Gnathostomiasis Clinical Presentation

  • Author: Robert W Tolan Jr, MD; Chief Editor: Russell W Steele, MD   more...
 
Updated: Jan 9, 2012
 

History

In patients with gnathostomiasis, mild malaise, fever, urticaria, anorexia, nausea, vomiting, diarrhea, and epigastric pain may occur 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 migration of the larvae.

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

CNS findings include the following[6] :

  • Radiculomyelitis (most common), radiculomyeloencephalitis, encephalitis, and/or meningitis may result. Condition may mimic or cause subarachnoid hemorrhage.
  • Agonizing neuritic pain followed by paralysis or decreased sensorium over a few days is typical.
  • Migration of focal neurologic symptoms and signs (eg, cranial nerve palsies, paralysis of an extremity, urinary retention) is typical. With eosinophilic meningitis caused by A cantonensis, CNS depression, low-grade fevers, headache, and nonfocal neurologic symptoms and signs (except for occasional cranial nerve VII or VIII involvement) are more typical.
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Physical

Physical examination findings depend on the area of the body into which the larvae migrate. Single or multiple regions may be involved.

Skin and soft tissue

  • Panniculitis
  • Intense, nonpitting edema
  • Creeping eruptions
  • Subcutaneous nodules or abscesses

Pulmonary

  • Lobar consolidation or collapse
  • Pleural effusions
  • Pneumothorax
  • Hydropneumothorax

GI

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

Ophthalmologic

  • Uveitis
  • Iritis
  • Intraocular hemorrhage
  • Increased intraocular pressure
  • Retinal scarring/detachment

CNS

  • Fever, stiff neck, and/or photophobia
  • Evidence of increased intracranial pressure
  • Migratory focal neurologic findings
  • Paralysis, cranial nerve involvement, and/or urinary retention
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Causes

Travel to or from an endemic area

  • Southeast Asia, especially Thailand and Japan
  • Latin America, especially Mexico and Ecuador
  • Australia
  • Asia and the Middle East

Dietary/occupational exposure or ingestion

  • Raw or undercooked freshwater fish (ceviche in Mexico and South America, sashimi in Japan, sum-fak in Thailand)
  • Other raw or undercooked flesh
  • Contaminated water
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Contributor Information and Disclosures
Author

Robert W Tolan Jr, MD  Chief, Division of Allergy, Immunology and Infectious Diseases, The Children's Hospital at Saint Peter's University Hospital; Clinical Associate Professor of Pediatrics, Drexel University College of Medicine

Robert W Tolan Jr, MD is a member of the following medical societies: American Academy of Pediatrics, American Medical Association, American Society for Microbiology, American Society of Tropical Medicine and Hygiene, Infectious Diseases Society of America, Pediatric Infectious Diseases Society, Phi Beta Kappa, and Physicians for Social Responsibility

Disclosure: Novartis Honoraria Speaking and teaching

Specialty Editor Board

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.

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.

Martin Weisse, MD  Program Director, Associate Professor, Department of Pediatrics, West Virginia University

Martin Weisse, MD is a member of the following medical societies: Ambulatory Pediatric Association, American Academy of Pediatrics, and Pediatric Infectious Diseases Society

Disclosure: Nothing to disclose.

Daniel Rauch, MD, FAAP  Director, Pediatric Hospitalist Program, Associate Professor, Department of Pediatrics, New York University School of Medicine

Daniel Rauch, MD, FAAP is a member of the following medical societies: Ambulatory Pediatric Association, American Academy of Pediatrics, and Society of Hospital Medicine

Disclosure: Baxter Honoraria Consulting

Chief Editor

Russell W Steele, MD  Head, Division of Pediatric Infectious Diseases, Ochsner Children's Health Center; Clinical Professor, Department of Pediatrics, Tulane University School of Medicine

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, and Southern Medical Association

Disclosure: Nothing to disclose.

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