BackgroundEpilepsy poses a significant public health problem in many parts of the world. The majority of people with epilepsy (PWE) are from low-income and middle-income countries (LMICs). Taenia solium neurocysticercosis (NCC) is estimated to cause 30% of preventable epilepsy in PWE in areas of T. solium endemicity. This study was conducted to assess the prevalence of NCC in PWE, evaluate the presence of cognitive impairment in PWE and assess potentially contributing factors. MethodsPWE were recruited within a mental health clinic-based cross-sectional study in rural Southern Tanzania. PWE underwent a detailed neurological examination, including mental state, and a blood sample was collected for T. solium cysticercosis (CC) serology testing. Patients who were serologically positive for CC and those detected to have prominent neurological deficits apart from epilepsy were invited to receive a cerebral computed tomography (CT) examination. ResultsOut of the 223 people with epilepsy (PWE) recruited, 221 underwent clinical examination. Among these, 26 (11.8 %) had cognitive impairment, and 2 had neurological signs or symptoms without cognitive impairment. Twenty-five of the 223 PWE (11.2 %) tested positive for CC, of which 4 had cognitive impairment. One hundred and ninety-eight (88.8 %) tested negative for CC, of which 22 had cognitive impairment. A total of 36 participants underwent CT scans, with 18 testing positive and 18 testing negative for CC. Of the 36 who had CT scans, 8 (22.2 %) were diagnosed with NCC; 7 were CC positive, and 1 was CC negative; only the latter had cognitive impairment. Multivariate logistic regression confirmed that cognitive impairment in PWE was 8.62 times higher for Kongwa participants than Chunya, with a statistically significant association (95 % CI: 1.75, 156; p = 0.037). Additionally, having and education was associated with a 91 % reduction in the odds of cognitive impairment (OR = 0.09) compared to no education, which was also statistically significant (95 % CI: 0.01, 0.33; p = 0.002). There was no association between cognitive impairment and NCC. ConclusionOur study found a 22.2 % prevalence of NCC among PWE. Cognitive impairment was present in 11.8 % of PWE but was not significantly associated with NCC. Socioeconomic and educational factors may play a larger role in cognitive impairment among PWE.

The parasitic infection caused by Taenia solium represents a significant public health concern in developing countries. Larval invasion of body tissues leads to cysticercosis (CC), while central nervous system (CNS) involvement results in neurocysticercosis (NCC). Both conditions exhibit diverse clinical manifestations, and the potential impact of concomitant HIV infection especially prevalent in sub-Saharan Africa on peripheral and CNS immune responses remains poorly understood. This study aimed to identify the potential impact of HIV coinfection in CC and NCC patients. A nested study within a cross-sectional analysis in two Tanzanian regions was performed and 234 participants (110 HIV+ and 124 HIV-) were tested for cysticercosis antibodies, antigens, CD4 counts and serum Th1 and Th2 cytokines via multiplex bead-based immunoassay. 127 cysticercosis seropositive individuals underwent cranial computed tomography (CCT) and clinical symptoms were assessed. Multiple regression analyses were performed to identify factors associated with cytokine modulation due to HIV in CC and NCC patients. Serologically, 18.8% tested positive for cysticercosis antibodies, with no significant difference HIV+ and HIV+. A significantly higher rate of cysticercosis antigen positivity was found in HIV+ individuals (43.6%) compared to HIV- (28.2%) (p = 0.016). CCT scans revealed that overall 10.3% had active brain cysts (NCC+). Our study found no significant changes in the overall cytokine profiles between HIV+ and HIV- participants coinfected CC and NCC, except for IL-5 which was elevated in HIV+ individuals with cysticercosis. Furthermore, HIV infection in general was associated with increased levels of pro-and some anti-inflammatory cytokines e.g. TNF-α, IL-8, and IFN-γ. However, based on the interaction analyses, no cytokine changes were observed due to HIV in CC or NCC patients. In conclusion, while HIV infection itself significantly modulates levels of key cytokines such as TNF-α, IL-8, and IFN-γ, it does not modulate any cytokine changes due to CC or NCC. This underscores the dominant influence of HIV on the immune system and highlights the importance of effective antiretroviral therapy in managing immune responses in individuals coinfected with HIV and CC/NCC.

