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Cerebral cysticercosis. A case report and review of the literature.

Two cases of histologically proven cerebral cysticercosis are presented. In both cases subcutaneous tissue nodules, a rare feature, were present. Several disease patterns are apparent--meningeal, parenchymatous and ventricular, spinal cord lesions and mixed patterns. Epilepsy is by far the major presenting symptom of cysticercosis, which in turn plays a significant role in the causation of adult-onset epilepsy in Blacks. Despite its drawbacks, the haemagglutination inhibition test remains the most satisfactory serological method at present available for the diagnosis of cysticercosis; it is positive in up to 85% of cases of proven cysticercosis. With the advent of computed tomography many cases of unsuspected cysticercosis (symptomatic or asymptomatic) are being discovered.

Adolescent↗

Clinical aspects of CNS cysticercosis.

Central nervous system cysticercosis, caused by infection with the larva of the pork tapeworm, is common throughout the world. Infection occurs after ingestion of fecal contaminants containing the ova of Taenia solium. The clinical manifestations depend on the number, age, and location of the larval cysts disrupting neural tissues. Several disease patterns are apparent: (1) basilar cysticercosis resulting in chronic meningitis or progressive hydrocephalus, (2) parenchymal cysts with focal symptoms, (3) diffuse parenchymal cysts with intracranial hypertension, (4) ventricular localization with episodic acute hydrocephalus, and (5) spinal cord cysticercosis mimicking mass lesions. Mixtures of these basic patterns may occur, and asymptomatic infections are common. In the United States, meningeal cysticercosis is often mistaken for tuberculous or fungal meningitis. A diagnosis of CNS cysticercosis should be considered in any patient with these syndromes who has resided in an area of high prevalence of T solium.

Adult↗

Immunization against Taenia crassiceps cysticercosis: identification of the most promising antigens in the induction of protective immunity.

Cross immunity between Taenia solium and Taenia crassiceps parasites points to T. crassiceps cysticercosis as a convenient model to test promising antigens aimed at the development of a vaccine against T. solium cysticercosis. Since total antigens from T. crassiceps metacestodes induce significant levels of protection in pigs against T. solium cysticercosis, we initiated this work to identify the most interesting antigens involved in protection. Twelve different antigen fractions isolated from T. crassiceps cysticerci were evaluated with respect to their capacity to induce resistance against a challenge with 10 T. crassiceps cysticerci in male BALB/cAnN mice. Mice were intraperitoneally immunized with 2 doses of each antigen, 5 or 15 micrograms per mouse. The 12 antigen fractions were classified as protecting (200, 123, 74, 66, 56, 40-50, 27 and 8-14 kDa), facilitating (220-205 kDa), or irrelevant (150-160, 93, 108 kDa), according to their effect on the parasite load. The 3 most promising antigen fractions were reevaluated via subcutaneous immunization with Freund's complete adjuvant. A high level of protection was obtained when antigen fractions of 56, 66, and 74 kDa were used together. Interestingly, antigens with similar molecular weights were also detected in early steps of differentiation in T. solium cysticercosis. These observations may be helpful in the development of a synthetic or a recombinant vaccine against cysticercosis.

Animals↗

[Cysticercosis in patients with neurologic diseases in hospital milieu in Lomé, Togo].

The aim of this study was to determine the frequency and clinical presentation of cysticercosis in patients consulting in the neurology unit of the Lomé, Togo Teaching Hospital. Among the 2.064 patients examined, 38 had cysticercosis. All 38 were males, age ranged 18 to 50 years. Diagnosis was established on the basis of multiple subcutaneous cysticercosis (n = 33), cerebral cysticercosis scan findings (n = 5), serology (n = 7) and cerebrospinal fluid findings (n = 3) of specific antibodies using the ELISA method. Recurrent epileptic seizures occurred in 33 patients. Three other were in a confusional state, one had headaches and one had hemiplegy. The results of this study contrast with the reported scarcity of cerebral cysticercosis in hospitals in other West African countries.

Adult↗

[Isolated intramedullary cysticercosis. Case report].

