Cestodes Flashcards
Hymenopolis Nana clinical presentation?
Epigastric, diffuse abdominal pain
Anal pruritus and urticaria
Eosinophilia
CHOLANGITIS
Diagnostic stage Hymenopolis Nana? Infective stage?
Dx:Eggs in stool
Ix: embryonated eggs
Different types of echinocous?
E. Granulosus- cystic HD
E Multilocularis- Alveolar HD
E Vogeli: Polycyclic hydatid disease
E Granulosus infective and diagnostic stage?
Infective: embryonated egg
Diagnostic: hydatic cyst
Where is hydatid disease normally in humans?
Predominantly in Liver then lungs
What are clinical manifestations of lung disease?
Thoracic pain, cough and haemoptysis. If it ruptures- get vomica, pleural and bronchial seeding
Classic sign on CXR of hydatid cysts?
Waterlily sign
How do you dx hydatid disease?
Imaging to see cysts and then Serology; ELISA, EITB
What are indications for surgery in echinnocous?
Large cysts (>10cm)
Superficial, likely to rupture
Infected cysts
Mass effect
What medical tx for hydatid cyst?
Albendazole continuous for 6 months
Check WBC and monitor trandaminases every 2 weeks for first 3 months
When do you use albendazole?
Inoperable
Peritoneal disease
Cysts in >2 organs
Use 1 week before and 3 months after surgery
When do you use PAIR?
CE1 ans CE3A liver cysts
NOT pulmonary
What stages do you watch and wait for liver hydatid cysts?
CE4 and CE5
What are the stages of liver cysts?
CE1- unilocular, unechoic
<5cm= Albendazole
>5cm= Albendazole + PAIR
CE2- multisepated honeycomb cyst
Tx albendazole and either modified catheterisation or surgery
CE3A- cyst with detached membrane (waterlily sign)
<5cm= Albendazole
>5cm= Albendazole + PAIR
CE3B- cysts with daughter cysts
Albendazole and surgery
CE4- cyst with heterogenous hyper/hypoechoic (no daughter cysts)
Watch and wait
CE5- solid and calcified
Watch and wait
How do you control hydatid disease?
Vaccinate dogs ans sheep
Give dogs praziquantel
What is alveolar hydatid disease?
Caused by proliferative larval stage of fox tapeworm- echinnocous multilpcularis. Foxes and dog are definitive hosts and rodents are intermediate.
Man gets infected accidently and the metacestode stage develops in the liver
Where is AHD found?
Predominatly in Northern hemisphere- Europe, Russia, China, Japan and North America
Site of AHD main pathology,m
Liver (99%)
Causes painful hepatomegaly
How do you treat AHD?
Albendazole long term + curative surgery
What is polycyclic hydatid disease caused by?
Echinnocous Vogeli
Found in Central and northern South america
What is pathology of polycystic hydatid?
Mainly in Liver
Multiple cystic masses
Painful hepatomegaly
How do you tx polycystic hydatid?
Radical “curative” surgery
Perioperstive and long term albendazole
What is dog tapeworm known as?
Dipylidium Caninum
What are clinical features of Diplydoum Caninum?
Abdo pain, diarrhoea, irritability, eosinophilia
Proglotids pass out of anus and seen moving in stool
Tx of Dipylidium Caninum?
Praziquantel
Niclosamide
What is diphyllobothrid linked to (fish tapeworm)
Vitamin B12 deficiency
How do you diagnose diphyllobothriasis?
Egg in stool
Tx with praziquantel single dose
How do you get T Saginata?
Undercooked beef
You shed the eggs or proglottids in stool
Need single dose praziquantel
What is Taena Asiatica?
Found in East Asia
Cyst is found in liver of pigs
Ingested Pork Liver (cysticeri in pigs)
What is the global distribution of neurocysticercosis?
Anywhere with pigs
Endemic in Asia, Africa, Latin America
How do you get Taenia Solium?
Humans eat cysticercus in pork meat and get T Solium
Or autoinfection of ingesting ova leads to cysticerosis
What is pathogenesis of neurocysticercosis?
Viable cysts suppress host inflammatory response
Older cysts lose the ability to suppress this inflammation
Parenchyma inflammation leads to seizures
What are the diff pathogenesis of neurocysticercosis?
-Parenchyma cysticerci; inflammation
-calcified cysticerci; inflammation
-Ventricular cysticerci; obstructive hydrocephalus
-SA cysticeri; arachnoiditi assoc with vasculitis/stroke
What is the most common form of cysticerosis from India?
A single enhancing lesion
Need anti epileptics
How do different forms of cysticercosis present?
SA: Chronic meningitis, stroke
Calcified: Chronic epilepsy
Ventricular: Obstructive hydrocephalus
Single enhancing: benign prognosis
Multiple cystic: recurrent seizures
How does ocular cysticercosis prsent?
Retinal, intravitreala and anterior chamber
Tx is usually surgical removal
What is the absolute criteria of neurocysticercosis?
Ocular cysticercosis
Seeing scolex within cystic lesion on neuroimaging
Histological demonstration of parasite from biopsy of brain or spinal cord lesion
What is major vs minor vs confirmatory neuroimaging criteria?
Major: cystic, enhancing or calcified lesions of NCC
Minor: Obstructive hydrocephalus, meningeal enhancement
Confirmatory: resolution
What is exposure critera?
Antibody or antigen detected
Cysticercosis outside of CNS
Household contact with T solium
Seizures or obstructive hydrocephalus
Prior residence in endemic village
What is the enzyme linked imminotransfer blot or Western blot for cysticercosis?
Drawbacks?
Uses parasite glycoproteins and immunoblotting
Response to any 7 glycoproteins bands is considered positive
Sensitivity and specificity excellent, but Not in single or calcified lesions
Tx of NCC?
Anti epileptics + Praziquantel + albendazole + steroids especially for multiple cystic lesions
Praziquantel inhibits the break down of albendazole so boosts its effect
Combo therapy therefore recommended
How do you manage SA NCC?
Several months to over a year of albendazole
Prolonged course of anti-inflammatories
Methotrexate and Etanercept used to taper steroids
Follow up with MRI or Ag assays to see resolution
How do you treat NCC in ventricles?
3rd and lateral ventricles– endoscopic removal
4th ventricles– Flexible scopes
Usually don’t need shunting afterwards
What should you do before giving antiparastic drugs for NCC?
Eye exam
How do you prevent cysticercosis?
mass chemotherapy of humans and pigs
Vaccinate pigs
What is a contraindication to antiparasitics?
Untreated raised ICP
Key points from lecture:
Ventricular NCC better outcomes if surgically removed, usually neuroendoscopy
SA NCC requires anti-inflammatories, intensive combo antiparasitics, Methotrexate and neuroendoscopy
