Spatial distribution and risk factors for human cysticercosis in Colombia.

BACKGROUND: Cysticercosis is a zoonotic neglected tropical disease (NTD) that affects humans and pigs following the ingestion of Taenia solium eggs. Human cysticercosis poses a substantial public health burden in endemic countries. The World Health Organization (WHO) aims to target high-endemicity settings with enhanced interventions in 17 countries by 2030. Between 2008 and 2010, Colombia undertook a national baseline serosurvey of unprecedented scale, which led to an estimated seroprevalence of T. solium cysticercus antibodies among the general population of 8.6%. Here, we use contemporary geostatistical approaches to analyse this unique dataset with the aim of understanding the spatial distribution and risk factors associated with human cysticercosis in Colombia to inform how best to target intervention strategies. METHODS: We used a geostatistical model to estimate individual and household risk factors associated with seropositivity to T. solium cysticercus antibodies from 29,253 people from 133 municipalities in Colombia. We used both independent and spatially structured random effects at neighbourhood/village and municipality levels to account for potential clustering of exposure to T. solium. We present estimates of the distribution and residual correlation of seropositivity at the municipality level. RESULTS: High seroprevalence was identified in municipalities located in the north and south of Colombia, with spatial correlation in seropositivity estimated up to approximately 140 km. Statistically significant risk factors associated with seropositivity to T. solium cysticercus were related to age, sex, educational level, socioeconomic status, use of rainwater, consumption of partially cooked/raw pork meat and possession of dogs. CONCLUSIONS: In Colombia, the distribution of human cysticercosis is influenced by socioeconomic considerations, education and environmental factors related to the spread of T. solium eggs. This information can be used to tailor national intervention strategies, such as targeting spatial hotspots and more highly exposed groups, including displaced people and women. Large-scale seroprevalence surveys accompanied by geospatial mapping are an essential step towards reaching the WHO's 2021‒2030 NTD roadmap targets.

WHO guidelines on management of Taenia solium neurocysticercosis

Taenia solium is a zoonotic tapeworm found globally but with particularly high transmission and hyperendemnicity in parts of Latin America, South and South-East Asia and sub-Saharan Africa. Depending on its life cycle, it causes two distinct presentations in humans: taeniasis and (neuro) cysticercosis. Although people with taeniasis do not have severe disease, they shed T. solium eggs, which can infect both pigs and humans. The resulting larvae form cysts in the muscles, skin, eyes or central nervous system (cysticercosis). "Neurocysticercosis" refers to the development of T. solium cysts in the human central nervous system, which causes focal epilepsy, epileptic seizures, hydrocephalus, chronic headaches, focal deficits and symptoms associated with increased intracranial hypertension. Neurocysticercosis is one of the leading preventable causes of epilepsy worldwide, estimated to contribute to up to 30% of epilepsy cases in areas where the disease is endemic. The total number of people with symptomatic or asymptomatic neurocysticercosis is estimated to be 2.56­8.30 million, according to the available data on the prevalence of epilepsy. These numbers may, however, be underestimates because of poor access of the groups at highest risk to diagnostic tests. Given this wide range, better understanding of the disease and its control is crucial, as is recognition of the lack of accurate information and the importance of more data on neurocysticercosis epidemiology. The internationally recognized criteria for diagnosis of neurocysticercosis include a requirement for neuroimaging techniques, such as computerized tomography (CT) and/or magnetic resonance imaging (MRI), ideally supported by serology. These facilities are not available in all settings, especially in rural areas of low-income countries, making it difficult to identify and treat patients. Additionally, there is controversy about the role, type and duration of anthelmintic, antiinflammatory and antiepileptic drug (AED) treatments for different forms of neurocysticercosis. These guidelines were developed to assist health-care providers in appropriate, evidence-based management of parenchymal neurocysticercosis. The guidelines do not address other forms of neurocysticercosis and do not include management of extraparenchymal disease (including cysticerci in the cerebral ventricles or subarachnoid space). The aim of the guidance is to improve decision-making to ensure appropriate patient care and to avoid misdiagnoses and inappropriate treatment of patients with neurocysticercosis. The guidelines were developed in a collaboration between the WHO departments of Control of Neglected Tropical Diseases and Mental Health and Substance Use.

