Taenia solium - Revision history

Aidan: /* Diagnostic Criteria */

2024-01-27T15:48:00Z

Diagnostic Criteria

← Older revision		Revision as of 15:48, 27 January 2024
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	#Parenchymal neurocysticercosis		#Parenchymal neurocysticercosis
	#*Definitive parenchymal ~~neurocysticercosisa~~, one of the following:		#*Definitive parenchymal neurocysticercosis, one of the following:
	#*#Parenchymal cyst with pathological diagnosis		#*#Parenchymal cyst with pathological diagnosis
	#*#Single or multiple active parenchymal cysts, with at least one cyst with scolex on CT or MRI		#*#Single or multiple active parenchymal cysts, with at least one cyst with scolex on CT or MRI
	#*#Multiple parenchymal vesicles without scolex associated with at least one of the following: ~~a. Seizures: focal or generalized tonic‐clonic b. Positive serum or CSF immunological test (ELISA, EITB)~~		#*#Multiple parenchymal vesicles without scolex associated with at least one of the following:
			#*##Seizures: focal or generalized tonic‐clonic
			#*##Positive serum or CSF immunological test (ELISA, EITB)
	#*#Any combination of the parenchymal cysticercus in different evolutive stages: vesicular with or without scolex, degenerative (colloidal or nodular), and calcified		#*#Any combination of the parenchymal cysticercus in different evolutive stages: vesicular with or without scolex, degenerative (colloidal or nodular), and calcified
	#*Probable parenchymal neurocysticercosis, one of the following:		#*Probable parenchymal neurocysticercosis, one of the following:
	#*#Single parenchymal calcification or vesicle (without scolex) or degenerating cyst(s), establishing differential diagnoses with other etiologies, associated with at least two of the following: a. Seizures: focal or generalized tonic‐clonic b. Subcutaneous or muscle cysts location confirmed by biopsy c. Positive serum or CSF immunological test (ELISA, EITB) d. Plain X‐ray films showing “cigar‐shaped” calcifications e. Individual who lives or has lived in or has traveled frequently to endemic countries		#*#Single parenchymal calcification or vesicle (without scolex) or degenerating cyst(s), establishing differential diagnoses with other etiologies, associated with at least two of the following:
			#*##Seizures: focal or generalized tonic‐clonic
			#*##Subcutaneous or muscle cysts location confirmed by biopsy
			#*##Positive serum or CSF immunological test (ELISA, EITB)
			#*##Plain X‐ray films showing “cigar‐shaped” calcifications
			#*##Individual who lives or has lived in or has traveled frequently to endemic countries
	#*#Multiple parenchymal calcifications in an individual who lives or has lived in or has traveled frequently to endemic countries and in whom clinical state excludes other etiologies of calcifications		#*#Multiple parenchymal calcifications in an individual who lives or has lived in or has traveled frequently to endemic countries and in whom clinical state excludes other etiologies of calcifications
	#Extraparenchymal neurocysticercosis (intraventricular/basal subarachnoid)		#Extraparenchymal neurocysticercosis (intraventricular/basal subarachnoid)
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	#*#Extraparenchymal cyst with pathological diagnosis		#*#Extraparenchymal cyst with pathological diagnosis
	#*#One or more extraparenchymal cysts on MRI special sequences with scolex in at least one of them		#*#One or more extraparenchymal cysts on MRI special sequences with scolex in at least one of them
	#*#One or more extraparenchymal cysts on MRI special sequences without scolex associated with at least two of the following: ~~a. Hydrocephalus b. Inflammatory CSF c. Positive CSF immunological test (ELISA, EITB) d. Presence of single or multiple calcifications or parenchymal vesicular or degenerative cyst~~		#*#One or more extraparenchymal cysts on MRI special sequences without scolex associated with at least two of the following:
			#*##Hydrocephalus
			#*##Inflammatory CSF
			#*##Positive CSF immunological test (ELISA, EITB)
			#*##Presence of single or multiple calcifications or parenchymal vesicular or degenerative cyst
	#Definitive parenchymal and extraparenchymal neurocysticercosis		#Definitive parenchymal and extraparenchymal neurocysticercosis
	#*Combination of the above definitive parenchymal and definitive extraparenchymal criteria		#*Combination of the above definitive parenchymal and definitive extraparenchymal criteria

