Research Article: Diagnosis of Human Visceral Pentastomiasis

Date Published: February 24, 2009

Publisher: Public Library of Science

Author(s): Dennis Tappe, Dietrich W. Büttner, Jeffrey M. Bethony

Abstract: Visceral pentastomiasis in humans is caused by the larval stages (nymphs) of the arthropod-related tongue worms Linguatula serrata, Armillifer armillatus, A. moniliformis, A. grandis, and Porocephalus crotali. The majority of cases has been reported from Africa, Malaysia, and the Middle East, where visceral pentastomiasis may be an incidental finding in autopsies, and less often from China and Latin America. In Europe and North America, the disease is only rarely encountered in immigrants and long-term travelers, and the parasitic lesions may be confused with malignancies, leading to a delay in the correct diagnosis. Since clinical symptoms are variable and serological tests are not readily available, the diagnosis often relies on histopathological examinations. This laboratory symposium focuses on the diagnosis of this unusual parasitic disease and presents its risk factors and epidemiology.

Partial Text: In a recently published case [1], an immigrant from Kazakhstan was admitted to a hospital in Germany with persistent cough and night sweats. The patient had a normal white blood cell count (7,140 cells/µl) with mild eosinophilia (7%, 500 cells/µl). Serology for tissue-invasive helminths, e.g., Ascaris, Toxocara, Strongyloides, Trichinella, Fasciola, Paragonimus, Schistosoma, and Echinococcus spp. was negative, as were repeated stool and sputum examinations. A chest X ray revealed multiple lesions in both lungs, and pulmonary malignancy was suspected. The patient eventually underwent thoracotomy, and multiple nodules were excised that revealed exceptional parasitic structures (Figure 1A). Because of its peculiarity, the examination of the parasite responsible was lengthy, but finally a diagnosis of visceral (pulmonary) pentastomiasis due to the nymphs of L. serrata was made. Written consent of the patient was obtained for the publication of his clinical data and history.



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