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A woman shocked doctors when she started sneezing worms after suffering sinus symptoms.
The 58-year-old unidentified sheep farmer from Greece visited her doctor several weeks after noticing progressively worsening pain around her sinuses and jaw. One week after the throbbing started, she also developed debilitating coughing fits.
The woman had no other symptoms for about a month until she sneezed one day and ‘worms’ started coming out of her nose, prompting her to seek help.
An otolaryngologist (an ear, nose and throat doctor) discovered and surgically removed ten larvae, which are immature worms, and one pupa, the later stage before a larva becomes an insect, from the woman’s sinuses.
The largest larva was about two centimeters (0.8 inches) long, roughly the size of a peanut.
Tests showed the worms were Oestrus ovis, also known as the sheep bot fly, which are found living in the nasal passages of sheep in warm, temperate regions such as the Mediterranean, Middle East and Australia.
Though less common in the US, sightings have been recorded in states such as California, Hawaii and Texas.
The woman said that a week before her symptoms began, she had noticed flies swarming around her face while she worked in a field with grazing sheep.
An unnamed woman in Greece ended up sneezing worms after suffering sinus pain and severe coughing (stock image)
Doctors treating the woman noted she had a severely deviated septum, which occurs when the septum – the thin wall between the nostrils – is off-center, making one nasal passage smaller than the other.
Writing in the CDC’s Emerging Infectious Diseases journal, the woman’s physicians speculated that her deviated septum may have given the flies an unobstructed path through her sinuses to where she would not notice them.
The doctors also noted that had larvae remained undetected, in most cases, they likely would not have become pupae or turned into adult flies.
Instead, they would have liquefied or calcified, raising the risk of bacterial infection.
They wrote that the sinuses are not humid enough for flies to become pupae and have natural bacteria that would create a hostile environment for the worms.
However, one of the eggs in the woman’s sinuses did progress to the pupa stage, which the team said ‘may represent an early indication of evolutionary adaptation, enabling O. ovis parasites to complete their life cycle in humans.’
One of the Oestrus ovis larva surgically removed from the woman’s sinuses
‘Additional cases and data are needed to understand this phenomenon, but clinicians should be aware of the potential for human bot fly infections in endemic areas,’ the doctors wrote.
O. ovis flies are endemic in Greece, particularly in areas with high sheep and goat populations, and have been detected in US areas where sheep are raised.
The CDC notes the flies are particularly common on Catalina Island, a small island off the coast of southern California, as well as the San Joaquin Valley and Los Angeles.
Wyoming and Montana have also detected O. ovis in bighorn sheep, and sporadic cases have been seen in Hawaii and Texas.
US health agencies do not formally track cases in humans, but they are thought to be rare and mainly involve the flies laying eggs on the surface of the eyes.
People who are not regularly exposed to sheep or other livestock are not thought to be at risk.
