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Subcutaneous nodules present on left side of the chest (A), right shoulder (B), and back (C); cyst on left lateral margins of tongue (D), and pseudo muscular hypertrophy (E). Biopsy and histopathology of the lesion was consistent with cysticercosis.
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In this study, we describe clinical and imaging spectrum, and the natural course of patients with disseminated cysticercosis. How albendazole affects the course of disease has also been evaluated. We assessed the Toll-like receptor-4 gene polymorphisms, to know the reason for the apparently higher prevalence of disseminated cysticercosis in India....
Citations
... It is estimated that several million people have echinococcosis at any time, mostly in endemic areas [1]. The first line of treatment is surgery accompanied by chemotherapy utilizing benzimidazole derivates, such as albendazole (ABZ) and mebendazole [2][3][4][5]. Drugs exhibit relatively good clinical efficacy, but treatment has to last from a few weeks up to life-long. In patients, this aggravates parasite-induced immunosuppression due to the drug´s adverse effects such as bone marrow suppression, reduction in lymphocyte proliferation, and liver toxicity. ...
The model flatworm Mesocestoides vogae proliferating stage of infection elicits immunosuppression in the host. It was used to investigate the effects of human leukocyte extract (DLE) alone and in combination with anthelmintic albendazole (ABZ) on the reduction in peritoneal infection, peritoneal exudate cells (PECs), their adherent counterparts, and peritoneal exudates after the termination of therapy. Balb/c mice were infected with the larvae of M. vogae. PECs and adherent macrophages were studied via flow cytometry, mRNA transcript levels, and immunofluorescence. The cytokine levels were measured via ELISA and larvae were counted. ABZ significantly reduced larval counts (581.2 ± 65, p < 0.001), but the highest reduction was observed after combined treatment with ABZ and DLE (389.2 ± 119, p < 0.001) in comparison with the control. Compared to an infected group, the proportions of CD11b+CD19- myeloid cells with suppressive ability decreased after albendazole (ABZ) in combination with DLE, which was the most effective in the elevation of B cells and CD11b+F4/80mid/highMHCIIhigh macrophages/monocytes (22.2 ± 5.4%). Transcripts of the M2 macrophage markers (arginase 1, FIZZ-1, and Ym-1) were downregulated after DLE and combined therapy but not after ABZ, and the opposite trend was seen for iNOS. This contrasts with reduced ex vivo NO production by LPS-stimulated PECs from DLE and ABZ+DLE groups, where adherent macrophages/monocytes had elevated transcripts of the INF-γ receptor and STAT1 and reduced expression of STAT3, STAT6, and IL-10. Each therapy differentially modulated transcription profiles and concentrations of IFN-γ, TNF-α, IL-12p40, IL-6, IL-10, and TGF-β cytokines. DLE strongly ameliorated ABZ-induced suppression of INF-γ and IL-12 and preserved downregulation for IL-4, IL-10, and TGF-β. Epigenetic study on adherent macrophages from infected mice showed that ABZ, ABZ-sulfoxide, and DLE could interact with the mRNA of examined markers in a dose-dependent pattern. Co-administration of DLE with ABZ seemed to augment the drug’s larvicidal effect via modulation of immunity. In comparison with ABZ, combined therapy was the most effective in alleviating parasite-induced Th2/Treg/STAT3/STA6 directed immunosuppression by stimulating the Th1 cytokines, M1 macrophage polarization, and activation of the IFNγ/STAT1 signaling pathway.
... Trematode infections that can be treated with albendazole and/or mebendazole are fascioliasis, clonorchiasis, opisthorchiasis, and intestinal fluke infections [13][14][15][16][17][18][19][20]. Cestode diseases responsive to albendazole and/or mebendazole include cysticercosis, hydatidosis, and intestinal taeniases [21][22][23][24][25]. Protozoan diseases for which albendazole and/or mebendazole have been tried were giardiasis, vaginal trichomoniasis, cryptosporidiosis, and microsporidiosis, although the efficacies against some of these infections need to be further evaluated [12,[26][27][28][29][30][31]. ...
