Clinical Manifestations of
Oesophagostomum Infection
Abdominal Mass Swelling
Borrowed from Orihel
and Ash. Parasites in Human Tissues. 1995. ASCP
Press.
Case Study 1: March 1st, 1950.
The Patient: 5 yr.
old,
European
female was admitted to Mulago hospital in Kampala, Uganda.
Signs and Symptoms:
Anorexia,
high fever (100 degrees F), gastrointestinal pain, nausea with no
vomiting, right side abdominal pain increased over the duration of 3 days, 3
loose stools
were passed by day 7, constipation after day 7, spherical abdominal mass
became increasingly tender, wbc: 8,500/c mm.
Outcome: 15 days after
patient was admitted, surgery was performed to remove the inflammatory
mass. A cavity containing pus was found when the mass was opened and a
large, live worm escaped from the mass. The jejunum was resected and the
patient recovered. The worm was latter identified as O.
stephostomum.
Case Study 2: April 22,1951
The Patient: A 31 yr. old
European male was admitted to the Mulago Hospital due to severe abdominal
pain.
Signs and Symptoms:
Patient's symptoms presented 24 hours prior examination, normal
temperature, peritonitis (indurated mass in the wall of the gut) appeared,
spleen and liver were inflamed.
Outcome: Surgery was
performed to resect part of the colon. A colostomy was performed and then
patient was administered heavy antibiotics. Tissue that had been removed
during the resection was analyzed and showed a perforation in the mass to
the peritoneum. Much of the submucosa had become necrotic. After the
cavity was opened, a live, female worm was found. Also, there was a
large infiltration of eosinophils and other leukocytes in the
cavity.
Case Study 3: May 19, 1952.
The Patient: An African
male, 50 yrs old, who worked as a laborer, entered the Mulago Hospital
with the characteristic abdominal pains.
Signs and Symptoms Patient
presented with abdominal pain, a sausage shaped abdominal tumor mass, was
vomiting but had normal bowel movements, was dehydrated, and toxic levels
of various proteins were determined.
Outcome: Surgery was
performed and intussusception (when the G.I. tract folds inward on its
self) had occurred. After the patient died and the nodule was examined, a
worm was found amongst the necrotic tissues.
- Various types of nodes, nodules, tumor-like
masses, and presence of the worm in these samples.
Borrowed from Thomas, H.W. (1910). The pathological
report of a case of oesophagostomiasis in man. Annals of Tropical Medicine
and Parasitology. 4: 57-88.
Pathology and Clinical
Manifestations
Oesophagostomiasis, as described
above in the
three
case studies, usually presents with pain in the abdomen, along with
non-specific parasitic infection symptoms such fever and infiltration of
macrophages and eosinophils to the infected bowel mucosa. Until recently,
Oesophagostomum infection was misclassified as hookworm infection
because of their similar clinical presentation.
The tumor-like
nodules characteristic of the disease are most often found in the
ileocecal region. Although there
is no uniform presentation of
Oesophagostomiasis, there are two major types of nodular pathology
that typically result. Some patients develop a multinodular disease in
which the colon is studded with many tiny nodules. Other patients present
with the Dapaong disease as depicted in the boy at the top of this page.
In this case, only a single nodular mass develops but it can be throughout
the colon wall. Nodules are not necessarily a problem unless they cause
bowel
obstruction or chronic colonic inflammation. Consequently, the Dapaong
tumor disease is considered the more severe of the two types because of
the pain it causes and the obstruction it can lead to.
In some
rare
cases, serious disease can occur including emaciation, fluid in the
pericardium, cardiomegaly, hepatospleenomegaly, perispleenitis, and
enlargement of the appendix.
Organ and Tissue Samples from Single and
Multinodular forms of Oesophagostomiasis
"Macrophotograph showing a) the multinodular and
b) the unilocular disease. In multinodular disease there are numerous
small abscesses filled
with pus throughout the bowel wall. The unilocular disease consists of a
fibrotic nodule with a central lumen surrounded by dense, whitish grey
connective tissue."
Borrowed from Bogers and Storey. "Human
Oesophagostomiasis: a histomorphometric study of 13 new cases in northern
Ghana." Virchows Arch. 2001. 439:21-26.
"Micrographs showing a), b) the multinodular form versus c) the wall of
the
nodule of unilocular disease. The abscess in the multinodular disease
often shows a transsection through an Oesophagostomum. The rest of the
lumen is filled with pus. The wall of some of the nodules consists of
fibrous tissue with a mixture of inflammatory cells of variable intensity,
with mainly eosinophilic granulocytes, plasma cells and histiocytes (b).
In the unilocular form the wall is of variable thickness and is made up of
fibrous tissue containing a mixture of inflammatory cells (eosinophilic
granulocytes, histiocytes and plasma cells). In the wall of some of the
nodules calcification was seen."
Borrowed from Bogers and Storey. "Human
Oesophagostomiasis: a histomorphometric study of 13 new cases in northern
Ghana." Virchows Arch. 2001. 439:21-26.
Introduction
Classification
Life
Cycle
Epidemiology
Clinical Manifestations
Diagnosis
Treatment
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