Sunday, 15 January 2017

Friedrich Küchenmeister and the Pork Tapeworm



Humans have known about the pork tapeworm since ancient times, mainly because of its size, but it wasn't until scientists of the mid-19th century turned their minds to it that anyone knew how this two- to ten-meter-long parasite gets into a human intestine in the first place. Early research methods were logical but often unethical.

Taenia solium Today


Over the millennia T. solium has been extraordinarily successful. No one knows how many people today have a pork tapeworm living in their intestines, but one estimate suggests a number between 11 and 29 million in Latin America alone. The same authors (Coyle et al, "Neurocysticercosis: Neglected But Not Forgotten") estimate that almost 15 million people in Latin America have neurocysticercosis, a disease where the larvae of T. solium live in the brain. Both the worm and neurocysticercosis are common in Africa, India, and parts of East Asia too.


A drawing of a pork tapeworm showing
the head (at lower left and center right)
with its suckers and a rosette of hooks,
and the long string of segments.
Delorieux drew this picture in 1831 for
Johann Gottfried Bremser.
One acquires a pork tapeworm by eating the larval form, or cysticercus, in undercooked pork. Pigs are infected by swallowing eggs produced by the adult worm and passed in human feces. Those eggs cause neurocysticercosis as well, when humans accidentally swallow them. Today, as in the past, the pork tapeworm is common where sanitation is poor.

In 2010, the World Health Organization added cysticercosis – larvae of T. solium in any body tissue – to the list of major neglected tropical diseases. It was another step in the long battle that began in earnest when Friedrich Küchenmeister, a German doctor and parasitologist, demonstrated that a particular large intestinal tapeworm of humans and the tiny cysticerci of pigs are different stages of the same creature.

Friedrich Küchenmeister


Taenia solium was a common European parasite in Küchenmeister's day. In his book On Animal and Vegetable Parasites of the Human Body, he described examining “freshly expelled Taeniae,” and  wrote that his “wife found cysticeri in the water used in washing sausages.” He also gives a detailed and colorful account of the scientists and theories of the day.

According to Küchenmeister, a few of his contemporaries almost figured out how the worm's life cycle worked and “might have saved... science from a most unpleasant debate.” They concluded, however, that the small tissue parasites of pigs were degenerate tapeworms that had strayed into the wrong host: “It appears to have been a peculiar fate,” Küchenmeister wrote, “which prevented the earlier solution of this zoological problem; naturalists either could not correctly comprehend the true direction of progress, or...they ignored the labors of their predecessors.”

Discovering the Life Cycle of T. solium



Humans get T. solium by eating the larval cysticerci in undercooked pork.
 Pigs get it by eating human feces that contain worm eggs. In cysticercosis,
humans eat the eggs and harbor larvae in the tissues, like the pig.
Life cycle diagram courtesy of United States CDC.
Küchenmeister wrote: “the thought... suggested itself to my mind, of administering various cystic worms [cysticerci] to different animals.” In 1851 he tried this with dogs and cats, and when the animals developed tapeworm infections, he concluded “the cystic worms constitute a necessary step in the development of the Taeniae.”

He figured out neurocysticercosis as well. In 1853, Küchenmeister fed the eggs of T. coenurus (a tapeworm of dogs) to a sheep to prove this caused a disease called vertigo. His experiment went slightly awry when the farmer, “Herr Kärmsen... only sent [him] the head for examination; the rest of the body was kept to be eaten by the people on the farm.” Nonetheless, he found “fifteen young vesicles of Coenurus, partly on the surface of the brain, which was reddened by inflammation, partly in the substance of the brain, and even in the ventricles.” Küchenmeister described similar cases in humans – neurocysticercosis.

