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PubMed1999

[Epidemiology of cerebral cysticercosis in an Andean community in Ecuador].

Taenia solium neurocysticercosis (NCC) has been documented to be an underlying cause of epilepsy, intractable headaches, hydrocephalus, dementia and other serious neurological conditions in many countries of Central and South America. However, methodological limitations had prevented the assessment of the true prevalence of this condition at the community level. We conducted a house-to-house neuroepidemiological survey of 6,118 residents of an Andean community. This information was used to target neuroimaging (CT-scan) and immunodiagnosis (enzyme-linked immunoelectrotransfer blot assay, EITB) tests in individuals suspected of harbouring Taenia solium NCC. In the rural population, NCC was confirmed in 8 out of 47 examined by CT-scan (17%) and in 6 of 42 examined by EITB (14%). In the urban population, NCC was confirmed in 35 of 147 examined by CT-scan (23.8%) and in 28 of 124 examined by EITB (22.6%). In a sample of relatives of patients with documented cerebral cysticercosis, 20 out of 81 examined by CT-scan (25%) and 12 of 79 (15%) examined by EITB had NCC. Finally, CT scans were performed for 83 school children from urban areas, and 9 (11%) were diagnosed as harbouring NCC. In a community-based study, cysticercosis appears to be much more frequent than initially thought, when CT examination is used as the "gold standard" for diagnosis.

Adolescent↗

PubMedDate not supplied

[Cysticercosis of the cerebellopontine angle: treatment with single-dose praziquantel].

INTRODUCTION: Praziquantel has not been considered useful for therapy of subarachnoid cysticercosis. However, recent studies suggest that the introduction of a new regimen of praziquantel therapy, that includes the administration of higher doses of the drug at shorter intervals, may improve pharmacokinetic properties of praziquantel and increase its efficacy in this form of the disease. CLINICAL CASE: A 28 year-old woman presented with a six month history of headache, vomiting, nystagmus, right peripheral facial palsy, and left hemiparesis. Computerized tomography (CT) scan of the head revealed a large cysticercus in the right cerebellopontine angle cistern compressing the brain-stem. She was treated with praziquantel 100 mg/kg in three divided doses at two hours apart. Thereafter, she received three 8 mg doses of intravenous dexamethasone given 6, 24 and 48 hours after the last dose of praziquantel. She improved after therapy, with total resolution of hemiparesis. Control CT showed progressive reduction and size and further disappearance of the cystic lesions three months later. CONCLUSION: This single-dose regimen of praziquantel seems to be effective for therapy of subarachnoid cysticercosis. Further studies with a large number of patients are needed to confirm the efficacy of the drug in this form of the disease.

Adult↗

PubMed2002

CSF-VP shunt placement and albendazole therapy for cerebral cysticercosis.

Cerebral cysticercosis is the most common worldwide parasitic infection of the central nervous system. Intraventricular involvement is apparent in 15% to 28.8% of cases with neural compartment infestation.' Although different forms of the disease (parenchymatous, subarachnoid, and mixed form ) have been treated successfully with chemotherapy, direct surgical excision of simple cystic lesions appears to be an adequate primary therapeutic strategy in the majority of intraventricular forms. In recent years, however, some authors have advocated the use of anthelmintic treatment in all cases of intraventricular cysts so that surgical procedures of the posterior fossa and their potential complications can be avoided. The strict definition for managing the spectrum of intraventricular infestation remains controversial. We present our experience in the treatment of a patient with primary isolated intraventricular cysticercosis.

Albendazole↗

PubMed2002

Spinal cord cysticercosis: neurosurgical aspects.

OBJECT: The authors report their experience in the treatment of 12 symptomatic patients with intradural spinal neurocysticercosis. METHODS: The mean age of the 12 patients was 33 years. There were eight female and four male patients. Cysticercosis was present in association with hydrocephalus in nine cases. In nine of 12 patients the spinal lesion was confined to the thoracic or lumbar spinal cord, and in three the cysticerci occupied the cervical region. In all patients with hydrocephalus nerve root symptoms developed seven to 48 months later (mean 27.6 +/- 15.5 months). In one patient hydrocephalus was absent, but he presented with cysticercal meningitis 24 months before spinal cord compression developed. Presenting symptoms suggesting spinal cysticercosis included muscular weakness (67%), pain (67%), and sphincter disturbance (25%). Neurological examination demonstrated a motor deficit in nine patients, sensory deficit in four, and radicular pain in three. The prognosis was worse in patients with moderate-to-severe arachnoiditis and spinal cord compression compared with those with isolated nerve roots involvement in whom outcome was favorable. Ten patients underwent laminectomy, after which neurological status improved in 44%, remained unchanged in 33%, or worsened in 22.2%. CONCLUSIONS: The authors discuss their findings in these cases. Additionally they briefly review the literature, pathophysiology, and therapeutic and/or surgical strategies involved in this disease.

