Gongylonema Pulchrum - Case Studies

Case Studies

In 1996, the first reported case of Gongylonema pulchrum infection was reported in Japan. A 34-year old male complaining of irritable stomatitis on his lower lip went in to see his doctor, but the pain subsided spontaneously. However, it reoccurred several times in the next few months. When he went in to his doctor after one of these episodes, a thread like organism was seen protruding from his ulcer. The patient also had eosinophilia, but the ulcer healed with no scar once the organism was removed. The organism was identified as a female G. pulchrum worm, and the patient needed no further treatment.

How the patient contracted the worm is still unknown. He didn’t report eating any abnormal foods, nor had he traveled outside of Japan in the past few years. He also did not report drinking any water from possibly infected wells. It is possible that he ate food that had been contaminated in an endemic country and shipped to Japan. With the globalized food market now present, this is not out of the realm of possibility, and should be considered as a possible means of transmission into countries that have no previous history of G. pulchrum infection.

In 1999, a 41 year old female resident of New York City went in to her doctor complaining of the sensation of something moving in her mouth. She said she had had the feeling for the duration of one year. Supposedly, she had removed worms from her mouth on two separate occasions- one from her lip, and one from her gums. She submitted one of the specimens for microscopic identification, and it was found to be an adult female G. pulchrum worm. She traveled frequently to visit relatives in Mississippi, so it is unknown whether she contracted the worm in New York or in the south. This was the first reported case of Gongylonema in the United States since 1963.

Also in 1999, a 38-year old woman of Cambridge, Massachusetts sought medical attention for the visible identification of a “migrating mass” in her cheek mucosa. Six months earlier, she had noted an irregular patch of mucosa on her cheek, but thought nothing of it. Previously in the year, she’d traveled to Mexico, Guatemala, and France. She didn’t report ingesting any beetles, but she did eat raw foods when vacationing in Mexico. She described the foods as “raw, crunchy, and saladlike”. Approximately 12 hours after eating the food, she and five other individuals she was traveling with had an acute attack of nausea, vomiting, and dizziness. The symptoms seemed to resolve themselves with no need of further treatment. A small female Gongylonema worm was surgically removed from her cheek mucosa under local anesthesia, and follow up treatment included albendazole two times daily for three days. This was the eleventh reported case of G. pulchrum infection in the United States. Most cases reported in the US are reported from the southeastern part of the country.

There was a 1916 infection reported in a 16 year old girl from Mississippi. She presented with gastrointestinal pain, vomiting and a low fever (101.5 °F (38.6 °C)). She complained of a sensation of a worm moving around her lower lip, but was disregarded by her physician. As she continued to complain, the physician examined her mouth, and discovered the outline of a worm. He extracted the worm with a sewing needle, and the child’s complaints stopped and she appeared to have no further symptoms of parasite infection.

In 2013, the first case of human gongylonemosis was reported in France. The patient, a healthy 48-year-old man felt the presence of a moving, worm-like organism in his mouth. Initially, the patient would occasionally feel, but not see, this mass at different sites: cheek, palate, gums and internal surface of the lower lip. The sensation would subside after several hours without leaving any visible lesions and without being accompanied by any associated localized or generalized symptoms. The patient had no medical history. He was a resident of Alsace, France, and had not travelled abroad. He reported not to have changed his lifestyle, especially not his diet, in the recent past. He also had no knowledge of having accidentally ingested an intermediate insect host. He consulted a doctor and all results of the clinical examination fell within the normal range. Haematology investigation revealed no abnormalities, particularly no elevated eosinophil count, and no microfilariae were seen using stained blood films; the filariasis serology was negative. No medical treatment was initiated. After 3 weeks of migration, the thread-like worm installed itself on the inner surface of the lower lip, allowing the patient to extract it by tongue pressure firstly, then using his fingers. He placed the parasite in alcohol and submitted it to a medical laboratory.