Medscape is available in 5 Language Editions – Choose your Edition here.


Gnathostomiasis Clinical Presentation

  • Author: Germaine L Defendi, MD, MS, FAAP; Chief Editor: Russell W Steele, MD  more...
Updated: Jun 20, 2015


Patients with gnathostomiasis may complain of mild malaise, fever, urticaria, anorexia, nausea, vomiting, diarrhea, and epigastric pain as the larvae migrate through the gastric and/or intestinal wall. Right upper quadrant pain may accompany the liver-migration phase of the illness. Further symptoms depend on the subsequent larval migration to different parts of the body.

  • Skin and soft tissue - One or more areas involved with tenderness or swelling; creeping eruptions; pain, pruritus, and erythema; nodules or boils
  • Ophthalmologic - Decreased visual acuity, blindness, pain, and/or photophobia[10] due to migration of larvae along optic nerves
  • Otologic - Decreased hearing and/or tinnitus
  • Pulmonary - Cough, chest pain, dyspnea, and/or hemoptysis; coughing up of worm segments
  • GI - May mimic appendicitis, cholecystitis, or an intestinal mass lesion
  • Genitourinary - Hematuria

CNS involvement includes the following:[11, 3]

  • Radiculomyelitis (most common), radiculomyeloencephalitis, encephalitis
  • Low-grade fevers, headache, CNS depression and nonfocal neurologic symptoms
  • Eosinophilic meningitis
  • Subarachnoid hemorrhage
  • Excruciating radicular pain and or headache followed by paralysis, cranial nerve palsies or decreased sensorium over a few days
  • Migration of focal neurologic symptoms (eg, cranial nerve palsies, paralysis of an extremity, urinary retention)


Physical examination findings depend on the area of the body into which the larvae migrate. Single or multiple regions of the body may be involved. The main areas affected are cutaneous, ocular, visceral and neurological.


Skin and soft tissue:

  • Nodular migratory panniculitis (inflammation of the subcutaneous fat), especially of the trunk and upper extremities
  • Nonpitting edematous swelling
  • Creeping eruptions
  • Subcutaneous nodules or abscesses



  • Uveitis (usually anterior)
  • Iritis
  • Intraocular hemorrhage
  • Increased intraocular pressure, glaucoma
  • Retinal scarring/detachment



  • Pleuritic chest pain accompanied by cough
  • Lobar consolidation or collapse
  • Pleural effusions
  • Pneumothorax, hydropneumothorax


  • Tender right upper quadrant, mid-epigastrium, and/or right lower quadrant
  • Right lower quadrant mass
  • Hematuria



  • Fever, stiff neck, and/or photophobia (clinical indicators of meningitis)
  • Clinical signs of increased intracranial pressure
  • Migratory focal neurologic findings
  • Paralysis, cranial nerve involvement, and/or urinary retention


Travel to or from an endemic area

See the list below:

  • Southeast Asia, especially Thailand
  • Japan
  • China
  • Latin America, especially Mexico and Ecuador
  • Western Australia
  • South Central Africa

Dietary/occupational exposure or ingestion

See the list below:

  • Raw or undercooked freshwater fish (ceviche in Mexico and South America, sashimi in Japan, sum-fak in Thailand). Nematode larvae not present in saltwater fish.
  • Other raw or undercooked flesh
  • Contaminated freshwater
Contributor Information and Disclosures

Germaine L Defendi, MD, MS, FAAP Associate Clinical Professor, Department of Pediatrics, Olive View-UCLA Medical Center

Germaine L Defendi, MD, MS, FAAP is a member of the following medical societies: American Academy of Pediatrics

Disclosure: Nothing to disclose.

Specialty Editor Board

Mary L Windle, PharmD Adjunct Associate Professor, University of Nebraska Medical Center College of Pharmacy; Editor-in-Chief, Medscape Drug Reference

Disclosure: Nothing to disclose.

Chief Editor

Russell W Steele, MD Clinical Professor, Tulane University School of Medicine; Staff Physician, Ochsner Clinic Foundation

Russell W Steele, MD is a member of the following medical societies: American Academy of Pediatrics, American Association of Immunologists, American Pediatric Society, American Society for Microbiology, Infectious Diseases Society of America, Louisiana State Medical Society, Pediatric Infectious Diseases Society, Society for Pediatric Research, Southern Medical Association

Disclosure: Nothing to disclose.

Additional Contributors

Glenn Fennelly, MD, MPH Director, Division of Infectious Diseases, Lewis M Fraad Department of Pediatrics, Jacobi Medical Center; Clinical Associate Professor of Pediatrics, Albert Einstein College of Medicine

Glenn Fennelly, MD, MPH is a member of the following medical societies: Pediatric Infectious Diseases Society

Disclosure: Nothing to disclose.

