Clinico-pathological studies in cattle experimentally infected with Taenia saginata eggs

Calves 1-2 months old were experimentally infected with eggs of Taenia saginata and clinical and haematological deviations, development and distribution of cysticerci and pathological changes were recorded. The calves infected with 5,000, 10,000 or 50,000 eggs showed an increase in pulse and respiratory rates. The animals that received 50,000 eggs had significantly increased pulse (p < 0.05) and respiratory rates (p < 0.005). The symptoms were more severe in young, 30-day-old calves infected with 50,000 eggs. Haemoglobin concentration, haematocrit values and red blood cell count decreased, but white blood cell count increased slightly. Lymphocytes and eosinophils also increased up to 88% and 14% (p < 0.05), respectively. Most of the cysticerci were not fully formed 1 month post-infection, but at 2 months the cysts were fully mature and at 4 months, some cysts had degenerated. There was no uniform pattern of distribution of cysticerci in the body of infected calves, but the most commonly affected sites were masseter and heart muscles, followed by diaphragm, tongue and other skeletal muscles. The maximum concentration of 8-14 cysticerci per 10 g of tissue was recorded in masseter muscles and heart. The affected parts revealed tissue reactions that included pressure atrophy, necrosis and fibrosis. Microscopically, the lesions comprised infiltration with lymphocytes, plasma cells, eosinophils and macrophages, fibrosis, necrosis and calcification. The tissue reaction was severe in calves infected with 50,000 eggs. The severity of clinical signs, haematological and pathological changes depended mostly on the age of the animals and dose of infection.

Clinical characteristics, seizure spread patterns and prognosis of seizures associated with a single small cerebral calcific CT lesion

Clinical characteristics of 97 patients with epilepsy associated with a small single cerebral calcific CT lesion (SSCCCTL), measuring 20 mm or less were analysed. The mean age was 20 years and 60% were in the first and second decades. Eighteen (18.5%) patients had a previous history of unprovoked seizures, with complex partial seizures (61%) being the most common type. Seizures could be localized to a single ILAE site in 73% of patients. None had neurological deficit and electroencephalograph abnormalities were noted in 29% of patients. Fifty-one (53%) patients had breakthrough seizures and were more common with frontal location. By 7 years 71.5% (95% confidence intervals (CI) 53.7-85.4) of patients achieved 3-year remission and 66% (CI 32.4-88.2) had achieved 5-year remission. The clinical pattern of the seizures was clearly distinctive to allow it to be localized to the location of the lesion on computerized tomography (CT) scan in 25 (26%) patients and in another 31 (31%) patients nearer to the anatomical site of the lesion on the CT scan. There was discordance between clinical localization and CT location of the lesion in 15 patients. Nine of the 10 patients with occipital or parieto-occipital location had focal tonic-clonic seizures with secondary generalization. Both patients with temporal location had motor seizures. The relevance of these findings to the seizure propagation was discussed.

Taenia solium cysticercosis in young pigs: age at first infection and histological characteristics

In spite of the vast knowledge that exists in the fields of immunology, biochemistry, diagnosis and treatment, the basic facts about the dynamics of the transmission of Taenia solium are incomplete. The present study determines the age at which piglets become infected in a rural community of Mexico, where the climate is divided into the dry and rainy seasons. It was found that piglets become infected during the dry months, not so during the rainy season. They pick up eggs at the age of 2 to 4 weeks and the metacestodes are present in the liver. In older animals aged 4 to 6 months, the larvae were also found in the muscles. In a 6-month-old pig larvae were found in the muscles and brain. These findings may be explained by behavioural studies of free living pigs and climatic conditions.

Neurocysticercosos in South-Central America and the Indian subcontinent. A comparative evaluation

Neurocysticercosis is an important public health problem in South-Central American and South Asia. A review of the differences in epidemiological and clinical attributes of cysticercosis and taeniasis in South Central America and India, respectively, is undertaken in the present communication. Intestinal taeniasis is hyperendemic in several American countries. In comparison, the prevalence of Taenia solium infestation is lower in India. The clinical manifestations in several American neurocysticercosis series comprise epilepsy, intracranial hypertension and meningeal-racemose cysticercosis, in roughly equal proportions. An overwhelming majority of the Indian subjects present with seizures. The commonest pathological substrate of the disorder in Indian patients is the solitary parenchymal degenerating cyst. The reasons for the predominance of solitary forms in India, and of multilesional forms in South Central America are discussed. The magnitude of Taenia solium infestation and the frequency of pork consumption in a given population appear to influence the quantum of cyst load in affected individuals.

