Tapeworm Carriers Research Articles

The role of CT scan in diagnosing neurocysticercosis in patients with seizures: a case report

Background: Neurocysticercosis is the most common parasitic infectious disease affecting the human central nervous system in endemic countries. It is caused by the ingestion of Taenia solium eggs excreted in the faeces of human tapeworm carriers. The disease is often asymptomatic, but can also cause seizures, disorientation, visual disturbances, focal neurologic deficits, psychiatric symptoms, strokes, and elevated intracranial blood pressure. Neuroimaging remains the gold standard for diagnosis, which includes the CT scan. This case report aimed to discuss the role of the CT scan in the diagnosis of neurocysticercosis in a 40-year-old male patient with a history of seizures. Case presentation: A 40-year-old male complained of seizures one hour before admission. Before the seizure, the patient reported that he was active as usual and had no complaints. The patient stated that he likes to eat pork and red lawar, which is made from raw pig blood. Physical examination revealed that the patient had a fever. Neurologic examination was within the normal range. Axial view CT scan of the head without contrast showed multiple calcifications with a hypodense area around them. Then, the patient was diagnosed with serial seizures due to symptomatic epilepsy and cerebral neurocysticercosis. He was treated with anthelmintic, antiseizure and symptomatic medication. After one month following therapy, there were no reports of headaches or seizures. The follow-up CT scan at the same slice as the lesion decreased the amount of calcifications, but the right frontal and left parietal regions were still visible. Conclusion: Neuroimaging studies such as CT scans are among the tests that can be performed on seizure patients to detect neurocysticercosis in endemic areas.

Why are tapeworm carriers so difficult to find? A methodological proposal for their search and recovery

Neurocysticercosis, caused by the larval stage of Taenia solium, is a life-threatening condition and the most severe form of the disease. Yet, despite being a required link in the parasite life cycle, tapeworm carriers are rarely reported. This study is aimed to find and evaluate T. solium carriers, describing some characteristics of these patients and the treatment. Taeniasis cases were searched for in various Mexican states from 1983 to 2016. Previous informed consent, tapeworm-carrier patients were administered with niclosamide and a saline purge. Parasite specimens were recovered and identified, both morphologically and by PCR. From 117 treated patients, Taenia sp. specimens were obtained from 46 subjects (47.8%). From these, complete parasites were recovered from 42 (90.5%), and only detached proglottids from 4 patients. Cases were more frequent in Morelos, Chiapas, and Guerrero. More than one adult cestode was recovered from 4 patients (9.5%). To improve treatment efficacy and adherence, the drug was administered in late afternoon, resulting a high recovery yield of complete parasites (90.5%). The success rate of deworming campaigns in areas of Mexico and the world that are endemic for Taenia sp. could be improved by administering the treatment at times that do not interfere with the patients’ daily activities, and national health authorities could apply this simple strategy to help eradication efforts in endemic areas. The detection of carriers will only be possible through the coordinated efforts of public and private health services, a better education of the general population to improve self-detection, and adequate, personalized diagnostic procedures for suspect cases.

A Starry Myocardium at CT: Cardiac Cysticercosis.

Supplemental material is available for this article.

57-Year-Old Man With Headache, Vomiting, and Gait Instability

57-Year-Old Man With Headache, Vomiting, and Gait Instability

Prevalence and factors associated with human Taenia solium taeniosis and cysticercosis in twelve remote villages of Ranomafana rainforest, Madagascar.

