Gnathostomiasis: shifting epidemiology and persistent challenges in diagnosis and treatment.

PURPOSE OF REVIEW: Gnathostomiasis is a neglected parasitic infection traditionally endemic in Southeast Asia and Latin America. However, in recent years, the disease has been increasingly reported beyond its traditional endemic regions. This review examines recent evidence on its epidemiology and discusses the challenges in diagnosis and management. RECENT FINDINGS: Gnathostomiasis is now frequently reported in a broader global context, reflecting changing patterns of human behavior and global travel. Transmission is still associated with behaviors, such as the consumption of raw or undercooked freshwater fish, rather than specific local cuisines. Clinical presentations remain diverse, with a growing number of reports describing ocular involvement and neurologic disease. Although immunoblot assays play a central role in diagnosis, its availability remains limited and diagnostic performance may vary across Gnathostoma species. Therapeutic options remain largely unchanged, with albendazole and ivermectin as the mainstay of treatment. However, some patients still experience incomplete responses or relapses. SUMMARY: Gnathostomiasis is increasingly reported in a broader global context, reflecting changing patterns of exposure and mobility of people. Important gaps remain in both diagnostic capacity and therapeutic effectiveness, particularly in severe disease, highlighting the need for improved diagnostic tools and treatment strategies.