Aidan: /* Cysticercosis */

2021-09-22T13:40:34Z

Cysticercosis

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 *CSF for neurocysticercosis shows lymphocytic or eosinophilic pleiocytosis, hypoglycorrhachia, and elevated protein
 **Can send lentil lectin glycoprotein Western blot (LLGP-WB) or antibody testing, but sensitivity is proportional to number of lesions
 *Serology is available, with enzyme-linked immunotransfer blot
 **Sensitivity high, but only confirms previous exposure
 **Sensitivity low in cases of only one cyst
 **High turnaround time
 ===Classification of Neurocysticercosis===

Aidan at 14:51, 3 December 2020

2020-12-03T14:51:45Z

← Older revision		Revision as of 14:51, 3 December 2020
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	*Can be infected with the tapeworm (i.e. as definitive host) or with the cysts (i.e. as intermediate host), or with both (~25% of infections)		*Can be infected with the tapeworm (i.e. as definitive host) or with the cysts (i.e. as intermediate host), or with both (~25% of infections)

	===~~Adult Tapeworms~~===		===Taeniasis===

	*No specific symptoms, though may cause some element of malnutrition		*No specific symptoms, though may cause some element of malnutrition
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	==Diagnosis==		==Diagnosis==

	===~~Adult Tapeworm~~===		===Taeniasis===

	*Stool O&P		*Stool O&P
	**Eggs are indistinguishable from ''T. saginata'', so ideally needs a proglottid for diagnosis		**Eggs are indistinguishable from ''[[Taenia saginata\|T. saginata]]'', so ideally needs a proglottid for diagnosis
	**If seen, consider looking for concommitant cysts		**If seen, consider looking for concommitant cysts

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	**Sensitivity high, but only confirms previous exposure		**Sensitivity high, but only confirms previous exposure
	**Sensitivity low in cases of only one cyst		**Sensitivity low in cases of only one cyst
			**High turnaround time

	===Classification of Neurocysticercosis===		===Classification of Neurocysticercosis===
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	===Adult Tapeworm===		===Adult Tapeworm===

	*Praziquantel 5 to 10 mg/kg once		*[[Praziquantel]] 5 to 10 mg/kg once
	**Well-tolerated, cysticidal		**Well-tolerated, cysticidal
	*Niclosamide 2 g once		*[[Niclosamide]] 2 g once
	**Not absorbed, stays in the gut, therefore only kills the adult worms		**Not absorbed, stays in the gut, therefore only kills the adult worms
	*Don't treat during pregnancy unless necessary		*Don't treat during pregnancy unless necessary
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	*Screen household members		*Screen household members

