1
|
Razok A, Ali M, Shams A, Zahid M. Neurocysticercosis presenting with oculomotor nerve palsy: Case report and literature review. IDCases 2023; 32:e01788. [PMID: 37214182 PMCID: PMC10197005 DOI: 10.1016/j.idcr.2023.e01788] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/24/2023] [Revised: 04/27/2023] [Accepted: 05/02/2023] [Indexed: 05/24/2023] Open
Abstract
Neurocysticercosis (NCC), a central nervous system infection caused by the cystic larvae of Taenia Solium, is endemic in many low-to-middle income countries. NCC is known to have a variety of presentations depending on the size and site of involvement including chronic headaches, seizures, hydrocephalus, and ischemic insults. NCC has also been rarely associated with cranial nerve palsies. We report the case of a 26-year-old Nepalese lady who presented with isolated left-sided oculomotor nerve palsy and was found to have midbrain NCC. She was treated with anthelminthic agents and corticosteroids which led to clinical improvement. NCC can present with a variety of focal neurological syndromes. To the best of our knowledge, this is the first case report of NCC presenting with third cranial nerve palsy in the state of Qatar and the middle east. We also review the literature for other cases of NCC which presented with isolated oculomotor nerve palsy.
Collapse
Affiliation(s)
- Almurtada Razok
- Department of Internal Medicine, John H. Stroger Jr. Hospital of Cook County, Chicago, IL 60612, USA
| | - Maisa Ali
- Department of Infectious Diseases, Hamad Medical Corporation, Doha PO 3050, Qatar
| | - Abdullah Shams
- Department of Cardiology, Hamad Medical Corporation, Doha PO 3050, Qatar
| | - Muhammad Zahid
- Department of Internal Medicine, Hamad Medical Corporation, Doha PO 3050, Qatar
| |
Collapse
|
2
|
Haddad N, Shaheen Y, Abunaib M, Melikyan G, El Sotouhy A, Wahbeh F, Nauman A, Al-Maadid F, Soliman M, Mesraoua B, Elkhider H, Mahfoud Z. Neurocysticercosis in non-endemic regions: The experience of Qatar. Front Neurol 2023; 14:1173909. [PMID: 37153684 PMCID: PMC10156967 DOI: 10.3389/fneur.2023.1173909] [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: 02/25/2023] [Accepted: 03/30/2023] [Indexed: 05/10/2023] Open
Abstract
Objective To describe the occurrence and features of Neurocystircercosis (NCC) in Qatar. Background Qatar has a mixed population of natives and expats. NCC is not endemic to the region, but clinical practice suggests its occurrence in large numbers. Design/ methods A database was created to summarize information retrospectively collected on patients with NCC seen through the national health system (HMC) between 2013 and 2018. We identified demographic and disease related variables (clinical manifestations, investigative findings, treatment and outcome) for all patients. Results Out of 420 identified NCC patients, 393 (93.6%) were men, and 98.3% were immigrants from NCC endemic countries such as Nepal (63.8%) and India (29.5%). Eighty percent of patients presented with seizures, with the majority (69%) experiencing generalized tonic-clonic seizures. Five percent presented with status epilepticus. Headaches, the second most common complaint, were reported in 18% of subjects. On imaging, 50% had a single lesion while 63% included pathology at the calcified stage. The lesions were parenchymal in 99.5% of cases, predominantly in the frontal lobe (59%). Thirteen percent were diagnosed incidentally on imaging, mainly in the form of isolated calcified non enhancing lesions. Albendazole was received by 55% of patients, and phenytoin was the most prescribed anti-seizure drug (57%). When long term follow up was available, 70% of the patients presenting with seizures were completely seizure free. Conclusion NCC is prevalent in Qatar, mainly within the large Southeast Asian immigrant population. NCC is currently a significant contributor to the epilepsy burden in Qatar, often with a good outcome regarding seizure control. NCC with intraparenchymal single lesion shares a large proportion of our cohort.
