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Jindal H, Gupta P, Arora H, Purushothaman P. Disseminated cysticercosis and neurocysticercosis with classic starry-sky appearance in an adolescent vegetarian Indian male. IDCases 2024; 38:e02079. [PMID: 39309039 PMCID: PMC11415943 DOI: 10.1016/j.idcr.2024.e02079] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/24/2024] [Revised: 09/04/2024] [Accepted: 09/06/2024] [Indexed: 09/25/2024] Open
Affiliation(s)
- Himanshu Jindal
- Intern Physician, Ganesh Shankar Vidyarthi Memorial Medical College, Kanpur 208002, India
| | - Priyanka Gupta
- Department of Neurology, Ganesh Shankar Vidyarthi Memorial Medical College, Kanpur 208002, India
| | - Hardika Arora
- Ganesh Shankar Vidyarthi Memorial Medical College, Kanpur 208002, India
| | - P. Purushothaman
- Department of Neuroradiology, PMSSY, Ganesh Shankar Vidyarthi Memorial Medical College, Kanpur 208002, India
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Abanto J, Sanchez Boluarte AN, Castillo Y, Perez E, Saavedra H, Gonzales I, Bustos JA, Abravanel F, Izopet J, Madden RG, Garcia HH, Dalton HR. Increased Prevalence of Antibodies to Hepatitis E Virus in Patients with Neurocysticercosis. Am J Trop Med Hyg 2024; 110:1210-1213. [PMID: 38653231 PMCID: PMC11154044 DOI: 10.4269/ajtmh.23-0856] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/01/2023] [Accepted: 01/24/2024] [Indexed: 04/25/2024] Open
Abstract
We explored the association between serological status for hepatitis E and neurocysticercosis (NCC) in neurologic patients attending a national neurological referral center in Lima, Perú, between the years 2008 and 2012. Anti-hepatitis E antibodies were evaluated in patients with and without NCC, and a control group of rural general population. Anti-hepatitis E IgG was found in 23.8% of patients with NCC, compared with 14.3% in subjects without NCC from a general rural population (P = 0.023) and 14.4% in subjects with neurological complaints without NCC (P = 0.027). Seropositive patients had a median age of 44 years compared with 30 years in seronegative patients (P <0.001). No significant differences in sex, region of residence, or liver enzyme values were found. Seropositivity to hepatitis E was frequent in this Peruvian population and higher in patients with NCC, suggesting shared common routes of infection.
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Affiliation(s)
- Jesus Abanto
- Centro de Salud Global, Universidad Peruana Cayetano Heredia, Lima, Perú
- Department of Neurology, University of Cincinnati, Cincinnati, Ohio
| | - Arantxa N. Sanchez Boluarte
- Facultad de Medicina, Universidad Peruana Cayetano Heredia, Lima, Perú
- Department of Global Health, University of Washington, Seattle, Washington
| | - Yesenia Castillo
- Centro de Salud Global, Universidad Peruana Cayetano Heredia, Lima, Perú
| | - Erika Perez
- Centro Básico de Investigación en Exámenes Auxiliares en Parasitosis del Sistema Nervioso Central, Instituto Nacional de Ciencias Neurológicas, Lima, Perú
| | - Herbert Saavedra
- Centro Básico de Investigación en Exámenes Auxiliares en Parasitosis del Sistema Nervioso Central, Instituto Nacional de Ciencias Neurológicas, Lima, Perú
| | - Isidro Gonzales
- Centro Básico de Investigación en Exámenes Auxiliares en Parasitosis del Sistema Nervioso Central, Instituto Nacional de Ciencias Neurológicas, Lima, Perú
| | - Javier A. Bustos
- Centro de Salud Global, Universidad Peruana Cayetano Heredia, Lima, Perú
- Centro Básico de Investigación en Exámenes Auxiliares en Parasitosis del Sistema Nervioso Central, Instituto Nacional de Ciencias Neurológicas, Lima, Perú
| | | | | | - Richie G. Madden
- Department of Gastroenterology and Hepatology, Royal Adelaide Hospital, University of Adelaide, South Australia
- HEV International Direct Action Group (HEViDrAG)
| | - Hector H. Garcia
- Centro de Salud Global, Universidad Peruana Cayetano Heredia, Lima, Perú
- Centro Básico de Investigación en Exámenes Auxiliares en Parasitosis del Sistema Nervioso Central, Instituto Nacional de Ciencias Neurológicas, Lima, Perú
| | - Harry R. Dalton
- Department of Gastroenterology and Hepatology, Royal Adelaide Hospital, University of Adelaide, South Australia
- HEV International Direct Action Group (HEViDrAG)
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Southall WR, Southall MS, Aldaas MB, Sagi V, Akella PV. Triggered: Discovery of Neurocysticercosis Following Self-Administered Albendazole. Cureus 2023; 15:e43746. [PMID: 37727167 PMCID: PMC10506364 DOI: 10.7759/cureus.43746] [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] [Accepted: 08/19/2023] [Indexed: 09/21/2023] Open
Abstract
A 25-year-old man with no medical history presented with a seizure one month after taking a self-administered dose of albendazole. Magnetic resonance imaging (MRI) of the brain revealed multiple ring-enhancing lesions, and the workup confirmed neurocysticercosis (NCC). Treatment with antiparasitics was delayed due to concern for worsening symptoms from the presence of cysts in the midbrain and hippocampus. The balance between treating NCC and limiting cerebral inflammation is delicate and relies on judgment from a multispecialty clinical team. In this case, corticosteroids and antiepileptics alone prevented additional seizures but failed to reduce the overall inflammation of cysts and the progression of the disease. Evidence of new cysts on MRI at week 13 from the onset of symptoms was evidence of an acute, evolving infectious process. Treatment with albendazole and praziquantel was initiated at 13 weeks from the onset of symptoms, and by 31 weeks, nearly all cysts had resolved with minimal residual inflammation.
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Affiliation(s)
| | | | - Mohamad B Aldaas
- Infectious Diseases, University of Louisville School of Medicine, Louisville, USA
| | - Vishwanath Sagi
- Neurology, University of Louisville School of Medicine, Louisville, USA
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Ratcliffe C, Adan G, Marson A, Solomon T, Saini J, Sinha S, Keller SS. Neurocysticercosis-related Seizures: Imaging Biomarkers. Seizure 2023; 108:13-23. [PMID: 37060627 DOI: 10.1016/j.seizure.2023.04.005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/20/2023] [Revised: 03/31/2023] [Accepted: 04/04/2023] [Indexed: 04/08/2023] Open
Abstract
Neurocysticercosis (NCC)-a parasitic CNS infection endemic to developing nations-has been called the leading global cause of acquired epilepsy yet remains understudied. It is currently unknown why a large proportion of patients develop recurrent seizures, often following the presentation of acute seizures. Furthermore, the presentation of NCC is heterogenous and the features that predispose to the development of an epileptogenic state remain uncertain. Perilesional factors (such as oedema and gliosis) have been implicated in NCC-related ictogenesis, but the effects of cystic factors, including lesion load and location, seem not to play a role in the development of habitual epilepsy. In addition, the cytotoxic consequences of the cyst's degenerative stages are varied and the majority of research, relying on retrospective data, lacks the necessary specificity to distinguish between acute symptomatic and unprovoked seizures. Previous research has established that epileptogenesis can be the consequence of abnormal network connectivity, and some imaging studies have suggested that a causative link may exist between NCC and aberrant network organisation. In wider epilepsy research, network approaches have been widely adopted; studies benefiting predominantly from the rich, multimodal data provided by advanced MRI methods are at the forefront of the field. Quantitative MRI approaches have the potential to elucidate the lesser-understood epileptogenic mechanisms of NCC. This review will summarise the current understanding of the relationship between NCC and epilepsy, with a focus on MRI methodologies. In addition, network neuroscience approaches with putative value will be highlighted, drawing from current imaging trends in epilepsy research.
