Abstract
Most infections that involve the small bowel are self-limiting, and endoscopic examination is rarely indicated in these cases. Suspicion of microbial enteritis can be confirmed by stool cultures and, if necessary, by detection of toxins or antigens. Persistent diarrhea and associated symptoms such as weight loss, fever, arthralgia, and neurologic deficits or findings such as anemia, inflammatory signs, eosinophilia, or signs of malabsorption warrant further investigation. Besides microscopic stool examination, the main tool for this purpose is flexible endoscopy with tissue sampling from the duodenum, terminal ileum, and colon. Video capsule endoscopy (VCE) can sometimes reveal changes in the jejunum or ileum, and it has a high negative predictive value to exclude such lesions. Its usefulness is limited by its inability to obtain biopsy specimens, but it can direct the type and approach of subsequent enteroscopy by providing information on localization and extent of the detected lesions.
The work was first published in 2006 by Springer Medizin Verlag Heidelberg with the following title: Atlas of Video Capsule Endoscopy.
Access provided by Autonomous University of Puebla. Download chapter PDF
Similar content being viewed by others
Keywords
- Whipple’s disease
- Intestinal tuberculosis
- Atypical mycobacteriosis
- Pseudo-Whipple
- Intestinal spirochetosis
- Cytomegalovirus enteritis
- HIV enteritis
- Intestinal blastomycosis
- IPSID
- Oxyuriasis
- Ascaris
- Hookworm
- Taenia
- Strongyloides
- Whipworm
- Helminthiasis
- Lymphangiectasia
Most infections that involve the small bowel are self-limiting, and endoscopic examination is rarely indicated in these cases. Suspicion of microbial enteritis can be confirmed by stool cultures and, if necessary, by detection of toxins or antigens. Persistent diarrhea and associated symptoms such as weight loss, fever, arthralgia, and neurologic deficits or findings such as anemia, inflammatory signs, eosinophilia, or signs of malabsorption warrant further investigation. Besides microscopic stool examination, the main tool for this purpose is flexible endoscopy with tissue sampling from the duodenum, terminal ileum, and colon. Video capsule endoscopy (VCE) can sometimes reveal changes in the jejunum or ileum, and it has a high negative predictive value to exclude such lesions. Its usefulness is limited by its inability to obtain biopsy specimens, but it can direct the type and approach of subsequent enteroscopy by providing information on localization and extent of the detected lesions.
28.1 Whipple’s Disease
28.1.1 Clinical Features
Whipple’s disease is very rare. It is characterized by diarrhea, malassimilation, arthritis, neurologic deficits, and psychiatric changes.
28.1.2 Etiology
The causative organism of Whipple’s disease is Tropheryma whipplei [1]. Affected individuals may suffer from a cellular immune defect [2].
28.1.3 Diagnosis
The diagnosis is based on a small bowel biopsy with the detection of periodic acid–Schiff (PAS)-positive macrophages. It can be confirmed by a polymerase chain reaction (PCR) assay in an intestinal biopsy.
28.1.4 Endoscopy
Endoscopy may reveal a glassy, gelatinous edema; lymphangiectasia (Fig. 28.1), [3]; erosions; ulcers; and diffuse hemorrhage [4–7]. Similar findings may be noted in intestinal histoplasmosis, atypical mycobacteriosis, or multiple myeloma [8, 9].
28.1.5 Treatment
Long-term antibiotic therapy is necessary, considering the involvement of the central nervous system. The therapeutic regimen consists of initial therapy with cephalosporin followed by a 12-month course of trimethoprim and sulfamethoxazole. Mucosal healing under this therapy has been reported, but failure of this regimen has been reported as well [10, 11].
28.2 Infection with Atypical Mycobacteria
28.2.1 Clinical Features
Intestinal involvement by atypical mycobacteria is known to occur alone or in addition to pulmonary and cutaneous involvement [12]. The infection may take an asymptomatic course or may become disseminated, especially in immunocompromised patients [13].
28.2.2 Etiology
The infection is caused by atypical mycobacteria. Over 125 species have been described, including Mycobacterium avium-intracellulare (MAI) and Mycobacterium genavense.
