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A patient with disseminated cysticercosis involving orbit, tongue, parotid glands, epicardial fat, muscle, and subcutaneous tissues is presented. Magnetic resonance findings are described with emphasis on intraorbital and extracranial lesions.
Cerebral cysticercosis is a neurologic disease with myriad manifestations. Three basic types of infections occur: localized, widespread, and proliferative inflammatory reaction. A case is reported illustrating the first type of infection and one type of clinical presentation,--focal seizures. The worldwide distribution of the disease suggests that as global travel increases we will have to consider the diagnosis more often. The diagnosis is established principally through thorough examination of the CSF plus signs of parasitosis in other parts of the body. A history of living in an endemic area should strengthen suspicion. Definitive treatment is currently limited to neurosurgical intervention.
A 55-year-old woman who underwent orbital fat excision for cosmesis was incidentally found to have an isolated orbital cysticercus identified by histopathologic examination. The ensuing workup was negative for disseminated cysticercal infection and further treatment was deferred. Although uncommon, orbital cysticercosis should be considered in the differential diagnosis of an asymptomatic orbital mass. Symptomatic orbital myocysticercosis has been effectively treated with albendazole at a dosage of 30 mg/kg for 15 days combined with simultaneous low-dose steroids.
We report the fourth case of subcutaneous cysticercosis infected in Japan since 1975. The patient noticed a subcutaneous nodule on his left shoulder without symptoms for three years. No remarkable changes were found in laboratory findings and physical examination after surgical excision of the subcutaneous nodule. The adult worm of Taenia solium could not be found in the intestine. Histological findings revealed a cystic structure with a fibrous capsule and a protoscolex with suckers, hooks, and calcareous corpuscula. It was identified as a Cysticercus cellulosae hominis based on morphological characteristics. The patient has been living in the Kanto area of Japan and has never been outside Japan since he was born.
A mouse monoclonal antibody (MoAb), reactive with a repetitive carbohydrate epitope on lentil-lectin adherent glycoproteins present on the surface and in the secretions of Taenia saginata cysticerci, was used in the construction of a diagnostic ELISA assay to detect these glycoproteins in the serum of T. saginata infected cattle. The MoAb was used as the trapping layer and subsequently bound glycoprotein was revealed using the same MoAb and biotinylated peroxidase-streptavidin complex as the developing system. The assay was suitably specific. Exceptionally low background values were obtained with sera from animals with a range of commonly occurring tropical parasitic infections, including Taenia hydatigena, Echinococcus granulosus and Fasciola gigantica. The minimal detection level was approximately 200 live cysticerci in cattle. Parasite derived glycoprotein could be detected in serum from about 4-5 weeks post-infection onwards and was associated with a current infection, as drug treatment of infected cattle to kill the cysticerci resulted in the disappearance of these components from the circulation, while the titre of anti-parasite antibody remained high. The same assay also detected Taenia solium cysticercosis in humans.
This study reports on the purification of an antigen predominant within the vesicular fluid (VF) of T. crassiceps metacestodes and shown to share identity with the major vesicular fluid protein of the T. saginata larval stage. Purification was achieved by gel filtration of the VF on Sephacryl S-300 superfine, followed by ion exchange HPLC. The antigen represents a single polypeptide chain (Mr appr. 37,000) with carbohydrate moieties without affinity to ConA. Isoelectric focusing of the electrophoretical and immunological homogeneous antigen resulted in five bands focusing at pH 4.0, 4.2, 4.4, 4.6 and 4.8, respectively. In ELISA, the purified antigen detected serum IgG-antibodies in all 21-35 weeks old calves (n = 10) with experimental cysticercosis (70 to 6,000 viable larvae recovered). When compared to T. saginata metacestode VF the antigen was the better reagent for discriminating between infected and non-infected animals. As shown by immunodiffusion and ELISA the antigen is also common to the T. saginata adult stage and obviously to other taeniid metacestodes where it is accumulated in the VF or hydatid fluid.
Cerebral cysticercosis is becoming more common in Australia as the immigrant population from areas of endemic disease increases. The case reported exemplifies the common presentation of this interesting infestation. Treatment consists primarily of Praziquantel with or without steroids and anti-seizure medication if indicated. Follow-up is by both clinical and radiological assessment.
Intractable headaches have been described as the presenting complaint of many patients with T. solium neurocysticercosis. We conducted a house-to-house neuroepidemiological survey of 2,723 residents of an Andean community, known to be endemic for this infection. Migraine headaches were confirmed in 187 cases (68.7 per thousand), and tension headaches were diagnosed in 77 cases (28.3 per thousand). Fifty-seven migraine sufferers accepted computed tomography examination, and in 19 it revealed neurocysticercosis. In 11 out of 52 migraineurs who had their blood drawn, electron immunotransfer blot testing (EITB) was positive for anticysticercal antibodies. In a computer-generated random sample of this community, 109 headache-free individuals were examined by CT, and 87 had EITB. Of the 109 subjects examined by CT, 14 were positive for cysticercosis. Of the 87 individuals tested by EITB, 7 were positive. A statistically significant difference between the symptom-free general population and the migraine patients was obtained for both CT (odds ratio 3.39, P < 0.005) and EITB (odds ratio 3.07, P < 0.05) diagnosis of neurocysticercosis. Neurocysticercosis appears to be a significant risk factor for the presentation of migraine-type headaches in areas endemic for T. solium infection.
