Human lagochilascariasis—A rare helminthic disease

Abstract

Lagochilascariasis is a parasitic disease caused by a helminth of the order Ascaroidea, genus Lagochilascaris that comprises 6 species, among which only Lagochilascaris minor Leiper, 1909, is implicated in the human form of the disease. It is remarkable that the majority of cases of human lagochilascariasis in the Americas have been reported in Brazil. The natural definitive hosts of this parasite seem to be wild felines and canines. Lagochilascariasis is mostly a chronic human disease that can persist for several years, in which the parasite burrows into the subcutaneous tissues of the neck, paranasal sinuses, and mastoid. L. minor exhibits remarkable ability to migrate through the tissues of its hosts, destroying even bone tissue. Fatal cases have been described in which the parasite was found in the lungs or central nervous system. Treatment is often palliative, with recurrence of lesions. This paper summarizes the main features of the disease and its etiologic agent, including prevalence, life cycle, clinical course, and treatment.

Unusual case of lagochilascariasis with breast involvement: the first case report in pregnancy

“…According to the literature review, cases mostly occur in cervical and mastoid regions, paranasal sinuses, middle ear, rhinopharynx, oropharynx and skull base. There are also cases described of lesions in the central nervous system, sacral region, eyeballs, Eustachian tube, chin, submandibular and supraclavicular regions, scapular muscles, cervical vertebrae, dental alveoli, lungs, cranial nerves, among others 2 , 3 , 5 , 7 , 10 - 12 . In this case report the patient also presented with involvement of thoracic spinal vertebrae.…”

“…Results of laboratory tests showed 8.4g/dL hemoglobin, 23.7% hematocrit, 71.17 fl mean corpuscular volume; 25.2 pg mean corpuscular hemoglobin (HCM; 35.4 g/dL mean corpuscular hemoglobin concentration (CHCM); 3,600 leukocytes/mm 3 with normal differential count; 336,000 platelets/mm 3 ; 108 U/L alkaline phosphatase; 53 U/L GT range; 31 U/L aspartate aminotransferase (AST); 22 U/L alanine aminotransferase (ALT); 0.2 mg/dL total bilirubin; 0.11 mg/dL direct bilirubin; 5.87 g/dL total proteins; 15 mg/dL urea; 0.34 mg/dL creatinine; 140 mm/h Erythrocyte Sedimentation Rate (ESR); 723 U/L lactic dehydrogenase (DHL).…”

“…In the transmission cycle, natural hosts which are probably wild carnivores (felids), eliminate the parasite eggs in feces that contaminate the soil. These embryonic eggs are ingested by other animals (probably rodents), resulting in infection with larvae and encysted forms developing in their tissues, thus being intermediate hosts that are mandatory for maintaining the natural zoonotic cycle of the species 3,6 .…”

“…The worm has tropism for the subcutaneous tissue of the neck, paranasal sinuses and mastoid, although it may migrate to other regions. In severe forms, the infection can compromise bones, lungs and the central nervous system 3,5 . Treatment is often unsatisfactorydue to the recurrence of lesions months or years after an apparent clinical cure 2,5 .…”

“…Lagochilascariasis is a parasitic infection whose etiological agent is a nematode helminth (Nematoda) of the order Ascoroidea, family Ascarididae, genus Lagochilascaris , that comprises six species, however only Lagochilascaris minor , can cause human disease. It was initially identified and described by Robert T. Leiper in 1909, based on two cases observed in Trinidad and Tobago 1 - 3 . Since this initial report, cases have been reported in tropical and subtropical areas of Latin America, from Southern Mexico to Argentina and the Caribbean islands 4 .…”