Taenia solium Cysticercosis and Its Impact in Neurological Disease

Abstract

Taenia solium neurocysticercosis (NCC) is endemic in most of the world and contributes significantly to the burden of epilepsy and other neurological morbidity. Also present in developed countries because of immigration and travel, NCC is one of few diseases targeted for eradication. This paper reviews all aspects of its life cycle (taeniasis, porcine cysticercosis, human cysticercosis), with a focus on recent advances in its diagnosis, management, and control. Diagnosis of taeniasis is limited by poor availability of immunological or molecular assays. Diagnosis of NCC rests on neuroimaging findings, supported by serological assays. The treatment of NCC should be approached in the context of the particular type of infection (intra- or extraparenchymal; number, location, and stage of lesions) and has evolved toward combined symptomatic and antiparasitic management, with particular attention to modulating inflammation. Research on NCC and particularly the use of recently available genome data and animal models of infection should help to elucidate mechanisms of brain inflammation, damage, and epileptogenesis.

Keywords: Peru; Taenia solium; cysticercosis; epilepsy; neurocysticercosis.

FIG 1

Geographic distribution of Taenia solium taeniasis/cysticercosis (WHO, 2015).

FIG 2

Life cycle of Taenia solium. (Adapted from reference .)

FIG 3

Taenia solium. (A) Egg; (B) scolex; (C) gravid proglottid. (All images courtesy of Juan Jimenez, Lima, Peru.)

FIG 4

Massive cysticercosis infection in a pig. (Courtesy of the Cysticercosis Elimination Program in Tumbes, Peru.)

FIG 5

Parenchymal neurocysticercosis. (A) Viable and degenerating cysts; (B) calcified lesions; (C) cysticercosis encephalitis.

FIG 6

Extraparenchymal neurocysticercosis. (A) Intraventricular cyst; (B) basal subarachnoid cysticercosis; (C) Sylvian fissure and interhemispheric cysticercosis.