Historical perspective: The British contribution to the understanding of neurocysticercosis.

Neurocysticercosis, or brain infestation with the larval stage of Taenia solium, is the most common risk factor for epilepsy in many endemic regions of the world. Hardly any cases are seen in Western developed countries, including Britain. However, a sizeable number (n = 450) was seen among British soldiers returning from deputation to India, then a British colony, first reported by Col. MacArthur at the Queen Alexandria Military Hospital in 1931. Here, we review the influence of the perceptive observations of British Army medics on the understanding of the parasitic disorder. The majority of these people presented with epilepsy. Among the contributions of the army medics were establishing the diagnosis, initially by histological examination of subcutaneous and muscular infestation, and later by radiography, clarifying the prognosis and the role of medical and surgical treatments and uncovering the close relationship between the larval (cysticercosis) and adult (intestinal tapeworm) stages of T. solium.

Experimental porcine cysticercosis using infected beetles with Taenia solium eggs.

Beetles are intermediate hosts for human and animal parasites, and several beetle species have been shown to carry Taenia eggs. An experimental porcine cysticercosis infection model was developed using beetles (Ammophorus rubripes) infected with Taenia solium eggs and then using these beetles for oral pig challenge. A total of 18 three months-old Landrace pigs were divided in four groups. Pigs from groups 1, 2, and 3 (n = 6 pigs per group) were challenged with one, three, and six beetles infected with T. solium eggs, containing approximately 52, 156 or 312 eggs respectively. Pigs were necropsied 12 weeks after infection to assess the presence of T. solium metacestode. Porcine cysticercosis by T. solium was produced in 17 out of 18 pigs (94.4%) challenged with infected beetles, all infected pigs had viable cysts. Only one pig from group 1 was negative to the presence of cysts. The median number of metacestodes per pig in groups 1, 2, and 3 were 2 (range 0-71), 26 (range 5-33) and 40 cysts (range 4-111), respectively. Experimental porcine cysticercosis infection is consistently obtained using beetles as mechanical vectors for T. solium eggs.

Neurocysticercosis among People Living Near Pigs Heavily Infected with Cysticercosis in Rural Endemic Peru.

Neurocysticercosis causes substantial neurologic morbidity in endemic regions around the world. In this cross-sectional study, we describe the frequency of neurocysticercosis among a presumed high-risk group of people in an endemic community in northern Peru. Participants who screened positive on a nine-question seizure survey were evaluated clinically to diagnose epilepsy using International League Against Epilepsy criteria. Those with epilepsy were offered a noncontrast computerized tomography (CT) of the head. We also tested sera from all participants using the lentil lectin-bound glycoprotein enzyme-linked immunoelectrotransfer blot (EITB) to detect anti-cysticercus antibodies and enzyme-linked immunosorbent assay (ELISA) B60/B158 to detect cysticercosis antigens. Participants with strongly positive ELISA (ratio ≥ 3) were offered a noncontrast magnetic resonance imaging (MRI) of the brain. We diagnosed 16 cases of epilepsy among 527 people screened (lifetime prevalence 30 per 1,000). Twelve with epilepsy accepted CT scan and five (41.7%) had parenchymal calcifications. None had viable cysts. Of the 514 who provided a blood sample, 241 (46.9%) were seropositive by EITB and 12 (2.9%) were strongly positive by ELISA (ratio ≥ 3). Eleven accepted MRI and eight (72.3%) had neurocysticercosis, including five with extraparenchymal cysts, five with parenchymal vesicular cysts, and two with parenchymal granulomas. These findings show that clinically relevant forms of neurocysticercosis and epilepsy can be found by applying screening interventions in communities endemic to Taenia solium. Longitudinal controlled studies are needed to better understand which subgroups are at highest risk and which are most likely to have improved prognosis as a result of screening.