28.2.3 Diagnosis
Diagnosis is based on the histologic detection of acid-fast rods in biopsy material, on PCR assay, or by culturing the organism from blood, bone marrow, biopsy specimens, or sputum. Due to the ubiquitous occurrence of MAI, detection of the organism in normally sterile materials like blood is the most accurate test. Detection of environmental mycobacteria in sputum often represents colonization.
28.2.4 Endoscopy
Infection with MAI often bears an endoscopic resemblance to Whipple’s disease, giving rise to the term “pseudo-Whipple’s disease” (Fig. 28.2). Infections with M. genavense may show edema, increased friability, or lymphangiectatic areas [14].
28.2.5 Treatment
If treatment is necessary, it consists of an antimycobacterial combination regimen based on sensitivity testing and often including classic antituberculosis substances. The course of treatment may be prolonged, depending on the patient’s immune status.
28.3 Tuberculosis
28.3.1 Etiology
Gastrointestinal tuberculosis most frequently involves the small intestine and ileocecum [15, 16]. Gastrointestinal tuberculosis may occur as a primary infection with Mycobacterium bovis or may be secondary to pulmonary infection with Mycobacterium tuberculosis.
28.3.2 Diagnosis
The diagnosis can be established by the biopsy detection of caseating granulomas and acid-fast rods and also by genetic testing (PCR) and culture studies. Stool PCR has proven to be as sensitive as sputum tests in patients with pulmonary tuberculosis [17], so the detection of M. tuberculosis in stool samples does not prove involvement of the gastrointestinal tract. On the other hand, gastrointestinal lesions can be found in asymptomatic patients with pulmonary tuberculosis [18].
28.3.3 Endoscopy
Edematous swelling and patchy redness are typical but unspecific findings in affected mucosa (Figs. 28.3 and 28.4). Ulcers are most commonly found in the ileocecal region (Fig. 28.5); strictures and obstructions also have been described [19, 20]. Differentiating intestinal tuberculosis from other ulcerative diseases of the small intestine can be challenging, especially in countries with a high prevalence of tuberculosis and Crohn’s disease. In Crohn’s disease, ulcers may appear longitudinal or aphthous, whereas tuberculosis may present with oblique or transverse ulcers with a necrotic base, as well as hypertrophic or nodular lesions [21–23]. Oblique ulcers also can be found in chronic, nonspecific multiple ulcers of the small intestine (CNSU) (Chap. 32), however, and lesions related to the use of nonsteroidal anti-inflammatory drugs (NSAIDs) may present with discrete ulcerations and concentric stenosis (Chap. 30) [24, 25]. Because of the morphologic resemblance, differentiation of these lesions through biopsy is warranted.
28.3.4 Treatment
Treatment consists of a combination regimen like that used for pulmonary tuberculosis. Recent studies showed similar effectiveness for 6-month and 9-month regimens [26].
28.4 Intestinal Spirochetosis
28.4.1 Etiology
The organisms causing intestinal spirochetosis are spirochetes such as Borrelia eurygyrata, Brachyspira aalborgi, Brachyspira hyodysenteriae, and Serpulina pilosicoli. There is no clinical relation to borreliosis or syphilis. The detection of intestinal spirochetosis in asymptomatic individuals may represent colonization, but it should be considered in the differential diagnosis of symptomatic patients, especially those suffering from immunodeficiency [27].
28.4.2 Clinical Features
Patients may present with abdominal pain, which sometimes resembles appendicitis. Chronic diarrhea, constipation, and weight loss also have been reported.
28.4.3 Diagnosis
Diagnosis can be established by biopsies of the colorectal or small bowel mucosa. Spirochetes can be detected in the specimens by microscopy and can be differentiated by PCR [28].
28.4.4 Endoscopy
Colonoscopic examination often shows normal mucosa. In some patients, lymphoid follicular hyperplasia or hemorrhagic lesions can be found [29]. Possible findings at small bowel capsule endoscopy are lymphoid follicular hyperplasia and aphthous ulcers (Fig. 28.6).
28.4.5 Treatment
Symptomatic intestinal spirochetosis can be treated with nitroimidazoles; metronidazole is the first-line drug of this type.
