Epidemiologic Notes and Reports
Intestinal Perforation Caused by Larval Eustrongylides -- Maryland
CDC recently received reports that three fishermen in
Baltimore,
Maryland, swallowed live minnows and developed severe abdominal
pain
within 24 hours.
Patient 1, a 23-year-old male, was seen at a community hospital
on
March 21, 1982, 2 days after swallowing two live minnows, because
of
progressive abdominal cramping pain of 24-hours' duration. During
surgery, two roundworms were found, one penetrating the cecum, the
other in the abdominal cavity. The transverse colon was found to
be
ecchymotic with punctate hemorrhage and exudates. On April 7,
patient
2, a 25-year-old fisherman, was brought to the emergency room of
the
same hospital with similar symptoms 24 hours after swallowing one
minnow. At laparotomy on April 9, two roundworms were found near a
perforated cecum. Patient 3, a fisherman who swallowed minnows
from
the same source, later developed similar symptoms, which resolved 4
days later without surgery. Twelve other persons who also ingested
live minnows reported no symptoms during 4 weeks of follow-up.
Sixty-seven minnows, collected in East Baltimore waters and
secured from the same store at which the patients obtained their
fish,
were examined; 32 (48%) were infected with roundworms identical to
those recovered from the two patients described above. Of the
infected fish, six had two worms, one had three worms, and 26 had
one
worm each. The worms, 1-2 mm in diameter and 80-120 mm long, were
identified as 4th-stage larval nematodes of the genus
Eustrongylides.*
Reported by PF Guerin, MD, S Marapudi, MD, L McGrail, RN, CL
Moravec,
MD, E Schiller, DSc, Baltimore, EW Hopf, MD, R Thompson, Baltimore
County Health Dept, FYC Lin, MD, E Israel, MD, State
Epidemiologist,
Maryland State Health Dept; JW Bier, PhD, GJ Jackson, PhD, Bureau
of
Foods, Div of Microbiology, US Food and Drug Adminstration;
Parasitic
Diseases Div, Center for Infectious Diseases, CDC.
Editorial Note
Editorial Note: Nematodes of the genus Eustrongylides (Family
Dioctophymidae Railliet, 1915) are parasitic as adults in the
gastrointestinal tract of fish-eating birds and as larvae in the
connective tissue or body cavity of freshwater fish (1).
Amphibians,
reptiles, and mammals (rarely) may become infected with larval
Eustrongylides spp. and may play an ecological role as paratenic or
transport hosts. Moreover, extensive larval migration in
accidentally
and experimentally infected reptilian, amphibian, and avian hosts
has
been observed and has sometimes been associated with high mortality
(1-3), suggesting a possible pathologic role for Eustrongylides
spp.
However, no human infections have been reported to CDC.** Although
data are incomplete, infection by larval Eustrongylides spp. is
widespread and common in numerous species of freshwater fish. The
high rates of infection for minnows (Fundulus spp.) reported here
and
earlier (3) may indicate a high degree of risk for persons who
choose
to eat these fish without cooking them first.
References
Lichtenfels JR, Lavies B. Mortality in red-sided garter
snakes,
Thamnophis sirtalis parietalis, due to larval nematode,
Eustrongylides sp. Lab Anim Sci 1976;26:465-7.
Abram JB, Lichtenfels JR. Larval Eustrongylides sp. (Nematoda:
Dioctophymatoidea) from otter, Lutra canadensis, in Maryland.
Proceeding of the Helminthological Society of Washington
1974;41:253.
Von Brand T, Cullinan RP. Physiological observations upon a
larval Eustrongylides. V. The behavior in abnormal warmblooded
hosts. Proceeding of the Helminthological Society of
Washington
1943; 10:29-33.
*Larval specimens have been deposited with the U.S. Department of
Agriculture (USDA) in the U.S. National Museum, Helminthological
Collection.
**The USDA National Helminthological Collection contains a single
larval specimen obtained from a human (2).
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