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Volume 28, Number 11—November 2022
Dispatch

Imported Haycocknema perplexum Infection, United States1

Bobbi S. PrittComments to Author , Blaine A. Mathison, Richard S. Bradbury, Teerin Liewluck, Stefan Nicolau, John C. O’Horo, David Grunst, Marcus V. Pinto, Amy A. Swanson, and Abinash Virk
Author affiliations: Mayo Clinic, Rochester, Minnesota, USA (B.S. Pritt, T. Liewluck, J.C. O’Horo, D. Grunst, M.V. Pinto, A. Swanson, A. Virk); ARUP Laboratories, Salt Lake City, Utah, USA (B.A. Mathison); Federation University, Melbourne, Victoria, Australia (R.S. Bradbury); Nationwide Children's Hospital, Columbus, Ohio, USA (S. Nicolau)

Main Article

Table

Characteristics of 13 case-patients who had Haycocknema perplexum (haycocknematosis) infections*

Case-patient (reference) Year of diagnosis Country of diagnosis Age, y/sex at diagnosis Travel Flora/fauna exposures Duration of symptoms, y Weakness Weight loss, kg Rash Eosinophils, × 109/L CK, U/L AST, U/L ALT, U/L ESR, mm/h Treatment Outcome
1 (1,5,6)
 1994/1998†
 NZ
 33†/F
 TAS,† NZ, Asia, Europe, Africa
 Native flora (botanist), bush meat consumption
 5
 Dp, PLE, PUE
 NA
 Y
 0.17–0.8
 5,532
 82–228
 92–5532
 NA
 ALB. 400 mg, 2×/d for 8 weeks
 Near full recovery
2 (1)
 1996
 AUS
 48/M
 TAS; trip Far North QLD and NT 5 earlier
 NA
 1.5
 PLE, PUE
 7
 Y
 2.0
 1,586
 84
 197
 26
 5 weeks: mebendazole, 600–900 mg 3×/d; ALB 400 daily
 Partial recovery
3 (7)
 2004
 AUS
 61/M
 TAS, Mackay (QLD)
 NA
 3
 Da, Dp, F, Gen
 NA
 N
 High, NOS
 1,263
 NA
 NA
 NA
 ALB, 9 weeks
 Died from complications
4 (7)
 2005
 AUS
 23/F
 Far North QLD, travel in WA, NSW and Victoria over previous 3 y
 NA
 2
 DLE, Dp, PLE
 18
 N
 1.1
 1,370
 52
 60
 50
 ALB 400 mg 2×/d for 8 weeks
 Partial recovery
5 (7)
 2006
 AUS
 61/M
 Mackay (QLD)
 Exposure to native wildlife NA; No bush meat consumption
 2
 Dp, Gen
 NA
 N
 1.36
 1,230
 67
 69
 NA
 ALB, for 8 weeks
 Partial recovery
6 (9)
 2011
 AUS
 50/M
 TAS, Ireland
 Native wildlife; consumption of bush meat and unfiltered water
 2
 Dp, F, NE, NF, PLE>DLE, PUE>DUE
 10
 N
 WNL
 6,218
 NA
 92–152
 NA
 ALB, 400 mg 2×/d for 12 weeks
 Near full recovery
7 (3)
 2012
 AUS
 80/F
 AUS, TAS, Asia, South America, Africa
 Native wildlife (animal carer); bush meat consumption NA
 1.5
 PLE > DLE, PUE > DUE
 5
 N
 0.7
 270
 NA
 NA
 15
 ALB, 400 mg 2×/d for 12 weeks
 No functional improvement
8 (2)
 2014
 AUS
 30/M
 North QLD, Mackay, Darling Downs (QLD)
 No native wildlife, no bush meat consumption
 2
 Da, Dp, PLE > DLE, PUE > DUE
 20
 N
 1.24
 3,400
 81–118
 142–291
 NA
 ALB, 400 mg 2×/d for 16 weeks
 Near full recovery
9 (2)
 2014
 AUS
 72/M
 Far North QLD, WA, TAS
 Native wildlife (hunter), bush meat consumption
 >2
 Gen
 NA
 N
 2.44
 2,082
 NA
 NA
 NA
 ALB, 400 mg 2×/d for several weeks
 Partial recovery
10 (8)
 2016
 AUS
 37/M
 TAS, Victoria
 Native wildlife (hunter); bush meat consumption
 2
 PLE(A)
 NA
 N
 0.54
 3,636
 94
 139
 NA
 ALB, 400 mg 2×/d for 12 weeks
 Partial recovery
11 (this study)
 2019
 USA
 37/M
 Mackay (QLD)
 Native wildlife; no bush meat consumption
 >8
 Dp, Fa, NF, PLE (A) > DLE, PUE > DUE
 32
 N
 0.16 (5%)
 2,000
 25‡
 33‡
 NA
 ALB, 400 mg 2×/d for 12 weeks
 Stable, no further deterioration at 19 mo after treatment
12 (11)
 2021
 AUS
 ≈40/M
 North QLD, TAS
 Limited wildlife, bush meat consumption
 4
 N
 NA
 N
 2.1
 2,530
 65
 94
 NA
 ALB, 400 mg 2×/d for 12 weeks
 Remained asymptomatic
13 (11) 2021 AUS ≈20/F North QLD, Brisbane, Thailand No known exposures 3 DLE, NF, PUE 5 N 1.9 3,162 50–80 45–95 NA ALB, 400 mg 2×/d for 12 weeks NA

*A, asymmetry; ALB, albendazole; ALT, alanine aminotransferase; AST, aspartate aminotransferase; AUS, Australia; CK, creatinine kinase; Da, dysarthria or dysphonia; DLE, distal lower extremity; Dp, dysphagia; DUE, distal upper extremity; ESR, erythrocyte sedimentation rate; Fa, facial; Gen, generalized weakness not otherwise specified; N, no; NA, not available; NE, neck extensors; NF, neck flexors; NOS, not otherwise specified; NSW, New South Wales; NT, Northern Territory; NZ, New Zealand; PLE, proximal lower extremity; PUE, proximal upper extremity; QLD, Queensland; TAS, Tasmania, USA, United States; WA, Western Australia; WNL, within normal limits, Y, yes. †Patient 1 was initially misdiagnosed as having trichinosis in 1994 and was retrospectively diagnosed as having haycocknematosis in 1998. Despite an extensive previous travel history, her most extensive wildlife exposures were in Tasmania and the Australian Northern Territory. ‡AST and ALT levels for patient 11 were mildly increased in 2011, but exact values are not available. These levels were not increased during his most recent presentation.

Main Article

References
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Main Article

1This study was presented as a late breaker abstract at the 68th Annual Meeting of the American Society of Tropical Medicine and Hygiene, November 20‒24, 2019, National Harbor, Maryland, USA.

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