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Affiliation(s)
- Corey Ratcliffe
- Department of Pharmacology and Therapeutics, Institute of Systems, Molecular, and Integrative Biology, University of Liverpool, Liverpool, UK; Department of Neuro Imaging and Interventional Radiology, National Institute of Mental Health and Neuro Sciences, Bangalore, India.
| | - Guleed Adan
- Department of Pharmacology and Therapeutics, Institute of Systems, Molecular, and Integrative Biology, University of Liverpool, Liverpool, UK; The Walton Centre NHS Foundation Trust, Liverpool, UK
| | - Anthony Marson
- Department of Pharmacology and Therapeutics, Institute of Systems, Molecular, and Integrative Biology, University of Liverpool, Liverpool, UK
| | - Tom Solomon
- The Walton Centre NHS Foundation Trust, Liverpool, UK; Veterinary and Ecological Sciences, National Institute for Health Research Health Protection Research Unit in Emerging and Zoonotic Infections, Institute of Infection, University of Liverpool, Liverpool, UK; Tropical and Infectious Diseases Unit, Royal Liverpool and Broadgreen University Hospitals NHS Trust, Liverpool, UK
| | - Jitender Saini
- Department of Neuro Imaging and Interventional Radiology, National Institute of Mental Health and Neuro Sciences, Bangalore, India
| | - Sanjib Sinha
- Department of Neurology, National Institute of Mental Health and Neuro Sciences, Bangalore, India
| | - Simon S Keller
- Department of Pharmacology and Therapeutics, Institute of Systems, Molecular, and Integrative Biology, University of Liverpool, Liverpool, UK; The Walton Centre NHS Foundation Trust, Liverpool, UK
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Steyn TJS, Awala AN, de Lange A, Raimondo JV. What Causes Seizures in Neurocysticercosis? Epilepsy Curr 2022; 23:105-112. [PMID: 37122403 PMCID: PMC10131564 DOI: 10.1177/15357597221137418] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/24/2022] Open
Abstract
Neurocysticercosis (NCC) is the most prevalent parasitic infection of the central nervous system. It is caused by the presence of larvae of the cestode Taenia solium in the brain. The most common symptom of NCC is seizures, and it is widely considered the world’s leading cause of preventable epilepsy. Despite the prevalence and impact of NCC, a thorough, mechanistic understanding of seizure generation is still lacking. In this review, we address the question “What causes seizures in NCC?” by summarizing and discussing the major theories that seek to explain the seizurogenic and epileptogenic processes in this disorder. In addition, we highlight the potential for recent advances in disease modeling to help accelerate progress in this area.
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Affiliation(s)
- Teresa Julieta Simões Steyn
- 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, Western Cape, South Africa
| | - Amalia Naita Awala
- 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, Western Cape, South Africa
| | - Anja de Lange
- 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, Western Cape, South Africa
| | - 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, Western Cape, South Africa
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Remadi M, Saguin E, Ficko C. Troubles neuropsychiatriques chez un jeune adulte : penser au parasite ! ANNALES MEDICO-PSYCHOLOGIQUES 2022. [DOI: 10.1016/j.amp.2022.04.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
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Coyle CM. New Insights Into Calcified Neurocysticercosis: Closing the Knowledge Gap. Clin Infect Dis 2021; 73:e2601-e2603. [PMID: 32619230 DOI: 10.1093/cid/ciaa927] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/22/2020] [Accepted: 07/02/2020] [Indexed: 11/14/2022] Open
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8
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White AC. Calcifications and the Global Burden of Neurocysticercosis: Not Just Rocks in Your Head. Clin Infect Dis 2021; 73:e2604-e2606. [PMID: 32556094 DOI: 10.1093/cid/ciaa764] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/21/2020] [Accepted: 06/11/2020] [Indexed: 11/14/2022] Open
Affiliation(s)
- A Clinton White
- Infectious Disease Division, Department of Internal Medicine, University of Texas Medical Branch, Galveston, Texas, USA
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Bustos JA, Arroyo G, Gilman RH, Soto-Becerra P, Gonzales I, Saavedra H, Pretell EJ, Nash TE, O’Neal SE, Del Brutto OH, Gonzalez AE, Garcia HH. Frequency and Determinant Factors for Calcification in Neurocysticercosis. Clin Infect Dis 2021; 73:e2592-e2600. [PMID: 32556276 PMCID: PMC8563199 DOI: 10.1093/cid/ciaa784] [Citation(s) in RCA: 20] [Impact Index Per Article: 6.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/06/2020] [Accepted: 06/11/2020] [Indexed: 11/14/2022] Open
Abstract
BACKGROUND Neurocysticercosis is a major cause of acquired epilepsy. Larval cysts in the human brain eventually resolve and either disappear or leave a calcification that is associated with seizures. In this study, we assessed the proportion of calcification in parenchymal neurocysticercosis and risk factors associated with calcification. METHODS Data for 220 patients with parenchymal NCC from 3 trials of antiparasitic treatment were assessed to determine what proportion of the cysts that resolved 6 months after treatment ended up in a residual calcification at 1 year. Also, we evaluated the risk factors associated with calcification. RESULTS The overall proportion of calcification was 38% (188/497 cysts, from 147 patients). Predictors for calcification at the cyst level were cysts larger than 14 mm (risk ratio [RR], 1.34; 95% confidence interval [CI], 1.02-1.75) and cysts with edema at baseline (RR, 1.39; 95% CI, 1.05-1.85). At the patient level, having had more than 24 months with seizures (RR, 1.25; 95% CI, 1.08-1.46), mild antibody response (RR, 1.14; 95% CI, 1.002-1.27), increased dose albendazole regime (RR, 1.26; 95% CI, 1.14-1.39), lower doses of dexamethasone (RR, 1.36; 95% CI, 1.02-1.81), not receiving early antiparasitic retreatment (RR, 1.45; 95% CI, 1.08-1.93), or complete cure (RR, 1.48; 95% CI, 1.29-1.71) were associated with a increased risk of calcification. CONCLUSIONS Approximately 38% of parenchymal cysts calcify after antiparasitic treatment. Some factors associated with calcification are modifiable and may be considered to decrease or avoid calcification, potentially decreasing the risk for seizure relapses.
