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Human cysticercosis: a probable case of cerebral cysticercosis with generalized subcutaneous nodular lesions.

A case is reported in Montreal of human cysticercosis in a 44-year-old man who emigrated from Italy in 1956. Numerous subcutaneous nodules were found throughout his body. X-ray of his thighs and chest showed oblong calcific densities measuring 1 x 0.5 cm in size. Examination of an excised nodule from the right biceps revealed a cysticercus larva morphologically similar to Cysticercus cellulosae although the scolex lacked hooks. On the basis of the intensity of infection, focal and generalized epileptic seizures, changes in the CSF, and well demarcated lucencies observed in brain scan, cerebral cysticercosis was considered the most likely diagnosis.

Adult

[Cerebrospinal fluid in cysticercosis of the brain].

Cerebrospinal fluid (CSF) changes in brain cysticercosis have long been known. Its characteristic features are a mild or moderate pleocytosis with eosinophils, a slight or moderate protein increase with an elevated gammaglobulin concentration, and a positive complement fixation test. Unfortunately all these abnormalities are not always present together and difficulties may be encountered in the diagnosis. This paper presents a study based on the experience acquired in the CSF Laboratory of the Neurological Department of Escola Paulista de Medicina (São Paulo, Brasil) after 35 years' work, and 120.000 CSF specimens examined. The material consists of 147 cases of brain cysticercosis confirmed by necropsy, surgery, subcutaneous or intraocular cysticercus, x ray of the skull, and of 509 clinical observation with suggestive CSF changes. It is the purpose of this paper to appreciate the importance of each of the CSF tests and to observe the CSF abnormalities during the course of this disease. The results of the study of the 79 cases varified by necropsy or surgery showed that the characteristic CSF changes that make the diagnosis of brain cysticercosis were observed in 54 percent of the cases. The eosinophils were present in 82 percent, protein changes in 78 percent, complement fixation test in 70 per cent, hypertension in 55 per cent, and decreased sugar content in 27 per cent of the cases. In two cases the CSF was normal. As the eosinophils and the protein abnormalities may be seen in several other diseases, the complement fixation test for cysticercus should be regarded as the most important CSF test in the diagnosis of brain cysticercosis. The successive CSF specimens withdrawn of 40 patients during the course of this disease have shown that the abnormalities went on for 4 to 18 years observation, suggesting that the parasites were alive. On the contrary, in 11 other cases it was varified the final CSF normalization after 5 to 14 years, suggesting that the parasites were dead. The CSF was normal in 31 out of 42 patients with opaque nodules visible in skull films (calcified cysticercus). In the remaining 11 cases, the characteristic CSF findings were observed in 3, but in 8 cases the only abnormalities were positive complement fixation test or eosinophils. In 14 out of 26 patients with subcutaneous or introacular cysticercus there were the usual CSF changes but in the other remaining cases the CSF was normal. The absence of treatment for brain cysticercosis is consistent with the persistence of CSF abnormalities in the specimens examined during the course of this disease. This calls for an integrated prophylactic to all Latin-American countries in order to exterminate this serious disease for the well-being of the next generation.

Brain Diseases

[Epidemiology of cysticercosis in Peru].

UNLABELLED: To determine the frequency and distribution of cysticercosis in Peru, we have reviewed the post mortem examinations of 12 years in the morgue in Lima (necropsies of persons apparently healthy, who died suddenly for different reasons) and in 11 hospitals: 6 in Lima (5 from adults and 1 from children) and from 5 hospitals from other cities located north and south of the capital. The material includes 50 000 necropsies and in those the frequency of cysticercosis was determined; its geographical distribution by states and regions and the frequency by age and sex. Comparison with other similar studies done in Latin America is made and prevalence determined. Frequency of porcine cysticercosis was determined in 82 452 animals killed in Lima in a 3 years period. CONCLUSIONS: frequency of cysticercosis in Peru's hospitals is 1.15%, while in the morgue, which represents approximately what happens in general population in 0.15%. Prevalence is 450 for 100 000 inhabitants.

Adolescent

Cerebral cysticercosis.

Five patients with cerebral cysticercosis, two within the year preceding the date of this article, were seen at the New York Neurological Institute. The patients presented with mental changes, seizures, and symptoms of increased intracranial pressure, and had a history of having immigrated from an area endemic for cysticercosis. They were found to have parenchymal or intraventricular cysticercosis cysts. The interval from immigration to onset of symptoms was as long as 3 years. Plain radiograms of the skull and soft tissues, ventriculograms, and especially the CT scan, as well as the CSF examination, were useful in making the diagnosis. Surgical removal of an intraventricular cyst was curative in two patients and seizures were controlled with anticonvulsants in the other three.

