eMedicine Specialties > Pediatrics: General Medicine > Parasitology

Cysticercosis: Follow-up

Author: Delaram Ghadishah, MD, FACEP, Staff Physician, Encino Hospital Emergency Department
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
Contributor Information and Disclosures

Updated: Oct 7, 2009

Follow-up

Further Inpatient Care

  • 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.

Further Outpatient Care

  • 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.

Inpatient & Outpatient Medications

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

Transfer

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

Deterrence/Prevention

  • 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.

Complications

  • 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.

Prognosis

  • 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.

Patient Education

  • 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.

Miscellaneous

Medicolegal Pitfalls

  • Failure to adequately evaluate the possibility of cysticercosis in a young, otherwise healthy patient with vague neurologic symptoms or new-onset seizures who may be at risk for cysticercosis due to emigration from or travel to an endemic area
  • Failure to seek other causes for the patient's symptoms, such as brain masses, intracranial hemorrhage, meningitis and encephalitis, acute hydrocephalus, and normal-pressure hydrocephalus
  • Failure to refer the patient to a neurologist when seizures are refractory to usual treatment
  • Failure to counsel the patient about the possibility of increased morbidity and mortality with antiparasitic treatment
  • Failure to treat concurrently with corticosteroids in a patient who is taking antiparasitic medications
  • Failure to evaluate ocular lesions before initiating antihelminthic treatment
  • Failure to monitor for antiparasitic drug toxicity while supervising a course of therapy
 


More on Cysticercosis

Overview: Cysticercosis
Differential Diagnoses & Workup: Cysticercosis
Treatment & Medication: Cysticercosis
Follow-up: Cysticercosis
Multimedia: Cysticercosis
References
[ CLOSE WINDOW ]

References

  1. Schantz PM, Moore AC, Munoz JL, et al. Neurocysticercosis in an Orthodox Jewish community in New York City. N Engl J Med. Sep 3 1992;327(10):692-5. [Medline].

  2. Krumholz A, Wiebe S, Gronseth G, et al. Practice Parameter: evaluating an apparent unprovoked first seizure in adults (an evidence-based review): report of the Quality Standards Subcommittee of the American Academy of Neurology and the American Epilepsy Society. Neurology. Nov 20 2007;69(21):1996-2007. [Medline].

  3. AAP Committee on Infectious Diseases. Cysticercosis. In: AAP 2000 Red Book: Report of the Committee on Infectious Diseases. 25th ed. 2000:560-2.

  4. Abuseir S, Kuhne M, Schnieder T, Klein G, Epe C. Evaluation of a serological method for the detection of Taenia saginata cysticercosis using serum and meat juice samples. Parasitol Res. Jun 2007;101(1):131-7. [Medline].

  5. Ahmad FU, Sharma BS. Treatment of intramedullary spinal cysticercosis: report of 2 cases and review of literature. Surg Neurol. Jan 2007;67(1):74-7; discussion 77. [Medline].

  6. Alonso-Trujillo J, Rivera-Montoya I, Rodriguez-Sosa M, Terrazas LI. Nitric oxide contributes to host resistance against experimental Taenia crassiceps cysticercosis. Parasitol Res. Jan 6 2007;[Medline].

  7. Bhigjee AI, Rosemberg S. Optimizing therapy of seizures in patients with HIV and cysticercosis. Neurology. Dec 26 2006;67(12 Suppl 4):S19-22. [Medline].

  8. Blanton R. Cysticercosis. In: Nelson Textbook of Pediatrics. 16th ed. Philadelphia, PA: WB Saunders; 2000:1078-9.

  9. Cohn-Zurita F, Guinto-Balanzar G, Perez-Cerdan H. [Neurocysticercosis associated with pituitary adenoma. Case report and literature review.]. Cir Cir. Jan-Feb 2006;74(1):47-9. [Medline].

  10. Evans CAW, Garcia HH, Gilman RH. Cysticercosis. In: Hunter's Tropical Medicine and Emerging Infectious Diseases. Philadelphia, PA: WB Saunders; 2000:862-6.

  11. Facanha MC. [Cysticercosis' admissions in public health hospitals: Ceara State distribuition]. Rev Soc Bras Med Trop. Sep-Oct 2006;39(5):484-7. [Medline].

