Key points
- Cysticercosis is a reportable disease in several states.
- Diagnosis often requires both imaging and serological testing.
- Lesion location and characteristics guide optimal treatment choices.
Considerations
A careful history should be taken, including
- Residency or long stays in developing countries.
- Consumption of food prepared by someone from a high-risk area.
Diagnosis often requires both imaging and serological testing.
A patient may have clinical disease from a single or very few cysticerci. In this instance, serological results may be negative, but the lesions may be visible on imaging.
A patient may have cysticerci in locations other than the brain. In this instance, CNS imaging is negative but serological results might be positive, indicating an antibody response to lesions elsewhere (e.g., the spinal cord).
The location and characteristics of the lesions on imaging, especially on MRI, are essential to determine the best treatment modalities.
Diagnostic imaging
Computerized tomography (CT) is superior to magnetic resonance imaging (MRI) for demonstrating small calcifications. CT and MRI usage in recent years identified neurocysticercosis cases with benign courses that were previously undetectable.
In comparison to CTs, MRIs:
- Are better at showing cysts in some locations (cerebral convexity, ventricular ependyma)
- Are more sensitive in order to demonstrate surrounding edema
- May show internal changes indicating the death of cysticerci.
Serological testing
There are two available serologic tests to detect cysticercosis:
- Enzyme-linked immunoelectrotransfer blot (EITB)
- Commercial enzyme-linked immunoassays
The EITB is the test preferred by CDC. Its sensitivity and specificity have been well characterized in published analyses.
More on: DPDx's Diagnostic Procedures
At least one commercial laboratory offers EITB testing. For additional testing for confirmation in cases where EITB is not available, contact the CDC Parasitic Laboratory directly at dpdx@cdc.gov or parasites@cdc.gov.
If this is an emergency, or you need assistance after business hours, call CDC's Emergency Operations Center at 770-488-7100.
Reporting cases
Cysticercosis is a reportable disease in several states. Healthcare providers should contact their state health department to determine if they require notification of patients testing positive for cysticercosis.