Volume 96, Issue 1
  • ISSN: 0002-9637
  • E-ISSN: 1476-1645



An estimated 50 million persons worldwide are infected with cysticerci, the larval forms of the tapeworm. Neurocysticercosis can cause seizures, epilepsy, and hydrocephalus, and fatal cases have been reported in the United States in immigrants and in travelers returning from endemic countries. Pregnant women with symptomatic neurocysticercosis present treatment challenges, whereas those with the adult tapeworm infection (i.e., taeniasis) can put their infants and other family members, as well as obstetrician-gynecologists and their staff, at risk for cysticercosis. A questionnaire developed by the American College of Obstetricians and Gynecologists was sent to a representative sample of 1,000 physicians to assess their awareness of infection and the potential for it to be encountered in an obstetrics and gynecology setting. In total, 31.4% of respondents correctly answered that taeniasis is caused by eating undercooked pork containing cysts (95% confidence interval [CI] = 26.6–36.5). While only 14.5% (95% CI = 11.0–18.6) of respondents correctly answered that cysticercosis is acquired by ingesting tapeworm eggs shed in human stools, twice that number (30.3%; 95% CI = 25.5–35.3) correctly answered that a mother with taeniasis can cause cysticercosis in her infant. Practicing in a state in which cysticercosis was reportable at the time of the survey was not significantly associated with answering any of the 12 knowledge questions correctly. Overall, knowledge of infection among U.S. obstetricians-gynecologists is limited. This may result in missed opportunities to diagnose and treat pregnant women with taeniasis, which may put family members and obstetrics clinical staff at risk for cysticercosis.


Article metrics loading...

Loading full text...

Full text loading...



