Gnathostomiasis Workup

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

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.[9]
  • Immunoblot testing for neurologic disease has been described.[10]
  • These tests are not widely available in the United States and many other countries.
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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.
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Other Tests

Sputum examination may reveal a worm.

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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
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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.

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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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