28.5 Immunoproliferative Small Intestinal Disease
28.5.1 Etiology
Immunoproliferative small intestinal disease (IPSID) is a form of extranodal marginal zone lymphoma (mucosa-associated lymphoid tissue (MALT lymphoma)) involving the small intestine. The production of truncated alpha heavy chains also led to the term alpha heavy chain disease, and the endemic presentation in the Middle East and Africa led to the term Mediterranean lymphoma. Bacterial infection of the small intestine as with Campylobacter jejuni has been attributed to the development of IPSID [30].
28.5.2 Clinical Features
Clinical presentation includes abdominal pain, secretory diarrhea, and malabsorption [31].
28.5.3 Endoscopy
Multiple nodules of the small intestine can be observed [32–34] (Fig. 28.7).
28.6 Cytomegalovirus Enteritis
28.6.1 Etiology
Cytomegalovirus (CMV) is a DNA virus from the group of herpesviruses. After primary infection, the virus persists and may later be activated or reactivated. Severe courses of disease can be found in patients with immunosuppression due to malignant diseases, pharmacologic treatment, or AIDS.
28.6.2 Clinical Features
The infection often remains asymptomatic, but it may affect the lungs, central nervous system, retina, liver, biliary tract, and all portions of the gastrointestinal tract. Mid-gastrointestinal bleeding, ulcers, perforation, and necrosis have all been described in the small bowel [35–38].
28.6.3 Diagnosis
The diagnosis is based on the biopsy detection of typical cytomegalic cells (“owl’s eye cells”) (Fig. 28.8), antigen detection in biopsy samples, and PCR assay in peripheral blood lymphocytes. IgM antibodies may be detectable in immunosuppressed patients.
28.6.4 Endoscopy
CMV ulcers often show no inflammatory reaction and have a punched-out appearance. Typically the ulcer base is not covered by fibrinous exudate [39] (Fig. 28.8).
28.6.5 Treatment
Most immunocompetent patients do not need treatment. Immunosuppressed patients may be treated with intravenous ganciclovir or oral valganciclovir; cidofovir or foscarnet can be used as second-line drugs.
28.7 AIDS
Patients with AIDS can develop enteritis due to a variety of causes [40]. These include mycobacteriosis, histoplasmosis, CMV infection, strongyloidiasis, and cryptosporidiosis [13, 41, 42]. Histologic and/or microbiologic identification of the causative organism is essential for planning a specific therapy. Malassimilation in patients suffering from AIDS may result from enteritis caused by HIV itself. HIV enteropathy is diagnosed by exclusion (Fig. 28.9). Endoscopic sign of HIV enteropathy may be diffuse, unspecific lymphangiectasia [43]. These enteropathies have become less common with the widespread use of highly active antiviral therapy, but they may be difficult to diagnose and treat [44].
Thinking the other way around, in patients with unusual findings at VCE, a detailed history is important and HIV testing might be considered.
Apart from lesions obviously of infectious origin, patients with HIV infection or AIDS may present with other rare and unusual gastrointestinal manifestations caused by inflammation, medication, or yet undiagnosed infections [45]. Examples of mesenteric panniculitis or severe gastric ulceration are shown in Figs. 28.10 and 28.11.
Panniculitis may occur as a rare complication of AIDS. This group of diseases is characterized by inflammation of adipose subcutaneous or visceral tissue. A diagnosis of panniculitis can be suggested by CT scans and verified by biopsy sampling. Further classification is made by histologic characteristics. If fat necrosis and inflammation predominate, the condition is called mesenteric panniculitis, whereas if fibrosis and retraction predominate, the condition is known as retractile mesenteritis. As the inflammatory reaction affects the mesentery and visceral fat tissue, only indirect signs, such as lymphangiectasia or mucosal fibrosis leading to hypomotility, can be observed (Fig. 28.12).
Although capsule endoscopy does not provide the possibility of biopsies, it may present an interesting possibility to investigate the entire gastrointestinal tract in HIV patients with a single-use endoscope (Fig. 28.13).
28.8 Blastomycosis
28.8.1 Etiology
South American blastomycosis is a fungal infection caused by Paracoccidioides brasiliensis.
28.8.2 Clinical Features
Besides sometimes mutilating cutaneous forms, visceral manifestations can affect multiple organs, including the lung, brain, and others, including the small intestine in rare cases [46]. Immunosuppression or diabetes frequently accompanies blastomycosis [47].