Evaluating the Recombinant T24H Enzyme-Linked Immunoelectrotransfer Blot Assay for the Diagnosis of Neurocysticercosis in a Panel of Samples from a Large Community-Based Randomized Control Trial in 60 Villages in Burkina Faso.

Current guidelines for the diagnosis of neurocysticercosis (NCC) recommend the use of the lentil lectin-bound glycoprotein enzyme-linked immunoelectrotransfer blot assay (LLGP-EITB) as the reference standard for serological testing. In response to the drawbacks involved with the use of the LLGP-EITB, a recombinant T24H antigen (rT24H) EITB assay was developed, with promising results. However, the test has yet to be evaluated among individuals from sub-Saharan Africa (SSA). The aim of the present study was to investigate the performance of the rT24H EITB assay for the detection of NCC cases in a panel of serum samples (N = 366, of which 173 patients presented with epileptic seizures and/or severe chronic headaches, and 193 matched manifestation-free participants) collected as part of a large community-based trial in Burkina Faso. A perfect agreement between the rT24H EITB and the native gp24 (and its homodimer, gp42) LLGP-EITB was found (kappa value of 1.0). Furthermore, among patients with the neurological manifestations of interest who underwent a computed tomography scan, the rT24H EITB and native antigen LLGP-EITB had a comparable ability to correctly identify NCC cases with multiple viable (rT24H: sensitivity: 80.0%), single viable (66.7%), and calcified/degenerating cysts only (25.0%), albeit for multiple viable and calcified cysts, the rT24H estimated sensitivity seemed lower, but more uncertain, than previously reported. The rT24H EITB specificity was high (98.2%) and in line with previous studies. This study confirms the value of the recombinant rT24H EITB as an alternative to the native antigen LLGP-EITB for the diagnosis of NCC in a SSA community setting.

A hyperendemic focus of Taenia solium transmission in the Banke District of Nepal.

Neurocysticercosis is a major cause of epilepsy in countries where Taenia solium is endemic and the parasite is a major cause of food-borne disease globally. Pigs are the natural intermediate host involved in transmission of the parasite. T. solium is known to be endemic in Nepal, however there is limited reliable data about the prevalence of the disease in Nepal. The aim of this study was to determine accurately the prevalence of porcine cysticercosis in slaughter age pigs in an area of Nepal where pigs are known to be free-roaming. Pigs were obtained from the Udaypur Village Development Committee (VDC) and Hirminiya & Betahani VDC of the Banke district in Nepal. One hundred and ten animals of slaughter age (approximately 8-16 months old) were purchased, slaughtered and the heart, liver, brain and half the body skeletal musculature were sliced using hand knives and the number and viability of T. solium cysts determined. Thirty two of the 110 animals were found to harbour T. solium cysticerci (29%), of which 30 (27%) were found to have viable cysticerci (93% of the infected animals). This is one of the highest prevalences of porcine cysticercosis that has been reported to date from the results of necropsy on randomly selected animals. This study highlights a high rate of transmission of T. solium in the Banke District of Nepal. It encourages further investigation of human and porcine cysticercosis in Nepal, as well as implementation of efforts to reduce transmission of the parasite and the associated human disease.

Hemiparesia súbita secundaria a cisticercosis cerebral: presentación de un caso clínico / Sudden hemiparesis secondary to cerebral cysticercosis: presentation of a clinical case

