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Linguatula serrata ("tongue worm") is a zoonotic intranasal parasite found globally in wild dogs, free-ranging dogs, some domestic dogs, and vulpids. Since there are no sensitive tests currently available, infections are underdiagnosed. This is a pilot observational prospective study aimed at determining whether nasal linguatulosis can be diagnosed using CT. The secondary aims were to evaluate radiography, rhinoscopy, and nasal egg swabs as methods in the diagnosis of tongue worms. Fifty-four wild canids and three vulpids euthanased by gunshot were sourced from pest-control officers. Cadaver heads were subjected to helical CT examination, nasal-swabbed for tongue worm eggs, and necropsied. Radiographs and rhinoscopy were performed on cadavers suspected to be infected based on preliminary CT examination. Tongue worms were retrieved at necropsy in 25 dogs and one fox. CT findings in animals with no nasal cavity ballistic damage were reviewed in six infected dogs and one infected fox. Adult female tongue worms were identified in 4 of 6 dogs and 1 of 1 fox as long, tubular, slightly heterogeneously attenuating structures in the mid to caudal nasal cavities. They were not clearly visible in CT scans when surrounded by nasal fluid, and small parasites (male and immature females) were not discernible. Radiographic findings were mild and nonspecific. One tongue worm was detected in 1 of 12 dogs examined rhinoscopically. Tongue worm eggs were found in swabs from 7 of 25 dogs. While small tongue worms could not be detected with CT, CT proved to be a useful diagnostic method for visualizing adult female tongue worms.

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PURPOSE: This study describes the composition and infection patterns of macro endoparasites associated with the lizard Phyllopezus periosus. METHODS: We collected 115 P. periosus over 12 expeditions on the rocky cliffs of the Missão Velha waterfall canyon in northeastern Brazil. Specimens were collected by hand, during active searches conducted between 18:00 h and 23:30 h. The infection patterns were estimated using prevalence, total abundance, and mean intensity of infection for all parasites found. RESULTS: A total of 4256 parasites were collected from 104 hosts, resulting in an exceptionally high overall prevalence of 90.4%. No significant ontogenetic difference in the prevalence of infection was detected. Although juveniles exhibited a high parasite prevalence their parasite loads were significantly lower compared to adults. Six species of endoparasites were found; among these, the nematode Spauligodon oxkutzcabiensis was the most common endoparasite in the digestive tract, while the pentastomid Raillietiella mottae was the only species found in the respiratory tract. CONCLUSIONS: Infection rates in Gekkota species appear to correlate with body size, with larger individuals generally exhibiting a higher prevalence. This pattern was also observed across separate populations of P. periosus and other geckos from distinct ecological domains. The dominance of the monoxenous S. oxkutzcabiensis highlights potential transmission mechanisms, suggesting that behaviors such as limb licking after feeding may contribute to its prevalence. The occurrence of Physalopteroides venancioi, Oswaldocruzia sp., Parapharyngodon sp., Physaloptera sp., infecting P. periosus are new records for this host. These findings significantly contribute to the knowledge of host-parasite dynamics in geckos.

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Raillietiella orientalis is established in Florida and rapidly spreading both geographically and in known host species. A banded water snake (Nerodia fasciata), purchased in Michigan at a regional reptile show, expectorated a pentastome whose morphology and DNA sequence indicated that it was R. orientalis. This event indicates that, through the pet trade, R. orientalis has been spread 1,500 km from its previously known distribution limit. Fecal sample analyses indicated that the snake was shedding large numbers of embryonated eggs for at least several months. The diversity of reptile species that are both known hosts of R. orientalis in Florida and are commonly sold in the pet trade indicates that this invasive pentastome may become a widespread health concern for pet owners and veterinarians.

