Patient of The Week: This week’s patient is Jake who has just returned from his third honeymoon with his wife Marion. For their third go-round at matrimony, they went to Thailand, which ended up giving them both some nasty worms (from train station sushi). Hers is in her arm and easily removable. His eats away at his stomach and then ends up in his spine, paralyzing him.
The parasite was one of the Gnathostoma worms. There are 2 species of the nematode, which infects vertebrate animals, Gnathostoma spinigerum and Gnathostoma hispidum. The patient probably had Gnathostoma spinigerum, which is endemic in Thialand. The parasite lives in a tumor in the gastric wall of the definitive host (usually a pig, dog, or cat). It deposits eggs in the feces. The eggs are embryonated in water and release first stage larvae, which are consumed by small crustaceans (Cyclops), which act as first intermediate hosts. The larvae develop into second-stage larvae and are consumed by a second intermediate host such as a fish, snake or frog. The larvae migrate into the flesh and matures into third stage larvae. The second intermediate host is consumed by a definitive host in which the larvae mature into adults. Humans may become infected by eating undercooked or raw fish containing third-stage larvae (or by drinking water containing infective second-stage larvae in Cyclops). Since humans are paratenic hosts, the larvae do not develop into adulthood.
The condition that Marian and Jake had was gnathostomiasis. The most common manifestations are painful, pruritic, migratory swellings under the skin (cutaneous larval migrans) like Marion had. Increased levels of eosinophils are seen in the blood. Rarely, the parasite can enter other tissues such as the eye (causing blindness), the liver, and the nerves, spinal cord, or brain (causing nerve pain, paralysis, coma and death). This is referred to as visceral larva migrans. In Jake's case, the organisms had migrated to his spinal column causing paralysis. Surgery was necessary to remove the larvae.
Check out more information on this parasite by clicking on the links below:
CDC life cycle and information
Monsters Inside Me
Back to Grey's- in an older episode, a man infected himself with Anisakis simplex, a worm commonly associated with eating sushi to prevent his terrible asthma attacks. The interesting thing is that this was based on a true story. Check it out!
For more information on this parasite refer to links below:
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