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Clinical Characteristics

It may be difficult to establish the date of infection, but it is rare for individuals to have clinical signs in less than 2 years after visiting an endemic area. While the cysticercus is growing, there are mild and transient manifestations such as headache, irregular fever, myalgia, and a transient eosinophilia. In most patients, however, these symptoms are completely absent. The larvae in muscle give rise to few symptoms: palpable cystic soft tissue swellings can develop around them (Fig. 7.9). Some collapse and disappear within a few days and others may develop over a dozen or more years. The impression may be that these palpable swellings migrate, but the ability to feel them depends on distention of the cyst capsule with fluid after the parasite dies. Cysts occur almost anywhere over the body, but are rarely palpable in the hands or feet even when demonstrable radiologically.

Fig. 7.9. Cysticercosis in an adult African man showing numerous subcutaneous swellings caused by the larval stage of T. solium. (Courtesy of Dr. Herman Zaiman).

Heart block has been reported as a result of a cysticercus impeding cardiac conduction (Fig. 7.10A). Cysticerci may remain alive and unencapsulated in either chamber of the eye and may cause interruption of vision, retinitis, uveitis, and palpebral conjunctivitis. The clinical and imaging signs of neurocysticercosis (Fig. 7.10B) will be discussed later.

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Fig. 7.10. (A) Multiple cysticerci in the myocardium of the left ventricle. (B) Cerebral cysticercosis of the base of the brain. (A, B courtesy of Dr. Herman Zaiman).

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