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Affiliation(s)
- Javier A Bustos
- Cysticercosis Unit, Instituto Nacional de Ciencias Neurológicas, Lima, Perú
- Center for Global Health, School of Public Health and Management, and School of Sciences and Philosophy, Universidad Peruana Cayetano Heredia, Lima, Perú
| | - Gianfranco Arroyo
- Cysticercosis Unit, Instituto Nacional de Ciencias Neurológicas, Lima, Perú
- Center for Global Health, School of Public Health and Management, and School of Sciences and Philosophy, Universidad Peruana Cayetano Heredia, Lima, Perú
| | - Robert H Gilman
- Department of International Health, Bloomberg School of Public Health, Johns Hopkins University, Baltimore, Maryland, USA
| | - Percy Soto-Becerra
- Center for Global Health, School of Public Health and Management, and School of Sciences and Philosophy, Universidad Peruana Cayetano Heredia, Lima, Perú
| | - Isidro Gonzales
- Cysticercosis Unit, Instituto Nacional de Ciencias Neurológicas, Lima, Perú
| | - Herbert Saavedra
- Cysticercosis Unit, Instituto Nacional de Ciencias Neurológicas, Lima, Perú
| | - E Javier Pretell
- Cysticercosis Unit, Instituto Nacional de Ciencias Neurológicas, Lima, Perú
- Department of Neurology, Hospital Alberto Sabogal, Callao, Perú
| | - Theodore E Nash
- Laboratory of Parasitic Diseases, National Institute of Allergy and Infectious Diseases, National Institutes of Health, Bethesda, Maryland, USA
| | - Seth E O’Neal
- Center for Global Health, School of Public Health and Management, and School of Sciences and Philosophy, Universidad Peruana Cayetano Heredia, Lima, Perú
- School of Public Health, Oregon Health and Science University and Portland State University, Portland, Oregon, USA
| | - Oscar H Del Brutto
- School of Medicine, Universidad Espíritu Santo–Ecuador, Samborondón, Ecuador
| | - Armando E Gonzalez
- Center for Global Health, School of Public Health and Management, and School of Sciences and Philosophy, Universidad Peruana Cayetano Heredia, Lima, Perú
| | - Hector H Garcia
- Cysticercosis Unit, Instituto Nacional de Ciencias Neurológicas, Lima, Perú
- Center for Global Health, School of Public Health and Management, and School of Sciences and Philosophy, Universidad Peruana Cayetano Heredia, Lima, Perú
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Cantey PT, Montgomery SP, Straily A. Neglected Parasitic Infections: What Family Physicians Need to Know-A CDC Update. Am Fam Physician 2021; 104:277-287. [PMID: 34523888 PMCID: PMC9096899] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/13/2023]
Abstract
Chagas disease, cysticercosis, and toxoplasmosis affect millions of people in the United States and are considered neglected parasitic diseases. Few resources are devoted to their surveillance, prevention, and treatment. Chagas disease, transmitted by kissing bugs, primarily affects people who have lived in Mexico, Central America, and South America, and it can cause heart disease and death if not treated. Chagas disease is diagnosed by detecting the parasite in blood or by serology, depending on the phase of disease. Antiparasitic treatment is indicated for most patients with acute disease. Treatment for chronic disease is recommended for people younger than 18 years and generally recommended for adults younger than 50 years. Treatment decisions should be individualized for all other patients. Cysticercosis can manifest in muscles, the eyes, and most critically in the brain (neurocysticercosis). Neurocysticercosis accounts for 2.1% of all emergency department visits for seizures in the United States. Diagnosing neurocysticercosis involves serology and neuroimaging. Treatment includes symptom control and antiparasitic therapy. Toxoplasmosis is estimated to affect 11% of people older than six years in the United States. It can be acquired by ingesting food or water that has been contaminated by cat feces; it can also be acquired by eating undercooked, contaminated meat. Toxoplasma infection is usually asymptomatic; however, people who are immunosuppressed can develop more severe neurologic symptoms. Congenital infection can result in miscarriage or adverse fetal effects. Diagnosis is made with serologic testing, polymerase chain reaction testing, or parasite detection in tissue or fluid specimens. Treatment is recommended for people who are immunosuppressed, pregnant patients with recently acquired infection, and people who are immunocompetent with visceral disease or severe symptoms.
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Affiliation(s)
- Paul T Cantey
- Centers for Disease Control and Prevention, Atlanta, GA, USA
| | | | - Anne Straily
- Centers for Disease Control and Prevention, Atlanta, GA, USA
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Abanto J, Blanco D, Saavedra H, Gonzales I, Siu D, Pretell EJ, Bustos JA, Garcia HH. Mortality in Parenchymal and Subarachnoid Neurocysticercosis. Am J Trop Med Hyg 2021; 105:176-180. [PMID: 34232912 DOI: 10.4269/ajtmh.20-1330] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/13/2020] [Accepted: 01/07/2021] [Indexed: 11/07/2022] Open
Abstract
Neurocysticercosis (NCC) is endemic in many parts of the world, carrying significant neurological morbidity that varies according to whether lesions are located inside the cerebral parenchyma or in extraparenchymal spaces. The latter, in particular subarachnoid NCC, is assumed to be more severe, but no controlled studies comparing mortality between types of NCC exist. The aim of this study was to compare all-cause mortality between patients with intraparenchymal NCC and those with subarachnoid NCC. Vital status and sociodemographic characteristics were evaluated in patients with intraparenchymal viable, intraparenchymal calcified, and subarachnoid NCC attending a neurological referral hospital in Lima, Perú. Survival analyses using Kaplan-Meier curves and Cox proportional regression models were carried out to compare mortality rates between groups. From 840 NCC patients followed by a median time of 82.3 months, 42 (5.0%) died, six (1.8%) in the intraparenchymal viable group, four (1.3%) in the calcified group, and 32 (16.6%) in the subarachnoid group (P < 0.001). Older age and lower education were significantly associated with mortality. The age-adjusted hazard ratio for death in the subarachnoid group was 13.6 (95% CI: 5.6-33.0, P < 0.001) compared with the intraparenchymal viable group and 10.7 (95% CI: 3.7-30.8, P < 0.001) when compared with the calcified group. We concluded that subarachnoid disease is associated with a much higher mortality in NCC.
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Affiliation(s)
- Jesus Abanto
- 1Centro de Salud Global, Universidad Peruana Cayetano Heredia, Lima, Peru.,2Centro Básico de Investigación en Exámenes Auxiliares en Parasitosis Del Sistema Nervioso Central, Instituto Nacional de Ciencias Neurológicas, Lima, Peru
| | - Daniel Blanco
- 3Unidad de Investigación, Instituto Nacional de Ciencias Neurológicas, Lima, Peru
| | - Herbert Saavedra
- 2Centro Básico de Investigación en Exámenes Auxiliares en Parasitosis Del Sistema Nervioso Central, Instituto Nacional de Ciencias Neurológicas, Lima, Peru
| | - Isidro Gonzales
- 2Centro Básico de Investigación en Exámenes Auxiliares en Parasitosis Del Sistema Nervioso Central, Instituto Nacional de Ciencias Neurológicas, Lima, Peru.,3Unidad de Investigación, Instituto Nacional de Ciencias Neurológicas, Lima, Peru
| | - Diego Siu
- 1Centro de Salud Global, Universidad Peruana Cayetano Heredia, Lima, Peru
| | | | - Javier A Bustos
- 1Centro de Salud Global, Universidad Peruana Cayetano Heredia, Lima, Peru.,2Centro Básico de Investigación en Exámenes Auxiliares en Parasitosis Del Sistema Nervioso Central, Instituto Nacional de Ciencias Neurológicas, Lima, Peru
| | - Hector H Garcia
- 1Centro de Salud Global, Universidad Peruana Cayetano Heredia, Lima, Peru.,2Centro Básico de Investigación en Exámenes Auxiliares en Parasitosis Del Sistema Nervioso Central, Instituto Nacional de Ciencias Neurológicas, Lima, Peru
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Abstract
PURPOSE OF REVIEW Neurocysticercosis is the most common helminthic infection of the central nervous system caused by the larval stage of the pork tapeworm, Taenia solium. Endemic regions include Latin American countries, sub-Saharan Africa, and large regions of Asia, including the Indian subcontinent and is a global health problem. Seizures are the most common manifestation and approximately 30% of adult-onset seizures in endemic regions are attributable to NCC. Calcifications because of neurocysticercosis is the most common finding on imaging in endemic regions and are important seizure foci contributing to the burden of epilepsy. RECENT FINDINGS After treatment with antiparasitics for multiple viable parenchymal disease, approximately 38% of cysts that resolved after 6 months of therapy will result in residual calcifications, which represents a significant burden of residual disease. Calcified disease has been referred to as 'inactive disease', but there is accumulating evidence to suggest that calcified granulomas are actually dynamic and substantially contribute to the development and maintenance of seizures. SUMMARY Calcified parenchymal neurocysticercosis contributes significantly to the development and maintenance of seizures in endemic regions. Understanding the pathogenesis of the role of calcified NCC in seizure development and risk factors for development of calcifications after treatment is critical to decreasing the burden of symptomatic disease in endemic regions.