Küchenmeister's Unwitting Volunteer


Küchenmeister and his peers continued to perform various experiments of this sort. He believed that raw pork was the source of the human tapeworm: “We find this Taenia very abundant wherever the breeding of pigs flourishes..." he wrote, "and especially amongst those engaged in trades which bring them in contact with raw pork... (as butchers, cooks, eating-house keepers and etc.) or in people who obtain portions of ready cooked or smoked sausages and hams from the butchers' shops.”

Getting definitive proof was difficult however: He couldn't experiment on humans as he did on animals. Or could he? Küchenmeister devised a plan, and then set his most famous - and most controversial – experiment in motion: without the man's knowledge or consent, Küchenmeister fed cysticerci found in pork to a convict who was sentenced to hang, and then dissected the body after the hanging to see if the man had intestinal tapeworms.


Friedrich Küchenmeister details his theories
and experiments in his book On Animal and

Vegetable Parasites of the Human Body, a

Manual of Their Natural History, Diagnosis,

and Treatment.
Book cover: Friedrich Küchenmeister.
“[I made] the following experiments upon a murderer condemned to death," he wrote. 72, 60, 36, 24 and 12 hours before execution 12, 18, 15, 12, and 18 specimens of Cysticercus cellulosae were administered to the criminal partly in rice or vermicelli soup cooled to a blood heat, and partly in blood puddings from which the fat was removed and replaced by cysticercae.

"On dissection, forty-eight hours after execution, I found ten young Taeniae... The little Taeniae were 4 – 6 millimeters in length, had exserted [sic] their hooks and proboscis and attached themselves therewith to the intestine...

“Subsequent experiments of the same kind will certainly give us the means of tracing the progress of this Taenia as it increases in age, according to the various times of the administration of Cysticercus cellulosae.”

Despite criticism, Küchenmeister repeated his experiment a few years later, again using a criminal facing the death sentence. This time he administered the larvae months ahead and recovered young T. solium tapeworms at a later stage of development. His experiments established that the worms were indeed the adult stage of the parasite found in pigs.

Today, no ethics committee would approve such an experiment, but research into the worm is ongoing, with many scientists focusing on ways to eradicate this serious and neglected tropical disease.

Further reading on Friedrich Küchenmeister and Taenia solium


Coyle, C.M., Mahanty, S. et al. (2012). "Neurocysticercosis: Neglected But Not Forgotten." PLoS Neglected Tropical  Diseases 6(5): e1500. doi:10.1371/journal.pntd.0001500. Accessed April 3, 2017. 

Küchenmeister, Friedrich. On Animal and Vegetable Parasites of the Human Body, a Manual of Their Natural History, Diagnosis, and Treatment. Translated from the 2d German ed., by Edwin Lankester. (1857). Sydenham Society. Accessed April 3, 2017.


World Health Organization. Taeniasis/Cysticercosis. Fact Sheet N°376. (2013). Updated March 2017.


Friday, 11 September 2015

Mysteries of Entamoeba histolytica and Amebic Dysentery



A beautiful Entamoeba histolytica
trohpozoite; Image by Stefan Walkowski,
CC BY-SA 3.0

Entamoeba histolytica has always had us guessing. It’s the only Entamoeba species that causes disease. Why? It causes amebic dysentery in some people and not in others. Why? How does it invade tissue? Fedor Lösch was the first to describe the organism (1875), which he found while looking for the cause of dysentery in a Russian patient. Lösch guessed that the organism he called Amoeba coli was not the cause of the illness, but he guessed wrong.

Prevalence of Entamoeba histolytica


For more than a hundred years after its discovery, we thought E. histolytica was much more common than it actually is. During that time, researchers gradually separated out the look-alikes: Entamoeba coli (1879), E. hartmanii (1912), E. polecki (1912), E. moshkovskii (1941), and finally E. dispar (1978). We now know that many organisms formerly identified as E. histolytica were actually the morphologically identical, but nonpathogenic E. dispar. Estimates that 10% of the population is infected with E. histolytica have been revised downward to 50 million symptomatic cases (although many infections are asymptomatic) (Medscape). In reality, nobody really knows.

