Neurocysticercosis in a 14-year-old boy in Italy: An unexpected case

Neurocysticercosis (NCC) is a parasitic infection of the central nervous system caused by larvae of Taenia solium. It represents the most common cause of neurological disease in children living in developing countries. In recent years, NCC is increasingly being diagnosed also in high-socioeconomic countries, mainly due to the high rate of immigration. We describe a case of a 14-year-old Ecuadorian boy living in Italy, who experienced a generalized tonic-clonic seizure and was diagnosed with NCC. The boy was successfully managed with anticonvulsant, anticysticercal and anti-inflammatory treatment. With the present case we would like to emphasize the importance of considering NCC as a possible cause of non febrile seizures in children living in developed countries, particularly in those immigrated from an endemic region or had a long-term stay in an area of high prevalence.     

NEUROCYSTICERCOSIS IN CHILDREN PRESENTING WITH AFEBRILE SEIZURE: CLINICAL PROFILE,IMAGING AND SERODIAGNOSIS

Neurocysticercosis (NCC) is one of the major causes of childhood seizuresin developing countries including India and Latin America. In this study neurologicalpediatric cases presenting with afebrile seizures were screened for anti-Cysticercusantibodies (IgG) in their sera in order to estimate the possible burden ofcysticercal etiology. The study included a total of 61 pediatric afebrile seizuresubjects (aged one to 15 years old); there was a male predominance. All the sera weretested using a pre-evaluated commercially procured IgG-ELISA kit (UB-MagiwellCysticercosis Kit ^™). Anti-Cysticercus antibody in serum was positive in 23 of 61 (37.7%)cases. The majority of cases with a positive ELISA test presented with generalizedseizure (52.17%), followed by complex partial seizure (26.08%), and simple partialseizure (21.73%). Headaches were the major complaint (73.91%). Other presentationswere vomiting (47.82%), pallor (34.78%), altered sensorium (26.08%), and muscleweakness (13.04%). There was one hemiparesis case diagnosed to be NCC. In this studyone child without any significant findings on imaging was also found to be positiveby serology. There was a statistically significant association found between thecases with multiple lesions on the brain and the ELISA-positivity (p= 0.017). Overall positivity of the ELISA showed a potential cysticercal etiology.Hence, neurocysticercosis should be suspected in every child presenting with afebrileseizure especially with a radio-imaging supportive diagnosis in tropical developingcountries or areas endemic for taeniasis/cysticercosis.     

Taenia solium cysticercosis/taeniosis: potential linkage with FAO activities; FAO support possibilities

Neurocysticercosis due to Taenia solium metacestodes is an important cause of human morbidity and mortality, particularly in parts of Latin America, Africa and Asia. The disease has been recognized as potentially eradicable. Emphasis has been placed on control through mass chemotherapy of human populations to remove tapeworm carriers, but this strategy does not control the source of infections, which is cysticercosis in pigs. Also, transmission may continue due to incomplete chemotherapy coverage of human carriers or because of immigration of tapeworm carriers into controlled areas. The FAO through the Veterinary Public Health (VPH) and Food Safety program has provided support for the write-up of guidelines for cysticercosis, diagnoses and control. This should be released in a joint effort with OIE and WHO and will provide regular support to seminars, workshops and congresses related to VPH. The FAO regular program has also established a global network of people directly involved in VPH, and is currently in the process of establishing four regional networks located in Asia, Africa, Eastern and Central Europe and Latin America. The networks should provide a basic framework to spread information related to diagnosis, prevention and control of major zoonotic diseases through electronic conferences, discussions, newsletters, and a Directory to establish contact with people involved in VPH and zoonotic diseases. Through the Technical Cooperation Program (TCP) the FAO has a tool to help Member Countries to create the basic environment to control emerging zoo-sanitary problems, such as zoonotic and food borne diseases.     

