Parasites, Hosts and Diseases

"Gnathostomiasis"

Case Report

A case of vocal cord gnathostomiasis diagnosed with sectional morphologies in a histopathological specimen from a Chinese woman living in Korea: Doo Sik Park, Eun Hyun Cho, Kyung Hoon Park, Soo Min Jo, Bumjung Park, Sun Huh; Parasites Hosts Dis 2023;61(3):298-303.
Published online August 21, 2023; DOI: https://doi.org/10.3347/PHD.23065

Abstract
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This study aimed to describe a rare case of gnathostomiasis in the vocal cord. A 54-year-old Chinese woman living in Korea visited with a chief complaint of voice change at the outpatient department of otorhinolaryngology in Hallym Sacred Heart Hospital, Hallym University on August 2, 2021. She had eaten raw conger a few weeks before the voice change developed, but her medical history and physical examinations demonstrated neither gastrointestinal symptoms nor other health problems. A round and red cystic lesion, recognized in the anterior part of the right vocal cord, was removed using forceps and scissors through laryngeal microsurgery. The histopathological specimen of the cyst revealed 3 cross-sections of a nematode larva in the lumen of the cyst wall composed of inflammatory cells and fibrotic tissues. They differ in diameter, from 190 μm to 235 μm. They showed characteristic cuticular layers with tegumental spines, somatic muscle layers, and gastrointestinal tracts such as the esophagus and intestine. Notably, intestinal sections consisted of 27-28 lining cells containing 0-4 nuclei per cell. We tentatively identified the nematode larva recovered from the vocal cord cystic lesion as the third-stage larva of Gnathostoma, probably G. nipponicum or G. hispidum, based on the sectional morphologies.

Citations

Citations to this article as recorded by

Imported parasitic diseases in the Republic of Korea: status and issues
Jong-Yil Chai
Journal of the Korean Medical Association.2025; 68(1): 52. CrossRef
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Veterinary Sciences.2025; 12(5): 437. CrossRef

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Original Article

Evaluation of Rapid IgG4 Test for Diagnosis of Gnathostomiasis: Yue Wang, An Ma, Xiao-Long Liu, Praphathip Eamsobhana, Xiao-Xian Gan; Korean J Parasitol 2021;59(3):257-263.
Published online June 21, 2021; DOI: https://doi.org/10.3347/kjp.2021.59.3.257

Human gnathostomiasis is a parasitic disease caused by Gnathostoma nematode infection. A rapid, reliable, and practical immunoassay, named dot immuno-gold filtration assay (DIGFA), was developed to supporting clinical diagnosis of gnathostomiasis. The practical tool detected anti-Gnathostoma-specific IgG4 in human serum using crude extract of third-stage larvae as antigen. The result of the test was shown by anti-human IgG4 monoclonal antibody conjugated colloidal gold. The sensitivity and specificity of the test were both 100% for detection in human sera from patients with gnathostomiasis (13/13) and from healthy negative controls (50/50), respectively. Cross-reactivity with heterogonous serum samples from patients with other helminthiases ranged from 0 (trichinosis, paragonimiasis, clonorchiasis, schistosomiasis, and cysticercosis) to 25.0% (sparganosis), with an average of 6.3% (7/112). Moreover, specific IgG4 antibodies diminished at 6 months after treatment. This study showed that DIGFA for the detection of specific IgG4 in human sera could be a promising tool for the diagnosis of gnathostomiasis and useful for evaluating therapeutic effects.

Citations

Citations to this article as recorded by

Health Impact of Gnathostomiasis and its Integral Approach to Parasitic Infection: A Systematic Review
Gisnella María Cedeño Cajas, José Andrés Zaporta Ramos, Andrea Stefannia Flores Villacrés, Cesar Guevara
Salud, Ciencia y Tecnología.2024; 4: 1096. CrossRef

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Brief Communications

Detection of Gnathostoma spinigerum Antibodies in Sera of Non-Traumatic Subarachnoid Hemorrhage Patients in Thailand: Amnat Kitkhuandee, Waranon Munkong, Kittisak Sawanyawisuth, Penchom Janwan, Wanchai Maleewong, Pewpan M. Intapan; Korean J Parasitol 2013;51(6):755-757.
Published online December 31, 2013; DOI: https://doi.org/10.3347/kjp.2013.51.6.755

