Disease: Cysticercosis (Pork Tapeworm Infection)

    Cysticercosis (pork tapeworm infection) facts

    • Cysticercosis is a parasitic disease caused by ingesting the eggs of the pork tapeworm, Taenia solium.
    • Humans are infected by ingesting raw or undercooked pork, and cysticercosis occurs after the ingestion of Taenia solium eggs.
    • The symptoms of neurocysticercosis may include headaches, confusion, seizures, and vision changes.
    • Cysticercosis is typically diagnosed based on the patient's symptoms and imaging study results. Blood work is sometimes useful.
    • Cysticercosis may be treated with medications, including anthelmintics, corticosteroids, and anticonvulsants, while some patients may require surgery.
    • Cysticercosis can lead to neurologic and ocular complications, and rarely death.
    • Cysticercosis can be prevented by educating individuals about proper food handling, avoidance of raw or undercooked pork, and good personal hygiene.

    What is cysticercosis?

    Cysticercosis is a systemic parasitic infestation caused by ingesting the eggs of the pork tapeworm, Taenia solium. The symptoms of this illness are caused by the development of characteristic cysts (cysticerci) which most often affect the central nervous system (neurocysticercosis), skeletal muscle, eyes, and skin. Many individuals with cysticercosis never experience any symptoms at all (asymptomatic).

    The tapeworm responsible for causing cysticercosis is endemic to many parts of the developing world, including Latin America, Asia, and sub-Saharan Africa. The World Health Organization (WHO) estimates that cysticercosis affects about 50 million people worldwide. The incidence of cysticercosis has increased in the United States due to increased immigration from developing countries. Neurocysticercosis is a leading cause of adult-onset seizures worldwide. The Centers for Disease Control and Prevention (CDC) has designated cysticercosis as one of five "neglected parasitic infections" in the United States, and the WHO has designated cysticercosis as one of 17 "neglected tropical diseases" worldwide.

    Historically, the disease has been recognized since about 2000 B.C. by the Egyptians, and later it was described in pigs by Aristotle. The disease was also recognized by Muslim physicians and is thought to be the reason for Islamic dietary prohibition of eating pork. In the 1850s, German investigators described the life cycle of T. solium.

    What causes cysticercosis?

    Cysticercosis is caused by the dissemination in humans of the larval form of the pork tapeworm, Taenia solium, that form cysts in various organs. When the eggs of Taenia solium are ingested by humans, the tapeworm eggs hatch and the embryos penetrate the intestinal wall and reach the bloodstream. The formation of cysts in different body tissues leads to the development of symptoms, which will vary depending on the location and number of cysts.

    How is cysticercosis transmitted?

    Humans are the host for Taenia solium, and they may carry the tapeworm in their intestine (taeniasis), often without symptoms. The tapeworm eggs are periodically shed in the feces by the human reservoir, and typically pigs ingest the eggs in contaminated food or water. The pigs subsequently become infected and develop cysticerci in their body tissue. When humans eat infected raw or undercooked pork, the life cycle of the tapeworm is complete and the cycle continues.

    Human cysticercosis, however, develops after humans ingest Taenia solium eggs. The eggs are typically spread via food, water, or surfaces contaminated with infected feces. Oftentimes, the eggs may be spread from the hands of infected food handlers who do not clean their hands or from foods fertilized/irrigated with water containing infected human feces. Though the source of this fecal-oral transmission often occurs from other infected individuals, it is also possible for individuals who carry the tapeworm to autoinfect themselves.

    What are cysticercosis symptoms and signs?

    The symptoms of cysticercosis may develop from several months to several years after the initial infection (incubation period). The symptoms will depend on the location and the number of cysticerci, though many individuals with cysticercosis will never develop any symptoms at all. The majority of patients with cysticercosis who present to a health-care professional have central nervous system involvement (neurocysticercosis or NCC). Symptoms of neurocysticercosis may include the following:

    • Nausea and vomiting
    • Headache
    • Lethargy
    • Confusion
    • Vision changes
    • Weakness or numbness
    • Seizure (often the presenting symptom, occurs in about 70% of people with NCC)

    Involvement of other body tissues may cause skeletal muscle swelling, subcutaneous cysts, and vision changes from cysts infecting the eyes.

    How is cysticercosis diagnosed?

