Case report: massive cardiopulmonary cysticercosis in a leukemic patient

Synergistic Manifestations in Cardiac Cysticercosis Complicated by Snake Bite: A Case Report and Literature Review

Cysticercosis presents a prevalent issue on a global scale. Nevertheless, disseminated cysticercosis (DCC) is infrequent; even rarer is asymptomatic DCC. Here, we present a unique case of asymptomatic DCC involving the heart in a young male who came to medical attention following a fatal snake bite, ultimately leading to his demise. Despite the widespread dissemination of cysticercosis affecting multiple organs, the individual remained asymptomatic for the condition. We present a case of a 23-year-old male who was brought to the emergency department with a history of alleged snake bites. The patient was declared dead upon arrival at the All India Institute of Medical Sciences (AIIMS), Rishikesh, India. Autopsy findings revealed multiple significant cardiac abnormalities, including atheromatous changes with calcification in the root of the aorta and aortic valve, along with numerous collateral vessels originating from the left main coronary artery. Additionally, cystic nodules containing cysticercus larvae were identified within the myocardium, suggesting cardiac cysticercosis. The cause of death was determined to be complications related to the snakebite. This case emphasizes the importance of considering multiple potential etiologies in complex clinical presentations, especially in the tropics.

CYSTICERCOSIS & HEART: A systematic review

Cysticercosis is a parasitic tissue infection caused by larval cysts of the tapeworm Taenia solium. These larval cysts infect brain, muscle, or other tissue, and are a major cause of adult-onset seizures in most low-income countries with tropical climate. Prevalence it's around 50 million people. Although cardiovascular system is not the most affected, this disease can also be associated with multiple and randomly distributed cysts in the subpericardium, subendocardium and myocardium in up to 25% of infected patients. Most cardiac cysticercosis' cases are asymptomatic, but it can manifest with ventricular arrhythmias and conduction disorders. Area Covered: The "Neglected Tropical Diseases and other Infectious Diseases affecting the Heart" (NET-Heart project) is an initiative by the Emerging Leaders group of the Interamerican Society of Cardiology to systematically review all these endemic conditions affecting the heart. A systematic review was conducted following PRISMA guidelines and including articles published in MEDLINE, ScienceDirect, PubMed and LILACS databases. A total of 41 papers were included in this review. Expert Opinion: In the areas of greatest prevalence, unhealthiness and poverty favor the development of this disease, which highlights the need to establish global health policies that reduce morbidity and mortality, economic losses of the affected population, and health costs related to hospitalizations for cardiovascular involvement. Authors provide an algorithm to evaluate the possibility of Cysticercosis' cardiovascular complications.

Neurocysticercosis and HIV/AIDS co-infection: A scoping review

OBJECTIVES

Neurocysticercosis (NCC) and human immunodeficiency virus (HIV) have a high disease burden and are prevalent in overlapping low- and middle-income areas. Yet, treatment guidance for people living with HIV/AIDS (PLWH/A) co-infected with NCC is currently lacking. This study aims to scope the available literature on HIV/AIDS and NCC co-infection, focusing on epidemiology, clinical characteristics, diagnostics and treatment outcomes.

METHODS

The scoping literature review methodological framework, and the Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines were followed. A total of 16,969 records identified through database searching, and 45 additional records from other sources were reduced to 52 included studies after a standardised selection process.

RESULTS

Two experimental studies, ten observational studies, 23 case series/case reports and 17 reviews or letters were identified. Observational studies demonstrated similar NCC seroprevalence in PLWH/A and their HIV-negative counterparts. Of 29 PLWH/A and NCC co-infection, 17 (59%) suffered from epileptic seizures, 15 (52%) from headaches and 15 (52%) had focal neurological deficits. Eighteen (62%) had viable vesicular cysts, and six (21%) had calcified cysts. Fifteen (52%) were treated with albendazole, of which 11 (73%) responded well to treatment. Five individuals potentially demonstrated an immune-reconstitution inflammatory syndrome after commencing antiretroviral therapy, although this was in the absence of immunological and neuroimaging confirmation.

CONCLUSIONS

There is a paucity of evidence to guide treatment of PLWH/A and NCC co-infection. There is a pressing need for high-quality studies in this patient group to appropriately inform diagnostic and management guidelines for HIV-positive patients with NCC.

Neurocysticercosis and HIV Infection: what can we learn from the published literature?

