Hi, Dr Bernard here. I’m not here to scare you about food trucks with this video. Sometimes we
like to joke that the sketchier the place, the more likely the food is really good. If you see
an unmarked food truck in the back alleyway by a dumpster, with an operator who’s been seen to
scratch between his legs and then touch the food, you're free to do what you like to do, but that’s
a little too sketchy for me. Luckily most trucks here in the United States are not like that.
A Man Ate Pork Tacos From An Illegal Food Truck. This Is How His Brain Shut Down.
CD is a 47 year old man, presenting to the
emergency room confused with a massive headache. His wife Natalie, tells the admitting nurse that
she found him collapsed, on the floor, shaking with his eyes rolling into the back of his head.
Several months earlier,
behind his office building, CD saw a food truck that he’d never seen before. He had heard some
stories about a mustached man, operating the truck, dropping by at random places in this
small town, to sell food so delicious that most people had never tasted anything like it before.
CD thought this
was kinda sketchy. A blank, unmarked truck, parked in the back alleyway. But he saw the
mustached man, and knew that this obviously is the perfect setting to enjoy the tastiest food.
At the truck now, CD decided to order
some pork tacos, on recommendation from the chef. At first, CD thought the meat felt maybe a little
too tender in his mouth, almost as if parts of it were like chewing the inside of his own cheeks,
maybe cooked medium rare. This was also the first time he had pork.. anything, except for maybe some
bacon, since he was a kid, so he didn’t quite remember exactly what the experience was like.
The flavor was bold and unbelievably delicious. Almost like it was made of something that wasn’t
allowed in this country.
Immediately after finishing the tacos, CD felt good. He was ok for the rest of
the day. As he was walking to his car on his way out of work, he thought he felt something
weird in his stomach. It didn’t last very long, so he didn’t think too much of it.
As the days passed,
CD would feel kind of strange at random times. Some weeks he’d have a cough that just wouldn’t
seem to go away. These would come with itchy and watery eyes and a low-grade fever. These could be
allergies but he didn’t know for sure.
One day, a couple months after eating those tacos, CD used the bathroom. He looked back
in the toilet and thought he saw some rectangular fragments floating around in the bowl, emanating
from the mass. He hadn’t seen these before. He thought they kinda looked like pieces of canned
tuna floating around. But he hadn't eaten any canned tuna recently. He told his wife about this,
but he wasn’t going to show her his stool, so maybe he was just seeing things, he thought.
At a regular health checkup,
CD asked about his low-grade fever, about his cough, and about some strange headaches that he
would get sometimes. He also asked about the tuna pieces that appeared in his stool. The physician,
after doing some tests told CD that this was probably allergies, it was springtime anyways, and
so he recommended some over the counter medicines to help with this, as well as recommend CD to chew
his food more often. This would just be better overall for his health. And he was on his way.
CD started hearing rumors on how the food
truck may have been an unlawful business, mostly just because their small town had never seen
anything like it. The mustached man didn’t seem like he was from around the town, and it was rare
here to have visitors, but other people said that the man didn’t have permission from the county or
the state or any other authority in this area, to operate a truck like this. Some of CD’s coworkers
reported random bouts of not feeling well after eating at the truck. One even reported that she
saw the man scratch between his legs and then touch the food right after, taking a small sample
for himself. But CD didn’t care, he remembered how delicious those tacos were. Months later, he
came across the truck again, got the tacos again, and his mind was blown at how good they were.
But a couple days later,
CD thought he felt strange and he didn’t know why. It was a little bit of a cough,
maybe like a fever. When he stood up from his chair, he felt like his stomach was getting
pulled into the ground and heat would radiate out of his neck, but this was short lived.
Over the next several months,
CD started feeling a constant throbbing sensation in his head that started happening everyday.
It felt like his head was heavy. One day, it hurt so bad it brought him down to the ground,
and he emptied his stomach from both ends, and afterwards, he felt even worse. In the other room,
CD’s wife Natalie hears commotion, and as she walks in, she sees her husband on the floor
shaking, with his eyes rolling into the back of his head, as she calls for 911, and he’s brought
to the emergency room where we are now.
At examination, the medical team sees CD have a generalized tonic-clonic seizure, the kind where
one shakes and convulses. Typically, these only last a few moments, but in CD, it wouldn't stop
until the pharmacist gave medicine to terminate it. His blood pressure was high, heart rate was
high, his eyes were wide open, but he was unresponsive. And this gives the medical team some clues as to
what’s happening.
