Gnathostomiasis: An Emerging Infection of Raw Fish Consumers in Gnathostoma Nematode-Endemic and Nonendemic Countries

LC-MS/MS analysis of didehydrostemofoline from Stemona collinsiae roots extracts in rats plasma and pharmacokinetics profile after oral administration

Stemona collinsiae Craib., Stemonaceae, has been traditionally used as medicinal plants for insecticides, treatment of parasitic worms and various diseases in Southeast Asian countries. Its ethanolic root extract has been postulated for anthelminthic activities which has a potential for development for human gnathostomiasis drug. To investigate the pharmacokinetic profile, liquid chromatography coupled with tandem mass spectrometry (LC-MS/MS) method for the quantification of didehydrostemofoline in rats' plasma was developed and validated. The chromatographic separation was performed on a C18 column using 1 mM ammonium acetate in water and methanol (50:50, v/v). Tetrahydropalmatine was used as an internal standard. The multiple reaction monitoring mode was used for quantitative analysis. The validated method showed good sensitivity, linearity, precision, and accuracy. The results of stability showed that didehydrostemofoline was stable in the extracted samples in auto-sampler for 24 h and in the plasma samples under room temperature for 24 h, -20 °C for 1 month, and after three freeze-thaw processes. The developed method was applied to the pharmacokinetic study of didehydrostemofoline after oral administration of S. collinsiae root extract. Didehydrostemofoline was rapidly absorbed from the gastrointestinal tract. The time to peak drug concentration was 1.75 ± 0.62 h with maximum drug concentration of 1152.58 ± 271.18 ng/mL. Didehydrostemofoline was rapidly eliminated from the body with terminal half-life of 1.86 ± 0.50 h. Calculated drug clearance of didehydrostemofoline was 96.82 ± 23.51 L/h and volume of distribution was 260.40 ± 96.81 L. The present study provided useful data for understanding drug disposition in the body with dynamic time-course which could be beneficial for further clinical trials.

Gnathostoma infection after ingestion of raw fish is a probable cause of eosinophilic meningitis in the Brazilian Amazon

We report a case of eosinophilic meningitis associated with the ingestion of raw fish (Cichla sp.) from the Brazilian Amazon, likely caused by Gnathostoma. A 36-year-old male visited Juruena river on a fishing trip. After 50 days, the patient presented with an intense frontal headache. A cerebrospinal fluid examination revealed 63% eosinophilia. Another individual who ingested raw fish developed linear dermatitis on the abdominal wall. Anti-Gnathostoma serum antibodies were detected, and the patient made a full recovery after treatment with corticosteroids and albendazole. To date, autochthonous Gnathostoma spp. infections in Latin American countries have only caused linear panniculitis. This report raises awareness of gnathostomiasis-causing meningitis.

Human gnathostomiasis: A review on the biology of the parasite with special reference on the current therapeutic management

Gnathostoma is a parasitic nematode that can infect a wide range of animal species, but human populations have become accidental hosts because of their habit of eating raw or undercooked meat from a wide variety of intermediate hosts. While gnathostomiasis is considered an endemic disease, cases of human gnathostomiasis have been increasing over time, most notably in nonendemic areas. There are several complexities to this parasitic disease, and this review provides an update on human gnathostomiasis, including the life cycle, diagnosis, treatment, and treatment strategies used to combat drug resistance. Even now, a definitive diagnosis of gnathostomiasis is still challenging because it is difficult to isolate larvae for parasitological confirmation. Another reason is the varying clinical symptoms recorded in reported cases. Clinical cases can be confirmed by immunodiagnosis. For Gnathosotoma spinigerum, the detection of IgG against a specific antigenic band with a molecular weight of 24 kDa from G. spinigerum advanced third-stage larvae (aL3), while for other species of Gnathostoma including G. binucleatum, the 33-kDa antigen protein is being used. This review also discusses cases of recurrence of gnathostomiasis and resistance mechanisms to two effective chemotherapeutics (albendazole and ivermectin) used against gnathostomiasis. This is significant, especially when planning strategies to combat anthelmintic resistance. Lastly, while no new chemotherapeutics against gnathostomiasis have been made available, we describe the management of recurrent gnathostomiasis using albendazole and ivermectin combinations or extensions of drug treatment plans.