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Niang I, Ndiaye B, Diouf PMD, Kayembe A, Kasse Y, Ba S. 'Starry sky' appearance on brain CT in neurocysticercal encephalitis. Int J Infect Dis 2021; 108:4-5. [PMID: 33989772 DOI: 10.1016/j.ijid.2021.05.004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/12/2021] [Revised: 05/01/2021] [Accepted: 05/06/2021] [Indexed: 10/21/2022] Open
Affiliation(s)
- Ibrahima Niang
- Radiology Department, Fann University Hospital Center, Dakar, Senegal.
| | - Balla Ndiaye
- Radiology Department, Fann University Hospital Center, Dakar, Senegal
| | | | - Axel Kayembe
- Radiology Department, Fann University Hospital Center, Dakar, Senegal
| | - Youssoupha Kasse
- Radiology Department, Fann University Hospital Center, Dakar, Senegal
| | - Sokhna Ba
- Radiology Department, Fann University Hospital Center, Dakar, Senegal
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Hamamoto Filho PT, Fragoso G, Sciutto E, Fleury A. Inflammation in neurocysticercosis: clinical relevance and impact on treatment decisions. Expert Rev Anti Infect Ther 2021; 19:1503-1518. [PMID: 33794119 DOI: 10.1080/14787210.2021.1912592] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
Abstract
INTRODUCTION Neurocysticercosis is caused by the localization of Taenia solium larvae in the central nervous system. The disease remains endemic in most countries of Latin America, Asia and Africa. While major improvements have been made in its diagnosis and treatment, uncertainties persist regarding the clinical implications and treatment of the inflammatory reaction associated with the disease. AREAS COVERED In this review, based on PubMed searches, the authors describe the characteristics of the immune-inflammatory response in patients with neurocysticercosis, its clinical implications and the treatment currently administered. The dual role of inflammation (participating in both, the death of the parasite, and the precipitation of serious complications) is discussed. New therapeutic strategies of potential interest are presented. EXPERT OPINION Inflammatory reaction is the main pathogenic mechanism associated to neurocysticercosis. Its management is mainly based on corticosteroids administration. This strategy had improved prognostic of patients as it allows for the control of most of the inflammatory complications. On the other side, it might be involved in the persistence of parasites in some patients, despite cysticidal treatment, due to its immunosuppressive properties. New strategies are needed to improve therapeutical management, particularly in the severest presentations.
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Affiliation(s)
- Pedro T Hamamoto Filho
- Department of Neurology, Psychology and Psychiatry, UNESP-Univ Estadual Paulista, Botucatu Medical School, Botucatu, Brazil
| | - Gladis Fragoso
- Department of Immunology, Instituto de Investigaciones Biomédicas, Universidad Nacional Autónoma de México, Ciudad de México, Mexico
| | - Edda Sciutto
- Department of Immunology, Instituto de Investigaciones Biomédicas, Universidad Nacional Autónoma de México, Ciudad de México, Mexico
| | - Agnès Fleury
- Department of Genomic Medicine and Environmental Toxicology, Instituto de Investigaciones Biomédicas, Universidad Nacional Autónoma de México, Ciudad de México, Mexico.,Neurocysticercosis Clinic, Instituto Nacional de Neurología Y Neurocirugía, Ciudad de México, Mexico, mexico.,Neuroinflammation Unit, Instituto de Investigaciones Biomédicas-Universidad Nacional Autónoma de México/INNN/Facultad de Medicina-UNAM, Ciudad de México, Mexico
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Hanas JS, Hocker JRS, Evangeline B, Prabhakaran V, Oommen A, Rajshekhar V, Drevets DA, Carabin H. Distinguishing patients with idiopathic epilepsy from solitary cysticercus granuloma epilepsy and biochemical phenotype assessment using a serum biomolecule profiling platform. PLoS One 2020; 15:e0237064. [PMID: 32823271 PMCID: PMC7527271 DOI: 10.1371/journal.pone.0237064] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/13/2020] [Accepted: 06/24/2020] [Indexed: 11/19/2022] Open
Abstract
A major source of epilepsy is Neurocysticercosis (NCC), caused by Taenia solium infection. Solitary cysticercus granuloma (SCG), a sub-group of NCC induced epilepsy, is the most common form of NCC in India. Current diagnostic criteria for SCG epilepsy require brain imaging which may not be available in communities where the disease is endemic. Identification of serum changes and potential biomolecules that could distinguish SCG epilepsy from idiopathic generalized epilepsy (IE), without the initial need for imaging, could assist in disease identification, understanding, and treatment. The objective here was to investigate, using mass spectrometry (MS), sera biomolecule differences between patients with SCG epilepsy or IE to help distinguish these disorders based on physiological differences, to understand underlying phenotypes and mechanisms, and to lay ground work for future therapeutic and biomarker analyses. Sera were obtained from patients with SCG or IE (N = 29 each group). Serum mass peak profiling was performed with electrospray ionization (ESI) MS, and mass peak area means in the two groups were compared using leave one [serum sample] out cross validation (LOOCV). Serum LOOCV analysis identified significant differences between SCG and IE patient groups (p = 10-20), which became non-significant (p = 0.074) when the samples were randomly allocated to the groups and reanalyzed. Tandem MS/MS peptide analysis of serum mass peaks from SCG or IE patients was performed to help identify potential peptide/protein biochemical and phenotypic changes involving these two forms of epilepsy. Bioinformatic analysis of these peptide/protein changes suggested neurological, inflammatory, seizure, blood brain barrier, cognition, ion channel, cell death, and behavior related biochemical systems were being altered in these disease states. This study provides groundwork for aiding in distinguishing SCG and IE patients in minimally invasive, lower-cost manners, for improving understanding of underlying epilepsy mechanisms, and for further identifying discriminatory biomarkers and potential therapeutic targets.
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Affiliation(s)
- Jay S. Hanas
- Department of Biochemistry, University of Oklahoma Health Sciences Center, Oklahoma City, OK, United States of America
| | - James Randolph Sanders Hocker
- Department of Biochemistry, University of Oklahoma Health Sciences Center, Oklahoma City, OK, United States of America
| | - Betcy Evangeline
- Department of Neurological Sciences, Christian Medical College, Vellore, India
| | | | - Anna Oommen
- Department of Neurological Sciences, Christian Medical College, Vellore, India
| | - Vedantam Rajshekhar
- Department of Neurological Sciences, Christian Medical College, Vellore, India
| | - Douglas A. Drevets
- Department of Internal Medicine, University of Oklahoma Health Sciences Center, and the Veterans Administration Medical Center, Oklahoma City, OK, United States of America
| | - Hélène Carabin
- Department of Biostatistics and Epidemiology, University of Oklahoma Health Sciences Center, Oklahoma City, OK, United States of America
- Department of Pathology and Microbiology, Faculty of Veterinary Medicine, Université de Montréal, Saint-Hyacinthe, Canada
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Garcia HH, Gonzalez AE, Gilman RH. Taenia solium Cysticercosis and Its Impact in Neurological Disease. Clin Microbiol Rev 2020; 33:e00085-19. [PMID: 32461308 PMCID: PMC7254859 DOI: 10.1128/cmr.00085-19] [Citation(s) in RCA: 57] [Impact Index Per Article: 14.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/07/2023] Open
Abstract
Taenia solium neurocysticercosis (NCC) is endemic in most of the world and contributes significantly to the burden of epilepsy and other neurological morbidity. Also present in developed countries because of immigration and travel, NCC is one of few diseases targeted for eradication. This paper reviews all aspects of its life cycle (taeniasis, porcine cysticercosis, human cysticercosis), with a focus on recent advances in its diagnosis, management, and control. Diagnosis of taeniasis is limited by poor availability of immunological or molecular assays. Diagnosis of NCC rests on neuroimaging findings, supported by serological assays. The treatment of NCC should be approached in the context of the particular type of infection (intra- or extraparenchymal; number, location, and stage of lesions) and has evolved toward combined symptomatic and antiparasitic management, with particular attention to modulating inflammation. Research on NCC and particularly the use of recently available genome data and animal models of infection should help to elucidate mechanisms of brain inflammation, damage, and epileptogenesis.
