Subcutaneous nodules of cysticercosis as a sign of asymptomatic neurocysticercosis in an HIV positive patient

Abstract Cysticercosis is caused by the hematogenous dissemination of the larval form (cysticercus) of Taenia solium. It can affect any organ or tissue in the body but commonly affects the subcutaneous tissue, central nervous system, eyes, and skeletal muscle. Skin lesions can assist as a marker in the diagnosis of asymptomatic neurocysticercosis in endemic areas. A 49-year-old HIV positive man presented with multiple cutaneous nodules confirmed as cysticercomas which led to the diagnosis of asymptomatic neurocysticercosis. He was successfully treated with albendazole and steroids at recommended doses with no adverse effects.

Current Status of Taeniasis and Cysticercosis in Vietnam

Several reports on taeniasis and cysticercosis in Vietnam show that they are distributed in over 50 of 63 provinces. In some endemic areas, the prevalence of taeniasis was 0.2-12.0% and that of cysticercosis was 1.0-7.2%. The major symptoms of taeniasis included fidgeted anus, proglottids moving out of the anus, and proglottids in the feces. Clinical manifestations of cysticercosis in humans included subcutaneous nodules, epileptic seizures, severe headach, impaired vision, and memory loss. The species identification of Taenia in Vietnam included Taenia asiatica, Taenia saginata, and Taenia solium based on combined morphology and molecular methods. Only T. solium caused cysticercosis in humans. Praziquantel was chosen for treatment of taeniasis and albendazole for treatment of cysticercosis. The infection rate of cysticercus cellulosae in pigs was 0.04% at Hanoi slaughterhouses, 0.03-0.31% at provincial slaughterhouses in the north, and 0.9% in provincial slaughterhouses in the southern region of Vietnam. The infection rate of cysticercus bovis in cattle was 0.03-2.17% at Hanoi slaughterhouses. Risk factors investigated with regard to transmission of Taenia suggested that consumption of raw meat (eating raw meat 4.5-74.3%), inadequate or absent meat inspection and control, poor sanitation in some endemic areas, and use of untreated human waste as a fertilizer for crops may play important roles in Vietnam, although this remains to be validated.

Cisticercosis ocular / Ocular cisticercosis

La cisticercosis establece un grupo de enfermedades zoonóticas parasitarias; cuando se aloja en el ojo y sus anexos producen una cisticercosis ocular y periocular. Constituye una de las causas de uveítis ocular y pérdida importante de la visión. El diagnóstico clínico se realiza mediante la observación directa del parásito, cuando existen opacidades de los medios, el ultrasonido se emplea como medio diagnóstico útil. Los anti helmintos asociados a esteroides forman parte de su terapéutica, sumado al tratamiento definitivo de la extracción del parásito, en este tipo de afección mediante vitrectomía vía pars plana. Se presenta un caso portador de esta condición, se describen las características más importantes del cuadro clínico, diagnóstico, manejo y curso evolutivo-terapéutico

Cysticercosis brings about a group of zoonotic parasitic diseases, when it deals with the eye and its appendices, then ocular and periocular cistercosis emerges. It is one of the causes of ocular uveÝtis and significant loss of vision. The clinical diagnosis is made by direct observation of the parasite. If there are opacities, then the ultrasound technique is the useful diagnostic means. The steroid-related antihelminthic drugs are part of the treatment together with the final extraction of the parasite through pars plana vitrectomy. The most important characteristics of the clinical picture, the diagnosis, the management and the progression and treatment of a patient suffering this disease is presented in this article

Uso de corticóide sistêmico e intravítreo na inflamação secundária a cisticercose intra-ocular: relato de caso / The use of systemic and intravitreous steroid in inflammation secondary to intraocular cysticercosis: case report

A cisticercose é uma parasitose causada por ovos de Taenia solium, que pode acometer diversos tecidos como coração, músculo esquelético, cérebro e olhos. Neste estudo será descrito o caso de um paciente de 62 anos do sexo masculino encaminhado com queixa de baixa acuidade visual progressiva no olho direito há dois meses. O exame biomicroscópico e ultra-sonográfico permitiu o diagnóstico ocular de cisticercose intravítrea. Foi realizada cirurgia de vitrectomia via pars plana para remoção do parasita e no intra-operatório ocorreu ruptura do cisto com extravasamento intravítreo. Durante o procedimento foram injetadas 400 microgramas de dexametasona intravítreo e prescrito 60 mg/dia de prednisona via oral por 14 dias. O paciente evoluiu com recuperação visual e acuidade visual final de 20/25, retina aplicada e vítreo claro. Em conclusão, farmacoterapia com corticóide intravítreo associada à terapia com corticóide sistêmico pode ser considerada como alternativa a ser associada para o controle inflamatório após cirurgia vitreorretiniana de cisticercose ocular.

