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Platyhelminths : Cestodes

Platyhelminths : Cestodes. Pseudophyllidea Diphyllobothrium latum (pernicious anemia). Cyclophyllidea Taenia solium (pork tapeworm) Taenia saginata (beef tapeworm) Echinococcus granulosus (cystic, CE) Echinococcus multilocularis (alveolar, AE). A rare and emerging disease.

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Platyhelminths : Cestodes

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  1. Platyhelminths : Cestodes • Pseudophyllidea • Diphyllobothrium latum (pernicious anemia) • Cyclophyllidea • Taenia solium (pork tapeworm) • Taenia saginata (beef tapeworm) • Echinococcus granulosus (cystic, CE) • Echinococcus multilocularis (alveolar, AE)

  2. A rare and emerging disease

  3. Macroparasite example 2 : Taenia solium : Disease Neurocysticercosis Cestode. Unique zoonosis. Under-reported disease. Diagnostic difficulties. Lack of epidemiological data.

  4. Biology of Taenia solium • Unique zoonosis : Human only known definitive host, pig intermediate host • Humans carry both adult worms in the intestine & larval cysticercosis in the muscle & other tissues • Infection with adult worm in humans dangerous to host & other contacts • Under-reported disease

  5. Symptomatology and pathology 1 • Primarily due to pressure effects of a space-occupying cyst or lesion in an organ or tissue • CNS involvement : Neurocysticercosis (NCC) : pathology relates to number, size, type (cellulose or racemose), condition & site of cysticerci in the brain • Active versus inactive NCC

  6. Symptomatology and Pathology 2 • Active NCC : arachnoiditis (spinal fluid pleocytosis, increased CSF protein, positive CSF serologic test) • Small number of patients : obstructive hydrocephalus, cranial nerve involvement, intercranial hypertension, arterial thrombosis & stroke • Epilepsy, dementia, meningitis Intraocular cysts : visual impairment

  7. Location of parasites in 2188 cases of cysticercosis • CNS 82% • Eye 17% • Subcutaneous tissue 7% • Muscle 5% • Other organs 6% • Generalized 1% Flisser & Craig, 2005

  8. Diagnosis 1 Adult worms • Stool analysis : uterine branch structure or scolex morphology after treatment • Molecular differentiation of adult worms • Capture ELISA for coproantigen detection

  9. Diagnosis 2 Cysticercosis • Imaging methods (CT scan useful for brain & calcified cysts ; MRI not but excellent for detecting active cysts in soft tissue) • Serology (ELISA versus Immunoblot)

  10. Epidemiology : cysticercosis • Retrospective case finding • fixed time period, annual incidence rate per 100,000 population • Active screening • Mass radiological imaging surveys • Immunodiagnostic surveys • Autopsy surveys

  11. Cysticercosis in communities • Endemic focus: Rural Latin America • Major risk factor: current or past case of intestinal Taenia in the household • Non-endemic community: New York City • Significant number of human cysticercosis cases in an Orthodox Jewish community

  12. Treatment : cysticercosis • Until recently symptomatic patients : anticonvulsants, corticosteroids, surgery • Chemotherapy • CT useful for monitoring • Active parenchymal brain cysts and subarachnoid (racemose) cysts : albendazole • Albendazole also effective against ocular cysticercosis • Alternative drug : praziquantel less effective

  13. Control : Taenia solium • Freezing and appropriate cooking of pork • Identification and treatment of Taenia carriers (mass treatment ?) • Improved health education, prevention of vegetables irrigated with contaminated water • Confinement of pigs • Porcine vaccine

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