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ORIGINAL CONTRIBUTIONS
Year : 1990  |  Volume : 56  |  Issue : 2  |  Page : 115-118

Cutaneous, mucocutaneous and neurocutaneous cysticercosis




Correspondence Address:
P N Arora


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Source of Support: None, Conflict of Interest: None


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  Abstract 

Cutaneous cysticerci are often a pointer to the involvement of internal organs. A series of 33 patients including 5 vegetarians, between 10 to 48 years age, were investigated. Almost half the patients presented with cutaneous cysts of less than one month duration or were unaware of it. In the, other the duration varied upto 10 years. Cutaneous cysts were present in the case& Mental retardation, diminished vision and flashes of lights were, recorded in one case each, raised intracranial tension in 11 and seizures in 29 patients. Four, of the 6 patients with solitary cysts had no involvement of the internal- organs, whereas all the 27 patients with multiple had in nt of brain. Trunk was the commonest site in 16 patients. The other sites involved were scalp, eyelids, face, tongue neck, breast and limbs. Stool examination -for tapeworm segments/ eggs was positive in 2,calcification was seen on X-ray examination of skull in one and of soft tissues in 3, CT scan of skull was suggestive of cysticerci in 27 and skin biopsy for cysticercosis was confirmatory in all the 33 patients. Four patients with a solitary cutaneous cyst were treated by excision. One patients with neurocutaneous cysts was treated with albendazole without response. Out of 16patients with mucocutaneous and neurocutaneous cysticercosis treated with praziquantel, one did not respond. 7 responded partially and 8 had complete relief.


Keywords: Cysticercosis, Praziquantel


How to cite this article:
Arora P N, Sanchetee P C, Ramakrishnan K R, Venkataram S. Cutaneous, mucocutaneous and neurocutaneous cysticercosis. Indian J Dermatol Venereol Leprol 1990;56:115-8

How to cite this URL:
Arora P N, Sanchetee P C, Ramakrishnan K R, Venkataram S. Cutaneous, mucocutaneous and neurocutaneous cysticercosis. Indian J Dermatol Venereol Leprol [serial online] 1990 [cited 2020 Sep 22];56:115-8. Available from: http://www.ijdvl.com/text.asp?1990/56/2/115/3496


In India, the first case of cysticercosis involving the skin was recorded by Campbell and Thomson in 1912.[1] Earlier, in 1888, Arm­strong[2] had published the first case of cerebral cysticercosis which was followed by the report of a case of mucous membrane involvement by cysticercus.[3] Subsequently there have been a few case reports[4],[5],[6],[7],[8],[9],[10],[11] of cutaneous cysticercosis. Reddy et al[12] reviewed biopsies of cysticercosis in 20 cases, out of which 12 were subcutaneous.

The therapy advocated for cysticercosis in the past was surgical excision irrespective of the site. We found encouraging results with praziquantel. It has not been mentioned in some of the modern text books of derma­tology[13],[14],[15] We are reporting our experience in 33 cases.


  Materials and Methods Top


The material for this study included 33 cases of cysticercosis seen between January 1986 and June 1988. The diagnosis was confirmed by histopathology.

Detailed clinical findings of individual patients were recorded. Each patient underwent investigations like stool examination for segments or eggs of tapeworm, hemoglobin estimation, total and differential white cell count, urinalysis, radiological examination of skull and soft tissues for calcification, electroencephalographie studies (EEG), computerised tomographic (CT) scan of skull, and skin biopsy for microscopic examina­tion. Cutaneous cysts without involvement of the internal organs were treated with excision. Cysticercosis - with involvement of internal organs were treated with praziquantel 50 mg per kg body weight per day, with a maximum of 3.0 gm daily for 15 days, or albendazole 400 mg daily for 30 days. One patient in the series died for which autopsy was performed. All the remaining patients are under follow up.


