Doctors suspected man had brain cancer. He had worms

74 points by Bender 3 days ago|32 comments

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woadwarrior01 3 days ago

This is a big fear of mine. I have a course of albendazole once every year just for this. It is de facto over the counter in India. I bought enough to last 4 years, the last time I was there.

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tristor 3 days ago

I have often thought it might be a wise idea to do some form of prophylactic course against parasitic infections given my extensive travels, but this isn't something that's generally recommended here in the US and I've yet to meet a doctor who would be willing to prescribe deworming without evidence of an active infection. Is this something that's common in India?

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spwa4 4 hours ago

The medical world is wildly against this, because of course it will cause resistance in the exact problem your trying to help with.

Even within a single patient this is sometimes observed.

So yes, it helps. Until it suddenly doesn't. And the point where it suddenly doesn't comes faster every year. We have no real alternatives.

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woadwarrior01 3 days ago

When I was growing up in India, the family physician would prescribe single dose deworming syrup/tablets for kids, every year. I recently learned that Mebendazole is available over the counter, here in Ireland (also in the UK). But I have enough Albendazole from my trip to India last year, to last a couple of years.

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teruakohatu 3 days ago

It’s available here in New Zealand over the counter in family sized packs of chocolate flavoured tablets.

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uh_uh 3 days ago

AFAIK there is no prophylactic for pork tapeworms. I'd love to be proven wrong.

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woadwarrior01 3 days ago

https://www.cdc.gov/taeniasis/hcp/clinical-care/index.html

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uh_uh 3 days ago

These dewormers treat the condition after the individual was already infected. I don't think they prevent the disease. Additionally, taking Albendazole without anti-inflammatory meds can be fatal in case of an active infection. Reason is that if the cysts start dying the brain, the toxins released might cause swelling which can lead to neurological damage or death.

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aurareturn 3 days ago

Do you take it even if you don't have any symptoms?

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woadwarrior01 3 days ago

Yes. 400mg prophylactic dose, once every year.

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sva_ 3 days ago

> The finding surprised the doctors since tapeworms aren’t endemic to Spain and he said he hadn’t traveled. However, the man may have been exposed during his work. Until 10-years prior, when he retired, he had worked in construction, often working alongside people who had migrated from regions where pork tapeworms (Taenia solium) are endemic. The parasitic worms can spread through the fecal-oral route. His doctors speculated his infection might have been a rare case of cryptic transmission from sharing meals and bathrooms with his coworkers, one of whom apparently had a tapeworm infection.

yikes

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avadodin 3 days ago

The Taenia genus —among many other pork parasites— is —or used to be— endemic in the whole Iberian peninsula and all ethnic Spaniards eat raw pork meat.

I don't even know which mystery non–Spaniard dark–skins the doctor is trying to blame here.

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dlcarrier 3 days ago

That's pretty much the only way norovirus spreads, and it's common enough to kill ~200,000 people a year.

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eschulz 3 days ago

Moral of the story, eating shit and undercooked meat come with risks.

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btach 2 days ago

Saw something like this in one ER I worked at years ago. Guy in his 50's was brought in for seizures. Don't remember exactly where he came from, but it was some place where tapeworms from pigs was not unheard of. CT of head showed numerous cysts in his brain. I remember seeing the spots in his head being a bit smaller than in the imagery in the article and more spread out. Anyway he was diagnosed with neurocysticercosis and admitted. No idea what happened after, often I didn't get follow-up in the ER setting. Anyway, that... was memorable. Never ate undercooked pork before that, but after... never ever will.

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ramon156 3 days ago

But actually, it was lupus

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sourcegrift 3 days ago

And the throat incision clip

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retinaros 3 days ago

if the worms are in the brain the man is likely not fine and won't ever be like before

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tim-tday 3 days ago

The brain is remarkably good at recovering from injury and mapping functions around damaged areas. There have been dozens of reported cases of massive one time injuries that people are able to recover from. Kill the worms and I bet he makes a full recovery.

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dlcarrier 3 days ago

Half the time, there aren't any symptoms at all: https://pmc.ncbi.nlm.nih.gov/articles/PMC4621219/

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retinaros 3 days ago

I guess the symptoms might be super hard to identify. llike a cognitive decline on some functions.

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dlcarrier 3 days ago

Most of the time it's seizures, with headaches the second most common symptoms. Cognitive decline is a distant third and relatively rare.

Thru don't consume brain tissue or even live very long in the brain. The biggest problem is that cysts form around them, which can apply pressure.

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thelastgallon 3 days ago

Sounds like a Dr. House episode.

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omsta 3 days ago

The first one specifically: https://en.wikipedia.org/wiki/Pilot_(House)

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tamimio 3 days ago

Ok, and what happened to the man after? Did they remove it? Was he ok and back to normal or forever damaged?

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throawayonthe 3 days ago

> NCC can be serious, causing seizures, significant neurological deficits, cognitive decline, stroke, and other problems. But it can also be asymptomatic. The severity depends on where in the brain the worms settle. Luckily for the man, the effects were relatively mild. Doctors prescribed him two anti-parasitic drugs, and he recovered.

and here is the actual case report: https://wwwnc.cdc.gov/eid/article/32/7/26-0587_article

> We treated the patient successfully with albendazole (400 mg 2×/d) and praziquantel (1,200 mg 3×/d), alongside dexamethasone taper, without complications.

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busymom0 3 days ago

Do the worms disappear after these drugs? Or they just die and are left in the brain?

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snootypoot 3 days ago

they slowly decay and the immune system removes the remains. it can cause a toxicity shock called the herxheimer effect, the body often has symptoms when removing decaying foreign matter and the stored toxins they release. often parasite decomposition results in a sudden release of heavy metals and other things which accumulate in parasites. people try to use binding agents to aid in detoxing during this time to minimize fever and joint swelling and other signs of severe inflammation.

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tamimio 3 days ago

Thanks and glade he made it!

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mhb 3 days ago

Why did they use CT before MRI?

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bdcravens 3 days ago

Presumably what they had available. Since MRI machines (and qualified technicians) are much more expensive, it's not uncommon for smaller facilities to rely on mobile MRIs which aren't on-site every day.