1
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Singh DK, Kumar Sharma P, Singh N, Chand V. Intraventricular migration of fourth ventricular neurocysticercosis: an unusual complication during endoscopic surgery. BMJ Case Rep 2023; 16:e255813. [PMID: 37399344 PMCID: PMC10314531 DOI: 10.1136/bcr-2023-255813] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 07/05/2023] Open
Abstract
A boy in his middle childhood presented with intermittent episodes of headache with vomiting for 6 months. Plain CT of the head and MRI of the brain revealed fourth ventricular cysticercal cyst with acute obstructive hydrocephalus. Endoscopic excision of the cyst was done along with endoscopic third ventriculostomy and septostomy with external ventricular drain placement. Although we were able to decompress the cysticercal cyst, unfortunately, the cyst got slipped from the grasper leaving the grasped cyst wall in the tooth of the grasper. Through this case report, we want to highlight that such a complication could also happen during neuroendoscopic cysticercal cyst removal and how we dealt with it. Our patient was discharged neurologically intact and was symptom free on follow-up.
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Affiliation(s)
- Deepak Kumar Singh
- Neurosurgery, Dr Ram Manohar Lohia Institute of Medical Sciences, Lucknow, Uttar Pradesh, India
| | - Prevesh Kumar Sharma
- Neurosurgery, Dr Ram Manohar Lohia Institute of Medical Sciences, Lucknow, Uttar Pradesh, India
| | - Neha Singh
- Radiodiagnosis and Imaging, Dr Ram Manohar Lohia Institute of Medical Sciences, Lucknow, Uttar Pradesh, India
| | - Vipin Chand
- Neurosurgery, Dr Ram Manohar Lohia Institute of Medical Sciences, Lucknow, Uttar Pradesh, India
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2
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Hagen EH, Blackwell AD, Lightner AD, Sullivan RJ. Homo medicus: The transition to meat eating increased pathogen pressure and the use of pharmacological plants in Homo. AMERICAN JOURNAL OF BIOLOGICAL ANTHROPOLOGY 2023; 180:589-617. [PMID: 36815505 DOI: 10.1002/ajpa.24718] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/27/2022] [Revised: 01/31/2023] [Accepted: 02/08/2023] [Indexed: 02/24/2023]
Abstract
The human lineage transitioned to a more carnivorous niche 2.6 mya and evolved a large body size and slower life history, which likely increased zoonotic pathogen pressure. Evidence for this increase includes increased zoonotic infections in modern hunter-gatherers and bushmeat hunters, exceptionally low stomach pH compared to other primates, and divergence in immune-related genes. These all point to change, and probably intensification, in the infectious disease environment of Homo compared to earlier hominins and other apes. At the same time, the brain, an organ in which immune responses are constrained, began to triple in size. We propose that the combination of increased zoonotic pathogen pressure and the challenges of defending a large brain and body from pathogens in a long-lived mammal, selected for intensification of the plant-based self-medication strategies already in place in apes and other primates. In support, there is evidence of medicinal plant use by hominins in the middle Paleolithic, and all cultures today have sophisticated, plant-based medical systems, add spices to food, and regularly consume psychoactive plant substances that are harmful to helminths and other pathogens. We propose that the computational challenges of discovering effective plant-based treatments, the consequent ability to consume more energy-rich animal foods, and the reduced reliance on energetically-costly immune responses helped select for increased cognitive abilities and unique exchange relationships in Homo. In the story of human evolution, which has long emphasized hunting skills, medical skills had an equal role to play.
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Affiliation(s)
- Edward H Hagen
- Department of Anthropology, Washington State University, Pullman, Washington, USA
| | - Aaron D Blackwell
- Department of Anthropology, Washington State University, Pullman, Washington, USA
| | - Aaron D Lightner
- Department of Anthropology, Washington State University, Pullman, Washington, USA
- Department of the Study of Religion, Aarhus University, Aarhus, Denmark
| | - Roger J Sullivan
- Department of Anthropology, California State University, Sacramento, California, USA
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3
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Haq SH, Shah SR, Bux J, Le AS, Golzarian H, Mueller D, Sreenan JJ, Patel SM, Laird A, Cole W. To intervene or not to intervene: A case of symptomatic neurocysticercosis complicated by ventriculitis. IDCases 2023; 31:e01702. [PMID: 36747911 PMCID: PMC9898726 DOI: 10.1016/j.idcr.2023.e01702] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/28/2022] [Revised: 01/19/2023] [Accepted: 01/19/2023] [Indexed: 01/22/2023] Open
Abstract
Although well described in the current literature, Neurocysticercosis [NCC] remains an enigma when confronted by practitioners. This is in part due to the haphazard nature of the parasitic infection on the central nervous system [CNS]. These include single or multiple anatomic sites of infection, stage of parasitosis, and the resultant inflammatory response. As a result, NCC can present with a complex constellation of symptomatic presentations, making therapeutic regiments highly individualized. Despite intervention, other impediments may arise post-therapy due to the nature of the infection. We present a case of rapidly progressive symptomatic NCC that initially was successfully treated, however would eventually succumb to complications of ventriculitis.
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Affiliation(s)
- Syed H. Haq
- Department of Internal Medicine, BonSecour Mercy Health—St. Rita’s Medical Center, Lima, OH, USA
| | - Sidra R. Shah
- Department of Internal Medicine, BonSecour Mercy Health—St. Rita’s Medical Center, Lima, OH, USA
| | - Jannet Bux
- Department of Internal Medicine, BonSecour Mercy Health—St. Rita’s Medical Center, Lima, OH, USA
| | - Anh Si Le
- Department of Internal Medicine, BonSecour Mercy Health—St. Rita’s Medical Center, Lima, OH, USA
| | - Hafez Golzarian
- Department of Internal Medicine, BonSecour Mercy Health—St. Rita’s Medical Center, Lima, OH, USA
| | - Daniel Mueller
- Department of Internal Medicine, BonSecour Mercy Health—St. Rita’s Medical Center, Lima, OH, USA
| | - Joseph J. Sreenan
- Department of Pathology Medicine, BonSecour Mercy Health—St. Rita’s Medical Center, Lima, OH, USA
| | - Sandeep M. Patel
- Department of Interventional Cardiology, BonSecour Mercy Health—St. Rita’s Medical Center, Lima, OH, USA
| | - Amanda Laird
- Department of Critical Care Medicine, BonSecour Mercy Health—St. Rita’s Medical Center, Lima, OH, USA
| | - William Cole
- Department of Critical Care Medicine, BonSecour Mercy Health—St. Rita’s Medical Center, Lima, OH, USA
- Correspondence to: Department of Critical Care, St. Rita's Medical Center (Mercy), 730 West Market Street, Lima, OH 45801, USA.
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4
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Welch RL, Bernardin B, Albayar A. A hidden infection: Racemose neurocysticercosis causing hydrocephalus; a case report. Int J Surg Case Rep 2022; 98:107477. [PMID: 35987027 PMCID: PMC9411572 DOI: 10.1016/j.ijscr.2022.107477] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/09/2022] [Revised: 07/31/2022] [Accepted: 08/01/2022] [Indexed: 11/28/2022] Open
Abstract
Introduction and importance Neurocysticercosis (NCC) is the most common helminthic central nervous system infection (CNS) in the Western hemisphere and the most common cause of acquired epilepsy worldwide. Due to its relatively prolonged latent period and clinical similarity to other infectious diseases – including bacterial or viral meningitis and other helminthic infections – NCC may be difficult to diagnose, especially for clinicians who rarely encounter it. Case presentation This case report discusses a patient with obstructive hydrocephalus and eosinophilic meningitis secondary to racemose NCC. The diagnosis process was initially complicated by the patient's history of pork allergy and absence of radiographic evidence of helminthic CNS infection. Further investigation showed a 4th ventricle multi-cystic lesion causing hydrocephalus which prompted a surgical intervention with a ventriculoperitoneal shunt (VPS) in conjunction with anti-helminthic medical treatment. At 1-year follow-up, the patient has reported recurrence of VPS related complications. Clinical discussion Larval cysts typically deposit within the brain parenchyma, making them easily detected on head computed tomography (CT) scans and leading to neurologic sequelae such as epilepsy. In this case, the absence of CT evidence of NCC and the patient's lifelong history of pork allergy slowed the diagnosis process. Conclusion Racemose NCC is a rare subset of the disease in which cyst clusters occupy the extra parenchymal space, thereby changing the symptomatic profile and making the cysts more difficult to visualize in imaging studies. In this case, magnetic resonance imaging (MRI) was the best imaging modality to diagnosis extra parenchymal NCC and guide its surgical management. NCC causes parasitic infections in the brain and acquired epilepsy. Racemose is a rare form of NCC affecting the extra parenchymal space in the brain. Making the diagnosis of NCC is challenging, requiring advanced neuroimaging studies. This case report describes racemose NCC complicated by obstructive hydrocephalus. Ventriculoperitoneal shunt and anti-parasitic medicines were successful treatments.
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Affiliation(s)
- Rachel L Welch
- Yale College, Yale University, New Haven, CT 06510, USA.
| | - Brooke Bernardin
- Department of Neurosurgery, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA 19104, USA
| | - Ahmed Albayar
- Department of Neurosurgery, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA 19104, USA
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5
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Idro R, Ogwang R, Barragan A, Raimondo JV, Masocha W. Neuroimmunology of Common Parasitic Infections in Africa. Front Immunol 2022; 13:791488. [PMID: 35222377 PMCID: PMC8866860 DOI: 10.3389/fimmu.2022.791488] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/08/2021] [Accepted: 01/18/2022] [Indexed: 11/13/2022] Open
Abstract
Parasitic infections of the central nervous system are an important cause of morbidity and mortality in Africa. The neurological, cognitive, and psychiatric sequelae of these infections result from a complex interplay between the parasites and the host inflammatory response. Here we review some of the diseases caused by selected parasitic organisms known to infect the nervous system including Plasmodium falciparum, Toxoplasma gondii, Trypanosoma brucei spp., and Taenia solium species. For each parasite, we describe the geographical distribution, prevalence, life cycle, and typical clinical symptoms of infection and pathogenesis. We pay particular attention to how the parasites infect the brain and the interaction between each organism and the host immune system. We describe how an understanding of these processes may guide optimal diagnostic and therapeutic strategies to treat these disorders. Finally, we highlight current gaps in our understanding of disease pathophysiology and call for increased interrogation of these often-neglected disorders of the nervous system.
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Affiliation(s)
- Richard Idro
- College of Health Sciences, Makerere University, Kampala, Uganda.,Centre of Tropical Neuroscience, Kitgum, Uganda.,Nuffield Department of Medicine, Centre for Tropical Medicine and Global Health, University of Oxford, Oxford, United Kingdom
| | - Rodney Ogwang
- College of Health Sciences, Makerere University, Kampala, Uganda.,Centre of Tropical Neuroscience, Kitgum, Uganda.,Kenya Medical Research Institute (KEMRI) - Wellcome Trust Research Programme, Nairobi, Kenya
| | - Antonio Barragan
- Department of Molecular Biosciences, The Wenner-Gren Institute, Stockholm University, Stockholm, Sweden
| | - Joseph Valentino Raimondo
- Division of Cell Biology, Department of Human Biology, Neuroscience Institute and Institute of Infectious Disease and Molecular Medicine, Faculty of Health Sciences, University of Cape Town, Cape Town, South Africa
| | - Willias Masocha
- Department of Pharmacology and Therapeutics, Faculty of Pharmacy, Kuwait University, Safat, Kuwait
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6
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Singh P, Singh SP. A case of racemose and intraventricular neurocysticercosis in an unusual location. SA J Radiol 2021; 25:2171. [PMID: 34956661 PMCID: PMC8678948 DOI: 10.4102/sajr.v25i1.2171] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/27/2021] [Accepted: 08/16/2021] [Indexed: 11/01/2022] Open
Abstract
Racemose and intraventricular neurocysticercosis are uncommon types of neurocysticercosis, resulting in a multiloculated, grape-like cluster appearance in the cerebrospinal fluid (CSF) spaces. A male patient presented with symptoms of raised intracranial pressure and demonstrated racemose neurocysticercosis at an atypical location involving the region of the crus of the fornix at the level of the body of lateral ventricles on magnetic resonance imaging. Associated intraventricular neurocysticercosis was seen in the atrium of the left lateral ventricle and fourth ventricle.
