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Key Features

  • Infection caused by eating undercooked fish, shellfish, chicken, pork

  • Can also be transmitted by ingesting copepods in contaminated water

  • After ingestion, larvae cannot complete development in humans, but rather migrate through tissues

  • Infection is most common in southeast Asia but has been described in many other areas

Clinical Findings

  • Acute gastrointestinal symptoms

    • Include nausea, vomiting, abdominal pain, and fever

    • May develop soon after infection and persist for 2–3 weeks

  • The disease may then progress to findings consistent with cutaneous or visceral larva migrans

  • Migratory subcutaneous erythematous swellings may be painful or pruritic

  • Migrating larvae may also invade other tissues, leading to findings in the eyes, lungs, intestines, and elsewhere

  • Most serious complications are due to invasion of the CNS, leading to eosinophilic meningoencephalitis and other serious findings

  • Severe pain due to migration through spinal roots and focal neurologic findings may be seen

  • CSF eosinophilic pleocytosis and peripheral eosinophilia are seen

Diagnosis

  • Diagnosis is suggested by history of intermittent subcutaneous swellings and typical CNS findings

  • Worms can occasionally be identified in skin lesions

  • Serologic tests may be helpful

Treatment

  • Ivermectin, 200 mcg/kg single oral dose, or albendazole, 400 mg/kg orally daily for 21 days

  • However, indications for treatment are uncertain with CNS disease because inflammatory responses to dying worms might worsen outcomes; corticosteroids may be indicated with antihelminthics in these cases

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