What are the Symptoms of Cysticercosis?
The symptoms of cysticercosis can develop anywhere from several months to several years after the initial infection (incubation period) to the human host. The symptoms will depend on two things, the location and the number of cysticerci. Many individuals with cysticercosis will never develop any symptoms at all. The majority of people with cysticercosis who present to a health-care provider have central nervous system involvement (neurocysticercosis or NCC). Symptoms of neurocysticercosis may include the following:
- Nausea and Vomiting - sensation that there is a need to vomit, or actual vomiting
- Headache - pain in the head or upper neck.
- Lethargy - 1. Abnormal drowsiness, stupor. 2. A state of indifference.
From the Greek lethargia, drowsiness. - Confusion - Inablity to Think Quickly
- Vision changes
- Weakness or numbness - decrease in the strength in one or more muscles.
- Seizure (often the presenting symptom, occurs in about 70% of people with NCC)
How is Cysticercosis Diagnosed?
The diagnosis of cysticercosis can sometimes be difficult, it may require a combination of tests and imaging studies to make the diagnosis. In general, however, the patient's clinical presentation along with abnormal radiographic imaging results (CT scan of the brain/MRI of the brain) lead to the diagnosis of neurocysticercosis. Pictures of the cysts in the brain can be found. Blood testing can sometimes be helpful in making the diagnosis, though it is not always useful or accurate. These tests are usually done by specialist labs. Rarely, a biopsy from affected tissue may be needed to make the diagnosis. Stool studies are sometimes also obtained because they may contain identifiable parasite eggs.
What is the Treatment for Cysticercosis?
The treatment of cysticercosis depends on many things. The individual's symptoms, the location and number of cysticerci, and the stage of cyst development. In general, treatment is based on each individual patient and their particular presentation. Treatment regimens may include anthelmintic agents, corticosteroids, anticonvulsant medications, and/or surgery. Asymptomatic patients may not require any treatment at all. Controversy does exist as to which patients require treatment with the various medications.
The most commonly used anthelmintic agents include albendazole and less common praziquantel. These antiparasitic medications are used to eliminate some viable cysticerci even though they may cause reactive localized inflammation. Consequently, the use of these medications must be evaluated on a case-by-case basis. More than one course of treatment may be necessary to completely eliminate active cysts.
Corticosteroids may also be used in conjunction with, or instead of, antiparasitic medications. Corticosteroids are used to decrease inflammation but are not active against the parasite. Again, treatment with these medications must be tailored to each individual case. The consultation with an infectious disease expert is recommended.
Anticonvulsant medications are used in patients with neurocysticercosis experiencing seizures or at high risk for periodic seizures. Various anticonvulsant medications, such as carbamazepine (Tegretol) or phenytoin (Dilantin), may be prescribed. The consultation with an experienced neurologist may be helpful to determine patient treatments.
Surgical management may also be necessary in select cases of cysticercosis. Surgical removal of central nervous system cysts or placement of a brain shunt (to relieve pressure) is sometimes necessary in some cases of neurocysticercosis. Certain cases of cysticercosis involving the eyes or subcutaneous cysts may also require a surgical procedure.
The most commonly used anthelmintic agents include albendazole and less common praziquantel. These antiparasitic medications are used to eliminate some viable cysticerci even though they may cause reactive localized inflammation. Consequently, the use of these medications must be evaluated on a case-by-case basis. More than one course of treatment may be necessary to completely eliminate active cysts.
Corticosteroids may also be used in conjunction with, or instead of, antiparasitic medications. Corticosteroids are used to decrease inflammation but are not active against the parasite. Again, treatment with these medications must be tailored to each individual case. The consultation with an infectious disease expert is recommended.
Anticonvulsant medications are used in patients with neurocysticercosis experiencing seizures or at high risk for periodic seizures. Various anticonvulsant medications, such as carbamazepine (Tegretol) or phenytoin (Dilantin), may be prescribed. The consultation with an experienced neurologist may be helpful to determine patient treatments.
Surgical management may also be necessary in select cases of cysticercosis. Surgical removal of central nervous system cysts or placement of a brain shunt (to relieve pressure) is sometimes necessary in some cases of neurocysticercosis. Certain cases of cysticercosis involving the eyes or subcutaneous cysts may also require a surgical procedure.
How is cysticercosis prevented?
The prevention of cysticercosis can be achieved through various measures including the following:
- Public education regarding the parasite and its route of transmission
- Avoidance of raw or undercooked pork (USDA says safe cooked pork reaches 160 degrees F) in endemic areas
- Avoidance of potential fecal-oral routes of transmission through hand washing, good personal hygiene, as well as through the proper handling and preparation of foods
- Meat inspection and the proper disposal of infected meat in endemic areas
- Improved sanitary measures for human waste disposal in endemic areas
- Screening contacts of infected individuals and instituting appropriate treatment
- Developing a vaccine for the prevention of cysticercosis, which may be used in the future; currently, there is no vaccine approved for use in humans
