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

Fuller AJ, Munckhof W, Kiers L, et al. Eosinophilic meningitis due to Angiostrongylus cantonensis. West J Med. 1993 Jul. 159(1):78-80. [QxMD MEDLINE Link].
Rusnak JM, Lucey DR. Clinical gnathostomiasis: case report and review of the English- language literature. Clin Infect Dis. 1993 Jan. 16(1):33-50. [QxMD MEDLINE Link].
Herman JS, Chiodini PL. Gnathostomiasis, another emerging imported disease. Clin Microbiol Rev. 2009 Jul. 22 (3):484-92. [QxMD MEDLINE Link].
Catalano M, Kaswan D, Levi MH. Wider range for parasites that cause eosinophilic meningitis. Clin Infect Dis. 2009 Oct 15. 49(8):1283. [QxMD MEDLINE Link].
Youn H. Review of zoonotic parasites in medical and veterinary fields in the Republic of Korea. Korean J Parasitol. 2009 Oct. 47 Suppl:S133-41. [QxMD MEDLINE Link]. [Full Text].
Vonghachack Y, Dekumyoy P, Yoonuan T, et al. Sero-epidemiological survey of gnathostomiasis in Lao PDR. Parasitol Int. 2010 Dec. 59(4):599-605. [QxMD MEDLINE Link].
Zambrano-Zaragoza JF, Durán-Avelar Mde J, Messina-Robles M, Vibanco-Pérez N. Characterization of the Humoral Immune Response against Gnathostoma binucleatum in Patients Clinically Diagnosed with Gnathostomiasis. Am J Trop Med Hyg. 2012 Jun. 86(6):988-92. [QxMD MEDLINE Link].
Katchanov J, Sawanyawisuth K, Chotmongkoi V, Nawa Y. Neurognathostomiasis, a neglected parasitosis of the central nervous system. Emerg Infect Dis. 2011 Jul. 17 (7):1174-80. [QxMD MEDLINE Link].
Nawa Y. Historical review and current status of gnathostomiasis in Asia. Southeast Asian J Trop Med Public Health. 1991 Dec. 22 Suppl:217-9. [QxMD MEDLINE Link].
Pillai GS, Kumar A, Radhakrishnan N, Maniyelil J, Shafi T, Dinesh KR. Intraocular gnathostomiasis: report of a case and review of literature. Am J Trop Med Hyg. 2012 Apr. 86(4):620-3. [QxMD MEDLINE Link].
Katchanov J, Sawanyawisuth K, Chotmongkoi V, Nawa Y. Neurognathostomiasis, a neglected parasitosis of the central nervous system. Emerg Infect Dis. 2011 Jul. 17(7):1174-80. [QxMD MEDLINE Link].
Chaves CM, Chaves C, Zoroquiain P, Belfort R Jr, Burnier MN Jr. Ocular Gnathostomiasis in Brazil: A Case Report. Ocul Oncol Pathol. 2016 Apr. 2 (3):194-6. [QxMD MEDLINE Link].
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. 2010 Nov. 41(6):1316-21. [QxMD MEDLINE Link].
Intapan PM, Khotsri P, Kanpittaya J, Chotmongkol V, Sawanyawisuth K, Maleewong W. Immunoblot diagnostic test for neurognathostomiasis. Am J Trop Med Hyg. 2010 Oct. 83(4):927-9. [QxMD MEDLINE Link]. [Full Text].
Kraivichian P, Kulkumthorn M, Yingyourd P, et al. Albendazole for the treatment of human gnathostomiasis. Trans R Soc Trop Med Hyg. 1992 Jul-Aug. 86(4):418-21. [QxMD MEDLINE Link].
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. 2006 May. 37(3):433-40. [QxMD MEDLINE Link].
Freudenmann RW, Lepping P. Delusional infestation. Clin Microbiol Rev. 2009 Oct. 22(4):690-732. [QxMD MEDLINE Link]. [Full Text].
Lee CS. Delusions of parasitosis. Dermatol Ther. 2008 Jan-Feb. 21(1):2-7. [QxMD MEDLINE Link].
Bhattacharjee H, Das D, Medhi J. Intravitreal gnathostomiasis and review of literature. Retina. 2007 Jan. 27(1):67-73. [QxMD MEDLINE Link].
