Long-term albendazole therapy for diffuse parenchymal neurocysticercosis in an immunocompetent patient:A case report

Rationale:Neurocysticercosis is a neglected tropical disease caused by the larvae of Taenia solium and may occur in immunocompetent people.We report a case of diffuse parenchymal neurocysticercosis mimicking tuberculous meningitis in an immunocompetent patient.Patient concerns:A 24-year-old immunocompetent woman presented with serial focal to generalized seizure,left body weakness,left abducens palsy,chronic cough,and body weight loss.She came from an area where she was unlikely to have contact with Taenia solium.Diagnosis:Diffuse parenchymal neurocysticercosis.Intervention:Valproic acid,dexamethasone and 15 months of albendazole therapy.Outcome:Complete recovery without any neurological sequelae.

Taenia solium taeniasis and cysticercosis:extinction or outbreak

Taenia solium taeniasis and cysticercosis are neglected zoonotic diseases that affect human health and economies of developing countries.In this work,we formulate and analyze deterministic and continuous time Markov chain(CTMC)stochastic models to determine parameters that drive Taenia solium taeniasis and cysticercosis and the likelihood of their extinction.The basic reproduction number R0 is computed by the next generation matrix approach,sensitivity index of each parameter in R0 is derived by the normalized forward sensitivity index and the likelihood of diseases’extinction is computed by the multitype branching process.The analysis shows that humans with Taenia solium taeniasis,infectious pork and Taenia solium eggs in the environment play an important role in the transmission of Taenia solium taeniasis and cysticercosis,and the model exhibits forward bifurcation at R0=1.This implies that R0<1 is a sufficient condition to eliminate Taenia solium taeniasis and cysticercosis.For CTMC model,analysis shows that the probability of Taenia solium taeniasis and cysticercosis extinction is high if the diseases emerge from humans with Taenia solium cysticercosis and there is an outbreak if the diseases emerge from either humans with Taenia solium taeniasis or infectious pork or Taenia solium eggs in the environment.To control Taenia solium taeniasis and cysticercosis,the intervention strategies should focus on improving hygiene and sanitation for reducing shedding rate of Taenia solium eggs in the environment,inspection of pork for reducing the rate of acquiring Taenia solium taeniasis and spraying of insecticides for killing Taenia solium eggs in the environment.

Cysticercosis of the eye

Cysticercosis is a preventable and eradicable cause of blindness endemic in the Indian subcontinent,SouthEast Asia and other developing countries. Ocular and orbital cysticercosis has varied presentations depending upon the site of involvement,number of lesion and the host immune response. In this article we present a review of the various clinical manifestations,diagnosis and management protocol for orbital and ocular cysticercosis.Owing to its varied presentation,cysticercosis may pose a diagnostic challenge to the health professionals. Early diagnosis and management can prevent the vision loss and optimize visual outcomes.

Diagnosis of neurocysticercosis among patients with seizures in northern coastal districts of Andhra Pradesh, India

Objective: To report cases of neurocysticercosis(NCC) from three neighboring districts of Andhra Pradesh state in India where NCC burden was never explored before.Methods: A total of 160 patients presenting with recent onset seizures were recruited from neurology, general medicine, and pediatric outpatient clinics of a local major tertiary care teaching hospital serving above districts during the period 2011–2014. Brain imaging was performed in all the above cases. A commercial immunoglobulin G-ELISA kit(sensitivity = 85%; specificity = 94%) was employed for the serological diagnosis of NCC.Results: The recruited patients presented with generalized, simple partial, and complex partial seizures(55%, 31.25% and 13.75% respectively). NCC was diagnosed in 44 of160(27.5%) seizure cases based on imaging characteristics, and a positive serum antibody ELISA. No association was detected between seropositivity with the number and location of the lesion(s) in the brain.Conclusions: The possible potentiality of NCC could be identified as an underlying cause of the recent onset of seizures in this region as explored in the present study. It is recommended that NCC should be suspected as one of the major differential in every recent onset seizure with or without a radio imaging supportive diagnosis, especially in areas endemic for taeniasis/cysticercosis.