[Evoked potentials in neurocysticercosis]

In 25 patients with cysticercosis of central nervous system, classified in two clinical forms, benign and malign, evoked potentials were obtained. Normal exam was found in 9 cases with the benign form. From 4 patients with malign clinical presentations, 2 had multiple abnormalities of the evoked potentials, and F wave alterations (mixed pattern). The authors suggest that this mixed pattern may be indicative of severe prognosis.

Albendazole therapy for neurocysticercosis: a prospective double-blind trial comparing 7 versus 14 days of treatment. Cysticercosis Working Group in Peru

OBJECTIVE

To compare the effectiveness of two regimens of albendazole therapy for neurocysticercosis.

DESIGN

Randomized, double-blind clinical trial.

SETTINGS

Patients admitted to neurologic wards in Lima, Peru.

PATIENTS

Adult patients with active neurocysticercosis demonstrated by CT and Western blot (immunoblot).

INTERVENTION

One week (n = 25) versus 2 weeks (n = 25) of albendazole therapy.

MEASUREMENTS

Decrease in the number of cysts on CT.

RESULTS

Effectiveness of albendazole was 78%, with no difference between the groups when compared 3 months after therapy. Complete cure was obtained in only 38% of patients. Patients with more than 20 cysts had poorer responses to therapy. The clinical course and EEG evolution improved in most patients. Side effects were present in 38% of patients, mainly mild, transient gastrointestinal symptoms. Therapy was also associated with exacerbation of neurologic symptoms. Two patients died in the first year after therapy, both because of aggregated infections of ventricle-peritoneal shunts. One-year follow-up CT showed lesions in three of 10 patients presumed to be cured 3 months after therapy.

CONCLUSIONS

Extension of albendazole therapy for more than 7 days adds no benefits for the patients.

Evolution of cerebral edema and its relationship with power in the theta band

In previous papers we have proposed that in patients with space-occupying lesions, delta power was related with the volume of the lesion and theta power with the volume of the edema. In this report we analyze the evolution of 10 patients with space-occupying lesions in whom we measured the volume of the lesion and of the edema before and after treatment that produced changes in these volumes. EEGs were recorded in the leads of the 10-20 system referenced to linked earlobes. Delta and theta powers were calculated for voltage and current source densities (CSD) and compared with age-norms to compute conventional Z-maps. These maps provide probability statements about the deviation of observed values from the norm. Rank correlations between the change in the volume of the lesion before and after treatment and the change in Z-values before and after treatment were significant only in the delta band. However, rank correlations between the change in the volume of the edema and the change in EEG Z-values were only significant in the theta band. These correlations were higher for CSD than for voltage estimates. We also observed that the site of the lesion and of the edema was better represented by CSD maps than by voltage maps. These results are also in agreement with our previous reports, in which we observed more precise localization of brain lesions by CSD than by voltage estimates.

Large cerebral infarction during praziquantel therapy in neurocysticercosis

BACKGROUND

Large cerebral infarction is a rare complication of neurocysticercosis. Endarteritis by inflammation of the leptomeninges is known to be its cause.

CASE DESCRIPTION

A 59-year-old man with known neurocysticercosis developed a large cerebral infarction during praziquantel therapy. A follow-up MRI obtained immediately after his cerebral infarction demonstrated notable decrease in the size of the cysts and more prominent enhancement around the peripheral margins of the cysts and the major vessels in comparison with the initial MRI. Cerebral angiography disclosed occlusions and narrowing of both internal carotid arteries at the supraclinoid portions, where multiple cysts were found on the MRI.