Human case management and treatment of cysticercosis

Disease manifestations due to neurocysticercosis vary markedly and depend upon the location, size and number of cysts as well as the viability or degeneration of cysts and presence, type and degree of host response. Accordingly, the clinical management for each patient should be individualized. Treatment modalities include: (1) larvicidal drugs such as albendazole or praziquantel in patients with viable cysts; (2) corticosteroids or other agents to suppress or prevent the host's immune response; (3) anti-seizure medication(s) to treat or prevent recurrent seizures; (4) surgical interventions; and (5) the use of supportive family, social or health agencies in impaired individuals. Although it is known that larvicidal treatment kills viable cysts that commonly resolve or calcify, the clinical benefit of this treatment in the most common presentations is unproven. However, medical treatment of giant subarachnoid cysts, large parenchymal cysts or orbital cysts causing mass effect has led to definite clinical improvement in uncontrolled trials. Whether there is faster radiological improvement and/or clinical benefit in the treatment of cysts showing signs of inflammation by magnetic resonance imaging (enhancement and/or edema) is like-wise controversial. There is no general understanding when or how to use corticosteroids to suppress natural or treatment-induced inflammation around cysts although their use when inflammation contributes or could be expected to cause undue morbidity or mortality is reasonable. Anti-seizure medication should usually be employed in patients with seizures or patients who may likely develop seizures. Surgical intervention is required to alleviate mass effect, remove some cysts causing obstruction of the ventricles, shunt placement for hydrocephalus, and sometimes for removal and/or decompression of large or critically located cysts before larvicidal treatment.     

Imaging findings in neurocysticercosis

The diagnosis of neurocysticercosis was greatly improved by the introduction of computed tomography (CT) and magnetic resonance imaging (MRI). These techniques demonstrate the number and topography of lesions, their stage of involution, and the degree of inflammatory reaction of the host against the parasites and have largely replaced previous radiological procedures such as plain roentgenograms, pneumoencephalograms, cerebral angiography and myelography. In general, MRI provides better image detection and definition. The possibility of multiplanar reconstruction of images, its capability to visualize the posterior fossa without bone artifacts, and its high contrast resolution (far superior to that of CT) allow MRI to recognize many forms of cysticercosis not visualized on CT. However, the costs of MRI are high and the equipment is scarcely available in many endemic countries, and its sensitivity for the detection of calcified lesions is poor. CT remains the best screening neuroimaging procedure for patients with suspected neurocysticercosis, and MRI is the imaging modality of choice for the evaluation of patients with intraventricular cysticercosis, brainstem cysts and small cysts located over the convexity of cerebral hemispheres. Its better image definition also suggests that MRI is superior to CT in the follow-up of the patients after therapy.     

An Individualized Behavioral Approach to Spiritual Development for the Recovering Alcoholic/Addict

The individual alcoholic/addict's recovery is described as a threefold spiritual journey best facilitated by a humanistic yet behaviorally-oriented therapeutic relationship with a counselor utilizing behavioral methodologies and personally following a similar path of spiritual growth. With the availability of a wide variety of psychological and psychospiritual, personal growth manuals and cassette programs, expertise in pastoral or psychological counseling is seen as unnecessary for the counselor's efficacy in assisting the recovering individual "ascertain what benefits him most." Appendices include a tentative "daily, spiritual behavior checklist, BASIC-ISs modality profile, and a list of suggested materials for use in the clinical setting.     

Unusual colonoscopy finding： Taenia saginata proglottid

Infection with tapeworms is a major problem in many parts of the world. Patients may be asymptomatic or have a significant morbidity depending on the species. Infection with Taenia species is sometimes found by expulsion of eggs or proglottids in stool. Species specific diagnosis of Taenia is difficult, but possible. We present a case of Taenia saginata incidentally discovered, and risk factors for transmission, diagnosis, symptoms, and treatment.     

Somatostatin: An endogenous antiepileptic

The neuropeptide somatostatin (SST) is highly expressed in brain regions associated with seizures. In hippocampus, SST expression and release is regulated by seizures, and SST-containing neurons within the hilus of the dentate gyrus are sensitive to seizure-induced death. In vivo and in vitro studies suggest that the loss of SST function in the dentate could contribute to epileptogenesis and seizure susceptibility. SST also has inhibitory actions in the CA1 and CA3 hippocampus indicating this peptide is an important homeostatic regulator throughout the hippocampus. In vivo studies show SST has robust antiepileptic properties with the major site of action being hippocampus. In rodents, somatostatin receptor subtype 2 (SST₂) and SST₄ appear to mediate the majority of the antiepileptic actions of SST, with SST₂ predominate in rat and SST₄ in mouse. Thus SST receptors may be appropriate targets for new antiepileptic drugs (AEDs), although validation in human tissue is lacking.     

