The cutaneous manifestations are not unlike loiasis, where the patient complains of migratory cutaneous and subcutaneous swellings, which may be amorphous or resemble cutaneous larva migrans (serpiginous). Up to 75% of patients with gnathostomiasis may have cutaneous manifestations. Patients may complain of pruritus, arthralgias and myalgias, fever, nausea, and abdominal pain. Larvae can migrate through any organ and, therefore, nearly any physical symptom is possible; for example, right-upper-quadrant pain and transaminitis may occur as the larvae migrate through the liver. Central nervous system (CNS) disease is rarely reported but carries a markedly worse prognosis (mortality 25%). Marked eosinophilia is common.
Gnathostomiasis is endemic to many parts of Asia and South / Central America and has been described after travel to South and Central Africa. Symptoms (constitutional) occur approximately 2 days to 2 weeks after ingestion of the offending food item, but skin manifestations usually do not begin until 2 weeks or longer after exposure. If left untreated, symptoms may persist for over a decade. Gnathostomiasis occurs more commonly in adults, and there may be a slight male predominance. Recurrence requiring retreatment is not uncommon.
B83.1 – Gnathostomiasis
44086001 – Gnathostomiasis
Differential Diagnosis & Pitfalls
- Loiasis is endemic to Africa, whereas gnathostomiasis is endemic to Asia and Central / South America.
- Strongyloidiasis (larva currens) can be distinguished from gnathostomiasis by morphology (generally linear) and by serology (Strongyloides stercoralis).
- Sparganosis usually presents with a fixed nodule rather than migratory nodules / plaques.
- Cutaneous larva migrans can be distinguished clinically; it usually presents on the foot after exposure to sand / soil.
- Erythema nodosum