	===Intraparenchymal ~~lesions~~===		===Intraparenchymal Lesions===

	*Indications		*Indications
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	**May not need treatment if they are from India (overall good prognosis)		**May not need treatment if they are from India (overall good prognosis)
	*Antiparasitic		*Antiparasitic
	**If 1-2 viable cysticerci: albendazole 15 mg/kg/day (max 1200 mg/day) divided bid for 10 to 14 days with food		**If 1-2 viable cysticerci: [[albendazole]] 15 mg/kg/day (max 1200 mg/day) divided bid for 10 to 14 days with food
	***60% resolve spontaneously by 1-2 years		***60% resolve spontaneously by 1-2 years
	***~~Meds~~ may increase time to resolution, but will lower risk of seizure recurrence		***Medications may increase time to resolution, but will lower risk of seizure recurrence
	**If >2 viable cysticerci: albendazole 15 mg/kg/day plus praziquantel 50 mg/kg/day for 10 to 14 days		**If >2 viable cysticerci: [[albendazole]] 15 mg/kg/day plus [[praziquantel]] 50 mg/kg/day for 10 to 14 days
	**If only calcified cysticerci: supportive treatment only		**If only calcified cysticerci: supportive treatment only
	**If diffuse encephalitis: avoid treating		**If diffuse encephalitis: avoid treating
	*Adjuncts		*Adjuncts
	**Adjunctive corticosteroids for all for 6-8 weeks then taper		**Adjunctive [[corticosteroids]] for all for 6-8 weeks then taper
	***Need to start at least 24 hours before starting antiparasitic		***Need to start at least 24 hours before starting antiparasitic
	**If refractory seizures, consider neurosurgery		**If refractory seizures, consider neurosurgery service
	**Antiepileptic medications, which may later be tapered		**Antiepileptic medications, which may later be tapered
	*Monitoring		*Monitoring
	**Monitor liver enzymes and leukopenia if >14+ days		**Monitor liver enzymes and leukopenia if >14+ days
	**MRI ~~q6mo~~ until resolution		**MRI every 6 months until resolution
	**Re-treat if parenchymal cysts persist for 6 months after initial treatment		**Re-treat if parenchymal cysts persist for 6 months after initial treatment

	===Extraparenchymal and ~~intraventricular~~ ~~lesions~~===		===Extraparenchymal and Intraventricular Lesions===

	*Neurosurgical removal with minimally-invasive neuroendoscopy for lateral and third ventricles, and possibly fourth ventricle		*Neurosurgical removal with minimally-invasive neuroendoscopy for lateral and third ventricles, and possibly fourth ventricle
	**If unable to, may need VP shunt		**If unable to, may need VP shunt
	*Corticosteroids perioperatively		*[[Corticosteroids]] perioperatively
	*Antihelminthic therapy only necessary in those that cannot have surgical removal		*Antihelminthic therapy only necessary in those that cannot have surgical removal

	===Subarachnoid ~~lesions~~===		===Subarachnoid Lesions===

	*Screen with spinal MRI for concommitant spinal cysticercus		*Screen with spinal MRI for concommitant spinal cysticercus
	*Treat with antihelminthic until radiographic resolution on MRI (at least 2-3 months, can be more than a year)		*Treat with antihelminthic until radiographic resolution on MRI (at least 2-3 months, can be more than a year)
	**Variable response with high rate of relapse		**Variable response with high rate of relapse
	*Corticosteroids prior to antiparasitic drugs		*[[Corticosteroids]] prior to antiparasitic drugs
	*Consider methotrexate as steroid-sparing agent		*Consider [[methotrexate]] as steroid-sparing agent
	*VP shunt preferred to neurosurgery		*VP shunt preferred to neurosurgery

	===Spinal ~~lesions~~===		===Spinal Lesions===

	*Consider steroids and antihelminthic, as well as surgical options		*Consider [[steroids]] and antihelminthic, as well as surgical options

	===Ocular ~~lesions~~===		===Ocular Lesions===

	*Surgical removal		*Surgical removal

Aidan at 02:17, 3 December 2020

2020-12-03T02:17:11Z

← Older revision		Revision as of 02:17, 3 December 2020
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	**Also one of the leading causes of seizure worldwide		**Also one of the leading causes of seizure worldwide
	*Usually acquired abroad, but there are cases of local acquisition from within the household		*Usually acquired abroad, but there are cases of local acquisition from within the household
			*Risk factors for cysticercosis include:
			**Residence in endemic country
			**Increasing age
			**Frequent consumption of pork
			**Poor household hygiene

	[[File:WHO_Map_of_Endemic_Taenia_solium.png\|link=Special:FilePath/WHO_Map_of_Endemic_Taenia_solium.png\|alt=Map of endemic Taenia solium\|center\|Map of endemic ''Taenia solium'']]		[[File:WHO_Map_of_Endemic_Taenia_solium.png\|link=Special:FilePath/WHO_Map_of_Endemic_Taenia_solium.png\|alt=Map of endemic Taenia solium\|center\|Map of endemic ''Taenia solium'']]
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	*They will eventually die and calcify, but will still be seen on plain X-ray		*They will eventually die and calcify, but will still be seen on plain X-ray

