Thread by @IUIDfellowship

#idboardreview 27 F from rural Mexico exposure to 🐄🐖🐏🐕1 yr of progressive headaches, excessive drooling/ sweating, now with bladder/bowel incontinence, dec consciousness. diagnosis? #medEd #idmedEd

CT scan previously & recently were negative. +Single fluid-filled cystic lesion in sub-arachnoid space. Visualization of a fluid filled cyst with a scolex inside is diagnostic of #cysticercosis without further diagnostic or laboratory testing.

Serology often negative w/ other forms of neurocysticercosis who only have a single cyst but is almost always positive in subarachnoid disease regardless of cyst number.

#Cysticercosis is infection w/ larval stages of the human pork tapeworm Taenia solium. Humans acquire cysticercosis after ingesting eggs of T. solium in material contaminated with feces originating in human tapeworm carriers.

Humans that do not eat pork can get #cysticercosis. Ingestion of contaminated pork ➡️adult intestinal tapeworm – not cysticercosis. Cysticercosis is common in many developing countries. Ingested eggs hatch in stomach & carried to tissues ➡️larvae encyst & reach 1 cm w/in few mo

cysticerci evade immune system & remain viable for yrs w/o causing any inflammatory response: most infected pts are asymptomatic for yrs. Most clinical sx are direct result of inflammatory responses of eventual cyst degeneration, but most pts likely remain asx even as cysts die.

Epileptic seizures are primary manifestation in upto 80% of sx pts. In endemic regions new onset seizures in teenagers young adults is most likely due to neurocysticercosis. Symptoms also due to mass effect, impingement on vital structure or intraventricular cyst, CSF blockage

Urgent treatment: managing neurological complications, may require anticonvulsant therapy, corticosteroids, neurosurgical intervention +/- treatment of increased intracranial pressure. Albendazole use w/ caution as larval death provokes an inflammatory response that may inc sx

cdc.gov/parasites/cyst…