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 al bendazole and prednisolone in the management of myocysticercosis. Design: Retrospective, noncomparative case series. Participants: Twenty-six consecutive patients with myocysticercosis, Intervention: 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 pe r day) and prednisolone (1.5 mg/kg body weight per day) for 4 weeks, Main Outcome Measures: Presence of scolex on CT scan compared to USG and cl inical response to medical therapy were the main outcome measures. Recovery was defined as complete resolution of the scoter or of the main presenting clinical feature. Results: Presence of scoter on CT scan (11 of 24) and USG (11 of 22) was no t 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 scoter were seen to progress to a cyst withou t scoter before final resolution. Time to recovery on treatment (0.5-35 mon ths) 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 antibo dies (P = 0.57, log-rank test) or the presence of scoter (P = 0.52, log-ran k test), Conclusions: Treatment with a combination of oral albendazole and prednisol one is effective in the management of myocysticercosis. Imaging methods CT and USG are equally effective in identifying the cyst and the scolex; seria l USG is useful in studying the temporal sequence of therapeutic response. The longer recovery time correlating with the duration of symptoms may indi cate the chronicity of the inflammatory changes requiring longer time for r ecovery.