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Socio-demographic trends in ocular cysticercosis.

There has been a gradual change in the socio-demographic trends of ocular/adnexal cysticerosis. We present the results of a 5-year study of 33 cases of ocular/adnexal cysticercosis and compare our observations with those reported by previous authors. The male:female ratio in our study was 2:1 and maximum number of patients (45%) belonged to the age-group of 31-40 years. Seventy percent of our patients were of low socio-economic status and 70% were strictly vegetarians. The most common location of cysticerci was in the vitreous (50% of all cases); orbital cysts were present in 5% and subconjunctival cyst in 3%. Most common extraocular site for associated cysticercosis was the brain (18%): Ultrasonography proved to be an effective and economical alternative to magnetic resonance imaging and computerized tomographic scanning for the detection of cysticerci in the orbit and in eyes with hazy media.

Adolescent↗

Orbital cysticercosis--an ultrasonic diagnosis.

Ocular cysticercosis, a platyhelminth infection, involves various ocular and adnexal sites. Orbital cysticercosis is a relatively rare site of presentation. We illustrate that this parasitic cyst, when present in the orbit, mimics an orbital pseudotumour. We have used ultrasound as an effective pre-operative diagnostic modality.

Adult↗

Cysticercosis in labial tissue. Case report.

Cysticercosis is a condition in which a human acts as the intermediate host of Taenia solium, a pork tapeworm. The larvae infestation sites frequently include cerebral tissue, ocular organs, and muscles. The present case report describes a rare incidence of cysticercosis in the oral region.

Adult↗

Cysteine proteinase inhibitors in murine cysticercosis.

We explored the prophylactic efficacies of two novel protease inhibitors in murine cysticercosis. Our results demonstrated a 95% and 80% reduction in parasite burden for mice injected with Z-LLL-FMK and Z-LLY-FMK, respectively. Further studies are merited on the role of cysteine proteinase inhibitors in treatment of cysticercosis.

Animals↗

Comparative evaluation of purified Taenia solium glycoproteins and crude metacestode extracts by immunoblotting for the serodiagnosis of human T. solium cysticercosis.

A lentil-lectin purified glycoprotein (LL-Gp) and a crude saline extract of Taenia solium metacestodes were compared for the immunodiagnosis of human cysticercosis by immunoblotting. The LL-Gp preparation was 95% sensitive for antibodies against a range of seven antigens with molecular masses of 50 to 13 kDa, whereas the sensitivity of the crude saline extract for the detection of antibodies against two major polypeptide molecules (26 and 8 kDa) was 91%. Specificity was 100% with both sets of diagnostic antigens. Affinity-purified antibodies against the 26-kDa molecule from the crude saline extract recognized the 24-kDa diagnostic region in the LL-Gp-purified extract and vice versa, suggesting that the antigens had common epitopes recognized by cysticercotic sera. In addition, in a preliminary community study of 115 randomly selected people from Bali (Indonesia), seroprevalence by immunoblot assay varied from 7.8% (with the crude saline antigen extract) to 9.6% (with the LL-Gp-purified extract). The results of this study demonstrate that both antigenic preparations are applicable for the immunodiagnosis of T. solium cysticercosis. The crude T. solium metacestode antigen extract was as specific as the purified LL-Gp T. solium metacestode extract and simpler to produce but slightly less sensitive.

Animals↗

Serological diagnosis of human cysticercosis by use of recombinant antigens from Taenia solium cysticerci.

A Taenia solium metacestode cDNA expression library in the lambda ZAPII vector was screened with pooled sera from patients with neurocysticercosis. Sixty primary clones were identified and shown to belong to two classes. The clones NC-3 and NC-9 did not reveal any significant homologies to sequences deposited in the databases and were further characterized. Both recombinant antigens were expressed as glutathione S-transferase fusion proteins and applied for serological diagnosis of human cysticercosis. An enzyme-linked immunosorbent assay was established and evaluated with 27 serum samples of La Réunion and Madagascar patients with cysticercosis. Diagnosis in these patients was established with radiological and serological procedures. For antigen NC-3 a sensitivity of 96.3% and a specificity of 91.5% for the serodiagnosis were achieved. In contrast, the sensitivity of antigen NC-9 was only 33.3%.

Animals↗

Granuloma cytokines in murine cysticercosis.