Introducción: La neurocisticercosis es una infección parasitaria del sistema nervioso central, ocasionada por la etapa larval del parásito Taenia solium. Su prevalencia mundial es de 9,1%. Se presenta a continuación un caso clínico en el que destaca una clínica infrecuente y tamaño de la lesión poco común; caso que fue resuelto con éxito mediante neurocirugía. Presentación del caso: Hombre de 48 años, residente en localidad rural, consultó por cuadro súbito de hemiparesia derecha de predominio crural, posteriormente con aumento de paresia braquial ipsilateral. Al examen físico destacó síndrome piramidal derecho. Se estudió con Tomografía Computarizada que evidenció quiste frontal izquierdo con compresión del área motora, sugerente de lesión parasitaria. Resonancia Nuclear Magnética de Cerebro (RNMC) informó proceso expansivo quístico fronto-parietal parasagital izquierdo de 5 x 5,5 cm, con efecto de masa. Por tamaño, tipo de lesión y clínica se decidió realizar cirugía abierta con extirpación total y biopsia que informó cisticercosis cerebral. El paciente evolucionó con recuperación total de su déficit motor posterior a la cirugía. Discusión: La neurocisticercosis se encuentra dentro de los diagnósticos diferenciales de lesiones quísticas encefálicas. Su clínica es inespecífica, manifestándose comúnmente con convulsiones y cefalea. La RNMC permite el diagnóstico y localización de las lesiones. El tratamiento es médico, quirúrgico o combinado. Generalmente, el manejo se basa en antiepilépticos y antiparasitarios sistémicos, sin embargo en este caso, se decidió el manejo quirúrgico que llevó a una mejoría total del paciente, lo que avala la cirugía precoz como principal medida en lesiones de este tipo

Introduction: Neurocysticercosis is a parasitic infection of the central nervous system, caused by the larval stage of the parasite Taenia solium. Its worldwide prevalence is 9.1%. We present below a clinical case with an infrequent clinical and uncommon lesion size, with surgical resolved. Case report: A 48 year old man, who was a resident of a rural locality, consulted for sudden hemiparesis on the right side of the crural predominance, subsequently with increased ipsilateral brachial paresis. Physical examination highlighted right pyramidal syndrome. It was studied with Computed Axial Tomography that showed left frontal cyst with compression of the motor area, suggestive of parasite lesion. Brain Nuclear Magnetic Resonance (BNMR) reported left parasagittal fronto-parietal cystic expansive process of 5 x 5.5 cm, with mass effect. By size, type of lesion and clinic it was decided to perform open surgery with total extirpation and biopsy that reported cerebral cysticercosis. The patient evolved with complete recovery of motor deficit after surgery. Discussion: Neurocysticercosis is a differential diagnosis of brain cystic lesions. Its clinic is non-specific, commonly manifesting with seizures and headache. The RNMC allows the diagnosis and location of the lesions. The treatment is medical, surgical or combined. Usually, the management is based on antiepileptics and systemic antiparasitic, however in this case, it was decided the surgical management that led to the total improvement of the patient, which guarantees the early surgery as the main measure in lesions of this type

Testing pigs of non-technified rearing farms for serum antibodies against Taenia solium in a region of the state of São Paulo, Brazil / Anticorpos séricos contra Taenia solium em suínos de criações não tecnificadas em uma região do Estado de São Paulo, Brasil

Taenia solium is a zoonotic tapeworm of great importance in developing countries, due to the occurrence of human taeniasis and cysticercosis. Pigs have an important role in the biological cycle of the parasite as intermediate hosts. The scientific literature has been describing risk factors associated with the occurrence of this disease that must be avoided in countries with poor sanitation, in order to reduce the exposure of swine to the parasite eggs. This research focused on testing pigs of non-technified rearing farms for serum antibodies against Taenia solium in the region of Jaboticabal municipality, in the state of São Paulo, Brazil. The found prevalence was 6.82% (CI 95% 4.18 - 9.45) at animal level and 28.87% (CI 95% 16.74 - 40.40) at herd level. These figures are probably associated with low technification adoption during animal rearing in the studied area, which increased the exposure of the animals to risk factors associated with the occurrence of Taenia solium complex. The results found based on serological evidences of swine cysticercosis in the studied region serves as a warning to public sanitary authorities to improve public health and control T. solium.

