Neurocysticercosis

Repost of a post I wrote for the Global Health Diaries, the blog of the Global Health Program at the University of Vermont Robert Larner M.D. College of Medicine and the Western Connecticut Health Network. Find the original here.

Recently, I treated a patient with neurocysticercosis. While infection with Taenia solium is not common in the US, neurocysticercosis is not a zebra in Danbury, Connecticut because many patients are originally from countries where Taenia infection is a threat. The patient I saw was young and presented after having a seizure. Though they had received their diagnosis several years earlier at another US hospital, the disease course had started long before. Initially after their diagnosis, antiseizure medications were effective. The latest seizure occurred after a series of unfortunate events caused the patient to stop the medications.

The CT scan showed speckled calcifications throughout the brain. MRI revealed several enhancing lesions convincing us there was a need for antiparasitic and steroid treatment. The patient did well after treatment initiation and was discharged home to complete their albendazole and steroid course with a plan to follow-up with neurology. Their case lingered in my mind. It lingered not because of sadness or complexity, but because it reminded me of how connected our global population is and because the patient had impressed me with their calmness.

COVID-19 has highlighted how easily communicable diseases can travel and how important the health of the global community is for the health of our local communities. And while Taenia solium is an infectious disease, it does not spread like COVID-19. My chances of infection with Taenia solium are meager while living in Danbury, CT. Yet, we have patients with neurocysticercosis because people are mobile. I find it fascinating that the mix of diseases that are the most common in a particular hospital is not only dependent on the vectors and circumstance of life in the hospital region, but also the experiences and diseases prevalent in the places from which the people who make up the community around the hospital came.

As I contemplated our connectedness, the patient impressed me with their politeness and trust. Here was a person who was sick and did not speak English, yet they had complete faith that we could help them. I found myself humbled remembering that patients rely on us, the medical community, to guide them to better health when disease strikes. The patient’s calmness spread to anyone who spoke with them. There is something impressive about patients who can impart positive feelings on those around them despite being sick. I thought about the patient’s history and all the roads they had traveled so that our paths crossed during my medical training. Mobility is an amazing feature of the human experience. It both connects and separates us.