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Affiliation(s)
- Priya Singh
- Department of Radiodiagnosis, Sanjay Gandhi Postgraduate Institute of Medical Science, Lucknow, India
| | - Surya P Singh
- Department of Radiodiagnosis, Sanjay Gandhi Postgraduate Institute of Medical Science, Lucknow, India.,Department of Radiodiagnosis, All India Institute of Medical Sciences (AIIMS), New Delhi, India
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7
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Mhatre R, Konar SK, Sadashiva N, Mahadevan A, Devi BI. Cysticercal brain abscess: a distinct entity mimicking pyogenic brain abscess in the colloidal vesicular stage. J Parasit Dis 2021; 45:592-598. [PMID: 34475638 DOI: 10.1007/s12639-021-01424-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/11/2021] [Accepted: 07/12/2021] [Indexed: 11/25/2022] Open
Abstract
Cysticercal brain abscess is a rare entity with the clinical presentation and radiological findings closely mimicking a pyogenic abscess. We report three cases of cysticercal abscess presenting as solitary lesion in the brain with radiological appearance like an abscess. All the patients underwent excision of the lesion with histopathological diagnosis of cysticercal brain abscess with evidence of cysticerci in the colloidal vesicular stage. The clinical outcome was satisfactory after surgical excision. Cysticercal abscess, though rare, should be considered as a differential diagnosis of a solitary rim-enhancing lesion, mainly if the patients belong to the endemic zone of neurocysticercosis. Surgical excision with or without a short course of the anti-parasitic agent is the treatment of choice for the intracranial mass lesion with evidence of mass effect For the small lesion of cysticercal brain abscess or early stage of abscess, anti-parasitic medication and steroids can be considered.
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Affiliation(s)
- Radhika Mhatre
- Department of Neuropathology, National Institute of Mental Health and Neurosciences, Bangalore, India
| | - Subhas K Konar
- Department of Neurosurgery, National Institute of Mental Health and Neurosciences (NIMHANS), Bangalore, 560029 India
| | - Nishanth Sadashiva
- Department of Neurosurgery, National Institute of Mental Health and Neurosciences (NIMHANS), Bangalore, 560029 India
| | - Anita Mahadevan
- Department of Neuropathology, National Institute of Mental Health and Neurosciences, Bangalore, India
| | - B Indira Devi
- Department of Neurosurgery, National Institute of Mental Health and Neurosciences (NIMHANS), Bangalore, 560029 India
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8
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Ramesh D, Maurya DK, Gopalakrishnan MS, Pegu B, Ananthakrishnan R, Nair PP, Keepanasseril A. Diagnostic and management challenges of intraventricular neurocysticercosis presenting in the third trimester of pregnancy: A case report. Obstet Med 2021; 14:57-61. [PMID: 33995577 DOI: 10.1177/1753495x20904895] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/29/2019] [Accepted: 01/12/2020] [Indexed: 11/16/2022] Open
Abstract
The diagnosis of neurocysticercosis in pregnancy is challenging, even in endemic areas, as other neurological conditions with similar manifestations are common. Obstetricians and physicians may be reluctant to do neuroimaging in pregnancy and often the availability is limited in endemic areas. Management of neurocysticercosis depends on the symptomatology. In those presenting with features of increased intracranial pressure early treatment is necessary, taking into consideration the gestational age and the maternal condition at presentation. Presence of intraventricular cysts causing obstructive hydrocephalus necessitates their removal due to the risk of intracranial hypertension which could be life-threatening, particularly peripartum. We report a case of a woman with intraventricular neurocysticercosis, who presented in the third trimester, and described the management dilemmas that were encountered. The differential diagnoses and other aspects of the medical and surgical management of neurocysticercosis in pregnancy are also discussed.
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Affiliation(s)
- Devika Ramesh
- Department of Obstetrics and Gynaecology, Jawaharlal Institute of Post-graduate Medical Education & Research (JIPMER), Puducherry, India
| | - Dilip K Maurya
- Department of Obstetrics and Gynaecology, Jawaharlal Institute of Post-graduate Medical Education & Research (JIPMER), Puducherry, India
| | - Madhavan S Gopalakrishnan
- Department of Neurosurgery, Jawaharlal Institute of Post-graduate Medical Education & Research (JIPMER), Puducherry, India
| | - Bhabani Pegu
- Department of Obstetrics and Gynaecology, Jawaharlal Institute of Post-graduate Medical Education & Research (JIPMER), Puducherry, India
| | - Ramesh Ananthakrishnan
- Department of Radio-diagnosis, Jawaharlal Institute of Post-graduate Medical Education & Research (JIPMER), Puducherry, India
| | - Pradeep P Nair
- Department of Neurology, Jawaharlal Institute of Post-graduate Medical Education & Research (JIPMER), Puducherry, India
| | - Anish Keepanasseril
- Department of Obstetrics and Gynaecology, Jawaharlal Institute of Post-graduate Medical Education & Research (JIPMER), Puducherry, India
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9
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Targeted burr hole surgery for Sylvian cistern subarachnoid neurocysticercosis. INTERDISCIPLINARY NEUROSURGERY 2021. [DOI: 10.1016/j.inat.2020.100996] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
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10
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Gondim BLC, da Silva Catarino J, de Sousa MAD, de Oliveira Silva M, Lemes MR, de Carvalho-Costa TM, de Lima Nascimento TR, Machado JR, Rodrigues V, Oliveira CJF, Cançado Castellano LR, da Silva MV. Nanoparticle-Mediated Drug Delivery: Blood-Brain Barrier as the Main Obstacle to Treating Infectious Diseases in CNS. Curr Pharm Des 2020; 25:3983-3996. [PMID: 31612822 DOI: 10.2174/1381612825666191014171354] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/06/2019] [Accepted: 09/19/2019] [Indexed: 12/25/2022]
Abstract
BACKGROUND Parasitic infections affecting the central nervous system (CNS) present high morbidity and mortality rates and affect millions of people worldwide. The most important parasites affecting the CNS are protozoans (Plasmodium sp., Toxoplasma gondii, Trypanosoma brucei), cestodes (Taenia solium) and free-living amoebae (Acantamoeba spp., Balamuthia mandrillaris and Naegleria fowleri). Current therapeutic regimens include the use of traditional chemicals or natural compounds that have very limited access to the CNS, despite their elevated toxicity to the host. Improvements are needed in drug administration and formulations to treat these infections and to allow the drug to cross the blood-brain barrier (BBB). METHODS This work aims to elucidate the recent advancements in the use of nanoparticles as nanoscaled drug delivery systems (NDDS) for treating and controlling the parasitic infections that affect the CNS, addressing not only the nature and composition of the polymer chosen, but also the mechanisms by which these nanoparticles may cross the BBB and reach the infected tissue. RESULTS There is a strong evidence in the literature demonstrating the potential usefulness of polymeric nanoparticles as functional carriers of drugs to the CNS. Some of them demonstrated the mechanisms by which drugloaded nanoparticles access the CNS and control the infection by using in vivo models, while others only describe the pharmacological ability of these particles to be utilized in in vitro environments. CONCLUSION The scarcity of the studies trying to elucidate the compatibility as well as the exact mechanisms by which NDDS might be entering the CNS infected by parasites reveals new possibilities for further exploratory projects. There is an urgent need for new investments and motivations for applying nanotechnology to control parasitic infectious diseases worldwide.
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Affiliation(s)
- Brenna Louise Cavalcanti Gondim
- Human Immunology Research and Education Group-GEPIH, Technical School of Health, Federal University of Paraiba, Joao Pessoa, Paraiba, Brazil.,Post-Graduation Program in Dentistry, Department of Dentistry, State University of Paraíba, Campina Grande, Paraíba, Brazil
| | - Jonatas da Silva Catarino
- Department of Microbiology, Immunology and Parasitology, Federal University of Triangulo Mineiro, Uberaba, Minas Gerais, Brazil
| | | | - Mariana de Oliveira Silva
- Department of Microbiology, Immunology and Parasitology, Federal University of Triangulo Mineiro, Uberaba, Minas Gerais, Brazil
| | - Marcela Rezende Lemes
- Department of Microbiology, Immunology and Parasitology, Federal University of Triangulo Mineiro, Uberaba, Minas Gerais, Brazil
| | | | - Tatiana Rita de Lima Nascimento
- Human Immunology Research and Education Group-GEPIH, Technical School of Health, Federal University of Paraiba, Joao Pessoa, Paraiba, Brazil
| | - Juliana Reis Machado
- Department of Pathology, Genetics and Evolution, Federal University of Triangulo Mineiro, Uberaba, Minas Gerais, Brazil
| | - Virmondes Rodrigues
- Department of Microbiology, Immunology and Parasitology, Federal University of Triangulo Mineiro, Uberaba, Minas Gerais, Brazil
| | - Carlo José Freire Oliveira
- Department of Microbiology, Immunology and Parasitology, Federal University of Triangulo Mineiro, Uberaba, Minas Gerais, Brazil
| | - Lúcio Roberto Cançado Castellano
- Human Immunology Research and Education Group-GEPIH, Technical School of Health, Federal University of Paraiba, Joao Pessoa, Paraiba, Brazil
| | - Marcos Vinicius da Silva
- Department of Microbiology, Immunology and Parasitology, Federal University of Triangulo Mineiro, Uberaba, Minas Gerais, Brazil
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11
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Barrie U, Badejo O, Aoun SG, Adeyemo E, Moler N, Christian ZK, Caruso JP, El Ahmadieh TY, Ban VS, MacAllister MC, Reyes VP, Hall K, Whitworth L, Bagley CA. Systematic Review and Meta-Analysis of Management Strategies and Outcomes in Adult Spinal Neurocysticercosis. World Neurosurg 2020; 138:504-511.e8. [PMID: 32224269 DOI: 10.1016/j.wneu.2020.03.093] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/18/2020] [Revised: 03/15/2020] [Accepted: 03/16/2020] [Indexed: 11/24/2022]
Abstract
OBJECTIVE Spinal involvement in neurocysticercosis is rare and can lead to debilitating injury if not diagnosed and treated early. We aim to provide the reader with a thorough analysis of the best available evidence regarding patient characteristics, optimal treatment modality, and outcomes in cases of spinal neurocysticercosis. METHODS A systematic review of the literature using PubMed, Google Scholar, and Web of Science electronic databases was made according to the PRISMA guidelines. An illustrative case of intramedullary-cervical spinal disease is also presented for illustrative purposes. RESULTS A total of 46 reports of 103 patients fitting the screening criteria were identified. Isolated spinal involvement was seen in 46.15% of patients. Most infections (76.92%) had an intradural extramedullary localization, with 43.27% of cases involving >1 spinal cord level. The most common presenting symptoms were motor deficits (77.88%), pain syndromes (64.42%), and sensory deficits (53.85%). Combined surgical resection and pharmacologic therapy was the most frequently used treatment modality (49.04%) and had the highest proportion of patients reporting symptomatic improvement at follow-up (78.43%). Combination therapy had a significantly higher rate of neurologic recovery compared with surgery alone (P = 0.004) or medical treatment (P = 0.035). CONCLUSIONS Spinal involvement in neurocysticercosis should be considered in patients from or who traveled to endemic areas presenting with ring-enhancing lesions. Combined treatment with surgery followed by cysticidal and steroid medication seems to be superior to surgery or medical treatment in isolation and seems to provide the highest chances of recovery.
