Case 190. Gnathostomiasis (56 y-o M)
         
    Biopsy from creeping disease (cutaneous larva migrans) of the abdominal skin, seen after eating imported loach    
         
   
Key words : 
Gnathostoma hispidum, gnathostomiasis, creeping disease, larva migrans    
         
   
zoonosis
   
     
 
     
The worm was found in the dotted skin site. The migration speed of Gnathostoma sp. is high, so that superficial echography is powerful to identify the location of the worm.   A deeply situated nematode provokes eosinophilic cellulitis around the tunnel with granulation tissue reaction (HE, low power).
     
 
     
Close-up view of the nematode shows the spiculated cuticle, muscle layer of coelomyarian type and well-developed lateral chords (HE). The gut is monolayered.   Another lateral section of Gnathostoma hispidum shows the spiculated cuticle, muscle layer and a dilated gut (HE).
     
 
     
The 1:500 diluted patient's own serum is reactive to the gut component of the nematode (indirect immunoperoxidase). It seems that the gut component is much more immunogenic than the cuticles.   Reference case 190A
Zoonotic parasitosis by Gnathostoma hispidum, provoking creeping disease. In tangential section, the gut is lined by single-layered microvillous cells (HE). The final hosts of G. hispidum are the pig and wild pig. The first intermediate host is Cyclops, and the second intermediate host is freshwater fish (loach).
     
 
     
Reference case 190A
Cross section of G. hispidum at the level of esophagus. Four tubules (ballonets) surround the esophagus. Eosinophilic reaction is pronounced (HE). The species of Gnathostoma can be distinguished by the number of nucleus in the gut epithelium: G. hispidum and G. nipponicum 1, G. doloresi 2 and G. spinigerum 3-7.
  Reference case 190A
Another cross section of G. hispidum shows markedly swollen lateral chords and microvillous gut (HE). Eating of raw loach imported from China, Taiwan, Hong Kong and Korea has a risk of this disorder. Mexican cuisine Cebiche and Thai cuisine Som phak may also cause gnathostomiasis.