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Gnathostomiasis in remote northern Western Australia: the first confirmed cases acquired in Australia

Cameron J Jeremiah, Chanad S Harangozo and Andrew J Fuller
Med J Aust 2011; 195 (1): 42-44.

A husband and wife became unwell after eating a fish from the Calder River in northern Western Australia. Gnathostomiasis was diagnosed, and treated with ivermectin and albendazole. Serological testing was positive for gnathostomiasis, and there has been no recurrence. These appear to be the first proven endemically acquired cases of gnathostomiasis in Australia, and demonstrate the difficulties in diagnosis and treatment. (MJA 2011; 195: 42-44)

A 52-year-old man developed epigastric discomfort, nausea, diarrhoea and lethargy 10 days after eating a fish (identified by the patient as “black bream”, possibly Acanthopagrus berda or Hephaestus jenkinsi) caught from the Calder River in northern Western Australia (Box 1). The fish had been pan-fried whole over a camp fire, but the duration and thoroughness of cooking is unclear. The patient’s epigastric discomfort persisted, followed a week later by fevers and myalgia and then pruritic subcutaneous swellings and skin thickening over his chest and abdomen. He had no response to a prescribed course of antibiotics. His abdominal symptoms and myalgia continued and, over the next 2 months, multiple episodic swellings developed over his abdomen. The swellings progressed to involve both thighs and were associated with feelings of movement under his skin.

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  • Cameron J Jeremiah1
  • Chanad S Harangozo2
  • Andrew J Fuller1

  • 1 The Alfred Hospital, Melbourne, VIC.
  • 2 South Eastern Private Hospital, Melbourne, VIC.

Correspondence: a.fuller@alfred.org.au

  • 1. Herman JS, Chiodini PL. Gnathostomiasis: another emerging imported disease. Clin Microbiol Rev 2009; 22: 484-492.
  • 2. Nawa Y, Hatz C, Blum J. Sushi delights and parasites: the risk of fishborne and foodborne parasitic zoonoses in Asia. Clin Infect Dis 2005; 41: 1297-1303.
  • 3. Ramirez-Avila L, Slome S, Schuster FL, et al. Eosinophilic meningitis due to Angiostrongylus and Gnathostoma species. Clin Infect Dis 2009; 48: 322-327.
  • 4. Moorhouse DE, Bhaibulaya M, Jones HI. Suspected human gnathostomiasis in Queensland. Med J Aust 1970; 2: 250.
  • 5. DPDx, Laboratory Identification of Parasites of Public Health Concern. Adapted from Gnathostomiasis: life cycle. Centers for Disease Control and Prevention. http://www.dpd.cdc.gov/dpdx/HTML/gnathostomiasis.htm (accessed Feb 2011).
  • 6. Nopparatana C, Setasuban P, Chaicumpa W, Tapchaisri P. Purification of Gnathostoma spinigerum specific antigen and immunodiagnosis of human gnathostomiasis. Int J Parasitol 1991; 21: 677-687.
  • 7. Nuchprayoon S, Sanprasert V, Suntravat M, et al. Study of specific IgG subclass antibodies for diagnosis of Gnathostoma spinigerum. Parasitol Res 2003; 91: 137-143.
  • 8. Tapchaisri P, Nopparatana C, Chaicumpa W, Setasuban P. Specific antigen of Gnathostoma spinigerum for immunodiagnosis of human gnathostomiasis. Int J Parasitol 1991; 21: 315-319.
  • 9. Nontasut P, Bussaratid V, Chullawichit S, et al. Comparison of ivermectin and albendazole treatment for gnathostomiasis. Southeast Asian J Trop Med Public Health 2000; 31: 374-377.
  • 10. Strady C, Dekumyoy P, Clement-Rigolet M, et al. Long-term follow-up of imported gnathostomiasis shows frequent treatment failure. Am J Trop Med Hyg 2009; 80: 33-35.
  • 11. Smales LR. Species of Gnathostoma (Nematoda: Spiruroidea) from bandicoots and dasyurids (Marsupialia) from Australia [brief communication]. Transact Roy Soc South Aust 1999; 123: 83-84.
  • 12. Adams PJ. Parasites of feral cats and native fauna from Western Australia: the application of molecular techniques for the study of parasitic infections in Australian wildlife [doctoral thesis]. Perth: Murdoch University, 2003. http://researchrepository.murdoch.edu.au/29/ (accessed Jan 2011).

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