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The authors describe a case of encephalomeningitis chronica eosinophilia in a 60-year-old woman. The etiology was not investigated clinically. The autoptic diagnosis was cerebral cysticercosis.
We present a review of the biological aspects of taeniasis-cysticercosis binomial, emphasizing those related to its biotic potential, resistance, and viability of eggs in the environment, as well as the morphological features of the corresponding adults, which are instrumental for the diagnosis of taeniasis. A new infection mechanism through the ingestion of posoncospheres present in macerated meat is discussed. The significance of unifying epidemiological criteria to control this important binomial is pointed out.
A case of intraventricular and cisternal cerebral cysticercosis with no intraparenchymatous involvement is reported. The clinical features were characterized by episodes of blockage of the C.S.F. pathways producing acute hydrocephalus. On three occasions surgical treatment was required: two ventriculoperitoneal shunts and a ventriculocisternostomy were performed. The intraventricular cystic membranes found during the third operation suggested the diagnosis. Epidemiological arguments, the pathogenesis of hydrocephalus and diagnostic and therapeutic aspects are discussed in the light of the literature data.
Recombinant DNA and related technologies are providing valuable, novel reagents for application in control strategies against the major parasitic diseases, including hydatid disease and cysticercosis. The impact of these powerful techniques for improving diagnosis and identification of various life cycle stages of Echinococcus spp. and Taenia solium, essential pre-requisites for epidemiological studies and for evaluating control programs, is beyond question. Furthermore, the use of molecular technology for characterizing sub-specific variants of strains of both Echinococcus and T. solium has led to important revisions of our understanding of the diseases they cause. In light of the recent remarkable development of a recombinant vaccine against T. ovis, the first practical parasite vaccine to be produced, the prospects for rapid development of similar vaccines against the medically important taeniids appear to be very encouraging.
Cysticercosis is a health problem in Reunion Island. A representative sample (3388 sera) of the Reunion population (more than 14 years of age) shows a prevalence of 8.2%. A statistically significant correlation is found with mode of transmission (pig raising, toilet). This result contributes to proposed measures of prevention.
Enzyme linked immunosorbent assay (ELISA) using a fraction of larval Taenia hydatigena cyst fluid antigen was carried out on 469 bovine sera collected at slaughter from feedlot cattle for the presence of anticysticercosis antibodies. Cysticerci, in low numbers, were found in the heart, tongue and/or masseter muscles of 84 of the 469 cattle at postmortem inspection. Only nine sera gave positive ELISA reactions and in only one of these nine animals were cysticerci found. Within the limitations of this study, the high rate of false negative and false positive reactions suggests that the ELISA with the antigen used is not a satisfactory procedure to diagnose cysticercosis in cattle, at least in animals with light infections.
A fraction of larval Taenia hydatigena cyst fluid was shown to have high sensitivity and specificity in the enzyme-linked immunosorbent assay (ELISA) for the detection of bovine antibodies to the heterologous parasite Taenia saginata. This antigenically active lipoprotein fraction was isolated by ultracentrifugal density flotation using either ammonium sulfate (specific gravity = 1.231 g per ml) or NaCl/KBr (specific gravity = 1.225 g per ml), followed by ion-exchange chromatography. Sodium dodecyl sulfate-polyacrylamide gel electrophoresis (SDS-PAGE) indicated that this fraction was composed of high molecular weight (65,000 to 77,000 Mr) and low molecular weight (9,500 to 16,000 Mr) proteins. Electrophoresis under non-denaturing conditions in either acrylamide (5%) or agarose (1%) resulted in 1 major diffuse band staining for both protein and lipid. The high and low molecular weight proteins observed on SDS-PAGE under reducing conditions could not be resolved by gel filtration chromatography and emerged as a single lipoprotein peak. This T. hydatigena cyst fluid fraction appears promising as a diagnostic reagent in the ELISA for bovine cysticercosis.
The clinical pictures produced in man by cysticercosis and hydatidosis are well known, not being infrequent the occurrence of fatal cases. Nevertheless, retrospective studies, carried out in autopsies, have permitted to demonstrate that only about one third on the cases of each of one of the quoted parasitoses, were caused by the corresponding etiologies. In this respect, in a study performed in Santiago, Chile between 1947 and 1984, which included the revision of 189,909 autopsy protocols, it was possible to verify that out of 116 neurocysticercosis cases 79 (68.1%) corresponded to autopsy findings, whereas out of 568 hydatidosis cases, 363 (63.9%) were autopsy findings, without a previous clinical history suggesting the respective parasitosis and not depending of the location of the parasite.
Progress in recent research towards vaccination against cysticercosis is reviewed briefly. An antigen of Taenia ovis has recently been cloned using recombinant DNA techniques and this single defined recombinant molecule has been shown to induce high-level protection against challenge infection in sheep. Prospects for the application of this discovery in T. ovis for development of effective vaccines against infection with the metacestodes of other taeniid parasites are discussed. The extent and level of cross protection between different taeniid species is reviewed. Recent research results defining stage-specific immune responses against T. taeniaeformis in mice following immunization with oncosphere and metacestode antigens is discussed in relation to the potential development of cocktail vaccines. Such vaccines may be capable of protecting against initial infection and the killing of those parasites which might evade the early-phase immune responses. Recent advances in the development of a practical vaccine against Taenia ovis infection in sheep raise the realistic prospect of the development of a similar vaccine against other taeniid parasites including T. solium. Advances in the understanding of vaccination - induced immune responses against T. taeniaeformis infection in mice also indicate that effective immunization may be capable of eliminating the establishment of any viable metacestodes.
