Man who fell from car struggled with parasite (CAUTION: Pix on thread may be unappetizing)

A man who either fell or jumped off the roof of his moving Mercedes-Benz in Scottsdale has been identified as an acclaimed chief financial officer for Phoenix whose struggles with a parasite might have caused his behavior Wednesday. Kevin Keogh, 55, died about 3 p.m. after he climbed onto the roof of the car he was driving east on Camelback Road with arms outstretched, similar to actor Leonardo DiCaprio in the movie “Titanic.”

Police haven't determined if the death was suicide or accidental, Scottsdale detective Sam Bailey said.

Keogh contracted the illness a couple of years ago while on vacation in Mexico and his wife, Karlene, told city officials "she believes the parasite impaired his frontal lobe inhibition, said Toni Maccarone, a Phoenix spokeswoman.

The specifics of Keogh's illness were unavailable, but he had been receiving treatment, city officials said.

Will Humble, bureau chief for disease control for the Arizona Department of Health Services, said that in general, tapeworms can invade brain tissue and cause brain damage. People can get tapeworms from eating undercooked pork in Mexico or pig feces on vegetables, he said.

"Usually, it's someone who’s from Mexico who comes up here as a migrant or someone who is binational that goes back and forth a lot. Very seldom is it a tourist who goes shopping and has a street taco or something," Humble said.

The worms have long incubation periods, ranging from weeks to 10 years, he said.

Autopsy results won't be available for a couple of months, Bailey said. Keogh, who had worked for Phoenix since 1976, made $164,000 a year and supervised 300 employees and part of the city’s $1 billion budget, Maccarone said.

“There is nothing we can do to replace Kevin,” City Manager Frank Fairbanks said at a news conference. “Kevin was more than a professional; he was a person.”

Witnesses told police the car was going about 40 mph when he got on the roof. Wednesday, police said the car was traveling 50 mph.

Police found his body on a sidewalk near 68th Street and Camelback Road, about 300 yards from where his car crashed into another, Bailey said.

Outside of work, he was known to be a patron of the arts and for his work with charities.

Keogh and his wife started the Arnold Keogh Health Foundation, which provided health insurance to mostly working-class women and their children.

“Kevin is very, very community minded," said Phoenix Vice Mayor Peggy Bilsten. “It’s sad for me for a number of reasons. They were a beautiful, beautiful couple, just a great example of what a good couple should be."

Bilsten is a member of the foundation board and a friend who had worked with Keogh for 10 years.

Keogh was reserved and noted for his sense of humor, co-workers said. He had no children.

City and State magazine named Keogh one of the top 11 financial innovators in the country in 1993. The magazine selected Keogh the best finance director in the nation in 1987.

He held a bachelor's degree in philosophy and political science from Iona College in New York and a master’s degree in public administration from Syracuse University.

Jeff DeWitt, the assistant finance director, will serve as the interim chief financial officer, Maccarone said.

“He’s probably one of most intelligent, very professional, very, very good finance directors. I learned a great deal from him in 10 years," said DeWitt, who called Keogh his mentor and worked with him daily.

Kevin Randolph, 25, a counselor intern at Brophy College Preparatory School who lives in Phoenix, suffered minor injuries after Keogh’s car plowed into the back of his 2000 Plymouth Neon.

He recalled thinking, "I've been hit, but there’s nobody in the car.” Randolph was stopped at a red light waiting for a man to cross Camelback on a bicycle.

The man later told Randolph he was grateful Randolph's car blocked him from the runaway Mercedes.

Cysticercosis

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Pigs normally serve as the intermediate host for the pork tapeworm, Taenia solium, and humans are infected with the adult stage of the tapeworm when they ingest an immature tapeworm (a cysticercus) in raw or undercooked pork.

However, if humans ingest eggs of T. solium, they can be infected with cysticerci, resulting in a condition known as cysticercosis. What might be the source of these eggs? Humans harbor the adult stage of this tapeworm, and it is the adult stage that produces eggs. Thus, many cases of cysticercosis probably result from a person ingesting eggs that are produced by a tapeworm living in his or her own intestinal tract.

Poor personal hygiene is one obvious way in which this could occur. It is also possible for the proglottids of T. solium to migrate anteriorly from the small intestine into the stomach and then back into the small intestine. Should this occur the eggs in the proglottids would hatch resulting in the potential for a massive infection of cysticerci.

People can also be infected via food contaminated with eggs, or via eggs present in a household or work environment. Since the tapeworm's proglottids can crawl out of the anus and contaminate clothing, furniture, etc., or drop to the ground, such contamination could occur in the absence of any visible source of "fecal" contamination.

