Intestinal pathology: Taeniasis[9]
Cerebral pathology: Neurocysticercosis
Larvae suffer some pathological changes until its death. This evolution can be described in four stages:
1.Vesicular stage 2.Colloidal vesicular stage 3.Granular nodular stage 4.Calcified nodular stage These pathology is characterized by a natural progression of innate (neutrophils and macrophages), early induced (NK cells and γδ T cells) and adaptive immune response (αβ T cells and B cells) in infected mice.Th1 response
It depends on the number, size, stage and localization of cysts and the patient’s immune response.
Possible explanation of relation between brain injury, inflammation and epilepsy [6]
General information:
Taenia solium:
Norm
al l
ifec
ycl
e of
Taen
ia S
oli
um
A
ber
rant
cycl
e
EPILEPSY
Brain injury
Head trauma
Stroke Cortical
malformations
Perinatal
injury
Brain inflammati
on
Microglia Macrophages
Astrocytes Neurons
Innate immunity
Altered excitability
Neuronal death
BBB Lymphocytes
Adaptative immunity
Dichotomous role of inflammation
Infection Seizures Unknown
Reference 1. Willingham AL 3rd, Wu HW, Conlan J, Satrija F. Combating Taenia solium cysticercosis in Southeast Asia an opportunity for improving human health and livestock production. Adv Parasitol. 2010;72:235-66 2. Marcia Ramos Monteiro da Silva, et al. Recombinant expression of Taenia solium TS14 antigen and its utilization for immunodiagnosis of neurocysticercosis. Acta Trop. 2006;100(3):192-8. 3. Oscar H. Del Brutto. Neurocysticercosis: A review. Surg Neurol. 2005;63(2):123-32. 4. Astrid E.Cardona et al. Development of an Animal Model for Neurocysticercosis: Immune Response in the Central Nervous System Is Characterized by a Predominance of γδ T Cells. J Immunol. 1999;162(2):995-1002 5. Sumit Sinha, B.S Sharma. Neurocysticercosis: A review of current status and management. J.Clin.Neurosci. 2009;16(7):867-76.
Affected countries: Latin America, India, Asia and Sub-Saharan Africa. Imported cases: Europe, Australia, USA and Canada. 1/1000 for human teaniasis Incidence 1-10% for humans CC 20-40% for pig CC Age of infection: 5-15 years old Age of manifestation: 25-35 years old Problems: high poverty, warm weather, illiteracy...
Immunodiagnosis Medical imaging
EITB ELISA RMN TAC
Lifecycle of Taenia solium
• Neurocysticercosis is endemic in many parts of the world, specially in developing countries. However we have to take into consideration the diagnosis in developed countries by immigration of endemic countries. •Neurocysticercosis is the most common cause of symptomatic epilepsy worldwide. Despite the severity of the disease, most people don’t give the importance to it, since it principally affects developing countries. •Treatment and diagnosis works well, but can be improved. •This parasitic disease is potentially eradicable, but to be effective we need eradication programs that consists: 1. Interrupt the tape worm-host cycle. 2. The vaccination of pig against infection with the parasite, which indirectly reduce the appearance of new cases of the disease. 3. Public health and awareness. 4. Possible vaccination for human. But the best alternative is the education and the health promotion, specially in developing countries.
Taenia solium Cerebral symptoms Surgery
Albendazol Praziquantel Epilepsy Inflammation
•Dose: 50 mg/kg/day
•Duration: 15 days
•Efficacy: 60-70% in
parenchymatous cyst
•Dose: 15 mg/kg/day
•Duration: 3 weeks
•Efficacy: 80% of the cyst
•Enhance GABA channel (fenobarbiturate and benzodiazepine) •Inhibit Sodium channel (carbamazepine) •Inhibit Calcium channel (gabapentin)
•Corticosteroid: Prednisolone
8.Conclusions 7.Treatment
4.Diagnosis
Clinical manifestation [5]
Pathology
Epilepsy
Pericyst inflammation, granuloma formation
Raised intracranial pressure
Hydrocephalus (arachnoiditis, ependymitis, ventricular cysts), pseudotumor (edema), giant cysts, cysticercal encephalitis
Focal deficits
Direct compression by large or multiple cysts
Meningitis
Widespreas subarachnoid inflammation
Myelo radiculopathy
Inlammation, local mass effect, vasculitis
Others Dementia
Multiple parenchymatous cysts
Encephalitis
Intense inflammation and edema
Subarachnoid haemorrhage
Inflammatory aneurysm
Trigeminal neuralgia
Arachnoiditis
Subdual hematoma
Collection of multiple cysts
Stroke/transient ischemia attack
Angiitis
Dizziness
Intermittent CSF obstruction
Endocrinological or ophthalmic symptoms
Sellar/intraocular cysts
1.Diagnostic criteria [3] Absolute criteria • Histologic demonstration of the parasite from biopsy of a brain or spinal cord lesion •Cystic lesions showing the scolex on CT or MRI •Direct visualization of subretinal parasites by funduscopic examination
Major criteria •Lesions highly suggestive of neurocysticercosis on neuroimaging studies •Positive serum EITB for the detection of anticysticercal antibodies •Resolution of intracranial cystic lesions after therapy with albendazole or praziquantel •Spontaneous resolution of small single enhancing lesions
Minor criteria • Lesions compatible with neurocysticercosis on neuroimaging studies • Clinical manifestations suggestive of neurocysticercosis •Positive CSF ELISA for detection of anticysticercal antibodies or cysticercal antigens •Cysticercosis outside the CNS
Epidemiologic criteria •Evidence of a household contact with Taenia solium infection •Individuals coming from or living in an area where cysticercosis is endemic •History of frequent travel to disease-endemic areas
Basic protein
NK T cell
Chemotaxis
Mast cell
Mast cell
Macrophage
C3b
IL-4 IL-3 IL-5
Plasma cell
IgE
Mediators
Inflammation
C3b
C3a C5a
C3a C5a
C
C Eosinophil
Neutrophil
Platelets
PAF NCF
IL-4
ECF
(Th 1)
Th 2
Mediators
IFN-γ
Activation and differentiation of naive CD4 T cells in the presence of IL-4 into Th 2 cells.
