No full-text available
To read the full-text of this research,
you can request a copy directly from the authors.
Extraocular Muscle Cysticercosis: Clinical Presentations and Outcome of Treatment
Abstract
To report various clinical presentations and treatment outcomes in a series of patients with extraocular muscle cysticercosis.
This retrospective study reviewed the charts of 43 patients diagnosed with extraocular muscle cysticercosis with computed tomography and orbital B-scan ultrasonography between January 1991 and December 2002. Clinical presentation, results of investigations, treatment, and outcome were recorded.
The superior rectus was the most commonly affected extraocular muscle. Restricted ocular motility was present in 88% of patients, and inflammatory signs were noted in the involved quadrant in 70% of patients. Eleven patients were treated with oral albendazole alone and 31 patients were treated with oral albendazole and prednisolone. Four extraocular muscle cysts were excised surgically, and five extruded spontaneously. Inflammatory signs subsided in all patients, and residual restriction of ocular motility was seen in 16 (50%) of 32 patients at a mean follow-up of 5 months. Type of treatment made no significant difference in the ocular motility outcome.
Extraocular muscle cysticercosis should be considered in patients who present with restricted ocular motility and inflammatory signs. The direction of motility restriction does not indicate the muscle involved. Residual restriction of ocular motility is common despite the addition of corticosteroids to albendazole therapy.
... [1,2] However, the subconjunctival (3%-86%), orbital (7%-59%), and eyelid (0-14%) tissues may get involved in descending order. [1][2][3][4][5][6] Subconjunctival cysticercosis has been mentioned as an anterior extension of the cyst from the insertions of extraocular muscles (recti and obliques). [1,2] The extraocular cysticercosis can have a myriad of clinical presentations depending on the cyst stage, its site, size, and relation to adjacent vital ophthalmic structures. ...
... Both tuberculosis and cysticercosis are endemic in India as well as other developing nations. [1][2][3][4][5][6][7][8]22,23] Classically, total and differential leukocyte counts, Mantoux test, chest X-ray, and sputum examination for acid-fast bacilli help in establishing the diagnosis of tuberculosis and help in starting appropriate treatment. For cysticercosis, blood investigations like peripheral eosinophilia, ELISA for anticysticercal antibodies, and stool examination for cysts can be helpful but are inconclusive, if negative. ...
... [21] The management of orbital myocysticercosis is medical in >95% of cases and a few need surgical intervention for the removal of nonresponding cysts. [1][2][3][4][5][6][7][8]22,23] In either of the management strategies, residual restriction of extraocular movements in extreme gaze can be seen as the sequelae of orbital myocysticercosis. However, in the case of subconjunctival cysticercosis, the surgical management can be performed earlier at a stage when acute anterior inflammation has subsided. ...
Purpose: To study the clinical presentation, radiological features, diagnosis, and treatment response in subconjunctival and atypical orbital myocysticercosis.
Methods: Retrospective analysis of diagnosed subconjunctival and atypical (strabismus, diplopia, and blepharoptosis) orbital myocysticercosis was performed. A diagnostic criterion (2 of the 3) among clinical features, radiological findings, and treatment response was used in our study. A minimum of "post-treatment" follow-up of 12 months was observed.
Results: Thirty-five patients were included with a mean age of 16 years having male predominance (n = 22, 62.8%). All had a unilateral presentation, with 24 (68.6%) patients having subconjunctival cysticercosis, of which 22 were located in close proximity of the rectus muscle insertion. At presentation, 10 patients had diplopia, 7 had strabismus, and 6 had face turn. Pseudo Duane's and pseudo-Brown's syndrome were noted in 5 and 4 patients, respectively. Radiologically, single muscle myositis without scolex was seen in 12 (34.3%) cases. All patients first received medical treatment, and surgical intervention (cyst removal) was attempted after treatment failure. Complete resolution of symptoms was noted in 22 (after medical treatment only) and in 8 (after surgery).
Conclusion: In the majority, the subconjunctival cysticercosis is found in proximity to the rectus muscle insertion, as a part of orbital myocysticercosis. In atypical scenarios, a satisfactory response to medical treatment can be considered as diagnostic of cysticercosis.
... 1,7,9,16 Cysts can settle into extraocular muscles, producing limitations on the range of eye movements that can mimic cranial nerve palsies. 1,7,8,20 Skeletal muscle or subcutaneous cysticercosis can cause localized pain and nodules. 7 ...
... 4 CT and ultrasonography are sensitive for the detection of ocular or extraocular muscle cysticercosis. 20,24 Serology is available for detection of cysticercal antibodies through an enzyme-linked immunoblot assay or enzyme-linked immunosorbent assay of the serum or cerebrospinal fluid; these have a sensitivity of 65 to 98 percent and a specificity of 67 to 100 percent, depending on the specific test used, cyst burden, location, and phase of the infection. 2,7,22,25 When available, enzyme-linked immunoblot assay of the serum has the greatest sensitivity and specificity and as major diagnostic criteria is the test of choice. ...
... Small case series suggest that antiparasitic therapy with albendazole (Albenza) or praziquantel (Biltricide), generally in conjunction with steroids, is effective in the treatment of extraocular muscle involvement. 20,24 However, surgical excision is an option, and an ophthalmologic consultation is warranted. ...
Cysticercosis (i.e., tapeworm infection) is an increasingly common medical problem in the United States, especially in the Southwest and other areas of heavy emigration from endemic areas or in populations with significant travel to these areas. The larval stage of the pork tape-worm, Taenia solium, causes the clinical syndrome of cysticercosis, with humans as dead-end hosts after ingestion of T solium eggs. Its clinical effects vary depending on site of larval lodging, larval burden, and host reaction. These effects include seizures, headaches, focal neurologic symptoms, visual disturbances, and localized skeletal muscle nodules and pain. Cysticercosis should be considered in any patient from an endemic area presenting with these symptoms. Treatment varies with the clinical presentation. Parenchymal neurocysticercosis generally is treated with albendazole in conjunction with steroids to limit edema and with antiepileptic medications for seizure control. Ocular and extraocular muscle cysticercosis generally requires surgical intervention. Skeletal muscle cysts are surgically removed only if painful. Because cysts can lodge in multiple locations, all patients with cysticercosis should have an ophthalmologic examination to rule out ocular involvement, and all patients with extraneurologic cysticercosis should have computed tomography or magnetic resonance imaging of the brain to rule out neurocysticercosis.
... [6,7] Myocysticercosis is known to have varied presentations with inflammation, proptosis, ptosis, and restricted ocular motility. [1,8] The ocular motility deficit in our case simulated the pattern seen in exotropic-Duane retraction syndrome, akin to a previously reported case. [6] Mohan et al., in a series of extraocular myocysticercosis (n = 32), reported that half of their cases had residual ocular motility deficit, in spite of combining oral steroids with albendazole. ...
... [6] Mohan et al., in a series of extraocular myocysticercosis (n = 32), reported that half of their cases had residual ocular motility deficit, in spite of combining oral steroids with albendazole. [8] In our case, too, the ocular motility deficit improved only partially. ...
