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Current Issues in Cysticercosis: Proteins, Proglottids, Pigs, and Privies

  • Ralph T. Bryan

Abstract

Cysticercosis has existed since ancient times. The life cycle of the cestode responsible for this condition (Taenia solium) is often misunderstood. It is important to distinguish between taeniasis, an intestinal infection with the adult tapeworm, and cysticercosis, a tissue infection with larval T. solium. Humans are suseptible to both conditions. Clinically, cysticercosis exhibits great diversity. Neurocysticercosis is the most clinically significant form of the disease, but cysts can occur in almost any anatomic location. Geographic and age/gender-related differences in clinical manifestations also occur. Diagnosis depends on the appropriate use of radiologic, immunologic, and histopathologic techniques. Both surgical and medical treatments are available. The T. solium taeniasis/cysticercosis complex is endemic throughout the developing world where human consumption of inadequately cooked pork and swine husbandry practices favor transmission. The importance of person-to-person transmission is being increasingly recognized. Recent advances include the use of magnetic resonance imaging and improved immunologic techniques for diagnosis; alternative medical treatment with the new antiparasitic agent, albendazole; and recent epidemiologic insights into risk factors and transmission dynamics in both endemic and nonendemic areas.

Despite considerable progress, many unanswered questions remain. Future efforts should focus on controlled clinical trials, wider application of available technology, and expanded epidemiologic studies. Intervention efforts should emphasize education and social determinants of disease. Finally, better utilization of existing data to foster prevention is crucial. Despite a wide range of clinical and epidemiologic variables, the single most consistent and important aspect of this disease is that it is preventable.

Keywords

Autochthonous Case Taenia Solium Adult Tapeworm Porcine Cysticercosis Albendazole Therapy 
These keywords were added by machine and not by the authors. This process is experimental and the keywords may be updated as the learning algorithm improves.

