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Stelzle D, Abraham A, Kaminski M, Schmidt V, De Meijere R, Bustos JA, Garcia HH, Sahu PS, Bobić B, Cretu C, Chiodini P, Dermauw V, Devleesschauwer B, Dorny P, Fonseca A, Gabriël S, Morales MÁG, Laranjo-González M, Hoerauf A, Hunter E, Jambou R, Jurhar-Pavlova M, Reiter-Owona I, Sotiraki S, Trevisan C, Vilhena M, Walker NF, Zammarchi L, Winkler AS. Clinical characteristics and management of neurocysticercosis patients: a retrospective assessment of case reports from Europe. J Travel Med 2023; 30:6759132. [PMID: 36222148 DOI: 10.1093/jtm/taac102] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/13/2022] [Revised: 08/15/2022] [Accepted: 08/30/2022] [Indexed: 01/25/2023]
Abstract
OBJECTIVES Neurocysticercosis (NCC) is a parasitic disease caused by the larval stage of the tapeworm Taenia solium. NCC mainly occurs in Africa, Latin America and South-East Asia and can cause a variety of clinical signs/symptoms. Although it is a rare disease in Europe, it should nonetheless be considered as a differential diagnosis. The aim of this study was to describe clinical characteristics and management of patients with NCC diagnosed and treated in Europe. METHODS We conducted a systematic search of published and unpublished data on patients diagnosed with NCC in Europe (2000-2019) and extracted demographic, clinical and radiological information on each case, if available. RESULTS Out of 293 identified NCC cases, 59% of patients presented initially with epileptic seizures (21% focal onset); 52% presented with headache and 54% had other neurological signs/symptoms. The majority of patients had a travel or migration history (76%), mostly from/to Latin America (38%), Africa (32%) or Asia (30%). Treatment varied largely depending on cyst location and number. The outcome was favorable in 90% of the cases. CONCLUSIONS Management of NCC in Europe varied considerably but often had a good outcome. Travel and migration to and from areas endemic for T. solium will likely result in continued low prevalence of NCC in Europe. Therefore, training and guidance of clinicians is recommended for optimal patient management.
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Affiliation(s)
- Dominik Stelzle
- Department of Neurology, Center for Global Health, School of Medicine, Technical University of Munich, Munich, Germany
| | - Annette Abraham
- Department of Neurology, Center for Global Health, School of Medicine, Technical University of Munich, Munich, Germany
- Centre for Global Health, Institute of Health and Society, University of Oslo, Oslo, Norway
| | - Miriam Kaminski
- Department of Psychiatry and Psychotherapy, Charité University Medical Center, Campus Benjamin Franklin, Berlin, Germany
| | - Veronika Schmidt
- Department of Neurology, Center for Global Health, School of Medicine, Technical University of Munich, Munich, Germany
- Centre for Global Health, Institute of Health and Society, University of Oslo, Oslo, Norway
| | - Robert De Meijere
- Department of Neurology, Center for Global Health, School of Medicine, Technical University of Munich, Munich, Germany
| | - Javier A Bustos
- Cysticercosis Unit, Instituto Nacional de Ciencias Neurológicas, Lima, Peru
| | - Hector Hugo Garcia
- Cysticercosis Unit, Instituto Nacional de Ciencias Neurológicas, Lima, Peru
| | | | - Branko Bobić
- Centre of Excellence for Food- and Vector-borne Zoonoses, Institute for Medical Research, National Institute of Republic of Serbia, University of Belgrade, Belgrade, Serbia
| | - Carmen Cretu
- Department of Parasitology, Carol Davila University of Medicine, Bucharest, Romania
| | - Peter Chiodini
- Hospital for Tropical Diseases, University College London Hospitals, London, UK
- Diagnostic Parasitology Laboratory, London School of Hygiene and Tropical Medicine, London, UK
| | - Veronique Dermauw
- Department of Biomedical Sciences, Institute of Tropical Medicine, Antwerp, Belgium
| | - Brecht Devleesschauwer
- Department of Epidemiology and Public Health, Sciensano, Brussels, Belgium
- Department of Translational Physiology, Infectiology and Public Health, Faculty of Veterinary Medicine, Ghent University, Belgium
| | - Pierre Dorny
