Cysticercosis in Patiala (Punjab).
Cysticercosis in man usually manifests itself in a generalised form with widespread involvement of the subcutaneous tissues, muscles and brain. Cerebral cysticercosis causes the most serious and dramatic symptoms; the majority of the reported instances are, therefore, those of cerebral cysticercosis.
Although the man is the definitive host for adult worms of Taenia solium, at times his tissues become sites of larval encystment. The eggs of these helminths often gain entery to the alimentary tract by ingestion of undercooked, contaminated food as by auto-infection either due to unclean personal habits or by regurgitation of gravid segments from the intestine to the stomach. The eggs liberate embryos which penetrate the intestina mucosa and gain entery into the blood stream and settle in the various tissues of the body.
Although there are a few reports of human cysticercosis, published in this country, these do not give a proper epidemiological survey of the diseases in our country.,,,,,
This paper deals with a pattern of human cysticercosis seen in the patients admitted in the various units of the Rajendra Hospital attached to Medical College, Patiala.
One hundred and fifty-six cases of cysticercosis, histologically proved in the department of Pathology, Medical College, Patiala over a period of 27 years (January 1956 to March, 1983) have been analysed.
The general distribution of cysticercosis is given in [Table - 1]
Sex and age distribution
Among the 156 case of cysticercosis examined, 82 were males and 74 were females. The majority i.e. 146 out of 156 cases were seen during the age period of 0-40 years. The youngest patient was 2½ years old.
Site of distribution
The majority of the cases i.e. 137 (87.82%) presented with a solitary lesion. The most frequent sites for the solitary lesions were the upper, arm, chest wall, eye, abdominal wall, and neck followed by the tongue, face and breast. Six patients with solitary nodules presented with the history of epileptiform convulsions and out of these six cases, one showed radio-opaque shadow in the skull most probably due to calcified Cysticercus cellulosae. Multiple lesions, mostly subcutaneous or in the muscles, were present among 19 cases, out of which only three patients gave the history of epileptiform convulsions, which could be presumed to be suffering from cerebral cysticercosis though no cerebral biopsy was done. One patient presented with multiple cystic swellings of the peritoneum and on opening the abdominal cavity, multiple vesicles were seen in the peritoneal cavity.
A correct diagnosis of cysticercosis was made clinically in 63 cases (40.38%); the remaining cases were labelled as fibroma, lymphadenitis, hydatid cyst, sebaceous cyst, epidermoid cyst, cold abscess and in the case of the breast as adenoma or fibroadenoma. All the nine cases with epileptiform convulsions with solitary or multiple subcutaneous nodules were clinically suspected to have cystecercosis.
The sections from the specimens removed from all the cases showed typical larval stages of Cysticercus cellullosae. Many of these cases showed non-specific, chronic inflammation with predominant eosionophils and at times foreign body giant cell reaction [Fig. 1].
Nematode infestation is extremely common and greatly prevalent in certain parts of our country. However, there are only a few reports of human cysticercosis published in this country and the incidence of the same has not been accurately determined.,, Solitary lesion is the common mode of manifestation of cysticercosis and the majority of these solitary lesions are not suspected clinically but only made out by histopathological examination of the excised material. Malik et al observed solitary lesions in 68 amongst the 110 patients of human cysticercosis. Prabhakar et al reported 59 cases out of 78. In our series comprising of 156 cases, 137 presented with solitary lesions.
Occular involvement in cysticercosis has been reported frequently. ,,,,,, Sixteen cases of solitary cysticercosis occurred in the eye in our series.
Isolated cases of cerebral cysticercosis have been reported in the Indian literature.,,,,, In the present studies, there were 9 cases of cysticercosis having epileptiform convulsions.
Majority of the solitary lesions occurred in the upper arm, chest wall and abdominal wall, neck and eye. The lesions at these sites were located in the subcutaneous tissue or in the muscles.
Five cases occurred in the female breast; four in number have been reported to occur in the female breast by Prabhakar et al.
As reported by Prabhakar et al, the majority of the solitary lesions were located above the umbilical region and only six solitary lesions were in the lower extremities. The review of the literature on human cysticercosis confirms this observation. The reason for such sparing of the lower extremities is unknown.
One case had multiple vesicles in the peritoneal cavity with cystic lesions on the peritoneum and was clinically diagnosed as having mucous cysts. But these lesions were histopathologically turned out to be Cysticerus cellulosae. This is a very rare location and not reported in the literature.
We wish to thank Mr. O. P. Khosla, Photo-tine Officer of this institution for preparing the photomicrographs.