CD’s wife started talking about the headaches that he had been experiencing over the last
several months. Taking over the counter medicines sometimes didn’t help. Both the seizures happening
now, and the headache developing over time, means that something has been happening to his brain,
but what could it be?
CD didn’t have any recent insomnia, which could suggest a psychiatric problem, or
something like a nutritional deficiency, or a tumor. He didn’t have any recent personality
changes and he didn’t have any sudden neck stiffness either, which could mean meningitis.
A blood test finds that CD has leukocytosis. Leuk
from Greek Leukos meaning white, cyte referring to cell, and -osis meaning a disorder of. White
blood cell disorder, and in this case meaning that there’s more white blood cells floating around
than normal. This could be because CD might have a brain infection, but having just had a seizure,
adrenaline was getting released into his body, causing white blood cells that typically stick to
the lining of his blood vessels to detach, maybe causing that leukocytosis and meaning meningitis
would be unlikely. But what wouldn’t be out of the question is maybe some other kind of infection.
CD told his wife about the pork tacos
from the food truck, but he didn’t tell her some of the other details about the truck. That some
of his coworkers had recently gotten sick after eating there. That he found the unmarked truck
hidden in the back alleyway. He told her about a weird “tuna fish” like appearance in his stool.
She tells the medical team about this and it gives them a more clear idea of what’s happening.
Pigs and humans have lived together
throughout much of history. This proximity has made for some special developments. Human stomachs
are a definitive host for a tapeworm called Taenia solium. The worms have a scolex that attaches to
our intestines, and they survive and feed off our diet while growing to be 20 to 40 feet
long. As time passes, their segments break off and appear in the person’s stool. Some of these
segments contain eggs and they’re called gravid proglottids. Remnants of this contaminated human
waste can get into pigs’ food supply. Pig stomach is similar to human stomach. Inside the pig,
Taenia solium oncospheres hatch and penetrate the intestinal wall, circulating into muscle tissue.
And when we eat meat, we’re eating muscle, this is where the exposure and then infection happens.
As the medical team
takes a stool sample from CD, they confirm, he has Taenia solium tapeworm segments in there. It
wasn’t canned tuna that he saw that day, it was pork tapeworm. And if he usually never ate pork
except for those 2 times at the unmarked food truck, then how did this happen?
In the United States, agricultural policy,
standards, and enforcement has helped to prevent Taenia solium from infecting pigs. Sanitation,
hygiene standards, and slaughterhouse inspection have made it so anyone living in the US, buying
USDA inspected pork, shouldn’t come into contact with Taenia solium. A different species of Taenia,
called Taenia saginata is known as beef tapeworm, comes from cows, different because of how cow
stomachs are different from humans and pigs. This is also something that you’re not going
to find with legal foods. Food trucks in the United States overwhelmingly are fine and not
at all like this.
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The Taenia that CD has, is Taenia solium, specifically
from undercooked pork. Cooking it well helps against infection. And he’s a person who doesn’t eat
pork, except for those 2 specific times.
In his workspace, another coworker who had eaten food from the same truck had also reported similar
symptoms. Reported what looked like canned tuna pieces inside their stool after feeling a low
grade fever over the span of several weeks. But this still doesn’t explain CD’s seizures.
A Brain MRI for CD reveals multiple lesions
representing viable cysts. The Taenia solium parasite, wasn’t just in his gut, but multiple
oncospheres had lodged into his brain and have been living there, for at least the last several
months. They passed through his stomach wall, got into small blood vessels, and crossed his
blood-brain barrier causing neurocysticercosis.
Multiple cysts were found at different stages of disease. When the larva cross in to the brain,
they’re small. They evade the immune system. At this vesicular stage, they make the brain
look like it has holes everywhere. But as time passes, these cysts start to change.
As the larva start to degenerate and shrink,
the immune system starts to react. Cysts enter the colloidal vesicular stage, and the brain starts to
swell from the extra immune response. The brain keeps expanding inside a closed space, the skull,
but those cysts aren’t going anywhere.
Then the cysts continue to degenerate. At first, they’re still active in the granular nodular
stage, but eventually, they become mineralized and inactive, with no swelling nearby. But this
nodular calcified stage can cause recurrent seizures due to the fact that a calcified,
dead parasite is lodged in and stuck in the brain.
