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Maurya RP, Mishra CP, Roy M, Singh VP, Singh MK, Yadav M, Al-Mujaini AS. Ocular cysticercosis at a teaching hospital in Northern India. Oman J Ophthalmol 2021; 14:8-13. [PMID: 34084028 PMCID: PMC8095313 DOI: 10.4103/ojo.ojo_122_2020] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/04/2020] [Revised: 10/04/2020] [Accepted: 10/06/2020] [Indexed: 11/17/2022] Open
Abstract
BACKGROUND: Ocular cysticercosis (OC) is common in tropical countries. This study aimed to analyze the clinical presentation patterns, management and treatment outcomes of OC cases seen at a teaching hospital in North India. METHODS: This study took place between March 2014 and February 2019. A total of 36 patients with OC were analyzed to determine clinical presentation and outcomes. RESULTS: Of the 36 patients, 13 (36.11%) were male and 23 (63.89%) were female. The most frequently affected age group was 10–29 years (n = 22; 61.11%). All of the patients had unilateral lesions, with involvement of the left eye in 22 (61.11%) and the right in 14 (38.89%). The majority of cases were isolated to the ocular region; however, five (13.89%) demonstrated neural involvement as well. In terms of cyst location, 15 (41.67%) were orbital, 13 (36.11%) were subconjunctival and four each (11.11%) were intraocular or on the eyelid. The most common clinical presentations were subconjunctival masses or proptosis in 13 each (36.11%) and periorbital swelling in 12 (33.33%). Most patients received medical treatment (n – 23; 63.89%), while the others required surgical excision. Recurrence was noted in seven patients (19.44%), of which three underwent surgery while the rest were treated medically. Two patients (5.56%) developed phthisis. Conclusions: In this study, OC cysts were more often orbital or subconjunctival compared to findings reported from Western countries. In addition, a female preponderance was noted in contrast to previously reported findings. Advanced radioimaging is crucial to ensure early diagnosis and treatment.
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Affiliation(s)
- Rajendra P Maurya
- Regional Institute of Ophthalmology, Institute of Medical Sciences, Banaras Hindu University, Varanasi, Uttar Pradesh, India
| | - C P Mishra
- Department of Community Medicine, Institute of Medical Sciences, Banaras Hindu University, Varanasi, Uttar Pradesh, India
| | - Meghna Roy
- Regional Institute of Ophthalmology, Institute of Medical Sciences, Banaras Hindu University, Varanasi, Uttar Pradesh, India
| | - Virendra P Singh
- Regional Institute of Ophthalmology, Institute of Medical Sciences, Banaras Hindu University, Varanasi, Uttar Pradesh, India
| | - Mahendra K Singh
- Regional Institute of Ophthalmology, Institute of Medical Sciences, Banaras Hindu University, Varanasi, Uttar Pradesh, India
| | - Mahima Yadav
- Department of Pathology, Institute of Medical Sciences, Banaras Hindu University, Varanasi, Uttar Pradesh, India
| | - Abdullah S Al-Mujaini
- Department of Ophthalmology, College of Medicine and Health Sciences, Sultan Qaboos University, Sultan Qaboos University Hospital, Muscat, Oman
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2
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Al-Mujaini A, Maurya R, Mishra CP, Roy M, Singh V, Singh M, Yadav M. Ocular cysticercosis at a teaching hospital in Northern India. Oman J Ophthalmol 2021. [DOI: 10.4103/0974-620x.190051] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
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3
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Hamamoto Filho PT, Singh G, Winkler AS, Carpio A, Fleury A. Could Differences in Infection Pressure Be Involved in Cysticercosis Heterogeneity? Trends Parasitol 2020; 36:826-834. [DOI: 10.1016/j.pt.2020.07.003] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/03/2020] [Revised: 07/03/2020] [Accepted: 07/05/2020] [Indexed: 12/13/2022]
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4
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Wiwanitkit V. Diagnostic and management strategies of ocular cysticercosis: current perspectives. EXPERT REVIEW OF OPHTHALMOLOGY 2020. [DOI: 10.1080/17469899.2020.1806714] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
Affiliation(s)
- Viroj Wiwanitkit
- Department of Community Medicine, Dr DY Patil University, Pune, India
- Department of Tropical Medicine, Hainan Medical University, Haikou, China
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5
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Del Brutto OH. Current approaches to cysticidal drug therapy for neurocysticercosis. Expert Rev Anti Infect Ther 2020; 18:789-798. [DOI: 10.1080/14787210.2020.1761332] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/01/2023]
Affiliation(s)
- Oscar H. Del Brutto
- School of Medicine, Universidad Espíritu Santo, Ecuador, Samborondón, Ecuador
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6