  Results Top


The largest number (75.8%) of patients were between 21 to 40 years in age. There were 29 males and 4 females. Five patients were vegetarian. Sixteen (48.5%) patients presented with cutaneous lesions of less than one month duration, or were unaware of the cysts. The dura­tion of cutaneous lesions in the remaining varied upto ten years. Mental retardation, diminished vision and flashes of lights were recorded in 1 (3.0%) case each, raised intracranial tension in 11 (33.3%), seizure in 29 (87.91%) and cutane ous cysts in all the 33 (100.0%). Solitary cyst was present in 6 (18.2%), 23 (69.7%) had less than 10 cysts and 4 (12.1 %) had more than 10 cutaneous cysts. Trunk was the commonest site in 16 (48.5%) patients. The other sites involved were scalp, eyelids, face, tongue, neck, breast, upper limbs and thighs. Stool examination for tapeworm segments; eggs was positive in 2 (6.0%). Radiological examination revealed calcification in of skull 1 (3.0%) and soft tissues in 3 (9.1%). EEG revealed seizure discharge in 29 (87.9%) patients, not suggestive of any specific diagnosis. CT scan of brain revealed cysticercosis in 27 (81.9%). Skin biopsy confirmed the diagnosis of cysticercosis in all the 33 (100%) patients. Autopsy of the solitary fatal case revealed multiple cysticerci in the brain and subcutaneous tissues. Four patients of cutaneous cysticercosis with no involvement of the internal organs, were treated with excision. One patient with neurocutancous cysts was treated with albendazole without any response. Out of 16 (48.5%) cases having mucocutaneous and neurocutaneous cysticercosis treated with praziquantel, 1 (3.0%) patient did not respond to the drug, 7 (2.1.2%) responded partially and 8 (24.2%) had complete relief. Three (9.1.%) patients developed recurrent seizures and raised intracranial tension and one (3.0%) developed fresh cutaneous cysts during the course of treatment. All these side effects were of transient nature.


  Comments Top


Human cysticercosis,[16] a potentially deadly infestation,[17] is the consequence of ingestion of eggs of Taenia solium present in contaminated food or water or unwashed hands or by means of an autoinoculation resulting from reverse peristalsis.[18] Cysticercosis and intestinal infes­tation with Taenia solium are extremely rare in developed countries.[16] Although there are no series of cutaneous cysticercosis, yet large series of central nervous' system cysticercosis attest to its frequency in India,[19] China,[20] Mexico[21] and Eastern Europe.[22]

Cutaneous cysticercosis, often believed to be common in poor and non-vegetarians, did not appear to respect the social status in the present study. All the vegetarian patients in the present study were fond of eating raw vegetables possibly leading to ingestion of the ova.

Two patients developed central nervous system involvement after 4 to 6 months of cutaneous cysticercosis, 4 patients developed cutaneous, mucocutaneous and neurocutaneous cysts almost simultaneously and 23 developed the cutaneous lesions one month to 13 years after having developed the neurological mani­festations. When man acts as the intermediate host, the larva may migrate to almost any organ and may remain viable for as long as 56 years.[23] Clinical manifestations of neurocys­ticercosis recorded in the present study are well documented. [21] Raised intracranial tension was the cause of death in one patient.

Solitary cutaneous cysts were present in 6 patients, 4 of these had no involvement of inter­nal organs, while 2 had associated neurccysticer cosis; whereas in all the patients with more than one cutaneous cyst, the internal organs were involved. Maximum number of cysts were present on the trunk and none on the shins, bands and feet. This appears proportional to the amount of subcutaneous tissue at the affected sites.

Investigations revealed segments/ova in the stools in only 2(6%) patients and yet clinical manifestations of abdominal discomfort, chronic indigestion, and/or diarrhoea alternating with constipation were conspicuously absent in all our cases. Eosinophilia was also not recorded even in a single patient. Radiological examina­tion revealed calcified cysts in the skull of 1 and in the soft tissues in 3 patients. All the four patients had been harbouring cysts for more than five years. Soft tissue roentgenograms were normal in all the remaining who had been harbouring cysts for less than 5 years. Two patients of idiopathic epilepsy with no cutaneous lesions had non-specific findings on CT scans. Subsequently, when the cutaneous cysts appeared in these two patients, these confirmed the diagnosis of neurocysticercosis. Skin biopsy remains the single most important investigation to prove the diagnosis of cysticercosis.

For the treatment of taeniasis, various drugs, e g extract of male fern, mepacrine, organic tin compounds, niclosamide and paromomycin have been used with varying degrees of success.[25] Metrifonate[25] and albendazole[27] have been reported effective in, cutaneous cysticercosis. We treated one patient of neurocutaneous cysticercosis with albendazole without any benefit. The therapeutic effect of praziquantel against cerebral cysticercosis were first reported by Rim[28] from South Korea. Out of 16 patients treated with praziquantel by us, 7 patients had partial and eight had complete response in the form of disappearance of cutaneous cysti­cerci within 1 to 3 months and neurocysticerci in 3 to 9 months. Tests on clinical haematology and urinalysis before and after treatment in all the cases revealed no abnormality.