... Cysticercosis has no predilection for any particular extraocular muscle as the commonly involved muscle varies according to different studies. [7][8][9][10][11][12] Inferior oblique involvement was noted in one patient. There is only one previous report of inferior oblique involvement. ...
... Moreover, surgical procedures to access deep-seated orbital lesions can cause inadvertent iatrogenic damage to the muscle and other orbital tissues resulting in permanent ocular motility disturbances and visual compromise. 9,10 There is also a risk of inadvertent cyst rupture and intractable postoperative orbital inflammation. Treatment response was graded as good, fair, and poor based subjectively on the resolution of proptosis, ocular movement restriction, pain, and diplopia. ...
Aim: To describe the clinical and radiological features of orbital cysticercosis and its management outcome.
Material and Method: A retrospective analysis of consecutive cases of orbital cysticercosis between January 2008 and January 2018. The management outcome was classified into good, fair, and poor depending upon the resolution of the clinical features and status of the cyst and scolex in the imaging studies.
Results: A total of 61 patients with a mean age of 24.33± 31.04 years were included. The male: female ratio was 1.9:1. Pain, with or without prominence of the eye was the most common presenting symptom (n = 35, 57.4%). The mean duration of symptoms was 3.65 +/-8.56 months. Ocular motility restriction was the most common sign (n = 52, 85.2%). Fifty-five (90.16%) patients had myocysticercosis with inferior rectus being most commonly involved (n = 17, 27.9%), while 6 (9.83%) cases had orbital cysticercosis without any ocular muscle involvement. Four patients had compressive optic neuropathy. Subjectively, good clinical outcome was documented in 37 (60.65%), fair in 17 (27.87%) and poor in 7 (11.47%) patients. Objectively, imaging studies showed complete resolution of the cysticercosis lesion in 18 (45%), partial in 19 (47.5%), and no change in 3 (7.5%) patients.
Conclusion: A high index of suspicion and a thorough knowledge of the clinical and radiological features are necessary for the proper diagnosis and management of orbital cysticercosis. Medical
management with oral albendazole combined with oral steroids leads to desired outcome in the majority.
... In cystic lesion without scolex or ELISA is negative, oral steroids must be prescribed if the patient is from cystisercosis endemic zone empirical therapy with albendazole with steroid is to be given for 4 to 6 weeks. For the extraocular muscle form and retro-orbital cysticercosis medical therapy is recommended (Mohan K et al, 2005). For subconjunctival and eyelid cysticercosis surgical removal is recommended. ...
... Early treatment with oral albendazole, corticosteroids and cyst removal helps to restore normal function early (Pushker N et al, 2001;Mohan K et al, 2005). Motility restriction can persist if the diagnosis is delayed. ...
Introduction:
Ocular cysticercosis is a preventable cause of blindness. It is caused by parasitic infestation caused by the larval form of Taenia solium. Poor sanitation and improper management of food and meat products are the major causes for cysticercosis infestation.
Case:
Two cases of myocysticercosis presented to our hospital differently. A 12 years boy, first case presented with drooping of right eye (RE) upper lid with recurrent swelling, pain, redness with mild headache and intermittent vomiting for 1 and half months. On examination swelling of RE upper lid, mild ptosis, abaxial proptosis with restricted motility in upgaze was noted. Orbital CT (computer tomography) scan and ocular ultrasound reports showed findings suggestive of myocysticercosis of superior rectus muscle of RE. Routine microscopic examination (RME) of stool demonstrated eggs of Taenia. Complete blood count (CBC) showed eosinophilia. As a suspected case of myocysticercosis and since the patient resided at an endemic zone, empirical therapy with albendazole and steroid was started to continue for 4 weeks. After one week the patient presented with features suggestive of RE orbital cellulitis. With proper counseling about medical therapy and cyst excision, the patient recovered well with only mild RE upper lid ptosis of 2mm. The histopathological examination (HPE) of the excised cyst was suggestive of inflammatory cystic lesion. A 55 years male presented as a second case to us with gradually increasing mass in the RE lower lid with a history of pain, difficulty in opening RE and intermittent swelling of RE 2 months back. On examination RE lower lid mass with exotropia of 15 degree, mild hypertropia was noted. CT scan showed presence of cystic mass 3.5x2x1.5cm in the right orbit involving the right inferior rectus muscle, abutting and displacing the globe superolaterally. CBC showed eosinophilia. Post cyst excision patient recovered well with remaining mild restriction in infraduction most probably due to fibrosis. HPE was conclusive of cysticercus cellulosae. Both the patients improved well with no recurrence until last visit 17 months in 12 years boy and 6 months in 55 years male after which he lost to follow.
Conclusion:
Myocysticercosis can occur at any age. There is equal importance of clinical, radiological, microbiological and histopathological support for proper diagnosis and management of cysticercosis. Medical therapy along with surgical excision of the cyst with it's content may be needed in the management of myocysticersosis.
... [7] Superior rectus muscle followed by lateral rectus muscle is the most common site of cyst lodgment in the extraocular muscle. [8] Vision loss in orbital cysticercosis usually occurs in intraocular form due to subretinal/vitreous inflammatory cysts and nodules. Vision loss rarely occurs in the extraocular type, especially in the extraocular muscle variety, as the extraocular muscle cysts cause proptosis and restriction in eyeball movements. ...
... Medical therapy, combining albendazole with prednisolone, is the recommended treatment for the extraocular muscle form of cysticercosis. [5,6,8,10] However, in all these series, patients suffered from proptosis and restriction of eyeball movements rather than vision loss. We recommend that surgical decompression of the optic nerve be done if the patient presents early in the course of disease with progressive vision loss. ...
Extraocular muscle cysticercosis usually presents with proptosis and restriction of eyeball movements. However, it can cause vision loss by compression of the optic nerve at the optic foramen in infrequent circumstances. We report a rare case with an unusual manifestation of ptosis, proptosis, lateral rectus palsy, and acute vision loss in the right eye. Magnetic resonance imaging was suggestive of cysticercal cyst. Emergency optic nerve decompression with cyst excision was done. Treatment of choice for extraocular muscle cysticercosis presenting with restriction of eyeball movements is mainly medical, consisting of albendazole and steroids. However, as this lesion rarely causes vision loss, indications of surgical decompression of optic nerve are not well defined. We recommend that early surgical management should be done along with medical treatment in cases of vision loss caused by extraocular muscle cysticercosis.
... [7] Superior rectus muscle followed by lateral rectus muscle is the most common site of cyst lodgment in the extraocular muscle. [8] Vision loss in orbital cysticercosis usually occurs in intraocular form due to subretinal/vitreous inflammatory cysts and nodules. Vision loss rarely occurs in the extraocular type, especially in the extraocular muscle variety, as the extraocular muscle cysts cause proptosis and restriction in eyeball movements. ...
... Medical therapy, combining albendazole with prednisolone, is the recommended treatment for the extraocular muscle form of cysticercosis. [5,6,8,10] However, in all these series, patients suffered from proptosis and restriction of eyeball movements rather than vision loss. We recommend that surgical decompression of the optic nerve be done if the patient presents early in the course of disease with progressive vision loss. ...