Bunnag T. Gnathostomiasis. Strickland GT, ed. Hunter's Tropical Medicine. 1991. 764-7.
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. 2008 Sep. 39(5):800-3. [QxMD MEDLINE Link].
Cameron ML, Durack DT. Helminthic infections. Scheld WM, Whitley RJ, Durack DT, eds. Infections of the Central Nervous System. Lippincott Williams & Wilkins; 1997. 845-78.
Campista-León S, Delgado-Vargas F, Landa A, Willms K, López-Moreno HS, Mendoza-Hernández G. Identification of immunodominant peptides from Gnathostoma binucleatum. Am J Trop Med Hyg. 2012 Nov. 87(5):888-96. [QxMD MEDLINE Link].
Chai JY, Han ET, Shin EH, et al. An outbreak of gnathostomiasis among Korean emigrants in Myanmar. Am J Trop Med Hyg. 2003 Jul. 69(1):67-73. [QxMD MEDLINE Link]. [Full Text].
Chandenier J, Husson J, Canaple S, et al. Medullary gnathostomiasis in a white patient: use of immunodiagnosis and magnetic resonance imaging. Clin Infect Dis. 2001 Jun 1. 32(11):E154-7. [QxMD MEDLINE Link].
Despommier DD. Tissue nematodes. Long SS, Pickering LK, Prober CG, eds. Principles and Practice of Pediatric Infectious Diseases. Churchill Livingstone; 2003. 1340-7.
Elzi L, Decker M, Battegay M, et al. Chest pain after travel to the tropics. Lancet. 2004 Apr 10. 363(9416):1198. [QxMD MEDLINE Link].
Finsterer J, Auer H. Parasitoses of the human central nervous system. J Helminthol. 2012 Oct 10. 1-14. [QxMD MEDLINE Link].
Fox LM. Ivermectin: uses and impact 20 years on. Curr Opin Infect Dis. 2006 Dec. 19(6):588-93. [QxMD MEDLINE Link].
Germann R, Schachtele M, Nessler G, et al. Cerebral gnathostomiasis as a cause of an extended intracranial bleeding. Klin Padiatr. 2003 Jul-Aug. 215(4):223-5. [QxMD MEDLINE Link].
Gillespie SH. Cutaneous Larva Migrans. Curr Infect Dis Rep. 2004 Feb. 6(1):50-53. [QxMD MEDLINE Link].
Graeff-Teixeira C, da Silva AC, Yoshimura K. Update on eosinophilic meningoencephalitis and its clinical relevance. Clin Microbiol Rev. 2009 Apr. 22(2):322-48, Table of Contents. [QxMD MEDLINE Link].
Gutierrez Y. Other tissue nematode infections. Guerrant RL, Walker DH, Weller PF, eds. Tropical Infectious Diseases: Principles, Pathogens, & Practice. Churchill Livingstone; 1999. 933-48.
Herman JS, Chiodini PL. Gnathostomiasis, another emerging imported disease. Clin Microbiol Rev. 2009 Jul. 22(3):484-92. [QxMD MEDLINE Link]. [Full Text].
High WA, Bravo FG. Emerging diseases in tropical dermatology. Adv Dermatol. 2007. 23:335-50. [QxMD MEDLINE Link].
Intapan PM, Morakote N, Chansung K, Maleewong W. Hypereosinophilia and abdominopulmonary gnathostomiasis. Southeast Asian J Trop Med Public Health. 2008 Sep. 39(5):804-7. [QxMD MEDLINE Link].
Jeremiah CJ, Harangozo CS, Fuller AJ. Gnathostomiasis in remote northern Western Australia: the first confirmed cases acquired in Australia. Med J Aust. 2011 Jul 4. 195(1):42-4. [QxMD MEDLINE Link].
Kraivichian K, Nuchprayoon S, Sitichalernchai P, et al. Treatment of cutaneous gnathostomiasis with ivermectin. Am J Trop Med Hyg. 2004 Nov. 71(5):623-8. [QxMD MEDLINE Link]. [Full Text].
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. 2010 Dec. 126(4):611-6. [QxMD MEDLINE Link].
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. 2007 Aug. 101(3):703-8. [QxMD MEDLINE Link].
