Neurocysticercosis platyhelminthes,cysticercus, albendazole, praziquantel tape worm seizure infestation

1. NEUROCYSTICERCOS
IS
Dr. Sagar Ghimire

2. Introduction
• Neurocysticercosis (NCC) is the infection of CNS caused by larval
stage (Cysticercus cellulosae) of Taenia Solium, pig tapeworm.
• Most common parasitic disease of the nervous system
• Leading cause of Adult onset Epilepsy (30% in endemic regions)
• Out of 50 million cases of epilepsy worldwide 1/3rd cases occur in
region where T. Solium is endemic.
• Endemic in central and South America, sub-Saharan Africa, regions of
far-east including Indian subcontinent, China and Indonesia

3. Epidemiology of T. Solium

4. Tapeworms
• Taenia Solium – The pork tapeworm
• Taenia Saginata – The beef tapeworm
• Diphyllobothrium Latum – The fish tapeworm
• Echinococcus Granulosus – The dog tapeworm
• Hymenolepis Nana – The dwarf tapeworm
• Dipylidium Caninum – the double-pored dog tapeworm

6. Life cycle of Taenia Solium
-3m length
-1000 proglottides
-50,000 eggs

8. Gist of the lifecycle
•CysticercosisEggs
•TaeniasisLarvae
•Autoinoculation

9. Clinical manifestations
Neurocysticercosis

10. • Two types : > Intestinal infection (Taeniasis) and Cysticercosis
• Taeniasis- may be asymptomatic, passage of proglottides
• Cysticercosis – most commonly in the Brain, CSF, Striated muscle,
Tongue, Eye
• Neurologic Manifestation is Most common presenting mainly as Seizure
• Seizure – Generalized, Focal or Jacksonian type
• Features of raised ICP d/t Hydrocephalus – Headache, Nausea,
Vomiting, Dizziness, Ataxia, Confusion, Vision disturbances
• May also cause Arachnoiditis, Chronic meningitis or even Stroke.

11. INVESTIGATIONS
•AEC (30-350 normal) raised if cyst leaking
• IgE level
•Stool Examination
•CSF examination
• CSF ELISA more sensitive than serum (85% sensitive and 95% specific)
•Enzyme Linked ImmunoelectroTransfer Blot (95% sensitive and 100% specific) –
serum more specific than CSF
•CT Scan
•MRI
•USG for Ocular
•X-Ray

12. Diagnosis Of NCC(Criteria)
1. Absolute Criteria
a) Demonstration of cysticerci by histologic or microscopic
examination of biopsy material
b) Visualization of the parasite in the eye by fundoscopy
c) Neuroradiologic demo of cystic lesions containing a
characteristic scolex

13. 2. Major Criteria
a) Neuroradiologic lesion suggestive of Neurocysticercosis
b) Demonstration of antibodies to cysticerci in serum by enzyme-linked
ImmunoelectroTransfer blot
c) Resolution of intracranial cystic lesions spontaneously or after therapy
with Albendazole or Praziquantel alone
3. Minor Criteria
a) Lesions compatible with Neurocysticercosis detected by neuroimaging
studies
b) Clinical manifestation suggestive of NCC
c) Demonstration of antibodies to cysticerci or cysticercal antigen in CSF by
ELISA
d) Evidence of Cysticercosis outside the CNS (e.g., cigar shaped soft-tissue
like calcification)

16. • Diagnosis confirmed if
1 Absolute criteria or,
 2 Major criteria or,
• Probable Diagnosis if
 1 major + 2 minor
 Major+Minor+Epidemiologic
 3 Minor + Epidemiologic
4. Epidemiologic Criteria
a) Residence in a Cysticercus endemic area
b) Frequent travel to a Cysticercus-endemic area
c) Household contact with an individual infected with Taenia Solium

17. Differential Diagnosis
• Congenital
– Dermoids
– Epidermoids
• Traumatic
– Subdural or Extradural Hematoma
• Inflammatory
– Abscess, Tuberculoma, Syphilitic Gumma, Fungal Gumma
• Neoplasm

18. PREVENTION
• Major method is adequate cooking
of pork viscera/muscles to as low as
56˚C for 5 minutes
• Refrigerating
• Salting
• Freezing at -10˚C for 9 days
• Proper disposal of human feces
• Treatment of human intestinal inf
• Mass Chemotherapy

19. Treatment of NCC
• Initial symptomatic management of Seizures or Hydrocephalus
• Seizure control – Antiepileptic Treatment (for 1-2 years)
• Fundoscopy
• Parenchymal Cysticerci – Antiparasitic Treatment favored including:
– Albendazole (15 mg/kg/day for 8-28 days)
– Praziquantel (50-100 mg/kg/day in 3 divided doses for 15-30 days)
• Longer courses in multiple subarachnoid cysticerci
• High doses of corticosteroids
• Cimetidine and Glucocorticoids w/ Praziquantel

20. Treatment (contd..)
• Hydrocephalus – Reduction of ICP
• Obstructive Hydrocephalus – Endoscopic removal or a V/P shunt
• Sub arachnoid cysts or giant cysticerci – Glucocorticoids then surgery
• Diffuse cerebral edema and elevated ICP – Steroids main stay
• Spinal and Ocular lesions – Surgery preferred
• Intestinal Infection – Praziquantel (10 mg/kg) single dose

21. Prognosis
• In most cases, the prognosis is good.
• Seizures improve with anticysticercal drugs
• 22% develop recurrent seizures
• Others include headache, neurologic deficits related to strokes and
hydrocephalus
• Patients with complications such as hydrocephalus, large cysts, multiple
lesions, chronic meningitis, vasculitis donot respond well to treatment

22. 1. HARRISON’S 18th edition
2.Parasitology K.D Chatterjee
3.Nelson’s textbook of
pediatrics
4.Bruno et al journal
References:

23. Thank You