Cysticercosis: Difference between revisions

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Revision as of 19:42, 11 September 2017

Template:DiseaseDisorder infobox

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

For patient information click here

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.

Overview

Historical Perspective

Classification

Pathophysiology

Causes

Differentiating Cysticercosis From other Diseases

Epidemiology and Demographics

Risk Factors

Screening

Natural History, Complications and Prognosis

Diagnosis

Treatment

Case Studies

Case #1

Template:WikiDoc Sources

@@ Line 33: / Line 33: @@
 ==[[cysticercosis natural history, complications and prognosis|Natural History, Complications and Prognosis]]==
-==[[Diagnosis]]==
+==Diagnosis==
-===CT===
+[[cysticercosis history and symptoms|History and Symptoms]] | [[cysticercosis physical examination|Physical Examination]] | [[cysticercosis electrocardiogram|Electrocardiogram]] | [[cysticercosis laboratory findings|Laboratory Findings]] | [[cysticercosis x ray|X-Ray Findings]] | [[cysticercosis echocardiography and ultrasound|Echocardiography and Ultrasound]] | [[cysticercosis CT scan|CT-Scan Findings]] | [[cysticercosis MRI|MRI Findings]] | [[cysticercosis other diagnostic studies|Other Diagnostic Studies]] | [[cysticercosis other imaging findings|Other Imaging Findings]]
-[[Computerized tomography]] (CT) is superior to [[magnetic resonance imaging]] (MRI) for demonstrating small [[calcification]]s. However, MRI shows cysts in some locations (cerebral convexity, ventricular ependyma) better than CT, is more sensitive than CT to demonstrate surrounding [[cerebral edema|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.
-[[cysticercosis history and symptoms|History and Symptoms]] | [[cysticercosis physical examination|Physical Examination]] | [[cysticercosis laboratory findings|Laboratory Findings]] | [[cysticercosis CT|CT]] | [[cysticercosis MRI|MRI]] | [[cysticercosis other diagnostic studies|Other Diagnostic Studies]]
 ==Treatment==
+[[cysticercosis medical therapy|Medical Therapy]] | [[cysticercosis surgery|Surgery]] | [[cysticercosis primary prevention|Primary Prevention]] | [[cysticercosis secondary prevention|Secondary Prevention]] | [[cysticercosis cost-effectiveness of therapy|Cost-Effectiveness of Therapy]] | [[cysticercosis future or investigational therapies|Future or Investigational Therapies]]
-[[cysticercosis medical therapy|Medical Therapy]] | [[cysticercosis surgery|Surgery]] | [[cysticercosis primary prevention|Primary Prevention]]
-===Antimicrobial therapy===
-:* '''Neurocysticercosis treatment'''
-::* 1. '''Parenchymal neurocysticercosis'''
-:::* 1.1 '''Single lesions'''<ref name="pmid12364377">{{cite journal| author=García HH, Evans CA, Nash TE, Takayanagui OM, White AC, Botero D et al.| title=Current consensus guidelines for treatment of neurocysticercosis. | journal=Clin Microbiol Rev | year= 2002 | volume= 15 | issue= 4 | pages= 747-56 | pmid=12364377 | doi= | pmc=PMC126865 | url=http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=12364377  }} </ref>
-::::* 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''' <ref name="pmid12364377">{{cite journal| author=García HH, Evans CA, Nash TE, Takayanagui OM, White AC, Botero D et al.| title=Current consensus guidelines for treatment of neurocysticercosis. | journal=Clin Microbiol Rev | year= 2002 | volume= 15 | issue= 4 | pages= 747-56 | pmid=12364377 | doi= | pmc=PMC126865 | url=http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=12364377  }} </ref>
-::::* 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
-==References==
-{{reflist|2}}
 ==Case Studies==
 [[cysticercosis case study one|Case #1]]
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Cysticercosis: Difference between revisions

Revision as of 19:42, 11 September 2017

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