When worms wiggle their way into your lungs

Growing up in the 80s and 90s was adventurous and fun. We had the strictest parents and we spent a lot of time devising ingenious ways around the rules they set.

My mother’s cardinal rule was that no one ate away from home without permission. This was a crazy rule to observe considering all children belonged to the community. You were fed where meal times found you and refusing food would also get you in trouble. Despite applying this rule with the precision of a navy commander, she specialised in feeding the entire neighbourhood.
The one thing my mom is grateful for is the handwashing habits that have resulted from this Covid-19 pandemic. Her home and compound has plenty of handwashing sinks. We had to scrub our hands clean whenever we got home. She also insisted that fruits and non-leafy vegetables once bought from the market were to be washed with soap before they were considered fit to enter her kitchen larder.
She abhorred eating out. She would never trust the hygiene of a kitchen she had no access to. Whenever we travelled by road, mom packed food and drinks for the entire family and some water to wash our hands on the journey.
Many years later I would tease her about these habits and she rightfully snapped back in jest. She would proudly say none of her children ever suffered from intestinal worm infestation. I would not hold back the laughter. She worked this hard to prevent worms? Something a single tablet every three months could very well deal with.
Her steadfast implementation of these lessons in church and other places paid off. We grew up mostly healthy and we are grateful. These crazy moms of the 60s to 80s raised a generation of mostly infection-free children as these simple hygiene measures protected us from worms and many other infectious diseases, allowing us freedom to get up to other mischief.
Several years later, on a balmy November night while on call as a medical officer intern in the surgical ward, I witnessed something that reminded me of my mom’s utter disdain for worm infestation. A young man in his 30s was admitted to the ward with intestinal obstruction. It had been a really tough week for him, unable to pass stool and now vomiting intractably, he was getting dehydrated and sick.
He was brought to the ward for urgent surgery. The cause of the obstruction was not obvious, but he definitely needed surgery to alleviate his distress. While awaiting his turn in theatre, we hooked him up to intravenous fluids and inserted a nasogastric tube to relieve his tummy and reduce the vomiting. He seemed to settle down for a while and even dozed off.
Suddenly he woke up from his sleep and vomited a pile of worms all over the acute room floor. The sight was astonishing and I froze for a minute. All I could recall were my mother’s words: “My children never had worms.” The poor patient was traumatised. He could not believe those living creatures wriggling on the floor had come out of him. He started shrieking in horror, causing the entire team into fits of laughter.
Over a billion people worldwide are living with roundworms (Ascaris lumbricoides). These very opportunistic parasites can live up to two years in a person’s gut. They are acquired by ingesting the fertilised and mature eggs found in contaminated food, mostly vegetables growing in contaminated soil. The eggs hatch into larvae in the intestines, then migrate through the bloodstream to the lungs where they mature.
While in the lungs, they may cause Covid-19-like symptoms in some people, with fever, dry cough, difficulty in breathing and wheezing. They take 10 to 14 days developing further, before moving to the upper respiratory airways, where they get coughed up and swallowed into the intestines, their final home. They mature in two to three months and start laying eggs. An adult female roundworm is about a foot long and hatches up to 200,000 eggs a day.
A small number of worms may live for the two years unnoticed, but large numbers can cause stunted growth especially in young children, resulting from malnutrition. For both adults and children, the worms may also cause abdominal pain, intestinal obstruction or the even more catastrophic intestinal rupture, with the whole load of the wrigglies pouring into the abdomen.
Many other types of worms exist, including the whip worms and pinworms that cause crazy itching in the perianal area especially in children and the dreaded tapeworms. Did you know that throughout history, lore has it that women knowingly ingested tapeworm cysts to lose weight? That they could eat whatever they wanted without worrying about calories as the worm would take up most of them? Well, this has led to proliferation of illegal sale of tapeworm diet pills as a weight loss tool.
The crazy notion led Michael Mosley, a BBC presenter, to swallow three tapeworm cysts which he apparently procured from Kenya to see how they would affect him. He kept them for several weeks, observing them through a pill camera and concluded that they definitely did not help with weight loss. Tapeworms come in various types based on their source. Pig tapeworm can grow as long as 25 metres, but the fish tapeworms take the cup as they can get to 90 feet.
Our patient narrowly escaped surgery as the vomiting seemed to have eased up his obstruction. He took his deworming medication and was ready to go home in a few days. I have no idea what he told his kin was the cause of his hospitalization, but I sure hope the experience taught him to rethink his sanitation and food sources.

Dr Bosire is an obstetrician/gynaecologist