Neurocysticercosis (NC) remains a major public health problem in developing and some developed countries. Currently, the best procedures for diagnosing NC are neuroimaging studies. Immunoserologic assays, such as enzyme-linked immunoelectrotransfer blot assay (EITB) or enzyme-linked immunosorbent assay (ELISA), detect antibodies against Taenia solium, or cysticercus. Consequently, they are useful in identifying a population at risk of contact with the parasite but do not necessarily indicate a systemic active infection. Most seropositive individuals are asymptomatic. No data from prospective studies concern the proportion of these individuals that will develop seizures or other neurologic symptoms. There is a discrepancy between the results of serologic assays and neuroimaging studies: >50% of those individuals with NC diagnosed by computed tomography (CT) scan test EITB negative. Pathophysiologic classification of NC into active, transitional, and inactive forms permits a good correlation between clinical manifestations and neuroimaging procedures and facilitates medical and surgical management and research. The most frequent clinical manifestations of NC are seizures. We assume that NC is the main cause of symptomatic epilepsy in developing countries; however, no case-control or cohort studies demonstrate this association. Most patients with NC with seizures have a good prognosis; nevertheless, further studies analyzing factors related to recurrence of seizures and possibilities of discontinuation of antiepileptic medications (AEDs) are needed. Regarding treatment of NC with antihelminthic drugs, no controlled clinical trials exist that establish specific indications, definitive doses, and duration of treatment. The most effective approach to taeniasis/cysticercosis infection is prevention. This should be a primary public health focus for developing countries. We critically review the available information regarding the epidemiology and diagnosis of human cysticercosis, the physiopathology and imaging correlation of the parasite in the central nervous system (CNS) of the host, the relation between seizures or epilepsy and NC, and the issues surrounding the treatment and prognosis of NC, including the use of antihelminthic therapy.
We report a case of a cystic lesion in the left cerebellopontine (CP) angle cistern. The magnetic resonance (MR) imaging features closely resembled an epidermoid inclusion cyst, and was interpreted as such. However, at surgery and on histopathological examination the lesion was found to be a cysticercus cyst. It may be impossible to distinguish between the two by imaging. The MR imaging findings of cysticercosis, epidermoid and other common differentials are discussed.
The effect of a program to control Teania ovis cysticercosis was investigated on 32 adjacent farms at Mt Manypeaks in Western Australia. Farmers were advised not to feed dogs any raw sheep meat or offal and they were supplied with sufficient cestocide to treat all their dogs every 2 months. Other aspects such as the need for control of the movement of dogs and the correct disposal of offal from home killing of sheep were discussed and recommendations made. The success of the program was determined by recording the incidence of Cysticercus ovis in lambs born on the farms and killed at a local abattoir, and the incidence of T. ovis in dogs on the farms. Before the trial 6.9% of lambs were infected with C. ovis and 11 of the 32 farms had a T. ovis infected dog. The C. ovis incidence figures fell to 2.8%, 0.5%, 1.8% and 0.3% for the four years of the trial, and only 1 dog, a recently introduced puppy, was found to be infected with T. ovis. The results are discussed and reasons for the success of the program as a whole and apparent individual farm failures are discussed.
A new type of immunogenic molecule was engineered by replacing all three complementarity-determining-region (CDR) loops of the human immunoglobulin (Ig) heavy-chain variable (V(H)) domain with the Taenia crassiceps epitope PT1 (PPPVDYLYQT) and by displaying this construct on the surfaces of M13 bacteriophage. When BALB/c mice were immunized with such phage particles (PIgphage), a strong protection against challenge infection in very susceptible female hosts was obtained. When specifically stimulated, the in vivo-primed CD4(+) and CD8(+) T cells isolated from mice immunized with PT1, both as a free peptide and as the PIgphage construct, proliferated in vitro, indicating efficient epitope presentation by both major histocompatibility complex class II and class I molecules in the specifically antigen-pulsed macrophages used as antigen-presenting cells. These data demonstrate the immunogenic potential of recombinant phage particles displaying CDR epitope-grafted Ig V(H) domains and establish an alternative approach to the design of an effective subunit vaccine for prevention of cysticercosis. The key advantage of this type of immunogen is that no adjuvant is required for its application. The proposed strategy for immunogen construction is potentially suitable for use in any host-pathogen interaction.
