It turns out that a vivid, parasitic worm was the cause of the woman’s diverse range of symptoms (Image credit: Hossain, M., Kennedy, K. J., Wilson, H. L., Spratt, D., Koehler, A., Gasser, R. B….Senanayake, S. N. (2023). Human Neural Larva Migrans Caused by Ophidascaris robertsi Ascarid. Emerging Infectious Diseases, 29(9), 1900-1903. https://doi.org/10.3201/eid2909.230351.)
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The patient: A 64-year-old female residing in New South Wales, Australia
The symptoms: The woman was hospitalized following a three-week period of abdominal discomfort and diarrhea. She also had an unremitting dry cough, as well as night sweats.
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What happened next: The woman was readmitted to the medical center three weeks afterward with a cough and a fever, despite ongoing prednisolone treatment, and the lesions affecting her organs had not healed.
Additional evaluations were unable to ascertain the cause of her respiratory distress. Analyses of tissue sample cultures revealed no indication of bacterial or fungal infection. Blood tests showed her immune response was not generating antibodies to a range of parasitic flatworms, such as blood flukes (Schistosoma) or liver flukes (Fasciola). Similarly, her fecal samples contained no evidence of these parasites.
Medical practitioners advised the patient to continue taking prednisolone and also prescribed ivermectin, a medication intended for parasitic worms, since she had informed them that she had traveled to nations where such parasites are widespread.
Nonetheless, her respiratory symptoms did not improve, and they deteriorated when she tried reducing the prednisolone dose. Her condition stayed unchanged for several months.
The diagnosis: About a year following her initial visit to the hospital, the woman started displaying symptoms of depression and suffered episodes of forgetfulness. Doctors ordered a brain MRI, which revealed a lesion on the right frontal lobe. Consequently, they carried out an open biopsy to expose and scrutinize the affected area. It was then that they came across “a stringlike structure” inside the lesion, which they identified as a living parasitic worm categorized as a helminth, as per the case report.
The worm exhibited a vibrant red color and measured about 3 inches (80 millimeters) in length and 0.04 inches (1 millimeter) in diameter.
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The treatment: Doctors extracted the helminth from the woman’s frontal lobe and studied the tissue surrounding it, finding no further parasites. They administered ivermectin for a duration of two days, this time in conjunction with a four-week treatment of albendazole, a broad-spectrum medication utilized for addressing helminth infections, to eliminate any persistent parasites within her organs.
Compared to ivermectin, albendazole is absorbed at a faster rate by the central nervous system, and these medications have been combined previously in the treatment of nematode infections affecting humans and snakes. Moreover, the patient was given a 10-week regimen of the corticosteroid dexamethasone to avert additional inflammation.
Six months after the surgical procedure and three months after the dexamethasone treatment concluded, the lesions within the patient’s lungs and liver had vanished, her count of white blood cells had reverted to normal, and her neuropsychiatric symptoms had shown improvement.
OTHER DILEMMAS
—Woman had her twin brother’s XY chromosomes — but only in her blood
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—A woman got a rare parasitic lung infection after eating raw frogs
What makes the case unique: The medical team determined that the helminth was a third-stage larva belonging to Ophidascaris robertsi, a species of parasitic nematode indigenous to Australia. Adult worms propagate within carpet pythons (Morelia spilota), although the nematode has the ability to infect other animals during the larval phases of its existence.
Carpet pythons were a frequent sight close to the woman’s residence by the lake, and although she had no memory of any direct interactions with snakes, she commonly collected wild greens for use in cooking. The case report authors proposed that she most likely contracted the infection by touching or consuming plant life contaminated with O. robertsi eggs. Following the hatching of the eggs, the larvae spread to her organs.
The sustained nature of this larval infection was not unusual, given that laboratory rats are able to host O. robertsi larvae for a duration exceeding four years, according to the report. Nonetheless, there had been no previous documentation of human infection caused by this parasite, nor had the parasite’s larva ever been detected inside the brain of any host.
For more intriguing medical cases, check out our Diagnostic Dilemma archives.
Disclaimer
This article is for informational purposes only and is not meant to offer medical advice.
Article Sources
Hossain, M., Kennedy, K. J., Wilson, H. L., Spratt, D., Koehler, A., Gasser, R. B….Senanayake, S. N. (2023). Human Neural Larva Migrans Caused by Ophidascaris robertsi Ascarid. Emerging Infectious Diseases, 29(9), 1900-1903. https://doi.org/10.3201/eid2909.230351
TOPICSDiagnostic dilemma
Mindy WeisbergerSocial Links NavigationLive Science Contributor
Mindy Weisberger serves as a science journalist and wrote “Rise of the Zombie Bugs: The Surprising Science of Parasitic Mind-Control” (Hopkins Press). Previously, she performed editing duties for Scholastic and held positions as a channel editor and senior writer at Live Science. She has provided coverage on general science subjects, encompassing climate variations, paleontology, biology, and space exploration. Mindy pursued film studies at Columbia University; before joining LS, she was involved in producing, writing, and directing multimedia content for the American Museum of Natural History located in NYC. Her cinematic contributions on dinosaurs, astrophysics, biodiversity, and evolution are featured in museums and science centers across the world, earning accolades like the CINE Golden Eagle and the Communicator Award of Excellence. Her articles have also been published in Scientific American, The Washington Post, How It Works Magazine and CNN.
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Diagnostic dilemma: An 83-year-old man’s atypical presentation of syphilis had an ‘uncertain’ origin
Teenager contracts rare ‘welder’s anthrax,’ marking the ninth known case ever reported