Abstract
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Gnathostoma spinigerum can cause subarachnoid hemorrhage (SAH). The detection of specific antibodies in serum against G. spinigerum antigen is helpful for diagnosis of neurognathostomiasis. There is limited data on the frequency of G. spinigerum infection in non-traumatic SAH. A series of patients diagnosed as non-traumatic SAH at the Srinagarind Hospital, Khon Kaen University, Thailand between January 2011 and January 2013 were studied. CT or MR imaging of the brain was used for diagnosis of SAH. Patients were categorized as aneurysmal subarachnoid hemorrhage (A-SAH) or non-aneurysmal subarachnoid hemorrhage (NA-SAH) according to the results of cerebral angiograms. The presence of specific antibodies in serum against 21- or 24-kDa G. spinigerum antigen was determined using the immunoblot technique. The detection rate of antibodies was compared between the 2 groups. Of the 118 non-traumatic SAH patients for whom cerebral angiogram and immunoblot data were available, 80 (67.8%) patients had A-SAH, whereas 38 (32.2%) had NA-SAH. Overall, 23.7% were positive for specific antibodies against 21- and/or 24-kDa G. spinigerum antigen. No significant differences were found in the positive rate of specific antibodies against G. spinigerum in both groups (P-value=0.350).

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A Recombinant Matrix Metalloproteinase Protein from Gnathostoma spinigerum for Serodiagnosis of Neurognathostomiasis: Penchom Janwan, Pewpan M. Intapan, Hiroshi Yamasaki, Porntip Laummaunwai, Kittisak Sawanyawisuth, Chaisiri Wongkham, Chatchai Tayapiwatana, Amnat Kitkhuandee, Viraphong Lulitanond, Yukifumi Nawa, Wanchai Maleewong; Korean J Parasitol 2013;51(6):751-754.
Published online December 31, 2013; DOI: https://doi.org/10.3347/kjp.2013.51.6.751

Abstract
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Neurognathostomiasis is a severe form of human gnathostomiasis which can lead to disease and death. Diagnosis of neurognathostomiasis is made presumptively by using clinical manifestations. Immunoblotting, which recognizes antigenic components of molecular mass 21 kDa and 24 kDa in larval extracts of Gnathostoma spinigerum (Gs 21/24), has high sensitivity and specificity for diagnosis of neurognathostomiasis. However, only very small amounts of the Gs 21/24 antigens can be prepared from parasites harvested from natural or experimental animals. To overcome this problem, we recently produced a recombinant matrix metalloproteinase (rMMP) protein from G. spinigerum. In this study, we evaluated this rMMP alongside the Gs 21/24 antigens for serodiagnosis of human neurognathostomiasis. We studied sera from 40 patients from Srinagarind Hospital, Khon Kaen University, Thailand, with clinical criteria consistent with those of neurognathostomiasis, and sera from 30 healthy control adults from Thailand. All sera were tested for specific IgG antibodies against both G. spinigerum crude larval extract and rMMP protein using immunoblot analysis. The sensitivity and specificity for both antigenic preparations were all 100%. These results show that G. spinigerum rMMP protein can be used as an alternative diagnostic antigen, in place of larval extract, for serodiagnosis of neurognathostomiasis.

Citations

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Protein and antigen profiles of third-stage larvae of Gnathostoma spinigerum assessed with next-generation sequencing transcriptomic information
Kathyleen Nogrado, Tipparat Thiangtrongjit, Poom Adisakwattana, Paron Dekumyoy, Sant Muangnoicharoen, Charin Thawornkuno, Onrapak Reamtong
Scientific Reports.2022;[Epub] CrossRef
Development of Immunochromatographic Test Kit for Rapid Detection of Specific IgG4 Antibody in Whole-Blood Samples for Diagnosis of Human Gnathostomiasis
Penchom Janwan, Pewpan M. Intapan, Lakkhana Sadaow, Rutchanee Rodpai, Hiroshi Yamasaki, Patcharaporn Boonroumkaew, Oranuch Sanpool, Tongjit Thanchomnang, Phuangphaka Sadee, Wanchai Maleewong
Diagnostics.2021; 11(5): 862. CrossRef
Proteomics of Gnathostomiasis: A Way Forward for Diagnosis and Treatment Development
Tipparat Thiangtrongjit, Kathyleen Nogrado, Thawatchai Ketboonlue, Preeyarat Malaitong, Poom Adisakwattana, Onrapak Reamtong
Pathogens.2021; 10(9): 1080. CrossRef
Combining lexical and context features for automatic ontology extension
Sara Althubaiti, Şenay Kafkas, Marwa Abdelhakim, Robert Hoehndorf
Journal of Biomedical Semantics.2020;[Epub] CrossRef
Human gnathostomiasis: a neglected food-borne zoonosis
Guo-Hua Liu, Miao-Miao Sun, Hany M. Elsheikha, Yi-Tian Fu, Hiromu Sugiyama, Katsuhiko Ando, Woon-Mok Sohn, Xing-Quan Zhu, Chaoqun Yao
Parasites & Vectors.2020;[Epub] CrossRef
Surveillance and diagnosis of zoonotic foodborne parasites
Reza Zolfaghari Emameh, Sami Purmonen, Antti Sukura, Seppo Parkkila
Food Science & Nutrition.2018; 6(1): 3. CrossRef

