Cysticercosis may not always need treatment. About 80% of the patients with cysticercosis do not present any symptoms and these patients may not require any treatment. Each case should be assessed thoroughly for deciding the treatment modalities. Patients with Subcutaneous or intramuscular cysticercosis that cause symptoms due to inflammation can be managed by administering anti-inflammatory agents or by excision of cysticerci. For a solitary symptomatic lesion, excision is preferred. In case of single extracranial lesion, excision may be considered only after neurocysticercosis is ruled out with brain imaging. Ocular cysticercosis which involves extraocular muscle may present recurrent eye pain and diplopia. Albendazole and corticosteroids are useful in the treatment of this condition. However, surgical removal is the choice of treatment for intraocular cysticerci, instead of antiparasitic drug therapy.

Treatment for neurocysticercosis:

Neurocysticercosis is managed as per the presenting symptoms. Patient presenting with seizures are treated with antiepileptic drug therapy. Patients with vasculitis or cerebral edema should be treated with anti-inflammatory drugs like methotrexate and corticosteroids. Those diagnosed with having hydrocephalus require a shunt surgery that reduces the intracranial pressure by channeling out cerebrospinal fluid from the brain. Although antiparasitic treatment is vital for treatment of cysticercosis, it should never be given emergently. This is because the antiparasitic drugs can further deteriorate cerebral edema and these drugs must be avoided in patients with high intracranial pressure caused by untreated hydrocephalus or diffuse cerebral edema.

Antiparasitic drugs given along with corticosteroids have better outcomes for patients with parenchymal cystic neurocysticercosis. The treatment for parenchymal neurocysticercosis is based on its form. For diffuse cerebral edema or untreated hydrocephalus, treatment involves management of increased intracranial pressure alone. For viable parenchymal cysticercosis, administration of antiparasitic drugs, only of there is no increased intracranial pressure. For a single enhancing lesion or 1-2 viable parenchymal cysts, monotherapy with albendazole at 15 mg/kg/day in 2 daily doses (up to 1200 mg/day) for 10-14 days is preferable. For more than two viable parenchymal cysts, combination of praziquantel (15 mg/kg/day in 3 daily doses) and albendazole (15 mg/kg/day in 2 daily doses up to 1200 mg/day) for 10-14 days is required. Antiparasitic drugs should always be given along with corticosteroids. All cases of seizures should be treated with antiepileptic drugs. Calcified parenchymal neurocysticercosis should not be managed with antiparasitic treatment and excision is the treatment of choice in this case.

PROGNOSIS

Most individuals with parenchymal cysticercosis either do not present any symptoms or develop a seizure disorder. Patients with intracerebral calcifications, often have recurrent seizures. These seizures can be easily controlled by anticonvulsant drugs. Ventricular neurocysticercosis is usually treated by shunting. Neurosurgery can have complications like focal neurologic damage. Often shunt revisions are required, unless corticosteroids or antiparasitic drugs are used for the treatment. However, some patients may still require subsequent revision despite the treatment. Subarachnoid disease was associated with a 90% 10-year fatality rate before the use of corticosteroids and antiparasitic drugs, even with shunting. With adaptation of current management guidelines, fatalities have become rare. Evidence suggests that, once a person has been infected with cysticercosis, they are immune to reinfection.

PREVENTION AND CONTROL OF CYSTICERCOSIS

The transmission of cysticercosis can be controlled by:

  • Educating the population in endemic areas about the route of transmission of the tapeworm eggs.
  • Organising meat inspection in regions with high prevalence.
  • Cooking meat thoroughly and freezing it before cooking can kill the cysticerci.
  • voiding undercooked pork in the areas of endemic cysticercosis.
  • Identifying human carriers of tapeworm depending on the history of proglottid passage and initiating targeted treatment.
  • Maintaining good sanitary conditions, especially by properly disposing human stool in endemic areas.
  • Changing pig-raising methods in endemic areas, probably by confining the animals and stopping them from roaming freely to prevent them from contacting infectious ova excreted in human feces.
  • Vaccinating the pigs.

Combination of mass treatment of pigs, mass treatment for tapeworm carriage, and vaccination of pigs have shown to be beneficial in interrupting the transmission of T. solium infection in endemic regions. Also, mass chemotherapy has shown to be effective in interrupting the transmission, but the infection usually recurs in a few years. Mass anthelminthic therapy have shown only limited success; but importantly, this method can cause adverse neurologic events in patients with undiagnosed neurocysticercosis.

References

  1. CDC. Parasites-Cysticercosis. https://www.cdc.gov/parasites/cysticercosis/index.html#:~:text=Cysticercosis%20is%20a%20parasitic%20tissue,in%20most%20low%2Dincome%20countries. Accessed on 6th October 2020
  2. WHO. Taeniasis/ Cysticercosis. https://www.who.int/news-room/fact-sheets/detail/taeniasis-cysticercosis. Accessed on 6th October 2020
  3. Medscape. Cysticercosis (Pork Tapeworm Infection). https://emedicine.medscape.com/article/215589-overview. Accessed on 6th October 2020
  4. NORD. Cysticercosis. https://rarediseases.org/rare-diseases/cysticercosis/#:~:text=After%2060%20to%2090%20days,stage%20of%20their%20life%20cycle. Accessed on 6th October 2020
  5. Del Brutto OH. Diagnostic criteria for neurocysticercosis, revisited. Pathog Glob Health. 2012;106(5):299-304. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4005113/
  6. Prasad KN, Prasad A, Verma A, Singh AK. Human cysticercosis and Indian scenario: a review. J Biosci. 2008;33(4):571-582. https://pubmed.ncbi.nlm.nih.gov/19208982/
  7. Rajshekhar V, Joshi DD, Doanh NQ, van De N, Xiaonong Z. Taenia solium taeniosis/cysticercosis in Asia: epidemiology, impact and issues. Acta Trop. 2003;87(1):53-60.
  8. https://www.sciencedirect.com/science/article/abs/pii/S0001706X0300055X?via%3Dihub
  9. UpToDate. Epidemiology, transmission, and prevention of cysticercosis. https://somepomed.org/articulos/contents/mobipreview.htm?18/14/18669?source=HISTORY. Accessed on 6th October 2020.
  10. WHO/ FAO/ OIE Guidelines for the surveillance, prevention, and control of taeniosis/ cysticercosis. https://www.oie.int/doc/ged/d11245.pdf. Accessed on 6th October 2020
  11. Mayoclinic. Tapeworm Infection. https://www.mayoclinic.org/diseases-conditions/tapeworm/symptoms-causes/syc-20378174. Accessed on 6th October 2020.
  12. NCH. Tapeworm infection. https://www.nchmd.org/education/mayo-health-library/details/CON-20025898#:~:text=The%20most%20common%20treatment%20for,Nitazoxanide%20(Alinia). Accessed on 6th October 2020.
  13. MedlinePlus. Fish tapeworm infection. https://medlineplus.gov/ency/article/001375.htm. Accessed on 6th October 2020.
  14. Lesh EJ, Brady MF. Tapeworm (Taenia Solium, Taenia Saginata, Diphyllobothrium, Cysticercosis, Neurocysticercosis) [Updated 2020 Aug 10]. In: StatPearls [Internet]. Treasure Island (FL): StatPearls Publishing; 2020 Jan-. Available from: https://www.ncbi.nlm.nih.gov/books/NBK537154/

Cysticercosis