CYSTICERCOSIS (cysticercosis) — the helminthosis caused by parasitizing in fabrics of larval stages of a pork tapeworm (tsistitserok, or the Finn), proceeding chronically and which is characterized by damage of skin, hypodermic cellulose, muscles, a head and spinal cord, eyes is more rare than internals and bones.
Feature of an invasion of the person a pork tapeworm consists that the person is a final (definitivny) owner of helminth at a disease of the teniosis (see) caused by adult tapeworms, and the intermediate owner — at a disease of cysticercosis.
The first description of cysticercosis of pigs is given And a ristotel. Cysticercosis of the person in Europe is known from 16 century.
Etiology. Activator C. the person of Cysticercus cellulosae Gmelin, 1790 — a larval stage of a cestode of Taenia solium L., 1758 (see the Teniosis). The cysticercus represents a bubble of an ovoidny form with transparent walls and the head screwed inside — a scolex, supplied with four suckers and a nimbus kryuchyev (see fig. 1 to St. Teniosis, t. 24, Art. 543). The sizes and a form of tsistitserok depend on their age and character of fabrics, in to-rykh they live; naira., in skin and hypodermic cellulose they have the rounded or oval shape, in muscles — extended spindle-shaped, in cerebral cavities — almost spherical. Usually diameter of tsistitserok
5 — 8, sometimes 10 — 15 mm, however are described huge bubbles in cerebral cavities (to 3 — 5 cm in the diameter). In a soft cover on a lower surface of a brain sometimes find a racemose cysticercus (Cysticercus racemosus) having an appearance of bubbly formation of the extended form up to 25 cm long with branchings and uviform protrusions, sometimes without scolex. Assume that the racemose cysticercus is the abnormal cellulosae form C., however it is not finalized. Life expectancy of tsistitserok
from 3 to 17 years, on a nek-eye to data, up to 20 and more years with the subsequent full calcification.
Epidemiology and geographical distribution. A source of an invasion is the person allocating mature eggs and joints of a pork tapeworm with excrements. The person catches C. through the hands, food and water contaminated by the excrements (including and own) containing eggs of a parasite.
of C. register in the countries of Africa, in India, Northern China, in a number of the countries of the Southern Asia, Central and South America, especially in Mexico. According to WHO data (1979), in Mexico City 1,9% of all registered death are caused by cysticercosis, in 3,5% of all openings find cysticercosis. In Europe register only sporadic cases, hl. obr. in the south. In the USSR isolated cases of cysticercosis are registered everywhere, is slightly more often in BSSR and districts of USSR, boundary with it.
Pathogeny. Getting into a wall of a stomach or a small bowel of a tsisti-cercus a blood flow are carried on fabrics and bodies. In a pathogeny of C. the leading role is played by localization of a parasite, mechanical impact on bodies and fabrics against the background of a sensitization of an organism antigenic and active metabolites of tsistitserok. At localization of tsistitserok in cerebral cavities an important factor is disturbance of outflow of cerebrospinal liquid up to full occlusion. Besides, parasites put the mechanical pressure upon the vital centers located in bark of big hemispheres and a cerebellum, and also cause a reactive inflammation, hypostasis of a parenchyma, vasculites. At acute reaction of an organism on death of a parasite, disturbance of integrity of the capsule the acute anaphylaxis can develop (see).
Pathological anatomy. Distinguish three stages of C.: a stage of a viable parasite, a stage of dying off of a parasite (shorter) and a stage of residual changes after death of a parasite.
In a stage of a viable parasite the cysticercus has usually an appearance of a thin-walled bubble. In a wall of a bubble distinguish three layers: internal, or reticular, poor in cells; average, or parenchymatous, rich with kernels; outside, presented by a homogeneous cuticle, edges at the parasites who are located freely (e.g., in cerebral cavities), forms characteristic wavy or scalloped ledges. These ledges allow to distinguish a cysticercus at morfol. a research even if the scolex is not found. On the periphery of a cysticercus inflammatory reaction with growth of granulyatsionny fabric and formation of the reactive capsule is noted. In this capsule it is possible to distinguish three layers: internal — exudative, average — fibrous, and also outside — infiltrative of which dominance of lymphocytes is characteristic. Sometimes the inner layer is poorly expressed or is absent, and to a cysticercus directly prilezhit a fibrous layer. Around the capsule the hypertrophy and a hyperplasia of glial cells and fibers is quite often noted, perivascular lymphocytic infiltrates sometimes are found.