Once the eggs hatch in the human's small intestine, the larvae penetrate the lining of the small intestine and enter the blood stream. From here the larvae can be distributed to any organ in the body. The larvae then grow into the metacestode stage, a cysticercus. Mature cysticerci can range in size from 5 mm in diameter up to 20 cm (almost 8 inches!) in diameter.

The pathology associated with cysticercosis depends on which organs are infected and the number of cysticerci. An infection consisting of a few small cysticerci in the liver or muscles would likely result in no overt pathology and go unnoticed. In fact, many cases of human cysticercosis are discovered only during routine autopsies. On the other hand, even a few cysticerci (perhaps only one), if located in a particularly "sensitive" area of the body, might result in irreparable damage.

For example, a cysticercus in the eye might lead to blindness, a cysticercus in the spinal cord could lead to paralysis, or a cysticercus in the brain (neurocysticercosis) could lead to traumatic neurological damage. Thus, even though infections with adult T. solium are rarely a problem, treatment of such infections is absolutely essential.

Historically, diagnosis of cysticercosis has been difficult. However, there are now several immunological tests available that will detect the presence of cysticerci, and improved imaging techniques such as CAT and MRI can be very useful in detecting cysticerci in various organs.

Tapeworm and the brain

Prof. H. Foyaca-Sibat, University of Transkei

A neurologist based in the former Transkei region of South Africa profiles a seldom heard of neurological ailment which affects more than 50 million people world-wide. The catch is not knowing you may have it. In southern Africa where many are living with HIV, a bleak picture is painted.

Neurocysticercosis(NCC) is the most common parasitic infection of the brain affecting more than 50 million people all over the world. NCC is caused by infection of the larvae of the pig tapeworm Taenia solium(TS). Pigs become How the tapeworm spreads. infected when they ingest contaminated human faeces. If someone ingests diseased (measly) pork meat containing larva forms of this tapeworm or ingests its eggs when eating contaminated foods, the parasite fins its way to the small intestine where they become mature. From here the parasite spreads to the brain to form of cystic lesions, also affecting the eyes, muscles or spinal cord.

This parasite can live for years sometimes for entire life-times in the brains of humans who can be free of symptoms, particularly so in HIV infected patients. In HIV patients where the immune system is compromised the parasite remains alive far longer in the brain, but its is a two way street. Neurocysticercosis debilitates the body's defense system and these patients become much more susceptible to get infection and are more prone to develop AIDS. In HIV-positive patients with NCC, epilepsy, epileptic attacks and seizures are the symptoms most commonly observed.

In non-HIV patients the parasite symptoms differ from country to country but in general the most common symptoms include epileptic attacks , headaches, visual and skin problems, and psychiatric manifestations. Any person living, visiting or in close contact with persons from endemic areas such as Latin American, Asian, or African countries could be a candidate for CT Scan. Arrows showing cystic lesions on the Brain cortex NCC. If you are in that group and you developed epilepsy later in your life (though younger ages are not an exclusion criteria) you could be a candidate. Diagnosis by a health professional could rule out NCC as a cause. Radiographic tests such as Computer Tomography (CT Scan) of the brain is the best confirmatory test, as it identifies most of the cystic lesions and also the head of the parasites (see image to the right). The CT Scan test is available in most cities in South Africa and for patients Radiographic studies - alternative tests requiring special care the New Nelson Mandela Academic Hospital a National Reference Center is an option. Alternative ways do exist in case CT Scan is not available.

The medication of choice for infection of the brain by this tapeworm is praziquantel or albendazol taken with steroids under medical supervision. These anti-parasitic medications kill parasites in all stages of their development in the human brain, eyes or muscles. Most patients respond very well to one-day treatments with praziquantel. However, for people living in endemic areas who remain susceptible to re-infection, periodical treatment is necessary.

The good news is that after the treatment the damage to the brain is 100 % reversible in most cases and only a few require intensive medical attention.

National figures for NCC remain unknown. NCC is a disease of poverty and underdevelopment and its dissemination is permanent in areas where the population have a limited or non-existent access to primary health care attention, health education, proper access to toilet facilities, proper refuse disposal, safe and clean water, electricity, employment, and money. The former Transkei areas of Southern Africa are perhaps hardest hit. According to Prof Foyaca patients are treated for NCC with young children more so than adults. While this situation persists the number of infected immigrants to developed areas will continue increasing. Patients diagnosed in Soweto, Cape Town, and other places are migrants from impoverished regions of Southern Africa.

Although we can't expect radical changes we may contribute to reduce the risks to this disease by:

spreading this information
encouraging all people with a high suspicion of NCC to be seen by health professionals,
educating our population towards better personal hygiene, hygienic food preparation,
freezing suspected pork meat when it is possible or simply overcooking it ,
educating people to limit access of pigs to human feces.

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