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Tongue worms (Subclass: Pentastomida) are endoparasites found in carnivorous reptiles, fish, amphibians, birds, and mammals. Several pentastomids cause pentastomiasis, a zoonotic disease. We encountered tongue worm infection in two reptiles imported into Japan: a Wahlberg's velvet gecko (Homopholis wahlbergii) bred in Germany and a wild-caught green tree python (Morelia viridis) from the Republic of Indonesia. The infecting tongue worms were identified as Raillietiella sp. and Armillifer sp. in the gecko and python, respectively, based on morphological and molecular analyses. Gecko is a newly recorded definitive host harboring Raillietiella tongue worm. Live tongue worms were first detected in domestic reptiles in Japan, and this indicates a risk that these tongue worms could be spread to other animals, as well as humans. Therefore, the diagnosis and treatment of infected pets are of importance. In the case of the two infected reptiles, the availability of fecal egg examination for diagnosis was shown. In addition, the effectiveness of treatment with 200 µg/kg/day ivermectin orally once weekly was demonstrated, without no side-effects and no re-detection of eggs after the cessation of treatment.

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Linguatula serrata is a worm-like parasite with zoonotic potential that inhabits the nasal cavities of canids. Although most cases of linguatulosis are associated with unspecific and rather mild respiratory symptoms, cases of unusual infestations and severe courses in both animals and humans have been reported. In central and northern Europe, the pathogen used to appear only sporadically, however, within the last few years the number of detections has increased noticeably. In July 2020 an approximately nine-month-old dog, imported from Romania, was presented in a veterinary practice in Gotha, central Germany, due to persistent worsening cough. Despite antibiotic treatment the tussis became more severe until the dog expectorated multiple worm-like structures. Three of these specimens were sent to the Institute of Parasitology (Faculty of Veterinary Medicine, University of Leipzig, Leipzig) for morphological and genetic species identification. The latter was based on a 1000-bp fragment of the mitochondrial cytochrome c oxidase subunit I gene (cox1) and the complete nuclear 18S rRNA gene. The dog presented in this study suffered from a severe respiratory impairment caused by worm-like parasites inhabiting its upper respiratory tract. The detected parasites were morphologically identified as female specimens of the so-called tongue-worm L. serrata, which was confirmed by pairwise alignment and phylogenetic analysis of the produced sequences. We report an unusually severe case of L. serrata infection in an imported dog and discuss the spread of this potentially dangerous parasite in central and northern Europe.

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Identification of specimens belonging to the genus Linguatula (Pentastomida) is relatively easy due to their unique morphology. However, differentiation between species of Linguatula can be challenging for several reasons, including considerable differences between different developmental stages of the parasite within and between species. Currently, 18S rRNA and Cox1 sequences are the only available comparable sequences in GenBank, but recent research has discussed the utility of 28S rRNA for pentastomid phylogenetics. This study presents 28S rRNA gene sequences for two members of the genus Linguatula. Sequences of 28S rRNA were successfully obtained from well-identified samples of L. serrata (collected in Australia) and L. nuttalli (collected in South Africa), with voucher specimens. Phylogenetic analysis of the 28S rRNA region showed 6% difference between L. serrata and L. nuttalli, with low levels of intraspecific variation. In comparison, 18S rRNA and Cox1 sequences from the same specimens showed 0.23% and 13% interspecific differences, respectively. The results of this study show that 28S rRNA has greater genetic diversity to allow for improved differentiation between species of Linguatula than 18S rRNA but is on par with Cox1. Records that do not provide adequate morphological or molecular data to justify independent specific diagnoses must be regarded cautiously, and the need for continued research on species of Linguatula, using a combined morphological and molecular analysis, across a number of different hosts, development stages, geographical regions and molecular markers is highlighted.

