Human gnathostomiasis is a food-born parasitic disease of relative importance in many countries in Southeast Asia. It is caused by several species of nematodes of the genus Gnathostoma. In Mexico is an emerging public health problem since , when first cases were reported. Until today, larval morphometric characters that have been proposed to differentiate between the three species of Gnathostoma present in this country, are not satisfactory.
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This case report describes the second reported case of gnathostomiasis acquired in Brazil. The French traveller returned from a sport fishing trip from Tocantins where he was repeatedly consuming raw freshwater fish marinated with lemon juice.
Gnathostoma infection was diagnosed based on clinical symptoms, dietary record and by detection of specific antibodies in the blood. Human gnathostomiasis is a foodborne parasitic zoonosis acquired after consumption of raw or undercooked freshwater fish, shrimp or crabs containing third-stage larvae of the nematode Gnathostoma.
It is mainly endemic in Southeast Asia but in recent years has also become an increasing problem in Central and South America.
Due to increased international travel to tropical countries and changes in dietary habits, i. This case report describes the second reported case of cutaneous gnathostomiasis acquired in Brazil. A French traveller was infected and diagnosed by detection of specific antibodies by western blot.
This represents a sentinel case showing emergence of Gnathostoma infections in Brazil. A Tocantins area in Brazil. B Cichla sp. A Extensive swelling nodule in the abdominal wall.
B Serpiginous lesion in the back on the third day of albendazol treatment. At that time the serodiagnostic test was negative. The immunoblot for gnathostomiasis is routinely performed at the Swiss TPH with antigen from the most widely distributed species in Asia, Gnathostoma spinigerum. All tested samples showed reactivity with the G. The plasma showed a positive reactivity on both antigens.
A serologic screening test covering seven other tissue helminth infections echinococcosis, fasciolosis, strongyloidiasis, toxocariasis, trichinellosis, filariasis and schistosomiasis was performed in addition and was negative for all antigens.
We report a case of cutaneous gnathostomiasis of a traveller returning to France from Brazil. According to literature this is the second reported case of gnathostomiasis acquired in Brazil. The first reported case was acquired in the same region of Tocantins, Brazil, and was published by Vargas et al. Travellers returning from endemic countries might get infected by consumption of raw fish and bring the disease back to their home countries.
Diagnosis can be difficult as only few clinicians outside of endemic areas are familiar with gnathostomiasis, and hence corresponding diagnostic tests are not requested or diagnosis is delayed. The classic triad of epidemiological exposition, migratory panniculitis and eosinophilia leading to a high index of suspicion is rarely followed up by identification of larvae or by serology. Only few laboratories offer serological tests for gnathostomiasis i.
Definitive diagnosis of gnathostomiasis is only possible by direct identification of larvae. But biopsy or surgical removal of larvae is only feasible in cases of very superficial migration. A biopsy revealed eosinophilic panniculitis and hypereosinophily in the blood. In general, eosinophilia develops in association with larval penetration but not in all cases.
This would only be applicable for regions without endemicity of other helminth infections, since these could also cause eosinophilia. There are four cutaneous signs associated with gnathostomiasis: migratory panniculitis, creeping dermatitis, oedema and nodules. Our patient presented with deep swelling nodules, eosinophilic panniculitis and creeping dermatitis.
In combination with the diet history he was diagnosed with cutaneous larva migrans CLM syndrome, most likely caused by Gnathostoma infection. This has been confirmed by the serological test. It has to be considered that CLM syndrome can also be caused by other invasive nemathode larvae like animal hookworm, Strongyloides stercoralis or Toxocara sp. Currently, a number of serological tests are available for diagnosis of gnathostomiasis. Immunoblot for detection of the specific kDa band is regarded as the most reliable in terms of sensitivity and cross-reactivity to other helminth infections.
The diagnostic immunoblot had initially been performed with G. Both blots with the plasma from 5 October , yielded a negative result. The time point for serology was definitively too early for detection of sufficient IgG on the immunoblot. Seroconversion takes several weeks after exposure to parasites and detectable levels of IgG are therefore not measured in the early phase of infection. Two and a half months later, and after treatment with albendazol and subsequent treatment with ivermectin, the Gnathostoma serology was positive with both antigen preparations, G.
Treatment with albendazol may not be successful and might require a subsequent or combined treatment with ivermectin. A single dose of ivermectin, 0. Due to the good tolerability and the incomplete efficacy of either drug, some experts recommend combination or sequential therapy with both drugs. In a review of fishborne diseases in Brazil from 19 the authors were not aware of the occurrence of Gnathostoma spp. Cichlids are freshwater bass species also known as peacock bass and are widely consumed in Brazil due to the excellence of the flesh.