Infections with the tapeworm Taenia solium (taeniosis and cysticercosis) are Neglected Tropical Diseases (NTD) highly endemic in Madagascar. These infections are however underdiagnosed, underreported and their burden at the community level remains unknown especially in rural remote settings. This study aims at assessing the prevalence of T. solium infections and associated risk factors in twelve remote villages surrounding Ranomafana National Park (RNP), Ifanadiana District, Madagascar. A community based cross-sectional survey was conducted in June 2016. Stool and serum samples were collected from participants. Tapeworm carriers were identified by stool examination. Taenia species and T. solium genotypes were characterised by PCR and sequencing of the mitochondrial cytochrome c oxidase subunit 1 (cox1) gene. Detection of specific anti-cysticercal antibodies (IgG) or circulating cysticercal antigens was performed by ELISA or EITB/Western blot assays. Of the 459 participants with paired stool and blood samples included ten participants from seven distinct villages harbored Taenia spp. eggs in their stools samples DNA sequencing of the cox1 gene revealed a majority of T. solium Asian genotype (9/10) carriage. The overall seroprevalences of anti-cysticercal IgGs detected by ELISA and EITB were quite similar (27.5% and 29.8% respectively). A prevalence rate of 12.4% of circulating cysticercal antigens was observed reflecting cysticercosis with viable cysts. Open defecation (Odds Ratio, OR = 1.5, 95% CI: 1.0-2.3) and promiscuity with households of more than 4 people (OR = 1.9, 95% CI: 1.1-3.1) seem to be the main risk factors associated with anticysticercal antibodies detection. Being over 15 years of age would be a risk factor associated with an active cysticercosis (OR = 1.6, 95% CI: 1.0-2.7). Females (OR = 0.5, 95% CI: 0.3-0.9) and use of river as house water source (OR = 0.3, 95% CI: 0.1-1.5) were less likely to have cysticercosis with viable cysts. This study indicates a high exposure of the investigated population to T. solium infections with a high prevalence of cysticercosis with viable cysts. These data can be useful to strengthen public health interventions in these remote settings.

712. Neurocysticercosis at a Large Academic Center in the USA

BackgroundNeurocysticercosis (NCC) is a parasitic infection that results from the ingestion of eggs from the adult tapeworm Taenia solium that develops when cysticercoids migrate into the central nervous system. In addition, this infection has been found to affect over 50 million individuals worldwide. In the United States, NCC mainly affects immigrants from Latin America, where the disease is endemic with seroprevalence rates ranging from 5% to 11%. Most data regarding NCC in the United States comes from hospital reports from California and Texas. We are undertaking this study to determine the differences seen in a higher Latin American and Haitian population compared to a previously seen predominantly Mexican population. In this retrospective review, we characterized the population diagnosed with NCC at one large tertiary medical center in South Florida, University of Miami Hospital.MethodsThis retrospective chart review included adult patients from January 2009 to December 2019 with the admission or discharge diagnosis of neurocysticercosis (ICD 10 Code B 69.0 Neurocysticercosis and CPT code 86682 Cysticercosis). We extracted data on demographics, clinical symptoms, recurrence, treatment, resolution and follow up.ResultsForty-seven patients were analyzed to completion. Most of the cases were seen in Hispanics 72.3 % and from Central America 40.4%. The most common symptom was headache 53.2% followed by seizures 42.6%. Normal physical exam was noted in 93.6% of the cases. Most of the cases have 1-10 lesions (98%), located in the brain parenchyma (75%). Serum serology, CSF antibody or stool studies were not obtained in around 90% of the cases. Treatment was indicated in 70.2% of cases and recurrence was low at 17.0%. Refer to Tables 1-5 for full results.Figure 1. Demographics and Clinical Symptoms Figure 2. History and Imaging Figure 3. Laboratory Evidence and Follow up ConclusionNCC is a neglected tropical disease which is preventable. Our study noted that the majority of the affected population were immigrants that had been in the US for more than 10 years and came from central America and the Caribbean. With appropriate treatment, most of the symptoms and CNS lesions resolved, with a low mortality. Public health efforts to identify and treat the tapeworm carrier could be improved to allow for public health follow-up of cases. Although not yet considered endemic in Florida, we hope to bring awareness in this state.Disclosures All Authors: No reported disclosures

Human Taeniasis and Cysticercosis and Related Factors in Phu Tho Province, Northern Vietnam.

