egypt.
Clinical Presentation
Intestinal capillariasis initially manifests as abdominal/gastrointestinal disease, which can become serious if not
treated because of autoinfection. A protein-losing enteropathy can develop which may result in complications such
as cardiomyopathy, severe emaciation, cachexia, and death. In the first recognized outbreak of intestinal capillariasis,
the case fatality rate was over 10%.
Image Gallery
Capillaria philippinensis eggs.
Capillaria philippinensis eggs are 35 to 45 µm in length by 20-25 µm in width, somewhat smaller than C. hepatica.
They have two flat polar prominences and a striated shell. Eggs are unembryonated when passed in feces.
Figure A: Egg of C. philippinensis in an unstained wet mount of stool.
Figure B: Egg of C. philippinensis in an unstained wet mount of stool.

Figure C: Egg of C. philippinensis in an unstained wet mount of stool.
Capillaria philippinensis adults.
Capillaria philippinensis adult males are 2.0—3.5 mm in length and females are 2.5—4.5 mm in length. Females may
contain embryonated or unembryonated eggs in utero.
Figure A: Longitudinal section of an adult of C. philippinensis from an intestinal biopsy specimen stained with
hematoxylin and eosin (H&E).
Figure D: Higher magnification of Figure C, showing stichocytes within the adult worm.
Figure B: Longitudinal section of an adult of C. philippinensis from an intestinal biopsy specimen stained with
hematoxylin and eosin (H&E).
Figure E: Cross-section of a gravid adult female C. philippinensis from an intestinal biopsy specimen, stained with
H&E. Shown in this figure are a bacillary band (blue arrow), the intestine (red arrow) and uterus containing an
egg in cross-section (black arrow).
Figure C: Longitudinal section of an adult C. philippinensis from an intestinal biopsy specimen, stained with H&E.
Figure C: Longitudinal section of an adult C. philippinensis from an intestinal biopsy specimen, stained with H&E.
Laboratory Diagnostic
Diagnostic Findings
The specific diagnosis of C. philippinensis is established by finding eggs, larvae and/or adult worms in the stool or in
intestinal biopsies. Unembryonated eggs are the typical stage found in the feces. In severe infections, embryonated
eggs, larvae, and even adult worms can be found in the feces. No valid serologic testing is available for diagnosis.
More on: Morphologic comparison with other intestinal parasites
Laboratory Safety
Standard precautions apply when processing stool samples. Eggs of C. philippinensis are not infectious to humans.
Resources
Page last reviewed: October 3, 2019

CDC - DPDX - Intestinal Capillariasis

Uploaded by

Copyright:

Available Formats

CDC - DPDX - Intestinal Capillariasis

Uploaded by

Document Information

Original Description:

Original Title

Copyright

Available Formats

Share this document

Share or Embed Document

Sharing Options

Did you find this document useful?

Is this content inappropriate?

Copyright:

Available Formats

CDC - DPDX - Intestinal Capillariasis

Uploaded by

Copyright:

Available Formats

[Capillaria philippinensis]

Capillaria philippinensis eggs.

Figure B: Egg of C. philippinensis in an unstained wet mount of stool.

Capillaria philippinensis adults.

More on: Morphologic comparison with other intestinal parasites

Page last reviewed: October 3, 2019

You might also like