Infection levels of Gnathostomatidae (Nematoda) larvae in commercial fishes in north-eastern Australian waters and related food safety concerns

The majority of research on the safety of marine edible fish has primarily focused on anisakid nematodes, neglecting the potential risks posed by other parasites, including those belonging to the family Gnathostomatidae. In Australia, there have been few reported cases of human infections with gnathostomatid parasites since 2011. However, due to the absence of a standardized diagnostic test in the country, it is believed that the actual number of infections is higher than reported. This study aimed to assess the occurrence and prevalence of infectious gnathostomatid parasites in selected commercial fish species in Australia. A total of 1947 marine fish from northern Australia, representing 9 families, 16 genera, and 30 species, were examined for gnathostomatid nematode infections. Overall, 12.3 % of the fish were found to be infected with at least one gnathostomatid larva. Among the species examined, the yellow-dabbled flounder (Branchypleura novaezeelandiae) exhibited the highest prevalence (83.3 %; n = 6) and the largest number of gnathostomatid larvae. The identification of the gnathostomatid larvae was confirmed as belonging to the genus Echinocephalus based on both morphological characteristics and sequence data. No significant correlation was observed between the prevalence, mean abundance, and mean intensity of infection with the length or weight of the examined fish species. Notably, several of the infected fish species are considered popular choices in the Australian market. Hence, it is imperative to raise awareness among relevant food safety authorities regarding the occurrence of these parasites. The findings from this study should be taken into consideration for the revision of current seafood safety protocols in the country.

Regulation of immune response against third-stage Gnathostoma spinigerum larvae by human genes

Background

Gnathostomiasis is an important zoonosis in tropical areas that is mainly caused by third-stage Gnathostoma spinigerum larvae (G. spinigerum L3).

Objectives

This study aimed to prove whether G. spinigerum L3 produces extracellular vesicles (EVs) and investigate human gene profiles related to the immune response against the larvae.

Methods

We created an immune cell model using normal human peripheral blood mononuclear cells (PBMCs) co-cultured with the larvae for 1 and 3 days, respectively. The PBMCs were harvested for transcriptome sequencing analysis. The EV ultrastructure was examined in the larvae and the cultured medium.

Results

Extracellular vesicle-like particles were observed under the larval teguments and in the pellets in the medium. RNA-seq analysis revealed that 2,847 and 3,118 genes were significantly expressed on days 1 and 3 after culture, respectively. The downregulated genes on day 1 after culture were involved in pro-inflammatory cytokines, the complement system and apoptosis, whereas those on day 3 were involved in T cell-dependent B cell activation and wound healing. Significantly upregulated genes related to cell proliferation, activation and development, as well as cytotoxicity, were observed on day 1, and genes regulating T cell maturation, granulocyte function, nuclear factor-κB and toll-like receptor pathways were predominantly observed on day 3 after culture.

Conclusion

G. spinigerum L3 produces EV-like particles and releases them into the excretory-secretory products. Overall, genotypic findings during our 3-day observation revealed that most significant gene expressions were related to T and B cell signalling, driving T helper 2 cells related to chronic infection, immune evasion of the larvae, and the pathogenesis of gnathostomiasis. Further in-depth studies are necessary to clarify gene functions in the pathogenesis and immune evasion mechanisms of the infective larvae.

Molluscicidal Activity of Compounds From the Roots of Aralia armata Against the Golden Apple Snail (Pomacea canaliculata)

Background: Aralia armata (Araliaceae) is considered to exhibit effective molluscicidal activity, however, the relationship between the chemical components and molluscicidal activity has not been clearly elucidated. This research attempts to decipher these correlations among the 15 compounds isolated from Vietnam-grown A. armata roots against the freshwater snail, Pomacea canaliculata, a gastropod causing severe damage in agricultural production. Methods: Fifteen saponins were isolated from the methanol root extract of A. armata using chromatographic methods and were identified using spectroscopic techniques. The compounds were screened for molluscicidal activity against P. canaliculata, as well as toxicity against brine shrimp ( Artemia sp.) and phytotoxicity against rice germination and growth. Results: The saponin compounds exhibited extraordinary inhibition of P. canaliculata with LC50 values ranging from 7.90 to 17.50 µg/mL. Notably, the active compounds from A. armata exhibit safety for both nontarget aquatic animals, specifically Artemia sp. with LC50 values between 148.55 and 193.22 µg/mL, and the growth and development of Oryza sativa L. plants showed very little difference compared with the negative control . A molecular docking analysis indicated P. canaliculata acetylcholinesterase (PcAChE) and the actin-binding protein villin (PcVillin) to be potential biomolecular targets of the A. armata saponins. Conclusion: The present experimental and in silico data illustrate the potential of A. armata in agricultural applications.

Imported Infectious Diseases, Tropical Diseases and Local Endemic Infectious Diseases in Japan

We aimed to describe the historical perspectives and the current epidemiology of tropical, imported and local endemic infectious diseases in Japan in this review. Public health legislation for infectious diseases and immigration statistics were overviewed to provide the background of the infectious disease situation in Japan. Many tropical diseases were successfully controlled and eliminated in the latter half of the 20th century and the majority of those diseases are imported today. The trend of the main 15 imported infectious diseases before the advent of COVID-19 was summarized as well as local endemic infectious diseases in Japan. Transmission risks of traditional cuisines, lifestyles and nature exposures in Japan are introduced to guide clinicians for travel advice to prevent those local infectious diseases.

