A rare case of cutaneous larva migrans due to Gnathostoma sp

Parasitic Infections of the Skin and Subcutaneous Tissues

A variety of arthropods, protozoa, and helminths infect the skin and subcutaneous tissues and may be identified by anatomic pathologists in standard cytology and histology preparations. The specific organisms seen vary greatly with the patient's exposure history, including travel to or residence in endemic countries. Arthropods are the most commonly encountered parasites in the skin and subcutaneous tissues and include Sarcoptes scabei, Demodex species, Tunga penetrans, and myiasis-causing fly larvae. Protozoal parasites such as Leishmania may also be common in some settings. Helminths are less often seen, and include round worms (eg, Dirofilaria spp.), tapeworms (eg, Taenia solium, Spirometra spp.), and flukes (eg, Schistosoma spp.). This review covers the epidemiologic and histopathologic features of common parasitic infections of the skin and subcutaneous tissues.

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.

Ocular Gnathostomiasis-Update of Earlier Survey

Ocular gnathostomiasis is rather a rare food-borne zoonosis caused by infection with the larvae of several species of genus Gnathostoma and is a representative ocular larva migrans syndrome. In our previous literature survey, we found 73 cases of ocular gnathostomiasis reported up to and including 2009, though additional sporadic cases have been reported in Asia and the Americas since that report. Here, we review 10 additional cases reported since 2010, and also update current findings regarding epidemiological and clinical features in affected patients.

Cutaneous Manifestations of Selected Parasitic Infections in Western Pacific and Southeast Asian Regions

Cutaneous manifestations of parasitic infections often result in discomfort, debilitation, and even stigmatization. Data on cutaneous manifestations of parasitic infections, however, are limited. This article provides updates on the cutaneous manifestations of parasitic infections which are known to occur in Western Pacific and Southeast Asian regions, such as scabies, pediculosis, cutaneous larva migrans, larva currens, cutaneous schistosomiasis, cutaneous enterobiasis, cutaneous cysticercosis, acute dermatolymphangioadenitis (lymphatic filariasis), and cutaneous amoebiasis. The lack of epidemiological data on these conditions suggests the need for improvements in recording and reporting of cases. Utilization of advance diagnostic modalities and capacity building of health workers are important for proper case management. Cutaneous manifestations of parasitic infections are a topic rarely studied and thus represent an opportunity for further research.

Larva migrans in India: veterinary and public health perspectives

Despite an important public health problem in developing world like India, larva migrans remains a neglected zoonosis. Cutaneous larva migrans, Visceral larva migrans, and Ocular larva migrans are the important clinical manifestations seen in humans in India. Although many nematode parasites have the ability to cause the infection, the disease primarily occurs due to Ancylostoma caninum and Toxocara canis. Presence of the infection in dogs is an indirect indication of its incidence in humans in endemic regions. In India, sporadic cases of this neglected but important parasitic zoonosis are the main implications of lack of diagnostic methods and under-reporting of human cases. Tropical climate in addition to overcrowding, poor hygiene and sanitation problems, stray dogs, open defecation by dogs and improper faecal disposal are the important factors for persistence of this disease in the country. Sanitary and hygienic measures, improved diagnostic techniques and surveillance programme in dogs as well as humans should be adopted for its effective control. Comprehensive collaborative efforts by physicians and veterinarians are required to tackle this problem in order to attain optimal health for humans, animals and the environment. Moreover, recognition of larva migrans as an important public health problem is the most important step to combat this neglected disease in developing countries like India.

Neurognathostomiasis in a young child in India: A case report

Eosinophilc meningitis is commonly associated with Angiostrongylus and Gnathostoma infection and has largely been reported from Thailand. We present the first case report of neurognathostomaisis in a pediatric patient from India. A 3.5 year old girl presented with fever, parasthesis, behavioral changes followed by flaccid quadriparesis. Neuroimaging showed haemorrhagic radiculomyelitis with cerebrospinal fluid eosinophilia. Diagnosis of Gnathostoma infection was confirmed serologically and she was treated with anthelminthic drugs and steroids. This report emphasizes the increasing importance of central nervous system helminithic infections as an alternative diagnosis to common infections like neurotuberculosis in developing countries, even in pediatric patients. Increasing intercontinental travel and migration have increased the incidence and importance in the developed world as well.

Occurrence of Gnathostoma spinigerum in a leopard cat from Wayanad Wildlife Sanctuary, Kerala

The post-mortem examination of a leopard cat from Wayanad Wildlife Sanctuary, Kerala, died in a road accident, revealed presence of gastric tumours containing worms which were identified as Gnathostoma spinigerum based on morphological characteristics.

The burden of parasitic zoonoses in Nepal: a systematic review

Background

Parasitic zoonoses (PZs) pose a significant but often neglected threat to public health, especially in developing countries. In order to obtain a better understanding of their health impact, summary measures of population health may be calculated, such as the Disability-Adjusted Life Year (DALY). However, the data required to calculate such measures are often not readily available for these diseases, which may lead to a vicious circle of under-recognition and under-funding.

Methodology

We examined the burden of PZs in Nepal through a systematic review of online and offline data sources. PZs were classified qualitatively according to endemicity, and where possible a quantitative burden assessment was conducted in terms of the annual number of incident cases, deaths and DALYs.

Principal Findings

Between 2000 and 2012, the highest annual burden was imposed by neurocysticercosis and congenital toxoplasmosis (14,268 DALYs [95% Credibility Interval (CrI): 5450–27,694] and 9255 DALYs [95% CrI: 6135–13,292], respectively), followed by cystic echinococcosis (251 DALYs [95% CrI: 105–458]). Nepal is probably endemic for trichinellosis, toxocarosis, diphyllobothriosis, foodborne trematodosis, taeniosis, and zoonotic intestinal helminthic and protozoal infections, but insufficient data were available to quantify their health impact. Sporadic cases of alveolar echinococcosis, angiostrongylosis, capillariosis, dirofilariosis, gnathostomosis, sparganosis and cutaneous leishmaniosis may occur.

Conclusions/Significance

In settings with limited surveillance capacity, it is possible to quantify the health impact of PZs and other neglected diseases, thereby interrupting the vicious circle of neglect. In Nepal, we found that several PZs are endemic and are imposing a significant burden to public health, higher than that of malaria, and comparable to that of HIV/AIDS. However, several critical data gaps remain. Enhanced surveillance for the endemic PZs identified in this study would enable additional burden estimates, and a more complete picture of the impact of these diseases.

Various parasites that infect humans require animals in some stage of their life cycle. Infection with these so-called zoonotic parasites may vary from asymptomatic carriership to long-term morbidity and even death. Although data are still scarce, it is clear that parasitic zoonoses (PZs) present a significant burden for public health, particularly in poor and marginalized communities. So far, however, there has been relatively little attention to this group of diseases, causing various PZs to be labeled neglected tropical diseases. In this study, the authors reviewed a large variety of data sources to study the relevance and importance of PZs in Nepal. It was found that a large number of PZs are present in Nepal and are imposing an impact higher than that of malaria and comparable to that of HIV/AIDS. These results therefore suggest that PZs deserve greater attention and more intensive surveillance. Furthermore, this study has shown that even in settings with limited surveillance capacity, it is possible to quantify the impact of neglected diseases and, consequently, to break the vicious circle of neglect.