Taenia solium cause the synthesis and secretion of IL-4 by NK T cells
Is a cestode that belongs to the Cyclophyllidea order and the Taeniidae family. Tree Stage: egg, larvae and adult tapeworm. Target tissues: CNS, eye, skeletal and heart muscles, subcutaneous tissues.
Brain parenchyma
Time p.i IL-2 IL-12 INF-γ TNF-α IL-5 Il-1,6,13 Il-4,10
2 days - - - ND - - -
3 days - - - ND - - -
5 days - - - ND - - -
1 wk - - - - - - -
3 wk - + - - - - -
5 wk - + + - + - -
8 wk - + + - - - -
11 wk + + - - - - -
13 wk + + - - - - -
Cytokines were detected in immunohistochemistry reaction.-, undetectable;+, 1-100 positive cells per section; ++, 100-300 positive cells; +++, 300-500 positive cells;++++, >500 positive cells. MHC class II expression=I-Ad.[4]
Possible causes of epilepsy:
Cytokines: IL-1β, IL-6 and TNFα
Permeability of blood–brain barrier
Gliosis
Neuronal death
ELISA results using HISTS14 antigen. In (A) serum sample from patients and in (B) CFS sample.[2]
Left: RMN showing one cyst. Right: TAC showing multiple parenchymal brain calcification.[5, 10]
2. Degrees of certainty for the diagnosis [3]
Definitive diagnosis
• Presence of one absolute criterion •Presence of two major plus one minor and one epidemiologic criterion Probable diagnosis
•Presence of one major plus two minor criteria •Presence of one major plus one minor and one epidemiologic criterion •Presence of three minor plus one epidemiologic criterion
Diagnostic criteria
Map illustrates the distribution of Neurocysticercosis.[1]
3.Introduction
1. Objective
Neuroinfections are important brain diseases and they affect a lot of people all over the world, but not all the people know about their existence. The aim of this work is to deepen in the pathological, biochemistry and clinical aspects of Neurocysticercosis, an helminthic disease that affects the central nervous system. It is caused by larvae of Taenia solium, who lives in the small intestine of humans.
2.Sources and methods
Sources Articles, books and scientific reviews about Neurocysticercosis. Methods •Search all the information. •Read general articles about the topic to get a general idea, and then more specifics articles. •Sum up all the important aspects of the pathology.
5.Immuno response 6.Clinical Manifestations
1.Adult Taenia solium in small intestine
2.Taenia solium eggs in human feces
3.Taenia solium eggs ingested by pork
4.Cysticerci in pork muscles
5.Infected pork meat ingested by humans
6.Larvae evagination in human stomach
9.Neurocysticercosis
8.Taenia solium eggs ingested by humans
7.Auto contamination Contaminated water Contaminated food
Body (proglottids) Neck Scolex
Subcutaneous tissues
CNS
Eyes
Muscles
Taenia solium
Places affected
Larvae
6. Annamaria Vezzani, Tiziana Granata. Brain inflammation in epilepsy: experimental and clinical evidence. Epilepsia. 2005;46(11):1724-43. 7. Hector H.Garcia et al. Current Consensus Guidelines for Treatment of Neurocysticercosis. Clin Microbiol Rev. 2002;15(4):747-56. 8. Pramod Kumar Mishare and Judy M Teale. Transcriptome analysis of the ependymal barrier during murine neurocysticercosis. J Neuroinflammation 2012;9:141. 9. Thomas J. Kindt. Kuby Immunology, sixth edition. W. H. Freeman, 2007 10.Eric T.Kimura-Hayama, et al. Neurocysticercosis: Radiologic-Pathologic Correlation. Radiographics. 2010;30(6):1705-19.