Published Date: 2003-09-29 23:50:00
Subject: PRO/EDR> Cysticercosis - India
Archive Number: 20030929.2454
CYSTICERCOSIS - INDIA
A ProMEDmail post
ProMEDmail is a program of the
International Society for Infectious Diseases
Date: Mon, 29 Sep 2003
From: Dr Rana Jawad Asghar <email@example.com>
Source: SIFY.com [edited]
Cysticercosis behind increase in seizures and epilepsies
A disease is ringing alarm bells not just in Delhi but most of northern
India. Battling increasing cases of neurocysticercosis, doctors are now
releasing figures that signal the beginning of an epidemic: 13 percent of
the epilepsy cases coming to Delhi's hospitals are being triggered by cyst
formation in vulnerable areas of the human brain.
The fallout: Anything ranging from seizures, convulsions, nervous disorder,
blackouts, vertigo, blindness, coma, and even death.
A woman breaks into tears when she explains how her 20-year-old son has
been blinded due to cysts. His eyes have been affected by tapeworms, which
entered his blood through infested food and "blocked ventricles leading to
his eyes." He has left his studies and is planning to join a blind school.
Previously, it was the consumption of pork that was considered the trigger
to cysts. "Cysticercosis is the most common parasitic infestation of the
human nervous system. The tapeworm enters our body through leafy vegetables
like cabbage and spinach, or uncooked and undercooked food and wreaks havoc
once it reaches the brain," says Dr (Col) V S Madan, consultant, spinal and
neurosurgery, Sir Ganga Ram Hospital.
"Cysticercosis is acquired by ingestion of tapeworm eggs. The problem is
not serious when there is one cyst in the brain, but matters deteriorate
when cysts multiply, like in the young man's case above. Cysts themselves
are harmless, but while dying, they release toxic substances and expand.
The brain reacts to it by swelling and convulsing. Apart from the brain,
cysts can affect muscles, skin, lungs, liver, and other parts," Dr. Madan adds.
It was December 1999 when the young man, then in Class XII, was struck with
a headache, which snowballed into fever. Doctors diagnosed malaria. "I felt
I was losing consciousness. Slowly, I started losing vision, first in one
eye, but soon in my 2nd eye too," he says. Within 6 months, he was
blind. "It was only after an MRI that cysts were detected," says his mother.
"Cysts manifest in seizures, headaches, high fever. The patient can also
slip into coma, which can result in death. The disease is common among
children and is growing among adults," says Dr M V Padma, consultant
neurophysician, department of neurology, AIIMS.
Another case is a fortunate man, as he has only one cyst in his brain.
"Once I fell on a busy road. The doctors have given me medicines which I
take daily," he says.
Then there is a journalist with a national daily who was struck with a
seizure on the first day of her outstation posting. She was rushed to
hospital and diagnosed with 6 cysts. "I have been on a cocktail of
medicines ever since. The treatment has been painful as I have been
experiencing headache, vertigo, and nausea."
Doctors say the disease is spreading rapidly due to unhygienic food. "The
problem of single lesions is unique to India. However cases of multiple
lesions are increasing now. Once the larva dies, it calcifies," says Dr
Satish Jain, director, Indian Epilepsy Centre. Nearly one percent of the
population suffers from epilepsy. "Out of this, 10 percent are affected by
a single lesion, while another 2 to 3 percent have multiple cysts. That's
very alarming," adds Dr Jain.
So how can one detect tapeworms in the brain? "Subcutaneous nodules and
ocular cysts are important indicators. If you experience a severe headache
you have not experienced earlier, rush to a doctor. Most patients come to
us after suffering seizures," says Dr Padma. There may be cases when the
cyst remains dormant for long before manifesting itself. The patients are
administered cysticidal drugs to kill the cysts, but "it's a delicate
So, are leafy vegetables and salad an absolute no-no? "Not really, but
you've got be very careful in washing them. You need to wash them in
running water at least thrice," says Shashi Mathur, dietician, Sri Ganga
Ram Hospital. "Leafy vegetables are in direct contact with soil and are
consumed as such." Cysticercosis is caused by the tapeworm _Taenia solium_.
Symptoms include fits, seizures, headaches, and high fever. Cabbage,
spinach, etc, are new tapeworm carriers, as these are increasingly grown in
[Byline: Vineet Khare]
Dr Rana Jawad Asghar
Program Manager Child Survival, Mozambique
Provincial Coordinator Sofala Province, Mozambique
Health Alliance International, Seattle, WA, USA
Coordinator South Asian Public Health Forum
[_Taenia solium_, the pig tapeworm, causes cysticercosis and is common in
pig-rearing countries. Humans get an intestinal infection from eating pig
meat containing cysticercoids. In the human intestine, the larvae mature
and excrete tens of thousands of eggs, which in turn may infect pigs and
man. If humans are infected with the eggs, the extra intestinal cycle may
take place in the human, leading to cysticerci all over the body, including
the brain. If indeed cysticerci are behind this outbreak, a community
survey should reveal a high frequency of subcutaneous nodules. It has been
discussed whether people eating pork containing cysticerci may be able to
infect themselves with their own excreted _T. solium_ eggs, and it believed
that this is possible.
Otherwise infection with _T. solium_ eggs requires contact with human fecal
material, for instance by using contents from latrines as fertilizer. In
addition to surgical removal, treatment with praziquantel and albendazole
have good effect in some cases. The kind of substantial increase reported
here leads to speculation about a new introduction into pork production or
changes in the use of human manure as fertilizer. The posting also
speculates that the infection is transmitted through vegetables, in which
case it can be stopped by not using human feces as fertilizer. - Mod.EP]