- Department of Biomedical Sciences, Institute of Tropical Medicine, Antwerp, Belgium
| | - Ana Fonseca
- Public Health Department, NOVA Medical School, NOVA University of Lisbon, Lisbon, Portugal
| | - Sarah Gabriël
- Department of Translational Physiology, Infectiology and Public Health, Faculty of Veterinary Medicine, Ghent University, Belgium
| | - Maria Ángeles Gómez Morales
- Department of Infectious Diseases, European Union Reference Laboratory for Parasites, Istituto Superiore di Sanità, Rome, Italy
| | - Minerva Laranjo-González
- IRTA, Centre de Recerca en Sanitat Animal (CReSA, IRTA-UAB), Campus de la UAB, Bellaterra (Cerdanyola del Vallès), Spain
| | - Achim Hoerauf
- Institute of Medical Microbiology, Immunology and Parasitology (IMMIP), University Hospital Bonn, Bonn, Germany
- German Center for Infection Research (DZIF), Partner Site Bonn-Cologne, Cologne, Germany
| | - Ewan Hunter
- Department of Infection and Tropical Medicine, The Newcastle-upon-Tyne Hospitals NHS Foundation Trust, Newcastle upon Tyne, UK
| | - Ronan Jambou
- Global Health Department, Institut Pasteur, Paris, France
| | - Maja Jurhar-Pavlova
- Institute for Microbiology and Parasitology, Medical faculty, University "Ss. Cyril and Methodius", Skopje, Republic of North Macedonia
| | - Ingrid Reiter-Owona
- Institute of Medical Microbiology, Immunology and Parasitology (IMMIP), University Hospital Bonn, Bonn, Germany
| | - Smaragda Sotiraki
- Veterinary Research Institute, Hellenic Agricultural Organisation DIMITRA, Thessaloniki, Greece
| | - Chiara Trevisan
- Department of Biomedical Sciences, Institute of Tropical Medicine, Antwerp, Belgium
- Department of Translational Physiology, Infectiology and Public Health, Faculty of Veterinary Medicine, Ghent University, Belgium
| | - Manuela Vilhena
- MED-Instituto Mediterrâneo para a Agricultura, Ambiente e Desenvolvimento, Universidade de Évora, Évora, Portugal
| | - Naomi F Walker
- Hospital for Tropical Diseases, University College London Hospitals, London, UK
- Department of Clinical Sciences, Liverpool School of Tropical Medicine, Liverpool, UK
| | - Lorenzo Zammarchi
- Department of Experimental and Clinical Medicine, University of Florence, Florence, Italy
| | - Andrea Sylvia Winkler
- Department of Neurology, Center for Global Health, School of Medicine, Technical University of Munich, Munich, Germany
- Centre for Global Health, Institute of Health and Society, University of Oslo, Oslo, Norway
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Human Neurocysticercosis: An Overview. Pathogens 2022; 11:pathogens11101212. [PMID: 36297269 PMCID: PMC9607454 DOI: 10.3390/pathogens11101212] [Citation(s) in RCA: 12] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/08/2022] [Revised: 10/14/2022] [Accepted: 10/17/2022] [Indexed: 11/20/2022] Open
Abstract
Human cysticercosis is caused by ingestion of T. solium eggs from taenia carriers. Neurocysticercosis (NCC), defined as the infection of the CNS and the meninges by the larval stage of Taenia solium, is the most common helminthic infection of the CNS worldwide. Parasites may lodge in brain parenchyma, subarachnoid space, ventricular system, or spinal cord, causing pathological changes that account for the pleomorphism of this disease. Seizures/epilepsy are the most common clinical manifestation, but other patients present with headache, focal deficits, intracranial hypertension, or cognitive decline. Accurate diagnosis of NCC is possible after interpretation of clinical data together with findings of neuroimaging studies and results of immunological tests. However, neuroimaging studies are fundamental for diagnosis because immunological test and clinical manifestations only provide circumstantial evidence of NCC. The introduction of cysticidal drugs changed the prognosis of most NCC patients. These drugs have been shown to reduce the burden of infection and to improve the clinical course of the disease in many patients. Efforts should be directed to eradicate the disease through the implementation of control programs against all the steps in the life cycle of T. solium, including carriers of the adult tapeworm, infected pigs, and eggs in the environment.
