Gongylonema pulchrum: Description, Causes and Risk Factors:
The gullet worm of cattle; a species that penetrates the submucosa of the esophagus or rumen of many domestic and wild ruminants, pigs, bears, and humans (human cases are chiefly caused by immature worms); it is transmitted by coprophagous beetles and is of Worldwide distribution.
Gongylonema pulchrum is the species that has been identified as the cause of Gongylonema infection in humans. Infection caused by this species has been reported to occur in sheep, cattle, pigs, and other ungulates. The Life cycle of G. pulchrum requires an insect as the intermediate host. Fully embryonated eggs are passed in the feces of the aforementioned species and require ingestion by an appropriate insect host, such as a cockroach or a dung beetle. The parasite undergoes obligate development to the infective stage within the insect (20-30 days after ingestion), and infection of the definitive vertebrate host occurs after ingestion of the insect. Adult worms require some 60-80 days to develop in the definitive host after ingestion of an infected insect.
In humans, ingestion is typically accidental and unrecognized. None of the data from recorded cases of Gongylonema pulchrum infection have indicated that the infected patients had knowingly ingested insects. Although the Life cycle of Gongylonema pulchrum is well known, the factors that put some people at increased risk for infection with Gongylonema pulchrum are not clearly understood. It is plausible that the risk of eating insect-contaminated food is increased in areas where levels of sanitation are poor, including some areas visited by travelers. In some parts of the World and in some cultures, insects are an important source of protein and calories, and Gongylonema infection could potentially be a risk for those who eat uncooked insects. Presumably, a roasted or otherwise well-cooked insect would pose no risk of Gongylonema infection.
In humans, there can be an up to six week incubation period for worm development and symptoms may not appear until the second molting of the worm, in which the young adult worms begin migration to from the esophagus to the buccal and oral palate tissue. It is this movement through the mucosa of the mouth and lips that causes patients to complain of symptoms.
Gongylonema pulchrum infection of man is very rare, but to date, there have been nearly 50 cases in humans described Worldwide, including China, Europe, the Middle East, Australia and New Zealand.
With initial infection, some patients have reported mild fever and flu-like symptoms. There are also reports of acute attack of nausea, vomiting, and dizziness.The most common symptom is the complaint of sensation of a something is moving around the mouth, near the lips, and in the soft palate area. Eosinophilia is noted in some patients.
Diagnosis is often made by visible recognition of the worm moving through the tissue of the buccal cavity by either patient or doctor. Also, recovery of worm from patient is also a diagnostic technique. Microscopic identification of worm removed from patient's mouth or tissue is another diagnostic technique for determining the parasite infection type.
Treatment with albendazole, a broad-spectrum anthelmintic, was initiated because of the concern that additional worms might still be present. There is no confirmed proof that treatment with albendazole or any other anthelmintic results in a cure in humans. However, because of the wide margin of safety associated with this drug and the possibility of additional worms being present, treatment seems to provide some advantages over no treatment. Treatment done by removal of worms either by use of the fingers or by use of a curette in a physician's office also be successful.
Follow up measures include periodic of checks of buccal cavity and esophagus to ensure parasite infection has cleared.
NOTE: The above information is educational purpose. The information provided herein should not be used during any medical emergency or for the diagnosis or treatment of any medical condition.
DISCLAIMER: This information should not substitute for seeking responsible, professional medical care.
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