Disseminated cysticercosis incidentally diagnosed in a patient of low backache:A case report and concise review of literature

Disseminated cysticercosis is an uncommon presentation of a common disease.Asymptomatic disseminated cysticercosis is rarely reported in literature.Here,we are reporting a case of asymptomatic disseminated cysticercosis incidentally diagnosed in a patient of low backache. Magnetic resonance imaging of lumbosacral spine and neuroimaging done subsequently during the course of evaluation revealed diffuse cysticercosis involving abdominal,paraspinal,pelvic and gluteal muscles along with neurocysticercosis.Such a disseminated cysticercosis was diagnosed incidentally in this patient of low backache with right sciatica and radiculopathy at L5-S1 prolapsed intervertebral disc and was subsequently managed by L5-S1 interlaminar fenestration and discectomy.

Microsurgical Treatment of Epilepsy with Parenchymal Neurocysticercosis

Parenchymal neurocysticercosis is the most common form of neurocysticercosis in the central nervous system(CNS),which mainly causes epilepsy and usually responses well to routine medications.However,there are appreciable cases of relapses refractory to medical treatment.We investigated microsurgical treatment of epilepsy with parenchymal neurocysticercosis.Nine cases of epilepsy caused by parenchymal neurocysticercosis from 2002 to 2018 were analyzed retrospectively.Cysts in 7 cases were completely removed.No case died of operation and no new dysfunction of the nervous system was observed after surgery.Among the other 9 cases,8 cases became seizure-free or controlled by medicine according to the postoperative follow­up for 6 months to 9 years.One case was lost for followup.It was suggested that epilepsy with parenchymal neurocysticercosis can usually be controlled after routine medications.However,surgery is still indicated in some cases and careful microsurgery is associated with satisfactory clinical outcomes in appropriately selected cases.

Intraventricular neurocysticercosis: Presentation, diagnosis and management

Neurocysticercosis is thought to be the most common helminthic infection of the central nervous system and its epidemiology is changing due to increasing travel and migration.Evidence to guide management of the intraventricular form is limited.We aimed to review the clinical presentation,diagnosis and treatment of intraventricular neurocysticercosis with reference to two recent cases seen at our institution.The intraventricular variant of neurocysticercosis is less common than parenchymal disease and usually presents with acutely raised intracranial pressure and untreated it progresses rapidly with high mortality.The diagnosis is based on imaging and serological tests but more invasive testing including histopathological examination of surgically acquired tissue specimens is sometimes required.Treatment is mainly surgical,using a neuroendoscopic approach if possible.Patients should also receive antihelmintic treatment with concomitant corticosteroids to reduce the incidence of shunt failure if a ventricular shunt is inserted and to treat viable lesions elsewhere.

Needs of exploring the burden of recent onset seizures due to neurocysticercosis and challenges in southeast Asia focusing on scenario in Malaysia

Seizures due to neurocysticercosis(NCC) is a neglected human-to-human transmitted disorder and an emerging problem worldwide.A substantial portion of recent onset seizures is known to be attributed to NCC in Taenia solium(T.solium) endemic areas where populations which neither raise pigs nor eat pig meat are also at risk.High prevalence of NCC causing epilepsy has been reported in the underdeveloped areas of Southeast Asia(SEA) however,only fragmentary information on its incidence is available in countries like Malaysia.In Malaysia T.solium infection was previously thought to be infrequent due to Muslim population majority and the religious prohibition of consuming pork,but it is not totally absent There is an evident lack of knowledge and awareness of the actual burden,routes of transmission,and the impact of NCC in this region.The problem is assumed to be more prevalent particularly in cities because of the frequent inflow of possibly T.solium infected individuals or carriers among those who migrate from neighboring endemic countries to Malaysia.The issue of imported cases that are likely to be emerging in Malaysia is highlighted here.An accurate quantification of regional burdens of epilepsy due to NCC in Malaysia is warranted considering the disease emergence in its neighboring countries.It is suggested that the importance of NCC be recognized through quantification of its burden,and also to collect epidemiological data for its subsequent elimination in line of World Health Organization's mission for control of cysticercosis as a neglected tropical disease.In this review the need as well as a strategy for neurc-care center screening of epilepsy cases,and various issues with possible explanations are discussed.It is also proposed that NCC be declared as a reportable disease which is one of the eradicable public health problems in SEA.

