eMedicine Specialties > Pediatrics: General Medicine > Parasitology

Gnathostomiasis: Differential Diagnoses & Workup

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
Contributor Information and Disclosures

Updated: Jan 22, 2009

Differential Diagnoses

Amebic Meningoencephalitis
Fascioliasis
Ancylostoma Infection
Fibromyalgia
Angioedema
Filariasis
Appendicitis
Hookworm Infection
Ascariasis
Hymenolepiasis
Bancroftian Filariasis
Hypereosinophilic Syndrome
Childhood Cancer, Epidemiology
Intestinal Protozoal Diseases
Cholecystitis
Meningitis, Aseptic
Chorioretinitis
Meningitis, Bacterial
Coccidioidomycosis
Neurocysticercosis
Cutaneous Larva Migrans
Paragonimiasis
Cysticercosis
Schistosomiasis
Diphyllobothrium Latum Infection
Strongyloidiasis
Dirofilariasis
Taenia Infection
Dracunculiasis
Echinococcosis

Other Problems to Be Considered

Angiostrongylus cantonensis
Baylisascaris procyonis
Cysticercus cellulosae
Encephalitis
Eosinophilia-myalgia syndrome
Loa loa
Pentastomiasis
Sparganosis
Subarachnoid hemorrhage

Workup

Laboratory Studies

The following studies are indicated in gnathostomiasis:

  • CBC count
    • Eosinophilia may be present, particularly during the active phases of larval migration. Eosinophils may exceed 50% of the circulating WBCs.
    • Findings may reveal leukocytosis.
  • Urinalysis
    • Rarely, microscopic hematuria is present.
    • The worm may be found.
  • Serology
    • Enzyme-linked immunosorbent assay (ELISA) and the Western blot are promising diagnostic tests.
    • These tests are not widely available in the United States and many other countries.

Imaging Studies

  • Plain radiography - Pulmonary or GI findings
  • Xerography - Rarely helps in localizing a soft tissue worm
  • CT
    • CT rarely helps in localizing a soft tissue worm.
    • In CNS disease, CT may reveal evidence of intracranial hemorrhage, obstructive hydrocephalus, or meningeal inflammation in one half of the cases.

Other Tests

  • Sputum examination may reveal a worm.

Procedures

  • Surgical excision and/or resection rarely help in making the diagnosis by revealing the larvae in the skin, subcutaneous tissue, gingivae, or wounds.
  • Lumbar puncture may be helpful.
    • Pleocytosis (20-1430 WBCs, but typically <500, with a mean of 250)
    • Eosinophilia (5-94%, with a mean of 38%)
    • Xanthochromia, some RBCs

Histologic Findings

  • When found, larvae are 2.5-12.5 mm by 0.4-1.2 mm. In tissue, eosinophils predominate, with the presence of fibroblasts, histiocytes, and foreign-body giant cells; this finding may suggest an eosinophilic granuloma.
  • In the CNS, migratory tracts may be present with perivascular infiltration of eosinophils, plasma cells, and lymphocytes. Unlike eosinophilic meningitis due to A cantonensis, no CNS granulomata or parasite fragments are observed.

More on Gnathostomiasis

Overview: Gnathostomiasis
Differential Diagnoses & Workup: Gnathostomiasis
Treatment & Medication: Gnathostomiasis
Follow-up: Gnathostomiasis
References
Further Reading
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References

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Further Reading

See Image 18 at the McGill Faculty of Medicine Web site.

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Keywords

gnathostomiasis, CNS infection, chokofishi, consular disease, encephalitis, eosinophilia, eosinophilic meningitis, eosinophilic myeloencephalitis, Gnathostoma binucleatum, G binucleatum, G doloresi, G hispidum, G nipponicum, G procyonis, G spinigerum, hematuria, hydropneumothorax, intraocular hemorrhage, iritis, meningitis, nodular (migratory) eosinophilic panniculitis, panniculitis, parasitic infection, photophobia, pleural effusions, pneumothorax, radiculomyelitis, radiculomyeloencephalitis, Shanghai rheumatism, Tau-cheed, tinnitus, urticaria, uveitis, Woodbury bug, Yangtze River edema

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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: GlaxoSmithKline Honoraria Speaking and teaching; MedImmune Honoraria Consulting; MedImmune Honoraria Speaking and teaching; Merck Honoraria Speaking and teaching; Novartis Honoraria Speaking and teaching; sanofi pasteur Grant/research funds Unrestricted research grant; sanofi pasteur  Consulting; sanofi pasteur Honoraria Speaking and teaching; Tap Honoraria Speaking and teaching; Baxter Healthcare Honoraria Speaking and teaching

Medical Editor

Glenn J Fennelly, MD, MPH, Director, Division of Pediatric Infectious Diseases, Jacobi Medical Center; Associate Professor, Department of Pediatrics, Albert Einstein College of Medicine
Glenn J Fennelly, MD, MPH is a member of the following medical societies: Pediatric Infectious Diseases Society
Disclosure: Nothing to disclose.

Pharmacy Editor

Mary L Windle, PharmD, Adjunct Assistant Professor, University of Nebraska Medical Center College of Pharmacy, Pharmacy Editor, eMedicine
Disclosure: Pfizer Inc Stock Investment from financial planner; Avanir Pharma Stock Investment from financial planner ; WebMD Salary and stock Employment and investment from financial planner

Managing Editor

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.

CME Editor

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; Pfizer 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: None None None

 
 
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