Cysticercosis - Causes, symptoms and treatment. MF.

The prevalence of cysticercosis in the world is similar to that in the case of shadyosis( pig chain).The geographical area includes territories with widely developed cattle breeding. Cysticercosis draws the attention of specialists to the severity of leakage in a person with the possibility of hitting vital organs and systems, low efficiency of specific therapy and lethality. It is known that it is cysticercosis that can cause neurological diseases, including epilepsy, prevalent in South America, Africa, and Asia.

Cysticercosis is a disease of a human parasitic etiology caused by the larvae of the pork chain - Cysticercus cellulosae, capable of settling and parasitizing in various organs( brain, spinal cord, muscle tissue, eyes, bone and others), andalso poorly treatable. In the event of this disease a person is an intermediate host of a pork chain.

Cysticerci( larvae)

Geographic prevalence of cysticercosis is almost the same as in the shadow. These are South and Central America, Africa, India, China, Ukraine, Belarus, Georgia, Siberia.

Causes of development of cysticercosis.

The causative agent of cysticercosis is the larval stage of the pork tapeworm( Taenia solium), cysticerc or finna( Cysticercus cellulosae).Cysticercus is an oval form of formation or a vesicle in which the scolex or head of a pork chain is located, equipped with 4 suckers and a double row of hooks( hence the name "armed tapeworm").In the tissues and organs of the patient, the shape may vary from rounded to spindle-shaped to 15 mm in size, but rarely describe giant bubbles with clusters( the so-called branching form of cysticerca).Over time, the shell becomes denser, which is due to the deposition of calcium salts in it, but the cysticerc inside is still viable.

Source of infection - a sick person, with feces which are released into the environment eggs of pork chopsticks.

The infection mechanism is more often fecal-oral, and the pathway is contact-household, food. When exogenous infection transmission factors are dirty hands, contaminated food, with which eggs of pork chopsticks fall into the human stomach. In patients with shadows( pig chain), endogenous infection or autoinvasia can occur( the throwing of mature segments of the chain from the intestine during vomiting followed by ingestion of oncospheres or eggs).

Population susceptibility is universal, but the disease occurs in a small percentage of cases - up to 5%.With the same frequency, people become male and female.

Pathogenic effect of cysticerc in the human body.

Once in the human stomach, the eggs( oncospheres) of the pork chain are moved to the small intestine, where larvae emerge from them, enter the intestinal wall, and then enter the bloodstream. With blood flow, they are carried throughout the body and settle in various organs and tissues, where cysticercises are formed( bubbles up to 15 mm with clear liquid and scolex inside).The main places of localization of cysticerci: subcutaneous fat, brain, organs of vision, muscle tissue, heart, liver, lungs, peritoneum, bone tissue. Up to 80% of the lesions occur in the central nervous system, in the second place - the organs of vision. Maturation of cysticerci occurs within 4 months.

Lifetime of the larva is 3-10 years.

Pathological effect of larvae associated with:

1) Mechanical action( pressure of the growing helminth on organs and tissues and, as a consequence, a violation of their function).
2) The irritating effect of larvae on the surrounding tissue and the development of the inflammatory process is the onset of inflammatory and degenerative infiltrates. For example, in the brain - is the development of meningitis, encephalitis, hydrocephalus, in the organs of vision - damage to the retina, vitreous body and others.
3) Toxico-allergic action on the body due to the introduction of parasite-parasitic antigens into the general bloodstream( the development of a generalized allergic reaction, with the massive death of a parasite, the development of anaphylactic shock is possible).

Symptoms of cysticercosis

The clinical symptomatology of the disease is diverse depending on the affected organ or body system, as well as the degree of infection. Allocate cysticercosis of the central nervous system( CNS), cysticercosis of the eye, cysticercosis of the muscles, skin, subcutaneous fat layer. Other forms are extremely rare. The defeat of the central nervous system accounts for about 80% of all lesions.

Cysticercosis of the central nervous system.

In the defeat of the central nervous system, it is customary to distinguish the following forms:
1) cysticercosis of the cerebral hemispheres( GM);
2) cysticercosis of the ventricular system;
3) cysticercosis of the base of the brain;
4) mixed cysticercosis.

When lesions of the large hemispheres of the GM, patients complain of headaches in the form of attacks, dizziness, nausea and vomiting that does not bring relief. All these symptoms are associated with a violation of the outflow of cerebrospinal fluid due to occlusion of the ventricular formations of the brain by floating cysticercles and, as a consequence, increased intracranial pressure. One of the common symptoms is epileptiform seizures.

With the defeat of the ventricular system, an acute onset( development of hypertensive-hydrocephalic syndrome) is possible. There are sudden intense headaches, which increase when the position of the head and body changes, which leads to the emergence of forced postures in patients. Headaches are accompanied by severe vomiting.