	===Neurocysticercosis===		====Neurocysticercosis====

	*Incubation period is usually [[Usual incubation period::3 to 5 years]] but can be [[Incubation period range::up to 30 years]]		*Incubation period is usually [[Usual incubation period::3 to 5 years]] but can be [[Incubation period range::up to 30 years]]
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	*Ophthalmologic cysticercosis		*Ophthalmologic cysticercosis

	===Cardiac cysticercosis===		====Cardiac cysticercosis====

	*Rare, but can cause heart failure and conduction abnormalities		*Rare, but can cause heart failure and conduction abnormalities

Aidan at 02:12, 3 December 2020

2020-12-03T02:12:26Z

← Older revision		Revision as of 02:12, 3 December 2020
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	*Usually acquired abroad, but there are cases of local acquisition from within the household		*Usually acquired abroad, but there are cases of local acquisition from within the household

	[[File:WHO_Map_of_Endemic_Taenia_solium.png\|~~WHO~~ ~~map~~ of endemic ''Taenia solium''~~\|link=Special:FilePath/WHO_Map_of_Endemic_Taenia_solium.png~~]]		[[File:WHO_Map_of_Endemic_Taenia_solium.png\|link=Special:FilePath/WHO_Map_of_Endemic_Taenia_solium.png\|alt=Map of endemic Taenia solium\|center\|Map of endemic ''Taenia solium'']]
			<br />

	==Clinical Presentation==		==Clinical Presentation==

Aidan: /* Epidemiology */

2020-12-03T02:11:31Z

Epidemiology

← Older revision		Revision as of 02:11, 3 December 2020
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	*Usually acquired abroad, but there are cases of local acquisition from within the household		*Usually acquired abroad, but there are cases of local acquisition from within the household

	[[File:~~Endemicity_Taenia_Solium_2015~~.~~jpg~~\|WHO ~~Map~~ of ~~Endemic~~ Taenia solium\|link=Special:FilePath/~~Endemicity_Taenia_Solium_2015~~.~~jpg~~]]		[[File:WHO_Map_of_Endemic_Taenia_solium.png\|WHO map of endemic ''Taenia solium''\|link=Special:FilePath/WHO_Map_of_Endemic_Taenia_solium.png]]

	==Clinical Presentation==		==Clinical Presentation==

Aidan: /* Neurocysticercosis */

2020-08-05T14:09:18Z

Neurocysticercosis

← Older revision		Revision as of 14:09, 5 August 2020
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	*Incubation period is usually [[Usual incubation period::3 to 5 years]] but can be [[Incubation period range::up to 30 years]]		*Incubation period is usually [[Usual incubation period::3 to 5 years]] but can be [[Incubation period range::up to 30 years]]
	*Most commonly presents with seizure (70%) or intracranial hypertension		*Most commonly presents with seizure (70%) or intracranial hypertension
	*~~Intraparenchyal~~ cerebral cysts enlarge slowly, asymptomatic for years or decades until they begin to die, causing inflammation		*Intraparenchymal cerebral cysts enlarge slowly, asymptomatic for years or decades until they begin to die, causing inflammation
	**They can leak, provoking inflammation with cerebritis and meningitis		**They can leak, provoking inflammation with cerebritis and meningitis
	**These can lead to focal or generalized seizures, focal neurological deficits, intellectual impairment, psychiatric disorders, and hydrocephalus		**These can lead to focal or generalized seizures, focal neurological deficits, intellectual impairment, psychiatric disorders, and hydrocephalus
	*~~Itraventricular~~ and basilar cysts present earlier		*Intraventricular and basilar cysts present earlier
	**Obstruction of CSF or local meningeal irritation		**Obstruction of CSF or local meningeal irritation
	**Can cause cranial nerve or brainstem deficits		**Can cause cranial nerve or brainstem deficits
	**Racemose cysticercosis (aggressive basilar neurocysticercosis) occurs when cysts proliferate at the base of the brain, causing coma and death		**Racemose cysticercosis (aggressive basilar neurocysticercosis) occurs when cysts proliferate at the base of the brain, causing coma and death
	*Cysticercotic encephalitis ~~occus~~ when there is a massive infection of the brain parenchyma		*Cysticercotic encephalitis occurs when there is a massive infection of the brain parenchyma
	*Intraparenchymal spinal cord lesions can become symptomatic ~~ealy~~ due to local effects, or more slowly if outside the cord itself		*Intraparenchymal spinal cord lesions can become symptomatic early due to local effects, or more slowly if outside the cord itself
	*Ophthalmologic cysticercosis		*Ophthalmologic cysticercosis

