第四脑室脑囊虫临床误诊分析

本文通过对11例四脑室囊虫的早期误诊分析，总结出以下几点对今后诊治有益之处。（1）第四脑室囊虫约占脑室内囊虫的70%，早期临床表现各异，应注意结合有无生食或半生食猪肉史诊断。（2）CT早期可正常，但病情呈渐进性发展。（3）对CT有四脑室不对称扩大，壁缘有钙化者应高度怀疑。MRI对脑室内囊虫诊断率为70%，是首选的诊断检查。（4）早期早治愈后好。     

A seroepidemiological study of human cysticercosis in West Cameroon

We studied the occurrence of human cysticercosis in 4993 individuals from three rural communities of Menoua Division, West Province of Cameroon. Circulating antigens of Taenia solium metacestodes were detected in 0.4%, 1.0% and 3.0% of the serum samples taken in Bafou, Bamendou and Fonakekeu, respectively, and examined using a monoclonal antibody-based enzyme-linked immunosorbent assay. This test detects only carriers of living cysticerci and gives thus a good idea of the presence of active cysticercosis. The percentage of persons infected with cysticercosis increased with age. Twenty-two of the 34 seropositives underwent computed tomography (CT) of the brain. Thirteen of them were CT-scan positive, which shows that neurocysticercosis was present in 59.1% of the tested seropositive persons. No living cysticerci were detected among 20 seronegative people. About 20.6% of the seropositives had a history of or current taeniasis against only 1.9% of the seronegatives. Based on these figures and on the data on porcine cysticercosis (prevalence: 11%) and human taeniasis (prevalence: 0.13%) collected in the same region, we conclude that T. solium cysticercosis is an endemic, but overlooked public health problem in West Cameroon.     

Parasitic worms of the central nervous system: an Australian perspective

Abstract
The diagnosis and management of parasitic diseases of the central nervous system (CNS) is difficult, even for infectious diseases physicians and neurologists. Furthermore, few overviews of the spectrum of causative helminths and clinical syndromes have been published. In the present study, we review the seven most common parasitic diseases of the CNS: (i) cysticercosis, (ii) neuroschistosomiasis, (iii) paragon­imiasis, (iv) angio-strongyliasis, (v) hydatid disease, (vi) sparganosis and (vii) gnathostomiasis. Major syndromes of parasitic disease of the CNS and their differential causes are discussed, including: (i) cystic lesions, (ii) enhancing granulomas (with and without creeping subcutaneous eruptions), (iii) eosinophilic meningoencephalitis and (iv) spinal cord disease. Specific risk factors that predispose to these infections are also discussed and particular attention is drawn to the situation in Australia. (Intern Med J 2002; 32: 541−553)     

Cerebral cysticercosis: A case report

A case of cerebral cysticercosis is reported in a 49-year-old female who presented with headache, nausea, and vomiting. Lumbar CSF showed the findings of mild aseptic meningitis. CT scan revealed an enlargement of the left ambient cistern and a small cystic lesion in the left frontal cortex. MRI demonstrated multilobular cysts in the left ambient cistern with enhancement of their capsules, which compressed and distorted the midbrain. The cysts were surgically excised, and histological examination of the specimen disclosed characteristic features of cysticercus with viable larva. An excellent value of MRI in the diagnosis of intracisternal cysticercosis is emphasized.     

Bilateral Multifocal Intraocular Cysticercosis

A 47-year-old male from India was treated for the rare condition of bilateral multifocal intraocular infestation with Cysticercus cellulosae, the larval form of Taenia solium. The intravitreous parasite in the left eye was removed via pars plana vitrectomy. A subretinal cysticercus in the right eye, which caused a rhegmatogenous retinal detachment, was removed via sclerotomy during the scleral buckling procedure. An additional peripapillary subretinal cyst could not be removed. A subconjunctival cysticercus was incidently found and removed at the time of surgery. The patient returned to India six weeks after surgery and is doing well.     