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Affiliation(s)
- Hector H Garcia
- Center for Global Health, Universidad Peruana Cayetano Heredia, Lima, Peru
- Cysticercosis Unit, Instituto Nacional de Ciencias Neurológicas, Lima, Peru
| | - Armando E Gonzalez
- Center for Global Health, Universidad Peruana Cayetano Heredia, Lima, Peru
- School of Veterinary Medicine, Universidad Nacional Mayor de San Marcos, Lima, Peru
| | - Robert H Gilman
- Department of International Health, Johns Hopkins School of Public Health, Baltimore, Maryland, USA
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Herrick JA, Bustos JA, Clapham P, Garcia HH, Loeb JA, For The Cysticercosis Working Group In Peru. Unique Characteristics of Epilepsy Development in Neurocysticercosis. Am J Trop Med Hyg 2020; 103:639-645. [PMID: 32431269 PMCID: PMC7410468 DOI: 10.4269/ajtmh.19-0485] [Citation(s) in RCA: 17] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/30/2022] Open
Abstract
The parasitic helminth infection neurocysticercosis (NCC) is the most common cause of adult-acquired epilepsy in the world. Despite the serious consequences of epilepsy due to this infection, an in-depth review of the distinct characteristics of epilepsy due to neurocysticercosis has never been conducted. In this review, we evaluate the relationship between NCC and epilepsy and the unique characteristics of epilepsy caused by NCC. We also discuss recent advances in our understanding of NCC-related epilepsy, including the importance of anti-inflammatory therapies, the association between NCC and temporal lobe epilepsy, and the recent discovery of biomarkers of severe epilepsy development in individuals with NCC and seizures.
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Affiliation(s)
- Jesica A Herrick
- Division of Infectious Diseases, Immunology, and International Medicine, University of Illinois at Chicago, Chicago, Illinois
| | - Javier A Bustos
- Center for Global Health, Instituto Nacional de Ciencias Neurológicas, Universidad Peruana Cayetano Heredia, and Cysticercosis Unit, Lima, Perú
| | - Philip Clapham
- Division of Infectious Diseases, Immunology, and International Medicine, University of Illinois at Chicago, Chicago, Illinois
| | - Hector H Garcia
- Center for Global Health, Instituto Nacional de Ciencias Neurológicas, Universidad Peruana Cayetano Heredia, and Cysticercosis Unit, Lima, Perú
| | - Jeffrey A Loeb
- Department of Neurology and Rehabilitation Medicine, University of Illinois at Chicago, Chicago, Illinois
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18
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Nash TE, Ware JM, Coyle CM, Mahanty S. Etanercept to Control Inflammation in the Treatment of Complicated Neurocysticercosis. Am J Trop Med Hyg 2020; 100:609-616. [PMID: 30608049 PMCID: PMC6402894 DOI: 10.4269/ajtmh.18-0795] [Citation(s) in RCA: 21] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/31/2022] Open
Abstract
Manifestations of neurocysticercosis (NCC) are primarily due to host inflammatory responses directed at drug-damaged or naturally degenerating metacestodes (cysts) of the tapeworm Taenia solium. Prolonged high-dose corticosteroids are frequently required to control this inflammation in complicated disease, often causing severe side effects. Studies evaluating alternatives to corticosteroids are lacking. Here, we describe the clinical course of NCC in 16 patients prescribed etanercept (ETN), a tumor necrosis factor-alpha inhibitor to control inflammation resulting from anthelmintic treatment. Twelve patients with extraparenchymal NCC were administered ETN with corticosteroids (11/12, 91.7%) and/or methotrexate (9/12, 75.0%). The median age of the subgroup with extraparenchymal NCC was 40 years (range 26–57 years) and 66.7% were male. They were administered ETN for a median period of 311 days (range 31–461 days) and then followed for a median of 3.4 years (range 0.3–6.6 years). Among nine assessable patients, all improved clinically after starting ETN and one deteriorated transiently. Of the remaining three, one was lost to follow-up and two patients have improved but had not completed their assigned course. Four additional persons with recurrent perilesional edema (PE) episodes were given ETN for a median of 400.5 days (range 366–854 days) and followed post-ETN for a median of 1.7 years (range 0.2–2.4 years). All PE patients improved and two successfully tapered corticosteroids. Etanercept administration was associated with clinical improvement, stable disease, absence of recurrence, and lack of serious side effects. Etanercept appears to contribute to the control of inflammation and facilitate corticosteroid taper.
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Affiliation(s)
- Theodore E Nash
- Laboratory of Parasitic Diseases, National Institutes of Allergy and Infectious Diseases, National Institutes of Health, Bethesda, Maryland
| | - JeanAnne M Ware
- Laboratory of Parasitic Diseases, National Institutes of Allergy and Infectious Diseases, National Institutes of Health, Bethesda, Maryland
| | - Christina M Coyle
- Department of Medicine, Albert Einstein College of Medicine, Bronx, New York
| | - Siddhartha Mahanty
- Laboratory of Parasitic Diseases, National Institutes of Allergy and Infectious Diseases, National Institutes of Health, Bethesda, Maryland
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White AC, Coyle CM, Rajshekhar V, Singh G, Hauser WA, Mohanty A, Garcia HH, Nash TE. Diagnosis and Treatment of Neurocysticercosis: 2017 Clinical Practice Guidelines by the Infectious Diseases Society of America (IDSA) and the American Society of Tropical Medicine and Hygiene (ASTMH). Clin Infect Dis 2019; 66:e49-e75. [PMID: 29481580 DOI: 10.1093/cid/cix1084] [Citation(s) in RCA: 117] [Impact Index Per Article: 23.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/04/2017] [Accepted: 12/19/2017] [Indexed: 11/14/2022] Open
Affiliation(s)
| | | | | | | | | | | | - Hector H Garcia
- Instituto Nacional de Ciencias Neurologicas and Universidad Peruana Cayetano Heredia, Lima, Peru
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20
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Hunter E, Cliff M, Armstrong M, Manji H, Jäger HR, Chiodini P, Brown M. Active neurocysticercosis at the Hospital for Tropical Diseases, London: a clinical case series. Trans R Soc Trop Med Hyg 2019; 112:326-334. [PMID: 29982795 DOI: 10.1093/trstmh/try060] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/05/2018] [Accepted: 06/06/2018] [Indexed: 11/12/2022] Open
Abstract
Background Neurocysticercosis is the commonest infectious cause of epilepsy in endemic countries, and accounts for a greater number of cases worldwide than any other single pathology. Infection is associated with long-term exposure in low-income countries, although acquisition after travel has been recognized. The standard of care in the UK is inpatient treatment with anti-helminthic drugs and steroids. Methods The authors reviewed all cases of neurocysticercosis managed at the Hospital for Tropical Diseases in London, England, between 2001 and 2015. Active disease was defined as evidence of either viable cysts or involuting cysts with associated parenchymal inflammation. Results Of 26 active cases, 65.4% were migrants from nine different countries; 34.6% were UK-born travellers who had visited 19 countries across South and Central America, sub-Saharan Africa, South and South-east Asia; India was the commonest country of exposure in both groups. Only 73.1% presented with seizures; two diagnoses were made through brain imaging of patients with peripheral cysticerci; 53.8% had a single cyst. Migrants were more likely to be seropositive than travellers (p=0.033). Only two patients had seizures during admission, one of whom had multiple seizures prior to diagnosis. Conclusions Neurocysticercosis presents in a non-endemic setting in both migrants and travellers. Travellers are less likely to be sero-positive. Not all cases of neurocysticercosis present with seizures. Outpatient management could be considered for selected patients.
