Gnathostomiasis Medication

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

Medication Summary

Although surgical removal, when possible, is the treatment of choice in gnathostomiasis, albendazole appears to have an increasing role in complementing surgical intervention.[11] Ivermectin in a single dose is better tolerated than albendazole but may be less effective.[12] Mebendazole, which was formerly used, had variable results and significant toxicities and should no longer be used. Adjunctive corticosteroid therapy may have a role in the treatment of CNS disease.

Next

Anthelmintics

Class Summary

These agents are the drugs of choice when surgical treatment is not possible or successful. Parasite biochemical pathways are different from the human host, thus toxicity is directed to the parasite, egg, or larvae. The mechanism of action varies within the drug class. Antiparasitic actions may include the following:

  • Inhibition of microtubules that causes irreversible block of glucose uptake
  • Tubulin polymerization inhibition
  • Depolarizing neuromuscular blockade
  • Cholinesterase inhibition
  • Increased cell membrane permeability, resulting in intracellular calcium loss
  • Vacuolization of the schistosome tegument
  • Increased cell membrane permeability to chloride ions via chloride channels alteration
View full drug information

Albendazole (Albenza)

 

The first DOC for treating gnathostomiasis. A synthetic nitroimidazole that binds to tubulin, inhibits microtubule assembly, decreases glucose absorption, and inhibits fumarate reductase in the parasite. Poorly soluble in water, it is well absorbed when taken with a fatty meal. Concentration in the cerebrospinal fluid reaches 40% of that in the serum.

View full drug information

Thiabendazole (Mintezol)

 

A synthetic benzimidazole that should be used only when albendazole is not available because of its toxicities and questionable efficacy. Its mechanism of action is thought to be similar to that of albendazole.

View full drug information

Ivermectin (Mectizan, Stromectol)

 

Binds selectively with glutamate-gated chloride ion channels in invertebrate nerve and muscle cells, causing cell death. Half-life is 16 h; metabolized in liver.

Previous
Next

Corticosteroids

Class Summary

These agents may have an ancillary role in reducing inflammation associated with CNS gnathostomiasis.

View full drug information

Dexamethasone (Decadron, Dexone)

 

Decreases inflammation by suppressing migration of polymorphonuclear leukocytes and reducing capillary permeability.

Previous
Proceed to Follow-up
 
 
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.

References

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

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

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

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

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

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

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

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

  9. 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. Nov 2010;41(6):1316-21. [Medline].

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

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

  12. 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. May 2006;37(3):433-40. [Medline].

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

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

  15. 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. Sep 2008;39(5):800-3. [Medline].

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

  31. 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. Dec 2010;126(4):611-6. [Medline].

  32. 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. Aug 2007;101(3):703-8. [Medline].

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

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

  35. 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. Sep 15 2009;134(3):163-75. [Medline].

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

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

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

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

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

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

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

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

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

  45. 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. Jan 2009;103(1):102-4. [Medline].

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

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

  48. 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. Jan 2009;80(1):33-5. [Medline].

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

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

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

 
Previous
Next
 
 
 
 
All material on this website is protected by copyright, Copyright © 1994-2012 by WebMD LLC.
This website also contains material copyrighted by 3rd parties.

DISCLAIMER: The content of this Website is not influenced by sponsors. The site is designed primarily for use by qualified physicians and other medical professionals. The information contained herein should NOT be used as a substitute for the advice of an appropriately qualified and licensed physician or other health care provider. The information provided here is for educational and informational purposes only. In no way should it be considered as offering medical advice. Please check with a physician if you suspect you are ill.