Case Report: Cysticercosis: Sonographic Diagnosis of a Treatable Cause of Epilepsy and Skin Nodules

Heller, Tom; Wallrauch, Claudia; Kaminstein, Daniel; Phiri, Sam

doi:10.4269/ajtmh.17-0257

Cited by 6 publications

(5 citation statements)

References 7 publications

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“…In this review on human T. solium taeniosis and (neuro) cysticercosis within ESA, we found wide variations in the prevailing prevalence estimates depending on the quality of the study and the diagnostic methods used. There remain large gaps with regards to T. solium infections within the ESA region with 11 countries without any information on human taeniosis and cysticercosis, and even more countries [18] without any information for cysticercosis.…”

Section: Discussionmentioning

confidence: 99%

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The epidemiology of human Taenia solium infections: A systematic review of the distribution in Eastern and Southern Africa

et al. 2023

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Background Taenia solium is a tapeworm that causes taeniosis in humans and cysticercosis in humans and pigs. Within Eastern and Southern Africa (ESA), information on the presence of human taeniosis and cysticercosis seems scarce. This systematic review aimed to describe the current information available and gaps in the epidemiology of human T. solium infections in ESA. Methods/Principle findings Scientific literature published between 1st January 2000 and 20th June 2022 in international databases [MEDLINE (Ovid), Embase (Ovid), Global Health (Ovid), Scopus (Elsevier), African Index Medicus (via WHO Global Index Medicus), and Open Grey] was systematically reviewed for ESA. The study area included 27 countries that make up the ESA region. Information on either taeniosis, cysticercosis or NCC was available for 16 of 27 countries within the region and a total of 113 reports were retained for the review. Most case reports for cysticercosis and NCC were from South Africa, while Tanzania had the most aggregated cysticercosis reports. Eleven countries reported on NCC with seven countries reporting data on NCC and epilepsy. Unconfirmed human T. solium taeniosis cases were reported in nine countries while two countries (Madagascar and Zambia) reported confirmed T. solium cases. The cysticercosis seroprevalence ranged between 0.7–40.8% on antigen (Ag) ELISA and between 13.1–45.3% on antibody (Ab) ELISA. Based on immunoblot tests the Ab seroprevalence was between 1.7–39.3%, while the proportion of NCC-suggestive lesions on brain CT scans was between 1.0–76% depending on the study population. The human taeniosis prevalence based on microscopy ranged between 0.1–14.7%. Based on Copro Ag-ELISA studies conducted in Kenya, Rwanda, Tanzania, and Zambia, the highest prevalence of 19.7% was reported in Kenya. Conclusions Despite the public health and economic impact of T. solium in ESA, there are still large gaps in knowledge about the occurrence of the parasite, and the resulting One Health disease complex, and monitoring of T. solium taeniosis and cysticercosis is mostly not in place.

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Section: Discussionmentioning

confidence: 99%

“…There remain large gaps with regards to T . solium infections within the ESA region with 11 countries without any information on human taeniosis and cysticercosis, and even more countries [ 18 ] without any information for cysticercosis.…”

Section: Discussionmentioning

confidence: 99%

The epidemiology of human Taenia solium infections: A systematic review of the distribution in Eastern and Southern Africa

et al. 2023

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“…One patient originating from Peru also had high antibody titres against cysticercae. In this case, clinical cysticercosis co-infection was excluded through clinical examination and by cranial and muscular imaging [29].…”

Section: Patients Materials and Methodsmentioning

confidence: 99%

Percutaneous drainage and combined praziquantel-albendazole therapy: a novel approach for the treatment of simple echinococcal liver cysts

Richter,

Lindner,

Geisel

et al. 2023

Z Gastroenterol

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Cystic echinococcosis (CE) is a worldwide helminthic zoonosis causing serious disease in humans. The WHO Informal Working Group on Echinococcosis recommends a stage-specific treatment approach of hepatic CE that facilitates the decision on what therapy option is most appropriate. Percutaneous aspiration, instillation of a scolicide, e.g., ethanol or hypertonic saline, and subsequent re-aspiration (PAIR) have been advocated for treating medium-size unilocular WHO-stage CE1 cysts. PAIR can pose a risk of toxic cholangitis because of spillage of ethanol in the case of a cysto-biliary fistula or of life-threatening hypernatriaemia when hypertonic saline is used. The purpose of our study is to develop an alternative, safe, minimally invasive method to treat CE1 cysts, avoiding the use of toxic topic scolicides.We opt for percutaneous drainage (PD) in four patients: the intrahepatic drainage catheter is placed under CT-fluoroscopy, intracystic fluid is aspirated, and the viability of intracystic echinococcal protoscolices is assessed microscopically. Oral praziquantel (PZQ) is added to albendazole (ABZ) instead of using topical scolicidals.Protoscolices degenerate within 5 to 10 days after PZQ co-medication at a cumulative dosage of 250 to 335 mg/kg, and the cysts collapse. The cysts degenerate, and no sign of spillage nor relapse is observed in the follow-up time of up to 24 months post-intervention.In conclusion, PD combined with oral PZQ under ABZ coverage is preferable to PAIR in patients with unilocular echinococcal cysts.

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“…Disseminated cysticercosis is an uncommon manifestation of infection with T. solium and most commonly presents as subcutaneous and intramuscular nodules, although any organ can be infected [6][7][8][9][10]. Among people living with HIV, a recent case-control study did not find any association between HIV infection and NCC in Tanzania [11], and to date, no unique relationship between NCC and HIV has been reported [12].…”

Section: Introductionmentioning

confidence: 99%

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

et al. 2020

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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. Immunosuppressionfrom HIV and/or chemotherapymay 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.

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Case Report: Cysticercosis: Sonographic Diagnosis of a Treatable Cause of Epilepsy and Skin Nodules

Abstract: A case of disseminated cysticercosis of brain, muscle subcutaneous tissue is reported and the use of musculoskeletal ultrasound in the diagnosis of the condition emphasized.

Cited by 6 publications

References 7 publications

The epidemiology of human Taenia solium infections: A systematic review of the distribution in Eastern and Southern Africa

The epidemiology of human Taenia solium infections: A systematic review of the distribution in Eastern and Southern Africa

Percutaneous drainage and combined praziquantel-albendazole therapy: a novel approach for the treatment of simple echinococcal liver cysts

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

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