Introduction: Extraocular muscle cysticercosis usually present with proptosis and restriction of eyeball movements. However, it can cause vision loss by compression of the optic nerve at the optic foramen in infrequent circumstances.
Case description: We are reporting a rare case with an unusual manifestation of ptosis, proptosis, lateral rectus palsy, and acute vision loss in the right eye. MRI was suggestive of cysticercal cyst. Emergency optic nerve decompression with cyst excision was done.
Conclusion: Treatment of choice for extraocular muscle cysticercosis presenting with restriction of eyeball movements is mainly medical, consisting of albendazole and steroids. However, as this lesion rarely causes the vision loss, indications of surgical decompression of optic nerve are not well defined. We recommend that early surgical management should be done along with medical treatment in cases of vision loss caused by extraocular muscle cysticercosis.
... It mainly affects the central nervous system, the skin, and the skeletal muscle. 1 Extraocular cysticercosis is reported more commonly in India as compared with the intraocular form in western countries. 2,3 The extraocular muscle form is the commonest type of orbital and adnexal cysticercosis. Neurocysticercosis should be ruled out in all cases of ocular cysticercosis. ...
... The surgical treatment is the best choice in intraocular cysticercosis while medical treatment is the best choice for extraocular presentations including the extraocular muscles cysticercosis. 3,4 Photographs and text from: ...
... The cyst may be found in the subretinal space, in the vitreous cavity, or the anterior chamber in intraocular disease. [3][4][5][6] Extraocular disease may involve the subconjunctival space, the superior rectus/levator palpebrae superioris complex, [7] other extraocular muscles, [8,9] and the optic nerve. [10][11][12] Its presence in the lacrimal sac has also been reported. ...
... [10][11][12] Its presence in the lacrimal sac has also been reported. [13] The frequency of ocular affectation varies from study to study, [3,4,[6][7][8][9]14] with a tendency toward the increased diagnosis of intraocular disease with advances in vitreoretinal skills and technology. [3] Subconjunctival cysticercosis was previously reported as the most common type (44-86%), but more recent publications favor myocysticercosis at 79.2%. ...
... All cases dramatically improve on treatment with Albendazole and steroid, however surgical excision of cyst may be required in few cases. 2,3 In our first case long history of disease resulted in residual ocular motility restriction. ...
... In a retrospective case series by Rath et al., the cyst in 80.7% of orbital and subconjunctival cysticercosis is usually in relation to extraocular muscle. 2 The cyst attached to the muscle sheath induces an inflammatory reaction and because of its constant motility it comes to lie in subconjunctival space as subconjunctival swelling or erodes through the conjunctiva resulting in spontaneous extrusion. 3,5 As the cyst may be adherent to the adjacent muscle, care must be taken not to damage the extraocular muscle during dissection. ...
... The last report from our centre was 11 cases [12]. A few recently reported series of cases from India include 25 cases from Vellore [13], 44 from Chennai [14], 35 cases in a more recent report from Chennai [15], 18 from New Delhi [16], and 43 from Chandigarh [17]. A case of AIDS patient with subretinal cysticercosis has also been reported from Chennai [18]. ...
... Reports of earlier Indian studies have also shown the promising results in treatment of extraocular cysticercosis with oral albendazole [14]. The post treatment follow up of OCC is usually done by monitoring the cases clinically based on physical examination, ophthalmoscopy or imaging [17,29]. There was no information available on serological monitoring of the cases of OCC following therapy. ...
Ophthalmic cysticercosis (OCC) caused by Taenia solium larval infection in eye, is emerging as a far commoner disease in the tropics. There is a scarcity in serodiagnostics to aid its laboratory diagnosis; thereby management still continues to pose a serious challenge. Presently serum IgG-ELISAs were performed on 40 consecutive clinically diagnosed OCC cases. Extraocular muscle was found to be the predominant site of infection where ocular motility disorder was the major clinical presentation. ELISA using larval somatic and excretory secretory (ES) antigens was positive in 32.5% and 45% cases respectively. Anti-ES antibodies were detected more frequently in cases having extraocular cysts compared to intraocular location. Differential levels of antibodies specific to above two antigens were estimated during the course of parasite degeneration as evident from findings following treatment. These indigenous serum IgG ELISAs might be useful as an adjunct to existing tools for diagnosis of OCC with a more promising applications in post treatment follow up of extraocular form of cysticercosis in particular.
... Cysts when occurring in the subarachnoid or ventricular spaces can cause, meningeal signs and symptoms, obstructive hydrocephalus, or cranial nerve palsies caused by nerve entrapment (García et al., 2003). A cyst can lodge in the extraocular muscle of the eyes, and affect eye movement which mimics cranial nerve paralysis (García et al., 2003;Mohan et al., 2005). The presence of a cyst in skeletal muscle and subcutaneous tissue can cause nodule formation and pain (García et al., 2003;Kraft, 2007). ...
Cysticercosis is the infection caused by larvae of Taenia solium, which is one of the major zoonotic diseases in Nepal. Infection of larvae in the central nervous system is neurocysticercosis and infection of adult tapeworm is taeniasis. Cysticercosis is associated with the social, cultural, and economic aspects of the country and is endemic in many developing countries like Nepal. Detection of neurocysticercosis among eight Gurkhas in Hong Kong (1987) shows its existence in Nepal since many decades ago. The occurrence of cysticercosis/neurocysticercosis is higher in males and young people are more susceptible. Lack of awareness about disease and seizure, unhygienic behaviours, free-roaming pigs, and lack of su rveillance are major factors contributing to the transmission of this diseases from pigs to humans and among humans. Cysticercosis is endemic in Nepal and a large number of cases are reported in hospitals. The Social, public health and economic impact of the disease is yet to be evaluated. Increased survey and surveillance to understand the burden of cysticercosis throughout the country along with public awareness is urgently needed. The collaboration of multi-stakeholders including human and animal health, pig farmers, and policymakers using the concept of “One Health” is needed to reduce the burden of cysticercosis/neurocysticercosis in Nepal.
... In general, intraocular cysts require surgical intervention, and extraocular cysts often respond well to medical management. 98 ,104 ,108 ,193 ,60 (REF 60) Antihelminthic drugs are usually contraindicated in intraocular cysticercosis because, following the lysis of cyst, the intense in ammatory reactions can threaten vision. Hence, the various treatment approaches and their indications are as follows ( Tables 1 and 2 ). ...
Cysticercosis is caused by Taenia solium, a cestode or tapeworm that preferentially affects the subcutaneous tissue, brain, muscle, and the eye. It is traditionally a disease of low socioeconomic regions, but large-scale population migration has made it a matter of global concern. Its ocular invasion is a potentially blinding disease. In the last two decades, there has been considerable discussion of cysticercosis; however, most comes from a limited number of case observations. Thus, to overcome this limitation, we summarize and analyse twenty years of medical literature (from 2000 to 2020) on cysticercosis in ophthalmology.
... Extraocular cysticercosis is reported very commonly from India (Rath et al, 2010). Medical therapy has been recommended for the retro-orbital and extraocular muscle form (Mohan et al, 2005). Medical management involves oral albendazole and steroids. ...
