Chayangsu Chayanuchit, Ampawong Sumate, Reamtong Onrapak, Viriyavejakul Parnpen, Kanjanapruthipong Tapanee, Fongsodsri Kamonpan, Intapun Suwaphat, Polpong Pongwat, Intarat Rattanarat, Charunwatthana Prakaykaew, Chan Abigail Hui En, Watthanakulpanich Dorn
Navavej International Hospital, Bangkok, Thailand 10230.
Department of Tropical Pathology, Faculty of Tropical Medicine, Mahidol University, Bangkok, Thailand 10400.
Food Waterborne Parasitol. 2024 May 11;35:e00229. doi: 10.1016/j.fawpar.2024.e00229. eCollection 2024 Jun.
Human gnathostomiasis is a food-borne zoonotic helminthic infection widely reported in Latin America, Asia, and Southeast Asia. Consuming raw, or under-cooked fresh-water fish is the leading cause of this helminthic infection, which is clinically characterized by signs of inflammation, itching sensation, or irritation with migratory swelling. Neurological symptoms resulting from neurognathostomiasis vary, and there is scant information due to the rareness of patient brain samples. This study aimed to demonstrate the first evidence of human neurognathostomiasis by the detection of larva in patient's brain during craniotomy, supported by histopathological, immunological and proteomic evidence. Clinical symptoms were obtained from medical history and physical examination with laboratory investigations, including magnetic resonance imaging (MRI), left temporal craniotomy, histopathology of brain tissue, and Western blot analysis, were performed to elucidate the causative pathogens for diagnosis. In addition, the host-parasite interaction of the parasite invading the patient's brain was characterized through proteomics. Histopathology revealed worms with the characteristic cuticular spines of which were detected and identified. These histopathological findings were consistent with a positive Western blot showing a 24-kDa reactive-band for gnathostomiasis. Proteomic analysis revealed the presence of serpin and serine protease in the patient's serum. Moreover, the leucine-rich alpha-2-glycoprotein was indicated as a systemic biomarker of early brain injury related to invasion by Therefore, our study provides the initial evidence of human neurognathostomiasis due to larval invasion along with successful craniotomy and proven larval detection including complete follow-up, and the disease prognosis after surgical treatment.
人类颚口线虫病是一种食源性人畜共患蠕虫感染病，在拉丁美洲、亚洲和东南亚地区有广泛报道。食用生的或未煮熟的淡水鱼是这种蠕虫感染的主要原因，其临床特征为炎症迹象、瘙痒感或伴有游走性肿胀的刺激症状。神经颚口线虫病引起的神经症状各不相同，由于患者脑样本稀少，相关信息匮乏。本研究旨在通过在开颅手术期间检测患者大脑中的幼虫，证明人类神经颚口线虫病的首个证据，并辅以组织病理学、免疫学和蛋白质组学证据。通过病史、体格检查以及实验室检查获取临床症状，包括磁共振成像（MRI）、左颞叶开颅手术、脑组织组织病理学检查和蛋白质印迹分析，以阐明致病病原体用于诊断。此外，通过蛋白质组学对寄生虫侵入患者大脑的宿主 - 寄生虫相互作用进行了表征。组织病理学显示检测并鉴定出具有特征性表皮棘的蠕虫。这些组织病理学发现与蛋白质印迹阳性结果一致，该结果显示颚口线虫病有一条24 kDa的反应带。蛋白质组学分析显示患者血清中存在丝氨酸蛋白酶抑制剂和丝氨酸蛋白酶。此外，富含亮氨酸的α-2-糖蛋白被指出是与[寄生虫名称未完整给出]入侵相关的早期脑损伤的全身生物标志物。因此，我们的研究提供了人类神经颚口线虫病因[寄生虫名称未完整给出]幼虫入侵的初步证据，同时成功进行了开颅手术并证实检测到幼虫，包括完整的随访以及手术治疗后的疾病预后。
