Genetic diversity of infective larvae of Gnathostoma spinigerum (Nematoda: Gnathostomatidae) in freshwater swamp eels from Thailand.

Human gnathostomiasis is a food-borne zoonosis caused by a tissue nematode of the genus Gnathostoma. The disease is highly endemic in Asia, including Thailand. The freshwater swamp eel (Monopterus albus), the second intermediate host of the gnathostome nematode, has an important role in transmitting the infection in Thailand. Surveys on the infective larvae of Gnathostoma spinigerum based on morphological features in freshwater swamp eels have been performed continuously and reported in Thailand. However, there is still limited molecular data on intra-species variations of the parasite. In this study, a total of 19 third-stage larvae of morphologically identified G. spinigerum were collected from 437 liver samples of freshwater swamp eels purchased from a large wholesale market in Bangkok, Thailand. Molecular characterization based on mitochondrial cytochrome c oxidase subunit I (COI) sequences was performed to elucidate their genetic variations and phylogenetic relationship. Among the 19 infective larvae recovered from these eels, 16 were sequenced successfully. Phylogenetic analyses inferred from the partial COI gene showed the presence of three distinct COI haplotypes. Our findings confirm the presence of G. spinigerum as the main species in Thailand.

Proteomic analysis identification of antigenic proteins in Gnathostoma spinigerum larvae.

Gnathostoma spinigerum is the causative agent of human gnathostomiasis. The advanced third stage larva (AL3) of this nematode can migrate into the subcutaneous tissues, including vital organs, often producing severe pathological effects. This study performed immuno-proteomic analysis of antigenic spots, derived from G. spinigerum advanced third stage larva (GSAL3) and recognized by human gnathostomiasis sera, using two-dimensional (2-DE) gel electrophoresis based-liquid chromatography/tandem mass spectrometry (LC/MS-MS), and followed by the aid of a database search. The crude GSAL3 extract was fractionated using IPG strips (pH 3-11NL) and followed by SDS-PAGE in the second dimension. Each gel was stained with colloidal Coomassie blue or was electro-transferred onto a nitrocellulose membrane and probed with gnathostomiasis human sera by immunoblotting. Individual Coomassie-stained protein spots corresponding to the antigenic spots recognized by immunoblotting were excised and processed using LC/MS-MS. Of the 93 antigenic spots excised, 87 were identified by LC/MS-MS. Twenty-seven protein types were found, the most abundant being Ascaris suum37. Six spots showed good quality spectra, but could not be identified. This appears to be the first attempt to characterize antigenic proteins from GSAL3 using a proteomic approach. Immuno-proteomics shows promise to assist the search for candidate proteins for diagnosis and vaccine/drug design and may provide better understand of the host-parasite relationship in human gnathostomiasis.

Increasing Risk Factors for Imported and Domestic Gnathostomiasis in the United States.

Gnathostomiasis is a foodborne zoonotic helminthic infection, commonly described in Asia and Latin America, which may follow the consumption of raw fish, eels, amphibians, and reptiles infected with muscle-encysted larvae of Gnathostoma species nematodes. After an inoculum of as little as one infective larva and an incubation period of months to years, most infections are characterized by intermittent migratory swellings due to subdermal larval migration. Less commonly, larval migration to the central nervous system may result in radiculomyelopathy or eosinophilic meningoencephalitis with high fatality rates; or larval migration to the eye with resulting blindness in untreated cases. Since the US now supports a zoonosis of Gnathostoma species with infective larvae encysted in imported and domestic fish and eels that may be consumed raw as exotic ethnic dishes, the objectives of this review were to describe the biology and life cycle of Gnathostoma nematodes and the behavioral risk factors for gnathostomiasis; and to describe the clinical manifestations, diagnosis, management, and prevention of human gnathostomiasis. Since the eradication of gnathostomiasis is very unlikely given the global distribution of Gnathostoma nematodes and the increasingly exotic culinary tastes of US residents and travelers to endemic regions, the only effective strategies for gnathostomiasis include: (1) educating citizens in the US and travelers abroad in endemic areas that fish, eels, frogs, snakes, and chicken must be cooked thoroughly first and not eaten raw or marinated; and (2) seeking medical care immediately for evaluation of migratory subcutaneous swellings. The combination of international travel and increased immigration from Asia and Latin America to the US has resulted in greater popularity of exotic ethnic cuisine, especially raw seafood dishes. The ethnic cuisine industry is supported by domestic aquaculture that produces fish-farmed tilapia and trout, and by increased importation of live freshwater species, such as Asian swamp eels (Monopterus spp.).1 Although raw seafood dishes are typically prepared with saltwater species, freshwater species, which harbor more parasites, are also used in these dishes, such as limejuice marinated tilapia or trout ceviche and eel-sashimi and sushi.2 In 2014, biologists from the US Geological Survey detected Gnathostoma species infective-stage larvae in nearly 30 percent of imported Monopterus species Asian swamp eels and in 4.5 percent of locally-caught Monopterus species freshwater swamp eels in three states.1 The investigators concluded that consumption of imported swamp eels from Gnathostoma-endemic regions of Asia could transmit gnathostomiasis to humans in the US.1 In addition, the release of live imported swamp eels or the disposal of their offal after filleting has introduced more Gnathostoma larvae into open and fish-farmed freshwaters infecting more native species.1 Since the US has all of the components to support Gnathostoma's life cycle, a zoonosis of infective Gnathostoma species, such as G. spinigerum and others, has become established in the US and will increase the risks of gnathostomiasis in humans consuming native, wildcaught, or farmed fish in ethnic dishes.1 As a result, the objectives of this review were to describe the biology and life cycle of Gnathostoma nematodes and the behavioral risk factors for gnathostomiasis; and to describe the clinical manifestations, diagnosis, management, and prevention of human gnathostomiasis.