Human cysticercosis (CC) is a global public health problem, especially in Latin America, including Brazil. We aimed to analyze the seroprevalence of CC among school-age children and adolescents. We analyzed the presence of specific IgG antibodies against Taenia solium metacestodes in 500 serum samples from elementary school children and adolescents in Jataí City, state of Goiás, Brazil. IgG antibodies against the antigenic extract of the parasite were detected and analyzed by ELISA, and specific peptides were identified by confirmatory Western Blotting test. Of the 500 study participants, 205 (41%) were male, and 295 (59%) were female. Participants aged between 4 and 18 years (mean age 8.4 years). The percentage of serum samples reactive by ELISA was 37.2%. These samples were analyzed by Western Blotting, which confirmed that the seropositivity rate was 6.2% (95% CI 2.4-14.7) in 31 samples reactive for CC-specific bands, determined in serum samples from 18 male (5-11 years old) and 13 female (4-12 years old) students. The CC seroprevalence demonstrated in schoolchildren suggests that this parasitosis is endemic in the study area. Further investigations are necessary to clarify the local epidemiology of this parasitosis.

Disseminated Cysticercosis

Cysticercosis (CC) is the most common parasitic disease of the central nervous system. It is endemic in most developing countries where pigs are raised and consumed. An overview of all available data of this parasite in Madagascar is lacking. We conducted a literature review, collecting information on published and available literature about cysticercosis in Madagascar between January 1st, 1990 and June 30th, 2020. Out of 858 publications; 61 were included, issued from peer-review indexed journals, non-indexed journals, books, Ministry reports and press releases. In Madagascar, porcine cysticercosis has been reported since 1901; human cysticercosis is highly prevalent with an overall estimated seroprevalence between 7 and 21%. Serological analysis is based on Enzyme-Linked Immunosorbent Assay (ELISA) and Enzyme-linked immunoelectrotransfer blot techniques (EITB) for confirmative testing. Neurocysticercosis (NCC) is the most common pattern of cysticercosis in Madagascar and it is reponsible for pediatric morbidity causing more than 50% of epilepsy cases. Though CT-Scan is now available and tends to be considered the gold standard for NCC diagnosis, it remains unaffordable for most Malagasy patients and implies the proposal of a diagnostic algorithm for physicians. Our review has revealed that human taeniasis and bovine cysticercosis is a considerable burden in Madagascar. A national control program has been developed aiming to decrease the seroprevalence rate from 16 to 10% in 2015. The aim of the country is now to implement a CC control and elimination program. Meanwhile, some massive cysticercosis screenings have been conducted in the capital Antananarivo to drive people's attention on this widespread infection.

Rice-grain calcifications of cysticercosis.

La cisticercosis hepática es una enfermedad parasitaria bastante rara que consiste en el compromiso hepático por el cisticerco, con pocos casos reportados en la literatura, ninguno antes reportado en Colombia. Esta infección es producida por Cysticercus cellulosae, la forma larvaria del helminto Taenia solium. Es adquirida al consumir los huevos de la Tenia spp que se encuentran en la comida poco cocinada o el agua. En los casos reportados de cisticercosis hepática, el tratamiento se basa principalmente en el uso de antihelmínticos y en ocasiones quirúrgico. Se presenta el caso de un paciente mayor, indígena, quien consultó por melenas y dolor abdominal. En el examen físico se encontró hepatomegalia. Las imágenes diagnósticas plantean diagnóstico diferencial entre quiste hidatídico vs cistoadenoma/cistoadenocarcinoma. El examen histopatológico sugiere compromiso por cisticercosis. Se reporta el caso de una cisticercosis hepática, con histología altamente sugestiva y hallazgos imagenológicos bastante inusuales a los previamente descritos en literatura. MÉD.UIS. 2020;33(2):101-108

Isolated breast cysticercosis

A hailstorm of cysts-case of disseminated cysticercosis.

