FigureFigureMr. Y was an illegal immigrant. Fortunately, I'm not a border control agent, so I didn't care about his legal status. What brought him to my attention were the other illegal aliens he had brought with him: parasites. He hadn't been worried about the eggs dropping from his behind, tiny white balls that rolled down his leg and left little piles on the floor. No, what brought him to the attention of the medical community were the long worms he kept passing in his stool. He brought them in to various EDs as show-and-tell. Not my ED, where something perhaps would have been done but to other EDs and the walk-in clinics. Here he found that his sparse English and his lack of insurance brought him up against a brick wall. It probably didn't help that he was holding three-foot worms. He had been repeatedly turned away, allowed to continue spreading the little eggs at will. Eventually, he showed up at the health department. The eggs and worm samples were summarily sent off to the CDC, and within a few days, his parasite was identified: Taenia solium, pork tapeworm. Infection occurred initially when my patient had eaten undercooked pork in Africa, pork harboring some of the cysts that had hatched in his gut, latched on, and began to grow, creating eggs and producing new tapeworms. Eating undercooked contaminated pork is the main source of infection, but another method is fecal-oral contamination. If he had used the toilet, got eggs on his hands and didn't wash them off, and then touched food or serving ware, the eggs could be passed on to form tapeworms in other victims. Spreading Eggs My patient's job on the Gulf Coast was working the buffet in one of the major casinos. Consequently, he would be touching clean plates and perhaps serving utensils with his contaminated hands and spreading eggs throughout the many worldwide visitors to these casinos. I became involved when the regional medical officer of the health department, called my hospital asking for me. Why me? I'm not an infectious disease expert. I've never written a scholarly piece about the diagnosis and treatment of pork tapeworm. But we happened to sit next to each other at a county medical society meeting and we talked about my medical missionary trips to Africa. Apparently, that made me the local expert. He told me the diagnosis of the infection, and I went to my usual authoritative source: Google. Fortunately, the treatment was pretty simple; a single pill would cure him, killing all of his tapeworms. Our pharmacy said they could order the medication and have it within 24 hours. No Follow-Up Mr. Y lived with two other people in an apartment in Biloxi, an area where casino workers lived three or four or even seven to a room. One of the three, the one who owned the cell phone, understood a little English. I explained how his friend needed to come to the ED to be treated the next morning, repeating the address of our hospital several times, giving him the emergency department's phone number, and emphasizing how important it was for Mr. Y to show up. I posted the patient's name, his disease, his friend's phone number, the medication needed, and the number for the pharmacist who had promised to have the drug ready. I even mentioned the health officer. When I checked with the ED staff the next morning, they reported that Mr. Y had not shown up. I called his friend again and finally made him understand that he had to show up. Mr. Y arrived to get his medicine an hour later. The medical clinic director had me over for dinner two days later in appreciation of my efforts. (Who says good deeds are never rewarded?) I asked him about follow-up. It seemed to me that we had cured the source, but that it probably would be a good idea to treat Mr. Y's roommates and all the other workers in the casino kitchen and inform the local clinics and EDs to be on the lookout for other cases of tapeworm. He told me no further follow-up was intended. Letting word get out that a casino kitchen worker had been diagnosed with tapeworm would be bad for business, you see. We couldn't afford that! And this was in 2012. If you hear of someone who ate at one of the casino buffets complaining of strange things in their stool, just pat them on the back and suggest they go to their local health department. Then wash your hands well.
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