Epidemiology and management of cysticercosis and Taenia solium taeniasis in Europe, systematic review 1990-2011.

Lorenzo Zammarchi,Edoardo Pozio,Dora Buonfrate,Filippo Bartalesi,Marianne Strohmeyer,Héctor Hugo García,Elisa Bruno,Alessandra Nicoletti,José Muñoz,Alessandro Bartoloni,Sten H Vermund

doi:10.1371/journal.pone.0069537

Abstract

BackgroundCysticercosis is caused by the invasion of human or pig tissues by the metacestode larval stage of Taenia solium. In Europe, the disease was endemic in the past but the autochthonous natural life cycle of the parasite is currently completed very rarely. Recently, imported cases have increased in parallel to the increased number of migrations and international travels. The lack of specific surveillance systems for cysticercosis leads to underestimation of the epidemiological and clinical impacts.ObjectivesTo review the available data on epidemiology and management of cysticercosis in Europe.MethodsA review of literature on human cysticercosis and T. solium taeniasis in Europe published between 1990–2011 was conducted.ResultsOut of 846 cysticercosis cases described in the literature, 522 cases were autochthonous and 324 cases were imported. The majority (70.1%) of the autochthonous cases were diagnosed in Portugal from 1983 and 1994. Imported cases of which 242 (74.7%) diagnosed in migrants and 57 (17.6%) in European travellers, showed an increasing trend. Most of imported cases were acquired in Latin America (69.8% of migrants and 44.0% of travellers). The majority of imported cases were diagnosed in Spain (47.5%), France (16.7%) and Italy (8.3%). One third of neurosurgical procedures were performed because the suspected diagnosis was cerebral neoplasm. Sixty eight autochthonous and 5 imported T. solium taeniasis cases were reported.ConclusionsCysticercosis remains a challenge for European care providers, since they are often poorly aware of this infection and have little familiarity in managing this disease. Cysticercosis should be included among mandatory reportable diseases, in order to improve the accuracy of epidemiological information. European health care providers might benefit from a transfer of knowledge from colleagues working in endemic areas and the development of shared diagnostic and therapeutic processes would have impact on the quality of the European health systems.Key words: cysticercosis, neurocysticercosis, Taenia solium, taeniasis, Europe, travellers, migrants.

Highlights

Cysticercosis is due to the invasion of human or pig tissues by the metacestode larval stage of Taenia solium [1], a helminth that may reach of up to 8 m in length in the adult stage
Most of imported cases were acquired in Latin America (69.8% of migrants and 44.0% of travellers)
Cysticercosis remains a challenge for European care providers, since they are often poorly aware of this infection and have little familiarity in managing this disease

Summary

Introduction

Cysticercosis is due to the invasion of human or pig tissues by the metacestode larval stage of Taenia solium [1], a helminth that may reach of up to 8 m in length in the adult stage. T. solium is a zoonotic cestode which has a complex two host life cycle [1]. Adult tapeworms have a life span of some years during which they produce millions of eggs which are intermittently released in the environment with the faeces [3,4,5]. Humans and pigs acquire cysticercosis ingesting T. solium eggs by the fecal-oral route [1]. Cysticercosis is caused by the invasion of human or pig tissues by the metacestode larval stage of Taenia solium. The lack of specific surveillance systems for cysticercosis leads to underestimation of the epidemiological and clinical impacts

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Conclusion