health: DOH warns "kinilaw" food may kill
Balita News
that raw food, such as "kinilaw", may cause death.
The warning came after a study showed that several deaths from a
disease called Capillariasis were recently reported in several areas in
the country.
This prompted the department, in collaboration with the University
of the Philippine's College of Public Health (UP-CPH), to send a team to
conduct stool examination of symptomatic individuals in Barangay Awao in
Monkayo, Compostela Valley province in Mindanao.
Using the direct fecal smear and acid ether concentration
technique, the team's findings showed that out of 72 stool specimen
examined, 16 or 22.2 percent were found positive for capillaria
infection.
Similarly, the disease has recently been uncovered in Santiago,
Agusan del Norte and Pinan, Zamboanga del Sur. These areas are
additions in the already known endemic areas in the provinces of Ilocos
Sur, La Union, Zambales, Cagayan and Pangasinan in Northern Luzon and
Leyte in the Visayas. There is a great possibility that the intestinal
infection will also be disclosed in other parts of the country, thus,
posing another threat to public health.
This led the DOH to conclude that Capillariasis, an intestinal
infection caused by a round worm called Capillaria Philippinensis which
resides in the small intestine, is apparently re-emerging as a public
health problem in the country today.
Interestingly, the areas where the cases were found happened to be
all coastal locations. It could be assumed that living along coastal
areas and where eating raw fresh water fish, or kinilaw style, are
common and are high risk factors for getting Capillariasis.
Capillariasis is considered a food-borne disease acquired through
ingestion of the infective larvae from small fresh or brackish (somewhat
salty) water fish which acts as an intermediate host.
From the infected individual, eggs are passed with the feces and
embryonate water for at least five to ten days. These are ingested by
the fish immediate host where they develop into infective larvae in the
fish intestines in one to two weeks. Human infection occurs when fish
are eaten raw. Capillaria Philippinensis lives in the mucosa of the
small intestine and the female produces ova that passes out from the
human host before the development of the embryo.
Patients may either not feel any or only mild symptoms, but most
infected individuals suffer from the characteristics of enterophaty or
intestinal tract disease. The first signs and symptoms include gurgling
of the stomach (borborygmi) and diarrhea from four to ten times a day.
The diarrhea may be prolonged and accompanied by anorexia, nausea and
vomiting, and very low blood pressure (hypotension). These will result
to massive protein and electrolyte loss and extreme emanciation. Death
may occur, if left untreated, two weeks to two months, after the onset
of symptoms due to pneumonia, heart failure, very low calcium levels
(hypokalemia) or cerebral edema.
A person with history of eating raw food mainly fish and presenting
signs and symptoms such as chronic diarrhea, borborygmi, bipedal edema,
nausea and vomiting and weight loss is indicative of capillaria
infection. It can be confirmed by different diagnostic methods like
direct fecal smear, acid ether concentration technique, and formalin
ether concentration technique.
From the stool, not only eggs can be found but also the larvae, and
sometimes even the adult parasite. Capillaria philippinensis eggs are
very similar to trichuris ova that could lead to misidentification.
Microscopists, therefore, should be familiar with both eggs.
Mebendazole and Albendazole are drugs that have been proven
effective in the treatment of capillariasis. When a relapse occurs,
retreatment is necessary.
Medication must be supported by fluid replacement and protein diet,
particularly in cases at severe stage and in extreme emaciation. Such
cases should be referred to hospitals for proper management.
The three-fold classic control intervention experts recommend for
the prevention and control of capillariasis consist of the following:
Case detection and treatment -- this is to identify and treat cases
in order to kill the parasite and alleviate the suffering of patients as
well as to stop transmission. Early treatment will also prevent severe
complications of the disease.
Environmental sanitation -- this includes the construction and
proper use of sanitary toilets to prevent transmission of the disease.
The importance of sanitary means of waste disposal should be emphasized
to avoid infecting the fish intermediate host, since its infection
starts with the eggs passed out with the feces of infected human host.
Health education -- awareness and education of people regarding the
disease is the most important prevention and control measure against
capillariasis. It is to equip the public with the basic knowledge about
the disease and its control and prevention.
The first occurrence of Capillariasis case in the Philippines was
recorded in 1963 in a male patient from Ilocos Norte who died in the
Philippine General Hospital. The significance of the disease, however,
was not recognized until 1967 when the attention of health authorities
was attracted to the presence of a disease which also produced severe
symptoms and deaths in adult males in the province of Ilocos Sur.
Further investigations of the disease saw that Capillaria eggs were
found in the feces of most patients. The investigators who made the
study on the developmental stage of the parasite named Capillaria
Philippinensis. Subsequently, the disease was also disclosed in
Thailand and Japan and lately in Egypt and Iran. (PNA) BFM/TLY
PNA 02280745