  1. Fuller AJ, Munckhof W, Kiers L, et al. Eosinophilic meningitis due to Angiostrongylus cantonensis. West J Med. 1993 Jul. 159(1):78-80. [Medline].

  2. Rusnak JM, Lucey DR. Clinical gnathostomiasis: case report and review of the English- language literature. Clin Infect Dis. 1993 Jan. 16(1):33-50. [Medline].

  3. Herman JS, Chiodini PL. Gnathostomiasis, another emerging imported disease. Clin Microbiol Rev. 2009 Jul. 22 (3):484-92. [Medline].

  4. Catalano M, Kaswan D, Levi MH. Wider range for parasites that cause eosinophilic meningitis. Clin Infect Dis. 2009 Oct 15. 49(8):1283. [Medline].

  5. Youn H. Review of zoonotic parasites in medical and veterinary fields in the Republic of Korea. Korean J Parasitol. 2009 Oct. 47 Suppl:S133-41. [Medline]. [Full Text].

  6. Vonghachack Y, Dekumyoy P, Yoonuan T, et al. Sero-epidemiological survey of gnathostomiasis in Lao PDR. Parasitol Int. 2010 Dec. 59(4):599-605. [Medline].

  7. Zambrano-Zaragoza JF, Durán-Avelar Mde J, Messina-Robles M, Vibanco-Pérez N. Characterization of the Humoral Immune Response against Gnathostoma binucleatum in Patients Clinically Diagnosed with Gnathostomiasis. Am J Trop Med Hyg. 2012 Jun. 86(6):988-92. [Medline].

  8. Katchanov J, Sawanyawisuth K, Chotmongkoi V, Nawa Y. Neurognathostomiasis, a neglected parasitosis of the central nervous system. Emerg Infect Dis. 2011 Jul. 17 (7):1174-80. [Medline].

  9. Nawa Y. Historical review and current status of gnathostomiasis in Asia. Southeast Asian J Trop Med Public Health. 1991 Dec. 22 Suppl:217-9. [Medline].

  10. Pillai GS, Kumar A, Radhakrishnan N, Maniyelil J, Shafi T, Dinesh KR. Intraocular gnathostomiasis: report of a case and review of literature. Am J Trop Med Hyg. 2012 Apr. 86(4):620-3. [Medline].

  11. Katchanov J, Sawanyawisuth K, Chotmongkoi V, Nawa Y. Neurognathostomiasis, a neglected parasitosis of the central nervous system. Emerg Infect Dis. 2011 Jul. 17(7):1174-80. [Medline].

  12. Bussaratid V, Dekumyoy P, Desakorn V, Jaroensuk N, Liebtawee B, Pakdee W, et al. Predictive factors for Gnathostoma seropositivity in patients visiting the Gnathostomiasis Clinic at the Hospital for Tropical Diseases, Thailand during 2000-2005. Southeast Asian J Trop Med Public Health. 2010 Nov. 41(6):1316-21. [Medline].

  13. Intapan PM, Khotsri P, Kanpittaya J, Chotmongkol V, Sawanyawisuth K, Maleewong W. Immunoblot diagnostic test for neurognathostomiasis. Am J Trop Med Hyg. 2010 Oct. 83(4):927-9. [Medline]. [Full Text].

  14. Kraivichian P, Kulkumthorn M, Yingyourd P, et al. Albendazole for the treatment of human gnathostomiasis. Trans R Soc Trop Med Hyg. 1992 Jul-Aug. 86(4):418-21. [Medline].

  15. Bussaratid V, Desakorn V, Krudsood S, et al. Efficacy of ivermectin treatment of cutaneous gnathostomiasis evaluated by placebo-controlled trial. Southeast Asian J Trop Med Public Health. 2006 May. 37(3):433-40. [Medline].

  16. Freudenmann RW, Lepping P. Delusional infestation. Clin Microbiol Rev. 2009 Oct. 22(4):690-732. [Medline]. [Full Text].

  17. Lee CS. Delusions of parasitosis. Dermatol Ther. 2008 Jan-Feb. 21(1):2-7. [Medline].

  18. Bhattacharjee H, Das D, Medhi J. Intravitreal gnathostomiasis and review of literature. Retina. 2007 Jan. 27(1):67-73. [Medline].

  19. Bunnag T. Gnathostomiasis. Strickland GT, ed. Hunter's Tropical Medicine. 1991. 764-7.

  20. Bunyaratavej K, Pongpunlert W, Jongwutiwes S, Likitnukul S. Spinal gnathostomiasis resembling an intrinsic cord tumor/myelitis in a 4-year-old boy. Southeast Asian J Trop Med Public Health. 2008 Sep. 39(5):800-3. [Medline].

