Gnathostomiasis

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

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 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

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