Immigrants, Imaging, and Immunoblots: the Emergence of Neurocysticercosis as a Significant Public Health Problem

Taeniasis, or cysticercosis, caused by Taenia solium (often referred to as the pork tapeworm), is a classical zoonosis which has been recognized since antiquity. Cysticercosis is acquired by ingesting Taenia eggs shed in the feces of a human tapeworm carrier and may occur in humans who neither eat pork nor share environments with pigs. Although cysticerci may localize throughout the body, most clinical manifestations result from their presence in the central nervous system (neurocysticercosis (NCC)), where they can cause seizures, hydrocephalus, and other neurologic dysfunctions. 175 patients with active neurocysticercosis were randomly assigned to three treatment groups: (i) oral prednisolone alone, (ii) praziquantel (50 mg/kg for 15 days) with prednisolone, or (iii) albendazole (15 mg/kg) for 8 days with prednisolone. The results of this study suggest that still reliable criteria to determine which patients require treatment with either praziquantel or albendazole is lacking. Approximately half of the patients in this study had anticysticercal antibodies that recognized all seven of the diagnostic proteins. Although local persons are usually unaware of the threat to public health that this infection in pigs represents and do not relate the lesions in their animals to disease in humans, pig owners routinely check their live pigs for cysticercosis by direct examination of the tongue. Special studies reveal that morbidity caused by NCC is measurable and severe in areas where NCC is endemic.