2. Cysticercosis -Neurocysticercosis Dan King

3. We’ll Discuss:  Description  Symptoms  Diagnosis  Treatment  Prevention  Facts/Statistics/Numbers  Case Report  Q/A

4. Warning Chuck Norris is the only other person to accomplish a presentation on Cysticercosis due to grotesque content THIS IS NOT FOR THE FAINT

5. Description Most common infestation of CNS worldwide Most common infestation of CNS worldwide Obtained by ingesting eggs/larvae of tapeworm Taenia Solium, or the worm itself Obtained by ingesting eggs/larvae of tapeworm Taenia Solium, or the worm itself Found in fecally-contaminated water and undercooked pork Found in fecally-contaminated water and undercooked pork

7. Description cont. Larvae invade tissue in digestive tract and enter bloodstream, traveling to and imbedding in organs (Skeletal, heart, eye, brain, spinal cord, etc.) Larvae invade tissue in digestive tract and enter bloodstream, traveling to and imbedding in organs (Skeletal, heart, eye, brain, spinal cord, etc.) Larvae stay in tissue and form cysts, Cysticerci, can’t grow anymore Larvae imbed in muscle of pigs, we eat pork and ingest the worms Larvae imbed in muscle of pigs, we eat pork and ingest the worms

9. Description cont. Larvae do the damage, but adult worms can live in jejunum & lay eggs (< 50,000) Eggs excreted w/ feces unless….vomit Eggs go into stomach = hatch = swim in your blood

11. Symptoms Muscles: painless swelling Eye: impair vision by floating, cause blindness due to swelling & detach retina

12. Symptoms cont. Heart: abnormal rhythms, failure (rare) Brain: most common- seizures, H/A also- confusion, lack of attention, diff w/ balance, hydrocephalus

13. Symptoms cont. Spinal Cord: most dangerous- block nerve impulses, loss of motor control, weakness, paralysis

14. Symptoms cont. Often no symptoms till parasite dies Immune system detects worm remains & attacks Swelling/scaring cause most/worst damage

15. Diagnosis Difficult in early stage CT/MRI Sometimes appear on surface under skin Antibody tests/Biopsy

16. Treatment Anti-parasitic drugs Praziquantel and Albendazole Steroid often used w/ to reduce swelling from immune attack Low doses over several days If not treated Cysticerci can become calcified

18. Prevention Don’t eat undercooked pork Clean water services

19. Prevention cont. Extra care in places w/ poor hygeine and food laws Don’t drink the river water

20. Prevention cont. Wash & inspect fruit/veggies well Freezing infested pork for prolonged time will kill eggs/larvae/adult worms WASH YOUR HANDS!!!

21. Facts/Statistics/Numbers Most common in Latin America, Asia, Africa “Cysticercosis is virtually unknown in swine in the United States.”- CDC Most cases in U.S diagnosed in Western states among immigrants 1988-1990: 10 out of 138 cases reported to L.A Dept. of health Services had infection acquired locally, but those 10 lived in highly immigrant populated areas

22. Facts/Statistics/Numbers cont. “Increasingly common medical problem in U.S.” – Mossammat M. Mansur Louisianna State University Approx. 1000 new cases/yr. in U.S, most among Latin American immigrants in Cali. “Locally acquired infection in U.S is rare.” – emedicine.com

24. Facts/Statistics/Numbers cont. Mortality study w/ data from national Center for Health Statistics from 1990- 2002 62% of pt’s had emigrated from mexico Est. 50-100 mil. People infected worldwide Causes almost 50% of adult onset seizures in underdeveloped countries Mortality rare

26. Facts/Statistics/Numbers cont Cysticercal Encephalitis (severe infection)- most common in children/young females…??? General infection most common 10-40yrs of age

27. Case Report Case Report This case was presented at the 5th European Conference on Travel Medicine, Venice, March 23 to 25, 2006. England, December 2003 43-year-old Nicaraguan woman, Pt lived in England for past 25 years, returning to Nicaragua for a month ’ s holiday each Christmas. August 2003, in England, she became aware of pea- sized nodules in her right axilla, left antecubital fossa, right thigh, groin, neck, and soft palate.- painless & not evolving August 2003, in England, she became aware of pea- sized nodules in her right axilla, left antecubital fossa, right thigh, groin, neck, and soft palate.- painless & not evolving Concerned, sometimes had tingling all over body

