Neurocysticercosis in an Orthodox Jewish Community in New York City

From June 1990 through July 1991, intracerebral infection with the larval stage of the pork tapeworm Taenia solium was diagnosed in four unrelated persons in an Orthodox Jewish community in New York City. None of the patients had eaten pork, and only one had traveled to a country in which T. solium infection was endemic. We investigated this outbreak, screened serum samples from family members and household contacts for antibodies to cysticercosis, and examined stool specimens from household employees for eggs of taenia species. The four patients had recurrent seizures and brain lesions that were radiologically consistent with the presence of cysticerci. The diagnosis was confirmed in two patients by a brain biopsy, and in two by immunoblot assays for cysticercus antibodies. Of 17 immediate family members screened serologically, 7 from two families had cysticercus antibodies. Magnetic resonance imaging of the brain showed cystic lesions in two of the seropositive family members, one of whom had had a seizure. Examinations of six domestic employees from all four households revealed an active infection with taenia species in one and a positive serologic test in another. Since these women had recently emigrated from Latin American countries where T. solium infection is endemic, they were the most likely sources of infection in the members of these households. A diagnosis of neurocysticercosis should be considered in patients with seizures and radiologic evidence of cystic brain lesions, even in those who do not eat pork and who have not traveled to a country in which T. solium infection is endemic. Recent emigrants from countries in which T. solium infection is endemic should be screened for tapeworm infection in their stools before they are employed as housekeepers or food handlers. (N Engl J Med 1992;327:692–5.), NEUROCYSTICERCOSIS is an infection of the central nervous system with the larval forms (cysticerci) of the pork tapeworm Taenia solium. The two-host life cycle of the tapeworm involves humans as definitive hosts and swine as intermediate hosts. Pigs are the source of human taeniasis, an intestinal tapeworm infection acquired by eating undercooked pork contaminated with cysticerci. Cysticercosis, however, is acquired by ingesting taenia eggs shed in the feces of a human carrier of tapeworms and thus may occur in people who do not eat pork and have no contact with pigs. Cysticercosis may also develop in tapeworm carriers through…