Taenia solium cysticercosis

Musculoskeletal involvement in neglected tropical diseases: a comprehensive review

Neglected tropical diseases (NTDs) encompass a group of diseases predominantly found in tropical regions, with origins dating back to their inclusion in the United Nations Millennium Development Goals in 2000. This initiative aimed to raise awareness and global funding to combat these diseases, which thrive in areas with limited sanitation, healthcare, and education. NTDs are caused by various pathogens such as bacteria, fungi, parasites, and viruses and affect over two billion individuals in resource-poor communities, leading to preventable deaths and devastating consequences. While the musculoskeletal system is only occasionally affected, the resulting chronic disabilities prevent individuals from working, posing a significant socioeconomic burden in this region of the world. Some NTDs exhibit distinct imaging features, and radiologists need to be aware of these characteristics to facilitate early treatment. In this review, we delve into musculoskeletal NTDs, focusing on clinical features and imaging findings, differential diagnosis, and clinical management.

Epidemiology of swine cysticercosis in two rural communities of Zacapa, Guatemala

Taeniasis/cysticercosis complex caused by Taenia solium, is a serious public health problem and causes major economic losses to swine producers in developing countries in Asia, Africa and the Americas. Despite scarce epidemiological data, Guatemala is considered endemic for T. solium. A cross-sectional study was conducted in Azacualpa and Malpais, two villages in the department of Zacapa, to assess the prevalence of swine cysticercosis and associated factors. Between March and October 2019, 149 pigs were examined by tongue palpation and serum samples were then collected to detect antibodies by ab-ELISA, and necropsy was performed on pigs that were positive by tongue palpation and/or ab-ELISA, to assess parasite load. Pig owners were asked to fill out a questionnaire on factors related to pig husbandry and occurrence of swine cysticercosis. Pearson's chi-square test and multivariate analysis were used to measure the association between serological results and other variables (p < 0.05 was considered significant). The seroprevalence of swine cysticercosis was 13.4% (13/97, 95% C.I. 6.6%-20.2%) and 25% (13/52, 95% C.I. 13.2%-36.8%) in Azacualpa and Malpais, respectively, yielding an overall seroprevalence of 17.4% (26/149, 95% C.I. 11.4%-23.5%). Parasite loads ranged from 1 to over 23,000 metacestodes per carcass. No bivariate association was found between exposure variables and seropositivity. A positive diagnosis by tongue palpation increased the odds of finding pigs seropositive for cysticercosis by a factor of 16.1 in the multivariate analysis. Despite the high prevalence and parasite load of T. solium, risk factors associated with cysticercosis were not significant in this study.

Racemose neurocysticercosis: a case series

Neurocysticercosis (NCC) is a common parasitic condition of the central nervous system in certain parts of the world. The racemose variety of NCC is distinct from the commonly seen parenchymal form. It frequently infiltrates the basal cisterns and Sylvian fissures. Imaging plays a vital role in the diagnosis; however, as their signal intensity is similar to cerebrospinal fluid and due to the absence of enhancement in most cases, imaging diagnosis is often difficult on the conventional MRI sequences. Here, we present five cases of racemose NCC to emphasize the importance of a heavily T2-weighted sequence (Fast Imaging Employing Steady-state Acquisition) sequence in the diagnosing this entity.

Disseminated cysticercosis with tongue involvement: a rare case report from Nepal

Introduction and importance

Cysticercosis is a condition in which humans are infected by the larval form of the pork tapeworm Tenia solium. Cysticercosis in humans is common in the cerebral tissue but rare in the tongue.

Case presentation

Here, the authors report a rare case of a 38-year-old male with neurocysticercosis and cysticercosis of the tongue. The patient presented with a complaint of loss of consciousness for 4-5 min. Local examination of his oral cavity revealed a swelling of ~2×2 cm on the tongue. An MRI of the brain showed various stages of neurocysticercosis involving the neuroparenchyma and tongue. For this, he was started on low-dose prednisolone of 50 mg tapered over 6 weeks and levetiracetam of 500 mg BD continued for his seizure episodes. He is responding well with the medications and is planned to start antiparasitic agent only after the perilesional edema decreases.

Clinical discussion

Cysticercosis may involve the central nervous system, muscle, heart, lungs, peritoneum, eye, and subcutaneous tissue. Oral cavity and perioral involvement by cysticercous larva is rare in humans. Radiologic imaging, serology, and tissue biopsy can be used to confirm a diagnosis of cysticercosis. The most common locations for oral cysticercosis are the tongue, buccal mucosa, lower lip, and upper lip.Only 102 cases of oral cysticercosis have been reported based on a PubMed English-language literature search.

Conclusion

Oral cysticercosis is a rare event, and it represents a difficulty in clinical diagnosis. But a patient with a mass in the tongue should be considered as a possible case of cysticercosis especially in endemic regions like Nepal.

Preformulation and Long-Term Stability Studies of an Optimized Palatable Praziquantel Ethanol-Free Solution for Pediatric Delivery

To date, the treatment for cysticercosis and neurocysticercosis consists of a single oral intake of praziquantel (5-10 mg/kg), which since it is only available as tablets, hinders its administration to pediatric patients. Praziquantel is a poorly water-soluble drug which represents a challenge for its formulation in solution, particularly for the pediatric population. Thus, this study aimed to develop a palatable solution for praziquantel using pharmaceutical-accepted co-solvent systems. A design of experiments approach was applied to identify the optimal conditions for achieving a suitable amount of praziquantel in solution using co-solvent mixtures. Thus, praziquantel solubility increased from 0.38 up to 43.50 mg/mL in the optimized system. A taste masking assay in healthy human volunteers confirmed a successful reduction of drug bitterness after the addition of selected flavors and a sweetener. Stability studies were also conducted at different temperatures (4, 25, and 40 °C) for 12 months Even though the presence of the three known impurities of praziquantel was observed, their amounts never exceeded the acceptance criteria of the USP. Thus, this novel approach should be considered a valuable alternative for further preclinical studies considering the high prevalence of this infection worldwide.

Revisiting extracranial cysticercosis: A rare case series of mycoparasitism affecting the cervicofacial region from an endemic zone

A systemic parasitic infestation caused by the larval stages of the pork tapeworm, Taenia solium is known as Cysticercosis. While encysted form of the larval stage is attributed to rare variant of Cysticercosis of soft tissues. Muscle infestation by this parasite can lead to vague clinical presentation. We are presenting a series of 4 rare cases of extracranial, cervicofacial cysticercosis their clinical attributes and imaging characteristics leading to diagnosis of cysticercosis and approach to successful outcome with pharmacotherapy alone that spared the need of surgical management.

