February 20, 2018

This Oregon woman had 14 worms in her eye, perplexing doctors

Daily Briefing

    Abby Beckley had 14 half-inch-long, translucent worms removed from her eyeball, in what CDC researchers in a case study are calling the first case of a human infection by this type of eye worm.

    New case study: How to improve patient safety and reduce infection rates

    A perplexing case

    For days, Beckley had been experiencing irritation in her left eye. Her eye was red, and her "eyelid was droopy," Beckley recalled. Not only that, but she had been getting migraines as well.

    Eventually, she looked in a mirror and made a shocking discovery. "I pulled down the bottom of my eye and noticed that my skin looked weird there," she said. "So I put my fingers in with a sort of a plucking motion, and a worm came out!"

    As Beckley was a deckhand on a commercial salmon fishing boat, she initially thought that perhaps a common salmon worm had fallen in her eye. But after seeing a number of befuddled doctors, who removed more worms from her eyes but could not offer a diagnosis, Beckley learned from CDC scientists that she was infected by an eye worm that had never been seen in humans before.

    Richard Bradbury, a medical parasitologist on the CDC team, identified the worm—called Thelazia gulosa—after finding it mentioned in an obscure journal written in German in 1928.

    In the end, 14 worms were removed from Beckley's eye.

    About Thelazia gulosa

    This specific type of Thelazia gulosa is typically found in cattle in the northern United States and southern Canada. The worms are transmitted via flies who ingest the worm's larvae, land on a cow's eye, and then feed on the tears of the host.

    According to William Schaffner, a professor of medicine at Vanderbilt University's Division of Infectious Diseases who was not involved in the study, "Tears are full of proteins of various kinds, so the flies get a lot of nourishment from those tears."

    While feeding, the flies deposit the larvae into the eye. There, the larvae grow and eventually reproduce between the eye and eyelid.

    The offspring of the worms eventually leave the host's eye via secretion, which another fly then ingests. "The early-stage larvae need to go through the fly's digestive system to be able to develop to a more advanced stage to infect another host," said Bradbury. "It's a complicated life cycle."

    Beckley spent time in the weeks before her infection around cows and horses in southern Oregon, and she suspects she may have picked up the infection there.

    Bradbury said that, previously, only two species of this worm were known to infect humans, but this case shows there to be a third.

    "It's possible that there are cases that were misdiagnosed as another species of the worm, californiensis, because people just assume that it will be," he said. "But through our work, we were able to understand that a brand-new species can now infect people who are around cattle" (Cherelus, Reuters, 2/12; Sun, Washington Post, "To Your Health," 2/12; LaMotte, CNN, 2/13; Zimmerman, Becker's Clinical Leadership & Infection Control, 2/13).

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