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An Indian vegetable vendor washed green vegetables in a polluted water canal in New Delhi on December 11, 2013. Prakash Singh/Agence France-Presse/Getty Images
One Saturday in January, five-year-old Tanishk George lay in bed shaking uncontrollably.
His eyes rolled back so only the whites were visible and he squeezed both his hands into tight fists. Then suddenly, Tanishk’s body became very stiff. His father, Prince, shook him to bring him back to consciousness.
The boy woke up feeling weak and unable to sit. “I had the scare of my life,” said Mr. George, who immediately rushed his son to the hospital. Doctors found that Tanishk had a cyst in his brain containing larvae of the pork tapeworm.
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Tapeworm cysts in the brain have become a major public-health problem in India and other developing countries.
Their presence can cause epilepsy and other debilitating problems including, in extreme cases, dementia.
The infection is more easily acquired than one might think, and both rich and poor are susceptible.
“Anyone of us can get it, and it is very widely prevalent,” says V. Rajshekhar, head of a neurosurgery unit at Christian Medical College in Vellore, Tamil Nadu.
Though the Indian government does not keep official statistics on the number of people infected, neurologists estimate that more than a million people in India are affected by cysts that contain tapeworm larvae. Doctors say they lack data to show whether the problem is growing, but they find that it is being diagnosed more often thanks to the availability of better medical tests and greater awareness about the disease.
Tapeworm eggs get into human bodies when people consume food or water contaminated with human feces.
Here’s how the cycle works: A human who has an adult tapeworm in his body may release tapeworm eggs when he defecates.
In India, where many people defecate in the open, rain water brings human feces into fields and areas where vegetables are grown.
In Mumbai, for instance, green vegetables such as coriander, spinach and cabbage are grown on the sides of local railway tracks where people defecate and near sewage.
The Yamuna river in Delhi, which provides water for growing vegetables and fruit on its banks, is said to contain human feces.
When humans eat these vegetables without cleaning them properly, the tapeworm eggs enter human bodies.
This makes it critical to be careful about what you eat. Green leafy vegetables that grow close to the soil can hold tapeworm eggs. These must be washed thoroughly before eating.
“It has to be a running jet of water so that the eggs get blown off by the force of the water,” says Manjari Tripathi, a professor of neurology at the All India Institute of Medical Sciences in Delhi.
Doctors in India advise not eating raw vegetables and salads made outside the home unless the restaurant follows a high level of hygiene.
Mr. George suspects that his son got the tapeworm egg from Chinese takeout, which often includes vegetables and cabbage which he thinks may not have been properly cleaned or cooked.
Since these eggs transfer onto human hands easily, it is key that cooks routinely wash hands.
These larvae can puncture the stomach wall and “float through the blood,” says Dr. Vinit Suri, a neurologist at Indraprastha Apollo Hospitals. They may go into muscles or the eye or the brain and form a cyst.
When a cyst lodges itself in the brain or another part of the central nervous system, it causes neurocysticercosis, a leading cause of seizures.
The cyst can remain alive for a long time in the brain without causing any problems for the patient, and remain undetected.
“This will announce its arrival by a symptom,” says P. P. Ashok, head of neurology at Mumbai’s P.D. Hinduja National Hospital & Medical Research Center.
When the cyst dies, it causes a reaction such as brain swelling, severe headaches, and in some cases vomiting.
In many cases, it can cause seizures or epileptic attacks. Doctors estimate than brain cysts may be behind up to half of all epileptic attacks in India.
Brain scans by CT and MRI can help detect such cysts.
The cyst typically dies naturally in the brain or wherever it is lodged and is eventually absorbed by the body. The patient has to wait out this process, and some symptoms including seizures can continue during this time.
Doctors typically prescribe medicines to prevent seizures and steroids to reduce inflammation. A patient may have to take medication for six months to two years. In some cases, surgery is needed.
Since seizures occur erratically, doctors may advise that patients not drive, swim or even lock the bathroom door in case an episode occurs putting their lives in danger. The uncertainty of occurrence and the strong effect of medicines can potentially incapacitate a patient for days or weeks.
Doctors say that a majority of patients recover within a year or two.
Mr. George’s son has been on medication since January and though he hasn’t had another seizure, the doctor said Tanishk will likely continue medication for three years. They will do another brain scan next month, says Mr. George.
If a person has multiple cysts in the brain, the effects are much more severe.
Rakesh Sahni, a 61-year-old resident of Uttar Pradesh, was found to have multiple cysts in his brain more than seven years ago.
Over the years, Mr. Sahni’s ability to use his brain has weakened and he suffers from lapses of memory and loss of control over his bodily movements and is not able to sit down or walk on his own, according to his wife, Geetika Sahni.
Mrs. Sahni has taken her husband to several doctors who have prescribed a variety of medicines, but she isn’t sure when or if he will be able to be regain control of his body completely.
“I wish there was some way he could become like his old self again,” says Mrs. Sahni.
How to Avoid Tapeworm Eggs in the Brain
Cook meat, especially pork, thoroughly and at a high temperature.
Wash leafy, green vegetables such as coriander, spinach and cabbage with a strong jet of water to wash off any eggs.
Avoid uncooked food from places where you don’t know how things have been washed.
Make sure whoever is cooking washes their hands regularly to prevent the spread of tapeworm eggs.
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