For eight months, a 35 -year -old Indian man suffered from persistent eye problems. His left eye was constantly red and his vision increasingly vague. Despite the daily discomfort, he waited several months before consulting a specialized ophthalmology clinic. The medical examination quickly revealed the extent of the problem according to a study published in the New England Journal of Medicine and reported by Ars Technica.
The eye was injected with blood, inflamed and the dilated pupil remained fixed. The vision was strongly degraded, reduced to 20/80. But it was direct observation inside the eyeball that amazed the doctors: a small worm was slowly moving into the bottom of the eye, as practitioners described, “lazily moving” in the vitreous. This exceptional discovery illustrates a rare but serious complication of the infection by the gnathostoma spinigeruma parasite usually responsible for mild skin disorders.
Faced with this exceptional discovery, the doctors had to resort to a complex surgical procedure: the Pars Plana Vitrectomy. This intervention consists in sucking part of the vitreous frost which fills the interior with the eye. Although this technique is commonly used to treat various eye pathologies, its use to extract a living parasite remains extremely rare.
The procedure requires millimeter precision. Surgeons practice tiny incisions in the white part of the eye (sclerotic) and introduce a device similar to a hollow needle equipped with a suction system. The extracted eye gel is then replaced by a saline solution.
In this specific case, the intervention turned out to be delicate because the parasite was still alive and mobile. The doctors managed to suck up part of the tail of the worm and extract it – the parasite still wiggling during its extraction. The microscopic examination allowed a formal identification: with its bulbous head, its well -developed intestines and its thick external cuticle, it was undoubtedly about gnathostoma spinigerum.
After treatment with corticosteroids and antiparasitic drugs, inflammatory symptoms have improved in eight weeks. However, the patient has retained visual sequelae due to the development of a cataract, a common complication after a vitrectomy.
Le gnathostoma spinigerum : a parasite with multiple faces
Le gnathostoma spinigerum is responsible for a parasitic infection with very varied clinical manifestations. This worm, endemic to East and Southeast Asia as in Latin America, mainly infects cats and dogs. Humans accidentally contaminate by consuming raw or insufficiently cooked meat or fish that contain the parasite larvae.
Human infection begins with little specific symptoms: fever, fatigue, nausea, vomiting and abdominal pain for two to three weeks. The larvae then migrate through the body. In the majority of cases, they reach the skin, creating painful and itching migratory nodules. But as the Indian case illustrates, they can also migrate to vital organs: lungs, nervous system, brain and eyes. These visceral forms, rare but potentially deadly, can cause persistent cough, eye damage, meningitis or encephalitis.
Since 1889, around 5,000 cases have been reported worldwide, mainly in Southeast Asia and Latin America. In France, this infection remains exceptional and mainly concerns travelers returning from endemic areas.
The treatment is based on the Albendazole for 21 days. Medical follow -up must be extended because relapses can occur up to 24 months after healing. In serious neurological forms, corticosteroids may be necessary to reduce inflammation.
