eMedicine Specialties > Pediatrics: General Medicine > Parasitology

Gnathostomiasis: Follow-up

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

Follow-up

Further Inpatient Care

  • The need for inpatient care of patients with gnathostomiasis depends on the clinical presentation of the infection.

Further Outpatient Care

  • Most patients are treated on an outpatient basis, as the clinical circumstances dictate, except in cases with complications or CNS involvement.

Transfer

  • The need for transfer depends on the availability of necessary services and specialists.

Deterrence/Prevention

  • Emphasize the need to avoid exposure.
  • Ingestion of raw and undercooked food should be avoided in endemic areas.
  • Freezing meat at -20°C for 3-5 days kills the larvae.
  • Marinating meat in vinegar for 6 hours or in soy sauce for 12 hours kills the larvae.
  • Lime juice does not kill the larvae, even with prolonged exposure.
  • Contaminated water should be boiled for 5 minutes before use.
  • Gloves should be worn or the hands should be washed frequently if exposure to possibly contaminated water or flesh is likely.

Complications

  • In Thailand, 6% of subarachnoid hemorrhages in adults and 18% of those in infants and children are due to gnathostomiasis.
  • Pneumonia, sepsis, paralysis, and/or long-term neurologic sequelae are possible.

Prognosis

  • Gnathostomiasis is seldom fatal, except in CNS disease.
  • Long-term morbidity is possible because of tissue injury during migration.
  • With CNS disease, the mortality rate is 8-25%; one third of survivors have long-term sequelae.

Miscellaneous

Medicolegal Pitfalls

  • Epidemiology is the key to the diagnosis of gnathostomiasis.
    • Obtain the patient's travel and dietary history.
    • Ask about significant exposures.
  • Failure to consider the diagnosis in the appropriate clinical setting is a pitfall.

Special Concerns

  • Pregnancy
    • Three documented cases of intrauterine transmission of gnathostomiasis have been reported.
    • The use of antiparasitic agents is contraindicated in pregnancy.
 


More on Gnathostomiasis

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