Mortality associated with cysticercosis in a historical cohort from Britain.

BACKGROUND: The burden of premature mortality associated with human cysticercosis is largely ignored mainly due to poor record-keeping in Taenia solium endemic regions. OBJECTIVE: To document mortality and survival characteristics of an historical cohort with cysticercosis. METHODS: The years of onset of symptoms and death untill 1957 were extracted from published reports of a British military cohort (n=450) examined in London in the early twentieth century. Data were entered into a Kaplan Meier survival analysis with the presence (or absence) of clinical manifestations as independent variables, which were then fitted into a Cox proportional hazards model to determine their significance. RESULTS: Cysticercosis was responsible for 24 (52.2%) of 46 deaths in the first 15 years of follow-up in comparison to 7 (19.4%) of 36 deaths in the 20-40 years of follow-up period. In the univariate and Cox analyses, intracranial hypertension (hazard ratio [HR]: 8.26; CI: 4.71, 14.49), ocular cysticercosis (HR: 6.60; CI: 3.04, 14.33), and mental disorder (HR: 3.98; CI: 2.22, 7.13) but not epilepsy (HR: 0.66; CI: 0.20, 2.18) were associated with mortality. Over half of all deaths in the first 15 years of follow-up were attributed to cysticercosis. CONCLUSIONS: Several deaths occurred early after acquiring cysticercotic infection. Intracranial hypertension, ocular cysticercosis, and mental disorder but not epilepsy were predictors of mortality in this cohort.

Historical perspective: The British contribution to the understanding of neurocysticercosis.

Neurocysticercosis, or brain infestation with the larval stage of Taenia solium, is the most common risk factor for epilepsy in many endemic regions of the world. Hardly any cases are seen in Western developed countries, including Britain. However, a sizeable number (n = 450) was seen among British soldiers returning from deputation to India, then a British colony, first reported by Col. MacArthur at the Queen Alexandria Military Hospital in 1931. Here, we review the influence of the perceptive observations of British Army medics on the understanding of the parasitic disorder. The majority of these people presented with epilepsy. Among the contributions of the army medics were establishing the diagnosis, initially by histological examination of subcutaneous and muscular infestation, and later by radiography, clarifying the prognosis and the role of medical and surgical treatments and uncovering the close relationship between the larval (cysticercosis) and adult (intestinal tapeworm) stages of T. solium.

Taenia solium Cysticercosis--The lessons of history.

Human taeniasis as well as porcine and human cysticercosis--caused by the pork tapeworm Taenia solium--are ancient diseases. The fact that pigs were considered impure in the ancient Greece and that the Koran prohibited the consumption of pork, were likely related to the knowledge that cysticercosis may affect swine. Evidence suggests that human cysticercosis was also present in the ancient Egypt and Rome. During the Renaissance, the causative agent was properly identified and human cases were recognized. Confirmation that both taeniasis and cysticercosis were caused by the same parasite was provided during the 19th Century by German pathologists. During the 20th Century, bouts of human cysticercosis in non-endemic regions left us valuable lessons on the mechanisms of disease acquisition and spread. These included a large series of neurocysticercosis cases in the United Kingdom that occurred after the return of troops stationed in India (which demonstrated that symptoms may occur years after infection), the epidemic of cysticercosis-related epilepsy in the Ekari people of Papua New Guinea occurring after the gift of pigs with cysticercosis received from Indonesia (demonstrating the fast establishment of endemic transmission and the impact of cysticercosis in epilepsy frequency), and the occurrence of neurocysticercosis among members of an Orthodox Jewish community of New York City, related to Latin American Taenia carriers working in their houses (highlighting the fact that cysticercosis transmission do not require the presence of infected pigs). These lessons of history have significantly contributed to our current knowledge on this disease.

[Original procreation or generational change? The investigation of cysticercus and tapeworms]. / Urzeugung oder Generationswechsel? Zur Erforschung der Blasen- und Bandwürmer.

The doctrine of the abiogenesis postulated the origin of human and animal intestinal worms from "not complete digested ingesta". Indeed Peter Simon Pallas (1741-1811) defined already 1760 in his dissertation that endoparasitic worms reproduce themselves by eggs. But he characterised the nature of cysticercus as "pathologically degenerated tail bladder". In 1856 Rudolf Leuckart (1822-1898) paraphrased the alternation of generation with "marvellous metamorphoses and peculiar form of development". The Dane Johannes Japetus Smith Steenstrup (1813-1897) recognised finally the principle of the alternation of generation and Gottlob Friedrich Heinrich Küchenmeister (1821-1890), a physician at the Saxon city Zittau realised the special correlation between the alternate and end host of tapeworms. Both, Leuckart and Küchenmeister proved their insights by animal and human experimentations.

