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The woman who entered emergency room in Dijon, France, said she had had trouble riding her horse for three months. His symptoms only worsened: he suffered from weakness and fell to the electric shocks of both legs.
After a series of tests, doctors discovered a parasitic worm hidden in his spine.
When the doctors Marine Jacquier and Lionel Piroth of the University Hospital of Dijon performed a magnetic resonance imaging of his spine, found an abnormal lobular bulge in his ninth thoracic vertebra as they were 39, have written with a newly published image in the New England Journal of Medicine . Subsequent tests revealed that a tapeworm, Echinococcus granulosus, had caused the woman's symptoms.
When they saw the MRI, "to be honest, we could not imagine that I could be a loner", Piroth said. He presented the image to the journal to educate doctors about the possibility of this disease, which is rare in France and in the area of the woman's body in which she was found.
Echinococcus worms mainly two diseases in humans: cystic echinococcosis and alveolar echinococcosis . The disease is zoonotic, which means that is transferred to humans by animals in this case dogs, which in turn are infected with ungulates such as cattle or sheep. According to the World Health Organization, which lists echinococcosis as an unattended tropical disease, more than a million people worldwide are affected by echinococcosis at a given moment
. Well, the disease is certainly overlooked, it's not just tropical, said Dr. Dominique Vuitton, professor emeritus at the University of Franche-Comté and a member of the WHO Collaborating Center for prevention and treatment of human echinococcosis. Almost every country in the world has seen cases of the disease, added Vuitton, who was not involved in treating women.
Although it is rare to see Echinococcus in developed countries, the parasite causes disease up to 10% of the population in endemic countries such as Argentina, the Peru and China, according to WHO. In the hyperendemic regions of South America, between 20% and 95% of slaughtered cattle have the disease.
Doctors reported that the 35-year-old woman had no history of traveling abroad, but she owned a cat and had contact with the flock, which which allowed her to know where she could have infected the woman with the worm, but according to Christina Coyle, director of the Jacobi Hospital Tropical Medicine Clinic and Professor of Medicine at Albert Einstein College of Medicine, the cats and Cattle are false leads because the disease is usually pbaded on to humans by dogs.
Humans can be hosts to parasites when they ingest their eggs, which are present in the feces of an infected dog, according to the United States Centers for Disease Control and Prevention. Piroth said that the woman had reported no contact with dogs or had traveled to an area where the disease was endemic, as in Corsica.
"We have no idea of the contamination," he said. Vuitton said that about 65% of lesions (which reveal the location of the worm) develop in the liver, 20% in the lungs and the rest in other places, including the brain, bones and sometimes vertebrae.
Most people with echinococcosis are asymptomatic adds Coyle. When the parasite develops in the liver, cysts tend to grow for many years; in the case of this woman, however, the cyst was moving its spine as it grew and causing symptoms.
Magnetic resonance imaging of the woman's back was remarkable for the experts; Piroth said the lesion looked like "a little flower", and Vuitton said the picture was "very, very pretty" because it showed the woman's cyst very clearly.
However, she was "surprised" that the magazine published the doctor's note without requiring a more precise identification of worm species and information about where the woman might have been exposed.
After discovering the woman's cyst, the doctors surgically removed the worm and gave the patient the pest control drug albendazole. Nine months later, the woman had no residual symptoms or signs of recurrence, according to the report.
Vuitton stated that albendazole is the only medication available to treat patients and that about 20% of patients take side effects that may include hepatic toxicity. The drug should be used in conjunction with surgery, and even then, it is not 100% effective.
According to the WHO, prevention programs focus on the regulation of the slaughter and deworming of dogs and sheep. , who are the definitive hosts of the disease
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