History

Fact Explanation
A behavior of eating arthropod intermediate host, the cockroaches and beetles. Acanthocephala (a distinct phylum characterized by thorn headed worms) are zoonotic parasites that require at least two hosts to complete their life cycle, [1] an arthropod intermediate host and a mammal definitive host. [2] Human infection is rare and accidental, [3] and happens by ingesting the arthropod intermediate host. [1] [4] [5] [6] [7] [8]
Diarrhea, usually blood stained. It is due to mechanical damage caused by the insertion of the armed proboscis into the lumen of the host's intestine. [5] [9]
Passage of adult worms with stools. Some reports show cases with parasitic infestation with no symptoms. [2] However, some of the cases were identified after the patient has been passing adult worms in stools. Morphological assessment of the worms assist in diagnosing. [4] [5] [7] [8] [10]
Non-specific abdominal pain, nausea, vomiting and anorexia Majority of the cases reported milder non-specific gastrointestinal symptoms, in some symptoms have been there for months before arriving at a diagnosis. [2]
Abdominal distension. Abdominal distention or edema has been reported in several cases but in some there was co-existent other parasitic gastroenteritis types. [4]
Fever It is due to inflammatory response to the parasitic infection. [3] [10]
References
  1. MOORE JG, FRY GF and ENGLERT E JR. Thomy-headed worm infection in north american prehistoric man. Science. [online] 1969 Mar 21;163(3873):1324-5. [viewed April 22, 2014] Available at DOI:10.1126/science.163.3873.1324
  2. SALEHABADI A, MOWLAVI G and SADJJADI SM. Human Infection with Moniliformis moniliformis in Iran: Another Case Report After Three Decades. VECTOR-BORNE AND ZOONOTIC DISEASES [online] 2008, 8;1 [viewed April 25, 2014] Available at DOI: 10.1089/vbz.2007.0150
  3. BEAVER PC, JUNG RC and CUPP EW. Clinical Parasitology. 9th ed. Philadelphia, USA: Lea & Febiger; 1984. pp. 544–547.
  4. BERENJI F, FATA A and HOSSEININEJAD Z. A case of Moniliformis moniliformis (Acanthocephala) infection in Iran. Korean J Parasitol. [online] 2007 Jun;45(2):145-8. [viewed April 22, 2014] Available at doi: 10.3347/kjp.2007.45.2.145
  5. RICHARDSON, Dennis, and Peter J. KRAUSE. Northern American parasitic zoonoses. 2002: Vol. 6. Boston: Kluwer Academic.
  6. MARAGHI S, SHAMSIZADEH A, RAFIEI A and JAVAHERIZADEHHK H. Moniliformis moniliformis from Ahvaz Southwest Iran. J Paediatr (New Series) [online] 2014;19:93-95 [viewed April 23, 2014] Available at http://www.hkjpaed.org/details.asp?id=956&show=1234
  7. GARCIA LS. Diagnostics Medical Parasitology. 4th ed. Washington D.C., USA: ASM press; 2001. pp. 477–501.
  8. MARQUARDS WC, DEMAREE RS and GRIEVE RB. Parasitology and Vector Biology. 2nd ed. San Diego, USA: Harcourt academic Press; 2000. pp. 491–499.
  9. Centers for Disease Control and Prevention. Acanthocephaliasis. 2013. [web] Available at http://www.cdc.gov/dpdx/acanthocephaliasis/index.html
  10. MULLER R. Worm and Disease, a Manual of Medical Helminthology. 1st ed. London, UK: William Heinemann Medical Book Ltd; 1975. p. 64.
  11. ROBERTS L and JANOVY JR. Foundation of Parasitology. 7th ed. Boston, USA: McGraw-Hill

Examination

Fact Explanation
There are no significant examination findings reported. However a single case has presented with edema, but later it was shown that the patient had a concomittant giardia infection, thus the edema likely resulted from giardia-related protein malabsorption. [1]
References
  1. BERENJI F, FATA A and HOSSEININEJAD Z. A case of Moniliformis moniliformis (Acanthocephala) infection in Iran. Korean J Parasitol. [online] 2007 Jun;45(2):145-8. [viewed April 22, 2014] Available at doi: 10.3347/kjp.2007.45.2.145