Short report: cysticercosis in an Egyptian mummy of the late Ptolemaic period.

We describe here an ancient case of cysticercosis that was discovered in an Egyptian mummy of a young woman of about 20 years of age who lived in the late Ptolemaic period (second to first centuries b.c.). On removal of the stomach and its rehydration, a cystic lesion in the stomach wall was observed by naked eye. Microscopical examination of sections of this lesion revealed a cystic structure, with a wall, with numerous projecting eversions, a characteristic feature of the larval stage (cysticercus) of the human tapeworm Taenia solium (or "pig tapeworm"). Immunohistochemical testing with serum from a T. solium-infected human confirmed the identity of the cyst. This finding is the oldest on record of the antiquity of this zoonotic parasite. This observation also confirms that, in Hellenistic Egypt, the farming of swine, along with man an intermediate host of this parasite, was present, and supports other archeological evidence.

Vaccines against cysticercosis and hydatidosis: foundations in taeniid cestode immunology.

Recombinant oncosphere antigens have been used in the development of effective vaccines for the prevention of cysticercosis caused by Taenia ovis, Taenia saginata, Taenia solium and hydatid disease caused by Echinococcus granulosus. These vaccines were developed utilizing information gathered from numerous researchers over some 60 years which had established many of the principals concerning immunity to taeniid cestodes in their intermediate hosts. Australian scientists, or scientists with close Australian connections, made seminal early contributions to the understanding of cestode immunology that provided the foundations for more recent application of recombinant DNA methods and the development of practical vaccines. Here, some particular contributions to the field are highlighted from Drs. Michael Gemmell, Michael Rickard, David Heath and Graham Mitchell together with a précis of the recent progress in vaccine development, particularly for prevention of cysticercosis due to T. solium.

Neurocisticercose: aspectos clínicos, epidemiológicos e análise de 171 prontuários do Instituto de Infectologia Emílio Ríbas de 1980 a 1990 / Neurocisticercose: clinical aspects, epidemiologists and analysis of 171 handbooks of the Institute of Infectologia Emilio Ríbas of 1980 the 1990

De 171 casos de neurocisticercose registrados na instituição hospitalar foram extraídos os dados possíveis de ordem clínica, epidemiológica e de exploração laboratorial. A neurocisticercose, embora reúna razoável segurança de identificação de suas bases clínicas, parasitológicas e patológicas, é, freqüentemente, omitida quando desencadeia episódios de caráter subagudo, com reacutizações que são confundidas por meningites bacterianas, meningites virais, meningites indeterminadas, afecções cerebrais neoplásicas, vasculares e uma variedade de outros diagnósticos que retardam o esclarecimento e a conduta terapêutica. O A. procedeu ao estudo individual e conjuntural, estabelecendo tabelas com dados de naturalidade, procedência, idade, ocupação, hábitos, sintomatologia, evolução. Verificou que as informações dos prontuários são deficientes, contrastando com a importância, a freqüência e as repercussões graves da doença que, em geral, não é reconhecida de pronto. Ao final, faz recomendações para que se proceda a um interrogatório meticuloso do paciente sobre a sintomatologia e os antecedentes epidemiológicos, afim de obter o diagnóstico precoce

Polish and American collaboration on zoonotic parasitic studies, 1960 to 1997.

The Marshall Plan of 1947 kindled interest in research in Europe. The U.S. Public Health Service encouraged the use of blocked national currencies to research disease problems. The parasitic diseases were epidemic/epizootic problems in Poland. The initial project was trichinellosis. The 10-year study emphasized the natural history, epidemiology, diagnosis, and therapy of trichinellosis in Poland. The wildlife source of trichinellosis was widespread. Clinical studies discounted the effectiveness of mebendazole but found steroids useful. Taenia saginata is common in Eastern Europe. T. saginata cystericosis in cattle is not easily diagnosed. Physical examination by meat inspectors missed 50% of the infected carcasses. Taenia solium is uncommon. Giardiasis is declining in Poland. The epidemiology of giardiasis in Poland is different from that in the United States, where water-borne infections are common. A study of toxoplasmosis revealed a low prevalence in women but a high prevalence in cats. No cases were identified in 4,311 newborns.

