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Cysticercosis of the Human Nervous System PDF

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Cysticercosis of the Human NNNeeerrrvvvooouuusss SSSSSSyyyyyysssssstttttteeeeeemmmmmm Oscar H. Del Brutto Héctor H. García Cysticercosis of the Human Nervous System Oscar H. Del Brutto (cid:129) Héctor H. García Cysticercosis of the Human Nervous System Oscar H. Del Brutto Héctor H. García School of Medicine Cysticercosis Unit Universidad Espíritu Santo Instituto Nacional de Ciencias Neurológicas Ecuador Lima Peru Department of Neurological Sciences Hospital-Clinica Kennedy School of Sciences Guayaquil Universidad Peruana Cayetano Heredia Ecuador Lima Peru ISBN 978-3-642-39021-0 ISBN 978-3-642-39022-7 (eBook) DOI 10.1007/978-3-642-39022-7 Springer Heidelberg New York Dordrecht London Library of Congress Control Number: 2013946240 © Springer-Verlag Berlin Heidelberg 2014 This work is subject to copyright. All rights are reserved by the Publisher, whether the whole or part of the material is concerned, specifi cally the rights of translation, reprinting, reuse of illustrations, recitation, broadcasting, reproduction on microfi lms or in any other physical way, and transmission or information storage and retrieval, electronic adaptation, computer software, or by similar or dissimilar methodology now known or hereafter developed. Exempted from this legal reservation are brief excerpts in connection with reviews or scholarly analysis or material supplied specifi cally for the purpose of being entered and executed on a computer system, for exclusive use by the purchaser of the work. Duplication of this publication or parts thereof is permitted only under the provisions of the Copyright Law of the Publisher's location, in its current version, and permission for use must always be obtained from Springer. Permissions for use may be obtained through RightsLink at the Copyright Clearance Center. Violations are liable to prosecution under the respective Copyright Law. The use of general descriptive names, registered names, trademarks, service marks, etc. in this publication does not imply, even in the absence of a specifi c statement, that such names are exempt from the relevant protective laws and regulations and therefore free for general use. While the advice and information in this book are believed to be true and accurate at the date of publication, neither the authors nor the editors nor the publisher can accept any legal responsibility for any errors or omissions that may be made. The publisher makes no warranty, express or implied, with respect to the material contained herein. Printed on acid-free paper Springer is part of Springer Science+Business Media (www.springer.com) Preface Neurocysticercosis—defi ned as the infection of the central nervous system and its covering by the larval stage of the tapeworm T aenia solium —is a major public health challenge for most of the developing world and is increasingly recognized in developed countries due to mass immigration, refugee movements, international travelling, and overseas business affairs. Known since ancient civilizations as a dis- ease of swine and recognized as a human ailment during the Renaissance, it has not been until the past few decades when the introduction of modern neuroimaging techniques and reliable serologic tests allowed the preoperative recognition of neu- rocysticercosis and increased our knowledge on the many clinical forms of presen- tation of this parasitic disease. This, together with the availability of potent cysticidal drugs, has changed the prognosis of most affected patients. In addition, well- conducted epidemiologic surveys have changed our views on basic mechanisms of disease acquisition. Now, human cysticercosis must be considered a disease mainly transmitted from person to person, i.e., a healthy person ingesting T . solium eggs directly from a Taenia carrier by the fecal-oral route or through non-hygienic han- dling of food. In this context, the role of infected swine is to perpetuate the infection cycle only (human develop taeniasis after ingesting pork containing cysticerci). As occurs with most zoonosis, the disease complex of taeniasis/cysticercosis is closely linked to poverty and ignorance, disproportionately affecting underserved popu- lations. Despite the above-mentioned advances in diagnosis and therapy, neurocysticer- cosis is still the most common cause of acquired epilepsy in the world, with conservative estimates suggesting that 50 million people are infected by cysticerci. Much remains to be learned on some controversial aspects of this highly pleomorphic disease. This book intends to provide a comprehensive—and yet practical—review of basic and clinical aspects of human T . solium cysticercosis that will be of value to physicians of different specialties involved in the care of patients affected by this old scourge. Guayaquil, Ecuador Oscar H. Del Brutto Lima, Peru Héctor H. García v Contents 1 History of Taeniasis and Cysticercosis. . . . . . . . . . . . . . . . . . . . . . . . . 