Cysticercosis is a parasitosis caused by Taenia solium eggs that could affect several tissues, such as heart, skeletal muscles, brain and eyes. This study describes the case of a 62-year-old male who complained of progressively loss of vision in his right eye for two months. Slit-lamp and ultrasound exams suggested a diagnosis of intravitreous cysticercosis. The patient underwent pars plana vitrectomy to remove the intravitreous parasite. Intraoperatively the cyst ruptured and leaked into the vitreous cavity. Therefore, 400 µg of intravitreous dexamethasone was injected intraoperatively, and 60 mg/day of prednisone PO was prescribed for 14 days. The post-operative best corrected visual acuity was 20/25, the retina was attached and vitreous remained clear. In conclusion, drug therapy with intravitreous corticosteroids associated with systemic steroids showed to be an alternative approach to control inflammation following vitreoretinal surgery.

Extraocular muscle cysticercosis mimicking idiopathic orbital inflammation: case report

Presentation of one case of extraocular muscle enlargement caused by cysticercosis, its clinical, diagnostic and treatment aspects, and review of the literature on this theme. A female 38-year-old patient with extraocular muscle enlargement and a small cystic lesion at the superior rectus muscle insertion was treated with oral prednisone for almost one year, with a non-specific inflammation of right orbit diagnosis. There were important ocular motility restriction and pain. Computerized tomography disclosed a superior rectus muscle thickening with a small cystic and apparently empty lesion at the muscle's insertion. Excisional biopsy and histopathological study confirmed the clinical suspicion of cysticercosis. There was partial resolution of the restricted motility. Extraocular muscle cysticercosis is the most common site of this disease when involving the orbit. Oral albendazole and prednisone are efficient, but a long history of disease can lead to important residual ocular motility restriction.

Apresentação de um caso de aumento de músculo extra-ocular causado por cisticercose, seus aspectos diagnósticos, clínicos, tratamento e revisão da literatura sobre o tema. Paciente de 38 anos do sexo feminino com aumento de músculo reto superior e pequena lesão cística foi tratada por um ano com prednisona oral com o diagnóstico de inflamação inespecífica da órbita. Havia importante restrição da motilidade ocular e dor. Tomografia computadorizada demonstrou espessamento do reto superior e pequena lesão cística, aparentemente sem conteúdo, na inserção do músculo. Biópsia excisional e estudo histopatológico confirmaram a suspeita de cisticercose. Houve melhora parcial da restrição de motilidade. A cisticercose de músculo extra-ocular é a mais frequente forma orbitária da doença. Tratamento clínico com albendazol e prednisona é eficiente, mas um atraso no diagnóstico pode levar a importante restrição residual na motilidade ocular.

Mepacrine therapy in niclosamide resistant taeniasis.

OBJECTIVE: To evaluate the efficacy of mepacrine (quinacrine) in patients with niclosamide resistant Taenia saginata infection. METHODS: Eighty six cases with niclosamide resistant Taenia saginata (unresponsive to 2-8 courses of niclosamide) were treated with quinacrine (1 g) administered orally or via a nasogastric tube, and followed at 2, 4, 8 and 12 weeks for recurrence of passage of proglottids and presence of Taenia eggs in the stool examinations. Pre and post-therapy egg counts were obtained and egg viability was tested by staining with methylene blue. RESULTS: Eighty-one (94.2%) patients responded promptly with passage of the worm within 4-72 hours. The egg counts showed a drastic fall in 79 cases and a fall in viability from a median of 100% to 0% was observed. Only one patient demonstrated a relapse at 4 weeks. Gastrointestinal side effects occurred in 9 cases but were controlled easily by symptomatic therapy. CONCLUSION: We conclude that quinacrine is a safe, inexpensive, effective and generally well tolerated drug for the treatment of niclosamide resistant Taenia saginata infestations.

