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For further information, see CMDT Part 35-19: Invasive Cestode Infections

Key Features

  • Exposure to Taenia solium through fecal contamination of food

  • Focal CNS lesions; seizures, headache

  • Brain imaging shows cysts; positive serologic tests

Clinical Findings

  • Presenting symptoms include seizures, focal neurologic deficits, altered cognition, and psychiatric disease

  • Symptoms develop more quickly with intraventricular cysts, with findings of hydrocephalus and meningeal irritation, including

    • Severe headache

    • Vomiting

    • Papilledema

    • Visual loss

  • Neurocysticercosis

    • Can cause intracerebral, subarachnoid, and spinal cord lesions and intraventricular cysts

    • Single or multiple lesions may be present

    • Lesions may persist for years before symptoms develop, generally due to local inflammation or ventricular obstruction

  • Racemose cysticercosis

    • A particularly aggressive form of the disease

    • Involves proliferation of cysts at the base of the brain, leading to alterations of consciousness and death

Diagnosis

  • Cerebrospinal fluid examination may show

    • Lymphocytic or eosinophilic pleocytosis

    • Decreased glucose

    • Elevated protein

  • Enzyme-linked immunosorbent assay (ELISA) and related immunoblot assays have excellent sensitivity and specificity, but sensitivity is lower with only single or calcified lesions

  • Performing both CT and MRI is ideal

    • CT is better for identification of calcification

    • MRI is better for smaller and ventricular lesions

Treatment

  • Benefits of cyst clearance must be weighed against potential harm of an inflammatory response to dying worms

  • When treatment is deemed appropriate, standard therapy consists of albendazole (10–15 mg/kg/day orally for 8 days) or praziquantel (50 mg/kg/day orally for 15–30 days)

  • Corticosteroids are usually administered concurrently, but dosing is not standardized

  • Anticonvulsant therapy should be provided (if needed) and shunting performed (if required) for elevated intracranial pressure

  • Surgical removal of cysts may be helpful for some difficult cases of neurocysticercosis and for symptomatic non-neurologic disease

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