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References

  1. 1.
    Nieto D (1982) Historical notes on cysticercosis. In: Flisser A, Willms K, Laclette JP, Larralde C, Ridaura C, Beltran F (eds) Cysticercosis: present state of knowledge and perspectives.Academic Press Inc, New York, pp 1–2Google Scholar
  2. 2.
    Acha PD, Szyfres B (1987) Zoonoses and communicable diseases common to man and animals. 2nd ed. Washington, DC, Pan American Health Organization, pp 749–760Google Scholar
  3. 3.
    Richards F, Schantz PM (1991) Laboratory diagnosis of cysticercosis. Clin Lab Med 11: 1011–1028PubMedGoogle Scholar
  4. 4.
    Beaver PC, Jung RC, Cupp EW (1948) Clinical parasitology. 9th ed. Philadelphia, Lee and Febiger, pp 512–519Google Scholar
  5. 5.
    Nash TE (1986) Diagnosis and treatment of cysticercosis. In: Remington JS, Swartz MN (eds) Current clinical topics in infectious diseases. New York, McGraw Hill 7: 297–310Google Scholar
  6. 6.
    Sotelo J, Guerrero V, Rubio F (1985) Neurocysticercosis: a new classification based on active and inactive forms. A study of 753 cases. Arch Intern Med 145: 442–445PubMedGoogle Scholar
  7. 7.
    Bittencourt PRM, Costa AJ, Oliveira TV, et al (1990) Clinical, radiological and cerebrospinal fluid presentation of neurocysticercosis, a prospective study. Arq Neuropsiquiatr (Sao Paulo) 48: 286–295Google Scholar
  8. 8.
    Scharf D (1988) Neurocysticercosis: two hundred thirty-eight cases from a California hosp i tal. Arch Neurol 45: 777–780PubMedGoogle Scholar
  9. 9.
    Del Brutto OH, Sotelo J (1988) Neurocysticercosis: an update. Rev Infect Dis 10: 1075–1087PubMedGoogle Scholar
  10. 10.
    Flisser A, Larralde C (1986) Cysticercosis. In: Walls KW, Schantz PM (eds) Immunodiagnosis of parasitic diseases. Helminthic diseases, Academic Press Inc, Florida, pp 109–161Google Scholar
  11. 11.
    Dixon HBF, Lipscomb FM (1961) Cysticercosis: An analysis and follow-up of 450 cases. In: Report Series No. 299. London, Her Majesty’s Stationary OfficeGoogle Scholar
  12. 12.
    Earnest MP, Reller LB, Filley CM, Grek AJ (1987) Neurocysticercosis in the United States: 35 cases and a review. Rev Infect Dis 9: 961–979PubMedGoogle Scholar
  13. 13.
    Wei GZ, Li CJ, Meng JM, Ding MC (1988) Cysticercosis of the central nervous system. A clinical study of 1400 cases. Chin Med J 101: 493–500PubMedGoogle Scholar
  14. 14.
    Nash TE, Neva FA (1984) Recent advances in the diagnosis and treatment of cerebral cysticercosis. N Engl J Med 311: 1492–1496PubMedGoogle Scholar
  15. 15.
    Rabiela MT, Rivas A, Flisser A (1989) Morphological types of T solium cysticerci. Parasitol Today 5: 357–358PubMedGoogle Scholar
  16. 16.
    Welsh NH, Peters AL, Crewe-Brown W, Blignaut P, Donnoli P, Da Souza BS, Javary Y (1987) Ocular cysticercosis. A report of 13 cases. S Afr Med J 71: 719–722PubMedGoogle Scholar
  17. 17.
    Santayo H, Corona R, Sotelo J (1991) Total recovery of visual function after treatment for cerebral cysticercosis. N Engl J Med 324: 1137–1139Google Scholar
  18. 18.
    Pansey BK, Basra KS, Pasricha R (1989) Medically treated cysticercosis in a blind child. A case report. Surg Neurol 32: 56–58PubMedGoogle Scholar
  19. 19.
    DiLoreto DA, Kennedy RA, Neigel JM, Rootman J (1990) Infestation of extraocular muscle by cysticercus cellulosae. Br J Ophthalmol 74: 751–752Google Scholar
  20. 20.
    Cheung YY, Steinbaum S, Yuh W, Chiu L (1987) MR findings in extracranial cysticercosis: case report. J Assist Tomography 11: 179–181Google Scholar
  21. 21.
    Chi JG, Sung RH, Cho SY (1988) Tissue parasitic diseases in Korea. J Korean Med Sci 3: 51–62PubMedGoogle Scholar
  22. 22.
    Vuong PN (1989) Fine needle aspiration cytology of subcutaneous cysticercosis of the breast: case report and pathogenic discussion. Acta Cyto 33: 659–662Google Scholar
  23. 23.
    Wadia N, Desai S, Bhatt M (1988) Disseminated cysticercosis. New observations, including CT scan findings and experience with treatment by praziquantel. Brain 111: 597–614PubMedGoogle Scholar
