Endoscopic Diagnosis of <i>Necator americanus</i> Infection Presenting With Persistent Iron-Deficiency Anemia: Usefulness of Image-Enhanced Endoscopy and Capsule Endoscopy.
Consider <i>Necator americanus</i> infection in patients with persistent iron-deficiency anemia, as it may be a rare but treatable cause.
Where it sits
this study against the rest of the bpc-157 corpusSummary and findings
A 59-year-old Filipino man with long-standing unexplained iron-deficiency anemia was diagnosed with <i>Necator americanus</i> infection after gastrointestinal investigations. Image-enhanced endoscopy improved visualization of the parasites, leading to their identification and removal. Treatment with pyrantel pamoate resulted in symptom resolution and improved anemia.
Abstract
<i>Necator americanus</i> infection is now rare in developed countries but remains an important cause of iron-deficiency anemia and abdominal symptoms in individuals with relevant epidemiological backgrounds. A 59-year-old Filipino man with long-standing unexplained iron-deficiency anemia was admitted to our hospital for epigastric pain associated with choledocholithiasis. Although biliary enzymes improved after endoscopic treatment, his abdominal pain persisted. Subsequent gastrointestinal investigations, including upper gastrointestinal endoscopy, colonoscopy, and small-bowel capsule endoscopy, revealed multiple parasites distributed throughout the gastrointestinal tract. Image-enhanced endoscopy using narrow-band imaging clearly improved visualization of the parasites compared with conventional white-light imaging, facilitating their identification and endoscopic removal. Genetic analysis of the extracted worms confirmed <i>N. americanus</i> infection. The patient was treated with pyrantel pamoate, which resulted in the resolution of abdominal symptoms and improvement of iron-deficiency anemia. Follow-up stool examination confirmed eradication of the parasite. This case highlights the importance of considering hookworm infection in patients with persistent iron-deficiency anemia and abdominal pain, even in developed countries. In addition, image-enhanced endoscopy and capsule endoscopy are valuable diagnostic tools for detecting hookworms and assessing their distribution within the gastrointestinal tract.
Background
This paper addresses the clinical significance of <i>Necator americanus</i> infection, particularly its role in causing iron-deficiency anemia in developed countries. Prior knowledge indicates that hookworm infections are rare but can lead to significant gastrointestinal symptoms. The study emphasizes the need for awareness of such infections in patients presenting with unexplained anemia.
Methods
The study describes a case report involving a 59-year-old male patient. Diagnostic methods included upper gastrointestinal endoscopy, colonoscopy, and small-bowel capsule endoscopy. The primary outcome was the identification of parasites, while secondary outcomes included symptom resolution and anemia improvement post-treatment.
Results
The case report details the identification of multiple parasites throughout the gastrointestinal tract. Image-enhanced endoscopy was noted to improve visualization of the parasites. Treatment with pyrantel pamoate led to resolution of abdominal symptoms and improvement in iron-deficiency anemia.
Interpretation
This case highlights the importance of considering <i>Necator americanus</i> infection in differential diagnoses for patients with unexplained iron-deficiency anemia. While the findings are significant in identifying a rare cause of anemia, the effect size regarding clinical improvement is not quantified. Limitations include the single case nature of the report, which may not generalize to broader populations.
Key findings
- Multiple parasites distributed throughout the gastrointestinal tract identified via endoscopy.
- Image-enhanced endoscopy improved visualization of parasites compared to conventional imaging.
- Follow-up stool examination confirmed eradication of the parasite.
Limitations
- Single case report limits generalizability.
- No quantitative measures of symptom improvement reported.
- Not a controlled study.
- No long-term follow-up data provided.