Optical Coherence Tomography Features of Ocular Cysticercosis: A Review of Literature With Observer Variation

Ocular cysticercosis is a sparsely reported condition, requiring urgent management. The gold standard for diagnosis is an in toto extraction of the cyst with subsequent histopathology. The procedure can be demanding in contrast to the frequently adopted practice of in vivo cyst lysis. The latter, however, obviates a conventional biopsy. We reviewed published optical coherence tomography (OCT) images of ocular cysticercosis for their suitability to surrogate a conventional biopsy and identified commonly reported features. We also used triple masking and ascertained the observer agreement on identification of these features. We found that the features of the parasite are much more clearly discernible as compared with features of the involved ocular tissue itself. The hyperreflective cyst wall and scolex and the hyporeflective cyst cavity had the highest frequency and observer agreement among all the analyzed features, suggesting their use for diagnosis. We could match many of the OCT features with the previously reported histopathological findings, supporting the role of OCT as a diagnostic adjunct and a substitute for conventional biopsy. Conversely, features of the ocular tissue could be judged poorly with low observer agreement, suggesting poor prognostic ability of OCT. [Ophthalmic Surg Lasers Imaging Retina 2022;53:446-454.].

Development of a dose-response model for porcine cysticercosis

Taenia solium is an important cause of acquired epilepsy worldwide and remains endemic in Asia, Africa, and Latin America. Transmission of this parasite is still poorly understood despite the design of infection experiments to improve our knowledge of the disease, with estimates for critical epidemiological parameters, such as the probability of human-to-pig infection after exposure to eggs, still lacking. In this paper, a systematic review was carried out and eight pig infection experiments were analyzed to describe the probability of developing cysts. These experiments included different pathways of inoculation: with ingestion of proglottids, eggs, and beetles that ingested eggs, and direct injection of activated oncospheres into the carotid artery. In these experiments, different infective doses were used, and the numbers of viable and degenerated cysts in the body and brain of each pig were registered. Five alternative dose-response models (exponential, logistic, log-logistic, and exact and approximate beta-Poisson) were assessed for their accuracy in describing the observed probabilities of cyst development as a function of the inoculation dose. Dose-response models were developed separately for the presence of three types of cysts (any, viable only, and cysts in the brain) and considered for each of the four inoculation methods ("Proglottids", "Eggs", "Beetles" and "Carotid"). The exact beta-Poisson model best fit the data for the three types of cysts and all relevant exposure pathways. However, observations for some exposure pathways were too scarce to reliably define a dose-response curve with any model. A wide enough range of doses and sufficient sample sizes was only found for the "Eggs" pathway and a merged "Oral" pathway combining the "Proglottids", "Eggs" and "Beetles" pathways. Estimated parameter values from this model suggest that a low infective dose is sufficient to result in a 50% probability for the development of any cyst or for viable cyst infections. Although this is a preliminary model reliant on a limited dataset, the parameters described in this manuscript should contribute to the design of future experimental infections related to T. solium transmission, as well as the parameterization of simulation models of transmission aimed at informing control.

Diagnostic tools for the detection of taeniid eggs in different environmental matrices: A systematic review

The cestode family Taeniidae consists of the genera Echinococcus and Taenia, both of which include zoonotic tapeworms of serious public health importance. Various environmental matrices have been identified from which parasite transmission to animals and humans can occur, and many techniques for detecting taeniid eggs in different environments have been developed. However, the majority lack appropriate validation, and standardized egg isolation procedures are absent. This hampers interstudy comparisons and poses a challenge for future researchers when deciding which technique to implement for assessing taeniid egg contamination in a particular matrix. Therefore, the aim of this systematic review was to present an overview of the detection methods for taeniid eggs in the environment, to discuss and compare them, and to provide recommendations for future studies. In total, 1814 publications were retrieved from scientific databases, and, ultimately, data were systematically reviewed from 90 papers. The results provide an overview of numerous diagnostic tests for taeniid egg detection in (or on) water, food, soil, insects, objects, and air. These tools could be categorized as either conventional (light microscopy), molecular, or immunodetection tools. The relatively cheap microscopy techniques often lack sensitivity and are unable to identify a taeniid egg at the genus level. Nevertheless, several records ascribed a genus, or even species, to taeniid eggs that had been detected by light microscopy. Molecular and immunodetection tools offer better specificity, but still rely on the preceding egg recovery steps that also affect overall sensitivity. Finally, the majority of the methods lacked any attempt at performance evaluation and standardization, especially at the earlier stages of the analysis (e.g., sampling strategy, storage conditions, egg recovery), and viability was rarely addressed. As such, our review highlights the need for standardized, validated detection tools, that not only assess the extent of environmental contamination, but also the egg genus or species, and address viability.

•

The cestode family Taeniidae contains species of serious public health importance.

•

Parasite transmission may occur from several environmental matrices.

•

Many methods for environmental detection of taeniid eggs have been developed.

•

These often lack standardization, performance evaluation, and viability assessment.

Spatial distribution and risk factors for human cysticercosis in Colombia

Background

Cysticercosis is a zoonotic neglected tropical disease (NTD) that affects humans and pigs following the ingestion of Taenia solium eggs. Human cysticercosis poses a substantial public health burden in endemic countries. The World Health Organization (WHO) aims to target high-endemicity settings with enhanced interventions in 17 countries by 2030. Between 2008 and 2010, Colombia undertook a national baseline serosurvey of unprecedented scale, which led to an estimated seroprevalence of T. solium cysticercus antibodies among the general population of 8.6%. Here, we use contemporary geostatistical approaches to analyse this unique dataset with the aim of understanding the spatial distribution and risk factors associated with human cysticercosis in Colombia to inform how best to target intervention strategies.

Methods

We used a geostatistical model to estimate individual and household risk factors associated with seropositivity to T. solium cysticercus antibodies from 29,253 people from 133 municipalities in Colombia. We used both independent and spatially structured random effects at neighbourhood/village and municipality levels to account for potential clustering of exposure to T. solium. We present estimates of the distribution and residual correlation of seropositivity at the municipality level.

Results

High seroprevalence was identified in municipalities located in the north and south of Colombia, with spatial correlation in seropositivity estimated up to approximately 140 km. Statistically significant risk factors associated with seropositivity to T. solium cysticercus were related to age, sex, educational level, socioeconomic status, use of rainwater, consumption of partially cooked/raw pork meat and possession of dogs.

Conclusions

In Colombia, the distribution of human cysticercosis is influenced by socioeconomic considerations, education and environmental factors related to the spread of T. solium eggs. This information can be used to tailor national intervention strategies, such as targeting spatial hotspots and more highly exposed groups, including displaced people and women. Large-scale seroprevalence surveys accompanied by geospatial mapping are an essential step towards reaching the WHO’s 2021‒2030 NTD roadmap targets.

Graphical Abstract

Supplementary Information

The online version contains supplementary material available at 10.1186/s13071-021-05092-8.

