Calcified cysticercotic lesions and intractable epilepsy: a cross sectional study of 512 patients. endemic village. Understanding why active transmission stopped could provide insights on potential targets for control interventions. Atahualpa could provide an optimal scenario for longitudinal studies on the consequences of calcified NCC. Endemic areas for cysticercosis can be defined as places where all the interrelated steps needed for the completion of the life cycle of are present, including carriers harboring the adult parasite in the intestine, the practice of open-air defecation or improper disposal of human feces, the ability of free-roaming pigs to access human feces, and the consumption of undercooked pork.1 Once established in a given region, cysticercosis is difficult to eliminate. An historical example is the Enarotali region in Papua, which was free of cysticercosis until 1972, when Ekari people received a gift of infected pigs from the Indonesian government in Java. Soon thereafter, porcine cysticercosis and human taeniasis were diagnosed in the region, and an epidemic of human cysticercosis was observed among COG 133 natives.2 Nine years later, the disease spread to neighboring villages, and nowadays, it is still prevalent in the region.3 In other cases, however, elimination has been possible through improved sanitation, pig corralling, and education. The clearest example is the almost complete elimination of cysticercosis from Western Europe during the first half of the twentieth century. More recently, the prevalence of human neurocysticercosis (NCC) also decreased in urban centers of developing countries, COG 133 likely associated with development.4,5 In addition, some other examples exist at rural levels in developing countries, where enduring public health campaigns helped to reduce the disease burden, as shown in Salam (Honduras).6 COG 133 More recently, an intensive control program was conducted in Tumbes (Peru), involving several strategies directed to eliminate transmission. Results from this promising study provided robust evidence that transmission can be stopped in highly endemic villages after the combined COG 133 implementation of several active interventions.7 A major subsequent problem in many of these settings has been the continuous movement of people from endemic areas. This is the case of Western Europe and the U.S., where migration of people with taeniasis still cause new cases of active cysticercosis in both natives and immigrants, and migration of individuals with NCC results in significant numbers of symptomatic NCC cases attending their health systems.8,9 Spontaneously arrested transmission (in the absence of health education, improved sanitation, changes in lifestyles, or active control interventions) of this parasitic disease in an endemic population has not been ever documented. Atahualpa is a rural village located in Coastal Ecuador, where domestic pig raising is common and human cysticercosis has proven to be endemic.10 About 40% of pigs are not corralled and allowed to roam free in and around the houses and streets, being in close contact with humans (Figure 1). Atahualpa is remarkable for the homogeneous characteristics of its inhabitants regarding diet, socioeconomic status and living habits, the very low migration rate, and for the Rabbit polyclonal to EREG fact that pigs COG 133 are born and raised in the village (and not purchased from other places).11 According to our last door-to-door survey, about 20% of the houses still have open latrines for feces disposal, and evidence of open-air defecation still exists. Open in a separate window Figure 1. Free roaming pigs in Atahualpas streets and house backyards and in close contact with humans (reproduced with permission from ref. 11). This figure appears in color at www.ajtmh.org. The village hosts a field research center from the Universidad Espiritu Santo, Ecuador, where multiple epidemiological studies have been performed in close collaboration with the local population. As part of several studies aimed to assess the prevalence of neurological diseases, including NCC, a total of 1 1,273 (84%) out of 1 1,512 eligible villagers aged 20 years received a noncontrasted head computed tomography (CT) scan, after signing the informed consent form.12C14 CT showed lesions consistent with NCC in 121 cases (9.5%; 95% confidence interval: 8C11.3%). All of these individuals had calcified lesions in the brain parenchyma, but no other forms of NCC were seen on CT. In addition, none of these patients had previously received cysticidal agents in the past. As of August 2017, 494 participants, including 110 of the 121 individuals with NCC (91%) and 384 of 1 1,152 individuals without NCC on their CT scans (33%), also experienced a mind magnetic resonance imaging (MRI). MRIs did not detect any active cysticercotic lesion that might have been missed on CT (such as living.
Calcified cysticercotic lesions and intractable epilepsy: a cross sectional study of 512 patients
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