Physicians in California found a flock of flatworm parasites overrunning a man's innards – and they caught one of the little animals on a terrible video.
The case started harmlessly: A 40-year-old man came to an emergency room and complained of tiredness, which became progressively worse over a three-month period.
Doctors ran blood tests revealed that the man was anemic. They also found that he had a high proportion of white blood cells (eosinophils) that usually indicate an infection or other type of disease. Most recently, they detected elevated levels of alkaline phosphatase, which may be a sign of liver problems.
When the doctors performed abdominal scans, they found abnormalities in the man's bile ducts – the body whistles that move the bile and the liver and gallbladder connect the pancreas and small intestine.
Next, they decided to perform an endoscopic retrograde cholangiopancreatography (ERCP), a diagnostic procedure that examines and visualizes problems in the ducts around the small intestine, gallbladder, and pancreas. During the procedure, the doctors thread a long, flexible tube with a light source and a camera into the patient's neck, through the stomach and into the small intestine. The doctors inject dye through the tube to highlight the channels for X-rays.
With the camera turned on, the doctors immediately identified the cause of the problem: Large flatworms were spilled from the bile duct into the small intestine. They videotaped and reported this week in the New England Journal of Medicine.
The doctors extracted some of the worms and identified them as a common liver fluke Fasciola hepatica . These are – as the name implies – common flatworm parasites that typically infect native and wild ruminants, often sheep. The worms give eggs into the feces of the animals, which then hatch in freshwater environments and infect snails. After a while, when the snail growers have evolved, free-swimming parasites break out and stick to freshwater plants like watercress. When unhappy ruminants or humans eat the infected plants, the cycle begins again as the parasites enter the small intestine and enter the ducts.
In the case of the man He reported recently emigrating from Mexico, where he worked on a farm and ate watercress.
The doctors treated the man with a blood transfusion and the antiparasitic triclabendazole, which is used to treat liver flukes. Within a month, his symptoms disappeared – though the terrible video of his leeches is likely to haunt others for the rest of the time. (Of course, here's another video if you want to see more liver fluke action.)