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Diagnostic Tests and Therapy for Gnathostomiasis

 

Eosinophil percentages in 240 gnathostomiasis patients and 240 controls. Patients generally

 have higher eosinophil levels than controls (Camacho et al. 1998).

 

           Clinical presentation is the first key to recognizing gnathostomiasis. Migratory edema or creeping eruptions are visual signs of the parasite's presence. Background, such as travel history or eating and food preparation habits, can also provide key information. Eosinophil counts are also commonly used but provide very little specific insight regarding the cause of infection. Serological testing can be useful in obtaining a differential diagnosis. A wide array of serological tests--precipitin tests, radioimmunoassay, Ouchterlony gel diffusion, indirect fluorescent antibody, indirect hemagglutination, microprecipitation reactions, immunoblots, ELISA--have been used (Rusnak and Lucey 1993). Tests for IgG and IgE antibodies have been developed with increased specificity and sensitivity. Research has shown that the most accurate test currently available is the ELISA test for IgE antibodies (Soesatyo et al. 1987). However, as with any parasitic infection, the only definitive diagnosis can be isolation of the parasite itself.  

 

Comparisons of ELISA optical density readings for the IgeE antibody reaction in patients with cutaneous migratory swellings (MS), proven gnathostomiasis (G), and controls (C). Antibody readings come out higher in those with gnathostomiasis or non-specifically diagnosed swellings (Soesatyo et al. 1987).

 

             Although gnathostomiasis results from the presence of a helminthic nematode, most antihelminthic chemotherapies have shown to serve as ineffective treatments. Studies in mice have shown that biothonol, thiabendazole, niridazole, diethylcarbamazine, hetol, fouadin, metronidazole, dehydrometine, metrifonate, astiben, lucanthone, hycanthone, Lugol's solution, trodax, and jonit neither eradicate larvae nor disrupt their migration (Rusnak and Lucey 1993). Albendazole has been shown to be useful in treatment of gnathostomiasis, causing larval worms to migrate out from the skin and allowing them to be picked out with needles (Ogata et al. 1998). However, albendazole has also been shown to have significant clinical side effects, such as alopecia, rashes, and GI distress, in a small fraction of patients (Crowley and Kim 1995). Praziquantel also seems to cause outward migration (Ogata et al. 1998). Tests with rabbits have shown that ivermectin might also be suitable for treatment of human gnathostomiasis but no clinical results have been published (Anantaphruti et al. 1992). Mebendazole is now the most common treatment for gnathostomiasis. Even with mebendazole, albendazole, and ivermectin, there is no clear evidence of their effectivity in human gnathostomiasis treatment (Ruiz-Maldonado and Mosqueda-Cabrera 1999). In the absence of chemotherapeutic agents with assured success, the treatment of choice is often surgical removal (Feinstein and Rodriguez-Valdes 1984). Ultimately, prevention is the best therapy for gnathostomiasis.

 

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