His left eye was constantly red and irritated. While his vision declined, scrambled … At 35, however, this Indian patient knew no health problem, before living 8 months of horror in his eyes. Exhausted, he finally decided to consult a specialized ophthalmology clinic. But he certainly did not expect the diagnosis made and revealed by The New England Journal of Medicine.
A discovery to say the least … Living
On examination, the signs were already disturbing: eye injected with blood, severe inflammation, dilated pupil and reduced vision at 20/80. Odd. But it was direct observation inside the eye globe that amazed practitioners. There, in the globe, a small worm moved slowly in the glass frost. A parasite that seems to make his life “lazily”, say the experts. And who had taken up residence in this singular place.
The intruder turned out to be a Gnathostoma spinigeruma rare parasite, generally responsible for mild skin disorders, but which can in rare cases reach vital organs. Whose eyes, for the greatest misfortune of the affected man.
© Nejm
An operation with the eye, but especially at high risk
If touching an eye globe puts you off, the rest should delight you. To save the patient’s vision, the surgeons had to practice a Plana pars vitrectomy, an intervention which consists in removing part of the glass frost through tiny incisions in the sclerotic (the white of the eye). The tool, similar to a hollow needle, allows you to vacuum content … including the worm, still alive and mobile.
The extraction requested extreme precision: the long and fine parasite was still torted when it was released. A microscopic examination confirmed the identification thanks to its bulbous head, its intestines developed and its thick cuticle. After the operation, the patient followed a treatment associating corticosteroid and antiparasitic (standard treatment is based on albendazole for 21 days). His inflammation regressed in eight weeks. But a cataract, a frequent complication after a vitrectomy, left visual sequelae.
A fortunately rare infection (which you prefer to avoid)
Gnathostoma spinigerum is an endemic worm in Asia and Latin America. He mainly infects cats and dogs, whose stools disseminate his eggs in the water. After passing through a microscopic crustacean, then by fish or frogs, he can reach humans by consuming raw or insufficiently cooked flesh.
Rather repugnant detail in humans, larvae also have the possibility of migrating through the organism. Most of the time, they reach the skin, causing red and painful nodules. In some cases, they win the lungs, the nervous system, the brain … or the eyes, with sometimes irreversible consequences.
Since 1889, around 5,000 cases of gnathostomiase have been reported worldwide. In France, this infection remains extremely rare and mainly affects travelers returning from risk at risk. But the zero risk does not exist, it is strongly advised to avoid any raw meats or fish in the regions where the parasite is present. Unless you are looking for a little companion …