SAPUVETNET CYSTICERCOSISImpact on Public Health Case study Additional material: TAENIASIS CYSTICERCOSIS – A BIBLIOGRAPHIC REVIEW
SAPUVETNET Background • One afternoon, while Eduardo was going home from work, he suddenly felt a headache which he related to tiredness and stress. Once he got home, he took two acetylsalicylic acid tablets and went to rest. • The following day, as the headache had not stopped, he decided to see a doctor. Dr Perez prescribed ibuprofen advising him that if the pain did not go away he should go to the hospital for further tests.
SAPUVETNET Discuss and answer (1) • What would you have done in Eduardo’s situation? • What would you have suggested in Dr Perez’s place? www.netdoctor.es/ html/000146.html
SAPUVETNET • Two days later and still with the headache, Eduardo went to the General Hospital and had an appoinment at the neurology department. • The doctor in charge prescribed him a Computerised Axial Tomography (CAT). • CAT allowed to visualise some cystic forms disseminated in the cerebral parenchyma.
SAPUVETNET Discuss and answer (2) • What may the cystic forms observed in the brain suggest? • Is it necessary to carry out an additional test to confirm the tentative diagnosis?
SAPUVETNET • A suspected brain infection due to cysticercosis was confirmed through Immunoelectrotransfer Blot (EITB)tests. (positive to cysticercosis on 4 reactive bands). • Soon after, Eduardo had a copro-parasitological and serological tests which gave negative results for Taenia solium. • In the anamnesis there was no evidence of visits to endemic zones for cysticercosis and teniasis in or outside Peru.
SAPUVETNET Discuss and answer (3) • What is the biological cycle ofTaenia solium? • With the current background, could one speculate a particular kind of infection? • What additional information is needed?
SAPUVETNET • Eduardo informed that he was married and that he had two children: Gerardo, age 7 and Guillermo, age 4. He also told that they had a person working on domestic duties in the house since about 4 years. • Telling about his everyday habits, he said that he was the first person having breakfast and leaving the house, followed by his wife. His children used to leave afterwards to go to school, located at about 20 minutes from home. • One thing which considered important by the doctor was that the whole family, including the housekeeper, used the toilet before having breakfast.
SAPUVETNET Discuss and answer (4) • Does Eduardo’s testimony add information that allows to determine the source of infection? • What other steps should follow searching for the source of infection? www.calidalia.com/.../ content/view/full/3346
SAPUVETNET • The epidemiologists at the hospital recommended that all family members, the including the maid, should undergo a lab test for teniasis/cystercicosis • Results showed that the wife and children had 1 reactive band to cysticercosis and that the housekeeper was positive to both serological and copro-antigenic tests for Taenia solium.
SAPUVETNET Discuss and answer (5) • Do the found results allow you to interpret Eduardo’s infection mechanism? • How can you explain that the rest of the family did not show serological results similar to Eduardo’s? • What measures would you apply regarding the housekeeper? • How did she get teniasis? • Why did she not show any clinical symptoms? www.correodelmaestro.com/. ../1anteaula106.htm
SAPUVETNET • Carrying out the anamnesis with the housekeeper, she indicated that she was born and had lived in Parapuquio, a small village in the central sierra of Peru. Epidemiological studies carried out 3 years before had reported a seroprevalence of porcine cysticercosis of 60% and a prevalence of teniasis of 5%. From Patapuquio, she had gone to work at Eduardo’s house 4 years earlier.
SAPUVETNET • When asked about the knowledge she had about this disease, she mentioned that in her village the illness is known as “triquina” and that pigs infected are not eliminated and that they are usually sold at approximately a third of their value.
SAPUVETNET Discuss and answer (6) • With the information presented here,can you summarise how Eduardo could have got infected with cysticercosis? • What measures would you take with Eduardo? www.soton.ac.uk/~ceb/ Diagnosis/volume4.htm
SAPUVETNET • Which are the implications of selling pigs infected with cysticercosis? • Which measures would you take in order to diminish the prevalence of pig cysticercosis and human teniasis?
SAPUVETNET • Case study written by: • Néstor Gerardo Falcón Pérez • Guillermo Leguia Puente • The Authors would like to thank the “Grupo de Investigacion sobre Cisticercosis en Perú”, particularly Dr. Armando González and Dr. Hugo García, for making the information available for this case study. This material is available as an annex to help for the solution of the present case. Case study written by the members of SAPUVETNET II - Universidad Peruana Cayetano Heredia, Faculty of Veterinary Medicine and Zootechnics, Lima (Peru) contacts: Guillermo Leguia: email@example.com; Nestor Falcon: firstname.lastname@example.org