Official reprint from UpToDate®
www.uptodate.com ©2017 UpToDate, Inc. and/or its affiliates. All Rights Reserved.

Miscellaneous nematodes

Karin Leder, MBBS, FRACP, PhD, MPH, DTMH
Peter F Weller, MD, MACP
Section Editor
Edward T Ryan, MD, DTMH
Deputy Editor
Elinor L Baron, MD, DTMH


The nematodes (roundworms) reviewed here include dirofilariasis, capillariasis, trichostrongyliasis, anisakiasis, Angiostrongylus costaricensis, and dracunculiasis (table 1). Other tissue nematode infections are discussed separately, including gnathostomiasis, Baylisascariasis, and Angiostrongylus cantonensis. (See "Eosinophilic meningitis".)


A. costaricensis is a filariform nematode that causes eosinophilic enterocolitis, a granulomatous inflammatory reaction within the intestinal wall. The appendix, distal small bowel, or right colon may be involved. (See "Eosinophilic gastroenteritis".)

The life cycle of A. costaricensis begins with eggs laid by adult worms in the mesenteric arterioles of rats, the definitive hosts (figure 1). The first-stage larvae are passed in the stool and ingested by a snail or slug (intermediate host). The life cycle is completed with mollusk ingestion by the rat, and the third-stage larvae (infective larvae) migrate to the ileocecal area.

Humans can acquire the infection by eating raw or undercooked snails or slugs infected with the parasite; infection may also be transmitted by raw produce contaminated with larva-containing slug secretions. Alternatively, infection can be transmitted by ingestion of infected paratenic animals, such as crab or freshwater shrimp. In humans, worms migrate to the mesenteric arteries and release eggs into the intestinal tissues. Intense endothelial damage with subsequent arteritis and thrombosis can ensue, with necrosis of adjacent enteric tissue. The parasite usually dies in the gastrointestinal tract; eggs are not shed in the stool.

A. costaricensis has been reported most frequently from Central and South America, especially Costa Rica [1]. Cases have also occurred in the United States and elsewhere [2-4].

To continue reading this article, you must log in with your personal, hospital, or group practice subscription. For more information on subscription options, click below on the option that best describes you:

