Cystisercosis

• cysticercosis is an infection caused by the larvae of the

tapeworm, Taenia solium
• people get cysticercosis
- when they swallow eggs that are excreted in the stool
of people with the adult tapeworm. This may happen when
people drink water or eat food contaminated with tapeworm
eggs ,put contaminated fingers in their mouth
- internal autoinfection, whereby eggs are swept back into
the stomach by reverse peristalsis
• Epidemiology
Prevalence of human cysticercosis predictably parallels the
incidence of the adult worm.
It is quite common in Latin America (particularly in Mexico,
where approximately 3 million people are infected), Africa,
Indonesia, India, and China. In the United States, its highest
prevalence is in Southern California, mainly among migrant workers
and recent immigrants from Mexico and countries of central
and south America. In humans, for an unexplained reason,
males seem more vulnerable to infection than females.
• Causal Agent:

The cestode (tapeworm) Taenia solium (pork

tapeworm) is the main cause of human
cysticercosis, with various sites of localization
including the brain, subcutaneous tissue,
eye, or liver.
• Once eggs are ingested, oncospheres
hatch in the intestine , invade the intestinal
wall, and migrate to striated muscles, as
well as the brain, liver, and other tissues,
where they develop into cysticerci . In
humans, cysts can cause serious
sequellae if they localize in the brain,
resulting in neurocysticercosis.
Disease
• Cysts, called cysticerci, can develop in the muscles, the eyes, the
brain, and/or the spinal cord.  Symptoms caused by the cysts
depend on the location, size, number, and stage of the cysts.
• Cysts in the brain or spinal cord: Cause the most serious form of the
disease, called neurocysticercosis. May cause no symptoms . May
cause seizures and/or headaches (these are more common). May
also cause confusion, difficulty with balance, brain swelling, and
excess fluid around the brain (these are less common). May cause
stroke or death
• Cysts in the muscles:. Generally do not cause symptoms. May
cause lumps under the skin, which can sometimes. become tender
• The diagnosis of neurocysticercosis
usually requires MRI or CT brain scans.
Blood tests may be useful to help
diagnose an infection, but they may not
always be positive in light infections.
• Host Immune Response

One of the more critical results of infection with the

cysticercus larva of T. solium is the disease
neurocysticercosis resulting from the migration of the
oncosphere larva to the brain.
At this site it develops into a cysticercus larva or
metacestode. As the parasite dies, it deteriorates
towards a final calcified stage.
 While the larva is alive, it has the ability to suppress local
immune responses. It is not clear how this occurs although
there are several hypotheses.
One such hypothesis is that the parasite may mask its outer
membrane with host-derived proteins. A second possibility is
that the parasite may show molecular mimicry by
synthesizing proteins that resemble those of the host.
Once the parasite begins to die, a localized host response is
elicited.
Initially, a Th1 response occurs with the production of IFN-
g,IL-4, and IL-18 cytokines, which eventually develops into a
chronic mixed Th1 and Th2 profile associated with mature
granuloma formation
• A similar phenomenon is observed in other
helminthic infections such as schistosomiasis where
an initial Th1 response is followed by a mixed Th1
and Th2 response with accompanying granuloma
formation.
• The granuloma associated with fibrosis appears to
have good and bad repercussions for
neurocysticercosis patients. On one hand, it protects
adjacent neural tissue from injury; on the other hand,
it irreversibly damages the nervous tissue that
immediately surrounds the cysticercus.
• Clinical Presentation
• The symptoms of cysticercosis are caused by the
development of cysticerci in various sites. Of greatest
concern is cerebral cysticercosis (or neurocysticercosis),
which can cause diverse manifestations including
seizures, mental disturbances, focal neurologic deficits,
and signs of space-occupying intracerebral lesions.
Death can occur suddenly. Extracerebral cysticercosis
can cause ocular, cardiac, or spinal lesions with
associated symptoms. Asymptomatic subcutaneous
nodules and calcified intramuscular nodules can be
encountered.
TREATMENT
Drugs
• Several studies suggest that albendazole (conventional dosage 15
mg/kg/day in 2 divided doses for 15 days) may be superior to
praziquantel (50 mg/kg/day for 15 days) for the treatment of
neurocysticercosis. In comparative clinical trials, albendazole was
equivalent or superior to praziquantel in reducing the number of live
cysticerci. A recent placebo-controlled, double-blinded trial
demonstrated that albendazole treatment (400 mg twice daily plus 6
mg dexamethasone QD for 10 days) significantly decreased
generalized seizures over 30 months of follow-up.

SURGERY
Prevention
• The most effective preventive measures include strict
attention to personal hygiene, sexual habits, and
environmental sanitation. Removal of adult worms
from the patient once infection has been ascertained
is important in preventing autoinfection.
• Visitors to endemic areas should observe such
preventive measures as the boiling of drinking water
and avoiding salads and raw fruits and vegetables
without rinse.