Yes, you read that right. In medicine, it is termed as ‘Cardiac Cysticercosis’. Its really disgusting to think of, right? It might be but yes it exists. We will introduce you to this disgusting yet interesting condition in medicine- worms that can seek asylum in your heart. Let us introduce you to the terms one by bone.
What is cardiac cysticercosis?
Cysticercosis is a rare infection caused by the larvae of a cestode, Taenia Solium (Pork tapeworm). It is endemic in many parts of the world on account of the fact that there are not many stringent actions in place for controlling meat quality. It is estimated that nearly 50 million people are affected with cysticercosis worldwide. The larvae of Taenia Solium can get encysted in almost any tissue of the body including lungs, liver, kidneys, subcutaneous tissue, eyes, brain, and in the HEART too.
When the brain is affected, it is known as Neurocysticercosis(NCC) and when the heart is affected, it is known as Cardiac Cysticercosis. Neurocysticercosis is more common as compared to Cardiac Cysticercosis/Isolated Cardiac Cysticercosis.
Cardiac Cysticercosis is a rare but fatal condition as it may lead to cardiac failure or cardiac arrhythmias. Neurocysticercosis is also fatal. Cysticercosis of muscles usually remains unnoticed(symptoms-free).
Life Cycle of Taenia Solium– Explained
The life cycle of Taenia Solium usually begins with a pig ingesting eggs of the cestode from the fecal matter. The eggs hatch in the gastrointestinal tract and then they make their way through the gut wall and lodge themselves in the form of cysticerci. From here, their journey in the body of pig ends and now they need another host. When humans eat pork infested with viable cysticerci, the larval cysts(cysticerci) develop into adult tapeworms. Each of these tapeworms can release about 2.5 Lakh eggs daily.
A person usually gets cysticercosis by eating meat infected with eggs rather than the larvae. The larvae find their way into the soft tissues by travelling in the bloodstream.
Morphology of the cysts
The larvae after migrating through the blood lodge themselves in the tissues in the form of cysts. These cysts are like membranous sacs filled with fluid and encloses the larva. Since the environment is hostile inside humans, they can’t thrive for long. However, they do escape out immune system and are only able to trigger an inflammation response. They enlarge over time and when they burst, the neurological manifestation and shock are observed in the patient.
For the treatment of Cysticercosis or Taeniasis, Albendazole, an anti-helminthic drug, is commonly used. Sometimes, praziquantel is also used. Albendazole was approved for use in the treatment of Csyticercosis in 1996. Before this time, praziquantel was used.
Diagnosis and Radiological findings
Neurocysticercosis and other forms of Cysticercosis are commonly diagnosed through clinical history taking of the patient and through MRI and CT. In radiological findings, the cysts usually appear as cigar-shaped calcifications.
Is eradication of cysticercosis possible?
Cysticercosis is a common disease to occur but its rare manifestations are fatal. Since the only reservoir for the infection is the pool of larvae and eggs that reside in humans, pigs, and their feces. Prevention, as well as eradication of cysticercosis, is feasible as well as possible. People should adopt proper sanitization and personal hygiene measures for preventing it. The meat, especially pork meat should be properly killed before being eaten.
National Deworming Days
February 10 and August 10 are observed as National Deworming days every year to deal with the problem of infections by Soil-Transmitted Helminths (STH) and others. On these days, Albendazole is administered to children and teens in the age group of 1-19 years in various government educational institutes and Anganwadis. These days aim at eradicating Cysticercosis, Taeniasis, Ascariasis, etc.
Some Case Studies:
- Isolated cardiac cysticercosis: treatment with or without steroids? ( The Lancet)
- Isolated Cardiac Cysticercosis in an Adolescent (Pubmed)
Some References and Further Reads:
- Clinical trials for the treatment of Cysticercosis
- National Deworming Days
- Cysticercosis: Rare Disease Database
Himanshu Jindal-GSVM Medical College