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Pentastomida is a subclass of parasitic arthropods, related to crustaceans, which develop in the respiratory tract of vertebrates (i.e., fishes, amphibians, reptiles, birds and mammals). Within this group of parasites, Raillietiella spp. adults develop in the lungs of lizards, snakes and toads, whereas larval stages in insects (e.g., cockroaches), which are intermediate hosts. Lizards were captured under the frame of a study on reptile zoonotic parasites. Feces of the collected animals were examined and pentastomids were diagnosed in Tarentola mauritanica geckoes (1.2%; 3/259) from Linosa island. Adult forms of Railietiella hemidactyli pentastomids were morphologically characterized and molecularly identified through 18S rDNA amplification and sequencing. Positive animals had adult forms of R. hemidactyli pentastomids in the lungs as well as embryonated eggs in feces. Raillietiella was herein identified for the first time in synanthropic geckoes in a confined population of one of the southernmost islands of Italy, representing the first report of this zoonotic pentastomid in synanthropic and invasive reptiles in Europe. Further studies should focus on the prevalence of pentastomids on synanthropic reptiles in other Italian regions to assess the zoonotic risk of infection and to warn veterinarians and physicians about the risk they may represent for several species of hosts, including dogs, cats and humans.

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Human population is exposed to numerous parasitic ichthyozoonoses. Although Tamaulipas state (northeastern Mexico) is well known for its fishing and aquaculture industry, there are few reports of this type of zoonosis. Therefore, it is imperative to investigate whether the parasites that affect these fish may represent a zoonotic risk for the inhabitants of the area. The objective of this study was to identify molecular and/or morphologically muscle parasites of fish from coastal locations in Tamaulipas, Mexico, and assess the risk of infection for humans. Between 2017 and 2018, 764 individual fish belonging to 28 species were examined for parasites. Collected worms were processed for their identification using morphological characteristics. In addition, partial sequences of the large subunit (28S) ribosomal RNA gene were obtained from some species to corroborate their identity. Prevalence and mean intensity of all registered infections were calculated. A total of seven species of parasites were found: cestodes (Poecilancistrium caryophyllum), trematodes (Clinostomum tataxumui, Clinostomum cichlidorum), nematodes (Eustrongylides sp., Contracaecum sp.) and pentastomids (Sebekia purdieae, Sebekia sp.). Parasites infected 10 species belonging to different fish families (Ariidae, Centrarchidae, Centropomidae, Cichlidae, Eleotridae, Ictaluridae, Mugilidae and Sciaenidae). Congeneric species of parasites or related to those registered in this study have been identified as zoonotic agents in other regions of the world. Despite the low levels of infection (2.6-16.6% prevalence and 1-5.5 parasites per infected host), there is a latent risk of transmission to humans, so it is recommended to avoid eating raw or undercooked fish meat.

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Abstract In the present study, pentastomids belonging to the order Cephalobaenida were isolated from the lungs of Berber skinks Eumeces schneideri (Famiy: Scincidae), which were morphologically described by light and scanning electron microscopy and taxonomically justi- fied by 18s rDNA molecular analyses of the parasites. Seventeen host specimens were collected from well-vegetated wadis at high altitudes, Jizan, Saudi Arabia as new type locality; twelve specimens (70.59%) were infected. All of the recovered parasites were adults, possessed small broadly triangular cephalothorax flattened on the ventral surface and merged smoothly with a uniformly thick and squat abdomen and terminated in a pair of divergent lobes. The results obtained indicated that the parasites belong to the sharp-tipped posterior-hook Raillietiella spp. distinguished from other raillietiedids of the same group some important characteristic fea- tures including annulus number, shape and dimensions of the buccal cadre, copulatory spicules, and anterior and posterior hooks. The anterior hook of the female specimens (n = 5) had a blade length (AB) of 135±5 (110-146) ^m and shank length (BC) 158±5 (150-169) ^m while the posterior hook was much larger with AB measuring 221 ±5 (200-236) m and BC 286 ±6 (280-289) -o.m. For the male specimens (n = 5), the anterior hook had an AB of 73 ±3 (72-75) -j.m and a BC 102±5 (100-103) ^m. The posterior hook was much larger with AB 190.6±5 (190-191).