The Role of Serial Imaging in Neurocysticercosis for Disease Resolution

Neurocysticercosis (NCC), the most common parasitic infection of the CNS in humans, is a frequent cause of seizure disorders and epilepsy. The cystic larvae Taenia solium is endemic to developing countries where the population raises pigs as a reliable source of food, however, massive immigration has now forced the surge of the disease in developed areas making it a worldwide problem. Clinical presentation is affected by the size, number, and location of the lesions within the brain, with the most common manifestations being seizures, headaches, and increased intracranial pressure. The appearance of NCC on radiological imaging helps determine the stage of the disease, required for appropriate antiparasitic treatment. In this article, we detail the case of a patient who presented for recurrent seizures after reportedly undergoing treatment for NCC years prior.

Amplification of cestode DNA from the peri-anal region of naturally infected foxes by PCR and LAMP: proof of concept for a potential sampling strategy for diagnosing human taeniosis

The diagnosis of human taeniosis can be achieved through coproscopy, ELISA or PCR. An important limitation of these methods is the high turnaround time for stool sample collection and preparation, indicating the need for a straightforward sampling strategy. Due to the high metabolic activity and reproductive potential of Taenia spp., we hypothesise that parasite DNA (cells and eggs) present in the peri-anal region of the host can be exploited as a target for molecular diagnosis. We evaluated the feasibility of recovering parasite DNA from the peri-anal area of foxes naturally infected with Taenia spp. Before necropsy, cotton swabs were rubbed at the peri-anal region of foxes. DNA was extracted using alkaline lysis coupled with a commercial DNA isolation kit (method A) or alkaline lysis alone (method B). DNA was used in the multiplex-PCR assay (previously described and called here swab-PCR) and a novel LAMP assay detecting Taenia spp. commonly found in foxes (swab-LAMP). The results of these assays from 105 foxes were compared with the presence of intestinal helminths determined at necropsy and by the sedimentation and counting technique (SCT). The sensitivity of swab-PCR for detecting Taenia (n = 68) was 89.8% (95% CI, 77.7–96.6) and 89.5% (66.9–98.7) using methods A and B, respectively. The sensitivity of the swab-LAMP assay was 83.7% (70.3–92.7) using method A and 89.5% (66.9–98.7) with method B. We postulate that peri-anal swab sampling followed by simplified DNA extraction and LAMP might be a suitable strategy for surveillance of human taeniosis in resource-limited settings in the future.

Alterations in Taenia crassiceps cysticerci cytoskeleton induced by nitazoxanide and flubendazole

Cysticercosis is the presence of Taenia solium larval stage in tissues such as central nervous system, skin, muscles and eye globe. The current treatment is based on albendazole and praziquantel which already present resistance reports. Therefore, the search for alternative treatments is paramount. The aim of this study was to determine the effect of flubendazole and nitazoxanide on cytoskeleton proteins from Taenia crassiceps cysticerci, an experimental model for cysticercosis. Cysticerci were cultured in RPMI supplemented medium containing nitazoxanide and/or flubendazole. 24 h after the exposure the cysticerci were processed for scanning and transmission electron microscopy and for protein analysis of the cytoskeleton. The proteins were detected through 1D electrophoresis and identified through Western Blot. Nitazoxanide exposure increased tubulin and actin quantifications in T. crassiceps cysticerci. While flubendazole alone and the drugs combinations induced an increase in α-tubulin and actin and decreased β-tubulin quantifications in the parasite. Morphological changes such as swelling and rupture of vesicle, stiff membrane, decrease in movements were observed when the cysticerci were incubated with the different compounds. In conclusion the drugs induced significative impact in the parasite`s cytoskeleton and may be considered as alternative treatments for cysticercosis.

Evidence for Transmission of Taenia solium Taeniasis/Cysticercosis in a Rural Area of Northern Rwanda

Cysticercosis is a parasitic infection caused by the metacestode larval stage (cysticercus) of Taenia solium. In humans, cysticercosis may infect the central nervous system and cause neurocysticercosis, which is responsible for over 50,000 deaths per year worldwide and is the major cause of preventable epilepsy cases, especially in low-income countries. Cysticercosis infection is endemic in many less developed countries where poor hygiene conditions and free-range pig management favor their transmission. A cross-sectional study was conducted in 680 children from a rural primary school in Gakenke district (Northern province of Rwanda). Stool samples were collected from participants and analyzed using the Kato-Katz method (KK), formol-ether concentration (FEC), and/or copro-antigen enzyme-linked immunosorbent assay (CoAg-ELISA) to detect taeniasis. Blood samples were collected and analyzed using enzyme-linked immunoelectrotransfer blot (EITB) and antigen enzyme-linked immunosorbent assay (Ag-ELISA) to detect human cysticercosis. The overall proportion of taeniasis positivity was 0.3% (2/680), and both cases were also confirmed by CoAg-ELISA. A total of 13.3% (76/572) of the children studied were positive to cysticercosis (T. solium-specific serum antibodies detected by EITB), of whom 38.0% (27/71) had viable cysticercus (T. solium antigens by Ag-ELISA). This study provides evidence of the highest cysticercosis prevalence reported in Rwanda in children to date. Systematic investigations into porcine and human cysticercosis as well as health education and hygiene measures for T. solium control are needed in Gakenke district.

Data-driven analyses of behavioral strategies to eliminate cysticercosis in sub-Saharan Africa

Background

The multi-host taeniosis/cysticercosis disease system is associated with significant neurological morbidity, as well as economic burden, globally. We investigated whether lower cost behavioral interventions are sufficient for local elimination of human cysticercosis in Boulkiemdé, Sanguié, and Nayala provinces of Burkina Faso.

Methodology/Principal findings

Province-specific data on human behaviors (i.e., latrine use and pork consumption) and serological prevalence of human and pig disease were used to inform a deterministic, compartmental model of the taeniosis/cysticercosis disease system. Parameters estimated via Bayesian melding provided posterior distributions for comparing transmission rates associated with human ingestion of Taenia solium cysticerci due to undercooking and human exposure to T. solium eggs in the environment. Reductions in transmission via these pathways were modeled to determine required effectiveness of a market-focused cooking behavior intervention and a community-led sanitation and hygiene program, independently and in combination, for eliminating human cysticercosis as a public health problem (<1 case per 1000 population). Transmission of cysticerci due to consumption of undercooked pork was found to vary significantly across transmission settings. In Sanguié, the rate of transmission due to undercooking was 6% higher than that in Boulkiemdé (95% CI: 1.03, 1.09; p-value < 0.001) and 35% lower than that in Nayala (95% CI: 0.64, 0.66; p-value < 0.001). We found that 67% and 62% reductions in undercooking of pork consumed in markets were associated with elimination of cysticercosis in Nayala and Sanguié, respectively. Elimination of active cysticercosis in Boulkiemdé required a 73% reduction. Less aggressive reductions of 25% to 30% in human exposure to Taenia solium eggs through sanitation and hygiene programs were associated with elimination in the provinces.

