The New England Journal of Medicine has released a remarkable set of images and a not-safe-for-the-squeamish video in their weekly feature "Images in Clinical Medicine" introducing the world to a gentleman infected with a six-foot parasitic worm. A 48 year old man presented to his physician in New Delhi, India with a complaint of abdominal pain for two months associated with lethargy. A physical exam found the patient to be pale in appearance; lab work confirmed anemia. This sort of clinical presentation - abdominal discomfort with weakness and anemia in a middle-aged man - requires a colonoscopy, a procedure to visualize the colon, so as to evaluate the lower gastrointestinal tract for a possible cause of the bleeding and to rule out a malignancy. A colonoscopy was performed and a surprising finding was encountered in the lower aspect of the colon - a body segment, or proglottid, from a presumed tapeworm. Another procedure located the culprit. An esophagogastroduodenoscopy (EGD), which is essentially the opposite of a colonoscopy and evaluates the upper aspects of the gastrointestinal tract, located the head of the tapeworm just past the stomach, attached in the patient's duodenum. There are very few organisms that present in this manner, as a giant worm hiding in one's deep inner coils and discarding body parts at random. Three tapeworms infect humans in this manner: the pork tapeworm (Taenia solium), beef tapeworm (Taenia saginata), and fish tapeworm (Diphylobothrium latum). This patient was infected with the pork tapeworm, which occurs after eating improperly cooked pork infested with larvae that will unfurl in the gut after ingestion. The larvae will migrate to the upper intestine and latch on, and can grow up to 6 to 9 feet in length. Upon maturation in 10 to 12 weeks, the worm will release proglottids and eggs that will continue the worm's life cycle beyond the inner confines of its host's intestine. Infection is characterized by abdominal cramping, diarrhea, weight loss, and occasionally anemia. Treatment is simple - a single dose of the anti parasitic drugs albendazol or praziquantel is curative. These physicians took an alternative approach to this patient's tapeworm. While in the gut, they nabbed the head of the worm with the forceps and dragged it out slowly, past the stomach, up the esophagus, and out of the mouth. All six feet of it. All on video. Then they treated the patient with praziquantel. The man is doing just fine.
Please be sure to visit Taenia solium to check out the images and video published online by the New England Journal of Medicine.