Description of advanced third-stage larvae of Gnathostoma lamothei Bertoni-Ruiz et al. 2005 (Nematoda: Gnathostomatidae) from experimental hosts and contributions to its life cycle.

The advanced third-stage larvae (AdvL(3)) of Gnathostoma lamothei was obtained from experimental hosts. Frogs Lithobates heckscheri and snakes Nerodia fasciata pictiventris were compatible hosts allowing optimal larval development. AdvL(3) are 4,487.94 µm long, have two lateral cervical papillae between rows 10 and 16 and an excretory pore at row 23. The average counts of the cephalic bulb hooklets from the four rows are 39.3, 43.3, 44.2, and 47.3. Larvae show an esophagus that represents 40 % of the body width. These findings indicate that amphibians and reptiles could be involved as G. lamothei natural hosts; nevertheless, their role as etiological agents of human gnathostomiasis is uncertain. This paper reports for the first time the taxonomic description of G. lamothei AdvL(3) obtained from experimental hosts and contributes to the understanding of its life cycle.

Neurognathostomiasis, a neglected parasitosis of the central nervous system.

Gnathostomiasis is a foodborne zoonotic helminthic infection caused by the third-stage larvae of Gnathostoma spp. nematodes. The most severe manifestation involves infection of the central nervous system, neurognathostomiasis. Although gnathostomiasis is endemic to Asia and Latin America, almost all neurognathostomiasis cases are reported from Thailand. Despite high rates of illness and death, neurognathostomiasis has received less attention than the more common cutaneous form of gnathostomiasis, possibly because of the apparent geographic confinement of the neurologic infection to 1 country. Recently, however, the disease has been reported in returned travelers in Europe. We reviewed the English-language literature on neurognathostomiasis and analyzed epidemiology and geographic distribution, mode of central nervous system invasion, pathophysiology, clinical features, neuroimaging data, and treatment options. On the basis of epidemiologic data, clinical signs, neuroimaging, and laboratory findings, we propose diagnostic criteria for neurognathostomiasis.

Gnathostoma binucleatum: pathological and parasitological aspects in experimentally infected dogs.

Lesions and antibody kinetics produced by inoculation of Gnathostoma binucleatum larvae into dogs are described, as well as the morphology of the recovered parasites. In four out of five infected bitches parasite phases were found in the stomach. Only one bitch eliminated eggs and adult parasite phases in feces. In this bitch, the prepatency period lasted 22 weeks and the patency period 14 weeks. Necropsy results showed a copiously vascularized 8-cm diameter fibrous nodule lodged in the greater curvature of the stomach. Two bitches that eliminated no eggs showed 1- to 2-cm diameter nodules on the gastric wall, with five juvenile phases in each. One bitch that eliminated no eggs and exhibited no gastric nodules showed juvenile parasites on the gastric wall. Results confirm dogs as definitive hosts of this parasite. New data on the pathological and parasitological aspects of canine gnathostomosis are presented.

Gnathostoma hispidum infection in a Korean man returning from China.