Neurocysticercosis, caused by Taenia solium, is one of the most common causes of seizures worldwide. The symptoms result from granulomatous inflammation associated with dying cyst forms of the parasite. Although the invasive larvae can be killed by immune serum plus complement, immunity to the cyst stage depends on a cellular response. This dichotomous immune response is reminiscent of the extremes of the immune response associated with T helper 1 (Th1) and Th2 cytokine profiles. To characterize the cytokine response in cysticercosis, granulomas were removed from the peritoneal cavity of mice infected with Taenia crassiceps cysts and examined for cytokine message by in situ hybridization using 35S-labeled RNA probes. The granulomas were staged based on histologic appearance of the degenerating parasite. Message for gamma interferon (IFN-gamma) was identified by light microscopy in 11 of the 12 granulomas, and interleukin-2 (IL-2) message was identified in 9 of the 12. By laser scanning confocal microscopy, significantly increased IFN-gamma and IL-2 pixel intensity was identified in nearly all of the granulomas from early histologic stages. Message for IL-4 was seen in 6 of the 12 granulomas. Only granulomas with complete destruction of the parasite architecture displayed more than minimal amounts of IL-4 message by light microscopy, and only 2 of 12 granulomas had IL-4 pixel intensity significantly above background. Only minimal amounts of IL-10 message were detected in 4 of 11 granulomas. Thus, early granulomas in cysticercosis are predominantly associated with a Th1 response, whereas later granulomas, in which parasite destruction is complete, have a mixture of Th1 and IL-4. The Th1 response appears to play an important role both in the pathogenesis of disease as well as in the clearing of the parasites, with IL-4 involved in downregulation of the initial response.

Animals↗

Enzyme-linked immunosorbent assay for the diagnosis of cerebral cysticercosis.

Central nervous system cysticercosis is common in countries where Taenia solium occurs in pigs and the level of hygiene and sanitation is low. The clinical presentation may include epileptic seizures, focal neurological deficits, hydrocephalus, or aseptic meningitis. The disease is frequently seen in California residents of Hispanic origin. It sometimes occurs in whites from homes that employ Hispanic cooks. Diagnosis is often difficult. Computerized tomography scan and brain biopsy are the most reliable diagnostic procedures, but each has its limitations. We have found that a radioimmunoassay improves our diagnostic capability, and more recently we have adapted this to an enzyme-linked immunosorbent assay that is equally sensitive and specific and, in addition, obviates the need for radioactive materials. Details of the enzyme-linked immunosorbent assay procedure and its application to the diagnosis of central nervous system cysticercosis form the basis of this report.

Animals↗

Immunodiagnosis of human cysticercosis (Taenia solium) with antigens purified by monoclonal antibodies.

Monoclonal antibodies were generated from mice immunized with scolex protein antigen of Cysticercus cellulosae. Three monoclonal antibodies specific for cysticercal antigens, which did not show any cross-reactivity with Taenia solium or Taenia saginata antigens, were selected. Each monoclonal antibody coupled to Sepharose could purify one antigen, which appeared as a single band on polyacrylamide gel electrophoresis. When antigens purified by monoclonal antibodies were used to detect antibody in serum samples taken from patients with cysticercosis, taeniasis, and other parasitic infections in an enzyme-linked immunosorbent assay, cross-reactivity was observed until a serum dilution of 1:128 was reached. Since serum samples from unexposed subjects showed positive reactions until a dilution of 1:64 was reached, we chose a discriminative dilution (1:128) above which no cross-reaction was observed. The percent positive serum samples from cysticercosis patients was 100% by the enzyme-linked immunosorbent assay with any of the antigens purified by monoclonal antibodies.

Antibodies↗

Evaluation of enzyme-linked immunoassay for serological diagnosis of cysticercosis.