Collapse
Affiliation(s)
- Naim Haddad
- Department of Neurology, Weill Cornell Medicine-Qatar, Ar-Rayyan, Qatar
- Department of Neuroradiology, Hamad Medical Corporation, Doha, Qatar
- *Correspondence: Naim Haddad,
| | - Yanal Shaheen
- Department of Neurology, Weill Cornell Medicine-Qatar, Ar-Rayyan, Qatar
| | - Mohammed Abunaib
- Department of Neuroradiology, Hamad Medical Corporation, Doha, Qatar
| | - Gayane Melikyan
- Department of Neurology, Weill Cornell Medicine-Qatar, Ar-Rayyan, Qatar
- Department of Neuroradiology, Hamad Medical Corporation, Doha, Qatar
| | - Ahmed El Sotouhy
- Department of Neuroradiology, Hamad Medical Corporation, Doha, Qatar
| | - Farah Wahbeh
- Department of Neurology, Weill Cornell Medicine-Qatar, Ar-Rayyan, Qatar
| | - Areej Nauman
- Department of Neurology, Weill Cornell Medicine-Qatar, Ar-Rayyan, Qatar
| | - Fatima Al-Maadid
- Department of Neurology, Weill Cornell Medicine-Qatar, Ar-Rayyan, Qatar
| | - Mohamed Soliman
- Department of Neurology, Weill Cornell Medicine-Qatar, Ar-Rayyan, Qatar
| | - Boulenouar Mesraoua
- Department of Neurology, Weill Cornell Medicine-Qatar, Ar-Rayyan, Qatar
- Department of Neuroradiology, Hamad Medical Corporation, Doha, Qatar
| | - Hisham Elkhider
- Department of Neuroradiology, Hamad Medical Corporation, Doha, Qatar
| | - Ziyad Mahfoud
- Department of Population Health Sciences, Weill Cornell Medicine-Qatar, Ar-Rayyan, Qatar
| |
Collapse
|
3
|
A Large Case Series of Neurocysticercosis in Kuwait, a Nonendemic Arabian Gulf Country in the Middle East Region. Microorganisms 2021; 9:microorganisms9061221. [PMID: 34199952 PMCID: PMC8226849 DOI: 10.3390/microorganisms9061221] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/14/2021] [Revised: 05/23/2021] [Accepted: 05/27/2021] [Indexed: 12/31/2022] Open
Abstract
Neurocysticercosis (NCC), a leading global cause of severe progressive headache and epilepsy, in developed or affluent countries is mostly diagnosed among immigrants from poor or developing Taenia solium taeniasis-endemic countries. Taeniasis carriers in Kuwait are routinely screened by insensitive stool microscopy. In this study, enzyme-linked immunoelectrotransfer blot (EITB) was used as a confirmatory test for NCC. Screening was performed on 970 patients referred for suspected NCC on the basis of relevant history and/or ring-enhancing lesions on computed tomography and/or magnetic resonance imaging during a 14-year period in Kuwait. Demographic data and clinical details were retrieved from laboratory or hospital records. EITB was positive in 150 subjects (15.5%), including 98 expatriates mostly originating from taeniasis-endemic countries and, surprisingly, 52 Kuwaiti nationals. The clinical details of 48 of 50 NCC cases diagnosed during 2014–2019 were available. Most common symptoms included seizures, persistent headache with/without fever, and fits or loss of consciousness. Cysticercal lesions were located at various brain regions in 39 of 48 patients. Multiple members of 3 families with NCC were identified; infection was linked to domestic workers from taeniasis-endemic countries and confirmed in at least 1 family. Our data show that NCC is predominantly imported in Kuwait by expatriates originating from taeniasis-endemic countries who transmit the infection to Kuwaiti citizens.
Collapse
|
4
|
Forster D, Ko DK, Koehler AV, Kranz S, Goh C, Fleming B, Awad M, Johnson D, Gasser RB, Mahanty S. Case Report: Neurocysticercosis Acquired in Australia. Am J Trop Med Hyg 2020; 103:2318-2322. [PMID: 32959773 DOI: 10.4269/ajtmh.20-0839] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022] Open
Abstract
Neurocysticercosis (NCC) is a disease caused by infection of the central nervous system with the larval stage of the tapeworm Taenia solium. This disease is endemic in many parts of the world, including Africa, Asia, and Latin America, where animal husbandry practices are common such that pigs reared for human consumption ingest feces from humans infected with T. solium. Neurocysticercosis is rarely acquired in economically affluent regions, including North America, Central Europe, Japan, and Australasia, and in countries where pork consumption is discouraged by religious or social practices. In these countries, NCC is usually diagnosed in immigrants or returning travelers who have spent time in endemic regions. Here, we report a case of NCC in a 25-year-old woman presenting with worsening visual symptoms in association with headache, diagnosed previously as a migraine with visual aura. This person had always lived in Australia and had never traveled overseas to a country endemic for T. solium. The unusual features of the clinical presentation and epidemiology are highlighted to raise physicians' awareness that attention needs to be paid to the risk of autochthonous infection occurring in non-endemic countries.