In a stage of dying off of a parasite his swelling and fusion is observed, it is frequent with the subsequent calcification. In this stage decomposition products of a cysticercus make the toxic and sensibilizing impact which is the most expressed. At the same time considerable strengthening of local inflammatory reaction is observed. A first coat of the capsule it becomes distinct expressed at the expense of serous or fibrinous exudate, accumulations of leukocytes, macrophages, and further lymphocytes and colossal cells. In the second and third layers of the capsule and around vessels of adjacent fabric (in a perifocal zone) inflammatory infiltration by lymphocytes and plasmocytes accrues.
In a residual stage when the most part of decomposition products of a cysticercus already underwent lysis or calcification, inflammatory infiltration is absent or is insignificant, but the capsule around the remains of a parasite is well-marked. In this stage the remains of a parasite have no toxic effect.
Clinical picture. Wedge, manifestations of C. are defined by localization of parasites (in soft tissues, skin, in a brain, in an eye, internals). Defeat by tsistitserka of soft tissues, even multiple, usually proceeds asymptomatically and is an accidental find at a X-ray analysis or on opening.
Cysticercosis of skin is characterized by slow formation in skin and hypodermic cellulose, especially in a breast, a back and, more rare, other body parts, tumorous formations of roundish or oval outlines; more often they single, are more rare multiple — to tens and hundreds. If the parasite is live, nodes of a pasty or myagkoelastichesky consistence, are painless, after death of a parasite nodes become more dense and moderately painful. For many years nodes can almost not change, sometimes gradually resolve, in some cases petrifi-tsirutsya and much less often suppurate.
At cysticercosis of a brain in case of localization of parasites in bark of big hemispheres the leading signs are headaches, epileptiform attacks, disturbances of mentality — a delirium (see. A delirious syndrome, Hallucinations) or an amentia (see. Amental syndrome). Quite often these signs are followed by a gipertenzion-ny syndrome (see) — sharp pristupoobrazny headaches, nausea, vomiting, during attacks congestive nipples are observed (disks, T.) optic nerves. Sometimes intracranial hypertensia is expressed unsharply, but is tended to gradual increase of weight and frequency of attacks. Epileptiform attacks can be limited to spasms and paresthesias in separate groups of muscles, the short-term loss of consciousness is sometimes possible. Between attacks consciousness of patients is kept. In some cases there are twilight states, migraines, and also a picture of the epileptic status with a lethal outcome (see Epilepsy). Cysticercosis of the fourth ventricle a long time can proceed asymptomatically. In cases of free localization of a cysticercus the gipertenzi-onny syndrome arises at change of position of the head or trunk. In this regard patients quite often adopt the forced provision that leads to disappearance or reduction of a headache. During the progressing of a disease the cysticercus can be soldered to a wall of a ventricle, a vascular texture. In this case attacks become more frequent and long, light intervals shorter or are absent at all. Any attack can terminate in sudden death.
Cysticercosis of an eye is shown by gradual decrease in visual acuity in the affected eye. Most often the parasite is located in the back camera of an eyeglobe, is much more rare — under a fibrous cover, is rare — in an anterior chamber of an eyeglobe, a crystalline lens. Damage of a retina leads to its amotio to some loss of sight (see Amotio of a retina).
Cysticercosis of internals is a big rarity; clinical picture of its polimorfn.
The diagnosis is established on the basis by a wedge, pictures, data epidemiol. anamnesis (disease of a teniosis), rentgenol. and lab. researches, at a part of patients — on the basis of presence of a puberal pork tapeworm in intestines on what specifies detection of joints or eggs those-niid in excrements at exile of a parasite. On roentgenograms of soft tissues calciphied tsistitser-k come to light in the form of intensive sharply to Comte of rirovanny shadows. In a brain a cysticercus can be single, is more rare — multiple. The research of cerebrospinal liquid, in 1 mkl a cut is of value for diagnosis at C. find from 20 to several honeycombs cells (lymphocytes, sometimes with impurity of a small amount of eosinophils prevail). Lange's reaction (gradual decolouration of mix of cerebrospinal liquid with colloid solution of chloric gold) gives the characteristic curve reminding a curve at a general paralysis. Extent of damage of a brain, localization of parasites is specified by means of an electroencephalography (see), a computer tomography (see the Tomography computer). Existence of a cysticercus in an eye is established by means of an oftalmoskopiya (see). Serological tests (reaction of binding complement, reaction of indirect hemagglutination) with tsistitserkozny antigen are of great diagnostic value (see. Serological researches).
