Abstract
Human cysticercosis, caused by the parasitic infection of Taenia Solium, is an important challenge for public health in Ecuador and other countries where poor sanitary conditions are a key factor for its appearance. In this series of cases, we publish the imaging findings corresponding to three patients treated in 2022 at the Center of Medical Specialties “Comité del Pueblo” Quito - Ecuador, in which, through radiographic images, multiple radiodense lesions were found in different anatomical regions which follow the typical pattern of distribution parallel to the muscular tissues of the affected region, generating the radiological sign known as “rice grain calcifications”, which corresponds to the presence of Disseminated Cysticercosis (DCC)in the muscular tissue of the host.
Introduction
Human cysticercosis, caused by a parasitic infection of Taenia Solium, is a major public health challenge. Ref. [1] and is considered by the World Health Organization (WHO) and the Food and Agriculture Organization (FAO) as a neglected disease [2].
This disease is common in developing countries in Asia, Africa, and Latin America, and although it has been absent for many years in Europe, its incidence has recently increased because of human migration from endemic countries for cysticercosis [1].
In Ecuador the geographical distribution of cysticercosis is heterogeneous, according to previous reports its prevalence varies between 0.94 and 4.99% [3]. Given that in Ecuador disseminated cysticercosis (DCC) is not a mandatory epidemiological reporting disease, there is significant underreporting.
In this series of DCC cases, we publish the imaging findings corresponding to three patients treated in the year 2022 at the “Comité del Pueblo” Center for Medical Specialties in the city of Quito in Ecuador.
After performing radiographs, multiple oval radiodense lesions were found, which follow the typical pattern of distribution parallel to the muscle tissues of the affected region, resulting in the radiological sign known as “rice grain calcifications” that correspond to DCC in the host muscle tissue (unusual clinical presentation in humans). It should be noted that the diagnosis of this pathology in all the patients presented was accidental since the imaging tests in which the calcifications were observed were requested to diagnose pathologies other than DCC.
It is important to mention that the cases reported in this series, together with one more previously published case [3], add up to a total of four cases of DCC diagnosed in the same health unit, in less than a year, this being a reflection of the large number of patients with DCC in the population treated at the Center of medical Specialties “Comite del Pueblo” of the I.E.S.S (Ecuadorian Institute of Social Security).
The report of patients with DCC will allow a better understanding of the epidemiological behavior patterns of this parasite in Quito-Ecuador, in addition to strengthening efforts to combat it in the regions with the highest prevalence.
Epidemiology
Cysticercosis is one of the main causes of death secondary to foodborne illnesses [4]. It is produced by raising pigs in unsanitary conditions, which generates parasitized pork. This meat, when eaten undercooked, allows the cysticerci to stay alive and continue their life cycle within the host [6].
According to the WHO, the total number of people with DCC is between 2.56 and 8.30 million [4]. Human Neurocysticercosis (NCC) is the most common parasitic disease of the central nervous system [5] and in developing countries the main cause of acquired epilepsy in adults [6].
Clinical Case 1: Male, 87 years old. Study performed: Anteroposterior X-ray of bilateral knees (Fig. 1).
Description: Anteroposterior X-ray of bilateral knees. White arrows indicate calcified lesions ¨rice grains calcifications¨ distributed in the muscles surrounding the knee. Source: Images from the “Comité del Pueblo” Center for Medical Specialties. Ecuadorian Institute of Social Security (I. E. S. S). Quito, Ecuador.
Clinical Case 2: Woman, 59 years old. Study carried out: Anteroposterior and lateral X-ray of the right knee (Fig. 2).
Anteroposterior and lateral radiographs of the right knee
Citation: Imaging 2023; 10.1556/1647.2023.00150
Anteroposterior and lateral radiographs of the right knee
Citation: Imaging 2023; 10.1556/1647.2023.00150
Anteroposterior and lateral radiographs of the right knee
Citation: Imaging 2023; 10.1556/1647.2023.00150
Description: A: Anteroposterior radiograph, B: Lateral radiograph; right knee. White arrows indicate calcified lesions ¨rice grains calcifications¨ distributed in the muscles surrounding the knee. Source: Images from the “People's Committee” Center for Medical Specialties. Ecuadorian Institute of Social Security (I.E.S.S). Quito, Ecuador.
Clinical Case 3: Man 68 years. Study carried out: anteroposterior and lateral X-ray of the right knee (Fig. 3).
Anteroposterior and lateral radiographs of the right knee
Citation: Imaging 2023; 10.1556/1647.2023.00150
Anteroposterior and lateral radiographs of the right knee
Citation: Imaging 2023; 10.1556/1647.2023.00150
Anteroposterior and lateral radiographs of the right knee
Citation: Imaging 2023; 10.1556/1647.2023.00150
Description: A: Anteroposterior radiograph, B: Lateral radiograph; right knee. White arrows indicate calcified lesions ¨rice grains calcifications¨ distributed in the muscles surrounding the knee. Source: Images from the “People's Committee” Center for Medical Specialties. Ecuadorian Institute of Social Security (I.E.S.S). Quito, Ecuador.
Discussion
Taenia solium causes cysticercosis and human taeniasis, a disease with a great impact on public health and the rural economy in tropical countries [7]. So far in Ecuador there are no specific studies that determine the prevalence of Taeniasis despite knowing that the control of this disease would improve the health conditions of the population, mainly in pediatric patients [7].
Previous studies have shown that the inadequate disposal of human and animal excrements contaminate the soil and water, incorrect food hygiene, inadequate sanitary infrastructure, lack of veterinary care and the proliferation of rodents are important ecological factors that favor the spread of zoonotic parasites such as Taenia Solium [8]. In Ecuador in 2018, the Health and Nutrition Survey (ENSANUT) showed a chronic malnutrition rate of 23.9%, data related to chronic parasitism in school-age children [9].
We also know that epilepsy is the most common and striking clinical manifestation of neurocysticercosis and can present with non-specific symptoms such as: headache, focal deficit, intracranial hypertension, or cognitive impairment, therefore neuroimaging studies are essential for diagnosis. Considering that epilepsy represents an important and expensive disease for those who suffer from it, in regions with a high prevalence such as Ecuador, it should be considered a public health problem and prioritize the control of Taeniasis since, as demonstrated in this work, it is the leading cause of acquired epilepsy in adults [2].
Efforts should be directed at eradicating the disease by implementing control programs against all steps in the life cycle of T. solium, including human infections, infected pigs, and eggs in the environment [2]. The necessary interventions, such as the adequate treatment of infected patients, responsible pig farming, improvement in water treatment processes and sanitary control of meat intended for human consumption [10], should be a priority for the control of this disease parasitosis.
Ethical statement
The work respects all ethical principles and maintains the anonymity of patient data.
Conflicts of interest
The authors declare no conflicts of interest.
Funding sources
Fully financed by the authors.
Acknowledgments
We acknowledge the work of the medical radiation technologist. Lenin Nivelo for taking the X-ray images.
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