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An Unusual Case of Gastric Gnathostomiasis Caused by Gnathostoma spinigerum Confirmed by Video Gastroscopy and Morphological and Molecular Identification

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  • 1 Gastroenterology and Hepatology Division, Department of Medicine, Faculty of Medicine, Khon Kaen University, Khon Kaen, Thailand;
  • 2 Internal Medicine Unit, Ratchaphruek Hospital, Khon Kaen, Thailand;
  • 3 Department of Parasitology, Faculty of Medicine, Khon Kaen University, Khon Kaen, Thailand;
  • 4 Mekong Health Science Research Institute, Khon Kaen University, Khon Kaen, Thailand;
  • 5 Department of Medical Technology, School of Allied Health Sciences, Walailak University, Nakhon Si Thammarat, Thailand

Abstract.

Human gnathostomiasis is a harmful foodborne parasitic infection caused by nematodes of the genus Gnathostoma. Here, we report an unusual case of gastric gnathostomiasis seen in a hospital in Thailand along with the clinical characteristics, treatment, and outcome. A 39-year-old man presented with complaints of epigastric pain, dizziness, and history of passing dark, tarry stools for 2 days. The patient had a history of consuming raw freshwater fish. Supplementary differential diagnosis was performed via rapid serological testing, and presence of the causative agent was confirmed based on video gastroscopy, morphology of the removed parasite, and molecular identification. After its surgical removal from the stomach, the parasite was morphologically identified as Gnathostoma species. Molecular identification was performed via DNA extraction from the recovered worm, and amplification and sequencing of the second internal transcribed spacer (ITS2) region and partial cytochrome c oxidase subunit I (cox1) gene. The ITS2 and cox1 sequences were consistent with those of Gnathostoma spinigerum. Clinicians in endemic areas should therefore be aware of the rare clinical manifestations and use of supplementary serological tests to facilitate early diagnosis and treatment of gastric gnathostomiasis.

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Author Notes

Address correspondence to Wanchai Maleewong, Department of Parasitology, Faculty of Medicine, Khon Kaen University, Khon Kaen, Thailand. E-mail: wanch_ma@kku.ac.th

Financial support: This study was supported by a Distinguished Research Professor Grant from the Thailand Research Fund [Grant no. DPG6280002], a scholarship under Industrial Post-doctorate Development for Agriculture, Food, Energy and Bio-materials for Future from Khon Kaen University, Thailand [PJ, grant number KKU-PMU-B 63-001], and grants from the Khon Kaen University Research and Graduate studies [RP64010] and Faculty of Medicine [WM and OS, grant numbers DR63101and RG63301]. The fund providers had no role in study design, data collection/interpretation, or the decision to submit the work for publication.

Authors’ addresses: Kookwan Sawadpanich, Gastroenterology and Hepatology Division, Department of Medicine, Faculty of Medicine, Khon Kaen University, Khon Kaen, Thailand, E-mail: kookwans@yahoo.com. Nitiwat Chansuk, Internal Medicine Unit, Ratchaphruek Hospital, Khon Kaen, Thailand, E-mail: nitiwat_internist@hotmail.com. Patcharaporn Boonroumkaew, Lakkhana Sadaow, Rutchanee Rodapai, Oranuch Sanpool, Pewpan M. Intapan, and Wanchai Maleewong, Department of Parasitology, Faculty of Medicine, Khon Kaen University, Khon Kaen, Thailand, E-mails: patcharaporn.bo@kkumail.com, sadaow1986@gmail.com, rutchanee5020@gmail.com, sanpoolor@yahoo.com, pewpan@kku.ac.th, and wanch_ma@kku.ac.th. Penchom Janwan, Department of Medical Technology, School of Allied Health Sciences, Walailak University, Nakhon Si Thammarat, Thailand, E-mail: pair.wu@gmail.com.

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