Conclusions/Significance

Despite heterogeneity in effectiveness due to local transmission dynamics and behaviors, education on the importance of proper cooking, in combination with community-led sanitation and hygiene efforts, has implications for reducing morbidity due to cysticercosis and neurocysticercosis.

It is important to consider context-specific behaviors and transmission pathways when designing scalable and sustainable intervention strategies for neglected tropical diseases (NTDs). To reduce the morbidity and mortality associated with cysticercosis, suites of interventions have been recommended but are inconsistently implemented due to cost and feasibility-related constraints. This study investigated the potential of a cooking intervention to interrupt transmission via undercooked pork in marketplaces of Burkina Faso. The sensitivity of Taenia solium parasite to temperatures attainable via improved cooking strategies provides a low-cost, human-centered approach to prevent consumption of infected pork meals. By accounting for differential behavior and the relative role of this transmission route across three provinces, we show how the potential of cysticercosis elimination (as a public health problem) varies across behavior-focused interventions. Further investigation into intervention strategies against human and pig cysticercosis warrants data-driven analyses that account for local variation in transmission behaviors.

An atypical case of cutaneous cysticercosis in buccal mucosa

Cysticercosis is a recognized fatal disease to the humans. Taenia solium, a larval stage of pork tapeworm that causes cysticercosis which is an important cause of morbidity in the world. This case report shows the clinical presentations of an atypical case of cutaneous cysticercosis on the right buccal mucosa and its management. It presents the importance of thorough knowledge, proper investigation, symptomatic management with improved treatment regimens and important role of minimally invasive surgery. Its outcome and the treatment options mainly depend on the number, location, size and stage of parasites, as well as on the immune response of the host.

Psychiatric Disorders of Neurocysticercosis: Narrative Review

Neurocysticercosis, the most common type of neuroparasitosis, is a condition in which the central nervous system (CNS) is infested with the pork tapeworm Taenia solium cysticercosis' larvae. Neurocysticercosis is the most widespread parasitic CNS disease worldwide, affecting more than 50 million individuals. As neurocysticercosis is prevalent in developing countries, the growing number of migrants and travelers increases prevalence in developed countries. Possible neuropsychiatric manifestations are depression, cognitive dysfunction, dementia, and visual hallucinations. Depending on the cysts' location in the CNS, focal neurology or psychiatric symptoms manifest. The diagnosis of neurocysticercosis is based on neuroimaging and serology. The correlation between specific symptoms and the cyst's location might help better understand psychiatric disorders' pathophysiology. Nonetheless, the exact prevalence of neurocysticercosis is seldom reported in patients with psychiatric disorders, which may be due to the lack of imaging availability in developing countries with a high prevalence.

Taenia solium and Taenia crassiceps: miRNomes of the larvae and effects of miR-10-5p and let-7-5p on murine peritoneal macrophages

Neurocysticercosis (NCC), a major cause of neurological morbidity worldwide, is caused by the larvae of Taenia solium. Cestodes secrete molecules that block the Th1 response of their hosts and induce a Th2 response permissive to their establishment. Mature microRNAs (miRs) are small noncoding RNAs that regulate gene expression and participate in immunological processes. To determine the participation of Taenia miRs in the immune response against cysticercosis, we constructed small RNA (sRNA) libraries from larvae of Taenia solium and Taenia crassiceps. A total of 12074504 and 11779456 sequencing reads for T. solium and T. crassiceps, respectively, were mapped to the genomes of T. solium and other helminths. Both larvae shared similar miRNome, and miR-10-5p was the most abundant in both species, followed by let-7-5p in T. solium and miR-4989-3p in T. crassiceps, whereas among the genus-specific miRs, miR-001-3p was the most abundant in both, followed by miR-002-3p in T. solium and miR-003a-3p in T. crassiceps. The sequences of these miRs were identical in both. Structure and target prediction analyses revealed that these pre-miRs formed a hairpin and had more than one target involved in immunoregulation. Culture of macrophages, RT-PCR and ELISA assays showed that cells internalized miR-10-5p and let-7-5p into the cytoplasm and the miRs strongly decreased interleukin 16 (Il6) expression, tumor necrosis factor (TNF) and IL-12 secretion, and moderately decreased nitric oxide synthase inducible (Nos2) and Il1b expression (pro-inflammatory cytokines) in M(IFN-γ) macrophages and expression of Tgf1b, and the secretion of IL-10 (anti-inflammatory cytokines) in M(IL-4) macrophages. These findings could help us understand the role of miRs in the host–Taenia relationship.

Diagnosis of Taeniosis in rural Venezuelan communities: Preliminary characterization of a Taenia solium specific monoclonal (VP-1) Coproantigen ELISA

The objective of this study was to identify and treat carriers of adult Taenia solium present in two rural Venezuelan communities through examination of faecal samples by coproscopical analysis, and by the application of a polyclonal and a monoclonal (VP-1) coproantigen ELISA. Both the polyclonal and monoclonal ELISA's were negative when tested with soluble extracts of adults of Ascaris lumbricoides, Hymenolepis nana and Trichuris trichura. The polyclonal ELISA was positive for soluble extracts adults of T. solium and T. saginata, whereas the monoclonal ELISA, which recognizes a glycoprotein, was restricted to T. solium, and was also negative with faecal samples from five cases of T. saginata adult infections. In the first community studied, Potrero Largo (Total population: 300), of 248 faecal samples examined, 2 individuals were positive for Taenia spp eggs by coproscopical analysis and the VP-1 ELISA, and yielded T. solium adults upon purging. In contrast, when the polyclonal coproAg ELISA was applied to the same 248 faecal samples, there were a considerable number of positives. Indeed, seven patients highly positive in the polyclonal ELISA did not yield a Taenia spp upon purging and were negative in the VP-1 ELISA. In the second community studied La Yuca (Total population 560), none of the 333 individuals who donated faeces was positive for Taenia spp eggs. Many, however, were infected with a range of intestinal helminth and protozoan parasites. A total of 76 faecal samples with representative intestinal parasite were then tested in the polyclonal and VP-1 assays. Of these, many gave an unacceptable number of significant optical densities in the polyclonal coproAg ELISA. In contrast, all were negative in the VP-1 ELISA, thus providing evidence for the species specificity of the VP-1 ELISA in faecal samples. These results with the VP-1 coproAg ELISA, although preliminary, justify further validation through the testing of more faecal samples from T. solium and T. saginata adult infected individuals.