Human Gnathostoma hispidum infection is extremely rare in the world literature and has never been reported in the Republic of Korea. A 74-year-old Korean man who returned from China complained of an erythematous papule on his back and admitted to our hospital. Surgical extraction of the lesion and histopathological examination revealed sections of a nematode larva in the deep dermis. The sectioned larva had 1 nucleus in each intestinal cell and was identified as G. hispidum. The patient recalled having eaten freshwater fish when he lived in China. We designated our patient as an imported G. hispidum case from China.

Prevalence of Gnathostoma spinigerum infection in wild and cultured swamp eels in Vietnam.

Human infections with Gnathostoma spinigerum frequently occur in southern Vietnam. Previous investigations have implicated infected swamp eels (Monopterus albus) as an important source of infection to humans. Because aquaculture of M. alba is an important farming activity in Vietnam, a 2-yr study was carried out to assess the relative importance of farmed and wild eels as potential sources of gnathostome infections in humans. Eels sold for public consumption in markets in southern provinces were examined between November 2005 and August 2007. Although no infections were detected in 1,020 cultured eels and 1,021 wild-caught eels collected from November 2005 to September 2006, larval G. spinigerum (AL3) infections were first detected in September 2006 in 28 of 230 wild-caught eels (12.2%) obtained from markets in Long An province and the Hoc Mon district of Ho Chi Minh City. Subsequently, monthly surveillance of wild-caught eels from these markets was carried out through August 2007. Prevalence of AL3 varied monthly, ranging from 0.8 to 19.6%. Both prevalence and infection intensity were higher during the latter part of the rainy season (August- October). These results demonstrate that potentially zoonotic G. spinigerum larvae are common in wild eels in southern Vietnam and present a risk to consumers of raw fish dishes, especially during the annual rainy season. This information could help target public health education efforts in the region. The basis for the seasonal variation on eel infections is not known, but may be related to climate effects (flooding, higher temperatures) on intermediate host species ecology.

Finding advanced third-stage larvae of Gnathostoma turgidum Stossich, 1902 in Mexico from natural and experimental host and contributions to the life cycle description.

In order to clarify the role of Gnathostoma turgidum as an etiological agent involved in human gnathostomiasis in Mexico, establish the taxonomic identity of the advanced third-stage larvae (AdvL(3)), and contribute to the knowledge of its life cycle, experimental host infections, examination of potential natural hosts, and morphological comparisons were carried out. Examination of ten species of potential hosts at San Pedro las Playas and Tres Palos Lagoon in Guerrero state, Mexico revealed that two (Kinosternon integrum and Rana zweifeli) were infected by 15 AdvL(3) of G. turgidum. A specific identity was obtained comparing these larvae with those recovered from hosts experimentally infected. The AdvL(3) measured 1.6 mm in length, with two cervical papillae (both in 12th row) and an excretory pore on the 19th row. The average of cephalic hooklets, from first to fourth row, was 30.8, 34.0, 36.7, and 39.6, respectively. This is the first record of AdvL(3) of G. turgidum in America, and it represents a significant contribution for the understanding of the life cycle of this species.

Sensitivity of mottled sculpins (Cottus bairdi) and rainbow trout (Onchorhynchus mykiss) to acute and chronic toxicity of cadmium, copper, and zinc.

Studies of fish communities of streams draining mining areas suggest that sculpins (Cottus spp.) may be more sensitive than salmonids to adverse effects of metals. We compared the toxicity of zinc, copper, and cadmium to mottled sculpin (C. bairdi) and rainbow trout (Onchorhynchus mykiss) in laboratory toxicity tests. Acute (96-h) and early life-stage chronic (21- or 28-d) toxicity tests were conducted with rainbow trout and with mottled sculpins from populations in Minnesota and Missouri, USA, in diluted well water (hardness = 100 mg/L as CaCO3). Acute and chronic toxicity of metals to newly hatched and swim-up stages of mottled sculpins differed between the two source populations. Differences between populations were greatest for copper, with chronic toxicity values (ChV = geometric mean of lowest-observed-effect concentration and no-observed-effect concentration) of 4.4 microg/L for Missouri sculpins and 37 microg/L for Minnesota sculpins. Cadmium toxicity followed a similar trend, but differences between sculpin populations were less marked, with ChVs of 1.1 microg/L (Missouri) and 1.9 microg/L (Minnesota). Conversely, zinc was more toxic to Minnesota sculpins (ChV = 75 microg/L) than Missouri sculpins (chronic ChV = 219 microg/L). Species-average acute and chronic toxicity values for mottled sculpins were similar to or lower than those for rainbow trout and indicated that mottled sculpins were among the most sensitive aquatic species to toxicity of all three metals. Our results indicate that current acute and chronic water quality criteria for cadmium, copper, and zinc adequately protect rainbow trout but may not adequately protect some populations of mottled sculpins. Proposed water quality criteria for copper based on the biotic ligand model would be protective of both sculpin populations tested.