Collapse
Affiliation(s)
- Daniel Forster
- Victorian Infectious Diseases Service, Royal Melbourne Hospital, Parkville, Australia
| | - Dong-Kyoon Ko
- Victorian Infectious Diseases Service, Royal Melbourne Hospital, Parkville, Australia
| | - Anson V Koehler
- Department of Veterinary Biosciences, Melbourne Veterinary School, Faculty of Veterinary and Agricultural Sciences, The University of Melbourne, Parkville, Australia
| | - Sevastjan Kranz
- Department of Pathology, Royal Melbourne Hospital, Parkville, Australia
| | - Christine Goh
- Department of Radiology, Royal Melbourne Hospital, Parkville, Australia
| | - Benjamin Fleming
- Department of Neurosurgery, Royal Melbourne Hospital, Parkville, Australia
| | - Mohammed Awad
- Department of Neurosurgery, Royal Melbourne Hospital, Parkville, Australia
| | - Douglas Johnson
- Victorian Infectious Diseases Service, Royal Melbourne Hospital, Parkville, Australia
| | - Robin B Gasser
- Department of Veterinary Biosciences, Melbourne Veterinary School, Faculty of Veterinary and Agricultural Sciences, The University of Melbourne, Parkville, Australia
| | - Siddhartha Mahanty
- The Peter Doherty Institute for Infection and Immunity, University of Melbourne and the Royal Melbourne Hospital, Parkville, Australia.,Victorian Infectious Diseases Service, Royal Melbourne Hospital, Parkville, Australia
| |
Collapse
|
5
|
Del Brutto OH. Twenty-five years of evolution of standard diagnostic criteria for neurocysticercosis. How have they impacted diagnosis and patient outcomes? Expert Rev Neurother 2019; 20:147-155. [DOI: 10.1080/14737175.2020.1707667] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
Affiliation(s)
- Oscar H. Del Brutto
- School of Medicine, Universidad Espíritu Santo – Ecuador, Samborondón, Ecuador
| |
Collapse
|
6
|
Davaasuren A, Davaajav A, Ukhnaa B, Purvee A, Unurkhaan S, Luvsan A, Logan JE, Ito A. Neurocysticercosis: A case study of a Mongolian traveler who visited China and India with an updated review in Asia. Travel Med Infect Dis 2017; 20:31-36. [PMID: 28478337 DOI: 10.1016/j.tmaid.2017.04.007] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/21/2016] [Revised: 04/20/2017] [Accepted: 04/23/2017] [Indexed: 10/19/2022]
Abstract
BACKGROUND Neurocysticercosis (NCC) of Taenia solium has never been reported in Mongolia. A Mongolian traveler who visited China and India presented with epileptic seizures after his return to Mongolia. Magnetic resonance imaging showed multiple ring enhancing lesions with edema surrounding several lesions in his brain that were initially diagnosed to be viral encephalitis or NCC. METHODS Serology for cysticercosis using diagnostic antigens partially purified by cation-exchange chromatography and chimeric recombinant antigens and DNA analysis of a proglottid found in the patient's stool were applied for differential diagnosis. RESULTS Serology showed strong positivity for NCC, and mitochondrial cox1 gene analysis revealed Indian but not Chinese haplotype of T. solium. CONCLUSION This NCC case was considered to be caused by eggs released from adult tapeworm(s) established after eating uncooked or undercooked pork contaminated with cysticerci during his stay in India. This is a case report of taeniasis and secondary NCC associated with travel to India with an updated review of NCC in Asia. Molecular tracking of the specimen is highly informative as a way to identify where the infection was acquired.
