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Cysticercosis of the pituitary fossa is a rare finding. A case is described in which intra- and suprasellar cysticercosis produced disturbances in both visual acuity and visual fields. On clinical examination, angiography, and computerized tomography, it simulated an intrasellar tumor with suprasellar extension. The diaphragma sellae was absent.
Specific antibody test in serum and cerebrospinal fluid (CSF) is still the main mode of serological diagnosis of cysticercosis. Of different techniques of antibody test, enzyme-linked immunosorbent assay (micro-ELISA) has widely been applied. This study was undertaken to observe whether diagnostic capability can be improved by applying more sensitive techniques such as Protein A-ELISA and avidin biotin complex ELISA (ABC-ELISA). When evaluated using 115 sera of human cysticercosis, the antibody positive rates were not significantly improved in Protein A-ELISA (82.6%) and in ABC-ELISA (86.1%) than in micro-ELISA (81.7%). The specificities, evaluated in 165 sera from other diseases and normal controls, were significantly improved (88.5% by micro-ELISA, 93.3% by Protein A-ELISA and 93.8% by ABC-ELISA). Antibody levels (absorbance, abs.) in individual serum were correlated well (r = 0.83-0.86) each other. An actual benefit of Protein A-ELISA and ABC-ELISA was that they needed smaller amount of test sample.
Orbital cysticercosis is a benign infection with a variety of clinical presentations. Awareness of all of the possible clinical manifestations could aid early diagnosis and prevention of late sequelae. We report a case of bilateral, multifocal, intraconal orbital cysticercosis, which is an extremely rare presentation.
An ante mortem antigen-ELISA-based diagnosis of Taenia saginata cysticercosis was studied in artificially (n = 24) and naturally (n = 25) infected cattle with the objective of further validating the assay as a field diagnostic test. Based on total dissection as the definitive method of validity, the assay minimally detected 14 live cysticerci in artificially infected calves and 2 in naturally infected steers. In natural infections, the minimum number of live cysticerci consistently detected by Ag-ELISA was 5 while in artificial infections it was above 14. However, other animals with 12 and 17 live cysticerci in artificially infected calves, and 1 and 2 live cysticerci in naturally infected steers, escaped detection for unknown reasons. Animals harbouring dead cysticerci gave negative reactions in the assay as was the case in non-infected experimental control calves. There was a statistically significant positive linear correlation between Ag-ELISA optical density values and burdens of live cysticerci as obtained by total dissection of both artificially infected calves (r = 0.798, n = 24; P < 0.05) and naturally infected steers (r = 0.631, n = 25; P < 0.05). These results clearly show the potential effectiveness of ante mortem monoclonal antibody-based antigen detection ELISA in the diagnosis of bovine cysticercosis in cattle. Its value lies in the diagnosis of infection in cattle as a screening test in a herd, rather than as a diagnostic test at the individual level, due to false positive and negative reactions. In a herd of heavily infected cattle, the assay may, however, provide for individual diagnosis. Nevertheless, more work is recommended to increase its sensitivity so as to be able to diagnose light infections consistently in the field.
A 42-year-old woman from El Salvador presented with arthralgias and headache. She was found to have an enlarged sella with an intrasellar mass. Transsphenoidal exploration of the sella revealed a cysticercus. The cyst was removed and normal pituitary function was retained. Review of the literature showed three previously reported confirmed or suspected cases of intrasellar cysticercosis: in two, the diagnosis was made at autopsy; in the third, a patient with hypopituitarism, intrasellar cysticercosis was suspected in life but never confirmed histologically. Transsphenoidal cystectomy successfully treated our patient without compromise of pituitary function and is recommended for similar cases.
Serum specimens from persons with pathologically confirmed Echinococcus granulosus hydatidosis and Taenia solium cysticercosis were tested in indirect hemagglutination tests using both Echinococcus and Taenia antigens. There were cross-reactions with most sera, and it was not possible to distinguish specific reactions by comparing titers with the homologous or heterologous antigens. Using immunoelectrophoresis or double diffusion tests with E. granulosus antigens, the Echinococcus-specific arc 5 was demonstrated in 11 of 21 hydatidosis sera and in 1 of 20 cysticercosis sera.
