Epidemiology and surveillance of human (neuro)cysticercosis in Europe: is enhanced surveillance required?

OBJECTIVES: To report on relevant national surveillance systems of (N)CC and taeniasis (the infection with the adult tapeworm) in the European Union/European Economic Area and to assess the magnitude of (N)CC occurrence by retrieving information on cases for the period 2000-2016. METHODS: (N)CC cases were retrieved via national reporting systems, a systematic literature search, contact with clinicians and a search for relevant 'International Statistical Classification of Diseases and Related Health Problems' (ICD)-based data. RESULTS: Mandatory notification systems for (N)CC were found in Hungary, Iceland and Poland. Ten cases were reported in Poland and none in Hungary and Iceland. Through the systematic literature review and information given by clinicians, 263 individual and 721 aggregated (N)CC cases from 19 European countries were identified. ICD-based data were obtained from five countries. From 2000 to 2016, a total of 3489 cases (N)CC cases were coded: 832 in Italy, eight in Latvia, 357 in Portugal, 2116 in Spain and 176 in Sweden. CONCLUSION: Despite being classified as a possible eradicable disease, (N)CC is still diagnosed across Europe, yet its true extent and impact remain unclear.

OBJECTIFS: Rapporter sur les systèmes nationaux de surveillance pertinents de la (neuro)cysticercose (N)CC et de la téniase (infection par le ténia adulte) dans l'Union européenne/l'Espace économique européen, et évaluer l'ampleur de l'occurrence de la (N)CC en reprenant des informations sur les cas durant la période 2000-2016. MÉTHODES: Les cas de (N)CC ont été repris à partir des systèmes nationaux de notification, une recherche systématique de la littérature, des contacts avec des cliniciens et une recherche de données pertinentes basées sur la 'Classification Statistique Internationale des Maladies et Problèmes de Santé Connexes' (ICD). RÉSULTATS: Des systèmes de notification obligatoires pour la (N)CC ont été trouvés en Hongrie, en Islande et en Pologne. Dix cas ont été rapportés en Pologne et aucun en Hongrie et en Islande. Grâce à la revue systématique de la littérature et aux informations fournies par les cliniciens, 263 cas individuels et 721 cas agrégés de (N)CC de 19 pays européens ont été identifiés. Des données ICD ont été obtenues de cinq pays. De 2000 à 2016, un total de 3489 cas de (N)CC ont été codés: 832 en Italie, 8 en Lettonie, 357 au Portugal, 2116 en Espagne et 176 en Suède. CONCLUSION: Bien qu'elle soit classée comme une maladie pouvant être éradiquée, la (N)CC est toujours diagnostiquée à travers l'Europe, mais sa véritable ampleur et son impact restent incertains .

Disseminated cysticercosis and Kaposi sarcoma in a child with HIV/AIDS: A case report.

BACKGROUND: Clinical manifestations of extraneural infection with the pork tapeworm Taenia solium typically affect the muscles, eyes, alimentary canal, and/or subcutaneous tissues. Children living with HIV are at increased risk for more widespread and severe manifestations of food-borne opportunistic infections, including T. solium, due to fluctuating levels of immunosuppression. We present a case of disseminated T. solium in a HIV-positive child with Kaposi sarcoma living in Tanzania with cysticercosis presenting as widespread subcutaneous nodules. CASE PRESENTATION: A 4-year-old HIV-positive boy in Southern Tanzania presented for evaluation of > 30 violaceous skin lesions, few subcutaneous nodules, and a circumferential violaceous penile lesion which rapidly grew after initiation of ART. The patient was clinically diagnosed with Kaposi sarcoma and started on chemotherapy with bleomycin, vincristine, and doxorubicin. He completed 10 cycles of chemotherapy, with full resolution of the violaceous skin and penile lesions but persistence of his subcutaneous nodules, thus paclitaxel was added. After 12 additional cycles of paclitaxel, his subcutaneous nodules enlarged, and biopsy of a scapular subcutaneous nodule was performed. Histopathology revealed a cystic structure with a central larval scolex and serrated spiral canal consistent with T. solium, which confirmed a diagnosis of disseminated cysticercosis. He completed a 10-day course of praziquantel and albendazole with resolution of the subcutaneous nodules. CONCLUSIONS: Disseminated cysticercosis is an unusual opportunistic infection which can present as subcutaneous nodules without other typical cysticercosis symptoms. Immunosuppression - from HIV and/or chemotherapy - may unmask cysticercosis in children in endemic regions and result in more severe manifestations of this disease. Cysticercosis should remain on a clinician's differential for subcutaneous nodules, especially in children living with HIV. Cysticercosis can mimic Kaposi sarcoma, and histopathology is essential to accurately diagnose and manage patients with concerning skin lesions.

