Comparative Parasitology 67(1) 2000 - Peru State College

72 COMPARATIVE PARASITOLOGY, 67(1), JANUARY 2000
picture and compares our results with related
findings in other cases.
Materials and Methods
One 70% ethanol-preserved nematode extracted by
J.B. and W.D. from the neck of a 44-yr-old Venice,
California, Caucasian male patient on 12 April 1998
was received by O.M.A. on 18 April 1998 for identification.
The worm was first examined externally, then
stained in Mayer's acid carmine overnight, destained
in 4% HC1 in 70% ethanol, dehydrated in ascending
concentrations of ethanol, cleared in graded terpineol-
100% ethanol, and prepared as a whole mount in Canada
balsam. Figures were made with the aid of photoprojection.
All measurements are in millimeters unless
otherwise indicated. Width measurements refer to
maximum width. The specimen is deposited in the
U.S. National Parasite Collection (USNPC), Beltsville,
Maryland.
Results
The patient (T.S.) was a 44-yr-old Caucasian
male with amyotrophic lateral sclerosis (ALS),
a degenerative neuromuscular disorder. He was
completely healthy until 1992, when he was diagnosed
(spinal tap) with Lyme disease after
suffering flu-like symptoms and joint pains. He
received 2 courses of antibiotics, including ampicillin,
bioxin, doxycycline, and vancomycin,
before he felt cured. In 1994, he was further diagnosed
with ALS at 2 major medical centers in
South Carolina and New York and was told that
he had 6 mo to live. Muscle biopsies showed
cell death consistent with ALS. The patient
sought help at The Natural Medicine Center in
1996 as his condition continued to deteriorate.
All his laboratory tests were normal (including
explorations of possible neurotoxins) except for
a spinal tap that showed Lyme disease in the
central nervous system. He was treated with
heavy doses of antibiotics but without favorable
results.
During April 1998, he received a series of co-
Ionic irrigations, during which time "parasites"
were claimed to have been observed. These presumed
"parasites" were not collected by the junior
authors nor observed by O.M.A. However,
a worm was actually extracted from a neck sore
and sent to O.M.A. for identification. Upon external
examination, the worm was initially identified
as an anisakid nematode. After processing
(see above), the identity of the nematode was
determined to be a third-stage larva of P. decipiens.
At that time, T.S. indicated on the Requisition
Form that he was experiencing "severe
Copyright © 2011, The Helminthological Society of Washington
weakness, neuromuscular damage, severe
weight loss, loss of balance, and speech impairment."
He also indicated no travel history but a
history of diet often including sushi and sashimi
over the previous few years. After the worm diagnosis,
T.S. was treated with pharmaceutical
anti-parasitic medications (albendazole and
praziquantel) in large doses. Subsequently, his
symptoms of malaise disappeared and his red
blood cell count dramatically increased to 4.30
from a pretreatment low of 2.74 on 11 March
1998. After repeat treatment with praziquantel,
T.S. felt better though his muscular condition remained
unchanged. For the past few years, T.S.
had always felt ill and experienced loss of function.
He recently weighed 105 Ib, down from a
pre-illness weight of 160 Ib. Before his death in
April 1999, T.S. was unable to use his hands and
could barely ambulate, with help. He could talk
only with difficulty and breathed adequately but
not enough to blow his nose.
Description of the third-stage larva of
Pseudoterranova decipiens (Figs. 1-3)
Body 42.12 long by 0.85 wide near middle.
Cuticle wrinkled at regular intervals, about
0.025 thick but thinner toward both ends. One
dorsal, 2 subventral large fleshy lips each with
2 rounded lobes, anterior dentigenous ridges,
and large papilla (Fig. 1). Prominent boring
tooth (spine) anteriorly. Excretory pore ventral
at base of lips. Nerve ring prominent, 0.42 from
anterior tip. Esophagus 2.03 long by 0.24 wide
at base. Cecum extends anteriorly and about as
long as ventriculus, 1.02 long by 0.18 wide (Fig.
2). Ventricular appendage and alae absent. Reproductive
structures not observed. Tail (anus to
posterior end) 0.16 long. Anal glands prominent,
each with a single darkly stained nucleus. Conically
shaped fine-pointed mucron (caudal spine)
0.025 long (Fig. 3). Evidence of development
(molting) noted as the larva appeared trapped in
the cuticle of the previous stage at various
points.
Taxonomic summary
HOST: Homo sapiens Linnaeus, 1758.
LOCALITY: California, U.S.A.
SITE OF INFECTION: Neck.
SPECIMEN DEPOSITED: USNPC No. 88504.
Remarks
The specimen was identified as P. decipens
primarily because it possessed a cecum and no