Subretinal gnathostomiasis: A successful focal laser photocoagulation for a living parasite

Purpose

To report a case of subretinal gnathostomiasis presenting with progressive subretinal tracts of a living parasite and successfully treated with focal laser photocoagulation.

Method

Observational case report.

Patient

A 29-year-old Thai male complained of blurred vision and floaters in his left eye for two weeks. An ocular examination showed multiple, whitish, subretinal tracks at the superotemporal retina. After 5 days of oral albendazole, a moving parasite was confirmed by multimodal retinal imaging. An immunoblotting analysis was positive for Gnathostoma species.

Result

The patient was treated by laser photocoagulation with frequency-doubled Nd:YAG laser around and over the parasite. Oral albendozole was continued and naproxen was prescribed for four weeks. His vision improved to 20/20 and the inflammation subsided completely within three months. The patient has been followed for five years without local and systemic complications.

Conclusions

Focal laser photocoagulation without systemic steroids could be a successful treatment for active subretinal gnathostomiasis with a satisfactory safety profile in a long-term follow-up.

Intracameral Gnathostomiasis: A Case Report and Literature Review

PURPOSE

The purpose of this article is to report a case of ocular gnathostomiasis presenting with acute anterior uveitis and uveitis glaucoma.

METHODS

observational case report and literature review.

RESULTS

A 56-year-old Thai male was referred to a tertiary eye center with acute anterior uveitis and uveitis glaucoma in the right eye. A nematode was found in the right anterior chamber. Surgical removal of the nematode was successfully performed. Gnathostoma spinigerum was the nematode identified on pathological examination.

CONCLUSIONS

Early detection of the parasite and timely surgical removal is the key to the management of ocular gnathostomiasis.

Protein and antigen profiles of third-stage larvae of Gnathostoma spinigerum assessed with next-generation sequencing transcriptomic information

Gnathostomiasis is a food-borne zoonotic disease that can affect humans who eat improperly cooked meat containg infective third-stage larvae. Definitive diagnosis is through larval recovery. However, this is an invasive technique and is impractical if the larvae have encysted in inaccessible areas of the body. Antigen or antibody detection might be more interesting techniques for diagnosis. Proteomic could elucidate diagnostic markers and improve our understanding of parasite biology. However, proteomic studies on Gnathostoma spinigerum are hampered by the lack of a comprehensive database for protein identification. This study aimed to explore the protein and antigen profiles of advanced third-stage G. spinigerum larvae (aL3Gs) using interrogation of mass spectrometry data and an in-house transcriptomic database for protein identification. Immunoproteomic analysis found 74 proteins in 24-kDa SDS-PAGE bands, which is size-specific for the immunodiagnosis of gnathostomiasis. Moreover, 13 proteins were found in 2-DE 24-kDa bands. The data suggest that collagenase 3, cathepsin B, glutathione S-transferase 1, cuticle collagen 14, major antigen, zinc metalloproteinase nas-4, major egg antigen, peroxiredoxin, and superoxide dismutase [Cu–Zn] may be good candidates for novel human gnathostomiasis diagnostic assays. These findings improve our understanding of the parasite’s biology and provide additional potential targets for novel therapeutics, diagnostics, and vaccines.

Human gnathostomiasis in Sri Lanka: an underreported disease?

A healthy young man from Sri Lanka, currently living in Switzerland, consulted at the University Hospital of Geneva with a history of painful erythema and swelling of the left forearm. Laboratory tests showed a slight eosinophilia. Western blot serology for Gnathostoma spp, inconclusive at presentation, became positive 2 weeks later.

The returned traveler with neurologic manifestations: could my patient have a parasite?

PURPOSE OF REVIEW

The present review focuses on parasitic infections of the central nervous system (CNS) that can affect the international traveler.

RECENT FINDINGS

The epidemiology of imported parasitic infections is changing and clinicians are treating increasing numbers of returned travelers with parasitic infections in the CNS with which they are not familiar.

SUMMARY

The epidemiology, life cycle, clinical manifestations, diagnosis, and treatment of parasites that affect the CNS will be discussed.