Adolescent↗

PubMed2006

Spinal cord cysticercosis: a case report.

Cysticercosis caused by the infection with the larva of Taenia solium, common through out the world, is located in the muscles, the eyes and the central nervous system, but mostly in the brain. Spinal cord infection is rare. The authors report a case of a young girl, living in Paris who had traveled in Latin America, and complained of back pains and troublesome walking. MRI showed a cyst in spinal cord, but other examinations were normal. Diagnosis was confirmed by a pathologist. It was a pure intramedullary cysticercosis, the check-up to find other locations was negative. Only approximately 130 cases are reported in the literature, with motor and sensory disorders. The diagnosis was based on MRI and pathological examination. Antiparasitic medical treatment was useful when combined with surgery.

Adult↗

PubMed2003

Taenia solium cysticercosis.

The larval stage of the pork tapeworm (Taenia solium) infects the human nervous system, causing neurocysticercosis. This disease is one of the main causes of epileptic seizures in many less developed countries and is also increasingly seen in more developed countries because of immigration from endemic areas. Little information is available on the natural evolution of taeniasis or cysticercosis. Available therapeutic measures include steroids, treatments for symptoms, surgery, and, more controversially, antiparasitic drugs to kill brain parasites. Efforts to control and eliminate this disease are underway through antiparasitic treatment of endemic populations, development of pig vaccines, and other measures.

Animals↗

PubMed2002

Taenia solium oncosphere antigens induce immunity in pigs against experimental cysticercosis.

Immunity to Taenia solium infection was investigated using an experimental intramuscular oncosphere infection assay (IMOA) model in pigs. Three naturally infected pigs with cysticercosis were treated with oxfendazole (OFZ), a drug demonstrated to kill cysts in porcine muscle. These animals were then challenged with oncospheres but did not develop any cysts while three uninfected pigs that were similarly challenged, did develop intramuscular cysts. In another study, two groups of three pigs each were immunized with crude T. solium oncosphere and metacestode antigens, respectively, and tested with the IMOA. Immunization with crude oncosphere antigens (OAs) induced 100% protection, while metacestode antigens provided only partial protection. Immunoblots showed that pigs with complete immune protection to oncosphere intramuscular challenge had antibodies to two OAs at 31.3 and 22.5 kDa, respectively. Antibody to these two antigens was absent in pigs immunized with metacestodes or in uninfected control pigs. This study demonstrated the presence of two antigens that are unique to the oncosphere. Although, antibody to these two antigens is consistently present in pigs that are protected from an oncosphere intramuscular challenge their role in preventing infection by T. solium larval cysts is still hypothetical.

Animals↗

PubMed1988

Sex-related severity of inflammation in parenchymal brain cysticercosis.

To determine sex-related differences in the severity of host inflammatory reaction to cysticercosis, we studied computed tomographic findings in 100 patients with parenchymal neurocysticercosis and cerebrospinal fluid results in 239 patients with subarachnoid neurocysticercosis. Computed tomographic and cerebrospinal fluid data in male subjects were compared with those obtained in female subjects. We found that when cysticerci are found in brain parenchyma, women develop a greater degree of inflammation; such differences disappear when cysticerci are found in the subarachnoid space. Our results point out the possibility of a factor located within brain parenchyma that accounts for the observed sex-related differences in the severity of immune response to the parasite; this factor could also play a role in the pathogenesis of other immunologically mediated diseases of the brain that may occur more frequently in women. To our knowledge, this study is the first in demonstrating that sex is a risk factor for the severity of inflammatory response within brain parenchyma to a parasitic disease.

Cysticercosis↗

PubMed1982

Cysticercosis cerebri. Review of 127 cases.

