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Cystisercosis

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by

mahmoud salah

on 9 November 2015

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Transcript of Cystisercosis

la
b
o
r
at
o
ry
di
a
g
n
osi
s o
f
cy
s
t
i
c
er
co
s
i
s

an
inflammatory response

leads to
degeneration of the cysticercus
. An inflammatory response that occurs in the CNS parenchyma causes
seizures
typical of parenchymal neurocysticercosis. As the
degeneration
continues
, the
parasite becomes encased in a
granuloma
, which either
resolves
or
leads to
scarring
and
calcification
.
MRI and CT-scan of parenchymal cysticerci.
Human back and buttocks exhibiting cysticercosis

musculoskeletal cysticercosis
Summary
Cysticercosis
overview :
3-CSF

CSF findings include
pleocytosis
(
an increase in white blood cell (WBC) count, in a bodily fluid, such as cerebrospinal fluid (CSF)

)
,
elevated protein levels
and
depressed glucose levels
; but these may not be always present.
Note
infection caused by
eggs
of the pork tapeworm(tenia solium)
p
a
t
h
o
g
e
n
e
s
is
epidemiology
Del Brutto et al defined the diagnostic categories :
in rare cases, patients with numerous parenchymal cysticerci develop a
diffuse cerebral edema termed
cysticercal encephalitis.
Pathologically, cysticercal encephalitis may progress to
meningoencephalitis
,
granulomatous

meningitis
,
focal

granulomas
or
abscess
,
hydrocephalus
,
ependymitis
, or
arteritis
50-100 million people are infected with cysticercosis worldwide.

This is probably an underestimate since many infections go undiagnosed.
Neurocysticercosis is one of the leading causes of adult-onset seizures worldwide.

CT scanning and MRI of the brain have greatly improved the diagnosis of neurocysticercosis.
Areas of endemic disease include
Central and South America,

India
,
China
,
Southeast Asia
, and
sub-Saharan Africa.

Studies in Latin America and India have noted adult-onset seizures in approximately 2% of the population, with as many as half due to neurocysticercosis.

1.
Histologic demonstration
of the parasite on a
biopsy
sample from the
brain
or
spinal cord
lesion

2.
Direct visualization
of subretinal parasites via
funduscopic examination

3. Cystic lesions showing the
scolex on CT scans or MRi
Absolute criteria include the following:
Major criteria :

غ
The diagnostic categories that follow pertain to the criteria outlined in the model developed by Del Brutto et al:

Definite neurocysticercosis (1 of the following)
One absolute criterion

Two major criteria plus 1 minor criterion and 1 epidemiologic criterion

Probable neurocysticercosis (1 of the following)

One major criterion plus 2 minor criteria

One major criterion plus 1 minor criterion plus 1 epidemiologic criterion

Three minor criteria plus 1 epidemiologic criterion
Diagnosis
-
Ophthalmic cysticercosis
can be diagnosed by visualizing parasite in eye by
fundoscopy
.
diagnosis is a sensitive problem and requires
biopsy
of the infected tissue
CT scan shows both calcified and uncalcified cysts, as well as distinguishing active and inactive cysts.
-caused by the
metacestode
, or larval, stage of Taenia solium, the pork tapeworm. The clinical syndromes caused by T solium are categorized as either
cysticercosis
(cysts in various tissues including the brain) or
taeniasis
(intestinal tapeworm infection
food contaminated with eggs from infected person


autoinfection :

exnternal
:(anus : mouth contamination of food )
internal
:( use of emetics that help distinigration of gravid segment and release of the oncosphere which circulates to reach tissue )
Mode of infection :
sites
of
infection
:
Extraneural cysticercosis
: involves the eye, muscle, or subcutaneous tissue.
It is not known whether oncospheres actively migrate to those organs or passively enter tissues during high blood flow.
Neurocysticercosis
: cysticercus cellulosa infect the brain tissue.
Clinical diagnosis: according site (on detail)


Laboratory diagnosis:
(1- stool examination 2- csf examination 3- serological examination which include ELISA, EITB)
Radiological diagnosis:
(1- x ray 2- ct scan 3 –MRI )
Fundoscope.
Biopsy.

Diagnostic tests
:
The diagnosis of neurocysticercosis relies on
neuroradiologic imaging
and
laboratory testing
.
Computed tomographic scans
and
magnetic resonance
imaging can provide vital prognostic information and may be diagnostic if a
scolex
is visualized.
Laboratory diagnosis
1 -
stool examination
is not used .
2-
The enzyme-linked immunoelectrotransfer blot (EITB)
is currently the
best
tool for diagnosis because it has a specificity of 100% and a sensitivity of 94–100%.However, the sensitivity of EITB is lower in the presence of a single cyst (approximately 50%) or calcified cysts (approximately 75%).
Done by :
83 : Mahmoud Hossam el din Elsayed .
84 :Mahmoud Saad Saad Elnadi
85 : Mahmoud Salah Mohammed shehat
86 :Mahmoud Salah Mohammed Saleh
87 :Mahmoud talat Mohammed Elsayed
Under supervision of :
Dr . Wafaa Atef
Lesions on
neuroimaging studies
(CT scan or MRI showing cystic

lesions
without scolex
, enhancing lesions, or typical parenchymal brain
calcifications

Serum
anticysticercal antibodies
demonstrated by
immunoblot assay

Resolution
of intracranial cystic lesions after therapy with
albendazole
or
praziquantel
Minor criteria :
- Lesions compatible
with neurocysticercosis on neuroimaging studies

- Clinical manifestations suggestive of neurocysticercosis (eg,
epilepsy
,
focal neurologic sign
s, intracranial hypertension, dementia)

- Positive findings from
CSF
(ELISA) .
and some epidemiologic factors .
objectives :
1- an inroduction about cysticercosis .
2- understanding the pathogenesis of cysticercosis .
3- epidemiology of cysticercosis .
4- laboratory dignosis .
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