OBJECTIVE

Infections caused by the human immunodeficiency virus (HIV) and by the larvae of Taenia solium (i.e., cysticercosis) are still widespread in many developing countries. Both pathologies modify host immune status and it is possible that HIV infection may modulate the frequency and pathogeny of cysticercosis of the central nervous system (i.e., neurocysticercosis [NCC]). To describe published cases of NCC among HIV-positive patients and to evaluate whether the characteristics of NCC, including frequency, symptoms, radiological appearance, and response to treatment differed between HIV-positive and HIV-negative patients.

METHODS

Forty cases of NCC/HIV co-infected patients were identified in the literature. Clinical and radiological characteristics, as well as response to treatment, were compared with non-matching historical series of NCC patients without HIV infection.

RESULTS

Most of these patients had seizures and multiple vesicular parasites located in parenchyma. Clinical and radiological characteristics were similar between HIV-positive and HIV-negative patients with NCC, as well as between immunocompromised and non-immunocompromised HIV-positive patients.

CONCLUSION

Our review did not reveal clear interactions between HIV and NCC. This may be partially due to the small number of cases and reliance on published research. A systematic, multi-institutional effort aiming to report all the cases of this dual pathology is needed to confirm this finding and to clarify the possible relationship between both pathogens.

Neurocysticercosis in Europe: Still a public health concern not only for imported cases

Neurocysticercosis (NCC), a parasitic disease caused by the larvae of the cestode Taenia solium, is the most frequent parasitic disease of the central nervous system (CNS) in the world and the leading cause of secondary epilepsy in Central and South America, East and South Asia, and sub-Saharan Africa. It is endemic in many low- and middle-income countries of the world. Due to increased travels and immigration, NCC may be diagnosed also in non-endemic areas. In fact, tapeworm carriers from endemic zones can transmit infection to other citizens or arrive already suffering NCC. This phenomenon, occurred first in USA during the last 30 years, has been also observed in Europe, as well as in Australia, Canada, Israel, Japan and Muslim countries of the Arab World. Actually, concerning Europe, although, in some areas only few cases have been described, nevertheless the prevalence of NCC may be considered increasing, especially in Spain and Portugal. We reviewed the literature on the burden of NCC in Europe, by a search of PubMed regarding papers from 1970 to present. We only considered on PubMed published and available papers in English, French, Italian, and Spanish, the languages understood by the authors. One hundred seventy six cases of NCC have been reported in seventeen European countries (Austria, Belgium, Denmark, Finland, France, Germany, Greece, Hungary, Ireland, Italy, Latvia, Netherlands, Sweden, United Kingdom, and Croatia, Norway, Switzerland). A particular epidemic situation is present in Spain and Portugal. In fact, we collected data that show, in Spain, an increasing incidence both in immigrated patients and in those which were born in certain Spanish geographical areas and, in Portugal, prevalence similar to that observed in endemic areas. Globally, it is clear that as a result of increased migrations and travels from endemic regions, NCC is becoming an emerging public health problem in high-income countries, particularly affecting communities where hygiene conditions are poor and sub-sequentially the parasite can spread from human to human through eggs even in absence of a travel to the tropics. NCC is a preventable disease, it derives that it's important to acquire a great consciousness of the epidemiology and to implement accurate surveillance systems.

Human cysticercosis and Indian scenario: a review

Cysticercosis, caused by Taenia solium larva is a major public health problem,especially in the developing world and neurocysticercosis (NCC) is considered to be the most common parasitic infestation of the central nervous system. NCC is identified as the single most common cause of community acquired active epilepsy; 26.3% to 53.8% active epilepsy cases in the developing world including India and Latin America are due to NCC.It is also becoming more common in the developed world because of increased migration of people with the disease or Taenia solium carriers and frequent travel to the endemic countries. It is estimated that three quarters of the estimated 50 million people with active epilepsy live in the poor countries of the world. Recent Indian studies using neuroimaging techniques suggest that the disease burden in India surpasses many other developing countries. Hence it is important to know the epidemiology,pathogenesis and diagnostic criteria so as to assess the disease burden and adopt interventional strategies for its control.Literature search was done for this review with special emphasis on Indian studies to create awareness about the disease in India,since cysticercosis is preventable and potentially eradicable.

Isolated cardiac cysticercosis in an adolescent

Cardiac cysticercosis is a rare and typically asymptomatic infection. We report a case of a young man from Cameroon with a left ventricular cyst discovered during a screening echocardiogram. Computed tomography and plain films did not reveal additional cysts. Serology was negative. The patient had the cyst surgically removed for suspected echinococcosis. Sectioning demonstrated a cysticercus. The literature on cardiac cysticercosis is reviewed.

