- Email: [email protected]
Gnathostomiasis
EARLY REPORT
9
Acknowledgments This study was supported by grants from Stockholm County Council.
10
References 1
2
3
4
5
6
7
8
Centers for Disease Control and Prevention. Pneumococcal and influenza vaccination levels among adults ⭓65 years (United States 1997). Morbid Mortal Wkly Rep 1998; 47: 797–802. Nicholson KG, Wiselka MJ, May A. Influenza vaccination of the elderly: perceptions and policies of general practitioners and outcome of the 1985–86 immunisation program in Trent, UK. Vaccine 1987; 5: 302–06. Goavert ME, Thijs CTMCN, Sprenger MJW, Dinant GJ, Knottnerus JA. The efficacy of influenza vaccination in elderly individuals: a randomized double-blind placebo-controlled trial. JAMA 1994; 272: 1661–65. Foster DA, Talsma AN, Furumoto-Dawson A, et al. Influenza vaccine effectiveness in preventing hospitalisation for pneumonia in the elderly. Am J Epidemiol 1992; 136: 296–307. Fedson DS, Wajda A, Nichol JP, Hammond GW, Kaiser DL, Roos LL. Clinical effectiveness of influenza vaccination in Manitoba. JAMA 1993; 270: 1956–61. Mullooly JP, Bennett MD, Hornbrook MC, et al. Influenza vaccination programs for elderly persons: cost-effectiveness in a health maintenance organization. Ann Intern Med 1994; 121: 947–52. Nichol KL, Margolis KL. Wuorenma J, von Sternberg T. The efficacy and cost effectiveness of vaccinations against influenza among elderly persons living in the community. N Engl J Med 1994; 331: 778–84. Ahmed AH, Nicholson KG, Nguyen-Van Tham JS, Pearson JCG. Effectiveness of influenza vaccine in reducing hospital admissions during the 1989–90 epidemic. Epidemiol Infect 1997; 118: 27–33.
11 12
13
14
15
16
17 18
19
Nichol KL, Wuorenma J, von Sternberg T. Benefits of influenza vaccination of low-, intermediate-, and high-risk senior citizens. Arch Intern Med 1998; 158: 1769–76. Gaillat J, Zmirou D, Mallaret MR, et al. Clinical trial of an antipneumococcal vaccine in elderly subjects living in institutions. Rev Epidemiol Sante Publique 1985; 33: 437–44. Gillick MR, Ditzion B. Influenza vaccination: are we doing better than we think? Arch Interm Med 1991; 151: 1742–44. Koivula I, Sten M, Leunonen M, Mäkelä PH. Clinical efficacy of pneumococcal vaccine in the elderly: a randomized, single-blind, population-based trial. Am J Med 1997; 103: 281–90. Nichol KL, Baken L, Vuorenma J, Nelson A. The health and economic benefits associated with pneumococcal vaccination of elderly persons with chronic lung disease. Arch Intern Med 1999; 159: 2437–42. Shapiro ED, Berg AT, Austrian R, et al. The protective efficacy of polyvalent pneumococcal polysaccharide vaccine. N Engl J Med 1991; 325: 1453–60. Butler JC, Breiman RF, Campbell JF, Lipman HB, Broome CV, Facklam RR. Pneumococcal polysaccharide vaccine efficacy. JAMA 1993; 270: 1826–31. Farr BM, Johnston BL, Cobb DK, et al. Preventing pneumococcal bacteremia in patients at risk: results of a matched case-control study. Arch Intern Med 1995; 155: 2336–405. Höglund D, Stenqvist K. Influenza vaccination coverage among the elderly in the Göteborg area. Läkartidningen 2001; 98: 156–58. Örtqvist Å, Hedlund J, Burman LA, et al. Randomised trial of 23valent pneumococcal capsular polysaccharide vaccine in prevention of pneumonia in middle-aged and elderly people. Lancet 1998; 351: 399–403. Honkanen PO, Keistinen T, Miettinen L, et al. Incremental effectiveness of pneumococcal vaccine on simultaneously administered influenza vaccine in preventing pneumonia and pneumococcal pneumonia among persons aged 65 years or older. Vaccine 1999; 17: 2493–500.
Clinical picture: Gnathostomiasis Philippe Parola, Paron Dekumyoy, Jean Delmont, Philippe Brouqui
A 48-year-old man living in France presented with a 2-day history of creeping eruption on the right side of the trunk. He had returned from Vietnam 2 months previously, where he had stayed for 6 weeks in the area of Hanoi. He had no symptoms during his trip. The patient was afebrile and physical examination was entirely normal with the exception of a serpiginous, reddened, elevated pruritic skin lesion (figure A). He had an eosinophil count of 2200/mL. Skin biopsies showed an inflammatory infiltrate and a larval worm in the subcutaneous tissue (figure B; haematoxylin and eosin, ⫻100). Serum antibodies against Gnathostoma spinigerum were detected by immunoblot. This infection was acquired in Vietnam by ingestion of raw freshwater fish containing third-stage larvae of G spinigerum. In human beings, larval forms do not mature into adults as they do in their definitive hosts. They migrate through the subcutaneous tissues and cause recurrent episodes of migratory swelling or creeping eruptions. There is no effective treatment for human gnathostomiasis other than removal of the worm. Service des Maladies Infectieuses et Tropicales, Centre Hospital-Universitaire Nord, 13015 Marseille, France (P Parola MD, J Delmont MD, P Brouqui PhD), Faculty of Tropical Medicine, Mahidol University, Bangkok, Thailand (P Dekumyoy MD)
THE LANCET • Vol 357 • March 31, 2001
1011
For personal use only. Reproduce with permission from The Lancet Publishing Group.