State of the art in neurocysticercosis

Diagnosis of neurocysticercosis(NCC)based merely on computed tomography(CT)and magnetic resonance imaging may be doubtful when considering that parenchymal and extraparenchymal NCC are practically distinct clinical and pathophysiological entities.In this letter,we comment on a recent case report by Rizvi et al.

Disseminated cysticercosis presenting with bilateral proptosis: A case report

Rationale: Disseminated cysticercosis is characterized by presence of cysts in multiple body organs, like brain, skin, eyes, muscles and rarely heart and lungs.Patient concerns: A 22-year-old man presented with bilateral proptosis of 1-year duration. He also had two episodes of cysticercosis encephalitis. In the second episode of encephalopathy, the patient died.Diagnosis: Disseminated cysticercosis.Interventions: Corticosteroids(Initially intravenous dexamethasone 0.4 mg/kg/day for 2 weeks, followed by oral prednisolone 1.0 mg/kg/day).Outcomes: The patient died of cysticercosis encephalitis approximately 2 months later.Lessons: Disseminated cysticercosis in our case presented only with proptosis as he had very heavy infestation of the brain and eyes. Heavy larval infestation in a patient with disseminated cysticercosis can be life-threatening.

A Review of Human Cysticercosis and Diagnostic Challenges in Endemic Resource Poor Countries

Human cysticercosis is a neglected tropical parasitic zoonotic disease with high public health concerns. Infection of Taenia solium cysticerci in the brain commonly known as neurocysticercosis is a cause to over 29% of all epileptic cases in endemic countries. Unfortunately, this infection can go unnoticed for over 10 years. The objective of this review was to characterize the diagnostic approaches accessible in endemic poor resource countries. The review sought literature from library catalogues and public databases for studies on epidemiology and diagnosis challenges of human cysticercosis. The search key words included “Taenia solium, T. solium cysticercosis, human cysticercosis, neurocysticercosis and diagnosis”. Most of the diagnostic procedures rely on serology. Neuroimaging tools which would confirm and thus enable the assessment of the burden of the disease in endemic countries are rarely used. Therefore assessing the estimate on prevalence and burden of the disease fallacious is owing to the low sensitivity of serological tools and the inhibition of humoral, cellular immune responses, inflammatory reaction and cytokines by the living cysticerci.

Oral cysticercosis-a rare presentation

Cysticercosis is a condition that occurs when man is infected with larvae of Taenia solium.Oral cysticercosis is a rare event,and it represenls difficulty in clinical diagnosis.A case of oral cysticercosis in 11 year old girl is presented which complained of painless swelling for 6 months. A FNAC was performed which revealed bluish pink fibrillary material and interspersed nuclei and fragments of wall of larvae.Patient was treated with antihelminthic.

The Financial Costs Associated with Porcine Cysticercosis and Epilepsy in Iringa Rural District

Taenia solium cysticercosis is a zoonotic disease that poses serious public health risk and significant economic losses in the pig industry. Human neurocysticercosis is recognized as an important cause of epilepsy in regions where T. solium is endemic. The monetary burden caused by T. solium cysticercosis condemned pigs and epilepsy is under-reported in Tanzania, Iringa rural district being no exception. The aim of the present study was to estimate the financial costs associated with porcine cysticercosis (PCC) and epilepsy in Iringa rural areas. The study employed questionnaires and interviews to explore the public health and socio-economic impacts of T. solium cysticercosis. A total of 365 randomly selected participants comprising of 306 pig farmers and 59 families with epileptic patients were involved in the survey. The findings indicated that the average selling price was USD 84 for mature pigs and ranged from USD 13 - 27 for piglets. The estimated annual monetary loss due to PCC was USD 144,449. The estimated monetary burden due to epilepsy management in hospitals and/or by traditional healers was USD 78,592 per annum. It is concluded that the monetary burden incurred by pig farmers due to PCC caused economic loss at both the subsistence and commercial levels. Yet, epilepsy has serious potential economic impacts through direct and indirect costs incurred on the management of epileptic patients from family to national level. It is hence recommended to practice indoor pig keeping for the elimination of economic losses caused by PCC infection. There is an urgent need to raise awareness on the economic burden caused by porcine cysticercosis and epilepsy in Iringa rural district.