Ocular cysticercosis is a preventable cause of blindness. Medical therapy has been recommended for the retro-orbital and extraocular muscle form. Surgical management is largely done in cases with conjunctival or lid affliction. Though, the medical management is simple; however, the diagnosis is challenging. The anterior segment findings often mimic the more common pathologies and hence often missed at the early stage. This case series of 3 pediatric patients, tries to highlight certain clinical clues which are suggestive of ocular myocysticercosis in children. Literature often recalls anterior segment findings in ocular myocysticercosis as “non- specific and nondiagnostic”. Canthal congestion and contiguous conjunctival congestion extending upto corresponding limbal border in absence of anterior chamber inflammation with other clinical clues are very suggestive of corresponding recti myocysticercosis.
... 4 Therefore, medical therapy alone is recommended for extraocular muscle form and retro-orbital form and surgical removal is needed for subconjunctival and eyelid cysticercosis. 11 ...
Cysticercosis is a parasitic infection caused by Cysticercus cellulosae, the larval form of cestode, Taenia solium. It is a preventable cause of blindness endemic in many developing countries especially where there is poor hygiene and sanitation. Humans become infected by ingestion of contaminated food and water. The most preferred locations are central nervous system (CNS), eyes, heart, bladder, muscles and subcutaneous tissues. Ocular cysticercosis can be extraocular or intraocular and may show different clinical presentations. We report a case of ocular cysticercosis which presented with unilateral ptosis and mild pain.
A young male patient presented with mild swelling and drooping of right upper eyelid for 2 weeks associated with mild pain and redness on first 3 days. Ocular examination revealed ptosis and mild swelling on temporal side of right upper eyelid. The swelling was soft in consistency with no tenderness. Levator function was good with normal Bell’s phenomenon and ocular motility was in full in all cardinal gazes. The computed tomography imaging of the orbit showed bulky right superior rectus muscle with ring enhancing hypodense lesion suggestive of right eye myocysticercosis involving superior rectus muscle. The patient was treated with oral albendazole and oral prednisolone for 4 weeks and a significant improvement of ptosis was seen at 1 month follow up visit.
Extraocular muscle cysticercosis should be highly suspicious in young patients with unilateral acquired blepharoptosis. Radiological investigations play a vital role in diagnosis and a complete resolution can be achieved with standard medical therapy alone.
... Clinical presentations of patients with extraocular muscle cysticercosis17 ...
Cysticercosis, caused by the larval form of the pork tapeworm Taenia solium is potentially harmful disease with a variable clinical manifestation. The most commonly involved sites include eye, brain, bladder wall, and heart. Ocular cysticercosis can be extraocular or intraocular and may present with varied clinical symptoms. We report the case of extraocular cysticercosis in a 20 year old female presented with right exotropia, head tilting and painful right eye. CT-scan of right orbit showed bulky medial rectus with multiple ring enhancing lesions within the muscle, suggestive of cysticercosis. It becomes important to report this case because of the relative rarity of the condition, unusual site of the cyst i.e atypical involvement of medial rectus and the young age of the patient.
... 4,5 In a retrospective case series by Rath et al., the cyst in 80.7% of orbital and subconjunctival cysticercosis is usually in relation to extraocular muscle. 2 The cyst attached to the muscle sheath induces an inflammatory reaction and because of its constant motility it comes to lie in subconjunctival space as subconjunctival swelling or erodes through the conjunctiva resulting in spontaneous extrusion. 6,7 In this case individual presented with unusual presentation of conjunctival congestion nasally. On detailed examination found to have restricted ocular movements and raised suspicion of ocular pathology and found to have myocysticercosis. ...
... Orbital cysticercosis typically presents with conjunctival injection, ocular motility disorder and ptosis. [1][2][3][4] This young girl with features of left optic neuropathy had pain on eye movements and edema of the left optic nerve fulfilling the criteria of classic optic neuritis. However, even with such typical presentation, it is important to consider cysticercosis as a masquerade, especially in endemic areas. ...
... Isolated muscular or subcutaneous cysticercosis require no specific treatment unless it is painful, which may necessitate excision along with antihelminthic medications like albendazole or praziquantel. Recently, case reports have advocated non-operative management, even for painful masses, with antihelminthic medication and oral steroid therapy [14][15][16][17]. ...
Cysticercosis, a parasitic infection caused by larval form of the pork tapeworm, Taenia solium, presents with vague clinical presentation and its unfamiliarity among clinicians make it difficult to diagnose when seen as isolated cyst. One such case of isolated cysticercosis of sternocleidomastoid muscle in an adult female, who presented with painful neck swelling, is described along with relevant literature review.
... When there is no evidence of a cystic lesion then biopsy is indicated. Medical therapy is the recommended treatment for the extraocular muscle form and retro-orbital cysticercosis [25] . Surgical removal is advocated for subconjunctival and eyelid cysticercosis. ...
Cysticercosis is a preventable and eradicable cause of blindness endemic in the Indian subcontinent, South-East Asia and other developing countries. Ocular and orbital cysticercosis has varied presentations depending upon the site of involvement, number of lesion and the host immune response. In this article we present a review of the various clinical manifestations, diagnosis and management protocol for orbital and ocular cysticercosis. Owing to its varied presentation, cysticercosis may pose a diagnostic challenge to the health professionals. Early diagnosis and management can prevent the vision loss and optimize visual outcomes. © 2017, International Journal of Ophthalmology (c/o Editorial Office). All rights reserved.
... Isolated muscular or subcutaneous cysticercosis require no specific treatment unless it is painful, which may necessitate excision. Recently, case reports have advocated non-operative management, even for painful masses, with antihelminthic medication and oral steroid therapy [6,17,20]. In our case, the patient refused operative excision and steroid therapy due to an upcoming family wedding in his native village. ...
... Many case reports of successful nonsurgical treatment of muscular cysticercosis with oral anthelmintic drugs albendazole or praziquantel have been published. 3,14,15 In our case also patient got relieved of symptoms with oral albendazole. ...
Isolated muscular cysticercosis is very rare and poses a diagnostic challenge to treating doctor. It often presents as a case of muscle strain and you have to think out of the box to reach the diagnosis. We are presenting a case of isolated involvement of the brachialis muscle in a young male, who presented to us with complaints of pain of the lower arm. When patient could not get relief with conservative treatment a MRI of the arm was ordered which revealed the diagnosis of cysticercosis of brachialis muscle. In patients from endemic zone, who present with intractable muscular pain and not responding to conservative treatment, diagnosis of muscular cysticercosis should be kept in mind.
... New advances in the diagnosis and treatment, as well as studies of the pathogenesis and histological features of OC are continually being reported in last decade with a majority of studies being originated from India [13,[30][31][32][33][34][35][36][37][38][39]. Though less frequent, however, cases of OC are also documented from many other countries that include but not limited to Korea [40], Mexico [41], Thailand [42], Zimbabwe [43], Canada [44], Madagascar [5], Nigeria [45], and Indonesia [21]. ...
