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Eradication of Taenia solium cysticercosis: a role for vaccination of pigs.

Neurocysticercosis due to Taenia solium is an important cause of human morbidity and mortality, particularly in Latin America and parts of Africa and Asia. The disease has been recognised as potentially eradicable. Emphasis has been placed on control of the parasite through mass chemotherapy of human populations to remove tapeworm carriers. This strategy does not control the source of tapeworm infections, cysticercosis in pigs, and parasite transmission may continue due to incomplete chemotherapy coverage of human tapeworm carriers or because of immigration of tapeworm carriers into control areas. Exceptionally effective, practical vaccines have been developed against cysticercosis in sheep and cattle and a recent trial has proved recombinant antigens to be effective against Taenia solium cysticercosis in pigs. A new strategy for eradication of Taenia solium is proposed, based principally on a combined approach of chemotherapy of human tapeworm carriers and vaccination of all pigs at risk of infection.

Animals↗

Evidence for high seroprevalence of Taenia solium cysticercosis in individuals from three rural communities in Venezuela.

A serological study was undertaken in 1998 to evaluate levels of Taenia solium cysticercosis in 3 rural Venezuelan communities. Infection with viable metacestodes was diagnosed with a trapping enzyme-linked immunosorbent assay (ELISA) that detects a secreted product of viable parasites. Anti-metacestode antibodies were assayed by ELISA using T. solium vesicular fluid as antigen. A total of 1254 sera was collected from 3 communities (Canoabo, Sanare, and Rio Tocuyo) where previous studies had suggested the presence of T. solium. Our results demonstrate an unusually high seroprevalence of cysticercosis, indicating an attendant risk of transmitting the disease to other areas. The seroprevalence of infection with viable cysts, as indicated by detection of circulating parasite antigen, was 9.1% in Canoabo, 6.1% in Sanare, and 5.7% in Rio Tocuyo. The corresponding frequency of antibodies to T. solium cyst antigens was 36.5% in Canoabo, 36.5% in Sanare, and 4% in Rio Tocuyo. As these communities are probably representative of many others in Venezuela, T. solium cysticercosis may be a significant public health problem and more work is certainly indicated. An important finding was that local knowledge of the disease and its transmission do not necessarily guarantee diminished disease prevalence, indicating a lack of appropriate vigilance towards disease control.

Adolescent↗

Clinical significance of neurocysticercosis in endemic villages. The Cysticercosis Working Group in Peru.

Cerebral cysticercosis is the main cause of late-onset epilepsy in most developing countries. Data on the neuroepidemiology of cysticercosis in endemic populations is scarce. In an endemic village on the northern coast of Peru, 49 individuals with neurological symptomatology (41 epileptic and 8 non-epileptic) were screened for antibodies to Taenia solium, using a serum electroimmunotransfer blot assay. Fifteen subjects were seropositive, 14 (34%) of those with epilepsy but only one (13%) of those who were non-epileptic. A history of passing proglottides was associated with positive serology. Thirteen of the 15 seropositive individuals underwent cerebral computed tomography; only 7 (54%) were abnormal. A randomly selected sample of 20 pigs from the village was also tested, and 6 (30%) were seropositive. This study demonstrated the importance of cysticercosis in the aetiology of epilepsy in endemic villages and the close relationship between porcine and human infection.

Adolescent↗

Prevalence of cysticercosis in epileptics and members of their families in Burundi.

In the province of Bururi in Burundi, 103 epileptics and 72 control subjects from the same households were examined for cysticercosis. Antigen was detected by enzyme-linked immunosorbent assay in 4.9% of epileptic persons and in 4.2% of controls. Antibody was detected by enzyme-linked electroimmunotransfer blot assay (EITB) in 11.7% of epileptics and in 2.8% of controls. Neither difference was statistically significant, nor was a history of taeniasis significantly more frequent in epileptics than in controls. However, cysticercosis was significantly more frequently diagnosed by EITB in people with a history of taeniasis than in those without such a history. The prevalence of taeniasis in schoolchildren ranged between 0 and 1.0%. Meat inspection detected cysticercosis in 2% and 39% of pigs in 2 localities, respectively.

Adolescent↗

Seroprevalence of cysticercosis in Bénin.