The use of albendazole and mebendazole, i.e., benzimidazole broad-spectrum anthelmintics, in treatment of parasitic infections, as well as cancers, is briefly reviewed. These drugs are known to block the microtubule systems of parasites and mammalian cells leading to inhibition of glucose uptake and transport and finally cell death. Eventually they exhibit ovicidal, larvicidal, and vermicidal effects on parasites, and tumoricidal effects on hosts. Albendazole and mebendazole are most frequently prescribed for treatment of intestinal nematode infections (ascariasis, hookworm infections, trichuriasis, strongyloidiasis, and enterobiasis) and can also be used for intestinal tapeworm infections (taeniases and hymenolepiasis). However, these drugs also exhibit considerable therapeutic effects against tissue nematode/cestode infections (visceral, ocular, neural, and cutaneous larva migrans, anisakiasis, trichinosis, hepatic and intestinal capillariasis, angiostrongyliasis, gnathostomiasis, gongylonemiasis, thelaziasis, dracunculiasis, cerebral and subcutaneous cysticercosis, and echinococcosis). Albendazole is also used for treatment of filarial infections (lymphatic filariasis, onchocerciasis, loiasis, mansonellosis, and dirofilariasis) alone or in combination with other drugs, such as ivermectin or diethylcarbamazine. Albendazole was tried even for treatment of trematode (fascioliasis, clonorchiasis, opisthorchiasis, and intestinal fluke infections) and protozoan infections (giardiasis, vaginal trichomoniasis, cryptosporidiosis, and microsporidiosis). These drugs are generally safe with few side effects; however, when they are used for prolonged time (>14-28 days) or even only 1 time, liver toxicity and other side reactions may occur. In hookworms, Trichuris trichiura, possibly Ascaris lumbricoides, Wuchereria bancrofti, and Giardia sp., there are emerging issues of drug resistance. It is of particular note that albendazole and mebendazole have been repositioned as promising anti-cancer drugs. These drugs have been shown to be active in vitro and in vivo (animals) against liver, lung, ovary, prostate, colorectal, breast, head and neck cancers, and melanoma. Two clinical reports for albendazole and 2 case reports for mebendazole have revealed promising effects of these drugs in human patients having variable types of cancers. However, because of the toxicity of albendazole, for example, neutropenia due to myelosuppression, if high doses are used for a prolonged time, mebendazole is currently more popularly used than albendazole in anti-cancer clinical trials.
... In a recent prospective evaluation, besides a comprehensive review of literature, we demonstrated that the standard dose (15 mg/kg/body weight) of albendazole given for 4 weeks was safe in patients with disseminated cysticercosis, and those who received albendazole did better in terms of clinical and radiological outcome as compared to patients who received symptomatic treatment alone. Complete resolution of lesions was observed in 35% of patients, while either reduction in the number of lesions or calcification was observed in the rest of the patients [2]. Of late, several authors have initiated and reported good benefit of anti-cysticidal therapy in patients with disseminated cysticercosis [9][10][11][12][13][14]. ...
... We hypothesized that administering 3 cycles of albendazole might lead to the better clearance of neurocysticerci compared to a single cycle. The concept of using more than one cycle was based on the result that a single cycle of 28 days of albendazole in patients with disseminated neurocysticercosis led to complete resolution of only 1/3rd lesions [2]. Similar results had been observed in the standard-dose albendazole arm in a previous randomized controlled trial [6]. ...
... A diagnosis of cysticercosis was made on the basis of the established diagnostic criteria [18,19]. Disseminated cysticercosis was defined as the presence of multiple (≥3) cystic viable lesions in the brain, along with evidence of involvement of at least one extra site, like subcutaneous tissues, skeletal muscles, eyes, or presence in any visceral organ [2,18,19]. ...
Background:
The management of disseminated cysticercosis is unclear and largely considered hazardous. The role of albendazole remains controversial in such patients.
Methods:
A tertiary care, University hospital-based prospective intervention study was conducted from December 2015 to December 2017. Patients with disseminated cysticercosis, defined as the presence of multiple viable neurocysticerci (≥ 3) in the brain along with involvement of an additional extra site, were included in the study. Patients with cysticercal encephalitis were excluded. A detailed evaluation, including ophthalmoscopy, ocular B scans, ultrasound abdomen, and X-rays were done. Albendazole was administered at a dose of 15 mg/kg/day in 3 cycles of 28 days each. All patients were also given adjuvant corticosteroids and anti-epileptic drugs. Clinical and radiological follow up was carried out at a difference of 3 months between each treatment cycle. For radiological quantification, lesions were counted at 10 pre-specified levels. Statistical analysis was done to estimate the difference in seizure frequency and lesion load.
