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A clinical case of cerebral infection by parenchymal racemose cysticercus, diagnosed by means of morphological characteristics in a patient of Valdivia city is described. The rare frequency of parenchymal location of racemose cysticercus as well as its differential diagnosis with other larval stages of cestodes that develop in the brain and its treatment are discussed.
An electron microscopic study was performed to know the basic tegumental structure of Cysticercus cellulosae. The scolex and bladder portions of cysticerci (human and porcine strains) were prepared for transmission and scanning electron microscopy by conventional procedures. In general, the tegument of C. cellulosae showed the basic ultrastructure of cestode tegument on electron micrographs. The teguments of both scolex and bladder portions consisted of such components i.e., an outer vesicular layer with numerous microtriches and inner fibrous layer. Below the fibrous layer, there were layers of muscle bundles and tegumental cells. The microtriches which covered the surface of cysticercus revealed two distinctly different shapes. The characteristic bladder-like, elongated pyramid shaped 'tetrahedral form' was observed on the surface of the scolex portion, whereas the elongated cylindrical 'filamentous form' was distributed on the surface of bladder portion. In spite of the difference of isolated host and location, the cysticerci showed the same result. But dimensional variations of the tegument according to topography of the worm were observed. The possibility of application in making differential diagnosis from other larval cestodes and possible functions of this larval tegument were discussed.
A case of acute suppurative dacryoadenitis caused by a cysticercus cellulosa in a male of 20 years is reported. The diagnosis was established by histopathologic examination of the cyst that escaped along with pus during drainage of the abscess. The abscess in the palpebral lobe of the lacrimal gland resulted from acute inflammation produced by the presence of an intact larva. There was no other focus of cysticercosis in the same eye, in the other eye, or anywhere else in the body. Postoperative recovery was uneventful and there were no sequelae. To our knowledge, this is the first case report of acute dacryoadenitis caused by a cysticercus cellulosa. As cysticercosis is still prevalent in the underdeveloped countries, it is to be kept in mind in the differential diagnosis of ocular and adnexal lesions in patients coming from these areas of the world.
OBJECTIVE: To investigate the clinical features, laboratory tests, medical imaging manifestations, diagnosis and treatment of orbital cysticercus cellulosae. METHODS: 23 cases of orbital cysticercus cellulosae were analyzed from 1973 to 1997. RESULTS: Most cases had features of exophthalmos, lid swelling, limitation of ocular movement. Some of them with visual loss, optic papilledema and orbital mass. B-scan ultrasonography revealed a cystic tumor and a strong echo spot with spontaneous movement. On CT scanning, found was a well-defined hyperdensity mass in which there was a low density area. On MRI, the signal intensity of T(1)WI of cystic fluid was low or moderate and of T(2)WI was high, while the signal intensity of T(1)WI and T(2)WI of surrounding scar tissue was still low. CONCLUSION: We can make diagnosis by imaging tests and treat them with surgical operations.
BACKGROUND: It is now agreed that the prognosis of seizure disorder due to solitary cysticercus granuloma (SCG) is generally good. However, the choice antiepileptic drugs (AEDs) remain empirical, with no comparative trials of different AEDs being available. AIMS: To determine the safety and efficacy (measured by the incidence of 'treatment failure') of clobazam in comparison to standard treatment with phenytoin-sodium for prevention of seizures in persons with solitary cysticercus granulomas (SCGs). SETTINGS AND DESIGN: This pilot study was conducted in a neurology department of a medical college hospital in the form of a prospective, randomized, open-labeled trial. MATERIALS AND METHODS: Forty-eight patients with seizures due to SCG were randomized in an open-labeled trial to either, clobazam (1 mg/kg oral loading followed by 0.5 mg/kg/d) (n=21) or phenytoin (15 mg/kg, oral loading in 3 divided doses over 24 h, followed by 5 mg/kg/d) (n=27). They were followed over 6 months with the primary outcome measure being treatment failure (either discontinuation or modification of AEDs) due to either adverse effects or breakthrough seizures. RESULTS: Treatment failures were noted to be significantly less common (P =0.03) in the clobazam-treated group (n=1; 4.7%) than in phenytoin-treated group (n=9; 33.3%). These included one patient (4.7%) in the clobazam-group who had breakthrough seizures and 3 (11.1%) who had breakthrough seizures and 6 (22.2%) in the phenytoin-treated group who had adverse effects requiring treatment discontinuation. CONCLUSIONS: Clobazam was well tolerated, safe and more effective than phenytoin in the AED treatment of patients with SCG.