  12. Galan-Puchades MT, Fuentes MV. The specificity of the electroimmunotransfer blot assay for Taenia solium cysticercosis. Clin Microbiol Infect. Jan 2007;13(1):111-2; author reply 112. [Medline].

  13. Garcia HH, Cancrini G, Bartalesi F, et al. Evaluation of immunodiagnostics for toxocarosis in experimental porcine cysticercosis. Trop Med Int Health. Jan 2007;12(1):107-10. [Medline].

  14. Garcia HH, Del Brutto OH. Taenia solium cysticercosis. Infect Dis Clin North Am. Mar 2000;14(1):97-119, ix. [Medline].

  15. Geysen D, Kanobana K, Victor B, et al. Validation of meat inspection results for Taenia saginata cysticercosis by PCR-restriction fragment length polymorphism. J Food Prot. Jan 2007;70(1):236-40. [Medline].

  16. Goetz CG, Pappert EJ. Textbook of Clinical Neurology. Philadelphia, PA: WB Saunders; 1999.

  17. Ishida MM, Peralta RH, Livramento JA, et al. Serodiagnosis of neurocysticercosis in patients with epileptic seizure using ELISA and immunoblot assay. Rev Inst Med Trop Sao Paulo. Nov-Dec 2006;48(6):343-6. [Medline].

  18. King CH. Cestode infections. In: Cecil Textbook of Medicine. ed. 2000:1975-8.

  19. King CH. Cestodes (tapeworms). In: Mandell's Principles and Practice of Infectious Diseases. 5th ed. New York, NY: Churchill Livingstone; 2000:2956-62.

  20. Kumar A, Pushker N, Bajaj MS, et al. Unifocal, subconjunctival twin cysticercosis cysts. J Pediatr Ophthalmol Strabismus. Jan-Feb 2007;44(1):55-6. [Medline].

  21. Li T, Craig PS, Ito A, et al. Taeniasis/cysticercosis in a Tibetan population in Sichuan Province, China. Acta Trop. Dec 2006;100(3):223-231. [Medline].

  22. Mahajan D, Khurana N, Setia N. Coexistence of salivary gland cysticercosis with squamous cell carcinoma of the mandible. Oral Surg Oral Med Oral Pathol Oral Radiol Endod. Jan 11 2007;[Medline].

  23. Manfredi MT, Ghirardelli R, Zanzani S. [Cysticercus tenuicollis infection in a goat farm]. Parassitologia. Sep 2006;48(3):433-6. [Medline].

  24. Proano JV, Madrazo I, Avelar F, et al. Medical treatment for neurocysticercosis characterized by giant subarachnoid cysts. N Engl J Med. 2001;345(12):879-85. [Medline]. [Full Text].

  25. Rajshekhar V, Raghava MV, Prabhakaran V, et al. Active epilepsy as an index of burden of neurocysticercosis in Vellore district, India. Neurology. Dec 26 2006;67(12):2135-9. [Medline].

  26. Rodriguez-Hidalgo R, Benitez-Ortiz W, Praet N, et al. Taeniasis-cysticercosis in Southern Ecuador: assessment of infection status using multiple laboratory diagnostic tools. Mem Inst Oswaldo Cruz. Nov 2006;101(7):779-82. [Medline].

  27. Sandes AR, Mouzinho A, Valente P. Orbital cysticercosis: diagnosis and treatment controversies. Pediatr Infect Dis J. Feb 2007;26(2):180-1. [Medline].

  28. Sciutto E, Rosas G, Hernandez M, et al. Improvement of the synthetic tri-peptide vaccine (S3Pvac) against porcine Taenia solium cysticercosis in search of a more effective, inexpensive and manageable vaccine. Vaccine. Feb 9 2007;25(8):1368-78. [Medline].

  29. Singhi P, Dayal D, Khandelwal N. One week versus four weeks of albendazole therapy for neurocysticercosis in children: a randomized, placebo-controlled double blind trial. Pediatr Infect Dis J. 2003;22(3):268-72. [Medline].