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Affiliation(s)
- Ewan Hunter
- Hospital for Tropical Diseases, University College Hospital, London.,London School of Hygiene and Tropical Medicine, London
| | | | | | - Hadi Manji
- Department of Molecular Neuroscience, MRC Centre for Neuromuscular Disease, UCL Institute of Neurology, Queen Square, London
| | - Hans Rolf Jäger
- Academic Neuroradiological Unit, Department of Brain Repair and Rehabilitation, UCL Institute of Neurology, London, UK
| | - Peter Chiodini
- Hospital for Tropical Diseases, University College Hospital, London.,London School of Hygiene and Tropical Medicine, London
| | - Mike Brown
- Hospital for Tropical Diseases, University College Hospital, London.,London School of Hygiene and Tropical Medicine, London
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21
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Affiliation(s)
- A. Clinton White
- Infectious Disease Division, Department of Internal Medicine, University of Texas Medical Branch, Galveston, Texas
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22
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23
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Overview of Taenia solium cysticercosis in West Africa. Acta Trop 2019; 190:329-338. [PMID: 30529447 DOI: 10.1016/j.actatropica.2018.12.012] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/24/2018] [Revised: 12/06/2018] [Accepted: 12/06/2018] [Indexed: 12/15/2022]
Abstract
Human and porcine cysticercosis is endemic in West Africa, where epilepsy is relatively common, but rarely reported due to fear of stigmatization. Neurocysticercosis, caused by Taenia solium, tends to affect the poor in developing countries and control is hampered by inadequate infrastructure and financial resources coupled with lack of adequate information about its significance and distribution. The risk factors for human cysticercosis are closely associated with the characteristics of smallholder or backyard pig farming systems prevalent in this region. Poverty, ignorance and lack of political will militate against successful eradication, while tools for effective diagnosis, prevention and treatment, including vaccines for pigs, are not yet available in many countries. Cysticercosis was targeted for control by The World Health Organization global plan for 2008-2015; however, measures for control are yet to be undertaken in a coordinated manner in West Africa. Diagnostic tools, including neuroimaging facilities, should be strategically situated and made accessible to rural populations in West Africa. Community education in combination with a multipronged approach consisting of vaccination of pigs using TSOL18 vaccine and treatment with oxfendazole along with mass chemotherapy of humans with praziquantel could eliminate taeniasis and should be considered. In-depth and extensive epidemiological studies are required in West Africa in order to fully elucidate the prevalence of T. solium and to support more coordinated and effective control of human and porcine cysticercosis.
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24
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Toledo A, Osorio R, Matus C, Martinez Lopez Y, Ramirez Cruz N, Sciutto E, Fragoso G, Arauz A, Carrillo-Mezo R, Fleury A. Human Extraparenchymal Neurocysticercosis: The Control of Inflammation Favors the Host…but Also the Parasite. Front Immunol 2018; 9:2652. [PMID: 30505305 PMCID: PMC6250850 DOI: 10.3389/fimmu.2018.02652] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/14/2018] [Accepted: 10/26/2018] [Indexed: 12/14/2022] Open
Affiliation(s)
- Andrea Toledo
- Unidad de Neuroinflamación, Instituto de Investigaciones Biomédicas, UNAM/ Facultad de Medicina UNAM / Instituto Nacional de Neurología y Neurocirugía, Ciudad de México, Mexico
| | - Rocio Osorio
- Unidad de Neuroinflamación, Instituto de Investigaciones Biomédicas, UNAM/ Facultad de Medicina UNAM / Instituto Nacional de Neurología y Neurocirugía, Ciudad de México, Mexico
| | - Carlos Matus
- Unidad de Neuroinflamación, Instituto de Investigaciones Biomédicas, UNAM/ Facultad de Medicina UNAM / Instituto Nacional de Neurología y Neurocirugía, Ciudad de México, Mexico
| | - Yazmin Martinez Lopez
- Unidad de Neuroinflamación, Instituto de Investigaciones Biomédicas, UNAM/ Facultad de Medicina UNAM / Instituto Nacional de Neurología y Neurocirugía, Ciudad de México, Mexico
| | - Nancy Ramirez Cruz
- Unidad de Neuroinflamación, Instituto de Investigaciones Biomédicas, UNAM/ Facultad de Medicina UNAM / Instituto Nacional de Neurología y Neurocirugía, Ciudad de México, Mexico
| | - Edda Sciutto
- Departamento de Inmunología, Instituto de Investigaciones Biomédicas, UNAM, Ciudad de México, Mexico
| | - Gladis Fragoso
- Departamento de Inmunología, Instituto de Investigaciones Biomédicas, UNAM, Ciudad de México, Mexico
| | - Antonio Arauz
- Clínica de Enfermedad Vascular, Instituto Nacional de Neurología y Neurocirugía, Ciudad de México, Mexico
| | - Roger Carrillo-Mezo
- Departamento de Neurorradiología, Instituto Nacional de Neurología y Neurocirugía, Ciudad de México, Mexico
| | - Agnès Fleury
- Unidad de Neuroinflamación, Instituto de Investigaciones Biomédicas, UNAM/ Facultad de Medicina UNAM / Instituto Nacional de Neurología y Neurocirugía, Ciudad de México, Mexico.,Clínica de Neurocisticercosis, Instituto Nacional de Neurología y Neurocirugía, Ciudad de México, Mexico
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25
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Abstract
Neurocysticercosis (NCC) occurs following brain infection by larvae of the cestode Taenia solium. It is the leading cause of preventable epilepsy worldwide and therefore constitutes a critical health challenge with significant global relevance. Despite this, much is still unknown about many key pathogenic aspects of the disease, including how cerebral infection with T. solium results in the development of seizures. Over the past century, valuable mechanistic insights have been generated using both clinical studies and animal models. In this review, we critically assess model systems for investigating disease processes in NCC. We explore the respective strengths and weaknesses of each model and summarize how they have contributed to current knowledge of the disease. We call for the continued development of animal models of NCC, with a focus on novel strategies for understanding this debilitating but often neglected disorder.
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27
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28
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Hanas JS, Hocker JR, Ramajayam G, Prabhakaran V, Rajshekhar V, Oommen A, Manoj JJ, Anderson MP, Drevets DA, Carabin H. Distinguishing neurocysticercosis epilepsy from epilepsy of unknown etiology using a minimal serum mass profiling platform. Exp Parasitol 2018; 192:98-107. [PMID: 30096291 DOI: 10.1016/j.exppara.2018.07.015] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/05/2018] [Revised: 06/08/2018] [Accepted: 07/20/2018] [Indexed: 11/29/2022]
Abstract
Neurocysticercosis is associated with epilepsy in pig-raising communities with poor sanitation. Current internationally recognized diagnostic guidelines for neurocysticercosis rely on brain imaging, a technology that is frequently not available or not accessible in areas endemic for neurocysticercosis. Minimally invasive and low-cost aids for diagnosing neurocysticercosis epilepsy could improve treatment of neurocysticercosis. The goal of this study was to test the extent to which patients with neurocysticercosis epilepsy, epilepsy of unknown etiology, idiopathic headaches and among different types of neurocysticercosis lesions could be distinguished from each other based on serum mass profiling. For this, we collected sera from patients with neurocysticercosis-associated epilepsy, epilepsy of unknown etiology, recovered neurocysticercosis, and idiopathic headaches then performed binary group comparisons among them using electrospray ionization mass spectrometry. A leave one [serum sample] out cross validation procedure was employed to analyze spectral data. Sera from neurocysticercosis patients was distinguished from epilepsy of unknown etiology patients with a p-value of 10-28. This distinction was lost when samples were randomized to either group (p-value = 0.22). Similarly, binary comparisons of patients with neurocysticercosis who has different types of lesions showed that different forms of this disease were also distinguishable from one another. These results suggest neurocysticercosis epilepsy can be distinguished from epilepsy of unknown etiology based on biomolecular differences in sera detected by mass profiling.