A study was carried out in a rural community of the state of Guerrero in order to find ways to control human taeniasis/cysticercosis (Taenia solium). At the beginning of the study the frequency of porcine cysticercosis was established to be around 6.6%. Fecal examination in the human population showed that of 760 persons, 24 were carriers of Taenia sp (3%). Of 440 human sera tested for antibodies against cysticercus cellulosae, 9 showed absorbance values of 0.2 or higher (2.3%). 900 persons received treatment against taeniasis. 400 soil samples and 600 flies were examined for the presence of eggs of Taenioae, all with negative results. Meetings with the adult population were organized to explain the disease and the life cycle of the parasite. Lectures and demonstrations for adults were given at the school for primary and secondary grade children. Special emphasis was given to the need to construct latrines in every home, as it was found that defaecation was practiced mainly in the open, usually at places where pigs had immediate access and ingested the faeces. One year after the initiation of the programme, pigs under the age of 1 year were inspected, to determine whether the cestocide treatment of humans has had an effect on the degree of parasitized pigs and if hygiene had improved. 11% of these animals were found to have cysticerci in their tongue. Two years after the initiation of the programme 78% of the children and 2% of adults answered questions about the lifecycle of the parasite correctly. The results of the trial are discussed and suggestions for future programmes are made.
A preliminary report of praziquantel (PZQ) treatment in 10 patients with cysticercosis in Vietnam is presented in this paper. One patient with a severe neurological disorder probably died due to increased intracranial pressure. Nine patients were treated with relatively low dose of PZQ (15-20 mg/kg). Almost all subcutaneous cysts disappeared while patients with neurological symptoms definitely improved. However, more or less severe side effects were observed during the treatment course in spite of concurrently applied corticosteroids. The patients are still under follow-up attention.
Swines with cysticercosis are a useful model to study human disease. A multidisciplinary approach was undertaken to study in detail the effect of praziquantel treatment on hosts and parasites. Computerised tomographic scans showed changes in the number and size of parasites in treated pigs. These changes were more apparent in muscle than in brain cysticerci. Neurophysiologic data were normal in cysticercotic pigs before and after drug treatment. An increase in antibody response was seen immediately after treatment regarding the amount of antibodies and number of antigens recognised. A lower number of polyploid lymphocytes was seen after treatment in cysticercotic pigs as compared to untreated pigs. At different times after treatment pigs were humanely euthanised. Oxygen consumption rate of cysticerci decreased after treatment and evagination was abolished. The inflammatory reaction that surrounded parasites increased in number and type of cells. This was more apparent around cysticerci obtained from muscle than from the brain.
In this paper we report the immunodiagnosis of cysticercosis by the detection of antibodies in the cerebrospinal fluid (CSF) of patients, by standard enzyme immunoassay (EIA) which gave 90% sensitivity. We are also showing the results obtained with a double homologous polyclonal or monoclonal antibody based EIA that detects parasite products: we analysed CSF of patients and obtained sensitivities ranging from 14% to 75% for single antibody systems and 90% when analysing the samples with two or three systems simultaneously. The sera of infected pigs were also evaluated; with one monoclonal antibody we could detect 79% of positive samples. The good results obtained encourage the standardization and improvement of the technique for diagnostic as well as for epidemiologic purposes.
The micro-ELISA described in this report is simple and can give objective results for the serodiagnosis of human cysticercosis. The visual assessment of results was satisfactory. The ELISA results showed a remarkably good correlation with IHA. It gave good reproudcibility. Cross-reactions were eliminated by using whole worm antigen instead of the cysticercus.
Patients with cerebral cysticercosis (CC) have specific antibodies of the IgG type in blood and cerebrospinal fluid (CSF). In order to determine if the specific antibodies present in the CSF come from blood or synthetized in the subarachnoid space, we studied the integrity of the blood brain barrier (BBB) and the intrathecal synthesis of specific antibodies. We found a ruptured BBB with more frequency and in a higher intensity in patients with CC and hydrocephalus (malignant CC) than in patients with parenchymal CC (benign CC). The patients with malignant CC have a greater number of inflammatory cells, a higher albumin index (serum albumin/CSF albumin), a higher level of protein and a higher titre of specific antibodies in the CSF than those with benign CC. In 15 patients in both groups we could demonstrate intrathecal synthesis of antibodies. We conclude that in CC the specific antibodies are produced intrathecally, and in a lesser amount come from the blood through a ruptured blood-brain barrier.
ELISA detection of specific antibodies in the serum (IgG) and cerebrospinal fluid (IgG, IgM and IgA) was evaluated in 28 patients. Diagnosis of cerebral cysticercosis and evaluation of disease activity was based on CT scan findings. Specific IgG antibodies were found in the serum in 83.3% of patients with active disease and 10% of those with inactive disease. Cerebrospinal fluid tests evidenced specific antibodies in all patients with active disease and none of the patients with inactive disease. The specific CSF antibodies were IgG (94.4%), IgM (66.6%) or IgA (66.6%). Antibody titers were significantly higher in patients with an intraventricular vesicle or cyst.
A viable intravitreal cysticercus cellulosae communicating with subretinal space was identified in a 45-year-old man. The cyst was removed in toto via the direct scleral approach without incident. To our knowledge this is the first report of intravitreal cysticercus with subretinal extension removed successfully by the direct route. The role of careful ultrasonic scanning in cases of intravitreal cysticercosis is emphasized.
A case of cysticercosis with scattered calcifications has been reported; this, owing to the rarity of cases brought to our notice with certainty, is considered a medical curiosity. The case is subjected to analysis by us and we review the literature pertaining to such cases.