Dermatosis de origen alimentario al regreso de un viaje: gnathostomiasis / Foodborne dermatosis after traveling: gnathostomiasis

Se describe el caso de un paciente de 32 años de edad, residente en Buenos Aires, con manifestaciones dermatológicas compatibles con gnathostomiasis. Había realizado un viaje a Colombia en el mes previo a la aparición de la sintomatología. Allí consumió cebiche (pescado crudo marinado en jugo de limón) en reiteradas oportunidades. El cuadro clínico se presentó como paniculitis eritematosa y migratoria acompañada de eosinofilia sanguínea. Se le realizó biopsia cutánea de una lesión y el diagnóstico anatomopatológico fue "paniculitis eosinofílica". La tríada de paniculitis migratoria, eosinofilia sanguínea y el consumo de pescado crudo durante el viaje a Colombia fue sugestiva de gnathostomiasis por lo que se indicó tratamiento con ivermectina con buena evolución inicial y recaída posterior. Se realizó un nuevo tratamiento con la misma droga con buena evolución y sin recaídas durante tres años de seguimiento. La afección dermatológica es un motivo frecuente de consulta al regreso de un viaje, y representa la tercera causa de morbilidad en viajeros. Es muy importante el reconocimiento de las enfermedades que pueden tener manifestación cutánea, ya que muchas de ellas son potencialmente graves y pueden poner en riesgo la vida del paciente si no son oportunamente diagnosticadas y tratadas.

We describe a case of a 32-year-old man, resident in Buenos Aires, with dermatologic manifestations compatible with gnathostomiasis. The patient had traveled to Colombia in the month prior to the onset of symptoms. There, he repeatedly ate ceviche (raw fish marinated in lemon juice). He presented with an erythematous migratory panniculitis accompanied by eosinophilia. He underwent skin biopsy of a lesion and pathological diagnosis was "eosinophilic panniculitis". The triad of migratory panniculitis, eosinophilia and consume of raw fish during the trip to Colombia was suggestive of gnathostomiasis. Ivermectin treatment started out with good initial response but subsequent relapse. We performed a new treatment with the same drug with good results and no relapses during three years of follow up. The dermatological disease is common upon return from a trip, and is the third leading cause of morbidity in travelers. It is very important to recognize cutaneous manifestations of disease as many of them are potentially serious and may compromise the patient's life if not promptly diagnosed and treated.

Gnathostoma infection in fish caught for local consumption in Nakhon Nayok Province, Thailand I. Prevalence and fish species.

Between August 2000 and August 2001, 12,216 fish of 73 species were purchased from several local markets in Nakhon Nayok Province, Thailand, and examined for the presence of Gnathostoma larvae. Almost all species were fresh-water fish that had grown naturally, rather than raised commercially. Eight species were found to be infected with gnathostome larvae. The overall prevalence was 5.1% (626/12,216) and a total of 5,969 larvae was recovered. The highest rate of infection (30.1 %) was found in Monopterus albus (swamp eel). The rates in the remaining infected fish were as follows: Anabas testudineus (climbing perch) 7.7%, Channa striata (striped snake-head fish) 7.4%, Clarius macrocephalus (Gunther's walking catfish) 6.7%, Channa micropeltes (giant snake-head fish) 5.1%, Channa lucius (blotched snake-head fish) 4.0%, Clarius batrachus (Batrachian walking catfish) 1.4%, and Ompok krattensis (butter sheatfish) 0.6%. The mean number of larvae/fish was highest in swamp eels (10.0 larvae/eel), and the maximum number of 698 larvae was recovered from one eel. The body sizes of the recovered G. spinigerum advanced third-stage larvae were 2.70-5.10 mm in length (average, 3.97+/-0.50 mm) and 0.29-0.60 mm in width (average, 0.40+/-0.04 mm). The average number of cephalic hooklets of the larvae from rows 1 to 4 were 41.8+/-0.5 (range, 40-43), 43.6+/-0.6 (range, 42-45), 46.1+/-0.9 (range, 44-48) and 49.3+/-0.7 (range, 48-51), respectively.

Gnatostomiasis intraocular: caso anatomoclínico

La gnatostomiasis humana es una enfermedad rara, cuya frecuencia aumentó en los últimos años; es ocasionada por la infestación de un nematodo, Gnathostoma, el cual se adquiere por ingestión de pescado crudo. El presente trabajo describe el caso de una paciente de 27 años de edad, residente de Uxpanapa, Ver., a quien se le encontró una larva de 3er. estadio alojada en la cámara anterior del globo ocular derecho, que se extrajo quirúrgicamente con éxito; se identificó como Ghathostoma probablemente spinigerum.

Gnathostomiasis in Southeast Asia.

Five species of Gnathostoma are at present reported from Southeast Asia with specific diagnostic characteristic of each. Also important references relating to the specific characters of the species concerned were mentioned, and the known experimental life cycles of three species namely G. spinigerum, G. hispidum, and G. doloresi found in the region were compared. The incomplete experimental study on the life cycle of G. vietnamicum is presented but the investigation on the life cycle of G. malaysiae is not yet initiated. Methods of transmission, symptoms and signs, the diagnosis and treatment of animal and human gnathostomiasis were also summarized. Effective therapeutic value of many anthelmintic drugs has not been satisfactory, by screening test on white mice previously infected in the tissue with G. spinigerum larvae. However, successful result of treatment was reported on one Japanese gnathostomiasis patient with thiabendazole. In the treatment of animal gnathostomiasis, Ancylol disophenol seems to be he effective drug for eliminating adult and migrating stage in the experimentally infected cats. Brief preventive measures against human gnathostomiasis was mentioned.