Treatment Outcome in Patients with Disseminated Cysticercosis: A Systematic Review of Case Reports and Case Series.

Disseminated cysticercosis is defined by multiple brain lesions and involvement of other body sites. Cysticidal treatment in disseminated cysticercosis is considered life-threatening. We conducted a systematic review of all published cases and case series to assess the safety and efficacy of cysticidal treatment. We conducted a systematic review in accordance with Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines (PROSPERO CRD42022331895) to assess the safety and efficacy of cysticidal treatment. Using the search term "disseminated neurocysticercosis OR disseminated cysticercosis," databases like PubMed, Scopus, Embase, and Google Scholar were searched. Outcomes included death and secondary measures like clinical improvement and lesion reduction. We calculated the predictors of primary outcome (death) using the binary logistic regression analysis. We reviewed 222 published cases from 101 publications. Approximately 87% cases were reported from India. Of 222 cases, 134 (60%) received cysticidal treatment. Follow-up information was available from 180 patients, 11 of them died, and 169 showed clinical improvement. The death rate was 4% (5 out of 114) in patients treated with cysticidal drugs plus corticosteroids, in comparison with 13% (5 out of 38) in patients who were treated with corticosteroids alone. All patients using only praziquantel faced fatality. Death predictors identified were altered sensorium and lack of treatment with albendazole. We noted that the risk of death after cysticidal treatment is not as we expected, and a multicentric randomized controlled trial is needed to resolve this issue.

Αcute visceral cysticercosis caused by Taenia hydatigena in lambs: ultrasonographic findings.

BACKGROUND: Cysticercosis caused by cysticercus tenuicollis is a metacestode infection that affects several species of ungulates. It is caused by the larval stage of Taenia hydatigena, an intestinal tapeworm in dogs and wild canids. In the intermediate host, the mature cysticerci are usually found in the omentum, mesentery, and peritoneum, and less frequently in the pleura and pericardium. The migrating larvae can be found mostly in the liver parenchyma causing traumatic hepatitis in young animals. Most infections are chronic and asymptomatic, and are diagnosed at the abattoir. The acute form of infection is unusual in sheep and reports of death in lambs are rare. METHODS: In March 2018, fifteen female lambs presented anorexia, weakness, lethargy, and death secondary to acute visceral cysticercosis. Twelve of them underwent hepatic ultrasonography. Examinations were performed on standing or left lateral recumbent animals. RESULTS: Livers of affected animals presented rounded margins and a thickened, irregular and hyperechoic surface. Hepatic parenchyma appeared to be wholly or partially affected by lesions characterized by heterogeneous areas crossed by numerous, irregular, anechoic tracts ranging from 1 to 2 cm in length and 0.1 to 0.2 cm in width. Superficial and intraparenchymal cystic structures were also visualized. The presence of lesions was confirmed by anatomopathological examination, and T. hydatigena cysticerci was identified by morphological and molecular characterization of isolates. CONCLUSIONS: Our results highlighted that hepatic ultrasonography is effective for an intra-vitam diagnosis of acute cysticercosis in lambs.

Spatial analysis of dengue, cysticercosis and Chagas disease mortality in Ecuador, 2011-2016.

Background: Neglected tropical diseases (NTDs) continue to be an important cause of disability and mortality in the poorest tropical and subtropical areas. Methods: This is an ecological study. We included all death certificates with dengue, cysticercosis and Chagas disease in Ecuador from 2011 to 2016. The spatial autocorrelation was evaluated by GeoDa software through the Global Moran's I index and the formation of clusters by the local index of spatial association. Results: The Global Moran's I index for the study period shows a positive spatial autocorrelation for dengue, cysticercosis and Chagas disease (0.25, p=0.001; 0.07, p=0.04; 0.45, p=0.001, respectively). Conclusions: The clusters identified as higher risk in the country could be targeted by policymakers to adequately develop strategies to strengthen health promotion policies that break the cycle of these diseases.

Cysticercosis-related hospitalizations in the United States, 1998-2011.

