CYSTICERCOSIS

INTRODUCTION :
• Tissue infection caused by ingestion of larval cysts of the cestode Taenia solium.
• Acquired by swallowing food, water or feces contaminated by T. solium eggs
• In cysticercosis, the human represents an intermediate host and the parasite develops
cysticerci in various organs.

• Cysticercus : stage in which the scolex is inverted in a sac like structure within various
tissues.

• Taeniasis: infection caused by the adult tapeworm in the human intestine, which occurs
from ingestion of larvae in undercooked pork
• Cysticerci: larval forms of tapeworms found within a fluid filled cyst
Definitive Host: Humans

Intermediate host: pigs

Cysticercosis results when humans act as accidental intermediate

hosts ( after consumption of raw/uncooked contaminated pork.
Infection can also occur through ingestion of contaminated food or
water containing eggs or proglottids.
 EPIDEMIOLOGY

• 50 - 100 million people infected worldwide (eMedicine: Cysticercosis

[Accessed 27 August 2018])]

• Endemic areas include: Central and South America, India, China

Southeast Asia, Africa and Eastern Europe
 SITES

• Cysticerci develop in the nervous system, heart, skeletal muscle, eyes

and subcutaneous tissue
 CLINICAL FEATURES
• In humans, T. solium can manifest as

a. Asymptomatic or minimally symptomatic intestinal carriage which is

referred to as TAENIASIS

b. Infection with cysticerci referred to as CYSTICERCOSIS, predominantly in

the subcutaneous tissue, intramuscular, eyes, and neural tissues.

-Cysticercosis of the skin is rare and it often presents as a palpable,

subcutaneous nodule
- In the breast, may present as a freely mobile cystic mass
 DIAGNOSIS
Thorough history, skin biopsy, serology (serum or CSF) and imaging can aid
in the proper diagnosis

RADIOLOGY DESCRIPTION
CT scan can reveal hyperdense lesions in subcutaneous tissue with or
without calcification
Ultrasound can reveal cystic lesions
 GROSS DESCRIPTION

• Circumscribed, white to tan, cystic nodules containing a clear fluid

• Viable cysts are translucent, through which a single scolex may be
visible (2 - 3 mm nodule)
• As the cyst begins to degenerate, the fluid becomes dense and
opaque
• In the later stages, only a calcified nodule may be present
• Cyst sizes vary; commonly 1 mm - 2 cm
• Larval forms identified within the cyst cavity
 MICROSCOPIC (HISTOLOGIC) DESCRIPTION

• Cystic cavity contains the larval form: scolex with hooklets and 2 pairs of
suckers
• The larval form, composed of duct-like invaginations, is lined by a double
layered, eosinophilic membrane
• Scolex is single and invaginated; contains a rostellum, 4 suckers and 22 -
23 bifrefringent hooklets (may persist for a long time)
• Body wall exhibits a calcified bodies.
• Cysticerci may remain viable for years
• Colloidal stage: first stage of involution of cysticerci; transparent vesicular
fluid is replaced by a turbid, viscous fluid and the scolex shows signs of
hyaline degeneration

• Granular stage: cysticercus is no longer viable; cyst wall thickens and the
scolex is transformed into coarse mineralized granules

• Host inflammatory reaction is usually not present if the larva is viable

• Finally, granulomatous reaction develops characterized by histiocytes,

epitheloid cells and foreign body giant cells, leading to fibrosis of the
supporting stroma and calcification of the parasitic debris