RESUMO
Taenia solium cysticercosis is difficult to eliminate without interventions or societal development. Atahualpa is a rural Ecuadorian village with documented low migration rate, where domestic pig raising is common and human cysticercosis is endemic. To assess neurocysticercosis (NCC) prevalence, 1,273 villagers aged ≥ 20 years underwent neuroimaging studies, which showed calcified lesions in 121 (9.5%) individuals, but no active disease. Likewise, positive reactions, apparently nonspecific, were found in only 3/200 subjects by the use of a monoclonal antibody-based enzyme-linked immunosorbent assay to detect T. solium antigens in urine. Only 2/418 pigs reacted to three antibody bands on serum western blot and none to more than three bands. This is the first time that spontaneously arrested T. solium transmission is documented in a known endemic village. Understanding why active transmission stopped could provide insights on potential targets for control interventions. Atahualpa could provide an optimal scenario for longitudinal studies on the consequences of calcified NCC.
Assuntos
Doenças Endêmicas/prevenção & controle , Neurocisticercose/prevenção & controle , Neurocisticercose/transmissão , Doenças dos Suínos/prevenção & controle , Doenças dos Suínos/transmissão , Adulto , Criação de Animais Domésticos , Animais , Anticorpos Anti-Helmínticos/sangue , Antígenos de Helmintos/urina , Equador/epidemiologia , Fezes/parasitologia , Feminino , Humanos , Masculino , Neurocisticercose/diagnóstico por imagem , Neurocisticercose/epidemiologia , Neuroimagem/métodos , Prevalência , População Rural , Suínos , Doenças dos Suínos/epidemiologia , Doenças dos Suínos/parasitologia , Taenia solium/fisiologiaRESUMO
PURPOSE OF REVIEW: This review comments on the recent advances in the understanding of the controversial aspects of neurocysticercosis (NCC). RECENT FINDINGS: The number of autochthonous cases of NCC in nonendemic countries has increased during the last few years: it is likely that the migration of Taenia carriers from endemic areas is responsible for the increased prevalence of locally acquired NCC in these regions. NCC is mostly acquired from person to person, and the old theories crediting the environment as the main source of human infection with Taenia solium eggs must be abandoned. There is growing evidence suggesting that cysticercus granulomas (one of the most common forms of presentation of NCC) represent fresh infections and not old infections resulting from spontaneous destruction of viable cysticerci. Calcifications, often seen as inactive lesions producing no symptoms, are responsible for a sizable proportion of NCC-related seizures or headache. It is likely that exposure of parasitic antigens to the host's immune system is the cause of these manifestations. SUMMARY: During the last few years, there has been an increased knowledge on the controversial aspects of NCC, including epidemiology, mechanisms of disease acquisition, the natural involution of lesions in the brain parenchyma, and the role of calcifications as responsible for symptom occurrence.
Assuntos
Encéfalo/patologia , Neurocisticercose/parasitologia , Taenia solium/isolamento & purificação , Animais , Cysticercus/imunologia , Humanos , Neurocisticercose/complicações , Neurocisticercose/epidemiologia , Neurocisticercose/transmissão , Convulsões/etiologia , Taenia solium/imunologiaRESUMO
We used baseline data on 154 symptomatic neurocysticercosis (NCC) patients in Ecuador to identify predictors of the burden of cysts. We ran logistic regression models with the burden of cysts as the outcome, defined as the number of cysts in the brain (1 vs >1), and having cysts in all 3 phases of evolution (active, transitional and calcifications) vs <3. These two outcomes are thought to be indicators of exposure dose and/or repeated exposure over time. The predictors examined were: living in a rural area, living on a dirt road, living in an adobe or wood house (vs brick/cement), no running water in the house, no bathroom in the house, having a domestic employee cook in the home, eating most meals at restaurants or street vendors, working in a manual labour job. We found that the odds of having multiple NCC cysts was higher among those working in manual labour (OR=3.5, p=0.004), and those who ate most meals outside the home had higher odds of having cysts in all 3 phases (OR=5.0, p=0.007). Burden of cysts may be a useful outcome when looking to identify exposure risk factors in the absence of an uninfected control group.
