Q: My 31 years old wife is suffering from continuous acute pain in her right hand. Swelling is also there for the past five days. The doctor asked her to go for a MRI scan, as there could be the possibility of some foreign particle. The doctor found some round shaped object in her hand, which is being assumed as Cysticercosis. How can Cysticercosis be treated? Are there any complications related to Cysticercosis?

A:Swelling of the hand may be due to several reasons- both infectious as well as non-infectious. In order to come to a provisional diagnosis knowledge of the history of present illness and the physical examination findings are very important. The useful clues include: exact anatomical site of the swelling, size and shape of the swelling, duration (the first time the swelling was noticed), was there any preceding incidents such as trauma/injury, or bite (human, insect or animal), progression of the swelling with time (was it always painful or has the pain begun recently), signs of inflammation (redness, pain or tenderness, increased temperature of the area). In addition information about similar swellings in other areas of the body (present or past) would be useful. These information would help to narrow down the long list of medical possibilities (which include bacterial abscess, swelling related to bone/joints, swelling due to impacted foreign body, ganglion cyst, etc). Cysticercosis is one of the many reasons which may be responsible for the current condition. Cysts caused by the tapeworm Taenia solium, are the larval stage of the parasite. The adult form of this parasite commonly resides in the intestine of man, who get infected by ingesting the larval stage of the parasite, residing in the soft tissues/muscles of pigs. Ingestion of the egg stage of the parasite by man (usually through the ingestion of contaminated food/water) lead to the development of the larval stage in the soft tissues of man. Sometimes these manifest as swelling beneath the skin (subcutaneous swelling), but may also be present in other organs of the body (brain, eyes, muscle, heart). Definitive diagnosis is achieved by histopathological confirmation of the surgically excised soft tissue swelling. Serological tests, either by detection of specific antibodies against Cysticercus cellulosae or by the detection of specific antigens of the parasite in blood or other body fluids such as urine, may act as corroborative evidence to support the diagnosis. Imaging investigation, such as X-ray, CT scan, or MRI may give additional clues about the nature of the swelling, and extent of involvement of underlying soft tissues and bones. In many cases of subcutaneous cysticercosis the lesions are subclinical or asymptomatic, and may be present for many months or even years without causing any significant problem. Increase in the size of the lesion or development of pain may be due to bodies reaction to the foreign antigens exuded by the larva, or due to secondary bacterial infection. Some patients (especially those who have no symptoms) may get better without medicines. However, the anti-parasitic medicine albendazole or praziquantel could be offered as specific treatment by experienced physicians depending on site of affection, current illness etc. In some patients the pain and swelling may paradoxically increase for a while after institution of treatment. Surgery is an option, especially if the cysts are large, and not amenable to cure by medical treatment alone. The main complications of this disease are: 1) possible development of disseminated cysticercosis, when the parasite spreads to different parts of the body, leading to affection of different organs, 2) development of secondary bacterial infection, 3) development of allergic reaction, 4) any side effects arising out of medical or surgical treatment.