Video:Gnathostomiasis

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Description

Gnathostomiasis also known as larva migrans profundus[1] is the human infection caused by the nematode Gnathostoma spinigerum and/or Gnathostoma hispidum, which infects vertebrates.[2]The medication albendazole has shown high cure rates for cutaneous symptoms of gnathostomiasis[3]

Presentation

A few days after ingestion epigastric pain, fever, vomiting, and loss of appetite resulting from migration of larvae through intestinal wall to the abdominal cavity, will appear in the patient.[4]

Causes

Human gnathostomiasis is infection by the migrating third-stage larvae of any of five species of Gnathostoma, which is a type of worm (more specifically a type of nematode). The most common cause in Asia is G. spinigerum, and the most common cause in the Americas is G. binucleatum. G. hispidium and G. doloresi occur in East and Southeast Asia; the former has also been found in Eastern Europe. G. nipponicum occurs only in Japan and China.[5][6][7]

Transmission

Gnathostomiasis is transmitted by the ingestion of raw or insufficiently cooked intermediate hosts such as fresh water fish, poultry, or frogs.[8]

Mechanism

Infection of humans by gnathostomiasis is accidental because humans are not one of the definitive hosts of the parasite and do not allow the parasite to complete its life cycle. Infection in humans follows ingestion of raw or insufficiently cooked infected intermediate hosts.[9] The ingested third stage larva migrates from the gastric wall and its migration results in the symptoms associated with infection by gnathostomiasis.[4]

Diagnosis

Diagnosis of gnathostomiasis is possible (with microscopy) after removal of the worm. The primary form of diagnosis of gnathostomiasis is the identification of larva in the tissue.[10]

Differential diagnosis

As to the differential diagnosis we find the following: Loiasis (Loa loa), Fascioliasis, Myiasis and Paragonimiasis.[11]

Prevention

The best strategies for preventing accidental infection of humans is to educate those living in endemic areas to only consume fully cooked meat. The inability of the parasite to complete its life cycle within humans means that transmission can easily be contained by adequate preparation of meat from intermediate hosts. This is especially useful because of the difficulty and lack of feasibility inherent in eliminating all intermediate hosts of gnathostomiasis. [10][12]

Treatment

In terms of management surgical removal or treatment with albendazole or ivermectin is recommended.The most frequent treatment for gnathostomiasis is surgical removal of the larvae but this is only effective when the worms are located in an accessible location.[8]

Epidemiology

Endemic areas include Asia, Mexico, India and parts of South Africa.[4]Originally believed to be confined to Asia, in the 1970s gnathostomiasis was discovered in Mexico,[4] and found in Australia in 2011.[13][14]

History

The first case of Gnathostoma infection was identified by Sir Richard Owen when inspecting the stomach of a young tiger that had died at London Zoo from a ruptured aorta.[15]However it was not until 1889 that the first human case was described by Levinson when he found the Gnathostoma larva in an infested Thai woman. The lifecycle of G. spinigerum was described by Svasti Daengsvang and Chalerm Prommas from Thailand in 1933 and 1936.[16]

References

  1. William D. James; Timothy G. Berger; Dirk M. Elston (2006). Andrews' Diseases of the Skin: Clinical Dermatology (10th ed.). Saunders Elsevier. ISBN 0-7216-2921-0.
  2. "Gnathostomiasis". DermNet®. 26 October 2023. Retrieved 1 January 2025.
  3. "Clinical Care of Gnathostomiasis". Gnathostomiasis (Gnathostoma Infection). 20 February 2024. Retrieved 1 January 2025.
  4. 4.0 4.1 4.2 4.3 David T. John; William A. Petri (2006). "The blood- and tissue-dwelling nematodes". Markell and Voge's Medical Parasitology (9th ed.). Elsevier. pp. 274–321. ISBN 978-0-7216-4793-7
  5. Herman, Joanna S.; Chiodini, Peter L. (July 2009). "Gnathostomiasis, Another Emerging Imported Disease". Clinical Microbiology Reviews. 22 (3): 484–492. doi:10.1128/CMR.00003-09.
  6. Katchanov J, Sawanyawisuth K, Chotmongkol V, Nawa Y (2011). "Neurognathostomiasis, a neglected parasitosis of the central nervous system". Emerging Infectious Diseases. 17 (7): 1174–1180. doi:10.3201/eid1707.101433. PMC 3321562. PMID 21762569. Archived from the original on 2012-01-04. Retrieved 2021-10-03.
  7. "CDC - DPDx - Gnathostomiasis". www.cdc.gov. 7 May 2019. Retrieved 10 January 2025.
  8. 8.0 8.1 "About Gnathostomiasis". Gnathostomiasis. 14 March 2024. Retrieved 11 January 2025.
  9. "Gnathostomiasis: Overview - eMedicine Pediatrics: General Medicine". web.archive.org. 3 March 2009. Retrieved 12 January 2025.
  10. 10.0 10.1 "Gideon". web.archive.org. Retrieved 14 January 2025.
  11. Keystone, Jay S. (1 January 2007). "CHAPTER 25 - Skin Problems". Immigrant Medicine. W.B. Saunders. pp. 375–391. ISBN 978-0-323-03454-8.
  12. Nogrado, Kathyleen; Adisakwattana, Poom; Reamtong, Onrapak (1 December 2023). "Human gnathostomiasis: A review on the biology of the parasite with special reference on the current therapeutic management". Food and Waterborne Parasitology. 33: e00207. doi:10.1016/j.fawpar.2023.e00207. ISSN 2405-6766. Archived from the original on 30 October 2023. Retrieved 6 January 2025.
  13. Cameron J Jeremiah; Chanad S Harangozo; Andrew J Fuller (2011). "Gnathostomiasis in remote northern Western Australia: the first confirmed cases acquired in Australia". Medical Journal of Australia. 195 (1): 42–44. doi:10.5694/j.1326-5377.2011.tb03188.x. PMID 21728942. S2CID 37139535. Archived from the original on 2011-09-09. Retrieved 2021-10-03.
  14. "Couple eaten alive by tiny worms". Yahoo. July 5, 2011. Archived from the original on July 7, 2011. Retrieved July 8, 2011.
  15. "Yangtse Oedema (Gnathostomiasis) Patient UK". Archived from the original on 2012-02-12. Retrieved 2021-10-03.
  16. Valai Bussaratid; Srivicha Krudsood; Udomsak Silachamroon; Sornchai Looareesuwan (2005). "Tolerability of ivermectin in gnathostomiasis" (PDF). Southeast Asian Journal of Tropical Medicine and Public Health. 36 (3): 644–9. PMID 16124431. Archived (PDF) from the original on 2021-11-04. Retrieved 2021-10-03.