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Brain cysts developing as a result of pork tapeworm infection should be confirmed through neuroimaging and serologic testing, according to new clinical guidelines from the Infectious Diseases Society of America and the American Society of Tropical Medicine and Hygiene.

In diagnosing , clinicians should take a history and do a physical examination, followed by both brain magnetic resonance imaging and non-contrast computed tomography scans, said A. Clinton White, Jr., MD, of the University of Texas Medical Branch in Galveston, and colleagues.

Patients should then have serologic testing with enzyme-linked immuno-transfer blot, rather than the less sensitive enzyme-linked immunosorbent assays, the authors wrote in

The team noted that some 2,000 people are with neurocysticercosis every year, which costs the healthcare system over . The infection, which results from eating undercooked pork products, is one of the most common causes of seizures worldwide, comprising of cases of seizures in endemic countries, White and colleagues wrote, adding that pork tapeworm is common in developing countries in Latin America, Africa, and Asia.

Patients with neurocysticercosis most commonly present with seizures and headaches, but nausea, vomiting, dizziness and altered mental status are also symptoms.

"Forms of the infection can range from single cysts that may be relatively harmless to blockages in the ventricles that cause pressure and fluid on the brain and can be deadly if they're not surgically removed," White said in a statement. "The right diagnosis and treatment are critical, which is why it requires management by a team that includes infectious diseases specialists, neurologists, and often neurosurgeons."

Additional testing to be performed prior to therapy includes a funduscopic examination, or an eye exam, prior to initiation of anthelmintic therapy, which expels parasites. Other screening considerations may include screening for tuberculosis or Strongyloides stercoralis, or thread-worm, in patients likely to require prolonged corticosteroids. The authors suggest potentially screening household contacts from patients with neurocysticercosis who did not acquire it from a non-endemic area, but note this "can often be addressed by the local health department."

Potential treatments for the disease include anti-parasitic and anti-inflammatory therapy, and sometimes also anti-epileptic drugs or surgery. While no additional monitoring is needed for patients receiving combination therapy with the anti-parasitic therapies albendazole and praziquantel "beyond that recommended for patients receiving albendazole monotherapy," the authors note that patients treated with this therapy for more than 14 days should be monitored for hepatotoxicity and leukopenia.

White and colleagues wrote that "due to this complexity, clinicians with little experience with this disease should have a low threshold for consultation with an expert in the disease," as neurocysticercosis has a number of different forms. These include the following:

• Viable intraparenchymal neurocysticercosis
• Degenerating intraparenchymal neurocysticercosis (including patients with single enhancing lesions due to the disease)
• Calcified parenchymal neurocysticercosis
• Intraventricular neurocysticercosis
• Subarachnoid neurocysticercosis
• Spinal neurocysticercosis
• Ocular cysticercosis

In terms of special populations, the authors said that children should not be managed differently from adults, although "dosing should be weighed," and in pregnant populations, the recommendation is that anthelmintic therapy is deferred until after pregnancy, but pregnant patients with intracranial pressure "need to be aggressively managed," as they would be if they were not pregnant, and any antiepileptic drugs should take into account potential teratogenicity.

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