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 Table of Contents  
CASE REPORT
Year : 2013  |  Volume : 12  |  Issue : 2  |  Page : 114-115

Intraocular Gnathostoma spinigerum: A rare nematode infestation


Department of Tropical Medicine, School of Tropical Medicine, Kolkata, West Bengal, India

Date of Web Publication20-Jun-2014

Correspondence Address:
Kumkum Sarkar
Department of Tropical Medicine, School of Tropical Medicine,108, C R Avenue, Kolkata - 700 073, West Bengal
India
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Source of Support: None, Conflict of Interest: None


DOI: 10.4103/2384-5589.134907

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  Abstract 

Live intraocular nematode is seen rarely and it is most commonly seen in South East Asian Countries. Here, we are reporting a 27 -year -old male who presented with headache for 2 months, fever and redness of right eye for 1½ months due to small worm in the anterior chamber of right eye. Worm was removed and the patient was successfully treated with albendazole and oral steroid. This infection mainly occurs due to intake of contaminated food or water, so health awareness may prevent such type of disease by proper sewage disposal and treatment of drinking water.

Keywords: Gnathostoma spinigerum , health promotion, intraocular nematode


How to cite this article:
Sarkar K, Haldar SN, Gonjhu D, Pramanik N. Intraocular Gnathostoma spinigerum: A rare nematode infestation. Afr J Med Health Sci 2013;12:114-5

How to cite this URL:
Sarkar K, Haldar SN, Gonjhu D, Pramanik N. Intraocular Gnathostoma spinigerum: A rare nematode infestation. Afr J Med Health Sci [serial online] 2013 [cited 2021 Jan 17];12:114-5. Available from: http://www.ajmhs.org/text.asp?2013/12/2/114/134907


  Introduction Top


0Gnathostoma spinigerum is a parasitic nematode that causes gnathostomiasis which is a rare zoonotic infection of human beings. It is one of the causes of visceral larva migrans and also of creeping eruption. This infection is most commonly seen in Japan and Thailand and occasionally occur in India, Burma, Malaysia, New Guinea, Indonesia, and China. [1] Gnathostomiasis is caused by ingestion of third stage larva which may be found in raw or poorly cooked meat (fish, chicken, snail, frogs) or in contaminated water. As human being is not a suitable host for the parasite, ingestion of infected food causes migration of the infective form of the nematode from stomach via intestine to skin, subcutaneous tissue and it is often associated with localized pain, pruritus and erythema. Ocular involvement may occur years after initial infection. A total of 12 cases of intraocular gnathostomiasis have been reported in literature until 1994. [2] Till 2009, 6 such cases of intraocular gnathostomiasis have been reported from India. [3] Herewith, we are reporting such a case from West Bengal, India. In this patient, a live worm was found to be present in the anterior chamber of the right eye. The case is reported because of its rarity and clinical importance and less documented case from West Bengal.


  Case report Top


A 27 -year -old, Hindu male, migrating carpenter by occupation from a village of Malda district of West Bengal, presented with right -sided continuous headache and fever for 2 months. Then, he developed itching in his right eye and the area around the eye became swollen. Half a month later, he developed redness and photophobia in the affected eye and a gradual decrease in visual acuity. He was accustomed to eating meat or roasted fish outside the home and used to drink plain ground water. On general examination, there was no edema, pallor, organomegaly, and lymphadenopathy. During that period, he was treated with analgesics and antibiotic eye drops by local doctor. Then he was referred to ophthalmologist for opinion. On examination, there was conjunctival congestion and mild uveitis. Small worm was found in anterior chamber of the right eye on slit lamp examination. Then the worm was removed from the anterior chamber of right eye under local anesthesia with keratome by viscoextraction. Then the patient was referred to our tropical Medicine department with the worm specimen for the identification of the worm and for further treatment. His blood examination revealed normal laboratory parameters except slightly raised eosinophil count (8%). Both thick and thin peripheral blood smear were negative for Microfilaria. No ova, cyst, or egg were found in the stool microscopy for three consecutive days. The worm was diagnosed as Gnathostoma spinigerum under low and high power magnification [Figure 1]. The worm was found to be approximately 1 cm in length, having a typical head bulb with five circumferential rows of hooklets and fine cuticular spine on body surface. Then the patient was successfully treated with oral albendazole and steroid.
Figure 1: Larva of Gnathostoma spinigerum

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  Discussion Top


Live intraocular nematode is a rare occurrence and mostly reported from Southeast Asian countries, particularly Thailand and Japan. [4] The first human case of intraocular Gnathostomiasis was reported in Thailand. [5] The eggs of the worm hatch in fresh water and the larvae are eaten by Cyclops which are eaten by small fishes. On ingestion of the raw fish or contaminated water, the larva bores through the stomach wall and migrates around in the host's body. As human beings are not a normal host for the larva, they do not mature in human beings, but can cause various degrees of damage, depending on where the larva wanders in the body. [6] Gnathostomes is one of the causes of larva migrans and may produce fatal eosinophilic myeloencephalitis [7] and even can cause cerebrovascular accident. Infection can be prevented by avoiding the intake of raw or partially cooked meat, fish, snails, etc. and contaminated drinking water. Proper sewage disposal and treatment of drinking water may prevent the spread of infection in the community. Therapeutic success depends on early and complete surgical removal, which could be life saving, because no anti -parasitic drugs are available to treat the ocular involvement. [8]

 
  References Top

1.Gnathostoma spinigerum Owen. In: Ralph Muller, Heinemann, editors. Worms and disease, a manual of medical Helminthology. London, Great Britain: Bulter and Tanner Ltd Frome; 1975. p. 91 -2.  Back to cited text no. 1
    
2.Biswas J, Gopal L, Sharma T, Badrinath SS. Intraocular Gnathostoma spinigerum. clinico -pathological study of two cases with review of literature. Retina 1994;14:438 -44.   Back to cited text no. 2
    
3.Tiwari S, Chayani N, Rautaraya B. Intraocular Gnathostoma spinigerum: A case report. Cases J 2009;22:9370.  Back to cited text no. 3
    
4.Nawa Y. Historical review and current status of gnathostomiasis in Asia. Southeast Asian J Trop Med Public Health 1991;22 Suppl:217 -9.  Back to cited text no. 4
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5.Rhithibaed C, Daengsvang S. A case blindness caused by Gnathostoma spinigerum. J Med Assoc Thai 1937;840 -45.   Back to cited text no. 5
    
6.Available from: http://en.wikipedia.org/wiki/Gnathostoma_spinigerum, February to May, 2013.  Back to cited text no. 6
    
7.Bunang T, Comer DS, Punyagupta S. Eosinophilic myeloencephalitis caused by Gnathostoma spinigerum. Neuropathology of nine cases. J Neurol Sci 1970;10:419 -34.   Back to cited text no. 7
    
8.Barua P, Hazarika NK, Barua N, Barua CK, Choudhury B. Gnathostomiasis of the anterior chamber. Indian J Med Microbiol 2007;25:276 -8.  Back to cited text no. 8
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