Several factors presumed to facilitate the transmission of Taenia spp. were reported in Vietnam. We conducted a cross-sectional study taking questionnaires from 1,185 participants, and collecting 1,151 sera and 1,036 stool samples in northern Vietnam. Sera were examined for circulating antigens of Taenia solium cysticerci using ELISA, stools for Taenia eggs by Kato-Katz smear, and copro-antigens by ELISA. Ag-ELISA revealed 4.6% antigen positivity, indicating infection with viable cysticerci. Taenia eggs were detected in 1.5% of participants. Copro-antigens were found in 2.8% of participants. Eating raw meat and/or vegetables was significantly associated with the presence of copro-antigen (OR=8.6, 95% CI: 1.16–63.9, P=0.01). Considering the high taeniasis prevalence and the associated threat, public health attention should be given to treat the tapeworm carriers in the projected areas.

Prevalence and risk factors for neurocysticercosis in children with a first-onset seizure in rural North India

ABSTRACT Background Neurocysticercosis (NCC) is a parasitic infection acquired by consuming food and water contaminated by the faeces of a Taenia solium tapeworm carrier. It is an important cause of acquired seizures and also the common identifiable cause of new-onset seizures in children. Methods A hospital-based prospective cross-sectional study of NCC was undertaken in a medical college in north-west India. All patients aged 1–15 years admitted to the paediatric emergency room with a first-onset seizure were selected.NCC was diagnosed and staged on the basis of MRI findings. A structured, pretested schedule was administered to each patient’s parent for analysis of risk factors for NCC. Results Of 79 patients with first-onset seizure, 43 (54.4% were diagnosed with NCC based on MRI findings. The association of NCC with age and pig-rearing near the patients’ homes was statistically significant (p = 0.01 and 0.02, respectively). The association between NCC and other risk factors such as gender, religion, father’s occupation, parents’ literacy, source and storage of drinking water, the washing and peeling of fruit and vegetables and distance of refuse disposal from residential areas was not statistically significant. Although open defaecation is an important risk factor for transmission of NCC, there was no significant association with NCC. Conclusion In India, NCC is a common cause of first-onset seizure. The major risk factors are poor environmental sanitation and poor food and drinking water hygiene. NCC can be controlled and prevented by generating awareness of hygienic consumption of food and water and the provision of good sanitation.

Implementation of a practical and effective pilot intervention against transmission of Taenia solium by pigs in the Banke district of Nepal

Taenia solium is a zoonotic cestode parasite which causes human neurocysticercosis. Pigs transmit the parasite by acting as the intermediate host. An intervention was implemented to control transmission of T. solium by pigs in Dalit communities of Banke District, Nepal. Every 3 months, pigs were vaccinated with the TSOL18 recombinant vaccine (Cysvax, IIL, India)) and, at the same time, given an oral treatment with 30mg/kg oxfendazole (Paranthic 10% MCI, Morocco). The prevalence of porcine cysticercosis was determined in both an intervention area as well as a similar no intervention control area, among randomly selected, slaughter-age pigs. Post mortem assessments were undertaken both at the start and at the end of the intervention. Participants conducting the post mortem assessments were blinded as to the source of the animals being assessed. At the start of the intervention the prevalence of porcine cysticercosis was 23.6% and 34.5% in the control and intervention areas, respectively. Following the intervention, the prevalence of cysticercosis in pigs from the control area was 16.7% (no significant change), whereas no infection was detected after complete slicing of all muscle tissue and brain in animals from the intervention area (P = 0.004). These findings are discussed in relation to the feasibility and sustainability of T. solium control. The 3-monthly vaccination and drug treatment intervention in pigs used here is suggested as an effective and practical method for reducing T. solium transmission by pigs. The results suggest that applying the intervention over a period of years may ultimately reduce the number of tapeworm carriers and thereby the incidence of NCC.

Clustering of Necropsy-Confirmed Porcine Cysticercosis Surrounding Taenia solium Tapeworm Carriers in Peru.