Isolated cardiac cysticercosis: treatment with or without steroids?

Double inversion recovery in detection of perilesional gliosis in calcific cysticercosis.

Objective To study the staging of cerebral parenchymal cysticercosis by fractional anisotropy(FA) value and average diffusion coefficient(DCavg) value on diffusion tensor imaging(DTI). Methods Forty-eight patients (30 men and 18 wemen) with cerebral parenchymal cysticercosis were admitted to the First Affiliated Hospital of Dali University from January in 2015 to December in 2016. Their averge age was (34±11) years (rang from 19 to 65 years). Eight patients with subclinical stage, 13 patients with vesicular stage, 15 patients with colloidal-vesicular stage, and 12 patients with granular-nodular stage of cerebral neurocysticercosis were included in this study. The data of FA and DCavg of lesions with different stages were measured, as well as the contralateral normal brain parenchyma. The FA values and DCavg values of lesions were analyzed by variance analysis, respectively. Paired t test was used to compare the FA and DCavg values of the lesions and the contralateral brain. Results The FA values of lesions with subclinical stage, vesicular stage, colloidal-vesicular stage, and granular-nodular stage of cerebral parenchymal cysticercosis were 0.074 7±0.002 5, 0.105 8±0.003 1, 0.127 3±0.002 1, and 0.159 3±0.001 4, respectively. The differences were statistically significant among the stages (F=639.17, P<0.05). The DCavg values were (1.312 5±0.006 7)×10-3, (1.514 2±0.005 9)×10-3, (1.112 1±0.005 8)×10-3, and (1.093 2±0.008 4)×10-3mm2/s for lesions with each stage, respectively. There was a significant difference in the DCavg values among the stages (P<0.05).The data of FA and DCavg for lesions with every stage had a significant difference from those of normal contralateral brain(F=491.24, P<0.05). Conclusion The parameters FA and DCavg values of diffusion tensor imaging may be helpful in the diagnosis of different stages of cerebral parenchymal cysticercosis, and may provide guidance for clinical treatment. Key words: Neurocysticercosis; Magnetic resonance imaging; Diagnosis

BackgroundCysticercosis (CC) is a tissue infection caused by the larval cysts of the pork tapeworm Taenia solium. It is usually acquired by eating contaminated food or drinking water. CC Cysts can develop in the muscles, the eyes, the brain, and/or the spinal cord. T. solium is found worldwide, but its prevalence has decreased in developed countries due to stricter meat inspection and better hygiene and sanitation. Nevertheless, CC is still a leading cause of seizures and epilepsy. In Spain, The disease is not nationally reportable and data on CC infected animals are also missing, despite the European Directive 2003/99/EC.Methodology/Principal findingsWe performed a retrospective descriptive study using the Spanish Hospitalization Minimum Data Set (CMBD). Data with ICD-9 CM cysticercosis code (“123.1”) placed in first or second diagnostic position from 1997 to 2014 were analyzed. Hospitalization rates were calculated and clinical characteristics were described. Spatial distribution of cases and their temporal behavior were also assessed. A total of 1,912 hospital discharges with clinical cysticercosis were identified. From 1998 to 2008, an increasing trend in the number of CC hospitalizations was observed, decreasing afterwards, in parallel with a decrease in the external migration rate. The Murcia region had the highest median hospitalization rate (13.37 hospitalizations/100,000 population), followed by Navarra and Madrid. The 16–44 age group was the most represented (63.6%). The three most frequent associated diagnoses were epilepsy and convulsions (49.5%), hydrocephalus (11.8%) and encephalitis/myelitis/meningitis (11.6%).Conclusions/SignificanceThere is a need for a common strategy on data collection, monitoring and reporting, which would facilitate a more accurate picture on the CC epidemiological scenario. Even if most cases might be imported, improving the human and animal CC surveillance will result useful both in gaining extended disease knowledge and reducing morbidity and related-costs.