Lingual Cysticercosis: A Case Series with Review of Literature

Cysticercosis is a condition in which humans are infected by the larval form of Pork Tapeworm Taenia solium. Isolated lingual cysticercosis is a rare entity due to the high muscular activity and metabolic rate of tongue which prevents the development of larva. We present a series of three patients with isolated lingual cysticercosis. One patient was treated by medical management while the other two were treated with surgical excision followed by medical therapy. All patients are asymptomatic after repeated follow ups.

Advances in Serological Diagnosis of Taenia solium Neurocysticercosis in Korea

Cysticercosis, a parasitic disease caused by Taenia solium metacestode (TsM), has a major global public health impact in terms of disability-adjusted life years. The parasite preferentially infects subcutaneous tissue, but may invade the central nervous system, resulting in neurocysticercosis (NC). NC is an important neglected tropical disease and an emerging disease in industrialized countries due to immigration from endemic areas. The prevalence of taeniasis in Korea declined from 0.3%–12.7% during the 1970s to below 0.02% since the 2000s. A survey conducted from 1993 to 2006 revealed that the percentage of tested samples with high levels of specific anti-TsM antibody declined from 8.3% to 2.2%, suggesting the continuing occurrence of NC in Korea. Modern imaging modalities have substantially improved the diagnostic accuracy of NC, and recent advances in the molecular biochemical characterization of the TsM cyst fluid proteome also significantly strengthened NC serodiagnosis. Two glycoproteins of 150 and 120 kDa that induce strong antibody responses against sera from patients with active-stage NC have been elucidated. The 150 kDa protein showed hydrophobic-ligand binding activities and might be critically involved in the acquisition of host-derived lipid molecules. Fasciclin and endophilin B1, both of which play roles in the homeostatic functions of TsM, showed fairly high antibody responses against calcified NC cases. NC is now controllable and manageable. Further studies should focus on controlling late-onset intractable seizures and serological diagnosis of NC patients infected with few worms. This article briefly overviews diagnostic approaches and discusses current issues relating to NC serodiagnosis.

Pathological and molecular identification of porcine cysticercosis in Maharashtra, India

Porcine cysticercosis, caused by metacestodes of Taenia solium is an important emerging zoonotic disease with public health and economic significance. Pigs acquire the disease through consumption of Taenia solium eggs excreted by human tapeworm carriers. The present study was conducted to investigate the prevalence of porcine cysticercosis in Nagpur and Mumbai region of Maharashtra, India by P/M examination of carcasses followed by histopathology of affected organs in infected animals and molecular identification of cysts for confirmation. Out of 1000 pigs examined during slaughter, three pigs were found to be heavily affected with T. solium cysts giving a prevalence of 0.3%. Histological section of brain in infected animals revealed marked vascular congestion of meninges, mild neuronal degeneration, perivascular cuffing and gliosis while the liver showed the infiltration of mononuclear cell, predominantly eosinophils throughout the parenchyma. Some degree of calcification was observed in the cysts lodged in liver while calcification was not evident in case of cysts lodged in brain, tongue, diaphragm and skeletal muscle. Molecular identification by PCR using two sets of oligonucleotide primers against LSU rRNA gene and Mt-Cox1 gene of T. solium confirms the cysts to be that of T. solium. The molecular diagnostics methods have been considered for validation in conjunction with P/M inspections, parasitological and histopathological examinations. The study confirms the presence of porcine cysticercosis in the two regions and demands proper sanitary measures to minimize the risk of infection from zoonoses and food safety point of view.

Oral Cysticercosis: A Case Series and Review of Literature

The cysticercus is the larval form of the pork tapeworm. Oral cavity involvement of cysticercosis is rare but frequently reported from developing countries. This report presents 3 cases of oral cysticercosis involving the tongue and buccal mucosa in isolation. All 3 patients were treated with surgical excision and had an uneventful postoperative course. A brief review of the PubMed English-language literature search is presented. Oral cavity involvement with cysticercosis presents a diagnostic dilemma. Management is primarily surgical and carries an excellent prognosis.

Human taeniasis/cysticercosis: a potentially emerging parasitic disease in Europe

Taenia saginata (T. saginata)/Taenia solium (T. solium) taeniasis/cysticercosis disease complexes remain a significant challenge for food safety and public health. Human taeniasis is an infectious disease caused by the ingestion of the metacestode larval stage, the cysticerci of T. saginata in beef or T. solium in pork. Humans can also become infected via the ingestion of T. solium eggs. In this case, the cysticerci can establish in the central nervous system, causing the infection called neurocysticercosis. T. solium is of higher importance than T. saginata because the former species can cause neurocysticercosis in humans, a major cause of neurological morbidity in the world. The taeniasis/cysticercosis complex is included in the list of neglected zoonotic diseases by the World Health Organization and Food and Agriculture Organization, with T. solium being the number one foodborne parasite; it occurs mostly in developing countries, such as regions of Asia, Africa and Latin America, where the disease remains endemic. Long absent in Western Europe and other developed countries, cysticercosis has been recently re-emerged as a result of immigration, travel and commerce. In this review, cysticercosis is presented with special emphasis on some aspects of this neglected disease: the main clinical manifestations, risk factors and epidemiology. In addition, any recent advances in diagnostic approaches and treatment are discussed. Finally, the complexities involved in the control of the disease and the need to revise current management strategies are highlighted.

A Case Report of Isolated Cysticercosis of Biceps Muscle

INTRODUCTION

Cysticercosis is more commonly seen in developing countries like India caused by larval stage of Taenia solium. Neurocysticercosis is more commonly seen than isolated muscle involvement. There are very few sporadic cases of isolated biceps muscle involvement, but most of them are managed medically. We are reporting an isolated case of cysticercosis of biceps muscle managed surgically.

CASE REPORT

A 32-year-old male, security personnel by occupation, comes with complaints of painful swelling of the right arm for past 1 week. There was no trauma to the limb and no similar swellings elsewhere in the body. On examination, there was an anteromedial tender swelling of mid-third of arm. X-ray was normal with soft tissue shadow on the anterior aspect. Ultrasound showed cystic lesion with central hyperechoic lesion. Magnetic resonance imaging of arm showed 7.7 mm × 4.8 mm lesion in anteromedial aspect of arm with surrounding edema s/o granuloma. The patient underwent excision of the cyst and biopsy was suggestive of cysticercosis and surrounding granuloma.

CONCLUSION

Isolated cysticercosis of muscle is very rare, but when it is symptomatic and hindering in daily activities, surgical excision can be done for faster relief and early return to normal day-to-day activities.