    The diagnosis of cysticercosis can sometimes be difficult, and it may require a combination of tests and imaging studies to make the diagnosis. In Texas, young adults who have immigrated from Mexico, especially from the mountainous regions, that have a new onset seizure should have cysticercosis considered as a possible cause. In general, however, the patient's clinical presentation along with abnormal radiographic imaging results (CT scan of the brain/MRI of the brain) lead to the diagnosis of neurocysticercosis. Blood testing can sometimes be used as an adjunct in making the diagnosis, though it is not always helpful or accurate. These tests are usually performed in more specialized labs. Rarely, a biopsy from affected tissue may be needed to make the diagnosis. Stool studies are sometimes also obtained because they may contain identifiable parasite eggs.

    What is the treatment for cysticercosis?

    The treatment of cysticercosis depends on various factors, including the individual's symptoms, the location and number of cysticerci, and the stage of cyst development. Generally speaking, treatment is tailored to each individual patient and their particular presentation, and treatment regimens may include anthelmintic agents, corticosteroids, anticonvulsant medications, and/or surgery. Asymptomatic patients may not require any treatment at all. Controversy does exist as to which patients require treatment with the various medications.

    The most commonly used anthelmintic agents include albendazole (Albenza) and less commonly praziquantel (Biltricide). These antiparasitic medications are effective in eliminating viable cysticerci though they may cause reactive localized inflammation. Consequently, the use of these medications must be evaluated on a case-by-case basis. More than one course of treatment may be necessary to completely eliminate active cysts.

    Learn more about: Albenza | Biltricide

    Corticosteroids may also be used in conjunction with, or instead of, antiparasitic medications. Corticosteroids are used to decrease inflammation but are not active against the parasite. Again, treatment with these medications must be tailored to each individual case. Consultation with an infectious disease expert is recommended.

    Anticonvulsant medications are used in patients with neurocysticercosis experiencing seizures or at high risk for recurrent seizures. Various anticonvulsant medications, such as carbamazepine (Tegretol) or phenytoin (Dilantin), may be prescribed. Consultation with an experienced neurologist may be helpful to determine patient treatment.

    Learn more about: Tegretol | Dilantin

    Learn more about: Albenza | Biltricide

    Surgical management may also be necessary in select cases of cysticercosis. Surgical removal of central nervous system cysts or placement of a brain shunt (to relieve pressure) is sometimes necessary in some cases of neurocysticercosis. Certain cases of cysticercosis involving the eyes or subcutaneous cysts may also require surgery.

    What causes cysticercosis?

    Cysticercosis is caused by the dissemination in humans of the larval form of the pork tapeworm, Taenia solium, that form cysts in various organs. When the eggs of Taenia solium are ingested by humans, the tapeworm eggs hatch and the embryos penetrate the intestinal wall and reach the bloodstream. The formation of cysts in different body tissues leads to the development of symptoms, which will vary depending on the location and number of cysts.

    How is cysticercosis transmitted?

    Humans are the host for Taenia solium, and they may carry the tapeworm in their intestine (taeniasis), often without symptoms. The tapeworm eggs are periodically shed in the feces by the human reservoir, and typically pigs ingest the eggs in contaminated food or water. The pigs subsequently become infected and develop cysticerci in their body tissue. When humans eat infected raw or undercooked pork, the life cycle of the tapeworm is complete and the cycle continues.

    Human cysticercosis, however, develops after humans ingest Taenia solium eggs. The eggs are typically spread via food, water, or surfaces contaminated with infected feces. Oftentimes, the eggs may be spread from the hands of infected food handlers who do not clean their hands or from foods fertilized/irrigated with water containing infected human feces. Though the source of this fecal-oral transmission often occurs from other infected individuals, it is also possible for individuals who carry the tapeworm to autoinfect themselves.

    What are cysticercosis symptoms and signs?

    The symptoms of cysticercosis may develop from several months to several years after the initial infection (incubation period). The symptoms will depend on the location and the number of cysticerci, though many individuals with cysticercosis will never develop any symptoms at all. The majority of patients with cysticercosis who present to a health-care professional have central nervous system involvement (neurocysticercosis or NCC). Symptoms of neurocysticercosis may include the following:

    • Nausea and vomiting
    • Headache
    • Lethargy
    • Confusion
    • Vision changes
    • Weakness or numbness
    • Seizure (often the presenting symptom, occurs in about 70% of people with NCC)

    Involvement of other body tissues may cause skeletal muscle swelling, subcutaneous cysts, and vision changes from cysts infecting the eyes.

