Gnatostomiasis cutánea, primer caso confirmado en Colombia / Cutaneous gnathostomiasis, first confirmed case in Colombia

La gnatostomiasis es una zoonosis parasitaria causada por algunas especies del género de helmintos Gnathostoma . La presentación clínica es muy variada y su diagnóstico constituye un desafío; es endémica en países tropicales y subtropicales, y la transmisión se asocia con el consumo de carne de animales acuáticos, cruda o mal cocida. En las últimas décadas, el creciente turismo internacional y el consumo de alimentos exóticos, han provocado un notable aumento de casos de la enfermedad. En nuestro país no se ha reportado ningún caso confirmado de gnatostomiasis. Se presenta el caso de un hombre colombiano de 63 años de edad, viajero frecuente al exterior, que consultó por presentar síntomas gastrointestinales. Durante la hospitalización desarrolló una lesión cutánea en el flanco abdominal derecho, de la cual se extrajo una larva cuya descripción morfológica permitió clasificarla como Gnathostoma spinigerum . Se trata de la primera confirmación de un caso importado de gnatostomiasis en Colombia. En este artículo se discuten las generalidades, la etiología, la patogenia y el tratamiento de la enfermedad, con especial énfasis en las características particulares de este paciente.

Gnathostomiasis is a parasitic zoonosis caused by some species of helminthes belonging to the genus Gnathostoma . It has a wide clinical presentation and its diagnosis is a challenge. Tropical and subtropical countries are endemic, and its transmission is associated with eating raw or undercooked meat from fresh water animals. Increasing global tourism and consuming exotic foods have produced a noticeable rise in cases of the disease in the last decades. However, in our country, there has not been any confirmed case of gnathostomiasis previously reported. We present the case of a 63-year-old Colombian man with an international travel history, who presented with gastrointestinal symptoms. During the hospital stay, he developed a cutaneous lesion on the upper right abdominal quadrant, where later, a larva was found. A morphological study allowed us to identify it as Gnathostoma spinigerum . As such, this is the first report of an imported case of gnathostomiasis confirmed in Colombia. This article describes the principles, etiology, pathogenic cycle and treatment of this disease with special considerations to our patient´s particular features.

Gnathostoma spinigerum Infection in the Upper Lip of a Korean Woman: An Autochthonous Case in Korea

Autochthonous human gnathostomiasis had never been reported in the Republic of Korea. We report here a case of Gnathostoma spinigerum infection in a 32-year-old Korean woman, presumed to have been infected via an indigenous route. The patient had experienced a painful migratory swelling near the left nasolabial fold area of the face for a year, with movement of the swelling to the mucosal area of the upper lip 2 weeks before surgical removal of the lesion. Histopathological examinations of the extracted tissue revealed inflammation with heavy eosinophilic infiltrations and sections of a nematode suggestive of a Gnathostoma sp. larva. The larva characteristically revealed about 25 intestinal cells with multiple (3-6) nuclei in each intestinal cell consistent with the 3rd-stage larva of G. spinigerum. The patient did not have any special history of travel abroad except a recent trip, 4 months before surgery, to China where she ate only cooked food. The patient is the first recorded autochthonous case of G. spinigerum infection in Korea.

Positivity and Intensity of Gnathostoma spinigerum Infective Larvae in Farmed and Wild-Caught Swamp Eels in Thailand

From July 2008 to June 2009, livers of the swamp eels (Monopterus alba) were investigated for advanced third-stage larvae (AL3) of Gnathostoma spinigerum. Results revealed that 10.2% (106/1,037) and 20.4% (78/383) of farmed eels from Aranyaprathet District, Sa Kaeo Province and those of wild-caught eels obtained from a market in Min Buri District of Bangkok, Thailand were infected, respectively. The prevalence was high during the rainy and winter seasons. The infection rate abruptly decreased in the beginning of summer. The highest infection rate (13.7%) was observed in September and absence of infection (0%) in March-April in the farmed eels. Whereas, in the wild-caught eels, the highest rate (30.7%) was observed in November, and the rate decreased to the lowest at 6.3% in March. The average no. (mean+/-SE) of AL3 per investigated liver in farmed eels (1.1+/-0.2) was significantly lower (P=0.040) than those in the caught eels (0.2+/-0.03). In addition, the intensity of AL3 recovered from each infected liver varied from 1 to 18 (2.3+/-0.3) in the farmed eels and from 1 to 47 (6.3+/-1.2) in the caught eels, respectively. The AL3 intensity showed significant difference (P=0.011) between these 2 different sources of eels. This is the first observation that farmed eels showed positive findings of G. spinigerum infective larvae. This may affect the standard farming of the culture farm and also present a risk of consuming undercooked eels from the wild-caught and farmed eels.

