Brain Parasites Can Stealthily Cause Great Damage Worms

Robert F. Kennedy Jr.’s disclosure that a doctor apparently found a dead worm in his brain has prompted questions about what brain parasites are, the damage they can cause, and how, exactly, they get there.

Brain parasites encompass far more than worms. There are “legions” of organisms that can affect the brain, said Scott Gardner, a professor of biological sciences at the University of Nebraska-Lincoln who specializes in parasites, including single-celled organisms such as Toxoplasma gondii and some amoebas.

The damage varies depending on the type of parasite and where it ends up in the brain. “Some of them actively invade the tissues and destroy tissues,” said Dr. Daniel Pastula, chief of neuro-infectious diseases and global neurology at University of Colorado Medicine. Others cause an inflammatory reaction.

TAPEWORMS Humans are typically exposed to tapeworms through raw or undercooked food or through food contaminated with feces.

Doctors consulted by The New York Times speculated that Mr. Kennedy described symptoms of an infection with larvae from the pork tapeworm, Taenia solium, one of multiple types of tapeworm that can infect the brain. When a person accidentally swallows pork tapeworm eggs, the eggs hatch in the intestines, and the larvae can travel to other organs, including the brain. There, they form cysts, causing a condition known as neurocysticercosis.

It can take months, or years, for people to show signs of infection. Symptoms vary based on how many cysts develop and where they are (in the eyes, muscles, and spinal cord). Generally, people with neurocysticercosis experience headaches and seizures, and they sometimes feel confused, struggle to pay attention, and have issues with balance. The condition can be fatal.

AMOEBAS Another type of parasite that can affect the brain is a brain-eating amoeba. Infections of this kind are extremely rare but can lead to a potentially fatal swelling of the brain or spinal cord, said Tajie H. Harris, an associate professor of neuroscience at the University of Virginia. The organisms enter through the nose when people swim in lakes and rivers, and then travel to the brain. People have also been infected when using neti pots or other sinus rinses with untreated or non-sterile water.

TOXOPLASMA GONDII One of the most common parasitic brain infections is toxoplasmosis. Over 40 million people in the United States may be infected with the parasite that causes that infection, according to the Centers for Disease Control and Prevention. People can be infected by eating undercooked meat or contaminated shellfish, by drinking contaminated water, or by accidentally swallowing the parasite when they encounter it in cat feces in litter boxes.

The parasite that causes toxoplasmosis can linger in humans for years potentially, for one’s entire life – but most people will not develop symptoms. “For the most part, our immune system does an amazing job at just handling and dealing with this parasite, allowing us to live our lives without ever knowing,” Dr. Harris said.

But it can make some people feel as if they have the flu. People with compromised immune systems are at risk of serious illness and brain damage if infected, and developing fetuses can be severely affected if pregnant women are exposed. (That’s why doctors sometimes advise pregnant women to avoid coming into contact with cat litter.)

How would people determine if they had a parasite?

“You wouldn’t know yourself, unless someone is looking,” Dr. Gardner said. Sometimes a patient’s blood can be tested for antibodies that are produced in response to a parasite. In other cases, doctors call for an M.R.I. or a C.T. scan.

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