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Cysticercosis


OVERVIEW OF Cysticercosis :

Cysticercosis is a parasitic tissue infection caused by larval cysts of the tapeworm Taenia solium. These larval cysts infect the brain tissue, muscle tissue or other tissues.

A person gets cysticercosis by swallowing eggs found in the feces of a person who has an intestinal tapeworm.  People living in the same household with someone who has a tapeworm have a much higher risk of getting cysticercosis than people who don’t get the exposure.

The features of the clinical syndromes depends upon the site of the occurrence of the cysticercosis in the body.  If the cysticercosis is located outside the nervous system then it is called as  extraneural cysticercosis. The site of the extraneural systicercosis occurs most commonly in subcutaneous tissue such as muscle tissue, heart tissue. If the cysts are in the nervous system, then it is called neurocysticercosis (NCC). In NCC, a cyst can either be located within specific brain tissues (parenchymal neurocysticercosis) or it can be located outside of these specific tissues (extraparenchymal neurocysticercosis). Extraparenchymal forms include cyst development in the fluid filled regions of the brain (intraventricular cysticercosis), in the space surrounding the brain (subarachnoid cysticercosis), in or around the spinal cord (spinal cysticercosis), and in the eye (ophthalmic cysticercosis). Some forms of subarachnoid cysticercosis are termed racemose cysticercosis and are very rare.


EPIDEMIOLOGY :

Cysticercosis can affect anyone at any age but the clinical onset in most patients is between the ages of 10 and 40 years old.

Cysticercosis can affect anyone at any age, but the clinical onset in most patients is between the ages of 10 and 40 years old. Symptoms can appear weeks to years after becoming infected with the eggs of the pork tapeworm (T. solium). Most symptoms appear when the cysts start dying. If the cysts are viable, they can “disguise” themselves from the host’s immune system causing only mild symptoms. Few symptoms can arise directly from the presence of the cyst itself. When cysts die, however, it activates the immune system to react against it, and there is a large inflammatory reaction. This inflammation may cause seizures and headache. Cysts can also block the flow of fluid generated in the brain, resulting in increased pressure, puts pressure on the brain and causes symptoms like headache, nausea, dizziness, altered vision etc.


CAUSES :

Eating contaminated food

Exposure to the faecal  matters

Exposure to blood and other tissues contaminated with the infected products.

Routes of transmission:

It is an infection caused in both human and in pigs. Pigs acts an transmitter in causing the infection. Pigs acquire the infection by the ingestion of segments of the pork tapeworm which is termed as proglottids, infected human faecus, or by the food contaminated by infected human faecus. Following ingestion of the virus, the embryos hatch in the small intestine, passed into the blood stream and travel through the pig’s body to the brain and the muscles and also to the other tissues.

After three to eight weeks the fluid filled cyst with an invaginated scolex called tissue cysticerci develops in the tissue where the embryo travelled.

 

 

When the humans ingests these infected pork, the scolex form of the parasites evaginates and attaches to the small intestine of the humans by it suckers. Segments of the parasite called proglottids begin to grow from the scolex and the result is a growing adult tapeworm. Adult tapeworm can live in the small intestine for many years and grow as much big. The length may vary and it can exceed upto 7 meters. The proglottids produces eggs which are shed in human stools. The egg shedded thorough human faecus can be transmitted to the pig when they consumes these contaminated matters. Additionally, these eggs can be ingested by humans via the fecal-oral route. Humans can ingest the eggs in a multitude of ways.

The humans might get these infection when they tries to get exposure  with human feces containing the eggs, drinking unsafe water contaminated with eggs, lack of handwashing after using the toilet, fertilization of vegetables with human waste. When a human ingests the eggs, the eggs will hatch, and the larvae will enter the bloodstream, and then distribute to one or more sites over a period of three to eight weeks, and then form cysts (cysticerci).

 


COMMON CLINICAL SIGNS AND SYMPTOMS :

The symptoms can appears after the cyst start dying. If the cyst are viable then they might mask the disease and symptoms by deteriorating the immune system of the host.

fever,

 a general feeling of ill health (malaise),

 fatigue,

and loss of appetite.

include joint pain (arthralgia),

 muscle pain (myalgia),

 chills,

 sweats, and

 headaches

prostration

erythema migrans

conjunctivitis

seizure

Neuronal symptoms:

The most common neuronal symptoms include seizures , head ache,mental confusions, nausea and vomiting, fever.

Extaparenchymal neurocysticercosis is more common in adults than I children and carries a high risk of complications.

Other symptoms might include altered metal status, high excessive fluid such as cerebrospinal fluid in the skull which is known as hydrocephalus which might result in the headache, nausea and vomiting. The patient who might develop hydrocephalus often in turn develop swelling of the optic disc called papilledema. Papilloedema might result in blurred vision or double vision.

The subarachnoid cysticercosis and intraventricular cysticercosis include headache, nausea and vomiting, dizziness, altered mental status, altered vision and constellation of involvement of the eyes mainly the ability to move the eyes upwards and downwards called as Parinaud syndrome.

Subarachnoid cysticercosis can cause swelling of a tissue that surrounds the brain such as arachnoiditis which might lead to the neck stiffness intolerance to bright light and headache , stroke and hydrocephalus. In a rare form of subarachnoid cysticercosis called racemose cysticercosis, there is an accumulation of cysts at the base of the brain, which could result in mental deterioration, coma, and life-threatening complications.

Spinal cysticercosis result in shooting, burning,numbness or sense of weakness in the particular area of the body or an abnormal sensation tingling or prickling termed as pins and needles which is called as paresthesia.

Ophthalmic cysticercosis occurs in the eyes.  Symptoms might include visual disturbance, vision loss, inflammation of the eye(uvitis), ), inflammation of the retina (retinitis), limited eye movement, protrusion of the eyeball (proptosis), recurrent eye pain, double vision (diplopia), and symptoms related to the nerve that transmits visual information from the eyes to the brain (optic nerve), such as vision loss in one eye, and/or flashing lights

If the cyst occurs outside the nervous system, such as subcutaneous tissue, muscle tissue or heart tissue then it is called as extraneural cysticercosis. individuals with subcutaneous cysticercosis may have small hard lumps (nodules) that are painless in the arms and chest. These nodules will become swollen and painful right before they begin to disappear. In rare cases, a very large number of cysts can cause enlarged limbs.

 


DIAGNOSTIC :

Imaging tests: CT scan, MRI scan SPECTs and  PET scans help doctors locate the abnormalities in the areas of the brain.

Neurological exam: During a neurological exam, your doctor will look for changes in your balance, coordination, mental status, hearing, vision and reflexes. These changes can point to the part of your brain that may be affected by the infection.

Spinal tap:A doctor uses a small needle to remove fluid from around the spine. A laboratory examines this fluid for any sort of infection.

Ophthalmic examination

 


TREATMENT AND PROGNOSIS :

Antiparasitic drugs yields good results in controlling the infection.

Albendazole was approved by the Food and Drug administration.

Corticosteroid reduces the inflammation and prevents from brain edema.

Antiepileptic drugs are used for seizure treatment .

Surgical excision of the cyst is depends upon the severity.


PROGNOSIS :

Most of the patient is treated with antiparasitic drugs. If this not goes well then surgery should be elicited.


PREVENTION :

Wash the hands with soap and water after touching the contaminated areas and using toilets

wash and peel all the vegetables and fruits before consuming

Always consume foods that are boiled properly


Medicines used in the Treatment :

the FDA approved drug is Albendazole.