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cysticercosis [2026/05/26 18:23] Scott Larsoncysticercosis [2026/05/26 18:35] (current) Scott Larson
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   * The larvae spread hematologically and settle in tissues, especially the CNS and eye.   * The larvae spread hematologically and settle in tissues, especially the CNS and eye.
   * Neurocysticercosis is the leading cause of epilepsy in endemic areas   * Neurocysticercosis is the leading cause of epilepsy in endemic areas
 +  * Endemic areas 
 +    * Latin America, sub-Saharan Africa, Indian Subcontinent, Southeast Asia and China. 
 +    * In the USA (not endemic) cases are more often seen among immigrant populations 
 =====Diagnosis==== =====Diagnosis====
     * Neuroimaging     * Neuroimaging
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         * Well defined cystic lesion with eccentric intracystic echogenic focus (nidus) representing the scolex, thick cyst wall, surrounding inflammation and retinal detachment          * 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)      * Serologic testing- enzyme linked immunoelectrotransfer blot assay (EITB) 
-  * Endemic areas  
-    * Latin America, sub-Saharan Africa, Indian Subcontinent, Southeast Asia and China.  
-    * In the USA (not endemic) cases are more often seen among immigrant populations  
  
 ====Ocular manifestations==== ====Ocular manifestations====
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   * Intraocular cysts require surgical removal   * Intraocular cysts require surgical removal
     * Vitrectomy and cyst removal and repair of retinal detachment      * Vitrectomy and cyst removal and repair of retinal detachment 
 +  * Subconjunctival cysts are usually removed as well. 
   * Cysticidal therapy can cause severe ocular inflammation   * Cysticidal therapy can cause severe ocular inflammation
-  * Extraocular cysts are more amenable to medical treatment alone +    * Extraocular cysts are more amenable to medical treatment alone 
-  * Albendazole and cortiosteroids >90% resolution +    * Albendazole cortiosteroids >90% resolution 
-    * possible persistent motility restriction, proptosis or ptosis+      * Standard regimen:  
 +        * albendazole PO (15mg/kg/day usually about 400 mg BID, max 1200 mg/day) for 10-14 days (FDA label permits up to 30 days but some evidence supports shorter courses 3-7 days for example) 
 +        * prednisone PO (1mg/kg/day) given for the duration and the tapered.  
 +      * possible persistent motility restriction, proptosis or ptosis 
 +    * 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://1drv.ms/b/c/31d83ae8e55e0542/ESPvY4XqC1BPg1_kzYOcbUQBgRAIUlsb7_eISmJBNaZHLQ?e=ANUFCJ| Pujari A. et al. Cysticercosis in ophthalmology. Surv Ophthal. 2022;67:544-569]]   - [[https://1drv.ms/b/c/31d83ae8e55e0542/ESPvY4XqC1BPg1_kzYOcbUQBgRAIUlsb7_eISmJBNaZHLQ?e=ANUFCJ| Pujari A. et al. Cysticercosis in ophthalmology. Surv Ophthal. 2022;67:544-569]]
 +  - [[https://pubmed.ncbi.nlm.nih.gov/20060168/|Rath S. et al. Orbital cystercosis: clinical manifestations, diagnosis, management, and outcome. Ophthalmology 2010;117(3):600-605.]]