The pork tapeworm, Taenia solium, is among the leading causes of preventable epilepsy in the world and is common in rural areas of developing countries where sanitation is limited and pigs have access to human feces. Prior studies in rural villages of Peru have observed clusters of T. solium cysticercosis among pigs that live near human tapeworm carriers. Such spatial analyses, however, have been limited by incomplete participation and substandard diagnostic tests. In this study, we evaluated the association between necropsy-confirmed cysticercosis in pigs and their distance to T. solium tapeworm carriers in six villages in northern Peru. A total of six (1.4%) tapeworm carriers were detected using copro-antigen enzyme-linked immunosorbent assay and seven of 10 (70%) pigs belonging to the tapeworm carriers were found with viable cyst infection on necropsy. This was significantly greater than the prevalence of viable cyst infection among pigs living < 500 m (11%) and > 500 m (0.5%) from a tapeworm carrier (P < 0.001 for distance trend). Similar statistically significant prevalence gradients were observed after adjustment for possible confounders and for other pig-level outcomes including infection with > 10 viable cysts, degenerated cyst infection, and serological outcomes. This investigation confirms that porcine cysticercosis clusters strongly around tapeworm carriers in endemic rural regions of northern Peru and supports interventions that target these hotspots.

Pathological and molecular identification of porcine cysticercosis in Maharashtra, India.

Porcine cysticercosis, caused by metacestodes of Taenia solium is an important emerging zoonotic disease with public health and economic significance. Pigs acquire the disease through consumption of Taenia solium eggs excreted by human tapeworm carriers. The present study was conducted to investigate the prevalence of porcine cysticercosis in Nagpur and Mumbai region of Maharashtra, India by P/M examination of carcasses followed by histopathology of affected organs in infected animals and molecular identification of cysts for confirmation. Out of 1000 pigs examined during slaughter, three pigs were found to be heavily affected with T. solium cysts giving a prevalence of 0.3%. Histological section of brain in infected animals revealed marked vascular congestion of meninges, mild neuronal degeneration, perivascular cuffing and gliosis while the liver showed the infiltration of mononuclear cell, predominantly eosinophils throughout the parenchyma. Some degree of calcification was observed in the cysts lodged in liver while calcification was not evident in case of cysts lodged in brain, tongue, diaphragm and skeletal muscle. Molecular identification by PCR using two sets of oligonucleotide primers against LSU rRNA gene and Mt-Cox1 gene of T. solium confirms the cysts to be that of T. solium. The molecular diagnostics methods have been considered for validation in conjunction with P/M inspections, parasitological and histopathological examinations. The study confirms the presence of porcine cysticercosis in the two regions and demands proper sanitary measures to minimize the risk of infection from zoonoses and food safety point of view.

Prevalence and risk factors for porcine cysticercosis in rural communities of eastern Minas Gerais, Brazil

ABSTRACT: Cysticercosis is caused by Taenia solium, a parasitic zoonosis that affects human and pigs raised free-range in developing countries. The epidemiology of the taeniosis cysticercosis complex in Brazil is poorly understood especially when it comes to field research. The aim of this study was to estimate the prevalence and identify the risk factors associated with porcine cysticercosis in rural communities located in the east of Minas Gerais (MG), Brazil. From 371 farms in the county of Tumiritinga/MG, 101 farms from 14 communities were randomly sampled. Blood samples from pigs were collected, and epidemiological questionnaires were carried out. The serum samples obtained were analyzed through immunodiagnosis techniques, including ELISA and Western Blot, both for the detection of antibodies. The data obtained by different surveys were analyzed using EpiInfo 3.5.1 software to determine seroprevalence and risk factors associated with cysticercosis. The prevalence of farms with porcine cysticercosis was 9.9% (10/101) and antibody-based seropositive was 5.3% (13/247). The results indicate that cysticercosis occurs in high level in the rural area never studied before. These results suggest the presence of tapeworm carriers contributing to the occurrence and maintenance of this zoonotic life cycle in the county. Regarding risk factors, the most significant determinants for porcine cysticercosis in the field were free-range pig management (OR: 17.4, p: 0.0001), the method of disposal of human faeces in the environmental (OR: 7.6; p 0.012), and the size of the farm. Porcine cysticercosis was diagnosed only in areas represented by Agrarian Reform Settlements. From the results, it is possible to recommend as a means of control and prevention the destination of human faeces in appropriate sanitary landfills and the production of pigs in an enclosed area. Additionally, improving education in the communities sampled will indirectly affect the spreading of this disease. The results draw attention to the largest studies of this zoonotic disease in human settlements from rural areas due to the lack of knowledge about the epidemiology of the taeniosis-cysticercosis complex. The results could serve as the basis to support public policies aimed at creating an effective program to control the taeniosis-cysticercosis complex in the studied area. Awareness of TC among medical doctors, veterinarians, meat animal family producers and the public should be developed through appropriate information and education.