  1. Garcia HH, Gonzalez AE, Evans CA, Gilman RH, Cysticercosis Working Group in Peru; , 2003. Taenia solium cysticercosis. Lancet 362: 547556.[Crossref]
  2. Roman G, Sotelo J, Del Brutto O, Flisser A, Dumas M, Wadia N, Botero D, Cruz M, Garcia H, de Bittencourt PR, Trelles L, Arriagada C, Lorenzana P, Nash TE, Spina-Franca A, , 2000. A proposal to declare neurocysticercosis an international reportable disease. Bull World Health Organ 78: 399406.
  3. Moyano LM, Saito M, Montano SM, Gonzalvez G, Olaya S, Ayvar V, Gonzalez I, Larrauri L, Tsang VC, Llanos F, Rodriguez S, Gonzalez AE, Gilman RH, Garcia HH, Cysticercosis Working Group in Peru; , 2014. Neurocysticercosis as a cause of epilepsy and seizures in two community-based studies in a cysticercosis-endemic region in Peru. PLoS Negl Trop Dis 8: e2692.[Crossref]
  4. Allan JC, Velasquez-Tohom M, Torres-Alvarez R, Yurrita P, Garcia-Noval J, , 1996. Field trial of the coproantigen-based diagnosis of Taenia solium taeniasis by enzyme-linked immunosorbent assay. Am J Trop Med Hyg 54: 352356.
  5. Cruz M, Davis A, Dixon H, Pawlowski ZS, Proano J, , 1989. Operational studies on the control of Taenia solium taeniasis/cysticercosis in Ecuador. Bull World Health Organ 67: 401407.
  6. Cantey PT, Coyle CM, Sorvillo FJ, Wilkins PP, Starr MC, Nash TE, , 2014. Neglected parasitic infections in the United States: cysticercosis. Am J Trop Med Hyg 90: 805809.[Crossref]
  7. Del Brutto OH, , 2012. Neurocysticercosis among international travelers to disease-endemic areas. J Travel Med 19: 112117.[Crossref]
  8. Sorvillo F, Wilkins P, Shafir S, Eberhard M, , 2011. Public health implications of cysticercosis acquired in the United States. Emerg Infect Dis 17: 16.[Crossref]
  9. O'Neal SE, Townes JM, Wilkins PP, Noh JC, Lee D, Rodriguez S, Garcia HH, Stauffer WM, , 2012. Seroprevalence of antibodies against Taenia solium cysticerci among refugees resettled in United States. Emerg Infect Dis 18: 431438.[Crossref]
  10. Croker C, Reporter R, Mascola L, , 2010. Use of statewide hospital discharge data to evaluate the economic burden of neurocysticercosis in Los Angeles County (1991–2008). Am J Trop Med Hyg 83: 106110.[Crossref]
  11. Ehnert KL, Roberto RR, Barrett L, Sorvillo FJ, Rutherford GW, 3rd, 1992. Cysticercosis: first 12 months of reporting in California. Bull Pan Am Health Organ 26: 165172.
  12. O'Neal S, Noh J, Wilkins P, Keene W, Lambert W, Anderson J, Compton Luman J, Townes J, , 2011. Taenia solium tapeworm infection, Oregon, 2006–2009. Emerg Infect Dis 17: 10301036.[Crossref]
  13. Sorvillo FJ, Waterman SH, Richards FO, Schantz PM, , 1992. Cysticercosis surveillance: locally acquired and travel-related infections and detection of intestinal tapeworm carriers in Los Angeles County. Am J Trop Med Hyg 47: 365371.
  14. Townes JM, Hoffmann CJ, Kohn MA, , 2004. Neurocysticercosis in Oregon, 1995–2000. Emerg Infect Dis 10: 508510.[Crossref]
  15. O'Keefe KA, Eberhard ML, Shafir SC, Wilkins P, Ash LR, Sorvillo FJ, , 2015. Cysticercosis-related hospitalizations in the United States, 1998–2011. Am J Trop Med Hyg 92: 354359.[Crossref]
  16. Sorvillo FJ, DeGiorgio C, Waterman SH, , 2007. Deaths from cysticercosis, United States. Emerg Infect Dis 13: 230235.[Crossref]
  17. Barton Behravesh C, Mayberry LF, Bristol JR, Cardenas VM, Mena KD, Martinez-Ocana J, Flisser A, Snowden KF, , 2008. Population-based survey of taeniasis along the United States-Mexico border. Ann Trop Med Parasitol 102: 325333.[Crossref]
  18. DeGiorgio CM, Sorvillo F, Escueta SP, , 2005. Neurocysticercosis in the United States: review of an important emerging infection. Neurology 64: 1486.[Crossref]
  19. Jones JL, Schulkin J, Maguire JH, , 2005. Therapy for common parasitic diseases in pregnancy in the United States: a review and a survey of obstetrician/gynecologists' level of knowledge about these diseases. Obstet Gynecol Surv 60: 386393.[Crossref]
  20. Croker C, Redelings M, Reporter R, Sorvillo F, Mascola L, Wilkins P, , 2012. The impact of neurocysticercosis in California: a review of hospitalized cases. PLoS Negl Trop Dis 6: e1480.[Crossref]
  21. Forsbach G, Iris S, Zarate A, Azuela JC, Canales ES, , 1976. Empty sella syndrome due to cysticercosis cerebri in a pregnant woman. Rev Invest Clin 28: 3335.
  22. Gardner E, Chang M, Mancuso P, Chaney SE, , 2012. Neurocysticercosis in pregnancy: not just another headache. Nurs Womens Health 16: 118124.[Crossref]
  23. Kurl R, Montella KR, , 1994. Cysticercosis as a cause of seizure disorder in pregnancy: case report and review of literature. Am J Perinatol 11: 409411.[Crossref]