A Taenia solium é uma importante zoonose com grande importância em países em desenvolvimento, devido a ocorrência de teníase e cisticercose em humanos. Os suínos possuem grande importância no ciclo biológico desse parasita como hospedeiros intermediários. A literatura científica descreve alguns fatores de risco associados com a ocorrência da enfermidade e que devem ser evitados em países com baixo saneamento básico a fim de reduzir a exposição dos suínos aos ovos do parasita. Assim, objetivou-se avaliar a presença de anticorpos séricos contra Taenia solium em suínos de criações não tecnificadas na região do Município de Jaboticabal, Estado de São Paulo, Brasil. A prevalência estabelecida foi de 6,82% (IC 95% 4,18 - 9,45) a nível animal e 28,87% (IC 16,74 - 40,40) nos rebanhos. Isso está provavelmente associado ao baixo nível de tecnificação adotado durante a criação dos animais na área avaliada, o qual aumenta a exposição dos animais aos fatores de risco associados ao complexo Taenia solium. Os resultados da ocorrência de cisticercose suína baseados em evidências sorológicas na região avaliada servem como um alerta as autoridades sanitárias para promover a saúde pública e controlar a Taenia solium.

Neurocisticercosis racemosa subaracnoidea gigante y ventricular: a propósito de un caso / Giant racemose subarachnoid and intraventricular neurocysticercosis: A case report

La neurocisticercosis es la enfermedad parasitaria más frecuente del sistema nervioso central. Es causada por las larvas de Taenia solium, las cuales pueden estar alojadas en distintas localizaciones anatómicas. En países como España existe una prevalencia en ascenso debido, principalmente, a la inmigración desde regiones endémicas. Las formas extraparenquimatosas son menos frecuentes, pero más graves por su tendencia a producir complicaciones. La neuroimagen desempeña un papel primordial en el diagnóstico y seguimiento de esta enfermedad, apoyada en la serología y un contexto clínico-epidemiológico compatible. El tratamiento de elección son los fármacos cisticidas albendazol y praziquantel, habitualmente se asocian a estos corticoides y, cuando corresponde, la cirugía. Se presenta un caso de neurocisticercosis con afectación simultánea intraventricular y subaracnoidea en su forma racemosa gigante.

Neurocysticercosis is the most frequent parasitic disease of the central nervous system. It is caused by the larvae of Taenia solium, which can affect different anatomical sites. In Spain there is an increasing prevalence mainly due to immigration from endemic areas. The extraparenchymal forms are less common, but more serious because they usually develop complications. Neuroimaging plays a major role in the diagnosis and follow-up of this disease, supported by serology and a compatible clinical and epidemiological context. First-line treatments are cysticidal drugs such as albendazole and praziquantel, usually coadministered with corticosteroids, and in some cases surgery is indicated. We here report a case of neurocysticercosis with simultaneous intraventricular and giant racemose subarachnoid involvement.

The economic impact of pig-associated parasitic zoonosis in Northern Lao PDR.

The parasitic zoonoses human cysticercosis (Taenia solium), taeniasis (other Taenia species) and trichinellosis (Trichinella species) are endemic in the Lao People's Democratic Republic (Lao PDR). This study was designed to quantify the economic burden pig-associated zoonotic disease pose in Lao PDR. In particular, the analysis included estimation of the losses in the pork industry as well as losses due to human illness and lost productivity. A Markov-probability based decision-tree model was chosen to form the basis of the calculations to estimate the economic and public health impacts of taeniasis, trichinellosis and cysticercosis. Two different decision trees were run simultaneously on the model's human cohort. A third decision tree simulated the potential impacts on pig production. The human capital method was used to estimate productivity loss. The results found varied significantly depending on the rate of hospitalisation due to neurocysticerosis. This study is the first systematic estimate of the economic impact of pig-associated zoonotic diseases in Lao PDR that demonstrates the significance of the diseases in that country.

