Neurocysticercosis.
Neurocysticercosis.
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DOI：
10.1016/b978-0-7020-4088-7.00097-3
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发表时间：
2014-10-01
期刊：
影响因子：
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通讯作者：
Del Brutto, Oscar H
中科院分区：
文献类型：
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作者：
Del Brutto, Oscar H
囊尾蚴病在古代文明中被称为猪病，目前被认为是神经系统最常见的蠕虫感染，也是全球获得性癫痫的主要原因。当人类从受污染的食物中或最常见的是通过粪口途径直接从带绦虫携带者那里摄入虫卵，从而成为带绦虫的中间宿主时，就会发生这种疾病。一旦进入人体肠道，带绦虫卵就会进化成六钩蚴，然后穿过肠壁并停留在人体组织中-特别是神经系统-囊尾蚴在那里发育。大脑是一个敌对的环境，寄生虫试图逃避免疫监视，而宿主则试图驱逐感染。在某些情况下，囊尾蚴被这种免疫攻击摧毁，而在其他情况下，寄生虫可能多年不变。囊尾蚴可位于脑实质、蛛网膜下腔、脑室系统或脊髓中，引起无数的病理变化，这些病理变化是导致神经囊尾蚴病临床多形性的主要变化。癫痫发作是该病最常见的临床表现，但有些患者表现为局灶性缺陷、颅内高压或认知能力下降。除了囊性病变显示头节为偏心结节外，神经囊虫病的神经影像学表现无特异性，可见于其他神经系统疾病。同样，免疫诊断测试也面临着与灵敏度或特异性差有关的问题。在适当的流行病学情况下，在解释临床数据以及神经影像学研究结果和免疫学试验结果后，准确的诊断是可能的。杀囊药物的引入改变了脑囊虫病的预后。吡喹酮和阿苯达唑已被证明可以减轻大脑中的感染负担（如神经影像学研究所示），并改善大多数患者的临床病程。进一步的努力应针对消灭这种疾病，通过实施控制计划的所有相关步骤，在生命周期的T。脑囊虫病是一种常见的神经系统寄生虫病，是世界范围内获得性癫痫的主要病因。当人类通过无症状的带绦虫携带者的感染而摄入其卵后成为带绦虫的中间宿主时，就会发生这种疾病。在神经系统内，寄生虫可位于脑实质、蛛网膜下腔、脑室系统或脊髓中，引起导致疾病临床多形性的几种病理变化。癫痫发作是最常见的临床表现，但相当大比例的患者会出现局灶性功能障碍、颅内高压或认知功能下降。神经囊尾蚴病的术前诊断是可能的适当整合后，从神经影像学研究和免疫学试验的数据。杀囊药物（阿苯达唑和吡喹酮）改变了大多数脑囊虫病患者的预后。这些药物的使用已显示出减少中枢神经系统内的寄生虫负荷，并在许多情况下改善疾病的临床预后。未来的研究应侧重于通过实施控制计划来根除疾病，这些控制计划针对T solium生命周期中的所有相关步骤，包括成年绦虫的人类携带者、受感染的猪和环境中的虫卵。
Known as a disease of swine in ancient civilizations, cysticercosis is currently considered the most common helminthic infection of the nervous system, and a leading cause of acquired epilepsy worldwide. The disease occurs when humans become intermediate hosts of the tapeworm Taenia solium by ingesting its eggs from contaminated food or, most often, directly from a Taenia carrier by the fecal-oral route. Once in the human intestine, Taenia eggs evolve to oncospheres that, in turn, cross the intestinal wall and lodge in human tissues - especially the nervous system - where cysticerci develop. The brain is a hostile environment in which parasites attempt to escape the immune surveillance while the host is trying to drive out the infection. In some cases, cysticerci are destroyed by this immunological attack, while in others, parasites may live unchanged for years. Cysticerci may be located in brain parenchyma, subarachnoid space, ventricular system, or spinal cord, causing a myriad of pathologic changes that are the main changes responsible for the clinical pleomorphism of neurocysticercosis. Seizures are the most common clinical manifestation of the disease, but some patients present with focal deficits, intracranial hypertension, or cognitive decline. With the exception of cystic lesions showing the scolex as an eccentric nodule, neuroimaging findings of neurocysticercosis are nonspecific and may be seen in other diseases of the nervous system. Likewise, immune diagnostic tests have been faced with problems related to poor sensitivity or specificity. Accurate diagnosis is possible after interpretation of clinical data together with findings of neuroimaging studies and results of immunologic tests, in a proper epidemiologic scenario. The introduction of cysticidal drugs has changed the prognosis of neurocysticercosis. Praziquantel and albendazole have been shown to reduce the burden of infection in the brain (as seen on neuroimaging studies) and to improve the clinical course of the disease in most patients. Further efforts should be directed towards eradicating this disease through the implementation of control programs for all the interrelated steps in the life cycle of T. solium, including human carriers of the adult tapeworm, infected pigs, and eggs in the environment.Neurocysticercosis, the most common helminthic infection of the nervous system, is a major cause of acquired epilepsy worldwide. The disease occurs when humans become intermediate hosts of the tapeworm Taenia solium after ingesting its eggs by contagion from an asymptomatic Taenia carrier. Within the nervous system, parasites may locate in brain parenchyma, subarachnoid space, ventricular system, or spinal cord, causing several pathological changes that are responsible for the clinical pleomorphism of the disease. Seizures are the most common clinical manifestation, but a sizable proportion of patients develop focal deficits, intracranial hypertension, or cognitive decline. Preoperative diagnosis of neurocysticercosis is possible after proper integration of data from neuroimaging studies and immunological tests. Cysticidal drugs (albendazole and praziquantel) have changed the prognosis of most patients with neurocysticercosis. The use of these drugs has shown to reduce the parasite load within the central nervous system and to improve the clinical prognosis of the disease in many cases. Future studies should focus on disease eradication through the implementation of control programs against all the interrelated steps in the life cycle of T solium, including human carriers of the adult tapeworm, infected pigs, and eggs in the environment.