Cysticercosis has become increasingly recognized as an important infection in the United States in recent decades. Despite its potential impact, there is a lack of comprehensive information on the nationwide burden of disease. To better define the burden of cysticercosis in the United States, we analyzed in-patient records using the Nationwide Inpatient Sample for 1998-2011 to estimate cysticercosis-related hospitalizations and patient/institutional characteristics. There were an estimated 33,060 (95% confidence interval [95% CI] = 29,610.5-36,510.3) cysticercosis-related hospitalizations nationwide, representing a hospitalization rate of 8.03 per million population. The highest proportion of cases were male (54.8%), Hispanic (62.0%), aged 18-44 (58.8%), and occurred in the West (45.1%). An estimated 459 deaths occurred, representing an in-hospital case-fatality rate of 1.4%. These findings indicate the burden of cysticercosis-related hospitalizations in the United States is considerable and may be greater than currently appreciated. Cysticercosis should be a nationally reportable disease.

Cysticercosis-related mortality in the State of São Paulo, Brazil, 1985-2004: a study using multiple causes of death.

Cysticercosis-related mortality has not been studied in Brazil. Deaths recorded in the State of São Paulo from 1985 to 2004 in which cysticercosis was mentioned on any line or in any part of the death certificate were studied. Causes of death were processed using the Multiple Cause Tabulator. Over this 20-year period, cysticercosis was identified in 1,570 deaths: as the underlying cause in 1,131 and as an associated cause of death in 439. Standardized mortality rates with cysticercosis as the underlying cause showed a downward trend and were higher among men and older individuals. Intracranial hypertension, cerebral edema, hydrocephalus, inflammatory diseases of the central nervous system, and cerebrovascular diseases were the main associated causes in deaths due to cysticercosis. AIDS was the principal underlying cause of death in which cysticercosis was an associated cause. The counties (municipalities) with the most cysticercosis-related deaths were São Paulo, Campinas, Ribeirão Preto, and Santo André. Wide variation was observed between counties regarding the value ascribed to cysticercosis as the underlying cause of death. This leads to underestimation of the disease's importance in planning health interventions.

Cysticercosis-related mortality in the State of São Paulo, Brazil, 1985-2004: a study using multiple causes of death

Cysticercosis-related mortality has not been studied in Brazil. Deaths recorded in the State of São Paulo from 1985 to 2004 in which cysticercosis was mentioned on any line or in any part of the death certificate were studied. Causes of death were processed using the Multiple Cause Tabulator. Over this 20-year period, cysticercosis was identified in 1,570 deaths: as the underlying cause in 1,131 and as an associated cause of death in 439. Standardized mortality rates with cysticercosis as the underlying cause showed a downward trend and were higher among men and older individuals. Intracranial hypertension, cerebral edema, hydrocephalus, inflammatory diseases of the central nervous system, and cerebrovascular diseases were the main associated causes in deaths due to cysticercosis. AIDS was the principal underlying cause of death in which cysticercosis was an associated cause. The counties (municipalities) with the most cysticercosis-related deaths were São Paulo, Campinas, Ribeirão Preto, and Santo André. Wide variation was observed between counties regarding the value ascribed to cysticercosis as the underlying cause of death. This leads to underestimation of the disease's importance in planning health interventions.

A mortalidade relacionada à cisticercose na população não tem sido pesquisada no Brasil. Foram estudados os óbitos registrados entre 1985 e 2004 no Estado de São Paulo em que a cisticercose foi mencionada em qualquer linha ou parte da Declaração de Óbito. As causas de morte foram processadas pelo Tabulador de Causas Múltiplas. No período de vinte anos ocorreram 1.570 óbitos, sendo a cisticercose causa básica em 1.131 e causa associada de morte em 439. Os coeficientes padronizados de mortalidade por cisticercose como causa básica apresentaram tendência de declínio, foram maiores entre os homens e nas idades mais avançadas. As principais causas associadas nas mortes por cisticercose foram hipertensão intracraniana, edema cerebral, hidrocefalias, doenças inflamatórias do sistema nervoso central e doenças cerebrovasculares. A AIDS foi a principal causa básica nas mortes com a cisticercose como causa associada. Os municípios com maior número de mortes foram São Paulo, Campinas, Ribeirão Preto e Santo André. Observou-se grande variação entre os municípios na valorização da cisticercose como causa básica de morte, determinando sua subestima para subsidiar o planejamento de políticas de saúde.