 
  References Top

1.Campbell TV and Thomson T T: A case of mul­tiple cysticercus cellulosae, Ind Med Gaz, 1912; 47 : 145-146.  Back to cited text no. 1    
2.Armstrong H : Proceedings of South Indian Branch of British Medical Association : Cysticer­cosis, Ind Med Gaz, 1888; 23 : 251-252.  Back to cited text no. 2    
3.Elliot RH and Ingram AC : A case of subconjunc­tival cysticercus cellulosae, Ind Med Gaz, 1911; 46 : 215-217.  Back to cited text no. 3    
4.Reddy DJ, Rao TS, Gupta KG et al : Cysticercosis, Ind J Med Se, 1956; 10 : 389-390.  Back to cited text no. 4    
5.Banerjee D : Cysticercosis, J Ind Med Assoc, 1958; 30 : 157-159.  Back to cited text no. 5    
6.Wahi PL and Chugh KS : Cysticercosis, Punjab Med J, 1958; 7 : 233-236.  Back to cited text no. 6    
7.Sadana DN : Report on a case of generalised cysticercosis, Armed Forces Med J India, 1960; 18 : 168-170.  Back to cited text no. 7    
8.Sainani GS and Saoji MH : Cysticercus cellulosae. Ind J Med Sci, 1964; 18 : 330-334.  Back to cited text no. 8    
9.Prakash C : Cysticercosis with taeniasis in a vegetarian, J Trop Med Hyg, 1965; 78 : 109-112.  Back to cited text no. 9    
10.Misra RS, Dharampal and Bikhchandani R : A review of cysticercosis cellulosae with two case reports, Ind J Dermatol Venereol, 1970; 36: 164-168.  Back to cited text no. 10    
11.Chandra J and Sengupta P : Subcutaneous cysticercosis : Report of five cases, Ind J Dermatol, 1983; 28 : 85-89.  Back to cited text no. 11    
12.Reddy DS, Murthy VR and Sarala Devi M Cysticercosis, Antiseptic, 1967; 64 : 819-824.  Back to cited text no. 12    
13.Harman RRM : Parasitic worms and protozoa, in : Textbook of Dermatology, 4th ed, Editors, Rook A, Wilkinson DS, Ebling FJG et al Oxford University Press, Bombay, 1987; p 1011-1012.  Back to cited text no. 13    
14.Farah FS : Protozoan and helminth infections, in : Dermatology in General Medicine, 3rd ed, Editors, Fitzpatric TB, Eisen AZ, Wolff K et al McGraw Hill, New York, 1987; p 2488-2489.  Back to cited text no. 14    
15.Domonkos AS, Arnold HL and Odom RB Andrew's Diseases of the Skin, 7th ed, WB Saunders, London, 1982, p 541.  Back to cited text no. 15    
16.Chatterjee KD . Parasitology, 7th ed, Sree Saras­wathy Press, Calcutta, 1969; p 113-117.  Back to cited text no. 16    
17.Raimer S and Wolf JE Jr : Subcutaneous cysticer­cosis, Arch Dermatol, 1978; 114 : 107-108.  Back to cited text no. 17    
18.Wilcocks C and Manser-Bahr PEC : Manson's Tropical Diseases, 17th ed, Williams and Wilkins, Baltimore, 1972; p 338.  Back to cited text no. 18    
19.Abuja GK, Roy S and Kamala G : Cerebral cysticercosis, J Neurol Sci, 1978; 35 : 356-374.  Back to cited text no. 19    
20.Feng Y, Quyang S and Xhou X : Clinicoencepha­lographic studies of cerebral cysticercosis of 158 cases, Chin Med J, 1979; 92 : 770-786.  Back to cited text no. 20    
21.Lomardo L and Matcos JH : Cerebral cysticercosis in Mexico, Neurology, 1961; 11 : 824-828.  Back to cited text no. 21    
22.Stephen L : Cerebral cysticercosis in Poland Clinical symptoms and operative results in 132 cases, J Neurosurg, 1962; 19 : 505-513.  Back to cited text no. 22    
23.Hunter GH, Freys WW and Swartozwelder JC : A Manual of Tropical Medicine, WB Saunders, Philadelphia, 1966; p 572-576.  Back to cited text no. 23    
24.Walton J : Brain's Diseases of the Nervous System, 9th ed, Oxford University Press, Bombay, .1986; p 135-182.  Back to cited text no. 24    
25.Davis A and Wagner HG : Multicentric trial of praziquantel in human schistosomiasis : Designs and Tcchnics, Bull WHO, 1979; 57 : 767-771.  Back to cited text no. 25    
26.Tschen EH, Tschen EA and Smith EB : Cutaneous cysticercosis treated with metrifonate, Arch Dermatol, 1981 ; 117 : 507-509.  Back to cited text no. 26    
27.Heath DD, Christi MJ and Chevis RAF : The lethal effects of mebendazole on secondary Echino­coccus granulosus, cysticerci of Taenia piciforinis and Tetrathyridia of Mesocestoides (orli, Parasi­tology, 1975; 70 : 273-285.  Back to cited text no. 27    
28.Rim HJ, Park SB, Lee JS et al : Therapeutic effects of praaiquantel against Taenia soliunt infection, The Korean J Parasitology, 1979; 17 67-72.  Back to cited text no. 28    



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