Resumen En el presente estudio se aisló un pentastómido perteneciente al orden Cephalobaenida del pulmón de un eslizón bereber (Eumeces schneideri, Familia: Scincidae). Se efectuó su descripción morfológica basada en observación por microscopía óptica y de bar rido y se justificó su ubicación taxonómica mediante análisis molecular del gen 18S del ADNr. Se recolectaron 17 especímenes del citado huésped en valles ubicados a elevadas altitudes, en la región de Jizan (Arabia Saudí); 12 de ellos (70,59%) estaban infectados. Todos los parásitos recuperados eran adultos y poseían un pequeño cefalotórax triangular, aplanado en la super ficie ventral, que se fusionaba con un abdomen abultado y terminado en un par de lóbulos divergentes. Los resultados indicaron que este parásito pertenece a Raillietiella spp., que agrupa especies con gancho posterior puntiagudo; estas se distinguen de otros miembros de la Familia Raillietiella por algunos rasgos característicos, como el número de anillos y la forma y dimensiones del cuadro bucal, las espículas copulatorias y los ganchos anterior y posterior. La caracterización morfológica demostró que el parásito recuperado era muy similar a R. aegypti, previamente aislada del mismo huésped. El alineamiento de secuencias mediante el método de probabilidad máxima basado en el análisis del gen 18s del ADNr detectó identidades del 88-95% con los géneros de pentastómidos disponibles en GenBank. Dentro del árbol filogenético se pudo incluir este parásito dentro del clado monofilético pentastómido con máxima identidad con las especies de Raillietiella. Las secuencias obtenidas fueron depositadas en GenBank, con número de acceso MK970649.1. El presente análisis molecular confirma por primera vez la posición taxonómica de Raillietiella aegypti, anteriormente aislado del mismo huésped.

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In the present study, pentastomids belonging to the order Cephalobaenida were isolated from the lungs of Berber skinks Eumeces schneideri (Famiy: Scincidae), which were morphologically described by light and scanning electron microscopy and taxonomically justified by 18s rDNA molecular analyses of the parasites. Seventeen host specimens were collected from well-vegetated wadis at high altitudes, Jizan, Saudi Arabia as new type locality; twelve specimens (70.59%) were infected. All of the recovered parasites were adults, possessed small broadly triangular cephalothorax flattened on the ventral surface and merged smoothly with a uniformly thick and squat abdomen and terminated in a pair of divergent lobes. The results obtained indicated that the parasites belong to the sharp-tipped posterior-hook Raillietiella spp. distinguished from other raillietiedids of the same group some important characteristic features including annulus number, shape and dimensions of the buccal cadre, copulatory spicules, and anterior and posterior hooks. The anterior hook of the female specimens (n=5) had a blade length (AB) of 135±5 (110-146) µm and shank length (BC) 158±5 (150-169) µm while the posterior hook was much larger with AB measuring 221±5 (200-236) µm and BC 286±6 (280-289) µm. For the male specimens (n=5), the anterior hook had an AB of 73±3 (72-75) µm and a BC 102±5 (100-103) µm. The posterior hook was much larger with AB 190.6±5 (190-191) µm and BC 221±5 (280-289) µm. The morphological characterization of the recovered parasites was closely similar to R. aegypti previously isolated from the same host. Sequence alignment by the maximum likelihood analysis for the data obtained from the 18S rDNA analysis of the parasites exhibits identities ranging between 88-95% with pentastomid genera recovered from the GenBank. The phylogenetic tree supported the inclusion of the parasites within the monophyletic Pentastomida clade with maximum identity to the raillietiellid species. The recovered sequences from the present study were deposited in GenBank under Accession number MK970649.1. The present molecular analysis was the first to confirm the taxonomic position of R. aegypti isolated from the host examined.