BACKGROUND AND PURPOSE: Cysticercosis is the most common parasitic disease affecting the central nervous system. Although it is still very rare in Europe, the frequency will increase due to the influx of immigrants from the endemic areas and increasing trips in these countries. Spinal intramedullary cysticercosis is an uncommon manifestation of neurocysticercosis. CLINICAL PRESENTATION: We report a case of pure intramedullary cysticercosis in a young white French girl, presenting as a progressive paraplegia with a cystic lesion in T4 on MRI. The diagnosis was made only after surgery by pathological examination. CONCLUSIONS: A preoperative diagnosis of spinal intramedullary cysticercosis must be suspected not only in an endemic area in the presence of multiple soft tissue calcifications and segmental lesions revealed by myelography or MRI studies, but also for all cystic lesion of central nervous system even in no endemic area. Surgery is the unique treatment which can be used for spinal intramedullary cysticercosis and with the use of the microsurgical techniques for medullar surgery the outcome is not as dismal as reported earlier.

Adult↗

Oral cysticercosis--report of six cases.

BACKGROUND: Cysticercosis cellulosae rarely involves the oral region in humans. METHODS: Six cases of oral cysticercosis were diagnosed, three each in lips and buccal mucosa. Diagnosis was made by characteristic gross and histopathologic appearances. RESULTS: Of 146 cases of cysticercosis, 6 (4.1%) were of the oral cavity. All 6 cases were initially seen with painless swellings. Clinical differential diagnosis ranged from retention cyst, lipoma, fibroma, neurofibroma, and angular stomatitis. Histopathologic examination revealed cysticercus larvae. CONCLUSIONS: The oral cavity is a rare site of involvement by cysticercosis, even in an endemic area. Histopathologic findings of the excised cyst are diagnostic of the lesion.

Adolescent↗

Mobile myelographic filling defects: spinal cysticercosis.

Cysticercosis usually affects the brain and is easily demonstrated by CT. Spinal cysticercosis is much rarer and is usually diagnosed only at surgery. Myelographic demonstration of multiple rounded filling defects, some of which were mobile, allowed diagnosis of spinal extramedullary cysticercosis in an unsuspected case. The literature on spinal cysticercosis is briefly reviewed. Diagnosis is important in view of the recent development of medical treatment.

Arachnoiditis↗

CNS cysticercosis--a problem of differential diagnosis.

Although a well-known disease worldwide, cerebral cysticercosis in European countries is a rare event. Due to increased travel to East-Asian and Latin American countries it is possible that the occurrence of brain cysticercosis will become more frequent. These facts should remind us of the possibility of cysticercosis of the nervous system. A case of cerebral and spinal cord cysticercosis is presented, causing symptoms of progressive dementia with ventricular occlusion and hydrocephalus. Differential diagnosis causes a major problem. It is shown that myelography may demonstrate characteristic features of the disease.

Aged↗

[Cutaneous manifestation of cysticercosis].

Cysticercosis, an infection with the larva of Taenia solium, is caused by the accidental ingestion of the parasite's eggs. In many countries of the Third World, cysticercosis, and especially neurocysticercosis, is a widespread problem. A patient from Northern Malawi presented not only with cysticercosis but also with BT leprosy and pityriasis versicolor. Dermatologists should be familiar with the clinical picture of cysticercosis in order to make an early diagnosis in patients from at-risk areas.

Adult↗

Proposal of diagnostic criteria for human cysticercosis and neurocysticercosis.

Taenia solium cysticercosis is a major public health problem in several areas of the world. While the disease has a recognized etiologic agent, its definitive histological diagnosis is not possible in most cases because this parasite tends to lodge in cerebral tissues where routine biopsy is not feasible. Therefore, the diagnosis of human cysticercosis (and neurocysticercosis) should rest on the proper interpretation of the patients' symptoms together with data provided by radiological studies and immunologic tests for the detection of anticysticercal antibodies. Unfortunately, the pleomorphism of this parasitic disease creates confusion when non-specific clinical, radiological, or immunologic criteria alone are used to detect cases among populations or to diagnose hospitalized patients with neurological manifestations. We propose a chart of diagnostic criteria for human cysticercosis that objectively permit clinicians and health care workers to evaluate clinical, radiological, immunologic, and epidemiologic data of patients. The chart uses four degrees of criteria: absolute, major, minor, and epidemiologic, that were selected on the basis of their individual diagnostic strength. Interpretation of such criteria will result in three categories of diagnostic certainty: definitive, probable and possible, according to the likelihood that cysticercosis is present in a given person.

Cysticercosis↗

Taeniasis-cysticercosis in Honduras.