Prevalence and risk factors for porcine cysticercosis in rural communities of eastern Minas Gerais, Brazil

ABSTRACT: Cysticercosis is caused by Taenia solium, a parasitic zoonosis that affects human and pigs raised free-range in developing countries. The epidemiology of the taeniosis cysticercosis complex in Brazil is poorly understood especially when it comes to field research. The aim of this study was to estimate the prevalence and identify the risk factors associated with porcine cysticercosis in rural communities located in the east of Minas Gerais (MG), Brazil. From 371 farms in the county of Tumiritinga/MG, 101 farms from 14 communities were randomly sampled. Blood samples from pigs were collected, and epidemiological questionnaires were carried out. The serum samples obtained were analyzed through immunodiagnosis techniques, including ELISA and Western Blot, both for the detection of antibodies. The data obtained by different surveys were analyzed using EpiInfo 3.5.1 software to determine seroprevalence and risk factors associated with cysticercosis. The prevalence of farms with porcine cysticercosis was 9.9% (10/101) and antibody-based seropositive was 5.3% (13/247). The results indicate that cysticercosis occurs in high level in the rural area never studied before. These results suggest the presence of tapeworm carriers contributing to the occurrence and maintenance of this zoonotic life cycle in the county. Regarding risk factors, the most significant determinants for porcine cysticercosis in the field were free-range pig management (OR: 17.4, p: 0.0001), the method of disposal of human faeces in the environmental (OR: 7.6; p 0.012), and the size of the farm. Porcine cysticercosis was diagnosed only in areas represented by Agrarian Reform Settlements. From the results, it is possible to recommend as a means of control and prevention the destination of human faeces in appropriate sanitary landfills and the production of pigs in an enclosed area. Additionally, improving education in the communities sampled will indirectly affect the spreading of this disease. The results draw attention to the largest studies of this zoonotic disease in human settlements from rural areas due to the lack of knowledge about the epidemiology of the taeniosis-cysticercosis complex. The results could serve as the basis to support public policies aimed at creating an effective program to control the taeniosis-cysticercosis complex in the studied area. Awareness of TC among medical doctors, veterinarians, meat animal family producers and the public should be developed through appropriate information and education.

Two cases of pulmonary cysticercosis manifesting as pleural effusion: case report and literature review

Cysticercosis is an important public health problem in developing countries. The major involvement sites are the central nervous system and the eyes, although striated muscles and subcutaneous tissues are frequently involved in the disseminated form of disease. Pulmonary involvement in cysticercosis is very rare and ill-defined nodular shadows distributed throughout the lung is the usual radiological presentation. Only one case of cysticercosis presenting as lung cavity with pleural effusion has been reported so far in literature. We describe two cases in which pleural effusion due to cysticercosis were detected on chest X-ray and computed tomography (CT) scan.

Spinal racemose cysticercosis: case report and review

Cysticercosis is a common helminthic infection worldwide, endemic in Central and South America, sub-Saharan Africa, and Southeast Asia. Neurocysticercosis typically involves brain parenchyma, subarachnoid space, and the ventricular system. Although the spinal cord is frequently involved in patients with parenchymal neurocysticercosis, isolated spinal involvement is rare, occurring in only 1-3% of patients. We report a case of racemose spinal neurocysticercosis with brain parenchyma involvement in a 49-year-old Mexican man, who presented with unsteady gait and bilateral arm numbness and weakness. Magnetic resonance imaging revealed multiseptated cystic lesions in the upper cervical spinal canal and nonenhancing intradural extramedullary cystic lesions in the thoracic spine. The patient underwent sub-occipital craniectomy with decompression, followed by a course of steroids and albendazole. Pathology confirmed the diagnosis of neurocysticercosis, and the patient's symptoms resolved after treatment. We include discussion on the symptoms, diagnosis, and treatment of neurocysticercosis with a focus on the spinal form.

Cisticercosis subcutánea

Se presenta el caso de una paciente de 57 años de edad, natural del distrito de San Martín de Porres en Lima, quien acude a emergencias en el Hospital II Lima Norte-Callao Luis Negreiros Vega de EsSalud por presentar una tumoración en el muslo derecho. La paciente refiere dolor al palpar el muslo y al ponerse en marcha, por lo que se realizan estudios y se procede a la exéresis quirúrgica de dicha tumoración. El análisis macroscópico indicó fragmento de tejido de 5x4x11cm con losange de piel de 4x1.5cm y superficie irregular compuesta de tejido adiposo; al corte a 0.8cm de la piel presenta formación nodular de color pardo amarillento de 1.5x1.8cm con formación quística de 0.6cm, bien delimitada por el tejido fibroso. Además, presenta otras tres formaciones quísticas de 0.3 a 0.8cm de diámetro. De igual forma, el diagnóstico histológico señaló formaciones quísticas en tejido celular subcutáneo de paredes fibrosas recubiertas en su parte interna por macrófagos y células epitelioides a cuerpo extraño, compatible con cisticercosis subcutánea.

Routes of Transmission in the Food Chain

More than 250 different foodborne diseases have been described to date, annually affecting about one-third of the world's population. The incidence of foodborne diseases has been underreported and underestimated, and the asymptomatic presentation of some of the illnesses, worldwide heterogeneities in reporting, and the alternative transmission routes of certain pathogens are among the factors that contribute to this. Globalization, centralization of the food supply, transportation of food products progressively farther from their places of origin, and the multitude of steps where contamination may occur have made it increasingly challenging to investigate foodborne and waterborne outbreaks. Certain foodborne pathogens may be transmitted directly from animals to humans, while others are transmitted through vectors, such as insects, or through food handlers, contaminated food products or food-processing surfaces, or transfer from sponges, cloths, or utensils. Additionally, the airborne route may contribute to the transmission of certain foodborne pathogens. Complicating epidemiological investigations, multiple transmission routes have been described for some foodborne pathogens. Two types of transmission barriers, primary and secondary, have been described for foodborne pathogens, each of them providing opportunities for preventing and controlling outbreaks. Primary barriers, the most effective sites of prophylactic intervention, prevent pathogen entry into the environment, while secondary barriers prevent the multiplication and dissemination of pathogens that have already entered the environment. Understanding pathogen dynamics, monitoring transmission, and implementing preventive measures are complicated by the phenomenon of superspreading, which refers to the concept that, at the level of populations, a minority of hosts is responsible for the majority of transmission events.

