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Spurious human infection with Gongylonema: nine cases reported from Thailand

Nematodes in the genus Gongylonema (family Gongylonematidae) are gastrointestinal parasites of mammals and birds. Accidental infection of humans occurs when insects containing the third-stage larvae of the parasites are ingested. Adult worms then develop from the ingested larvae and migrate to the host’s mucosae and submucosae, mostly in the oral cavity or oesophagus (Thomas and Lawrence, 1995). Most clinical diagnoses of gongylonemiasis are made by detection of the adult worms in mucosal tissue. Gongylonema eggs were, however, recently found in faecal specimens collected from nine residents of a rural area in Thailand, during helminthiasis surveillance programmes. In 2000, faecal specimens were collected from 213 individuals living in Tambon Korko in Muang district, part of the province of Surin, in north– eastern Thailand. The direct microscopical examination of wet smears of these samples revealed that two of the female subjects (one aged 14 years and the other 35 years) were excreting unusual helminth eggs. After faecal samples were collected from a further 1671 residents of Tambon Korko, in March 2001, another five individuals (two women aged 29 and 30 years and three men aged 40, 45 and 55 years) were found to be excreting the same type of eggs. Under a light microscope, the eggs were found to have an ellipsoidal shape and a thick and transparent shell. Each measured approximately 55635 mm and most contained a larva (see Figure). The eggs were identified as those of a Gongylonema species, as described by Thomas and Lawrence (1995). In March 2004, another helminthiasis surveillance programme was conducted in Tambon Ban Rae in the Khwao Sinarin sub-district, which lies immediately to the north of Muang district. In this survey, another two cases of Gongylonema ‘infection’ (a 4-year-old boy and a 50-year-old man) were detected when faecal samples from 1458 individuals were examined. Curiously, although further faecal samples were collected (on two consecutive days) from each of the nine cases of infection, no Gongylonema eggs were seen in any of these later specimens. All nine cases reported eating poultry in the 24 h before their egg-positive faecal samples had been collected. All the eggs seen in the fresh samples were either unembryonated or embryonated but with inactive larvae.