Ophthalmic cysticercosis due to larval Taenia solium infestation in eye is one of the common preventable causes of acquired blindness particularly in the tropics. Though haematogenously disseminated oncospheres of this parasite can lodge in any tissue or body parts in human, there is a known predilection for brain, skeletal muscle and eye where they develop into metacestode larvae or cysticerci. However a number of cases have been reported having solitary cysticercosis only in eye without affecting brain and/or skeletal muscles. It is not clear to understand the exact route of entry into eye, the timing and environmental circumstances that produce ocular invasion without affecting other tissues. In this article, we have highlighted on the possibility of an alternate non-haematogenous route of transmission of infection particularly affecting eye or its adnexa in T. solium endemic tropical developing countries with poor sanitation practice, and deficient environmental monitoring system. Experimental infection studies might be helpful to prove the hypothesis on direct inoculation with T. solium eggs causing larval infestation in eye.
... Few small case series also support that antiparasitic therapy with albendazole or praziquantel, in conjunction with steroids, is effective in the treatment of extraocular muscle involvement with cysticercosis. 30 In this context, we consider surgical excision of isolated muscular cysticercosis loosing popularity among practitioners when noninvasive promising treatment options are available. Among the two mentioned antihelmenthics, albendazole is the preffered drug. ...
Cysticercosis, an infection with the larval form of pork tape worm, Taenia solium , commonly presents with multiple muscular cysts or CNS involvement. Due to vague clinical presentation and unfamiliarity of clinicians with this entity, it is difficult to diagnosis when seen as an isolated cyst. Traditional treatment is surgical excision and a course of deworming agents. We present two cases of isolated muscular cysticercosis diagnosed by USG, MRI and blood tests, who responded successfully to oral medication without need of operative intervention.
Case reports
A 45-year-old male patient had a tender 2 week swelling of 4 × 5 cm on medial right proximal calf. A 26-year male presented with discomfort and diffuse 6 cm swelling at inner left forearm. In both ultrasound showed characteristic hypoechoic cyst with hyperechoic scolex, and MRI revealed isolated cyst surrounded by inflamed muscles. FNAC confirmed cysticercosis, and the patient responded to oral albendazole (3 weeks) with oral steroids (2 weeks).
Conclusion
Although rare, possibility of isolated muscular cysticercosis should always be considered in any small musculoskeletal soft tissue swelling presenting with nonspecific clinical findings. Both our patients responded to medical therapy and were disease free, as confirmed at 3 months by follow-up MRI. These cysts can be confidently diagnosed on the basis of ultrasound and MRI, and can be very well-treated nonsurgically with an oral drug regimen consisting of albendazole and steroid.
How to cite this article
Rangdal SS, Prabhakar S, Dhatt S S, Prakash M, Dhillon MS. Isolated Muscular Cysticercosis: A Rare Pseudotumor and Diagnostic Challenge, can It be treated Nonoperatively? A Report of Two Cases and Review of Literature. J Postgrad Med Edu Res 2012;46(1):43-48.
... Surgical removal of the cyst presents a high risk of inadvertent injury to the muscle, resulting in ocular motility disturbances. Surgical intervention is not recommended in myocysticercosis (Mohan K et al, 2005). ...
Background:
Ocular myocysticercosis is rare and a high index of suspicion is required for its diagnosis.
Objective:
To describe clinical characteristics and treatment outcome of ocular myocysticercosis.
Cases:
We describe a series of three patients who had different clinical presentations of ocular myocysticerocosis namely diplopia, restricted ocular motility and sub-conjunctival cyst. The treatment with oral albendazole and prednisolone was effective in all three cases.
Conclusion:
Favorable outcomes can be achieved with a high index of suspicion, early diagnosis and treatment with oral albendazole and prednisolone in patients with ocular myocysticercosis.
... A short duration of follow-up may also have limited observation of favourable clinical response. 10 Steroids may control infl ammation from dying cysticerci and so reduce chronic fi brotic sequelae which may impact long-term ocular motility. 1 The effi cacy of albendazole in LPS myocysticercosis is likely similar to extraocular myocysticercosis as a group. ...
... La cisticercosis es más habitual en el sistema nervioso central (Sotelo y Del Brutto la India esta aumentando (Sekhar et al., 1996;Nainiwal et al., 2005;Kaliaperumal et al., 2005;Mohan et al., 2005). La el ojo puede ser subcoroidea, subretiniana, subhialoidea, handra et al., 2007). ...
Las cestodiosis continúan produciendo serios problemas en salud humana y animal, causan patologías muy serias, no sólo por el grado de discapacidad que producen sino también por la gravedad de las lesiones que generan y que en ocasiones pueden provocar la muerte de los individuos. Su amplia distribución geográfica, con prevalencias más elevadas en regiones menos desarrolladas, la importancia de las lesiones y su repercusión en salud y economía de las áreas afectadas, han despertado el interés de organizaciones internacionales, como la Organización Mundial de la Salud, y en este momento teniasis/cisticercosis están incluidas en el grupo de “enfermedades tropicales olvidadas”, con prioridad para su estudio en vías a conseguir su eliminación. Taenia solium es un parásito de importancia médica y veterinaria, ya que es el responsable de la teniosis humana y la cisticercosis porcina y humana. Pocos estudios se han realizado sobre las relaciones parásito-hospedador en el estado adulto de T. solium y la identificación de moléculas que pudiesen utilizarse como dianas en diagnóstico o protección. Por lo que los objetivos del presente trabajo fueron: (i) aislamiento y caracterización de los genes que se expresan en el cuello-escólex y proglótides del adulto, (ii) el análisis de la posible utilidad de algunas moléculas como marcadores en el diagnóstico precoz de la teniasis, (iii) así como la identificación diferencial de ténidos obtenidos de hospedadores intermediarios, mediante el empleo de distintos protocolos moleculares. Para este estudio se utilizaron cuatro genotecas de expresión de adulto de T. solium. Se aislaron mediante cribado al “azar” una variedad de genes con posible interés diagnóstico; de ellos, una molécula con similitud con el fragmento HDP2, descrito en T. saginata, se empleó para poner a punto una PCR semi-anidada. Por otra parte mediante el inmunocribado se aislaron cuatro moléculas que no fueron reconocidas por los sueros de pacientes portadores de ténidos (T. saginata). La utilización de diferentes marcadores moleculares para el diagnóstico de los quistes aislados de hospedadores intermediarios, permitió la identificación de Sarcocystis suihominis y S. hominis en muestras que previamente fueron diagnosticadas como cisticercos calcificados, además de la detección especie–especifica de T. saginata, T. solium, T. hydatigena, E. granulosus y sus genotipos.
... Early treatment with oral albendazole, corticosteroids and cyst removal is successful in restoring normal function (4,8) . However, motility restriction deficits can persist when the diagnosis is delayed, enforcing the need of an early diagnosis. ...