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Ganesh SK, Priyanka. Analysis of Clinical Profile, Investigation, and Management of Ocular Cysticercosis Seen at a Tertiary Referral Centre. Ocul Immunol Inflamm 2018; 26:550-557. [DOI: 10.1080/09273948.2017.1413395] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
Affiliation(s)
- Sudha K. Ganesh
- Uvea and Ocular Pathology, Medical Research Foundation, Nungambakkam, Chennai, India
| | - Priyanka
- Sankara Nethralya, Uvea, Medical Research Foundation, Nungambakkam, Chennai, India
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7
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Gonzales I, Rivera JT, Garcia HH. Pathogenesis of Taenia solium taeniasis and cysticercosis. Parasite Immunol 2016; 38:136-46. [PMID: 26824681 DOI: 10.1111/pim.12307] [Citation(s) in RCA: 36] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/09/2015] [Accepted: 01/25/2016] [Indexed: 12/22/2022]
Abstract
Taenia solium infections (taeniasis/cysticercosis) are a major scourge to most developing countries. Neurocysticercosis, the infection of the human nervous system by the cystic larvae of this parasite, has a protean array of clinical manifestations varying from entirely asymptomatic infections to aggressive, lethal courses. The diversity of clinical manifestations reflects a series of contributing factors which include the number, size and location of the invading parasites, and particularly the inflammatory response of the host. This manuscript reviews the different presentations of T. solium infections in the human host with a focus on the mechanisms or processes responsible for their clinical expression.
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Affiliation(s)
- I Gonzales
- Cysticercosis Unit, Department of Transmissible Diseases, Instituto Nacional de Ciencias Neurológicas, Lima, Peru
| | - J T Rivera
- Department of Microbiology and Center for Global Health, Universidad Peruana Cayetano Heredia, Lima, Peru
| | - H H Garcia
- Cysticercosis Unit, Department of Transmissible Diseases, Instituto Nacional de Ciencias Neurológicas, Lima, Peru.,Department of Microbiology and Center for Global Health, Universidad Peruana Cayetano Heredia, Lima, Peru
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8
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Abstract
Neurocysticercosis is an important cause of seizures worldwide and is endemic in most of Latin America, Sub-Saharan Africa, Southeast Asia, India, and China. Neurocysticercosis has profoundly different disease manifestations varying from asymptomatic presentation to life-threatening hydrocephalus. Clinical manifestations, pathogenesis, diagnostic methods, and optimal treatment vary with the location, number of lesions, and host response. Diagnosis is based on a combination of clinical presentation, neuroimaging findings, history of exposure, and serologic testing. Initial therapy should be focused on symptom management including seizure control and management of increased intracranial pressure. Emerging data are demonstrating that the optimal management approach varies with stage. Single enhancing or cystic lesions should be treated with albendazole and steroids. Patients with more than two cystic lesions should be treated with combination therapy with albendazole and praziquantel, whereas patients with hydrocephalus benefit from surgical management, especially with minimally invasive approaches.
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Affiliation(s)
- Camille M Webb
- Infectious Disease Division, Department of Internal Medicine, University of Texas Medical Branch, 301 University Boulevard, Rt 0435, Galveston, TX, 77555-0435, USA
| | - A Clinton White
- Infectious Disease Division, Department of Internal Medicine, University of Texas Medical Branch, 301 University Boulevard, Rt 0435, Galveston, TX, 77555-0435, USA.
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9
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Ocular parasitoses: A comprehensive review. Surv Ophthalmol 2016; 62:161-189. [PMID: 27720858 DOI: 10.1016/j.survophthal.2016.09.005] [Citation(s) in RCA: 48] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/21/2016] [Revised: 09/27/2016] [Accepted: 09/29/2016] [Indexed: 12/14/2022]
Abstract
Parasitic infections of the eyes are a major cause of ocular diseases across the globe. The causative agents range from simple organisms such as unicellular protozoans to complex metazoan helminths. The disease spectrum varies depending on the geographic location, prevailing hygiene, living and eating habits of the inhabitants, and the type of animals that surround them. They cause enormous ocular morbidity and mortality not because they are untreatable, but largely due to late or misdiagnosis, often from unfamiliarity with the diseases produced. We provide an up-to-date comprehensive overview of the ophthalmic parasitoses. Each section describes the causative agent, mode of transmission, geographic distribution, ocular pathologies, and their management for common parasites with brief mention of the ones that are rare.