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Affiliation(s)
- Jay S Hanas
- Dept. of Biochemistry, University of Oklahoma Health Sciences Center (HSC), Oklahoma City, 73104, USA
| | - James R Hocker
- Dept. of Biochemistry, University of Oklahoma Health Sciences Center (HSC), Oklahoma City, 73104, USA
| | - Govindan Ramajayam
- Dept. of Neurological Sciences, Christian Medical College, Vellore, 632004, India
| | | | - Vedantam Rajshekhar
- Dept. of Neurological Sciences, Christian Medical College, Vellore, 632004, India
| | - Anna Oommen
- Dept. of Neurological Sciences, Christian Medical College, Vellore, 632004, India
| | - Josephine J Manoj
- Dept. of Neurological Sciences, Christian Medical College, Vellore, 632004, India
| | - Michael P Anderson
- Dept. of Biostatistics and Epidemiology, University of Oklahoma HSC, Oklahoma City, 73104, USA
| | - Douglas A Drevets
- Dept. of Internal Medicine, University of Oklahoma HSC, And the VA Medical Center, Oklahoma City, 73104, USA
| | - Hélène Carabin
- Dept. of Biostatistics and Epidemiology, University of Oklahoma HSC, Oklahoma City, 73104, USA.
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29
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Clinical topography relationship in patients with parenchymal neurocysticercosis and seizures. Epilepsy Res 2018; 145:145-152. [PMID: 30007239 DOI: 10.1016/j.eplepsyres.2018.06.011] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/26/2018] [Revised: 06/11/2018] [Accepted: 06/21/2018] [Indexed: 11/24/2022]
Abstract
OBJECTIVE Discordances between imaging findings of parenchymal neurocysticercosis and seizure expression have been reported, and as such the possibility that neurocysticercosis and seizures may frequently coexist by chance has been raised. In this study, we evaluate the topographic relationship between seizure foci based on semiology and electroencephalography with the location of parenchymal neurocysticercotic lesions. METHODS Seizure information, neuroimaging (computed tomography and magnetic resonance imaging [MRI]) and electroencephalographic data from three randomized clinical trials of individuals with parenchymal neurocysticercosis and focal seizures were analyzed. Blinded epileptologists defined a potential seizure onset zone and a symptomatogenic zone for each individual based on semiology. The topographic relationship between semiology, either lesion location or areas of perilesional edema on baseline MRI, and electroencephalographic abnormalities were assessed. RESULTS Fifty-eight patients with one or two parenchymal neurocysticercotic lesions were included in this study. From them, 50 patients (86%; 95% CI, 75%-93%) showed a clinical-topography relationship with the potential seizure onset zone, and 44 (76%) also with the symptomatogenic zone. From the eight patients with no topographic relationship, five had focal seizures 30 days before or after the baseline MRI and showed perilesional edema. All of these five patients showed a clinical-topography relationship between such seizures and an area of perilesional edema, making a total of 55 patients (95%; 95% CI, 85%-99%) with clinical-topography relationship when perilesional edema is considered. Most patients with focal epileptiform discharges (7/8, 88%) had a topographic association between electroencephalographic focality, the potential seizure onset zone and a cysticercotic lesion. CONCLUSION Seizure semiology and focal epileptiform discharges are topographically related to neurocysticercotic lesions in most patients. These data strongly support seizure origin in the cortex surrounding these lesions.
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30
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White AC, Coyle CM, Rajshekhar V, Singh G, Hauser WA, Mohanty A, Garcia HH, Nash TE. Diagnosis and Treatment of Neurocysticercosis: 2017 Clinical Practice Guidelines by the Infectious Diseases Society of America (IDSA) and the American Society of Tropical Medicine and Hygiene (ASTMH). Am J Trop Med Hyg 2018; 98:945-966. [PMID: 29644966 PMCID: PMC5928844 DOI: 10.4269/ajtmh.18-88751] [Citation(s) in RCA: 78] [Impact Index Per Article: 13.0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022] Open
Affiliation(s)
| | | | | | | | | | - Aaron Mohanty
- University of Texas Medical Branch, Galveston, Texas
| | - Hector H Garcia
- Universidad Peruana Cayetano Heredia, Lima, Peru
- Instituto Nacional de Ciencias Neurologicas, Lima, Peru
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31
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Tale S, Chhabria BA, Gawalkar AA, Banavath HN, Bhalla A. 'Sleeping under the starry sky'-cysticercal encephalitis. QJM 2017; 110:833-834. [PMID: 29025065 DOI: 10.1093/qjmed/hcx162] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/25/2017] [Indexed: 11/14/2022] Open
Affiliation(s)
- Sudheer Tale
- Department of Internal medicine, Post Graduate Institute of Medical Education and Research, Chandigarh 160012, India
| | - Bharath A Chhabria
- Department of Internal medicine, Post Graduate Institute of Medical Education and Research, Chandigarh 160012, India
| | - Atit A Gawalkar
- Department of Internal medicine, Post Graduate Institute of Medical Education and Research, Chandigarh 160012, India
| | - Hanuma N Banavath
- Department of Internal medicine, Post Graduate Institute of Medical Education and Research, Chandigarh 160012, India
| | - Ashish Bhalla
- Department of Internal medicine, Post Graduate Institute of Medical Education and Research, Chandigarh 160012, India
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32
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Duque KR, Burneo JG. Clinical presentation of neurocysticercosis-related epilepsy. Epilepsy Behav 2017; 76:151-157. [PMID: 28882721 DOI: 10.1016/j.yebeh.2017.08.008] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/04/2017] [Revised: 07/27/2017] [Accepted: 08/02/2017] [Indexed: 11/15/2022]
Abstract
Neurocysticercosis (NCC) is the most common parasitic infection of the central nervous system and a major risk factor for seizures and epilepsy. Seizure types in NCC vary largely across studies and seizure semiology is poorly understood. We discuss here the studies regarding seizure types and seizure semiology in NCC, and examine the clinical presentation in patients with NCC and drug-resistant epilepsy. We also provide evidence of the role of MRI and EEG in the diagnosis of NCC-related epilepsy. Focal seizures are reported in 60-90% of patients with NCC-related epilepsy, and around 90% of all seizures registered prospectively are focal not evolving to bilateral tonic-clonic seizures. A great number of cases suggest that seizure semiology is topographically related to NCC lesions. Patients with hippocampal sclerosis and NCC have different clinical and neurophysiological characteristics than those with hippocampal sclerosis alone. Different MRI protocols have allowed to better differentiate NCC from other etiologies. Lesions' stages might account on the chances of finding an interictal epileptiform discharge. Studies pursuing the seizure onset in patients with NCC are lacking and they are specially needed to determine both whether the reported events of individual cases are seizures, and whether they are related to the NCC lesion or lesions. This article is part of a Special Issue entitled "Neurocysticercosis and Epilepsy".
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Affiliation(s)
- Kevin R Duque
- Center for Global Health-Tumbes, Universidad Peruana Cayetano Heredia, Lima, Peru; Hypnos Center for Sleep Medicine, Clínica San Felipe, Lima, Peru.
| | - Jorge G Burneo
- Epilepsy Program, Department of Clinical Neurological Sciences, Schulich School of Medicine, Western University, London, Canada.
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33
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Singh G, Sharma R. Controversies in the treatment of seizures associated with neurocysticercosis. Epilepsy Behav 2017; 76:163-167. [PMID: 28673685 DOI: 10.1016/j.yebeh.2017.05.033] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/01/2017] [Accepted: 05/16/2017] [Indexed: 01/08/2023]
Abstract
Seizures are the commonest manifestation of brain parenchymal cysticercosis. In terms of pathophysiological basis and prognostic significance of the seizures, a distinction might be applied between viable cysts, solitary cysticercus granuloma and calcific cysticerci. A number of uncertainties shroud the management of seizures in people with neurocysticercosis (NCC). Although antihelminthic treatment is effective in eliminating viable cysts and possibly cysticercus granulomas, its effect on seizure outcome remains uncertain. Corticosteroids and combinations of antihelminthic and corticosteroid treatments reduce the incidence of seizures in the short term at least. Although antiepileptic drugs (AEDs) are routinely employed in the treatment of seizures associated with NCC, there is no clear consensus regarding the choice and optimal duration of AED treatment. Long-term AED treatment is warranted in people with calcific residue following involution of brain parenchymal cysticercosis. This article is part of a Special Issue entitled "Neurocysticercosis and Epilepsy".