Esquema corto de Praziquantel para el tratamiento de la neurocisticercosis parenquimatosa / Short regimen of Praziquantel for the treatment of parenclymatose neurocysticercosis

Objetivo. La terapia para la neurocisticercosis parenquimatosa con praziquantel (PZQ) de 15 días ha mostrado ser efectiva. Las concentraciones en plasma y líquido cefalorraquídeo (LCR) del PZQ son más elevadas después de dos horas de su administración. Nosostros pensamos que el mantenimiento de concentraciones elevadas de PZQ por seis horas pudieran ser una terapia cisticida adecuada para estos pacientes. Métodos. Tratamos 30 pacientes con neurocisticercosis parenquimatosa con tres dosis orales de 25 mg por kg de peso de PZQ con intervalos de dos horas. Ellos recibieron dexametasona 10 mg intramuscular por tres días consecutivos a la administración del PZQ. Resultados. En 21 pacientes desaparecieron los quistes, en siete hubo una desaparición de 30 a 60 por ciento y dos pacientes permanecieron sin cambios. Del número total de quistes, hubo una tasa de desaparición de 70.7 por ciento. Dos pacientes presentaron crisis convulsivas, seis cefalea y otros más náusea. Ningún paciente cursó con convulsiones durante el tratamiento con antiepilépticos. Conclusión. El costo y el tiempo de administración del PZQ se reducen significativamente y la inflamación que sigue a la destrucción del parásito es tratada secuencialmente

Human taenaisis and cysticercosis in slaughtered cattle, buffaloes and pigs in Egypt

Human taeniasis and cysticercosis are zoonotic parasites of considerable public health problem. A total of 6434039 slaughtered animals over a period of 4 years [1994-1997] showed 0.72% cysticercosis [bovis and cellulosae] infections. Individual animal species infection was 0.23% in native breed cattle, 7.25% in imported cattle, 0.14 in buffalos and 0.09% in pigs. The highly infested parts were the heart [64.2%], followed by the head [34.5%], the whole body [1.1%] and lastly, the quarter [0.2%] in both types of cattle and the heart [64.3%], the head [34.9%], the whole body [0.6%] and the quarter [0.2%] in buffalos. In pigs, the highly infested parts were the whole body [55.4%], followed by the heart [37.8%] and lastly the head [6.8%]. Some interesting cysticercosis was macroscopically and microscopically, parasitologically and histopathologically studied

Padronizaçäo de índices tomográficos do IV§ ventrículo e suas características em doentes com neurocisticercose / Standardization of tomographic indexes of the fourth ventricle and its characteristics in patients with neurocysticercosis

A cisticercose do IV§ ventrículo cursa com manifestaçöes de hipertensäo intracraniana (HIC) de fossa posterior, conseqüente à obstruçäo da circulaçäo do líquido cefalorraqueano (LCR) pela gliose, ependimite granular ou à presença de cistos parasitários. Sua dilataçäo isolada constitui uma entidade clínico-patológica denominada IV§ ventrículo isolado, cuja fisiopatogenia permanece controvertida. A terapêutica, clínica ou cirúrgica, apresenta indicaçöes e contra-indicaçöes específicas à gravidade do quadro. O diagnóstico ainda está no campo da subjetividade. Várias modificaçöes do método de Evans, que tentou impor mais objetividade na definiçäo de hidrocefalia, surgiram. Pouco se relata sobre a metodologia para o diagnóstico de dilataçäo isolada do IV§ ventrículo. Os objetivos desse trabalho foram propor um padräo de normalidade de parâmetros representativos das dimensöes do IV§ ventrículo em indivíduos com tomografias computadorizadas em crânio (TC) normais e estudar as características do IV§ ventrículo em doentes com neurocisticercose (NCC). Foram realizadas medidas da distância fronto-polar dos ventrículos laterais (FP) e dos diâmetros craniano interno (Cr), antero-posterior (AP) e latero-lateral (LL) do IV§ ventrículo em 114 indivíduos com TCs normais (grupo CONTROLE, ou GC) e em 80 doentes com o diagnóstico de NCC (grupo com NCC, ou GN) e estabelecidos os índices FP/Cr, AP/Cr, LL/Cr, AP/FP, LL/FP e AP/LL. Após análise estatística, os índices AP/Cr, AP/LL e AP/FP foram considerados os mais representativos das dimensöes do IV§ ventrículo, permitidno selecionar 51 doentes com NCC que apresentavam, pelo menos, um desses índices com valores acima de dois desvios-padräo da média estatística obtida no GC - grupo com comprometimento do IV§ ventrículo (GN-IV§), que foi analisado mais detalhadamente. No GC, os valores obtidos dos índices estudados foram: FP/Cr = 0,244 ñ 0,034; AP/Cr = 0,063 ñ 0,020; LL/Cr = 0,109 ñ 0,026; AP/FP = 0,267 ñ 0,100; LL/FP = 0,458 ñ 0,136 e AP/LL = 0,582 ñ 0,139. No GN, mostraram outros valores: FP/Cr = 0,257 ñ 0,041; AP/Cr = 0,082 ñ 0,037; LL/Cr = 0,102 ñ 0,034; AP/FP = 0,323 ñ 0,143; LL/FP = 0,409 ñ 0,139 e AP/LL = 0,797 ñ 0,213. Com exceçäo de LL/Cr e de LL/FP, essas diferenças entre os dois grupos foram estatisticamente significantes (GN > GC), näo havendo diferença (p > 0,10) no que diz respeito a sexo e faixa etária, em ambos grupos. No GN, os índices encontrados antes do tratamento com albendazol näo diferiram...

