Neurocysticercosis In Papua, Indonesia

Introduction

Human neurocysticercosis, the infection of the nervous system by the larvae of Taenia solium, is a major cause of epileptic seizures and significant proportion of late-onset seizures in developing countries. Human cysticercosis occurs when a human host ingests infective eggs by fecal contamination and replaces the pig as intermediate host. Humans are the only host for the adult tapeworm and thus the only source of cysticercosis for pigs or other humans. Human cysticercosis occurs anywhere in the human body, but becomes symptomatic almost exclusively in the nervous system (NCC) or the eye.
Computed tomography and MRI provide objective evidence on the number and location of intracranial cysticerci, their viability, and the severity of the host inflammatory reaction against the parasites.

This is a case report of neurocysticercosis established at Central Hospital of Jayapura, Papua, Indonesia :

A 48-year-old man presented with recurrent general tonic-clonic seizures that worst in frequency since last six month before admitted to the hospital. Clinical examination founds dementia, hyperreflexia, retinal venous congestion and bilateral extensor toes response.

Neuroimaging findings by head CT scan is remarkable evidence of parenchymal NCC with vesicular (living) cysticerci as cystic lesions spreads within the brain parenchyma. The cyst wall is thin and isodense with the surrounding tissues and is generally not visible on imaging studies. The cyst fluid is hypodense and is clearly demarcated. These cysts lack perilesional edema, do not enhance after contrast medium administration, and characteristically show a bright nodule (hole-with-dot imaging) in their interior that represents the scolex.

Active cysticercus, before contrast

Active cysticercus, after contrast

By plain x-ray, some appearance of “calcified spindles” had been note linearly follows the muscle lines in the right shoulder muscles.

plain xray

Epidemiology:
Inlander lives in highland area of New Guinea Island have many communal tradition which makes possible the faeco-oral route and direct ingestion of undercooked pork which maintains the circle of this infectious disease. The ceremonial “Bakar Batu” in which meats cooked inappropriately utilizing hot river stones by burns it previously. All these tradition characterized the rural people in every village on highland area.