    How is cysticercosis diagnosed?

    The diagnosis of cysticercosis can sometimes be difficult, and it may require a combination of tests and imaging studies to make the diagnosis. In Texas, young adults who have immigrated from Mexico, especially from the mountainous regions, that have a new onset seizure should have cysticercosis considered as a possible cause. In general, however, the patient's clinical presentation along with abnormal radiographic imaging results (CT scan of the brain/MRI of the brain) lead to the diagnosis of neurocysticercosis. Blood testing can sometimes be used as an adjunct in making the diagnosis, though it is not always helpful or accurate. These tests are usually performed in more specialized labs. Rarely, a biopsy from affected tissue may be needed to make the diagnosis. Stool studies are sometimes also obtained because they may contain identifiable parasite eggs.

    What is the treatment for cysticercosis?

    The treatment of cysticercosis depends on various factors, including the individual's symptoms, the location and number of cysticerci, and the stage of cyst development. Generally speaking, treatment is tailored to each individual patient and their particular presentation, and treatment regimens may include anthelmintic agents, corticosteroids, anticonvulsant medications, and/or surgery. Asymptomatic patients may not require any treatment at all. Controversy does exist as to which patients require treatment with the various medications.

    The most commonly used anthelmintic agents include albendazole (Albenza) and less commonly praziquantel (Biltricide). These antiparasitic medications are effective in eliminating viable cysticerci though they may cause reactive localized inflammation. Consequently, the use of these medications must be evaluated on a case-by-case basis. More than one course of treatment may be necessary to completely eliminate active cysts.

    Learn more about: Albenza | Biltricide

    Corticosteroids may also be used in conjunction with, or instead of, antiparasitic medications. Corticosteroids are used to decrease inflammation but are not active against the parasite. Again, treatment with these medications must be tailored to each individual case. Consultation with an infectious disease expert is recommended.

    Anticonvulsant medications are used in patients with neurocysticercosis experiencing seizures or at high risk for recurrent seizures. Various anticonvulsant medications, such as carbamazepine (Tegretol) or phenytoin (Dilantin), may be prescribed. Consultation with an experienced neurologist may be helpful to determine patient treatment.

    Learn more about: Tegretol | Dilantin

    Learn more about: Albenza | Biltricide

    Surgical management may also be necessary in select cases of cysticercosis. Surgical removal of central nervous system cysts or placement of a brain shunt (to relieve pressure) is sometimes necessary in some cases of neurocysticercosis. Certain cases of cysticercosis involving the eyes or subcutaneous cysts may also require surgery.

    Source: http://www.rxlist.com

    The treatment of cysticercosis depends on various factors, including the individual's symptoms, the location and number of cysticerci, and the stage of cyst development. Generally speaking, treatment is tailored to each individual patient and their particular presentation, and treatment regimens may include anthelmintic agents, corticosteroids, anticonvulsant medications, and/or surgery. Asymptomatic patients may not require any treatment at all. Controversy does exist as to which patients require treatment with the various medications.

    The most commonly used anthelmintic agents include albendazole (Albenza) and less commonly praziquantel (Biltricide). These antiparasitic medications are effective in eliminating viable cysticerci though they may cause reactive localized inflammation. Consequently, the use of these medications must be evaluated on a case-by-case basis. More than one course of treatment may be necessary to completely eliminate active cysts.

    Learn more about: Albenza | Biltricide

    Corticosteroids may also be used in conjunction with, or instead of, antiparasitic medications. Corticosteroids are used to decrease inflammation but are not active against the parasite. Again, treatment with these medications must be tailored to each individual case. Consultation with an infectious disease expert is recommended.

    Anticonvulsant medications are used in patients with neurocysticercosis experiencing seizures or at high risk for recurrent seizures. Various anticonvulsant medications, such as carbamazepine (Tegretol) or phenytoin (Dilantin), may be prescribed. Consultation with an experienced neurologist may be helpful to determine patient treatment.

    Learn more about: Tegretol | Dilantin

    Learn more about: Albenza | Biltricide

    Surgical management may also be necessary in select cases of cysticercosis. Surgical removal of central nervous system cysts or placement of a brain shunt (to relieve pressure) is sometimes necessary in some cases of neurocysticercosis. Certain cases of cysticercosis involving the eyes or subcutaneous cysts may also require surgery.

    Source: http://www.rxlist.com

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