28.8.3 Diagnosis
Fungal cultures and antibody tests can be used for diagnosis. A characteristic feature at histology is the steering wheel-like appearance of the pathogen (Fig. 28.13).
28.8.4 Endoscopy
Lesions may be nodular, ulcerous, or stenotic [48]. Besides nodules and ulcers, lymphangiectasia also can be seen at endoscopy [34] (Fig. 28.14).
28.8.5 Treatment
Systemic amphotericin B has been widely used for treatment.
28.9 Giardiasis
Giardiasis is caused by the protozoon Giardia lamblia, which is present worldwide in varying frequency, with a higher prevalence in the tropics. G. lamblia preferably affects the upper gastrointestinal tract.
28.9.1 Clinical Features
The typical manifestation is diarrhea, in some cases causing severe illness. Most infected persons are asymptomatic or have only minor, nonspecific symptoms, but the course is sometimes prolonged [49]. The infection may be self-limiting. Imidazole derivates are effective in treatment [50].
28.9.2 Diagnosis
The first-line diagnostic test is stool examination. The diagnostic yield of an enzyme-linked immunoassay is superior to the previously used microscopic evaluation.
28.9.3 Endoscopy
Endoscopy is usually normal in giardiasis. Rarely, lymphoid hyperplasia of the entire small intestine (Fig. 28.15) or villous atrophy may be visible, for example, in patients with immunoglobulin A deficiency [51]. At endoscopy, it is possible to obtain duodenal aspirate for immediate microscopic examination, but histology from duodenal biopsy is preferable to duodenal aspirate. Histology usually demonstrates normal intestinal architecture with trophozoites adhering to the mucosa (Fig. 28.16).
28.10 Helminthiases
28.10.1 Epidemiology
Helminth infections are more prevalent in the tropics and subtropics, so it is more common to find parasitic worms during capsule endoscopy in those regions [52]. Human pathogenic helminthes can be divided into nematodes (roundworms), cestodes (tapeworms), and trematodes (flukes). Nematodes are found most frequently in the small bowel lumen. Ascaris lumbricoides, the largest of these, may be up to 30 cm long. Smaller nematodes are the whipworm Trichuris trichiura, the pinworm Enterobius vermicularis, and the hookworms Ancylostoma duodenale and Necator americanus (up to 12 mm) and Strongyloides stercoralis (2 mm). For Necator americanus, occurrence of eosinophilic enteropathy has been observed by capsule endoscopy [53]. Tapeworms (Taenia solium, Taenia saginata, or Diphyllobothrium latum/nihonkaiense) may reach a length of up to several meters in the small intestine, causing malnutrition, vitamin deficiency, obstruction, and even intestinal bleeding [54, 55].
28.10.2 Development
Adult nematodes live in the human intestine, and therefore humans are the definitive host. The infection may be acquired through the oral ingestion of eggs or by larvae penetrating the skin. With strongyloidiasis or E. vermicularis infection, autoinfection can occur.
28.10.3 Endoscopy
Motile worms of varying size may be observed in the bowel lumen [56]. Ascarids can easily be identified by their large size (Figs. 28.17 and 28.18). On the other hand, the tiny Strongyloides is hardly visible at all (Fig. 28.19). Flexible endoscopy with the possibility of biopsy sampling may be desirable [57–59]. Enterobius usually occurs in the cecum, where multiple small worms may be seen (Fig. 28.20). Trichuris is a long worm (smaller than Ascaris) with a thin proximal end (Fig. 28.21), which is not seen in hookworms (Figs. 28.22 and 28.23). The largest helminths are tapeworms, consisting of multiple proglottides and reaching a length of several meters (Figs. 28.24 and 28.25) [60]. Visualization of adult worms at endoscopy or in stool, sometimes combined with microscopic detection of worm eggs, enables a correct classification of the parasites. Serology is rather insensitive because of frequent cross-reactions.
The outer cuticle of the parasites remains intact even after the worms have been killed. Wormlike structures with irregular outlines in the small bowel are usually food residues.
References
Bentley SD, Maiwald M, Murphy LD, et al. Sequencing and analysis of the genome of the Whipple’s disease bacterium Tropheryma whipplei. Lancet. 2003;361:637–44.