Data on human taeniasis and human and animal cysticercosis from Honduras were gathered from laboratory, medical and slaughterhouse records, proglottid identification and surveys. The infection rate for human taeniasis was 2.7/1000 individuals at the University Hospital, 10/1000 in the southern provinces of Choluteca and Valle, and 0.6/1000 in Cortes and Atlantida in the north. In surveys, the rates found ranged from 14 to 62/1000 in 9 of 15 communities studied. Taenia solium was identified in 135 of 181 individuals (74.5%) who submitted proglottids for speciation, 23 of whom were children 0-5 years old. The male:female ratio of infection rate was 1:2. The rates of infection with cysticercosis in pigs and cattle at one abattoir in 1981-1986 were 5% and 0.05% respectively. Diagnosis of human cysticercosis at the University Hospital increased five-fold with the introduction of computerized tomography and an enzyme-linked immunosorbent assay: 22 cases were diagnosed in 1980-1984 and 107 cases in 1985-1988. Rates at the neurosurgical ward were higher (29/1000 patients) than in the general hospital census (1.6/1000 patients). aeniasis-cysticercosis may be a serious health problem in some areas of Honduras.

Adolescent↗

Epidemiological investigation of Taenia solium taeniasis and cysticercosis in a rural village of Michoacan state, Mexico.

We performed a survey for taeniasis and cysticercosis among persons living in a Mexican village where Taenia solium infection in pigs was known to be enzootic. A standardized questionnaire was administered in all 577 households to obtain medical histories and information on demographic and environmental factors and on risk factors associated with transmission of infection. Serum and/or stool specimens were obtained from 1005 volunteers and examined for cysticercosis antibodies and intestinal parasites. Faecal examination of 828 participants revealed infection by Taenia sp. in 2 (0.2%). Three additional cases of taeniasis were detected in individuals who evacuated proglottids after treatment with praziquantel. Of 1005 human serum specimens, 49 (4.9%) were positive in the cysticercosis immunoblot assay. Seropositivity increased with age and reached a peak in subjects aged 46-55 years (P < 0.05). A history of seizures was significantly associated with seropositivity (P < 0.05); approximately 25% of persons with such histories were seropositive. Histories of headache, dizziness, trembling, blurred vision, and vomiting were also significantly associated with positive immunoblot assays. This study has demonstrated previously undiagnosed morbidity associated with T. solium neurocysticercosis and identified community behavioural and environmental practices that must be modified to prevent continued transmission of cysticercosis and taeniasis.

Adolescent↗

Countercurrent immunoelectrophoresis in the diagnosis of Taenia hydatigena cysticercosis in goats.

The procedure of countercurrent immunoelectrophoresis in the diagnosis of Taenia hydatigena cysticercosis in goats was carried out for antemortem diagnosis of T. hydatigena cysticercosis in experimentally and naturally infected goats. The antigens of cyst fluid, scolex and membrane of T. hydatigena metacestodes were purified and compared. The sensitivity of the test in experimentally and naturally infected goats was 57.1 and 52.5%, respectively, whereas its specificity using antisera raised against T. solium cysticercosis, hydatid cyst and Fasciola gigantica was 66.7 and 83.4% with partially purified and fractionated antigens, respectively. Of all three antigens, the cyst fluid antigen was found to be most reactive. The test could be employed for antemortem diagnosis of T. hydatigena cysticercosis using purified antigen.

Animals↗

Oral cysticercosis.

Cysticercosis is the result of infection with the larval stage of the tapeworm, Taenia solium. The parasite may settle at any site in the body without causing symptoms, which arise almost exclusively from the involvement of brain or eye, and this may occur several years after infection. Cysticercosis is one of the leading causes of acquired epilepsy in Latin America, parts of Asia, and Africa. More cases are being reported in other countries as a result of immigration from endemic areas. Cysticercosis may cause cystic swellings or nodules in the mouth, and these may be the only evidence of the disease. We present a healthy patient who had multiple intraoral cystic swellings that were diagnosed as cysticercosis in a biopsy specimen. Subsequent investigations showed cysticerci in the brain.

Adult↗

Characterization and cloning of GP50, a Taenia solium antigen diagnostic for cysticercosis.