Proteomics of Gnathostomiasis: A Way Forward for Diagnosis and Treatment Development

Gnathostoma spinigerum is the most common cause of gnathostomiasis in humans. It has a complex life cycle, which requires two intermediate hosts and a definitive host, and poses a high risk for zoonosis. Definitive prognosis of gnathostomiasis relies mainly on the isolation of advanced-stage larvae (aL3), which is very challenging especially if the aL3 is sequestered in difficult-to-reach organs. There is also a lack of a confirmatory diagnostic test for gnathostomiasis. With the ongoing advancement of proteomics, a potential diagnostic approach is underway using immunoproteomics and immunodiagnostics. In addition to this, the employment of mass spectrometry could further elucidate not only understanding the biology of the parasite but also determining potential targets of prospective drugs and vaccines. This article reports the past, present, and future application of proteomics in the study of gnathostomiasis.

Evaluation of Rapid IgG4 Test for Diagnosis of Gnathostomiasis

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.

Morphological and Phylogenetic Analysis of Eustrongylides sp. and Gnathostoma spinigerum Parasitizing the Asian Swamp Eel Monopterusalbus in China

Nematode infections transmitted to humans by the consumption of wild or cultured eels are increasingly being reported. In the present study, 120 Asian swamp eel, Monopterus albus (Zuiew), individuals collected from China were examined for parasite infections, and 78 larval nematodes were isolated. Morphological and molecular characteristics, including sequence and phylogenetic analysis of the internal transcribed spacer (ITS) and cytochrome c oxidase subunit I (COI) gene regions, were employed to identify these nematodes at the lowest taxonomic level possible. Asian swamp eel was infected with two zoonotic parasite taxa: Gnathostoma spinigerum advanced third-stage larvae, with 6.67% prevalence and mean intensity = 1.25, and Eustrongylides sp. fourth-stage larvae, with 26.67% prevalence and mean intensity = 2.13. These findings evidence the need to enhance public hygiene and food safety awareness toward eel consumption.

Development of Immunochromatographic Test Kit for Rapid Detection of Specific IgG4 Antibody in Whole-Blood Samples for Diagnosis of Human Gnathostomiasis

Human gnathostomiasis is a harmful food-borne zoonosis caused by roundworms of the genus Gnathostoma. The parasite can occasionally migrate to the central nervous system, causing life-threatening disease and death. Here, we report a new point-of-care (POC) test kit, the gnathostomiasis blood immunochromatographic test (GB-ICT) kit. The kit is based on recombinant Gnathostoma spinigerum antigen and detects specific IgG4 antibody in whole-blood samples (WBSs). The GB-ICT kit showed potentially high diagnostic values with simulated WBSs (n = 248), which were obtained by spiking patients’ sera with red blood cells. The accuracy, sensitivity, specificity, and positive and negative predictive values were 95.2%, 100%, 93.8%, 81.5%, and 100%, respectively. Ten WBSs from clinically suspected gnathostomiasis patients were all positive according to the GB-ICT kit, while 10 WBSs from healthy volunteers were negative. The GB-ICT kit is a simple and convenient POC testing tool using finger-prick blood samples: venous blood sampling and serum separation processes are not required. The GB-ICT kit can support clinical diagnosis in remote areas and field settings without sophisticated equipment facilities.

Food safety in fisheries: Application of One Health approach

Fisheries comprise the fastest growing sector meeting the global protein requirements. Being an affordable enterprise, it is considered a safe source of food and the muscles of healthy fishes are almost sterile. However, a multitude of hazards (biological, chemical, and environmental) can be introduced into aquaculture throughout the production and supply chain. Also, it can originate from unsuitable farming practices, environmental pollution, and socio-cultural habits prevailing in various regions. Hence, with an increasing global population and demands for aquacultural products, assessment and regulation of food safety concerns are becoming significantly evident. Ensuring safe, secure, affordable, and quality food for all in a global context is pragmatically difficult. In this context, it is quite imperative to understand the ecology and dynamics of these hazards throughout the entire production chain in a One Health approach. Here, we discuss the issues and challenges faced in the fisheries sector as a whole and the need for a One Health approach to overcome such hurdles.

Human gnathostomiasis: a neglected food-borne zoonosis

BACKGROUND

Human gnathostomiasis is a food-borne zoonosis. Its etiological agents are the third-stage larvae of Gnathostoma spp. Human gnathostomiasis is often reported in developing countries, but it is also an emerging disease in developed countries in non-endemic areas. The recent surge in cases of human gnathostomiasis is mainly due to the increasing consumption of raw freshwater fish, amphibians, and reptiles.

METHODS

This article reviews the literature on Gnathostoma spp. and the disease that these parasites cause in humans. We review the literature on the life cycle and pathogenesis of these parasites, the clinical features, epidemiology, diagnosis, treatment, control, and new molecular findings on human gnathostomiasis, and social-ecological factors related to the transmission of this disease.

CONCLUSIONS

The information presented provides an impetus for studying the parasite biology and host immunity. It is urgently needed to develop a quick and sensitive diagnosis and to develop an effective regimen for the management and control of human gnathostomiasis.