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Takkar B, Chandra P, Kumar K, Vanathi M. Toxic granulomatous anterior uveitis in live intracameral cysticercosis masquerading as leukocoria. Can J Ophthalmol 2015; 49:e140-1. [PMID: 25433748 DOI: 10.1016/j.jcjo.2014.08.011] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/22/2014] [Revised: 08/13/2014] [Accepted: 08/19/2014] [Indexed: 11/19/2022]
Affiliation(s)
| | | | - Kiran Kumar
- Cornea & Ocular Surface Services, Dr R P Centre for Ophthalmic Sciences, All India Institute of Medical Sciences, Ansari Nagar, New Delhi, India
| | - Murugesan Vanathi
- Cornea & Ocular Surface Services, Dr R P Centre for Ophthalmic Sciences, All India Institute of Medical Sciences, Ansari Nagar, New Delhi, India.
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11
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John D, Irodi A, John S, Kuriakose T, Jacob P. Unusual presentation of subretinal cysticercosis with hypopyon uveitis. J Pediatr Ophthalmol Strabismus 2015; 52 Online:e17-9. [PMID: 25871533 DOI: 10.3928/01913913-20150311-13] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/12/2013] [Accepted: 01/14/2015] [Indexed: 11/20/2022]
Abstract
Subretinal cysticercosis presenting with anterior uveitis and hypopyon is rare. A 7-year-old boy presented with pain and hypopyon in the right eye. Ultrasonography showed a cystic lesion with scolex. Because visual prognosis was poor, he was treated conservatively. Timely diagnosis would facilitate early therapy and prevent visual loss.
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12
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Abstract
Neurocysticercosis, the most common helminthic infection of the nervous system, is a major cause of acquired epilepsy worldwide. The disease occurs when humans become intermediate hosts of the tapeworm Taenia solium after ingesting its eggs by contagion from an asymptomatic Taenia carrier. Within the nervous system, parasites may locate in brain parenchyma, subarachnoid space, ventricular system, or spinal cord, causing several pathological changes that are responsible for the clinical pleomorphism of the disease. Seizures are the most common clinical manifestation, but a sizable proportion of patients develop focal deficits, intracranial hypertension, or cognitive decline. Preoperative diagnosis of neurocysticercosis is possible after proper integration of data from neuroimaging studies and immunological tests. Cysticidal drugs (albendazole and praziquantel) have changed the prognosis of most patients with neurocysticercosis. The use of these drugs has shown to reduce the parasite load within the central nervous system and to improve the clinical prognosis of the disease in many cases. Future studies should focus on disease eradication through the implementation of control programs against all the interrelated steps in the life cycle of T solium, including human carriers of the adult tapeworm, infected pigs, and eggs in the environment.
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Affiliation(s)
- Oscar H. Del Brutto
- Department of Neurological Sciences, School of Medicine, Universidad Espíritu Santo–Ecuador, Hospital-Clínica Kennedy, Guayaquil, Ecuador
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13
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Sahu PS, Seepana J, Padela S, Sahu AK, Subbarayudu S, Barua A. Neurocysticercosis in children presenting with afebrile seizure: clinical profile, imaging and serodiagnosis. Rev Inst Med Trop Sao Paulo 2014; 56:253-8. [PMID: 24879004 PMCID: PMC4085870 DOI: 10.1590/s0036-46652014000300011] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/26/2012] [Accepted: 10/04/2013] [Indexed: 11/22/2022] Open
Abstract
Neurocysticercosis (NCC) is one of the major causes of childhood seizures
in developing countries including India and Latin America. In this study neurological
pediatric cases presenting with afebrile seizures were screened for anti-Cysticercus
antibodies (IgG) in their sera in order to estimate the possible burden of
cysticercal etiology. The study included a total of 61 pediatric afebrile seizure
subjects (aged one to 15 years old); there was a male predominance. All the sera were
tested using a pre-evaluated commercially procured IgG-ELISA kit (UB-Magiwell
Cysticercosis Kit ™). Anti-Cysticercus antibody in serum was positive in 23 of 61 (37.7%)
cases. The majority of cases with a positive ELISA test presented with generalized
seizure (52.17%), followed by complex partial seizure (26.08%), and simple partial
seizure (21.73%). Headaches were the major complaint (73.91%). Other presentations
were vomiting (47.82%), pallor (34.78%), altered sensorium (26.08%), and muscle
weakness (13.04%). There was one hemiparesis case diagnosed to be NCC. In this study
one child without any significant findings on imaging was also found to be positive
by serology. There was a statistically significant association found between the
cases with multiple lesions on the brain and the ELISA-positivity (p
= 0.017). Overall positivity of the ELISA showed a potential cysticercal etiology.
Hence, neurocysticercosis should be suspected in every child presenting with afebrile
seizure especially with a radio-imaging supportive diagnosis in tropical developing
countries or areas endemic for taeniasis/cysticercosis.
