Cysticercosis of the Human Nervous System

144 Pages·2014·4.32 MB·English

by  Oscar H. Del Brutto, Héctor H. García (auth.)

Cysticercosis of
the Human
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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
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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