1 1.1 Ancient Knowledge. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 2 1.2 Unraveling Taenia solium. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 2 1.3 First Descriptions of Human Cysticercosis. . . . . . . . . . . . . . . . . . . 3 1.4 Taeniasis and Cysticercosis Were Caused by the Same Parasite. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 4 1.5 Pioneer Clinical Descriptions . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 4 1.6 Lessons from History . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 6 1.6.1 The British Endemia. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 6 1.6.2 The Epidemic of Burns in West New Guinea. . . . . . . . . . . 7 1.7 Modern Times: Advances in Diagnosis and Treatment . . . . . . . . . 8 References . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 8 2 Taenia solium: Biological Characteristics and Life Cycle . . . . . . . . . 11 2.1 Developmental Stages of Taenia solium. . . . . . . . . . . . . . . . . . . . . 11 2.2 Life Cycle of Taenia solium . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 15 References . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 19 3 Neuropathology of Cysticercosis. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 23 3.1 Microscopic Identifi cation of the Parasite. . . . . . . . . . . . . . . . . . . . 23 3.2 Macroscopic Appearance of Cysticerci . . . . . . . . . . . . . . . . . . . . . 25 3.3 Stages of Involution of Cerebral Cysticerci . . . . . . . . . . . . . . . . . . 29 3.4 Tissue Reactions Around Cysticerci. . . . . . . . . . . . . . . . . . . . . . . . 31 References . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 35 4 Epidemiology of Human Cysticercosis in Endemic Regions . . . . . . . 39 4.1 Data on Asymptomatic Individuals/General Population. . . . . . . . . 41 4.1.1 Rates of Infection . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 41 4.2 Data on Symptomatic Patients/Clinical Series . . . . . . . . . . . . . . . . 44 4.2.1 Antibodies, Antigen, and Imaging in Clinical Series . . . . . 44 4.2.2 Rates of Disease . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 45 4.2.3 Factors Associated to Infection and Disease. . . . . . . . . . . . 45 4.2.4 Geographical Variations in the Pattern of Clinical Expression of Cysticercosis . . . . . . . . . . . . . . . 46 References . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 46 vii viii Contents 5 Epidemiology of Human Cysticercosis in Non-endemic Regions and in the Traveler. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 51 5.1 The United States . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 53 5.2 Canada. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 54 5.3 Western European Countries. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 54 5.4 Countries of the Arab World. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 56 5.5 Australia and New Zealand. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 57 5.6 International Travelers . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 57 References . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 58 6 Immunopathology of Taeniasis and Cysticercosis . . . . . . . . . . . . . . . 63 6.1 Immunopathology of Human Cysticercosis . . . . . . . . . . . . . . . . . . 63 6.1.1 Single Enhancing Lesion. . . . . . . . . . . . . . . . . . . . . . . . . . . 64 6.1.2 Immune Response and Symptomatic Disease. . . . . . . . . . . 64 6.1.3 Diagnostic Antigens and Immunodiagnosis . . . . . . . . . . . . 66 6.1.4 Immunity to Cysticercosis and Comorbidity . . . . . . . . . . . 66 6.1.5 NCC in Immunosuppressed Patients. . . . . . . . . . . . . . . . . . 66 6.2 Immunopathology of Taenia solium Taeniasis . . . . . . . . . . . . . . . . 66 6.2.1 Tapeworm Prevalence and Life Span . . . . . . . . . . . . . . . . . 66 6.2.2 Tapeworm Infection . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 67 6.3 Immunopathology of Porcine Cysticercosis. . . . . . . . . . . . . . . . . . 67 References . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 68 7 Clinical Manifestations of Neurocysticercosis. . . . . . . . . . . . . . . . . . . 73 7.1 Parenchymal Neurocysticercosis. . . . . . . . . . . . . . . . . . . . . . . . . . . 74 7.1.1 Seizures. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 74 7.1.2 Focal Neurological Defi cits. . . . . . . . . . . . . . . . . . . . . . . . . 