Brain worms on our minds

The types of parasitic infections of the central nervous system found in Malaysia include neurocysticercosis, toxoplasmosis and cerebral malaria. — Others

NOBODY wants to hear their doctor tell them a dead worm has been found in their brain.

But that’s what happened to US presidential candidate Robert F. Kennedy Jr in 2010, when he sought medical attention after suffering from “brain fog” and memory loss.

The recent admission from the independent candidate revealed that the worm had reportedly somehow found its way to his brain, eaten a portion of it and then died.

Kennedy’s campaign has since tried to downplay the incident, saying the issue was resolved 10 years ago and that the candidate is currently in robust health.

Kennedy has shared that a dead worm was found in his brain a few years ago. — AFPKennedy has shared that a dead worm was found in his brain a few years ago. — AFP

But now we’ve all got brain worms on our minds.

The number one thing most people would want to know after learning about what happened to Kennedy would probably be, “How does this happen? What are the symptoms? And how can I stop it from happening to me?”

According to Emeritus Prof Datuk Dr Raymond Azman Ali, a senior consultant neurologist at Hospital Al-Sultan Abdullah on the Universiti Teknologi Mara campus at Puncak Alam, Selangor, brain parasites can be worms like tapeworms and roundworms, single-celled organisms called protozoa like amoeba, cerebral malaria, toxoplasmosis, or flukes such as schistosomiasis.

Based on reports about it, he says the worm found in Kennedy’s brain was most likely cysticercosis, or more specifically, neurocysticercosis.

Rare cases

The good news is that this condition is rarely reported in Malaysia, he says, as it more commonly occurs in sub-Saharan Africa, Central and South America, Russia, and certain parts of Asia like India and Thailand.

Neurocysticercosis is also not contagious. It is transmitted through food and water contaminated by the eggs of a tapeworm known as Taenia solium, which is typically found in the intestines of pigs, Dr Raymond says.

“So if your hands touch food or water contaminated by these eggs and then you use your hands to eat, these eggs hatch in your intestines and the larva of the worms enter the bloodstream to end up in your organs, most commonly the brain, eye and spinal cord,” he explains.

Typical symptoms for neurocysticercosis would include headaches, epileptic seizures, appearance of multiple cysts, and cognitive abnormalities.

It is somewhat comforting to know neurocysticercosis is a rare occurrence in this country, but Dr Giri Shan Rajahram – a senior consultant infectious disease physician at Queen Elizabeth Hospital in Kota Kinabalu – says there are other types of brain parasites that have been reported in Malaysia.

“There have been reported cases and small studies conducted locally, depending on the parasite. However, true prevalence and incidence are possibly underappreciated,” Dr Giri says.

This is due to a variety of factors, he says, including the lack of large population-based systematic studies and parasitic infections not being easily recognised or diagnosed.

Aside from neurocysticercosis, other parasitic infections of the central nervous system that have been reported in Malaysia include toxoplasmosis and cerebral malaria.

Cerebral malaria – caused by severe infections of the protozoan parasite Plasmodium falciparum – is almost never seen in Malaysia now, Dr Giri says.

“This is because we have eliminated human malaria species in Malaysia.”

This is good to know since he says even those who survive cerebral malaria can have residual neurological abnormalities such as epilepsy, behavioural and cognitive disorders, and neurological deficits as sequelae.

The rare cerebral malaria cases Malaysia gets, he says, are usually from non-immunised travellers acquiring the infection from regions where plasmodium falciparum is endemic; ie sub-Saharan Africa.

Symptoms of cerebral malaria usually present as high-grade fever and seizures progressing to coma.

Meanwhile, toxoplasmosis, which is usually transmitted through uncooked food and contact with cat faeces, has symptoms that include fever, headaches, confusion, seizures, and possibly the ocular disease retinochoroiditis.

Severe cases of this parasitic infection can present with a type of brain inflammation known as toxoplasma encephalitis, he adds.

“Toxoplasmosis happens usually when latent infections are reactivated when the host is immunocompromised,” Dr Giri says.

Good sanitation, better awareness

But there’s no need to go into overdrive worrying about parasitic infection of the central nervous system yet, as there are many things one can do to prevent contracting such infestation.

For example, Dr Raymond suggests washing one’s hands properly before and after meals to prevent neurocystercicosis.

Good sanitation and hygiene practices in general will help prevent one from getting infested by a parasite, says Dr Giri.

“Consume thoroughly cooked meat and well-prepared meals,” he adds.

Good sanitation and hygienic practices in general will help prevent one from getting infested by a parasite. — 123rfGood sanitation and hygienic practices in general will help prevent one from getting infested by a parasite. — 123rf

Another personal measure that can be taken would be to improve one’s own awareness and education on parasitic infections, says Dr Giri.

Due to diseases such as cerebral malaria which usually stems from non-immune travellers bringing it back to the country, Dr Giri also proposes for individuals to seek travel advice from qualified medical practitioners before their travels.

“There are also public health measures that can be incorporated,” he says.

Specific parasites may require more targeted measures, but Dr Giri says generally the government should also implement policies to raise awareness of such diseases to reduce the risk of acquisition and come up with a provision for clean drinking water for everyone and good sanitation practices.

Depending on the burden of the disease and parasite, the government can also provide specific chemoprophylaxis and vaccines.

However, if you already suspect that you may be exhibiting symptoms of a parasitic infection of the central nervous system, medical professionals suggest seeking immediate medical consultation.

Dr Raymond says an individual’s stools can be sent to the lab to check for ova and cysts while physicians can perform a brain scan if there are neurological symptoms involved.

“If you suspect that you are infested with a worm, you need to consult a doctor.”

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