No toda convulsión es epilepsia. caso clínico de neurocisticercosis múltiple en pediatría / Not every seizure is epilepsy. clinical case of multiple neurocysticercosis in pediatrics

En el mundo se considera que hay aproxi - madamente m ás de 50 millones de infecta dos con neurocisticercosis, teniendo como zonas end émicas M éxico, Centro y Sur Am érica, África, Asia e India (1). Se considera la enfermedad infecciosa neu- rol ógica m ás importante por sus manifesta ciones cl ínicas. El agente causal en cerdos y humanos es el cisticerco de la Taenia solium que puede alojarse en diferentes partes de cuerpo humano como ser mus -culo, cerebro y ventr ículos (2). El ser humano es el único hospedero de la solitaria y el cerdo es el inte rmediario, por lo que la prevalencia de la teniasis - cisticercosis depende de este vinculo. En zonas end émicas se diagnostica por la presencia de crisis convulsivas, cefalea, sí ntomas neurol ógicos focales, trastornos de visi ón, hipertensi ón endocraneal y con tomograf ías cerebrales que reporten zonas hipodensas o quiste con un anillo hiper -denso. El tratamiento con antiparasitarios es controversial en pediatr ía, se sugiere administrarse en la fase quí stica no calcifi cada y en casos de epilepsia asociada. Pocos son los casos que ameritan tratami ento quir úrgico por hidrocefalia o por cisticerco intraventricular, que es muy raro. El presente caso tiene como finalidad conocer una forma de presentaci ón de la neurocisticercosis en pediatr ía , as í como el adverti r cl ínico que debe tener en cuenta esta entidad dentro del diagnó stico diferen cial del " S índrome Convulsivo " haciendo uso razonable de la tecnolog ía en im ágenes y del laboratorio , perimitiendo as í un diag- nóstico y tratamiento oportuno . Palabras claves: Neurocisticercosis, Taenia solium , TAC cerebral, RMN cerebral...(AU)

Observaciones al microscopio electrónico de barrido del interior de un proglótido de un parásito adulto de taenia solium / Scanning electron microscopy observations of the cross-section of a taenia solium adult tapeworm

No existen, hasta el momento, imágenes que muestren la disposición de la citoarquitectura de parásitos adultos de Taenia solium, parásitos los cuales se encuentran en el intestino de portadores humanos asintomáticos. Las causas de ello podrían tener como base el que cuando se recuperan los parásitos, ellos han sufrido alteraciones debidas a la respuesta inmune de sus hospederos o bien, por el efecto que han producido en los parásitos los fármacos antihelmínticos que hayan sido usados en el tratamiento de los pacientes. Una de las alternativas que se han encontrado para la obtención de parásitos adultos, es la obtención de tenias a partir del modelo de teniosis experimental en hámsteres dorados e inmunosuprimidos y que gracias a este modelo se han podido efectuar diferentes tipos de estudios de los parásitos de esta fase infectiva. El propósito de este reporte es presentar imágenes de ultraestructura, obtenidas mediante Microscopía Electrónica de Barrido, de un corte transversal obtenido de un proglótido de una tenia recuperada de una infección experimental. Las imágenes se obtuvieron a diferentes aumentos y muestran aspectos relacionados con la superficie tegumentaria, el tegumento sincicial continuo, la capa germinal que incluye el soma de algunas células subtegumentarias y los ductos del sistema protonefridial tanto vacíos como llenos con corpúsculos calcáreos. Las imágenes ultraestructurales obtenidas muestran una forma de observación de la anatomía microscopica de los parásitos en estudio y ello contribuye a ampliar el conocimiento de los mismos en relación a aspectos de su biología celular y su fisiología.

There are no clear morphological evidences of the cytoarchitecture of intestinal adult tapeworms of Taenia solium recovered from infected humans. Parasites could be altered because of the host´s immunological response or by the direct action of drugs used for antihelminthic treatment. Experimental taeniosis in immunosuppressed golden hamsters is a useful way for recovering and studying adult parasites. The purpose of this report is to show images, taken at the ultrastructural level by Scanning Electron Microscopy (SEM), of a cross-sectioned strobilar chain from an adult tapeworm. The parasite was recovered from an experimental infection. Images were taken at several magnifications; they show the brush border tegumental surface, the syncytial tegument, the germinal layer, some cell bodies and the protonephridial system ducts: empty or filled with calcareous corpuscles. Ultrastructural images taken using SEM of T. solium adult parasites, recovered from experimental infections, could be a new way for observing the microscopic anatomy of these parasites and for increasing the knowledge of aspects related to their cellular biology and physiology.