Collapse
Affiliation(s)
- Anu Davaasuren
- Laboratory of Parasitology, National Center for Communicable Diseases, Ulaanbaatar, Mongolia.
| | - Abmed Davaajav
- Laboratory of Parasitology, National Center for Communicable Diseases, Ulaanbaatar, Mongolia.
| | - Baigalmaa Ukhnaa
- Department of Radiology, Luxmed Hospital, Ulaanbaatar, Mongolia.
| | | | - Saraa Unurkhaan
- Neurology Center, The State Third Central Hospital, Ulaanbaatar, Mongolia.
| | - Amartuvshin Luvsan
- Department of Radiology, The State Third Central Hospital, Ulaanbaatar, Mongolia.
| | - Jenae E Logan
- Division of Infectious Disease, School of Medicine and Global Health Institute, Duke University, North Carolina, USA.
| | - Akira Ito
- Department of Parasitology, Asahikawa Medical University, Asahikawa, Japan.
| |
Collapse
|
7
|
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.
Collapse
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
| |
Collapse
|
8
|
Gordon CA, McManus DP, Jones MK, Gray DJ, Gobert GN. The Increase of Exotic Zoonotic Helminth Infections: The Impact of Urbanization, Climate Change and Globalization. ADVANCES IN PARASITOLOGY 2016; 91:311-97. [PMID: 27015952 DOI: 10.1016/bs.apar.2015.12.002] [Citation(s) in RCA: 39] [Impact Index Per Article: 4.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/30/2022]
Abstract
Zoonotic parasitic diseases are increasingly impacting human populations due to the effects of globalization, urbanization and climate change. Here we review the recent literature on the most important helminth zoonoses, including reports of incidence and prevalence. We discuss those helminth diseases which are increasing in endemic areas and consider their geographical spread into new regions within the framework of globalization, urbanization and climate change to determine the effect these variables are having on disease incidence, transmission and the associated challenges presented for public health initiatives, including control and elimination.
Collapse
Affiliation(s)
- Catherine A Gordon
- Molecular Parasitology Laboratory, Infectious Diseases Division, QIMR Berghofer Medical Research Institute, Brisbane, QLD, Australia
| | - Donald P McManus
- Molecular Parasitology Laboratory, Infectious Diseases Division, QIMR Berghofer Medical Research Institute, Brisbane, QLD, Australia
| | - Malcolm K Jones
- Molecular Parasitology Laboratory, Infectious Diseases Division, QIMR Berghofer Medical Research Institute, Brisbane, QLD, Australia; School of Veterinary Science, University of Queensland, Brisbane, QLD, Australia
| | - Darren J Gray
- Research School of Population Health, The Australian National University, Canberra, ACT, Australia
| | - Geoffrey N Gobert
- Molecular Parasitology Laboratory, Infectious Diseases Division, QIMR Berghofer Medical Research Institute, Brisbane, QLD, Australia
| |
Collapse
|
9
|
Ito A, Yanagida T, Nakao M. Recent advances and perspectives in molecular epidemiology of Taenia solium cysticercosis. INFECTION GENETICS AND EVOLUTION 2015; 40:357-367. [PMID: 26112071 DOI: 10.1016/j.meegid.2015.06.022] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/02/2015] [Revised: 06/19/2015] [Accepted: 06/20/2015] [Indexed: 12/17/2022]
Abstract
Cysticercosis caused by accidental ingestion of eggs of Taenia solium is spreading all over the world through globalization and is one of the most neglected, neglected tropical diseases (NTDs) or neglected zoonotic diseases (NZDs). In the present study, the reason why T. solium cysticercosis has been neglected is discussed at first, and followed with an overview on the most recent advances and perspectives in molecular approaches for epidemiology of T. solium taeniasis/cysticercosis, since although taeniasis does not constitute recognized zoonoses, transmission and complete development are dependent on human definitive hosts. Main topics are discussions on (1) the two, Asian and Afro/American, genotypes of T. solium, (2) comparative analysis of mitochondrial (haploid) and nuclear (diploid) genes, and (3) the presence of hybrids of these two genotypes which indicates out-crossing of two genotypes in hermaphrodite tapeworms in Madagascar. Additional topics are on (4) the usefulness of phylogeographic analyses to discuss where the infection was acquired from, and (5) miscellaneous unsolved topics around these genetic diversity of T. solium.
