A human infection of Echinostoma hortense in duodenal bulb diagnosed by endoscopy

Chang, Young Doo; Sohn, Woon Mok; Ryu, Jae Hwa; Kang, Sung-Soo; Hong, Sung Jong

doi:10.3347/kjp.2005.43.2.57

Cited by 30 publications

(20 citation statements)

References 13 publications

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“…The hypoalbuminemia, hypocholesterolemia, low BUN and moderate anemia might have been caused by malabsorption and enteritis of the intestinal mucosa due to the infection. The small intestine, particularly the duodenum, is the usual site of E. hortense infection in humans [3,4,8]. In the present case, the parasites were also found in the duodenum by endoscopy.…”

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confidence: 55%

<i>Echinostoma hortense</i> Infection with Enteritis Diagnosed by Upper Gastrointestinal Endoscopy in a Dog

Okanishi

Matsumoto

Nogami

et al. 2013

The Journal of Veterinary Medical Science

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ABSTRACT. An 8-year-old male Shiba dog presented with chronic vomiting and diarrhea. Upper gastrointestinal endoscopy revealed severe enteritis and infection of the duodenal mucosa with Echinostoma hortense. We performed therapy for parasites and enteritis. The therapy was successful for deworming and temporarily improved the symptoms, but the dog died soon thereafter. To the authors' knowledge, this is the first case report of an antemortem diagnosis of E. hortense infection in a dog. Echinostoma hortense is a member of the Echinostomatidae family, and its characteristics include a large elongated body, a head crown with collar spines and a large oral sucker [1,5]. The fluke is zoonotic and inhabits the small intestines of birds and mammals, such as humans and mice [16]. Human echinostomiasis has been identified in China [12], Japan [7,9] and Korea [16,18]. Infection with E. hortense was found for the first time after autopsy of a stray dog in an epidemiological study in 1927 [2] and was found again in 1981 [6]. However, antemortem diagnosis and clinical data including those pertaining to therapy for E. hortense infection in dogs have not been described. This report describes a dog with E. hortense infection that was diagnosed by upper gastrointestinal endoscopy.An 8-year-old neutered, domestic, male Shiba dog weighing 6.55 kg (body condition score, 1) was referred to the Animal Medical Center at Nihon University, Japan. The dog had symptoms of chronic diarrhea, vomiting and weight loss over a period of 4 years. The dog had been kept at the foot of a mountain in Kanagawa, Japan, near a brook and had never been taken outside Japan. At a local animal hospital, the dog received an elimination diet (Sensitivity Control Blue Whiting and Tapioca, Royal Canin, Japan) and antibiotics, but no improvement in symptoms was observed. Prednisolone therapy (1 mg/kg/day) temporarily improved excretion from watery diarrhea to loose stool. However, watery diarrhea and vomiting returned soon thereafter, occurring once or twice per week, and the dog was then referred to us. Severe weight loss and wambling were evident during the first medical examination, but abdominal tenderness was absent. A blood test revealed (values with reference ranges) albumin (ALB), 1.8 g/dl (2.3-4.0 g/dl); total cholesterol (T. chol), 54 mg/dl (110-320 mg/dl); blood urea nitrogen (BUN), 5 mg/ dl (7-27 mg/dl); hematocrit (Ht), 27.5% (37-55%); and Creactive protein (CRP), 0.05 mg/dl (<1.00 mg/dl). There was no eosinophilia; the dog had an eosinophil count of 56/µl (100-1,250/µl). No significant abnormalities were observed in a general fecal examination (direct and flotation method), urinalysis, X-ray examination or abdominal ultrasound. Gastrointestinal endoscopy was performed to identify the cause of the anemia, hypoalbuminemia and gastrointestinal symptoms. During gastroduodenal endoscopy, motile flukes were found attached to the edematous duodenal mucosa (Fig. 1). The flukes, which looked slender and elongated, were ex-

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confidence: 55%

<i>Echinostoma hortense</i> Infection with Enteritis Diagnosed by Upper Gastrointestinal Endoscopy in a Dog

Okanishi

Matsumoto

Nogami

et al. 2013

The Journal of Veterinary Medical Science

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“…The severity of symptoms is generally stronger than those seen in other intestinal fluke infections, such as heterophyids [5]. In this respect, reports of patients with E. hortense infection is noteworthy who sufferred from severe epigastric discomfort and ulcerative lesions in the stomach or duodenum and diagnosed by recovery of worms at gastroduodenal endoscopy [125][126][127][128][129]. A patient admitted to a hospital because of epigastric pain and hematemesis revealed in gastroduodenoscopy an adult fluke attached at the lesion, which was removed by an endoscopic clipper [125].…”

Section: Echinostomesmentioning

confidence: 98%

“…Another patient suffered from epigastric discomfort for a year, and acute epigastric pain and diarrhea for 1 month, which was accompanied by acidic belching, dizziness, and weight loss of 2 kg [126]. The third patient complained of epigastric discomfort for several days [127], and the fourth patient suffered from upper abdominal pain and discomfort persisting for 2 wk [128]. The fifth patient had epigastric discomfort, indigestion, anorexia, dizziness, headache, nausea, and vomiting; these symtpoms became severer and she was hospitalized [129].…”

Section: Echinostomesmentioning

confidence: 99%

“…The worm wiggled on stimulation and became tightly stretched during retrieval with a forcep [126]. Two more patients diagnosed at gastroduodenal endoscopy had 2 living wroms each in the duodenal bulb area, at times accompanied by mucosal erosions [127,128]. In another patient, from whom 2 living E. hortense flukes were recovered, the affected gastric mucosa revealed signs of chronic gastritis, and at the proximal part of the duodenum multiple cured ulcerative lesions were observed [129].…”

Section: Echinostomesmentioning

confidence: 99%

“…In the Republic of Korea, an endemicity of this echinostome infection, with 22.4% prevalence, was reported among residents of Cheongsong-gun [124]. In hospitals of the Republic of Korea, clinical cases are at times diagnosed by extracting worms through gastroduodenal endoscopy [125][126][127][128][129].…”

Section: Echinostoma Cinetorchismentioning

confidence: 99%

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