Taenia eggs in a stabilization pond system with poor hydraulics: concern for human cysticercosis?

The objective of this study is to compare the removal of Taenia eggs to the removal of Ascaris eggs in a wastewater stabilization pond system consisting of three ponds in series, where the hydraulic residence time distribution has been characterized via a tracer study supported by computational fluid dynamics modeling. Despite a theoretical hydraulic retention time of 30 days, the peak dye concentration was measured in the effluent of the first pond after only 26 hours. The smaller-sized Taenia eggs were detected in higher concentrations than Ascaris eggs in the raw wastewater. Ascaris eggs were not detected in the pond system effluent, but 45 Taenia eggs/L were detected in the system effluent. If some of these eggs were of the species Taenia solium, and if the treated wastewater were used for the irrigation of crops for human consumption, farmers and consumers could potentially be at risk for neurocysticercosis. Thus, limits for Taenia eggs in irrigation water should be established, and precautions should be taken in regions where pig taeniasis is endemic. The results of this study indicate that the theoretical hydraulic retention time (volume/flow) of a pond is not always a good surrogate for helminth egg removal.

Orbital cysticercosis: clinical manifestations, diagnosis, management, and outcome.

PURPOSE: To describe the clinical manifestations, diagnosis, management, and outcome of orbital cysticercosis in a tertiary eye care center in Southern India. DESIGN: Retrospective observational case series. PARTICIPANTS: A total of 171 patients with orbital cysticercosis. METHODS: Retrospective case series involving consecutive patients with orbital cysticercosis from March 1990 to December 2001. MAIN OUTCOME MEASURES: Clinical resolution and significant residual deficit. RESULTS: The median age at presentation was 13 years (range 2-65 years), and 93 patients (54.4%) were male. The 3 main symptoms at presentation were periocular swelling (38%), proptosis (24%), and ptosis (14%) with a median duration of 2 (range 0-24) months. The 3 main signs at presentation included ocular motility restriction (64.3%), proptosis (44.4%), and diplopia (36.8%). The cyst locations in the decreasing order of frequency were anterior orbit (69%), subconjunctival space (24.6%), posterior orbit (5.8%), and the eyelid (0.6%). In all, 80.7% of patients had cysts in relation to an extraocular muscle. The superior rectus (33.3%) was the most commonly involved extraocular muscle. Contact B-scan ultrasonography was diagnostic of cysticercosis in 84.4% of patients. Orbital cysticercosis was managed medically in 158 of 166 patients. Although 149 patients received a combination of oral albendazole and prednisolone, 1 patient received oral albendazole alone, 7 patients received oral prednisolone alone, and 1 patient received oral praziquantel. Surgery was performed in 8 patients. Clinical resolution was seen in 128 of 138 patients (92.8%) at 1 month and 81 of 85 patients (95.3%) at 3 months. A significant residual deficit was present in 29 of 138 patients (21.0%) at the final follow-up and included proptosis in 7 patients, ptosis in 6 patients, ocular motility restriction in 3 patients, diplopia in 2 patients, strabismus in 2 patients, and a combination of the above in 9 patients. CONCLUSIONS: Orbital cysticercosis is a common clinical condition in the developing world. It typically affects young individuals and has a wide spectrum of clinical manifestations. Both B-scan ultrasonography and computed tomography scan are useful in confirming the diagnosis. Despite resolution of cysticercosis with medical management, a significant proportion of patients may have residual functional deficits.

Human cysticercosis and Indian scenario: a review.

Cysticercosis, caused by Taenia solium larva is a major public health problem,especially in the developing world and neurocysticercosis (NCC) is considered to be the most common parasitic infestation of the central nervous system. NCC is identified as the single most common cause of community acquired active epilepsy; 26.3% to 53.8% active epilepsy cases in the developing world including India and Latin America are due to NCC.It is also becoming more common in the developed world because of increased migration of people with the disease or Taenia solium carriers and frequent travel to the endemic countries. It is estimated that three quarters of the estimated 50 million people with active epilepsy live in the poor countries of the world. Recent Indian studies using neuroimaging techniques suggest that the disease burden in India surpasses many other developing countries. Hence it is important to know the epidemiology,pathogenesis and diagnostic criteria so as to assess the disease burden and adopt interventional strategies for its control.Literature search was done for this review with special emphasis on Indian studies to create awareness about the disease in India,since cysticercosis is preventable and potentially eradicable.