Estuarine fish and turtles as intermediate and paratenic hosts of Gnathostoma binucleatum in Nayarit, Mexico.

Human gnathostomosis is a severe public health problem in the State of Nayarit, Mexico. Between 1995 and 2005, the registration of human cases numbered 6,328, which makes it one of the largest focal points of the disease in the country. The present study determined the presence of natural hosts of Gnathostoma binucleatum larvae at the Laguna de Agua Brava in Nayarit, Mexico. A total of 5,450 fish and 247 turtles were sampled. Muscular tissue was ground and observed against the light using a 100-W lamp to identify advanced third-stage larvae. The estuarine species Cathorops fuerthii, Pomadasys macracanthus, Mugil curema, and Dormitator latifrons were found positive for presence of larvae, and annual prevalence was 4.8, 1.83, 2.16, and 4.0%, respectively. The species Oreochromys aureus and Chanos chanos were negative. The species of estuarine turtles Kinosternum integrum and Trachemys scripta were positive with annual prevalence of 79.1 and 52.5%, respectively. The criteria of identification of the Gnathostoma species were: mean number of nuclei in intestinal larval cells (2.3), larval morphometry with optic microscopy, larval morphometry with scanning electron microscopy, and number and sequence of ribosomal deoxyribonucleic acid of adult parasites obtained from experimental infection in dogs. The estuarine fish Pomadasys macracanthus and Mugil curema are reported as intermediate hosts for the first time and likewise the estuarine turtle Kinosternon integrum as a paratenic host.

Outward migration of Gnathostoma spinigerum in interferon alpha treated hepatitis C patient.

After the first dose injection of pegylated interferon alpha-2b (Peg-IFN alpha-2b) to a HCV infected Thai woman, she developed cyclic painful swelling nodules on right upper quadrant of abdomen and right anterior lower chest wall. The nodules subsided spontaneously within 1-2 days but were recurrent after every Peg-IFN alpha-2b injection. She also experienced acute urticaria. After nine months of therapy, an immature male of G. spinigerum migrated out from the skin nodule shortly after a Peg-IFN alpha-2b injection as scheduled. The worm showed a head-bulb bearing 8 transverse rows of spines which indicated immature stage. It had well defined four pairs of caudal papillae on posterior body part which were used to identify male gender. Painful migratory swelling and urticaria disappeared after the parasite was removed. She was continually treated and had sustained both virological and biochemical responses to HCV treatment. This case demonstrates that the outward migration of G. spinigerum may be stimulated by the injection of Peg-IFN alpha-2b.

[Parasitic dead-end: update]. / Impasses parasitaires: quoi de neuf?

Parasitic dead-ends occur when a parasite is unable to establish a permanent interaction in an unnatural host. Although the likelihood of successful reproduction by the pathogenic agent is nul, parasitic dead-end heralds capture of new parasites and therefore expansion of the host range. Angiostrongyliasis due to A. cantonensis or A. costaricensis, anisakiasis, Ancylostoma caninum infection, gnathostomiasis and sparganosis are undoubtedly emerging zoonoses of particular medical interest. Prevention of these diseases relies on abstinence from eating raw meat from invertebrates or cold-blooded (poikilotherm) vertebrates (e.g. used in exotic dishes). These guidelines must be included in recommendations to travelers.

Gnathostomiasis. Infestation in an Asian immigrant.

With the recent influx of southeast Asians into the United States, an increased incidence of human gnathostomiasis can be expected. A Laotian woman had had two weeks of pruritus associated with fleeting erythematous patches on her abdomen. A peripheral eosinophilia was present. She withdrew a Gnathostoma spinigerum from the skin of her abdomen. Gnathostomiasis is endemic in much of Asia and causes not only migratory cutaneous swellings with erythema but also serious visceral sequelae such as eosinophilic encephalomyelitis. Excision of the parasite is the treatment of choice when possible.

Gastric gnathostomiasis in a cat.