We reviewed the clinical features, diagnosis, and treatment in 127 cases of cysticercosis cerebri. The chief syndromes were seizures (55.1%), hydrocephalus (37.8%), and stroke (11.8%). Serum or CSF indirect hemagglutination titers, determined in 101 patients, were positive in 84.1% of those with CSF pleocytosis but in only 42.1% of those without. Computed tomography (CT), employed in 85 patients, showed typical multiple calcifications in 64.7%. The CT scans were most useful in the surgical treatment of ventriculomeningeal infestation. Ventricular shunt implantation was performed in 40 patients with hydrocephalus and produced marked improvement in 32. Cyst resection was necessary only for patients with rapidly enlarging fourth ventricle cysts.

Adolescent↗

PubMed1985

Intra-blood-brain barrier IgG synthesis in cerebral cysticercosis.

Patients with central nervous system cysticercosis show elevated binding of cerebrospinal fluid (CSF) IgG to homogenized cysticercus. To determine whether any of the CSF IgG was the result of de novo intra-blood-brain barrier (BBB) synthesis, CSF and serum samples from six patients were examined for elevated rate of synthesis and oligoclonal bands. Five of the six patients had increased intra-BBB IgG synthesis rate and four of these patients also had oligoclonal IgG bands present in the CSF that were absent in the serum. These results demonstrate intra-BBB IgG synthesis similar to that observed in other infectious and inflammatory diseases of the central nervous system.

Blood-Brain Barrier↗

PubMed1979

Intraocular cysticercosis.

Two intravitreal Taenia cysts were removed intact by pars plana vitrectomy from a 59-year-old woman who had never left the continental United States. The intraocular course of the cysts progressed from an initial chorioretinal location, accompanied by an intense focal inflammatory reaction, to free floating in the vitreous cavity within two months; thereafter, there was only a low-grade vitritis for an additional five months until removal. Light and electron microscopic studies suggested Cysticercus cellulosae as the infecting agent, although mature hooklets were absent. Local pork products were considered to be the source of the infection. Preretinal fibrosis and posterior subcapsular vacuoles were the final residua and did not progress after removal of the cysts. Although uncommon in the United States, cysticercosis should be considered in cases of focal necrotizing chorioretinitis.

Cysticercosis↗

PubMed1977

Cysticercosis of the nervous system: diagnosis by means of specific radioimmunoscan.

A new method for diagnosing cerebral cysticercosis by means of specific radioimmunoscan is described. The method has been evaluated in 24 patients with encouraging results. The technique involves a single intravenous injection followed by brain scanning and thus far has been entirely nontoxic. The accuracy of the scan was confirmed in 6 patients by surgical removal of lesions that coincided in location and number with the diagnostic scan of the parasites.

Animals↗

PubMed1991

Fine-needle aspiration cytology in the diagnosis of cysticercosis presenting as palpable nodules.

The cytologic findings in the fine-needle aspirate of 30 cases of cysticercosis presenting as palpable nodules are described. Essential for a diagnosis are identification of parasitic fragments. These include bluish fibrillary structures sometimes with honeycombing, tegument of parasite thrown into rounded wavy folds, and scolex with hooklets and hyaline membrane surrounding it. The inflammatory reaction consisted of eosinophils, neutrophils, lymphocytes, histiocytes, epithelioid cells, and giant cells in varying proportions.

Adolescent↗

PubMed1992

Clinical pharmacokinetics of albendazole in patients with brain cysticercosis.

Albendazole pharmacokinetics were studied in eight patients who were receiving albendazole in doses of 15 mg/kg per day for 8 days as treatment of brain cysticercosis. Albendazole was not detected in plasma, but its main metabolite albendazole sulphoxide could be measured. Maximum plasma levels for albendazole sulphoxide ranged from 0.45 to 2.96 micrograms/mL. The half-life of albendazole sulphoxide was between 10 and 15 hours. A double peak was found in three patients. Mean residence time values were from 14 to 20 hours. Plasma levels of albendazole sulphoxide at the steady state showed great intraindividual variability. The results suggest that albendazole can be administered twice daily rather than three times as is currently done.

Administration, Oral↗

PubMed1996

Taenia saginata: vaccination against cysticercosis in cattle with recombinant oncosphere antigens.

