Myocysticercosis: experience with imaging and therapy.
OBJECTIVE
To compare computed tomography (CT) and B-scan ultrasonography (USG) in the diagnosis and to study the efficacy of a combination of oral albendazole and prednisolone in the management of myocysticercosis.


METHODS
Retrospective, noncomparative case series.


METHODS
Twenty-six consecutive patients with myocysticercosis.


METHODS
Diagnostic imaging was performed by CT scan and USG in 24 and 22 patients, respectively; serial USG was obtained in 7 patients receiving treatment. All patients received oral albendazole (15 mg/kg body weight per day) and prednisolone (1.5 mg/kg body weight per day) for 4 weeks.


METHODS
Presence of scolex on CT scan compared to USG and clinical response to medical therapy were the main outcome measures. Recovery was defined as complete resolution of the scolex or of the main presenting clinical feature.


RESULTS
Presence of scolex on CT scan (11 of 24) and USG (11 of 22) was not different (P = 1.0; chi-square test). Recovery was seen in 24 (92%) of 26 patients receiving medical treatment. On serial USG of patients receiving treatment (n = 7), cysts with scolex were seen to progress to a cyst without scolex before final resolution. Time to recovery on treatment (0.5-35 months) correlated with the duration of symptoms at presentation (correlation coefficient r = 0.56, P = 0.003, linear regression analysis), but not with positive serum enzyme-linked immunosorbent assay for anticysticercal antibodies (P = 0.57, log-rank test) or the presence of scolex (P = 0.52, log-rank test).


CONCLUSIONS
Treatment with a combination of oral albendazole and prednisolone is effective in the management of myocysticercosis. Imaging methods CT and USG are equally effective in identifying the cyst and the scolex; serial USG is useful in studying the temporal sequence of therapeutic response. The longer recovery time correlating with the duration of symptoms may indicate the chronicity of the inflammatory changes requiring longer time for recovery.
Sekhar
G C
GC
Center for Ophthalmic Plastic Surgery and Orbital Diseases, LV Prasad Eye Institute, Hyderabad, India. gcs@lvpeye.stph.net
Honavar
S G
SG
D000284:Administration, Oral; D000293:Adolescent; D000328:Adult; D015766:Albendazole / Q000627:therapeutic use*; D000893:Anti-Inflammatory Agents / Q000627:therapeutic use; D000981:Antiprotozoal Agents / Q000627:therapeutic use; D002648:Child; D002675:Child, Preschool; D003551:Cysticercosis / Q000175:diagnosis* / Q000188:drug therapy / Q000469:parasitology; D004359:Drug Therapy, Combination; D015822:Eye Infections, Parasitic / Q000175:diagnosis* / Q000188:drug therapy / Q000469:parasitology; D005260:Female; D006801:Humans; D008297:Male; D009801:Oculomotor Muscles / Q000000981:diagnostic imaging* / Q000187:drug effects / Q000469:parasitology; D009916:Orbital Diseases / Q000175:diagnosis* / Q000188:drug therapy / Q000469:parasitology; D011239:Prednisolone / Q000627:therapeutic use*; D012189:Retrospective Studies; D014057:Tomography, X-Ray Computed; D014463:Ultrasonography
D000893:Anti-Inflammatory Agents; D000981:Antiprotozoal Agents; D011239:Prednisolone; D015766:Albendazole