Current Status of Prevalence, Possible Control and Risk Factors Associated with Porcine Cysticercosis from Endemic Countries in Africa

Porcine cysticercosis (PC) caused by Taenia solium larvae is continuing being an important zoonotic neglected disease in many developing countries, is responsible for severe health disorders such as seizures and death in human and it poses a serious public health risk. In general estimated prevalence for porcine cysticercosis by Ag-ELISA was 29.7% (95% CI [4.8 - 58.2]), by EITB was 24.7% (95% CI [9.2 - 38.2]), by Tongue examination was 9.4% (95% CI [0.2 - 13.2]), and by postmortem examination was 15% (95% CI [0.2 - 27.4]). Average seroprevalence of human cysticercosis by circulating antibody detection (Ab-ELISA) was ranged from 1.3% to 45.3%. Average seroprevalence of human cysticercosis by circulating T. solium antigen detection (Ag-ELISA) was ranged from 4.6% to 11.9%. Average seroprevalence of human cysticercosis by EITB was ranged from 6.9% to 16.7%. Average prevalence of human cysticercosis by CT scan was ranged from 23.2% to 54.6%. A fundamental factor in the occurrence of infections in most of the article was lack of health education to the community on T. solium, cysticercosis and taeniasis complex as the key towards control and eradication. The major causal factors of the disease occurrence were free roaming pigs and poor sanitary conditions.

The Serological Survey for Human Cysticercosis Prevalence in Mbulu District, Tanzania

Human cysticercosis, a zoonotic disease due to Taeniasolium, is of the highly debilitating and stigmatizing neglected tropical diseases due to epilepsy, ophthalmia and dermatological disorders in endemic developing countries. Tanzania is among the sub-Saharan African countries with an average prevalence of porcine cysticercosis 17.2% [1], which increases the risk of human cysticercosis infection. Studies on people with epilepsy in northern zone of Tanzania show a 16.2% [2] to be suffering from neurocysticercosis. While this was the case, there were no single report on the prevalence of human cysticercosis neither to regular hospital visitors, admissions, and nor general public that result to insufficient deployment of intervention strategies. Study was performed to assess the prevalence of human cysticercosis in general public in Mbulu district. The cephalic venous blood was collected from assorted community members. Serum was extracted and then subjected to Cysticercus IgG Western Blot Assay for human cysticercosis sero-screening. It was found that about 16.3% of the community members had antibodies signifying infection by human cysticercosis. This is the first ever study to assess the prevalence of human cysticercosis in the country and it has revealed the problem to be very high. This study can be valuable for deployment of appropriate intervention measures on human cysticercosis in the study area and extend to the entire country.

Seroprevalence of cysticercosis in North Indian population

Objective:To estimate the seroprevalence,morbidity of Taenia solium(T.solium) cysticercosis and its relationship to socio-economic,sanitary parameters.Methods:Using multistage stratified random sampling.2 500 subjects from urban(n=1 250) and rural population(n =1 250) of Lucknow. India were registered.Blood,stool samples,socioeconomic and demographic data were collected. Serum enzyme-linked-immunosorbent-assay(ELISA) was used to detect anticysticercus IgG and IgM antibodies.Microscopic examination of stool samples after processing by concentration method was done to observe taeniasis and other intestinal parasites.CT scan of seropositive cases presenting with seizures was done for confirmation of neurocysticercosis.Results:The overall,urban and rural seroprevalence of T.solium cysticercosis was 3.48%,4.64%and 2.32%, respectively.The risk factors significantly associated with the disease were pig rearing in both study populations,unsanitary waste disposal in urban,vegetarian diet and open defecation in rural population.One case of intestinal taeniasis was observed.Twenty-six of 30 cases undergoing CT scan were diagnosed as neurocysticercosis.Conclusions:Seroprevalence of cysticercosis is high in the study community.Prevalence of cysticercosis is related to roaming pigs and behavioral and environmental practices in local community.Health education and identification of tapeworm carriers seems promising control strategy.

