Doctors suspected man had brain cancer. He had worms | Hacker News Reader

Doctors suspected man had brain cancer. He had worms

arstechnica.com

74 pointsBender35 comments

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.

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

Yes. 400mg prophylactic dose, once every year.

Yeah, I live in Central America now. 7 years ago after a month of subtle... Issues... and and a bunch of weight loss, I finally discovered an 8 inch worm in my poop after taking some albendazol.

Since then, I take it every few months. There's really no risk as it is barely absorbed into your system - it just stays in the intestines and paralyzes (doesn't kill) the worms, they loosen their grip, so to speak, and fall out.

I also give it regularly to my dogs even when they aren't showing symptoms.

If you have more... violent... symptoms, it's likely bacteria etc rather than worms. Secnidazol is what you want for that - single dose and youre done. Most doctors prescribe metronidazol because they don't know anything - it is something like 3 pills a day for a week, and bacteria have high resistance to it. More expensive, more hassle, less effective.

I also give Secnidazol to my dogs.

Albendazol and Secnidazol are essentially free here at any pharmacy.

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?

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

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

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.

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.

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

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.

You may be correct, but I assume the word prophylaxis here is to some extent being misused, and really what's happening is that in regions where parasitic infections are endemic, nearly everyone has parasites but because they're often asymptomatic you don't get treated unless you have symptoms, so ensuring you clear our your parasitic load regularly may be beneficial to health regardless of whether you actively have symptoms. I would not expect anti-parasitic agents to become less effective if used on an individual where they don't have any parasitic infection, as there's no evolutionary pressure on the parasites, but it might become less effective over time if someone is actively infected but the agent doesn't successfully kill all the parasites allowing them to reproduce with those evolutionary changes.

Yeah but that's opening a can of worms nobody even wants to talk about.

What we do about parasites is simple, and you describe it well. Tell people to take basic measures, and when visible signs are observed, give medication that works "in most cases". How is this done? Informally (luckily at least by people who were educated and are at least aware of the problems. And not just the problem right in front of their faces). Additionally, give the same medicine to 50 million cows without any check or treatment because that's cheaper.

The correct way to deal with it is to go look for infection sources, clean them (which is done, but not nearly enough), and essentially go look for patients. Not waiting for patients to come but if you find some source of infection, "arrest" everyone around there, given them near-overdoses of medication for a very long time (so that the odds of a single parasite surviving are almost nothing). Outside of these actions it should be almost impossible for a parasite to encounter the medicine (ie. there should be no way for patients to get it on their own initiative). Why? That would make it very hard for parasites to adapt.

(oh and if you find it in cows? Don't try to treat them, kill every cow less than 1 km or so from a known infected one, and burn them all to a crisp, in an oven, never using any part of them for anything)

But if you put it like this, it becomes pretty clear why it's not going to happen, doesn't it?

> 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

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

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

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.

But actually, it was lupus

And the throat incision clip

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.

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

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

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

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.

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.

Sounds like a Dr. House episode.

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

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

> 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.

Thanks and glade he made it!

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

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.

Why did they use CT before MRI?

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.

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