Presentation of one case of extraocular muscle enlargement caused by cysticercosis, its clinical, diagnostic and treatment aspects, and review of the literature on this theme. A female 38-year-old patient with extraocular muscle enlargement and a small cystic lesion at the superior rectus muscle insertion was treated with oral prednisone for almost one year, with a non-specific inflammation of right orbit diagnosis. There were important ocular motility restriction and pain. Computerized tomography disclosed a superior rectus muscle thickening with a small cystic and apparently empty lesion at the muscle's insertion. Excisional biopsy and histopathological study confirmed the clinical suspicion of cysticercosis. There was partial resolution of the restricted motility. Extraocular muscle cysticercosis is the most common site of this disease when involving the orbit. Oral albendazole and prednisone are efficient, but a long history of disease can lead to important residual ocular motility restriction.
... Oththalmic involvement is seen in 13-46% of the infected patients at times leading to impaired vision or blindness (Madigubba et al., 2007). Recently there is an increased reporting of ophthalmic cysticercosis from different parts of India including South India, which indicates that ophthalmic cysticercosis, is emerging as a far commoner disease than previously considered (George et al., 1999;David and Mathai, 2000;Chowdhary et al., 2003;Sharma et al., 2003;Sundaram et al., 2004;Kaliaperumal et al., 2005;Mohan et al., 2005;Madigubba et al., 2007). ...
For the first time, presence of locally secreted specific IgA antibodies in tear specimen from human with ophthalmic cysticercosis is documented in the present study. The ELISA using Taenia solium metacestode excretory secretory (ES) antigen demonstrated a diagnostic level of IgA antibodies in tears with 100% sensitivity (6 out of 6 confirmed cases of ophthalmic cysticercosis) whereas, 25 of 34 (73.52%) clinically suspected cases were diagnosed positive. The ELISA using T. solium metacestode somatic antigen detected a diagnostic titre of IgA antibody in tears with a sensitivity of 50% (3 out of 6 confirmed cases). The specificity of the tear IgAELISA using T. solium metacestode somatic and ES antigens is observed to be 94.87% and 92.3%, respectively. Overall in tears, the ELISA using T. solium metacestode ES antigens for detection of IgA antibodies shows a higher diagnostic efficiency (93.33%) compared to that using T. solium metacestode somatic antigen (88.88%). The sensitivities of the ELISA for detection of IgA antibodies in tears is observed to be higher than that for detection of IgG antibodies in serum using either somatic or ES antigens of the parasite.
Purpose: To ascertain the incidence, identify risk factors and calculate cumulative eff ect of risk factors in
patients developing glaucoma following optical penetrating keratoplasty. Materials and Methods: We
carried out retrospective analysis of 445 patients, those underwent optical PK and had a minimum follow
up of 6 m. Data on post-operative intra-ocular pressure (IOP) recorded at 3, 6, 9, 12 and 18 m or more was
analyzed. Various risk factors including age, sex, indications for penetrating keratoplasty, pre-existing
glaucoma and type of surgical procedures performed were analyzed by using univariate analysis and logistic
regression technique. Results: Ninety (21%) of eyes developed post-PK glaucoma. On applying logistic
regression, age, sex, indication of surgery, pre-existing glaucoma were found to be signifi cant risk factors for
the development of post-PK glaucoma (P < 0.05). Using logistic regression equation the cumulative risk of
developing post-PK glaucoma in an individual patient can be calculated. Conclusions: Male patients, aged
more than 40 years, having opaque grafts as an indication and with pre-existing glaucoma were found to be
higher risk of developing post-PK glaucoma. Patients at higher cumulative risk for development of post-PK
glaucoma may be closely monitored during follow-up.
Background: Orbital cysticercosis is a common disease in the developing world. Although previous studies reported the spectrum of imaging findings of orbital cysticercosis and variable involvement of the extraocular muscles, the relationship between the lesion and the extraocular muscle (within the muscle or on the surface), as well as its distribution within the muscle (muscle belly or the tendinous insertion) was uncertain.
Purpose: To characterize the predominant imaging findings of orbital cysticercosis on computed tomography (CT) and assess the relationship between orbital infection and extraocular muscles.
Methods and Methods: A cohort of 35 patients with orbital cysticercosis was included in the analysis. All patients underwent CT examination, whereas 6 underwent magnetic resonance imaging.
Results: 52 lesions were visualized on CT. The nodular calcified stage was rather common, followed by the colloidal vesicular or granular nodular stage and vesicular stage. Approximately, two-thirds of the lesions were presented as a cyst with/without an intramural nodule and the remaining as calcification. The extraocular muscle involvement consisted of a single, two, and three lesions, respectively; these were predominantly located within the extraocular muscles, whereas 12 lesions were attached to the extraocular muscles. The lesions were frequently within or adjacent to the muscle belly and less frequently associated with the tendinous insertion. The lateral rectus was frequently involved. The intracranial or extra-orbital involvement was found in 12 patients.
Conclusion: Orbital cysticercosis mainly presented as a cyst containing an intramural nodule and frequently residing within an extraocular muscle, with a predilection for the muscle belly.
Ocular cysticercus can involve the anterior segment, posterior segment, or adnexa. The most common sites of infestation in the eye are subretinal and intravitreal. Orbital involvement, in which the parasite localises within the extraocular muscles or lies subconjunctivally, is rare. Orbital cysticercosis commonly presents with signs of inflammation, restricted extraocular motility and proptosis. This report is of a 14-year-old girl with orbital cysticercus lying in the retrobulbar space, presenting as a painless proptosis of sudden onset.
INTRODUCTI
ON:
Orbital cysticercosis
may present with a wide spectrum of
clinical findings and
extra ocular myocysticercosis should be considered in patients who present
with restricted ocular motility and inflammatory signs.
W
e present a case of primigravida
presenting with restrictive ocul
ar motility and seizures at third trimester.
In this case ocular
motility restriction led to the incidental diagnosis of neurocysticercosis on magnetic resonance
imaging of the brain which is a rare, but an important, cause of first
-
time convulsions in
pre
gnancy. The patient responded well to oral steroids and antiepileptics with partial resolution of
restricted motility and no further epileptic attacks.
CONCLUSION
:
Orbital cysticercosis is a
common clinical condition in the developing world and result in s
ignificant ocular morbidity.
Restrictive strabismus, diplopia, recurrent redness, and painful proptosis are some of the clinical
signs in patients with orbital cysticercosis. These patients should be evaluated for cysticercosis
elsewhere
.
Neurocysticercosi
s should be suspected in pregnant women presenting with seizures
which cannot be explained by eclampsia
An 8-year-old girl presented to the neurology department with a complaint of insidious onset of left-sided ptosis and restricted elevation of the left eye. A CT scan orbit and brain revealed a ring-enhancing lesion in the levator palpebral superioris (LPS) and superior rectus (SR) muscle complex of the left eye and left parietal and right temporal region. She was started on steroid, followed by albendazole with improvement. The LPS/SR complex is the least common site of involvement among extraocular muscles in ocular cysticercosis. Specially, with brain neurocysticercosis (NCC), it is extremely rare. We report an unusual association of multiple brain NCC with ocular cysticercosis involving LPS and SR muscle.
To report 2 children with medial rectus cysticercosis presenting as proptosis of eyeball.
Case report.