9
Acknowledgments This study was supported by grants from Stockholm County Council.
10
References 1
2
3
4
5
6
7
8
Centers for Disease Control and Prevention. Pneumococcal and influenza vaccination levels among adults ⭓65 years (United States 1997). Morbid Mortal Wkly Rep 1998; 47: 797–802. Nicholson KG, Wiselka MJ, May A. Influenza vaccination of the elderly: perceptions and policies of general practitioners and outcome of the 1985–86 immunisation program in Trent, UK. Vaccine 1987; 5: 302–06. Goavert ME, Thijs CTMCN, Sprenger MJW, Dinant GJ, Knottnerus JA. The efficacy of influenza vaccination in elderly individuals: a randomized double-blind placebo-controlled trial. JAMA 1994; 272: 1661–65. Foster DA, Talsma AN, Furumoto-Dawson A, et al. Influenza vaccine effectiveness in preventing hospitalisation for pneumonia in the elderly. Am J Epidemiol 1992; 136: 296–307. Fedson DS, Wajda A, Nichol JP, Hammond GW, Kaiser DL, Roos LL. Clinical effectiveness of influenza vaccination in Manitoba. JAMA 1993; 270: 1956–61. Mullooly JP, Bennett MD, Hornbrook MC, et al. Influenza vaccination programs for elderly persons: cost-effectiveness in a health maintenance organization. Ann Intern Med 1994; 121: 947–52. Nichol KL, Margolis KL. Wuorenma J, von Sternberg T. The efficacy and cost effectiveness of vaccinations against influenza among elderly persons living in the community. N Engl J Med 1994; 331: 778–84. Ahmed AH, Nicholson KG, Nguyen-Van Tham JS, Pearson JCG. Effectiveness of influenza vaccine in reducing hospital admissions during the 1989–90 epidemic. Epidemiol Infect 1997; 118: 27–33.
11 12
13
14
15
16
17 18
19
Nichol KL, Wuorenma J, von Sternberg T. Benefits of influenza vaccination of low-, intermediate-, and high-risk senior citizens. Arch Intern Med 1998; 158: 1769–76. Gaillat J, Zmirou D, Mallaret MR, et al. Clinical trial of an antipneumococcal vaccine in elderly subjects living in institutions. Rev Epidemiol Sante Publique 1985; 33: 437–44. Gillick MR, Ditzion B. Influenza vaccination: are we doing better than we think? Arch Interm Med 1991; 151: 1742–44. Koivula I, Sten M, Leunonen M, Mäkelä PH. Clinical efficacy of pneumococcal vaccine in the elderly: a randomized, single-blind, population-based trial. Am J Med 1997; 103: 281–90. Nichol KL, Baken L, Vuorenma J, Nelson A. The health and economic benefits associated with pneumococcal vaccination of elderly persons with chronic lung disease. Arch Intern Med 1999; 159: 2437–42. Shapiro ED, Berg AT, Austrian R, et al. The protective efficacy of polyvalent pneumococcal polysaccharide vaccine. N Engl J Med 1991; 325: 1453–60. Butler JC, Breiman RF, Campbell JF, Lipman HB, Broome CV, Facklam RR. Pneumococcal polysaccharide vaccine efficacy. JAMA 1993; 270: 1826–31. Farr BM, Johnston BL, Cobb DK, et al. Preventing pneumococcal bacteremia in patients at risk: results of a matched case-control study. Arch Intern Med 1995; 155: 2336–405. Höglund D, Stenqvist K. Influenza vaccination coverage among the elderly in the Göteborg area. Läkartidningen 2001; 98: 156–58. Örtqvist Å, Hedlund J, Burman LA, et al. Randomised trial of 23valent pneumococcal capsular polysaccharide vaccine in prevention of pneumonia in middle-aged and elderly people. Lancet 1998; 351: 399–403. Honkanen PO, Keistinen T, Miettinen L, et al. Incremental effectiveness of pneumococcal vaccine on simultaneously administered influenza vaccine in preventing pneumonia and pneumococcal pneumonia among persons aged 65 years or older. Vaccine 1999; 17: 2493–500.
Clinical picture: Gnathostomiasis Philippe Parola, Paron Dekumyoy, Jean Delmont, Philippe Brouqui
A 48-year-old man living in France presented with a 2-day history of creeping eruption on the right side of the trunk. He had returned from Vietnam 2 months previously, where he had stayed for 6 weeks in the area of Hanoi. He had no symptoms during his trip. The patient was afebrile and physical examination was entirely normal with the exception of a serpiginous, reddened, elevated pruritic skin lesion (figure A). He had an eosinophil count of 2200/mL. Skin biopsies showed an inflammatory infiltrate and a larval worm in the subcutaneous tissue (figure B; haematoxylin and eosin, ⫻100). Serum antibodies against Gnathostoma spinigerum were detected by immunoblot. This infection was acquired in Vietnam by ingestion of raw freshwater fish containing third-stage larvae of G spinigerum. In human beings, larval forms do not mature into adults as they do in their definitive hosts. They migrate through the subcutaneous tissues and cause recurrent episodes of migratory swelling or creeping eruptions. There is no effective treatment for human gnathostomiasis other than removal of the worm. Service des Maladies Infectieuses et Tropicales, Centre Hospital-Universitaire Nord, 13015 Marseille, France (P Parola MD, J Delmont MD, P Brouqui PhD), Faculty of Tropical Medicine, Mahidol University, Bangkok, Thailand (P Dekumyoy MD)
THE LANCET • Vol 357 • March 31, 2001
1011
For personal use only. Reproduce with permission from The Lancet Publishing Group.