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| cysticercosis [2025/06/02 20:01] – Scott Larson | cysticercosis [2026/05/26 18:35] (current) – Scott Larson | ||
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| ====== Cysticercosis ====== | ====== Cysticercosis ====== | ||
| - | FIXME | + | * A parasitic infection caused by the larval stage of the pork tapeworm //Taenia solium// |
| + | * Caused by ingesting food or water contaminated by the worm's eggs (frequently fecal-oral transmission) which hatch in the gut and larvae migrate to the tissues then form cysts in the tissue. | ||
| + | * Cysts can be viable (dormant), degenerating (non-viable) or resolved with calcification | ||
| + | * The larvae spread hematologically and settle in tissues, especially the CNS and eye. | ||
| + | * Neurocysticercosis is the leading cause of epilepsy in endemic areas | ||
| + | * Endemic areas | ||
| + | * Latin America, sub-Saharan Africa, Indian Subcontinent, | ||
| + | * In the USA (not endemic) cases are more often seen among immigrant populations | ||
| + | =====Diagnosis==== | ||
| + | * Neuroimaging | ||
| + | * MRI | ||
| + | * T2-hyperintesnse and T1-hypointense showing cyst morphology (scolex, cyst fluid and surrounding inflammation) | ||
| + | * CT | ||
| + | * Complementary to MRI, more sensitive for detecting calcified lesions | ||
| + | * Ocular imagining | ||
| + | * B-scan | ||
| + | * Well defined cystic lesion with eccentric intracystic echogenic focus (nidus) representing the scolex, thick cyst wall, surrounding inflammation and retinal detachment | ||
| + | * Serologic testing- enzyme linked immunoelectrotransfer blot assay (EITB) | ||
| + | |||
| + | ====Ocular manifestations==== | ||
| + | * 1-3% of all cases have ocular infection but //T. solium// is the most common intraocular parasite worldwide | ||
| + | * Intraocular cysts | ||
| + | * Free floating in vitreous (60%) | ||
| + | * Subretinal space (40%) | ||
| + | * Vitreous inflammation 84% | ||
| + | * Anterior segment inflammation 30% | ||
| + | * Retinal detachment +/- PVR 50% | ||
| + | * cyst rupture causes more inflammation than intact cysts | ||
| + | * Orbital/ | ||
| + | * Most often superior rectus affected causing restriction, | ||
| + | * Retro-orbital cysts can affect optic nerve and cause proptosis | ||
| + | * Vision loss from CNS disease | ||
| + | * papilledema, | ||
| + | ====Treatment==== | ||
| + | * Intraocular cysts require surgical removal | ||
| + | * Vitrectomy and cyst removal and repair of retinal detachment | ||
| + | * Subconjunctival cysts are usually removed as well. | ||
| + | * Cysticidal therapy can cause severe ocular inflammation | ||
| + | * Extraocular cysts are more amenable to medical treatment alone | ||
| + | * Albendazole + cortiosteroids >90% resolution | ||
| + | * Standard regimen: | ||
| + | * albendazole PO (15mg/ | ||
| + | * prednisone PO (1mg/ | ||
| + | * possible persistent motility restriction, | ||
| + | * Treatment response monitored by vision exam, and repeat imaging. | ||
| + | * If cystic lesions persist beyond 6-12 months, retreatment is recommended. | ||
| + | * albendazole can be repeated, praziquantel can be added or switched to. | ||
| + | * a combination may be superior if ≥ 3 cysts | ||
| + | * Monitor: liver enzymes, CBC | ||
| + | * Hepatotoxicity occurs in 16% | ||
| + | * Leukopenia in 10% | ||
| + | * Reversable alopecia may occur | ||
| + | * More common to have above with more prolonged treatment | ||
| ====References==== | ====References==== | ||
| - [[https:// | - [[https:// | ||
| + | - [[https:// | ||