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Pediatric Cysticercosis Follow-up

  • Author: Delaram Ghadishah, MD; Chief Editor: Russell W Steele, MD  more...
 
Updated: Apr 03, 2012
 

Further Outpatient Care

See the list below:

  • Treat seizures with anticonvulsant medications.
  • Follow-up with a neurologist is recommended for patients with numerous lesions or seizures.
  • Follow-up with an ophthalmologist is recommended for patients with visual lesions or complications.
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Further Inpatient Care

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  • Monitor patients with cysticercosis for anticonvulsant levels or signs of toxicity.
  • Monitor with serial neurologic examinations and initiate corticosteroid therapy if cerebral edema is present.
  • Place a ventriculoperitoneal shunt if acute hydrocephalus develops.
  • Brain surgery may be recommended for a mass effect, and ocular surgery may be recommended for the removal of cysts.
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Inpatient & Outpatient Medications

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  • Anticonvulsant medications as indicated
  • Corticosteroids for cerebral edema due to inflammation
  • Antihelminthic medications if indicated
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Transfer

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  • Transfer patients if specialized care, such as that provided by a neurosurgeon or ophthalmologist, is needed.
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Deterrence/Prevention

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  • Avoid areas and countries with poor hygiene.
  • Persons traveling to developing countries with high rates of endemic cysticercosis should avoid ingestion of unboiled or nonpurified water or ice cubes and should also avoid eating uncooked pork or vegetables and fruits that cannot be peeled.
  • All family members of an index patient with cysticercosis, as well as persons handling their food, should be examined for signs of disease or evidence of adult worm infection.
  • Persons known to have the adult T solium tapeworm should be immediately treated and should exercise care in handwashing to prevent contamination with feces.
  • Examine the stool of food handlers who have recently emigrated from countries with endemic disease for T solium eggs and proglottids.
  • Raw or undercooked pork should not be eaten, as this may result in infection with the adult tapeworm.
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Complications

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  • Complications of cysticercosis are numerous. They are most severe when they involve the CNS, visual, or cardiac system.
    • Permanent brain damage, seizures, strokes, hydrocephalus, and vague neurologic symptoms may result.
    • Blindness often results from ocular cysticercosis, despite antiparasitic and surgical treatment.
  • Muscle involvement may result in myositis and myocarditis.
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Prognosis

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  • The prognosis depends on the number and location of lesions, as well as the host response.
  • Treatment with antihelminthics may result in radiologic improvement of CNS lesions, but this may or may not result in clinical improvement.
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Patient Education

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  • Improved sanitation and hygiene are essential to the prevention of cysticercosis.
  • Use of toilets and proper disposal of human feces that may contain tapeworm eggs may eliminate transmission of infection. Avoid ingestion of unclean water. Proper cooking of pork may result in fewer T solium infections.
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Contributor Information and Disclosures
Author

Delaram Ghadishah, MD Physician, Emergency Department, Kaiser Permanente West Los Angeles Medical Center

Delaram Ghadishah, MD is a member of the following medical societies: American Academy of Emergency Medicine, American College of Emergency Physicians

Disclosure: Nothing to disclose.

Coauthor(s)

Michael James Burns, MD, FACEP, FACP Health Science Clinical Professor, Department of Emergency Medicine, Department of Internal Medicine, Division of Infectious Diseases, University of California Irvine School of Medicine

Michael James Burns, MD, FACEP, FACP is a member of the following medical societies: Alpha Omega Alpha, American Geriatrics Society, American Society of Tropical Medicine and Hygiene, Infectious Diseases Society of America, Phi Beta Kappa, Royal Society of Tropical Medicine and Hygiene, American College of Emergency Physicians, American College of Physicians, California Medical Association, Society for Academic Emergency Medicine

Disclosure: Nothing to disclose.

Specialty Editor Board

Mary L Windle, PharmD Adjunct Associate Professor, University of Nebraska Medical Center College of Pharmacy; Editor-in-Chief, Medscape Drug Reference

Disclosure: Nothing to disclose.

Martin Weisse, MD Program Director, Associate Professor, Department of Pediatrics, West Virginia University

Martin Weisse, MD is a member of the following medical societies: Academic Pediatric Association, American Academy of Pediatrics, Pediatric Infectious Diseases Society

Disclosure: Nothing to disclose.

Chief Editor

Russell W Steele, MD Clinical Professor, Tulane University School of Medicine; Staff Physician, Ochsner Clinic Foundation

Russell W Steele, MD is a member of the following medical societies: American Academy of Pediatrics, American Association of Immunologists, American Pediatric Society, American Society for Microbiology, Infectious Diseases Society of America, Louisiana State Medical Society, Pediatric Infectious Diseases Society, Society for Pediatric Research, Southern Medical Association

Disclosure: Nothing to disclose.

Additional Contributors

Glenn Fennelly, MD, MPH Director, Division of Infectious Diseases, Lewis M Fraad Department of Pediatrics, Jacobi Medical Center; Clinical Associate Professor of Pediatrics, Albert Einstein College of Medicine

Glenn Fennelly, MD, MPH is a member of the following medical societies: Pediatric Infectious Diseases Society

Disclosure: Nothing to disclose.

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Cysticercosis life cycle. Image courtesy of the Centers for Disease Control and Prevention.
MRI of 6-year-old boy from Peru with single right frontal cyst (coronal image). Image courtesy of Eric H. Kossoff, MD.
Axial image MRI of same patient as in Media file 2. Image courtesy of Eric H. Kossoff, MD.
CT scan of intraparenchymal cysticercosis with lesions in different stages. Lesions that are breaking down demonstrate peripheral enhancement after intravenous contrast injection, whereas lesions without peripheral enhancement are intact. Typical residual calcification from an old focus of infection is observed in the left occipital lobe. Image courtesy of Fred Greensite, MD.
Racemose (extraparenchymal) cysticercosis (T1-weighted MRI). Note the cyst in the fourth ventricle, causing obstructive hydrocephalus. Image courtesy of Fred Greensite, MD.
Racemose cysticercosis (T1-weighted MRI). Note cluster of cysts anterior to the pons and inferior to the hypothalamus in a different patient. Image courtesy of Fred Greensite, MD.
Racemose cysticercosis (same patient as in Media file 6). Note the enhancing margin of the cysts in the suprasellar cistern and in the left sylvian fissure after gadolinium injection (T1-weighted MRI). Image courtesy of Fred Greensite, MD.
Racemose cysticercosis (same patient as in Media files 6-7). Coronal image (postgadolinium T1-weighted MRI) posterior to the slice in Media file 7. Cysts in this slice (below the hypothalamus) do not have enhancing margins. Also, unlike intraparenchymal lesions, scolexes are typically not identified in the cysts of racemose cysticercosis. Image courtesy of Fred Greensite, MD.
 
 
 
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