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Affiliation(s)
- Umaru Barrie
- Department of Neurological Surgery, University of Texas Southwestern Medical Center, Dallas, Texas, USA
| | - Olatunde Badejo
- Department of Neurological Surgery, University of Texas Southwestern Medical Center, Dallas, Texas, USA
| | - Salah G Aoun
- Department of Neurological Surgery, University of Texas Southwestern Medical Center, Dallas, Texas, USA.
| | - Emmanuel Adeyemo
- Department of Neurological Surgery, University of Texas Southwestern Medical Center, Dallas, Texas, USA
| | - Nicole Moler
- Department of Neurological Surgery, University of Texas Southwestern Medical Center, Dallas, Texas, USA
| | - Zachary K Christian
- Department of Neurological Surgery, University of Texas Southwestern Medical Center, Dallas, Texas, USA
| | - James P Caruso
- Department of Neurological Surgery, University of Texas Southwestern Medical Center, Dallas, Texas, USA
| | - Tarek Y El Ahmadieh
- Department of Neurological Surgery, University of Texas Southwestern Medical Center, Dallas, Texas, USA
| | - Vin Shen Ban
- Department of Neurological Surgery, University of Texas Southwestern Medical Center, Dallas, Texas, USA
| | - Matthew C MacAllister
- Department of Neurological Surgery, University of Texas Southwestern Medical Center, Dallas, Texas, USA
| | - Valery Peinado Reyes
- Department of Neurological Surgery, University of Texas Southwestern Medical Center, Dallas, Texas, USA
| | - Kristen Hall
- Department of Neurological Surgery, University of Texas Southwestern Medical Center, Dallas, Texas, USA
| | - Louis Whitworth
- Department of Neurological Surgery, University of Texas Southwestern Medical Center, Dallas, Texas, USA
| | - Carlos A Bagley
- Department of Neurological Surgery, University of Texas Southwestern Medical Center, Dallas, Texas, USA; Department of Orthopedic Surgery, University of Texas Southwestern Medical Center, Dallas, Texas, USA
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12
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Tan YT, Zhang SJ, Shu K, Lei T, Niu HQ. Microsurgical Treatment of Epilepsy with Parenchymal Neurocysticercosis. Curr Med Sci 2019; 39:984-989. [PMID: 31845231 DOI: 10.1007/s11596-019-2132-1] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/17/2019] [Revised: 11/25/2019] [Indexed: 12/01/2022]
Abstract
Parenchymal neurocysticercosis is the most common form of neurocysticercosis in the central nervous system (CNS), which mainly causes epilepsy and usually responses well to routine medications. However, there are appreciable cases of relapses refractory to medical treatment. We investigated microsurgical treatment of epilepsy with parenchymal neurocysticercosis. Nine cases of epilepsy caused by parenchymal neurocysticercosis from 2002 to 2018 were analyzed retrospectively. Cysts in 7 cases were completely removed. No case died of operation and no new dysfunction of the nervous system was observed after surgery. Among the other 9 cases, 8 cases became seizure-free or controlled by medicine according to the postoperative follow-up for 6 months to 9 years. One case was lost for follow-up. It was suggested that epilepsy with parenchymal neurocysticercosis can usually be controlled after routine medications. However, surgery is still indicated in some cases and careful microsurgery is associated with satisfactory clinical outcomes in appropriately selected cases.
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Affiliation(s)
- Yu-Tang Tan
- Department of Neurosurgery, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, 430030, China
| | - Suo-Jun Zhang
- Department of Neurosurgery, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, 430030, China
| | - Kai Shu
- Department of Neurosurgery, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, 430030, China
| | - Ting Lei
- Department of Neurosurgery, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, 430030, China
| | - Hong-Quan Niu
- Department of Neurosurgery, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, 430030, China.
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13
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Gastrointestinal helminths from the common warthog, Phacochoerus africanus (Gmelin) (Suidae), in KwaZulu-Natal Province, South Africa, with comments on helminths of Suidae and Tayassuidae worldwide. Parasitology 2019; 146:1541-1549. [PMID: 31106726 DOI: 10.1017/s0031182019000684] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
Thirty warthogs, Phacochoerus africanus, were collected in the Pongola Game Reserve, South Africa and examined for helminths. Gastrointestinal helminth assemblages comprised Gastrodiscus aegyptiacus, the cestode genus Moniezia and seven species of nematodes. A single warthog harboured a metacestode of Taenia hydatigena in the mesenteries. No helminths were found in the heart, lungs or liver of the warthogs. Probstmayria vivipara and Murshidia spp. were the most prevalent as well as abundant helminth species, followed by Physocephalus sexalatus. The incidence of Moniezia did not differ between hosts of different sex or age. Numbers of Murshidia spp. were not affected by host sex, but were higher in adults than in juveniles. Conversely, burdens of Trichostrongylus thomasi were not affected by host age, but were higher in males than in females. While not highly significant, helminth assemblages in male warthogs were more species rich than in females. Helminth communities in the three genera of wild sub-Saharan suids are largely unique, but Ph. africanus and Hylochoerus meinertzhageni share more worm species with each other than with Potamochoerus larvatus, possibly because the former two are more closely related. Overlap between helminth communities of African wild suids and those of other suids and Tayassuidae worldwide is limited.
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Hydrocephalus in Neurocysticercosis: Challenges for Clinical Practice and Basic Research Perspectives. World Neurosurg 2019; 126:264-271. [DOI: 10.1016/j.wneu.2019.03.071] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/22/2019] [Revised: 03/06/2019] [Accepted: 03/07/2019] [Indexed: 11/19/2022]
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Sharma BS, Sawarkar DP, Verma SK. Endoscopic Management of Fourth Ventricle Neurocysticercosis: Description of the New Technique in a Case Series of 5 Cases and Review of the Literature. World Neurosurg 2018; 122:e647-e654. [PMID: 30814022 DOI: 10.1016/j.wneu.2018.10.117] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/28/2018] [Revised: 10/16/2018] [Accepted: 10/19/2018] [Indexed: 10/28/2022]
Abstract
BACKGROUND Around 7%-33% of cases of neurocysticercosis (NCC) have intraventricular involvement, and the fourth ventricle is the most frequent site. Medical management and various surgical approaches have been described for treating this disease. The objective of this study was to describe technical modification for endoscopic fourth ventricular NCC removal in a series of 5 cases. METHODS In this study (January 1, 2016, to December 31, 2017), all cases of fourth ventricular NCC which were treated with a special technique (endoscopic transcortical transforaminal transaqueductal approach) using a rigid endoscope system and 6-French infant feeding tube (IFT) were included in the study. The IFT was passed through the main channel, the cyst was engaged at the tip by applying gentle suction with a 20 cm3 syringe, and the cyst was removed along with the whole endoscopic assembly. Patient's clinical, radiologic, and follow-up data were retrieved from the department database records. RESULTS Five patients (3 men, 2 women; mean age, 20 years; range, 11-27 years) were enrolled. All patients had features of raised intracranial pressure. Two patients also had drop attacks, and one presented with altered sensorium and one had upgaze palsy. Duration of symptoms ranged from 3 months to 3 years. All patients had isolated fourth ventricular NCC with obstructive hydrocephalus. Complete removal of the neurocysticercal cyst could be performed in all patients without any injury to the periaqueductal region or fornix. There was no intraoperative rupture of the neurocysticercal cyst. On follow-up (range, 12-28 months; mean, 19.4 months), all patients had relief of symptoms and imaging showed no cyst and hydrocephalus. CONCLUSIONS We conclude that our endoscopic approach is safe, simple, cost-effective, and allows minimally invasive removal of the fourth ventricle cyst and treatment of hydrocephalus without any morbidity.
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Affiliation(s)
- Bhawani Shanker Sharma
- Department of Neurosurgery and Gamma Knife Center, All India Institute of Medical Sciences, New Delhi, India
| | | | - Satish Kumar Verma
- Department of Neurosurgery and Gamma Knife Center, All India Institute of Medical Sciences, New Delhi, India
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Abstract
Prevention and management of opportunistic infections in children is particularly relevant in an era demonstrating an increased prevalence of immunocompromising conditions. The presence of an unusual organism which results in serious infection in a child should therefore always raise the consideration of immune compromise. The more common opportunistic infections have become easier to recognize in recent times due to improved awareness and more refined diagnostic testing. Targeted treatment is usually followed by long-term prophylactic medication. The impact of these conditions on patient outcome is of clear significance and certainly warrants further discussion.
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Maste PS, Lokanath YK, Mahantshetti SS, Soumya S. Isolated Intramedullary Spinal Cysticercosis: A Case Report with Review of Literature of a Rare Presentation. Asian J Neurosurg 2018; 13:154-156. [PMID: 29492150 PMCID: PMC5820875 DOI: 10.4103/1793-5482.180894] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022] Open
Abstract
A number of parasitic infections can involve the central nervous system of which neurocysticercosis (NCC) is the most common one in developing countries. Most often the brain is involved, spine and spinal cord involvement is very rare and intramedullary involvement is rarer still. Here, we report a 30-year-old male patient, with intramedullary NCC of dorsal spinal cord.
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Affiliation(s)
- Praful Suresh Maste
- Department of Neurosurgery and Microbiology, J.N Medical College and KLES Dr. Prabhakar Kore Hospital and Medical Research Centre, KLE University, Belgaum, Karnataka, India
| | - Yadhu Kasetti Lokanath
- Department of Neurosurgery and Microbiology, J.N Medical College and KLES Dr. Prabhakar Kore Hospital and Medical Research Centre, KLE University, Belgaum, Karnataka, India
| | - Shambhulingappa Shrishilappa Mahantshetti
- Department of Neurosurgery and Microbiology, J.N Medical College and KLES Dr. Prabhakar Kore Hospital and Medical Research Centre, KLE University, Belgaum, Karnataka, India
| | - S Soumya
- Department of Neurosurgery and Microbiology, J.N Medical College and KLES Dr. Prabhakar Kore Hospital and Medical Research Centre, KLE University, Belgaum, Karnataka, India
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Medina Ortega A, López Valencia D, Vásquez Arteaga LR. Recurrent neurocysticercosis of the frontal lobe. Case report. CASE REPORTS 2018. [DOI: 10.15446/cr.v4n1.65860] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022] Open
Abstract
Introducción. La neurocisticercosis (NCC) es causada por la ingesta de huevos de la tenia del cerdo (Taenia solium) provenientes de un individuo con teniosis (complejo teniasis-cisticercosis). Esta enfermedad produce la mayor morbimortalidad por sus efectos dañinos sobre el sistema nervioso central. El 80% de los casos pueden ser asintomáticos y el 20% restante presenta manifestaciones clínicas que son inespecíficas.Presentación del caso. Paciente con cefalea, tendencia dromomaníaca, síndrome de hipertensión intracraneal, deterioro cognitivo y alteración de la marcha. Se realizó una tomografía computarizada que reveló un quiste subcortical frontal derecho y calcificaciones frontoparietales bilaterales. Como diagnóstico principal se sospechó NCC del lóbulo frontal por su cuadro clínico, anamnesis y epidemiología regional.Discusión. Se sospecha que el paciente cursaba con reinfección por T. solium en el lóbulo frontal derecho por la presencia de edema perilesional, los nódulos calcificados distribuidos aleatoriamente en la imagen y la información suministrada por sus familiares durante la anamnesis. Los signos y síntomas de la NCC dependen de la ubicación, el número, las dimensiones, los estadios del cisticerco (vesicular, coloidal, granular-nodular y nódulo calcificado), el genotipo y el estado inmune del hospedero. El 60-90% de los cisticercos se ubican en el parénquima cerebral, siendo menos frecuentes las ubicaciones ventricular, subaracnoidea, ocular, meníngea y medular.Conclusiones. Es importante educar a la comunidad, por un lado, sobre el ciclo de vida del parásito T. solium y su epidemiología y, por el otro, acerca de las medidas de prevención y las manifestaciones clínicas de la NCC, esto con el fin de realizar un diagnóstico oportuno y un manejo efectivo.
