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Published online: 2019-09-26

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Rare trematode in irritable bowel syndrome: Pathogen or commensal?

Sunit K. Shukla, Pankaj K. Asati, Tuhina Banerjee1, Vinod K. Dixit

Departments of Gastroenterology and 1Microbiology, Institute of Medical Sciences, Banaras Hindu University, Varanasi, ,

Abstract A healthy young adult male presented with complaints of frequent (>3/day) formed stools and passage of excessive mucous in stool for 3 months. He did not complain of nocturnal motions, recent , in stool, straining, weight loss, or pain abdomen. Stool test was normal. He was counseled and treated as a case of irritable bowel syndrome. Due to inadequate relief with empirical therapy, colonoscopy was performed in a subsequent visit. Club‑shaped small, round organisms with moving proboscis were seen in the cecum. Organism was later identified as a trematode hominis, a rare foodborne trematode. The patient was treated with , without complete relief. Trematode infection might not be the cause of symptoms. Key words Gastrodiscoides hominis, irritable bowel syndrome, praziquantel, trematode

A healthy young adult male patient presented with frequent but fluke. The patient was treated with praziquantel; he did not formed motions and excess of mucous in stool for 3 months. He seem to respond clinically. He refused repeat colonoscopy and did not give history of recent diarrhea, blood in stool, straining, was lost to follow‑up.

weight loss, or pain abdomen. He was reassured regarding benign and prevalent nature of his complaint and advised mild Trematodes or flukes as these are commonly called enter antispasmodic. Although symptoms improved marginally, he body through food or skin. Trematodes are unsegmented thick continued to pass excessive mucous. Stool examination was leaf‑shaped worms that are slightly flattened dorsoventrally; negative for ova, cyst, and red blood cell and contained excess they bear 2 suckers, one in ventral aspect of body and other on of mucous clumps. He was advised to undergo colonoscopy to the proboscis, which serve as organs of attachment [Figure 2]. exclude organic pathology, considering anxiety of the patient. Human intestine is infected when metacercariae (encysted Colonic mucosa was normal up to terminal ileum. Multiple form residing inside body) is ingested with freshwater club‑shaped organisms, 8–10 mm in size, with a circular aquatic . Gastrodiscoides hominis is an intestinal body and mobile proboscis were seen in the cecum of colon fluke. Cercaria (the free‑swimming infective form) may [Figure 1]. Proboscises which were later identified as suckers penetrate skin to infect blood vessels (e.g., ), were actively stretched more than twice the body diameter. liver (e.g., fascioliasis), pancreas (e.g., eurytrema pancreaticum), Organisms were collected in saline and formalin separately. and lung (e.g., ).[1] It was later identified as Gastrodiscoides hominis, an intestinal Exact burden of intestinal flukes in human population is not known.[2] A few case reports of human infestation are available

Address for correspondence: [3‑5] Dr. Sunit K. Shukla, Department of Gastroenterology, Sir Sunder outside Southeast Asia. It has been reported mostly from Lal Hospital, Near Laser OT, Institute of Medical Sciences, Banaras in India or from Southeast Asian countries because Hindu University, Varanasi ‑ 221 005, Uttar Pradesh, India. E‑mail: [email protected] This is an open access article distributed under the terms of the Creative Access this article online Commons Attribution‑NonCommercial‑ShareAlike 3.0 License, which allows others to remix, tweak, and build upon the work non‑commercially, as long as the Quick Response Code author is credited and the new creations are licensed under the identical terms. Website:

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DOI: How to cite this article: Shukla SK, Asati PK, Banerjee T, Dixit VK. Rare 10.4103/0976-5042.193745 trematode infestation in irritable bowel syndrome: Pathogen or commensal?. J Dig Endosc 2016;7:123-4.

© 2016 Journal of Digestive Endoscopy | Published by Wolters Kluwer - Medknow 123 Shukla, et al.: Gastrodiscoides hominis infection in human

Figure 1: Gastrodiscoides hominis in cecum Figure 2: Gastrodiscoides hominis with extended in saline of prevalent aquaculture in these regions. and Conflicts of interest domestic are definitive hosts, and freshwater There are no conflicts of interest. are intermediate . Infection is frequently asymptomatic. Diarrhea and abdominal pain are common symptoms for intestinal flukes. References 1. Graczyk TK, Fried B. Human waterborne trematode and protozoan Praziquantel remains the drug of choice for all trematode infections. Adv Parasitol 2007;64:111‑60. infections, except fascioliasis, for which bithionol is the drug 2. WHO Initiative to Estimate the Global Burden of Foodborne Diseases. of choice.[1] Triclabendazole is an alternative in case patient First Formal Meeting of the Foodborne Disease Burden Epidemiology is allergic to praziquantel. Reference Group (FERG). Geneva; 26‑28 November, 2007. Available from: http://www.who.int/foodsafety/publications/foodborne_disease/

burden_nov07/en. Acknowledgment 3. Kumar V. The digenetic trematodes, buski, Gastrodiscoides We would like to acknowledge the support and guidance hominis and Artyfechinostomum malayanum, as zoonotic infections in provided by Prof. Ashok Kumar Jain in clinical decision South Asian countries. Ann Soc Belg Med Trop 1980;60:331‑9. support and management issues of unique cases on day to 4. Gupte A, Shah C, Koticha A, Shukla A, Kuyare S, Bhatia S. Gastrodiscoides day basis. hominis infestation of colon: Endoscopic appearance. Gastrointest Endosc 2014;79:549‑50. 5. Dada‑Adegbola HO, Falade CO, Oluwatoba OA, Abiodun OO. Financial support and sponsorship Gastrodiscoides hominis infection in a Nigerian‑case report. West Afr J The study is funded by the internal resources of the department. Med 2004;23:185‑6.

Journal of Digestive Endoscopy 124 Vol 7 | Issue 3 | July‑September 2016