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 .To continue reading this article, you must log in with your personal, hospital, or group practice subscription. For more information on subscription options, click below on the option that best describes you:
- Montano SM, Villaran MV, Ylquimiche L, et al. Neurocysticercosis: association between seizures, serology, and brain CT in rural Peru. Neurology 2005; 65:229.
- Nicoletti A, Bartoloni A, Sofia V, et al. Epilepsy and neurocysticercosis in rural Bolivia: a population-based survey. Epilepsia 2005; 46:1127.
- Medina MT, Durón RM, Martínez L, et al. Prevalence, incidence, and etiology of epilepsies in rural Honduras: the Salamá Study. Epilepsia 2005; 46:124.
- Rajshekhar V, Raghava MV, Prabhakaran V, et al. Active epilepsy as an index of burden of neurocysticercosis in Vellore district, India. Neurology 2006; 67:2135.
- Ndimubanzi PC, Carabin H, Budke CM, et al. A systematic review of the frequency of neurocyticercosis with a focus on people with epilepsy. PLoS Negl Trop Dis 2010; 4:e870.
- Moyano LM, Saito M, Montano SM, et al. Neurocysticercosis as a cause of epilepsy and seizures in two community-based studies in a cysticercosis-endemic region in Peru. PLoS Negl Trop Dis 2014; 8:e2692.
- Budke CM, White AC Jr, Garcia HH. Zoonotic larval cestode infections: neglected, neglected tropical diseases? PLoS Negl Trop Dis 2009; 3:e319.
- Willingham AL 3rd, Engels D. Control of Taenia solium cysticercosis/taeniosis. Adv Parasitol 2006; 61:509.
- del la Garza Y, Graviss EA, Daver NG, et al. Epidemiology of neurocysticercosis in Houston, Texas. Am J Trop Med Hyg 2005; 73:766.
- Ong S, Talan DA, Moran GJ, et al. Neurocysticercosis in radiographically imaged seizure patients in U.S. emergency departments. Emerg Infect Dis 2002; 8:608.
- Sorvillo FJ, DeGiorgio C, Waterman SH. Deaths from cysticercosis, United States. Emerg Infect Dis 2007; 13:230.
- O'Neal SE, Flecker RH. Hospitalization frequency and charges for neurocysticercosis, United States, 2003-2012. Emerg Infect Dis 2015; 21:969.
- Del Brutto OH. Neurocysticercosis among international travelers to disease-endemic areas. J Travel Med 2012; 19:112.
- Croker C, Redelings M, Reporter R, et al. The impact of neurocysticercosis in california: a review of hospitalized cases. PLoS Negl Trop Dis 2012; 6:e1480.
- Schantz PM, Moore AC, Muñoz JL, et al. Neurocysticercosis in an Orthodox Jewish community in New York City. N Engl J Med 1992; 327:692.
- Goodman KA, Ballagh SA, Carpio A. Case-control study of seropositivity for cysticercosis in Cuenca, Ecuador. Am J Trop Med Hyg 1999; 60:70.
- Sorvillo F, Wilkins P, Shafir S, Eberhard M. Public health implications of cysticercosis acquired in the United States. Emerg Infect Dis 2011; 17:1.
- Coyle CM, Mahanty S, Zunt JR, et al. Neurocysticercosis: neglected but not forgotten. PLoS Negl Trop Dis 2012; 6:e1500.
- Gonzalez AE, López-Urbina T, Tsang BY, et al. Short report: secondary transmission in porcine cysticercosis: description and their potential implications for control sustainability. Am J Trop Med Hyg 2005; 73:501.
- Garcia HH, Del Brutto OH, Cysticercosis Working Group in Peru. Neurocysticercosis: updated concepts about an old disease. Lancet Neurol 2005; 4:653.
- García HH, Gilman RH, Gonzalez AE, et al. Hyperendemic human and porcine Taenia solium infection in Perú. Am J Trop Med Hyg 2003; 68:268.
- Lescano AG, Garcia HH, Gilman RH, et al. Taenia solium cysticercosis hotspots surrounding tapeworm carriers: clustering on human seroprevalence but not on seizures. PLoS Negl Trop Dis 2009; 3:e371.
- García HH, González AE, Del Brutto OH, et al. Strategies for the elimination of taeniasis/cysticercosis. J Neurol Sci 2007; 262:153.
- Garcia HH, Gonzalez AE, Tsang VC, et al. Elimination of Taenia solium Transmission in Northern Peru. N Engl J Med 2016; 374:2335.
- Gonzalez AE, Gauci CG, Barber D, et al. Vaccination of pigs to control human neurocysticercosis. Am J Trop Med Hyg 2005; 72:837.