Clinical epidemiology and classification of human oesophagostomiasis

The intestinal helminth Oesophagostomum bifurcum is highly and focally ende mic in northern Ghana and Togo, and its juveniles produce a nodular inflamm atory response as they develop in the intestinal wall. This pathology can p roduce clinical symptoms. We report on 156 cases of oesophagostomiasis pres enting in 1996-98 to Nalerigu hospital in northern Ghana. The disease accou nted for 0.2% of the out-patient department new presentations (about 1 pati ent per week), and 1% (16) of the major acute surgical cases. Children aged 5-9 years were most commonly affected. Multinodular disease (13% of the ca ses) results from hundreds of pea-sized nodules within the colon wall and o ther intra-abdominal structures, and presents with general abdominal pain, persistent diarrhoea and weight loss. Dapaong tumour (87%) presents as an a bdominal inflammatory mass often associated with fever. The 3-6-cm tumour i s painful, well-delineated, smooth, spherical, 'wooden', periumbilical, and adhered to the abdominal wall. Cases most commonly presented during the la te rains and early dry season. Diagnosis by ultrasound has reduced the need for exploratory surgery, and the ability to sonographically evaluate conse rvative treatment with albendazole has curtailed management by colectomy or incision and drainage.