Gruesome Parasitic Growth Cut From Boy's Brain

A teenage boy had a giant growth removed from his brain after being infected with a parasitic tapeworm.

The previously healthy 14-year-old from a farm in India sought medical attention after experiencing episodic headaches and vomiting for one month.

Doctors eventually diagnosed the boy with a form of echinococcosis—an infectious disease caused by tapeworms. The case study was published in The New England Journal of Medicine (NEJM).

More than 1 million people may be affected by echinococcosis at any one time around the world, figures from the World Health Organization show. Many of these individuals will be experiencing severe clinical syndromes that can be life-threatening if left untreated.

The 14-year-old boy in question was infected by the larval form of the tapeworm species Echinococcus granulosus. This leads to a form of the disease known as cystic echinococcosis.

This is characterized by the development of one or more cysts—a sac or cavity of abnormal character in the body containing fluid—most frequently in the liver and lungs. These cysts can also form in the bones, kidneys, spleen, muscles and central nervous system, albeit less frequently.

"Once ingested, most of the larvae of the tapeworm get trapped in the liver or lungs," Dr. Sumit Thakar told Newsweek. He is an author of the case report and senior consultant in the Department of Neurosurgery at Sri Sathya Sai Institute of Higher Medical Sciences in Bangalore, India.

Occasionally, some of the tapeworm larvae make their way into the blood circulation of the rest of the body and end up in unusual sites like the brain. There, they cause the formation of single or multiple cysts that slowly enlarge.

When the disease affects the brain in this way—as was the case with the 14-year-old Indian boy—it is described as cerebral cystic echinococcosis. This condition is "very rare," Thakar said.

"The brain is affected in less than 2 percent of the cases of tapeworm infection, and is seen more commonly in children and young adults," he said.

Symptoms, such as seizures, headache, vomiting, weakness or sensory deficits, may develop as the cyst enlarges and causes pressure on the surrounding brain. The tapeworm may be present in the patient's body for many years before cysts grow to the extent that they cause noticeable symptoms.

"If the infection is left untreated, complications can arise due to raised pressure within the brain caused by the enlarging cyst," Thakar said. "Sometimes, if the cyst ruptures, either spontaneously or during surgery, the cyst fluid might escape out, resulting in an allergic reaction that the patient might succumb to."

Cystic echinococcosis occurs around the world and is found in every continent except Antarctica. Infections most frequently occur in rural areas where older animals are slaughtered.

"Dogs or livestock are the usual victims of this tapeworm infestation," Thakar said. "Humans get the infection by accidentally ingesting the tapeworm's eggs or coming in close contact with infected dogs or livestock, or by consuming water or vegetables contaminated with the excreta of the infected animals."

The young boy from India likely contracted the tapeworm via contact with infected livestock or canine feces, the case-study authors said. The infection resulted in the formation of a single, large, fluid-filled cyst in his brain.

"Cysts like these have a thin wall and contain milky fluid with high protein and lipid content," Thakar said. "The innermost layer of the cyst gives rise to smaller 'daughter' cysts. The outermost layer of the wall is formed as a result of the reaction of the brain cells that encase the cyst."

To treat the boy, Thakar and colleagues performed a craniotomy and then successfully removed the cyst. A craniotomy is a procedure that involves cutting a small hole in the skull to expose the brain underneath.

"During surgery, it is important to carefully peel the cyst off from the brain without rupturing it," Thakar said. "Spillage of the fluid from within the cyst can result in spread or recurrence of the disease, and sometimes a life-threatening reaction."

The patient's symptoms resolved completely soon after surgery. He returned to school and resumed normal activities within two weeks of being discharged from hospital.

Thakar said there was no lasting damage from the cyst that was removed from the boy's brain. However, he was prescribed a three-month course of albendazole—a medication used to treat tapeworm infections.

The neurosurgery department at Sri Sathya Sai Institute, where Thakar has been working for 15 years, has seen only 15 cases of cerebral cystic echinococcosis in the past two decades out of 400,000 patients treated, the doctor said.

"We have seen a relatively large number of these cases since most of our patients are from rural India, ours being a fully charitable, tertiary-care private hospital—where all treatment is completely free of cost to patients," Thakar said.

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