  24. 24.
    California Morbidity (1990) Cysticercosis in California. June 15, 1990, 23–24.Google Scholar
  25. 25.
    Loo L, Braude A (1982) Cerebral cysticercosis in San Diego: a report of 23 cases and a review of the literature. Medicine (Baltimore) 61: 341–359Google Scholar
  26. 26.
    Sotelo J, Marin C (1987) Hydrocephalus secondary to cysticercotic arachnoiditis. A long-term follow-up of 92 cases. J Neurosurg 66: 686–689PubMedGoogle Scholar
  27. 27.
    Sotelo J, Del Brutto OH, Penagos P, Escobedo F, Torres B, Rodriguez-Carbajal J, Rubio-Donnadieu F (1990) Comparison of therapeutic regimen of anticysticercal drugs for parenchymal brain cysticercosis. J Neurol 237: 69–72PubMedGoogle Scholar
  28. 28.
    Sotelo J, Escobedo F, Rodriguez-Carbajal J, Torres B, Rubio-Donnadieu F (1984) Therapy of parenchymal brain cysticercosis with praziquantel. N Engl J Med 310: 1001–1007PubMedGoogle Scholar
  29. 29.
    Robles C, Sedano AM, Vargas-Tentori N, Galindo-Virgen S (1987) Long-term results of praziquantel therapy in neurocysticercosis. J Neurosurgery 66: 359–363Google Scholar
  30. 30.
    Van Dellen JR, McKeon CP (1988) Praziquantel in active cerebral cysticercosis. Neurosurgery 22: 92–96PubMedGoogle Scholar
  31. 31.
    Rangel R, Torres B, Del Brutto O, Sotelo J (1987) Cysticercotic encephalitis: a severe form in young females. Am J Trop Med Hyg 36: 387–392PubMedGoogle Scholar
  32. 32.
    Del Brutto OH, Garcia E, Talarnas O, Sotelo J (1988) Sex-related severity of inflamation in parenchymal brain cysticercosis. Arch Intern Med 148: 544–546PubMedGoogle Scholar
  33. 33.
    Lopez-Hernandez A (1983) Clinical manifestations and sequential computed tomography scans of cerebral cysticercosis in childhood. Brain Dev 6: 269–277Google Scholar
  34. 34.
    Mitchell WG, Snodgrass SR (1985) Intraparenchymal cerebral cysticercosis in children: a benign prognosis. Neurol 1: 151–156Google Scholar
  35. 35.
    Mitchell WG, Crawford TO (1988) Intraparenchymal cerebral cysticercosis in children: diagnosis and treatment. Pediatr 82: 76–82Google Scholar
  36. 36.
    Reeder MM, Palmer PES (1981) The radiology of tropical diseases with epidemiogical, pathological and clinical correlation. Baltimore, The Williams and Wilkins Co, pp 911— 931Google Scholar
  37. 37.
    Byrd SE, Daryabagi J, Thompson R, Zant J, Locke GE, Biggers S (1985) The computed tomographic spectrum of cerebral cysticercosis. J Natl Med Assoc 78: 553–560Google Scholar
  38. 38.
    Gottstein B, Zini D, Schantz PM (1987) Species-specific immunodiagnosis of Taenia solium cysticercosis by ELISA and immunoblotting. Trop Med Parasitol 38: 299–303PubMedGoogle Scholar
  39. 39.
    Tsang VCW, Brand JA, Boyer AE (1989) An enzyme-linked immunoelectrotransfer blot assay and glycoprotein antigens for diagnosing human cysticercosis (Taenia solium) . J Infect Dis 159: 50–59PubMedGoogle Scholar
  40. 40.
    Tsang VCW, Pilcher JA, Zhou W, et al (1991) Efficacy of the imm uno blo t assay for cysticercosis in pigs and modulated expression of distinct IgM/IgG activities to Taenia solium antigens in experimental infections. Vet Immunol Immunopathol 29: 69–78PubMedGoogle Scholar
  41. 41.
    Nuñez R, Muñoz A, Nuñez C, Gomez B (1989) A micro ELISA for the diagnosis of cerebral cysticercosis. J Immunoassay 10: 169–178PubMedGoogle Scholar
  42. 42.
    Schantz PM, Sarti-Gutierrez E (1989) Diagnostic methods and epidemiologic surveillance of Taenia solium infection. Acta Leidensia 57: 153–163PubMedGoogle Scholar
  43. 43.
    Feldman M, Plancarte A, Sandoval M, Wilson M, Flisser A (1990) Comparison of two assays (EIA and EITB) and two samples (saliva and serum) for the diagnosis of neurocysticercosis. Trans R Soc Trop Med Hyg 84:559–562PubMedGoogle Scholar
  44. 44.
    Wilson M, Bryan RT, Fried JA, et al (1991) Clinical evaluation of the cysticercosis enzyme-linked immunoelectrotransfer blot (EITB)) in patients with neurocysticercosis. J Inf Dis 164: 1007–1009Google Scholar
