Migratory Skin Worms from Sushi

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Gnathostomiasis from raw fish is a growing problem, manifested by tiny worms that burrow under our skin and, in rare cases, can get into our eyes and brain.

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There was a report recently of a woman in San Francisco suffering from gnathostomiasis. I had learned about it in med school, but never actually saw a case, though evidently it’s now on the rise. Clinically, the disease commonly presents as migratory cutaneous swelling–bumps on the skin–that move around. Why? Because there’s a worm under there. They migrate through the subcutaneous tissues–under the skin–and cause recurrent episodes of migratory swelling or creeping eruptions. There is no effective treatment, really, other than removal of the worm. Here’s a picture of the thing. Note its head has these rings of little hooks that allow it to burrow through tissue.

Because humans are essentially a dead-end host for the larva, no further development into mature worms can occur, and symptoms are experienced owing to the wandering of the organisms throughout the body.

It can also crawl into our eyeballs. A 42-year-old woman with a four-year history of migratory swellings on her face. Then a little bleeding from the eyelid, and you know where this is going. No problem though. You can make a little cut, stick some forceps in, locate the worm, and then just pull the puppy out of the eyeball. But if you have any pimples on your face that move around, better to grab them before they start swimming around in your eyes.

By far the most serious manifestation, though, is when it gets into our brain. As the worm migrates along the nerves, the patient may experience excruciating pain. It can lead to paralysis, bleeding in the brain and finally death. But in non-cerebral disease, it’s the worms that die, though it may take about 12 years.

How do the worms get into our brain, though? So-called neurognathostomiasis These Gnathostoma worms are highly invasive parasites. After leaving the sushi bar, the larvae penetrate the wall of the intestine. They can then enter the brain through the base of the skull, crawling along the spinal nerves and vessels. They start out in the nerve roots, enter the spinal cord and then can climb up into the brain. The worm isn’t poisonous or anything; it’s just the migration of the worm through the body that causes direct mechanical injury because of tearing of nerve tissue.

Bottom line, this diagnosis should be considered in patients who present with nonspecific little lumps and bumps, especially when there is a history of frequent consumption of raw fish.

Thankfully, most raw foodists stick to plants, and thereby avoid things like this. A 21-year old experienced acute, severe pain in her mouth immediately after swallowing a raw squid. Seems consumption of a squid with sperm bags and an active ejaculatory apparatus can lead to unintended ejection of the sperm bag and injury to the oral cavity. The habit of eating raw food, especially living organisms… is risky. Though, some living organisms (plants) are substantially less risky than others.

To see any graphs, charts, graphics, images, and quotes to which Dr. Greger may be referring, watch the above video. This is just an approximation of the audio contributed by Katie Schloer.

Please consider volunteering to help out on the site.

Images thanks to Heike Rau via 123rf. Images have been modified.

There was a report recently of a woman in San Francisco suffering from gnathostomiasis. I had learned about it in med school, but never actually saw a case, though evidently it’s now on the rise. Clinically, the disease commonly presents as migratory cutaneous swelling–bumps on the skin–that move around. Why? Because there’s a worm under there. They migrate through the subcutaneous tissues–under the skin–and cause recurrent episodes of migratory swelling or creeping eruptions. There is no effective treatment, really, other than removal of the worm. Here’s a picture of the thing. Note its head has these rings of little hooks that allow it to burrow through tissue.

Because humans are essentially a dead-end host for the larva, no further development into mature worms can occur, and symptoms are experienced owing to the wandering of the organisms throughout the body.

It can also crawl into our eyeballs. A 42-year-old woman with a four-year history of migratory swellings on her face. Then a little bleeding from the eyelid, and you know where this is going. No problem though. You can make a little cut, stick some forceps in, locate the worm, and then just pull the puppy out of the eyeball. But if you have any pimples on your face that move around, better to grab them before they start swimming around in your eyes.

By far the most serious manifestation, though, is when it gets into our brain. As the worm migrates along the nerves, the patient may experience excruciating pain. It can lead to paralysis, bleeding in the brain and finally death. But in non-cerebral disease, it’s the worms that die, though it may take about 12 years.

How do the worms get into our brain, though? So-called neurognathostomiasis These Gnathostoma worms are highly invasive parasites. After leaving the sushi bar, the larvae penetrate the wall of the intestine. They can then enter the brain through the base of the skull, crawling along the spinal nerves and vessels. They start out in the nerve roots, enter the spinal cord and then can climb up into the brain. The worm isn’t poisonous or anything; it’s just the migration of the worm through the body that causes direct mechanical injury because of tearing of nerve tissue.

Bottom line, this diagnosis should be considered in patients who present with nonspecific little lumps and bumps, especially when there is a history of frequent consumption of raw fish.

Thankfully, most raw foodists stick to plants, and thereby avoid things like this. A 21-year old experienced acute, severe pain in her mouth immediately after swallowing a raw squid. Seems consumption of a squid with sperm bags and an active ejaculatory apparatus can lead to unintended ejection of the sperm bag and injury to the oral cavity. The habit of eating raw food, especially living organisms… is risky. Though, some living organisms (plants) are substantially less risky than others.

To see any graphs, charts, graphics, images, and quotes to which Dr. Greger may be referring, watch the above video. This is just an approximation of the audio contributed by Katie Schloer.

Please consider volunteering to help out on the site.

Images thanks to Heike Rau via 123rf. Images have been modified.

Doctor's Note

This is like my Tongue Worm in Human Eye or Cheese Mites and Maggots videos. Extremely rare, but extremely fascinating (to me at least!). There is one parasitic infection that is much more common and a major cause of disability worldwide, neurocysticercosis:

I think the only other sushi videos I have are Fecal Contamination of Sushi and Allergenic Fish Worms, though the nori is good for you (Which Seaweed is Most Protective Against Breast Cancer?).

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