Clinical Features:
The clinical manifestations in human gnathostomiasis are caused by migration of the immature worms (L3s).  Migration in the subcutaneous tissues causes intermittent, migratory, painful, pruritic swellings (cutaneous larva migrans).  Migration to other tissues (visceral larva migrans), can result in cough, hematuria, and ocular involvement, with the most serious manifestations eosinophilic meningitis with myeloencephalitis.  High eosinophilia is present.

Laboratory Diagnosis:
Removal and identification of the worm is both diagnostic and therapeutic.

• Microscopy

Treatment:
Surgical removal or treatment with albendazole* or ivermectin* is recommended.  For additional information, see the recommendations in The Medical Letter (Drugs for Parasitic Infections).

* This drug is approved by the FDA, but considered investigational for this purpose.