We evaluated a commercially available enzyme-linked immunoassay (ELISA) from LMD Laboratories, Inc., Carlsbad, Calif., for the detection of antibodies in serum to the cysticercus of Taenia solium. The ELISA was performed on 308 serum samples; 198 from a pool of healthy individuals, 42 from patients who had antibodies against a variety of parasites other than T. solium, and 68 from patients suspected of having cysticercosis. All of these 68 specimens were tested both by the ELISA and by an immunoblot method (enzyme-linked immunoelectrotransfer blot assay [EITB]) developed at the Parasitic Serology Laboratory of the Centers for Disease Control and Prevention. Twenty-seven of the 68 serum samples from patients suspected of having cysticercosis were positive by both EITB and ELISA, while 31 were negative by both assays. ELISA results for three and two samples were considered false positive and false negative, respectively, when compared with the results of EITB. Results for an additional five samples were considered equivocal but were technically positive because their optical density readings were slightly above the cutoff value. Three of the 198 serum samples from the bank of serum samples from healthy individuals were also false positive by ELISA (the EITB result for the samples was negative). Six other serum samples from healthy individuals which had equivocal results and the five serum samples from patients with equivocal results were EITB negative. Serum samples containing antibodies against Echinococcus spp. frequently cross-reacted with the cysticercus ELISA antigen (13 of 16 specimens), but serum samples with antibodies against other parasites did not (2 of 26 specimens); all of these serum samples were EITB negative. The commercially available ELISA that we describe is a simple and rapid test. Considering all 308 specimens, the ELISA had a specificity of 93% (when samples with equivocal results were considered negative) or 89% (when samples with equivocal results were considered positive); the sensitivity was 93%.

Animals↗

DNA differential diagnosis of taeniasis and cysticercosis by multiplex PCR.

Multiplex PCR was established for differential diagnosis of taeniasis and cysticercosis, including their causative agents. For identification of the parasites, multiplex PCR with cytochrome c oxidase subunit 1 gene yielded evident differential products unique for Taenia saginata and Taenia asiatica and for American/African and Asian genotypes of Taenia solium with molecular sizes of 827, 269, 720, and 984 bp, respectively. In the PCR-based detection of tapeworm carriers using fecal samples, the diagnostic markers were detected from 7 of 14 and 4 of 9 T. solium carriers from Guatemala and Indonesia, respectively. Test sensitivity may have been reduced by the length of time (up to 12 years) that samples were stored and/or small sample volumes (ca. 30 to 50 mg). However, the diagnostic markers were detected by nested PCR in five worm carriers from Guatemalan cases that were found to be negative by multiplex PCR. It was noteworthy that a 720 bp-diagnostic marker was detected from a T. solium carrier who was egg-free, implying that it is possible to detect worm carriers and treat before mature gravid proglottids are discharged. In contrast to T. solium carriers, 827-bp markers were detected by multiplex PCR in all T. saginata carriers. The application of the multiplex PCR would be useful not only for surveillance of taeniasis and cysticercosis control but also for the molecular epidemiological survey of these cestode infections.

Animals↗

Cysticercosis of the central nervous system with amyotrophic lateral sclerosis: case report and review of the literature.

A case is described in which the clinical and pathological features of amyotrophic lateral sclerosis (ALS) occurred in a patient with cysticercosis of the central nervous system and associated pachymeningitis of the cervical spinal cord. This is an extremely rare finding. The patient also presented the two symptom complexes more commonly encountered in this condition: focal and generalized epilepsy, and signs of obstructive hydrocephalus. The literature relevant to this case, and to cysticercosis in Great Britain, is briefly reviewed. The case described adds to the concept of motor neurone disease as a syndrome rather than a disease entity of undetermined aetiology.

Amyotrophic Lateral Sclerosis↗

Selective indications for the use of praziquantel in the treatment of brain cysticercosis.

The selective use of praziquantel for the treatment of brain cysticercosis in human beings is described, based upon the results of clinical tests conducted during a 2 year period. Forty patients with clinical diagnosis of cysticercosis, confirmed and documented by CT, were treated. They are divided into four groups, representative of the various forms of the disease. The results assessed by clinical evaluation and sequential CT, give a ten point criterion of the indications for praziquantel.

Brain Diseases↗

Cerebral cysticercosis as a common cause of epilepsy in Gurkhas in Hong Kong.

A prospective study of Nepalese adults (Gurkhas) based in Hong Kong who presented with adult-onset epileptiform seizures determined that cerebral cysticercosis was causative in 7 out of 8 cases. The relative roles of specific cysticercal serology and computerised axial tomography in diagnosis are discussed. Serum IgE levels were found to be raised in all patients with cerebral cysticercosis in the absence of other parasitic infection and reverted to normal after the patients were treated with praziquantel. Evidence suggests that the Gurkhas acquired their cysticercal infections in Nepal.

Adult↗

Radiology of cysticercosis of the central nervous system including computed tomography.