Collapse
Affiliation(s)
- Akira Ito
- Department of Parasitology, Asahikawa Medical University, Midorigaoka Higashi 2-1-1-1, Asahikawa 078-8510, Japan.
| | - Tetsuya Yanagida
- Department of Parasitology, Asahikawa Medical University, Midorigaoka Higashi 2-1-1-1, Asahikawa 078-8510, Japan; Laboratory of Parasitology, Joint Faculty of Veterinary Medicine, Yamaguchi University, 1677-1 Yoshida, Yamaguchi 753-8515, Japan.
| | - Minoru Nakao
- Department of Parasitology, Asahikawa Medical University, Midorigaoka Higashi 2-1-1-1, Asahikawa 078-8510, Japan.
| |
Collapse
|
10
|
Braae UC, Saarnak CFL, Mukaratirwa S, Devleesschauwer B, Magnussen P, Johansen MV. Taenia solium taeniosis/cysticercosis and the co-distribution with schistosomiasis in Africa. Parasit Vectors 2015; 8:323. [PMID: 26065414 PMCID: PMC4465723 DOI: 10.1186/s13071-015-0938-7] [Citation(s) in RCA: 41] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/06/2015] [Accepted: 06/05/2015] [Indexed: 12/03/2022] Open
Abstract
Background This study aimed to map the distribution of Taenia solium taeniosis/cysticercosis and the co-distribution with schistosomiasis in Africa. These two major neglected tropical diseases are presumed to be widely distributed in Africa, but currently the level of co-distribution is unclear. Methods A literature search on T. solium taeniosis/cysticercosis was performed to compile all known studies on the presence of T. solium and apparent prevalence of taeniosis and porcine cysticercosis in Africa. Studies were geo-referenced using an online gazetteer. A Bayesian framework was used to combine the epidemiological data on the apparent prevalence with external information on test characteristics to estimate informed district-level prevalence of taeniosis and porcine cysticercosis. Districts with T. solium taeniosis/cysticercosis presence were cross-referenced with the Global Neglected Tropical Diseases Database for schistosomiasis presence. Results The search strategies identified 141 reports of T. solium in Africa from 1985 to 2014 from a total of 476 districts in 29 countries, 20 with porcine cysticercosis, 22 with human cysticercosis, and 16 with taeniosis, in addition to 2 countries identified from OIE reports. All 31 countries were considered, on national scale, to have co-distribution with schistosomiasis. Presence of both parasites was confirmed in 124 districts in 17 countries. The informed prevalence of taeniosis and porcine cysticercosis were estimated for 14 and 41 districts in 10 and 13 countries, respectively. Conclusions With the paucity of data, T. solium infection is grossly under-reported and expected to be more widespread than this study suggests. In areas where co-distribution occurs there is a need for increased emphasis on evaluation of integrated intervention approaches for these two helminth infections and allocation of resources for evaluating the extent of adverse effects caused by mass drug administration. Electronic supplementary material The online version of this article (doi:10.1186/s13071-015-0938-7) contains supplementary material, which is available to authorized users.
Collapse
Affiliation(s)
- Uffe Christian Braae
- Department of Veterinary Disease Biology, Section for Parasitology and Aquatic Diseases, Faculty of Health and Medical Sciences, University of Copenhagen, DK-1870, Frederiksberg, Denmark.
| | - Christopher F L Saarnak
- Department of Veterinary Disease Biology, Section for Parasitology and Aquatic Diseases, Faculty of Health and Medical Sciences, University of Copenhagen, DK-1870, Frederiksberg, Denmark.
| | - Samson Mukaratirwa
- School of Life Sciences, University of KwaZulu-Natal, Durban, South Africa.
| | - Brecht Devleesschauwer
- Department of Virology, Parasitology and Immunology, Faculty of Veterinary Medicine, Ghent University, 9820, Merelbeke, Belgium. .,Institute of Health and Society (IRSS), Université catholique de Louvain, 1200, Brussels, Belgium.
| | - Pascal Magnussen
- Department of Veterinary Disease Biology, Section for Parasitology and Aquatic Diseases, Faculty of Health and Medical Sciences, University of Copenhagen, DK-1870, Frederiksberg, Denmark. .,Centre for Medical Parasitology, Faculty of Health and Medical Sciences, University of Copenhagen, DK-1353, Copenhagen, Denmark.
| | - Maria Vang Johansen
- Department of Veterinary Disease Biology, Section for Parasitology and Aquatic Diseases, Faculty of Health and Medical Sciences, University of Copenhagen, DK-1870, Frederiksberg, Denmark.