CONCLUSIONS

Findings in our patient strongly suggest that a secondary inflammation reaction caused by the destruction of the cysts might have enhanced the process of endarteritis. The possible deleterious effects of praziquantel therapy should be considered in the treatment of patients with subarachnoid cysticerci.

Neurocysticercosis

Cysticercosis is an infection caused by Taenia solium larvae (cysticerci). When the cysticercus is lodged in the central nervous system (CNS), the disease is known as neurocysticercosis (NCC). NCC is the most frequent and most widely disseminated human neuroparasitosis. It is endemic in many parts of the world, particularly Latin America, Africa, and Asia, and still relatively frequent in Portugal, Spain and Eastern European countries It is also endemic in developed countries with high rates of immigration from endemic areas. Man may act as an intermediate host after ingestion of mature, viable T. solium eggs via the fecal-oral route. The development of lesions in the brain and leptomeninges, and the consequent of onset of symptoms associated with NCC are mainly due to the host immune-inflammatory response. As long as the cysticercus remains viable, there is relative host immune tolerance. It is only when the parasite dies that massive antigen exposure occurs, with intensification of the immune response/inflammatory reaction and the appearance or worsening of symptoms. NCC can be asymptomatic or cause widely varied clinical manifestations, such as seizures, increased intracranial pressure, ischemic cerebrovascular disease, dementia, and signs of compression of the spinal roots/cord. The combination of two or more symptoms is common. Such clinical polymorphism is determined by 1) the number of lesions (single or multiple cysticerci); 2) the location of CNS lesions (subarachnoid, intracerebral, intraventricular, intramedullary); 3) the type of cysticercus (Cysticercus cellulosae, Cysticercus racemosus); 4) the stage of development and involution of the parasite (vesicular or viable, necrotic, fibrocalcified nodule); and 5) the intensity of the host immune-inflammatory response (no inflammatory reaction, leptomeningitis, encephalitis, granular ependymitis, arteritis).

Inhibition of sexual behavior in male mice infected with Taenia crassiceps cysticerci

Prominent estrogenization and deandrogenization ensue in male mice as a consequence of experimental intraperitoneal infection with Taenia crassiceps cysticerci. The impact of these endocrine changes upon sexual behavior was explored in a group of infected Balb/c male mice at weekly intervals for 15 wk and compared with the behavior of otherwise paired, nonparasitized male mice. Mounting, intromission, and ejaculation responses markedly declined as infection progressed. Six weeks after infection, none of the infected mice displayed ejaculation, the number of mounts and intromissions gradually decreased, and their latencies increased, until, by the 13th wk, none of the parasitized mice showed any sexual response toward female mice. Fifteen weeks after infection, the number of metacestodes per host increased to a couple of thousand, the mean serum estradiol level was approximately 50 times higher than the normal value, and testosterone fell to 5% of its normal level. To fully assess that the inhibition of sexual behavior resulted from the decrease in testosterone levels, a group of 8-wk-infected mice received testosterone, and complete restoration of their sexual behavior was observed. Inhibition of masculine sexual behavior during the infection period is the result of hormonal changes, estradiol being ineffective in maintaining copulation.

Intravitreal cysticercosis

Examination of a 36-year-old man with naked visual acuity of 20/20 revealed a floating, conspicuous cyst of Cysticercus cellulosae in the vitreous cavity of the right eye. A vitreous traction band from the vitreous base and the optic disc was connected to the lodging bulb of the cyst. In the superonasal area, an ovoid retinal break surrounded by a white retinal lesion with two elliptical retinal hemorrhages was found, and this seems to be the previous lodging site of the cyst. A pars plana vitrectomy was performed to remove the parasite, and laser photocoagulation was carried out around the retinal break. Four months after the operation, the patient was satisfied with naked visual acuity of 25/20 without any complication in the affected eye.

Magnetoencephalographic features in neurocysticercosis

BACKGROUND

Magnetoencephalography (MEG) is a method of determining the brain activity noninvasively be detecting the magnetic fields associated with neuronal electrical activities.

METHODS

By using 37-channel DC-superconducting quantum interference devices, MEG activity was recorded in a patient with neurocysticerosis, who had a long-term history of epilepsy.