Adult

[Human cysticercosis. Four cases. (second part) (author's transl)].

Beside the principal aspects of cysticercosis (see the first part of this article) there are others clinical forms : medullar, ocular, subcutaneous, often associated to cerebral cysticercosis, latent or not. The complemental investigations are numerous, their value is variable. The complemental investigations are numerous, their value is variable. It is often difficult to distinguish cysticercosis from cenurosis. Therapy remains deceitful. Very important and useful are the measures of prevention.

Adult

[Cysticercosis of the brain (author's transl)].

Two cases of cysticercosis of the brain with multilocular parasite infestation are reported. Case 1 showed temporal lobe epilepsy with corresponding EEG and parkinsonism. Pathomorphologically there were parasites in the sylvian fossa and a bilateral necrosis of the pallidum. In case 2 there was a cranial nerve deficit (n.vestibulo-cochlearis) with pronounced vestibular ataxia. Parasite vesicles were surgically removed from the cerebello-pontine angle. Neurohistologically, chronic inflammatory changes were present in the immediate vicinity of the parasite. In both cases there was cysticercosis of the rhomboid fossa and base of the brain (leptomeningitis) with evidence of a process of the posterior cranial fossa. Psychic changes (hysteriform behavioral abnormalities, psychotic episodes and, increasingly, an organic psychosyndrome) were observed particularly in case 1. This case was followed for 11 years on the basis of documented and personal investigations. This report discusses the differential diagnosis and therapy of brain cysticercosis with reference to the two cases and the literature.

Ataxia

Indirect immunofluorescense reaction in cysticercosis.

The indirect immunofluorescence reaction (IIR) was used to investigate cysticercosis in the serum of 604 subjects; control group I, with 100 subjects gave the following results: 2 per cent positive, 3 per cent weak positive and 95 per cent negative. Group II had 35 cases of cysticercosis, showing 94.28 per cent positive, 5.71 per cent weak positive and 0 per cent negative. In group III, with 100 patients, other diseases were studied showing 5 per cent positive, 7 per cent weak positive and 88 per cent negative. Group IV, with 364 cases with possible cysticercosis, showed 48.90 per cent positive, 10.98 per cent weak positive and 40.10 per cent negative. In group V, five cases of Taenia saginata parasitosis were studied showing a weak positive reading.

Adolescent

The immunology of human and animal cysticercosis: a review.

In this review of the literature concerning the immunology of animal and human cysticercosis, emphasis is placed on whether previous exposure to the antigen confers protection to the host. Statistical analysis of the published data indicates that immunized animals have a lower risk than non-immunized animals of contracting cysticercosis, there being large variations within and between different host-cysticercus relationships. There is no indication as to which antigen is best for immunization but, although live parasites in all stages of development, or extracts, appear to give protection, embryos, eggs, and excretions are most frequently used. Antibodies appear to be the principal mediators of resistance, but the action seems to be only upon very young larvae, while fully grown cysticerci are unharmed. Several immunological methods are valuable in the diagnosis of cysticercosis, the choice depending more on the purpose of the study than on differences in their ability to discriminate between healthy and sick. The presence of anticysticercus antibodies in the serum of up to 50% of human patients indicates that human vaccination may be possible in high-risk areas; the remaining patients pose an interesting problem open to speculation and research on immunological evasion, immunodepression, and the existence of serotypes.

Animals

Cerebral cysticercosis.

A case of cerebral cysticercosis in an American child is described. The patient was only 2 years old and had never left the United States. Her symptoms began with febrile seizures and progressed to focal motor seizures. Cerebrospinal fluid pleocytosis with eosinophilia, candle-guttering of the walls of the ventricles on pneumoencephalography, and a titer of 1:4,096 against cysticercosis antigen in her blood led to the diagnosis. Over a five-year follow-up period, the patient's course has been one of resolution of her symptoms, improvement in her electroencephalogram, and excellent seizure control with anticonvulsant therapy. Cysticercosis should be considered in the differential diagnosis of a child who shows CSF pleocytosis with eosinophilia, particularly if accompanied by focal seizures.

Brain Diseases

[Immunoelectrophoresis and double immunodiffusion in the diagnosis of human cerebral cysticercosis].