Taenia solium cysticercosis and taeniosis: Achievements from the past 10 years and the way forward.

BackgroundWe reviewed studies that analyzed cysticercosis (CC), neurocysticercosis (NCC) and epilepsy across Latin America, Asia and Sub-Saharan Africa, to estimate the odds ratio and etiologic fraction of epilepsy due to CC in tropical regions.MethodologyWe conducted a systematic review of the literature on cysticercosis and epilepsy in the tropics, collecting data from case-control and cross-sectional studies. Exposure criteria for CC included one or more of the following: serum ELISA or EITB positivity, presence of subcutaneous cysts (both not verified and unverified by histology), histology consistent with calcified cysts, and brain CT scan consistent with NCC. A common odds-ratio was then estimated using meta-analysis.Principal findings37 studies from 23 countries were included (n = 24,646 subjects, 14,934 with epilepsy and 9,712 without epilepsy). Of these, 29 were case-control (14 matched). The association between CC and epilepsy was significant in 19 scientific articles. Odds ratios ranged from 0.2 to 25.4 (a posteriori power 4.5–100%) and the common odds ratio was 2.7 (95% CI 2.1–3.6, p <0.001). Three subgroup analyses performed gave odds ratios as: 2.2 (EITB-based studies), 3.2 (CT-based studies), 1.9 (neurologist-confirmed epilepsy; door-to-door survey and at least one matched control per case). Etiologic fraction was estimated to be 63% in the exposed group among the population.SignificanceDespite differences in findings, this meta-analysis suggests that cysticercosis is a significant contributor to late-onset epilepsy in tropical regions around the world, and its impact may vary depending on transmission intensity.

BackgroundThe frequency of Taenia solium, a zoonotic helminth, is increasing in many countries of sub-Saharan Africa, where the prevalence of the human immunodeficiency virus (HIV) is also high. However, little is known about how these two infections interact. The aim of this study was to compare the proportion of HIV positive (+) and negative (−) individuals who are infected with Taenia solium (TSOL) and who present with clinical and neurological manifestations of cysticercosis (CC).MethodsIn northern Tanzania, 170 HIV+ individuals and 170 HIV– controls matched for gender, age and village of origin were recruited. HIV staging and serological tests for TSOL antibodies (Ab) and antigen (Ag) were performed. Neurocysticercosis (NCC) was determined by computed tomography (CT) using standard diagnostic criteria. Neurological manifestations were confirmed by a standard neurological examination. In addition, demographic, clinical and neuroimaging data were collected. Further, CD4+ cell counts as well as information on highly active antiretroviral treatment (HAART) were noted.ResultsNo significant differences between HIV+ and HIV– individuals regarding the sero-prevalence of taeniosis-Ab (0.6% vs 1.2%), CC-Ab (2.4% vs 2.4%) and CC-Ag (0.6% vs 0.0%) were detected. A total of six NCC cases (3 HIV+ and 3 HIV–) were detected in the group of matched participants. Two individuals (1 HIV+ and 1 HIV–) presented with headaches as the main symptom for NCC, and four with asymptomatic NCC. Among the HIV+ group, TSOL was not associated with CD4+ cell counts, HAART duration or HIV stage.ConclusionsThis study found lower prevalence of taeniosis, CC and NCC than had been reported in the region to date. This low level of infection may have resulted in an inability to find cross-sectional associations between HIV status and TSOL infection or NCC. Larger sample sizes will be required in future studies conducted in that area to conclude if HIV influences the way NCC manifests itself.Electronic supplementary materialThe online version of this article (doi:10.1186/s40249-016-0209-7) contains supplementary material, which is available to authorized users.