RESULTS

MEG clearly demonstrated accumulation of current dipoles originating from high-frequency waves around the cysticercal cyst, while scalp electroencephalogram failed to reveal paroxysmal discharge. Intraoperative electrocorticography revealed multiple spike activities around the lesion, consistent with MEG findings.

CONCLUSIONS

We discussed the application of MEG to the patients with neurocysticercosis in estimating epileptogenic sources.

Retrobulbar optic nerve cysticercosis. Case report

The authors report a first case of intraoptic neurocysticercosis in a 12-year-old boy living on Reunion Island. Cysticercosis of the retrobulbar portion of the optic nerve is rare. Because of the patient's age and disturbances in both visual acuity and visual field, it was initially believed to be an optic nerve tumor. Computerized tomography scans and surgical aspects were confirmed by pathological findings. A conservative removal using en bloc orbitotomy showed good functional and aesthetic results.

Comparison of single and trickle infections of pigs with eggs of the Asian Taenia

Two groups of seven Belgian Landrace piglets each were either infected with a single dose of 3000 or with five consecutive doses of 600 Asian Taenia eggs at weekly intervals. Nine weeks after the first infection all pigs were autopsied and the number of metacestodes was obtained by slicing the liver. There were no significant differences between the mean number of viable or dead cysts present in both groups of animals. Only very low numbers of living metacestodes were found: 0.4% (3/779) of the total number of cysts present in the single infection group and 1.8% (13/707) in the trickle infection group. Circulating antigens could be detected in only four out of 13 animals and no differences in antibody kinetics were present between the two groups of pigs. The presence of high numbers of degenerated cysts in experimental as well as in field conditions seems to indicate that the biotic potential of the Asian Taenia is rather low.

Experimental Taenia solium cysticercosis in pigs: characteristics of the infection and antibody response

Pigs were infected with taeniid eggs to study the susceptibility to infection and reinfection of the animals of mixed breeds and of different ages, the viability and death of the metacestodes in the host tissue, and the antibody response which accompanies these events. Sixteen pigs were infected with Taenia solium eggs for this purpose. At necropsy metacestodes were counted in 2 kg of shoulder muscles and classified as vesicular or caseous, and all the metacestodes in brains were counted and classified. The results show that pigs inoculated at 49 and 60 days of age became infected to different degrees and reacted differently to the presence of parasites. In the brain the metacestodes remain viable for longer periods than in muscles. Enzyme-linked immunosorbent assay (ELISA) showed a significant rise in antibodies after infection, which started to decrease 92 days post-infection (p.i.). Pigs with viable cysts remained seropositive up to the end of the experiment (281 days p.i.). Antibody levels rose further after reinfection or after treatment. The results of Western blot were comparable to those of ELISA. Antigens of 13, 14 and 18 kDa were most frequently recognized in early infections and then started to decrease 92 days p.i., while the antigens of 42, 50 and 24 kDa were recognized during later stages of infection (200 days p.i.). The results suggest that older animals are more resistant to the infection [corrected].

Spectrum of epilepsy in neurocysticercosis: a long-term follow-up of 143 patients

To characterize the clinical profile and the prognostic factors of the epilepsy due to parenchymal neurocysticercosis (NCC) 143 patients were analysed. Patients (62 men, 81 women) had a mean age at epilepsy onset of 29 years (range 2-71), mean epilepsy duration of 16 years (range 1-58) and mean follow-up of 5.2 years. Seizures were generalised tonic-clonic (GTC) in 50 patients (35%), simple partial (SP) in 66 (46%) and complex partial (CP) in 27 (19%). Epilepsy began as a single seizure in 73% and as a cluster of seizures or status epilepticus in 27%. Seizures were controlled in 64% of patients. Multivariate analysis revealed that significant prognostic factors associated with seizure control were type of seizures and age at epilepsy onset. Control is more likely in GTC and SP seizures and in patients with a higher age at seizures onset. Our analysis establishes that epilepsy due to NCC is a heterogeneous syndrome concerning age and mode of onset, seizure type, duration of epilepsy and pattern of evolution probably related with different pathogenic mechanisms.

