Imported Intraocular Gnathostomiasis with Subretinal Tracks Confirmed by Western Blot Assay

Abstract

We report a case of intraocular gnathostomiasis diagnosed by western blot assay in a patient with subretinal tracks. A 15-year-old male patient complained of blurred vision in the right eye, lasting for 2 weeks. Eight months earlier, he had traveled to Vietnam for 1 week and ate raw wild boar meat and lobster. His best-corrected visual acuity was 20/20 in both eyes and anterior chamber examination revealed no abnormalities. Fundus examination showed subretinal tracks in the right eye. Fluorescein angiography and indocyanine green angiography showed linear hyperfluorescence of the subretinal lesion observed on fundus in the right eye. Ultrasound examination revealed no abnormalities. Blood tests indicated mild eosinophilia (7.5%), and there was no abnormality found by systemic examinations. Two years later, the patient visited our department again for ophthalmologic evaluation. Visual acuity remained 20/20 in both eyes and the subretinal tracks in the right eye had not changed since the previous examination. Serologic examination was performed to provide a more accurate diagnosis, and the patient's serum reacted strongly to the Gnathostoma nipponicum antigen by western blot assay, which led to a diagnosis of intraocular gnathostomiasis. This is the first reported case of intraocular gnathostomiasis with subretinal tracks confirmed serologically using western blot in Korea.

Ocular Gnathostomiasis—Update of Earlier Survey

“…Since our initial survey performed of cases reported up to and including 2009, we found an additional nine case reports of ocular gnathostomiasis and two of our own unpublished cases (one each from Thailand and Venezuela), which were listed in Table 1. [4][5][6][7][8][9][10][11][12] Following careful investigation of each report, two cases reported from India 5,6 were determined to be the same case. Therefore, during the survey period the actual number of unique cases from India is four and the total number is 10 including two unpublished cases.…”

First reported case of intraocular Gnathostoma spinigerum in Cambodia

“…Laboratory testing is based on microscopic examination of larvae extracted from the lesions, serological tests (IgG ELISA, Immunoblot) or L3 antigen detection [9,16,18].…”

Gnathostoma spinigerum Infection in the Upper Lip of a Korean Woman: An Autochthonous Case in Korea

“…(possible G. nipponicum ) were reported in Korea [14-17], and an outbreak of G. spinigerum infection occurred among 38 Korean emigrants who consumed raw fish served in a restaurant in Myanmar [18]. However, indigenous human infections with Gnathostoma spp.…”

“…However, human autochthonous infection with Gnathostoma sp. has never been reported, while several reports were published on imported G. spinigerum [14,15], G. hispidum [16], and possible G. nipponicum infection cases [17], and an outbreak of G. spinigerum infection among 38 Korean emigrants residing in Myanmar [18]. We recently encountered an interesting case of G. spinigerum infection in a patient who never visited any endemic area of gnathostomiasis before the onset of the disease.…”