Helminth infections in fish in Vietnam: A systematic review

In Vietnam, fisheries play a key role in the national economy. Helminth infections in fish have a major impact on public health and sustainable fish production. A comprehensive summary of the recent knowledge on fish helminths is important to understand the distribution of parasites in the country, and to design effective control measures. Therefore, a systematic review was conducted, collecting available literature published between January 2004 and October 2020. A total of 108 eligible records were retrieved reporting 268 helminth species, among which are digeneans, monogeneans, cestodes, nematodes and acanthocephalans. Some helminths were identified with zoonotic potential, such as, the heterophyids, opisthorchiids, the nematodes Gnathostoma spinigerum, Anisakis sp. and Capillaria spp. and the cestode Hysterothylacium; and with highly pathogenic potential, such as, the monogeneans of Capsalidae, Diplectanidae and Gyrodactylidae, the nematodes Philometra and Camallanidae, the tapeworm Schyzocotyle acheilognathi, the acanthocephalans Neoechinorhynchus and Acanthocephalus. Overall, these studies only covered about nine percent of the more than 2400 fish species occurring in the waters of Vietnam. Considering the expansion of the aquaculture sector as a part of the national economic development strategy, it is important to expand the research to cover the helminth fauna of all fish species, to assess their potential zoonotic and fish health impacts.

Case Report: The First Direct Evidence of Gnathostoma spinigerum Migration through Human Lung

Gnathostomiasis is a helminthic infection caused by the third-stage larvae of nematodes of the genus Gnathostoma. The life cycle in humans starts with an enteric phase, with the worm perforating the gastric or intestinal mucosa to reach the peritoneal cavity and migrating through the human body. Subsequent penetration through the diaphragm may produce pleuropulmonary symptoms. We herein present a previously healthy 56-year-old Thai man from Southern Thailand who was an ex-smoker presented with chronic dry cough progressing to hemoptysis after consuming grilled swamp eels and freshwater fish. Chest computed tomography showed consolidation at the lingular segment, and the differential diagnosis was primary lung cancer and pulmonary tuberculosis. The lung tissue biopsied during bronchoscopy displayed segments of organisms with the phenotypic characteristics of Gnathostoma spp., and abundant eosinophils were seen in the alveolar tissue. Gnathostoma spinigerum infection was confirmed by a Western blot assay for G. spinigerum-specific 24-kDa reactive band. The patient received albendazole, and a follow-up chest radiograph revealed improvement in the consolidation in the lung and reduction in hemoptysis. We report the first direct evidence including pathology and immunohistochemistry of Gnathostoma invasion via the human lung, with clinical and radiographic presentations mimicking either malignancy or chronic infection.

Gnathostomiasis acquired after consumption of raw freshwater fish in the Amazon region: a report of two cases in Brazil

Gnathostomiasis is a parasitic zoonosis caused by the helminth Gnathostoma spp., acquired through the consumption of raw or undercooked contaminated aquatic animals.The disease is endemic in Southeast Asia and Central America. Two male patients, both middle-aged, presented with single itchy erythemato-edematous plaques on the anterior thorax and left flank. Both had consumed raw fish in the Amazon region. The clinical and epidemiological examinations suggested gnathostomiasis, and treatment with albendazole caused total regression of the lesions. Health teams should be familiar with the disease to provide correct diagnosis. The control strategy should be based on health education for the population.

Molecular Phylogeny of Thelastomatoidea (Nematoda) with the Description of a New Genus and Two New Species of Hystrignathidae Associated with Bess Beetles (Coleoptera: Passalidae) from Oaxaca, Mexico

Bess beetles (Passalidae) display important roles in forestall ecosystems, particularly in energy extraction from dead wood. These organisms maintain complex biological interactions with their gut symbiotic communities, including bacteria, protists, and metazoans. Very little is known about symbionts since most of the species of Passalidae haven't been studied from a parasitological point of view. Here we describe a new genus and 2 new species of nematodes of the family Hystrignathidae associated with 2 beetle species of the tribe Proculini collected in the State of Oaxaca, Mexico. Tuhmai garciaprietoi n. gen., n. sp., found in Vindex agnoscendus is characterized by the presence of an unarmed cervical cuticle, a subcylindrical procorpus and a conspicuous isthmus, a monodelphic-prodelphic reproductive system, and a short subulate tail. Urbanonema osorioi n. sp., found in Verres hageni mainly differs from other species of Urbanonema by the number and disposition of cervical spines, as well as by a subulate tail. For each new taxon, we describe the external and internal morphology, and we generated molecular data (nuclear ribosomal DNA) to place the new taxa in a phylogenetic context.