Gnatostomiasis, experiencia en una práctica privada en Lima-Perú / Gnathostomiasis, experience in private practice in Lima, Peru

Objetivo: determinar las características epidemiológicas y clínicas de la gnatostomiasis en un consultorio de práctica privada de Lima. Material y métodos: estudio descriptivo de una serie de pacientes con diagnóstico de gnatostomiasis en un consultorio privado de dermatología en Lima. Se revisaron las historias de los pacientes diagnosticados de gnatostomiasis según criterio clínico e histopatológico entre enero del 2010 y setiembre del 2011; además se realizó una encuesta telefónica para obtener los antecedentes epidemiológicos. Resultados: se identificaron 20 pacientes de los cuales 18 tuvieron los datos clínicos completos. La población en estudio estuvo conformada por 18 pacientes con diagnóstico de gnatostomiasis. Todos residían en distritos de estrato social alto. La edad promedio fue de 47.5 años. La forma de presentación clínica más frecuente fue la infamatoria o paniculítica y la localización topográfica más frecuente fue en tórax. Se evidenció eosinofilia en trece pacientes. Cinco pacientes recibieron albendazol 400mg/d por 21 días y trece pacientes recibieron tratamiento combinado de albendazol 400-800mg/d por 21 días con ivermectina 200ug/kg/dosis en una o dos oportunidades. La mayor frecuencia de consumo de pescado crudo fue de una a dos veces por semana. El tipo de comida más consumida fue el cebiche. El tipo de pescado más frecuente de consumo fue la corvina en restaurantes exclusivos de precios altos. Conclusión: el número de casos de gnatostomiasis vistos en el presente reporte fue mayor en el periodo del 2011 comparado con el 2010. La forma de presentación clínica más frecuente fue la infamatoria o profunda. El pescado crudo más frecuente consumido por estos pacientes fue el de corvina en forma de cebiche en restaurantes en el rango de alto precio. Todos los pacientes tuvieron buena respuesta terapéutica con los antiparasitarios, siendo la combinación de albendazol e ivermectina la más utilizada.

Aim: to determine the epidemiological and clinical characteristics of gnathostomiasis in a private practice setting in Lima, Peru. Methods: descriptive study of a group of patients with gnathostomiasis attended at a dermatology private clinic at Lima. We reviewed the records of all patients with diagnosis of gnathostomiasis, based on clinical and histopathological findings, from January 2010 to September 2011; we also conducted a telephone interview to obtain additional epidemiological data. Results: we identified 20 cases of which 18 had a complete clinical history. All subjects reported residing in a higher social strata neighborhood. The average age was 47.2 years. The most common clinical presentation was the deep paniculitic form and chest was the most common topographic location. Eosinophilia was present in 13 patients. Five patients received albendazole 400 mg / d for 21 days and thirteen patients were treated with combination of albendazole 400-800mg/d for 21 days and ivermectin 200ug/kg/dosis in one or two occasions. The highest frequency of raw fish consumption before the disease was once to twice a week. Regarding the type of food, most patients consumed cebiche. The most common type of consumed fish was seabass in exclusive restaurants of high prices. Conclusion: the number of gnathostomiasis cases seen in this report was higher in the period of 2011 compared with 2010. The most common clinical presentation was the inflamatory or paniculitic form. Seabass cebiche was the most common type of raw fish consumed by patients, always in expensive restaurants. All patients had good therapeutic response to antiparasitics, with the combination of albendazole and ivermectin as the most used therapeutic regimen.