| |
Collapse
|
11
|
Pathan SA, Abosalah S, Nadeem S, Ali A, Hameed AA, Marathe M, Cameron PA. Computed tomography abnormalities and epidemiology of adult patients presenting with first seizure to the emergency department in Qatar. Acad Emerg Med 2014; 21:1264-8. [PMID: 25377404 DOI: 10.1111/acem.12508] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/20/2014] [Revised: 06/18/2014] [Accepted: 07/04/2014] [Indexed: 11/28/2022]
Abstract
OBJECTIVES There is little information available from the Middle Eastern region on adult patients presenting with first seizure. The objectives of this study were to describe epidemiological characteristics of patients presenting to the emergency department (ED) in Doha, Qatar, with first seizure and to determine the incidence of computed tomographic (CT) scan abnormalities. METHODS A retrospective cohort study was conducted on all adult patients with first seizure presenting to Hamad General Hospital ED over a 1-year period (June 2012 through May 2013). Electronic patient records were reviewed for demographics, neuroimaging, electroencephalography, laboratory test results, and medications administered. RESULTS There were 439 patients who satisfied inclusion criteria. Patients were aged a mean of 35.3 years (95% confidence interval [CI] = 33.92 to 36.69 years) with a male-to-female ratio of five to one. CT abnormalities were detected in 154 patients (35.3%; 95% CI = 30.81% to 39.82%). Out of reported abnormal scans, 14.7% patients had significant abnormalities such as neurocysticercosis (9.2%); brain metastasis and neoplasm (3.4%); and subarachnoid and subdural hemorrhage, cavernous sinus thrombosis, acute stroke, and brain edema (2.0%). None of the patients had any electrolyte abnormalities, and three patients had hypoglycemia. Patients with initial abnormal CT brain results were more likely to have recurrent seizures (OR = 1.65; 95% CI = 1.11 to 2.45) within 6 months. CONCLUSIONS Adults who presented with first seizure to the ED in Qatar had a young male predominance, and a high proportion of brain CT scans were reported as abnormal. It is recommended that all such patients in this population should undergo prompt CT scanning in the ED, but the utility of routine electrolyte tests requires further investigation.
Collapse
Affiliation(s)
- Sameer A. Pathan
- The Department of Emergency Medicine Hamad General Hospital Hamad Medical Corporation Doha Qatar
| | - Salem Abosalah
- The Department of Emergency Medicine Hamad General Hospital Hamad Medical Corporation Doha Qatar
| | - Sana Nadeem
- The Department of Emergency Medicine Hamad General Hospital Hamad Medical Corporation Doha Qatar
| | - Amjad Ali
- The Department of Emergency Medicine Hamad General Hospital Hamad Medical Corporation Doha Qatar
| | - Asma A. Hameed
- The Department of Emergency Medicine Hamad General Hospital Hamad Medical Corporation Doha Qatar
| | - Mandar Marathe
- The Department of Emergency Medicine Hamad General Hospital Hamad Medical Corporation Doha Qatar
| | - Peter A. Cameron
- The Department of Epidemiology and Preventive Medicine The Alfred Hospital Monash University Melbourne Victoria Australia
| |
Collapse
|
12
|
|
13
|
Del Brutto OH. Neurocysticercosis in infants and toddlers: report of seven cases and review of published patients. Pediatr Neurol 2013; 48:432-5. [PMID: 23668866 DOI: 10.1016/j.pediatrneurol.2013.02.001] [Citation(s) in RCA: 21] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/19/2012] [Revised: 01/31/2013] [Accepted: 02/05/2013] [Indexed: 11/25/2022]
Abstract
Neurocysticercosis in infants and toddlers has received little attention in the literature, and little is known about the mechanisms of disease acquisition and clinical forms of presentation of the disease in this age group. All patients aged ≤3 years with neurocysticercosis evaluated at Hospital-Clínica Kennedy, Guayaquil, over a 22-year period were included in this study. Their household contacts were screened to detect Taenia solium carriers, which may represent the source of infection. A literature search on neurocysticercosis in infants and toddlers was also performed to compare personal cases with those described elsewhere. A total of 25 infants and toddlers with neurocysticercosis were included (seven from our institution and 18 from the literature). All patients had seizures as the primary manifestation of the disease, and neuroimaging studies showed one or two parenchymal brain cysticerci in the colloidal stage in 88% of patients. The source of infection was investigated in 11 houses, including the seven households of the present series, and only four of the 18 reported in the literature. A Taenia carrier was found in five (45%) of these households, including three from the present series and two from the literature. A sizable proportion of infants and toddlers with neurocysticercosis have been infected at home. Compulsory search of Taenia carriers among household contacts will allow the detection of the potential source of infection and will reduce further spread of the disease. The search must not be limited to family members, but also extended to domestic employees who are in daily contact with the children.