Gnathostomiasis Acquired by Visitors to the Okavango Delta, Botswana

Gnathostomiasis is a zoonotic nematode parasite disease, most commonly acquired by eating raw or undercooked fish. Although the disease is well known in parts of Asia and Central and South America, relatively few cases have been reported from Africa. Raw fish consumed in the Okavango River delta area of Botswana, and in nearby western Zambia, has previously produced laboratory-proven gnathostomiasis in tourists. The purpose of this communication is to record additional cases of the infection acquired in the Okavango delta, and to alert visitors to the inadvisability of eating raw freshwater fish in the southern African region.

Emerging infections: mimickers of common patterns seen in dermatopathology

The following discussion deals with three emerging infection diseases that any dermatopathologist working in the northern hemisphere can come across. The first subject to be dealt with is gnathostomiasis. This parasitic disease is produced by the third larvarial stage of the parasite that in most patients is associated with the ingestion of raw fish. Epidemiologically, it is most commonly seen in South East Asia, Japan, China, and the American continent, mainly in Mexico, Ecuador, and Peru. Nowadays, the disease is also seen in travelers living in the developed countries who recently came back from visiting endemic countries. The disease produces a pattern of migratory panniculitis or dermatitis with infiltration of eosinophils in tissue. The requirements for making the diagnosis are provided, including clinical forms, common histological findings on skin biopsy as well as the use of ancillary testing. Buruli ulcer, a prevalent mycobacterial infection in Africa, is described from the clinical and histopathological point of view. The disease has been described occasionally in Central and South America as well as in developed countries such as Australia and Japan; Buruli ulcer has also been described in travelers returning from endemic areas. Clinically, the disease is characterized by large, painless ulcerations with undermined borders. Systemic symptoms are usually absent. Classical histological findings include a particular type of fat necrosis and the presence of abundant acid fast bacilli in tissue. Such findings should raise the possibility of this disease, with the purpose of early therapeutically intervention. Lastly, the infection by free living ameba Balamuthia mandrillaris, an emerging condition seen in the US and Peru, is extensively discussed. Special attention is given to clinical and histological characteristics, as well as to the clues for early diagnosis and the tools available for confirmation.

Case Report: Ocular Gnathostomiasis in Venezuela Most Likely Acquired in Texas

A 69-year-old male dentist in Caracas, Venezuela, was referred to our Cornea Clinic with a history of pain, photophobia, and blurred vision on his left eye. Routine biomicroscopic examination with a slit lamp showed a worm in the corneal stroma of his left eye. The worm was surgically removed and was identified morphologically as Gnathostoma binucleatum.

Foodborne Parasites in Europe: Present Status and Future Trends

Although foodborne parasites (FBPs) are becoming recognized as important foodborne pathogens, they remain neglected compared with bacterial and viral foodborne pathogens. As drivers for infection with FBPs are variable, it is often unclear for funding bodies where research should be prioritized. Through a COST Action (Euro-FBP; FA1408), we harnessed Europe-wide expertise to address these questions, using an Expert Knowledge Elicitation approach. Eating habits, lack of food-chain control, lack of awareness from relevant agencies, globalization, and water quality were identified as major drivers for FBP infection. Prioritized research needs to be largely focused on methodological gaps, but also on surveillance concerns, impact-assessment issues, and the role of microbiota. Despite the European focus, these responses should be relevant to those concerned with FBPs globally.

Molecular identification and genetic diversity of Gnathostoma spinigerum larvae in freshwater fishes in southern Lao PDR, Cambodia, and Myanmar

Gnathostomiasis, an emerging food-borne parasitic zoonosis in Asia, is mainly caused by Gnathostoma spinigerum (Nematoda: Gnathostomatidae). Consumption of raw meat or freshwater fishes in endemic areas is the major risk factor. Throughout Southeast Asia, including Thailand, Lao PDR, Cambodia, and Myanmar, freshwater fish are often consumed raw or undercooked. The risk of this practice for gnathostomiasis infection in Lao PDR, Cambodia, and Myanmar has never been evaluated. Here, we identified larvae of Gnathostoma species contaminating freshwater fishes sold at local markets in these three countries. Public health authorities should advise people living in, or travelling to, these areas to avoid eating raw or undercooked freshwater fishes. Identification of larvae was done using molecular methods: DNA was sequenced from Gnathostoma advanced third-stage larvae recovered from snakehead fishes (Channa striata) and freshwater swamp eels (Monopterus albus). Phylogenetic analysis of a portion of the mitochondrial cytochrome c oxidase subunit I gene showed that the G. spinigerum sequences recovered from southern Lao PDR, Cambodia, and Myanmar samples had high similarity to those of G. spinigerum from China. Sequences of the nuclear ribosomal DNA internal transcribed spacer 2 region closely resembled sequences of G. spinigerum from Thailand, Indonesia, the USA, and central Lao PDR. This is the first molecular evidence of G. spinigerum from freshwater fishes in southern Lao PDR, Cambodia, and Myanmar.

