Cysticercosis

Cysticercosis Facts

1. Cysticercosis is a disease where tapeworm larvae move out of the intestine and infect other organs like the brain, eye or heart.
2. Seek medical attention for new onset of seizures, epileptic activity, stroke, and/or psychiatric problems.
3. There are no home remedies for asymptomatic (80%) or symptomatic individuals with cysticercosis. Treatments for symptomatic disease may include anticonvulsants, antihelminthic, corticosteroids and surgery in some individuals. There are reported home remedies for intestinal tapeworms but not cysticercosis.

Cysticercosis is a disease where ingested tapeworm larvae move out of the intestine and infect other organs. Taenia solium (pork tapeworm) is the main cause of human cysticercosis. Food and water contaminated with porcine and human waste and poor hygiene are major risk factors.

Cysticercosis is not considered contagious. The incubation period is about three and a half years but ranges from 10 days to 10 years.

Symptoms and signs of intestinal tapeworms may include abdominal pain, nausea, diarrhea or constipation and for neurocysticercosis, may include nausea, vomiting, headache, lethargy, confusion, blurred vision, detached retina, swelling of optic disc, difficulty with balance, weakness and/or numbness and seizure(s).

Emergency medicine, Infectious disease, neurology and neurosurgery specialists are usually involved with diagnosis and/or treatment of the disease. A new onset of seizures, epileptic activity, stroke and/or psychiatric problems should be medically evaluated urgently or emergently.

Clinical history, physical exam, CT scan and/or MRI, biopsy and direct visualization of the parasites and serology are used to diagnose cysticercosis. There are no home remedies for cysticercosis. Treatment options include no treatment, antiparasitic drugs, corticosteroids, antiseizure drugs and surgical interventions; options vary according to the individual's condition.

Complications of the disease may include brain edema, hydrocephalus, chronic meningitis, vasculitis, paralysis, partial blindness, seizures, coma and death. The prognosis for the majority (80% or more) is good; if complications develop, the prognosis declines. By stopping contamination of food and water from pig and human feces, prevention of many infections can be prevented.

Taenia solium (pork tapeworm) is the main cause of human cysticercosis, although other Taenia species may also cause the disease (taeniasis or general term for all Taenia tapeworm diseases although some consider the term for only intestinal tapeworm infection). The life cycle pictured below shows that embryonated eggs are ingested and hatch, penetrate the intestinal wall, and then circulate to other tissues like the muscles (intramuscular), skin (lumps under the skin or in breast tissue), brain (cerebral), and eye (ocular) and develop into cysticerci (larval cysts). In addition, the individual infected with adult T. solium can ingest eggs made by the adult intestinal tapeworm by reverse peristalsis or by self-fecal contamination (termed autoinfection).

Neurocysticercosis is the term that describes brain infection; it may be further described as racemose (forming a cluster) in the ventricular system or as cellulosae (larval stage without clusters).

Illustration of the life cycle of Taenia solium; image courtesy of the CDC

The major risk factors for the disease are close association with pigs and drinking water or eating food contaminated with tapeworm eggs from porcine and even human feces. Poor sanitary conditions can lead to autoinfection. People living with a person who has a tapeworm infection are at higher risk.

Cysticercosis is not considered contagious, but if infected people have poor hygiene (for example, not washing hands after passing stool), they may infect others if the person accidentally ingests a parasite egg.

Washing and peeling all raw vegetables and fruits before eating can help prevent transmission.

The incubation period is estimated to be about three and a half years, but it may have a range of 10 days to 10 years.

Many people have no symptoms or signs. However, intestinal symptoms of the tapeworm may include abdominal pain, nausea, diarrhea, or constipation. Although as many as 80% of people with neurocysticercosis (brain and/or spinal involvement) have no symptoms, the some people may develop nausea, vomiting, headache, lethargy, confusion, blurred vision, detached retina, swelling of optic disc, difficulty with balance, weakness and/or numbness, and seizure(s). Unfortunately, in neurocysticercosis, the first symptom that causes the patient to be evaluated is a seizure.

Since a new onset seizure is often the presenting sign, the first doctors to diagnose the disease are emergency medicine doctors when they obtain a CT scan of the head. Other doctors who treat and manage the patient may include an infectious disease specialist, neurosurgeon, and a neurologist.

If a person has a new onset of seizures, epileptic activity, stroke, and/or psychiatric problems, especially if the individual has had risk factors for the disease, they should seek medical care urgently or emergently.

The diagnosis of cysticercosis is usually based on clinical presentation, abnormal findings on neuroimaging and serology (blood test like an immunoblot assay), and occasionally with a biopsy. Criteria for diagnosis include absolute criteria (histologic demonstration of the parasite, direct visualization of subretinal parasites and cystic lesions showing the scolex, the anterior end of a tapeworm with suckers and hooks for attachment). Medical professionals may use other major and minor criteria if absolute criteria are not met.

CT scan of neurocysticercosis, view of a cyst, and a view of an MRI showing neurocysticercosis; images courtesy of the CDC

There are no home remedies for cysticercosis. However, there are claims that papaya, pineapple, garlic, cloves, and pumpkin seeds preparations can rid a person of tapeworms. It is best that you discuss such treatments with your health care provider, especially if you are pregnant, before using these remedies.

About 80% or more patients with cysticercosis have no symptoms or signs and no evidence indicates antiparasitic therapy is beneficial to these individuals. However, in symptomatic patients, medical and/or surgical treatments are available. For example, physicians may treat ocular cysticercosis with albendazole, corticosteroids, and surgery to remove the cysticerci. A doctor may surgically excise an inflamed granuloma in the muscle caused by a cysticercus while cerebrospinal fluid may require surgical diversion if hydrocephalus develops. Some individuals with neurocysticercosis may need treatments with albendazole or praziquantel, corticosteroids, and antiseizure medications. Your doctors will help determine the appropriate treatments for each individual.

The complications of the disease may include brain edema, hydrocephalus, chronic meningitis, vasculitis, paralysis, partial blindness, seizures, coma, and death. For example, an 18-year-old male in India went to the ER because of seizures. His head MRI showed a huge number of cysts in the brain. He died two weeks later.

The prognosis for cysticercosis is good for the 80% or more who have no symptoms. The prognosis begins to become worse as complications increase.

It is possible to prevent the disease by preventing people from swallowing eggs from the parasites. This is accomplished by stopping contamination of food and water from pig and human feces. Eliminating undercooked pork from the diet reduces intestinal infection rates by tapeworms. Washing and peeling all raw vegetables and fruits before eating can help prevent transmission.