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Singh SK, Prasad KN, Singh AK, Gupta KK, Singh A, Tripathi M, Gupta RK. Adhesion molecules, chemokines and matrix metallo-proteinases response after albendazole and albendazole plus steroid therapy in swine neurocysticercosis. Exp Parasitol 2017; 182:1-8. [DOI: 10.1016/j.exppara.2017.08.009] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/01/2016] [Revised: 06/23/2017] [Accepted: 08/13/2017] [Indexed: 01/15/2023]
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McClugage SG, Lee RA, Camins BC, Mercado-Acosta JJ, Rodriguez M, Riley KO. Treatment of racemose neurocysticercosis. Surg Neurol Int 2017; 8:168. [PMID: 28840072 PMCID: PMC5551286 DOI: 10.4103/sni.sni_157_17] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/21/2017] [Accepted: 05/31/2017] [Indexed: 11/09/2022] Open
Abstract
Background: Neurocysticercosis (NCC) is a common parasitic infection of the central nervous system, caused by the tapeworm Taenia solium. It is endemic to certain parts of the world, including Central America, South America, Asia, and Africa. The racemose form, characterized by extraparenchymal location, increased morbidity and mortality, and large loculated cystic lesions, is rarely seen in industrialized countries, such as the United States. The management of racemose neurocysticercosis (RNCC) differs from that of the typical parenchymal variant. The ideal course of treatment is debated by experts, but typically includes either surgical intervention with subsequent medical therapy or medical therapy alone. Case Description: We present the case of a 34-year-old male diagnosed with RNCC and treated successfully with surgical cyst drainage, resection, and subsequent medical therapy. Conclusion: Currently, no standardized evidence-based protocol exists that dictate appropriate treatment for extraparenchymal or racemose NCC. We present a case of RNCC treated successfully with surgical and medical intervention. Further research encompassing well-designed clinical trials is necessary to delineate appropriate and standardized protocols for treatment of this disease.
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Affiliation(s)
- Samuel G McClugage
- Department of Neurological Surgery, University of Alabama at Birmingham, Birmingham, AL, USA
| | - Rachael A Lee
- Department of Medicine, Division of Infectious Diseases, University of Alabama at Birmingham, Birmingham, AL, USA
| | - Bernard C Camins
- Department of Medicine, Division of Infectious Diseases, University of Alabama at Birmingham, Birmingham, AL, USA
| | - Juan J Mercado-Acosta
- Department of Pathology, Division of Neuropathology, University of Alabama at Birmingham, Birmingham, AL, USA
| | - Martin Rodriguez
- Department of Medicine, Division of Infectious Diseases, University of Alabama at Birmingham, Birmingham, AL, USA
| | - Kristen O Riley
- Department of Neurological Surgery, University of Alabama at Birmingham, Birmingham, AL, USA
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da Silva VBR, Campos BRKL, de Oliveira JF, Decout JL, do Carmo Alves de Lima M. Medicinal chemistry of antischistosomal drugs: Praziquantel and oxamniquine. Bioorg Med Chem 2017; 25:3259-3277. [DOI: 10.1016/j.bmc.2017.04.031] [Citation(s) in RCA: 59] [Impact Index Per Article: 8.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/01/2017] [Revised: 04/21/2017] [Accepted: 04/26/2017] [Indexed: 12/20/2022]
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Thamilselvan P, Muthuraman KR, Thasan SA, Kasinathan G, Mandal J, Parija SC. A Stratified Analysis of Clinical Manifestations and Different Diagnostic Methods of Neurocysticercosis-Suspected Tamilian Population Residing in and Around Puducherry. J Clin Diagn Res 2017; 11:DC10-DC15. [PMID: 28658758 DOI: 10.7860/jcdr/2017/23711.9844] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/23/2016] [Accepted: 09/30/2016] [Indexed: 11/24/2022]
Abstract
INTRODUCTION Human beings are accidental hosts for Cysticercus cellulosae showing varied clinical manifestations based on the site harbored by the parasitic cyst because of which disease profile remains unexplored at large. Besides this, diagnosis of the disease with a single conventional method is problematic due to lack of specificity and sensitivity. AIM To assess the varied clinical manifestations and stratify based on imaging and serological methods for diagnosis of Neurocysticercosis (NCC) in our study population. MATERIALS AND METHODS A hospital-based study was carried out at Jawaharlal Institute of Post-Graduate Medical Education and Research (JIPMER), the tertiary care centre caters patients from Puducherry and surrounding regions of Tamil Nadu. This is a cross-sectional analysis of clinically and radiologically suspected cases of NCC (n=119) for a period of three years (2012 to 2015). The collection of detailed clinical history and imaging findings (MRI or CT) along with the lifestyle parameters was done after obtaining informed consent. Enzyme-Linked Immune-Electro Transfer Blot (EITB) was carried out for the samples collected from study subjects. RESULTS Based on dietary and environmental factors non-vegetarians, pork eaters, raw vegetable consumers and open-field defecation showed significant seropositivity. The clinical manifestations like seizures, blurring of vision and chronic headache with nausea followed by neck pain, cognitive deficits and movement disorder have higher seropositivity respectively. Generalized seizures were found to be more than focal seizures. While comparing the imaging and serological tests for NCC diagnosis, the positivity rate was 46.2% considering positive by both methods; but 18.5% of sero-positive cases were imaging negative, and 16% of the sero-negative cases were imaging positive. The study showed a predominance of multiple cysts (62%) in cases with cystic lesions. CONCLUSION This study is first of its kind in associating varied and less commonly explored clinical manifestations with two different diagnostic measures in practice and its importance among our study settings. These manifestations must be considered as strong disease entities of NCC, which has to be suggested for differential diagnosis, and cannot be left ignored. Combinatorial diagnostic methods like serology and imaging techniques should be followed in diagnosis and assessing the disease burden.
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Affiliation(s)
| | | | | | | | - Jharna Mandal
- Associate Professor, Department of Microbiology, JIPMER, Puducherry, India
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Sahu PS, Lim YAL, Mahmud R, Somanath SD, Tan CT, Ramachandran CP. Needs of exploring the burden of recent onset seizures due to neurocysticercosis and challenges in southeast Asia focusing on scenario in Malaysia. ASIAN PAC J TROP MED 2017; 10:332-340. [PMID: 28552103 DOI: 10.1016/j.apjtm.2017.03.024] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/13/2016] [Revised: 03/10/2017] [Accepted: 03/15/2017] [Indexed: 10/19/2022] Open
Abstract
Seizures due to neurocysticercosis (NCC) is a neglected human-to-human transmitted disorder and an emerging problem worldwide. A substantial portion of recent onset seizures is known to be attributed to NCC in Taenia solium (T. solium) endemic areas where populations which neither raise pigs nor eat pig meat are also at risk. High prevalence of NCC causing epilepsy has been reported in the underdeveloped areas of Southeast Asia (SEA) however, only fragmentary information on its incidence is available in countries like Malaysia. In Malaysia T. solium infection was previously thought to be infrequent due to Muslim population majority and the religious prohibition of consuming pork, but it is not totally absent. There is an evident lack of knowledge and awareness of the actual burden, routes of transmission, and the impact of NCC in this region. The problem is assumed to be more prevalent particularly in cities because of the frequent inflow of possibly T. solium infected individuals or carriers among those who migrate from neighboring endemic countries to Malaysia. The issue of imported cases that are likely to be emerging in Malaysia is highlighted here. An accurate quantification of regional burdens of epilepsy due to NCC in Malaysia is warranted considering the disease emergence in its neighboring countries. It is suggested that the importance of NCC be recognized through quantification of its burden, and also to collect epidemiological data for its subsequent elimination in line of World Health Organization's mission for control of cysticercosis as a neglected tropical disease. In this review the need as well as a strategy for neuro-care center screening of epilepsy cases, and various issues with possible explanations are discussed. It is also proposed that NCC be declared as a reportable disease which is one of the eradicable public health problems in SEA.
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Affiliation(s)
- Priyadarshi S Sahu
- Division of Pathology, School of Medicine, International Medical University, 57000 Kuala Lumpur, Malaysia.
| | - Yvonne A L Lim
- Department of Parasitology, Department of Medicine, Faculty of Medicine, University of Malaya, 50603 Kuala Lumpur, Malaysia
| | - Rohela Mahmud
- Department of Parasitology, Department of Medicine, Faculty of Medicine, University of Malaya, 50603 Kuala Lumpur, Malaysia
| | - Sushela D Somanath
- Division of Pathology, School of Medicine, International Medical University, 57000 Kuala Lumpur, Malaysia
| | - Chong T Tan
- Division of Neurology, Department of Medicine, Faculty of Medicine, University of Malaya, 50603 Kuala Lumpur, Malaysia
| | - C P Ramachandran
- Programme Review Group, Neglected Tropical Diseases-WHO-Western Pacific Region, Kuala Lumpur, Malaysia
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Gripper LB, Welburn SC. The causal relationship between neurocysticercosis infection and the development of epilepsy - a systematic review. Infect Dis Poverty 2017; 6:31. [PMID: 28376856 PMCID: PMC5381143 DOI: 10.1186/s40249-017-0245-y] [Citation(s) in RCA: 38] [Impact Index Per Article: 5.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/29/2016] [Accepted: 01/13/2017] [Indexed: 12/02/2022] Open
Abstract
BACKGROUND Neurocysticercosis (NCC) is a parasitic infection of the human central nervous system, the most common form of which involves infection of the brain parenchyma with the larval form of the Taenia solium tapeworm. A causal relationship between such an NCC infection and the development of epilepsy in infected individuals is acknowledged, in part supported by high levels of comorbidity in endemic countries worldwide. METHODS This study undertook a systematic review and critical analysis of the NCC-epilepsy relationship with the primary objective of quantifying the risk of developing epilepsy following NCC infection. A secondary aim was to analyse the proportions of NCC-associated epilepsy within different populations. Significant emphasis was placed on the importance of neuroimaging (CT or MRI) availability and use of clear guidelines for epilepsy diagnosis, in order to avoid overestimations of prevalence rates of either condition; a limitation identified in several previous studies. RESULTS A common odds ratio of 2.76 was identified from meta-analysis of case-control studies, indicating that an individual infected with NCC has almost a three times higher risk of developing epilepsy than an uninfected individual. Furthermore, meta-analysis of studies identified a common proportion of 31.54% of epilepsy cases associated with NCC infection which suggests that amongst epileptic populations in at risk countries, approximately one-third may be associated with NCC infection. CONCLUSION A significant finding was the lack of good clinical data to enable accurate determination of a causal relationship. Even studies that were included had noticeable limitations, including a general lack of consistency in diagnostics, and lack of accurate epidemiological data. This review highlights a need for consistency in research in this field. In the absence of reliable estimates of its global burden, NCC will remain of low priority in the eyes of funding agencies - a truly neglected disease.
