History

Patients with gnathostomiasis may complain of mild malaise, fever, urticaria, anorexia, nausea, vomiting, diarrhea, and epigastric pain 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 larval migration to different parts of the body.

Skin and soft tissue - One or more areas involved with tenderness or swelling; creeping eruptions; pain, pruritus, and erythema; nodules or boils
Ophthalmologic - Decreased visual acuity, blindness, pain, and/or photophobia^[10]due to migration of larvae along optic nerves
Otologic - Decreased hearing and/or tinnitus
Pulmonary - Cough, chest pain, dyspnea, and/or hemoptysis; coughing up of worm segments
GI - May mimic appendicitis, cholecystitis, or an intestinal mass lesion
Genitourinary - Hematuria

CNS involvement includes the following:^{[11, 3]}

Radiculomyelitis (most common), radiculomyeloencephalitis, encephalitis
Low-grade fevers, headache, CNS depression and nonfocal neurologic symptoms
Eosinophilic meningitis
Subarachnoid hemorrhage
Excruciating radicular pain and or headache followed by paralysis, cranial nerve palsies or decreased sensorium over a few days
Migration of focal neurologic symptoms (eg, cranial nerve palsies, paralysis of an extremity, urinary retention)

Physical

Physical examination findings depend on the area of the body into which the larvae migrate. Single or multiple regions of the body may be involved. The main areas affected are cutaneous, ocular,^[12]visceral and neurological.

Cutaneous

Skin and soft tissue:

Nodular migratory panniculitis (inflammation of the subcutaneous fat), especially of the trunk and upper extremities
Nonpitting edematous swelling
Creeping eruptions
Subcutaneous nodules or abscesses

Ocular

Eyes:

Uveitis (usually anterior)
Iritis
Intraocular hemorrhage
Increased intraocular pressure, glaucoma
Retinal scarring/detachment

Visceral

Pulmonary:

Pleuritic chest pain accompanied by cough
Lobar consolidation or collapse
Pleural effusions
Pneumothorax, hydropneumothorax

Gastrointestinal/genitourinary:

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

Neurological

CNS:

Fever, stiff neck, and/or photophobia (clinical indicators of meningitis)
Clinical signs of increased intracranial pressure
Migratory focal neurologic findings
Paralysis, cranial nerve involvement, and/or urinary retention

Travel to or from an endemic area

See the list below:

Southeast Asia, especially Thailand
Japan
China
Latin America, especially Mexico and Ecuador
Western Australia
South Central Africa

Dietary/occupational exposure or ingestion

See the list below:

Raw or undercooked freshwater fish (ceviche in Mexico and South America, sashimi in Japan, sum-fak in Thailand). Nematode larvae not present in saltwater fish.
Other raw or undercooked flesh
Contaminated freshwater

Differential Diagnoses

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