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Neurocysticercosis in the Tropics (and Beyond). CURRENT TROPICAL MEDICINE REPORTS 2022. [DOI: 10.1007/s40475-022-00269-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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Herrador Z, Pérez-Molina JA, Henríquez Camacho CA, Rodriguez-Guardado A, Bosch-Nicolau P, Calabuig E, Domínguez-Castellano A, Pérez-Jacoiste MA, Ladrón de Guevara MC, Mena A, Ruiz-Giardin JM, Torrús D, Wikman-Jorgensen P, Benito A, López-Vélez R. Imported cysticercosis in Spain: A retrospective case series from the +REDIVI Collaborative Network. Travel Med Infect Dis 2020; 37:101683. [PMID: 32335208 DOI: 10.1016/j.tmaid.2020.101683] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/22/2019] [Revised: 02/21/2020] [Accepted: 04/17/2020] [Indexed: 02/06/2023]
Abstract
BACKGROUND Neurocysticercosis (NCC) is the most common parasitic neurological disease worldwide and a major cause of epilepsy. Spain is the country reporting the highest number of NCC imported cases in Europe. METHODOLOGY Retrospective case series of NCC patients registered in the +REDIVI Network from October 1, 2009 to July 2018. A specific questionnaire, including clinical and diagnostic characteristics, was created and sent to the collaborator centers. RESULTS 46 cases were included in the analysis. 55% were male, mean age of 40 years. 95.6% were migrants. The median duration since migration from an endemic area was 10 years. Predominant nationalities were Ecuadorians (50%) and Bolivians (30.4%). Frequent locations were parenchymal (87%), subarachnoid (26.1%) and intraventricular cysts (10.9%). Serological analysis was performed in 91.3%, being 54.8% positive. Most prevalent clinical manifestations were persistent headache (60.9%), epilepsy (43.5%) and visual changes (13%). Patients were mainly treated with albendazole (76.1%), corticosteroids (67.4%), and anticonvulsionants (52.2%). 82.5% had a favorable clinical outcome. CONCLUSIONS Most NCC cases were long-standing migrants. Few clinical differences were observed depending on the cysticerci location. The treatment was often not according to current recommendations, and no uniform criteria were followed when it came to the therapeutic regimen. NCC case management in Spain (including clinician awareness and laboratory capacity improvements) needs to be strengthened.
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Affiliation(s)
- Zaida Herrador
- Centro Nacional de Medicina Tropical, Instituto de Salud Carlos III, Madrid, Spain; Network Biomedical Research on Tropical Diseases (RICET in Spanish), Madrid, Spain.
| | - José A Pérez-Molina
- Network Biomedical Research on Tropical Diseases (RICET in Spanish), Madrid, Spain; National Referral Unit for Tropical Diseases, Infectious Diseases Department, Hospital Universitario Ramón y Cajal, IRICYS, Madrid, Spain
| | - César Augusto Henríquez Camacho
- National Referral Unit for Tropical Diseases, Infectious Diseases Department, Hospital Universitario Ramón y Cajal, IRICYS, Madrid, Spain
| | | | | | | | | | | | | | - Ana Mena
- Hospital Universitario Son Espases, Palma Mallorca, Spain
| | | | - Diego Torrús
- Hospital Universitario de Alicante, Alicante, Spain
| | - Philip Wikman-Jorgensen
- Hospital Universitario de Elda, Alicante, Spain; Foundation for the Promotion of Health and Biomedical Research of Valencia Region, FISABIO, Spain
| | - Agustín Benito
- Centro Nacional de Medicina Tropical, Instituto de Salud Carlos III, Madrid, Spain; Network Biomedical Research on Tropical Diseases (RICET in Spanish), Madrid, Spain
| | - Rogelio López-Vélez
- Network Biomedical Research on Tropical Diseases (RICET in Spanish), Madrid, Spain; National Referral Unit for Tropical Diseases, Infectious Diseases Department, Hospital Universitario Ramón y Cajal, IRICYS, Madrid, Spain
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Norman FF, Chamorro S, Comeche B, Pérez-Molina JA, López-Vélez R. Update on the major imported helminth infections in travelers and migrants. Future Microbiol 2020; 15:437-444. [PMID: 32250168 DOI: 10.2217/fmb-2019-0273] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/14/2022] Open
Abstract
Helminth infections cause considerable morbidity worldwide and may be frequently underdiagnosed especially in areas of lower endemicity. Patients may harbor latent infections that may become symptomatic years or decades after the initial exposure and timely diagnosis may be critical to prevent complications and improve outcomes. In this context, disease in special populations, such as immunosuppressed patients, may be of particular concern. Heightened awareness and recent diagnostic developments may contribute to the correct management of helminth infections in nonendemic regions. A review of the main helminth infections in travelers and migrants (strongyloidiasis, taeniasis-neurocysticercosis and schistosomiasis) is presented, focusing on epidemiology, developments in diagnosis, treatment and prevention.
