R Patnayak, D Kalyani, I Satish Rao, A Prayaga, C Sundaram, A Jena
cysticercosis, fine needle aspiration cytology
R Patnayak, D Kalyani, I Satish Rao, A Prayaga, C Sundaram, A Jena. Cysticercosis: The Hidden Parasite With Short Review Of Literature. The Internet Journal of Infectious Diseases. 2006 Volume 6 Number 1.
Cysticercosis is the most common parasitic infection of soft tissue. It is endemic in Latin America, Africa and Asia. In India it is more common in northern parts. The commonest sites of involvement include brain, muscle, eye and heart. Man occasionally serving as the larval host of
Materials and methods
In this retrospective study from January 2001-2006 there were 5 cases. In all the cases smears stained with Papanicolaou and May-Grünwald-Giemsa were reviewed.
Two cases presented with chest wall swelling, one case each with neck, axillary and calf muscle swelling. In all the five cases there was no clinical suspicion of C
On aspiration four of the swellings yielded clear fluid and pus was aspirated from one. Microscopically all the five cases showed features of inflammation comprising of both acute and chronic inflammatory cells, presence of calcospherules and fragments of wall of
Fine needle aspiration cytology is useful in the diagnosis of parasitic infections. For definitive diagnosis of
Kamal et al described presence of polymorphous inflammation and fragments of wall in subcutaneous cysticercosis 6. Verma etal studied aspirates from 182 cases of subcutaneous cysticercosis and semiquantitated the type and degree of inflammatory response, and the amount and preservation of the parasite. They concluded that the tissue response is variable with 88–92% being eosinophils, 50–70% palisading histiocytes, 68–80% epithelioid cell granulomas and 46–74% giant cells 7. In another large study of 132 cases by Khurana etal showed presence of calcospherules and fragments of wall in all the cases in addition to hooklets seen in 98 cases 8. In the present study clear fluid was aspirated in three cases and microscopically presence of inflammation, calcospherules and fragments of wall was seen in all the cases. These spherules represent the degenerated integument of the parasite found in the histologically excised cyst. They indicate the presence of an encysted flat worm, but are not specific for
Cysticercus generally presents as soft tissue swelling and is not clinically diagnostic as illustrated in the present study as well as in other studies where there was no clinical suspicion of cysticercus. In cases where clear fluid is aspirated diagnosis of cysticercus can be considered. A careful search for hooklets is indicated wherever there is clear fluid aspiration with eosinophil prominence. In our cases no hooklets were seen as in other studies, where however the diagnosis was proved by histopathological examination. (Table – 2)
Fine needle aspiration cytology in cysticercosis is low cost, out- patient procedure.
The authors wish to thank senior technician Mrs. Padmini for her help.