A mass found in the stomach of a 10-year old cat contained a female worm of the genus Gnathostoma. The mass was described as a muscular pseudogranuloma induced by the worm. Although the worm species could not be ascertained, it was concluded that the cat served as an aberrant host for a Gnathostoma sp that usually infects wild mammals in the area.

Fish as the natural second intermediate host of Gnathostoma spinigerum.

Gnathostomiasis is a helminthic disease most frequently occurring in Thailand. Human infections are usually found to be caused by Gnathostoma spinigerum, although five species of the genus Gnathostoma exist in Thailand, and three of these are capable of infecting man. In Thailand, 47 species of vertebrates--fish (19), frogs (2), reptiles (11), birds (11) and mammals (4)--have been reported to serve naturally as the second intermediate (and/or paratenic) hosts of G. spinigerum. Of these, fish, especially swamp eels (Monopterus albus), were found to be the best second intermediate/paratenic hosts: they had the highest prevalence rate and the heaviest infection intensity. However, the scientific names of these fish have been revised from time to time. Therefore, for clarity and consistency, we have summarized the current scientific names of these 19 species of fish, together with their illustrations. We describe one additional fish species, Systomus orphoides (Puntius orphoides), which is first recorded as a naturally infected second intermediate host of G. spinigerum.

Gnathostome infection in swamp eels, Fluta alba, in central Thailand.

To investigate the distribution of gnathostome worms in central Thailand, the infective larvae of Gnathostoma spp were examined from the flesh and liver of swamp eels, Fluta alba. Seven hundred and eighty-eight eels were purchased from markets in 11 provinces; Ang Thong (30), Ayutthaya (36), Chachoengsao (30), Lop Buri (30), Nakhon Nayok (437), Pathum Thani (30), Prachin Buri (48), Ratchaburi (53), Saraburi (30), Samut Prakan (30) and Suphan Buri (34). The highest rate of gnathostome infection was observed in swamp eels from Nakhon Nayok (68.7%). The infection rates in Ayutthaya, Ang Thong, Prachin Buri, Ratchaburi, Saraburi and Lop Buri were 33.3%, 26.7%, 25.0%, 18.9%, 13.3% and 10.0% respectively. Gnathostome larvae were not found in swamp eels from Chachoengsao, Pathum Thani, Samut Prakan and Suphan Buri. Among the 9,573 larvae recovered, almost all were the advanced third stage larvae of G. spinigerum, except one larva from Nakhon Nayok and two larvae from Ratchaburi which were identified as the advanced third stage larvae of G. vietnamicum and G. hispidum respectively. This study is the first report of swamp eels as natural intermediate hosts of G. vietnamicum and G. hispidum.

Seasonal variation in the intensity of Gnathostoma larvae in swamp eels (Fluta alba) sold in a local market in Bangkok.

The viscera of swamp eels were obtained from a local market in Bangkok twice a month from June 1996 to May 1997. The livers were separated, weighed and counted. Gnathostome larvae were recovered from the livers by the digestion technic, examined, identified, and counted. A total of 12,278 Gnathostoma larvae were obtained from 18,561.1 g (15,264 pieces) of eel livers. The overall average number of larvae/g liver and the overall average number of larvae/liver are 0.91 and 0.94, respectively. The greatest number of larvae/g liver (on average) was in December (high levels of infection during the months of October to December) whereas the lowest was in April (lowest levels of infection during the months of March to April). Thus there was a marked decrease in the average number of larvae/g liver during January to April, which then started to rise in May. This finding suggests that the level of infection abruptly decreases soon after the completion of the rainy season, starts to rise when the rain has come, and reaches its peak when the amount of rainfall is highest. More than 99% of the total gnathostome larvae recovered were identified to be G. spinigerum, and 25.4% of the entire larvae recovered bore variant or abnormal cephalic hooklets. The most common unusual feature was that there were extra rudimentary hooklets above row one, below row four and in between the four rows of hooklets which comprised 21.4%. In addition, the body size and the number of cephalic hooklets of G. spinigerum are also discussed.

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.

Study on pathogenicity and central nervous system migration of the larval stage of Gnathostoma spinigerum in experimental animals.

Studies were conducted on the pathogenicity and the route of migration to the central nervous system by the immature larval stage of G.spinigerum in experimental animals. Five mice and one rat showed signs of nervous tissue damage and CNS involvement. The significant findings were massive haemorrhagic areas and blood clot around large lower nerve trunk and spinal cord invasion by the worm. The possible roles of the immature larval stages of G.spinigerum in human was discussed.