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.

Prevalence and intensity of third stage Gnathostoma spinigerum larvae in swamp eels sold in three large markets in Bangkok, Thailand.

Gnathostoma spinigerum is a common human tissue parasite in Thailand. The swamp eel is the major intermediate or paratenic host for this parasite. The high prevalence of the infective third stage larvae (L3) of this parasite in the rainy season has been noted in previous studies. During June 1999 (rainy season), we performed a cross-sectional survey of the prevalence and the intensity of G. spinigerum L3s in the livers of swamp eels that were obtained from three large Bangkok markets (Klong Toey, Pran Nok, and Tevej). Of a total of 785 livers, G. spinigerum L3s were found in 97: an infection rate of 12%. The prevalence rates in Klong Toey, Pran Nok, and Tevej markets were 13%, 10% and 14% respectively. There was no significant difference in the proportion of infected eels between the markets (p > 0.05). The intensity of L3 burden in the livers ranged from 1-17 larvae, with an average of 2.60 +/- 0.24 larvae (mean +/- SE). In this study a high prevalence of G. spinigerum L3s was found; there was no significant difference in the intensity of larvae in swamp eels between markets. These findings emphasize the importance of public health education: people need to be aware of the dangers of consuming raw or undercooked food.

Production of monoclonal antibodies to the cuticle of advanced third-stage larva of Gnathostoma spinigerum.

This study has demonstrated that sera from Balb/c mice infected with live advanced third-stage larvae (aL3), but not those immunized with crude larval extract, immunoprecipitated the 25-kDa protein from surface-iodinated extract of aL3. Hybridoma cell lines derived from spleen cells of an infected mouse secreted antibodies that reacted with several tissue of aL3 including the esophagus, intestine, muscle and cuticle by immunofluorescence assay. However, none of the cuticle-positive hybridoma cell lines produced antibodies that recognized surface-iodinated protein of aL3 by immunoprecipitation. Western blot analysis showed that monoclonal antibodies (MAbs) secreted by clones derived from one of the cuticle-positive hybridoma lines recognized proteins of molecular weights ranging from 55-96 kDa. The MAbs most likely reacted with the collagenous component of the cuticle.

Experimental infection of Gnathostoma spinigerum larvae in prawns and tadpoles.

Naturally captured Lanchester's freshwater prawns (Macrobrachium lanchesteri) and farm-bred Rana regulosa tadpoles were assessed for their capability of being the first or second intermediate hosts of Gnathostoma spinigerum. Seventy specimens from each animal group were randomized into a control group and investigated for larvae of G. spinigerum by pressing them between two pieces of glass and examination under stereomicroscope. No Gnathostoma larvae were found in the entire control group. Another 120 specimens of each animal were used in two treatment groups; 60 being exposed to the first-stage larvae, G. spinigerum, and 60 exposed to cyclops containing the third-stage larvae for 7 days. No larvae of G. spinigerum were found in the prawns of both treatment groups that resembled tadpoles exposed to the first-stage larvae. In contrast, 18.3% of tadpoles, which were exposed to cyclops containing third-stage larvae, were infected. Lanchester's freshwater prawns cannot serve as intermediate host of G. spinigerum, while R. regulosa can serve as the second intermediate host.

A survey of Gnathostoma larvae in fresh water fish in the valley of the Yangtze River and morphological characteristics of the recovered larvae.

Investigations of the prevalence of larval gnathostomes in fresh water fishes were carried out at the southeastern Yangtze Valley, People's Republic of China, in the periods of October 1989 and November 1990. Fishes were collected from Shanghai, Chenchiang, Nanching, Chiuchiang and Nanchang districts in 1989. Additional sampling in Shanghai district was done at Kunshan, Tien-shanfu, Chingpu and Nanhui. Species of fishes collected were Channa argus (110), Siniperca chuatsi (24) and Silurus asotus (2). Muscle tissue of the fishes was dissected into small pieces, sliced and then examined under a dissecting microscope. The viscera were pooled by species in groups of 4 or 5 individuals, homogenized, and were then digested overnight in artificial gastric-juice at 37 degrees C. Four encysted larvae were recovered from the muscle tissue of four C. argus. Thirty-four larvae were obtained from digestion of viscera. A total of 38 larvae were recovered. Eighteen of 38 larvae were examined morphologically and they were able to be divided into three types by their body length; 5 early third-stage larvae (0.58-0.86 mm), 12 third-stage larvae (1.12-2.61 mm), and one advanced third-stage larva of 4.86 mm. Light and scanning electron microscopy revealed that the former two types had characteristics of Gnathostoma hispidum and the last one had those of G. spinigerum. In 1990, we investigated fish near Hongtze-hu and Tai-hu lakes. A total of 553 fishes belonging to 12 genera and 12 species were examined. Seventeen larvae were recovered from the viscera of G. argus and Monopterus albus. These larvae were identified as G. hispidum.

Comparative surface ultrastructure of adults and eggs of Gnathostoma obtained in Japan.

