The cause of the man's severe migraines turned out to be porcine tsetse
Headaches are a common condition that most people experience repeatedly throughout their lives. They can occur for a variety of reasons. A recent episode from the practice of American doctors has shown that parasitic infections can also manifest themselves as migraines.
A 52-year-old Florida resident turned to the doctors for help with complaints of increased migraines in the last four months. According to the patient, the pain was concentrated in the back of the head on both sides and could not be relieved with the usual medications. The man also suffered from diabetes mellitus and obesity. The doctors did not note any other notable details in the history or additional neurological symptoms such as seizures or facial asymmetry. The only thing that alerted them was the patient's mentioned fondness for undercooked bacon.
Subsequent examination with CT scan and serological tests confirmed the medical staff's suspicions. The man's brain was found to contain a cluster of cysts (eggs) of the tapeworm Taenia solium, also known as the pig's chain or solitaire.
The most common source of this parasitic infection is eating undercooked meat contaminated with larval cysts of the helminth. Just this gastronomic habit was confessed by the patient.
Having thus entered the human body, the porcine chain develops and settles in the upper part of the small intestine, where it attaches to the mucous membrane with suckers and hooks. This intestinal form is called teniasis. The parasite can grow up to one and a half to two metres in length and reproduces by laying eggs or body segments with them, which are excreted from the intestines of the patient with the faeces. The disease is treated with anti-parasitic drugs.
However, the US patient had not teniosis, but its complication - neurocysticercosis, in which the larvae of pig solitaire, called cysticerca, from the gastrointestinal tract with the bloodstream penetrate into the central nervous system and brain. Medics have suggested that the man developed the disease as a result of repeated self-infection due to poor hygiene: he may have ingested the parasite eggs without washing his hands thoroughly after using the toilet.
Neurocysticercosis often manifests as seizures, but in this case the symptom that prompted the doctors to perform a CT scan was a change in the nature and frequency of migraines. After a definitive diagnosis was made, the man was treated. In addition to the antihelminthic agents albendazole and praziquantel, he took the steroidal anti-inflammatory drug dexamethasone to prevent seizures and reduce cerebral oedema. The patient was closely monitored in the intensive care unit. After the course, the patient's condition improved and headaches subsided.
We would like to add that neurocysticercosis is the most common helminth infection of the nervous system and one of the main causes of epilepsy in the world, especially in developing countries of Africa, Asia and Latin America. In developed nations, the disease is more common among immigrants and travellers to different parts of the world.
In the case described, the US patient had no recent travel or contact with pigs on the farm. In a report published recently in the American Journal of Case Reports, health officials identified uncooked bacon as the most likely cause of primary infection and recommended that regulatory authorities pay attention.