How Did Entamoeba histolytica Become Pathogenic?


Entamoeba histolytica differs from the other Entamoeba species in that it can invade tissue. It can cause amebic dysentery, with ulcers and abscesses in the intestine, and it can travel further to set up abscesses in other places - usually the liver, sometimes the lung or the brain.

I can see that causing diarrhea might be to the amoeba's advantage: this would result in organisms being rapidly expelled from the body to contaminate the environment, with other potential hosts being exposed. But diarrhea usually means the release of the vulnerable trophozoite stage, not the hardier infectious cyst stage, and organisms in deeper abscesses would never reach the outside world. How does tissue invasion benefit the parasite?

Maybe it doesn’t. One theory suggests that the ability of E. histolytica to invade and feed on human tissue is coincidental: the same thing that enables it to feed on bacteria and other organisms, and compete for food in the intestine, just happens to enable it to feed on our cells as well. That would make abscesses in the liver and other organs simply bad luck for both parasite and host.

Another theory explores the possibility that virulence develops when hosts are crowded together. When diseases are easily passed from one host to another due to crowding, the organisms that quickly make people sick and contagious do better than the slower-moving ones. This could explain how E. histolytica might have evolved as a pathogen in the cooler climate of Europe.

Where Did Entamoeba histolytica Evolve?


The recent discovery of E. histolytica in a Jerusalem cesspit dating back to Medieval times (15th and 16th century) is suggested evidence that people were visiting the city from Europe. Interestingly, E. histolytica has been confirmed in a number of European coprolites dating back as far as 500 BCE. But very few coprolites from tropical locations have been tested for E. histolytica and the evidence might be gone after so long in a tropical climate.

Did E. histolytica spread around the world from Europe? Europeans certainly had it and spread it, but I find it difficult to believe that E. histolytica evolved in what is today Europe for a number of reasons:
  • It is an ancient and predominantly human parasite, and humans didn’t evolve in Europe.
  • It is vulnerable to cold, dying at temperatures below 5C. This is in contrast to other parasites such as Giardia and Cryptosporidium, which survive much colder temperatures and are more common in cooler climates, even today.
  • It is relatively uncommon in Europe and other temperate climates today, but very common in the tropics.
  • A number of early accounts from other parts of the world appear to describe amoebic dysentery. The earliest of these came from 1000 BCE in India, and Avicenna’s writings from the Middle East around 1000 CE have good descriptions of both amebic dysentery and liver abscess.

The mysteries remain unsolved. I’m interested to see whether further research can resolve them. Meanwhile, E. histolytica continues to cause an estimated 100,000 deaths annually.



Further Reading


Cox, F. E. G. 2002. "History of Human Parasitology." Clinical Microbiology Reviews 15(4) 595-612 doi: 10.1128/CMR.15.4.595-612.2002

Harrison, Alan. 2015 “500 Year Old Toilet in JerusalemReveals Clues About Long-distance Trade and Travel in the Medieval Period" Bugbitten

Roberts, Larry S., and John Janovy Jr. 2009. Gerald D. Schmidt & Larry S. Roberts’ Foundations of Parasitology. Boston, McGraw Hill.

Samie A, ElBakri A, and AbuOdeh R. 2012 "Amoebiasis in the Tropics: Epidemiology and Pathogenesis." Current Topics in Tropical Medicine, Dr. Alfonso Rodriguez-Morales (Ed.), ISBN: 978-953-51-0274-8, InTech

Sargeaunt PG, Williams JE, and Grene JD. 1978 “The Differentiation of Invasive and Non-invasive Entamoeba histolytica by Isoenzyme Electrophoresis.” Transactions of the Royal Society of Tropical Medicine and Hygiene 72 (5): 519-521 doi:10.1016/0035-9203(78)90174-8

Singh U, Huston CD. 2012 “Evolution of Entamoeba histolytica Virulence.” In Evolution of Virulence in Eukaryotic Microbes, L. David Sibley, Barbara J. Howlett, Joseph Heitman (Eds.) Chapter 22.