It is necessary to differentiate cysticercosis of skin most often with syphilomas (see Syphilis), metastasises of cancer (see), sarkoidny atheromas, deratofibromas (see), neurinoma (see), lipomas (see), myomas (see). The diagnosis is confirmed by results of a research of the material received at a biopsy and a puncture limf, a node (during the finding in it of a cysticercus or its separate fragments — it is frequent kryuchyev). Cysticercosis of a brain is differentiated with tumors of a brain (see the Brain, tumors), echinococcal (see), an alveococcosis (see), multiple sclerosis (see), a toxoplasmosis (see); main differential diagnostic character of C. instability of neurologic symptomatology and mental disorders, sharp change of acute manifestations with the periods of full remission, especially in an initial stage of a disease is.
Treatment. At cysticercosis of skin large single nodes delete in the operational way; multiple small nodes of skin usually do not cause concern and treatments do not demand.
Treatment of cysticercosis of a brain, eye and internals operational in combination with antiinflammatory and dehydrational therapy.
The forecast at cysticercosis of soft tissues and skin favorable, at cysticercosis of c. N of page, eyes and internals — very serious.
Prevention consists in early identification and treatment of patients with a teniosis (see); the prevention of pollution of the soil excrements of patients with a teniosis (the device of waterproof vygreb in not channeled bathrooms, regular cleaning of cesspools, etc.); careful washing of vegetables, fruit, berries before their use in food; washing of hands before food. Great value in prevention of C. has a dignity. - a gleam, work, in particular an explanation to the patient with a teniosis that the delay with treatment can lead to autoinvasion and a disease of cysticercosis. Bibliography: Belyaev N. V.,
va T. Hare of JI. and B r and and G. I. K N to a question of cysticercosis of skin, Vestie, dermas, and veins., No 2, page 69, 1978; Zenkon. I. K to radiodiagnosis of cysticercosis of muscles, Vestn. rentgenol. and radio-gramophones., t. 26, No. 4, page 51, 1946; M and to with and m about in P. I. and And with-tafyevb. A. Helminthoses in medicolegal diagnosis, Chisinau, 1984; World of med of G. S., Murokhinb. Item and Artemenkov.V. Defeat by cysticercosis of a brain, meninx, hearts, diaphragms, Arkh. patol., t. 36, No. 10, page 74, 1974; The multivolume guide to microbiology, clinic and epidemiology of infectious diseases, under the editorship of Zhukov-Verezhnikov, t. 9, page 481, M., 1968; Ozeretskovsky H. N, Zalnova N. S. and Tumol-s to and I am N. I. Klinika and treatment of helminthoses, JI., 1984; Sinyachenko V. V., Kostenko E. A. and Shevtsova N. G. Multiple cysticercosis with damage of a brain, Klin, medical, t. 57, No. 9, page 108, 1979; Surgery of parasitic diseases, under the editorship of. And. JI. Bregadze and E. N. Wangqiang, M., 1976; Sh at l R. S. c and in about z d e in E. V. Bases of the general helminthology, t., 3, page 68, M., 1976; Beck J. W. a. D a v i e s J. E. Medical parasitology, p. 214, St Louis a. o., 1981; Intestinal protozoan and helminthic infections, Techn. Rep. Ser. No. 666, Geneva, WHO, 1981; R an i m e r S. a. W about 1 f J. E. Subcutaneous cysticercosis, Arch. Derm., v. 114, p. 107, 1978; Robles Castillo C.,
Tratamiento medico de la cisticercosis cerebral, Salud publ. Mexico, v. 23, p. 443, 1981. H. H. Ozeretskovskaya; P. S. Babayants (cysticercosis of skin), G. P. Nazarishvili
(rents.), B. S. Hominsky (stalemate. An.).