GP50, a Taenia solium protein diagnostic for cysticercosis has been cloned, sequenced, and characterized. GP50 is one diagnostic component of the lentil lectin purified glycoprotein (LLGP) antigens that have been used for antibody-based diagnosis of cysticercosis in a Western blot assay for nearly 15 years. GP50 is a glycosylated and GPI-anchored membrane protein. The native protein migrates at 50kDa, but the predicted molecular weight of the mature protein is 28.9. Antigenically active recombinant GP50 has been expressed in a baculovirus expression system. The antigenic activity of both the native and recombinant proteins is dependent upon the correct formation of disulfide bonds. GP50, purified from cysticerci, has two homologs expressed in the adult worm, TSES33 and TSES38. Both are diagnostic for taeniasis. In spite of the amino acid similarities between GP50 and the TSES proteins, each appears to be a stage-specific antigen. A preliminary evaluation of recombinant GP50 in a Western blot assay showed 100% specificity for cysticercosis and 90% sensitivity for cysticercosis positive serum samples reactive with the GP50 component of LLGP.

Amino Acid Sequence↗

Taeniasis, cysticercosis and echinococcosis in Thailand.

Taeniasis is one of the major food-borne parasitic zoonoses in Thailand. During the years 1957-1997, the prevalence was low in most parts of the country. Recent (2000-2005) country prevalence was lower than 1%. A high prevalence (5.9%) was found among 1450 villagers from 30 villages in the North, and among 1233 stool samples from 19 provinces in the Northeast (2.8%). Taenia saginata was the dominant species. Cysticercosis in Thailand is somewhat under-reported/recorded. During the period 1965-2005, diagnosis was based on techniques other than serodiagnosis, giving a total of cysticercosis cases of less than 500. However, an immunoblot technique using delipidized cyst antigen showed 314 positive cases out of 754 samples tested in 2000-2005. Reports of neurocysticercosis appeared more often than cutaneous cysticercosis. A total of 24 cases of echinococcosis, mostly hydatid cysts (only 2 cases of alveolar cysts), were recorded during 1936-2005. These records included 3 cases of foreigners seeking surgery in hospitals in Bangkok. Most Thai patients were migrant workers from the Middle East, and only a few cases were indigenous. The prevalence of cysticercosis and echinococcosis is increasing resulting from sensitive modern diagnostic tests. Taeniasis will persist in Thailand as the consumption of raw/half-cooked meat dishes is still a normal practice for Thai people.

Adolescent↗

Coexistence of salivary gland cysticercosis with squamous cell carcinoma of the mandible.

Cysticercosis is a parasitic infestation caused by the pork tapeworm larval stage, Cysticercus cellulosae. The majority of the cases present in ocular, cerebral, and subcutaneous locations. We report the presence of cysticercosis inside the submandibular gland in association with squamous cell carcinoma of the inferior alveolar ramus of the mandible. To the best of our knowledge, this is the first case report documenting cysticercosis inside a salivary gland. A 65-year-old male presented with complaints of an ulcerative lesion on the inferior alveolar ramus present for 2 months. Histological examination revealed a keratinizing well-differentiated squamous cell carcinoma involving the alveolar margin and mandible. The histopathological examination of the submandibular gland revealed cysticercosis. This case emphasizes the importance of adequate sampling of all the tissues obtained for associated infectious disorders, more so in immunosuppressed patients, which will help the clinician to manage the case appropriately.

Aged↗

Recombinant bacteriophage-based multiepitope vaccine against Taenia solium pig cysticercosis.

The aim of this study was to test the capacity of recombinant phages to deliver antigens for vaccination against porcine cysticercosis. Thus, three peptides (KETc1, KETc12, GK1) and a recombinant antigen KETc7, previously proven to induce high levels of protection against pig cysticercosis, were expressed on the surface of the M13 bacteriophage at multiple copies. The pool of these four recombinant phages induced high levels of protection against an experimental murine cysticercosis. The immunogenicity of the phage vaccine preparation was therefore, tested in pigs, the natural host of Taenia solium. Subcutaneous or oral vaccination with these phages induced antigen-specific cellular immune responses in pigs. Preliminary data also points to the protective capacity of this recombinant phage vaccine against pig cysticercosis. The immunogenicity of these recombinant phages, together with the low cost of their production, make them a realistic candidate to be tested in pigs as an anti-cysticercus phage vaccine for field trials. This is the first report describing the application of a filamentous bacteriophage as a vaccine in large animals such as pigs, the only intermediate hosts of T. solium, a parasite of major medical importance in developing countries. The potential application of phages as a modern platform for vaccines for human and animal diseases is discussed.

Administration, Oral↗