Anguillulosis: what are the signs of this tropical disease?

An intestinal parasitosis, anguillosis is a disease linked to the presence of a roundworm in the intestine, the Strongyloid stercoralis and more rarely the Strongyloid full bomi. It is common in tropical countries. It causes digestive pain, diarrhea or constipation, and an alteration of the general state of health.

What is anguillosis?

Anguillosis is a digestive parasitosis linked to the presence of a roundworm in the small intestine, the Strongyloid stercoralis and more rarely the Strongyloid full bomi.

How is the contamination done ?

The contamination is made from larvae present in soiled water and which will cross the skin. These larvae will reach the blood or lymphatic circulation (lymphatic vessels) to pass by the heart, the lungs, the trachea and then be swallowed to reach the first part of the small intestine, the duodenum and the jejunum.

Once they arrive in this part of the intestine, they will bury themselves in the intestinal mucous membrane and transform into an adult worm, the anguillule. This roundworm will lay eggs by parthenogenesis (without the intervention of a male worm) which will in turn become larvae, which will be expelled through the stools to contaminate other people.

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This intestinal parasitosis is common in tropical countries such as Black Africa, the Caribbean, Central America, the Indian Ocean and some areas of Southwest Asia. A few cases have been reported in Eastern Europe and France. It affects between 30 and 60 million people worldwide.

What causes Anguillulosis?

People are infected by water contaminated with faeces, by walking barefoot in mud or by bathing in small polluted ponds. It is also possible to be contaminated by walking barefoot on sand at the seaside.
This contamination is caused by larvae present in these stagnant waters in tropical countries, which will cross the skin and mucous membranes to migrate inside the body. The presence of these larvae is favored by poor hygiene conditions locally (fecal peril), by humidity and by heat. Sexual contamination (sodomy) is also possible.

What are the symptoms of Anguillulosis?

Symptoms are of a different nature depending on the maturation phase of the larva to the adult worm:

Skin disorders

They are caused by the penetration of the larvae through the skin, causing an eruption of pimples (papules) at the points of penetration of the larvae associated with local allergic reactions (hives, itching).

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Respiratory disorders

They can appear during the migration of the larvae in the lungs with an irritative cough, a breathlessness which evokes asthma.

Digestive disorders

By the presence of the adult worm in the beginning of the small intestine (inflammation of the duodenum, abdominal pain, diarrhea, constipation, irritation in the anal region). But at the beginning of the parasitic infestation, there are no or few digestive symptoms in almost half of the cases.

Dealing with complications

Later on or in an immunocompromised person (reduced immunity due to a disease or treatment), the symptoms are more severe and can lead to an alteration of the general state (AEG) with weight loss, anorexia, great fatigue (severe asthenia).

Other complications are possible, in particular infectious ones such as septicemia (microbes that pass into the bloodstream), pulmonary and cerebral abscesses, lung infections (pneumopathy). The microbes found are of digestive origin. These severe infections can lead to death if treatment is not carried out in time.

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Biological signs are found in a blood test with a multiplication of a certain type of white blood cells, the eosinophils, which are normally situated between 2 and 7% and which can be found at 40 or 60% of all white blood cells.

Finally, a parasitological examination of the stool as well as the search for anti-Strongyloides antibodies in the blood (Elisa test) may find the presence of anguillid larvae and prove positive for the test (recommendation Haute Autorité de Santé 2017).

What are the treatments for Anguillulosis?

The initial treatment for Anguillulosis will be a single dose antiparasitic drug, ivermectin, which is 83% effective. Other antiparasitic treatments are also proposed if necessary. These treatments will be combined with antibiotics to treat the infectious complications of this parasitosis.

Finally, in severe forms, other treatments will also be implemented depending on the complications present.

Prophylaxis (prevention) is based on the fight against faecal peril by ensuring better hygiene in the countries concerned and better living conditions.