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Affiliation(s)
- F F Norman
- National Referral Unit for Tropical Diseases, Infectious Diseases Department, Ramón y Cajal University Hospital, IRYCIS, Ctra Colmenar, Km 9100, 28034 Madrid, Spain
| | - S Chamorro
- National Referral Unit for Tropical Diseases, Infectious Diseases Department, Ramón y Cajal University Hospital, IRYCIS, Ctra Colmenar, Km 9100, 28034 Madrid, Spain
| | - B Comeche
- National Referral Unit for Tropical Diseases, Infectious Diseases Department, Ramón y Cajal University Hospital, IRYCIS, Ctra Colmenar, Km 9100, 28034 Madrid, Spain
| | - J A Pérez-Molina
- National Referral Unit for Tropical Diseases, Infectious Diseases Department, Ramón y Cajal University Hospital, IRYCIS, Ctra Colmenar, Km 9100, 28034 Madrid, Spain
| | - R López-Vélez
- National Referral Unit for Tropical Diseases, Infectious Diseases Department, Ramón y Cajal University Hospital, IRYCIS, Ctra Colmenar, Km 9100, 28034 Madrid, Spain
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Abraham A, Schmidt V, Kaminski M, Stelzle D, De Meijere R, Bustos J, Sahu PS, Garcia HH, Bobić B, Cretu C, Chiodini P, Deksne G, Dermauw V, Devleesschauwer B, Dorny P, Fonseca A, Gabriël S, Gómez-Morales MA, Kucsera I, Laranjo-González M, Trevisan C, Vilhena M, Walker NF, Zammarchi L, Winkler AS. Epidemiology and surveillance of human (neuro)cysticercosis in Europe: is enhanced surveillance required? Trop Med Int Health 2020; 25:566-578. [PMID: 32083787 DOI: 10.1111/tmi.13384] [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] [Indexed: 11/28/2022]
Abstract
OBJECTIVES To report on relevant national surveillance systems of (N)CC and taeniasis (the infection with the adult tapeworm) in the European Union/European Economic Area and to assess the magnitude of (N)CC occurrence by retrieving information on cases for the period 2000-2016. METHODS (N)CC cases were retrieved via national reporting systems, a systematic literature search, contact with clinicians and a search for relevant 'International Statistical Classification of Diseases and Related Health Problems' (ICD)-based data. RESULTS Mandatory notification systems for (N)CC were found in Hungary, Iceland and Poland. Ten cases were reported in Poland and none in Hungary and Iceland. Through the systematic literature review and information given by clinicians, 263 individual and 721 aggregated (N)CC cases from 19 European countries were identified. ICD-based data were obtained from five countries. From 2000 to 2016, a total of 3489 cases (N)CC cases were coded: 832 in Italy, eight in Latvia, 357 in Portugal, 2116 in Spain and 176 in Sweden. CONCLUSION Despite being classified as a possible eradicable disease, (N)CC is still diagnosed across Europe, yet its true extent and impact remain unclear.
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Affiliation(s)
- Annette Abraham
- Department of Neurology, School of Medicine, Technical University Munich, Munich, Germany.,Centre for Global Health, Institute of Health and Society, University of Oslo, Oslo, Norway
| | - Veronika Schmidt
- Department of Neurology, School of Medicine, Technical University Munich, Munich, Germany.,Centre for Global Health, Institute of Health and Society, University of Oslo, Oslo, Norway
| | - Miriam Kaminski
- Klinik für Psychiatrie und Psychotherapie, Charité-Universitätsmedizin Berlin, Berlin, Germany
| | - Dominik Stelzle
- Department of Neurology, School of Medicine, Technical University Munich, Munich, Germany.,Department of Sport and Health Sciences, Technical University of Munich, Munich, Germany
| | - Robert De Meijere
- Department of Neurology, School of Medicine, Technical University Munich, Munich, Germany
| | - Javier Bustos
- Cysticercosis Unit, Instituto Nacional de Ciencias Neurológicas, Lima, Peru
| | | | - Hector Hugo Garcia
- Cysticercosis Unit, Instituto Nacional de Ciencias Neurológicas, Lima, Peru
| | - Branko Bobić
- Centre of Excellence for Food- and Vector-borne Zoonoses, University of Belgrade, Belgrade, Serbia
| | - Carmen Cretu
- Department of Parasitology, Carol Davila University of Medicine, Bucharest, Romania
| | - Peter Chiodini
- Hospital for Tropical Diseases, University College Hospital, London, UK.,London School of Hygiene and Tropical Medicine, London, UK
| | - Gunita Deksne
- Institute of Food Safety, Animal Health and Environment "BIOR", Riga, Latvia.,Faculty of Biology, University of Latvia, Riga, Latvia
| | - Veronique Dermauw
- Department of Biomedical Sciences, Institute of Tropical Medicine, Antwerp, Belgium
| | - Brecht Devleesschauwer
- Department of Epidemiology and Public Health, Sciensano, Brussels, Belgium.,Department of Veterinary Public Health and Food Safety, Ghent University, Ghent, Belgium
