Cysticercosis of the Human Nervous System
By Oscar H. Del Brutto, Héctor H. GarcÃa
Cysticercosis of the Human Nervous System PDF. Neurocysticercosis (neural infection by larvae of Taenia solium) occurs when humans become intermediate hosts of the tapeworm Taenia solium after ingesting its eggs. The disease is now the most common helminthic infection of the nervous system in humans, and its prevalence has risen significantly even in countries where it was formerly considered exotic. The introduction of modern neuroimaging and serologic techniques has improved the diagnosis of neurocysticercosis; furthermore, the development of potent cysticidal drugs has changed the prognosis of most affected patients. Nevertheless, much remains to be learned about this parasitic disease. This book provides a comprehensive and up-to-date review of the various aspects of cysticercosis of the nervous system that will be of interest to all who are involved in the care of patients with this disease. Epidemiology, neuropathology, immunopathogenesis, clinical manifestations, diagnosis, and management are all thoroughly discussed based on current evidence and practice.
1 History of Taeniasis and Cysticercosis . . . . . . . . . . . . . . . . . . . . . . . . . 1
1.1 Ancient Knowledge. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 2
1.2 Unraveling Taenia solium . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 2
1.3 First Descriptions of Human Cysticercosis. . . . . . . . . . . . . . . . . . . 3
1.4 Taeniasis and Cysticercosis Were Caused
by the Same Parasite . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 4
1.5 Pioneer Clinical Descriptions . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 4
1.6 Lessons from History . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 6
1.6.1 The British Endemia . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 6
1.6.2 The Epidemic of Burns in West New Guinea . . . . . . . . . . . 7
1.7 Modern Times: Advances in Diagnosis and Treatment . . . . . . . . . 8
References . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 8
2 Taenia solium: Biological Characteristics and Life Cycle . . . . . . . . . 11
2.1 Developmental Stages of Taenia solium . . . . . . . . . . . . . . . . . . . . . 11
2.2 Life Cycle of Taenia solium . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 15
References . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 19
3 Neuropathology of Cysticercosis. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 23
3.1 Microscopic Identifi cation of the Parasite. . . . . . . . . . . . . . . . . . . . 23
3.2 Macroscopic Appearance of Cysticerci . . . . . . . . . . . . . . . . . . . . . 25
3.3 Stages of Involution of Cerebral Cysticerci . . . . . . . . . . . . . . . . . . 29
3.4 Tissue Reactions Around Cysticerci . . . . . . . . . . . . . . . . . . . . . . . . 31
References . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 35
4 Epidemiology of Human Cysticercosis in Endemic Regions . . . . . . . 39
4.1 Data on Asymptomatic Individuals/General Population. . . . . . . . . 41
4.1.1 Rates of Infection . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 41
4.2 Data on Symptomatic Patients/Clinical Series . . . . . . . . . . . . . . . . 44
4.2.1 Antibodies, Antigen, and Imaging in Clinical Series . . . . . 44
4.2.2 Rates of Disease . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 45
4.2.3 Factors Associated to Infection and Disease. . . . . . . . . . . . 45
4.2.4 Geographical Variations in the Pattern
of Clinical Expression of Cysticercosis . . . . . . . . . . . . . . . 46
References . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 46
5 Epidemiology of Human Cysticercosis in Non-endemic Regions
and in the Traveler . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 51
5.1 The United States . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 53
5.2 Canada. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 54
5.3 Western European Countries. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 54
5.4 Countries of the Arab World . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 56
5.5 Australia and New Zealand. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 57
5.6 International Travelers . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 57
References . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 58
6 Immunopathology of Taeniasis and Cysticercosis . . . . . . . . . . . . . . . 63
6.1 Immunopathology of Human Cysticercosis . . . . . . . . . . . . . . . . . . 63
6.1.1 Single Enhancing Lesion. . . . . . . . . . . . . . . . . . . . . . . . . . . 64
6.1.2 Immune Response and Symptomatic Disease. . . . . . . . . . . 64
6.1.3 Diagnostic Antigens and Immunodiagnosis . . . . . . . . . . . . 66
6.1.4 Immunity to Cysticercosis and Comorbidity . . . . . . . . . . . 66
6.1.5 NCC in Immunosuppressed Patients. . . . . . . . . . . . . . . . . . 66
6.2 Immunopathology of Taenia solium Taeniasis . . . . . . . . . . . . . . . . 66
6.2.1 Tapeworm Prevalence and Life Span . . . . . . . . . . . . . . . . . 66
6.2.2 Tapeworm Infection . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 67
6.3 Immunopathology of Porcine Cysticercosis . . . . . . . . . . . . . . . . . . 67
References . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 68
7 Clinical Manifestations of Neurocysticercosis. . . . . . . . . . . . . . . . . . . 73
7.1 Parenchymal Neurocysticercosis. . . . . . . . . . . . . . . . . . . . . . . . . . . 74
7.1.1 Seizures . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 74
7.1.2 Focal Neurological Defi cits. . . . . . . . . . . . . . . . . . . . . . . . . 75
7.1.3 Increased Intracranial Pressure . . . . . . . . . . . . . . . . . . . . . . 75
7.1.4 Cognitive Decline and Psychiatric Disturbances . . . . . . . . 76
7.1.5 Headache. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 76
7.2 Subarachnoid Neurocysticercosis . . . . . . . . . . . . . . . . . . . . . . . . . . 77
7.2.1 Increased Intracranial Pressure . . . . . . . . . . . . . . . . . . . . . . 77
7.2.2 Cranial Nerve Involvement . . . . . . . . . . . . . . . . . . . . . . . . . 77
7.2.3 Acute Meningitis. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 78
7.2.4 Stroke Syndromes . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 78
7.3 Ventricular Neurocysticercosis . . . . . . . . . . . . . . . . . . . . . . . . . . . . 79
7.4 Spinal Neurocysticercosis . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 80
7.5 Other Locations of Intracranial Cysticerci . . . . . . . . . . . . . . . . . . . 80
7.5.1 Intrasellar Neurocysticercosis . . . . . . . . . . . . . . . . . . . . . . . 80
7.5.2 Subdural Neurocysticercosis. . . . . . . . . . . . . . . . . . . . . . . . 81
7.5.3 Ocular and Orbital Cysticercosis . . . . . . . . . . . . . . . . . . . . 81
7.6 Systemic Cysticercosis . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 81
References . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 82
8 Diagnosis of Taeniasis and Cysticercosis . . . . . . . . . . . . . . . . . . . . . . . 87
8.1 Diagnosis of Taeniasis. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 87
8.1.1 Microscopy . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 87
8.1.2 Stool Antigen Detection . . . . . . . . . . . . . . . . . . . . . . . . . . . 88
8.1.3 DNA-Based Assays. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 88
8.2 Imaging Diagnosis of Neurocysticercosis. . . . . . . . . . . . . . . . . . . . 88
8.2.1 Old Imaging Diagnostic Methods . . . . . . . . . . . . . . . . . . . . 89
8.2.2 Computed Tomography (CT) and Magnetic
Resonance Imaging (MRI) . . . . . . . . . . . . . . . . . . . . . . . . . 90
8.3 Immunological Diagnosis of Neurocysticercosis . . . . . . . . . . . . . . 97
8.3.1 Antibody Detection . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 98
8.3.2 Antigen Detection . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 99
8.3.3 Other Immune Diagnostic Tests . . . . . . . . . . . . . . . . . . . . . 99
8.3.4 Antigen Versus Antibody Testing . . . . . . . . . . . . . . . . . . . . 100
8.3.5 Interpretation of a Positive Immune Diagnostic Test . . . . . 100
8.4 Other Diagnostic Tests for Human Cysticercosis . . . . . . . . . . . . . . 101
8.5 Diagnostic Criteria for Neurocysticercosis . . . . . . . . . . . . . . . . . . . 102
References . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 103
9 Management of Neurocysticercosis . . . . . . . . . . . . . . . . . . . . . . . . . . . 109
9.1 Symptomatic Management . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 110
9.2 Surgical Management . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 112
9.3 Specifi c (Etiological) Management. . . . . . . . . . . . . . . . . . . . . . . . . 113
9.3.1 Cysticidal Drugs . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 113
9.3.2 Trials of Cysticidal Drugs . . . . . . . . . . . . . . . . . . . . . . . . . . 114
9.3.3 Meta-Analysis Data on Cysticidal Drug
Therapy for Neurocysticercosis . . . . . . . . . . . . . . . . . . . . . 117
9.3.4 Concomitant Medication During Antiparasitic Treatment . 118
9.3.5 Treatment of Asymptomatic Neurocysticercosis . . . . . . . . 119
9.3.6 Further Directions of Cysticidal Treatment . . . . . . . . . . . . 119
References . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 119
10 Control and Perspectives for Elimination of Taenia solium
Taeniasis/Cysticercosis. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 125
10.1 Principles of Control . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 126
10.1.1 Treatment of Taeniasis . . . . . . . . . . . . . . . . . . . . . . . . . . . . 126
10.1.2 Treatment of Infected Pigs . . . . . . . . . . . . . . . . . . . . . . . . . 127
10.1.3 Pig Vaccination . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 128
10.1.4 Other Potential Points of Intervention. . . . . . . . . . . . . . . . . 128
10.2 Current Status of Taenia solium Control. . . . . . . . . . . . . . . . . . . . . 131
10.3 Monitoring of Interventions . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 131
10.4 Control Versus Elimination . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 132
10.5 Foreseeable Future . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 132
References . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 132
Index . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 137
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