Cichlids live very territorial and Cichla piquiti , as well as P. The source of infection could be one or even both fish species. According to our patient, another member of the same fishing team had symptoms of CLM syndrome and swellings but this person has never been tested for the infection.
In addition to our reported case, another suspicious case was identified retrospectively. This person returned with the same clinical presentation from a recreational sport fishing trip from Tocantins. A dermatologist in France treated him twice after his travel in and in for CLM syndrome with ivermectin. Unfortunately, no serological test was performed for detection of tissue helminth infections.
The accumulation of cases of travellers returning from the same area in combination with consumption of raw fish dishes suggests a substantial infection rate of freshwater fish in the Amazonas basin.
We think that a survey for Gnathostoma spp. We describe the second reported case of confirmed gnathostomiasis in a traveller returning from Brazil. Gnathostomiasis might be more widely present and underestimated not only in Brazil, but also in other South-American countries due to lack of awareness and poor diagnostics.
Besides the consultation in travel medicine on recommended vaccinations and preventive measures, the advice of doctors to travellers to avoid consumption of raw meat fish and other meat during the trip is paramount.
The awareness of a possibly acquired gnathostomiasis should be considered for all returning travellers fulfilling epidemiological and clinical conditions. Gnathostomiasis, another emerging imported disease. Clin Microbiol Rev ; 22 : — Google Scholar. Cross-reactivity pattern of Asian and American human Gnathostomiasis in western blot assays using crude antigens prepared from Gnathostoma spinigerum and Gnathostoma binucleatum third-stage larvae.
Am J Trop Med Hyg ; 95 : — 6. Autochthonous gnathostomiasis in Brazil. Emerg Infect Dis ; 18 : — 9. Diaz JH. Gnathostomiasis: an emerging infection of raw fish consumers in gnathostoma nematode-endemic and nonendemic countries. J Travel Med ; 22 : — Gnathostomiasis acquired by British tourists in Botswana. Emerg Infect Dis ; 15 : — 7. Gnathostomiasis in remote northern Western Australia: the first confirmed cases acquired in Australia.
Med J Australia ; : 42 — 4. Images in clinical tropical medicine, a year-old woman with migratory panniculitis. Am J Trop Med Hyg ; 90 : — 7. Gnathostomiasis: an emerging imported disease. Emerg Infect Dis ; 9 : — Imported cutaneous gnathostomiasis: report of five cases. Long-term follow-up of imported gnathostomiasis shows frequent treatment failure. Albendazole stimulates outward migration of Gnathostoma spinigerum to the dermis in man.
Gnathostomiasis, an emerging foodbourne zoonotic disease in Acapulco, Mexico. Emerg Infect Dis ; 5 : — 6. Caumes E Danis M. From creeping eruption to hookworm-related cutaneous larva migrans. Lancet Infect Dis ; 4 : — Specific antigen of Gnathostoma spinigerum for immunodiagnosis of human gnathostomiasis. Int J Parasitol ; 21 : — 9. Purification of Gnathostoma spinigerum specific antigen and immunodiagnosis of human gnathostomiasis.
Int J Parasitol ; 21 : — Development and usefulness of an immunochromatographic device to detect antibodies for rapid diagnosis of human gnathostomiasis. Parasit Vectors ; 9 : Neumayr A.
In: Antiparasitic Treatment Recommendations. A Practical Guide to Clinical Parasitology , 1st edn. Hamburg : Tradition GmbH , , pp. Google Preview. Fishborne zoonotic parasites and aquaculture: a review. Aquaculture ; : —
Gnathostoma spp. Humans are accidental hosts; the only forms found in humans are larvae or immature adults that never reach reproductive maturity. Most human infections are caused by G. Two unconfirmed human cases of G. In definitive hosts, adult worms of most Gnathostoma spp reside in a tumor-like mass in the gastric wall; adult worms of some species are found in the esophagus or kidney. Adults mate and produce unembryonated eggs, which pass through a small opening in the tumor-like mass and ultimately into the feces.
[Gnathostoma Binucleatum (Spirurida: Gnathostomatidae) From the Freshwater Fish in Tabasco, Mexico]
This case report describes the second reported case of gnathostomiasis acquired in Brazil. The French traveller returned from a sport fishing trip from Tocantins where he was repeatedly consuming raw freshwater fish marinated with lemon juice. Gnathostoma infection was diagnosed based on clinical symptoms, dietary record and by detection of specific antibodies in the blood. Human gnathostomiasis is a foodborne parasitic zoonosis acquired after consumption of raw or undercooked freshwater fish, shrimp or crabs containing third-stage larvae of the nematode Gnathostoma. It is mainly endemic in Southeast Asia but in recent years has also become an increasing problem in Central and South America. Due to increased international travel to tropical countries and changes in dietary habits, i. This case report describes the second reported case of cutaneous gnathostomiasis acquired in Brazil.