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.

Life Cycle
Clinical Manifestations
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