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SOME STUDIES on CAPILLARIA PHILIPINENSIS and ITS MYSTERIOUS TRIP from PHILIPPINES to EGYPT (REVIEW ARTICLE) by REFAAT M.A

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SOME STUDIES on CAPILLARIA PHILIPINENSIS and ITS MYSTERIOUS TRIP from PHILIPPINES to EGYPT (REVIEW ARTICLE) by REFAAT M.A Journal of the Egyptian Society of Parasitology, Vol.44, No.1, April 2014 J. Egypt. Soc. Parasitol. (JESP), 44(1), 2014: 161 - 171 SOME STUDIES ON CAPILLARIA PHILIPINENSIS AND ITS MYSTERIOUS TRIP FROM PHILIPPINES TO EGYPT (REVIEW ARTICLE) By REFAAT M.A. KHALIFA AND RAGAA A. OTHMAN Department of Medical Parasitology, Faculty of Medicine, Assiut University (e-mail correspondence: [email protected]) Abstract Capillaria philippinensis is a mysterious parasite and intestinal capillariasis is a mysterious disease. It is now more than half a century since the discovery of the first case in Philippines without answering many questions concerning the parasite's taxonomy, morphology, life cycle, diagnosis, pathology, clinical symptoms, mode of transmission as well as how it was transported to Egypt and how it started to spread and progressed in most Egyptian Governorates; particularly those of Middle Egypt. This article is a trial to overview all these aspects of the parasite. Key words: Egypt, Capillaria philipinensism, Egypt, comments, recommendations. Introduction with sporadic cases were reported from The intestinal capillariasis caused by Japan (Mukai et al,1983), Korea(Lee et Capillaria philippinensisis a life-threa- al,1993; Hong et al,1994), Taiwan(Chen et tening disease in humans that causes severe al, 1989, Bair et al,2004, Lu et al,2006), enteropathy (Cross, 1998).The outcome of India Kang et al,1994;Vasantha et al, 2012), the disease may be fatal if untreated in due Iran (Hoghooghi-Rad et al,1987; Rokni, time (Abd-ElSalam et al, 2012). Small 2008), Egypt (Youssef et al,1989; Mansour freshwater and brackish-water fish are the et al,1990, Khalifa et al,2000), Indonesian in source of infection and probably fish-eating Italy(Chichino et al,1992), Egyptians in the birds the reservoir host (Cross, 1998). United Arab Emirates (El-Hassan and Although more than 250 Capillaria species Mikhail, 1992; Austin et al, 1999) and Spain have been found in fish, amphibians, (Dronda et al,1993). reptiles, birds and mammals, only 3 species The first outbreak was in a small village in have been found in humans: C. philippi- Thailand in 1981 involving 20 patients and 9 nensis, C. hepatica and C. aerophila (Eucol- deaths. Most of the cases were adults who eusaerophilus). Reports of human infections were over 20 years of age and 80% of them with C. hepatica, C. aerophila are rare, but habited in the same household with a wrong reports of C. philippinensis infections are belief of man to man transmission (Kunara- increasing and appear to be spreading tanapruk et al, 1981). Kunaratanapruk et al. geographically (Cross, 1992). (1983) reported that 100 cases of C. The first human case of intestinal philippinensis infection had occurred from capillariasis was reported in the Philippines 1979 to 1981. Out of them 15 cases died. in 1963 (Chitwood et al, 1964) while the Later on other case records were re-ported first record of the disease in Thailand was in (Benjanuwattar et al, 1990; Chunlertrith et 1973 (Pradatsundarasar et al, 1973), then al, 1992; Sangcha et al, 2007). more and more cases were detected from No doubt, Capillaria philippinensis is a both Philippines and Thailand (Sanpakit et mysterious nematode parasite and intestinal al., 1974; Bhaibulaya, 1975; Cross and capillariasis is a mysterious disease. It is Bhaibulaya, 1983). Now more than 2,000 now about half a century since the discovery cases of intestinal capillariasis have been of the first case of the disease in Philippines reported from the Philippines and Thailand, without answering many questions con- 161 cerning the parasite's taxonomy, morpho- (females may produce larvae; adults in logy, life cycle, diagnosis, pathology, warm-blooded vertebrates; larvae in fishes). clinical symptoms, mode of transmission as Sukontason et al. (2006), Nunez et al. well as how it was transported to Egypt and (2010) accepted the classification and named how it started to spread and progressed in it P. Crossicapillaria philippinensis. In the most Egyptian governorates; particularly present authors’ opinion, these differences those of Middle Egypt. This article is a trial are not sufficient to create a new genus or to overview all these aspects of the parasite. subgenus and we should not mix between Classification and Taxonomy: According to human capillarids and those of birds, fishes, Chitwood et al. (1968) this parasite belongs reptiles and amphibians as the latter to Phylum Nematoda Class Adenophorea, parasites have different morphology, mode Subclass Enoplia, Order Trichocephalida, of transmission and life cycles. Moreover, C. Family Capillariidae, Genus Capillaria, philippinensis is the name given to the species philippinensis. On basis of the parasite by the majority of medical inaccurate original description given by parasitologists. Chitwood et al. (1968), Moravec (1982) Description of the parasite: Although C. assigned