  21. Cameron ML, Durack DT. Helminthic infections. Scheld WM, Whitley RJ, Durack DT, eds. Infections of the Central Nervous System. Lippincott Williams & Wilkins; 1997. 845-78.

  22. Campista-León S, Delgado-Vargas F, Landa A, Willms K, López-Moreno HS, Mendoza-Hernández G. Identification of immunodominant peptides from Gnathostoma binucleatum. Am J Trop Med Hyg. 2012 Nov. 87(5):888-96. [Medline].

  23. Chai JY, Han ET, Shin EH, et al. An outbreak of gnathostomiasis among Korean emigrants in Myanmar. Am J Trop Med Hyg. 2003 Jul. 69(1):67-73. [Medline]. [Full Text].

  24. Chandenier J, Husson J, Canaple S, et al. Medullary gnathostomiasis in a white patient: use of immunodiagnosis and magnetic resonance imaging. Clin Infect Dis. 2001 Jun 1. 32(11):E154-7. [Medline].

  25. Despommier DD. Tissue nematodes. Long SS, Pickering LK, Prober CG, eds. Principles and Practice of Pediatric Infectious Diseases. Churchill Livingstone; 2003. 1340-7.

  26. Elzi L, Decker M, Battegay M, et al. Chest pain after travel to the tropics. Lancet. 2004 Apr 10. 363(9416):1198. [Medline].

  27. Finsterer J, Auer H. Parasitoses of the human central nervous system. J Helminthol. 2012 Oct 10. 1-14. [Medline].

  28. Fox LM. Ivermectin: uses and impact 20 years on. Curr Opin Infect Dis. 2006 Dec. 19(6):588-93. [Medline].

  29. Germann R, Schachtele M, Nessler G, et al. Cerebral gnathostomiasis as a cause of an extended intracranial bleeding. Klin Padiatr. 2003 Jul-Aug. 215(4):223-5. [Medline].

  30. Gillespie SH. Cutaneous Larva Migrans. Curr Infect Dis Rep. 2004 Feb. 6(1):50-53. [Medline].

  31. Graeff-Teixeira C, da Silva AC, Yoshimura K. Update on eosinophilic meningoencephalitis and its clinical relevance. Clin Microbiol Rev. 2009 Apr. 22(2):322-48, Table of Contents. [Medline].

  32. Gutierrez Y. Other tissue nematode infections. Guerrant RL, Walker DH, Weller PF, eds. Tropical Infectious Diseases: Principles, Pathogens, & Practice. Churchill Livingstone; 1999. 933-48.

  33. Herman JS, Chiodini PL. Gnathostomiasis, another emerging imported disease. Clin Microbiol Rev. 2009 Jul. 22(3):484-92. [Medline]. [Full Text].

  34. High WA, Bravo FG. Emerging diseases in tropical dermatology. Adv Dermatol. 2007. 23:335-50. [Medline].

  35. Intapan PM, Morakote N, Chansung K, Maleewong W. Hypereosinophilia and abdominopulmonary gnathostomiasis. Southeast Asian J Trop Med Public Health. 2008 Sep. 39(5):804-7. [Medline].

  36. Jeremiah CJ, Harangozo CS, Fuller AJ. Gnathostomiasis in remote northern Western Australia: the first confirmed cases acquired in Australia. Med J Aust. 2011 Jul 4. 195(1):42-4. [Medline].

  37. Kraivichian K, Nuchprayoon S, Sitichalernchai P, et al. Treatment of cutaneous gnathostomiasis with ivermectin. Am J Trop Med Hyg. 2004 Nov. 71(5):623-8. [Medline]. [Full Text].

  38. Laummaunwai P, Intapan PM, Wongkham C, Lulitanond V, Tayapiwatana C, Maleewong W. Gnathostoma spinigerum: molecular cloning, expression and characterization of the cyclophilin protein. Exp Parasitol. 2010 Dec. 126(4):611-6. [Medline].

  39. Laummaunwai P, Sawanyawisuth K, Intapan PM, Chotmongkol V, Wongkham C, Maleewong W. Evaluation of human IgG class and subclass antibodies to a 24 kDa antigenic component of Gnathostoma spinigerum for the serodiagnosis of gnathostomiasis. Parasitol Res. 2007 Aug. 101(3):703-8. [Medline].

  40. Ligon BL. Gnathostomiasis: A review of a previously localized zoonosis now crossing numerous geographical boundaries. Semin Pediatr Infect Dis. 2005 Apr. 16(2):137-43. [Medline].