Single parenchymal brain cysticercus in the acute encephalitic phase: definition of a distinct form of neurocysticercosis with a benign prognosis

Fifty four patients with a single parenchymal brain cysticercus in the acute encephalitic phase were studied to outline the features of this form of the disease. Seizures were the presenting symptom in all cases. Twenty six patients had a single seizure and 28 had several seizures before admission. Neurological examination was normal in 45 patients and showed focal signs in nine. All patients had a single enhancing CT lesion; all but three lesions were < 20 mm. Anticonvulsants were started in every patient. Forty five patients were followed up for 18 (SD 6) months. Thirty seven of these 45 patients received albendazole. Four weeks after the trial, CT showed resolution of lesions in all cases. The remaining eight patients refused albendazole, and CT showed persistence of lesions by 16 weeks in six cases. At the end of the follow up, all patients who received albendazole were free of seizures as opposed to three of eight patients who did not receive the drug. Focal signs improved in the nine patients with these signs (all received albendazole). Recognition of this form of neurocysticercosis permits early treatment with albendazole that greatly improves the prognosis.

Experimental infection of an isolate of Taenia solium from Hainan in domestic animals

The present study was designed to determine the susceptibility of domestic animals to an isolate of Taenia solium from Hainan Province, People's Republic of China. A total of 162 cysticerci were recovered from two pigs and 21 from two dogs after experimental inoculation. Cats, goats and a calf were not susceptible to T. solium. Cysticerci were recovered mainly from muscles of the pigs and all were alive. The remainder were in the liver and only one was alive. In the dog, all cysticerci were recovered from the muscles and all were alive.

Radiologic evaluation of the liver and gastrointestinal tract in rats infected with Taenia taeniaeformis

In rats infected with the cestode Taenia taeniaeformis, hepatomegaly results from development of parasitic cysts in the liver. Diffuse nodular mucosal hyperplasia in the glandular region (corpus and antrum) of the stomach, and gross thickening of the intestinal mucosa also result. Between postinfection days (PID) 21 and 84, radiologic observations were made after oral administration of a barium sulfate suspension in T taeniaeformis-infected rats and in age/sex-matched controls. There was radiographic evidence of hepatic enlargement at PID 21. Enlargement of the gastric folds was first observed along the greater curvature of the stomach at PID 35. Fimbriation of small intestinal mucosal surfaces resulted from thickening of the intestinal villi and was observed in the duodenum at PID 21. Intestinal motility was assessed, and contractions were counted, using image intensification fluoroscopy, then were recorded on videotape. There were no significant differences between control and infected rats for gastric emptying time, intestinal transit time, and number of intestinal contractions per minute. Barium contrast radiography clearly indicated large gastric folds, thickening of the small intestinal villi, and hepatic enlargement, and was useful for assessing gastrointestinal motility.

Neurocysticercosis

Neurocysticercosis can be a cause of new-onset seizures. Cysticercosis is caused by fecal-oral spread of the parasite Taenia solium, the pork tapeworm, from affected individuals. Neurocysticercosis results from parasitic invasion of the central nervous system. The clinical presentation ranges from headaches to acute obstructive hydrocephalus. Computed tomography or magnetic resonance imaging is usually diagnostic, while serologic tests are generally less reliable. Treatment consists of praziquantel or albendazole, generally prescribed in combination with oral corticosteroids.

Isolated fourth ventricle in neurocysticercosis: pathophysiology, diagnosis, and treatment

Four cases of isolated fourth ventricle in neurocysticerocosis are reported (three after ventriculoperitoneal shunting, and one after hydrocephalus without shunting). Diagnosis was made based on computed tomography (CT) and/or CT cisternogram/ventriculogram. Three patients underwent fourth ventricle drainage (two died and the third remains well). The fourth patient refused surgical treatment and continues to have severe ataxia. Diagnosis, pathophysiology, and treatment of this entity in neurocysticercosis are discussed.

Spontaneous extrusion of cysticercosis: report of three cases

We report three cases of spontaneous extrusion of cysticercosis. In two cases, it got extruded from the orbit and in one case from the subconjunctival space. Extrusion of cysticercosis was associated with improvement in clinical signs and symptoms.