Subscribers log in here

Literature review current through: Nov 2017. | This topic last updated: Nov 03, 2017.
The content on the UpToDate website is not intended nor recommended as a substitute for medical advice, diagnosis, or treatment. Always seek the advice of your own physician or other qualified health care professional regarding any medical questions or conditions. The use of this website is governed by the UpToDate Terms of Use ©2017 UpToDate, Inc.
  1. Loría-Cortés R, Lobo-Sanahuja JF. Clinical abdominal angiostrongylosis. A study of 116 children with intestinal eosinophilic granuloma caused by Angiostrongylus costaricensis. Am J Trop Med Hyg 1980; 29:538.
  2. Wu SS, French SW, Turner JA. Eosinophilic ileitis with perforation caused by Angiostrongylus (Parastrongylus) costaricensis. A case study and review. Arch Pathol Lab Med 1997; 121:989.
  3. Baird JK, Neafie RC, Lanoie L, Connor DH. Abdominal angiostrongylosis in an African man: case study. Am J Trop Med Hyg 1987; 37:353.
  4. Kramer MH, Greer GJ, Quiñonez JF, et al. First reported outbreak of abdominal angiostrongyliasis. Clin Infect Dis 1998; 26:365.
  5. Waisberg J, Corsi CE, Rebelo MV, et al. Jejunal perforation caused by abdominal angiostrongyliasis. Rev Inst Med Trop Sao Paulo 1999; 41:325.
  6. Silvera CT, Ghali VS, Roven S, et al. Angiostrongyliasis: a rare cause of gastrointestinal hemorrhage. Am J Gastroenterol 1989; 84:329.
  7. Rodriguez R, Dequi RM, Peruzzo L, et al. Abdominal angiostrongyliasis: report of two cases with different clinical presentations. Rev Inst Med Trop Sao Paulo 2008; 50:339.
  8. Vázquez JJ, Sola JJ, Boils PL. Hepatic lesions induced by Angiostrongylus costaricensis. Histopathology 1994; 25:489.
  9. Quirós JL, Jiménez E, Bonilla R, et al. Abdominal angiostrongyliasis with involvement of liver histopathologically confirmed: a case report. Rev Inst Med Trop Sao Paulo 2011; 53:219.
  10. Geiger SM, Laitano AC, Sievers-Tostes C, et al. Detection of the acute phase of abdominal angiostrongyliasis with a parasite-specific IgG enzyme linked immunosorbent assay. Mem Inst Oswaldo Cruz 2001; 96:515.
  11. Rodriguez R, da Silva AC, Müller CA, et al. PCR for the diagnosis of abdominal angiostrongyliasis in formalin-fixed paraffin-embedded human tissue. PLoS One 2014; 9:e93658.
  12. Ben R, Rodrigues R, Agostini AA, Graeff-Teixeira C. Use of heterologous antigens for the immunodiagnosis of abdominal angiostrongyliasis by an enzyme-linked immunosorbent assay. Mem Inst Oswaldo Cruz 2010; 105:914.
  13. Liu LX, Chi J, Upton MP, Ash LR. Eosinophilic colitis associated with larvae of the pinworm Enterobius vermicularis. Lancet 1995; 346:410.
  14. Drugs for Parasitic Infections, 3rd Ed, The Medical Letter, New Rochelle, NY 2013.
  15. Audicana MT, Kennedy MW. Anisakis simplex: from obscure infectious worm to inducer of immune hypersensitivity. Clin Microbiol Rev 2008; 21:360.
  16. Hochberg NS, Hamer DH. Anisakidosis: Perils of the deep. Clin Infect Dis 2010; 51:806.
  17. Caramello P, Vitali A, Canta F, et al. Intestinal localization of anisakiasis manifested as acute abdomen. Clin Microbiol Infect 2003; 9:734.
  18. Park MS, Kim KW, Ha HK, Lee DH. Intestinal parasitic infection. Abdom Imaging 2008; 33:166.
  19. Nawa Y, Hatz C, Blum J. Sushi delights and parasites: the risk of fishborne and foodborne parasitic zoonoses in Asia. Clin Infect Dis 2005; 41:1297.
  20. Amir A, Ngui R, Ismail WH, et al. Anisakiasis Causing Acute Dysentery in Malaysia. Am J Trop Med Hyg 2016; 95:410.
