Abdominal pain and eosinophilia in suburban goat keepers--trichostrongylosis [corrected
Ralph, A.; O'Sullivan, M.V.N.; Sangster, N.C.; Walker, J.C.
Medical Journal of Australia 184(9): 467-469
2006
ISSN/ISBN: 0025-729X PMID: 16646749 Document Number: 597745
A 41-year-old man presented with a 3 week-history of watery diarrhoea and central abdominal pain. Two days prior, he had passed blood per rectum, for which the general practitioner had prescribed metronidazole without any effect. Abdominal examination was unremarkable and he was afebrile. Faecal examination showed watery faeces with occasional leukocytes. Colonoscopy revealed mild terminal ileitis. Biopsies of the affected area showed eosinophilic infiltrate in the lamina propria and submucosa but intact surface epithelium. Occasional adult worms measuring about 70 micro m wide at the midbody were seen on the luminal surface and were initially identified as Enterobius vermicularis. He was treated with mebendazole one week apart but his conditions did not improve. Faecal examination revealed eggs of Trichostrongylus sp. Further questioning revealed that the patient kept goats in his backyard in suburban Sydney, New South Wales, Australia. Another patient, a 42-year-old vegetarian presented with a 5-week history of severe cramping, upper abdominal pain, nausea and diarrhoea. Examination showed epigastric tenderness. His blood tests showed eosinophilia. Endoscopy showed small duodenal erosions. He was treated empirically with albendazole (400 mg orally for 3 days), with minor diminution in the frequency of abdominal cramps and diarrhoea and later with metronidazole (400 mg orally three times daily for one week) without response. The patient revealed that 4 weeks before symptom onset, he had taken care of a pet goat at his house and had used fresh goat manure as fertilizer for his lettuce and other vegetable seedlings. A sample of goat faeces was examined and revealed Trichostrongylus colubriformis larvae of various stages. Trichostrongylosis was diagnosed on the basis of circumstantial evidence. Both patients showed improvement of clinical condition after treatment with ivermectin (single dose 13.5 mg and 15 mg, respectively).