ABSTRACT
Gnathostomiasis, caused by infection with nematode parasites in the genus Gnathostoma, is endemic in tropical and temperate zones, and is classically associated with East and Southeast Asia and, more recently, Latin America and Africa. We report a case of gnathostomiasis acquired in Costa Rica, which has not previously been considered an endemic country. The patient had eosinophilia with migratory myalgia, and the diagnosis was made after serological testing. Full resolution of symptoms and eosinophilia followed treatment with ivermectin and albendazole. The diagnosis can be challenging to make because of variability in presentation, lack of access to diagnostics, and emerging knowledge of endemic areas. Increased awareness of this disease among clinicians is vital for faster diagnosis and better outcomes in afflicted patients.
ABSTRACT
Introduction. Aggregatibacter are Gram-negative, facultatively anaerobic rods or coccobacilli that are infrequently encountered as pathogens causing infection.Hypothesis/Gap Statement. The range of invasive infection that Aggregatibacter cause is poorly described. The pathogenicity of species such as Aggregatibacter segnis is debated.Aim. To identify invasive infection due to Aggregatibacter species in a large healthcare organization and to characterize clinical syndromes, co-morbidities and risk factors.Methodology. All microbiological samples positive for Aggregatibacter species were identified by conventional culture or 16S rRNA PCR between October 2017 and March 2021. Electronic records for all patients with positive samples were reviewed and the infection syndrome classified for patients with invasive disease.Results. Twenty-seven patients with invasive infection were identified, with a statistically significant difference in species-specific patterns of invasive infection (P=0.02) and a statistically significant association with residence in the 30â% most deprived households in the UK by postcode (P<0.01). The three most common co-morbidities were periodontitis or recent dental work (29.6%), cardiovascular disease (25.9%) and diabetes (18.5â%).Conclusion. We describe a novel association of Aggregatibacter segnis with skin and soft tissue infection. The propensity of the Aggregatibacter species to cause invasive infection at different body sites and be associated with deprivation is reported. Aggregatibacter actinomycetemcomitans bacteraemia was associated with infective endocarditis, and Aggregatibacter aphrophilus was implicated in severe appendicitis and noted to cause brain abscess. Areas warranting future research include exploring the risk-factors required for invasive infection and those that may determine the species-specific differences in patterns of invasive disease.
