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Annals of African Medicine, Vol. 10, No. 1, January-March, 2011, pp. 62-63 Commentary Pentasomide infestation Yomi Ogun Department of Medicine, Olabisi Onabanjo University Teaching Hospital, Sagamu, Nigeria Correspondence Address:Yomi Ogun, Department of Medicine, Olabisi Onabanjo University Teaching Hospital, Sagamu, Nigeria, yomiogun2002@yahoo.com Code Number: am11014 Pentastomiasis, also known as porocephalosis or tongue worm infestation, is rare and limited to the tropics and subtropics. The worm inhabits the respiratory tract of reptiles and rarely infects humans. Linguatula serrata and Armillifer armillatus account for about 99% of all human cases. [1] Majority of the cases are asymptomatic when the parasite load is low and are discovered incidentally during autopsy, routine X-ray examination, or surgery. A 57-year-old female Nigerian farmer - a habitual snake eater - presented with clinical and radiological features of Armillifer infestation with hepatic encephalopathy. She presented with a 6-month history of mood disturbance, confusional state, nocturnal pruritus, altered sleep pattern, weight loss and abdominal discomfort. She had had several treatments for pneumonia in the past, including treatment for pulmonary tuberculosis. She was chronically ill-looking, cachetic, pale, icteric with finger clubbing and asterixis. Liver function test was suggestive of a decompensated cholestatic chronic liver disease with predominantly conjugated hyperbilirubinemia, hypoproteinemia, hypoalbuminemia and an elevated alkaline phosphatase. Chest X-ray and computed tomography (CT) scan revealed multiple crescentic, comma-shaped calcific opacities in the lungs and abdomen. Consent for a liver biopsy was not granted. She was managed conservatively on high-carbohydrate, low-protein diet, antibiotic (metronidazole), antihistamines, and lactulose, and showed significant clinical improvement. The hepatic encephalopathy in this patient was consequent of extensive hepatic parenchymal destruction due to severe granulomatous reaction and accumulation of false neurotransmitters that would have been metabolized by the liver, while the cholestasis could have been a result of fibrosis around the porta hepatis. Pentastomiasis is the third most common cause of hepatic fibrosis after tuberculosis and schistosomiasis. [2] Diagnosis of pentastomiasis is mostly made incidentally at surgery, at autopsy or during radiographic examinations. The serological test for Armillifer is rarely used in clinical practice. [3] Management is usually conservative, and health education to discourage the consumption of snake meat is advised. References
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