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Affiliation(s)
| | - Jyotsna Seepana
- Department of Microbiology, Alluri Sitarama Raju Academy of Medical Sciences, Eluru, Andhra Pradesh-534005, India
| | - Sudarsini Padela
- Department of Paediatrics, Alluri Sitarama Raju Academy of Medical Sciences, Eluru, Andhra Pradesh-534005, India
| | - Abani Kanta Sahu
- Department of Paediatrics, Alluri Sitarama Raju Academy of Medical Sciences, Eluru, Andhra Pradesh-534005, India
| | - Swarna Subbarayudu
- Department of Microbiology, Alluri Sitarama Raju Academy of Medical Sciences, Eluru, Andhra Pradesh-534005, India
| | - Ankur Barua
- Division of Community Medicine, School of Medicine, International Medical University, Kuala Lumpur, Malaysia
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Mas-Coma S, Agramunt VH, Valero MA. Neurological and ocular fascioliasis in humans. ADVANCES IN PARASITOLOGY 2014; 84:27-149. [PMID: 24480313 DOI: 10.1016/b978-0-12-800099-1.00002-8] [Citation(s) in RCA: 74] [Impact Index Per Article: 7.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/11/2022]
Abstract
Fascioliasis is a food-borne parasitic disease caused by the trematode species Fasciola hepatica, distributed worldwide, and Fasciola gigantica, restricted to given regions of Africa and Asia. This disease in humans shows an increasing importance, which relies on its recent widespread emergence related to climate and global changes and also on its pathogenicity in the invasive, biliary, and advanced chronic phases in the human endemic areas, mainly of developing countries. In spite of the large neurological affection capacity of Fasciola, this important pathogenic aspect of the disease has been pronouncedly overlooked in the past decades and has not even appear within the numerous reviews on the parasitic diseases of the central nervous system. The aim of this wide retrospective review is an in-depth analysis of the characteristics of neurological and ocular fascioliasis caused by these two fasciolid species. The terms of neurofascioliasis and ophthalmofascioliasis are restricted to cases in which the direct affection of the central nervous system or the eye by a migrant ectopic fasciolid fluke is demonstrated by an aetiological diagnosis of recovered flukes after surgery or spontaneous moving-out of the fluke through the orbit. Cases in which the ectopic fluke is not recovered and the symptoms cannot be explained by an indirect affection at distance may also be included in these terms. Neurofascioliasis and ophthalmofascioliasis cases are reviewed and discussed. With regard to fascioliasis infection giving an indirect rise to neurological affection, the distribution and frequency of cases are analysed according to geography, sex, and age. Minor symptoms and major manifestations are discussed. Three main types of cases are distinguished depending on the characteristics of their manifestations: genuine neurological, meningeal, and psychiatric or neuropsychic. The impressive symptoms and signs appearing in each type of these cases are included. Brain examination techniques and neuroimaging useful for the diagnosis of neurological cases are exposed. Within fascioliasis infection indirectly causing ocular manifestations, case distribution and frequency are similarly analysed. A short analysis is devoted to clarify the first reports of a human eye infection. The affection of related and close organs is discussed by differentiating between cases of the dorsal spine, pulmonary manifestations, heart and vessel affection, findings in blood vessels, skin and dermatologic reactions, cases of ectopic mature flukes, and upper body locations. The clinical complexity of the puzzling polymorphisms, the disconcerting multifocality of the manifestations, and their changes along the evolution of the disease in the same patient, as well as the differences between the clinical pictures shown by different patients, are highlighted. The many syndromes involved are enumerated. The pathogenic and physiological mechanisms underlying neurofascioliasis and ophthalmofascioliasis caused by ectopic flukes and the physiopathogenic processes indirectly affecting the central nervous system and causing genuine neurological, meningeal, psychiatric, and ocular manifestations are discussed. The diagnosis of neurological and ophthalmologic fascioliasis is analysed in depth, including clinical and paraclinical diagnosis, eosinophilia in the blood and cerebrospinal fluid, differential diagnosis from other parasitic infections such as helminthiases and myiases, an update of human fascioliasis diagnosis, and fluke and/or fluke egg recovery by surgery. Diagnostic analyses with faecal and blood samples for fascioliasis patients are updated. Therapy for patients with major neurological manifestations includes both antiparasitic treatments and anti-inflammatory therapeutics. Prognosis in fascioliasis patients with neurological manifestations is discussed, with emphasis on sequelae and fatal cases, and the care of patients with ophthalmologic manifestations is added. Conclusions indicate that neurological cases are overlooked in human fascioliasis endemic areas and also in developing countries in general. In remote zones, rural health centres and small hospitals in or near the human endemic areas do not dispose of the appropriate equipments for neurological analyses. Moreover, physicians may not be aware about the potential relationship between liver fluke infection and neurological implications, and such cases may therefore remain misdiagnosed, even in developed countries. Priority should henceforth be given to the consideration of neurological and ocular affection in human endemic areas, and efforts should be implemented to assess their characteristics and frequency. Their impact should also be considered when estimating the global burden of fascioliasis.