Taeniasis caused by Taenia saginata in Gianyar town and Taenia solium in Karangasem villages of Bali, Indonesia, 2011–2016: How to detect tapeworm carriers, anamnesis or microscopy?

From January 2011 until September 2016, screening of taeniasis carriers was carried out in a town in Gianyar District (Taenia saginata) and in villages which consisted of several Banjars (the smallest community units) on the eastern slope of Mt. Agung, Karangasem District (Taenia solium) in Bali, Indonesia. Fecal samples from all community members who chose to participate were examined microscopically for detection of taeniid eggs each person completedwith a questionnaire to determine if they had seen whitish, noodle-like proglottids (anamnesis) in their feces. Members with egg positive feces, and those with anamnesis, were treated with niclosamide (Yomesan®, Bayer). A total of 39T. saginata tapeworm carriers were confirmed in Gianyar after deworming based on anamnesis (100%, 39/39). Only three of them (3/39, 7.7%) and 3/173 participants (1.7%) were identified by fecal microscopy. In contrast, 20T. solium carriers including one migrated to Gianyar were confirmed from 12 patients with eggs in their feces and from another 8 persons of 12 persons suspected to be infected due anamnesis only (8/12,66.7%) in Karangasem. The majority of carriers (12/20, 60.0%) identified by microscopy included 4 (33.3%) and 8 (66.7%) carriers confirmed microscopically with and without anamnesis, respectively. The prevalence rate was 12/1090 (1.10%) of participants. The results indicate that anamnesis is reliable for detection of T. saginata carriers, whereas it is not so reliable for detection of T. solium taeniasis (8/12, 66.7%) and that microscopy is more informative than anamnesis for T. solium. Eggs were detected more frequently in T. solium carriers (4/12, 33.3%) than in patients infected with T. saginata (3/39, 7.7%). T. solium carriers have so far been confirmed from nine of 13 Banjars examined in Karangasem. This study reveals that anamnesis is highly useful for screening of T. saginata carriers, whereas microscopy is a more valuable tool for detection of T. solium carriers.

Spatial relationship between Taenia solium tapeworm carriers and necropsy cyst burden in pigs.

BackgroundTaenia solium, a parasite that affects humans and pigs, is the leading cause of preventable epilepsy in the developing world. Geographic hotspots of pigs testing positive for serologic markers of T. solium exposure have been observed surrounding the locations of human tapeworm carriers. This clustered pattern of seropositivity in endemic areas formed the basis for geographically targeted control interventions, which have been effective at reducing transmission. In this study, we further explore the spatial relationship between human tapeworm carriers and infected pigs using necroscopic examination as a quantitative gold-standard diagnostic to detect viable T. solium cyst infection in pigs.Methodology/Principal findingsWe performed necroscopic examinations on pigs from 7 villages in northern Peru to determine the number of viable T. solium cysts in each pig. Participating humans in the study villages were tested for T. solium tapeworm infection (i.e., taeniasis) with an ELISA coproantigen assay, and the distances from each pig to its nearest human tapeworm carrier were calculated. We assessed the relationship between proximity to a tapeworm carrier and the prevalence of light, moderate, and heavy cyst burden in pigs. The prevalence of pig infection was greatest within 50 meters of a tapeworm carrier and decreased monotonically as distance increased. Pigs living less than 50 meters from a human tapeworm carrier were 4.6 times more likely to be infected with at least one cyst than more distant pigs. Heavier cyst burdens, however, were not more strongly associated with proximity to tapeworm carriers than light cyst burdens.Conclusion/SignificanceOur study shows that human tapeworm carriers and pigs with viable T. solium cyst infection are geographically correlated in endemic areas. This finding supports control strategies that treat humans and pigs based on their proximity to other infected individuals. We did not, however, find sufficient evidence that heavier cyst burdens in pigs would serve as improved targets for geographically focused control interventions.