Cysticercosis of the base of the brain entails a mass of symptoms with less severe complaints compared to previous forms of the disease. Patients are concerned about the pain in the occipital part of the head, neck, hearing loss, dizziness especially when turning the head, a violation of taste. There may be violations of motor activity from abnormalities of gait to paresis. Some patients have sensitivity disorders and mental disorders.

For the mixed form of cysticercosis, epileptiform seizures, hallucinations, mental disorders of any kind are characteristic. This form is unfavorable.

Cysticercosis, brain damage

Cysticercosis of the eye.

When the eyes are affected, patients are first disturbed by various kinds of visual impairment, which can be aggravated up to complete blindness( the prognosis is serious, almost irreversible).Cysticerci can be located in all shells and structures of the eye, can cause retinal detachment, changes in the lens.

Cysticercosis, eye damage

Cysticercosis of the skin and subcutaneous fat.

For a long time it is asymptomatic, only after years you can find small rounded formations that rise above the surface of the skin, painless and soft to the touch, but in the end they become denser. Most often located on the palms, chest, shoulders. Often in patients there is a generalized allergic reaction according to the type of urticaria. This form is favorable.

Rare forms of cysticercosis occur with heart damage with cardiac rhythm disorders, as well as with lung damage( as a random finding in radiography - rounded shadows up to 1.5 cm).

Cysticercosis of subcutaneous fat

Diagnosis of cysticercosis.

The diagnosis of cysticercosis is made on the basis of the following criteria:

1) Epidemiological history( disease with shadows, non-observance of personal hygiene when eating food).
2) Clinical data( the presence of specific patient complaints, characteristic of a clinical form of cysticercosis).
3) Paraclinical methods of investigation: in the general analysis of blood eosinophilia up to 40%, in the analysis of cerebrospinal fluid - lymphocytosis, protein increase.
4) Instrumental methods of examination( electroencephalography, CT, MRI, radiography of the lungs and other organs, ophthalmoscopy) - the presence of cavities with a dense shell.
5) Biopsy of nodules and a historical study of materials( in particular, examination of the cavities of subcutaneous fat, inside which the larva is located) is possible.
6) Serological blood tests to identify antibodies to larvae of pork chopsticks, for the purpose of which DSC, RNGA, ELISA are used.

Differential diagnosis is carried out with tumoral formations of the brain, echinococcosis, toxoplasmosis, neurosyphilis, phlebitis, pulmonary tuberculosis and bones, and others.

Treatment of cysticercosis.

Severe cases of cysticercosis( brain damage, eye) are subject to hospitalization. With cysticercosis of the skin, muscles and subcutaneous fat, patients are observed outpatiently.

Treatment methods:

1) Antiparasitic therapy is administered with extreme caution in connection with the danger of parasite death and the appearance of a severe allergic reaction due to its decay products( in particular, anaphylactic shock).Therapy is carried out only in a hospital. Treatment is subject to inoperable cases of cysticercosis of the brain, cysticercosis of the eye. The following antiparasitic drugs are prescribed: praziquantel, mebendazole, albendazole. Recommended 3 courses of therapy with a 3-week interval. Cysticercosis of the skin, RVC and muscles in the absence of complaints is not treated, and patients undergo dynamic monitoring.

2) Surgical treatment methods are used in case of accurate identification of the source and the possibility of its removal without damaging the vital centers of the brain. In the absence of guarantees for complete recovery, therapy is complemented by conservative treatment: the appointment of antiparasitic drugs - prazikvantel.

Any therapy with antiparasitic drugs for cysticercosis should be supplemented by the appointment of GCS( glucocorticosteroids), for example, prednisolone, dexamethasone.

3) Symptomatic treatment of supplements prescribed antiparasitic therapy( antihistamines - zodak, zirtek, suprastin, pipolfen, anticonvulsant, sedative, dengydrative therapy, topical therapy, etc.).

The prognosis of the disease depends on the form of the disease. If there is cysticercosis of the skin and muscle tissue, then the prognosis is favorable. If the patient has a lesion of the internal organs and, as is often the case, the diagnosis is made late, if the process is far gone, then the forecast is unfavorable.

Prevention of cysticercosis

• Compliance with measures and personal hygiene rules( timely and thorough washing of hands after visiting the toilet room and before meals, careful processing of food before consumption - fruits, vegetables, berries and others).
• Hygienic education of the younger generation, instilling in them hygienic standards of life.
• Timely address to a doctor with a disease with shadows( pig chain) for the purpose of sanitation and dispensary observation.
• Avoiding the consumption of raw, semi-dry and thermally poorly processed pig meat and wild boar.
• Visualization of pig meat before use in order to identify the finnish chain.
• Survey of the decrepit population groups on the shadows( workers of meat-packing plants, pig farms).
• Sanitary and veterinary supervision to prevent the ingress of pork, infected with a pig chain on the counters to the end user.

The doctor infektsionist Bykov N.I.