Taenia solium dUTPase: A potential target for anti-human cysticercosis.

dUTPase plays an essential role in pyrimidine metabolism in many organisms. In this study we report the dUTPase-encoding gene (Tdut) from Taenia solium oncospheres and larvae. Alignment reveals that the putative protein contains five conserved motifs that are often found in many characterized dUTPases. The deduced amino acid sequence has only 65.2% identity with human dUTPases. This low identity encourages its use for the design of new drugs against cysticercosis.

[Seroprevalence of cysticercosis and associated risk factors in a group of patients examined at the Regional Referral Hospital in Antsirabe]. / Séroprévalence de la cysticercose et facteurs de risque associés chez un groupe de patients vus au Centre Hospitalier Régional de Référence d'Antsirabe, Madagascar.

INTRODUCTION: In Madagascar, cysticercosis, a disease caused by Taenia Solium's larval form, is a public health problem. In 2003, the seroprevalence of cysticercosis ranged between 7% and 21% with a higher rate in the central regions of the island. However, epidemiological data on human cysticercosis have been limited over the last dozen years. The objective of our study aimed to determine the seroprevalence of cysticercosis Western blot as well as its associated risk factors in patients from the region of Vakinankaratra with clinical suspicion. METHODS: We conducted a cross-sectional, descriptive study at the Regional Referral Hospital in Antsirabe over a period of 6 months. All the patients included in the study answered a clinic questionnaire collecting their socio-demographic and cultural features as well as their dietary habits and their clinical symptoms. RESULTS: The seroprevalence of cysticercosis in the study population was 14.8% (35/237). These rates did not differ significantly according to sex, age, pork consumption or meat preparation (p > 0.05). However, a significant difference (p < 0.05) was observed among patients with subcutaneous nodules or positive for cysticercosis. CONCLUSION: In our study, the high index of exposure to Taenia solium justifies the strengthening of control and prevention measures already set up in our country.

Human cysticercosis: parasitology, pathology, clinical manifestations and available treatment.

Human cysticercosis is a global health problem and neurocysticercosis a serious clinical syndrome. The diagnosis of neurocysticercosis can now be made with a high degree of accuracy by scrutiny of clinical signs and symptoms in combination with X-ray, computed tomography or magnetic resonance imaging, serological tests and laboratory examinations. Differential clinical diagnosis with tumor, and vascular and inflammatory conditions, may however, prove difficult in nonendemic areas. The management of cysticercosis has been radically changed by the advent of effective chemotherapy. Both the heterocyclic pyrazinoisoquinoline compound, praziquantel and the benzimidazole carbamate, albendazole, have now been extensively tested and successfully used for treatments of neurocysticercosis, usually in combination with corticosteroids. The definition of appropriate criteria and guidelines for the use of chemotherapy, may however, require further research. Surgical interventions continue to play an important role in certain clinical presentations. Recent advances in immunological research hold realistic promise for the development of a vaccine against Taenia solium.

Seroprevalence of human cysticercosis and its associated risk factors among humans in areas of Kaduna metropolis, Nigeria.

INTRODUCTION: Taenia solium cysticercosis is considered an emerging parasitic zoonosis of global importance due to its impact on both agriculture and public health in developing countries. Epidemiological information on human cysticercosis is limited in Nigeria. This study was conducted to determine the seroprevalence of human cysticercosis in areas of Kaduna metropolis, Nigeria, where small-holder pig farming is practiced. METHODOLOGY: A cross-sectional survey was conducted in Kaduna South and Chikun Local Government Areas of Kaduna metropolis, which are widely involved in small-holder pig farming and pork consumption. A total of 300 human sera were collected and tested for the presence of IgG antibodies to T. solium using an enzyme-linked immunosorbent assay (ELISA) technique. A structured questionnaire was used to identify risk factors in the population and was administered to the study population. RESULTS: A total of 43 of 300 sera tested positive to IgG antibodies, indicating a cysticercosis prevalence of 14.3%. Method of pork preparation and history of epilepsy were found to be strongly associated with seropositivity. Epileptics in this study were two times more likely to be seropositive than non-epileptics. A large proportion (74.0%) of the population had very poor knowledge of cysticercosis, and knowledge of cysticercosis was strongly associated with method of pork preparation and respondents' occupations. CONCLUSIONS: A high seroprevalence of human cysticercosis was found in Kaduna South and Chikun Local Government Areas. The main risk and behavioral factors contributing to the high prevalence include poor knowledge of cysticercosis and lack of knowledge on proper pork preparation methods.

Neurocysticercosis and human immunodeficiency virus infection. A possible association.