Friday, 10 July 2015

Dodging Mosquito-Borne Diseases

Malaria, dengue fever, Japanese encephalitis, yellow fever, chikungunya, West Nile and other unpleasant diseases are mosquito-borne. The WHO estimates that, each year, there are:
•    390 million cases of dengue (2015)
•    198 million cases of malaria (2013)
•    200 thousand cases of yellow fever (2014)
•    68 thousand cases of Japanese encephalitis (2014)

Those are big numbers. Travelers need to be alert to health risks from mosquito bites in some parts of the world, but mosquito borne diseases can be avoided.

Who Has the Most Dangerous Mosquitoes?

You might not know you've been bitten by a mosquito
until you become ill. User: Ngari.norway CC BY-SA 3.0

Mosquito bites in North America, Europe, northern Asia and most of Australia are unwelcome but usually not considered life threatening. They’re painful, itchy, and can become infected, and the sound of a bloodthirsty mosquito whining around your head can drive you mad. Mosquito-borne diseases, however, aren’t usually a big concern. In recent years, a slight risk of contracting West Nile virus has heightened the level of concern about mosquito bites in North America.

In the tropics, it’s different. Mosquito bites can be deadly. Day flying mosquitoes transmit dengue fever and yellow fever: the night flyers bring malaria and Japanese encephalitis. Some locations as well as some seasons mean higher risk. Be careful. The first line of defense is to know the enemy – travelers should take time, before they go, to find out what the risks are at their destination.

Preventing Mosquito-Bourne Diseases


Travelers can be immunized against yellow fever and Japanese encephalitis, and antimalarial drugs are advised to prevent malaria, but none of these work 100 percent of the time, and there’s no protection against dengue or chikungunya. The only way to be sure you don’t catch any of the mosquito borne diseases is to be sure you don’t get any mosquito bites. It’s not as easy as you might think.

A trip to Southeast Asia – my first trip to a destination where mosquitoes were a particular concern – taught me many useful things:

•    Even in the dry season, there are mosquitoes virtually everywhere you go; I saw my first Asian mosquito in the taxi from the Bangkok airport.

•    Many hotels and guest houses do not have intact window screens and tight doors – mosquitoes get in through grates, tears in screens, and under doors. Perhaps this shouldn’t have surprised me, but it did.

•    Mosquito bed netting often isn’t provided either. Mosquito bed netting is indispensable, preferably netting that has been soaked in mosquito repellent. Buy it at home and take it with you. Don’t assume there will be a hook available to hang bed netting – carry a hook that can be screwed into wood and a long piece of cord that you can stretch across a room, say from a curtain rod to a closet rod or some other fixture. You may have to get creative.

•    Don’t expect the local people to warn you about mosquitoes or help you take precautions. Their level of concern can be surprisingly low and they may deny the presence of mosquitoes even when you have just seen one checking out your ankles.

•    Bring lots of mosquito repellent with a minimum concentration of 30% DEET (check recommendations for children). This can be hard to find in Asian shops, though, surprisingly, we had better luck in the small markets used by local people than in the shops aimed at tourists. Remember that insect repellent is only effective for a certain number of hours and will be removed by swimming, sweating, and showering. Carry repellent with you and reapply it diligently – at a minimum, morning and evening.

•    Light colored clothing is recommended, as well as long sleeves and long pants or skirts. Don’t be too quick to rule out the more extensive clothing – long sleeved shirts and pants made of light cotton can be surprisingly cool and they’ll protect you from both insects and sunburn.

I got through my Southeast Asian vacation without any mosquito bites that I was aware of, though one black fly did sample my blood in northern Thailand. I say “that I was aware of” because I found the mosquitoes in Thailand, Cambodia and Laos to be both smaller and quieter than the ones I’m used to; if you don’t react to the bite you might never know you had a visitor.