Diphyllobothriasis Associated with Eating Raw Pacific Salmon

The incidence of human infection with the broad tapeworm Diphyllobothrium nihonkaiense has been increasing in urban areas of Japan and in European countries. D. nihonkaiense is morphologically similar to but genetically distinct from D. latum and exploits anadromous wild Pacific salmon as its second intermediate host. Clinical signs in humans include diarrhea and discharge of the strobila, which can be as long as 12 m. The natural life history and the geographic range of the tapeworm remain to be elucidated, but recent studies have indicated that the brown bear in the northern territories of the Pacific coast region is its natural final host. A recent surge of clinical cases highlights a change in the epidemiologic trend of this tapeworm disease from one of rural populations to a disease of urban populations worldwide who eat seafood as part of a healthy diet.     

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.     

Cerebrale Cysticercose des Menschen

Zusammenfassung Im deutschen Schrifttum nach 1945 existieren lediglich kasuistische Beiträge über einzelne Fälle von Cysticercose des Zentralnervensystems. 14 eigene Beobachtungen seit 1956 sollen daher erneut auf dieses Krankheitsbild aufmerksam machen. Obwohl vielfältige neurologische und auch psychiatrische Symptome vorkommen, können charakteristische Syndromkonstellationen zur Verdachtsdiagnose führen.Allgemeinsymptome, Hirnnervenstörungen, Zeichen der hinteren Schädelgrube und ein entzündlicher Liquorbefund weisen auf eine basale (lymphocytäre) Meningitis hin (Cysticercenmeningitis). Cerebrale Herdstörungen verschiedenster Lokalisation (Großhirnhemisphären, innere Kapsel, Hirnstamm) einschließlich cerebraler Anfälle (Cysticercenepilepsie) werden durch intracerebrale Cysticercen oder einen begleitenden Gefäßprozeß (Cysticercenarteriitis) hervorgerufen. Die wechselnde klinische Symptomatik kann von intermittierenden Hirndruckkrisen (Ventrikelcysticercen) überlagert werden. Das psychische Bild wird vielfach durch ein hirnorganisches Psychosyndrom, eine Psychose oder einen dementiven Abbau geprägt.Für die differentialdiagnostische Abgrenzung der Erkrankung besitzt nach unseren Erfahrungen die Komplementbindungsreaktion im Liquor eine entscheidende Bedeutung. Eine Liquoreosinophilie ist ebenfalls häufig, aber nicht so spezifisch. Der Nachweis verkalkter Cysticercen (Schädel, Weichteile) ist zwar auch ein wichtiger, aber nicht häufiger Befund.Konservative therapeutische Maßnahmen (einschließlich Chemotherapie) besitzen nur eine begrenzte Wirksamkeit, so daß die Prognose bei dem subakut oder chronisch verlaufenden Krankheitsprozeß schlecht ist. Bei solitären intracerebralen oder intraventrikulären Cysticercen ist eine operative Entfernung indiziert. Bei Hirndruckerscheinungen ist als Palliativmaßnahme eine Ventrikeldrainage angezeigt.Auf die Möglichkeit einer Berufserkrankung oder Wehrdienstbeschädigung wird hingewiesen.

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Cerebral cysticercosis in manClinical symptomatology, differential diagnosis and treatment in 14 own observations

Summary Only sporadic cases of cysticercosis of the central nervous system have been reported in the german literature since 1945. This presentation of 14 cases observed by us since 1956 indicates that this disease deserves greater attention. The clinical picture may show a broad variety of neurological and psychiatric symptoms, certain characteristic signs being, however, suggestive of an infection of the central nervous system due to cysticercus.Symptoms of general CNS disease, affections of cranial nerves, symptoms arising from the posterior fossa, and signs of an inflammatory disease on cerebrospinal fluid evaluation all point to a basal (lymphocytic) meningitis. Focal symptoms concerning the cerebrum, internal capsule, and brain stem as well as convulsions are either due to an intracerebral localization of cysticercus or to vascular complications, i.e. arteriitis. The intraventricular cysticercus may lead to intermittent rises of the intracranial pressure, thus obscuring the described symptoms. Also an organic psychosyndrome, psychosis or mental deterioration may develop.The complement fixation test in the cerebrospinal fluid is of great significance in the differential diagnosis of the disease. Eosinophilic leukocytes are often observed in the cerebrospinal fluid, but this finding is not quite specific. The demonstration of intracranial and intramuscular calcifications caused by cysticercus is an important, though infrequent finding.Conservative treatment of the disease including chemotherapy is not very effective; the prognosis of this subacute or chronic disorder is poor. In some cases with a single intracerebral or intraventricular cysticercus of obstructive or space-occupying nature neurosurgicyl intervention is of value. In cases of increased intracranial pressure drainage of the ventricles may be indicated. Cysticercosis may be due to infection during military service or to occupational hazards and thus be subject to compensation.

     

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％。