Intraocular cysticerci are mostly located in the subretinal space or vitreous. When the fundus is obscured by exudate or hemorrhage, the diagnosis becomes very difficult with the ophthalmoscope or biomicroscope. The authors performed A- and B-scan echographic studies on 20 cases of intraocular cysticercus during February 1985 to December 1988; it was found that B-scan was very useful in diagnosing intraocular cysticercus with regard to its location and relation to surrounding tissues. Several cases with typical echograms are presented with discussions. The ultrasonic diagnoses were confirmed by surgery.
Out of 4 fenced pastures, 2 stationary flocks and 3 wandering flocks with approx. 2,000 mother sheep, 962 samples of faeces were checked for the occurrence of gastro-intestinal nematodes and lungworms. Irrespective of the way the sheep are kept, an infestation incidence of 11.1 to 100% with gastro-intestinal nematodes was found. In one flock even after two treatments 66.7% were still infected; therefore, suspect methods of treatment have to be avoided and a constant change of anthelmintics is absolutely essential. Dictyocaulus filaria occurred in 6 out of 9 flocks and was easy to be treated chemotherapeutically, whereas the protostrongyles could be reduced but were not eliminated totally. - 785 out of 4,710 slaughter sheep (= 16.7%) harboured metacestodes of Taenia hydatigena in the omentum majus. In most cases one or two specimens (= 66.6 i.e. 17.6%) of Cysticercus tenuicollis could be found, once there were even 117. 1.332 cysticercus (= 78.1%) showed ready to contract and according to these and other morphological criteria, a total of 1,416 (= 83%) were regarded to be vital and able to evoke an infection. Relating to practice, the sheep dog should always be treated at the same time as deworming of the flock takes place.
Three groups of calves aged 6 months were completely protected against oral challenge with Taenia saginata eggs following immunisation by three different methods. These were hyperimmunisation with six serial inoculations of a homogenate of T. saginata strobila in Freund's complete adjuvant, a single intramuscular inoculation with hatched T. saginata eggs or a single oral dose of unhatched T. saginata eggs. The calves immunised with tapeworm homogenate developed the strongest haemagglutinating and precipitating antibody response to the complex of antigens in an extract of tapeworm strobila, cysticercus tissue or cysticercus fluid. The orally infected calves developed a moderate antibody response to these antigens but the calves inoculated with hatched eggs showed only a very weak antibody response. The calves infected orally with eggs developed a peripheral eosinophilia but the other two methods of immunisation did not evoke this response. After challenge infection all groups showed an increase in peripheral eosinophil counts except the group immunised with tapeworm homogenate.
The nervous system of Cysticercus cellulosae, the metacestode stage of the tapeworm Taenia solium, was delineated using histochemical methods for the localization of the enzyme markers; nonspecific esterase and acetylcholinesterase. The main features of the nervous system include a pair of cerebral ganglia, a circumcerebral nerve ring, a rostellar nerve ring, and anterior and posterior nerves and their branches. The posterior nerves form a subtegumental network in the strobila and the bladder wall. A nerve network around excretory tubules could also be demonstrated, suggesting neuronal control of excretion in the metacestode. No sheath was observed around the nervous system. The morphological features described suggest "cephalization" of the nervous system in this parasite.
Protection was induced in hogs against Taenia solium cysticercosis using an immunogenic complex obtained from its larval "bladder worm" form, Cysticercus cellulosae. Immunoelectrophoresis revealed that this complex contained at least eight antigens. In immunized hogs a total of 71 (mean 11.8) cysticerci were found, whereas in the control animals 397 (mean 74.9) were found. Histopathological studies showed that more than 40% of larvae obtained from immunized hogs were completely destroyed and the others were seen in various stages of degeneration. Eosinophils and mononuclear cells were observed infiltrating the internal structures of the larvae. Intense granulomatous reactions of eosinophils, lymphocytes, macrophages, epithelioid cells, plasma cells, and fibroblasts surrounded the larvae. Larvae from control hogs were intact and surrounded by a small inflammatory reaction. The cellular response was measured by the macrophage migration inhibition test, which was higher in immunized hogs when compared with control animals, either before the infection with T. solium eggs or before slaughter. No significant difference was found in the humoral response of immunized and control hogs.