Herculean appearance due to disseminated cysticercosis:Case report

Cysticercosis is a common tropical disease.Disseminated form is one of the uncommon manifestations and a rare complication of this disease.We report an immunocompetent patient with disseminated cysticercosis who had involvement of the brain and skeletal muscles giving rise to Herculean appearance.

A preliminary analysis of some epidemiological factors involved in porcine cysticercosis in Bafut and Santa subdivisions,North West Region of Cameroon

Objective:To examine the magnitude and some risk factors of porcine eysticercosis in Bafut and Santa,two sub-divisions noted for pig farming in the North West Region of Cameroon.Methods: A total of 499 pigs in 300 households were examined by tongue inspection and serologically by Ag-ELISA.Information was sought on the age and sex of the animals,prevailing husbandry systems,types of feed,the state of each pen and the state of toilets.Futhermore,a questionnaire was administered to the farmers to determine their awareness on taeniasis/cysticercosis and related factors.Results:The prevalence of the disease was significantly higher in Santa(10.2%) than in Bafut(4.2%),although there was a higher level of awareness in both localities(62.3%).Age of pigs,traditional rearing systems(roaming,tethered,earth floor pen,raised floor pen),faecal disposal in the environmenl and poor sanitation significantly influenced the seroprevalence of porcine cysticercosis in both localities.Most farmers(79.7%) used a combination of concentrate, grass and kitchen waste to feed pigs.Financial loss from porcine cysticercosis was estimated at 346 900 CFA representing 2%of total income.Conclusions:Control measures advanced here include sensitization campaigns,periodic examination and treatment of infected pigs by veterinarians,improved husbandry systems,proper use of standard latrines regularly inspected by sanitary officers,and sound hygienic and sanitary practices.

Taeniasis vs cysticercosis infection routes

Although cysticercosis caused by Taenia solium(T. solium) is considered a neglected disease, its life cycle has been well known for more than two centuries. T. solium not only causes cysticercosis but also taeniasis in humans. These two diseases have totally different infection routes. To acquire taeniasis(the presence of the adult stage of T. solium in the intestine), humans have to ingest the larval stage(cysticercus) that infects a variety of organs and viscera in pigs, its intermediate hosts. Therefore, taeniasis is acquired when eating raw or undercooked infected pork. The adult stage in the human intestine release eggs that contain a hexacanth embryo, the oncosphere. If humans accidentally ingest the eggs of T. solium, the released oncospheres penetrate the intestine and become cysticerci. Therefore, cysticercosis is acquired by the ingestion of eggs that contaminate water, vegetables, hands etc. These facts should not be forgotten to avoid misinformation in scientific publications.

Fine needle aspiration cytology in the diagnosis of cysticercosis cases

Objective:To document the value of Fine Needle Aspiration Cytology(FNAC) in the diagnosis of cysticercosis. Methods:Aspirates smears of 102 cases of cysticercosis from different sites like extremities,head,neck, forearm,arm,chest wall and abdominal wall were studied in the Department of Pathology,BPKIHS,Dharan, Nepal.Results:In 7 cases(9.73%) lingual cysticercosis was diagnosed.Involvement of breast was seen in 4 cases(5.56%) which is a rare presentation.On cytomorphological examination,parts of cysticercus cellulose were seen in(97.22%) cases.Conclusion:The characteristic cytomorphological features of parasitic tegument,parenchymatous portion,presence of giant cells and inflammatory cells in cytological smears help diagnose the cases of cysticercosis.FNAC provides safe and rapid tool for diagnosis of cysticercosis.In endemic areas,cysticercosis should be considered one of the differential diagnosis of the swellings.