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Case Reports

Cutaneous Gnathostomiasis with Recurrent Migratory Nodule and Persistent Eosinophilia: a Case Report from China: Jing Cui, Ye Wang, Zhong Quan Wang; Korean J Parasitol 2013;51(4):467-470.
Published online August 30, 2013; DOI: https://doi.org/10.3347/kjp.2013.51.4.467

Abstract
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The present study reports a human case of cutaneous gnathostomiasis with recurrent migratory nodule and persistent eosinophilia in China. A 52-year-old woman from Henan Province, central China, presented with recurrent migratory reddish swelling and subcutaneous nodule in the left upper arm and on the back for 3 months. Blood examination showed eosinophila (21.2%), and anti-sparganum antibodies were positive. Skin biopsy of the lesion and histopathological examinations revealed dermal infiltrates of eosinophils but did not show any parasites. Thus, the patient was first diagnosed as sparganosis; however, new migratory swellings occurred after treatment with praziquantel for 3 days. On further inquiring, she recalled having eaten undercooked eels and specific antibodies to the larvae of Gnathostoma spinigerum were detected. The patient was definitely diagnosed as cutaneous gnathostomiasis caused by Gnathostoma sp. and treated with albendazole (1,000 mg/day) for 15 days, and the subsequent papule and blister developed after the treatment. After 1 month, laboratory findings indicated a reduced eosinophil count (3.3%). At her final follow-up 18 months later, the patient had no further symptoms and anti-Gnathostoma antibodies became negative. Conclusively, the present study is the first report on a human case of cutaneous gnathostomiasis in Henan Province, China, based on the past history (eating undercooked eels), clinical manifestations (migratory subcutaneous nodule and persistent eosinophilia), and a serological finding (positive for specific anti-Gnathostoma antibodies).

Citations

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First reported case of intraocular gnathostomiasis in China
Shuang Wang, Ling Zhang, Feng Miao, Jun Huang, Juan Guo
Journal of Travel Medicine.2022;[Epub] CrossRef
Current and future strategies against cutaneous parasites
Ernest Man, Helen P. Price, Clare Hoskins
Pharmaceutical Research.2022; 39(4): 631. CrossRef
Eosinophilic Meningitis (Angiostrongylus spp. and Gnathostoma spp.)
Nelson Iván Agudelo Higuita, Jackrapong Bruminhent
Current Tropical Medicine Reports.2022; 9(1): 40. CrossRef
Morphological and Phylogenetic Analysis of Eustrongylides sp. and Gnathostoma spinigerum Parasitizing the Asian Swamp Eel Monopterusalbus in China
Sixin Zhang, Guangping Huang, Liang Li, Xianyong Liu, Xiaoli Tang, Xun Suo
Pathogens.2021; 10(6): 711. CrossRef
Human gnathostomiasis: a neglected food-borne zoonosis
Guo-Hua Liu, Miao-Miao Sun, Hany M. Elsheikha, Yi-Tian Fu, Hiromu Sugiyama, Katsuhiko Ando, Woon-Mok Sohn, Xing-Quan Zhu, Chaoqun Yao
Parasites & Vectors.2020;[Epub] CrossRef
Imported gnathostomiasis manifesting as cutaneous larva migrans and Löffler’s syndrome
William L. Hamilton, Daniel Agranoff
BMJ Case Reports.2018; 2018: bcr-2017-223132. CrossRef

12,906 View
175 Download
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Gnathostoma spinigerum Infection in the Upper Lip of a Korean Woman: An Autochthonous Case in Korea: Jae Hee Kim, Hyemi Lim, Young-Sang Hwang, Tae Yeon Kim, Eun Mee Han, Eun-Hee Shin, Jong-Yil Chai; Korean J Parasitol 2013;51(3):343-347.
Published online June 30, 2013; DOI: https://doi.org/10.3347/kjp.2013.51.3.343

Abstract
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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.