Hepatic Echinococcal Cysts: A Review

Cystic echinococcosis (CE) is a widely endemic helminthic disease caused by infection with metacestodes (larval stage) of the Echinococcus granulosus tapeworm. E. granulosus are common parasites in certain parts of the world, and are present on every continent with the exception of Antarctica. As a result, a large number of people are affected by CE. The increased emigration of populations from endemic areas where prevalence rates are as high as 5–10% and the relatively quiescent clinical course of CE pose challenges for accurate and timely diagnoses. Upon infection with CE, cyst formation mainly occurs in the liver (70%). Diagnosis involves serum serologic testing for antibodies against hydatid antigens, but preferably with imaging by ultrasound or CT/MRI. Treatment methods include chemotherapy with benzimidazole carbamates and/or surgical approaches, including percutaneous aspiration injection and reaspiration. The success of these methods is influenced by the stage and location of hepatic cysts. However, CE can be clinically silent, and has a high risk for recurrence. It is important to consider the echinococcal parasite in the differential diagnosis of liver cystic lesions, especially in patients of foreign origin, and to perform appropriate long-term follow-ups. The aim of this review is to highlight the epidemiology, natural history, diagnostic methods, and treatment of liver disease caused by E. granulosus.     

绦虫永久染色标本的制作技术

目的制作绦虫玻片染色标本用于教学和科研。方法用墨汁染色法制作绦虫妊娠节片玻片标本,卡红染色法制作绦虫成熟节片、头节和囊尾蚴玻片标本。结果妊娠节片、成熟节片、头节和囊尾蚴经染色制片后特征结构明显可见。如妊娠节片染色标本清晰可见染成墨汁颜色的子宫主干和分支状的子宫侧支,节片一侧边缘中部可见突出的生殖腔;成熟节片染色标本均染成红色,内有着色更深的雌雄生殖系统各一套。结论墨汁染色和卡红染色制作带绦虫染色标本效果好,可永久保存。     

安徽省猪带绦/囊虫病现状调查与疫情分析

目的摸清我省猪带绦(囊)虫病的流行和分布情况,为制定防治对策提供依据。方法按全国方案进行分层整群随机抽样,在全省共抽8个县(市)16个调查点(村)。对抽样村人群进行问卷调查、病原学检查、血清学检查;在抽样市、县医院进行囊虫病人的回顾调查。结果抽样村问卷调查16389人,食“米猪肉”史30人,其中13人有排节片史;粪便检查共4196人,猪带绦虫感染率为0%;血清学检查2500人,均为阴性。对综合及专科医院1991～2001年住院病人作囊虫病回顾性调查,共发现猪囊虫病住院病例1368例,比1980～1990年这些医院收治的病人数增长了1.46倍。结论尽管抽样点粪检和血清学调查没有发现猪带绦/囊虫人体感染,但囊虫病住院病人回顾性调查表明,我省的囊虫病疫情呈上升趋势。一定要加大对该病的防治力度。     

CEREBRAL CYSTICERCOSIS: A CASE REPORT WITH PARTICULAR REFERENCE TO RECENT ADVANCES IN DIAGNOSIS AND TREATMENT

Cerebral cysticercosis is becoming more common in Australia as the immigrant population from areas of endemic disease increases. The case reported exemplifies the common presentation of this interesting infestation.
Treatment consists primarily of Praziquantel with or without steroids and anti-seizure medication if indicated. Follow-up is by both clinical and radiological assessment.     

江苏江都县吴堡乡缩小膜壳绦虫流行病学调查

本文报告１９９３年在江苏江都县吴堡乡进行了缩小鹏壳绦虫流行病学调查，采用定量透明法和饱和盐水浮聚法检查１９２１份粪样，阳性２２例．感染率１．１％，其中６例混合肠道线虫感染；采用饱和硝酸钠浮聚法检测庭院士样４５０份，阳性６份，污染率１．３％．同时证实家鼠存在感染，缩小膜壳绦虫在当地人、鼠之间相互传播构成了流行的可能性。     

云南省人群绦虫感染情况调查

１９８８—１９９１年间，应用整群随机抽样方法，共调查５３０６１人，结果查见绦虫３种，其感染率分别为：带绦虫０．９％、缩小膜壳绦虫０．０２％、微小膜壳绦虫０．０１％。感染年龄最小的为２岁，最大的为８０岁。调查结果表明，不同年龄、民族、职业者的感染率间的差别具有显著意义。膜壳绦虫在我省呈散在分布，共查见１８例，以儿童感染为主。７例微小膜壳绦虫为我省首次发现。主要集中分布于兰坪、大理、景洪、永德和盈江５个县，感染率为０．７％—１７．４％。其中以兰坪县三界乡的普米族聚居地区人群的感染率最高，达４７．４％，其次为大理市周城乡（白族）的１０．７％，景洪曼听乡（傣族）的为６．３％。     

The control of human (neuro)cysticercosis: which way forward?

