Oesophagostomum - Clinical Presentation in Humans

Clinical Presentation in Humans

There is no overarching clinical picture for symptoms of oesophagostomiasis; however, most patients experience pain in the lower right quadrant, accompanied by the presence of one or several protruding abdominal masses. In oesophagostomiasis, larvae can invade the colon wall, potentially causing two pervading types of nodular pathology. Multinodular disease is characterized by the formation of many tiny nodular lesions containing worms and pus along the colon wall. About 15% of patients have this form of oesophagostomiasis. Nodules themselves are usually not a problem, but they can give rise to further complications, such as bowel obstruction, peritonitis and intestinal volvulus. In rare cases serious disease can occur including emaciation, fluid in the pericardium, cardiomegaly, hepatosplenomegaly, perisplenitis and enlargement of the appendix.

Single-nodular disease, more commonly known as Dapaong disease, is characterized by the development of a single mass that develops throughout the colon wall. This is the most common form of oesophagostomiasis, affecting 85% of patients. This nodule can instigate intense tissue reactions that result in the formation of painful projecting masses.

Common misdiagnosis include carcinoma, appendicitis, amebiasis and tuberculosis.

The following is a summary of the second recorded case of oesophagostomiasis, as reported by H. Wolferstan Thomas in 1910:

Patient: male, 36 years old, native of the Rio Purus region in the Amazon State Chief complaints: suffering from acute dysentery, later experiencing deliriousness Outcome: Died within the three days following his admission. Major Findings: Lungs were emphysematous. Heart had evidence of hypertrophy in muscle, with some atheromatous patches along the aortic ring. Exterior of the small intestine was lined with several prominent tumors dark in color, 37 in total. Most of the tumors were found between the outside muscular layer and the bowel’s peritoneal covering of the bowel. The tumors were generally small and varied in shape, from smooth ovular masses to flat button shapes to elongated masses akin to a leech; they were elevated by as much as 6 to 8 mm above the bowl surface. These nodules were found to contain one worm each, no more, no less. In the interior of the small intestine, twenty nodules were found along the walls, causing a discernable bulging of the mucous membrane. The caecum walls were irregularly thickened and dark in color, with three ovular tumors containing immature adult Oesophagostomum. Interior of the caecum was filled with rope-like opaque masses of rows of cystic tumors, which caused great thicking of the walls. Examination of the exterior of the ascending colon revealed the formation of thick adhesions spanning the whole length of the colon; these adhesions were filled with fat, enlarged glands and omental tissue. Underneath were a multitude of small cystic tumors that ruptured upon disturbance of the adhesion, disclosing small worms. The interior of the colon was most affected, with tumors of widely varying shapes and sizes occupying the walls and floor of the gut, causing as much as 5 mm of thickening of colon walls.