Deaths from cysticercosis, United States.

Cysticercosis has emerged as a cause of severe neurologic disease in the United States. We evaluated cysticercosis-related deaths in the United States for 1990-2002 by race, sex, age, state of residence, country of birth, and year of death. A total of 221 cysticercosis deaths were identified. Mortality rates were highest for Latinos (adjusted rate ratio [ARR] 94.5, relative to whites) and men (ARR = 1.8). The mean age at death was 40.5 years (range 2-88). Most patients (187 [84.6%]) were foreign born, and 137 (62%) had emigrated from Mexico. The 33 US-born persons who died of cysticercosis represented 15% of all cysticercosis-related deaths. The cysticercosis mortality rate was highest in California, which accounted for = 60% of all deaths. Although uncommon, cysticercosis is a cause of premature death in the United States. Fatal cysticercosis affected mainly immigrants from Mexico and other Latin American countries; however, US-born persons were also affected.

Cysticercosis-related deaths, California.

Cysticercosis is an increasingly important disease in the United States, but information on the occurrence of related deaths is limited. We examined data from California death certificates for the 12-year period 1989-2000. A total of 124 cysticercosis deaths were identified, representing a crude 12-year death rate of 3.9 per million population (95% confidence interval [CI] 3.2 to 4.6). Eighty-two (66%) of the case-patients were male; 42 (34%) were female. The median age at death was 34.5 years (range 7-81 years). Most patients (107, 86.3%) were foreign-born, and 90 (72.6%) had emigrated from Mexico. Seventeen (13.7%) deaths occurred in U.S.-born residents. Cysticercosis death rates were higher in Latino residents of California (13.0/106) than in other racial/ethnic groups (0.4/106), in males (5.2/106) than in females (2.7/106), and in persons >14 years of age (5.0/106). Cysticercosis is a preventable cause of premature death, particularly among young Latino persons in California and may be a more common cause of death in the United States than previously recognized.

CD4+ TCRalphabeta T cells are critically involved in the control of experimental murine cysticercosis in C57BL/6J mice.

Taenia crassiceps cysticerci develop in the peritoneal cavity of BALB/cAnN mice and, to a lesser extent, in C57BL/6J mice. The mechanisms involved in the immunity to this murine cysticercosis seem to be mainly mediated by T cells. To gain further insight into the mechanisms of cysticercal immunity, the susceptibility of mice deficient in different immunologically relevant genes was compared with that of the respective wild type. Mice were classified according to the parasite load and survival after infection: highly susceptible (HS), with an increased parasite load and mortality rate (CD4-/-, TCRalpha-/-, TCRbeta-/-, RAG1-/-), susceptible, with only increased parasite load (TCRdelta-/-, BALB/cAnN), and relatively resistant, with a lower number of parasites (CD8-/-, WT). Neither specific proliferative response nor Th2 cytokine or antibody responses were observed in HS mice. These data strongly suggest that CD4+TCRalphabeta+ T cells have a critical role in the control of T. crassiceps murine cysticercosis.

Possible relationship between neurocysticercosis and hematological malignancies

Background. Previous studies have shown an increased frequency of chromosomal abnormalities in lymphocytes from animals and humans with cysticercosis. Some reports have suggested an association between neurocysticercosis and cancer. Methods. We designed a mortality rate study from the autopsy files of the Department of pathology at the General Hospital of Mexico. A total of 1,271 autopsy files were reviewed. All files in which a malignant neoplasia was found during autopsy were selected a cases. Autopsies in which no malignant disease was found were used as controls. The odds ratio was determined between the frequency of neurocysticercosis in patients with any malignant neoplasia and that of the controls. Results. Neurocysticercosis was more frequent in cases with malignant hematological diseases (MHD), than in controls (p= 0.01). The odds ratio for this association was 3.54, with 95 percent confidence interval from 1.17-9-79. Conclusions. Most human cancers arise from the interaction of a multiplicity of factors, indluding xenobiotics and endogenous constituents. Therefore, while it will be difficult to demostrate that neurocysticercosis is a causal agent of malignant hematological diseases (MHD), it should be considered as a potential risk factor for cancer induction in countries where cysticercosis remains a public health problem