Taenia saginata is a medically and economically important cestode parasite. Infection with the cysticercus larval stage in cattle causes economic loss in the beef meat industry. A practical vaccine to prevent infection with the parasite in cattle would be valuable and would assist in control of transmission of the parasite to humans, the obligate definitive host. Here we use recombinant DNA techniques to clone oncosphere antigens of T. saginata and use the recombinant antigens in vaccine trials in cattle. Vaccination with a combination of two antigens, designated TSA-9 and TSA-18, induced up to 99.8% protection against experimental challenge infection with T. saginata eggs. Operational characteristics of the vaccine will need to be defined, such as duration of immunity and protection of newborn calves. The vaccine has the potential to be used on a commercial scale for the control of bovine cysticercosis.

Amino Acid Sequence↗

PubMed1987

Improved immunodiagnosis of human cysticercosis with scolex protein antigens.

Crude antigenic extract (CAE) and a scolex protein antigen (SPA) of Taenia solium cysticerci were used in indirect haemagglutination (IH) and enzyme-linked immunosorbent assay (ELISA) to detect serum antibodies in cysticercosis patients. Complement fixation (CF) was used for comparison with antigens obtained as an alcoholic extract of CAE (ACAE) and SPA (ASPA). For each test, a dilution was chosen which showed no cross-reactivity with sera from patients with other parasitic diseases such as taeniasis, schistosomiasis, ancylostomiasis, ascaridiasis, strongyloidiasis, Chagas' disease and syphilis. For the CF, 1:4 was the discriminative dilution determined; for IH, 1:16 and for ELISA, 1:256. The CF could detect serum antibodies to cysticerci in 45% of patients when ACAE antigen was used and 73% using ASPA. In the IH, serum antibody was detected in 73% of patients when CAE was used and 86% using SPA. In ELISA 63% of patients were positive when CAE was used and 91% using SPA. The use of SPA improved the serological distinction between infected and uninfected patients in all tests and the ELISA showed a significantly higher capacity to detect infected patients.

Animals↗

PubMed1987

Penetration of praziquantel into cerebrospinal fluid and cysticerci in human cysticercosis.

Two patients with cysticercosis received praziquantel (PZQ) 75 mg/kg/day orally together with 30 mg prednisone daily for 3 weeks. The first patient presented with grand-mal seizures, a pyramidal tract syndrome and subcutaneous cysticerci, and the other had internal hydrocephalus necessitating drainage. Serial plasma samples were taken after the first dose of PZQ. Lumbar CSF was obtained from the first patient and ventricular CSF from the second. Subcutaneous cysticerci were removed from the first patient. PZQ in the specimens was assayed by GLC. For distribution between plasma and CSF a rate constant of 4.9 h-1 for free PZQ, corresponding to a t1/2 of 8 min or less for the non-protein bound fraction was calculated for Patient 1. In the second patient the distribution was so rapid that the rate constant could not be calculated. The difference in distribution rate might have been due to use of different sampling times or to a time lag in the entry of PZQ between the ventricles and the lumbar sac. The rate constant for distribution of the drug between plasma and parasites was 1.4 h-1, corresponding to a t1/2 of 30 min or less. Thus PZQ penetrates rapidly into the CSF. It enters the parasite more slowly, although still more rapidly than the plasma half-life of PZQ (1-1 1/2 h).

Adult↗

PubMed1981

Isolation of fraction no. 10 from Taenia saginata and evaluation of its specificity for the diagnosis of bovine cysticercosis.

In an attempt to prove the specificity of the crude Taenia saginata antigen for the immunodiagnosis of bovine cysticercosis, a major and highly immunogenic fraction (F10), responsible for the formation of the typical "long band" reaction in immunoelectrophoresis, has been isolated from T. saginata proglottides by immunoaffinity chromatography. The immunoabsorbent was prepared by coupling a specifically raised hyperimmune serum (HIS) anti-F10 to Sepharose 4B. The purity of the isolated F10 was demonstrated by immunoprecipitation reactions. The HIS anti-F10, however, cross-reacted with several larval and adult Taenia spp. Consequently, F10 showed cross-reactions with the sera of animals infected with hydatid cysts or larval T. hydatigena. F10 also reacted with HIS anti-F5 (Echinococcus granulosus) but was shown to be non-identical with the well known F5 of E. granulosus. These data prove that F10 of T. saginata was not species-specific but showed a group specificity for the taeniid family - a situation analogous to F5 of E. granulosus.

Animals↗