Be Careful What You Eat!

Abstract

The readership of the American Journal of Tropical Medicine and Hygiene is well acquainted with the risks of infectious diseases acquired from foods contaminated with pathogenic viruses, bacteria, protozoans, or helminths due to improper hygiene. Less familiar may be uncommon infections associated with ingestion of unusual uncooked foods, eaten either purposely or inadvertantly. A number of instructive examples have been published in the Journal within the last 2 years; these all involve helminths for which humans are generally not the definitive host, but can become ill when they unwittingly become accidental hosts after ingestion of undercooked animal products. This issue of the Journal includes two reports on cases of sparganosis, which is caused by infection with larvae of Spirometra canine or feline tapeworms. One case involved a Chinese woman who presented with a brain mass 1 ; another was a Thai resident of Switzerland who presented with a chronic history of subcutaneous nodules. 2 In both cases, surgical exploration led to the unexpected discovery of living (mobile) worms, and genetic and morphological analyzes identified these as Spirometra. Both patients appeared to respond to surgical resection without antihelminthic therapy. Risk factors for infection were frequent ingestion of potentially undercooked stir-fried frogs for the Chinese patient and untreated tap water for the Thai patient. Angiostrongylus cantonensis, the rat lungworm, is a roundworm of rodents that can be acquired after ingestion of larvae within slug, snail, or other invertebrate intermediate hosts. In humans, A. cantonensis can migrate to the brain, causing eosinophilic meningitis. Angiostrongylus cantonensis was originally described in Southeast Asia and the South Pacific, but it is now appreciated to cause disease in much of the tropics, including tropical areas of the Americas and Australia. Of relevance to American clinicians, the worm is endemic in Hawaii. A new report in the Journal describes 82 cases of A. cantonensis infection reported in Hawaii from 2007 to 2017; 51 of these cases were confirmed, the others probable. 3 The most common presentations included headache, arthralgia, myalgia, and stiff neck in those older than 10 years, and fever and vomiting in children. Cerebrospinal fluid commonly demonstrated eosinophils. Of the 82 cases, 65 were hospitalized and two died. One case occurred after ingesting a slug on a dare, but most were probably due to ingestion of larvae associated with slugs or snails in unwashed produce. Travelers to Hawaii and other tropical areas, even in developed countries, should take care to wash produce before ingestion. And they should avoid ingesting uncooked slugs or snails. Angiostrongylus cantonensis infection was also reported in the Journal recently in a Korean woman and her adult son, both of whom presented with eosinophilic meningitis after

Shiitake Mushroom Dermatitis in a Returning Traveler

“…We agree with the editorial by Philip J. Rosenthal "Be Careful What You Eat!" 1 and wish to highlight other foodstuffs which can have a deleterious impact on the health of returning travelers.…”