1. Platyhelminths : Cestodes
Pseudophyllidea
Diphyllobothrium latum (pernicious anemia)
Cyclophyllidea
Taenia solium (pork tapeworm)
Taenia saginata (beef tapeworm)
Echinococcus granulosus (cystic, CE)
Echinococcus multilocularis (alveolar, AE)

3. A rare and emerging disease

4. Macroparasite example 2 : Taenia solium : Disease Neurocysticercosis
Cestode. Unique zoonosis. Under-reported disease. Diagnostic difficulties. Lack of epidemiological data.

5. Biology of Taenia solium
Unique zoonosis : Human only known definitive host, pig intermediate host
Humans carry both adult worms in the intestine & larval cysticercosis in the muscle & other tissues
Infection with adult worm in humans dangerous to host & other contacts
Under-reported disease
Biology of Taenia solium

6. Symptomatology and pathology 1
Primarily due to pressure effects of a space-occupying cyst or lesion in an organ or tissue
CNS involvement : Neurocysticercosis (NCC) : pathology relates to number, size, type (cellulose or racemose), condition & site of cysticerci in the brain
Active versus inactive NCC
Symptomatology and pathology 1

8. Symptomatology and Pathology 2
Active NCC : arachnoiditis (spinal fluid pleocytosis, increased CSF protein, positive CSF serologic test)
Small number of patients : obstructive hydrocephalus, cranial nerve involvement, intercranial hypertension, arterial thrombosis & stroke
Epilepsy, dementia, meningitis
Symptomatology and Pathology 2
Intraocular cysts : visual impairment

9. Location of parasites in 2188 cases of cysticercosis
CNS 82%
Eye 17%
Subcutaneous
tissue 7%
Muscle 5%
Other organs 6%
Generalized 1%
Flisser & Craig, 2005

10. Adult worms
Stool analysis : uterine branch structure or scolex morphology after treatment
Molecular differentiation of adult worms
Capture ELISA for coproantigen detection
Diagnosis 1

12. Diagnosis 2 Cysticercosis
Imaging methods (CT scan useful for brain & calcified cysts ; MRI not but excellent for detecting active cysts in soft tissue)
Serology (ELISA versus Immunoblot)
Diagnosis 2

13. Epidemiology : cysticercosis
Retrospective case finding
fixed time period, annual incidence rate per 100,000 population
Active screening
Mass radiological imaging surveys
Immunodiagnostic surveys
Autopsy surveys
Epidemiology : cysticercosis

14. Cysticercosis in communities
Endemic focus: Rural Latin America
Major risk factor: current or past case of intestinal Taenia in the household
Non-endemic community: New York City
Significant number of human cysticercosis cases in an Orthodox Jewish community

15. Treatment : cysticercosis
Until recently symptomatic patients : anticonvulsants, corticosteroids, surgery
Chemotherapy
CT useful for monitoring
Active parenchymal brain cysts and subarachnoid (racemose) cysts : albendazole
Albendazole also effective against ocular cysticercosis
Alternative drug : praziquantel less effective

16. Control : Taenia solium
Freezing and appropriate cooking of pork
Identification and treatment of Taenia carriers (mass treatment ?)
Improved health education, prevention of vegetables irrigated with contaminated water
Confinement of pigs
Porcine vaccine
Control : Taenia solium