Gnathostomiasis is a representative fish-borne parasitic disease. Among 13 valid Gnathostoma species, five species have been proven to be human pathogens: four species (Gnathostoma spinigerum, Gnathostoma hispidum, Gnathostoma doloresi, and Gnathostoma nipponicum) in Asia and only one species, Gnathostoma binucleatum, in the Americas.1 Although Gnathostoma species have a rather wide areas of distribution, human gnathostomiasis cases have been found in limited countries such as Thailand, Japan, Mexico, and Ecuador where people have the habit of consuming freshwater fish in raw or undercooked condition.1,2 Recent epidemiological surveys added several Southeast Asian countries such as Vietnam and Laos as endemic.1 In addition, sporadic cases of gnathostomiasis have recently been reported from previously nonendemic countries such as Australia,3 Brazil,4,5 and Peru.6 The cases among travelers, not only those who have been to endemic countries7 but also to nonendemic African countries such as Botswana8 or Zambia,9 suggest much wider distribution of this parasite than we thought previously. In terms of clinical manifestations, the vast majority of gnathostomiasis patients presented with serpiginous eruptions or nodular migratory panniculitis on the skin.1 Although the frequency is extremely low, Gnathostoma worms sometimes migrate into the eyes10–12 or central nervous system13 to cause deleterious illness. In Venezuela, when infectious disease consultants examined patients suffering from ocular parasitosis, they usually first consider Onchocerca volvulus infection, a filarial nematode parasite that causes cutaneous and ocular lesions14 and has long been known to be endemic in this country.15 Here, we report a case of ocular gnathostomiasis found in Venezuela. The patient has been to Texas, United States, for a holiday fishing trip and supposed to be infected by drinking unfiltered water from the rivers and lakes. This is the first ocular gnathostomiasis case in Venezuela and the 83rd reported case of ocular gnathostomiasis in the world.12
We thank Kittisak Sawanyawisuth, Department of Medicine, Faculty of Medicine, Khon Kaen University, Thailand, for the identification of Gnathostoma species.
Nawa Y, Maleewong W, Intapan PM, Díaz-Camacho SP, 2015. Gnathostoma, Chapter 21. Xiao L, Ryan U, Feng Y, eds. Biology of Food-Borne Diseases. Boca Raton, London, New York: CRC Press, Taylor & Francis, 405–426.
Waikagul J, Diaz Camacho SP, 2007. Gnathostomiasis. Murrell KD, Fried B, eds. World Class Parasites, Vol. 11, Food-Borne Parasitic Zoonoses: Fish and Plant-Borne Parasites. New York, NY: Springer, 235–261.
Jeremiah CJ, Harangozo CS, Fuller AJ, 2011. Gnathostomiasis in remote northern Western Australia: the first confirmed cases acquired in Australia. Med J Aust 195: 42–44.
de Sousa Vargas TJ, Kahler S, Dib C, Cavaliere MB, Jeunon-Sousa MA, 2012. Autochthonous gnathostomiasis, Brazil. Emerg Infect Dis 18: 2087–2089.
Chaves CM, Chaves C, Zoroquiain P, Belfort R Jr., Burnier MN Jr., 2016. Ocular gnathostomiasis in Brazil: a case report. Ocul Oncol Pathol 2: 194–196.
Diaz JH, 2015. Gnathostomiasis: an emerging infection of raw fish consumers in Gnathostoma nematode-endemic and nonendemic countries. J Travel Med 22: 318–324.
Herman JS, Wall EC, van Tulleken C, Godfrey-Faussett P, Bailey RL, Chiodini PL, 2009. Gnathostomiasis acquired by British tourists in Botswana. Emerg Infect Dis 15: 594–597.
Nawa Y, Katchanov J, Yoshikawa M, Rojekittikhun W, Dekumyoy P, Kusolusuk T, Wattanakulpanich D, 2010. Ocular gnathostomiasis: a comprehensive review. J Trop Med Parasitol 33: 77–86.
Nawa Y, Yoshikawa M, Sawanyawisuth K, Chotmongkol V, Figueiras SF, Benavides M, Diaz-Camacho SP, 2017. Ocular gnathostomiasis—update of earlier survey. Am J Trop Med Hyg 97: 1232–1234.
Katchanov J, Sawanyawisuth K, Chotmongkol V, Nawa Y, 2011. Neurognathostomiasis, a neglected parasitosis of the central nervous system. Emerg Infect Dis 17: 1174–1180.
Convit J, Schuler H, Borges R, Olivero V, Domínguez-Vázquez A, Frontado H, Grillet ME, 2013. Interruption of Onchocerca volvulus transmission in northern Venezuela. Parasit Vectors 6: 289.
Eiras JC, Pavanelli GC, Takemoto RM, Nawa Y, 2017. Fish-borne nematodiases in South America: neglected emerging diseases. J Helminthol Oct 25: 1–6. doi: 10.1017/S0022149X17001006. [Epub ahead of print].
Kaminsky CA, De Kaminsky AR, Costantini SE, Abulafia J, 1989. Eosinophilic migratory nodular panniculitis (human gnathostomiasis) [in Spanish]. Med Cutan Ibero Lat Am 17: 158–162.
Jurado LF, Palacios DM, López R, Baldión M, Matijacevic E, 2015. Gnatostomiasis cutánea, primer caso confirmado en Colombia. Biomedica 35: 462–470.
Daengsvang S, 1980. A Monograph on the Genus Gnathostoma and gnathostomiasis in Thailand. Tokyo, Japan: Southeast Asian Medical Information Center (SEAMIC), International Medical Foundation of Japan.
Subhedar V, Nandedkar S, Jain M, Bajpai T, 2014. Gnathostomiasis: a rare case of cutaneous creeping eruptions. Indian J Dermatopathol Diagn Dermatol 1: 32–34.
Bertoni-Ruiz F, Lamothe Argumedo MR, García-Prieto L, Osorio-Sarabia D, León-Régagnon V, 2011. Systematics of the genus Gnathostoma (Nematoda: Gnathostomatidae) in the Americas. Rev Mex Biodivers 82: 453–464.
Neumayr A 2016. Cross-reactivity pattern of Asian and American human gnathostomiasis in western blot assays using crude antigens prepared from Gnathostoma spinigerum and Gnathostoma binucleatum third-stage larvae. Am J Trop Med Hyg 95: 413–416.