Even though the cause of the sanitation worker's infection is unknown, experts noted that the individual had several environmental characteristics that made him particularly vulnerable to the parasite.
In an uncommon case, Doctors in Spain could see roundworm larvae crawling under the skin of a 64-year-old sewer worker who had a severe roundworm illness. A study described the man’s unusual "hyperinfection" in the New England Journal of Medicine.
According to the report, the sewer treatment worker realised something was wrong with him when he developed minor diarrhoea and an itching rash, and he went to the hospital with worms crawling beneath his skin.
The man presented himself at Madrid's University Hospital. The medical professionals discovered that the man had Strongyloides stercoralis, a parasitic roundworm species that is common in tropical and subtropical areas of the world and that is responsible for the ailment known as strongyloidiasis.
When surgeons sketched traces of the initial implantation of the larvae just under the skin, revealing that they migrated over the course of 24 hours, a set of photos provided in the study resembled shoddy tattoos more than a parasite.
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Doctors also observed that although it is unknown how the sanitation worker contracted the infection, a number of environmental conditions made him particularly vulnerable to the parasite.
However, the experts said that Strongyloides is typically asymptomatic and can go years without being discovered, which they believe was initially the situation with the sanitation worker.
His hormone therapy for malignant spinal cord compression, which weakened his immune system and consequently allowed the parasites to flourish, was what ultimately caused his symptoms to manifest.
As a result, the patient entered a potentially lethal condition called hyperinfection, where an excess of larvae can result in sepsis and organ failure. The roundworms eventually got so bad that they started crawling under his skin. The publication reported that the larvae could also be seen in the man's stool samples. But thankfully, doctors were able to treat the man with potent anti-parasitic medications.
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 "Picture credits: New England Journal of Medicine")
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