An Overview of Fish-borne Nematodiases among Returned Travelers for Recent 25 Years- Unexpected Diseases Sometimes Far Away from the Origin

Along with globalization of traveling and trading, fish-borne nematodiases seems to be increasing in number. However, apart from occasional and sporadic case reports or mini-reviews of particular diseases in particular countries, an overview of fish-borne nematodiasis among travelers have never been performed. In this review, we gathered fishborne nematodiasis among travelers for recent 25 years by an extensive global literature survey using appropriate keywords, e.g. travelers diseases, human infection, anisakiasis, gnathostomiasis, capillariasis, sushi, sashimi, ceviche, Gnathostoma, Pseudoterranova, Anisakis, Capillaria, etc., as well as various combinations of these key words. The Internet search engines PubMed, Medline, Google and Googler Scholar were used as much as possible, and the references of every paper were checked in order to identify useful and reliable publications. The results showed unexpectedly high incidence of gnathostomiasis and low incidence of anisakidosis. The different incidence values of the infection with several fish-borne zoonotic nematode species are discussed, as well as some epidemiological aspects of the infections. The difficulties of differential diagnosis in non-endemic countries are emphasized. It is concluded that travelers must avoid risky behaviors which can lead to infection and that physicians and health authorities must advice travelers on the risks of eating behaviors during travel.

Gnathostomiasis: an emerging infectious disease relevant to all dermatologists

Gnathostomiasis is a parasitic infection caused by the third larval stage of nematodes of the genus Gnathostoma. The disease is endemic in some countries around the world. In the American continent, the majority of cases is concentrated in Mexico, Ecuador, and Peru. However, due to increasing traveling either at the intercontinental or intracontinental level, the disease is seen each time more frequently in tourists. Furthermore, countries, such as Brazil, that have never been considered endemic are reporting autochthonous cases. The disease usually presents as a deep-seated or slightly superficial migratory nodule in patients with history of eating raw fish, in the form of ceviche, sushi, or sashimi. Along with the clinical presentation, diagnostic criteria include either blood or tissue eosinophilia. In most instances, these criteria are enough for the attending physician to institute therapy. Chances of finding the parasite are low, unless the biopsy is taken from a very specific area that develops after antiparasitic treatment is started. The potential of other organ involvement with more serious consequences should always be kept in mind.

Imported gnathostomiasis manifesting as cutaneous larva migrans and Löffler's syndrome

Here, we report an unusual case of invasive gnathostomiasis in a returning traveller, with a shifting pattern of relapsing cutaneous disease. The previously fit and well 32-year-old man first presented with serpiginous, pruriginous erythematous tracks characteristic of cutaneous larva migrans shortly after returning from South-East Asia. He was systemically well with no other symptoms. After ivermectin therapy, he re-presented with respiratory symptoms, peripheral eosinophilia and transient pulmonary infiltrates; the classic triad of Löffler's syndrome associated with invasive helminth infection. Gnathostoma spinigerum immunoblot was positive. After a second round of ivermectin therapy his respiratory symptoms resolved, but the patient's cutaneous disease relapsed repeatedly over months, with migratory erythematous swellings appearing and settling after a few days. He was treated with a 21-day course of albendazole and is lesion free at 40 weeks post initial presentation.

A filtration-based rapid test using a partially purified third-stage larval antigen to detect specific antibodies for the diagnosis of gnathostomiasis

Human gnathostomiasis is an emerging food-borne parasitic disease caused by nematodes of the genus Gnathostoma. Currently, serological tests are commonly applied to support clinical diagnosis. In the present study, a simple and rapid filtration-based test, dot immune-gold filtration assay (DIGFA) was developed using a partially purified antigen of Gnathostoma third-stage larvae (L3). A total of 180 serum samples were tested to evaluate the diagnostic potential of DIGFA for gnathostomiasis. The diagnostic sensitivity and specificity were 96.7% (29/30) and 100% (25/25), respectively. The cross-reactivity with sera from other helminthiasis patients ranged from 0 to 4%, with an average of 1.6% (2/125). DIGFA using a partially purified L3 antigen was not only simple and rapid, but also more accurate than standard assays for the diagnosis of human gnathostomiasis. DIGFA may represent a promising tool for application in laboratories or in the field, without requiring any instrumentation.