Alguns comentários sobre a história da cisticercose e dos seus transtornos neuropsiquiátricos / Some comments on the history of cysticercosis and its neuropsychiatric disorders

A história da aquisiçäo do conhecimento médico sobre a cisticercose (infestaçäo por formas larvárias da Taenia solium) é revista, com ênfase nos problemas psico-sociais e nos transtornos neuropsiquiátricos.

Historia de la cisticercosis porcina en México / History of porcine cysticercosis in México

La cisticercosis al igual que las parasitosis intestinales representa un problema de salud pública endémico en América Latina que ha permanecido sin variación en los últimos 50 años, consecuencia del fecalismo y coprofagia al que han sido sometidos inconcientemente animales y seres humanos que habitan vastas y variadas regiones del continente hispanoamericano, contraste dramático se establece con las condiciones sanitarias que privan en Canadá y E.E.U.U. en donde esta parasitosis se considera como una enfermedad exótica producto de las corrientes turísticas y de la migración de trabajadores del tercer mundo. Después de la conquista española en virtud de la afición gastronómica de los españoles que probablemente la heredaron durante la dominación romana en la península, se introdujo inmediatamente la cria del cerdo doméstico, infestado por cisticerosis; el desarrollo de la porcinocultura fue realizado en condiciones no propicias para un sano desarrollo y crecimiento del cerdo puesto que las condiciones de insalubridad, ignorancia, aislamiento geográfico, hábitos y costumbres en la cria y manejo de alimentos así como el uso de agua de desecho en el cultivo de hortalizas y frutas favorecieron las condiciones que mantuvieran la promiscuidad de cerdos y humanos; es evidente que las invasiones masivas de parásitos (vesículas) en el cerebro, ojos y músculos de los animales sacrificados fue habitual hallazgo de matanceros y consejeros lengueros del rey, desgraciadamente la frecuencia de estas infestaciones no quedó registrada o bien, los documentos y testimonio han desaparecido, sin embargo existía gran interés y atención durante los siglos XVIII y XIX por parte de los médicos latinoamericanos que observaron la enfermedad y se mantenían actualizados con los informes y avances acerca de este singular parásito que se realizaban en Europa. Durante el período de 1857 a 1900 existen múltiples comunicaciones de doctores mexicanos, argentinos y brasileños acerca del ciclo vital del cisticerco y del hallazgo de las lesiones oculares retinianas, cerebrales y meníngeas...

Hipólito Unanue y la neurocisticercosis / Hipolito Unanue and neurocysticercosis

De acuerdo a las evidencias presentadas en esta trabajo, el primer caso de neurocisticercosis humana en el Perú fué publicado en 1972 por don Hipólito UNANUE en el Mercurio Peruano. Se discute la historia clínica del paciente y se expresan algunas reflexiones en torno a la problemática general de la cisticercosis en nuestro país

Cisticercose: apresentação de um caso localizado na bochecha / Cysticercose: report of a case in bucal mucosa

O autor apresenta um caso de Cisticercose de bochecha direita, numa criança de 4 anos, fazendo considerações sobre; histórico, distribuição geográfica, localização, infecção, sintomatologia, formas, diagnóstico, tratamento e profilaxia de doenças

[A Danish pathography from the 17th century (Johan Valentin Wille) (author's transl)]. / En sygdomsbeskrivelse fra 1600-tallets Danmark.

A monograph written by the physician Johan Valentin Wille in 1675 is discussed and commented. The monograph was published in Th. Bartholin Acta medica, the first medical journal in Denmark, and was in 1934 translated from Latin into Danish by the physician Eiler Høeg. It givees a detailed description of organ changes and internal parasites found in cattle and hare autopsied on Sealand 1674-75. Vermiform bodies found in the liver of cattle are undoubtedly identical with Fasciola hepatica. The tumorous or cystic formations in the bovine lung and liver correspond certainly with the larval stages of Echinococcus granulosus and the small cysts arranged as "bunches of grapes" on the liver surface and mesentery of hares cannot be anything else than Cysticercus pisiformis. It is possibly the first description of the mentioned parasites in animals in Denmark. The observations are published almost two centuries before the life-cycles of these parasites were finally clarified and about one century before the Danish Veterinary School was established at Christianshavn (in Copenhagen) and the founder Abildgaard started to publish his interesting observations on intestinal parasites.--The monograph is typical for that particular time, reflecting the decline of the medieval humoralism and the growth of the Renaissance science.