Neurocysticercosis cases were identified in 1991 in an Orthodox Jewish community. Transmission was linked to tapeworm-infected immigrant housekeepers from countries where Taenia solium is endemic. To evaluate the extent of and risks for locally acquired cysticercosis, a seroprevalence survey was conducted in 9% of the households in this community. Cysticercosis antibodies were detected in 23 (1.3%) of 1,789 persons from 612 families. All 23 seropositive persons were asymptomatic, and no intracerebral lesions were found for the 21 seropositive persons who underwent brain imaging. Seropositivity was associated with female sex (relative risk [RR] = 2.45, P = 0.049), hiring a domestic worker for child care duties (RR = 3.79, P = 0.05), and with employees from Central America (RR = 2.70, P = 0.0001). Exposure to T. solium in this community is unexpectedly high. Widespread employment of domestic workers from endemic regions and high employee turnover contributes to exposure risk.
An enzyme-linked immunoelectrotransfer blot (EITB) assay was used to study the prevalence of cysticercosis in rural Bolivia. Dried blood spots on filter paper from fingersticks were used as assay samples. Before the serosurvey, experiments were performed to show that samples eluted from dried whole blood on filter paper exhibited no decrease in sensitivity when compared with the more traditional serum samples used in the EITB. Fingerstick blood dried on filter paper is a convenient, economical way of transporting and storing field samples for epidemiologic surveys of cysticercosis in developing countries. This report shows the utility of this sample collection method in underdeveloped countries where refrigeration is not possible and where venipuncture is a problem. Blood was obtained from randomly selected residents in three rural regions of Bolivia: Chuquisaca (n = 1,859), Cochabamba (n = 1,516), and Tarija (n = 1,010). The estimated seroprevalence on 10% of the sample collected for the three regions were 9%, 4.5%, and 2%, respectively.
Cysticercosis, the infestation with the encysted larval stage of Taenia solium, is increasingly recognized as a major problem in most countries in Latin America, Asia, and Africa, involving mainly the central nervous system. Muscle involvement is also common, although it usually remains asymptomatic. We describe a case of disseminated muscular cysticercosis followed by myositis (fever, diffuse myalgia, weakness of the lower limbs, and inflammatory reaction around dying cysticerci) induced by praziquantel therapy, an event not described previously.
The prevalence of neurocysticercosis has been well documented in rural communities in Latin America using the enzyme-linked inmmunoelectrotransfer blot (EITB) assay. We studied the prevalence of neurocysticercosis in an urban, upper-middle class population in Cuenca, Ecuador. Family members of 34 index cases with parenchymal neurocysticercosis on a computed tomography (CT) scan and family members of 14 patients who had normal CT scans after a trauma or migraine were enrolled in the study. Serum was obtained from 226 individuals, 173 (72%) from the case families and 67 (28%) from the control families. Twelve percent of the case family members and 4% of the control family members were seropositive by the EITB assay. This was a statistically significant difference (P < 0.05) when age and education were held constant by logistic regression. Seropositivity was not related to age. No neurologic symptom proved predictive of serostatus and the only demographic variable that correlated with seropositivity was increased crowding. Positive serology in index cases did correlate with CT findings as follows: 86% of patients with active lesions, 67% with transitional lesions, and only 41% of patients with inactive lesions were positive by the EITB assay. Eighteen percent of family members with a positive EITB test result had parenchymal lesions on a subsequent CT scan. This study demonstrates a high rate of seropositivity of cysticercosis among urban, middle to upper-middle class individuals in a region endemic for Taenia solium. Household contacts of patients with neurocysticercosis had a three-fold higher risk of positive serology for cysticercosis, in comparison with controls.
To determine markers of Taenia solium transmission and risk factors in an urban community, we studied 1,000 soldiers from a military camp in Mexico City and their relatives. Serum samples were used to detect antigens and antibodies and fecal specimens were examined for Taenia coproantigens and helminth eggs. Prevalences of 12.2% and 5.8% for cysticercosis were found among soldiers and their relatives, respectively. Taeniasis was found in 0.5% and none of the groups, respectively. Relatives of soldiers positive for cysticercosis and taeniasis markers ate more pork from street stores than restaurants or markets compared with relatives of soldiers without these indicators of infection. Also, 12.0% of the relatives of positive soldiers had a history of expelling tapeworm proglottids in the feces in contrast to 3.7% of the family members of the control group. Prevalence values and risk factors in this urban population are similar to those of previous studies performed in rural populations.
