Korean J Gastroenterol.  2017 Mar;69(3):177-180. 10.4166/kjg.2017.69.3.177.

A Case of Endoscopically Treated Laryngopharyngitis Resulting from Clinostomum complanatum Infection

• Lee GS
• Park SW
• Kim J
• Seo KS
• You KW
• Chung JH
• Moon HC
• Hong GY

• KMID: 2383411
• DOI: http://doi.org/10.4166/kjg.2017.69.3.177

Abstract

A 46-year-old woman visited our hospital presenting throat pain and globus sensation. The symptoms occurred seven days after eating raw perch and mullet. An endoscopy under sedation showed a fluke"•with an approximate length of 4.8 mm and width of 1.5 mm"•on the left aryepiglottic fold, with active motility on the mucosa. It was extracted from the larynx using biopsy forceps and was identified as Clinostomum complanatum. To the best of our knowledge, this is the second reported case of human infection with Clinostomum complanatum diagnosed and treated by an endoscopy in Korea. Endoscopy is a useful tool in the diagnosis and treatment of patients at risk for parasitic infections complaining of throat pain.

Keyword

Food-borne diseases; Parasites; Endoscopy; Digenea; Clinostomum complanatum

MeSH Terms

Biopsy
Diagnosis
Eating
Endoscopy
Female
Foodborne Diseases
Humans
Korea
Larynx
Middle Aged
Mucous Membrane
Parasites
Perches
Pharynx
Sensation
Smegmamorpha
Surgical Instruments

Figure

• 

  Fig. 1. (A, B) Endoscopy shows the entire Clinostomum complanatum organism (black arrow) on the lateral side of the left aryepiglottic fold. (B– E) The fluke is approximately 5 mm in length and 2 mm in width, and it was torn during the removal procedure. (F) After removal, small mucosal petechiae are observed in the affected area, but neither active bleeding nor mucosal defects are observed.

• 

  Fig. 2. (A) Histological sections of the fluke show a characteristic distribution of internal organs for Clinostomum complanatum. The two testes are roughly triangular. The posterior testis is a rounded triangular shape and anteriorly concave. A part of the uterus containing eggs is positioned between the anterior and posterior testes. The ovary is placed laterally to the uterus. The numerous follicular vitellaria are distributed along the lateral margins of the posterior half of the body. Two intestinal ceca (white arrows) run posteriorly, containing digested materials that are stained brown and dark gray in color (H&E stain, ×40). (B) Histological examination demonstrates the tegument with the many filamentous materials (H&E stain, ×400). Ta, anterior testis; U, uterus; Tp, posterior testis.

Reference

References

1. Aohagi Y, Shibahara T, Machida N, Yamaga Y, Kagota K, Hayashi T. Natural infections of Clinostomum complanatum (Trematoda: Clinostomatidae) in wild herons and egrets, Tottori Prefecture, Japan. J Wildl Dis. 1992; 28:470–471.

2. Yamashita J. Clinostomum complanatum, a trematode parasite new to man. Annot Zool Japan. 1938; 17:563–566.

3. Hara H, Miyauchi Y, Tahara S, Yamashita H. Human laryngitis caused by Clinostomum complanatum. Nagoya J Med Sci. 2014; 76:181–185.

4. Chung DI, Moon CH, Kong HH, Choi DW, Lim DK. The first human case of Clinostomum complanatum (Trematoda: Clinostomidae) infection in Korea. Korean J Parasitol. 1995; 33:219–223.

5. Park CW, Kim JS, Joo HS, Kim J. A human case of Clinostomum complanatum infection in Korea. Korean J Parasitol. 2009; 47:401–404.

6. Jung SC, Oh HJ, Kim DM, Park JH. A case of pharyngitis caused by Clinostomum complanatum. Korean J Otorhinolaryngol-Head Neck Surg. 2015; 58:61–63.

7. Sohn WM, Na BK, Cho SH, Lee SW, Choi SB, Seok WS. Trematode metacercariae in freshwater fish from Water Systems of Hantangang and Imjingang in Republic of Korea. Korean J Parasitol. 2015; 53:289–298.

8. Chung DI, Kong HH, Moon CH. Demonstration of the second intermediate hosts of Clinostomum complanatum in Korea. Korean J Parasitol. 1995; 33:305–312.

9. Chai JY. Fish-borne parasitic diseases. Hanyang Med Rev. 2010; 30:223–231.

10. Kitagawa N, Oda M, Totoki T, Washizaki S, Oda M, Kifune T. Lidocaine spray used to capture a live Clinostomum parasite causing human laryngitis. Am J Otolaryngol. 2003; 24:341–343.

11. Choi JH, Kim EJ, Kim DM, Park SH, Kim SW. A case of anisakiasis invading the oropharynx. Korean J Otorhinolaryngol-Head Neck Surg. 2015; 58:61–63.

12. Lee EJ, Kim YC, Jeong HG, Lee OJ. The mucosal changes and influencing factors in upper gastrointestinal anisakiasis: analysis of 141 cases. Korean J Gastroenterol. 2009; 53:90–97.