Cysticercosis: an emerging parasitic disease

Abstract

Cysticercosis (i.e., tapeworm infection) is an increasingly common medical problem in the United States, especially in the Southwest and other areas of heavy emigration from endemic areas or in populations with significant travel to these areas. The larval stage of the pork tape-worm, Taenia solium, causes the clinical syndrome of cysticercosis, with humans as dead-end hosts after ingestion of T solium eggs. Its clinical effects vary depending on site of larval lodging, larval burden, and host reaction. These effects include seizures, headaches, focal neurologic symptoms, visual disturbances, and localized skeletal muscle nodules and pain. Cysticercosis should be considered in any patient from an endemic area presenting with these symptoms. Treatment varies with the clinical presentation. Parenchymal neurocysticercosis generally is treated with albendazole in conjunction with steroids to limit edema and with antiepileptic medications for seizure control. Ocular and extraocular muscle cysticercosis generally requires surgical intervention. Skeletal muscle cysts are surgically removed only if painful. Because cysts can lodge in multiple locations, all patients with cysticercosis should have an ophthalmologic examination to rule out ocular involvement, and all patients with extraneurologic cysticercosis should have computed tomography or magnetic resonance imaging of the brain to rule out neurocysticercosis.