Cestode Infestations: Hydatid Disease and Cysticercosis

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Cystic echinococcosis

Echinococcal cysts comprise the host-derived pericyst, which surrounds the parasite endocyst. The endocyst includes an outer acellular laminated layer and an inner germinative layer. The germinative layer gives rise to brood capsules and protoscolices. Early-stage cysts are filled with clear fluid. With nonsurgical treatments, or sometimes spontaneously, the cystic structures can degenerate (see classification). When ingested by canines, the protoscolices convert to tapeworms. After the rapture

Alveolar echinococcosis (E multilocularis)

Tissue larvae of E multilocularis cause alveolar echinococcosis. In the liver, E multilocularis produces a multivesiculated mass that may liquefy centrally and grows by infiltrating the surrounding tissues. Canines, including foxes and dogs, are the usual definitive hosts. Rodents are the usual intermediate hosts. Humans are incidental intermediate hosts, infected from eggs shed in the environment by the final hosts (eg, dogs).

Definitions

Cysticercosis is caused by infection with the larval stage of T solium. Humans are the obligate definitive host for the intestinal tapeworm. The mature segments termed proglottids produce the ova, which infect pigs (the normal intermediate host) (Fig. 5). In the pig, the ova hatch, release the invasive larvae, which mature into cysticercus within the tissues. The cysticercus consists of a translucent bladder and a mural nodule containing the invaginated scolex. When ingested in undercooked

Treatment

Optimal treatment of neurocysticercosis often includes symptomatic therapy for seizures and hydrocephalus and specific therapy for the parasites (including antiparasitic drugs or surgical removal).31, 34, 39 Antiepileptic drugs, such as phenytoin and carbamazepine, are used to control the seizures. Newer antiepileptic drugs may also be at least effective. Neurosurgery is the mainstay of therapy for obstructive hydrocephalus.40 Most cysticerci in the ventricles can be managed by endoscopic

Other larval cestode infections

Sparganosis refers to tissue infection with the larval (plerocercoid) stage of Spirometra mansonoides. Sparganosis is acquired from exposure of skin to infected flesh (eg, poultices of infected frogs, birds, or fish) or by ingestion. The plerocercoids develop in tissues, causing subcutaneous or central nervous system nodules or larva migrans. Treatment usually requires surgical removal of the nodule.48

Coenurosis is a rare infection caused by the human infection of Taenia serialis or Taenia

Acknowledgments

The authors are grateful to Prof Peter Kern, University of Ulm, Ulm, Germany, for reviewing the section on Alveolar echinococcosis and to Prof Hugo Garcia, Universidad Peruana Cayetano Heredia, Lima, Peru, for providing the CT and MRI images of neurocysticercosis.

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    The authors declare no conflicts of interest.

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