Cysticercosis is a parasitic disease in which man serves as the intermediate host of Taenia solium, the pork tapeworm. The larvae have a predilection for the central nervous system and can cause a variety of neurologic and psychiatric symptoms. Areas of involvement are classified as intraventricular, parenchymal, arachnoidal, and mixed. The diagnosis is made primarily by roentgenographic and spinal fluid examinations. The authors reviewed 232 cases of cysticercosis involving the central nervous system. It was found that computed tomography is a useful tool in assessing this illness.

Adolescent↗

DNA vaccine against Taenia solium cysticercosis expressed as a modified hepatitis B virus core particle containing three epitopes shared by Taenia crassiceps and Taenia solium.

Many studies have provided evidence that the hepatitis B core antigen particle is useful as a vaccine carrier for foreign epitopes. Epitopes KETc1, KETc12, and GK-1 are three promising candidates for designing a vaccine against Taenia solium cysticercosis. In the present study, epitopes KETc1 and KETc12 were inserted into the immunodominant loop of the truncated HBc149, and epitope GK-1 was fused to its C-terminus. The fused protein deltaC-3n was expressed and purified successfully. The polymeric character was tested by SDS-PAGE. After inoculation of BALB/c mice with deltaC-3n, antibody titers were assayed by ELISA, and the antibody specification was analyzed by Western blot. Dot ELISA was performed to verify the protection of the three epitopes. Results showed that the purified polymeric protein was formed, high antibody titers were induced in immunized mice and three antibodies different in molecular weight were induced, serum specific antibody recognized the native peptide localized mainly in cyst wall cells, and there was no specific antibody toward the three epitopes in sera of infected pig and humans. All these revealed that the protein deltaC-3n was a potential candidate for vaccine against cysticercosis. So the deltaC-3n sequence and the signal peptide sequence of IL-2 were cloned to a vector pVAX3.0 to construct pVAX-S-deltaC-3n. Pigs were immunized with pVAX-S-deltaC-3n. Two weeks after the immunization booster, pigs were introduced to infectious T. solium eggs. The relative protective rate induced in pigs immunized with the DNA vaccine pVAX-S-deltaC-3n was 83%.

Amino Acid Sequence↗

A case of cysticercosis cerebri. Neurotologic implications.

Cysticercosis is an unusual disease entity in the United States. A case is reviewed in which a young Mexican-American female presented to an otologist's office with a headache and vertigo. Her symptoms were a manifestation of a single larval cysticercus cyst which had become lodged in the fourth ventricle resulting in an obstructive hydrocephalus and a fatal course. The epidemiology of this disease traces the life cycle of the pork tapeworm from man, normally the definitive host, to the pig, the intermediate host. It is noteworthy that the disease cysticercosis in humans is a deviation from the parasite's normal life cycle in which man serves as the intermediate host. The literature is reviewed. The broad clinical spectrum of this disease's presentation can extend from a single headache to multiple nerve palsies and convulsions. The importance of radiographic evaluation complement fixation testing and CSF evaluation in making a diagnosis is stressed. There is no known medical treatment for this disease. Surgical procedures such as primary excision and shunts to relieve intracranial pressure have had mixed results. The prognosis depends on the location and the number of infesting larva. Special note is made of this disease's endemic status in Mexico and other Latin American countries and the role that this may play in medicine practiced in the southwest United States considering the ever-increasing immigration from this area.

Adult↗

Cysticercosis of slaughter cattle in southeastern Nigeria.

The incidence of cysticercosis due to Taenia saginata in both local and exotic breeds of cattle slaughtered for meat in southeastern Nigeria between November 1999 and April 2002 is reported. The examination of various organs of 25,800 cattle in 10 major abattoirs of this region showed that 6750 (26.2%) were infected with Cysticercus (C.) bovis. The prevalence rates varied from one abattoir to another while the rates of cysticercosis in local and exotic breeds varied significantly (P > 0.05). Sixty percent of all the infected animals had cysts. The tongue, cardiac, and masseter muscles were the main predilection sites of the cysts. Out of 11,720 male cattle, examined, 3215 (27.4%) had cysts of C. bovis while 160 (13.6%) of the 1180 female animals investigated were infected. There was an inverse relationship between the ages of the animals and prevalence of infection with C. bovis (r = -0.8743, P < 0.05). Monthly occurrence of the cysts in the animals revealed an upsurge of infected animals during the dry season. The epidemiology and epizootiology of Taenia saginata and C. bovis in relation to the veterinary service agencies and public health planners in southeastern Nigeria are highlighted.

Abattoirs↗