Suppose You Passed A Worm One Foot Long!
18 Aug 2008
It was once written that, "That for want of a nail the shoe was lost, for want of a shoe the horse was lost, for want of a horse the rider was lost, and for want of a rider the war was lost". And Julius Cesar said much the same, "In war trivial causes produce momentous events". It might also be said, that in medicine, trivial decisions can cause needless deaths.
The Canadian Medical Association Journal reports that a 22 year old woman who had been in good health, was examined due to a four day history of hemorrhagic lesions on both legs. During that time the lesions had been increasing in number.
She stated that neither she nor her family had experienced previous bleeding problems. Nor was she taking medication that could have triggered the bleeding.
Examination showed that her temperature was normal. Cardiovascular, respiratory and abdominal examinations were also normal. And there was no evidence of physical trauma.
However, seven days before her admission to hospital she had returned from a visit to northeastern Peru. While travelling in Peru, she had decided one day not to wear shoes, and had unexpectedly stepped on five caterpillars. She immediately experienced a burning pain in her foot that radiated to her thigh. It increased when she walked. Later, she developed a headache. But during the following 12 hours the pain and headache subsided and she decided not to seek medical attention.
Doctors in Canada were not sure of the diagnosis. But initially they believed that blood within the patient’s vessels was clotting for unknown reasons. They decided, that in view of her trip to Peru, they would use Medline and Google Scholar to find a diagnosis. They discovered that two species of caterpillar could cause symptoms of this kind.
Unfortunately, when they contacted the local poison control centre, it had no knowledge of such a reaction. But they did contact doctors in Brazil who recommended a locally produced antivenin. This however, did not arrive in Canada for 48 hours.
During the first two days in hospital the patient’s condition remained satisfactory. But 12 hours later she developed acute kidney failure and went into shock. In spite of antivenin from Brazil, the support of renal dialysis, mechanical ventilation of the lungs and a number of drugs she died on the third hospital day due to failure of multiple organs. All for the want of a shoe this young women was lost.
Today, with increased international travel, tourists tend to believe that the only way to contact infection is from food and drinks. It’s true that by eating raw fish tapeworms can be ingested. But bare feet may also pick up tapeworm infection.
But, regardless of whether or not you wear shoes, it’s always prudent to be a cautious traveller. For instance, don’t go for a dip in the lakes and rivers of Caribbean islands. They often harbour schistosomiasis, which infects the bladder, and causes bloody urine. Take your swim in the ocean. You’ve got a better chance with sharks!
Experts in tropical disease have known for years that we live in a wormy world. The U.S Centre for Disease Control in Atlanta reports that in rural areas of the world, nearly everyone has worms. They add that in North America, 25 percent of people are infected with Ascaris lumbricoides which looks like an earthworm and can be a foot long.
I normally do not treat patients infected with worms. But, several years ago, a terrified patient arrived at my office having noticed one of these creatures in the toilet following a bowel movement. It’s a terrible way to start the day.
Ascaris lumbricoides normally lives out its lifetime in the bowel, but on rare occasions it can migrate to the stomach or lungs, and provide another frightening experience when people cough up one of these worms. Fortunately they do not multiply in the body and can be eradicated by drugs.
The best way to prevent this infection is to wash your hands as it’s spread by fecal contamination. And if you’re planning a trip to South America, be sure to pack shoes and wear them.
