Doctors find worms squirming through teen’s neck: A cautionary tale

In the early 20^th century, the American South was crawling with intestinal hookworms. Some initial surveys in the 1930s suggested nearly 54 percent of the population was infected, with prevalence in some areas as high as 76 percent. Through concerted deworming efforts and improved hygiene, the worms were largely flushed out over the subsequent decades. But as one medical editorial put it in 2017: We still got ’em. That year, a study detected genetic traces of N. americanus in the stool of more than a third of people tested in an impoverished community in Lowndes County, Alabama. In Lowndes, approximately 50 percent of households have failing or no sewage systems.

Creeping eruption

While that’s something you can enjoy thinking about before bed tonight, let’s not forget that there’s a second category of hookworms: the ones that bore into your body but generally don’t make it into your intestines. This may seem like the better scenario than the intestinal group. But, that’s only the case if you’re ok with hookworm larvae wandering aimlessly through the layers of your skin, leaving an intensely itchy, serpentine rash, marked by redness and little pus-filled blisters in their wake. The rash is called cutaneous larva migrans (CLM), or “creeping eruption.”

This second type of invasion is borne from worm-infested animals. The pack of parasites that cause CLM in people include hookworms that infect dogs and cats (Ancylostoma caninum, A. braziliense, and Uncinaria stenocephala), and in rarer cases cattle (Bunostomum phlebotomum).

In animals, these hookworms live out a life cycle much like the intestinal cycle described earlier, with the parasites making themselves at home in the animals’ small intestines. But, in humans, the worms find a dead-end. Most never make it out of the skin, roaming randomly until their death, which, without treatment, can take about five to six weeks. In their desperate meandering, some larvae—which measure 500 to 600 micrometers (0.05 to 0.06 centimeters) long—will travel several centimeters each day. Others can make it into deeper tissue, but become stuck. On occasion, A. caninum—which normally infect dogs—have been known to make it to the intestines and partially develop. But they never complete their life cycle.