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Raillietiella orientalis is an obligate, crustacean parasite that resides in the respiratory tract of definitive snake hosts. Common throughout southeastern Asia and Australia, R. orientalis is believed to have been introduced into southern Florida, United States along with Burmese pythons (Python bivittatus) in the 1990s. While the invasive range of Burmese pythons is restricted to southern Florida, R. orientalis has advanced north in the state in native snake species. R. orientalis were recovered from the lungs, trachea, oral cavity, and esophagus of an emaciated adult female free-ranging banded water snake (Nerodia fasciata) in north central (Alachua County), Florida, USA. Concurrent findings included the recovery of Ochetosoma sp. trematodes from the oral cavity, and multifocal dermal lesions consistent with snake fungal disease (Ophidiomyces ophiodiicola). This is the first report of R. orientalis in north central Florida, well outside the invasive range of the Burmese python, documenting the substantial northward expansion of the known geographical range of this invasive pentastome in Florida.

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In this work, we document for the first time four species of Ichthyostraca in Mexico, one Branchiura: Argulus foliaceus (fish parasite), and three Pentastomida: Porocephalus clavatus (reptile parasite), Raillietiella hebitihamata (reptile parasite) and Raillietiella orientalis (frog parasite). In addition, a total of 11 new host records and 16 new localities are presented for Ichthyostraca in Mexico. Based on the compilation of published information and on specimens deposited in scientific collections, the first checklist of Ichthyostraca from North America (Canada, United States of America and Mexico) is compiled. To March 2019, records of Ichthyostraca from North America include 64 species and 8 undetermined taxa, parasitizing 293 host species (64 of them identified only to a supra-specific level) in 77 provinces and states (8 from Canada, 47 from the USA, and 22 from Mexico). The subclass Branchiura is represented by 1 order, 1 family, 1 genus, 35 species and 1 undetermined taxa; the subclass Pentastomida includes records of 4 orders, 9 families, 14 genera, 29 species and 7 undetermined taxa. Ten species reported in this work are thought to be introduced into North America with only a few records of them parasitizing native hosts. This checklist summarizes the available records of this class of crustaceans in North America and represents a base line for future studies.

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Larval stages of pentastomids were collected from different organs of small mammals from the Peruvian Amazon. These parasitized mammals included: a western Amazonian oryzomys (Hylaeamys perenensis), an elegant oryzomys (Euryoryzomys nitidus), a lowland paca (Cuniculus paca), two kinkajous (Potos flavus), two silvery woolly monkeys (Lagothrix poeppigii) and a brown-mantled tamarin (Leontocebus fuscicollis). Pentastomids were found in the mesentery and parenchyma of the liver and lungs of these animals. All pentastomids were morphologically identified as nymphs of Porocephalus spp. Only the nymphs collected from select animals (the western Amazonian oryzomys, the elegant oryzomys and the brown-mantled tamarin) were analysed molecularly. Molecular analysis was performed amplifying the mitochondrial cytochrome c oxidase subunit I gene from select nymphs collected from the western Amazonian oryzomys, the elegant oryzomys and the brown-mantled tamarin. The nucleotide sequences exhibited 95.8-97.7% similarity between them. Also, these sequences showed an identity of 95.8-97.9% to Porocephalus crotali (GenBank accession numbers MG559647-MG559655). Molecular analysis indicated the presence of at least two Porocephalus species. These findings represent the first record of Porocephalus in these mammals, thus adding new intermediate hosts for this pentastomid genus. This work represents the first molecular data of Porocephalus in a Neotropical climate.

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SUMMARY Halzoun syndrome, also known as nasopharyngeal linguatulosis, is a rare entity that is mostly prevalent in Eastern Mediterranean countries. The consumption of raw ovine liver and lymph nodes infested with Linguatula serrata nymphs remains a major cause of the nasopharyngeal symptoms and discomfort associated with the disease. Halzoun syndrome is a clinical diagnosis based on history and presentation. Treatment of this disease is still debated; however, our experience reveals that alcohol gargle can be a good option. Proper counselling on the hazards of eating raw liver in endemic areas is needed. Moreover, physicians should be aware of the sequence of events in the disease in order not to delay or miss the diagnosis. This communication presents a rare Lebanese case of Halzoun syndrome that offers medical implications in the clinical diagnosis and treatment of the nasopharyngeal symptoms of this syndrome, with a review of the literature.