  21. Gómez B, Tabar AI, Tuñón T, et al. Eosinophilic gastroenteritis and Anisakis. Allergy 1998; 53:1148.
  22. López-Serrano MC, Gomez AA, Daschner A, et al. Gastroallergic anisakiasis: findings in 22 patients. J Gastroenterol Hepatol 2000; 15:503.
  23. Lorenzo S, Iglesias R, Audícana MT, et al. Human immunoglobulin isotype profiles produced in response to antigens recognized by monoclonal antibodies specific to Anisakis simplex. Clin Exp Allergy 1999; 29:1095.
  24. Daschner A, Alonso-Gómez A, Caballero T, et al. Gastric anisakiasis: an underestimated cause of acute urticaria and angio-oedema? Br J Dermatol 1998; 139:822.
  25. Ramos L, Alonso C, Guilarte M, et al. Anisakis simplex-induced small bowel obstruction after fish ingestion: preliminary evidence for response to parenteral corticosteroids. Clin Gastroenterol Hepatol 2005; 3:667.
  26. Matsui T, Iida M, Murakami M, et al. Intestinal anisakiasis: clinical and radiologic features. Radiology 1985; 157:299.
  27. Takabayashi T, Mochizuki T, Otani N, et al. Anisakiasis presenting to the ED: clinical manifestations, time course, hematologic tests, computed tomographic findings, and treatment. Am J Emerg Med 2014; 32:1485.
  28. Lee JS, Kim BS, Kim SH, et al. Acute invasive small-bowel Anisakiasis: clinical and CT findings in 19 patients. Abdom Imaging 2014; 39:452.
  29. Shibata E, Ueda T, Akaike G, Saida Y. CT findings of gastric and intestinal anisakiasis. Abdom Imaging 2014; 39:257.
  30. Moreno-Ancillo A, Caballero MT, Cabañas R, et al. Allergic reactions to anisakis simplex parasitizing seafood. Ann Allergy Asthma Immunol 1997; 79:246.
  31. Daschner A, Alonso-Gómez A, Caballero T, et al. Usefulness of early serial measurement of specific and total immunoglobulin E in the diagnosis of gastro-allergic anisakiasis. Clin Exp Allergy 1999; 29:1260.
  32. García M, Moneo I, Audicana MT, et al. The use of IgE immunoblotting as a diagnostic tool in Anisakis simplex allergy. J Allergy Clin Immunol 1997; 99:497.
  33. Desowitz RS, Raybourne RB, Ishikura H, Kliks MM. The radioallergosorbent test (RAST) for the serological diagnosis of human anisakiasis. Trans R Soc Trop Med Hyg 1985; 79:256.
  34. García-Palacios L, González ML, Esteban MI, et al. Enzyme-linked immunosorbent assay, immunoblot analysis and RAST fluoroimmunoassay analysis of serum responses against crude larval antigens of Anisakis simplex in a Spanish random population. J Helminthol 1996; 70:281.
  35. Gutierrez Ramos R, Tsuji M. Detection of antibodies to Anisakis simplex larvae by enzyme-linked immunosorbent assay and immunoelectrophoresis using crude or purified antigens. J Helminthol 1994; 68:305.
  36. Iglesias R, Leiro J, Santamarina MT, et al. Monoclonal antibodies against diagnostic Anisakis simplex antigens. Parasitol Res 1997; 83:755.
  37. del Pozo MD, Moneo I, de Corres LF, et al. Laboratory determinations in Anisakis simplex allergy. J Allergy Clin Immunol 1996; 97:977.
  38. Okazaki M, Goto I, Kurokawa I. Studies on the detection of anti-Anisakis larvae antibodies by ELISA kits. Med Pharmacol 1992; 22:971.
  39. Lorenzo S, Iglesias R, Leiro J, et al. Usefulness of currently available methods for the diagnosis of Anisakis simplex allergy. Allergy 2000; 55:627.
  40. Chen Q, Yu HQ, Lun ZR, et al. Specific PCR assays for the identification of common anisakid nematodes with zoonotic potential. Parasitol Res 2008; 104:79.
  41. Sakanari JA, McKerrow JH. Anisakiasis. Clin Microbiol Rev 1989; 2:278.
  42. Pacios E, Arias-Diaz J, Zuloaga J, et al. Albendazole for the treatment of anisakiasis ileus. Clin Infect Dis 2005; 41:1825.
