\
OF GNATHOSTOMIASIS WITH SOME INTERESTING FEATURES
CASE
By P. A. MAPLESTONE,
d.s.o., d.sc., m.b., b.s., d.t.m.
and S.
(From
SUNDAR
RAO,
l.m.p.
the H elminthological Research Laboratory, School of Tropical Medicine, Calcutta
The first instance of a gnathostome infection human being in India was reported by a Maplestone (1929), and since that time the same worker has recorded three more. The same man, in whom the first recorded infection occurred, came recently with a similar condition again. Before discussing the history of the present manifestation it is thought advisable to recapitulate briefly the main points in the first infection. He is a Mahommedan clerk who was at that time 26 years of age. He had lived in the Jalpaiguri district of Bengal for many years prior to the attack and had never been out of the province in his life. For a period of about seven years he had suffered with transient swellings in various parts of the right hand, which in the of
THE INDIAN MEDICAL GAZETTE
480
final attack was localized in the middle finger. The man noticed a small whitish point beside the nail and when this was opened with a needle This worm was identia small worm escaped. fied as a gnathostome and described by Maplestone (loc. cit.). After the worm had been of the hand ceased removed the swelling altogether. The patient was not seen by us on this occasion, but the case notes and the worm were forwarded by the civil surgeon, Jalpaiguri. In the intervening ten years this man has remained all the time in the same district, and he recently reported at the out-patient department of the School of Tropical Medicine, Calcutta. He gave the following history :? In 1930, about a year after the first worm was removed and all attacks of swelling of the right hand had ceased, he noticed an cedematous swelling on the left side of the chest, just above and inside the nipple. This swelling soon subsided and shortly afterwards another one appeared over the sternum, which remained until 1936. It then disappeared and in 1937 a third swelling appeared on the right side of the chest. During 1938 transient swellings occurrcd in various parts of the right arm, finally reaching a position just above the right wrist. At the beginning of May this year (1939) the right forearm became swollen and subsided in about a week. On 29th May the right middle finger swelled, and he came to Calcutta where he was seen by.us on 2nd June. He had a blister on the pulp of the finger. This was incised and a small worm together with a few drops of serum escaped.
The worm was found to be not unlike the one removed from the same patient ten years earlier. This specimen was better fixed than the previous one so that there was no shrinkage, which fact may account for its slightly larger size, but apart from this the stage of development was no further advanced and there were the same number of rows of spines (four) on the head bulb.
Length
..
..
Old
New
specimen
specimen
3.56
5.28 0.54 0.33 0.22
0.42 Maximum diameter 0.34 Diameter of head bulb 0.20 Length of head bulb (Measurements in millimetres.) ..
..
..
This case presents several interesting features, which are discussed below. The infection seems to have persisted much longer than has ever been recorded before. Although it cannot be proved it appears probable that infection with both worms was acquired at the same time, because the disease is such a rarity in India the chances of the same man being infected on two different occasions appears ve'ry remote. If this is accepted it gives a minimum of 17 years that these worm have lived in the body of the man. The worms do not appear to have undergone any development over this long period as the two worms, removed with an interval of ten years between, are in the same stage of immaturity. This is all the more interesting because some gnathostomes that have been removed shown sufficiently from human beings have advanced development to have been classed as
[Aug.,
1939
adults. Therefore there must be factors other than of time which determine the development of these worms in the human tissues. It is a remarkable coincidence that botli worms finally reached the surface near the tip of the same finger after extensive migration through the body. The man said that on rare occasions he very
has eaten uncooked dried fish which may for his infection.
account
Rfeerence P. Vol. LX1V. p. 610.
Maplestone,
A.
(1929).
Indian
Med.
GaZ
OF GNATHOSTOMIASIS WITH SOME INTERESTING FEATURES
CASE
By P. A. MAPLESTONE,
d.s.o., d.sc., m.b., b.s., d.t.m.
and S.
(From
SUNDAR
RAO,
l.m.p.
the H elminthological Research Laboratory, School of Tropical Medicine, Calcutta
The first instance of a gnathostome infection human being in India was reported by a Maplestone (1929), and since that time the same worker has recorded three more. The same man, in whom the first recorded infection occurred, came recently with a similar condition again. Before discussing the history of the present manifestation it is thought advisable to recapitulate briefly the main points in the first infection. He is a Mahommedan clerk who was at that time 26 years of age. He had lived in the Jalpaiguri district of Bengal for many years prior to the attack and had never been out of the province in his life. For a period of about seven years he had suffered with transient swellings in various parts of the right hand, which in the of
THE INDIAN MEDICAL GAZETTE
480
final attack was localized in the middle finger. The man noticed a small whitish point beside the nail and when this was opened with a needle This worm was identia small worm escaped. fied as a gnathostome and described by Maplestone (loc. cit.). After the worm had been of the hand ceased removed the swelling altogether. The patient was not seen by us on this occasion, but the case notes and the worm were forwarded by the civil surgeon, Jalpaiguri. In the intervening ten years this man has remained all the time in the same district, and he recently reported at the out-patient department of the School of Tropical Medicine, Calcutta. He gave the following history :? In 1930, about a year after the first worm was removed and all attacks of swelling of the right hand had ceased, he noticed an cedematous swelling on the left side of the chest, just above and inside the nipple. This swelling soon subsided and shortly afterwards another one appeared over the sternum, which remained until 1936. It then disappeared and in 1937 a third swelling appeared on the right side of the chest. During 1938 transient swellings occurrcd in various parts of the right arm, finally reaching a position just above the right wrist. At the beginning of May this year (1939) the right forearm became swollen and subsided in about a week. On 29th May the right middle finger swelled, and he came to Calcutta where he was seen by.us on 2nd June. He had a blister on the pulp of the finger. This was incised and a small worm together with a few drops of serum escaped.
The worm was found to be not unlike the one removed from the same patient ten years earlier. This specimen was better fixed than the previous one so that there was no shrinkage, which fact may account for its slightly larger size, but apart from this the stage of development was no further advanced and there were the same number of rows of spines (four) on the head bulb.
Length
..
..
Old
New
specimen
specimen
3.56
5.28 0.54 0.33 0.22
0.42 Maximum diameter 0.34 Diameter of head bulb 0.20 Length of head bulb (Measurements in millimetres.) ..
..
..
This case presents several interesting features, which are discussed below. The infection seems to have persisted much longer than has ever been recorded before. Although it cannot be proved it appears probable that infection with both worms was acquired at the same time, because the disease is such a rarity in India the chances of the same man being infected on two different occasions appears ve'ry remote. If this is accepted it gives a minimum of 17 years that these worm have lived in the body of the man. The worms do not appear to have undergone any development over this long period as the two worms, removed with an interval of ten years between, are in the same stage of immaturity. This is all the more interesting because some gnathostomes that have been removed shown sufficiently from human beings have advanced development to have been classed as
[Aug.,
1939
adults. Therefore there must be factors other than of time which determine the development of these worms in the human tissues. It is a remarkable coincidence that botli worms finally reached the surface near the tip of the same finger after extensive migration through the body. The man said that on rare occasions he very
has eaten uncooked dried fish which may for his infection.
account
Rfeerence P. Vol. LX1V. p. 610.
Maplestone,
A.
(1929).
Indian
Med.
GaZ
