Clinical Gnathostomiasis: Case Report and Review of the English-Language Literature

Abstract

Human gnathostomiasis is most frequently caused by the nematode Gnathostoma spinigerum. This disease is endemic to Southeast Asia, particularly Thailand and Japan. The clinical presentation is most commonly characterized by localized, intermittent, migratory swellings of the skin and subcutaneous tissues, often in association with localized pain, pruritus, and erythema. Since this worm can migrate to deeper tissues, any organ system may become involved. Characteristically, patients with gnathostomiasis have a moderate to severe elevation of the peripheral eosinophil count, with values not uncommonly exceeding 50% of the total white blood cell count. With modern-day travel and immigration, cases of gnathostomiasis are being diagnosed with increased frequency in the United States. Because of its rarity in this country, however, gnathostomiasis often is not included in an initial differential diagnosis despite the characteristic triad of intermittent migratory swelling, a history of travel to Southeast Asia, and eosinophilia. We report a case of cutaneous gnathostomiasis diagnosed in the United States, and we present a clinical review of the English-language literature on human gnathostomiasis.

Emerging helminth zoonoses

“…Nevertheless, larvae were found in four different species of ®sh-eating birds trapped in the area. Clinical gnathostomiasis was identi®ed in 300 people from this area over a 3-year period, an incidence much greater than had been previously reported in Asia [40].…”

“…Eosinophilia (usually .50%) develops in association with larval penetration of the gastric or intestinal wall [40]. The worm migrates through the skin and subcutaneous tissues, causing intermittent swelling that is often painful or pruritic.…”

“…Although the parasite tends to remain in the subcutaneous tissues, resulting in cutaneous gnathostomiasis, the worm can migrate to deeper tissues, resulting in visceral disease. Gnathostomiasis has been reported to involve the pulmonary, ocular, genitourinary, gastrointestinal, auditory, and central nervous systems, occasionally with fatal consequences [40].…”

Gnatostomiasis cutánea, primer caso confirmado en Colombia

“…Comúnmente, las lesiones son edematosas, sin fóvea, de aspecto hemorrágico, de longitud muy variable y pueden ser pruriginosas o dolorosas. Una vez aparecen, persisten durante una o dos semanas y suelen deberse a una sola larva, aunque ocasionalmente pueden encontrarse dos o más (18,20). En este caso, el diagnóstico se hizo en cuanto la larva se extrajo, pero se ofreció el tratamiento indicado ante la posibilidad de que hubiera otras larvas infecciosas.…”

“…En las infecciones por Gnathostoma spp., también se han reportado otras manifestaciones, como sangrado vaginal, cervicitis, balanitis, masa suprarrenal y hematospermia (3,20).…”