Brain worms

“A worm … got into my brain and ate a portion of it and then died.” These are words no one wants to utter. Yet, they were spoken by a U.S. presidential candidate. According to a 2012 deposition unearthed and examined by The New York Times, Robert F. Kennedy Jr. disclosed that he sought medical assistance after grappling with mental fogginess and memory loss. Ultimately, he stated, a doctor aided him in identifying a brain abnormality detected on a scan, attributing it to a worm. Kennedy now informs The Times that he has fully recuperated with no enduring repercussions.

The narrative has sparked considerable discussion within the realm of politics. However, it transcends the personal health history of a single politician. According to the World Health Organization, over a billion individuals worldwide are afflicted by parasitic worms. The ramifications of such infections are frequently grave and enduring, underscoring the broader significance of addressing parasitic diseases and promoting public health initiatives aimed at prevention and treatment.

NPR recently interviewed Francisca Mutapi, a professor of global health infection and immunity at the University of Edinburgh with 25 years of experience studying parasites. She offered insights into RFK Jr.‘s case and the broader impact of parasitic worms worldwide. Here’s a condensed version of their conversation:

Q: Let’s begin with RFK Jr. His case remains somewhat unclear. Do you have any thoughts on what type of worm he may have encountered and how he could have been infected?

A: I don’t have specific information about his case. However, based on what I’ve read, it’s possible he had an infection known as Taeniasis, which is caused by tapeworms typically carried by pigs. When someone ingests tapeworm eggs, often from consuming raw or undercooked pork, the eggs hatch into larvae. These larvae can then spread throughout the body, potentially leading to a condition called cysticercosis.

Q: Where do these larvae tend to migrate in the body, and what harm can they cause?

A: Depending on where the larvae end up, they can cause various health issues. For instance, if they reach the eyes, they may result in blurred vision or blindness. If they settle in the muscles, they can cause weakness. However, if they infiltrate the central nervous system, including the spine or brain, they can trigger a condition known as neurocysticercosis.

This specific form of the disease can manifest differently based on factors such as your immune system and overall health, as well as the precise locations where the larvae have settled. Symptoms can include headaches and seizures, with neurocysticercosis being a leading cause of epilepsy in adults. Additionally, cognitive issues may arise, along with problems related to balance, attention, and confusion. The accumulation of excess fluid in the brain can exacerbate the severity of the condition, making it potentially life-threatening. While fatalities from neurocysticercosis are exceedingly rare, they can occur in some cases.

In a U.S. context, the likelihood of contracting neurocysticercosis is relatively low compared to regions where the disease is endemic, such as parts of Asia, South America, and certain areas in Africa. According to the Centers for Disease Control and Prevention, there are approximately 1,000 new cases of hospitalization due to cysticercosis reported in the United States each year.

As for treatment options, prevention through practices like ensuring proper food hygiene, such as thorough cooking of pork, and maintaining good hand hygiene and sanitation is key. However, if infection occurs, treatment is available and effective. Drugs like praziquantel and albendazole are commonly used to kill the larval stages of the parasites and can also alleviate associated inflammation. In severe cases, surgery may be necessary.

Broadly speaking, parasitic worms contribute significantly to the global burden of disease, particularly within the realm of neglected tropical diseases (NTDs). Approximately 1.7 billion individuals worldwide are affected by NTDs, with diseases caused by parasitic worms being a significant component. For instance, in Africa alone, over 200 million people are afflicted by schistosomiasis, also known as bilharzia, a condition caused by parasitic worms that can lead to a range of health issues, including anemia, blood in the urine, and cognitive impairments.

The burden of neglected tropical diseases (NTDs), including those caused by parasitic worms, is indeed substantial. To illustrate, if all the children worldwide affected by bilharzia were to hold hands, they would encircle the globe one and a half times. This staggering statistic underscores the enormity of just one of the 21 NTDs.

While deaths from diseases caused by parasitic worms are relatively few, the impact on daily health and functionality is significant. Consider the consequences of conditions like cysticercosis. Epileptic seizures can severely hinder one’s ability to maintain employment, while vision impairment can limit job opportunities and compromise safety. Balance issues further restrict mobility, resulting in a diminished quality of life.

Similarly, bilharzia, known as the “disease of cognitive function” in my mother tongue, Shona, can lead to fatigue, poor memory, and cognitive impairments in children. Treating these diseases promptly can lead to significant improvements in academic performance and physical activity.

Efforts to combat these diseases globally are underway, but more action is needed. Preventative chemotherapy, involving the treatment of at-risk populations with donated drugs, is a key strategy. However, accelerating these efforts and exploring innovative interventions, such as vaccine development, are essential to eliminate these diseases as swiftly as possible.

In regions where cysticercosis is prevalent, improving hygiene practices can significantly reduce the risk of infection. Simple measures, such as ensuring individuals do not come into contact with the feces or urine of pigs, can be highly effective in preventing transmission. These interventions are not only cost-effective but also straightforward to implement, making them an accessible means of protection for individuals in affected areas.