Changes in the seroprevalence of cysticercosis in suspected patients in Chandigarh, India between 1998 and 2014: analysis of 17 years of data.

Changes in seroprevalence of cysticercosis diagnosed in Chandigarh, India between 1998 and 2014 were investigated by extraction and analysis of data from records held at the Postgraduate Institute of Medical Education and Research in Chandigarh. Among the total number of samples for which cysticercosis had been suspected during this period (N = 9650), 1716 (17·8%) were seropositive. Adults were more likely to be seropositive than children, and women were more likely to be seropositive than men. In addition to there being fewer patients with suspicion of cysticercosis over the data analysis period, the proportion of patients seropositive also reduced significantly. Despite these reductions, which are probably associated with improved infrastructure and sanitation within Chandigarh, and despite meat consumption being relatively rare in this area, the extent of cysticercosis in this population remains problematic. Further efforts should be made to reduce transmission of this infection, with particular emphasis on women. Such efforts should follow the One Health concept, and involve medical efforts (including diagnosis and treatment of T. solium tapeworm carriers), veterinary efforts directed towards meat inspection and prevention of infection of pigs, and environmental health and sanitation engineers (to minimize environmental contamination with human waste).

CystiSim - An Agent-Based Model for Taenia solium Transmission and Control.

Taenia solium taeniosis/cysticercosis was declared eradicable by the International Task Force for Disease Eradication in 1993, but remains a neglected zoonosis. To assist in the attempt to regionally eliminate this parasite, we developed cystiSim, an agent-based model for T. solium transmission and control. The model was developed in R and available as an R package (http://cran.r-project.org/package=cystiSim). cystiSim was adapted to an observed setting using field data from Tanzania, but adaptable to other settings if necessary. The model description adheres to the Overview, Design concepts, and Details (ODD) protocol and consists of two entities—pigs and humans. Pigs acquire cysticercosis through the environment or by direct contact with a tapeworm carrier's faeces. Humans acquire taeniosis from slaughtered pigs proportional to their infection intensity. The model allows for evaluation of three interventions measures or combinations hereof: treatment of humans, treatment of pigs, and pig vaccination, and allows for customary coverage and efficacy settings. cystiSim is the first agent-based transmission model for T. solium and suggests that control using a strategy consisting of an intervention only targeting the porcine host is possible, but that coverage and efficacy must be high if elimination is the ultimate goal. Good coverage of the intervention is important, but can be compensated for by including an additional intervention targeting the human host. cystiSim shows that the scenarios combining interventions in both hosts, mass drug administration to humans, and vaccination and treatment of pigs, have a high probability of success if coverage of 75% can be maintained over at least a four year period. In comparison with an existing mathematical model for T. solium transmission, cystiSim also includes parasite maturation, host immunity, and environmental contamination. Adding these biological parameters to the model resulted in new insights in the potential effect of intervention measures.

Study of Neurocysticercosis in the Pediatrics Ward of Atertiary Care Centre in Garhwal Region (Uttarakhand) India

Neurocysticercosis (NCC) is infestation of human central nervous system with tissue cysts of pork tapeworm Taeniasolium. Human beings acquire cysticercosis through faecal oral contamination with T. soliumeggs or poor hygiene practices in food handling by tapeworm carriers. Clinical presentation of NCC can be variable. Seizures are the commonest presentation of NCC. Various types of seizures have been described among patients with NCC including generalized, focal and rarely myoclonus and acquired epilepticaphasia. In general, it seems that about half thecases have partial seizures and the other half generalized seizures, a proportion similar to that of the general population. Neuroimaging is the mainstay of diagnosis of NCC. Lesions suggestive of NCC on CT, in patients with compatible clinical picture in endemic areas are usually diagnosed as NCC. The study was based on 540 total number of patients admitted with neurocysticercosis (NCC) over a period of three years. These all patients were admitted in department of pediatrics, VCSGGMS&RI (Government Medical College, Srinagar Garhwal), Uttarakhand. All Neuroim aging investigations were investigated in department of Radio diagnosis, Government medical college and hospital, Srinagar. Pathological and microbiological investigation also done in central lab of government medical college and Hospital, Srinagar. All the patients were examined clinically and were investigated with neuro imaging. In addition to above X-Ray chest, Mantoux test, Hematological investigations including ESR and CSF was done to rule out Tuberculoma. Routine stool examination was also done. During our 3 years of study period NCC has emerged as an alarming public health problem of our region and its incidence has risen from 33.33% in 2012 to 42.26 % in 2014 in pediatric patients .The rising incidence could be due to high index of suspicion in every case presenting with seizures. A strikingly high incidence of Neurocysticercosis (NCC) was found among the pediatric patients of our tertiary care hospital. A high incidence of NCC in this region reflects the endemic presence of

