Researchers concluded that the patient had inadvertently become a host to a parasite due to her residence near a lake inhabited by carpet pythons

In startling medical revelation, neurosurgeons conducted brain surgery on a 64-year-old Australian woman, leading to unprecedented discovery with the extraction of a live 8-centimeter (3-inch) long parasitic roundworm from the woman’s brain. The woman was admitted to a hospital for symptoms like abdominal pain and diarrhea, gradually evolving into more severe conditions such as respiratory distress, forgetfulness, and depression.

The incident marked the world’s first-ever case of a live worm found within a human brain, sending shockwaves through the medical community.

Neurosurgeon Dr Hari Priya Bandi conducted brain surgery on the patient.

“I’ve only come across worms using my not-so-good gardening skills … I find them terrifying and this is not something I deal with at all,” Dr. Bandi told reporters, describing her astonishment at encountering the parasite.

The discovery led to a quest to identify the parasite. Dr Sanjaya Senanayake, an infectious disease expert at Canberra Hospital, enlisted the assistance of an animal parasitology expert to solve the mystery. The answer, when it came, was as unexpected as the situation itself: the worm was identified as Ophidascaris robertsi, a roundworm typically found in pythons.

This revelation marked a significant breakthrough. Researchers concluded that the patient had inadvertently become a host to a parasite due to her residence near a lake inhabited by carpet pythons. While she did not have direct contact with these reptiles, her interaction with the local environment, specifically native leafy vegetable, likely led to the ingestion of the roundworm eggs. These eggs might have been transmitted through the feces of pythons into the greens, which the patient subsequently touched and cross-contaminated with her food and cooking utensils.

The patient’s symptoms initially complained of abdominal pain and in later stages she complained of respiratory distress, forgetfulness, and depression. An MRI scan by psychiatrist eventually led to her operation that revealed the presence of the live parasitic roundworm in the right frontal lobe of her brain, a location never previously associated with this species.

Dr Senanayake warned that as humans encroach deeper into animal habitats, the potential for such infections to occur increases. The extracted worm has been preserved in the Australian National Wildlife Collection.

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Medical history

The case was first reported in the September edition of the journal Emerging Infectious Diseases. The journal says that the woman’s medical history included diabetes mellitus, hypothyroidism, and depression. She was born in England and had traveled to South Africa, Asia, and Europe 20–30 years earlier.

She was treated for community-acquired pneumonia with doxycycline and had not recovered fully. Three weeks later, she was admitted to a tertiary hospital with recurrent fever and a persistent cough while on prednisolone. Prednisolone is used alone or with other medications to treat the symptoms of low corticosteroid levels (lack of certain substances that are usually produced by the body and are needed for normal body functioning). Prednisolone is also used to treat certain conditions that affect the blood, skin, eyes, central nervous system, kidneys, lungs, stomach, and intestines.

The journal says a CT scan in mid-2021 showed improvement in the pulmonary and hepatic lesions but unchanged splenic lesions. “We added mepolizumab (interleukin-5 monoclonal antibody, 300 mg every 4 wk) in January 2022 because we were unable to reduce the prednisolone below 20 mg daily without a flare of respiratory symptoms.”

During a 3-month period in 2022, the patient experienced forgetfulness and worsening depression while continuing prednisolone and two other drugs mycophenolate and mepolizumab. In June 2022, she underwent an open biopsy. We noted a string like structure within the lesion, which we removed; it was a live and motile helminth (80 mm long, 1 mm diameter).

“Six months after surgery (3 months after ceasing dexamethasone), the patient’s PBEC remained normal. Neuropsychiatric symptoms had improved but persisted.”

The journal reported that as worm was removed from the patient’s brain, the patient was given medicines to treat any other worms that might be in her body. These worms can live for a long time in animals; for instance, rats have stayed infected with these worms for more than 4 years.

She was given two medicines, ivermectin and albendazole, based on how they’ve been used to treat similar infections in snakes and humans. Albendazole is better at reaching the brain than ivermectin. She was given dexamethasone, a medicine that helps prevent bad reactions in the brain after treating worm infections.

The journal says the case shows that there’s an ongoing risk of diseases passing from animals to humans as they come into close contact. Even though these specific worms are found in Australia, similar worms in other snakes around the world could lead to more cases like this one in the future.

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