| | - Pierre Dorny
- Department of Biomedical Sciences, Institute of Tropical Medicine, Antwerp, Belgium
| | - Ana Fonseca
- Public Health Department, NOVA University of Lisbon, Lisbon, Portugal
| | - Sarah Gabriël
- Department of Veterinary Public Health and Food Safety, Ghent University, Ghent, Belgium
| | | | | | - Minerva Laranjo-González
- Centre de Recerca en Sanitat Animal, Campus de la Universitat Autònoma de Barcelona, Bellaterra, Spain
| | - Chiara Trevisan
- Department of Biomedical Sciences, Institute of Tropical Medicine, Antwerp, Belgium
| | - Manuela Vilhena
- Instituto de Ciências Agrárias e Ambientais Mediterrânicas, Universidade de Évora, Évora, Portugal
| | - Naomi F Walker
- Hospital for Tropical Diseases, University College Hospital, London, UK.,London School of Hygiene and Tropical Medicine, London, UK
| | - Lorenzo Zammarchi
- Department of Experimental and Clinical Medicine, University of Florence, Florence, Italy
| | - Andrea Sylvia Winkler
- Department of Neurology, School of Medicine, Technical University Munich, Munich, Germany.,Centre for Global Health, Institute of Health and Society, University of Oslo, Oslo, Norway
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Goldsmid J, Bettiol S. Global Medicine, Parasites, and Tasmania. Trop Med Infect Dis 2020; 5:tropicalmed5010007. [PMID: 31906394 PMCID: PMC7157593 DOI: 10.3390/tropicalmed5010007] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/06/2019] [Revised: 12/24/2019] [Accepted: 12/30/2019] [Indexed: 01/20/2023] Open
Abstract
Until the 1970s, infectious disease training in most medical schools was limited to those diseases common in the area of instruction. Those wishing to explore a more globalised curriculum were encouraged to undertake specialist postgraduate training at schools or institutes of tropical medicine. However, the increase in global trade and travel from the 1970s onward led to dramatic changes in the likelihood of returning travellers and new immigrants presenting with tropical infections in temperate regions. Furthermore, population growth and the changing relationships between animals, the environment, and man in agriculture accentuated the importance of a wider understanding of emerging infectious diseases, zoonotic diseases and parasitic infections. These epidemiological facts were not adequately reflected in the medical literature or medical curriculum at the time. The orientation on tropical infections needed specialised attention, including instruction on diagnosis and treatment of such infections. We describe key global health events and how the changing field of global medicine, from the 1970s to early 2000, impacted on medical education and research. We describe the impact of global health changes in the Tasmanian context, a temperate island state of Australia. We retrospectively analysed data of patients diagnosed with parasites and present a list of endemic and non-endemic parasites reported during this period. Finally, we reflect on the new approaches to the changing needs of global health and challenges that medical programmes, learners and educators face today.
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Akyeampong A, Solomon N, Boire NA, Baqui AA. Cryptococcal Meningitis Presenting as New-Onset Seizures in an Immunocompetent Patient. J Investig Med High Impact Case Rep 2019; 7:2324709619861129. [PMID: 31353954 PMCID: PMC6661782 DOI: 10.1177/2324709619861129] [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] [Indexed: 11/16/2022] Open
Abstract
This report describes a 30-year-old immunocompetent male with new-onset seizures, later found on imaging to have 2 enhancing lesions in the brain. The patient underwent a left parietal craniectomy with resection of one of the masses, which demonstrated focal areas of necrosis and many small cystic structures positive for periodic acid-Schiff and Gomori's methenamine silver special stain. Numerous laboratory examinations, including HIV test, rapid plasma reagin, toxoplasma immunoglobulin G and immunoglobulin M, Lyme, cytomegalovirus, tuberculosis, cysticercosis, and Echinococcus serology, were all negative. Despite negative cerebrospinal fluid (CSF) culture and several negative CSF antigen tests, continued investigation, and follow-up, CSF antigen testing ultimately revealed Cryptococcus as the causative agent. In light of the mysterious and unusual presentation, the authors discuss potential infectious differential diagnoses in patients with atypical clinical presentation, laboratory tests, and surgical pathology.
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Affiliation(s)
| | | | | | - Aam A Baqui
- 2 The Brooklyn Hospital Center, Brooklyn, NY, USA
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