Helminth parasites of finfish commercial aquaculture in Latin America

Latin America has tripled production by aquaculture up to 78 million tonnes in the past 20 years. However, one of the problems that aquaculture is facing is the presence of helminth parasites and the diseases caused by them in the region. In this review we have collected all the available information on helminths affecting commercial aquaculture in Latin America and the Caribbean (LAC), emphasizing those causing serious economic losses. Monogeneans are by far the most common and aggressive parasites affecting farmed fish in LAC. They have been recognized as serious pathogens in intensive fish culture because they reach high levels of infection rapidly, and can infect other phylogenetically related fish species. The next most important group comprises the larval stages of digeneans (metacercariae) such as Diplostomum sp. and Centrocestus formosanus, which cause serious damage to farmed fish. Since LAC aquaculture has been based mainly on exotic species (tilapia, salmon, trout and carp), most of their parasites have been brought into the region together with the fish for aquaculture. Recently, one of us (A.I.P.-T.) has suggested that monogeneans, which have generally been considered to be harmless, can produce serious effects on the growth of cultured Nile tilapia. Therefore, the introduction of fish together with their 'harmless' parasites into new sites, regions or countries in LAC should be considered a breakdown of biosecurity in those countries involved. Therefore, the application of quarantine procedures and preventive therapeutic treatments should be considered before allowing these introductions into a country.

Cross-Reactivity Pattern of Asian and American Human Gnathostomiasis in Western Blot Assays Using Crude Antigens Prepared from Gnathostoma spinigerum and Gnathostoma binucleatum Third-Stage Larvae

Gnathostomiasis is a zoonotic parasitosis endemic in many Asian and some Latin American countries. Most human infections are caused by Gnathostoma spinigerum in Asia and Gnathostoma binucleatum in the Americas, and recently, imported cases have been increasing among travelers returning from endemic regions. Confirmation of the clinical diagnosis relies largely on serologic tests, with a G. spinigerum-antigen-based immunoblot currently being the diagnostic method of choice. However, we repeatedly experienced that sera from patients with clinically suspected American gnathostomiasis gave negative results in this assay. Therefore, we used homologous methods to prepare G. spinigerum- and G. binucleatum-antigen-based immunoblot assays, and evaluated the cross-reactivity of the two assays. The results show incomplete cross-reactivity between the two assays: the G. spinigerum-antigen-based immunoblot apparently only detects Asian gnathostomiasis caused by G. spinigerum, whereas the G. binucleatum-antigen-based immunoblot is apparently capable of detecting American as well as Asian gnathostomiasis.

Thoracic Myelopathy Due to Gnathostomiasis Acquired in New Zealand

Gnathostomiasis is a zoonotic disease endemic in Asia. It most commonly manifests as gastrointestinal and cutaneous disease. Central nervous system involvement is a rare but feared complication, often leaving patients with permanent neurologic deficits. Clinicians outside of Asia and Latin America may have little experience with this illness, causing delays in diagnosis and treatment. We describe a 40-year-old woman who developed a progressive myelopathy over 18 months. She had never traveled outside of New Zealand. Cerebrospinal fluid (CSF) showed marked eosinophilia and Gnathostoma serology was positive in both serum and CSF. This is the first report of gnathostomiasis acquired in New Zealand, and the first case of neurognathostomiasis reported outside Asia. Clinicians should include neurognathostomiasis in the differential diagnosis of myelopathy and CSF eosinophilia, even if there is no history of travel to endemic areas.

Gnathostomiasis in Brazil: an emerging disease with a challenging diagnosis

This case report describes the second reported case of gnathostomiasis acquired in Brazil. The French traveller returned from a sport fishing trip from Tocantins where he was repeatedly consuming raw freshwater fish marinated with lemon juice. Gnathostoma infection was diagnosed based on clinical symptoms, dietary record and by detection of specific antibodies in the blood.

The complete mitochondrial genomes of Gnathostoma doloresi from China and Japan

Gnathostoma doloresi is one of the neglected pathogens causing gnathostomiasis. Although this zoonotic parasite leads to significant socioeconomic concerns globally, little is known of its genetics and systematics. In the present study, we sequenced and characterized the complete mitochondrial (mt) genomes of G. doloresi isolates from China and Japan. The lengths of the mt genomes of the G. doloresi China and Japan isolates are 13,809 and 13,812 bp, respectively. Both mt genomes encode 36 genes, including 12 protein-coding genes (PCGs), 2 ribosomal RNA genes, and 22 transfer RNA genes. The gene order, transcription direction, and genome content are identical with its congener G. spinigerum. Phylogenetic analyses based on concatenated amino acid sequences of 12 PCGs by Bayesian inference (BI) indicated that G. doloresi are closely related to G. spinigerum. Our data provide an invaluable resource for studying the molecular epidemiology, phylogenetics, and population genetics of Gnathostoma spp. and should have implications for further studies of the diagnosis, prevention, and control of gnathostomiasis in humans and animals.