title: Acute outbreak of gnathostomiasis in a fishing community in Sinaloa, Mexico.
abstract: An increasing number of human cases of gnathostomiasis have been reported in Sinaloa, Mexico, most of whom have a custom of eating of raw fish dishes such as 'cebiche'. Here we report five adult patients, three women and two men, having an acute episode of vomiting and abdominal pain a few minutes after eating a dish of cebiche prepared from a spotted sleeper perch (Eleotris picta) fished from a nearby lake in southern Sinaloa. All five patients experienced acute throat pain, chest and joint pains, headache and fever. One patient, a 55-year-old male, was hospitalized with suspected pancreatitis and pneumonia. By 8-9 days later, all five patients developed between three and 12 edematous, migrating skin lesions on the back, abdomen, upper and lower extremities, face, eye and scalp. By ELISA, all of them were sero-positive to Gnathostoma doloresi antigen and had elevated IgE levels. Eosinophilia was found in two patients. These patients lived in an agricultural and fishing community. In this community we carried out a sero-epidemiological survey and study of living conditions in a random sample of 309 individuals distributed in 74 households. Frequent consumption of raw fish was reported in 36% of households, and 12 individuals had a clinical history of migrating skin lesions. The sero-prevalence to Gnathostoma antigens was 34.95%. Five fish species and four species of ichthyophagous birds collected from three lakes in the village and a nearby estuary were infected with the advanced third-stage larvae of G. binucleatum, a species found in Ecuador and Mexico. The results describe the first known outbreak of acute gnathostomiasis on the American continent.
authors.affiliation: Facultad de Ciencias Químico Biológicas, Universidad Autónoma de Sinaloa, Culiacán, Sinaloa 80000, Mexico.
authors.forename: Sylvia Paz
authors.initials: SP
authors.lastname: Díaz Camacho
authors.forename: Kaethe
authors.initials: K
authors.lastname: Willms
authors.forename: Ma del Carmen
authors.initials: Mdel C
authors.lastname: de la Cruz Otero
authors.forename: Magda Luz
authors.initials: ML
authors.lastname: Zazueta Ramos
authors.forename: Sergio
authors.initials: S
authors.lastname: Bayliss Gaxiola
authors.forename: Rafael
authors.initials: R
authors.lastname: Castro Velázquez
authors.forename: Ignacio
authors.initials: I
authors.lastname: Osuna Ramírez
authors.forename: Angel
authors.initials: A
authors.lastname: Bojórquez Contreras
authors.forename: Edith Hilario
authors.initials: EH
authors.lastname: Torres Montoya
authors.forename: Sergio
authors.initials: S
authors.lastname: Sánchez Gonzáles
mesh_terms: D000208:Acute Disease; D000328:Adult; D000818:Animals; D001717:Birds; D017714:Community-Acquired Infections / Q000175:diagnosis / Q000453:epidemiology; D004196:Disease Outbreaks; D004797:Enzyme-Linked Immunosorbent Assay; D004802:Eosinophilia / Q000097:blood / Q000175:diagnosis; D005260:Female; D005393:Fish Diseases / Q000469:parasitology; D005398:Fisheries; D006039:Gnathostoma / Q000302:isolation & purification; D006801:Humans; D007073:Immunoglobulin E / Q000097:blood; D007815:Larva Migrans / Q000175:diagnosis / Q000473:pathology; D008297:Male; D008800:Mexico / Q000453:epidemiology; D008875:Middle Aged; D010473:Perciformes / Q000469:parasitology; D016036:Seroepidemiologic Studies; D017205:Spirurida Infections / Q000175:diagnosis / Q000453:epidemiology* / Q000662:veterinary
chemical_list: D007073:Immunoglobulin E