Schneider T, Moos V, Loddenkemper C, et al. Whipple’s disease: new aspects of pathogenesis and treatment. Lancet Infect Dis. 2008;8:179–90.
Kolfenbach S, Monkemuller K, Rocken C, Malfertheiner P. Whipple’s disease: magnification endoscopy and histological characteristics. Endoscopy. 2008;40 Suppl 2:E112.
Fritscher-Ravens A, Swain CP, von Herbay A. Refractory Whipple’s disease with anaemia: first lessons from capsule endoscopy. Endoscopy. 2004;36:659–62.
Gay G, Roche JF, Delvaux M. Capsule endoscopy, transit times, and Whipple’s disease. Endoscopy. 2005;37:272–3.
Keane MG, Shariff M, Stocks J, et al. Imaging of the small bowel by capsule endoscopy in Whipple’s disease. Endoscopy. 2009;41 Suppl 2:E139.
Mateescu BR, Bengus A, Marinescu M, et al. First Pillcam Colon 2 capsule images of Whipple’s disease: case report and review of the literature. World J Gastrointest Endosc. 2012;4:575–8.
Bhat M, Laneuville P, Marliss EB, et al. Secondary intestinal lymphangiectasia due to multiple myeloma. Gastrointest Endosc. 2011;74:718–20.
Ratnaike RN. Whipple’s disease. Postgrad Med J. 2000;76:760–6.
Dzirlo L, Blaha B, Muller C, et al. Capsule endoscopic appearance of the small-intestinal mucosa in Whipple’s disease and the changes that occur during antibiotic therapy. Endoscopy. 2007;39 Suppl 1:E207–8.
Lagier JC, Fenollar F, Lepidi H, Raoult D. Failure and relapse after treatment with trimethoprim/sulfamethoxazole in classic Whipple’s disease. J Antimicrob Chemother. 2010;65:2005–12.
Pantongrag-Brown L, Nelson AM, Brown AE, et al. Gastrointestinal manifestations of acquired immunodeficiency syndrome: radiologic-pathologic correlation. Radiographics. 1995;15:1155–78.
Aldeman NL, Guimaraes LM, Cabral MM. Atypical duodenal mycobacteriosis in a patient with AIDS. Braz J Infect Dis. 2012;16:209–10.
Escapa VM, Beltran VP, Viudez LA, et al. Intestinal involvement by Micobacterium genavense in an immunodepressed patient. Gastrointest Endosc. 2010;72:1108–10.
Collado C, Stirnemann J, Ganne N, et al. Gastrointestinal tuberculosis: 17 cases collected in 4 hospitals in the northeastern suburb of Paris. Gastroenterol Clin Biol. 2005;29:419–24.
Radzi M, Rihan N, Vijayalakshmi N, Pani SP. Diagnostic challenge of gastrointestinal tuberculosis: a report of 34 cases and an overview of the literature. Southeast Asian J Trop Med Public Health. 2009;40:505–10.
Cordova J, Shiloh R, Gilman RH, et al. Evaluation of molecular tools for detection and drug susceptibility testing of Mycobacterium tuberculosis in stool specimens from patients with pulmonary tuberculosis. J Clin Microbiol. 2010;48:1820–6.
Loureiro AI, Pinto CS, Oliveira AI, et al. Ulcerated lesion of the cecum as a form of presentation of gastrointestinal tuberculosis. [Article in Portuguese]. Acta Med Port. 2011;24:371–4.
Kim ES, Keum B, Jeen YT, Chun HJ. Isolated small bowel tuberculosis with stricture diagnosed by capsule endoscopy. Dig Liver Dis. 2012;44:84.
Lee CW, Chang WH, Shih SC, et al. Gastrointestinal tract pseudo-obstruction or obstruction due to Mycobacterium tuberculosis breakthrough. Int J Infect Dis. 2009;13:e185–7.
Pulimood AB, Amarapurkar DN, Ghoshal U, et al. Differentiation of Crohn’s disease from intestinal tuberculosis in India in 2010. World J Gastroenterol. 2011;17:433–43.
Ramchandani M, Reddy DN, Gupta R, et al. Diagnostic yield and therapeutic impact of single-balloon enteroscopy: series of 106 cases. J Gastroenterol Hepatol. 2009;24:1631–8.