  45. 45.
    Kung ITM, Lee D, Yu HC (1989) Soft tissue cysticercosis: diagnosis by fine-needle aspiration. Am J Clin Pathol 92: 834–835PubMedGoogle Scholar
  46. 46.
    Sparks AK, Neahe RC, Connor DH (1976) Cysticercosis. In: Binford CH, Connor DH (eds) Pathology of tropical and extraordinary diseases. Washington, DC, Armed Forces Institute of Pathology, pp 539–542Google Scholar
  47. 47.
    Trenes JO, Trelles L (1979) Cysticercosis of the nervous system. In: Vinken PJ, Bruyn GW (eds) Handbook of clinical neurology. Amsterdam, NY, North Holland, pp 291–320Google Scholar
  48. 48.
    Case Records of the Massachusetts General Hospital (Case 20–1990) (1990) N Engl J Med 322: 1446–1457Google Scholar
  49. 49.
    Binstock PD, Azimi PH, Williams RA (1987) Cerebral cysticercosis in a 22-month-old infant. Am J Clin Pathol 88: 655–658PubMedGoogle Scholar
  50. 50.
    Zhi-biao X Wen-kai C, Hui-lan Z, et al (1985) Praziquantel in treatment of cysticercosis cellulosae: report of 200 cases. Chin Med J 98: 489–494Google Scholar
  51. 51.
    Castano S, Botero D (1985) Treatment of neurocysticercosis with praziquantel in Columbia. Progress in Clinical Neurosciences 2: 220–321Google Scholar
  52. 52.
    Joubert J, Joubert MJ, Lombaard CM (1985) Neurocysticercosis: a comprehensive approach to medical treatment. South Afr Med J 68: 11–14Google Scholar
  53. 53.
    King CH, Mahmoud AAF (1989) Drugs five years later: praziquantel. Ann Intern Med 110: 290–296PubMedGoogle Scholar
  54. 54.
    Spina-Franca A, Nobrega JPS, Machado LR, Livramento JA (1989) Neurocisticercose e praziquantel: evolucao a longo prazo de 100 pacientes (Portugese with English Abstract) . Arq Neuropsiquiat 47: 444–448PubMedGoogle Scholar
  55. 55.
    Pearson RD, Guerrant RL (1983) Praziquantel: a major advance in antihelminthic therapy. Ann Intern Med 99: 195–198PubMedGoogle Scholar
  56. 56.
    Moodley M, Moosa A (1989) Treatment of neurocysticercosis: is praziquantel the new hope? Lancet 1: 262PubMedGoogle Scholar
  57. 57.
    Baranski MC (1984) Treatment of dermal cysticercosis with praziquantel. A new cestocidal agent. Rev Inst Med Trop Sao Paulo 26: 259–266PubMedGoogle Scholar
  58. 58.
    Richards F (1986) Praziquantel in the treatment of cysticercosis (Letter) . JAMA 256: 349–50Google Scholar
  59. 59.
    Richards F (1986) Diagnosis and treatment of neurocysticercosis. IM 7: 1–11Google Scholar
  60. 60.
    Woo E, Yu YL Huang CY (1988) Cerebral infarct precipitated by praziquantel in neurocysticercosis: a cautionary note. Trop Geogr Med 40: 143–146PubMedGoogle Scholar
  61. 61.
    Ciferri F (1988) Delayed CSF reaction to praziquantel (Letter) LancetGoogle Scholar
  62. 62.
    DeGhetaldi LD, Norman RM, Douville AW (1983) Cerebral cysticercosis treated biphasically with dexamethasone and praziquantel. Ann Intern Med 99: 179–181Google Scholar
  63. 63.
    Vasquez ML Helgi J, Sotelo J (1987) Plasma levels of praziquantel decrease when dexamethasone is given simultaneously. Neurology 37: 1561–1562Google Scholar
  64. 64.
    Joubert J (1990) Cysticercal meningitis: a pernicious form of neurocysticercosis which responds poorly to praziquantel. S Afr Med J 77: 528–530PubMedGoogle Scholar
  65. 65.
    Pawlowski ZS (1990) Cestodiases: taeniasis, cysticercosis, diphyllobothriasis, hymenolepiasis and others. In: Warrren KS, Mahmoud AAF (ed) Tropical and geographic medicine, 2nd ed. New York, McGraw Hill, pp 490–504Google Scholar
  66. 66.
    Trujillo-Valdes VM, Gonzalez-Barranco D, Orozco-Bohne R, et al (1981) Experimental treatment of cysticercosis with metrifonate. Arch Invest Med 12: 15–28Google Scholar
  67. 67.
    Skromme-Kadlubik G, Celis C (1981) Cysticercosis of the nervous system: treatment by means of specific internal radiation. Arch Neurol 38: 288Google Scholar
  68. 68.
    Tellez-Giron E, Ramos MC, Dufour L, et al (1984) Treatment of neurocysticercosis with flubendazole. Am J Trop Med Hyg 33: 627–631PubMedGoogle Scholar