Taenia solium cysticercosis, and its public health and economic consequences, appears to be a growing problem in poor areas of Africa, Asia and Latin America where people eat pork and traditional pig husbandry is practiced (and expanding). Its burden is counted in terms of human disease (mainly neurocysticercosis related epilepsy) and economic losses, in a context of both commercial and traditional subsistence pig farming. Although substantial fragmentary information seems to be available from local settings, national and global burdens due to T. solium cysticercosis are still to be comprehensively assessed. With regard to control, several strategies have been checked out at a small or medium scale and have proven to be successful. Yet, no intervention programmes have been implemented so far at the national level with proven success. Although T. solium cysticercosis is considered to be a potentially eradicable disease, there is no evidence yet that it is feasible and recommendable to envisage this within a reasonable time frame. However, it appears realistic to aim for the rapid definition of a simple package of interventions, which can routinely be carried out by existing services and structures, and will give an optimal, long-term return in terms of burden relief. Also, a number of international initiatives and opportunities currently exist in which a more pro-active attitude towards the control of T. solium cysticercosis can be integrated and promoted. Commitment of both national and local authorities to control the disease needs to be convincingly solicited and, as for most zoonotic diseases, an interdisciplinary approach is essential.     

减轻脑囊虫病后遗症措施的研究

为探讨减轻脑囊虫病后遗症的治疗措施，采用了合理系统用药抗囊治疗、早期接受抗囊治疗、主动应用脱水剂和皮质激素、掌握好脑外科手术的适应症和及时恢复脑功能这五种治疗措施，结果发现吡喹酮和阿苯达唑联合用药效果优于单剂用药（P＜0．05）；接受抗囊治疗时间越早后遗症越轻（P＜0．05）；应用脱水剂和皮质激素组后遗症发生率明显低于未应用组（P＜0．05）；手术组后遗症发生率大为降低（P＜0．05）；恢复脑功能治疗组与未恢复脑功能治疗组在减轻脑囊虫病后遗症的效果差异有统计学意义（P＜0．05），表明五种措施均能不同程度地减轻脑囊虫病患后遗症的发生。     

Taenia solium taeniosis/cysticercosis in Asia: epidemiology,impact and issues

Several reports of patients with cysticercosis from many countries in Asia such as India, China, Indonesia, Thailand, Korea, Taiwan and Nepal are a clear indicator of the wide prevalence of Taenia solium cysticercosis and taeniosis in these and other Asian countries. However, epidemiological data from community based studies are sparse and available only for a few countries in Asia. Cysticercosis is the cause of epilepsy in up to 50% of Indian patients presenting with partial seizures. It is also a major cause of epilepsy in Bali (Indonesia), Vietnam and possibly China and Nepal. Seroprevalence studies indicate high rates of exposure to the parasite in several countries (Vietnam, China, Korea and Bali (Indonesia)) with rates ranging from 0.02 to 12.6%. Rates of taeniosis, as determined by stool examination for ova, have also been reported to range between 0.1 and 6% in the community in India, Vietnam, China, and Bali (Indonesia). An astonishingly high rate of taeniosis of 50% was reported from an area in Nepal populated by pig rearing farmers. In addition to poor sanitation, unhealthy pig rearing practices, low hygienic standards, unusual customs such as consumption of raw pork is an additional factor contributing to the spread of the disease in some communities of Asia. Undoubtedly, cysticercosis is a major public health problem in several Asian countries effecting several million people by not only causing neurological morbidity but also imposing economic hardship on impoverished populations. However, there are wide variations in the prevalence rates in different regions and different socio-economic groups in the same country. It is important to press for the recognition of cysticercosis as one of the major public health problems in Asia that needs to be tackled vigorously by the governments and public health authorities of the region.