Assuntos
Cistos/epidemiologia , Estilo de Vida , Modelos Estatísticos , Neurocisticercose/epidemiologia , Pobreza , Condições Sociais , Adulto , Cistos/diagnóstico , Cistos/parasitologia , Equador/epidemiologia , Comportamento Alimentar , Feminino , Habitação/estatística & dados numéricos , Humanos , Imageamento por Ressonância Magnética , Masculino , Neurocisticercose/diagnóstico , Neurocisticercose/transmissão , Variações Dependentes do Observador , Ocupações/estatística & dados numéricos , Oócitos , Fatores de Risco , População Rural/estatística & dados numéricos , Saneamento/estatística & dados numéricos , Fatores Socioeconômicos , Solo/parasitologia , Tomografia Computadorizada por Raios XRESUMO
A 2-year-old boy presented with seizures and two parenchymal brain ring-enhancing lesions. Diagnosis of neurocysticercosis was confirmed by positive serology and response to albendazole therapy. The patients's mother was a Taenia solium carrier, who had most likely infected the child through the fecal-oral route. Household contacts should always be investigated in children with neurocysticercosis. Proper identification and treatment of Taenia solium carriers will reduce the risk of further spread of the disease.
Assuntos
Neurocisticercose/diagnóstico , Neurocisticercose/patologia , Taenia solium/isolamento & purificação , Albendazol/administração & dosagem , Animais , Anti-Helmínticos/administração & dosagem , Pré-Escolar , Transmissão de Doença Infecciosa , Saúde da Família , Humanos , Masculino , Neurocisticercose/transmissão , Convulsões/etiologia , Testes Sorológicos , Resultado do TratamentoRESUMO
OBJECTIVE: Review of neurocysticercosis in citizens from non-endemic countries who developed the disease after a travel to endemic regions, to estimate the magnitude of the disease and to determine the pattern of disease expression in travelers to disease-endemic areas. METHODS: MEDLINE and manual search of international travelers with neurocysticercosis diagnosed in countries where the disease is not endemic, from 1981 to October 2011. Abstracted data included: demographic profile of patients, clinical manifestations, form of neurocysticercosis, and therapy. RESULTS: A total of 35 articles reporting 52 patients were found. Most patients were originally from Western Europe, Australia, Israel, and Japan. Mean age was 36.5 ± 15.1 years, and 46% were women. Common places for travelling were the Indian Subcontinent, Latin America, and Southeast Asia. Mean time spent aboard was 56.6 ± 56.1 months. Most patients developed symptoms 2 years or more after returning home. Seizures were the most common clinical manifestation of the disease (73%), and all but six patients had parenchymal brain cysticercosis (a single cysticercus granuloma was the most common neuroimaging finding, in 21 patients). Twenty patients underwent surgical resection of the brain lesion for diagnostic purposes, and 22 received cysticidal drugs. CONCLUSIONS: Neurocysticercosis is rare in international travelers to endemic countries, and most often occurs in long-term travelers. It is possible that most of these patients get infected by contact with a taenia carrier. The time elapsed between disease acquisition and symptoms occurrence suggests that, at least in some patients, clinical manifestations are related to reactivation of an infection that has previously been controlled by the host immune system.