Meningitis cisticercosa / Cysticerci meningitis

La neurocisticercosis (NC) es la parasitosis que afecta con mayor frecuencia el Sistema Nervioso Central (SNC) en todo el mundo. Casi la mitad de los pacientes con NC presenta meningitis cisticercosa, a pesar de lo cual, existe poca información actualizada con respecto a esta entidad. Esta forma de presentación puede ser de extraorinaria gravedad y por lo regular sigue un curso crónico. Hay controversia con respecto al manejo y algunos autores señalan que el uso de esteroides no reporta beneficio. Presentamos 5 casos de meningitis cisticercosa, seguidos durante un promedio de 18 meses y hacemos algunas consideraciones clínicas importantes, enfatizando la utilidad de los esteroides en el tratamiento de esta grave condición

Drug treatment of neurocysticercosis.

Neurocysticercosis, the most common parasitic disease of the central nervous system, was treated surgically for a long time. Praziquantel (an isoquinolone) and albendazole (an imidazole) are anticysticercal drugs that are currently being used for the treatment of neurocysticercosis. Both have been reported to eliminate or markedly reduce the number and size of cysticerci. Albendazole is less expensive than praziquantel, and is as effective when given for 8 days as compared to longer periods. In a small number of comparative trials, albendazole appeared to be slightly more effective than praziquantel for the treatment of parenchymal cysticercosis. Albendazole has also been found effective in ventricular, subarachnoidal and racemose forms of the disease. However, the response to treatment is not universal. Treatment with these drugs has been associated with a high frequency of adverse reactions, probably due to the host's inflammatory reaction to the dying parasites. Headache, nausea and seizures are common but usually transient. Steroids appear to ameliorate these effects and their concomitant administration has been advocated. However, no data are available to support this view. The rationale of medical therapy in spinal cysticercosis is presently based on the reported efficacy of anticysticercal drugs in cerebral cysticercosis. A marked improvement in an associated seizure disorder following anticysticercal therapy has been observed. Though seizure control is better, the total duration of anti-epileptic drug therapy has not been determined. Some single enhancing computed tomography lesions in patients of epilepsy may be benign forms of neurocysticercosis. The spontaneous resolution of a majority of these lesions has led to doubts of them being merely infective in aetiology. Also, a controlled trial could not demonstrate any beneficial effect of albendazole on such lesions. Hence, most authors recommend that these patients should be treated with anti-epileptic drugs only. Doubts persist about the efficacy of anticysticercal drugs in altering the natural course of the disease and the reported tendency of cysticercus lesions to resolve.