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Key Words
- Clinical polymorphisms, multifocality, manifestation changes, and syndromes
- Diagnosis, treatment, prognosis, sequelae, and fatal cases
- Distribution and frequency
- Fasciola hepatica, F. gigantica
- Human fascioliasis
- Minor and major symptoms and signs
- Neurofascioliasis and ophthalmofascioliasis
- Neurological and ocular affections
- Neurological, meningeal, and psychiatric manifestations
- Ocular disorders
- Pathogenic and physiological mechanisms
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Abstract
Known as a disease of swine in ancient civilizations, cysticercosis is currently considered the most common helminthic infection of the nervous system, and a leading cause of acquired epilepsy worldwide. The disease occurs when humans become intermediate hosts of the tapeworm Taenia solium by ingesting its eggs from contaminated food or, most often, directly from a Taenia carrier by the fecal-oral route. Once in the human intestine, Taenia eggs evolve to oncospheres that, in turn, cross the intestinal wall and lodge in human tissues - especially the nervous system - where cysticerci develop. The brain is a hostile environment in which parasites attempt to escape the immune surveillance while the host is trying to drive out the infection. In some cases, cysticerci are destroyed by this immunological attack, while in others, parasites may live unchanged for years. Cysticerci may be located in brain parenchyma, subarachnoid space, ventricular system, or spinal cord, causing a myriad of pathologic changes that are the main changes responsible for the clinical pleomorphism of neurocysticercosis. Seizures are the most common clinical manifestation of the disease, but some patients present with focal deficits, intracranial hypertension, or cognitive decline. With the exception of cystic lesions showing the scolex as an eccentric nodule, neuroimaging findings of neurocysticercosis are nonspecific and may be seen in other diseases of the nervous system. Likewise, immune diagnostic tests have been faced with problems related to poor sensitivity or specificity. Accurate diagnosis is possible after interpretation of clinical data together with findings of neuroimaging studies and results of immunologic tests, in a proper epidemiologic scenario. The introduction of cysticidal drugs has changed the prognosis of neurocysticercosis. Praziquantel and albendazole have been shown to reduce the burden of infection in the brain (as seen on neuroimaging studies) and to improve the clinical course of the disease in most patients. Further efforts should be directed towards eradicating this disease through the implementation of control programs for all the interrelated steps in the life cycle of T. solium, including human carriers of the adult tapeworm, infected pigs, and eggs in the environment.
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Affiliation(s)
- Oscar H Del Brutto
- School of Medicine, Universidad de Especialidades Espiritu Santo and Department of Neurological Sciences, Hospital Clinica Kennedy, Guayaquil, Ecuador.
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Djurković-Djaković O, Bobić B, Nikolić A, Klun I, Dupouy-Camet J. Pork as a source of human parasitic infection. Clin Microbiol Infect 2013; 19:586-94. [DOI: 10.1111/1469-0691.12162] [Citation(s) in RCA: 32] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
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Li JJ, Zhang LW, Li H, Hu ZL. Clinical and pathological characteristics of intraocular cysticercosis. THE KOREAN JOURNAL OF PARASITOLOGY 2013; 51:223-9. [PMID: 23710092 PMCID: PMC3662068 DOI: 10.3347/kjp.2013.51.2.223] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 06/22/2012] [Revised: 12/23/2012] [Accepted: 01/03/2013] [Indexed: 11/23/2022]
Abstract
This study aimed to explore the clinical, radiological, and pathological characteristics of intraocular cysticercosis due to Taenia solium metacestode infection. Total 8 patients diagnosed with intraocular cysticercosis at the Red Cross Hospital of Yunnan Province, China were examined retrospectively. Patients with clear dioptic media had undergone fundus chromophotography. All patients underwent B ultrasonography of the ocular region (CT) successive scanning of the orbit and cerebral tissues. Parasites were extracted surgically and then examined pathologically. The fundus chromophotography showed a white and condensing scolex package in the vesicle. The B ultrasonic examination showed a vesicle-like echogenic mass in the vitreous chamber, in which the high-level echo spot was the cysticercus scolex. The pathological examinations showed that the vesicle wall exhibited hyaline degeneration, inflammatory cell infiltration, neuroglial fiber, and glial cell proliferation layers from the inside to the outside. The scolex is round and is composed of the outer tissue (the body wall) and the inner furrow tissue; these tissues migrated together. Primordially differentiated sucking discs were found in one case, but no hooklets were found. The inner scolex tissue was folded like a paper flower. The severity of intraocular disease is closely correlated with the pathophysiological processes of the cysticercus worm. Pathological examination of the intraocular lesions can help to evaluate the course of the disease as well as to provide a scientific basis for effective antiparasitic medication.