We report the results of a seroepidemiological study on the prevalence of cysticercosis in Bénin. Cluster sampling at 3 levels was performed in the 6 départements (Atacora, Borgou, Zou, Mono, Atlantique and Oueme) and 2625 serum samples, from 1329 adult females and 1296 adult males, were collected. Antibodies against Taenia solium cysticerci were first searched for by enzyme-linked immunosorbent assay and the 41 seropositive samples were then examined by enzyme-linked electroimmunotransfer blot assay (EITB). Thirty-five samples gave positive results in the EITB. The overall seroprevalence of cysticercosis was therefore 1.3% (95% confidence interval [95% CI] 0.9-1.9). The seroprevalence was 1.9% in males (95% CI 1.2-2.7) and 0.8% (95% CI 0.4-1.5) in females (P < 0.05). A progressive increase in seroprevalence with increasing age was found. The highest seroprevalences were observed in Atacora and Atlantique, 2 non-Muslim départements (3.3% and 3.0%, respectively). This study demonstrated the public health importance of cysticercosis in Bénin.

Adolescent↗

New approaches to improve a peptide vaccine against porcine Taenia solium cysticercosis.

Cysticercosis caused by Taenia solium frequently affects human health and rustic porciculture. Cysticerci may localize in the central nervous system of humans causing neurocysticercosis, a major health problem in undeveloped countries. Prevalence and intensity of this disease in pigs and humans are related to social factors (poor personal hygiene, low sanitary conditions, rustic rearing of pigs, open fecalism) and possibly to biological factors such as immunity, genetic background, and gender. The indispensable role of pigs as an obligatory intermediate host in the life cycle offers the possibility of interfering with transmission through vaccination of pigs. An effective vaccine based on three synthetic peptides against pig cysticercosis has been successfully developed and proved effective in experimental and field conditions. The well-defined peptides that constitute the cysticercosis vaccine offer the possibility to explore alternative forms of antigen production and delivery systems that may improve the cost/benefit of this and other vaccines. Encouraging results were obtained in attempts to produce large amounts of these peptides and increased its immunogenicity by expression in recombinant filamentous phage (M13), in transgenic plants (carrots and papaya), and associated to bacterial immunogenic carrier proteins.

Animals↗

Central nervous system cysticercosis simulating an acute cerebellar hemorrhage.

We report the case of a Mexican man who suddenly developed severe occipital headache, vomiting, vertigo, and ataxia. Neurologic examination showed nystagmus and cerebellar findings. Computed tomography of the brain demonstrated a large left cerebellar cystic lesion consistent with the diagnosis of cysticercosis. The patient was treated with dexamethasone and praziquantel and required surgical removal of the lesion to prevent herniation. He recovered without neurologic sequelae. The abrupt onset of cerebellar findings is an unusual presentation of this disease. Central nervous system cysticercosis is being recognized with increasing frequency in the United States, where it is found primarily in Hispanic and Asian immigrants. The literature of central nervous system cysticercosis is reviewed and the pathogenesis, clinical presentation, and therapy are discussed.

Acute Disease↗

Oral cysticercosis. Review of the literature and report of 2 cases.

Oral cysticercosis is a rare condition in man. Our 2 cases bring the total number of published cases to 25. Although it is rare, the cysticercosis should be considered in the differential diagnosis of intra-oral nodules, especially in high incidence areas. Multiple foci are very common and every cases with oral cysticercosis should undergo thorough general examination. Surgical excision is the treatment of choice.

Adult↗

Comparative evaluation of an indirect ELISA test for diagnosis of swine cysticercosis employing antigen from Taenia solium and Taenia crassiceps metacestodes.

Taenia solium cysticercosis is still a serious public health problem in several countries where poverty and lack of hygiene favor transmission. Because pigs are the primary intermediate hosts, prevalence of porcine cysticercosis is a reliable indicator of active transmission zones. Serological diagnostic methods are important tools for epidemiological studies since they can be applied to living animals on a large scale. Four antigen preparations (cyst fluid and crude) from T. solium and T. crassiceps metacestodes were compared for swine cysticercosis diagnosis by indirect ELISA (IE). Twenty-eight serum samples from swine naturally and experimentally infected by cysticerci of T. solium and 56 serum samples from swine reared in commercial herds were tested. Best results of overall sensitivity were obtained by the use of cyst fluid and crude antigen of T. crassiceps metacestode (100 and 96.4%, respectively). Using homologous antigen preparations we have observed higher specificity percentage (98.2% for cyst fluid and 96. 4% for crude metacestode T. solium antigen). We concluded that sensitivity is of far more importance than specificity for identification of endemic areas in order to prevent transmission to man. We conclude, therefore, that IE performed with cyst fluid antigen of T. crassiceps metacestode is a better tool for that purpose.

Animals↗

Chemotherapy of porcine cysticercosis with albendazole sulphoxide.