Quimioterapia de la cisticercosis. Resultados de 10 años o más después del seguimiento / Chemotherapy for cysticercosis. Results of 10 or more years after follow up

La quimioterapia de la neurocisticercosis nació lógicamente por el poco éxito de la cirugía, que generalmente es paliativa y no curativa. Praxicuantel es la única droga acerca de la cual se han publicado series de más de 100 casos y con seguimiento de más de dos años. Su uso se ha hecho universal. Razones éstas para escogerlo como tema de este escrito. Se pretende contribuir a determinar su valor terapéutico en el tratamiento de la neurocisticercosis por medio del monitoreo clínico y radiológico de 50 enfermos seguidos entre 10 (72 por ciento) y más de 10 años (28 por ciento). Se les había tratado con praxicuantel a la dosis de 50mg por kilogramo de peso, durante 15 días. El 26 por ciento recibió un tratamiento, el 58 por ciento dos tratamiento y el 22 por ciento tres o más. Se les estudió una vez más clínica y radiológicamente por tomografía axial computada de cráneo o resonancia magnética, las pruebas biológicas se hicienron únicamente en los casos sospechosos de actividad. Como resultados se registró 68 por ciento de curaciones clínicas o mejorías importantes. Se hace énfasis en 6 por ciento de los casos en donde el proceso de curación clínica fue aparente. Se confirma que neurociticercosis es un padecimiento crónico generalizado, en el que la evolución se hace por períodos de actividad, alternando con períodos de recesión. Se condena el uso de testigos y se sugiere para ulteriores investigaciones el que sigan amplias series de casos durante largos lapsos. Se insiste en que el mejor tratamiento de la enfermedad es la profilaxis

A survey report--July 1993: cysticercosis in the Grand Dani Valley, Jayawijaya District, Irian Jaya Province, Indonesia.

A community survey was conducted in Gran Dani Valley, Jayawijaya District, Irian Jaya Province, Indonesia. A total of 537 adults were asked whether they experienced epilepsy, and were physically examined for cysticercosis cysts. Forty-eight percent experienced at least one attack of epilepsy. Men had attacks 2.5 times more often than woman. Cysticercosis cysts were found in 26.5% men having 4.6 times more cysts than women. The cysts were mostly found in the pectoral region. The survey showed a raise cysticercosis in the Highlands of Irian Jaya and is considered a public health problem. Treatment was not available, but improvement of personal and environmental hygiene would be important. Mass de-worming activity should be a part of routine public health service in the district.

Neurocisticercosis / Neurocysticercosis

La neurocisticercosis es la parasitosis del sistema nervioso central (SNC) producida por la forma larval de la taenia solium. En 1950 Parnolus encontró un cisticerco en el cuerpo calloso, pero sólo en 1985 Kuchen Meister asoció afección con la taenia solium. La forma muscular fue descubierta por primera vez por Priets en 1926 y subsecuentemente también la comunicaron M Gill, Jacob y Mathews. En Estados Unidos la neurocisticercosis se describió por primera vez en 1927 por Walter Dandy

Albendazole therapy in orbital cysticercosis.

A patient with orbital cysticercosis is being presented, where albendazole therapy was successfully used. Serial CT scans of the lesions showed definite signs of resolution. The role of albendazole therapy in cysticercosis has been discussed. The relevant literature has been reviewed in brief.

Neurocisticercosis infantil / Infant neurocysticercosis

Se informa sobre un caso de neurocisticercosis en una niña de 10 años de edad. Se revisan las características clínicas y los elementos diagnósticos de la neurocisticercosis, así como las formas de abordaje terapéutico

Severe forms of neurocysticercosis: treatment with albendazole

Study of 22 patients with the severe form of neurocysticercosis treated with albendazole (ABZ) administered in 6 different schedules ranging from 15 to 30 mg/kg/day for 21 to 60 days. Dextrochloropheniramine and ketoprofen were the adjuvant drugs. Multiple symptoms were observed in 90.9 per cent of patients. Intracranial hypertension was manifested in 90.9 per cent. Hydrocephaly occurred in 86.4 per cent. Evolution was satisfactory in 10 patients, 8 died and 4 had sequelae. Tomographic studies showed the appearance of an isolated IVth ventricle in 9 patients, after ventriculoperitoneal shunt, before ABZ treatment in 3 of them, during in 5 and after treatment in one. Median clinical follow-up duration was 10 months for the patients who died and 3-4 years for survivors. In 3 patients there was an increase in cyst size during the administration of the 15 mg/kg/day ABZ dose, which was not observed in any patient when the 30 mg/kg/day dose was used.