title: Occult enteric infection by Ancylostoma caninum: a previously unrecognized zoonosis.
abstract: OBJECTIVE
  Human disease caused by the canine hookworm Ancylostoma caninum and a high incidence of eosinophilic enteritis have been reported from northern Queensland, Australia. The aim of this study was to evaluate patients with unexplained abdominal pain and a possible association with cryptic infections by A. caninum.
  
  
  METHODS
  The clinical and demographic features of patients from this region with eosinophilic enteritis (group A1, n = 42), obscure abdominal pain associated with (group A2, n = 105) and without (group A3, n = 84) blood eosinophilia were reviewed and sera were tested against A. caninum excretory-secretory antigens by enzyme-linked immunosorbent assay (ELISA) and Western blot. Four additional patients, two with confirmed A. caninum, had hookworm infection.
  
  
  RESULTS
  The level of dog ownership in these four groups was 79%-100%, higher than in the local population (P < 0.001). The ELISA tested positive in 71% of A1, 67% of A2, and 30% of A3, versus 8% in controls (P < 0.002). All cases tested were positive on Western blot versus 10% of controls (P < 0.0001). The ELISA values increased with chronicity and decreased during convalescence.
  
  
  CONCLUSIONS
  We conclude occult human A. caninum infections are common and are characterized by eosinophilic enteritis and obscure abdominal pain with or without blood eosinophilia. The diagnosis can be confirmed by serology.
authors.affiliation: Townsville General Hospital, Queensland, Australia.
authors.forename: J
authors.initials: J
authors.lastname: Croese
authors.forename: A
authors.initials: A
authors.lastname: Loukas
authors.forename: J
authors.initials: J
authors.lastname: Opdebeeck
authors.forename: P
authors.initials: P
authors.lastname: Prociv
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D000722:Ancylostoma / Q000302:isolation & purification; D000724:Ancylostomiasis / Q000097:blood / Q000188:drug therapy / Q000469:parasitology*; D000818:Animals; D000937:Antigen-Antibody Reactions; D015153:Blotting, Western; D004797:Enzyme-Linked Immunosorbent Assay; D004804:Eosinophils / Q000473:pathology; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D007073:Immunoglobulin E / Q000032:analysis; D007410:Intestinal Diseases / Q000469:parasitology*; D007958:Leukocyte Count; D008297:Male; D008463:Mebendazole / Q000627:therapeutic use; D008875:Middle Aged; D015047:Zoonoses
chemical_list: D007073:Immunoglobulin E; D008463:Mebendazole