Cysticercosis – Definition, Symptoms, Treatment, Diagnosis

What is Cysticercosis?

• Cysticercosis is an infection of the tissues induced by the juvenile form of the pork tapeworm.[6]People can go years with few or no symptoms. In some instances, particularly in Asia, solid masses measuring between one and two centimeters may form beneath the epidermis.
• After a period of months or years, these tumors can become painful and swollen before disappearing. Neurological symptoms can be caused by a specific form of neurocysticercosis that effects the brain. In developing nations, this is one of the most prevalent causes of convulsions.
• Cysticercosis is typically contracted by consuming food or water contaminated with the ova of tapeworms found in human feces. Among dietary sources, egg-contaminated vegetables are a significant contributor.
• The feces of a person infected with adult tapeworms, a condition known as taeniasis, contain tapeworm ova. In the strictest sense, taeniasis is a distinct disease caused by eating cysts in inadequately cooked pork.
• Those who reside with someone infected with the porcine tapeworm are more likely to contract cysticercosis. Aspiration of a cyst can determine the diagnosis.
• Taking images of the brain with computer tomography (CT) or magnetic resonance imaging (MRI) is the most effective method for diagnosing brain diseases.
• The presence of more eosinophils, a type of white blood cell, in the cerebral spinal fluid and blood is also indicative.
• Personal hygiene and sanitation can effectively prevent infection; this includes cooking swine properly, using proper toilets and sanitary practices, and increasing access to clean water.It is essential to treat those with taeniasis to prevent its proliferation.
• When the disease does not affect the nervous system, it may not be necessary to administer treatment.Those diagnosed with neurocysticercosis may be treated with praziquantel or albendazole.These may be required for extended durations.
• Steroids, for anti-inflammatory purposes during treatment, and anticonvulsant drugs may also be necessary.Sometimes, surgery is used to eliminate cysts.
• In Asia, Sub-Saharan Africa, and Latin America, the pig tapeworm is especially prevalent.In some regions, it is estimated that up to 25 percent of the population is afflicted.In the industrialized world, it is extremely rare.
• In 2015, it caused about 400 fatalities worldwide. Cysticercosis also affects swine and cows, but symptoms are uncommon because most animals are slaughtered before symptoms develop. Humans have been affected by the disease throughout history. It is one of the tropical diseases that have been neglected.

Clinical manifestations of Cysticercosis

Cysticercosis is a parasitic infection caused by the larval stage of the tapeworm Taenia solium. The clinical manifestations of cysticercosis depend on the location of the cysticerci (larval stage) within the body.

• Subcutaneous cysticercosis: In subcutaneous cysticercosis, the cysticerci are located in the subcutaneous tissue, or the layer of tissue just beneath the skin. The most common manifestation of subcutaneous cysticercosis is the development of palpable subcutaneous nodules or lumps. These nodules are usually painless, and may or may not be associated with erythema or local inflammation.
• Muscular cysticercosis: In muscular cysticercosis, the cysticerci are located within the muscles. Muscular cysticercosis can present with a variety of symptoms, including myalgia (muscle pain), weakness, and swelling. Patients may also experience muscle stiffness or limited range of motion.
• Neurocysticercosis: Neurocysticercosis is the most common form of cysticercosis and occurs when the cysticerci are located within the brain or spinal cord. Neurocysticercosis can cause a wide range of neurological symptoms, including seizures, headaches, dizziness, confusion, and altered mental status. In severe cases, neurocysticercosis can lead to coma or death.
• Ocular cysticercosis: Ocular cysticercosis occurs when the cysticerci are located within the eye. Ocular cysticercosis can cause visual disturbances, including blurred vision, floaters, and photophobia (sensitivity to light). Patients may also experience pain, redness, and swelling of the affected eye. In some cases, ocular cysticercosis can lead to permanent vision loss.

It’s worth noting that not all patients with cysticercosis will experience symptoms. Asymptomatic cysticercosis is often diagnosed incidentally during routine imaging studies.

Laboratory diagnosis of Cysticercosis

The laboratory diagnosis of cysticercosis involves a combination of clinical evaluation, imaging studies, and serological tests. Here are some common methods used for the laboratory diagnosis of cysticercosis:

1. Imaging studies: Imaging studies such as computed tomography (CT) and magnetic resonance imaging (MRI) can be used to visualize the cysticerci in the affected tissues. Imaging studies can also help identify the stage and location of the cysticerci. There are several imaging methods that can be used for the diagnosis of cysticercosis. The choice of imaging method depends on the location and stage of the cysticerci. Here are some common imaging methods used for the diagnosis of cysticercosis:
   • Computed tomography (CT): CT scans use X-rays and computer technology to create detailed images of the body. CT scans are commonly used to visualize cysticerci located within the brain, muscles, or other soft tissues. CT scans can also be used to detect calcified cysticerci, which are the result of a chronic infection.
   • Magnetic resonance imaging (MRI): MRI scans use magnetic fields and radio waves to create detailed images of the body. MRI scans are highly sensitive for the detection of cysticerci in the brain and spinal cord. MRI scans can also be used to identify cysticerci located within the muscles or other soft tissues.
   • Ultrasonography: Ultrasonography uses high-frequency sound waves to create images of the body. Ultrasonography is commonly used to detect cysticerci located within the eye, subcutaneous tissue, or other superficial tissues.
   • X-rays: X-rays can be used to detect calcified cysticerci, which appear as white, opaque spots on the X-ray image. X-rays are less sensitive than CT or MRI for the detection of cysticerci and are typically used to confirm the presence of calcified cysticerci in cases where other imaging methods are inconclusive.
2. Serological tests: Serological tests are blood tests that can detect antibodies against the cysticercus larvae. The most commonly used serological tests for cysticercosis are enzyme-linked immunosorbent assay (ELISA) and Western blot. These tests are highly specific, but their sensitivity varies depending on the stage and location of the cysticerci. Serological methods are an important component of the laboratory diagnosis of cysticercosis. Serological tests detect antibodies produced by the host in response to the presence of cysticerci. Here are some common serological methods used for the diagnosis of cysticercosis:
   • Enzyme-linked immunosorbent assay (ELISA): ELISA is a serological test that detects antibodies against cysticerci in the blood or cerebrospinal fluid (CSF) of the infected individual. ELISA is a highly specific test, and it can be used to confirm the diagnosis of cysticercosis in conjunction with other diagnostic methods.
   • Western blot: Western blot is a confirmatory test that can be used to confirm the presence of antibodies against cysticerci. Western blot is a highly sensitive and specific test, but it requires specialized equipment and expertise to perform.
   • Immunoblot: Immunoblot is a serological test that uses recombinant antigens to detect antibodies against cysticerci. Immunoblot is a sensitive and specific test, and it can be used as an alternative to Western blot.
   • Indirect hemagglutination assay (IHA): IHA is a serological test that detects antibodies against cysticerci in the blood of the infected individual. IHA is a sensitive and specific test, but it requires specialized equipment and expertise to perform.
   • Immunochromatographic test: Immunochromatographic tests are rapid, point-of-care tests that can detect antibodies against cysticerci in the blood or urine of the infected individual. Immunochromatographic tests are less sensitive than ELISA or Western blot, but they are useful for screening large populations in resource-limited settings.
3. Biopsy: In some cases, a tissue biopsy may be necessary to confirm the presence of cysticerci. Biopsy is typically reserved for cases where imaging studies and serological tests are inconclusive or cannot be performed.

It’s worth noting that the laboratory diagnosis of cysticercosis can be challenging, and a combination of different diagnostic methods may be necessary to establish a definitive diagnosis. In addition, clinical evaluation and travel history are important factors to consider when making a diagnosis of cysticercosis.

Treatments of Cysticercosis

The treatment of cysticercosis depends on the location and stage of the cysticerci, as well as the severity of the symptoms. Here are some common treatments for cysticercosis:

1. Antiparasitic medications: Antiparasitic medications such as albendazole and praziquantel are the mainstay of treatment for cysticercosis. These medications kill the cysticerci and prevent them from causing further damage. Antiparasitic medications are most effective for the treatment of neurocysticercosis and are often given in combination with corticosteroids to reduce inflammation and prevent seizures.
2. Surgery: Surgery may be necessary in cases where the cysticerci are located in a critical area such as the brain, eyes, or heart. Surgery may also be necessary to remove large or calcified cysticerci that are causing symptoms.
3. Symptomatic treatment: Symptomatic treatment may be necessary to manage the symptoms of cysticercosis. For example, pain relievers may be prescribed for headaches, anti-seizure medications may be prescribed for seizures, and steroids may be prescribed to reduce inflammation.
4. Prevention: Prevention is an important aspect of the management of cysticercosis. Prevention measures include proper hygiene, proper disposal of human and animal waste, and avoiding the consumption of raw or undercooked pork.

Prophylaxis of Cysticercosis

Prevention is an important aspect of the management of cysticercosis. Here are some common measures for the prophylaxis of cysticercosis:

• Proper sanitation: Proper sanitation is key to preventing the spread of cysticercosis. Proper hygiene practices should be followed, including washing hands with soap and water before eating and after using the bathroom.
• Proper disposal of human and animal waste: Proper disposal of human and animal waste can help prevent the transmission of cysticercosis. Human waste should be disposed of in a sanitary manner, and animal waste should be disposed of in a way that prevents it from being consumed by pigs or other animals.
• Avoiding consumption of raw or undercooked pork: Consumption of raw or undercooked pork is the primary mode of transmission of cysticercosis. Therefore, it is important to avoid eating pork that has not been properly cooked.
• Vaccination of pigs: Vaccination of pigs against cysticercosis can help reduce the transmission of the disease. Several effective vaccines are available, and vaccination programs are recommended in areas where cysticercosis is endemic.
• Education and awareness: Education and awareness campaigns can help prevent the spread of cysticercosis by increasing knowledge about the disease and its transmission. Community-based interventions, including health education and behavior change communication, can be effective in preventing the transmission of cysticercosis.

FAQ

References

• https://www.aafp.org/pubs/afp/issues/2007/0701/p91.html
• https://rarediseases.org/rare-diseases/cysticercosis/
• https://www.cdc.gov/parasites/cysticercosis/disease.html