  69. 69.
    Torres JR (1989) Use of praziquantel in populations at risk of neurocysticercosis (Letter) . Rev Inst Med Trop Sao Paulo 31: 290PubMedGoogle Scholar
  70. 70.
    Nemeth DJ (1989) Commentary: a study of the interactions of human, pig and the human pork tapeworm. Anthrozoos 3: 4–13Google Scholar
  71. 71.
    Salazar-Schettino PM (1983) Customs which predispose to Chagas’ disease and cysticercosis in Mexico. Am J Trop Med Hyg. 1983;32:1179–80.Google Scholar
  72. 72.
    Richards F, Schantz PM (1984) Cysticercosis and taeniasis (Letter) . N Engl J Med 312: 787Google Scholar
  73. 73.
    Sarti-Gutierrez EJ, Schantz PM, Lara-Aquilera R, et al (1988) Taenia solium taeniasis and cysticercosis in a Mexican village. Trop Med Parasitol 39: 194–198PubMedGoogle Scholar
  74. 74.
    Flisser A (1988) Neurocysticercosis in Mexico. Parasitol Today 4: 131–136PubMedGoogle Scholar
  75. 75.
    Gracia F, Chavarria R, Archibold C, et al (1990) Neurocysticercosis in Panama: preliminary epidemiologic study in the Azuero region. Am J Trop Med Hyg 42: 67–69PubMedGoogle Scholar
  76. 76.
    Sacks LV, Berkowitz I (1990) Cysticercosis in an urban black South African community: prevalence and risk factors. Trop Gastroenterol 11: 30–33PubMedGoogle Scholar
  77. 77.
    Schantz PM (1989) Surveillance and control programs for cestode diseases. In: Miller MJ, Love EJ (eds) Parasitic diseases: treatment and control. Florida, CRC Press, Inc, pp 275–290Google Scholar
  78. 78.
    Medina MT, Rosas E, Rubio-Donnadieu F, Sotelo J (1990) Neurocysticercosis as the main cause of late-onset epilepsy in Mexico. Arch Intern Med 150: 325–327PubMedGoogle Scholar
  79. 79.
    Gernmen M, Matayas Z, Pawlowski Z, et al (eds) (1983) Guidelines for Surveillance, Prevention and Control of Taeniasis/Cysticercosis. VPH/83.49. Geneva, WHO, pp 69–75Google Scholar
  80. 80.
    Muller R, Linywhite J, Bending JJ, Catford JC (1987) Human cysticercosis and intestinal parasitism amongst the Ekari people of Irian Jaya. J Trop Med Hyg 90: 291–296PubMedGoogle Scholar
  81. 81.
    Kent DL, Larson EB (1988) Magnetic resonance imaging of the brain and spine. Ann Intern Med 108: 402–424PubMedGoogle Scholar
  82. 82.
    Suss RA, Maravilla KR, Thompson J (1986) MR imaging of intracranial cysticercosis: comparison with CT and anatomopathologic features. AJNR 7: 235–242PubMedGoogle Scholar
  83. 83.
    Zee CS, Segall HD, Boswell W, et al (1988) MR imaging of neurocysticercosis. J Comp Assist Tomography 12: 927–934Google Scholar
  84. 84.
    Teitelbaum GP, Otto RJ, Lin M, et al (1989) MR imaging of neurocysticercosis. AJR 153: 857–866PubMedGoogle Scholar
  85. 85.
    Martinez HR, Rangel-Guerra R, Elizondo G, et al (1989) MR imaging in neurocysticercosis. AJNR 10: 1011–1019PubMedGoogle Scholar
  86. 86.
    Lotz J, Hewlett R, Alheit B, Bowen R (1988) Neurocysticercosis: correlative pathomorphology and MR imaging. Neuroradiol 30: 35–41Google Scholar
  87. 87.
    Sarti-Gutierrez E, Schantz PM, Plancarte A, et al (1991) Prevalence and risk factors for Taenia solium taeniasis and cysticercosis in humans and pigs in a village in Morelos, Mexico. Am J Trop Med Hyg (in press)Google Scholar
  88. 88.
    Diaz F, Garcia HH, Gilman R, et al (1991) Epidemiology of taeniasis and cysticercosis in a Peruvian tropical village. Am J Epidemiol (in press)Google Scholar
  89. 89.
    Garcia HH, Martinez M, Gilman R, et al (1991) Diagnosis of cysticercosis in endemic regions. Lancet 338: 549–551PubMedGoogle Scholar
  90. 90.
    Gonzalez AE, Cama V, Gilman RH, et al (1990) Prevalence and comparison of serologic assays, necropsy, and tongue examination for the diagnosis of porcine cysticercosis in Peru. Am J Trop Med Hyg 43: 194–199PubMedGoogle Scholar
  91. 91.
    Acosta E (1990) Antibodies to the metacestode of Taenia solium in the saliva from patients with neurocysticercosis. J Clin Lab Anal 4: 90–44PubMedGoogle Scholar
  92. 92.