Aidan: /* Neurocysticercosis */

2020-08-05T14:08:49Z

Neurocysticercosis

← Older revision		Revision as of 14:08, 5 August 2020
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	===Neurocysticercosis===		===Neurocysticercosis===

	*Incubation period is usually 3 to 5 years but as ~~long~~ as 30 years		*Incubation period is usually [[Usual incubation period::3 to 5 years]] but can be [[Incubation period range::up to 30 years]]
	*Most commonly presents with seizure (70%) or intracranial hypertension		*Most commonly presents with seizure (70%) or intracranial hypertension
	*Intraparenchyal cerebral cysts enlarge slowly, asymptomatic for years or decades until they begin to die, causing inflammation		*Intraparenchyal cerebral cysts enlarge slowly, asymptomatic for years or decades until they begin to die, causing inflammation

Aidan: /* Neurocysticercosis */

2020-07-14T01:31:47Z

Neurocysticercosis

← Older revision		Revision as of 01:31, 14 July 2020
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	== Background ==		==Background==

	===Microbiology===		===Microbiology===
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	!Histopathology		!Histopathology
	\|-		\|-
	! colspan=3\|Parenchymal		! colspan="3" \|Parenchymal
	\|-		\|-
	\|Non-viable, calcified		\|Non-viable, calcified
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	\|Parasites with intact cyst wall, vesicular fluid and scolex, with variable inflammation suurounding the parasite sometimes invading cyst wall		\|Parasites with intact cyst wall, vesicular fluid and scolex, with variable inflammation suurounding the parasite sometimes invading cyst wall
	\|-		\|-
	! colspan=3 \|Extraparenchymal		! colspan="3" \|Extraparenchymal
	\|-		\|-
	\|Intraventricular		\|Intraventricular
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	===Neurocysticercosis===		===Neurocysticercosis===

			*Non-contrast CT (for calcifications) and MRI brain
	*NCCT + MRI
	*Screen for LTBI if likely to need long steroids		*Screen for [[LTBI]] if likely to need long steroids
	*Screen for ''Strongyloides'' if likely to need long steroids		*Screen for ''[[Strongyloides]]'' if likely to need long steroids
	*Fundoscopy prior to starting antihelminthic		*Fundoscopy prior to starting antihelminthic
	*Screen household members		*Screen household members

Aidan: /* Classification of Neurocysticercosis */

2020-07-14T01:21:21Z

Classification of Neurocysticercosis

← Older revision		Revision as of 01:21, 14 July 2020
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	!Histopathology		!Histopathology
	\|-		\|-
	\|~~'''~~Parenchymal~~'''~~		! colspan=3\|Parenchymal
	\|
	\|
	\|-		\|-
	\|Non-viable, calcified		\|Non-viable, calcified
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	\|Parasites with intact cyst wall, vesicular fluid and scolex, with variable inflammation suurounding the parasite sometimes invading cyst wall		\|Parasites with intact cyst wall, vesicular fluid and scolex, with variable inflammation suurounding the parasite sometimes invading cyst wall
	\|-		\|-
	\|~~'''~~Extraparenchymal~~'''~~		! colspan=3 \|Extraparenchymal
	\|
	\|
	\|-		\|-
	\|Intraventricular		\|Intraventricular