We present four patients with active neurocysticercosis and human immunodeficiency virus type 1 infection. In three patients, symptoms of neurocysticercosis brought the patient to medical attention and led to the diagnosis of human immunodeficiency virus infection. Neurocysticercosis should be considered in human immunodeficiency virus-infected persons who have been in areas where cysticercosis is endemic.

Intraparenchymal cerebral cysticercosis in children: diagnosis and treatment.

Cerebral cysticercosis is being diagnosed with increasing frequency in children in the United States. A total of 52 patients with intraparenchymal cerebral cysticercosis, 21 months to 20 years of age, were observed for 2 to 72 months. Actively inflamed acute lesions, with or without coexisting chronic calcified lesions, were seen in 42 patients. Solitary lesions were seen in 39 patients, multiple lesions in 13. Chronic inactive calcified lesions were seen in ten children. A total of 51 patients had seizures that were either partial or partial with secondary generalization. Patients were treated with anticonvulsants. Praziquantel was not used. All active lesions resolved completely or with punctate calcification in 2 to 9 months, according to radiographic findings. Seizures were easily controlled. Patients were gradually weaned from anticonvulsants and in 60% no seizures recurred. Prognosis was generally good. Characteristics of the CT scans are detailed.

Customs which predispose to Chagas' disease and cysticercosis in Mexico.

Customs in small isolated populations of Mexico are described which influence the prevalence of cysticercosis and Chagas' disease. People in some villages prefer the taste of pork harboring cysticerci. Certain triatomids are thought to have aphrodisiac properties and are therefore eaten.

Serological evidence for recent exposure to Taenia solium in Venezuelan Amerindians.

This study examined the seroprevalence and serum antibody isotype profile for Taenia solium cysticercosis in an Amerindian community in the Amazonas state of Venezuela. An antigen-trapping enzyme-linked immunosorbent assay (Ag-ELISA) was used to detect viable cysticercosis. Indirect ELISA (Ab-ELISA) and enzyme-linked immunoelectrotransfer blot (EITB) was performed by using antigens prepared from T. solium metacestodes to detect anti-parasite antibodies. The Ag-ELISA and Ab-ELISAs revealed 64.7% and 79.0% seropositivity, respectively, in the Amerindian population. Immunoglobulin (Ig) M was the predominant antibody class, suggesting recent infection. In comparison sera from, clinically defined, hospital neurocysticercosis cases revealed only 27% seropositivity by Ag-ELISA, compared with 86-92% seropositivity by Ab-ELISA, and IgG4 was the predominant antibody subclass detected. The EITB antigen recognition patterns of the hospitalized patients were very similar to that of the Amerindians, confirming exposure to the parasite. These results, combined with the predominance of IgM antibody responses and the marked detection of secreted products of viable parasites, strongly suggest that recent exposure to T. solium had occurred in the Amerindian population.

Spontaneous extrusion of extraocular cysticercus cysts.

PURPOSE: We treated two patients who had spontaneous extrusion of cysticercus cysts and subconjunctival swelling. Additionally, one patient had severe myositis and restriction of ocular movements. METHODS: The patients were prescribed oral albendazole, 15 mg/kg of body mass per day. Systemic corticosteroids were also given to the patient who had severe myositis. RESULTS: Spontaneous extrusion of the cysts occurred in both patients within three to five days of starting albendazole therapy. The conjunctival defects healed without any surgical intervention. The ocular motility in the patient with myositis returned to normal. CONCLUSION: As extrusion happened soon after the start of albendazole therapy, it is uncertain whether this therapy played any role. Additionally, it is not clear if systemic therapy must be continued in the absence of systemic and neurologic manifestations.

Intramedullary cysticercosis. Case report, literature review and comments on pathogenesis.

A 60-year-old woman developed progressive spastic crural paraplegia and global anesthesia and global anesthesia below T10, succumbing to urinary infection and bronchopneumonia 8 months after the onset of symptoms. At necropsy, the spinal cord was completely destroyed by a necrotic intramedullary cysticercus at T8. Six cysticerci were found in the brain. A review of the 17 published cases of intramedullary cysticercosis (including this one) showed this condition to be clinically indistinguishable from spinal cord tumours. The surgical prognosis was fair in 8 of 11 operated patients. The role of hematogenous and ventriculo-ependymal pathways in the pathogenesis of intramedullary cysticercosis was examined. The topographical distribution of intramedullary cysticerci (5 cervical, 12 thoracic, 2 lumbar, none sacral) was found to be statistically proportional to the blood flow to each of these regions; this favours the hematogenous route of infestation. The low spinal cord blood flow (100 times less than that to the brain), the type of vascularization of the cord (low calibre vessels under low pressure) and peculiarities of the cord tissue (such as its harder consistency) are all thought to be contributory factors accounting for the scarcity of intramedullary cysticerci. No evidence for an ependymal route of spread could be adduced.