The Taenia solium worm in the gut is from eating pork meat that has the oncospheres. Just eating
pork, doesn’t give brain cysts. The pigs were infected by eating human waste that has the
Taenia eggs and gravid proglottids. When the undercooked, infected, pork meat is consumed,
that part of the lifecycle causes the tapeworm in humans. But brain cysts come from a slight
deviation in the lifecycle, where humans come into contact with food that may have
been in indirect contact with human waste. So rather than the pigs eating the oncospheres,
humans eat them directly. This parasite, would have migrated in pigs to pig muscle, instead,
in humans, it migrates to the brain.
The owner-operator of the suspicious food truck had pork tapeworm himself. When he prepared
CD’s pork tacos, which he undercooked, hands that touched parts of the body containing Taenia eggs,
touched food that ended up in CD’s stomach. It’s not enough that CD just ate undercooked pork that
had Taenia oncoshperes from the pigs, but his brain infection was from consuming Taenia eggs
directly as if he were the pig, meaning that CD was infected twice by different forms of the
tapeworm.
This is an important point. The intestinal tape worm version of Taenia solium is from
eating undercooked pig meat. The brain infection, neurocysticercosis, is from eating parasite eggs
from a human who has the intestinal tape worm. That is, somehow, you are coming into indirect
contact with their feces, and ingesting it. Or they touched around their butt where Taenia
eggs can sometimes be found sometimes, and they touched something, that you happened to touch, and then
you make contact hand to mouth.
And knowing that this happens,
it should make sense as to why some traditions discourage the consumption of pork, if it’s not
for other reasons as well.
This isnt uncommmon. Around the world, neurocysticercosis is a common cause of
seizures. In some countries around the world, people get infected because they live in a
household where someone has a Taenia tapeworm infection. The infected person might use the
bathroom. They’ll wipe, or do whichever hygienic ritual they normally conduct post bowel-movement,
and they may not have washed off the Taenia eggs on their hands. They touch food,
eaten by others in the house, infecting them. As the oncospheres absorb into the gut,
they don’t form tapeworms in this case, they float around in the blood, sometimes crossing
the blood brain barrier and embed in. Over months to years, they form calcified masses in the brain,
and because you can’t just easily go into the brain to cut out whatever parts you want, these
aren’t easy to remove. At best, they don’t cause any problems, and people don’t even know they have
it. But at worst, they get into other parts of the brain. They can get into the eyes. The
spinal cord. The subarachnoid space. And they can cause seizures sometimes refractory to treatment,
all of this bringing us to the final point.
USDA inspected pork isn’t going to have this, so where did the truck get their meat? Well,
it’s been well documented that there exists an issue, whereby contraband meat is smuggled in to
this country, through various routes. Sometimes, you can find these unlawful products for sale,
no further than listings on local websites and on social media. These are meat products that
are banned likely for the reason of possibly spreading disease to humans and farm animals
in this realm. And while we may never know where the moustached man really got his pork from, we
know CD is a person whos only time eating pork was allegedly from the truck. And others also got sick
from this truck. In this case, we go with what the patient says. His wife didn’t appear to have
the tapeworm. And because the truck was mobile, operating in a small town that maybe hasn’t had
a need to handle food trucks, then we have a good guess as to where CD’s problem came from.
Food trucks, are almost never like this. If you’re
in an outdoor event, in warm weather in the US, it’s typically full of trucks, every which one has
been vetted. Probably inspected more often than most restaurants. The mobile medium, allows the
seller to set up shop quickly, make some sales, and they could disappear quickly, potentially
without any accountability should something go wrong. That’s why some places are super strict,
maybe a little too strict on food trucks, but the mobility of the truck is what sets it apart from
a stationary restaurant. Extra moving parts are always added, possible, points of malfunction.
As the
medical team evaluate CD’s situation, they start him on 2 antiparasitic medicines for both the
worms in his gut and the cysts in his brain. One medicine, praziquantel, forces calcium to enter
into the worm to force its muscles to contract, paralyzing it and getting its suckers to detach
and to dislodge. The other medicine, albendazole, destabilizes the parasite and begins to starve it,
depleting its energy. When the parasites start reacting to therapy, it can trigger an immune
response. Because we’re dealing with neurologic tissue, CD was started on corticosteroids to limit
that inflammatory response. He was also started on anti-seizure medicine to prevent another
seizure from happening again.
As CD was observed in the hospital for a few more days, he no longer had any more seizures and his
neurologic exam appeared to be normal. Everything else with his brain appeared to be ok. And when
he was discharged to go home, for several months after, he was noted to no longer have seizures
anymore, as it appeared he made a full recovery.
Thanks to Angie Burger for letting us film at her truck. Her burgers are DELICIOUS if you
get a chance, try them. Thank you so much for watching. Take care of yourself. And be well.