28. Case Report Case Report Pt was aware of lump in her mouth, which felt like small insect moving back and forth constantly inside the lesion. Pt 1st consulted English general practitioners, seeing 2 different physicians during 4 consultations. They initially diagnosed sebaceous cysts & then diffuse lipomata & recommended no treatment. Next visited her dentist, who took plain X-rays of her palatal swelling, reported these as normal but nevertheless prescribed high-dose erythromycin. This had no effect.

29. Case Report She then saw 2 consultant maxillofacial surgeons privately, of whom one found no explanation for her symptoms and the other advised third molar removal (which she declined) and then recommended a course of antidepressant therapy (which she also refused). She then saw 2 consultant maxillofacial surgeons privately, of whom one found no explanation for her symptoms and the other advised third molar removal (which she declined) and then recommended a course of antidepressant therapy (which she also refused). She finally saw 2 British specialists in tropical diseases, one privately & the other following a general practice referral. These specialists ordered various enzyme-linked immunosorbent assay tests, of which only one tested positive No one had yet ordered a CT/MRI

30. Case Report Tested for cysticercosis using the enzymelinked immunotransfer blot & this proved positive. CT scanning of her brain was normal. Diagnosed tissue cysticercosis and prescribed albendazole 400 mg twice daily for 30 days. Pt’s symptoms then resolved completely, & over the next 2 yrs she remained entirely well. Ashley M. Croft, MD, * Adán A. Flores, MD, † and Hugo Z. López, MSc ‡ * Medical Branch, Headquarters Fifth Division, Shrewsbury, UK ; † Clínica San José, León, Nicaragua ; ‡ Laboratorio Clínico Metropolitano, León, Nicaragua © 2007 International Society of Travel Medicine, 1195-1982 Journal of Travel Medicine, Volume 14, Issue 5, 2007, 349–351

31. Review Description- most common infestation in CNS worldwide Symptoms- muscle swelling, vision impairment, rhythm changes, seizures, H/A, loss of motor control, weakness Diagnosis- CT/MRI, Antibody tests/Biopsy Treatment- Praziquantel and Albendazole w/ steroids Prevention- cook pork well, drink clean water, wash/inspect fruits/veggies, WASH YOUR HANDS!!! Fun Facts- 50% adult onset seizures underdeveloped countries, not common around us

32. Works Cited http://en.wikipedia.org/wiki/Cysticercosis "Cysticercosis Fact Sheet""Cysticercosis Fact Sheet". CDC Division of Parasitic Diseases. http://www.cdc.gov/ncidod/dpd/parasites/cysticercosis/factsht_cystic ercosis.htm CDC http://www.cdc.gov/ncidod/dpd/parasites/cysticercosis/factsht_cystic ercosis.htm "Cysticercosis Fact Sheet"CDC http://www.cdc.gov/ncidod/dpd/parasites/cysticercosis/factsht_cystic ercosis.htm Sorvillo FJ, DeGiorgio C, Waterman SH (2007). "Deaths from cysticercosis, United States". Emerg Infect Dis 13 (2): 230–5. PMID 17479884 Deaths from cysticercosis, United StatesPMID 17479884Deaths from cysticercosis, United StatesPMID 17479884 Del Brutto OH, Roos KL, Coffey CS, Garcia HH (2006). "Meta- analysis: Cysticidal drugs for neurocysticercosis: albendazole and praziquantel". Ann Intern Med 145 (1): 43–51. doi:10.1001/archinte.145.1.43. PMID 16818928. doi10.1001/archinte.145.1.43PMID 16818928 doi10.1001/archinte.145.1.43PMID 16818928 http://www.dpd.cdc.gov/dpdx/HTML/Cysticercosis.htm http://emedicine.medscape.com/article/215589-overview

33. Q/A I’ll do my best