In hogs naturally infected with Taenia solium larvae (i.e., Cysticercus cellulosae), we studied the host response induced by antigens obtained from the larvae. Histopathological studies of cysticerci removed after 4 and 8 weeks of immunization showed an intense inflammatory reaction surrounding the larvae. The response was greater in the 8-week specimens. A dense layer of eosinophils was in close contact with the external membrane of the bladder wall and, in several cases, the eosinophils had infiltrated this tegument. Many eosinophils were seen in the spiral canal of larvae. This infiltration by eosinophils increased with time. Preparations from the 8-week samples showed many degenerated and disrupted eosinophils whose granules were found in close contact with the outer membrane of the larval tegument and, in some cases, had entered through the broken surface of this structure. More than 90% of the larvae were found in various stages of degeneration; the rest were completely destroyed and surrounded by a mass of eosinophils. After immunization, peripheral blood eosinophilia increased to 17%, whereas the eosinophilia of the control hog was 4% throughout the study. The larval worms removed from control hogs showed intact structures, with a low degree of infiltration by eosinophils and a discrete inflammatory reaction surrounding the bladder wall of the larvae.
The effects of glucose, yeast extract, fetal bovine serum albumin, and ruthenium red on endocytosis of smooth micropinocytotic vesicles (pinosomes) in the tegument of the cysticercus of Taenia crassiceps have been investigated stereologically. Glucose has been shown to stimulate pinocytosis, whether it was used alone or in combination with yeast extract or bovine serum albumin. Yeast extract was a stimulant of endocytosis. Bovine serum albumin was the most potent stimulant of all the substances investigated in this study. Although the time of incubation in ruthenium red was the same for all incubation experiments, varied numbers of ruthenium red-containing pinosomes were observed in different experiments. The role of ruthenium red as a stimulant and/or initiator of endocytosis and the possible explanations for differences in ruthenium red uptake are discussed.
Neurocysticercosis (NCC) is an important zoonotic infection, and a significant cause of morbidity and mortality in India. Immunodiagnosis plays an important role in the early, rapid, and specific diagnosis of the condition. The aim of the present study was to detect specific cysticercal antigen excreted in the urine for the diagnosis of NCC. The objective was to develop and evaluate staphylococcal Co-agglutination (Co-A) test for the detection of urinary cysticercal antigen. In the present study, urine samples were collected from 9 cases of clinically suspected NCC, 8 cases of CT/MRI proven cases of NCC, 11 of non-cysticercal CNS infection controls, and 25 healthy control subjects. Polyclonal antisera raised in rabbits against porcine complete cysticercus homogenate antigen, was used in the Co-A test to detect cysticercal antigen. The Co-A detected excreted cysticercal antigen in the urine of five of nine (55.5%) clinically diagnosed NCC and in five of eight (62.5%), CT/MRI proven cases of NCC. A false positive reaction was observed with 1 of 11 (9%) of control urine specimens from non-cysticercal CNS infection controls. No false positivity was demonstrated with 25 urine samples collected from healthy controls. Results of the present study shows that the Co-A test can be employed as a moderately sensitive and specific test for detection of urinary antigen in the diagnosis of NCC in poorly equipped laboratories.
Neutrophils, eosinophils and macrophages interact with invading parasites and naive hosts. The initial reaction of leukocytes is the generation of reactive oxygen species (ROS). The cytotoxic effects of extracts derived from intact Cysticercus cellulosae and from the scolex or membrane fractions on neutrophils were examined. DNA fragmentation of neutrophils was observed when cells were incubated with an extract from the intact metacestode; however, the addition of antioxidant enzymes to the incubation medium had a protective effect. The scolex and membrane extracts did not affect DNA fragmentation of neutrophils. Hydrogen peroxide production of neutrophils incubated with metacestode fractions from C. cellulosae increased by 190% (total extract), 120% (scolex) or 44% (membrane). An increase in antioxidant catalase activity (28%) concomitant with the increased production of ROS was observed in neutrophils incubated with metacestode fractions, which could be an attempt at self-protection. ROS production by neutrophils in the presence of the intact cysticerci extract did not alter phagocytosis. In contrast, the scolex and membrane fractions increased the phagocytic capacity of neutrophils by 44 and 28%, respectively. The results showed that the extract from intact C. cellulosae was toxic for neutrophils via ROS production, leading to DNA fragmentation and inhibition of phagocytic capacity, but neutrophils are able to protect themselves against oxidative stress by via catalase activity.
