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Brain Worms On Our Minds

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. — 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. — 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."

You May Have A Brain Worm Like RFK JR. And Not Even Know It

Unapologetic conspiracy theorist and out-and-proud anti-vaxxer Robert F. Kennedy Jr. Has long been accused by clearer heads of having "brain worms."

On Wednesday, it emerged that an actual worm allegedly once set up shop in the longshot presidential candidate's brain.

"[A] worm… got into my brain and ate a portion of it and then died," Kennedy, 70, said during a 2012 deposition reviewed by The New York Times, which first published details of the previously unrevealed parasitic infection.

Kennedy, an environmental lawyer by trade, sat for the deposition amid divorce proceedings from his second wife, the late Mary Richardson Kennedy, claiming his overall moneymaking abilities had taken a hit due to decreased cognitive abilities. In addition to the brain worm, Kennedy said he had also been diagnosed around the same time with mercury poisoning, which he chalked up to a fish-rich diet.

Most polling shows a RFK Jr. Presidency is highly unlikely. But if Kennedy—who has thus far not made his medical records publicly available, but said the worm infiltrated his brain in 2010—does manage to beat Joe Biden and Donald Trump to take the White House in November, any major missteps will almost certainly be of his own doing, not the worm's, according to experts.

"The bottom line is, no, this would not cause lasting effects on someone's mental abilities," Dr. Philip Budge, M.D., PhD, a tropical diseases specialist at Washington University in St. Louis, Missouri, told The Daily Beast. "The worm in question does not 'eat' brain, regardless of what he says his prior doctor said. Rather, it forms a cyst that displaces a small amount of brain. When the cyst dies there is some inflammation that can transiently affect brain function but should not cause long-term consequences."

Dr. Mario Madruga, director of the Internal Medicine Residency Program at Orlando Health, said a person can be completely asymptomatic and that a dead brain worm "usually" causes no problems.

"If the organism is dead and calcified, you don't treat that," he told The Daily Beast.

Still, the cyst left behind can occasionally serve as a catalyst for seizures, according to Madruga.

On the other hand, if a brain worm is "active, alive, and causing inflammation, you could definitely have symptoms," Madruga said, noting that all manner of variables come into play, including location and how early the worm is discovered.

"Potentially, brain swelling—some of these parasites end up in areas where it blocks the spinal fluid from leaving the brain, which could cause increased pressure," Madruga said. "That can be an emergency, and needs to be treated immediately: either steroids, anti-inflammatories, or even neurosurgery."

In an email on Wednesday, Kennedy campaign press secretary Stefanie Spear said Kennedy "traveled extensively in Africa, South America, and Asia in his work as an environmental advocate, and in one of those locations contracted a parasite. The issue was resolved more than 10 years ago, and he is in robust physical and mental health. Questioning Mr. Kennedy's health is a hilarious suggestion, given his competition."

Many online have hypothesized that Kennedy was likely suffering from cysticercosis, a parasitic tissue infection spread by eggs from a tapeworm passed back and forth between pigs and humans. It is more likely to occur in those who live in, or have traveled to, places with poor sanitation and hygiene, according to Budge.

In some instances, cysticercosis can do significant damage, Budge explained, echoing Madruga. If the infection worsens, or if a larval cyst forms in a sensitive area of the brain, a person might develop "severe or lasting disease," he said, adding, "But for most people, who may not even know they have been infected, with one or only a few cysts, the cysts eventually die without any lasting damage."

The lifecycle of different species of Taenia saginata.

CDC

At this point, the body simply absorbs or degrades the cyst-encased worm, and a calcium deposit normally forms around what's left, Budge went on. This, he said, can stay there forever, usually without consequence, and can be seen on an X-ray or CT scan, which is what Kennedy's doctor saw and thought was a tumor, according to the Times.

Some parasitic brain worms have to be surgically removed, such as Ophidascaris robertsi, which is spread through contact with python feces. In 2022, an Australian was admitted to the hospital with a still-wriggling roundworm in her brain after complaining of abdominal pain, diarrhea, dry cough, fever, night sweats, forgetfulness, and depression. Doctors removed a three-inch worm from the woman's grey matter, calling it a "once-in-a-career finding."

Earlier this year, another case of cysticercosis made headlines, and involved an unnamed U.S. Man who enjoyed undercooked pork—specifically, "a lifelong preference for soft bacon," according to a study Madruga co-authored in the American Journal of Case Reports. He hadn't traveled to any high-risk areas, and "denied eating raw or street food but admitted to a habit of eating lightly cooked, non-crispy bacon for most of his life."

Madruga told The Daily Beast on Wednesday that the patient in this case had "a long history of headaches and migraines." And while he had no idea he had worms in his brain, these sorts of things can be found while looking for something else altogether.

"Everybody has headaches, some people have migraines, and they can mistake some of these signs and symptoms as a typical migraine—until it doesn't go away with what you usually use to take [it] away," Madruga said. "Or you have vision problems, nausea, vomiting, which, actually, is what a migraine is. So, you can see how it can be confusing."

Public health expert Dr. Irwin Redlener, M.D. Called RFK Jr.'s situation "a medical oddity in the context of a very complex presidential election season."