As limited studies have been done on surface morphology of Gnathostoma, adult specimens and eggs of four kinds of species in Japan were compared by scanning electron microscopy. Worms had a subglobular head-bulb which was armed with 7-10 rows of cephalic hooks. Mutidigitate cuticular spines were spaced unevenly on transverse cuticular striations on the anterior half of the body. The lengths of the spines were variable with tridentate spines longer than bidentate ones, These tridantate spines became one of the species specific characteristics. The posterior half of the bodies of G. doloresi and G. hispidum were covered densely with long unidentate spines which were gradually shorter towards the posterior ends. Ventral sides of male terminals had different shape of papillae which so called small and caudal ones in species. Eggs recovered from the uteri of female worms were covered with cuticular pits of different sizes, shapes and depths in species.

Comunicación de un caso de gnathostomiasis humana / Human gnathostomiasis one case confirmed

La gnathostomiasis humana es una enfermedad endémica con mayor prevalencia en países de Asia, particularmente Tailandia y Japón. La causa más frecuente de esta parasitosis es la ingestión del nemátodo Gnathostoma spinigerum. La gnathostomiasis en el hombre se presenta con manifestaciones cutáneas o viscerales de gravedad variable. En la mayoría de los casos los síntomas no son graves; sin embargo, si el número de larvas o el sitio de ubicación es en los órganos vitales, pueden sobrevenir síntomas agudos con secuelas serias e incluso la muerte del individuo. El diagnóstico definitivo se basa en la identificación de la larva obtenida por una biopsia de piel. El único tratamiento eficaz es la remoción de la larva, pero esto debe hacerse en condiciones óptimas. Se recomienda el tratamiento con albendazol, 500 mg al día durante 21 días, para reducir la morbilidad larvaria y facilitar su extirpación. Se comunica la experiencia con un caso

Immunohistochemical localization of Gnathostoma spinigerum larval antigens by monoclonal antibodies: I. Light microscopy.

Immunohistochemical localization of antigens in advanced third-stage larvae of Gnathostoma spinigerum (GsAL3) was studied by indirect enzyme immunostaining using 7 G. spinigerum specific monoclonal antibodies, FS-3D11, SS-5H5, SK-6C4, SK-4E1, SK-7G6, SD-8D4 and SA-9B5. All these MAb belong to the IgG1 subclass and only FS-3D11 and SS-5H5 recognize carbohydrate determinants. Each MAb exhibited a different reaction pattern and staining intensity in sectioned GsAL3. FS-3D11 bound primarily to the intestinal brush border whereas SS-5H5 reacted with various tissues of the parasite including intestinal epithelium and brush border, lateral cords, muscle, pseudocoel, and cuticle. SK-6C4 predominantly stained muscle, however, SK-4E1 and SK-7G6 exhibited a lack of labeling. SD-8D4 bound to the cuticle and the lateral cords whereas SA-9B5 reacted primarily with the pseudocoel. These results suggest that antigens sharing common epitopes are present in various structures of the larvae with the intestine being the most antigenic site. The present data also suggest that certain GsAL3 antigens recognized by the MAb obtained in this study are sensitive to formalin fixation and/or paraffin embedding since for 2 out of the 7 MAb staining was negative.

Gnathostomiasis in Thailand: a survey on intermediate hosts of Gnathostoma spp. with special reference to a new type of larvae found in Fluta alba.

To clarify current status of gnathostomiasis in Thailand, a survey on intermediate hosts has been carried out at various localities since 1987. It was found that Fluta alba (Fresh water eel) as well as Channa striata (snake-headed fish) might be important in playing a role of transmitting the infection either among humans or reservoir animals. During the three years from 1987 to 1989, larvae of Gnathostoma spinigerum were found in 80-100% of F. alba obtained from markets in Nakhon Nayok, with a maximum recovery of 2,582 larvae per eel. Among larvae found in these eels, five were peculiar in possessing four rows of hooklets with complicated branches at the base. Epithelial cells of the intestine of these larvae contained 1-2 nuclei. These observations indicate that the larvae are different from those of reported species of Gnathostoma from Thailand including G. spinigerum, suggesting a possibility of the advanced third-stage larvae of G. malaysiae.

Circumoval and larval microprecipitation reactions in experimental and human gnathostomiasis.

Mice, rats and cats were infected either orally or percutaneously with a number of early or advanced third-stage larvae (EL3 or AL3, respectively) of G. spinigerum. Sera obtained from these infected animals and 10 human gnathostomiasis cases were tested against various developmental stages of the parasite which were prepared and used while being alive (fresh) or dead (air-dried) for the circumoval and larval microprecipitation (COP and LMP) reactions. No precipitin reactions were observed in all sera tested against unembryonated eggs, embryonated eggs and first stage larvae neither air-dried nor fresh preparations. Sera were merely reactive giving various degrees of membranous or filamentous precipitates against the air-dried preparation of AL3.

Scanning electron microscopy of the early third-stage larvae of Gnathostoma spinigerum.

Scanning electron microscopic observations were made on the early third stage (eL3) larvae of Gnathostoma spinigerum (Sakolnakhon, northeast Thailand) from 3-week-old infected cyclops (Mesocyclops leuckarti). The morphological surfaces of the anterior end, head spine, body cuticle, amphid, papillae, posterior end of larvae were described and compared with the advance third-stage (aL3) larvae.