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Affiliation(s)
- Lucy B. Gripper
- Division of Infection and Pathway Medicine, Edinburgh Infectious Diseases, Edinburgh Medical School: Biomedical Sciences, College of Medicine and Veterinary Medicine, The University of Edinburgh, Chancellor’s Building, 49 Little France Crescent, Edinburgh, EH16 4SB Scotland UK
| | - Susan C. Welburn
- Division of Infection and Pathway Medicine, Edinburgh Infectious Diseases, Edinburgh Medical School: Biomedical Sciences, College of Medicine and Veterinary Medicine, The University of Edinburgh, Chancellor’s Building, 49 Little France Crescent, Edinburgh, EH16 4SB Scotland UK
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Gripper LB, Welburn SC. Neurocysticercosis infection and disease-A review. Acta Trop 2017; 166:218-224. [PMID: 27880878 DOI: 10.1016/j.actatropica.2016.11.015] [Citation(s) in RCA: 62] [Impact Index Per Article: 8.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/25/2016] [Revised: 11/15/2016] [Accepted: 11/15/2016] [Indexed: 10/20/2022]
Abstract
Neurocysticercosis (NCC) is the most common parasitic disease of the human central nervous system (CNS), a pleomorphic disease with a diverse array of clinical manifestations. The infection is pleomorphic and dependent on a complex range of interconnecting factors, including number and size of the cysticerci, their stage of development and localisation within the brain with resulting difficulties in accurate diagnosis and staging of the disease. This review examines the factors that contribute to the accurate assessment of NCC distribution and transmission that are critical to achieving robust disease burden calculations. Control and prevention of T. solium transmission should be a key priority in global health as intervention can reduce the substantial healthcare and economic burdens inflicted by both NCC and taeniasis. Surveillance systems need to be better established, including implementing obligatory notification of cases. In the absence of reliable estimates of its global burden, NCC will remain-along with other endemic zoonoses, of low priority in the eyes of funding agencies-a truly neglected disease.
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Neurocysticercosis: a review on status in India, management, and current therapeutic interventions. Parasitol Res 2016; 116:21-33. [DOI: 10.1007/s00436-016-5278-9] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/16/2016] [Accepted: 09/28/2016] [Indexed: 12/17/2022]
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Verastegui MR, Mejia A, Clark T, Gavidia CM, Mamani J, Ccopa F, Angulo N, Chile N, Carmen R, Medina R, García HH, Rodriguez S, Ortega Y, Gilman RH. Novel rat model for neurocysticercosis using Taenia solium. THE AMERICAN JOURNAL OF PATHOLOGY 2016. [PMID: 26216286 DOI: 10.1016/j.ajpath.2015.04.015] [Citation(s) in RCA: 29] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Neurocysticercosis is caused by Taenia solium infecting the central nervous system and is the leading cause of acquired epilepsy and convulsive conditions worldwide. Research into the pathophysiology of the disease and appropriate treatment is hindered by lack of cost-effective and physiologically similar animal models. We generated a novel rat neurocysticercosis model using intracranial infection with activated T. solium oncospheres. Holtzman rats were infected in two separate groups: the first group was inoculated extraparenchymally and the second intraparenchymally, with different doses of activated oncospheres. The groups were evaluated at three different ages. Histologic examination of the tissue surrounding T. solium cysticerci was performed. Results indicate that generally infected rats developed cysticerci in the brain tissue after 4 months, and the cysticerci were observed in the parenchymal, ventricle, or submeningeal brain tissue. The route of infection did not have a statistically significant effect on the proportion of rats that developed cysticerci, and there was no dependence on infection dose. However, rat age was crucial to the success of the infection. Epilepsy was observed in 9% of rats with neurocysticercosis. In histologic examination, a layer of collagen tissue, inflammatory infiltrate cells, perivascular infiltrate, angiogenesis, spongy change, and mass effect were observed in the tissue surrounding the cysts. This study presents a suitable animal model for the study of human neurocysticercosis.
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Affiliation(s)
- Manuela R Verastegui
- Cysticercosis Working Group in Peru, Lima, Peru; Infectious Diseases Laboratory Research-LID, Faculty of Science and Philosophy, Alberto Cazorla Talleri, Universidad Peruana Cayetano Heredia, Lima, Peru.
| | - Alan Mejia
- Cysticercosis Working Group in Peru, Lima, Peru; Infectious Diseases Laboratory Research-LID, Faculty of Science and Philosophy, Alberto Cazorla Talleri, Universidad Peruana Cayetano Heredia, Lima, Peru
| | - Taryn Clark
- Cysticercosis Working Group in Peru, Lima, Peru; Weill Cornell Medical College, New York, New York
| | - Cesar M Gavidia
- Cysticercosis Working Group in Peru, Lima, Peru; Public Health Section, School of Veterinary Medicine, Universidad Nacional Mayor de San Marcos, Lima, Peru
| | - Javier Mamani
- Cysticercosis Working Group in Peru, Lima, Peru; Faculty of Veterinary Medicine and Animal Husbandry, Universidad Peruana Cayetano Heredia, Lima, Peru
| | - Fredy Ccopa
- Cysticercosis Working Group in Peru, Lima, Peru; Infectious Diseases Laboratory Research-LID, Faculty of Science and Philosophy, Alberto Cazorla Talleri, Universidad Peruana Cayetano Heredia, Lima, Peru
| | - Noelia Angulo
- Cysticercosis Working Group in Peru, Lima, Peru; Infectious Diseases Laboratory Research-LID, Faculty of Science and Philosophy, Alberto Cazorla Talleri, Universidad Peruana Cayetano Heredia, Lima, Peru
| | - Nancy Chile
- Cysticercosis Working Group in Peru, Lima, Peru; Infectious Diseases Laboratory Research-LID, Faculty of Science and Philosophy, Alberto Cazorla Talleri, Universidad Peruana Cayetano Heredia, Lima, Peru
| | - Rogger Carmen
- Cysticercosis Working Group in Peru, Lima, Peru; Infectious Diseases Laboratory Research-LID, Faculty of Science and Philosophy, Alberto Cazorla Talleri, Universidad Peruana Cayetano Heredia, Lima, Peru
| | - Roxana Medina
- Cysticercosis Working Group in Peru, Lima, Peru; Department of Biology Science, Universidad Nacional del Altiplano, Puno, Peru
| | - Hector H García
- Cysticercosis Working Group in Peru, Lima, Peru; Infectious Diseases Laboratory Research-LID, Faculty of Science and Philosophy, Alberto Cazorla Talleri, Universidad Peruana Cayetano Heredia, Lima, Peru; Cysticercosis Unit, Instituto de Ciencias Neurologicas, Lima, Peru
| | - Silvia Rodriguez
- Cysticercosis Working Group in Peru, Lima, Peru; Cysticercosis Unit, Instituto de Ciencias Neurologicas, Lima, Peru
| | - Ynes Ortega
- Cysticercosis Working Group in Peru, Lima, Peru; Department of Food Science & Technology, The University of Georgia, Athens, Georgia
| | - Robert H Gilman
- Cysticercosis Working Group in Peru, Lima, Peru; Department of International Health, Bloomberg School of Hygiene and Public Health, Johns Hopkins University, Baltimore, Maryland; Asociación Benéfica PRISMA, San Miguel, Lima, Peru
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Shah HC, Jain K, Shah JK. Endoscopic excision of intraventricular neurocysticercosis blocking foramen of Monro bilaterally. Asian J Neurosurg 2016; 11:176-7. [PMID: 27057236 PMCID: PMC4802951 DOI: 10.4103/1793-5482.175622] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Abstract
Neurocysticercosis (NCC) is a parasitic infestation of the central nervous system. NCC parasitic infestation can be misdiagnosed as hydatid cyst or intraventricular epidermoid cyst that can cause a diagnostic dilemma. A 23-year-old male patient presented with headache and vomiting for 3-4 days and giddiness for 4-5 days. Magnetic resonance imaging with contrast was suggestive of a rim-enhancing lesion at the level of the foramen of Monro. Endoscopic excision of the lesion was done, and the patient had relief of a headache and vomiting immediately after the procedure. He is being followed up regularly. Intraventricular NCC occluding both foramen of Monro is a rare entity. Complete endoscopic surgical excision followed by appropriate drug therapy should be given to achieve a cure.
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Affiliation(s)
- Harshil Chimanlal Shah
- Department of Neurosurgery, B. J. Medical College and Civil Hospital, Ahmedabad, Gujarat, India
| | - Kapil Jain
- Department of Neurosurgery, B. J. Medical College and Civil Hospital, Ahmedabad, Gujarat, India
| | - Jaimin Kiran Shah
- Department of Neurosurgery, B. J. Medical College and Civil Hospital, Ahmedabad, Gujarat, India
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29
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Krupa K, Krupa K, Pisculli ML, Athas DM, Farrell CJ. Racemose neurocysticercosis. Surg Neurol Int 2016; 7:12. [PMID: 26958418 PMCID: PMC4766808 DOI: 10.4103/2152-7806.175881] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/09/2015] [Accepted: 10/01/2015] [Indexed: 11/17/2022] Open
Abstract
Background: Neurocysticercosis (NCC) is an invasive parasitic infection of the central nervous system caused by the larval stage of the tapeworm Taenia solium. The clinical manifestations of NCC depend on the parasitic load and location of infection, as well as the developmental stage of the cysticerci and host immune response, with symptoms ranging from subclinical headaches to seizures, cerebrovascular events, and life-threatening hydrocephalus. Racemose NCC represents a particularly severe variant of extraparenchymal NCC characterized by the presence of multiple confluent cysts within the subarachnoid space and is associated with increased morbidity and mortality, as well as a decreased response to treatment. Albendazole is the preferred drug for the treatment of racemose NCC due to its superior cerebrospinal fluid penetration compared to praziquantel and the ability to be used concomitantly with steroids. Case Description: In this report, we describe a 39-year-old man recently emigrated from Mexico with racemose NCC and hydrocephalus successfully treated with prolonged albendazole treatment, high-dose dexamethasone, and ventriculoperitoneal shunt placement for the relief of obstructive hydrocephalus. Conclusions: Treatment of racemose NCC represents a significant clinical challenge requiring multimodal intervention to minimize infectious- and treatment-related morbidity. We review the clinical, diagnostic, and therapeutic features relevant to the management of this aggressive form of NCC.
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Affiliation(s)
- Kristin Krupa
- Sidney Kimmel Medical College, Thomas Jefferson University, Philadelphia, PA, USA
| | - Kelly Krupa
- Sidney Kimmel Medical College, Thomas Jefferson University, Philadelphia, PA, USA
| | - Mary L Pisculli
- Department of Neurological Surgery, Thomas Jefferson University, Philadelphia, PA, USA
| | - Deena M Athas
- Division of Infectious Diseases and Environmental Medicine, Thomas Jefferson University, Philadelphia, PA, USA
| | - Christopher J Farrell
- Department of Neurological Surgery, Thomas Jefferson University, Philadelphia, PA, USA
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30
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Bennett HM, Mok HP, Gkrania-Klotsas E, Tsai IJ, Stanley EJ, Antoun NM, Coghlan A, Harsha B, Traini A, Ribeiro DM, Steinbiss S, Lucas SB, Allinson KSJ, Price SJ, Santarius TS, Carmichael AJ, Chiodini PL, Holroyd N, Dean AF, Berriman M. The genome of the sparganosis tapeworm Spirometra erinaceieuropaei isolated from the biopsy of a migrating brain lesion. Genome Biol 2015. [PMID: 25413302 PMCID: PMC4265353 DOI: 10.1186/s13059-014-0510-3] [Citation(s) in RCA: 36] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Sparganosis is an infection with a larval Diphyllobothriidea tapeworm. From a rare cerebral case presented at a clinic in the UK, DNA was recovered from a biopsy sample and used to determine the causative species as Spirometra erinaceieuropaei through sequencing of the cox1 gene. From the same DNA, we have produced a draft genome, the first of its kind for this species, and used it to perform a comparative genomics analysis and to investigate known and potential tapeworm drug targets in this tapeworm. RESULTS The 1.26 Gb draft genome of S. erinaceieuropaei is currently the largest reported for any flatworm. Through investigation of β-tubulin genes, we predict that S. erinaceieuropaei larvae are insensitive to the tapeworm drug albendazole. We find that many putative tapeworm drug targets are also present in S. erinaceieuropaei, allowing possible cross application of new drugs. In comparison to other sequenced tapeworm species we observe expansion of protease classes, and of Kuntiz-type protease inhibitors. Expanded gene families in this tapeworm also include those that are involved in processes that add post-translational diversity to the protein landscape, intracellular transport, transcriptional regulation and detoxification. CONCLUSIONS The S. erinaceieuropaei genome begins to give us insight into an order of tapeworms previously uncharacterized at the genome-wide level. From a single clinical case we have begun to sketch a picture of the characteristics of these organisms. Finally, our work represents a significant technological achievement as we present a draft genome sequence of a rare tapeworm, and from a small amount of starting material.