Differential Diagnoses

Fact Explanation
Giardiasis It is an important differential, however it characteristically causes watery diarrhea. In investigation, Giardia cysts can be easily identified in stools. [1] [2] [3]
References
  1. FLANAGAN PA. Giardia--diagnosis, clinical course and epidemiology. A review. Epidemiol Infect. [online] 1992 Aug;109(1):1-22. [viewed April 25, 2014] Available at http://www.ncbi.nlm.nih.gov/pmc/articles/PMC2272232/pdf/epidinfect00034-0010.pdf.
  2. ADAM RD. Biology of Giardia lamblia. Clin Microbiol Rev. [online] 2001 Jul;14(3):447-75. [viewed April 25, 2014] Available at doi: 10.1128/CMR.14.3.447-475.2001
  3. JANOFF EN et al. Diagnosis of Giardia lamblia infections by detection of parasite-specific antigens. J Clin Microbiol. [online] Mar 1989; 27(3): 431–435. [viewed April 25, 2014] Available at http://www.ncbi.nlm.nih.gov/pmc/articles/PMC267335/pdf/jcm00063-0073.pdf

Investigations - for Diagnosis

Fact Explanation
Morphological examination of adult worms. The diagnostic feature of the acanthocephala is the presence of an anterior, protrudible proboscis that is usually covered with spiny hooks. Size of the worms differ according to the species and ranges from a few millimetres in length to 65 centimetres. The female worms are larger than the male. The body surface is covered by a tegumentum. [1]-[5]
Stool examination Stools rarely yield eggs of the parasite. [1]-[5]
References
  1. BERENJI F, FATA A and HOSSEININEJAD Z. A case of Moniliformis moniliformis (Acanthocephala) infection in Iran. Korean J Parasitol. [online] 2007 Jun;45(2):145-8. [viewed April 22, 2014] Available at doi: 10.3347/kjp.2007.45.2.145
  2. RICHARDSON, Dennis, and Peter J. KRAUSE. Northern American parasitic zoonoses. 2002: Vol. 6. Boston: Kluwer Academic.
  3. GARCIA LS. Diagnostics Medical Parasitology. 4th ed. Washington D.C., USA: ASM press; 2001. pp. 477–501.
  4. MARQUARDS WC, DEMAREE RS and GRIEVE RB. Parasitology and Vector Biology. 2nd ed. San Diego, USA: Harcourt academic Press; 2000. pp. 491–499.
  5. HAUSTEIN T, LAWES M, HARRIS E and CHIODINI PL. An eye-catching acanthocephalan. Clinical Microbiology and Infection. [online] 2009 Aug 18; 16(6) [viewed April 25, 2014] Available at http://onlinelibrary.wiley.com/doi/10.1111/j.1469-0691.2009.02896.x/pdf

Management - Specific Treatments

Fact Explanation
Levamisole Levamisole has shown to be effective in treating reported cases of acantocephalan infections. [1] [2] [3] [4]
References
  1. BERENJI F, FATA A and HOSSEININEJAD Z. A case of Moniliformis moniliformis (Acanthocephala) infection in Iran. Korean J Parasitol. [online] 2007 Jun;45(2):145-8. [viewed April 22, 2014] Available at doi: 10.3347/kjp.2007.45.2.145
  2. MARAGHI S, SHAMSIZADEH A, RAFIEI A and JAVAHERIZADEHHK H. Moniliformis moniliformis from Ahvaz Southwest Iran. J Paediatr (New Series) [online] 2014;19:93-95 [viewed April 23, 2014] Available at http://www.hkjpaed.org/details.asp?id=956&show=1234
  3. MULLER R. Worm and Disease, a Manual of Medical Helminthology. 1st ed. London, UK: William Heinemann Medical Book Ltd; 1975. p. 64.
  4. SALEHABADI A, MOWLAVI G and SADJJADI SM. Human Infection with Moniliformis moniliformis in Iran: Another Case Report After Three Decades. VECTOR-BORNE AND ZOONOTIC DISEASES [online] 2008, 8;1 [viewed April 25, 2014] Available at DOI: 10.1089/vbz.2007.0150