Cysticercosis is a zoonotic disease of humans produced by the larval stage of swine parasite, Taenia solium. Chemotherapy of infected pigs is a possible strategy for avoiding disease transmission and improving health programs in endemic areas of cysticercosis. In this preliminary study, seven naturally infected pigs from 6 to 12 months of age were allotted to treated (n = 4) and control groups (n = 3). The treated animals received a subcutaneous injection in their forelegs and thighs of 15 mg/kg per body weight of albendazole sulphoxide (ABZSO; Pisa, Mexico) once per day for 8 days. At the same time, the control group received a subcutaneous injection of saline solution (9% NaCl). After 12 weeks, all the animals were slaughtered and at least 200 metacestodes were isolated from the muscles and brain of each animal. Using histology and the metacestode viability criteria described in this study, treated animals had no viable cysts in their muscle (0/200), while 7 of 17 (41.1%) viable cysts were observed in those isolated from their brains. In the control group, 183/200 (91.5%) muscle metacestodes were viable and from brain, 22/29 (75.8%) metacestodes were viable. The 15 mg/kg per body weight dosage of ABZSO was 100% effective against muscular cysticercosis as shown by the lack of viable cysts and the micro-calcifications in meat from the treated pigs.

Albendazole↗

The inflammatory cell infiltrates in porcine cysticercosis: immunohistochemical analysis during various stages of infection.

Taenia solium metacestodes cause cysticercosis in both humans and pigs. In the former host species, the central nervous system involvement (neurocysticercosis (NCC)) may range from asymptomatic to life-threatening, but little is known about the corresponding variation in tissue response due to the difficulty in obtaining parasite-infected brain biopsies. The use of pigs as animal models for cysticercosis is ideal because the histological description of the animal's response around the parasites resembles the one recorded in human specimens. In this study the histological features of the immune response in swine were complemented by immunohistochemical analysis to determine the phenotype of the inflammatory cells. The presence of mononuclear cells and eosinophils, and the co-localization of MHC-II with B lymphocytes and monocytes/macrophages within the granulomas surrounding the parasites, were features that closely resembled the descriptions made in prior studies with human specimens. In addition, there were novel findings such as the upregulation of the adhesin CD44 in cells resembling monocytes/macrophages, eosinophils and in astrocytes from the central nervous system. The upregulation of CD44 may be important for the recruitment of inflammatory cells to the site of the lesion. Finally, the presence of null-gamma delta-T cells since stage I of the immune response was similar to the early detection of these cells in mouse models for cysticercosis.

Animals↗

Field trial for reducing porcine Taenia solium cysticercosis in Mexico by systematic vaccination of pigs.

It has previously been demonstrated that immunization of pigs with a crude extract of Taenia solium metacestodes can confer a high level of protection against an egg challenge. Furthermore, vaccination of infected animals also induces an immune response against the larvae, which are either destroyed or rendered non-infectious. To assess the efficacy of immunization as a strategy for reducing the prevalence of porcine cysticercosis, a field trial of this vaccine was performed in an endemic area in the northern region of the Guerrero State, Mexico, Random samples of pigs belonging to 17 villages were examined for metacestodes by inspection of their tongues. Each animal was immunized with a dose of 150 micrograms of protein (antigenic extract from Taenia solium metacestodes) by the intramuscular route. A prevalence of 2.4% of porcine cysticercosis on average was found in these villages at the beginning of the trial (62 cysticercotic pigs out of 2650 inspected). Six of these villages were selected for the periodic vaccination of new random samples of pigs. A statistically significant decline in the prevalence of porcine cysticercosis was observed at the end of the trial, decreasing from 2.4% at the beginning of vaccination to 0.45% at the end of the trial. A reduction of 82% was observed in spite of the poor living conditions in these villages. These results are consistent with previous data and suggest that it may be possible to turn a susceptible pig population into a protected one by systematic vaccination.

Animals↗

Performance of the ELISA test for swine cysticercosis using antigens of Taenia solium and Taenia crassiceps cysticerci.

Studies were conducted to evaluate antigens of Taenia solium (Tso) and Taenia crassiceps (Tcra) cysticerci in the ELISA test for the diagnosis of swine cysticercosis. The samples analyzed were cysticercosis positive and negative control sera and heterologous sera. Four antigens were assayed: vesicular fluid (VF) and crude (T) Tcra and scolex (S) and crude (T) Tso. All antigens showed good performance, but VF-Tcra was the best followed by T-Tcra. Sensitivity rates of ELISA were respectively, in 2nd and 3rd standard deviation cut-offs, 96.0 and 80.0% for the VF antigen and specificity of 97.5 and 100.0%. Cross-reactivity was verified only for hidatidosis and ascaridiosis. Due to the high performance observed, the ELISA test using Tcra antigens should be recommended for the diagnosis of swine cysticercosis.