Results:
Twenty-nine patients (21 with > 20 lesions; 8 with ≤ 20 lesions) were given albendazole as per the protocol. There was a significant reduction in the occurrence of seizures (P < 0.001) and headache (P < 0.001). A significant reduction in lesion load from baseline to third follow-up was seen in the estimations done at different levels (P < 0.001). No patient developed serious side-effect warranting cessation of therapy.
Conclusion:
Cyclical use of albendazole appears efficacious in treating disseminated cysticercosis. The method of quantification described may be used in future studies for objective assessment.
Trial registration:
ISRCTN11630542; 28th September 2019; Retrospectively registered.
... [2] Precise reasons of occurrence of encephalopathy in patients with massive neurocysticercosis are not known; a genetic factor is likely. [3][4][5] Financial support and sponsorship Nil. ...
... [2] A detailed description of the vascular supply to the CC was published by Ture et al., including variations in the main arterial supply. [3] The pericallosal branch of the anterior cerebral artery is most often the main vascular supply to the body. The subcallosal and medial callosal arteries, branches of the anterior communicating artery, provide the main supply for the anterior portion of the CC. ...
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... The central nervous system is most commonly afflicted in clinical cases [5,6]. However, extensive disseminated cysticercosis is relatively rare and fewer than 120 case have been reported in the worldwide, the majority of which were in India [7][8][9][10][11][12]. Here, we reported a rare case of extensive disseminated cysticercosis from Yunan province, China. ...
... Disseminated cysticercosis is more common in India. Some studies have suggested that genetic abnormalities may be responsible for a high incidence of disseminated cysticercosis in the Indian population, and they noted that Toll-like receptor 4 gene abnormalities confer genetic susceptibility to disseminated cysticercosis as well [12]. However, due to the limitations of the conditions, we did not detect genetic polymorphism in this patient. ...
Background:
Cysticercosis is spreading all over the world and it is a major health problem in most countries of Latin America, Africa, and Asia. Extensive disseminated cysticercosis is relatively rare and fewer than 120 case have been reported in the worldwide. We reported a rare case of extensive disseminated cysticercosis in Yunan province, China.
Case presentation:
A rare case of extensive disseminated cysticercosis, in a 61-year-old male Chinese was detected from Yunnan province in 2018. Clinical and etiological examination was performed, as well as the epidemiological investigation.
Conclusion:
The life cycle of T. solium in the area where the case came from is complete. We expect this case could raise the attentions to the control of Taenia solium infection and subsequent cysticercosis there.
... Another study demonstrated that TLR4 gene polymorphisms were related to disseminated cysticercosis in an Indian population (Qavi et al. 2016). Rasouli et al. (2012) indicated that the TLR4 Asp299Gly and Thr399Ile singlenucleotide polymorphisms could not be considered to play a principal role in visceral leishmaniasis susceptibility in an Iranian population. ...
Abstract
The study of pathogenesis mechanisms of larval stages in the Taeniidae has recently focused on host genetic factors, particularly
toll-like receptor (TLR) variations. However, the potential role of TLR4 polymorphism in hydatidosis has not yet been sufficiently
elucidated in postoperative patients. In this case-control investigation, 80 patients from Iran, including 40 with acute hydatidosis
(AH) and 40 with recurrent hydatidosis (RH), and 80 ethnically matched controls were evaluated from February 2015 to February
2017. Hydatidosis patients were confirmed using radiological, immunological, and histopathological examinations. Genotyping of
Asp299Gly and Thr399Ile of TLR4 single-nucleotide polymorphisms was determined by restriction fragment length polymorphism, sequencing, and phylogenetic strategies. The heterozygous mutant-type TLR4 Asp299Gly genotype indicated a tendency to
be associated with the occurrence of RH (P= 0.060) and conferred a 3-fold risk for susceptibility. There was no difference in
genotype frequency of Asp299Gly between patients with AH and healthy controls (P= 0.42; OR, 1.82; 95% CI, 0.11–30.1%).