  43. Moore DA, Girdwood RW, Chiodini PL. Treatment of anisakiasis with albendazole. Lancet 2002; 360:54.
  44. Limsrivilai J, Pongprasobchai S, Apisarnthanarak P, Manatsathit S. Intestinal capillariasis in the 21st century: clinical presentations and role of endoscopy and imaging. BMC Gastroenterol 2014; 14:207.
  45. Grencis RK, Cooper ES. Enterobius, trichuris, capillaria, and hookworm including ancylostoma caninum. Gastroenterol Clin North Am 1996; 25:579.
  46. Cross JH, Banzon T, Clarke MD, et al. Studies on the experimental transmission of Capillaria philippinensis in monkeys. Trans R Soc Trop Med Hyg 1972; 66:819.
  47. Cross JH. Intestinal capillariasis. Clin Microbiol Rev 1992; 5:120.
  48. Vasantha PL, Girish N, Leela KS. Human intestinal capillariasis: a rare case report from non-endemic area (Andhra Pradesh, India). Indian J Med Microbiol 2012; 30:236.
  49. Alcantara AK, Uylangco CV, Sangalang RP, Cross JH. A comparative clinical study of mefloquine and chloroquine in the treatment of vivax malaria. Southeast Asian J Trop Med Public Health 1985; 16:534.
  50. Cross JH, Basaca-Sevilla V. Albendazole in the treatment of intestinal capillariasis. Southeast Asian J Trop Med Public Health 1987; 18:507.
  51. Belizario VY Jr, G Totañes FI, de Leon WU, et al. Intestinal capillariasis, western Mindanao, the Philippines. Emerg Infect Dis 2010; 16:736.
  52. Dronda F, Chaves F, Sanz A, Lopez-Velez R. Human intestinal capillariasis in an area of nonendemicity: case report and review. Clin Infect Dis 1993; 17:909.
  53. Pampiglione S, Gustinelli A. Human hepatic capillariasis: a second case occurred in Korea. J Korean Med Sci 2008; 23:560.
  54. Klenzak J, Mattia A, Valenti A, Goldberg J. Hepatic capillariasis in Maine presenting as a hepatic mass. Am J Trop Med Hyg 2005; 72:651.
  55. Wang ZQ, Cui J, Wang Y. Persistent febrile hepatomegaly with eosinophilia due to hepatic capillariasis in Central China. Ann Trop Med Parasitol 2011; 105:469.
  56. Sawamura R, Fernandes MI, Peres LC, et al. Hepatic capillariasis in children: report of 3 cases in Brazil. Am J Trop Med Hyg 1999; 61:642.
  57. Kumar V, Brandt J, Mortelmans J. Hepatic capillariasis may simulate the syndrome of visceral larva migrans, an analysis. Ann Soc Belg Med Trop 1985; 65:101.
  58. Juncker-Voss M, Prosl H, Lussy H, et al. Serological detection of Capillaria hepatica by indirect immunofluorescence assay. J Clin Microbiol 2000; 38:431.
  59. Choe G, Lee HS, Seo JK, et al. Hepatic capillariasis: first case report in the Republic of Korea. Am J Trop Med Hyg 1993; 48:610.
  60. Jelinek T, Schulte-Hillen J, Löscher T. Human dirofilariasis. Int J Dermatol 1996; 35:872.
  61. Dantas-Torres F, Otranto D. Dirofilariosis in the Americas: a more virulent Dirofilaria immitis? Parasit Vectors 2013; 6:288.
  62. Simón F, Siles-Lucas M, Morchón R, et al. Human and animal dirofilariasis: the emergence of a zoonotic mosaic. Clin Microbiol Rev 2012; 25:507.
  63. Blaizot R, Receveur MC, Millet P, et al. Systemic Infection With Dirofilaria repens in Southwestern France. Ann Intern Med 2017.
  64. Genchi C, Kramer LH, Rivasi F. Dirofilarial infections in Europe. Vector Borne Zoonotic Dis 2011; 11:1307.
  65. Fleck R, Kurz W, Quade B, et al. Human dirofilariasis due to Dirofilaria repens mimicking a scrotal tumor. Urology 2009; 73:209.e1.
  66. Tada I, Sakaguchi Y, Eto K. Dirofilaria in the abdominal cavity of a man in Japan. Am J Trop Med Hyg 1979; 28:988.
