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Do worms exit via the nose when their human host is anesthetized (revisited)?

Dear Cecil:

OK, you printed my question with nothing other than a jab at my intelligence. [Morb wanted to know if ringworms exit a patient's nostrils en masse upon application of anesthesia. I pointed out that ringworm is a fungus, not a worm. — C.A.] Apparently, the article referred to tapeworms, not ringworm. Sorry — I'm not as familiar with parasites as you seem to be. Care to try again?

Morbid Curiosity in Providence

Illustration by Slug Signorino

Cecil replies:

Shows you the importance of detail, bub. Lately one of the little researchers has been getting “petroleum” and “plutonium” mixed up. I’m not sending this kid out to gas up the Toyota any time soon.

You told me privately you saw the article describing the fleeing worms in Maxim or Stuff, neither of which, it’s safe to say, is a peer-reviewed journal. You apparently then threw the magazine away, which is what the Teeming Millions always do when entrusted with vital artifacts. However, having perused the files, I think what you’re talking about is not tapeworm, as you (probably) incorrectly guessed (again), but rather roundworm, specifically the large intestinal roundworm Ascaris lumbricoides. These guys, the medical literature informs us, “may migrate up the esophagus and enter the air passages, especially when they are irritated by certain drugs or anesthetic agents.” So maybe when they put you under, the worms hightail it out of you like rats deserting a sinking ship.

That said, I haven’t been able to find any cases in the medical journals of this actually occurring — and they report everything in the medical journals. Here’s a sampling of what I did find:

  • A 23-year-old inebriated male got beaten silly with a baseball bat. (The people in these stories tend to have multiple problems.) The surgeons sewed him back together without incident, but when it was over he coughed up a 15-centimeter roundworm.
  • A 50-year-old man was hit by a car and arrived at the hospital comatose. After two days he developed respiratory arrest followed by heart failure and death. A postmortem exam revealed a 25-centimeter roundworm in the tracheal tube inserted to help him breathe.
  • A 64-year-old male had heart surgery but had numerous problems afterward, including multiple organ failure. Ten days after the operation a 20-centimeter roundworm was pulled out of his tracheal tube. Smaller worms were later seen in the bedsheets, and X rays revealed several large worms in the lungs. After 18 days he died of a massive candida infection. As I say, these guys had lots of problems.

Roundworm infestation is one of the most common health problems on earth, affecting an estimated 25 percent of the population worldwide with rates as high as 90 percent in some third world countries. Although there are all sorts of wormy parasites out there — remind me to tell you about guinea worms sometime — A. lumbricoides is particularly freaky because of the long trek it makes through the body over the course of its two-year life. Typically you acquire an infestation by swallowing eggs in contaminated soil. (Just so you know, “contaminated” is a euphemism for “containing egg-laden human feces.” Now you know why you’re supposed to wash fruit and vegetables before eating.) The eggs hatch in the stomach and small intestine, and the larvae migrate via the blood vessels and lymphatic system to the heart and then the lungs, where they mature into worms. The worms climb up the windpipe to the pharynx, at which point you swallow them again. Usually they end their days in the gut, although on occasion they’ve been found in the brain, eye, bladder, spinal cord, and so on. All of this takes two to three months. A full-grown worm can be as much as 45 centimeters long, and you can have more than one — sometimes an entire bellyful. A two-year-old girl weighing eight kilograms passed 80 worms while another 578 remained inside her, weighing more than 800 grams — that is, 10 percent of her body weight.

Getting back to your question, Current Medical Diagnosis & Treatment (this is a fascinating book, by the way — sort of a Chilton’s guide to human body repair) warns, “Treatment with anthelmintics [antiparasitic drugs] can cause worms to migrate before they die. Because anesthesia stimulates worms to hypermotility, they should be removed in advance in infected patients undergoing elective surgery” (my italics). So if you’re worried about mass worm evacuation via the schnozz, I guess you’re not alone.

OK, we’ve got a little space left. Guinea worms. Once endemic to parts of India, the Middle East, and Africa, but now found predominantly in the Sudan, the worms hatch in the stomach after the victim drinks water contaminated with a certain crustacean, the intermediate host. The female worm grows to 60 to 80 centimeters, burrows its way to the surface, and erupts through the skin. “Traditional extraction of emerging worms,” the diagnostic manual notes, is “by gradually rolling them out a few centimeters each day on a small stick.” But be careful, because breaking the worm during removal can lead to cellulitis, abscess formation, and septicemia. And we sure wouldn’t want that.

The worms crawl in, the worms crawl out

Dear Cecil:

I am a medical technologist who works in a parasitology lab (looking through peoples’ poop for the eggs of critters like this), so when I read your column, I couldn’t help but recognize the reference to Ascaris! According to an emergency room nurse who I chatted with once on the subject, she even observed an instance where the roundworms were irritated enough by an infected patient’s labor pains to migrate out her nose, mouth, and anus as she delivered a baby. Isn’t nature interesting?

— Cathy Snider, Elgin, Texas

Thanks, Cathy. We needed to know this.

Cecil Adams

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