Feet First

“It is much more important to know what sort of a patient has a disease than what sort of a disease a patient has.” - Sir William Osler

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    Friday, February 18, 2005
    Icky Nematodes

    (Warning: you won't want to read this while you're eating.)

    I haven't told you about the Worm Girl. She's been making my life interesting for the last three weeks. Worm Girl called me up in a panic one morning (Stat voice mail) and said she'd passed a worm and wanted to know what to do. My first reaction: "yeah, right." I have seen quite a few people who thought they had worms in their stool; what they bring in usually turns out to be plant fiber or some such. I thought it would be the same this time. I was wrong: my secretary came in two hours later bearing a jar. I looked in and GAAHHHH!! It was a huge worm, about fourteen inches long, coiled up in said jar.

    Well, we sent the specimen off for identification and I spent the next few days placating the patient and her mother, who called me on the following Sunday night wanting to know what the hell was going on and why we hadn't started treating her daughter yet. Just so you know, treating parasitic infections is not like treating bacterial infections: You can't just let loose with a broad-spectrum antibiotic and hope for the best. It really helps to know exactly what you're dealing with, as this determines both what medication you use and the dosage. Antiparasitic drugs, as a class, tend to carry the potential for significant side effects, so you want to minimize the dose when possible.

    Finally the ID came back. It was Ascaris lumbricoides, a roundworm. This particular fellow is known for multiplying in the digestive system and causing "worm balls" which can block the intestines. For examples, see here (lots of info and a disgusting picture at the bottom). The day we got the results, I caught my secretary with the medical dictionary in her hand looking up "ascaris" and wincing in disbelief. Next came the ghastly pictures pulled off the Internet and emailed around the office (I'll spare you the sight of a kid passing a worm ball, but trust me, it's out there somewhere). That same day, the sight of gummy worms in the lunchroom was greeted with shrieks, not enthusiasm.

    I still don't know how Worm Girl acquired her infection. She hadn't traveled anywhere likely, but she may have gotten it from her dog. (Public Health Warning: kissing the dog on the lips is not a good idea!) She's been treated twice with an appropriate antihelminthic - mebendazole (we couldn't get albendazole) - but continues to complain of symptoms and "something poking me in my stomach." I'm not sure if this is a symptom of ongoing infection or caused by anxiety. I'll let you know if anything more transpires...



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