PURPOSE: We treated two patients who had spontaneous extrusion of cysticercus cysts and subconjunctival swelling. Additionally, one patient had severe myositis and restriction of ocular movements. METHODS: The patients were prescribed oral albendazole, 15 mg/kg of body mass per day. Systemic corticosteroids were also given to the patient who had severe myositis. RESULTS: Spontaneous extrusion of the cysts occurred in both patients within three to five days of starting albendazole therapy. The conjunctival defects healed without any surgical intervention. The ocular motility in the patient with myositis returned to normal. CONCLUSION: As extrusion happened soon after the start of albendazole therapy, it is uncertain whether this therapy played any role. Additionally, it is not clear if systemic therapy must be continued in the absence of systemic and neurologic manifestations.
A novel cDNA was isolated from a library of Cysticercus cellulosae by immunological screening. Sequence analysis reveals that it has typical annexin structures. However, since its N-terminus is distinct and the core domain only has 32-44% amino acid identity to the tetrads of other annexins, the cDNA encodes a member of a novel annexin subfamily, which is designed as annexin B1. The recombinant protein, GST-anxB1, has the phospholipid-binding property and anticoagulatant activity common to annexins.
Neurocysticercosis (NCC) is a major cause of morbidity and mortality in developed and developing countries. The diagnosis of this disease remains a problem. We report the detection of specific antigenic fraction (antigen B) of Cysticercus cellulosae by enzyme-linked immunosorbent assay (ELISA) in various fractions of cerebrospinal fluid (CSF) obtained by high performance liquid chromatographic (HPLC) separation, for the diagnosis of human NCC. Forty patients attending or admitted to Nehru Hospital, Chandigarh were included in the study: 10 with suspected NCC, 20 with other neurological diseases and 10 undergoing surgery under spinal anaesthesia for non-neurological conditions, who served as controls. CSF samples collected from all patients and controls were subjected to chromatographic separation on an HPLC system. Antigen B (AgB) was detected in separated fractions by an ELISA test and compared with the detection of antibody response in CSF samples by indirect haemagglutination (IHA) technique. Antigen B was detected in 9 out of 10 patients with suspected NCC based on clinical symptoms and radioimaging reports, but in none of the control subjects. However, antigen B was also detected in 9 out of 20 patients with other neurological disorders, mostly tubercular meningitis. Antibody response by IHA was found positive in only 2 of 10 cases clinically suspected of NCC. In conclusion, antigen B detection in CSF samples may be a useful adjunct to clinical suspicion and radiological reports for the diagnosis of NCC as there is no gold standard criteria to confirm this disease. However, the test needs to be evaluated on more patients in countries where tuberculosis and cysticercosis are endemic due to the high cross reactivity with samples from tubercular meningitis patients.
PURPOSE: This study was performed to understand the relation between the scolex as demonstrated on gradient echo (GRE) imaging in a calcified cysticercus cyst and the development of perilesional edema that may be of value in understanding the pathogenesis of this entity. METHODS: Twenty-one patients with solitary calcified lesion on computed tomography (CT), with seizures of recent onset (within 15 days), were selected for this study. All the patients were subjected to magnetic resonance imaging (MRI) including GRE imaging. The patients were grouped on the basis of presence or absence of perilesional edema around the calcified lesion on MRI. RESULTS: There were 14 patients with perilesional edema, and seven patients had no evidence of edema. Of these 14 patients with perilesional edema, rim enhancement was detected in 13 patients on postcontrast MRI, whereas no enhancement was observed in one patient. The scolex was seen in all these 14 patients on GRE images. Of the seven patients without evidence of edema, the scolex was not seen in any of these patients on GRE imaging. In addition, there was no evidence of any contrast enhancement on postcontrast study in any of the patients in this group. CONCLUSIONS: We conclude that the calcified cysts with scolex seen on GRE imaging are associated with perilesional edema. This is probably due to preservation of antigenic material in these calcified cysts, the release of which provokes an inflammatory response that may be responsible for the perilesional edema.