  67. Kim MK, Kim CH, Yeom BW, et al. The first human case of hepatic dirofilariasis. J Korean Med Sci 2002; 17:686.
  68. Poppert S, Hodapp M, Krueger A, et al. Dirofilaria repens infection and concomitant meningoencephalitis. Emerg Infect Dis 2009; 15:1844.
  69. Kalogeropoulos CD, Stefaniotou MI, Gorgoli KE, et al. Ocular dirofilariasis: a case series of 8 patients. Middle East Afr J Ophthalmol 2014; 21:312.
  70. Pampiglione S, Franco F, Canestri Trotti G. Human subcutaneous dirofilariasis. 1. Two new cases in Venice. Identification of the causal agent as Dirofilaria repens Raillet and Henry, 1911. Parassitologia 1982; 24:155.
  71. Flieder DB, Moran CA. Pulmonary dirofilariasis: a clinicopathologic study of 41 lesions in 39 patients. Hum Pathol 1999; 30:251.
  72. Hiroshima K, Iyoda A, Toyozaki T, et al. Human pulmonary dirofilariasis: report of six cases. Tohoku J Exp Med 1999; 189:307.
  73. Ro JY, Tsakalakis PJ, White VA, et al. Pulmonary dirofilariasis: the great imitator of primary or metastatic lung tumor. A clinicopathologic analysis of seven cases and a review of the literature. Hum Pathol 1989; 20:69.
  74. Solaini L, Gourgiotis S, Salemis NS, Solaini L. A case of human pulmonary dirofilariasis. Int J Infect Dis 2008; 12:e147.
  75. Khoramnia R, Wegner A. Images in clinical medicine: Subconjunctival Dirofilaria repens. N Engl J Med 2010; 363:e37.
  76. Fuentes I, Cascales A, Ros JM, et al. Human subcutaneous dirofilariasis caused by Dirofilaria repens in Ibiza, Spain. Am J Trop Med Hyg 1994; 51:401.
  77. Arvanitis PG, Vakalis NC, Damanakis AG, Theodossiadis GP. Ophthalmic dirofilariasis. Am J Ophthalmol 1997; 123:689.
  78. Tzanetou K, Gasteratos S, Pantazopoulou A, et al. Subcutaneous dirofilariasis caused by Dirofilaria repens in Greece: a case report. J Cutan Pathol 2009; 36:892.
  79. Ciferri F. Human pulmonary dirofilariasis in the United States: a critical review. Am J Trop Med Hyg 1982; 31:302.
  80. Glickman LT, Grieve RB, Schantz PM. Serologic diagnosis of zoonotic pulmonary dirofilariasis. Am J Med 1986; 80:161.
  81. Rivasi F, Boldorini R, Criante P, et al. Detection of Dirofilaria (Nochtiella) repens DNA by polymerase chain reaction in embedded paraffin tissues from two human pulmonary locations. APMIS 2006; 114:567.
  82. Marusić Z, Stastny T, Kirac I, et al. Subcutaneous dirofilariasis caused by Dirofilaria repens diagnosed by histopathologic and polymerase chain reaction analysis. Acta Dermatovenerol Croat 2008; 16:222.
  83. Acharya D, Chatra PS, Padmaraj SR, Ahamed A. Subcutaneous dirofilariasis. Singapore Med J 2012; 53:e184.
  84. Khurana S, Singh G, Bhatti HS, Malla N. Human subcutaneous dirofilariasis in India: a report of three cases with brief review of literature. Indian J Med Microbiol 2010; 28:394.
  85. Greenaway C. Dracunculiasis (guinea worm disease). CMAJ 2004; 170:495.
  86. World Health Organization. Dracunculiasis eradication: Mali reports zero cases in 2016. http://www.who.int/neglected_diseases/news/Mali_reports_zero_cases_in_2016/en/ (Accessed on March 22, 2017).
  87. Hopkins DR. Dracunculiasis: an eradicable scourge. Epidemiol Rev 1983; 5:208.
  88. Boreham RE, McCowan MJ, Ryan AE, et al. Human trichostrongyliasis in Queensland. Pathology 1995; 27:182.
  89. Watthanakulpanich D, Pongvongsa T, Sanguankiat S, et al. Prevalence and clinical aspects of human Trichostrongylus colubriformis infection in Lao PDR. Acta Trop 2013; 126:37.
  90. Lattes S, Ferte H, Delaunay P, et al. Trichostrongylus colubriformis Nematode Infections in Humans, France. Emerg Infect Dis 2011; 17:1301.