  30. Singhi P, Singhi S. Neurocysticercosis in children. Indian J Pediatr. May 2009;76(5):537-45. [Medline].

  31. Verulashvili I, Glonti L, Miminoshvili D, et al. [Basal Ganglia calcification: clinical manifestations and diagnostic evaluation.]. Georgian Med News. Nov 2006;39-43. [Medline].

  32. Zheng Y, Cai X, Luo X, et al. Characterization of a new gene (SLC10) with a spliced leader from Taenia solium. Vet J. Feb 2 2007;[Medline].

[ CLOSE WINDOW ]

Further Reading

[ CLOSE WINDOW ]

Keywords

cysticercosis, neurocysticercosis, giant cysticercosis, cysticercus cellulosae, cysticercus racemosus, adult-onset epilepsy, cysticerci, tapeworm infection, cysticercoids, neurocysticercosis, cysticerci, hydrocephalus, parkinsonism, treatment, diagnosis

[ CLOSE WINDOW ]

Contributor Information and Disclosures

Author

Delaram Ghadishah, MD, FACEP, Staff Physician, Encino Hospital Emergency Department
Delaram Ghadishah, MD, FACEP is a member of the following medical societies: American Academy of Emergency Medicine and 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 College of Emergency Physicians, American College of Physicians, American Society of Tropical Medicine and Hygiene, California Medical Association, Infectious Diseases Society of America, Phi Beta Kappa, Royal Society of Tropical Medicine and Hygiene, and Society for Academic Emergency Medicine
Disclosure: Nothing to disclose.

Medical Editor

Glenn J Fennelly, MD, MPH, Director, Division of Pediatric Infectious Diseases, Jacobi Medical Center; Associate Professor, Department of Pediatrics, Albert Einstein College of Medicine
Glenn J Fennelly, MD, MPH is a member of the following medical societies: Pediatric Infectious Diseases Society
Disclosure: Nothing to disclose.

Pharmacy Editor

Mary L Windle, PharmD, Adjunct Assistant Professor, University of Nebraska Medical Center College of Pharmacy, Pharmacy Editor, eMedicine
Disclosure: Pfizer Inc Stock Investment from financial planner; Avanir Pharma Stock Investment from financial planner ; WebMD Salary and stock Employment and investment from financial planner

Managing Editor

Martin Weisse, MD, Program Director, Associate Professor, Department of Pediatrics, West Virginia University
Martin Weisse, MD is a member of the following medical societies: Ambulatory Pediatric Association, American Academy of Pediatrics, and Pediatric Infectious Diseases Society
Disclosure: Nothing to disclose.

CME Editor

Robert W Tolan Jr, MD, Chief, Division of Allergy, Immunology and Infectious Diseases, The Children's Hospital at Saint Peter's University Hospital; Clinical Associate Professor of Pediatrics, Drexel University College of Medicine
Robert W Tolan Jr, MD is a member of the following medical societies: American Academy of Pediatrics, American Medical Association, American Society for Microbiology, American Society of Tropical Medicine and Hygiene, Infectious Diseases Society of America, Pediatric Infectious Diseases Society, Phi Beta Kappa, and Physicians for Social Responsibility
Disclosure: GlaxoSmithKline Honoraria Speaking and teaching; MedImmune Honoraria Speaking and teaching; Merck Honoraria Speaking and teaching; sanofi pasteur Honoraria Speaking and teaching; Baxter Healthcare Honoraria Speaking and teaching

Chief Editor

Russell W Steele, MD, Head, Division of Pediatric Infectious Diseases, Ochsner Children's Health Center; Clinical Professor, Department of Pediatrics, Tulane University School of Medicine
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, and Southern Medical Association
Disclosure: None None None

 
 
HONcode

We subscribe to the
HONcode principles of the
Health On the Net Foundation

All material on this website is protected by copyright, Copyright© 1994- by Medscape.
This website also contains material copyrighted by 3rd parties.

DISCLAIMER: The content of this Website is not influenced by sponsors. The site is designed primarily for use by qualified physicians and other medical professionals. The information contained herein should NOT be used as a substitute for the advice of an appropriately qualified and licensed physician or other health care provider. The information provided here is for educational and informational purposes only. In no way should it be considered as offering medical advice. Please check with a physician if you suspect you are ill.