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Affiliation(s)
- Juan-Juan Li
- Department of Ophthalmology, Red Cross Hospital of Yunnan, Kunming, China
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18
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Abstract
Cysticercosis, an infection caused by the cystic larvae of the pork tapeworm Taenia solium, is one of the most frequent parasitic infections of the human nervous system (neurocysticercosis). It is endemic in most of Latin America, the sub-Saharan Africa, and vast parts of Asia, including the Indian subcontinent. It has also been increasingly diagnosed in developed countries because of migration of people from endemic zones and exposure in travelers. The life cycle involves the development of the adult tapeworm in the human small intestine (after ingesting infected pork with cysts) and larval infection in pig tissues (after ingesting human stools containing the eggs of the tapeworm). Humans get infected by the fecal-oral route, most often from a direct contact with an asymptomatic Taenia carrier. Most common clinical presentations are seizures (particularly late-onset seizures), chronic headaches, and intracranial hypertension. However, cysticerci can locate anywhere in the human nervous system, thus potentially causing almost any neurological syndrome and making clinical diagnosis a difficult task. Neuroimaging is the main diagnostic tool, and specific serology confirms the diagnosis and helps to define the diagnosis when images are unclear. Factors such as location (extraparenchymal versus intraparenchymal), number, size and evolutive stage of the parasites determine the clinical manifestations, therapeutic approach, and prognosis. Management includes symptomatic drugs (analgesics, antiepileptic drugs, anti-inflammatory agents) and in many cases cysticidal drugs, either albendazole or praziquantel. In recent years, efforts have focused on transmission control and potential elimination in endemic regions.
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Affiliation(s)
- Oscar H Del Brutto
- School of Medicine, Universidad Espiritu Santo, Guayaquil, Ecuador; Department of Neurological Sciences, Hospital Clinica Kennedy, Guayaquil, Ecuador.
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Mulla MA, Banker AS, Rishi E, Biswas J. Degenerated Intravitreal Cysticercus Cyst Masquerading as Endogenous Endophthalmitis. Ocul Immunol Inflamm 2012; 20:378-80. [DOI: 10.3109/09273948.2012.700991] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
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Wiwanitkit V. Letter to the editor. Orbit 2012; 31:203. [PMID: 22551378 DOI: 10.3109/01676830.2011.639478] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/31/2023]
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Wender JD, Rathinam SR, Shaw RE, Cunningham ET. Author response to “Intraocular Cysticercosis” by Somsri Wiwanitkit and Viroj Wiwanitkit. Ocul Immunol Inflamm 2012; 20:148. [DOI: 10.3109/09273948.2012.672873] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
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Del Brutto OH. Neurocysticercosis: a review. ScientificWorldJournal 2012; 2012:159821. [PMID: 22312322 PMCID: PMC3261519 DOI: 10.1100/2012/159821] [Citation(s) in RCA: 116] [Impact Index Per Article: 9.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/03/2011] [Accepted: 11/01/2011] [Indexed: 11/25/2022] Open
Abstract
Neuroysticercosis is the most common helminthic infection of the nervous system, and a leading cause of acquired epilepsy worldwide. The disease occurs when humans become intermediate hosts of Taenia solium by ingesting its eggs from contaminated food or, most often, directly from a taenia carrier by the fecal-to-oral route. Cysticerci may be located in brain parenchyma, subarachnoid space, ventricular system, or spinal cord, causing pathological changes that are responsible for the pleomorphism of neurocysticercosis. Seizures are the most common clinical manifestation, but many patients present with focal deficits, intracranial hypertension, or cognitive decline. Accurate diagnosis of neurocysticercosis is possible after interpretation of clinical data together with findings of neuroimaging studies and results of immunological tests. The introduction of cysticidal drugs have changed the prognosis of most patients with neurocysticercosis. These drugs have shown to reduce the burden of infection in the brain and to improve the clinical course of the disease in most patients. Further efforts should be directed to eradicate the disease through the implementation of control programs against all the interrelated steps in the life cycle of T. solium, including human carriers of the adult tapeworm, infected pigs, and eggs in the environment.
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Affiliation(s)
- Oscar H Del Brutto
- Department of Neurological Sciences, Hospital-Clinica Kennedy, Guayaquil, Ecuador.