Estimation of the health and economic burden of neurocysticercosis in India

Taenia solium is an endemic parasite in India which occurs in two forms in humans: cysticercosis (infection of soft tissues) and taeniosis (intestinal infection). Neurocysticercosis (NCC) is the most severe form of cysticercosis in which cysts develop in the central nervous system. This study was conducted to estimate health and economic impact due to human NCC-associated active epilepsy in India. Input data were sourced from published research literature, census data and other official records. Economic losses due to NCC-associated active epilepsy were estimated based on cost of treatment, hospitalisation and severe injury as well as loss of income. The disability-adjusted life years (DALYs) due to NCC were estimated by combining years of life lost due to early death and the number of years compromised due to disability taking the disease incidence into account. DALYs were estimated for five age groups, two genders and four regions, and then combined. To account for uncertainty, probability distributions were used for disease incidence data and other input parameters. In addition, sensitivity analyses were conducted to determine the impact of certain input parameters on health and economic estimates. It was estimated that in 2011, human NCC-associated active epilepsy caused an annual median loss of Rupees 12.03 billion (uncertainty interval [95% UI] Rs. 9.16-15.57 billion; US $ 185.14 million) with losses of Rs. 9.78 billion (95% UI Rs. 7.24-13.0 billion; US $ 150.56 million) from the North and Rs. 2.22 billion (95% UI Rs. 1.58-3.06 billion; US $ 34.14 million) from the South. The disease resulted in a total of 2.10 million (95% UI 0.99-4.10 million) DALYs per annum without age weighting and time discounting with 1.81 million (95% UI 0.84-3.57 million) DALYs from the North and 0.28 million (95% UI 0.13-0.55 million) from the South. The health burden per thousand persons per year was 1.73 DALYs (95% UI 0.82-3.39). The results indicate that human NCC causes significant health and economic impact in India. Programs for controlling the disease should be initiated to reduce the socio-economic impact of the disease in India.

A Case of Cerebral Cysticercosis in Thailand

Cysticercosis and sparganosis are not uncommon parasitic infections in the developing world. Central nervous system infection by both cestodes can present with neurological signs and symptoms, such as seizure and mass effect, including brain hernia. Early detection and accurate diagnosis can prevent a fatal outcome. Histological examinations of brain tissues can confirm the diagnosis of cerebral cysticercosis, which differs from sparganosis by the presence of a cavitated body. We report here a case of cerebral cysticercosis which has the similar clinical and imaging findings as sparganosis.

Clinical Symptoms, Imaging Features and Cyst Distribution in the Cerebrospinal Fluid Compartments in Patients with Extraparenchymal Neurocysticercosis

Extraparenchymal neurocysticercosis has an aggressive course because cysts in the cerebrospinal fluid compartments induce acute inflammatory reactions. The relationships between symptoms, imaging findings, lesion type and location remain poorly understood. In this retrospective clinical records-based study, we describe the clinical symptoms, magnetic resonance imaging features, and cyst distribution in the CSF compartments of 36 patients with extraparenchymal neurocysticercosis. Patients were recruited between 1995 and 2010 and median follow up was 38 months. During all the follow up time we found that 75% (27/36) of the patients had symptoms related to raised intracranial pressure sometime, 72.2% (26/36) cysticercotic meningitis, 61.1% (22/36) seizures, and 50.0% (18/36) headaches unrelated to intracranial pressure. Regarding lesion types, 77.8% (28/36) of patients presented with grape-like cysts, 22.2% (8/36) giant cysts, and 61.1% (22/36) contrast-enhancing lesions. Hydrocephalus occurred in 72.2% (26/36) of patients during the follow-up period. All patients had cysts in the subarachnoid space and 41.7% (15/36) had at least one cyst in some ventricle. Cysts were predominantly located in the posterior fossa (31 patients) and supratentorial basal cisterns (19 patients). The fourth ventricle was the main compromised ventricle (10 patients). Spinal cysts were more frequent than previously reported (11.1%, 4/36). Our findings are useful for both diagnosis and treatment selection in patients with neurocysticercosis.

Neurocysticercosis is caused by the accidental ingestion of eggs from Taenia solium whose larvae lodge in the central nervous system. In this study we found that cysts within the cerebrospinal fluid leaded to high rates of raised intracranial pressure, meningitis, seizures and headache. Imaging studies such as magnetic resonance are useful for diagnosis, identification of the compromised sites of the central nervous system and, then, for treatment guidance. The pattern of lesions identified through magnetic resonance in our paper helps physicians on searching and analyzing some typical findings of extraparenchymal neurocysticercosis.

Novel rat model for neurocysticercosis using Taenia solium

Neurocysticercosis is caused by Taenia solium infecting the central nervous system and is the leading cause of acquired epilepsy and convulsive conditions worldwide. Research into the pathophysiology of the disease and appropriate treatment is hindered by lack of cost-effective and physiologically similar animal models. We generated a novel rat neurocysticercosis model using intracranial infection with activated T. solium oncospheres. Holtzman rats were infected in two separate groups: the first group was inoculated extraparenchymally and the second intraparenchymally, with different doses of activated oncospheres. The groups were evaluated at three different ages. Histologic examination of the tissue surrounding T. solium cysticerci was performed. Results indicate that generally infected rats developed cysticerci in the brain tissue after 4 months, and the cysticerci were observed in the parenchymal, ventricle, or submeningeal brain tissue. The route of infection did not have a statistically significant effect on the proportion of rats that developed cysticerci, and there was no dependence on infection dose. However, rat age was crucial to the success of the infection. Epilepsy was observed in 9% of rats with neurocysticercosis. In histologic examination, a layer of collagen tissue, inflammatory infiltrate cells, perivascular infiltrate, angiogenesis, spongy change, and mass effect were observed in the tissue surrounding the cysts. This study presents a suitable animal model for the study of human neurocysticercosis.

Parasitic and rare spinal infections

The imaging features of spinal parasitic diseases and other rare infections are herein discussed. These diseases are distributed worldwide, with increased prevalence in areas with poor sanitary conditions and in developing countries. In nonendemic areas, sporadic cases may occur, consequent to increased international travel and immunocompromising conditions. Infectious diseases are usually treatable, and early detection is often crucial. A thorough comprehension of the imaging patterns associated with the clinical features, epidemiology, and laboratory results allows the radiologist to narrow down the options for differential diagnosis and facilitates the timely implementation of appropriate therapies.

Isolated intramuscular cysticercosis: Clinicopathological features, diagnosis and management - A review

Cysticercosis is an emerging parasitic disease affecting worldwide population. There is large volume of data present in the literature for neurocysticercosis. The isolated intramuscular involvement of cysticercosis is uncommon and there are only sporadic case reports available. There is no review available in the literature which gives in detail clinicoradiological features and management of isolated intramuscular cysticercosis. Knowledge about such a presentation is important especially in developing countries and to differentiate the condition from a variety of other similar conditions.

Conservative management of neurocysticercosis in a patient with hematopoietic stem cell transplantation: a case report and review

Neurocysticercosis, an infection of the central nervous system with the larval stage of the cestode Taenia solium, is common in developing countries but its occurrence and management in allogeneic hematopoietic stem cell transplantation (HSCT) has not been reported previously, to our knowledge. We report the case of an immigrant female patient who underwent a matched-related allogeneic HSCT for acute lymphoblastic leukemia and was incidentally found to have a solitary viable neurocysticercosis lesion. However, despite severe immunosuppression, the size of the cyst did not increase. More importantly, restoration of the immune system did not induce significant inflammation or seizures. Subsequent follow-up demonstrated complete resolution of the neurocysticercosis lesion. Thus, in the setting of HSCT, an asymptomatic patient with a single neurocysticercosis lesion was successfully managed without the use of anthelmintics, steroids, or anti-epileptics.