Seroprevalence of Taenia solium antibodies in Vellore district, south India.

Although Taenia solium neurocysticercosis is the cause of almost one-third of epilepsy in Vellore district, south India, the level of exposure to T. solium in the district is not known. This study determined the seroprevalence of cysticercus antibodies in seizure-free, study subjects aged 2-60 years from urban and rural areas of Vellore district. Cysticercus antibodies, as determined by immunoblots, were noted in 15.9% of 1063 people and were significantly higher in the rural population (17.7%) compared with the urban population (6.0%). Twenty-four percent of the rural population and 12% of the urban population ate pork. One-third of all households in the district had one or more members seropositive for cysticercus antibodies. The high index of exposure to T. solium in south India calls for improved animal husbandry and sanitation.

Saúde e meio ambiente / Health and environment

A sustentabilidade ambiental está diretamente relacionada à falta de informação e cuidados com a higiene. Veja o que o Dr. Dráuzio Varella diz sobre a prevenção e o tratamento da dengue, muitos meses antes da epidemia carioca.

Prevalência de neurocisticercose em pacientes atendidos no setor de neurologia do Hospital Universitário Regional de Maringá, Estado do Paraná, Brasil / Neurocysticercosis prevalence in patients assisted at the neurology sector of the Hospital Universitário Regional de Maringá, state of Paraná, Brazil

Com o objetivo de estimar a prevalência de neurocisticercose, livros de registro de pacientes internados e ambulatoriais atendidos no setor de neurologia do Hospital Universitário Regional de Maringá, Estado do Paraná, no período de janeiro de 2000 a junho de 2003, foram analisados. Dos 1.713 atendimentos realizados, observaram-se 13 (0,8%) pacientes com diagnóstico de neurocisticercose. Em quatro pacientes o diagnóstico foi estabelecido no período de estudo; nos demais, entre os anos de 1993 e 1999. Com relação ao sexo, a prevalência de neurocisticercose foi de 0,8% no sexo masculino e 0,7% no sexo feminino. Quanto ? idade, a prevalência foi maior na faixa etária de 11 a 30 anos (1,3%) e acima dos 50 anos (1,2%). Dos municípios que tiveram casos de neurocisticercose, os de Ângulo, Marialva, Floresta e Mandaguaçu apresentaram as maiores prevalências. Manifestações epilépticas e cefaléia foram as principais queixas dos pacientes diagnosticados. A observação de um caso com a forma ativa e um com a forma transicional, entre os quatro diagnosticados no período analisado, indica que a infecção continua ativa em nosso meio, merecendo das autoridades sanitárias constante vigilância.

Register books of ambulatory patients and of the ones in hospital, assisted at the neurology sector of the Hospital Universitário Regional de Maringá, State of Paraná, from January, 2000 to June, 2003, were evaluated with the purpose of estimating the neurocysticercosis prevalence. Out of the 1,713 individuals attended, 13 (0.8%) patients were given the diagnosis of neurocysticercosis. In four patients, such a diagnosis was established during the study period, and the others were evaluated from 1993 to 1999. Concerning sex, the prevalence of neurocysticercosis was of 0.8% in males and 0.7% in females. As for age, the prevalence was greater in 11-30-year-old patients (1.3%) and in individuals who were above 50 years old (1.2%). With respect to the municipal districts that presented cases of neurocysticercosis, Ângulo, Marialva, Floresta and Mandaguaçu showed the greatest prevalence. Epileptic crises and headaches were the main complaint of the diagnosed patients. The observation of one active case and of a transitional one, among the four cases diagnosed in the study period, indicates that the infection is still active in our environment and that it deserves a constant vigilance from the sanitary authorities.

