Taenia solium neurocysticercosis — DTM&H MCQ

Correct answer: D — Antiseizure therapy with specialist antiparasitic planning

Antiseizure therapy with specialist antiparasitic planning (D) is correct because this CT appearance (multiple small calcified lesions plus a cystic lesion with a visible scolex) is classic for neurocysticercosis with mixed-stage disease, and management must be individualised to cyst viability, number, location and the presence of oedema or raised intracranial pressure before any antiparasitic drug is given. Seizures are treated first with standard antiepileptic drugs, and antiparasitic therapy (albendazole, sometimes with praziquantel) is only started under specialist guidance, usually with corticosteroid cover, because killing viable cysts provokes an inflammatory response that can worsen oedema and precipitate raised intracranial pressure or hydrocephalus. Calcified lesions represent dead, degenerated cysts and do not need antiparasitic treatment, whereas the cystic lesion with a scolex is viable and requires careful staged management, not an immediate fixed drug regimen. This individualised, imaging-and-inflammation-guided approach is exactly what IDSA/ASTMH neurocysticercosis guidance, used in UK specialist tropical and infectious disease practice, recommends. Why the other options are wrong: E. Chloroquine: this is an antimalarial with no activity against Taenia solium cysts; it has no role in neurocysticercosis. A. Praziquantel without imaging: praziquantel may be used but never without imaging staging, because treating viable cysts without corticosteroid cover and without knowing lesion burden, number and location risks fatal cerebral oedema, especially with intraventricular or subarachnoid disease. C. Metronidazole alone: metronidazole treats protozoal and anaerobic infections, not cestode larval cysts, so it has no efficacy here. B. Fluconazole: this is an antifungal agent; neurocysticercosis is a helminthic (tapeworm larval) infection, not a fungal one, so fluconazole is pharmacologically irrelevant. Key point: In neurocysticercosis, seizure control comes first and antiparasitic therapy is only given after specialist staging of cyst viability and number, with corticosteroids to prevent inflammation-driven deterioration.

Reference: IDSA/ASTMH Clinical Practice Guidelines for the Diagnosis and Treatment of Neurocysticercosis (2018, Clinical Infectious Diseases), https://academic.oup.com/cid/article/66/8/e49/4885412