Deadly creepy crawlies Skin of Le Lan, a 41-year-old Hanoi woman, is disfigured after being infected by parasitic worm A woman in Hanoi went to hospital recently with worm-like creatures crawling just beneath her skin. If that is not creepy or scary enough, doctors at large hospitals in the country say they receive such patients every day. The woman was found to be infected with the pinworm, also known as threadworm, a human parasitic roundworm (Strongyloides stercoralis). Doctors say people catch the worm from contact with soil, animals or eating raw meat, VTC News, the news website of Vietnam Cable Television, said in a January 15 report. They said the infection can stop at leaving patients with an “ugly skin structure” or it can cause complicated, even fatal intestine disorders when the worm gets into digestive system. Dr. Nguyen Tien Lam, in charge of virus and parasite-related cases at the Central Tropical Hospital, said the patient, Le Lan, 41, caught the worm from soil and animals at home that she had regular direct skin contact with. Lam said people walking in paddy fields and gardens having the highest chance of catching the worm. The infection happens more easily when there are exposed cuts on hands and feet. Dr. Huynh Hong Quang of the Institute of Malariology, Parasitology and Entomology in Quy Nhon, a coastal town in south central Vietnam, said the infection was first described a century ago. Quang, whose institute also receives people with the infection every day, said the human body hosts roundworms as well as its eggs and larvae. The larvae penetrate the body through the skin, traveling along veins to the heart, lungs, and the windpipe. Through the fauces (the passage from the back of the mouth to the pharynx, bounded by the soft palate, the base of the tongue, and the palatine arches), the larvae enter the gullet and reach the intestines where they grow and lay eggs, Quang said. He said the crawling lines just beneath the skin appear during the start of the penetration, when the larvae are moving. They can be tens of centimeters long, usually appear around the hip, on the back of the hands, insteps, feet, and around the anus. External signs also include bruise spots and rashes. He said people can get an itchy feeling, like a skin allergy, during the penetration, which can be stopped at this stage if the body is strong enough to fight the larvae. However, the skin structure is already damaged at this stage. The doctor said the larvae can die in two weeks, but their life expectation in the human body is two years. Once the larvae reach the intestines and grow, they will cause disorders like diarrhea, light anemia and nervous breakdowns. Severe complications include ileus, when intestines are incapable of passing content, encephalitis, or pneumonia and blood infection when the worm is stuck and cannot reach the stomach, Quang said. The infection of the worm is also caused by eating raw meat, as Gnathosma spinigerum found on eels, snails and frogs; and Fasciola gigantica, a parasitic flatworm on cattle. Earlier, a man only identified as Dau was hospitalized in Hanoi after the infection had induced fatigue, the report said. Dau had lost around 13 kilograms, suffered regular bellyaches, diarrhea, vomiting and had lost his appetite. He said he had first visited a dermatology clinic but the treatment failed. He is recovering with medicines. Thiabendazole – a fungicide and parasiticide, and Albendazole are recommended drugs by Vietnamese doctors against the roundworm. Dau said he worked for a seafood restaurant and used to finish off all the dishes that were ordered and left untouched, including raw oysters and raw shrimp, which doctors said had caused the infection. Dr. Tran Tinh Hien, former deputy director of Ho Chi Minh City Hospital for Tropical Diseases, said, “Eating raw seafood always carries risks of parasite infection from the preservation and procession process, regardless of how safe the source is believed to be.” The parasites, including roundworms, live in the intestines of whales and seals before they are defecated and attach themselves to smaller sea creatures, becoming larvae that end up in restaurants and other eateries, doctors said. Some people have also reached the hospital with crawling lines caused byAnkylostoma caninum, or A. braziliense, hookworms that live on dogs or cats. Van Viet Dien, 43, was admitted to the Pham Ngoc Thach Hospital in Ho Chi Minh City last September with four parasites, Entamoeba histolytica,Toxocara sp, Strongyloides stercoralis and cysticercosis, that doctors believed were contracted from cats or dogs.  His family said the condition started with a pain in his ankle in July 2011, then his skin started shedding and his face turned dark brown, and his voice, vision, hearing and movement began deteriorating. The parasites have entered his lungs now, they said. Dien has lost 30 kilograms since became infected. People with weaker immune systems, such as those with diabetes, cancer, liver and kidney conditions, HIV/AIDS, or those taking medication or chemicals that inhibit immunity, will fail to stop the worm from reproducing and the parasite will keep damaging many organs until it kills the body, doctors said. “No matter how light it is, the infection must be treated once the worm is detected to prevent it from developing within the patient, as also limit the chances of causing an outbreak,” Quang said. Thanh Nien News (The story can be found in the January 24th issue of our print edition, Vietweek)