The dangers of itchy feet: Parasitic infections imported by returning travellers

One of the patients seen recently at our tropical disease clinic complained of a lump in the groin. He had just returned from a fishing holiday in the Okavango delta of Botswana, where he had swum in the river and eaten self-made sushi from freshly caught bream. Over the next few days, the lump moved to his knee and ankle and then chest, leaving a red itchy track in its wake. After a dose of trial treatment, it appeared on his neck, moved on to his face and was felt inside his nose. A day later, a small, white larva popped out of the skin of his face. This was a larva of Gnathostoma spinigerum, a parasitic nematode, which he had probably consumed in the raw fish (Figure 1)1. Although his disease was relatively mild, this larva can also use its sharp hooked head to burrow through the viscera, including the eye or brain, leaving a haemorrhagic track which can be fatal.