Cestodes

Question 1

Hymenopolis Nana clinical presentation?

Answer 1

Epigastric, diffuse abdominal pain
Anal pruritus and urticaria
Eosinophilia
CHOLANGITIS

Question 2

Diagnostic stage Hymenopolis Nana? Infective stage?

Answer 2

Dx:Eggs in stool
Ix: embryonated eggs

Question 3

Different types of echinocous?

Answer 3

E. Granulosus- cystic HD
E Multilocularis- Alveolar HD
E Vogeli: Polycyclic hydatid disease

Question 4

E Granulosus infective and diagnostic stage?

Answer 4

Infective: embryonated egg
Diagnostic: hydatic cyst

Question 5

Where is hydatid disease normally in humans?

Answer 5

Predominantly in Liver then lungs

Question 6

What are clinical manifestations of lung disease?

Answer 6

Thoracic pain, cough and haemoptysis. If it ruptures- get vomica, pleural and bronchial seeding

Question 7

Classic sign on CXR of hydatid cysts?

Answer 7

Waterlily sign

Question 8

How do you dx hydatid disease?

Answer 8

Imaging to see cysts and then Serology; ELISA, EITB

Question 9

What are indications for surgery in echinnocous?

Answer 9

Large cysts (>10cm)
Superficial, likely to rupture
Infected cysts
Mass effect

Question 10

What medical tx for hydatid cyst?

Answer 10

Albendazole continuous for 6 months
Check WBC and monitor trandaminases every 2 weeks for first 3 months

Question 11

When do you use albendazole?

Answer 11

Inoperable
Peritoneal disease
Cysts in >2 organs

Use 1 week before and 3 months after surgery

Question 12

When do you use PAIR?

Answer 12

CE1 ans CE3A liver cysts
NOT pulmonary

Question 13

What stages do you watch and wait for liver hydatid cysts?

Answer 13

CE4 and CE5

Question 14

What are the stages of liver cysts?

Answer 14

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

Question 15

How do you control hydatid disease?

Answer 15

Vaccinate dogs ans sheep
Give dogs praziquantel

Question 16

What is alveolar hydatid disease?

Answer 16

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

Question 17

Where is AHD found?

Answer 17

Predominatly in Northern hemisphere- Europe, Russia, China, Japan and North America

Question 18

Site of AHD main pathology,m

Answer 18

Liver (99%)
Causes painful hepatomegaly

Question 19

How do you treat AHD?

Answer 19

Albendazole long term + curative surgery

Question 20

What is polycyclic hydatid disease caused by?

Answer 20

Echinnocous Vogeli
Found in Central and northern South america

Question 21

What is pathology of polycystic hydatid?

Answer 21

Mainly in Liver
Multiple cystic masses
Painful hepatomegaly

Question 22

How do you tx polycystic hydatid?

Answer 22

Radical “curative” surgery
Perioperstive and long term albendazole

Question 23

What is dog tapeworm known as?

Answer 23

Dipylidium Caninum

Question 24

What are clinical features of Diplydoum Caninum?

Answer 24

Abdo pain, diarrhoea, irritability, eosinophilia
Proglotids pass out of anus and seen moving in stool

Question 25

Tx of Dipylidium Caninum?

Answer 25

Praziquantel Niclosamide

Question 26

What is diphyllobothrid linked to (fish tapeworm)

Answer 26

Vitamin B12 deficiency

Question 27

How do you diagnose diphyllobothriasis?

Answer 27

Egg in stool Tx with praziquantel single dose

Question 28

How do you get T Saginata?

Answer 28

Undercooked beef You shed the eggs or proglottids in stool Need single dose praziquantel

Question 29

What is Taena Asiatica?

Answer 29

Found in East Asia Cyst is found in liver of pigs Ingested Pork Liver (cysticeri in pigs)

Question 30

What is the global distribution of neurocysticercosis?

Answer 30

Anywhere with pigs Endemic in Asia, Africa, Latin America

Question 31

How do you get Taenia Solium?

Answer 31

Humans eat cysticercus in pork meat and get T Solium Or autoinfection of ingesting ova leads to cysticerosis

Question 32

What is pathogenesis of neurocysticercosis?

Answer 32

Viable cysts suppress host inflammatory response Older cysts lose the ability to suppress this inflammation Parenchyma inflammation leads to seizures

Question 33

What are the diff pathogenesis of neurocysticercosis?

Answer 33

-Parenchyma cysticerci; inflammation -calcified cysticerci; inflammation -Ventricular cysticerci; obstructive hydrocephalus -SA cysticeri; arachnoiditi assoc with vasculitis/stroke

Question 34

What is the most common form of cysticerosis from India?

Answer 34

A single enhancing lesion Need anti epileptics

Question 35

How do different forms of cysticercosis present?

Answer 35

SA: Chronic meningitis, stroke Calcified: Chronic epilepsy Ventricular: Obstructive hydrocephalus Single enhancing: benign prognosis Multiple cystic: recurrent seizures

Question 36

How does ocular cysticercosis prsent?

Answer 36

Retinal, intravitreala and anterior chamber Tx is usually surgical removal

Question 37

What is the absolute criteria of neurocysticercosis?

Answer 37

Ocular cysticercosis Seeing scolex within cystic lesion on neuroimaging Histological demonstration of parasite from biopsy of brain or spinal cord lesion

Question 38

What is major vs minor vs confirmatory neuroimaging criteria?

Answer 38

Major: cystic, enhancing or calcified lesions of NCC Minor: Obstructive hydrocephalus, meningeal enhancement Confirmatory: resolution

Question 39

What is exposure critera?

Answer 39

Antibody or antigen detected Cysticercosis outside of CNS Household contact with T solium Seizures or obstructive hydrocephalus Prior residence in endemic village

Question 40

What is the enzyme linked imminotransfer blot or Western blot for cysticercosis? Drawbacks?

Answer 40

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

Question 41

Tx of NCC?

Answer 41

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

Question 42

How do you manage SA NCC?

Answer 42

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

Question 43

How do you treat NCC in ventricles?

Answer 43

3rd and lateral ventricles-- endoscopic removal 4th ventricles-- Flexible scopes Usually don't need shunting afterwards

Question 44

What should you do before giving antiparastic drugs for NCC?

Answer 44

Eye exam

Question 45

How do you prevent cysticercosis?

Answer 45

mass chemotherapy of humans and pigs Vaccinate pigs

Question 46

What is a contraindication to antiparasitics?

Answer 46

Untreated raised ICP

Question 47

Key points from lecture:

Answer 47

Ventricular NCC better outcomes if surgically removed, usually neuroendoscopy SA NCC requires anti-inflammatories, intensive combo antiparasitics, Methotrexate and neuroendoscopy