Diferenciacão específica entre Taenia saginata e Taenia solium por ensaio de PCR e duplex-PCR / Specific discrimination between Taenia saginata and Taenia solium by one step PCR assay and duplex-PCR

Este estudo teve como objetivo a padronizacão de protocolos e a selecão de novos primers para a identificacão espécie-específica de Taenia saginata e Taenia solium através da reacão em cadeia da polimerase (PCR) e duplex-PCR. Inicialmente, foram recuperadas seqüências depositadas no GenBank (acesso nº AB020399 para T. saginata e nº AB020395 para T. solium) referentes ao gene da subunidade maior do ribossomo (LSU RNAr) de tenídeos. A partir do alinhamento das seqüências, um primer genérico denominado TBR-3 (5'-ggcttgtttgaatggtttgacg- 3') foi selecionado de região conservada e, de diferentes regiões semi-conservadas, os primers específicos TBR-4 para T. saginata (5'-cgactcatgaagataaacaaggt-3') e TBR-5 (5'-cggtcgaacagaccataaatct-3') e TBR-6 (5'-gctactacacctaaattctaacc- 3') para T. solium. Os primers foram avaliados quanto à especificidade através da PCR empregando-se DNA total (DNAt) de amostras de cisticercos e proglotes dos parasitos, previamente identificadas por critérios morfológicos. O par de primers TBR-3/TBR-4 permitiu a amplificacão específica do fragmento esperado de 328 pb a partir do DNAt de T. saginata. Os pares TBR-3/TBR-5 e TBR-3/TBR-6 permitiram a amplificacão, respectivamente, dos fragmentos específicos de 310pb e 286pb a partir do DNAt de T. solium. A identidade dos produtos de PCR foi comprovada comparando-se a seqüência dos amplicons obtidos às seqüências de referência do gene LSU RNAr registrado no GenBank (nº AB020399 e nº AB020395). As reacões apresentaram sensibilidade para deteccão de até 1fg do DNAt de T. solium e 0,2fg do DNAt de T. saginata. A combinacão dos primers TBR-3/TBR-4 e TBR3/TBR-6 e o tamanho dos fragmentos gênicos obtidos permitiram o estabelecimento de ensaios de duplex-PCR, eficaz na deteccão simultânea do DNA de T. saginata e T. solium em sistema único de reacão. Os primers utilizados não geraram qualquer produto de amplificacão cruzada quando testados com DNAt de Taenia hydatigena, Taenia taeniaeformis, Hymenolepis diminuta, Anoplocephala magna, Paranoplocephala mamillana e Moniezia expansa, nem frente ao DNAt dos hospedeiros Homo sapiens, Bos taurus e Sus scrofa.

Cysticercosis/taeniasis in Asia and the Pacific.

Three taeniid tapeworms infect humans in Asia and the Pacific: Taenia solim, Taenia saginata, and Taenia asiatica. Although there is continuing debate about the definition of a new species, phylogenetic analyses of these parasites have provided multiple lines of evidence that T. asiatica is an independent species and the sister species of T. saginata. Here we review briefly the morphology, pathology, molecular biology, distribution and control options of taeniasis/cysticercosis in Asia and the Pacific and comment on the potential role which dogs may play in the transmission of T. solium. Special attention is focused on Indonesia: taeniasis caused by T. asiatica in North Sumatra, taeniasis/cysticercosis of T. solium and taeniasis of T. saginata in Bali, and taeniasis/cysticercosis of T. solium in Papua (formerly Irian Jaya). Issues relating to the spread of taeniasis/cysticercosis caused by T. solium in Papua New Guinea are highlighted, since serological evidence suggests that cysticercosis occurs among the local residents. The use of modern techniques for detection of taeniasis in humans and cysticercosis in humans, pigs and dogs, with the possible adoption of new control measures will provide a better understanding of the epidemiology of taeniasis/cysticercosis in Asia and the Pacific and lead to improved control of zoonotic and simultaneously meat-borne disease transmission.