Neurocysticercosis: Diagnostic problems & current therapeutic strategies.

Neurocysticercosis (NCC) is the most common single cause of seizures/epilepsy in India and several other endemic countries throughout the world. It is also the most common parasitic disease of the brain caused by the cestode Taenia solium or pork tapeworm. The diagnosis of NCC and the tapeworm carrier (taeniasis) can be relatively inaccessible and expensive for most of the patients. In spite of the introduction of several new immunological tests, neuroimaging remains the main diagnostic test for NCC. The treatment of NCC is also mired in controversy although, there is emerging evidence that albendazole (a cysticidal drug) may be beneficial for patients by reducing the number of seizures and hastening the resolution of live cysts. Currently, there are several diagnostic and management issues which remain unresolved. This review will highlight some of these issues.

Taeniosis/Neurocysticercosis Control as a Medical Problem—A Discussion Paper

Taenia solium taeniosis is a zoonosis transmitted by cysticerci from pigs. Neurocysticercosis is a fecal-borne infection spread exclusively by T. soliumeggs in a tapeworm carrier or around. Neurocysticercosis is frequently fatal and debilitating disease and a common cause of late epilepsy. Taeniosis/neurocysticercosis (t/nc) can be prevented both by control of meat-borne zoonosis, which is a traditional responsibility of veterinarians, and by chemotherapy of human taeniosis, which is usually underestimated by medical profession. Elimination of T. solium taenosis is not only the matter of organized control projects but also of routine, daily medical and veterinary services. In order to promote more effective control by treatment of human T. solium carriers the following suggestions are proposed to be discussed: 1) accept that leaving untreated any detected human carrier of T. soliumtaeniosis, the only source of neurocysticercosis, is a medical error. This statement concerns both clinical settings and field interventions; 2) accept as the clinical and public health standards a search for T. solium carrier in any possible t/nc foci and treat both detected and suspected cases of taeniosis; 3) make the diagnosis and treatment of T. solium infections in humans widely accessible and possibly free; 4) improve easy applicable tools detecting T. solium taeniosis; 5) make modern and traditional taenicides available. There is a need to improve the stability and efficacy of niclosamide and elaborate an instruction how to avoid neurological side- effects of praziquantel; 6) include prevention of t/nc into professional training, especially in mental health, public health and primary health care professions; 7) intensify preventive education adapted to the local endemic situation.

Neurocysticercosis Diagnosed in a Patient with Taenia saginata Taeniasis after Administration of Praziquantel: A Case Study and Review of the Literature

Taeniasis, caused by infection with Taenia saginata or Taenia solium, occurs on Bali due to the consumption of undercooked beef and pork, respectively. Fieldwork conducted on Bali from 2002-2007, identified 69 taeniasis cases due to T. saginata. In August 2007, three T. saginata tapeworm carriers in the Gianyar district of Bali were treated with a single dose of praziquantel. Within a few hours of treatment, a 47 year old man had a seizure and was admitted to a hospital in the city of Denpasar. A computed tomography (CT) scan revealed two cystic lesions in the man’s brain. Serology showed specific antibody responses to T. solium metacestode antigens. The patient was, therefore, diagnosed with a dual infection of T. solium neurocysticercosis (NCC) and T. saginata taeniasis. This case report is illustrative of the risk of veiled NCC in areas where T. saginata and T. solium are co-endemic. As globalization increases, the possibility of co-infections will continue to rise and researchers and physicians participating in mass drug administration programs will need to be vigilant in their monitoring for adverse effects.