Tion of human taeniosis/ cysticercosis and porcine cysticercosis both diseases should be treated adequately. In theory, eradication of NCC through eradication of human taeniosis (destroying the source of infection and preventing the spread of cysticercosis, both in humans and in pigs)103 and porcine cysticercosis (prevention of new cases of taeniosis)103 seems possible. Although the term eradication has been replaced by `control and reduction of NCC’ in T. solium taeniosis/cysticercosis endemic areas,101,104,105 the aim is certainly still a valid one. How could this be achieved?Pathogens and Global HealthVOL .NO .WinklerNeurocysticercosis in sub-Saharan AfricaFor the control of human taeniosis mass drug administration of chemotherapeutics directed against T. solium (the adult pork tapeworm) to communities endemic for T. solium taeniosis/cysticercosis has been discussed at length, but so far no firm decision as to its instalment in sub-Saharan Africa has been reached.103 The drug of choice for treatment of human taeniosis would be niclosamide (2 g) in a single dose. It is not absorbed and therefore has virtually no side effects, but unfortunately it is not available in most countries of sub-Saharan Africa.104 Praziquantel, which is available, seems to be effective as well (dosage 5?10 mg/kg).104,106 However, when given by its own without steroids perifocal oedema get TSA around cysticerci in the brain or spinal cord may develop due to release of parasite antigen from viable cysticerci and may lead to neurological symptoms/signs in the treated individual (epileptic seizures, severe progressive headache; see above). So far, only case reports on the development of neurological symptoms/signs after administration of praziquantel have been published,32?4 but a large community-based study on neurological side effects after mass drug administration of praziquantel is underway. Another approach may be a more focally directed treatment as clustering of human cysticercosis around tapeworm carriers has been shown to be present.103,107,108 However, the uncertainty of the occurrence of undesirable neurological side effects still remains, although their detection seems more favourable in a focal setting rather than in whole communities. Considering transmission dynamics, chemotherapy of human taeniosis seems a crucial step towards control of NCC and definitely deserves further evaluation, whereas treatment of porcine cysticercosis (e.g. oxfendazole)109 seems more like an add-on procedure stabilizing the results of human chemotherapy.107 However, the combination of the above described measures, i.e. prevention/education and treatment of humans and pigs will have to be tailored to affected communities and strongly depends on local policies, financial means and available expertise, among others, and, in an ideal setting, should include all of the above components. In summary, symptomatic NCC may affect between one and three million people throughout T. solium taeniosis/cysticercosis endemic areas of sub-Saharan Africa. Asymptomatic cases are TSA site potentially at risk of developing neurological symptoms/signs through mass drug administration directed against schistosomiasis, lymphatic filariasis and soil-transmitted helminths. The clinical presentation of cysticercosis/NCC not only is determined by the prevailing genotype of T. solium cysticerci, which seems closely related to that of Latin America, but may also vary individually based on genetic, immunological and env.Tion of human taeniosis/ cysticercosis and porcine cysticercosis both diseases should be treated adequately. In theory, eradication of NCC through eradication of human taeniosis (destroying the source of infection and preventing the spread of cysticercosis, both in humans and in pigs)103 and porcine cysticercosis (prevention of new cases of taeniosis)103 seems possible. Although the term eradication has been replaced by `control and reduction of NCC’ in T. solium taeniosis/cysticercosis endemic areas,101,104,105 the aim is certainly still a valid one. How could this be achieved?Pathogens and Global HealthVOL .NO .WinklerNeurocysticercosis in sub-Saharan AfricaFor the control of human taeniosis mass drug administration of chemotherapeutics directed against T. solium (the adult pork tapeworm) to communities endemic for T. solium taeniosis/cysticercosis has been discussed at length, but so far no firm decision as to its instalment in sub-Saharan Africa has been reached.103 The drug of choice for treatment of human taeniosis would be niclosamide (2 g) in a single dose. It is not absorbed and therefore has virtually no side effects, but unfortunately it is not available in most countries of sub-Saharan Africa.104 Praziquantel, which is available, seems to be effective as well (dosage 5?10 mg/kg).104,106 However, when given by its own without steroids perifocal oedema around cysticerci in the brain or spinal cord may develop due to release of parasite antigen from viable cysticerci and may lead to neurological symptoms/signs in the treated individual (epileptic seizures, severe progressive headache; see above). So far, only case reports on the development of neurological symptoms/signs after administration of praziquantel have been published,32?4 but a large community-based study on neurological side effects after mass drug administration of praziquantel is underway. Another approach may be a more focally directed treatment as clustering of human cysticercosis around tapeworm carriers has been shown to be present.103,107,108 However, the uncertainty of the occurrence of undesirable neurological side effects still remains, although their detection seems more favourable in a focal setting rather than in whole communities. Considering transmission dynamics, chemotherapy of human taeniosis seems a crucial step towards control of NCC and definitely deserves further evaluation, whereas treatment of porcine cysticercosis (e.g. oxfendazole)109 seems more like an add-on procedure stabilizing the results of human chemotherapy.107 However, the combination of the above described measures, i.e. prevention/education and treatment of humans and pigs will have to be tailored to affected communities and strongly depends on local policies, financial means and available expertise, among others, and, in an ideal setting, should include all of the above components. In summary, symptomatic NCC may affect between one and three million people throughout T. solium taeniosis/cysticercosis endemic areas of sub-Saharan Africa. Asymptomatic cases are potentially at risk of developing neurological symptoms/signs through mass drug administration directed against schistosomiasis, lymphatic filariasis and soil-transmitted helminths. The clinical presentation of cysticercosis/NCC not only is determined by the prevailing genotype of T. solium cysticerci, which seems closely related to that of Latin America, but may also vary individually based on genetic, immunological and env.