This paper describes the immune reactivity of the sera of humans with different probabilities of suffering cerebral cysticercosis as measured in immunoelectrophoresis and double diffusion against antigenic fractions from the wall, the liquid and the scolex of Cysticercus cellulosae. The proportion of positive sera with any antigenic fraction increased with the likelyhood of suffering cerebral cysticercosis, although some variation was found between antigenic fractions. Scolex and wall antigens showed the maximal discriminatory power between sick and healthy individuals: the probability of a false positive being less than 0.05 and that of a false negative ranging between 0.4 and 0.5. With these estimates it is concluded that a positive serum in immunoelectrophoresis or double diffusion against scolex or wall antigens practically establishes the diagnosis of cerebral cysticerocosis, although this event will occur in only half of the patients afflicted by the disease. The ease of execution of these tests and their discriminatory power between healthy and sick humans justify their establishment among diagnostic tools in cerebral cysticercosis.

Antigen-Antibody Reactions

Spinal cysticercosis.

Myelopathy in a Cambodian patient proved to be due to cysticercosis. Spinal cysticercosis is rare, and Indochina is an unusual place to have acquired it.

Adult

Economic losses resulting from bovine cysticercosis with special reference to Botswana and Kenya.

Economic losses from cysticercosis are determined by disease prevalence, grade of animals infested, potential markets, prices of cattle and treatment costs for detained carcasses. The main features of the livestock economics of Botswana and Kenya are discussed. Botswana is more dependent on meat exports than Kenya and its cattle prices are much higher. The incidence of cysticercosis at export abattoirs in Botswana and Kenya is about 8 and 20% respectively. Annual losses in Botswana now approach 0-5 million pounds, while in Kenya they are about 1 million pounds. The loss per animal slaughtered is 2-25 pounds in Botswana and 1-50 pounds in Kenya. Some implications for veterinary research in this area are examined. Blanket treatment with a drug or vaccine would only be economical where prevalence was very high. An in vivo diagnostic test would be of use mainly with high value cattle.

Animals

Intramedullary spinal cysticercosis.

Intramedullary cysticercosis of the spinal cord is rare; there have been only 26 previous cases. We describe a patient with low back pain, paraparesis, lumbosacral sensory loss, and signs of meningeal irritation. The clinical diagnosis was spinal cord tumor, but at surgery there was a cysticercus cyst within the lumbosacral cord. Careful search did not reveal the parasite in any other part of the body. This is the first case of spinal cysticercosis reported in Japan.

Adult

Intrasellar cysticercosis presenting as a pituitary tumor: successful transsphenoidal cystectomy with preservation of pituitary function.

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.

Adult

[Human cysticercosis. Four cases (First part) (author's transl)].

Produced by the larval form of Taenia solium, human cysticercosis is especially redoutable because of its great affinity for the nervous system and the eyes. In France, the isolated cases, apparently autochtons, are very seldom; cysticercosis is discovered, more frequently, among immigrated people. After an historical recall, the authors describe the lesions and, among clinical manifestations, the epileptogenic, ventricular and diffuse cerebral forms.

Adult

[Diagnostic problems in the disseminated intraparenchymatous form of cerebral cysticercosis. A report on two cases (author's transl)].

The authors report 2 cases of brain localisation of cysticercosis due to Cysticercus cellulosae. In both cases epilepsy was found but only later was its origin proved by the finding of caracteristic ellipsoidal calcifications of cysticerci on the roentgenogram. The authors also recall the various possible symptoms; insist on the fact that early positive diagnosis is difficult and that the mode of treatment by surgery is exceptional. Though cysticercosis is rare in France, it should be remembered when a diagnosis of epilepsy is made and no apparent cause is found: further research of etiology should thus be made in such cases.

Brain Diseases

[Course of cerebral cysticercosis].

In the light of 4 cases of cerebral cysticercosis observed in the period 1970-1976 in Zabrze the authors call attention to the possibility of a very long, lasting even tens of years, time period preceding development of intracranial hypertension and to the diagnostic difficulties in this period. If immunological reactions are negative and the cerebrospinal fluid is normal, presence of calcified cysts in skeletal muscles visible on radiograms may be helpful. An uncertain syndrome of cerebral manifestations in a patient with occupational exposure (butchers) requires ruling out of cysticercosis. Three of these patients were butchers. In 2 plain radiograms showed calcified cysticerci in the muscles, in one they were present in the brain.

Adult

Neurological and related manifestations of cysticercosis.

Neurological and related manifestations of 17 cases of human cysticercosis have been reported. The cases have been grouped into convulsive disorder (6 cases), meningo-encephalitis (4 cases), pseudo-tumour syndrome (2 cases), psychiatric disease (2 cases), ocular cysticercosis (2 cases) and pseudomuscular hypertrophy (1 case) which proves the varied clinical manifestations of the disease.

Adolescent