Objective To discuss clinical application and significance of International Physician Referral Network(IPRN) in diagnosing and treating ocular diseases. Methods A total of 318 cases from March 2014 to September 2015 were enrolled in this study. All detailed data were transmitted to the center for Fundus Diseases Control and Prevention in Kansas for discussion about the diagnosis and the opinion of treatment and surgery. Results Among the 318 cases, there were 48 cases of proliferative diabetic retinopathy, 42 cases of age related macular degeneration, 39 cases of refractory glaucoma, 35 cases of familial exudative vitreoretionpathy, 22 cases of panuveitis, 20 cases of optic neuroretinopathy, 19 cases of external exudative retinopathy, 15 cases of retinal vein occlusion, 15 cases of retinopathy in high myopic eyes, 14 cases of cytomegalovirus retinitis, 13 cases of congenital coloboma of choroid, 11 cases of retinoschisis, 8 cases of central retinal arteral occlusion, 5 cases of retinal cysticercosis, 3 cases of acute evanescent white dots syndrome, 3 cases of melanoma of choroid, 2 cases of retinal racemose angioma, 2 cases of retinal macroaneurysm, 1 case of diffuse choroid atrophy, and 1 case of melanocytoma of the optic disc. The feedback diagnosis was identical with that of us in 292 cases, the corresponding rate of diagnosis was 91.82%(292/318). The 25 G vitrectomy was performed in 42 patients with diabetic retinopathy, 5 patients with retinal cysticercosis, and 4 patients with retinal detachment caused by cytomegalovirus retinitis. 12 patients with age related macular degeneration received intravitreal ranibizumab, patients with refractory glaucoma had glaucoma filtration device implantation. All the proposed treatment methods, except some very special drugs therapy, were adopted by our hospital. Conclusion A new work mode of medical diagnosis is started by telemedicine consultation and cooperation over international medical resources in China, which deserves further exploration and enhancement. Key words: International Physician Referral Network; Internet; Ocular diseases, difficulty, complicated

Taenia saginata and Taenia solium are found through the whole world, especially in developing countries. These tapeworms live in the small intestines of humans. Cattle and pigs are the intermediate animal hosts. Serious signs and symptoms are found if T. solium is infecting the central nervous system. Cases with epileptic seizures and abnormal behavior are often found in endemic areas. In Mexico among 68.754 human serum samples 0,06-2,97% were found positive for cysticercosis. Apparently there was an association between high sero prevalence rates and low socio-economic conditions. In several countries in Latin America, prevalences were between 0,1-8,7%, whereas prevalences between 0,05-10,4% were detected in Asia and Africa. In Indonesia taeniasis/cysticercosis are mostly found in three provinces i.e. North Sumatra, Bali and Irian Jaya. Cases were also discovered in North Sulawesi, Southeast Sulawesi, East Nusa Tenggara and West Kalimantan. The prevalences of taeniasis/cysticercosis in Indonesia were between 1,0-42,7%. The highest prevalence rate was in Irian Jaya (Papua). Not many reports are available for cysticercosis in cattle and in pigs in the world, including Indonesia. The collection of epidemiological data such as on prevalence rates and distribution are needed for a successful control program. In addition community health education should be implemented in control programs.

Disseminated cysticercosis: Many issues are still unresolved.

Objective To investigate the characteristic of the B-mode ultrasonography and the color Doppler flow imaging diagnosis for intraocular cysticercosis. Methods Eleven eyes of 11 patients diagnosed of intraocular cysticercosis clinically and confirmed by operation and pathology were retrospectively studied. Their B-mode ultrasonography and color Doppler flow imaging were analyzed. Surgery diagosis was also reviewed. Results Among 11 eyes of 11 patients, intravitreal cysticercus presented in 7 cases (7 eyes), and 4 cases (4 eyes) diagnosed of subretinal cysticercus. Intraocular cysticercosis showed a round or oval vesicle-like echogenic mass in the vitreous body or under the retina, and the high-level echo spot in it was the scolex. Some dot and stripe echo and retinal detachment also appeared in the vitreous cavity with vitreous inflammation. The blood flow signal was detected in retinal detachment with color Doppler flow imaging. Conclusions Ultrasonography is extremely useful in the diagnosis of intraocular cysticercosis and the findings can be pathognomonic. Key words: Ultrasonography; Eye infection, parasitic; Cysticercosis