Visceral pentastomiasis in humans is caused by the larval stages (nymphs) of the arthropod-related tongue worms Linguatula serrata, Armillifer armillatus, A. moniliformis, A. grandis, and Porocephalus crotali. The majority of cases has been reported from Africa, Malaysia, and the Middle East, where visceral pentastomiasis may be an incidental finding in autopsies, and less often from China and Latin America. In Europe and North America, the disease is only rarely encountered in immigrants and long-term travelers, and the parasitic lesions may be confused with malignancies, leading to a delay in the correct diagnosis. Since clinical symptoms are variable and serological tests are not readily available, the diagnosis often relies on histopathological examinations. This laboratory symposium focuses on the diagnosis of this unusual parasitic disease and presents its risk factors and epidemiology.
In January 2016, a 20-year-old female oriental small-clawed otter (Aonyx cinereus) from Night Safari in Singapore was euthanized and diagnosed with a thyroid gland carcinoma. Postmortem examination and histology also revealed metastasis to the regional lymph nodes and severe visceral pentastomiasis. Grossly, the lymph nodes were infested, and encapsulation was observed on the visceral serosal surface. Histopathologically, the lymph nodes were encysted by a thick fibrous connective capsule with minimal inflammatory response. Pentastomiasis has been previously reported in the smooth-coated otter (Lutrogale perspicillata) in Malaysia. This report is the first case of severe visceral pentastomiasis in an oriental small-clawed otter with functional thyroid carcinoma.
We report a case of visceral pentastomiasis caused by Armillifer moniliformis in a 70-year-old aboriginal farmer from rural Malaysian Borneo. The patient complained of upper abdominal pain, jaundice, and loss of weight. Radiological investigations and subsequent histopathological examination revealed an adenocarcinoma of the pancreas with an adjacent liver nodule containing a nymph of A. moniliformis. This report constitutes the first documented human pentastomid infection in the whole of Malaysia after nearly 40 years, and it is the third description from Malaysian Borneo. Cases of human and animal pentastomiasis in Malaysia are discussed.