Intramedullary spinal cord neurocysticercosis presenting as Brown-Séquard syndrome

Background

Cysticercosis is a parasitic disease caused by the larval stage of Taenia Solium. Involvement of the central nervous system by this tapeworm is endemic in developing countries. However, isolated spinal involvement by Taenia Solium is uncommon and having clinical presentation of Brown-Séquard syndrome is even rarer.

Case presentation

A 43-year-old male who came to the emergency department with clinical presentation of complete Brown-Séquard syndrome. Computed tomography scan of the brain was normal. Magnetic resonance imaging of the thoracic spine revealed an intramedullary mass of the spinal cord at C-7/T-l level. Patient underwent surgery that revealed a cystic lesion and was resected. Histopathological report confirmed the diagnosis of neurocysticercosis. Postoperatively, oral steroid therapy and a four week course of albendazol were administered.

Conclusions

Intramedullary neurcysticercosis represents a diagnostic challenge and should be considered in intramedullary lesions in settings where Taenia solium is endemic. Clinical, pathophysiological and diagnostic aspects of spinal cord intramedullary neurocysticercosis are discussed.

Oral cysticercosis: a diagnostic difficulty

Cysticercosis is a rare disease caused by the ingestion of the parasite Cysticercus cellulosae, a larval stage of Taenia solium. The definitive host is human who harbors the adult worm and may accidentally or incidentally become the host. The larval form of cyst is commonly seen in the brain, meninges and eyes. Cases in the maxillofacial region including oral cavity and cheek muscles are rarely reported. Cysticercosis is not commonly considered in the diagnosis of swellings of the head and neck and a diagnostic and therapeutic dilemma for clinicians. Hence, they are of utmost interest to the practitioner and have to be studied. We present an unusual case of cysticercosis presenting as a solitary cystic nodule in the upper left vestibule of the oral cavity in an 18 year male and the diagnosis was made on histopathological examination.

New insights in cysticercosis transmission

Taenia solium infection causes severe neurological disease in humans. Even though infection and exposure to swine cysticercosis is scattered throughout endemic villages, location of the tapeworm only explains some of the nearby infections and is not related to location of seropositive pigs. Other players might be involved in cysticercosis transmission. In this study we hypothesize that pigs that carry nematodes specific to dung beetles are associated with cysticercosis infection and/or exposure. We carried out a cross-sectional study of six villages in an endemic region in northern Peru. We euthanized all pigs (326) in the villages and performed necropsies to diagnose cysticercosis. For each pig, we counted cysticerci; measured anti-cysticercus antibodies; identified intestinal nematodes; tabulated distance to nearest human tapeworm infection; and recorded age, sex, productive stage, and geographic reference. For the purpose of this paper, we defined cysticercosis infection as the presence of at least one cysticercus in pig muscles, and cysticercosis exposure as seropositivity to anti-cysticercus antibodies with the presence of 0–5 cysticerci. Compared to pigs without nematode infections, those pigs infected with the nematode Ascarops strongylina were significantly associated with the presence of cysticerci (OR: 4.30, 95%CI: 1.83–10.09). Similarly, pigs infected with the nematode Physocephalus sexalatus were more likely to have cysticercosis exposure (OR: 2.21, 95%CI: 1.50–3.28). In conclusion, our results suggest that there appears to be a strong positive association between the presence of nematodes and both cysticercosis infection and exposure in pigs. The role of dung beetles in cysticercosis dynamics should be further investigated.

In endemic areas, pigs acquire cysticercosis when ingesting Taenia solium eggs that have been released into the environment in the feces of a person infected with T. solium. The present study has found evidence that players, such as dung beetles, might be involved in further dissemination of the parasite into the environment. Specifically, we found an association between helminths, for whom dung beetles act as an intermediate host, and porcine cysticercosis infection and exposure after adjusting for other porcine cysticercosis predictors such as distance to tapeworm carrier and age. Although the study does not evaluate dung beetles directly, parasites specific to dung beetles serve as a novel proxy to evidence the potential role of dung beetles in the epidemiology of cysticercosis. Therefore, it is important that further studies elucidate the role of other players in cysticercosis transmission in order to better explain the reemergence and persistence of cysticercosis after elimination and control efforts. In addition, vector populations could potentially be used as markers for cysticercosis in the communities.

Fine-needle aspiration cytology as a diagnostic modality for cysticercosis: A clinicocytological study of 137 cases

BACKGROUND

Cysticercosis, a parasitic tissue infection caused by the larva of Taenia solium, is quite a common disease in our part of the world, but its incidence is often underestimated. Fine-needle aspiration cytology (FNAC) plays an important role in early detection of this disease, especially when the lesion is located in anatomically approachable superficial locations.

AIMS

The aim was to study role of FNAC in the diagnosis of cysticercosis.

MATERIALS AND METHODS

In this retrospective study, the data of 137 patients with palpable nodules, who were diagnosed as having or suspicious of cysticercosis on FNAC, were retrieved and analyzed.

RESULTS

In 129 (94.2%) cases, a definitive diagnosis of cysticercosis was obtained in the form of parts of parasite tegument, hooklets, parenchymatous portion and calcareous corpuscles. In the background, giant cells, mixed inflammatory cells, and epithelioid cells were present. In remaining 8 (5.8%) cases, larval fragments could not be identified on the aspirates, and the diagnosis of parasitic inflammation was suggested on the basis of other cytological findings such as clear fluid aspirate, presence of eosinophils, histiocytes, foreign body giant cells, a typical granular dirty background, etc. Follow-up biopsy in these 8 cases confirmed the diagnosis of cysticercosis in 7 (87.5%) while in 1 (12.5%) case, histopathology was suggestive of parasitic cyst.

CONCLUSION

Fine-needle aspiration cytology in cysticercosis is a low-cost outpatient procedure. The cytological diagnosis is quite straightforward in cases where the actual parasite structures are identified in the smears. In other cases, a cytological diagnosis of suspicious of cysticercosis can be given if the cytological findings suggest the same.

Myoparasitism mimicking parotid swelling: a rare presentation of cysticercosis

Muscular infestation with larval stage of Taenia solium is a well-recognised entity but cysticercosis of the head and neck region is a rarity. We present a case of 35-year-old young man with diffuse swelling of 3.5×4 cm in the parotid region on the right side of the face with signs of inflammation. Diagnosis was established on high-resolution ultrasonography which revealed it to be of parasitic origin. The patient was managed with antihelminthic pharmacotherapy and improved within a month. Thus cysticercosis should be considered in the differential diagnosis of subcutaneous swellings of the head and neck region, especially in endemic zones and it must be investigated well with appropriate imaging modalities so that inadvertent surgery can be avoided.