2y ago

‘Oh my god’: live worm found in Australian woman’s brain in world-first discovery

www.theguardian.com ‘Oh my god’: live worm found in Australian woman’s brain in world-first discovery

Woman complained of forgetfulness and depression before doctors pulled out an 8cm roundworm normally found in pythons

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I wish this article talked about how they are treating it? They just said she is doing well
- With the actual worm they pulled it out and presumably cleaned up the bit of her brain where it resided.
  For the rest I guess they made her take something that kills nematode parasites, and some strong anti inflammatories?
  said the patient needed to be treated for other larvae that might have invaded other parts of her body, such as the liver. But given no patient had ever been treated for the parasite before, care was taken. Some medications for example could trigger inflammation as the larvae died off. Inflammation can be harmful to organs such as the brain, so they also needed to administer medications to counteract any dangerous side-effects.
  
  Yeah I just wish they had gone into detail since this was a groundbreaking medical discovery
  
  I got you fam. From the case write up:
  In June 2022, she underwent an open biopsy. We noted a stringlike structure within the lesion, which we removed; it was a live and motile helminth (80 mm long, 1 mm diameter) (Figure 2, panels B, C). We performed a circumferential durotomy and corticotomy and found no other helminths. Histopathology of the dural tissue revealed a benign, organizing inflammatory cavity with prominent eosinophilia.
  We provisionally identified the helminth as a third-stage larva of Ophidascaris robertsi on the basis of its distinctive red color, 3 active ascaridoid-like lips, presence of a cecum, and absence of a fully developed reproductive system, in the context of the known epidemiologic distribution of this species. The head and tail were preserved at the Australian National Wildlife Collection (W/LHC no. N5758). Small segments underwent independent PCR-based sequencing targeting the cytochrome oxidase c subunit 1 (cox1) (5,6) at the University of Sydney and the second internal transcribed spacer (ITS) 2 of nuclear ribosomal DNA (7) at the University of Melbourne. Both sequencing results provided 99.7% sequence match to Ophidascaris (formerly Amplicecum) robertsi isolates in the National Center for Biotechnology Information and in-house databases (Appendix).
  A progress CT scan revealed resolution of pulmonary and hepatic lesions but unchanged splenic lesions. The patient received 2 days of ivermectin (200 µg/kg/d) and 4 weeks of albendazole (400 mg 2×/d). She was given a weaning course of dexamethasone (starting 4 mg 2×/d) over 10 weeks, while all other immunosuppression was discontinued. Six months after surgery (3 months after ceasing dexamethasone), the patient’s PBEC remained normal. Neuropsychiatric symptoms had improved but persisted.
  And this bit from the conclusion:
  After we removed the larva from her brain, the patient received anthelmintics and dexamethasone to address potential larvae in other organs. Ophidascaris larvae are known to survive for long periods in animal hosts; for example, laboratory rats have remained infected with third-stage larvae for 4 years (4). The rationale for ivermectin and albendazole was based on data from the treatment of nematode infections in snakes and humans (8,9). Albendazole has better penetration into the CNS than ivermectin (10). Dexamethasone has been used in other human nematode and tapeworm infections to avoid deleterious inflammatory CNS responses following treatment (11).
  
  It’s always dexamethasone.
  I sure hope we don’t get a bunch of stuff developing immunity to that.
  
  But how are they treating the worm though?
  
  Just talk therapy for all the headache it went through
  
  Probably something like this. There is an entire class of drug rarely needed that does exactly this thing, but won't kill a fully formed spawn of an egg that wandered into the bloodstream. Antiparasitic drugs are rough, but save thousands of lives per years where this type of parasite is an issue. This case is exactly why doctors may ask if you've traveled recently, and to where.
  
  You’re probably speaking about roundworms more generally but this particular parasite has never been observed in humans before.

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