Reddy DN, Sriram PV, Rao GV, Reddy DB. Capsule endoscopy appearances of small-bowel tuberculosis. Endoscopy. 2003;35:99.
Chang DK, Kim JJ, Choi H, et al. Double balloon endoscopy in small intestinal Crohn’s disease and other inflammatory diseases such as cryptogenic multifocal ulcerous stenosing enteritis (CMUSE). Gastrointest Endosc. 2007;66:S96–8.
Matsumoto T, Kudo T, Esaki M, et al. Prevalence of non-steroidal anti-inflammatory drug-induced enteropathy determined by double-balloon endoscopy: a Japanese multicenter study. Scand J Gastroenterol. 2008;43:490–6.
Park SH, Yang SK, Yang DH, et al. Prospective randomized trial of six-month versus nine-month therapy for intestinal tuberculosis. Antimicrob Agents Chemother. 2009;53:4167–71.
Tsinganou E, Gebbers JO. Human intestinal spirochetosis–a review. Ger Med Sci. 2010;8:Doc01. doi:10.3205/000090.
Lozano C, Arellano L, Yaquich P. Human intestinal spirochetosis: clinical series and literature review. [Article in Spanish]. Rev Chilena Infectol. 2012;29:449–52.
Koulaouzidis A, Campbell S, Ahmed S, et al. Colonic spirochetosis associated with dermatomyositis. Endoscopy. 2007;39 Suppl 1:E30–1.
Al-Saleem T, Al-Mondhiry H. Immunoproliferative small intestinal disease (IPSID): a model for mature B-cell neoplasms. Blood. 2005;105:2274–80.
Mesnard B, De VB, Maunoury V, Lecuit M. Immunoproliferative small intestinal disease associated with Campylobacter jejuni. Dig Liver Dis. 2012;44:799–800.
Mönkemüller K, Safatle-Ribeiro AV, Olano C, Fry LC. Unusual findings in the small bowel. VJGIEN. 2013;1:286–8. http://dx.doi.org/10.1016/S2212-0971(13)70125-0.
Ersoy O, Akin E, Demirezer A, Atalay R, Buyukasik S. Capsule-endoscopic findings in immunoproliferative small-intestinal disease. Endoscopy. 2012;44(Suppl 2 UCTN):E61–2.
Safatle-Ribeiro AV, Iriya K, Couto DS, et al. Secondary lymphangiectasia of the small bowel: utility of double balloon enteroscopy for diagnosis and management. Dig Dis. 2008;26:383–6.
Cha JM, Lee JI, Choe JW, et al. Cytomegalovirus enteritis causing ileal perforation in an elderly immunocompetent individual. Yonsei Med J. 2010;51:279–83.
Kalaitzis J, Basioukas P, Karzi E, et al. Small-bowel necrosis complicating a cytomegalovirus-induced superior mesenteric vein thrombosis in an immunocompetent patient: a case report. J Med Case Rep. 2012;6:118.
Papadimitriou G, Koukoulaki M, Vardas K, et al. Small bowel obstruction caused by inflammatory cytomegalovirus tumor in a renal transplant recipient: report of a rare case and review of the literature. Transplant Infect Dis. 2012;14:E111–5.
Sakai E, Endo H, Tokoro C, et al. Cytomegalovirus-induced small-bowel bleeding detected by capsule endoscopy. Gastrointest Endosc. 2011;73:1058–60.
Kakugawa Y, Kim SW, Takizawa K, et al. Small intestinal CMV disease detected by capsule endoscopy after allogeneic hematopoietic SCT. Bone Marrow Transplant. 2008;42:283–4.
Jha AK, Uppal B, Chadha S, et al. Clinical and microbiological profile of HIV/AIDS cases with diarrhea in North India. J Pathog. 2012;2012:971958.
Nawabi DH, Ffolkes L, O’Bichere A. Cryptococcal small-bowel obstruction in an HIV-positive patient. J R Soc Med. 2005;98:513–4.
Tzimas D, Wan D. Small bowel perforation in a patient with AIDS. Diagnosis: small bowel infection with Cryptococcus neoformans. Gastroenterology. 2011;140:1882. 2150.
