Cysticercosis in ophthalmology

Ultrasound B-Scan for Posterior Segment and Extraocular Evaluation in Ocular Cysticercosis

Purpose

Cysticercosis, caused by Taenia solium larvae, can affect various ocular and extraocular structures, leading to significant morbidity. Ultrasound B-scan imaging plays a pivotal role in diagnosing and classifying cysticercosis lesions. The aim of the study was to describe the ultrasound B-scan characteristics of ocular and extraocular cysticercosis, proposing a classification system based on anatomical localization to enhance understanding and management.

Patients and Methods

A retrospective study of consecutive cases with intraocular or extraocular cysticercosis was conducted from January 1993 to December 2023 in Mumbai, India. B-scan ultrasound was performed by an experienced imaging specialist. Descriptive statistics were used to summarize demographic characteristics and the proportion of cysticercosis in each anatomical location. Cysticercosis lesions were classified based on anatomical location observed during imaging.

Results

Amongst the 56 eyes evaluated, intraocular posterior segment involvement (n=25) and extraocular involvement (n=31) were observed. Extraocular cysticercosis predominantly affected the medial rectus muscle (40%), followed by the inferior rectus (28%), lateral rectus (20%), and superior rectus muscles (12%). Orbital cysts were localized in the posterior extraconal (50%), anterior extraconal (34.33%), and intraconal (16.67%) regions. Intra-vitreous cysticercosis (n=9) exhibited thin-walled cysts with minimal inflammation, progressing to thickened cyst walls in the late stages. Sub-hyaloid cysticercosis (n=8) showed initial thin vitreous detachment, progressing to thickened vitreous adhesions. Sub-retinal cysticercosis (n=9) without retinal detachment indicated early disease, while cases with detachment suggested disease progression.

Conclusion

The proposed anatomical classification system based on B-scan ultrasound features provides a structured approach to categorizing cysticercosis lesions, enhancing understanding and management in ophthalmic practice.

An Unusual Presentation of Periorbital Cysticercosis Mimicking a Dermoid Cyst

Introduction

Cysticercosis is a parasitic infestation caused by Taenia solium, which is a pork tape worm. Humans are the definitive host, and pigs are the intermediate host. It is more prevalent in low socioeconomic regions with poor hygiene and among populations where undercooked pork is consumed.

Case Presentation

We hereby report an uncommon site of cyst lodgment and duration of presentation in a 24-year-old male who presented with a firm, non-tender mass over the superomedial aspect of the right orbital rim, superior to the medial canthal tendon for the last 9 years. Chronic presentation and location of the mass led to the tentative diagnosis of a dermoid cyst. Hence, a CECT orbit was advised to assess the extent and attachment of the mass. Unexpectedly, a cystic lesion with hyperdense nidus, suggestive of cysticercosis, was identified. Histopathology of the excised mass confirmed the diagnosis of cysticercosis.

Conclusion

Our case emphasizes the importance of an uncommon site and chronic presentation in cases of cysticercosis.

Development and evaluation of an immunochromatography-based point-of-care test kit for a rapid diagnosis of human cysticercosis

Human cysticercosis is a life-threatening zoonotic disease caused by infection with larvae (cysticerci) of the pork tapeworm, Taenia solium. This can affect the nervous system causing chronic headache and intracranial hypertension, potentially leading to epileptic seizures and paralysis. The disease is found in developing countries, especially in Southeast and South Asia, Sub-Saharan Africa, and Central and South America where porcine cysticercosis is endemic and people have a habit of eating undercooked pork. An immunochromatography-based test (ICT) kit, using T. solium cyst fluid as antigen, was manufactured to detect anti-T. solium IgG antibodies in human serum. To evaluate the kit, we used 187 serum samples including 24 from proven/confirmed cysticercosis cases, 133 from cases with other parasitosis and 30 healthy controls. Diagnostic efficiencies were calculated. The sensitivity, specificity, and accuracy were 83.3%, 92.0%, and 90.9%, respectively. Moreover, the ICT was positive before treatment but became negative after treatment, implying that this kit is also useful for follow-up monitoring post-treatment. In conclusion, we have successfully developed and present preliminary evaluation of an easy-to-handle rapid diagnostic tool for human cysticercosis in the form of an ICT platform using as antigen fluid from T. solium cysticerci.

Taenia solium taeniasis and Cysticercosis Prevalence and Control Practice in China

Taenia solium taeniasis/cysticercosis is an important global food-borne zoonosis transmitted between humans and pigs. In China, the prevalence of Theridion solium taeniasis/cysticercosis has been marked decline in recent decades based on the data revealed by both national surveys and field prevalence investigations. Health education and promotion, meat inspection, and chemotherapy are unquestionably the main control measures for diseases. It is worth noting that a variety of socio-ecological variables have been identified in the process of controlling T. solium taeniasis/cysticercosis. It has become difficult for pigs to come into direct or indirect contact with or consume human excreta as pig farming practices have been shifted from traditional backyard farms to large-scale commercial pig raising systems that are still in progress. The human toilet revolution in rural areas of China has ensured hygienic separation of human excreta from contact, and thereby preventing human excreta from polluting the soil, feeds, and water. These two important fundamental preventive measures are crucial to establishing an environmental restriction between humans and pigs cannot be overlooked for interrupting or limiting T. solium transmission. In this chapter, we reviewed the epidemiology, traditional measures, and ecological determinants that significantly contributed to the dramatic decline of taeniasis/cysticercosis in China.

Neurocysticercosis: an update on diagnosis, treatment, and prevention

Neurocysticercosis (NCC) is an important cause of neurological disease worldwide, including imported cases in nonendemic countries.

PURPOSE OF REVIEW

The purpose of this review is to update information on diagnosis, management, and prevention of neurocysticercosis.

RECENT FINDINGS

WHO and Infectious Diseases Society of America/American Society of Tropical Medicine and Hygiene guidelines emphasize the importance of corticosteroids and antiparasitic drugs for viable parenchymal disease and single enhancing lesions. Subarachnoid NCC is associated with a high fatality rate unless optimally treated. Advances in subarachnoid NCC include use of prolonged antiparasitic and anti-inflammatory courses and the increasing use of antigen-detection and quantitative PCR assays in diagnosis and follow-up. Emerging data support the safety and efficacy of minimally invasive surgery in ventricular cases. Calcified neurocysticercosis continues to be associated with a high burden of disease. Field studies are demonstrating the feasibility of eradication using a combination of mass chemotherapy for human tapeworms and vaccination/treatment of porcine cysticercosis.

SUMMARY

NCC remains an important and challenging cause of neurological disease with significant morbidity despite advances in treatment and prevention.