On what seemed like any other night, at 4 a.m., a perfectly healthy 38-year-old Massachusetts man fell out of bed in a violent fit. The commotion woke his wife, who found her husband on the floor, trembling and “talking clap”. He was admitted to Massachusetts General Hospital.
There doctors watched the man have a two-minute tonic-clonic (grand mal) seizure in which he lost consciousness and his muscles contracted aggressively. Doctors began the arduous process of figuring out what was wrong by running a series of tests and interviewing his family.
By almost all reports, the man was in very good health. He had no history of seizures or cardiovascular, respiratory, gastrointestinal, genitourinary, or neurological disorders. His toxicological screens were clear. He took no medication, neither prescribed nor over the counter. He did not smoke and seldom drank. There was no evidence that anything had happened to him recently that might have provoked a seizure; the man had spent the day before with his children, then had dinner with his brother, who reported nothing out of the ordinary. The only first indication of the diagnosis was that the man had immigrated to Boston from rural Guatemala about 20 years earlier.
But when doctors did a CT (computed tomography) scan of his head, they quickly narrowed the options. The scan showed three calcified lesions in his brain, and doctors focused on diagnosing neurocysticercosis. In other words, pork tapeworm larval cysts had migrated into his head years ago and lodged in different parts of his brain. The doctors documented their work on the man’s disease in a case study published Thursday, November 11th, in the New England Journal of Medicine.
Gut to brain
Learning the path to neurocysticercosis is not for the faint of heart; it is a mean disaster that is as nauseating as it is dangerous. The pork tapeworms, Taenia solium, usually inserted into the human intestines, where they can reach a shocking length of two to eight meters. Meanwhile, the victims of the worm excrete parasitic eggs from their feces. When this egg-laden excrement gets into an environment with pigs, the pigs can carry out the worm’s life cycle by ingesting the eggs.
In the pig’s stomach, stomach acid causes the eggs to lose their protective covering and hatch into larval cysts, the so-called oncospheres. These can penetrate the intestinal wall and ride through the pig’s body via the circulatory system. They eventually dig into the pig’s muscles and lie in wait as cysticerks – which is usually not a problem for the pig.
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