Kennedy "has lots of problems politically and otherwise," and his disclosure of brain worms "just adds a little extra dose of weirdness to this campaign," Redlener told The Daily Beast. However, as Budge also said, Redlener advised people not to "attribute anything he says or does to [the brain worm] issue."

For his part, Budge doesn't want people to be overly alarmed about worms getting into their brains. He emphasized that the malady is "uncommon," that it "usually does not cause problems," and that people in general "should not worry about being potentially infected."

"When people travel to developing countries they should see a travel medicine specialist," Budge said, "who will give specific advice, including about important vaccines and preventing other diseases like malaria."

Deadly Diseases

The female Anopheles mosquito may well be the most dangerous creature on Earth. When she lands on human skin, she sucks up blood through her needle-shaped mouth and injects saliva into the wound. If this saliva contains Plasmodia parasites, the victims will soon suffer severe fever, violent shivering, and profuse sweating — the telltale symptoms of malaria.

"Malaria" is a misnomer. Drawn from the Italian mala aria, or "bad air," the name reflects the historical belief that the disease is caused by miasmas, or noxious exhalations from rotting matter or stagnant water. In 1889, a tiny parasite was revealed as the disease-causing agent, and eight years later, the mosquito was identified as the parasite-carrying agent.

When a mosquito carrying malaria bites her victim, she injects parasites into the bloodstream, where they migrate to the liver and other organs and incubate. A malaria victim may show no symptoms for weeks or months during this incubation. Then the parasites return to the bloodstream and invade the red blood cells. Rapid multiplication of the parasites ruptures the red cells, releasing more parasites into the bloodstream and causing the characteristic symptoms. If the person does not receive prompt and effective drug therapy, damage may occur to the brain and other organs, sometimes leading to death.

Malaria is largely a geographical disease, endemic to tropical climates in Africa, Asia, and South America. An estimated 350 million to 500 million people worldwide are infected with malaria each year; of the more than one million who die, two-thirds are children. An African child under 5 suffers on average six bouts of the recurring illness each year.

In the United States, malaria was historically a problem in the southeastern states. Begun in 1947, the National Malaria Eradication Program (the precursor of the Centers for Disease Control, or CDC) applied the insecticide DDT to the interior surfaces of rural homes and entire properties where malaria was reportedly prevalent. About 4.6 million houses were sprayed, and five years later, malaria was considered eliminated in the United States.

A remarkable man named Fred Soper first took on malaria in Brazil in the 1930s. With the passion and determination of a field general directing an army, Soper eliminated the Anopheles gambiae mosquito from the country within a decade, stopping a deadly outbreak in its path. His success raised hopes that malaria could be eliminated worldwide. By 1948, 55 nations had signed up for the Global Malaria Eradication Program Soper would go on to lead.

With DDT as their tool, Soper's mosquito warriors were successful in sharply curtailing malaria or eliminating it entirely from nearly 40 countries, including Taiwan, many Caribbean nations, the Balkans, and parts of North Africa. But just as they seemed to be on the brink of victory, their luck ran out. First, mosquitoes began to develop resistance to DDT, and then, in 1962, Rachel Carson's Silent Spring identified the harmful effects of DDT on ecosystems. The chemical was subsequently banned in the United States. While this action benefited the environment, it hurt Soper and his team's international efforts to combat malaria, in which only a small amount of DDT was used indoors. To this day, researchers continue to look for a chemical comparable to DDT in its mosquito-killing effectiveness.

Despite decades of research work, a successful vaccine for malaria remains elusive. Scientists hope that the genetic decoding of the malaria parasite may offer helpful points of intervention for interrupting its life cycle. Meanwhile, several current research efforts seem promising, largely bolstered by the Bill & Melinda Gates Foundation (The Bill & Melinda Gates Foundation is a funder of the Rx for Survival project).

People residing in non-malaria-endemic areas are normally safe in their home countries, although a few cases are reported each year of "airport malaria," in which a mosquito, hitching a ride on an aircraft, causes disease. Travelers to malarial areas have a high risk of catching a serious infection because they lack the natural immunity that provides local residents some protection.

Tourists can take an antimalarial drug as an effective preventative. (If taken for a long time, some of these drugs have long-term side effects, and are therefore not recommended for residents of malaria-endemic regions). Doctors may prescribe a course of medication for travelers that covers the immediate time before, during, and after a visit to a malaria area. Several medications, including doxycycline, atovaquone/proguanil, mefloquine, and primaquine, have proven effective.

But malaria is one of nature's most resilient killers, and the Plasmodium parasite is becoming resistant to these older medications. A promising new drug, artemisinin, has been synthesized from a plant used as a treatment in China for centuries. Demand for artemisinin currently far outstrips supply, and costs of the treatment remain beyond the reach of many malaria victims.

About 99 percent of mosquitoes carrying the malarial parasite are night biters, so for travelers and native populations alike, netting treated with insecticide for sleeping areas is crucial. In the absence of an effective mosquito-elimination method, netting can prevent many of the one million malaria deaths of children under 5 each year, and save many adults from unnecessary illness and death as well.

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