RESUMO Esta comunicação apresenta um caso libanês raro de síndrome de Halzoun que oferece implicações médicas no diagnóstico clínico e no tratamento dos sintomas nasofaríngeos desta síndrome, com uma revisão da literatura. A síndrome de Halzoun, também conhecida como linguatulose nasofaríngea, é uma entidade rara predominante nos países do Mediterrâneo Oriental. O consumo de linfonodos ovinos e linfáticos ovinos infestados com ninfas Linguatula serrata continua a ser uma das principais causas dos sintomas nasofaríngeos e do desconforto associado à doença. A síndrome de Halzoun é um diagnóstico clínico baseado na história e na apresentação. O tratamento dessa doença ainda é debatido; no entanto, nossos resultados revelam que o gargarismo de álcool pode ser uma boa opção. É necessário um aconselhamento adequado sobre os perigos de comer fígado cru em áreas endêmicas. Além disso, os médicos devem estar cientes da sequência de eventos na doença, a fim de não atrasar ou perder o diagnóstico.

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The helminth and pentastomid fauna of 50 specimens of Crotalus tzabcan from the Yucatán Peninsula, Mexico is documented. The examination revealed the presence of three nematode species (Hastospiculum onchocercum, Hexametra boddaertii, and Travassosascaris araujoi), and one pentastomid (Porocephalus crotali). The threee nematode species had the same prevalence (2%), while the pentastomid had a higher prevalence (8%). The pentastomid P. crotali was the most abundant and intense parasite, although it was only found in four snake hosts. Crotalus tzabcan acts as definitive host for the adult helminths and pentastomids, with rodents as the probable intermediate hosts. This work represents the first systematic survey on the parasitic helminth and pentastomid fauna of C. tzabcan, and includes four new geographical records. Additionally, a checklist of helminths and pentastomids reported for Crotalus and Sistrurus is provided. To date, a total of 32 helminth and 7 pentastomid species have been recorded as parasites of rattlesnakes. Nematoda possessed the highest species richness. The genera with the highest number of host species were Mesocestoides and Hexametra, followed by Kalicephalus. The rattlesnake species with the highest number of reported parasites was C. durissus (18 nematodes and 2 pentastomids).

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Snakes have diverse feeding and living habits, being exposed to a variety of endoparasite communities. However, more studies are still necessary to document these relationships. We examined 18 specimens of the cat-eyed snake Leptodeira annulata from a semi-arid region in Northeast Brazil. Eight taxa of parasites were found, with higher prevalence of cystacanths (Acanthocephala). Five nematode species (Hexametra boddaertii, Oswaldocruzia sp., Oxyascaris sp., Physaloptera sp. and Raillietnema spectans) and the pentastome Raillietiella furcocerca represent a new parasitism record for the host studied. Our results also showed that L. annulata could act as paratenic host for acanthocephalans. These results contribute to the knowledge of the helminth fauna of L. annulata.

