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Cysticercosis: United States
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Cysticercosis is a parasitic disease commonly found in underdeveloped areas including Mexico, Central America, China, Korea, India and parts of Eastern Europe. While previously uncommon in the industrialized countries, this parasitic infestation is becoming more prevalent in the United States as a result of the recent influx of immigrants.1,2,3,4,5,6,7,8,9,10
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--> To the Editor: Cysticercosis is a tissue infection with the larval stage (cysticercus) of the tapeworm Taenia solium. Neurocysticercosis is considered to be the most common parasitic disease of the central nervous system and the main cause of late-onset epilepsy in areas where the infection is endemic.1 Cases of neurocysticercosis are increasingly being reported in the United States.2 Improved diagnostic techniques and immigration from areas where the infection is endemic are factors that have contributed to this increase, but ... frequently reported cases among travelers suggest that this is a group at particular risk for cysticercosis.3 Neurocysticercosis is diagnosed . . . [Full Text of this Article]
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Cysticercosis affects males and females in equal numbers. Some forms of cysticercosis such as racemose cysticercosis occur more frequently in females. Approximately 1,000 cases of cysticercosis are reported each year in the United States. The disease is more common in Mexico, Latin America, South America, Eastern Europe, and Southeast Asia. Cysticercosis cases have risen in the United States following increased immigration from endemic areas.
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Cysticercosis is only clinically manifest as the host's immune defenses activate and inflammatory processes begin. "Thus, most, if not all, patients with symptomatic parenchymal neurocysticercosis are infected with parasites that have lost their ability to suppress the host response and are in the process of dying."15 Grand mal seizures, focal seizure disorders, headaches, other focal neurological deficits, and even strokes have been reported. "Usually patients have partial seizures with or without secondary generalization, although a few patients may have primary generalized seizures."7 Other manifestations may ... occur such as obstructive hydrocephalus from intraventricular cysts, arachanoiditis, focal and generalized encephalitis, altered mental status including psychosis, and vasculitis.3,6,12,15 The nature of the clinical response of the host is dependent upon the location of the cysticerci as well as the numbers of cysts. However, postmortem studies have shown that 80% of cysticercus infestations are asymptomatic.8
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A case of cerebral cysticercosis in an American child is described. The patient was only 2 years old and had never left the United States. Her symptoms began with febrile seizures and progressed to focal motor seizures. Cerebrospinal fuid pleocytosis with eosinophilia, candle-guttering of the walls of the ventricles on pneumoencephalography, and a titer of 1:4,096 against cysticercosis antigen in her blood led to the diagnosis. Over a five-year follow-up period, the patient's course has been one of resolution of her symptoms, improvement in her electroencephalogram, and excellent seizure control with anticonvulsant therapy. cysticercosis should be considered in the differential diagnosis of a child who shows CSF pleocytosis with eosinophilia, particularly if accompanied by focal seizures.
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As in Europe, most cases of T. solium taeniasis/cysticercosis in the USA are attributed to immigration and travel. However, it has been reported recently that among the rising number of cases being seen in the country's western states, a proportion appears to be locally acquired. A retrospective analysis of hospital records (1995-2000) in Oregon revealed 89 hospitalizations due to cysticercosis, five of which occurred in people who had not travelled or lived outside the United States (Engels, 2003). In California, over a 12-year period (1989-2000) a total of 124 cysticercosis deaths were identified, representing a death rate of 3.9 per million population; the large majority were foreign born, predominantly in the United Mexican States (Dorny, Brandt, & Geerts, 2005). However, nearly 14 percent of deaths were among people born in the United States, some of whom may have had autochthonous infections, although travel-related exposure cannot be ruled out as a source of infection.
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