PORK TAPEWORM AND NEUROCYSTICERCOSIS

From the CDC[1]:

Neurocysticercosis is a preventable parasitic infection caused by larval cysts (enclosed sacs containing the immature stage of a parasite) of the pork tapeworm (Taenia solium). The larval cysts can infect various parts of the body causing a condition known as cysticercosis. Larval cysts in the brain cause a form of cysticercosis called neurocysticercosis which can lead to seizures. . . . A person acquires neurocysticercosis from unknowingly ingesting microscopic eggs excreted by a person who has an intestinal pork tapeworm.

From Epilepsy Currents[2]:

Neurocysticercosis is a leading cause of seizures and epilepsy in the developing world and is an increasingly important health issue in the United States. Recent results from the Cysticercosis Working Group in Peru provide new evidence supporting the use of antiparasitic agents in highly selected patients with active cysts and seizures.

1. Neglected Parasitic Infections in the United States - Neurocysticercosis. http://www.cdc.gov/parasites/resources/pdf/npi_cysticercosis.pdf

2. Neurocysticercosis. Epilepsy Curr. 2004 May; 4(3): 107–111. http://www.ncbi.nlm.nih.gov/pmc/articles/PMC1176337/

AN APHORISM

There is an aphorism in medical science which says: "You see what you look for; you look for what you know." It can work positively or negatively. If you know something exists but is hidden from view, you may be able to espy clues that thereafter will lead you to it. Thus, discoveries in diagnostic method may be made. On the other hand, if you know something exists in some instances and generalize it to be of significance in all, you may be right--or you may gravely mislead yourself and others.

Williams, Greer. The Plague Killers. Charles Scribners Sons, New York: 1969.

PROTEIN (MIS)FOLDING

An excellent, insightful lecture by Susan Lindquist on the process of protein folding, prions, and related diseases:

 

PECULIAR SUICIDE

The September 2012 issue of Forensic Science, Medicine, and Pathology contains an interesting article by Hejna, et al., analyzing a case of complex suicide. The article defines complex suicide as one "in which more than one suicide method is applied either simultaneously or successively (one after the other)" and distinguishes complex suicides by two variations: planned, where two or more methods of suicide are combined simultaneously; and unplanned, where a second method of suicide is attempted to compensate for some unsatisfactory aspect of the first, i.e. unbearable pain, or inadequate severity.

This particular case was an instance of planned complex suicide, with the 39 year-old victim employing both a firearm and hanging. While this combination tends to be the most common in planned complex suicides, what makes this case salient is the use of a black-powder derringer. In what was likely an attempt to improve lethality, the gun was loaded with a powder charge far exceeding manufacturer specifications. This resulted in instantaneous death and atypical markings circumscribing the ballistic entrance wound. The effectiveness of the shooting rendered the secondary method of suicide ineffectual, as evidenced by the lack of indicators which are normally present in hanging deaths (such as bleeding into the intevertebral discs).

Hejna, et al. conclude with five key points for forensic investigators to take away from this case:

"1. The combination of hanging and gunshot injury is the most common arrangement involved in primary complex suicides. 

2. Injuries and fatalities resulting from the use of black powder handguns are relatively rare compared to other firearms. 

3. Black powder weapons produce entrance wounds with extensive sooting and powder tattooing (in close range and intermediate range shooting). 

4. The wounds from black powder firearms may have a characteristic sulfurous odor and the soot deposits may have a yellowish color. 

5. The atypical morphology of the entrance wound with extensive back spatter in this presented case was conditioned by the excessively short barrel of the derringer, a higher amount of black powder charge and by artificial incision of the projectile ogive."

 View of the victim as found, with prominent atypical entrance wound. [Hejna, Fig. 2]

"The handgun used– black powder muzzle loading doublebarreled derringer." [Hejna, Fig. 6]

Hejna, Petr; Šafr, Miroslav; Zátopková, Lenka; Straka, Luboš. Complex suicide with black powder muzzle loading derringer. Forensic Science, Medicine, and Pathology (2012) 8: 296-300. 

POX

I'm through about 25% of Deborah Hayden's book, POX: Genius, Madness, and the Mysteries of Syphilis. Thus far, the work is riveting. Competing theories on the biological evolution and epidemiology of syphilis are weaved throughout a cogent narrative, flavored with notable excerpts from historical records. Apart from the Great Mortality, I can't think of another disease which was so widely personified by poetic mythos and dark imagination as was syphilis. Consider this lurid description by 19th Century French poet Théophile Gautier:

"There is a splendid American pox here, as pure as at the time of Francis I. The entire French army has been laid up with it; boils are exploding in groins like shells, and purulent jets of clap vie with the fountains in the Piazza Navona . . . tibias are exfoliating in extoses like ancient columns of greenery in a Roman ruin . . . lieutenants walking in the streets look like leopards, they are so dotted and speckled with roseola, freckles, coffee-colored marks, warty excrescences, horny and cryptogamic verruccae and other secondary and tertiary manifestations which appear here after a fortnight." [1]

1. Hayden, Deborah. Pox: Genius, Madness, and the Mysteries of Syphilis. Basic Books, New York: 2003. Quoting Claude Quétel: History of Syphilis (1990).