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Food-borne parasitic zoonoses are major threats to human health and only next to the 'big three' such as AIDS, tuberculosis and malaria. Linguatula serrata is a food-borne zoonotic pentastomid that affects a wide range of animals including humans. Dogs and other carnivores are the final hosts while most herbivores, including domestic ruminants serve as intermediate hosts. Here, the study was conducted on some epidemiologic and pathologic aspects of L. serrata infection in cattle and goats through a slaughterhouse based survey. A total of 302 samples, consisting of 257 mesenteric, 26 hepatic and 19 pulmonary lymph nodes (LNs) of cattle and goats were collected. Out of 302 LNs, 136 (45.0%) were infected with the nymphal stage of L. serrata (50.7% of cattle and 31.0% of goats). Significantly, a higher (P = 0.002) rate of infection was detected in cattle. Sex, but not seasons, is a prominent determinant of the infection. The infection was mostly detected in the mesenteric LNs (MLNs) (50.9%) but the parasite was also detected in the hepatic (3.9%) and pulmonary (21.1%) LNs. Grossly, the affected LNs were enlarged, edematous and soft. Cut surface of the LNs showed spongy appearance, and sometimes nymphs were found to crawl out. Histopathological studies revealed severe damage in parenchyma of LNs, characterized by the loss of typical pattern of lymphatic follicles and trabecule. Massive infiltration with eosinophils was detected. Collectively, the data suggest that L. serrata infection is endemic in food animals and has significant pathological impacts on livestock, and people of the country are at high risk to linguatulosis.

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Visceral pentastomiasis is usually found incidentally during surgery. We describe a case of visceral pentastomiasis discovered during inguinoscrotal hernia surgery for a man from Benin, Africa. Because surgical removal of nymphs is needed for symptomatic patients only, this patient's asymptomatic pentastomiasis was not treated and he recovered from surgery uneventfully.

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Pentastomids are obligate zoonotic arthropod parasites utilising canids and vulpids as their definitive hosts and several herbivorous species as their intermediate hosts. Reported only 10 times in Australia over the last 150 years as incidental findings, adult Pentastomids referred to as Linguatula serrata have been encountered in nasal cavities of domestic and wild dogs, and foxes. Nymphs have been reported in cattle and rabbits. In the present study, a number of potential definitive hosts, including red foxes (Vulpes vulpes), wild dogs (Canis lupus dingo and C.l. dingo x C. familiaris) and feral cats (Felis catus), and intermediate hosts cattle (Bos taurus), sheep (Ovis aries), feral pigs (Sus scrofa), rabbits (Oryctolagus cuniculus), goats (Capra hircus) and a European hare (Lepus europaeus), from the highlands of south-eastern Australia were examined. Of the animals examined 67.6% of wild dogs (n = 37), 14.5% of red foxes (n = 55) and 4.3% of cattle (n = 164) were found to be infected with Pentastomids, herein identified as Linguatula cf. serrata. The common occurrence of the parasite in wild dogs and less frequently in foxes suggests these wild canids have potential to act as a reservoir for infection of livestock, wildlife, domestic dogs and possibly humans. The unexpected high frequency of the parasite in wild dogs and foxes in south-eastern Australia suggests the parasite is more common than previously realised. Of the potential intermediate hosts in the region, only 4.3% of cattle were found to be infected with pentastomid nymphs which suggest the search for the host(s) acting as the main intermediate host in the region should continue. Future studies should investigate transmission patterns, health impacts on hosts and whether the parasite has zoonotic significance in Australia.

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Pentastomiasis, a zoonotic parasite infection, is typically found in the respiratory tract and viscera of the host, including humans. Here, we report for the first time an extremely rare case of intraosseous pentastomiasis in the human maxilla suffering from medication related osteonecrosis of the jaw (MRONJ). A 55-year-old male had continuously visited the hospital for MRONJ which had primarily developed after bisphosphonate and anti-neoplastic administration for previous bone metastasis of medullary thyroid cancer. Pain, bone exposure, and pus discharge in the right mandible and left maxilla were seen. Osteolysis with maxillary cortical bone perforation at the left buccal vestibule, palate, nasal cavity, and maxillary sinus was observed by radiologic images. A biopsy was done at the left maxilla and through pathological evaluation, a parasite with features of pentastome was revealed within the necrotic bone tissue. Further history taking and laboratory evaluation was done. The parasite was suspected to be infected through maxillary open wounds caused by MRONJ. Awareness of intraosseous pentastomiasis should be emphasized not to be missed behind the MRONJ. Proper evaluation and interpretation for past medical history may lead to correct differential diagnosis and therapeutic intervention for parasite infections.

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