75 7.1.3 Increased Intracranial Pressure. . . . . . . . . . . . . . . . . . . . . . 75 7.1.4 Cognitive Decline and Psychiatric Disturbances . . . . . . . . 76 7.1.5 Headache. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 76 7.2 Subarachnoid Neurocysticercosis. . . . . . . . . . . . . . . . . . . . . . . . . . 77 7.2.1 Increased Intracranial Pressure. . . . . . . . . . . . . . . . . . . . . . 77 7.2.2 Cranial Nerve Involvement. . . . . . . . . . . . . . . . . . . . . . . . . 77 7.2.3 Acute Meningitis. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 78 7.2.4 Stroke Syndromes. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 78 7.3 Ventricular Neurocysticercosis . . . . . . . . . . . . . . . . . . . . . . . . . . . . 79 7.4 Spinal Neurocysticercosis. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 80 7.5 Other Locations of Intracranial Cysticerci . . . . . . . . . . . . . . . . . . . 80 7.5.1 Intrasellar Neurocysticercosis. . . . . . . . . . . . . . . . . . . . . . . 80 7.5.2 Subdural Neurocysticercosis. . . . . . . . . . . . . . . . . . . . . . . . 81 7.5.3 Ocular and Orbital Cysticercosis . . . . . . . . . . . . . . . . . . . . 81 7.6 Systemic Cysticercosis . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 81 References . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 82 Contents ix 8 Diagnosis of Taeniasis and Cysticercosis . . . . . . . . . . . . . . . . . . . . . . . 87 8.1 Diagnosis of Taeniasis. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 87 8.1.1 Microscopy . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 87 8.1.2 Stool Antigen Detection . . . . . . . . . . . . . . . . . . . . . . . . . . . 88 8.1.3 DNA-Based Assays. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 88 8.2 Imaging Diagnosis of Neurocysticercosis. . . . . . . . . . . . . . . . . . . . 88 8.2.1 Old Imaging Diagnostic Methods. . . . . . . . . . . . . . . . . . . . 89 8.2.2 Computed Tomography (CT) and Magnetic Resonance Imaging (MRI) . . . . . . . . . . . . . . . . . . . . . . . . . 90 8.3 Immunological Diagnosis of Neurocysticercosis . . . . . . . . . . . . . . 97 8.3.1 Antibody Detection. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 98 8.3.2 Antigen Detection. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 99 8.3.3 Other Immune Diagnostic Tests . . . . . . . . . . . . . . . . . . . . . 99 8.3.4 Antigen Versus Antibody Testing. . . . . . . . . . . . . . . . . . . . 100 8.3.5 Interpretation of a Positive Immune Diagnostic Test . . . . . 100 8.4 Other Diagnostic Tests for Human Cysticercosis. . . . . . . . . . . . . . 101 8.5 Diagnostic Criteria for Neurocysticercosis. . . . . . . . . . . . . . . . . . . 102 References . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 103 9 Management of Neurocysticercosis . . . . . . . . . . . . . . . . . . . . . . . . . . . 109 9.1 Symptomatic Management . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 110 9.2 Surgical Management . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 112 9.3 Specifi c (Etiological) Management. . . . . . . . . . . . . . . . . . . . . . . . . 113 9.3.1 Cysticidal Drugs . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 113 9.3.2 Trials of Cysticidal Drugs. . . . . . . . . . . . . . . . . . . . . . . . . . 114 9.3.3 Meta-Analysis Data on Cysticidal Drug Therapy for Neurocysticercosis . . . . . . . . . . . . . . . . . . . . . 117 9.3.4 Concomitant Medication During Antiparasitic Treatment . 118 9.3.5 Treatment of Asymptomatic Neurocysticercosis . . . . . . . . 119 9.3.6 Further Directions of Cysticidal Treatment . . . . . . . . . . . . 119 References . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 119 10 Control and Perspectives for Elimination of Taenia solium Taeniasis/Cysticercosis. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 125 10.1 Principles of Control. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 126 10.1.1 Treatment of Taeniasis . . . . . . . . . . . . . . . . . . . . . . . . . . . . 126 10.1.2 Treatment of Infected Pigs . . . . . . . . . . . . . . . . . . . . . . . . . 127 10.1.3 Pig Vaccination . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 128 10.1.4 Other Potential Points of Intervention. . . . . . . . . . . . . . . . . 128 10.2 Current Status of Taenia solium Control. . . . . . . . . . . . . . . . . . . . . 131 10.3 Monitoring of Interventions . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 131 10.4 Control Versus Elimination. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 132 10.5 Foreseeable Future . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 132 References . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 132 Index . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 137

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