Paramyosin has been proposed as a vaccine candidate in schistosomiasis and filariasis. However, limited information is available about its protective potential against cysticercosis and the immune response it induces. Immunization of mice with recombinant full-length paramyosin of Taenia solium (TPmy) results in about a 52% reduction in parasite burden after a subsequent challenge by intraperitoneal inoculation of Taenia crassiceps cysticerci. Immunization assays using recombinant fragments of TPmy, corresponding approximately to thirds on the amino, central, or carboxyl regions, suggest that protective epitopes are located mostly in the amino-end third. Proliferation assays using T cells obtained from mice immunized with the full-length recombinant TPmy also showed a preferential response to the amino-terminal fragment. In contrast, antibodies in the sera from these mice predominantly recognize epitopes located in the carboxyl-terminal fragment, being the immunoglobulin G1 subclass, the predominant antibody isotype. Characterization of the cellular immune response induced against the protective amino-terminal fragment reveals production of gamma interferon and interleukin-2, but not interleukin-4, suggesting a Th1-like profile.
Two recombinant Taenia solium oncosphere antigens, designated TSOL18 and TSOL45-1A, were investigated as vaccines to prevent transmission of the zoonotic disease cysticercosis through pigs. Both antigens were effective in inducing very high levels of protection (up to 100%) in three independent vaccine trials in pigs against experimental challenge infection with T. solium eggs, which were undertaken in Mexico and Cameroon. This is the highest level of protection that has been achieved against T. solium infection in pigs by vaccination with a defined antigen. TSOL18 and TSOL45-1A provide the basis for development of a highly effective practical vaccine that could assist in the control and, potentially, the eradication of human neurocysticercosis.
A patient with intravitreous cysticercosis was treated with the new anthelminthic drug, praziquantel. A transient toxic effect on the cysticerus was observed, but the drug was unable to kill the parasite.
In a group of forty cases of cysticercosis of the central nervous system, 59% presented with intracranial hypertension due to obstructive hydrocephalus. Ventricular or cisternal cysts, and chronic cysticercus meningitis were the most common causes of hydrocephalus. Seizures occurred in 40% of the patients, in one-half of them in association with CT-detected parenchymatous cysts. In 20% of the cases progressive mental deterioration was the main clinical feature, at times associated with hydrocephalus. CT scan provided the highest diagnostic yield, being abnormal in 90% of cases. Long term prognosis was poor, with a mortality rate of 38% over a 40-month follow-up period. The most common cause of death (60%) was meningitis. CSF shunting is the treatment of choice for hydrocephalus, irrespective of its mechanism. Surgical resection is indicated in some cases with a single superficial (cortical) or posterior fossa cyst. Supratentorial cysts carry a relatively benign prognosis.
Cerebral cysticercosis is a parasitic infestation with a highly variable prognosis and diverse clinical manifestations. Over the period of two years 51 patients were studied prospectively with this infestation, paying particular attention to the duration and severity of the illness, clinical course, CT findings and therapeutic modalities. Patients with parenchymal cysts or calcification without hydrocephalus had a benign disorder presenting commonly with seizures. This type of infestation usually is long-standing, almost never requires surgical treatment, responds to praziquantel therapy and has a good prognosis. In contrast, patients who present with hydrocephalus, large supratentorial cysts, multiple granulomata with cerebral oedema or with vasculitis and cerebral infarction, have an aggressive, acute or subacute illness, presenting with raised intracranial pressure, gait disturbances, mental changes, seizures, cranial nerve palsies, hemisphere syndromes, chronic meningitis and stroke. This malignant form usually requires surgical therapy, does not respond to praziquantel and may produce a fatal outcome or serious sequelae.
The humoral immune response to treatment with praziquantel (PZQ) was studied in eight patients with parenchymal cerebral cysticercosis (CC). In the serum and in the cerebrospinal fluid (CSF) before, during and after the administration of the drug, the following were quantitated (a) levels of specific anticysticercous antibodies measured in optical densities by the ELISA method; (b) levels of IgG, IgM, IgA and IgE; (c) levels of complement fraction C3, C4; (d) presence of immune complexes; (e) total number of white blood cells in the CSF. It was found that after treatment with PZQ, the level of specific anticysticercous antibodies and the level of IgG rose significantly in the CSF but not in the blood. The levels of the fractions of the complement and the immunoglobulins IgM, IgA and IgE did not change significantly either in the serum or in the CSF. The blood-brain barrier was found ruptured in three patients before therapy and in five patients after the therapy as measured by the albumin index. Nevertheless, the IgG index showed that there was local production of IgG in five patients before treatment and in seven after the end of it. The relative specific antibody index was greater than 1.0 in five patients before therapy and in seven after therapy. This data strongly supports the idea that the specific antibodies are produced intrathecally and are not derived from the serum pool through a ruptured blood-brain barrier. It was concluded that patients with parenchymal CC have an elevation of specific anticysticercous probably due to a combination of a ruptured blood-brain barrier and intrathecal synthesis. The relatively small rupture of the blood-brain barrier and the high IgG and relative specific antibody index suggest that intrathecal synthesis is the most important mechanism. The humoral immune response may be of importance not only in the elimination of the parasite but also in the genesis of the illness.