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Brain-damaging infections, which are caused by tapeworm eggs accidentally ingested through undercooked food or fruits and vegetables washed with contaminated water in the monsoon, are on the rise in Mumbai. Tapeworm is parasitic and its eggs cause larval cysts in the brain, a condition known as neurocysticercosis.
“The disease made headlines in 2003 when tennis star Leander Paes developed it in the US, baffling doctors unfamiliar with the condition. His case underlined how the infection can affect anyone, even in developed settings,” says Dr Sudhir Kothari, senior consulting neurologist at the Poona Hospital and Research Centre. “Though the disease has been known for decades in India, it is caused by poor food hygiene and is highly preventable. But awareness remains low,” he adds, adding that boiling water, cooking food thoroughly and hand hygiene remain the best prevention.
Monsoon is usually associated with widespread flooding, compromised sanitation and poor food hygiene in open spaces. This environment allows a particular kind of tapeworm, Taenia solium, to proliferate. Its eggs and larvae spread more easily through undercooked food and unwashed vegetables —a risk that is heightened in informal food settings and when basic kitchen hygiene is neglected.
“Once ingested through contaminated food or water, tapeworm eggs hatch in the human intestines. While the adult worms (taeniasis) generally cause mild or no symptoms, the real threat arises when larvae migrate out of the gut via the bloodstream and form cysts in various organs. If these cysts lodge in the brain, they cause a serious neurological condition called neurocysticercosis,” explains Dr PN Renjen, senior consultant, neurology, Indraprastha Apollo Hospitals, Delhi.
“No”, says Dr Ameet Dravid, infectious diseases consultant with Noble Hospital, Pune. As per data worldwide, there are 25 to 30 lakh cases of brain tapeworm. “However not every intestinal tapeworm infection leads to a brain cyst. Many infections are asymptomatic and not everyone reports the case. Symptomatic patients can present with headache, vomitting and seizures which prompt brain imaging,” he says.
It is a leading cause of late-onset seizures in developing countries and can result in severe, sometimes irreversible, neurological damage. Symptoms depend on the number, size and location of cysts and the immune response of the infected person. “These include seizures and epilepsy (most common), debilitating headaches, persistent nausea and vomitting, confusion and neuropsychiatric issues, progressive cognitive decline or motor deficits and in severe or untreated cases, even coma or death,” says Dr Renjen.
The disease develops in stages. “In the vesicular stage, live cysts cause little inflammation. The colloidal stage shows cyst swelling and triggers inflammation, leading to symptoms like seizures. In the calcified stage, dead cysts leave hardened lesions in the brain, causing chronic epilepsy and neurological issues,” says Dr Renjen.
Contrary to popular belief, this is not confined to those who have animal protein. Flooding can mix sewage with drinking water supplies and contaminate crops, while the time pressure and food scarcity may lead people to overlook proper food washing and cooking.
“It affects people who ingest eggs passed on through human stool, which is excreted into the environment and ends up contaminating water sources during monsoon. Most of my patients with neurocysticercosis are strict vegetarians and get the disease because fruits and vegetables come into contact with contaminated water,” says Dr Kothari. Children and immunocompromised individuals are particularly at risk, according to Dr Renjen.
Treatment involves antiparasitic drugs (such as albendazole), anti-inflammatory medications (to control inflammation in the brain), anti-epileptic drugs (for seizures), and supportive care. “Surgery is sometimes needed for severe complications like hydrocephalus (fluid buildup in the brain),” says Dr Renjen.
Dr Dravid advocates mass deworming strategies undertaken by government agencies.
