Cysticercosis

Cysticercosis (Latin cysticercosis) is a chronic biogelmintosis caused by the larval stage of the pork chain-cysticerca (Finns).

ICD-10 codes

• Q69. Cysticercosis.
• B69.0. Cysticercosis of the central nervous system.
• B69.1. Cysticercosis of the eye.
• B69.8. Cysticercosis of other sites.
• B69.9. Cysticercosis unspecified.

Epidemiology of cysticercosis

Cysticercosis in humans develops after infection with oncospheres by the fecal-oral route or as a result of autoinvasia in the presence of intestinal shadows, when mature segments are thrown from the intestine into the stomach as a result of anti-peristaltic contractions. Cysticercosis, like intestinal shadows, is recorded in countries where pig production is well developed.

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What causes cysticercosis?

Cysticercosis is caused by Cysticercus cellulosae (larval stage of Taenia solium), which is a 5-15 mm diameter vesicle containing an inverted scolex.

Pathogenesis of cysticercosis

Parasitization of Cysticercus cellulosae is more often observed in the subcutaneous tissue, brain and spinal cord, eyes, muscles, heart, liver, lungs, peritoneum, etc. A helminth around all organs and tissues (except the eye) forms a reactive connective tissue capsule, inflammatory and degenerative changes. The significance of the factor of mechanical compression of parasites of surrounding tissues depends on the localization of cysticerci. To severe consequences leads to a skid in the brain and eyes. In the brain tissue around the cysticercus develop vasculitis, a marked glial reaction, possible encephalitis, meningitis, a disturbance of liquorodynamics. When the larva is localized, the racemose (branching) form of the cysticercus develops in the shells of the brain base, while the parasite, reaching a length of more than 20 cm, can descend along the spinal cord. When the eyes are involved in the process, both eyes are often involved. Expressed toxic-allergic reactions are observed when the parasite die, when its meltdown occurs; when calcification, an inflammatory reaction is absent.

Symptoms of cysticercosis

Symptoms of cysticercosis are very diverse and are determined by its localization, the intensity of infestation and the stage of development of the parasite.

Cysticercosis of the subcutaneous tissue and muscles often does not have any obvious signs, sometimes dense nodules are palpable in the tissues. Cysticercosis of the CNS proceeds in the form of cerebral, spinal lesions or combined lesions of the cerebral hemispheres, the ventricular system, the base of the brain, and therefore the developing symptoms of cysticercosis are very diverse. Characterized paroxysmal headache, accompanied by nausea, vomiting, attacks of epilepsy. Possible disturbances of the psyche in the form of delirious, hallucinatory and amenitary states, which have a transient character up to a certain time. With the localization of cysticerci in the ventricles of the brain, intracranial hypertension is detected; localization of the parasite in the IV ventricle can lead to sudden death. Cysticercosis of the eye at first is manifested by impaired vision, a decrease in its sharpness, including blindness. The introduction of cysticerci into the orbit causes exophthalmos. Localization of it in the heart in the area of the atrioventricular bundle leads to a disturbance of the heart rhythm.

Diagnosis of cysticercosis

Approximately 50% of patients with cysticercosis have a subcutaneous localization of the parasite. The diagnosis of "cysticercosis" in this case is established on the basis of an x-ray or according to the results of a biopsy of the nodes. Cysticercosis of the brain is diagnosed on the basis of anamnestic (including disease with shadows), clinical and epidemiological data, positive results of serological tests (ELISA, etc.), but it should be borne in mind that sometimes there are cross-reactions in the presence of other invasions.

When the brain is damaged in the cerebrospinal fluid, pleocytosis with a predominance of eosinophils and lymphocytes, an increase in protein concentration is possible.

To identify brain lesions use CT, MRI, angiography of the brain.

Detection of intraocular cysticercus is possible with direct ophthalmoscopy and biomicroscopy, when wavy movements of a live parasite are seen. With the death of the pathogen, the diagnosis of cysticercosis is hampered by the disorganization of intraocular structures.

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Differential diagnosis of cysticercosis

Differential diagnosis of cysticercosis is carried out with tumors and inflammatory diseases of organs, echinococcosis.

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Indications for consultation of other specialists

Consultations of other specialists (neurosurgeon, ophthalmologist, surgeon) are resorted to to conduct surgical treatment of cysticercosis.

Indications for hospitalization

Patients with neurocysticercosis and ocular cysticercosis for examination and treatment are hospitalized in profile hospitals.

Treatment of cysticercosis

Antiparasitic treatment of cysticercosis is performed with a prazikant for a daily dose of 50 mg / kg of body weight per day in three doses for 14 days or more or albendale at 15 mg / kg of body weight per day in three doses for 28 days. It is recommended to carry out three cycles of treatment with an interval of 2-3 weeks.

Simultaneously with the use of anthelmintic drugs, anti-inflammatory treatment of cysticercosis is performed, glucocorticoids are prescribed.

Patients with cysticercosis of the muscles and subcutaneous tissue are prescribed symptomatic treatment.

Surgical removal of single cysticerci (in the presence of technical capabilities) is indicated for lesions of the eyes, ventricles of the brain and spinal cord.

Prognosis for cysticercosis

The prognosis depends on the topography and the amount of damage to tissues and organs.

Cysticercosis of the brain (especially with multifocus lesions of various parts of it) and the eyes have an unfavorable prognosis. Patients with such lesions need long-term (almost lifelong) observation and treatment.