  41. Magana M, Messina M, Bustamante F, Cazarin J. Gnathostomiasis: clinicopathologic study. Am J Dermatopathol. 2004 Apr. 26(2):91-5. [Medline].

  42. Magnino S, Colin P, Dei-Cas E, Madsen M, McLauchlin J, Nöckler K, et al. Biological risks associated with consumption of reptile products. Int J Food Microbiol. 2009 Sep 15. 134(3):163-75. [Medline].

  43. Michaels MG. Eosinophilic meningitis. Long SS, Pickering LK, Prober CG, eds. Principles and Practice of Pediatric Infectious Diseases. Churchill Livingstone; 2003. 312-5.

  44. Moore DA, McCroddan J, Dekumyoy P, Chiodini PL. Gnathostomiasis: an emerging imported disease. Emerg Infect Dis. 2003 Jun. 9(6):647-50. [Medline].

  45. Nawa Y, Hatz C, Blum J. Sushi delights and parasites: the risk of fishborne and foodborne parasitic zoonoses in Asia. Clin Infect Dis. 2005 Nov 1. 41(9):1297-303. [Medline].

  46. Parola P, Bordmann G, Brouqui P, Delmont J. Eosinophilic pleural effusion in gnathostomiasis. Emerg Infect Dis. 2004 Sep. 10(9):1690-91. [Medline].

  47. Pearson RD, Weller PF, Guerrant RL. Chemotherapy of parasitic diseases. Guerrant RL, Walker DH, Weller PF, eds. Tropical Infectious Diseases: Principles, Pathogens, & Practice. Churchill Livingstone; 1999. 215-37.

  48. Preechawat P, Wongwatthana P, Poonyathalang A, Chusattayanond A. Orbital apex syndrome from gnathostomiasis. J Neuroophthalmol. 2006 Sep. 26(3):184-6. [Medline].

  49. Ramirez-Avila L, Slome S, Schuster FL, Gavali S, Schantz PM, Sejvar J. Eosinophilic meningitis due to Angiostrongylus and Gnathostoma species. Clin Infect Dis. 2009 Feb 1. 48(3):322-7. [Medline].

  50. Robertson J, Shilkofski N. Drug doses. The Harriet Lane Handbook: A Manual for Pediatric House Officers. Philadelphia, PA: Mosby; 2005. 679-1009.

  51. Rojas-Molina N, Pedraza-Sanchez S, Torres-Bibiano B, et al. Gnathostomosis, an emerging foodborne zoonotic disease in Acapulco, Mexico. Emerg Infect Dis. 1999 Mar-Apr. 5(2):264-6. [Medline].

  52. Sawanyawisuth K, Chlebicki MP, Pratt E, Kanpittaya J, Intapan PM. Sequential imaging studies of cerebral gnathostomiasis with subdural hemorrhage as its complication. Trans R Soc Trop Med Hyg. 2009 Jan. 103(1):102-4. [Medline].

  53. Sithinamsuwan P, Chairangsaris P. Images in clinical medicine. Gnathostomiasis - neuroimaging of larval migration. N Engl J Med. 2005 Jul 14. 353(2):188. [Medline].

  54. Stechenberg BW. Eosinophilic meningitis. Feigin RD, Cherry JD, Fletcher J, eds. Textbook of Pediatric Infectious Diseases. WB Saunders; 2004. 494-6.

  55. Strady C, Dekumyoy P, Clement-Rigolet M, Danis M, Bricaire F, Caumes E. Long-term follow-up of imported gnathostomiasis shows frequent treatment failure. Am J Trop Med Hyg. 2009 Jan. 80(1):33-5. [Medline].

  56. Vargas TJ, Kahler S, Dib C, Cavaliere MB, Jeunon-Sousa MA. Autochthonous gnathostomiasis, Brazil. Emerg Infect Dis. 2012 Dec. 18(12):2087-9. [Medline].

  57. Weller PF. Eosinophilic meningitis. Am J Med. 1993 Sep. 95(3):250-3. [Medline].

  58. Wilson CM, Freedman DO. Antiparasitic agents. Long SS, Pickering LK, Prober CG, eds. Principles and Practice of Pediatric Infectious Diseases. Churchill Livingstone; 2003. 1547-58.

  59. Wilson ME, Chen LH. Dermatologic Infectious Diseases in International Travelers. Curr Infect Dis Rep. 2004 Feb. 6(1):54-62. [Medline].

  60. Wiwanitkit V. Gnathostomiasis and sushi ingestion. Am J Dermatopathol. 2012 Aug. 34(6):675. [Medline].

All material on this website is protected by copyright, Copyright © 1994-2016 by WebMD LLC. This website also contains material copyrighted by 3rd parties.