Interestingly, a frequency of the G allele (12%: Gly) was observed to be a risk factor for susceptibility to RH patients (P=0.050;
OR, 7.08; 95% CI, 0.97–51.5%). A relative genetic variability of TLR4 Asp299Gly was found in RH patients (haplotype diversity:
0.700) compared to AH patients and healthy controls (Hd: 0.000). The Asp299Gly genotype was dominantly identified in patients
with hepatic hydatid cysts. The TLR4 Thr399Ile codon was not detected except in a patient with a pulmonary hydatid cyst. The
current findings enhance our knowledge regarding the TLR4 Asp299Gly polymorphism potentially leading to the development of
RH, by skewing the immune system towards a Th2 response. Identification of the Asp299Gly codon may be a diagnostic hallmark
in RH patients who have undergone unsuccessful postoperative intervention. However, further studies with a higher case number
are needed on ethnic population from various geographic regions, in order to confirm this hypothesis
... Cysticidal therapy should not be used in patients with disseminated NCC who have extensive cerebral edema and elevated intracranial pressure; it may further aggravate cerebral oedema by inflammatory response and may deteriorate the clinical condition [1]. Qavi et al. [11] studied 60 patients with disseminated cysticercosis and 8 of them had encephalitic presentation. None of them received cysticidal therapy. ...
Neurocysticercosis is a common parasitic infection in children in developing countries and neurological symptoms such as seizures are the most common manifestations. However, symptoms of encephalopathy are an unusual presentation in children. A 4-year-old boy presented with recurrent episodes of febrile encephalopathy. His magnetic resonance imaging of the brain was suggestive of milliary neurocysticercosis of various stages. Reports on recurrent encephalopathy following neurocysticercosis are scarce in literature. Hence, we report this case who presented with recurrent episodes of encephalopathy.
Background
Massive neurocysticercosis is a rare form of neurocysticercosis, and can lead to serious conditions and even death.
Case presentation
Here we present a case of ten-year-old Tibetan girl who developed headache and vomiting. Her brain magnetic resonance imaging (MRI) illustrated lots of intracranial cystic lesions, and no obvious extracranial lesions were found. Serum immunoglobulin G antibodies against cysticerci were positive by the use of an enzyme-linked immunosorbent assay (ELISA). These results in combination with her medical history were in line with massive neurocysticercosis. The patients recovered well after supportive management and antiparasitic treatment.
Conclusions
This case provides insights on the diagnosis and treatment of massive neurocysticercosis. The treatment of patients with massive neurocysticercosis should be in an individualized fashion, and the use of antiparasitic drugs in these patients must be decided after carefully weighing the risks and benefits.
Background and objectives:
Neurocysticercosis (NCC) due to Taenia Solium is a major public health problem. Our objective was to study patients with disseminated cysticercosis (DCC) who had NCC in the brain along with an additional site in the body and assess their clinical, radiological profile, and response to therapy.
Materials and methods:
A chart review of DCC with a high lesion load of NCC ≥20 (DNCC) in the brain was performed.
Results:
Sixteen (M:F = 13:3) patients were diagnosed with DNCC with a mean age of presentation of 35.1 ± 14.2 years. Headache was the predominant symptom, followed by seizures (93.75%), vomiting (43.75%), behavioral disturbances (31.25%), fever (12.5%), encephalopathy (12.5%), visual disturbances (6.25%), and muscle pain and limb weakness (6.25%). CT brain showed multiple active parenchymal cysts in all, and calcifications in 68.75%. MRI brain revealed involvement of cortex and subcortical structures in all, followed by cerebellum (81.25%) and brainstem (75%). Intramedullary spinal lesion was observed in 12.5% cases. Albendazole with steroids was used in 15 patients. In 93.3% patients, there was complete improvement in seizures; 12.5% subjects had persistent memory and behavioral abnormalities. One subject required decompressive craniectomy; mortality was observed in two subjects.
Conclusions:
We hereby report one of the largest case series on disseminated cysticercosis with a high lesion load of NCC in the brain. A comprehensive clinical, imaging, therapeutic response with repeat imaging and long-term follow-up has given us a better understanding of this difficult-to-treat neurological disorder. We suggest cautious use of anti-parasitic therapy under the cover of corticosteroids to prevent irreversible neurological sequelae.