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Wender JD, Rathinam SR, Shaw RE, Cunningham ET. Intraocular cysticercosis: case series and comprehensive review of the literature. Ocul Immunol Inflamm 2011; 19:240-5. [PMID: 21770801 DOI: 10.3109/09273948.2011.580074] [Citation(s) in RCA: 32] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
PURPOSE To analyze the demographics and clinical characteristics in patients with intraocular cysticercosis. METHODS Retrospective case series and comprehensive literature review. RESULTS Intraocular cysticercosis was diagnosed in 21 of 21,079 patients (0.10%) seen by the uveitis service at Aravind Eye Hospital. At presentation, visual acuity was 20/200 or worse in 14 eyes (63.6%). Inflammation was unilateral in all but one patient (95.2%). The cyst was located in the vitreous cavity in 36.4% of eyes and in the subretinal space in 63.6% of eyes. In the literature review, most patients were affected unilaterally (98.5%); visual acuity at presentation was 20/200 or worse in 82.3% of eyes; and the cyst was located in the vitreous cavity in 59.5% of eyes. CONCLUSIONS Intraocular cysticercosis usually affects young patients unilaterally. The cyst may be in either the vitreous cavity or the subretinal space, and visual acuity at presentation is often poor.
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Affiliation(s)
- Jon D Wender
- Department of Ophthalmology, California Pacific Medical Center, San Francisco, California, USA
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Relative seroprevalence of cysticercus antigens and antibodies and antibodies to Taenia ova in a population sample in south India suggests immunity against neurocysticercosis. Trans R Soc Trop Med Hyg 2011; 105:153-9. [DOI: 10.1016/j.trstmh.2010.10.007] [Citation(s) in RCA: 21] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/29/2010] [Revised: 10/27/2010] [Accepted: 10/27/2010] [Indexed: 11/18/2022] Open
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Malhotra R, Garg P, Mishra R, Khanduri S. Orbital cysticercosis: masquerading as orbital inflammatory disorder. Trop Doct 2010; 41:119-20. [DOI: 10.1258/td.2010.100249] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
Abstract
An eight-year-old female presented with symptoms and signs of orbital inflammation and proptosis. Enzyme-linked immunosorbent assay and magnetic resonance imaging confirmed the diagnosis of extraocular myocysticercosis. Oral treatment with albendazole and steroids was followed by spontaneous extrusion and resolution of the disease.
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Affiliation(s)
- Rubii Malhotra
- Ophthalmology Department, Era's Lucknow Medical College and Hospital, Lucknow
| | - Pragati Garg
- Ophthalmology Department, Era's Lucknow Medical College and Hospital, Lucknow
| | - Roop Mishra
- Ophthalmology Department, Hari Netralaya, Allahabad, Uttar Pradesh
| | - Sachin Khanduri
- Radiodiagnosis Department, Era's Lucknow Medical College and Hospital, Lucknow, Uttar Pradesh, India
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Orbital cysticercosis: clinical manifestations, diagnosis, management, and outcome. Ophthalmology 2010; 117:600-5, 605.e1. [PMID: 20060168 DOI: 10.1016/j.ophtha.2009.07.030] [Citation(s) in RCA: 68] [Impact Index Per Article: 4.9] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/05/2008] [Revised: 07/17/2009] [Accepted: 07/23/2009] [Indexed: 11/22/2022] Open
Abstract
PURPOSE To describe the clinical manifestations, diagnosis, management, and outcome of orbital cysticercosis in a tertiary eye care center in Southern India. DESIGN Retrospective observational case series. PARTICIPANTS A total of 171 patients with orbital cysticercosis. METHODS Retrospective case series involving consecutive patients with orbital cysticercosis from March 1990 to December 2001. MAIN OUTCOME MEASURES Clinical resolution and significant residual deficit. RESULTS The median age at presentation was 13 years (range 2-65 years), and 93 patients (54.4%) were male. The 3 main symptoms at presentation were periocular swelling (38%), proptosis (24%), and ptosis (14%) with a median duration of 2 (range 0-24) months. The 3 main signs at presentation included ocular motility restriction (64.3%), proptosis (44.4%), and diplopia (36.8%). The cyst locations in the decreasing order of frequency were anterior orbit (69%), subconjunctival space (24.6%), posterior orbit (5.8%), and the eyelid (0.6%). In all, 80.7% of patients had cysts in relation to an extraocular muscle. The superior rectus (33.3%) was the most commonly involved extraocular muscle. Contact B-scan ultrasonography was diagnostic of cysticercosis in 84.4% of patients. Orbital cysticercosis was managed medically in 158 of 166 patients. Although 149 patients received a combination of oral albendazole and prednisolone, 1 patient received oral albendazole alone, 7 patients received oral prednisolone alone, and 1 patient received oral praziquantel. Surgery was performed in 8 patients. Clinical resolution was seen in 128 of 138 patients (92.8%) at 1 month and 81 of 85 patients (95.3%) at 3 months. A significant residual deficit was present in 29 of 138 patients (21.0%) at the final follow-up and included proptosis in 7 patients, ptosis in 6 patients, ocular motility restriction in 3 patients, diplopia in 2 patients, strabismus in 2 patients, and a combination of the above in 9 patients. CONCLUSIONS Orbital cysticercosis is a common clinical condition in the developing world. It typically affects young individuals and has a wide spectrum of clinical manifestations. Both B-scan ultrasonography and computed tomography scan are useful in confirming the diagnosis. Despite resolution of cysticercosis with medical management, a significant proportion of patients may have residual functional deficits.