Animals↗

ELISA and immunoblot using purified glycoproteins for serodiagnosis of cysticercosis in pigs naturally infected with Taenia solium.

The establishment of reliable serological methods for cysticercosis in pigs is important for the surveillance, control and prevention of taeniosis/cysticercosis in humans as well as in pigs to prevent economic loss. Both ELISA and immunoblot using glycoproteins (GPs) purified by a single step of preparative iso-electric focusing, which are highly useful for human cysticercosis, have been applied for a serological study in pigs naturally infected with Taenia solium. All sera from pigs showed similar responses to those in human cysticercosis. Therefore, it is expected that both ELISA and immunoblots using GPs would be useful in differentiating infected pigs from uninfected ones.

Animals↗

A rare case of nasal cysticercosis mimicking a nasal dermoid.

Cysticercosis, caused by infestation with the pork tapeworm Taenia solium, is known to commonly involve the brain, muscles and subcutaneous tissue. Diagnosing cysticercosis can be difficult as its clinical presentation is usually non-specific. When involving subcutaneous tissue, it can present as firm, non-tender, solitary or multiple nodules. We report a case of subcutaneous cysticercosis at the nasion mimicking a nasal dermoid.

Child↗

Childhood cerebral cysticercosis: clinical features and computed tomographic findings in 89 Mexican children.

Cerebral cysticercosis was studied in 89 Mexican children. These patients were divided into two groups; those with proven diagnosis and those in whom the diagnosis was strongly suspected. The frequency of childhood cysticercosis at autopsy is significantly less than reported in adults from the same environment. Symptoms of initial cerebral invasion by the parasite include headache, fever, vomiting, and seizures. Cerebral edema is observed more frequently in children than in adults, and is the most common cause of intracranial hypertension. The cerebral edema generally is associated with an encephalitic syndrome, either a single bout or a chronic course with multiple relapses. Arterial hypertension, not previously described, was found in two probable cases. The variability of clinical symptomatology thus is great. Symptoms in childhood cerebral cysticercosis may be totally absent, moderate, or severe and ultimately fatal. Computed tomography of the brain is the most useful diagnostic aid, and determines the dynamic neuroradiologic sequence of this disease, since different images appear at each stage to permit its diagnosis. Uncalcified cysticerci may be demonstrated by contrast enhancement if associated with focal cerebral edema; images thus may disappear and reappear in the clinical course of the disease.

Adolescent↗

Cysticercosis of the oral mucosa: aspiration cytologic diagnosis.

Oral mucosa is a rare site for cysticercosis. This paper describes eight cases of cysticercosis involving the oral cavity: four in the buccal mucosa, two in the lips, one in the tongue and one in the gums. All of the patients presented with a solitary superficial mucosal nodule, with duration varying from one month to three years. Larval fragments of cysticercus cellulosae on an inflammatory background were seen in cytologic smears in all cases. Diagnosis of cysticercosis was clinically unsuspected in all these cases prior to aspiration cytologic diagnosis.

Adolescent↗

Semi-quantitative analysis of soft-tissue reactions in fine needle aspirates from tissue cysticercosis.

Fine needle aspiration cytology (FNA) has a well-documented role in the diagnosis of cysticercosis. However, little is discussed about the associated inflammatory response in the host tissues. Aspirates from 182 cases of subcutaneous cysticercosis were semiquantitated for the type and degree of inflammatory response, and the amount and preservation of the parasite. Tissue sections were reviewed where available. In the FNA where no parasite was observed but a confirmatory tissue diagnosis was available, it was found that eosinophils (52%), epithelioid cell granulomas (30%), palisading histiocytes (33%) and giant cells (28%) were seen less frequently than in those where larval fragments were identified in the aspirated material in varying quantities, the response being 88-92% eosinophils, 50-70% palisading histiocytes, 68-80% epithelioid cell granulomas and 46-74% giant cells. Repair cells were maximally seen when readily identifiable larval fragments were seen in the aspirate. Bizarre cells were equally distributed in these aspirates. The tissue response in FNA from subcutaneous cysticercosis can be varied and eosinophils are found to increase with the presence of the degenerating parasite. In soft-tissue aspirates, palisading histiocytes with epithelioid cell granulomas with or without giant cells and an inflammatory exudate with predominantly eosinophils alerts one to search diligently for a parasite.

Animals↗