Cysticercosis: The day to day public health problem and the various sites affected by it - A one year study.

INTRODUCTION: The present study is done to highlight the various regions in the body affected by cysticercosis and to educate the people about the personal hygiene and prevention of the parasite.
MATERIALS AND METHODS: This is a study done on patients who were referred for swelling in the body, which were diagnosed as cysticercosis in one of their differential diagnosis clinically.
RESULTS: During the 1 year study (from October 2011 to September 2012) we diagnosed seven cases of cysticercosis involving the various sites in the body. Our cases highlight the rare presentation of cysticercus infestation as cause of treatablelymphadenopathy.
CONCLUSIONS: Cysticercosis should be included in the differential diagnosis of cervical swellings especially in endemic regions. Timely diagnosis and intervention help in preventing fatal complications.

INTRODUCTION

Cysticercosis is a parasitic disease caused by Taenia solium. It is a major public health problem in developing countries. Infection is acquired through ingestion of raw or undercooked meat containing the cysticercus. Man is the definitive host and pig is intermediate host. Cases usually present with vague abdominal discomfort, indigestion and diarrhea. Cysticerci can be found anywhere in the body, but are most commonly detected in brain, eye, skeletal muscle and subcutaneous tissue. It is endemic in south east Asia, Central and South America and Africa.[1] In humans, the organisms penetrate the intestinal wall and invade subcutaneous tissue, brain, eye, muscle, heart, liver, lung, and peritoneum.

MATERIALS AND METHODS

The present study is a prospective study done for a period of 1 year (from October 2011 to September 2012) and we diagnosed total seven cases on histopathology during this period. Radiologically some of the cases diagnosed as cysticercosis but we could not get the findings. In the present study all the seven cases presented with a minimum duration of 4 months. Headache and giddiness were also observed in two patients. One patient complained about abdominal discomfort and diarrhea.

RESULTS

Based on the clinical and studies, we diagnosed cysticercosis affecting various locations in the body. We diagnosed seven cases of cysticercosis. Out of the seven cases, in one case patient complained of swelling on forehead which is firm in consistency, of size 2 × 2 cm with history of headache and vomitings. Other case presented with swelling on left upper eyelid of size 2 × 2 cm, firm to hard in consistency with no history of pain. Another case presented with swelling right lower eyelid, mobile of size 2 × 1 cm, firm in consistency. Other cases presented with swellings in right cervical, right supraclavicular lymph nodes, right cheek and on rectus abdominus muscle. All the cases were of size 2 × 2 cm, firm and easily mobile. Radiological data was not provided to us and we received only biopsy sample.

DISCUSSION

Cysticercosis is an infection with the larval (cysticercus) stage of T.solium.[2345] It is seen as cysts more commonly in the brain, muscle, heart and the orbit.[2] It is a major public health hazard in the developing countries.[2] Neurocysticercosis is the most common parasitic infestation. Human is the only definitive host of T.solium, harboring adult tapeworm in intestine, whereas both man and pig can act as intermediate host and harbor the larvae.[2] Human and pig, both acquire cysticercosis through ingestion of eggs excreted in feces by human carrier.

Lymphadenopathy is a rare mode of presentation of cysticercus infestation.[6] In our study we present two cases of cysticercus lymphadenitis involving the right cervical and right supraclavicular lymph node. In both the cases patient complains ofswelling in the cervical and supraclavicular regions for a period of 4 months. Swellings were of size 2 cm × 2 cm, firm, non-tender. There is no history of cough or fever. Differential diagnosis included reactive or granulomatous lymphadenitis. Lymph nodes were excised and cysticercosis was diagnosed histologically showing cysticercus parasite with an invaginated scolex with hooklets [Figure 1a and b].

Figure 1

(a and b) Section showing cysticercus parasite with an invaginatedscolex with hooklets (a) (H and E, ×4) and (b) (H and E, ×10)

We also present a rare location involving the rectus abdominus muscle [Figure 2a and b] and also on right cheek [Figure 3a and b]. This rare mode of presentation of cysticercus infestation highlights the importance of parasites as a cause of treatable lymph node enlargement. Hence, in endemic areas, cysticercosis must be included in the differential diagnosis of superficial palpable swellings in the neck region.

Figure 2

(a and b) Section showing cysticercus parasite interspersed with fibroblasts (a) (H and E, ×4) and (b) (H and E, ×10)

Figure 3

(a and b) Sections taken from cheek swelling showing cysticercus parasite along with fibroblast and inflammatory component (a) (H and E, ×4) and (b) (H and E, ×10)

Diagnosis is made by the demonstration of eggs or proglottids in feces and definitive diagnosis is by biopsy of the lesion. Diagnosis of cysticercosis is confirmed by histopathology. Various other tests used for diagnosis are, stool examination, and battery of serological tests like enzyme linked immune sorbent assay, indirect the magglutination test, intradermal test, compliment fixation test, ring precipitation test etc., In our study we received only biopsy specimen and we could not perform stool examination and serology.

The incidence of this parasitic infection can be decreased by increasing awareness. Cysticercosis is common in communities, where pigs are allowed to roam freely, residents consume undercooked pork and basic sanitary facilities are lacking.

Personal hygiene and sanitaryhealth measures are critical to avoid human fecal contamination. In addition, the larvae are destroyed by either freezing or thoroughly cooking pork. Cysticercosis mostly responds to medical management which includes various anti-helminthics like Albendazole, Praziquantal, and Niclosamide. We present this study to highlight the various locations affected by cysticercus parasite and cervical and other lymphadenopathies should be included in the differential diagnosis of cysticercosis. Cysticercosis should also be included in the differential diagnosis for swellings over the abdomen and on cheek in areas where cysticercosis is endemic. Proper cooking of the food and personal hygiene can prevent the parasitic infection.