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Intratarsal keratinous cysts of the Meibomian gland: distinctive clinicopathologic and immunohistochemical features in 6 cases. Am J Ophthalmol 2010; 149:82-94. [PMID: 19875094 DOI: 10.1016/j.ajo.2009.07.033] [Citation(s) in RCA: 44] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/29/2009] [Revised: 07/23/2009] [Accepted: 07/23/2009] [Indexed: 11/23/2022]
Abstract
PURPOSE To describe 6 patients representing a new entity of Meibomian gland keratinous cysts. DESIGN Retrospective, interventional, clinicopathologic study. METHODS Review of clinical histories and findings, histopathologic evaluations, and immunohistochemical studies of the cysts' linings with monoclonal antibodies directed against cytokeratins and cell surface epithelial markers. RESULTS Six patients with an average age of 62.5 years had noninflamed, upper eyelid nodules fixed to the tarsus. Eyelid eversion revealed a white-yellow nodular bulge in 3 cases, a bluish coloration in 2 cases, and a translucent appearance in 1 case. The cysts were lined by undulating squamous epithelium possessing an inner eosinophilic cuticle that produced a peculiar refractile, strand-like intracavitary keratin. Immunostaining for cytokeratin 17 and carcinoembryonic antigen showed strongly positive results in the Meibomian gland cysts and, by comparison, negative results in cutaneous epidermal cysts. Multiple recurrences occurred after incomplete excisions. CONCLUSIONS After chalazia and sebaceous cell tumors, Meibomian gland keratinous cysts seem to be the third most common primary intratarsal lesion. Anterior fixation to the tarsus and posterior protrusion beneath the palpebral conjunctiva without inflammation suggest the diagnosis. Histopathologic and immunohistochemical evaluations can distinguish unequivocally the current entity from common epidermal cysts. The optimal treatment consists of an en bloc excision of the cyst with a tarsectomy, or else wide excision with intratarsal cautery of any remnants of the cellular lining.
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Sahu PS, Parija SC, Sahu PK. Tear IgA-ELISA: a novel and sensitive method for diagnosis of ophthalmic cysticercosis. Acta Trop 2008; 106:168-74. [PMID: 18462701 DOI: 10.1016/j.actatropica.2008.03.004] [Citation(s) in RCA: 13] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/04/2007] [Revised: 03/09/2008] [Accepted: 03/11/2008] [Indexed: 11/29/2022]
Abstract
For the first time, presence of locally secreted specific IgA antibodies in tear specimen from human with ophthalmic cysticercosis is documented in the present study. The ELISA using Taenia solium metacestode excretory secretory (ES) antigen demonstrated a diagnostic level of IgA antibodies in tears with 100% sensitivity (6 out of 6 confirmed cases of ophthalmic cysticercosis) whereas, 25 of 34 (73.52%) clinically suspected cases were diagnosed positive. The ELISA using T. solium metacestode somatic antigen detected a diagnostic titre of IgA antibody in tears with a sensitivity of 50% (3 out of 6 confirmed cases). The specificity of the tear IgAELISA using T. solium metacestode somatic and ES antigens is observed to be 94.87% and 92.3%, respectively. Overall in tears, the ELISA using T. solium metacestode ES antigens for detection of IgA antibodies shows a higher diagnostic efficiency (93.33%) compared to that using T. solium metacestode somatic antigen (88.88%). The sensitivities of the ELISA for detection of IgA antibodies in tears is observed to be higher than that for detection of IgG antibodies in serum using either somatic or ES antigens of the parasite.
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Affiliation(s)
- Priyadarshi S Sahu
- Department of Microbiology, Jawaharlal Institute of Postgraduate Medical Education and Research, Pondicherry, India.
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