Marco-Lattur MD, Payeras A, Campins AA, et al. Intestinal lymphangiectasia: an undescribed cause of malabsorption and incomplete immunological recovery in HIV-infected patients. Enferm Infecc Microbiol Clin. 2011;29:117–20.
Cello JP, Day LW. Idiopathic AIDS enteropathy and treatment of gastrointestinal opportunistic pathogens. Gastroenterology. 2009;136:1952–65.
Venkataramani A, Behling CA, Lyche KD. Sclerosing mesenteritis: an unusual cause of abdominal pain in an HIV-positive patient. Am J Gastroenterol. 1997;92:1059–60.
Fonseca LC, Mignone C. Paracoccidioidomycosis of the small intestine. Radiologic and anatomo clinical aspects of 125 cases. Rev Hosp Clin Fac Med Sao Paulo. 1976;31:199–207.
Lemos LB, Baliga M, Guo M. Blastomycosis: the great pretender can also be an opportunist. Initial clinical diagnosis and underlying diseases in 123 patients. Ann Diagn Pathol. 2002;6:194–203.
Avritchir Y, Perroni AA. Radiological manifestations of small intestinal South American Blastomycosis. Radiology. 1978;127:607–9.
Sawatzki M, Peter S, Hess C. Therapy-resistant diarrhea due to Giardia lamblia in a patient with common variable immunodeficiency disease. Digestion. 2007;75:101–2.
Rossignol JF. Cryptosporidium and Giardia: treatment options and prospects for new drugs. Exp Parasitol. 2010;124:45–53.
Perez-Roldan F, Mate-Valdezate A, Villafanez-Garcia MC, et al. Nodular lymphoid hyperplasia by Giardia lamblia. Endoscopy. 2008;40 Suppl 2:E116–7.
Sriram PV, Rao GV, Reddy DN. Wireless capsule endoscopy: experience in a tropical country. J Gastroenterol Hepatol. 2004;19:63–7.
Croese J, Speare R. Intestinal allergy expels hookworms: seeing is believing. Trends Parasitol. 2006;22:547–50.
De Simone P, Feron P, Loi P, et al. Acute intestinal bleeding due to Taenia solium infection. Chir Ital. 2004;56:151–6.
Karanikas ID, Sakellaridis TE, Alexiou CP, et al. Taenia saginata: a rare cause of bowel obstruction. Trans R Soc Trop Med Hyg. 2007;101:527–8.
Floro L, Pak G, Sreter L, Tulassay Z. Wireless capsule endoscopy in the diagnosis of helminthiasis. Gastrointest Endosc. 2007;65:1078. discussion 9.
Mittal S, Sagi SV, Hawari R. Strongyloidiasis: endoscopic diagnosis. Clin Gastroenterol Hepatol. 2009;7:e8.
Somani SK, Goyal R, Awasthi G. Duodenal mucosal nodularity in Strongyloides stercoralis infection. Trop Gastroenterol. 2009;30:47–8.
Thompson BF, Fry LC, Wells CD, et al. The spectrum of GI strongyloidiasis: an endoscopic-pathologic study. Gastrointest Endosc. 2004;59:906–10.
Hosoe N, Imaeda H, Okamoto S, et al. A case of beef tapeworm (Taenia saginata) infection observed by using video capsule endoscopy and radiography (with videos). Gastrointest Endosc. 2011;74:690–1.
Author information
Authors and Affiliations
Corresponding author
Editor information
Editors and Affiliations
Rights and permissions
Copyright information
© 2014 Springer-Verlag Berlin Heidelberg
About this chapter
Cite this chapter
Baltes, P., Safatle-Ribeiro, A., Keuchel, M., Reddy, D.N. (2014). Infectious Diseases of the Small Intestine. In: Keuchel, M., Hagenmüller, F., Tajiri, H. (eds) Video Capsule Endoscopy. Springer, Berlin, Heidelberg. https://doi.org/10.1007/978-3-662-44062-9_28
Download citation
DOI: https://doi.org/10.1007/978-3-662-44062-9_28
Published:
Publisher Name: Springer, Berlin, Heidelberg
Print ISBN: 978-3-662-44061-2
Online ISBN: 978-3-662-44062-9
eBook Packages: MedicineMedicine (R0)