  24. Paparone PW, Menghetti RA, , 1996. Case report: neurocysticercosis in pregnancy. N J Med 93: 9194.
  25. Singhal SR, Nanda S, Singhal SK, , 2011. Neurocysticercosis as an important differential of seizures in pregnancy: two case reports. J Med Case Reports 5: 206.[Crossref]
  26. Thaker HK, Tacconi L, Snow MH, , 2001. Neurocysticercosis in pregnancy. Br J Neurosurg 15: 284.[Crossref]
  27. Bazley WS, , 1972. Maternal mortality due to cysticercus cerebri. Case Rep Obstet Gynecol 39: 362367.
  28. Suarez VR, Iannucci TA, , 1999. Neurocysticercosis in pregnancy: a case initially diagnosed as eclampsia. Obstet Gynecol 93: 816818.
  29. Ramus RM, Girson M, Twickler DM, Wendel GD, , 1994. Acute obstructive hydrocephalus due to cysticercosis during pregnancy. Infect Dis Obstet Gynecol 1: 198201.[Crossref]
  30. Garcia HH, Del Brutto OH, Cysticercosis Working Group in Peru; , 2005. Neurocysticercosis: updated concepts about an old disease. Lancet Neurol 4: 653661.[Crossref]
  31. Shweta S, Atul S, , 2013. Pica causing neurocysticercosis in pregnancy presenting as eclampsia: a report of two cases. J Obstet Gynaecol India 63: 6869.[Crossref]
  32. Bustos JA, Rodriguez S, Jimenez JA, Moyano LM, Castillo Y, Ayvar V, Allan JC, Craig PS, Gonzalez AE, Gilman RH, Tsang VC, Garcia HH, Cysticercosis Working Group in Peru; , 2012. Detection of Taenia solium taeniasis coproantigen is an early indicator of treatment failure for taeniasis. Clin Vaccine Immunol 19: 570573.[Crossref]
  33. Levine MZ, Calderon JC, Wilkins PP, Lane WS, Asara JM, Hancock K, Gonzalez AE, Garcia HH, Gilman RH, Tsang VC, , 2004. Characterization, cloning, and expression of two diagnostic antigens for Taenia solium tapeworm infection. J Parasitol 90: 631638.[Crossref]
  34. Wilkins PP, Allan JC, Verastegui M, Acosta M, Eason AG, Garcia HH, Gonzalez AE, Gilman RH, Tsang VC, , 1999. Development of a serologic assay to detect Taenia solium taeniasis. Am J Trop Med Hyg 60: 199204.
  35. Asnis D, Kazakov J, Toronjadze T, Bern C, Garcia HH, McAuliffe I, Bishop H, Lee L, Grossmann R, Garcia MA, Di John D, , 2009. Neurocysticercosis in the infant of a pregnant mother with a tapeworm. Am J Trop Med Hyg 81: 449451.
  36. Drugs for Parasitic Infections, 2013. The Medical Letter. New Rochelle, NY: The Medical Letter, Inc.
  37. Fong GC, Cheung RT, , 1997. Caution with praziquantel in neurocysticercosis. Stroke 28: 16481649.[Crossref]
  38. Nash TE, Singh G, White AC, Rajshekhar V, Loeb JA, Proano JV, Takayanagui OM, Gonzalez AE, Butman JA, DeGiorgio C, Del Brutto OH, Delgado-Escueta A, Evans CA, Gilman RH, Martinez SM, Medina MT, Pretell EJ, Teale J, Garcia HH, , 2006. Treatment of neurocysticercosis: current status and future research needs. Neurology 67: 11201127.[Crossref]
  39. Singhi P, , 2011. Neurocysticercosis. Ther Adv Neurol Disorder 4: 6781.[Crossref]
  40. Matthaiou DK, Panos G, Adamidi ES, Falagas ME, , 2008. Albendazole versus praziquantel in the treatment of neurocysticercosis: a meta-analysis of comparative trials. PLoS Negl Trop Dis 2: e194.[Crossref]
  41. Nash TE, Mahanty S, Garcia HH, Cysticercosis Working Group in Peru; , 2011. Corticosteroid use in neurocysticercosis. Expert Rev Neurother 11: 11751183.[Crossref]
  42. Dayan AD, , 2003. Albendazole, mebendazole and praziquantel. Review of non-clinical toxicity and pharmacokinetics. Acta Trop 86: 141159.[Crossref]
  43. World Health Organization/UNICEF, 2002. Breastfeeding and Maternal Medication: Recommendations for Drugs in the eleventh WHO model list of essential drugs. Available at: http://apps.who.int/iris/bitstream/10665/62435/1/55732.pdf. Accessed November 30, 2016.
  44. Bayer Pharmaceuticals, 2011. Biltricide package insert. Available at: http://www.univgraph.com/bayer/inserts/biltricidetab.pdf. Accessed July 7, 2016.
  45. Putter J, Held F, , 1979. Quantitative studies on the occurrence of praziquantel in milk and plasma of lactating women. Eur J Drug Metab Pharmacokinet 4: 193198.[Crossref]
  46. Young J, , 2005. Mail surveys of general practice physicians: response rates and non-response bias. Swiss Med Wkly 135: 187188.
  47. Wallin MT, Kurtzke JF, , 2004. Neurocysticercosis in the United States: review of an important emerging infection. Neurology 63: 15591564.[Crossref]

Data & Media loading...

  • Received : 02 May 2016
  • Accepted : 14 Jun 2016

Most Cited This Month

This is a required field
Please enter a valid email address
Approval was a Success
Invalid data
An Error Occurred
Approval was partially successful, following selected items could not be processed due to error