A case of intravitreal cysticercosis causing left uniocular cataract and eventual left visual loss in a healthy female Nigerian is presented. The diagnosis of cysticercus celulosae was not made until the patient had left cataract extraction done. The cysticercus larva found its way into the anterior chamber and this stimulated severe ocular inflammation. The use of antihelminthic and systemic steroid caused amelioration of the patient's ocular inflammation and symptoms. The review of literature on ocular involvement and the management of cysticercosis are discussed.
The clinical, neuroradiological, and pathological features of cysticercosis of the fourth ventricle, which occurred in a Cambodian immigrant, are reported. Comparisons between this case and Bruns' original description of cysticercosis of the fourth ventricle are made.
Cysticercosis of the central nervous system is seen infrequently in Australia. Most cases occur in adults, but two imported cases of neurocysticercosis in children are described. A 10-year-old Anglo-Indian girl presented with aseptic meningitis, raised intracranial pressure and a block to the flow of cerebrospinal fluid in the lumbar region. Laminectomy showed two cysticerci in the spinal subdural space. A three-year-old boy from Zimbabwe suffered a focal seizure. A granuloma that contained a degenerate cysticercus was found in the left parietal cortex. Serological examination of blood for cysticercosis was performed only in the second case and gave negative results. Examination of stools in both children gave negative results for the presence of parasites, cysts and ova.
OBJECTIVE: To highlight the sonographic appearances of cysticercosis involving uncommon muscular sites. METHODS: Two patients with nodular swelling involving the tongue and maxillary region were examined with high-resolution sonography. RESULTS: Sonographic examination revealed an anechoic area with a small calcified scolex suggesting cysticercus infection. CONCLUSIONS: High-resolution sonography is a noninvasive and nonionizing imaging modality that plays an important role in establishing the diagnosis of cysticercosis.
OBJECTIVE: To describe the sonographic appearances of cysticercosis. METHODS: Sonography was performed with both convex and linear array transducers in 4 patients with different symptoms. RESULTS: In 2 patients, an intramuscular fluid collection was seen with a cysticercus cyst in it. In 1 patient, an irregular cyst with a small fluid collection on 1 side was seen. In the last patient, multiple elliptical millet seed-shaped calcifications were seen in the liver, mesentery, and retroperitoneal fat. CONCLUSIONS: Four different sonographic appearances of soft tissue cysticercosis are described.
Studies were undertaken to assess the kinetics of antibody responses, lymphocyte transformation to Taenia solium larval antigens (crude soluble extract antigen and antigen B), and T cell subpopulation in piglets following experimental infection. Cysticercosis was established in 1-2 month old piglets after feeding 5,00,000 T. solium eggs per pig. The anti-CD4 and anti-CD8 monoclonal antibodies against swine T cells were raised indigenously. It was observed that at 60 days post infection (PI) there was a significant increase (P < 0.01) in CD4+ T cells without any change in CD8+ T cells. Increased 3H-thymidine uptake was found in infected piglets at 45 days PI using both CSE and antigen B. Kinetics of antibody responses indicated significant increase (P < 0.01) at 15 days PI (with CSE antigen) and 30 days PI (with antigen B) by ELISA. This increase persisted till 90 days PI (the time up to which the animals were followed). It was also observed that the cellular mechanisms were triggered in late stage (60 days PI) as compared to humoral responses (15-30 days PI) and may persist longer as seen by both lymphocyte transformation and T cell subpopulation studies. The study suggests that in cysticercosis, both humoral and cellular mechanisms may play a role in the host defences.
The authors describe a case of spinal intracanal cysticercosis. The cysts were situated intradurally, provoking radicular symptoms: pain, paresis. CT investigations showed herniation of discs L4/L5 and L5/S1 interpreted as the cause of the mentioned symptoms. Surgical treatment included discectomy L4/L5 and L5/S1. Recurrence of symptoms was investigated by means of MRI showing the presence of cysts situated among cauda equina roots. Intraoperative finding--cysticercosis was confirmed by pathologic investigation.