Fatal infection due to larval cysts of cestodes (neurocysticercosis and hydatid disease) in human immunodeficiency virus (HIV) infected patients in Spain: report of two cases

There is little information on infections caused by larval cestodes in patients with human immunodeficiency virus (HIV) infection in developed countries. Two infections by larval cestodes were found in 714 HIV-infected patients studied from 1998 to 2004 at the Hospital General Universitario de Elche in Spain (Mediterranean Coast). The first patient was a Colombian immigrant diagnosed as having neurocysticercosis, and subsequently found to have HIV infection. The second case was an HIV-infected Spanish patient who developed hydatid disease of the liver, lung and peritoneum. Both patients died. Although infrequent, infections by larval cestodes constitute a cause of disease in HIV-infected patients in developed countries, and might be linked with a more severe presentation.

Pulmonary and cardiac cysticercosis: helical CT findings

The authors aim to report the chest CT findings of a patient with disseminated cysticercosis, emphasising the pulmonary and cardiac features. The main finding consisted of multiple pulmonary, cardiac and chest wall nodules. The present case demonstrates that cysticercosis should be considered in the differential diagnosis of multiple pulmonary nodules, mainly in those patients with similar lesions in the cardiac muscle and/or in the chest wall.

Neurocysticercosis and human immunodeficiency virus infection: a case report

Ecuador is considered a holoendemic high-risk area for the transmission of cysticercosis. Moreover, the progression of human immunodeficiency virus (HIV) occurs worldwide. We present a case of simultaneous diagnosis of cysticercosis and HIV infection in a 22-year-old Ecuadorian immigrant. We would postulate that with the increasing HIV incidence in endemic areas of cysticercosis, the simultaneous diagnosis of both diseases is an event to be expected.

Parasitic central nervous system infections in immunocompromised hosts

Immunosuppression due to therapy after transplantation or associated with HIV infection increases susceptibility to various central nervous system (CNS) infections. This article discusses how immunosuppression modifies the presentation, diagnosis, and treatment of selected parasitic CNS infections, with a focus on toxoplasmosis, Chagas disease, neurocysticercosis, schistosomiasis, and strongyloidiasis.

Disseminated Cysticercosis With Pulmonary Involvement

Cysticercosis is an important public health problem in developing countries. The central nervous system is the major site of involvement, although striated muscles and subcutaneous tissue are frequently involved in the disseminated form of disease. We describe a recent case in which pulmonary nodules due to cysticercosis were detected on CT and MRI.

Unusual form of neurocysticercosis associated with HIV infection

Concurrent infection with Taenia solium and HIV would be expected to occur more frequently because of the increasing frequency of HIV infection in endemic areas of cysticercosis. However, little is known about the influence of HIV infection on the frequency and the clinical course of cysticercosis. Giant cysts and racemose forms of neurocysticercosis seem to be more frequent in HIV-infected patients and may be secondary to an uncontrolled parasitic growth because of an impaired cell-mediated immune response. We report an unusual case of epidural spinal racemose neurocysticercosis revealed by compression of cauda equina in an HIV-infected man and discuss the potential interactions between T. solium and HIV infections.

Possible relationship between neurocysticercosis and hematological malignancies

BACKGROUND

Previous studies have shown an increased frequency of chromosomal abnormalities in lymphocytes from animals and humans with cysticercosis. Some reports have suggested an association between cancer and cysticercosis. The aim of this study was to investigate the possible association between neurocysticercosis and cancer.

METHODS

We designed a mortality rate study from the autopsy files of the Department of Pathology at the General Hospital of Mexico. A total of 1,271 autopsy files were reviewed. All files in which a malignant neoplasia was found during autopsy were selected as cases. Autopsies in which no malignant disease was found were used as controls. The odds ratio was determined between the frequency of neurocysticercosis in patients with any malignant neoplasia and that of the controls.

RESULTS

Neurocysticercosis was more frequent in cases with malignant hematological diseases (MHD) than in controls (p = 0.01). The odds ratio for this association was 3.54, with 95% confidence interval from 1.17-9.79.

CONCLUSIONS

Most human cancers arise from the interaction of a multiplicity of factors, including xenobiotics and endogenous constituents. Therefore, while it will be difficult to demonstrate that neurocysticercosis is a causal agent of malignant hematological diseases (MHD), it should be considered as a potential risk factor for cancer induction in countries where cysticercosis remains a public health problem.