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31
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Bugeme M, Mukuku O. [Neurocysticercosis revealed by refractory epilepsy: report of a case]. Pan Afr Med J 2015; 20:104. [PMID: 26090052 PMCID: PMC4458307 DOI: 10.11604/pamj.2015.20.104.5958] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/18/2014] [Accepted: 02/03/2015] [Indexed: 02/05/2023] Open
Abstract
Nous rapportons une observation de neurocysticercose parenchymateuse chez un homme de 38 ans, consommant régulièrement la viande de porc, qui a présenté une épilepsie réfractaire. Le diagnostic de NCC était basé sur la présence de lésions kystiques montrant le scolex sur les images du scanner cérébrale, la présence de signes cliniques évocateurs de NCC (épilepsie faite des crises convulsives focales évoluant vers des crises bilatérales), la réponse clinique au traitement à l'albendazole et le fait que notre patient vit dans une zone reconnue endémique à la cysticercose. Après un traitement fait d'albendazole et de prednisolone, l’évolution est marquée par la disparition complète des crises épileptiques.
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Affiliation(s)
- Marcellin Bugeme
- Faculté de Médecine, Université de Lubumbashi, RDCongo ; Centre Neuropsychiatrique Dr Joseph Guislain/Frères de la Charité, Lubumbashi, RDCongo
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32
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Purvey S, Lu K, Mukkamalla SK, Anandi P, Dumitriu B, Kranick S, Hammoud DA, O'Connell E, Oh AL, Barrett J, Mahanty S, Battiwalla M. Conservative management of neurocysticercosis in a patient with hematopoietic stem cell transplantation: a case report and review. Transpl Infect Dis 2015; 17:456-62. [PMID: 25850995 DOI: 10.1111/tid.12392] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/30/2014] [Revised: 12/28/2014] [Accepted: 03/22/2015] [Indexed: 12/16/2022]
Abstract
Neurocysticercosis, an infection of the central nervous system with the larval stage of the cestode Taenia solium, is common in developing countries but its occurrence and management in allogeneic hematopoietic stem cell transplantation (HSCT) has not been reported previously, to our knowledge. We report the case of an immigrant female patient who underwent a matched-related allogeneic HSCT for acute lymphoblastic leukemia and was incidentally found to have a solitary viable neurocysticercosis lesion. However, despite severe immunosuppression, the size of the cyst did not increase. More importantly, restoration of the immune system did not induce significant inflammation or seizures. Subsequent follow-up demonstrated complete resolution of the neurocysticercosis lesion. Thus, in the setting of HSCT, an asymptomatic patient with a single neurocysticercosis lesion was successfully managed without the use of anthelmintics, steroids, or anti-epileptics.
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Affiliation(s)
- S Purvey
- Hematology Branch, National Heart, Lung, Blood Institute, National Institutes of Health (NIH), Bethesda, Maryland, USA
| | - K Lu
- Hematology Branch, National Heart, Lung, Blood Institute, National Institutes of Health (NIH), Bethesda, Maryland, USA
| | - S K Mukkamalla
- Hematology Branch, National Heart, Lung, Blood Institute, National Institutes of Health (NIH), Bethesda, Maryland, USA
| | - P Anandi
- Hematology Branch, National Heart, Lung, Blood Institute, National Institutes of Health (NIH), Bethesda, Maryland, USA
| | - B Dumitriu
- Hematology Branch, National Heart, Lung, Blood Institute, National Institutes of Health (NIH), Bethesda, Maryland, USA
| | - S Kranick
- National Institute of Neurological Disorders and Stroke, NIH, Bethesda, Maryland, USA
| | - D A Hammoud
- Center for Infectious Disease Imaging (CIDI), Radiology and Imaging Sciences, Clinical Center, NIH, Bethesda, Maryland, USA
| | - E O'Connell
- National Institute of Allergy and Infectious Diseases, NIH, Bethesda, Maryland, USA
| | - A L Oh
- University of Illinois at Chicago, Chicago, Illinois, USA
| | - J Barrett
- Hematology Branch, National Heart, Lung, Blood Institute, National Institutes of Health (NIH), Bethesda, Maryland, USA
| | - S Mahanty
- National Institute of Allergy and Infectious Diseases, NIH, Bethesda, Maryland, USA
| | - M Battiwalla
- Hematology Branch, National Heart, Lung, Blood Institute, National Institutes of Health (NIH), Bethesda, Maryland, USA
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Mahale RR, Mehta A, Rangasetty S. Extraparenchymal (Racemose) Neurocysticercosis and Its Multitude Manifestations: A Comprehensive Review. J Clin Neurol 2015; 11:203-11. [PMID: 26022457 PMCID: PMC4507373 DOI: 10.3988/jcn.2015.11.3.203] [Citation(s) in RCA: 38] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/04/2014] [Revised: 12/27/2014] [Accepted: 12/29/2014] [Indexed: 11/17/2022] Open
Abstract
Neurocysticercosis is an infection of the central nervous system caused by the larval form of the pork tapeworm Taenia solium. In the brain it occurs in two forms: parenchymal and extraparenchymal or racemose cysts. The clinical presentation of racemose cysts is pleomorphic, and is quite different from parenchymal cysticercosis. The clinical diagnosis of racemose cysts is quite challenging, with neuroimaging being the mainstay. However, the advent of newer brain imaging modalities has made a more accurate diagnosis possible. The primary focus of this article is racemose neurocysticercosis and its multitude manifestations, and includes a discussion of the newer diagnostic modalities and treatment options.
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Affiliation(s)
- Rohan R Mahale
- Department of Neurology, MS Ramaiah Medical College & Hospital, Bangalore, Karnataka, India.
| | - Anish Mehta
- Department of Neurology, MS Ramaiah Medical College & Hospital, Bangalore, Karnataka, India
| | - Srinivasa Rangasetty
- Department of Neurology, MS Ramaiah Medical College & Hospital, Bangalore, Karnataka, India
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Malik AM, Shamim MD, Ahmad M, Abdali N. Neurocysticercosis presenting as focal hydrocephalus. BMJ Case Rep 2014; 2014:bcr-2014-204269. [PMID: 24962486 DOI: 10.1136/bcr-2014-204269] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Abstract
A 40-year-old man presented with a 2-month history of headache, nausea and vomiting, with generalised seizures for the past 15 days. On examination he had bilateral papilloedema, visual acuity was 6/6 in both eyes but perimetry showed right homonymous inferior quadrantanopia. His MRI showed numerous small cystic lesions with eccentric nodules, diffusely distributed in bilateral cerebral and cerebellar hemispheres. There was also focal hydrocephalus involving occipital and temporal horns of the left lateral ventricle leading to its selective dilation. Stool examination showed ova of Taenia solium. He was treated with albendazole, prednisone and sustained release sodium valproate for 1 month. His headache resolved and he is free of seizures. Repeat perimetry at 1 month also showed resolution of visual field defect.
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Affiliation(s)
- Azharuddin Mohammed Malik
- Department of Medicine, Jawaharlal Nehru Medical College, Aligarh Muslim University, Aligarh, Uttar Pradesh, India
| | - Md Dilawez Shamim
- Department of Medicine, Jawaharlal Nehru Medical College, Aligarh Muslim University, Aligarh, Uttar Pradesh, India
| | - Mehtab Ahmad
- Department of Radiodiagnosis, Jawaharlal Nehru Medical College, Aligarh Muslim University, Aligarh, Uttar Pradesh, India
| | - Nasar Abdali
- Department of Medicine, Jawaharlal Nehru Medical College, Aligarh Muslim University, Aligarh, Uttar Pradesh, India
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Taschner CA, Doostkam S, Weyerbrock A, Schaefer HE, Urbach H, Keuler A, Prinz M. Freiburg neuropathology case conference: multiple small ring-enhancing lesions in a 75-year-old patient. Clin Neuroradiol 2014; 24:193-7. [PMID: 24823686 DOI: 10.1007/s00062-014-0307-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/26/2014] [Accepted: 04/14/2014] [Indexed: 11/29/2022]
Affiliation(s)
- C A Taschner
- Department of Neuroradiology, University Hospital Freiburg, Freiburg, Germany,
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36
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Rapoport BI, Baird LC, Cohen AR. Third-ventricular neurocysticercosis: hydraulic maneuvers facilitating endoscopic resection. Childs Nerv Syst 2014; 30:541-6. [PMID: 24037383 PMCID: PMC4281270 DOI: 10.1007/s00381-013-2273-7] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/15/2013] [Accepted: 08/22/2013] [Indexed: 11/30/2022]
Abstract
BACKGROUND Neurocysticercosis, an infection of the central nervous system with the larval cysts of the pork tapeworm, Taenia solium, is the most common parasitic disease of the central nervous system. The disease is a major global cause of acquired epilepsy and may also manifest as intracranial hypertension due to mass effect from large cysts or to cerebrospinal fluid flow obstruction by intraventricular cysts or inflammation of the subarachnoid space. While the condition is endemic in several regions of the world and has been appreciated as a public health problem in such regions for several decades, its emergence in the USA in areas far from the Mexican border is a more recent phenomenon. METHODS We present a case of surgically corrected acute hydrocephalus in a recent Haitian emigrant child due to a third ventricular neurocysticercal cyst complex. RESULTS We describe the endoscope-assisted en bloc removal of the complex, together with hydraulic maneuvers facilitating the removal of the intact cyst. CONCLUSIONS Simple hydraulic maneuvers can facilitate the endoscopic en bloc removal of third ventricular neurocysticercal cysts.