this parasite provisionally to philippinensis has been extensively studied Anochotheca LopezNeyera, 1947 whereas over the past 50 years, the only existing Anderson (1992) without giving a reason description of this nematode is that named it Colodium philippinensis. Until originally made by Chitwood et al. (1968). recently, the species have generally been Chitwood et al. (1964) described the parasite reported as Capillaria philippinensis in the from specimens collected at autopsy from medical literature (e.g. Hong et al, 1994; the first person known to have the infection Kang et al, 1994; Vilairatauna, 1994; Anis et and in material obtained from several al, 1998; Hwang, 1998), but Moravec (2001) subsequent autopsies. More specimens were redescribed the parasite and found his examined by other investigators, and the description fully corresponding that of initial findings were confirmed. As most of Paracapillaria, Mendonaca, 1963 as refined the laboratory investigators used to find by Moravec (1982) that included calliparids eggs, larvae and adults in the patient's stools, of fishes, amphibians and reptiles. As they should be familiar with the detailed compared to the known Paracapillaria spp morphological features of all the stages of known from cold-blooded hosts, C. phili- the parasite. ppinensis is unique in that its females may According to Moravec (2001), Attia et al. produce free 1st stage larvae besides normal (2012): Male: Length 2.162-3.114µm, thick-walled unembryonated eggs. All Para- maximum width 30-36µm. Entire esophagus capillaria spp. are known to produce only 1.170-1.646 µm long (53-57% of body unembryonated thick-shelled eggs except length). Muscular esophagus measuring 138- Paracapillaria rhamdiae which is a stomach 177µm. Stichosome 1.029-1.484µm long parasite of catfishes in Mexico that may lay (15-19% of body length). Posterior end of eggs containing already formed larvae, but body rounded, provided with well-developed no hatched larvae were observed in uterus membranous bursa, supported by 2 rather (Moravec et al, 1995). Moravec (2001) in a wide digital lateral projections, not reaching key form divided the genus Paracapillaria to posterior margin of bursa, projections into three subgenera according to the directed posteriorly in lateral view and females being oviparous or larviparous and curved to median line in ventral view. One adults being in worm blooded vertebrates or pair of large round postanal papillae present cold blooded fishes, amphibians and reptiles. at base of caudal projections. Spicule 411- The first subgenus was Crossicapillaria 468um in length, 6-12; 4-5; 3-4um in width 162 at anterior end, middle part; posterior end larvae represent an important diagnostic respectively; its anterior end somewhat stage, laboratory staff should be aware of expanded; posterior end rounded; covered their structure. So, it is easy to differentiate with very long spineless sheath (about them from Strongyloides stercoralis larvae 400um). Female: Length 2.870-3.971µm, which have rhabditiform esophagus. maximum width at the posterior body part Eggs: Peanut-shaped with flattened bi- 36-48µm. Length of entire esophagus 1.224- polar plugs and striated shells (Zhigang et 1.659µm, representing 42-47% of body al, 2012). They contain either a single cell- length, muscular esophagus 120-180µ long, stage embryo or larvae. An inexperienced stichosome 1.104-1.515µm long. Sticho- laboratory worker may confuse them with cytes on the posterior portion appeared Trichuris trichiura eggs which are barrel- somewhat larger than those on the anterior shaped and have prominent mucoid bipolar portion. Vulva located 24–36 µm posterior plugs (Saichua et al, 2008). According to to the esophagus. The uterus contained one Cross (1992), Anderson (2000), Moravec row of either thin- or thick-shelled eggs with (2001) and Attia et al. (2012), there are two defined or ill-defined embryos. Posterior types of C. philippinensis eggs: I- The thick- end rounded, and the anus subterminal. shelled eggs: peanut-shaped and had a Larvae: These stages were first satisfactorily yellowish-brown color, measuring40-48 x described (Chitwood et al,1968) as follows: 17-20 µm with inconspicuous flattened L1 is the smallest with a double row of bipolar plugs measuring 2-3.6 x 9-12 µm. stichocytes and esophagus about 4/5th the The wall thickness is 2-3 µm. Eggs usually body length; L2 is 417-550 um in length contain a single cell stage embryo that filled with double row of stichocytes in the most of the egg. Some eggs have a slipper or esophagus which is approximately 2/3rd the kidney shaped appearance (Khalifa et al, body length, genital column starts to appear; 2000). II- The thin-shelled eggs: peanut- L3 is 1.25 mm in length, most of the shaped measuring 38-45.6 x18-20 µm. They stichocytes are in one column and oral spear are translucent or yellowish in color having apparent, anterior genital column almost single cell-stage embryos or gradually complete and posterior one beginning to maturating larvae with two characteristically develop. L4 started the differentiation of the rounded mucoid plugs protruding from their future sex, but differ from adults in size and poles.
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