A 52-year-old U.S. man with a “predilection for undercooked pork” showed up at a Florida hospital complaining of brutal migraines, after which doctors found his brain infested with parasitic tapeworm larvae.
The unnamed patient said his migraines had gotten worse over the previous four months, and were now occurring “almost weekly,” according to the American Journal of Case Reports. He said he hadn’t traveled to any high-risk locations, and that his most recent trip was a cruise to the Bahamas two years prior. The man and his wife lived with a cat “in a modern home,” and were not food-insecure, the report states. It says his vitals were “unremarkable,” routine lab tests didn’t raise any red flags, and a full infectious disease workup came back negative.
However, a CT scan “revealed numerous cystic foci… within the deep cortical and periventricular white matter” of his brain, which physicians regarded as “suspicious,” the case report, which was published March 7, goes on.
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“On further questioning, the patient denied eating raw or street food but admitted to a habit of eating lightly cooked, non-crispy bacon for most of his life,” it says.
The fluid-filled cysts, subsequent tests showed, were evidence of neurocysticercosis, which the case report describes as “a condition caused by infection with the larval form of Taenia solium, a pork tapeworm that uses pigs as an intermediate host.”
Centuries ago, “the connection between human cysticercosis and pork consumption was plain, and pigs and swine were viewed as impure or unclean throughout the ancient world,” the case report explains. “Neurocysticercosis is virtually nonexistent in areas of the world that have banned pork consumption, further highlighting the strong link between swine and this disease.”
Cysticercosis remains common in Asia, Latin America, sub-Saharan Africa, and Oceania, though it has tapered off in developed countries “due to high scrutiny of food safety and sanitary standards,” according to the case report. Still, increased mobility by the global population has brought an increase in cases to the U.S. and elsewhere.
“Early cases were initially puzzling, such as when members of an Orthodox Jewish community in New York became infected from their houseworkers, who themselves were Taenia carriers, distancing the disease from direct exposures to swine,” the case report says. “Similarly, our patient lived in the United States and had no recent travel to endemic countries or contact with pigs.”
The man’s “lifelong preference for soft bacon” is likely the cause of his troubles, although simply eating undercooked pork would have led to taeniasis—an intestinal tapeworm resulting from the consumption of undercooked pork containing larval cysts embedded within the meat—not cysticercosis, according to the case report. Cysticercosis, on the other hand, “is contracted when humans ingest eggs found in the feces of other humans with taeniasis.”
“It can only be speculated,” the case report states, “but given our patient’s predilection for undercooked pork and benign exposure history, we favor that his cysticercosis was transmitted via autoinfection after improper handwashing after he had contracted taeniasis himself from his eating habits.”
The CDC recommends washing your hands well with soap and warm water after using the toilet or changing diapers, and before handling food.
The patient was admitted to the ICU and treated with dexamethasone, an anti-inflammatory, to prevent seizures and brain swelling, and the anti-parasitics albendazole and praziquantel, which stabilized his condition. The patient “was successfully treated, with regression of lesions and improvement of headaches,” the case report says.
Neurocysticercosis is rarely seen in the U.S., although eating rare pork “is
a theoretical risk factor for neurocysticercosis via autoinoculation, as we suspected in this case,” according to the case report.
“The great variability of symptoms that neurocysticercosis can present with should not be understated,” it concludes, “and although it is a leading cause of epilepsy worldwide, it can present with more subtlety.”
Lead author Dr. Stephen J. Carlan of the Orlando Regional Healthcare System did not immediately respond to The Daily Beast’s request for comment.
