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Review of human cysticercosis in Canada, to estimate the magnitude of the disease and to describe the pattern of disease expression in this country.
MEDLINE and manual search of case reports and case series of patients with cysticercosis diagnosed in Canada. Abstracted data included year of diagnosis, citizenship status, clinical manifestations, and form of cysticercosis.
A total of 21 articles reporting 60 patients were found. Forty (67%) of these patients were diagnosed in the past two decades. Most cases came from Ontario (n=43) and Quebec (n=14). Immigrants accounted for 96% of the 28 cases in whom citizenship information was available. Neurocysticercosis was observed in 55 patients, and isolated compromise of striated muscles in the remaining five. Seizures was the primary or sole manifestation of the disease in 72% of patients, and most of them had parenchymal brain cysticerci (either viable cysts or calcifications). Two of seven patients were positive for Taenia eggs. In no case were household contacts of the patients investigated for taeniasis.
An increasing number of patients with cysticercosis have been reported from Canada in the past two decades, suggesting that the prevalence of this parasitic disease may be on the rise. While most cases occur in immigrants, it is possible that at least some of these patients had acquired the disease in Canada.
Temporal (giant cell) arteritis is a systemic disease, involving various medium-sized and larger arteries, that occurs mostly in elderly patients. Blindness due to ischemic optic neuropathy is probably the most common and most feared sinister manifestation of the disease, but stroke is the leading cause of death in patients with temporal arteritis. Noninvasive angiography using computed tomography (CT) or magnetic resonance imaging (MRI) may reveal sites of vascular stenoses. A typical finding is smoothly tapered stenotic lesions different from the abrupt, irregular stenoses of atherosclerotic disease. These modalities may be helpful in assessing the extent of disease or potentially to aid diagnosis especially in biopsy negative cases. Fludeoxyglucose-positron emission tomography (FD-PET) scanning may reveal uptake in the larger thoracic vessels including aorta, subclavian, and carotid arteries. The mainstay of treatment is corticosteroids, although there is much debate about the optimal dose and use of steroid sparing immunosuppressives.
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