    Correa D, Sandoval MA, Harrison LJS, et al (1989) Human neurocysticercosis: comparison of enzyme immunoassay capture techniques based on monoclonal and polyclonal antibod-ies for the detection of parasite products in cerebrospinal fluid. Trans Roy Soc Trop Med Hyg 83: 814–816PubMedGoogle Scholar
  93. 93.
    Choromanski L Estrada JJ, Kuhn RE (1990) Detection of antigens of larval Taenia solium in the cerebrospinal fluid of patients with the use of HPLC and ELISA. J Parasitol 76: 69–73PubMedGoogle Scholar
  94. 94.
    Rishi AK, McManus DP (1987) DNA probes which unambiguously distinguish Taenia solium from Taenia saginata (Letter). Lancet 1275–1276Google Scholar
  95. 95.
    Flisser A, Reid A, Garcia-Zepeda E, McManus DP (1988) Specific detection of Taenia saginata eggs by DNA hybridization (Letter). Lancet 1429–1430Google Scholar
  96. 96.
    Flisser A, Plancarte A, Correa D, et al (1990) New approaches in the diagnosis of Taenia solium cysticercosis and taeniasis. Ann Parasitol Hum Comp 65 [Suppl 1] : 95–98PubMedGoogle Scholar
  97. 97.
    Escobedo F, Penagos P, Rodriguez J, Sotelo J (1987) Albendazole therapy for neurocysticercosis. Arch Intern Med 147: 738–741PubMedGoogle Scholar
  98. 98.
    Escobedo F, Sotelo J, Penagos P, Rodriguez J, Del Brutto O (1989) Albendazole therapy for human neurocysticercosis, a controlled study with computerized tomography and magnetic resonance. Acta Leidensia 57: 247–254PubMedGoogle Scholar
  99. 99.
    Sotelo J, Penagos P, Escobedo F, Del Brutto OH (1988) Short course of albendazole therapy for neurocysticercosis. Arch Neurol 45: 1130–1133PubMedGoogle Scholar
  100. 100.
    Carpio A, Santiillan F, Leon P, Borreo A, Tinoco F(1988) New treatment of brain cysticercosis with albendazole (Abstract) . Ann Neurol 24: 144Google Scholar
  101. 101.
    Agapejev S, Meira DA, Barraviera B, et al (1988) Neurocysticercosis: treatment with albendazole and dextrochlorpheniramine (preliminary report) . Rev Inst Med Trop Sao Paulo 30: 387–389PubMedGoogle Scholar
  102. 102.
    Gupta R, Yupta NV (1990) Failure of praziquantel and albendazole in neurocysticercosis. JAPI 38: 313–314PubMedGoogle Scholar
  103. 103.
    Del Brutto OH, Sotelo J (1990) Albendazole therapy for subarachnoid and ventricular cysticercosis. J Neurosurg 72: 816–817PubMedGoogle Scholar
  104. 104.
    Jung H, Hurtado M, Medina MT, Sanchez M, Sotelo J (1990) Dexamethasone increases plasma levels of albendazole. J Neurol 237: 279–280PubMedGoogle Scholar
  105. 105.
    Quintero-Rodriquez E (1989) Praziquantel vs. albendazole for cysticercosis (Letter) . Neurosurgery 23: 128Google Scholar
  106. 106.
    Johnson KS, Harrison GB, Lightowlers MW, et al (1989) Vaccination against ovine cysticercosis using a defined recombinant antigen (Letter) . Nature 338: 585–587PubMedGoogle Scholar
  107. 107.
    Mitchell GH (1989) A vaccine for ovine cysticercosis (Editorial) . Vaccine 7: 379PubMedGoogle Scholar
  108. 108.
    Richards FO, Schantz PM, Ruiz-Tiben E, Sorvillo FJ (1985) Cysticercosis in Los Angeles County. JAMA 254: 3444–3448PubMedGoogle Scholar
  109. 109.
    Sorvillo FJ, Waterman SH, Richards FO, Schantz PM (1992) Cysticercosis surveillance: locally acquired and travel-related infections and detection of intestinal tapeworm carriers in Los Angeles county. Am J Trop Med Hyg (in press)Google Scholar
  110. 110.
    Centers for Disease Control (1992) Locally acquired neurocysticercosis — North Carolina, Massachusetts, and South Carolina, 1989–1991. MMWR 41: 1–4Google Scholar
  111. 111.
    Mata L (1982) Sociocultural factors in the control and prevention of parasitic diseases. Rev Infect Dis 4: 871–879PubMedGoogle Scholar

Copyright information

© Springer Science+Business Media New York 1992

Authors and Affiliations

  • Ralph T. Bryan
    • 1
  1. 1.Division of Parasitic Diseases, National Center for Infectious DiseasesCenters for Disease ControlAtlantaUSA

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