Epidemiology, transmission, and prevention of cysticercosis
- A Clinton White, Jr, MD, FACP, FIDSA
A Clinton White, Jr, MD, FACP, FIDSA
- Paul R Stalnaker Distinguished Professor of Medicine and Director, Infectious Disease Division
- Department of Internal Medicine
- University of Texas Medical Branch
Cysticercosis is caused by the larval stage of the tapeworm Taenia solium; clinical syndromes include neurocysticercosis and extraneural cysticercosis. In endemic areas, neurocysticercosis is an important cause of adult-onset seizures [1-6].
The epidemiology and transmission of cysticercosis will be reviewed here. The clinical manifestations, diagnosis, treatment, and prevention of cysticercosis and the life cycle of T. solium are discussed separately. (See "Clinical manifestations and diagnosis of cysticercosis" and "Treatment of cysticercosis" and "Intestinal tapeworms".)
Approximately 50 million people worldwide are estimated to have cysticercosis infection, although estimates are probably low since many infections are subclinical and there are relatively few population-based data on prevalence [5,7]. Cysticercosis is endemic in many regions of Central and South America, sub-Saharan Africa, India, and Asia [1-6,8]. The prevalence of cysticercosis varies within these countries and is often higher in rural or periurban areas where pigs are raised and sanitary conditions are suboptimal [1-5,8]. In some such communities, the rate of epilepsy approaches 3 percent, and 25 to 40 percent of these cases have evidence of cysticercosis [2-4,6].
Individuals with cysticercosis also present for medical attention outside of endemic areas, particularly where there are significant numbers of immigrants [9-12]. A review of a national database estimated that there were 18,584 hospitalizations for neurocysticercosis in the United States between 2003 and 2012 . In a prospective study of 1800 patients presenting with seizures to 11 United States emergency departments over a two-year period, neurocysticercosis was the etiologic agent in about 2 percent of cases . Neurocysticercosis was observed more frequently in emergency departments of Los Angeles, Phoenix, and Albuquerque (5.7 percent), which had a higher proportion of immigrant Hispanic patients than the other hospitals. Travelers to endemic areas represent another source of cysticercosis, although such infection accounts for a minority of cases in the United States [10,13,14].
Individuals with no history of pork consumption or travel to endemic areas can also develop neurocysticercosis. In a report of four cases in an Orthodox Jewish community (whose dietary laws strictly prohibit consumption of pork), infection was transmitted by domestic workers who had recently emigrated from Latin American countries where T. solium is endemic . Epidemiologic studies have demonstrated tight clustering in households; household contacts of patients with neurocysticercosis have a threefold higher risk of positive serology for cysticercosis in comparison with controls .
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