Cysticercosis

This page is about clinical aspects of the disease.  For microbiologic aspects of the causative organism(s), see Taenia solium.

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Overview
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Differentiating Cysticercosis from Other Diseases
Epidemiology and Demographics
Risk Factors
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Natural History, Complications and Prognosis
Diagnosis
History and Symptoms
Physical Examination
Laboratory Findings
CT
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Medical Therapy
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Primary Prevention
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Case #1
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Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]; Associate Editor-In-Chief: Cafer Zorkun, M.D., Ph.D. [2];Associate Editor(s)-in-Chief: Ahmed Younes M.B.B.CH [3]

Synonyms and keywords: Taenia solium infection, cysticerciasis, Larval taeniasis, Larval teniasis

Diagnosis

CT

Computerized tomography (CT) is superior to magnetic resonance imaging (MRI) for demonstrating small calcifications. However, MRI shows cysts in some locations (cerebral convexity, ventricular ependyma) better than CT, is more sensitive than CT to demonstrate surrounding edema, and may show internal changes indicating the death of cysticerci.

In recent years, the use of CT and MRI has permitted identification of neurocysticercosis cases with a benign course that would not have been detected previously.

History and Symptoms | Physical Examination | Laboratory Findings | CT | MRI | Other Diagnostic Studies

Treatment

Medical Therapy | Surgery | Primary Prevention

Antimicrobial therapy

• Neurocysticercosis treatment

• 1. Parenchymal neurocysticercosis

• 1.1 Single lesions

• Preferred regimen: Albendazole 15 mg/kg/day PO bid for 3-8 days AND Prednisone 1 mg/kg/day PO qid for 8-10 days followed by a taper

• 1.2 Multiple cysts

• Preferred regimen: Albendazole 15 mg/kg/day PO bid for 8-15 days and high-dose steroids
• Preferred regimen: Praziquantel 50 mg/kg/day PO tid AND Albendazole 15 mg/kg/day PO bid

• 1.3 Cysticercal encephalitis

• Cysticercal encephalitis (diffuse cerebral edema associated with multiple inflamed cysticerci) is a contraindication for antiparasitic therapy, since enhanced parasite killing can exacerbate host inflammatory response and lead to diffuse cerebral edema and potential transtentorial herniation. Most cases of cysticercal encephalitis improve with corticosteroid therapy

• 1.4 Calcified cysts

• Radiographic evidence of parenchymal calcifications is a significant risk factor for recurrent seizure activity; these lesions are present in about 10 percent of individuals in regions where neurocysticercosis is endemic. Seizures in these patients should be treated with antiepileptic therapy.

• 2. Extraparenchymal NCC

• 2.1 Subarachnoid cysts

• Preferred regimen: Albendazole 15 mg/kg/day PO bid for 28 days AND (Prednisone up to 60 mg/day PO OR Dexamethasone (up to 24 mg/day)) along with the antiparasitic therapy. The dose can often be tapered after a few weeks. However, in cases for which more prolonged steroid therapy is required, methotrexate can be used as a steroid-sparing agent

• 2.2 Giant cysts

• Giant cysticerci are usually accompanied by cerebral edema and mass effect, which should be managed with high-dose corticosteroids (with or without mannitol).

• 2.3 Intraventricular cysts

• Emergent management with CSF diversion via a ventriculostomy or placement of a ventriculo-peritoneal shunt
• Treatment of residual hydrocephalus may be managed with endoscopic foraminotomy and endoscopic third ventriculostomy; this approach may also allow debulking of cisternal cysticerci

• 2.4 Ocular cysticercosis

• Surgical excision is warranted in the setting of intraocular cysts
• Cysticercal involvement of the extraocular muscles should be managed with albendazole and corticosteroids.

• 2.5 Spinal cysticercosis

• Medical therapy with corticosteroids and anti parasitic drugs

Case Studies

Case #1