[The chemotherapy of cysticercosis. The results 10 years or more after follow-up]. / Quimioterapia de la cisticercosis. Resultados de 10 años ó más después del seguimiento.

Chemotherapy for neurocysticercosis was born logically because of the scant success of surgery, which is generally palliative, not curative. Prazicuantel is the only drug about which serious of more than 100 cases, and follow-up of more than 2 years, have been published. Its use has become universal, reason enough for this theme to be addressed. This paper pretends to contribute to the determination of its therapeutic value in the treatment of neurocysticercosis by means of the clinical and radiologic treatment of 50 sick persons followed up for from between 10 (72%) and more than 10 (28%) years. The patients had been treated with prazicuantel with a dose of 50 mg per kilo of body weight during 15 days; 26% received one treatment, 58% received two, and 22%, three or more treatments. The patients were studied once again clinically and radiologically with computed axial tomography of the cranium and magnetic resonance. Biological testing was done only if activity-suspected cases. The results showed a rate of 68% clinical cures or important improvement. Emphasis is made of the 6% of cases in which the clinical cure process was apparent. It was confirmed that neurocysticercosis is a generalized chronic ailment in which evolution is achieved by means of periods of activity alternating with periods of recession. The employment of witnesses is not advised, and it is suggested for later investigation that ample series of cases be followed-up over long periods of time. It is insisted upon that the best treatment for the illness is prophylaxis.

Cisticercose humana diagnosticada em hospital geral, Säo Paulo, SP (Brasil) / Human cystercercosis in a general hospital in Säo Paulo, (Brazil)

Foi realizado estudo retrospectivo de pacientes internados no Hospital das Clínicas da Faculdade de Medicina da Universidade de Säo Paulo, Säo Paulo (Brasil), no período de 7 anos (1979 a 1985), tendo sido diagnosticados 260 casos de cisticercose, corrrespondendo a 0,2

Hydrocephalus secondary to cysticercotic arachnoiditis. A long-term follow-up review of 92 cases.

Ninety-two patients with hydrocephalus secondary to cysticercotic meningitis were followed for a mean period of 8 years 11 months. The mortality rate was 50%, with most patients dying within the first 2 years after cerebrospinal fluid (CSF) shunting. The prognosis was worse in females than in males. Multiple surgical procedures for shunt obstruction were necessary in half of the patients. Complications such as bacterial meningitis and shunt obstruction were more frequent in the patients who died than in those who survived. The follow-up data revealed that the clinical status was satisfactory in 78% of survivors and unsatisfactory in 22%. Spontaneous remission of the cysticercotic arachnoiditis, as shown by the CSF findings, occurred in only 18% of the cases. In most patients, arachnoiditis and positive immune reactions persisted unchanged even after several years. The results demonstrate the poor outcome of these patients and indicate the need for better medical and surgical therapy.

Tratamiento de la neurocisticercosis con praziquantel / Treatment of cysticercosis of the CNS with praziquantel

La Neurocisticercosis multiquistica racemosa basal es una afeccion maligna con alta mortalidad hasta ahora por falta de tratamiento especifico. La enfermedad ha disminuido notablemente en Bogota por las medidas sanitarias, pero aun persiste en algunas zonas del pais. La aparicion de un nuevo cestocida util contra las formas embrionarias y las tenias constituye una esperanza para los enfermos con estas parasitosis. En este articulo se presenta un caso quirurgicamente en el cual la evolucion progresiva y el deterioro clinico fue detenida con la administracion de Praziquantel, con recuperacion del paciente.