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Oxford Textbook of Medicine (5 ed.)

Edited by David A. Warrell, Timothy M. Cox, John D. Firth

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Latest update

The November 2012 update sees updates to over 70 chapters, focusing on Neurology and Gastroenterology. This update also incorporates a selection of 29 Case Histories taken from related titles in the Oxford Case Histories series, linked to from related chapters. Each case includes several questions followed by detailed answers and discussion to enhance diagnostic and clinical understanding.

Neurology updates include substantial updates to key chapters and new material on a wide range of topics including spinal cord injury, autonomic nervous system disorders, and inherited neurodegenerative diseases. 

Gastroenterology updates include extensive revisions of key chapters on liver failure and acute pancreatitis and new material on a wide range of matters, ranging from the common to the rare: including surgical treatments for colonic diverticular disease, antibody tests for immune disorders, and a revised treatment algorithm for small bowel bacterial overgrowth.

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Publisher:
Oxford University Press
Print Publication Date:
May 2010
Print ISBN-13:
9780199204854
Published to Oxford Medicine:
May 2012
DOI:
10.1093/med/9780199204854.001.1

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Disclaimer

Oxford University Press makes no representation, express or implied, that the drug dosages in this book are correct. Readers must therefore always check the product information and clinical procedures with the most up to date published product information and data sheets provided by the manufacturers and the most recent codes of conduct and safety regulations. The authors and the publishers do not accept responsibility or legal liability for any errors in the text or for the misuse or misapplication of material in this work. Except where otherwise stated, drug dosages and recommendations are for the non-pregnant adult who is not breastfeeding.

Contents

Cysticercosis

Chapter:
Cysticercosis
Author(s):

Hector H. Garcia,

Robert H. Gilman

DOI:
10.1093/med/9780199204854.003.071003_update_001

Update:

Epidemiology—seroprevalence in highlands of Papua, Indonesia.

Ocular cycticercosis.

Updated on 31 May 2012. The previous version of this content can be found here.

Cysticercosis, infection by larvae of the pork tapeworm Taenia solium (see Chapter 7.10.2), is the commonest helminthic infection of the human central nervous system. It accounts for up to 30% of all seizures and epilepsy in endemic countries, and travel and immigration now lead to its more frequent presentation in industrialized countries.

Ingestion of raw or undercooked pork can lead to infection with the T. solium cysticercus, formerly known as ‘Cysticercus cellulosae’, which is an immature tapeworm. Once attached to the person’s small intestine, the cysticercus develops segments (proglottids) to become an adult tapeworm. Proglottids discharged in the faeces contain tens of thousands of ova that can autoinfect the human host or pigs and other susceptible mammals. Ingestion of T. solium ova, for example by the faecal-oral route in those infected with adult tapeworms or their close contacts, or by eating food contaminated with raw sewage, can result in development of cysticerci in various tissues, but not an adult tapeworm. The ingested ova release embryos that penetrate the intestinal mucosa and migrate in the blood stream to the brain (causing neurocysticercosis), muscles, and subcutaneous tissues. Only by ingesting T. solium ova can humans develop cysticercosis.

Clinical features and diagnosis—manifestations of neurocysticercosis depend on the number, location, size, and stage of the parasite cysts in the brain, as well as on the immunological response of the host. The commonest syndromes are late-onset epilepsy or intracranial hypertension. Diagnosis is based on brain imaging studies (CT or MRI) and supported by highly specific serology.

Treatment and prognosis—treatment is (1) symptomatic—e.g. anticonvulsants; shunts for intracranial hypertension in patients with hydrocephalus; and (2) antiparasitic—albendazole or praziquantel, which are generally given with steroids to control cerebral oedema; but there is no role for these drugs in inactive neurocysticercosis (i.e. calcifications with or without enhancement on CT scan). Prognosis depends mainly on whether the cysts are intraparenchymal (better prognosis) or extraparenchymal (subarachnoid or intraventricular, poorer prognosis).

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