Collapse
Affiliation(s)
- Oscar H Del Brutto
- School of Medicine, Universidad de Especialidades Espíritu Santo, and Department of Neurological Sciences, Hospital-Clínica Kennedy, Guayaquil, Ecuador.
| |
Collapse
|
14
|
Del Brutto OH, Nash TE, Garcia HH. Cysticerci-related single parenchymal brain enhancing lesions in non-endemic countries. J Neurol Sci 2012; 319:32-6. [PMID: 22658897 PMCID: PMC3387547 DOI: 10.1016/j.jns.2012.05.027] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/23/2012] [Revised: 05/10/2012] [Accepted: 05/10/2012] [Indexed: 11/08/2022]
Abstract
OBJECTIVE Review of case reports and case series of patients with single cysticercus granulomas in non-endemic countries to determine the characteristics of this form of neurocysticercosis in these regions. METHODS MEDLINE and manual search of patients with single cysticercus granulomas diagnosed in non-endemic countries from 1991 to 2011. Abstracted data included: demographic profile, clinical manifestations, form of neurocysticercosis, and whether the disease occurred in immigrants, international travelers, or citizens from non-endemic countries who had never been abroad. RESULTS A total of 77 patients were found. Of these, 61 (79%) were diagnosed since the year 2000. Thirty-four patients (44%) patients were immigrants from endemic countries, 18 (23%) were international travelers returning from disease-endemic areas, and the remaining 25 (33%) were citizens from non-endemic countries who had never been abroad. Most immigrants and international travelers became symptomatic two or more years after returning home. Countries with the most reported patients were Kuwait (n=18), UK (n=11), Australia (n=8), USA (n=7), Japan (n=6), and Israel (n=5). CONCLUSIONS A single cerebral cysticercus granuloma in a non-endemic country is not a rare event. As seen in endemic regions, these cases have a good prognosis although more surgical procedures are performed in non-endemic countries, likely reflecting a decrease of diagnostic suspicion for cysticercosis and an increased availability of surgical options. The mean age of the reported cases was 25 years, and immigrants most often developed the disease greater than two years after arrival into a non-endemic area, suggesting a significant delay between infection and symptoms. However, some may have been infected and developed the disease while residing in non-endemic countries.
Collapse
Affiliation(s)
- Oscar H Del Brutto
- Department of Neurological Sciences, Hospital-Clínica Kennedy, Guayaquil, Ecuador.
| | | | | |
Collapse
|
15
|
|
16
|
Abstract
OBJECTIVE Review of neurocysticercosis in citizens from non-endemic countries who developed the disease after a travel to endemic regions, to estimate the magnitude of the disease and to determine the pattern of disease expression in travelers to disease-endemic areas. METHODS MEDLINE and manual search of international travelers with neurocysticercosis diagnosed in countries where the disease is not endemic, from 1981 to October 2011. Abstracted data included: demographic profile of patients, clinical manifestations, form of neurocysticercosis, and therapy. RESULTS A total of 35 articles reporting 52 patients were found. Most patients were originally from Western Europe, Australia, Israel, and Japan. Mean age was 36.5 ± 15.1 years, and 46% were women. Common places for travelling were the Indian Subcontinent, Latin America, and Southeast Asia. Mean time spent aboard was 56.6 ± 56.1 months. Most patients developed symptoms 2 years or more after returning home. Seizures were the most common clinical manifestation of the disease (73%), and all but six patients had parenchymal brain cysticercosis (a single cysticercus granuloma was the most common neuroimaging finding, in 21 patients). Twenty patients underwent surgical resection of the brain lesion for diagnostic purposes, and 22 received cysticidal drugs. CONCLUSIONS Neurocysticercosis is rare in international travelers to endemic countries, and most often occurs in long-term travelers. It is possible that most of these patients get infected by contact with a taenia carrier. The time elapsed between disease acquisition and symptoms occurrence suggests that, at least in some patients, clinical manifestations are related to reactivation of an infection that has previously been controlled by the host immune system.
Collapse
Affiliation(s)
- Oscar H Del Brutto
- Department of Neurological Sciences, Hospital-Clínica Kennedy, Guayaquil, Ecuador.
| |
Collapse
|