Assuntos
Antiparasitários/uso terapêutico , Doenças Endêmicas , Neurocisticercose , Procedimentos Neurocirúrgicos/métodos , Viagem/estatística & dados numéricos , Adulto , Encéfalo/patologia , Controle de Doenças Transmissíveis , Países em Desenvolvimento , Reservatórios de Doenças , Doenças Endêmicas/prevenção & controle , Doenças Endêmicas/estatística & dados numéricos , Feminino , Higiene das Mãos , Humanos , Masculino , Anamnese , Pessoa de Meia-Idade , Neurocisticercose/complicações , Neurocisticercose/diagnóstico , Neurocisticercose/epidemiologia , Neurocisticercose/terapia , Neurocisticercose/transmissão , Neuroimagem/métodos , Prevalência , Medição de Risco , Convulsões/etiologiaRESUMO
Neurocysticercosis (NC) is a central nervous system disease caused by Cysticercus cellulosae, the larvae of Taenia solium. NC is found worldwide, and endemic in Latin America and Asia. In 1993, 11 adult patients with NC were reported in Buenos Aires, 8 from Bolivia and the rest from Argentina. Pediatric cases reported in Argentina have been from inner provinces or from rural areas. The purpose of the present article is to present the first autochthonous pediatric case, with local source of contagion in the city of Buenos Aires, and to alert regarding the possibility that the city become an endemic area, due to the migratory movements leading to establishment of asymptomatic carriers of Taenia solium in the urban area.
Assuntos
Neurocisticercose , Argentina , Criança , Feminino , Humanos , Neurocisticercose/diagnóstico , Neurocisticercose/transmissão , Saúde da População UrbanaRESUMO
Os autores relatam o caso clínico de um paciente de 24 anos de idade, suinocultor, portador de neurocisticercose. O paciente apresentou um episódio de crise convulsiva e sua tomografia computadorizada de crãnio revelou lesões parenquimatosas sugestivas de neurocisticercose nos quatro estágios da doença (vesicular, vesicular coloidal, granular nodular e nodular calcificado). A neurocisticercose é a doença parasitária mais comum do sistema nervoso, sendo também a causa mais comum de crises epilépticas nos países em desenvolvimento, onde a prevalência das crises é duas vezes maior que nos países desenvolvidos.
It has been reported a clinical case of 24 years-old patient, farmer with neurocysticercosis. The patient presented a epileptic seizure and his computed tomography showed intraparenchymal lesions in the four stages of disease. Neurocysticercosis is the most common parasitic disease of the nervous system in humans and the single most common cause of acquired epileptic seizures in the developing world, where prevalence rates of active epilepsy are twice those in developed countries.
Assuntos
Humanos , Masculino , Neurocisticercose/diagnóstico , Neurocisticercose/etiologia , Neurocisticercose/fisiopatologia , Neurocisticercose/parasitologia , Neurocisticercose/terapia , Neurocisticercose/transmissão , Sistema Nervoso Central/parasitologia , Albendazol/uso terapêutico , Anticonvulsivantes/uso terapêutico , Antígenos de Helmintos/uso terapêutico , Epilepsia/etiologia , Fenitoína/uso terapêutico , Imageamento por Ressonância Magnética/tendências , Imageamento por Ressonância Magnética , Praziquantel/uso terapêutico , Prednisona/uso terapêutico , Taenia solium/patogenicidadeRESUMO
Cysticercosis contributes to higher epilepsy rates in developing countries than in industrialized ones, yet no estimate exists for the associated burden of disease. We used epidemiological data on neurocysticercosis in Peru to calculate the burden of disease and applied our model to the other countries of Latin America where neurocysticercosis is endemic to determine a regional estimate. Analysis of 12 population-based community studies demonstrated that neurocysticercosis was endemic in highland areas and high jungles, with seroprevalences from 6% to 24%. In one community, the adult seizure disorder rate was 9.1% among seropositive persons versus 4. 6% among seronegative persons; we used this difference for estimates. On the basis of average prevalence rates in areas of endemicity of 6%-10%, we estimated that there are 23,512-39,186 symptomatic neurocysticercosis cases in Peru. In Latin America, an estimated 75 million persons live in areas where cysticercosis is endemic, and approximately 400,000 have symptomatic disease. Cysticercosis contributes substantially to neurological disease in Peru and in all of Latin America.