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Affiliation(s)
- Benjamin I. Rapoport
- Harvard Medical School, Boston, Massachusetts, United States of America
- Department of Neurological Surgery, Weill Cornell Medical College, New York City, New York, United States of America
| | - Lissa C. Baird
- Department of Neurological Surgery, Doernbecher Children’s Hospital, Oregon Health and Science University, Portland, Oregon, United States of America
| | - Alan R. Cohen
- Harvard Medical School, Boston, Massachusetts, United States of America
- Department of Neurosurgery, Boston Children’s Hospital, Boston, Massachusetts, United States of America
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37
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de Almeida Leandro L, Fraga CM, de Souza Lino R, Vinaud MC. Partial reverse of the TCA cycle is enhanced in Taenia crassiceps experimental neurocysticercosis after in vivo treatment with anthelminthic drugs. Parasitol Res 2014; 113:1313-7. [PMID: 24481905 DOI: 10.1007/s00436-014-3770-7] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/04/2013] [Accepted: 01/10/2014] [Indexed: 12/12/2022]
Abstract
Neurocysticercosis (NCC) is the most common helminthic infection and neglected disease of the central nervous system. It is the leading cause of acquired epilepsy and seizures worldwide. Therefore, to study this important neglected disease, it is important to use experimental models. There is no report in the literature on how the parasite's metabolism reacts to antihelminthic treatment when it is still within the central nervous system of the host. Therefore, the aim of this study was to investigate the energetic metabolism of cysticerci experimentally inoculated in the encephala of BALB/c mice after treatment with low dosages (not sufficient to kill the parasite) of albendazole (ABDZ) and praziquantel (PZQ). BALB/c mice were intracranially inoculated with Taenia crassiceps cysticerci and, after 30 days, received treatment with low dosages of ABDZ and PZQ. After 24 h of treatment, the mice were euthanized, and the cysticerci were removed and analyzed through high-performance liquid chromatography (HPLC) to quantify the organic acids related to the energetic metabolism of the parasite. The partial reverse of the TCA cycle was enhanced by the ABDZ and PZQ treatments both with the higher dosage, as the organic acids of this pathway were significantly increased when compared to the control group and to the other dosages. In conclusion, it was possible to detect the increase of this pathway in the parasites that were exposed to low dosages of ABDZ and PZQ, as it is a mechanism that would amplify the energy production in a hostile environment.
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Affiliation(s)
- Leticia de Almeida Leandro
- Tropical Pathology and Public Health Institute, Federal University of Goiás, Rua 235 s/n, Setor Universitário, Goiás, 74650-050, Brazil
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38
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Bennett HM, Mok HP, Gkrania-Klotsas E, Tsai IJ, Stanley EJ, Antoun NM, Coghlan A, Harsha B, Traini A, Ribeiro DM, Steinbiss S, Lucas SB, Allinson KSJ, Price SJ, Santarius TS, Carmichael AJ, Chiodini PL, Holroyd N, Dean AF, Berriman M. The genome of the sparganosis tapeworm Spirometra erinaceieuropaei isolated from the biopsy of a migrating brain lesion. Genome Biol 2014; 15:510. [PMID: 25413302 PMCID: PMC4265353 DOI: 10.1186/preaccept-2413673241432389] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/19/2014] [Accepted: 10/28/2014] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Sparganosis is an infection with a larval Diphyllobothriidea tapeworm. From a rare cerebral case presented at a clinic in the UK, DNA was recovered from a biopsy sample and used to determine the causative species as Spirometra erinaceieuropaei through sequencing of the cox1 gene. From the same DNA, we have produced a draft genome, the first of its kind for this species, and used it to perform a comparative genomics analysis and to investigate known and potential tapeworm drug targets in this tapeworm. RESULTS The 1.26 Gb draft genome of S. erinaceieuropaei is currently the largest reported for any flatworm. Through investigation of β-tubulin genes, we predict that S. erinaceieuropaei larvae are insensitive to the tapeworm drug albendazole. We find that many putative tapeworm drug targets are also present in S. erinaceieuropaei, allowing possible cross application of new drugs. In comparison to other sequenced tapeworm species we observe expansion of protease classes, and of Kuntiz-type protease inhibitors. Expanded gene families in this tapeworm also include those that are involved in processes that add post-translational diversity to the protein landscape, intracellular transport, transcriptional regulation and detoxification. CONCLUSIONS The S. erinaceieuropaei genome begins to give us insight into an order of tapeworms previously uncharacterized at the genome-wide level. From a single clinical case we have begun to sketch a picture of the characteristics of these organisms. Finally, our work represents a significant technological achievement as we present a draft genome sequence of a rare tapeworm, and from a small amount of starting material.
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Affiliation(s)
- Hayley M Bennett
- />Wellcome Trust Sanger Institute, Parasite Genomics, Cambridge, CB10 1SA UK
| | - Hoi Ping Mok
- />Department of Infectious Diseases, Addenbrooke’s NHS Trust, Cambridge, CB2 0QQ UK
| | | | - Isheng J Tsai
- />Wellcome Trust Sanger Institute, Parasite Genomics, Cambridge, CB10 1SA UK
- />Biodiversity Research Center, Academia Sinica, Taipei, 11529 Taiwan
| | - Eleanor J Stanley
- />Wellcome Trust Sanger Institute, Parasite Genomics, Cambridge, CB10 1SA UK
- />Eagle Genomics, Babraham Research Campus, Babraham, Cambridge, CB22 3AT UK
| | - Nagui M Antoun
- />Department of Radiology, Addenbrookes’s NHS Trust, Cambridge, CB2 0QQ UK
| | - Avril Coghlan
- />Wellcome Trust Sanger Institute, Parasite Genomics, Cambridge, CB10 1SA UK
| | - Bhavana Harsha
- />Wellcome Trust Sanger Institute, Parasite Genomics, Cambridge, CB10 1SA UK
| | - Alessandra Traini
- />Wellcome Trust Sanger Institute, Parasite Genomics, Cambridge, CB10 1SA UK
| | - Diogo M Ribeiro
- />Wellcome Trust Sanger Institute, Parasite Genomics, Cambridge, CB10 1SA UK
| | - Sascha Steinbiss
- />Wellcome Trust Sanger Institute, Parasite Genomics, Cambridge, CB10 1SA UK
| | - Sebastian B Lucas
- />Department of Histopathology, St Thomas’s Hospital, London, SE1 UK
| | - Kieren SJ Allinson
- />Department of Histopathology Section, Addenbrookes’s NHS Trust, Cambridge, CB2 0QQ UK
| | - Stephen J Price
- />Department of Neurosurgery, Addenbrookes’s NHS Trust, Cambridge, CB2 0QQ UK
| | - Thomas S Santarius
- />Department of Neurosurgery, Addenbrookes’s NHS Trust, Cambridge, CB2 0QQ UK
| | - Andrew J Carmichael
- />Department of Infectious Diseases, Addenbrooke’s NHS Trust, Cambridge, CB2 0QQ UK
| | - Peter L Chiodini
- />Hospital for Tropical Diseases and London School of Hygiene and Tropical Medicine, London, WC1E 6JD UK
| | - Nancy Holroyd
- />Wellcome Trust Sanger Institute, Parasite Genomics, Cambridge, CB10 1SA UK
| | - Andrew F Dean
- />Department of Histopathology Section, Addenbrookes’s NHS Trust, Cambridge, CB2 0QQ UK
| | - Matthew Berriman
- />Wellcome Trust Sanger Institute, Parasite Genomics, Cambridge, CB10 1SA UK
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Abstract
Rhizobiales (formerly named Rickettsiales) cause in rare instances meningitis and meningovasculitis, respectively. In case of history of exposure, infection by Rhizobiales needs to be considered since both diagnosis and therapy may be extremely difficult and pathogen-specific. The same applies to protozoa; in this chapter, Babesia species, free-living amoebae and Entamoeba histolytica infection, including severe meningitis and brain abscess, infection by Trypanosoma species (South American and African trypanosomiasis) are discussed with respect to history, epidemiology, clinical signs, and symptoms as well as differential diagnosis and therapy. Parasitic flatworms and roundworms, potentially able to invade the central nervous system, trematodes (flukes), cestodes (in particular, Cysticercus cellulosae), but also nematodes (in particular, Strongyloides spp. in the immunocompromised) are of worldwide importance. In contrast, filarial worms, Toxocara spp., Trichinella spp., Gnathostoma and Angiostrongylus spp. are seen only in certain geographically confined areas. Even more regionally confined are infestations of the central nervous system by metazoa, in particular, tongue worms (=arthropods) or larvae of flies (=maggots). The aim of this chapter is (1) to alert the neurologist to these infections, and (2) to enable the attending emergency neurologist to take a knowledgeable history, with an emphasis on epidemiology, clinical signs, and symptoms as well as therapeutic management possibilities.
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Affiliation(s)
- Erich Schmutzhard
- Department of Neurology, Medical University Hospital Innsbruck, Innsbruck, Austria.
| | - Raimund Helbok
- Department of Neurology, Medical University Hospital Innsbruck, Innsbruck, Austria
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Chatterjee K, Ghosh GC. Disseminated neurocysticercosis presenting as affective mood disorder with chronic tension type headache. J Neurosci Rural Pract 2013; 4:461-3. [PMID: 24347961 PMCID: PMC3858773 DOI: 10.4103/0976-3147.120212] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022] Open
Abstract
Neurocysticercosis is a common parasitic infection in India presenting usually with seizues, headache, focal neurological deficits. Neurocysticercosis presenting as a psychiatric illness is rare. Disseminated cysticercosis with involvement of central nervous system and head and neck muscles is rare even in endemic areas. We present a case of disseminated cysticercosis, which presented with chronic tension type headache and affective mood disorder. Treatment with cysticidal drugs led to complete remission of psychiatric complaints. In endemic areas history suggestive of mood disorder should not be used as supportive evidence of a primary headache syndome like tension type headche without ruling out secondary causes. Making an early diagnosis can prevent morbidity.
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Affiliation(s)
- Krishnarpan Chatterjee
- Department of Medicine, Dr. Ram Manohar Lohia Hospital, GGSIP University, New Delhi, India
| | - Gopal Chandra Ghosh
- Department of Medicine, Dr. Ram Manohar Lohia Hospital, GGSIP University, New Delhi, India
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Abstract
SUMMARYTo assess the prevalence of Taenia solium cysticercosis in patients with neurological disorders in Slovenia, serum/cerebrospinal fluid (CSF) samples from 348 suspected patients were collected between the beginning of January 2001 and the end of December 2012 and analysed serologically for the presence of anti-T. solium IgG antibodies. Of 20 patients whose samples tested positive or equivocal by enzyme-linked immunosorbent assay (ELISA), samples of 7 patients were confirmed positive by Western blot (WB). The overall seroprevalence rate of T. solium infection in patients with neurological disorders included in the study was 2.0%. Serological results of positive patients corresponded to clinical and/or imaging findings concerning their brain cysts. Based on their personal data, it was ascertained that neurocysticercosis (NCC) positive patients had immigrated or came to Slovenia from the former Yugoslav republics. Since the disease is believed not to be endemic in Slovenia we assume that all of the NCC-positive patients had acquired the infection before immigration to Slovenia or visiting or being visited by their relatives infected with an adult T. solium parasite. The present results represent the first insight into the prevalence of NCC in patients with neurological disorders in Slovenia.
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Murunga AN, Owira PMO. Diabetic ketoacidosis: an overlooked child killer in sub-Saharan Africa? Trop Med Int Health 2013; 18:1357-64. [PMID: 24112393 DOI: 10.1111/tmi.12195] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/29/2022]
Abstract
The true incidence of diabetic ketoacidosis (DKA) in sub-Saharan Africa is unknown but unlike in the Western countries, DKA is also uniquely frequent among type 2 diabetes patients of African origin. Increased hyperglycaemia and hepatic ketogenesis lead to osmotic diuresis, dehydration and tissue hypoxia. Acute complications of DKA include cerebral oedema, which may be compounded by malnutrition, parasitic and microbial infections with rampant tuberculosis and HIV. Overlapping symptoms of these conditions and misdiagnosis of DKA contribute to increased morbidity and mortality. Inability of the patients to afford insulin treatment leads to poor glycemic control as some patients seek alternative treatment from traditional healers or use herbal remedies further complicating the disease process. Standard treatment guidelines for DKA currently used may not be ideal as they are adapted from those of the developed world. Children presenting with suspected DKA should be screened for comorbidities which may complicate fluid and electrolyte replacement therapy protocol. Patient rehabilitation should take into account concurrent treatment for infectious conditions to avoid possible life-threatening drug interactions. We recommend that health systems in sub-Saharan Africa leverage the Expanded Immunization Programme or TB/HIV/AIDS programmes, which are fairly well entrenched to support diabetes services.