Ligon BL. Gnathostomiasis: A review of a previously localized zoonosis now crossing numerous geographical boundaries. Semin Pediatr Infect Dis. 2005 Apr. 16(2):137-43. [QxMD MEDLINE Link].
Magana M, Messina M, Bustamante F, Cazarin J. Gnathostomiasis: clinicopathologic study. Am J Dermatopathol. 2004 Apr. 26(2):91-5. [QxMD MEDLINE Link].
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. 2009 Sep 15. 134(3):163-75. [QxMD MEDLINE Link].
Michaels MG. Eosinophilic meningitis. Long SS, Pickering LK, Prober CG, eds. Principles and Practice of Pediatric Infectious Diseases. Churchill Livingstone; 2003. 312-5.
Moore DA, McCroddan J, Dekumyoy P, Chiodini PL. Gnathostomiasis: an emerging imported disease. Emerg Infect Dis. 2003 Jun. 9(6):647-50. [QxMD MEDLINE Link].
Nawa Y, Hatz C, Blum J. Sushi delights and parasites: the risk of fishborne and foodborne parasitic zoonoses in Asia. Clin Infect Dis. 2005 Nov 1. 41(9):1297-303. [QxMD MEDLINE Link].
Parola P, Bordmann G, Brouqui P, Delmont J. Eosinophilic pleural effusion in gnathostomiasis. Emerg Infect Dis. 2004 Sep. 10(9):1690-91. [QxMD MEDLINE Link].
Pearson RD, Weller PF, Guerrant RL. Chemotherapy of parasitic diseases. Guerrant RL, Walker DH, Weller PF, eds. Tropical Infectious Diseases: Principles, Pathogens, & Practice. Churchill Livingstone; 1999. 215-37.
Preechawat P, Wongwatthana P, Poonyathalang A, Chusattayanond A. Orbital apex syndrome from gnathostomiasis. J Neuroophthalmol. 2006 Sep. 26(3):184-6. [QxMD MEDLINE Link].
Ramirez-Avila L, Slome S, Schuster FL, Gavali S, Schantz PM, Sejvar J. Eosinophilic meningitis due to Angiostrongylus and Gnathostoma species. Clin Infect Dis. 2009 Feb 1. 48(3):322-7. [QxMD MEDLINE Link].
Robertson J, Shilkofski N. Drug doses. The Harriet Lane Handbook: A Manual for Pediatric House Officers. Philadelphia, PA: Mosby; 2005. 679-1009.
Rojas-Molina N, Pedraza-Sanchez S, Torres-Bibiano B, et al. Gnathostomosis, an emerging foodborne zoonotic disease in Acapulco, Mexico. Emerg Infect Dis. 1999 Mar-Apr. 5(2):264-6. [QxMD MEDLINE Link].
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. 2009 Jan. 103(1):102-4. [QxMD MEDLINE Link].
Sithinamsuwan P, Chairangsaris P. Images in clinical medicine. Gnathostomiasis - neuroimaging of larval migration. N Engl J Med. 2005 Jul 14. 353(2):188. [QxMD MEDLINE Link].
Stechenberg BW. Eosinophilic meningitis. Feigin RD, Cherry JD, Fletcher J, eds. Textbook of Pediatric Infectious Diseases. WB Saunders; 2004. 494-6.
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. 2009 Jan. 80(1):33-5. [QxMD MEDLINE Link].
Vargas TJ, Kahler S, Dib C, Cavaliere MB, Jeunon-Sousa MA. Autochthonous gnathostomiasis, Brazil. Emerg Infect Dis. 2012 Dec. 18(12):2087-9. [QxMD MEDLINE Link].
Weller PF. Eosinophilic meningitis. Am J Med. 1993 Sep. 95(3):250-3. [QxMD MEDLINE Link].
Wilson CM, Freedman DO. Antiparasitic agents. Long SS, Pickering LK, Prober CG, eds. Principles and Practice of Pediatric Infectious Diseases. Churchill Livingstone; 2003. 1547-58.
Wilson ME, Chen LH. Dermatologic Infectious Diseases in International Travelers. Curr Infect Dis Rep. 2004 Feb. 6(1):54-62. [QxMD MEDLINE Link].
Wiwanitkit V. Gnathostomiasis and sushi ingestion. Am J Dermatopathol. 2012 Aug. 34(6):675. [QxMD MEDLINE Link].