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Clinical Presentation of Gnathostomiasis in Humans


A creeping eruption on the left wall of the abdomen of a 58-year-old woman (Ogata et al. 1998)

            Individuals infected with gnathostomiasis can develop symptoms as soon as 24 hours after ingestion of a worm. These initial indicators can include malaise, fever, urticaria, anorexia, nausea, vomiting, diarrhea, and epigastric pain (Rusnak and Lucey 1993). Eosinophilia often develops early on due to larval penetration of the gastric or intestinal walls. Once the worms have invaded their new human host, they commonly migrate through the liver, diaphragm, and other tissues, causing their host to feel substantial pain (Ibid). Because humans are not definitive hosts of gnathostoma, the worms can persist for up to 10 years, unable to reach adulthood and reproductive maturity (Taniguchi et al. 1991).

Location of skin lesions in 300 cutaneous gnathostomiasis patients (Camacho et al. 1998).

           Cases of gnathostomiasis have been observed in the pulmonary, ocular, genitourinary, gastrointestinal, auditory, and central nervous systems (Crowley and Kim 1995). Some specialists differentiate between cutaneous and visceral gnathostomiasis (Rusnak and Lucey 1993). However, a single clinical case can involve both cutaneous and visceral regions of the body. All four species of human-infecting Gnathostoma can cause any of the symptoms of gnathostomiasis. 

Fundus photograph of Gnathostoma in vitreous cavity of patient's eye (Biswas et al. 1994). 

             Cutaneous gnathostomiasis is often diagnosed by the presence of migratory edema or creeping eruptions (Ibid). Edema, localized swelling, is the more common of these indicators. However, creeping eruptions, skin abscesses that form due to migration of the larval worm, are a more specific sign for parasite infection. Cutaneous gnathostomiasis is often referred to as larva migrans profundus and nodular migratory eosinophilic panniculitis because of its characteristic effects (Crowley and Kim 1995).

Facial migratory edema in a 42-year-old man (Camacho et al. 1998).

            Visceral gnathostomiasis can take many forms and generally refers to the effects of the parasite inside the body, including within the eye (intraocular), GI tract, the pulmonary circuit, the genitourinary tract, the ear, nose, and throat, and the central nervous system (Rusnak and Lucey 1993). Migratory subcutaneous swellings are common with visceral gnathostomiasis. The effects of parasite presence in the different regions of the body vary, but are all very serious. Two good examples of potential damage are the effects of CNS and introcular gnathostomiasis. Subarachnoid hemorrhage, multiple types of encephalitis, and hydrocephalus have all been associated with CNS gnatostomiasis (Schmutzhard et al. 1988). Although it is not understood how gnathostomae are able to enter the eye, they have been known to irreversibly damage the sensory apparatus of the retina, leading to irreversible blindness (Funata et al. 1993). If left untreated, gnathostomiasis patients can experience significant long-term health issues.    

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