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Affiliation(s)
- A N Murunga
- School of Health Sciences, University of KwaZulu-Natal, Durban, South Africa
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Giacomet V, Penagini F, Erba P, Nello FD, Nannini P, Pisanelli S, Ramponi G, Zuccotti GV. Neurocysticercosis in a 14-year-old boy in Italy: An unexpected case. ASIAN PACIFIC JOURNAL OF TROPICAL DISEASE 2013. [DOI: 10.1016/s2222-1808(13)60078-x] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/24/2022]
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Zammarchi L, Strohmeyer M, Bartalesi F, Bruno E, Muñoz J, Buonfrate D, Nicoletti A, García HH, Pozio E, Bartoloni A. Epidemiology and management of cysticercosis and Taenia solium taeniasis in Europe, systematic review 1990-2011. PLoS One 2013; 8:e69537. [PMID: 23922733 PMCID: PMC3726635 DOI: 10.1371/journal.pone.0069537] [Citation(s) in RCA: 72] [Impact Index Per Article: 6.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/29/2013] [Accepted: 06/10/2013] [Indexed: 11/30/2022] Open
Abstract
BACKGROUND Cysticercosis is caused by the invasion of human or pig tissues by the metacestode larval stage of Taenia solium. In Europe, the disease was endemic in the past but the autochthonous natural life cycle of the parasite is currently completed very rarely. Recently, imported cases have increased in parallel to the increased number of migrations and international travels. The lack of specific surveillance systems for cysticercosis leads to underestimation of the epidemiological and clinical impacts. OBJECTIVES To review the available data on epidemiology and management of cysticercosis in Europe. METHODS A review of literature on human cysticercosis and T. solium taeniasis in Europe published between 1990-2011 was conducted. RESULTS Out of 846 cysticercosis cases described in the literature, 522 cases were autochthonous and 324 cases were imported. The majority (70.1%) of the autochthonous cases were diagnosed in Portugal from 1983 and 1994. Imported cases of which 242 (74.7%) diagnosed in migrants and 57 (17.6%) in European travellers, showed an increasing trend. Most of imported cases were acquired in Latin America (69.8% of migrants and 44.0% of travellers). The majority of imported cases were diagnosed in Spain (47.5%), France (16.7%) and Italy (8.3%). One third of neurosurgical procedures were performed because the suspected diagnosis was cerebral neoplasm. Sixty eight autochthonous and 5 imported T. solium taeniasis cases were reported. CONCLUSIONS Cysticercosis remains a challenge for European care providers, since they are often poorly aware of this infection and have little familiarity in managing this disease. Cysticercosis should be included among mandatory reportable diseases, in order to improve the accuracy of epidemiological information. European health care providers might benefit from a transfer of knowledge from colleagues working in endemic areas and the development of shared diagnostic and therapeutic processes would have impact on the quality of the European health systems.
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Affiliation(s)
- Lorenzo Zammarchi
- Infectious Disease Unit, Department of Experimental and Clinical Medicine, University of Florence School of Medicine, Florence, Italy
| | - Marianne Strohmeyer
- Infectious Disease Unit, Department of Experimental and Clinical Medicine, University of Florence School of Medicine, Florence, Italy
| | - Filippo Bartalesi
- SOD Malattie Infettive e Tropicali, Azienda Ospedaliero-Universitaria Careggi, Florence, Italy
| | - Elisa Bruno
- Department G.F. Ingrassia, Section of Neurosciences, University of Catania, Catania, Italy
| | - José Muñoz
- Servicio de Medicina Tropical y Salud Internacional, Centre de Recerca en Salut Internacional de Barcelona, Hospital Clínic-Universitat de Barcelona, Barcelona, Spain
| | - Dora Buonfrate
- Centre for Tropical Diseases, Sacro Cuore Hospital, Via Don Sempreboni, Negrar (Verona), Italy
| | - Alessandra Nicoletti
- Department G.F. Ingrassia, Section of Neurosciences, University of Catania, Catania, Italy
| | - Héctor Hugo García
- Cysticercosis Unit, Instituto de Ciencias Neurologicas, Department of Microbiology, Universidad Peruana Cayetano Heredia, Lima, Peru
| | - Edoardo Pozio
- Department of Infectious, Parasitic and Immunomediated Diseases, Istituto Superiore di Sanità, Rome, Italy
| | - Alessandro Bartoloni
- Infectious Disease Unit, Department of Experimental and Clinical Medicine, University of Florence School of Medicine, Florence, Italy
- SOD Malattie Infettive e Tropicali, Azienda Ospedaliero-Universitaria Careggi, Florence, Italy
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Parija SC, Gireesh A. Cysticercus cellulosae antigens in the serodiagnosis of neurocysticercosis. Trop Parasitol 2013; 1:64-72. [PMID: 23508242 PMCID: PMC3593475 DOI: 10.4103/2229-5070.86932] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/18/2011] [Accepted: 10/31/2011] [Indexed: 11/04/2022] Open
Abstract
Neurocysticercosis (NCC) is difficult to diagnose clinically because of its varied clinical presentation. However, an accurate diagnosis is possible only after suspicion on epidemiological grounds, proper interpretation of the clinical data, analysis of the findings on imaging studies, and specific immunological tests on the serum and cerebrospinal fluid (CSF). The diagnosis of NCC by any single parameter thus continues to remain difficult. In the past, detection of NCC was based on autopsy studies and histological confirmation. In recent times, the advent of imaging methods such as computed tomography and magnetic resonance imaging have provided excellent non-invasive tools for easy detection of NCC. Nevertheless, an imaging technique of the brain, although useful, is not considered as a gold standard for the diagnosis of NCC. Serological tests are being increasingly used in adjunct with imaging techniques, to aid the diagnosis of NCC. Immunodiagnostic techniques include detection methods for specific antibodies and for circulating parasite antigens in the serum and CSF. Currently, many of the immunodiagnostic tests, including the enzyme-linked immunosorbent assay and enzyme immunotransfer blot, use purified native antigens for the immunodiagnosis of NCC. Nevertheless, the main problem with the use of native cysticercal antigens is that the native proteins often show cross reactions with sera from humans infected with other parasites. The preparation of native antigens also demand a constant supply of parasitic material from the intermediate host pig. In order to overcome the problems in using native antigens, the recombinant antigens or synthetic peptides, which can be produced under stable conditions, are being evaluated for the serodiagnosis of NCC.
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Affiliation(s)
- Subhash Chandra Parija
- Department of Microbiology, Jawaharlal Institute of Postgraduate Medical Education and Research (JIPMER), Puducherry, India
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Sharma S, Modi M, Lal V, Prabhakar S, Bhardwaj A, Sehgal R. Reversible dementia as a presenting manifestation of racemose neurocysticercosis. Ann Indian Acad Neurol 2013; 16:88-90. [PMID: 23661971 PMCID: PMC3644790 DOI: 10.4103/0972-2327.107706] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/30/2011] [Revised: 01/18/2012] [Accepted: 07/09/2012] [Indexed: 12/05/2022] Open
Abstract
Racemose cysticercosis is a less frequent presentation of neurocysticercosis (NCC). It's presentation and management is quite different from cerebral parenchymal NCC. Diagnosis of racemose cysticercosis is based on the combination of clinical, epidemiologic, radiographic, and immunologic information. Compared with cysticercus cellulose, which most commonly presents as seizures, racemose NCC due to its extraaxial location presents with raised intracranial pressure and meningitis, and frequently requires neurosurgical intervention. Dementia as a sole presenting feature of NCC is rare. We report a case of racemose NCC with dementia as the presenting manifestation. The outcome of dementia patients with NCC seems favorable in most cases therefore a high index of suspicion for NCC should be kept especially in endemic areas.
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Affiliation(s)
- Sudhir Sharma
- Department of Neurology, Postgraduate Institute of Medical Education and Research, Chandigarh, India
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Ayyappan S, Seneviratne U. An African immigrant with seizures and multiple brain lesions. J Clin Neurosci 2013. [DOI: 10.1016/j.jocn.2013.02.011] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
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Gonzalez AE, Bustos JA, Jimenez JA, Rodriguez ML, Ramirez MG, Gilman RH, Garcia HH. Efficacy of diverse antiparasitic treatments for cysticercosis in the pig model. Am J Trop Med Hyg 2012; 87:292-6. [PMID: 22855760 DOI: 10.4269/ajtmh.2012.11-0371] [Citation(s) in RCA: 39] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022] Open
Abstract
Taenia solium cysticercosis infects pigs and humans. Because antiparasitic treatment for human cysticercosis has sub-optimal efficacy, alternative regimes are needed. Seven antiparasitic regimens were tested in 42 naturally infected pigs with cysticercosis, and compared with prednisone alone (n = 6) or no treatment (n = 6). The numbers of viable cysts in muscles and in the brain were examined after necropsy and were significantly decreased in pigs receiving combined albendazole plus praziquantel, albendazole alone, or oxfendazole. Pigs receiving praziquantel alone and nitazoxanide had numerous surviving cysts. Control (untreated) pigs and prednisone-treated pigs had many more viable cysts, suggesting no effect. Combined albendazole plus praziquantel, and oxfendazole, showed a strong cysticidal effect and provide suitable alternative treatments to be further explored for their use for treatment of human neurocysticercosis.
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Affiliation(s)
- Armando E Gonzalez
- School of Veterinary Medicine, Universidad Nacional Mayor de San Marcos, Lima, Peru.
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Santos GT, Leite CC, Machado LR, McKinney AM, Lucato LT. Reduced diffusion in neurocysticercosis: circumstances of appearance and possible natural history implications. AJNR Am J Neuroradiol 2012; 34:310-6. [PMID: 22821919 DOI: 10.3174/ajnr.a3198] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022]
Abstract
BACKGROUND AND PURPOSE Few studies discuss DWI findings in patients with NCC, and their conclusions are variable and contradictory. The aim of our study was to describe DWI findings of a cohort of patients with NCC, emphasizing the frequency of reduced diffusion. MATERIALS AND METHODS This retrospective study included 48 patients with NCC. Two neuroradiologists analyzed MR images regarding location, number, and stage of NCC lesions. On the basis of visual analysis, they defined, by consensus, the presence of high signal within NCC lesions on DWI and measured their ADC values when feasible. RESULTS The total number of lesions was 342: parenchymal (263), subarachnoid (65), and intraventricular (14); 83 were DWI hyperintense. The first pattern was a small eccentric hyperintense dot/curvilinear structure on DWI (representing the scolex) noted in intraparenchymal lesions in vesicular (41 lesions, 29%) and colloidal vesicular (18 lesions, 19%) stages, in 14 (22%) subarachnoid lesions, and 2 (14%) intraventricular lesions; rADC calculations were hampered by the intrinsic small dimensions of this finding. The second pattern was the presence of total/subtotal DWI hyperintensity in intraparenchymal lesions, 5 in the colloidal vesicular stage (5%) and 1 in the granular nodular phase (3%). Two subarachnoid lesions also showed the same presentation; in this second pattern, reduced diffusion was present in different degrees, measured by rADC calculations. CONCLUSIONS DWI may identify the scolex, increasing diagnostic confidence for NCC. Total/subtotal DWI hyperintensity, related to the stage of the lesion, though uncommon, allows including NCC as a consideration in the differential diagnosis of lesions with reduced diffusion and ring enhancement.
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Affiliation(s)
- G T Santos
- Departments of Radiology, Clinics Hospital of the University of Sao Paulo, School of Medicine, Sao Paulo, Brazil
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