In orbital cysticercosis, extraocular muscle cysticercosis is the most common type. Two children, a 12-year-old girl and an 8 year-old boy, presented with proptosis and pain in the left eye. Both were diagnosed with medial rectus cysticercosis based on computed tomographic scan and serologic report and treated with oral albendazole and prednisolone without any residual ocular motility restriction.
We report 2 cases of medial rectus muscle enlargement caused by cysticercosis; describe its clinical importance, diagnosis, and treatment; and present a review of the literature.
The authors describe a previously unreported case of subperiosteal orbital cysticercosis in a child. Surgical incision on the periosteum led to the extrusion of a cyst, which was confirmed histopathologically. Cysticercosis should also be considered in the differential diagnosis of subperiosteal abscess.
Extraocular muscle cysticercosis is rare and can be classified based on the stage of evolution as viable, degenerating, and inactive. A tailored approach to therapy using a combination of albendazole and steroids has been proposed. In this study, we have evaluated the clinical features and response of "viable" extraocular muscle cysticercosis to a tailored therapy with oral albendazole and steroids.
A retrospective review of 32 patients with viable extraocular muscle cysticercosis was performed over a 3-year period. Ultrasound examination was performed at 3 weeks and 6 weeks for resolution of the cyst and clinical signs following treatment with oral albendazole and prednisolone. The clinical presentation, ocular alignment, motility restriction, and ultrasound examination details were recorded on serial visits.
The mean age was 19.5 years. The most common presenting signs included limitation of ocular motility in 75%, conjunctival mass in 37.5%, diplopia in 28.1%, and proptosis in 28.1% of the patients, respectively. Ocular alignment evaluation revealed esotropia in 3.1%, exotropia in 12.5%, and hypertropia in 6.25%. Restriction of abduction and abduction in elevation was present in two patients each. The average time for complete resolution was 65.9 days. All the patients had resolution, except four, who had residual motility limitation but were asymptomatic.
Combination therapy with oral albendazole and steroids is effective in the management of viable extraocular muscle cysticercosis. However, residual motility restriction may persist despite treatment.
Surgical removal of extraocular cysticerci is fraught with complications. The effect of oral albendazole in such cases has been evaluated in a randomised, controlled, clinical trial. Of 24 ultrasonographically diagnosed, and ELISA positive cases of extraocular cysticerci, 12 received oral albendazole 15 mg/kg once daily for 1 month, while the 12 controls received a placebo. Marked clinical improvement was seen in all the cases in the treatment group at 4 weeks, with collapse of the cyst at 6 weeks (75%), and complete disappearance at 3 months (100%). No clinical or ultrasonographical change was noted in the control group. A trial of medical management with oral albendazole merits consideration in cases of extraocular cysticerci.
We sought to document the appearance of isolated cysticercal infestation of single extraocular muscles on MR and CT studies, and to compare these findings with results of histopathologic examination.
Six MR and three CT examinations of the orbits of six patients were reviewed. Histopathologic confirmation of the diagnosis was available in three patients, and response to specific medical therapy was available in one. In all, the imaging findings were considered highly suggestive of cysticercal infestation.
Typically, the affected extraocular muscle showed fusiform enlargement of its belly and contained a well-defined, spherical cyst with a nodule attached to its wall. The mural nodule was identified in all six cases with varying degrees of visibility. It was best seen on the CT examinations and in all cases in which contrast material had been administered. The nodule and the enlarged muscle showed intense enhancement on the contrast-enhanced studies. Imaging studies of the brain showed no evidence of cerebral cysticerci in any of the patients.
The MR and CT appearance of isolated infestation of single extraocular muscles by the larva of the pork tapeworm Taenia solium is quite characteristic and often diagnostic of this condition.
A 49-year-old Mexican male presented with a free-floating cyst in the vitreous. The cyst was removed at the time of cataract surgery and on the first postoperative day a second cyst was found in the anterior chamber. The second cyst was excised by cryoextraction 6 weeks after the initial surgery, but the eye developed an inoperable retinal detachment and phthisis bulbi. Although the diagnosis of cysticercosis was made clinically, initially, the only laboratory evidence for parasitic infection was a peripheral blood eosinophilia. The patient later developed an enlarged liver which was consistent with parasitic infection based on a liver scan. The morphology and life cycle of the parasite is described as well as suggestions for surgical removal.
Therapy of neurocysticercosis with cysticidal drugs is frequently complicated by the exacerbation of symptoms that follows the inflammation triggered by the acute destruction of cysticerci. Treatment of such adverse reactions with dexamethasone is highly effective. However, it has been shown that dexamethasone lowers the plasma levels of praziquantel, thus reducing its cysticidal efficacy. We measured plasma levels of albendazole, another strong cysticidal drug, when dexamethasone was given simultaneously. We found that dexamethasone increased the plasma levels of albendazole by about 50% (P less than 0.002); hence, it seems that cysticercosis and the ensuing inflammation can be treated simultaneously with albendazole and dexamethasone without diminishing the efficacy of the cysticidal drug.
Ocular cysticercosis, a platyhelminth infection, involves various ocular and adnexal sites. Orbital cysticercosis is a relatively rare site of presentation. We illustrate that this parasitic cyst, when present in the orbit, mimics an orbital pseudotumour. We have used ultrasound as an effective pre-operative diagnostic modality.
Reports of orbital cysticercosis are uncommon despite the high incidence of brain and ocular involvement. Infestation of extraocular muscle is exceedingly rare. Two cases of cysticercosis of the extraocular muscles are reported here. Surgical removal of the encysted parasites successfully resolved the infestation in both cases.
A 24-year-old East Indian woman presented with an inflammatory swelling in the supranasal quadrant of the left orbit and vertical diplopia. The motility disorder was of typical acquired Brown's syndrome. Histopathological examination of the lesion revealed Cysticercus cellulosae, a parasitic cyst known to produce a severe inflammatory reaction. To our knowledge this is the first report of acquired inflammatory Brown's syndrome caused by cysticercosis.
We observed and photographed intraocular cysticercosis in a 50-year-old woman. The subretinal cysticercus in the macular area produced a macular break during its passage from the subretinal space into the vitreous cavity. The parasite was removed by closed vitrectomy, but the macular break was left untreated because there was no vitreous traction to the macula. The patient ultimately developed a subretinal scar in the macular area, and visual acuity improved from hand movements to counting fingers.
The authors describe the magnitude of the cysticercosis problem and describe the organism, the clinical features of the disease, the propensity of the organism for development in the central nervous system, pathologic considerations, clinical diagnosis, and treatment.
ACCORDING TO Swellengrebel and Sterman,1 human cysticercosis is probably always due to infection with Cysticercus cellulosae, the bladderworm of Taenia solium. Human infection with C bovis, the bladderworm of T saginata, has never been described because cattle are practically the only animals that serve as its intermediate hosts. On the contrary, T solium has at least two intermediate hosts, namely, pig and man. Thus, man serves as definitive host as well as, in some instances, the intermediate host of T solium. As definite host, man harbors the adult tapeworm; and as intermediate host he harbors the bladderworm or cysticercus. In Holland, human infection with T solium is extremely rare and porcine cysticercosis is no longer found in indigenous hogs. During the last decades, human cysticercosis in this country has been diagnosed in foreigners only. The only previously described case of histologically proven intraocular cysticercus in Holland dates from 1901.