Investigation of risk factors for porcine Taenia solium cysticercosis: a multiple regression analysis of a cross-sectional study in the Yucatan Peninsula, Mexico.

A cross-sectional survey for seropositivity to cysticercosis of pigs in the Yucatan Peninsula, Mexico, was carried out in 1996 together with a standardized questionnaire on predetermined individual pig and household risk factors for porcine infection. Serum samples from 697 pigs were analysed by immunoblot for antibodies to Taenia solium cysticercosis and questionnaires from 227 households in 18 villages were collected. All the data were analysed using multivariate analytical techniques taking household clustering into account. The overall porcine seroprevalence in the area was found to be 29%. The most important risk factors for seropositivity in pigs were presence versus absence of a toilet (adjusted odds ratio [adj. OR] 2.37, P = 0.005), crowded households (adj. OR 1.75, P = 0.034) and both corralling (adj. OR 2.14, P = 0.017) and letting pigs loose (adj. OR 2.32, P = 0.035) versus tying them up. There was evidence of clustering at household level and that possible risk factors at municipal or village level may also interact with higher risk management practices such as allowing pigs to run loose.

Taenia saginata cysticercosis in cattle with special reference to its prevalence, pathogenesis and economic implications in Fars Province of Iran.

The study was carried out during a 3-year period. Of 9501 cattle examined, 736 (7.7%) were infected with cysticerci of Taenia saginata. The endemic foci were identified and prevalence was significantly higher (P < 0.005) in animals from Noorabad Mammasani (10.7%), Kenareh (10.0%) and Shiraz area (8.5%) than elsewhere. The prevalence was significantly higher (P < 0.005) during spring and autumn seasons. There was no variation in the infection rate in animals of different age groups, suggesting that immunity was acquired to super-infection. The most common sites were muscle of the shoulder (26.3%) and masseter (23.7%), tongue (24.9%) and heart (23.4%). Pharynx, oesophagus and diaphragm showed 0.9, 0.5 and 0.4% infection, respectively. The metacestode caused extensive damage resulting in infiltrative, degenerative changes, haemorrhages, necrosis and exudation mainly in the vicinity of cysts. The infection was the cause of condemnation of 34.6% of infected carcases. The rejected carcases and infected organs were valued at 100.1 million Rials over the 3-year period.

A contribution to the etiology of racemose cysticercosis.

An aberrant case of proliferating coenurosis caused by Taenia serialis in immunosuppressed mice is described. The coenuri closely resembled examples of racemose cysticerci described in the literature and the present results are discussed with reference to human cases of asexually proliferating larval cestode infections.

Taenia saginata cysticercosis in an Ohio cattle feeding operation.

In January to March 1981, 37 slaughter cattle from a single Ohio feeding operation were determined, at postmortem inspection, to be infected with Taenia saginata cysticerci. A subsequent outbreak on this same farm in March 1983 involved 7 slaughter cattle. An epidemiologic investigation was conducted of possible sources of the T saginata ova; these included leakage of raw sewage onto the pasture after a flood in 1980, municipal sewage sludge application on the farm, defecation in feed or water by farm workers, and other off-farm sources. Temporal and spatial observations implicated raw sewage contamination of pastures as the most likely source of infection in the 1981 outbreak. The outbreak in 1983 was more likely associated with sludge application. The possibility of an infected worker exposing the cattle to infected feces was not excluded definitely as a possible source.

Epidemiologic findings from an outbreak of cysticercosis in feedlot cattle.

An outbreak of cysticercosis in a south-central Idaho custom feedlot reached a peak prevalence of 11% in January 1993 and extended from October 1992 through March 1993. Of 5,164 cattle slaughtered from this feedlot during the outbreak, 457 (9%) were cysticercosis infected. Total discounts on the infected cattle at slaughter cost the feedlot $154,400. Most evidence was suggestive of feed-borne transmission of Taenia saginata eggs to the cattle in the feedlot. By use of logistic regression analysis of feedlot records, significant (P = 0.004) association of cysticercosis prevalence at slaughter with days on feed was revealed. Similarly, a decline in cysticercosis prevalence was significantly (P < 0.001) related to the number of days cattle were fed a ration not containing potato byproduct. Although sources other than potato byproduct were systematically evaluated during the investigation, findings suggested that potato byproduct fed in this feedlot was contaminated with T saginata eggs.