Cysticercosis

Also known as: Pork Tapeworm Infection

Infection with the larval (cysticercus) stage of Taenia solium, acquired by ingesting T. solium eggs, distinct from intestinal taeniasis (the adult tapeworm infection acquired by eating undercooked infected pork containing cysticerci, which then mature into an adult tapeworm in the human intestine).

A tapeworm carrier (taeniasis) is themselves the source of eggs that, if ingested by that person or others (fecal-oral transmission, including autoinfection), cause cysticercosis, most significantly neurocysticercosis (see that dedicated entry for the CNS-specific presentation and management).

Intestinal taeniasis: stool microscopy for eggs or proglottids (though species differentiation from Taenia saginata on eggs alone is not reliable; proglottid morphology or PCR distinguishes species, an important distinction since only T. solium carriage poses a cysticercosis transmission risk)
Subcutaneous/muscular cysticercosis: palpable nodules, confirmed by ultrasound or excisional biopsy showing the characteristic cyst with scolex
Ocular cysticercosis: fundoscopic or slit-lamp examination
See Neurocysticercosis entry for CNS-specific diagnostic approach (MRI, serology, Del Brutto criteria)

Intestinal taeniasis: praziquantel 5 to 10 mg/kg PO as a single dose, or niclosamide 2 g PO single dose, both highly effective at eliminating the adult tapeworm and interrupting further egg transmission
Subcutaneous or muscular cysticercosis without CNS involvement: often managed conservatively (surgical excision of symptomatic nodules) without systemic antiparasitic treatment given the generally benign, self-limited course at these sites
Ocular cysticercosis: surgical removal is generally preferred over antiparasitic drug treatment, given the risk of a damaging inflammatory response to a dying cyst within the confined ocular space
Neurocysticercosis: see that dedicated entry for full antiparasitic and corticosteroid management detail
Public health: identification and treatment of tapeworm carriers, improved sanitation, and food safety education are the key preventive measures given the fecal-oral transmission route responsible for cysticercosis

Referral: infectious disease/tropical medicine; neurology for any CNS involvement (see Neurocysticercosis entry); ophthalmology for ocular disease.

Clinical toolsCalculators

BMI GCS EDD Parkland Formula

Corrected Sodium Corrected Calcium Anion Gap Creatinine Clearance Insulin Calculations qSOFA Wells PE Wells DVT CHA₂DS₂-VASc HAS-BLED CURB-65 Centor/McIsaac

Ureaplasma Infection

Ureaplasma urealyticum and Ureaplasma parvum are genital mycoplasmas that colonize the lower genital tract of a significant proportion of sexually active adults asymptomatically, making their role as true pathogens versus incidental colonizers genuinely debated and context dependent.

They are implicated in a subset of cases of non-gonococcal urethritis in men, and have been associated with chorioamnionitis, preterm birth, and neonatal complications (particularly bronchopulmonary dysplasia in very preterm infants) when ascending into the upper genital tract or amniotic cavity in pregnancy.

Most colonized individuals are entirely asymptomatic.

Where symptomatic, presentation in men is typically non-gonococcal urethritis: mild to moderate urethral discharge and dysuria, clinically indistinguishable from chlamydial or other causes of NGU without specific testing.

In pregnancy, ascending infection is associated with preterm labor and, in the neonate born very preterm, has been linked to congenital pneumonia and chronic lung disease.

NAAT testing is available where clinically indicated, though routine screening of asymptomatic individuals is not recommended given the high background colonization rate and uncertain clinical significance of a positive result in this context.

Testing is more appropriately reserved for men with persistent non-gonococcal urethritis symptoms after chlamydia, gonorrhea, trichomonas, and Mycoplasma genitalium have been excluded, or in specific reproductive or neonatal contexts where a causal role is being specifically investigated.

Doxycycline 100 mg PO bd for 7 days is first line where treatment is indicated (symptomatic urethritis with ureaplasma identified as the likely cause after excluding other pathogens)
Azithromycin 1 g PO single dose is an alternative
Macrolide resistance is increasingly recognized, and treatment failure should prompt reconsideration of the diagnosis or a change in agent (a fluoroquinolone such as moxifloxacin may be used in resistant or persistent cases, though evidence specific to ureaplasma is more limited than for Mycoplasma genitalium)
Treatment of asymptomatic colonization is not generally recommended, including in pregnancy, given the lack of clear evidence that treatment improves outcomes and given the very high background prevalence of colonization

Referral: sexual health services for persistent non-gonococcal urethritis; neonatology/infectious disease input where ureaplasma is implicated in a specific neonatal complication.

Cysticercosis

Overview

Clinical Features

Diagnosis

Management

Overview

Clinical Features

Diagnosis

Management