One hundred and ten cases of general cysticercosis have been analyzed. Ocular involvement was observed in 14 cases. Ten patients presented with subconjunctival cysts. The disease was seen more commonly on the left side and near the nasal canthus. A probable explanation for this predilection has been suggested by the peculiar manner of the blood supply.
A 39-year-old Vietnamese refugee with upper eyelid swelling followed by vertical diplopia and mild proptosis was shown by computerised tomography to have a localised lesion in the region of the right superior oblique muscle. At operation, this was a cyst and histology confirmed the larval form of Taenia solium (cysticercosis).
An enzyme-linked immunosorbent assay (ELISA) for the detection of antibody to cysticerci of Taenia solium has been developed that employs a pork muscle antigen control for the cysticercus test antigen, somewhat improving the serological distinction between infected and uninfected subjects. Serum antibody to cysticercus was detected in 79% of classical neurocysticercosis patients from Mexico, and in 61% of a group of cysticercosis patients with an unusually rapid invasion of the central nervous system in an endemic focus of disease in Irian Jaya. Antibody was absent in a group of healthy American laboratory personnel, and in residents of a non-endemic region of Papua New Guinea. Additional test on sera from patients with other parasitic diseases showed that cross-reactivity may occur in some patients with schistosomiasis, echinococcosis, and possibly angiostrongyliasis; however, these parasites are not known to cause human infection in Irian Jaya.
We treated two patients who had spontaneous extrusion of cysticercus cysts and subconjunctival swelling. Additionally, one patient had severe myositis and restriction of ocular movements.
The patients were prescribed oral albendazole, 15 mg/kg of body mass per day. Systemic corticosteroids were also given to the patient who had severe myositis.
Spontaneous extrusion of the cysts occurred in both patients within three to five days of starting albendazole therapy. The conjunctival defects healed without any surgical intervention. The ocular motility in the patient with myositis returned to normal.
As extrusion happened soon after the start of albendazole therapy, it is uncertain whether this therapy played any role. Additionally, it is not clear if systemic therapy must be continued in the absence of systemic and neurologic manifestations.
There has been a gradual change in the socio-demographic trends of ocular/adnexal cysticerosis. We present the results of a 5-year study of 33 cases of ocular/adnexal cysticercosis and compare our observations with those reported by previous authors. The male:female ratio in our study was 2:1 and maximum number of patients (45%) belonged to the age-group of 31-40 years. Seventy percent of our patients were of low socio-economic status and 70% were strictly vegetarians. The most common location of cysticerci was in the vitreous (50% of all cases); orbital cysts were present in 5% and subconjunctival cyst in 3%. Most common extraocular site for associated cysticercosis was the brain (18%): Ultrasonography proved to be an effective and economical alternative to magnetic resonance imaging and computerized tomographic scanning for the detection of cysticerci in the orbit and in eyes with hazy media.
Cystic lesions of the extraocular muscles (EOMs) are uncommon. Six patients with a cystic lesion in an extraocular muscle, as observed by computerized tomography (CT) scanning, were retrospectively identified from the practice of one of the authors (G.C.S.), and their clinical course was reviewed. All the patients were treated initially with oral corticosteroids. Those who did not respond to this therapy underwent surgical exploration. Four patients demonstrated complete resolution of clinical signs and symptoms with oral steroid therapy. Posttreatment CT scans performed in two of these patients showed resolution of the cystic lesion with residual muscle thickening in one. The two patients not responding to steroids underwent surgical excision and histopathology confirmed the diagnosis of cysticercosis. Cysticercosis is a previously reported cause of a cystic lesion in an EOM. To the best of our knowledge, cystic lesions of the EOMs resolving with steroids have not been previously reported. Response to oral steroids in four of our patients is suggestive of myositis with a cystic change in the muscle. We recommend a trial of oral steroid therapy in patients with a cystic EOM lesion before surgical exploration is performed.
Human cysticercosis is secondary to an infestation by cysticercus cellulosae, the larval form of Taenia solium. Cysticercosis is endemic to regions with poor sanitation. The purpose of this report is to present a large series of patients with orbital cysticercosis and to discuss the current treatment.
A retrospective chart analysis of all patients with orbital cysticercosis from an urban practice in southern India was performed. The clinical features, the results of investigations, the therapies instituted, and the outcomes realized were recorded.
Twenty patients diagnosed with orbital cysticercosis were identified (11 female and 9 male). Their ages ranged from 5 to 25 years with a mean age of 12.5 years. Nine patients manifested subconjunctival cysts. Eight were excised and 5 of these were densely adherent to the adjacent extraocular muscle (EOM). The remaining 11 patients had a cyst in a single EOM. The EOM cysts had proptosis, restricted motility, recurrent inflammation, and blepharoptosis. Two of the EOM cysts were excised surgically and four extruded spontaneously. Six patients with EOM cysts were treated medically: they all received oral corticosteroids and, additionally, five were given oral albendazole and one was given oral praziquantel.
Excisional biopsy is recommended for subconjunctival cysticercosis. Idiopathic cystic myositis can present like EOM cysticercosis, but is differentiated by resolution with corticosteroid treatment. Medical therapy in orbital cysticercosis with oral albendazole and corticosteroids can arrest recurrent inflammation and improve ocular motility.
To highlight the different presentations of extraocular muscle cysticercosis, which can result in acquired ocular motility disorders.
Ten cases of acquired motility disorders examined between January 1998 and January 1999 were diagnosed as extraocular muscle cysticercosis with computed tomography (CT). All patients were treated with corticosteroid therapy and albendazole. Repeat CT scans were performed in 5 patients.
The inferior rectus muscle was most commonly affected with double elevator palsy the most common clinical presentation. Response to treatment was satisfactory with complete resolution of the ocular motility disorder in 8 patients. Initiating therapy with corticosteroids prior to the addition of cysticidal drugs prevented severe inflammatory reactions and residual strabismus.
A high index of suspicion should be entertained for extraocular muscle cysticercosis in every case of recent acquired ocular motility disorder. Response to medical therapy is satisfactory.
To evaluate the use of computed tomography (CT) and ultrasound (US) to diagnose orbital cysticercosis, and present the diagnostic features.
US and CT were used to evaluate patients with proptosis. Four patients were diagnosed as having orbital myocysticercosis and treated with oral albendazole and corticosteroid. Follow-up was undertaken with US and CT.
US features were confirmatory of myocysticercosis in two eyes where as CT was effective in diagnosing the condition in all four eyes. In two patients the medial rectus was involved, in one the superior rectus and, in the other, the inferior rectus muscles. Serial US and CT revealed complete resolution of the lesions in 3 months.
CT is useful method in diagnosing isolated orbital myocysticercosis. Our report demonstrated that ophthalmic signs and symptoms in the presence of proptosis, especially in an endemic region, should alert the clinician to the possibility of myocysticercosis. Though CT is superior, US can be used as a economical follow-up investigation.
Criocirugia na cisticercose ocular
- F A Mais
- Mais FA