Citations

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Imported parasitic diseases in the Republic of Korea: status and issues
Jong-Yil Chai
Journal of the Korean Medical Association.2025; 68(1): 52. CrossRef
Parasitic Diseases of Upper Gastrointestinal Tract
Heung Up Kim
The Korean Journal of Helicobacter and Upper Gastrointestinal Research.2024; 24(2): 127. CrossRef
A case of vocal cord gnathostomiasis diagnosed with sectional morphologies in a histopathological specimen from a Chinese woman living in Korea
Doo Sik Park, Eun Hyun Cho, Kyung Hoon Park, Soo Min Jo, Bumjung Park, Sun Huh
Parasites, Hosts and Diseases.2023; 61(3): 298. CrossRef
Morphological and Phylogenetic Analysis of Eustrongylides sp. and Gnathostoma spinigerum Parasitizing the Asian Swamp Eel Monopterusalbus in China
Sixin Zhang, Guangping Huang, Liang Li, Xianyong Liu, Xiaoli Tang, Xun Suo
Pathogens.2021; 10(6): 711. CrossRef
Human gnathostomiasis: a neglected food-borne zoonosis
Guo-Hua Liu, Miao-Miao Sun, Hany M. Elsheikha, Yi-Tian Fu, Hiromu Sugiyama, Katsuhiko Ando, Woon-Mok Sohn, Xing-Quan Zhu, Chaoqun Yao
Parasites & Vectors.2020;[Epub] CrossRef
Gnathostomiasis: an emerging infectious disease relevant to all dermatologists
Francisco Bravo, Bernardo Gontijo
Anais Brasileiros de Dermatologia.2018; 93(2): 172. CrossRef
Imported gnathostomiasis manifesting as cutaneous larva migrans and Löffler’s syndrome
William L. Hamilton, Daniel Agranoff
BMJ Case Reports.2018; 2018: bcr-2017-223132. CrossRef
Gnathostomiasis: an Emerging Infection of Raw Fish Consumers in Gnathostoma Nematode-Endemic and Nonendemic Countries
James H. Diaz
Journal of Travel Medicine.2015; 22(5): 318. CrossRef

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Imported Intraocular Gnathostomiasis with Subretinal Tracks Confirmed by Western Blot Assay: Ji Ho Yang, Moosang Kim, Eung Suk Kim, Byoung-Kuk Na, Seung-Young Yu, Hyung-Woo Kwak; Korean J Parasitol 2012;50(1):73-78.
Published online March 6, 2012; DOI: https://doi.org/10.3347/kjp.2012.50.1.73

Abstract
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We report a case of intraocular gnathostomiasis diagnosed by western blot assay in a patient with subretinal tracks. A 15-year-old male patient complained of blurred vision in the right eye, lasting for 2 weeks. Eight months earlier, he had traveled to Vietnam for 1 week and ate raw wild boar meat and lobster. His best-corrected visual acuity was 20/20 in both eyes and anterior chamber examination revealed no abnormalities. Fundus examination showed subretinal tracks in the right eye. Fluorescein angiography and indocyanine green angiography showed linear hyperfluorescence of the subretinal lesion observed on fundus in the right eye. Ultrasound examination revealed no abnormalities. Blood tests indicated mild eosinophilia (7.5%), and there was no abnormality found by systemic examinations. Two years later, the patient visited our department again for ophthalmologic evaluation. Visual acuity remained 20/20 in both eyes and the subretinal tracks in the right eye had not changed since the previous examination. Serologic examination was performed to provide a more accurate diagnosis, and the patient's serum reacted strongly to the Gnathostoma nipponicum antigen by western blot assay, which led to a diagnosis of intraocular gnathostomiasis. This is the first reported case of intraocular gnathostomiasis with subretinal tracks confirmed serologically using western blot in Korea.

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A case of vocal cord gnathostomiasis diagnosed with sectional morphologies in a histopathological specimen from a Chinese woman living in Korea
Doo Sik Park, Eun Hyun Cho, Kyung Hoon Park, Soo Min Jo, Bumjung Park, Sun Huh
Parasites, Hosts and Diseases.2023; 61(3): 298. CrossRef
Subretinal gnathostomiasis: A successful focal laser photocoagulation for a living parasite
Supalert Prakhunhungsit, Somanus Thoongsuwan, Sutasinee Boonsopon, Thitiyaporn Panawattanawong, Pitchaya Amornvararak, Nuttawut Rodanant, Nopasak Phasukkijwatana
American Journal of Ophthalmology Case Reports.2022; 26: 101413. CrossRef
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Jorge Costa Eiras, Gilberto Cezar Pavanelli, Ricardo Massato Takemoto, Yukifumi Nawa
The Korean Journal of Parasitology.2018; 56(3): 215. CrossRef
Imported gnathostomiasis manifesting as cutaneous larva migrans and Löffler’s syndrome
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BMJ Case Reports.2018; 2018: bcr-2017-223132. CrossRef
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The American Journal of Tropical Medicine and Hygiene.2017; 97(4): 1232. CrossRef
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The Korean Journal of Parasitology.2013; 51(3): 343. CrossRef
Cutaneous Gnathostomiasis with Recurrent Migratory Nodule and Persistent Eosinophilia: a Case Report from China
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The Korean Journal of Parasitology.2013; 51(4): 467. CrossRef