Hydrocephalus and racemose cysticercosis: surgical alternative by endoscopic third ventriculostomy

BACKGROUND AND PURPOSE: Hydrocephalus is a frequent and potentially serious complication of neurocysticercosis. Its treatment often requires ventricular shunting. The complication rate is high due to obstruction or material infection, which may justify endoscopic third ventriculostomy (ETV). OBSERVATION: We report a case of obstructive hydrocephalus in a 46-year-old man in the context of racemose cysticercosis, presenting with headaches and transient disorders of consciousness. Imaging showed cystic lesions of the cisterna magna, responsible for hydrocephalus which was treated effectively by ETV. Treatment with albendazole decreased the volume of the cisterna magna cysts. RESULTS: The patient was followed for 6 years after ETV with no recurrence of hydrocephalus despite two more symptomatic episodes of the disease with extension of the cysts into the lumen of the fourth ventricle and into the perispinal subarachnoid spaces, effectively treated by albendazole each time. CONCLUSIONS: Treatment of obstructive hydrocephalus secondary to cerebral racemose cysticercosis by ETV seems to be an effective and safety technique. The role of ETV should be evaluated in this indication.     

Evidence for high seroprevalence of Taenia solium cysticercosis in individuals from three rural communities in Venezuela

A serological study was undertaken in 1998 to evaluate levels of Taenia solium cysticercosis in 3 rural Venezuelan communities. Infection with viable metacestodes was diagnosed with a trapping enzyme-linked immunosorbent assay (ELISA) that detects a secreted product of viable parasites. Anti-metacestode antibodies were assayed by ELISA using T. solium vesicular fluid as antigen. A total of 1254 sera was collected from 3 communities (Canoabo, Sanare, and Rio Tocuyo) where previous studies had suggested the presence of T. solium. Our results demonstrate an unusually high seroprevalence of cysticercosis, indicating an attendant risk of transmitting the disease to other areas. The seroprevalence of infection with viable cysts, as indicated by detection of circulating parasite antigen, was 9.1% in Canoabo, 6.1% in Sanare, and 5.7% in Rio Tocuyo. The corresponding frequency of antibodies to T. solium cyst antigens was 36.5% in Canoabo, 36.5% in Sanare, and 4% in Rio Tocuyo. As these communities are probably representative of many others in Venezuela, T. solium cysticercosis may be a significant public health problem and more work is certainly indicated. An important finding was that local knowledge of the disease and its transmission do not necessarily guarantee diminished disease prevalence, indicating a lack of appropriate vigilance towards disease control.     

SPA—ELISA一步法检测囊虫病患者血清特异性抗体的研究

用ＳＰＡ－ＥＬＩＳＡ一步法检测了囊虫患者血清特异性抗体，并与快速ＳＡＰ－ＥＬＩＳＡ进行对比。两法同时检测了５９例囊虫病患者，３６例囊虫病病人和３０例正常人血清。结果表明：ＳＡＰ－ＥＬＩＳＡ一步法和快速ＳＰＡ－ＥＬＩＳＡ的阳性率分别为９４．９１％和９８．３１％，几何平均滴度分别为１：４２５．８９和１：５６５．７２，均无显著性差异。对１例肝吸虫病和１例包虫病人血清均起交叉反应。说明ＳＰＡ－ＥＬＩＳＡ一     

人囊虫病T淋巴细胞亚群及血清IgE的变化

应用直接ＳＰＡ菌花环法对２７例囊虫病患者外周血Ｔ淋巴细胞亚群进行检测，同时用ＥＬＩＳＡ法测定血清ＩｇＥ水平。发现患者ＣＤ３＋，ＣＤ４＋细胞的百分率明显降低，ＣＤ４／ＣＤ８比值明显下降，血清ＩｇＥ含量显著升高。经分析，患者ＣＤ４细胞、ＣＤ４／ＣＤ８比值与ＩｇＥ对数值呈负相关。揭示囊虫病患者Ｔ细胞亚群比例失调，免疫功能紊乱。本文对可能的免疫调节机制和发病机理进行了探讨。     

脑囊虫病42例临床分析

４２例经手术后病理检验或经皮下结节活检证实的脑囊虫病患者，其中脑实质型３８例占９０．５％，多以癫痫、肢体运动障碍，精神障碍为首发症状；脑室型４例，占９．５％，常以头痛、呕吐、眩晕，视乳头水肿等症状多见。作者认为若有以下标准之一可诊断为脑囊虫病，（１）头颅ＣＴ见典型囊虫结节或多数散在小异常钙化点；（２）头颅ＣＴ所见加皮下囊虫结节或绦虫感染史；（３）头颅ＣＴ所见加血囊虫间凝试验或其它免疫学试验阳性。