An Indigenous Case of Intestinal Capillariasis with Protein-Losing Enteropathy in Korea

Abstract

We encountered an indigenous case of intestinal capillariasis with protein-losing enteropathy in the Republic of Korea. A 37-year-old man, residing in Sacheon-si, Gyeongsangnam-do, admitted to the Gyeongsang National University Hospital (GNUH) due to long-lasting diarrhea, abdominal pain, anasarca, and weight loss. He recalled that he frequently ate raw fish, especially the common blackish goby (Acanthogobius flavimanus) and has never been abroad. Under the suspicion of protein-losing enteropathy, he received various kinds of medical examinations, and was diagnosed as intestinal capillariasis based on characteristic sectional findings of nematode worms in the biopsied small intestine. Adults, juvenile worms, and eggs were also detected in the diarrheic stools collected before and after medication. The clinical symptoms became much better after treatment with albendazole 400 mg daily for 3 days, and all findings were in normal range in laboratory examinations performed after 1 month. The present study is the 6th Korean case of intestinal capillariasis and the 3rd indigenous one in the Republic of Korea.

Intestinal capillariasis in the 21stcentury: clinical presentations and role of endoscopy and imaging

“…The findings of scallop appearance of mucosa reflecting villous atrophy and erythematous and edematous mucosa from mucosal inflammation were homogenous in all patients. These findings were similar to the previously described findings by Rana et al [ 12 ] and were also indistinguishable from celiac disease except for the involvement of duodenum, which was more prominent in celiac disease.…”

“…First, the disease has been unrecognized by clinicians. This might be due to atypical manifestations of the disease and the emerging of the disease in non-endemic area [ 9 , 12 , 13 ]. Second, the sensitivity of stool examination is not high because the parasitic eggs are excreted intermittently in stool.…”

An Overview of Fish-borne Nematodiases among Returned Travelers for Recent 25 Years– Unexpected Diseases Sometimes Far Away from the Origin

“…In Japan, 6 cases including 1 Japanese traveler returned from Malaysia and Singapore [ 71 ] and 1 Thai immigrant worker [ 72 ], have been reported. In Korea, 7 cases have been reported including 3 indigenous [ 73 – 75 ] and 4 cases of possible overseas infection. Among 4 cases of overseas infection, 2 cases were in Saipan (one Korean resident in Saipan [ 76 ] and one Korean traveler to Saipan [ 77 ]) and 1 case each of a temporary resident in Indonesia [ 74 ] and the Philippines [ 78 ].…”

Foodborne nematodes

“…Since 1988, intestinal capillariosis in humans has also been documented in Egypt, Japan, Indonesia, Iran, India, Korea, Lao PDR, People's Republic of China, and Taiwan and in travelers who acquire the infection in one of these endemic countries and develop the disease when they return home (Lu et al, 2006;Saichua et al, 2008;Soukhathammavong et al, 2008;Fan et al, 2012;Jung et al, 2012;Vasantha et al, 2012). Since 1988, intestinal capillariosis in humans has also been documented in Egypt, Japan, Indonesia, Iran, India, Korea, Lao PDR, People's Republic of China, and Taiwan and in travelers who acquire the infection in one of these endemic countries and develop the disease when they return home (Lu et al, 2006;Saichua et al, 2008;Soukhathammavong et al, 2008;Fan et al, 2012;Jung et al, 2012;Vasantha et al, 2012).…”