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Affiliation(s)
- Gagandeep Singh
- Department of Neurology, Dayanand Medical College, Ludhiana, India.
| | - Ravina Sharma
- Department of Neurology, Dayanand Medical College, Ludhiana, India
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Zammarchi L, Bonati M, Strohmeyer M, Albonico M, Requena-Méndez A, Bisoffi Z, Nicoletti A, García HH, Bartoloni A. Screening, diagnosis and management of human cysticercosis andTaenia soliumtaeniasis: technical recommendations by the COHEMI project study group. Trop Med Int Health 2017; 22:881-894. [DOI: 10.1111/tmi.12887] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/01/2022]
Affiliation(s)
- Lorenzo Zammarchi
- Unità di Malattie Infettive; Università Degli Studi di Firenze; Florence Italy
- SOD Malattie Infettive e Tropicali; Azienda Ospedaliero-Universitaria Careggi; Florence Italy
| | - Maurizio Bonati
- Department of Public Health, IRCCS; Istituto di Ricerche Farmacologiche Mario Negri; Milan Italy
| | - Marianne Strohmeyer
- Unità di Malattie Infettive; Università Degli Studi di Firenze; Florence Italy
| | - Marco Albonico
- Centro per le Malattie Tropicali; Ospedale Classificato Equiparato “Sacro Cuore Don Calabria”; Verona Italy
| | - Ana Requena-Méndez
- Barcelona Institute for Global Health; Universitat de Barcelona; Barcelona Spain
| | - Zeno Bisoffi
- Centro per le Malattie Tropicali; Ospedale Classificato Equiparato “Sacro Cuore Don Calabria”; Verona Italy
| | | | - Hector H. García
- Cysticercosis Unit; Universidad Peruana Cayetano Heredia; Lima Peru
| | - Alessandro Bartoloni
- Unità di Malattie Infettive; Università Degli Studi di Firenze; Florence Italy
- SOD Malattie Infettive e Tropicali; Azienda Ospedaliero-Universitaria Careggi; Florence Italy
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Carabin H, Winkler AS, Dorny P. Taenia solium cysticercosis and taeniosis: Achievements from the past 10 years and the way forward. PLoS Negl Trop Dis 2017; 11:e0005478. [PMID: 28426664 PMCID: PMC5398508 DOI: 10.1371/journal.pntd.0005478] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022] Open
Affiliation(s)
- Hélène Carabin
- Department of Biostatistics and Epidemiology, College of Public Health, University of Oklahoma Health Sciences Center, Oklahoma City, Oklahoma, United States of America
- * E-mail:
| | - Andrea S. Winkler
- Centre for Global Health, Institute of Health and Society, Faculty of Medicine, University of Oslo, Oslo, Norway
- Department of Neurology, Technical University of Munich, Munich, Germany
| | - Pierre Dorny
- Unit of Veterinary Helminthology, Department of Biomedical Sciences, Institute of Tropical Medicine Antwerp, Antwerp, Belgium
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Abstract
Neurocysticercosis is an important cause of seizures worldwide and is endemic in most of Latin America, Sub-Saharan Africa, Southeast Asia, India, and China. Neurocysticercosis has profoundly different disease manifestations varying from asymptomatic presentation to life-threatening hydrocephalus. Clinical manifestations, pathogenesis, diagnostic methods, and optimal treatment vary with the location, number of lesions, and host response. Diagnosis is based on a combination of clinical presentation, neuroimaging findings, history of exposure, and serologic testing. Initial therapy should be focused on symptom management including seizure control and management of increased intracranial pressure. Emerging data are demonstrating that the optimal management approach varies with stage. Single enhancing or cystic lesions should be treated with albendazole and steroids. Patients with more than two cystic lesions should be treated with combination therapy with albendazole and praziquantel, whereas patients with hydrocephalus benefit from surgical management, especially with minimally invasive approaches.
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Affiliation(s)
- Camille M Webb
- Infectious Disease Division, Department of Internal Medicine, University of Texas Medical Branch, 301 University Boulevard, Rt 0435, Galveston, TX, 77555-0435, USA
| | - A Clinton White
- Infectious Disease Division, Department of Internal Medicine, University of Texas Medical Branch, 301 University Boulevard, Rt 0435, Galveston, TX, 77555-0435, USA.
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Nash TE, Bustos JA, Garcia HH. Disease Centered Around Calcified Taenia solium Granuloma. Trends Parasitol 2016; 33:65-73. [PMID: 27720140 DOI: 10.1016/j.pt.2016.09.003] [Citation(s) in RCA: 27] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/07/2016] [Revised: 08/11/2016] [Accepted: 09/09/2016] [Indexed: 11/26/2022]
Abstract
Taenia solium (the pork tapeworm) is present in most developing countries, where it is a frequent cause of seizures and other neurological disease. Parasitic larvae invade the human brain, establish, and eventually resolve, leaving a calcified scar. While these lesions are common in endemic regions, and most of these are clinically silent, a proportion of individuals with calcified cysticerci develop seizures from these lesions, and 30-65% of these cases are associated with perilesional edema (PE), likely due to host inflammation. This manuscript summarizes the importance, characteristics, natural history, and potential prevention and treatments of symptomatic calcified neurocysticercosis (NCC).
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Affiliation(s)
- Theodore E Nash
- Laboratory of Parasitic Diseases, National Institute of Allergy and Infectious Diseases (NIAID), National Institutes of Health (NIH), Bethesda, MD, USA
| | - Javier A Bustos
- Unidad de Cisticercosis, Instituto Nacional de Ciencias Neurológicas, Lima, Peru.
| | - Hector H Garcia
- Unidad de Cisticercosis, Instituto Nacional de Ciencias Neurológicas, Lima, Peru; Departamento de Ciencias Celulares y Moleculares, Facultad de Ciencias y Filosofía, Universidad Peruana Cayetano Heredia, Lima, Peru
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Bustos JA, García HH, Del Brutto OH. Antiepileptic drug therapy and recommendations for withdrawal in patients with seizures and epilepsy due to neurocysticercosis. Expert Rev Neurother 2016; 16:1079-85. [PMID: 27228190 DOI: 10.1080/14737175.2016.1194757] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/01/2023]
Abstract
INTRODUCTION Neurocysticercosis (NCC) is a leading causes of secondary epilepsy worldwide. There is increasing evidence on the epileptogenic role of NCC, and the presence of edema, calcified scars, gliosis and hippocampal sclerosis support this phenomenon. AREAS COVERED We summarized principles of antiepileptic drug (AED) therapy as well as risk factors associated with seizure recurrence after AED withdrawal in patients with NCC. Expert commentary: First-line AED monotherapy is effective as a standard approach to control seizures in most NCC patients. Risks and benefits of AED withdrawal have not been systematically studied, and this decision must be individualized. However, a seizure-free period of at least two years seem prudent before attempting withdrawal. Risk factors for seizure recurrence after AED withdrawal include a history of status epilepticus, poor seizure control during treatment, neuroimaging evidence of perilesional gliosis, hippocampal sclerosis and calcified lesions, as well as persistence of paroxysmal activity in the EEG.
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Affiliation(s)
- Javier A Bustos
- a Center for Global Health - Tumbes , Lima , Peru.,b Department of Microbiology, Universidad Peruana Cayetano Heredia, and Cysticercosis Unit , Instituto Nacional de Ciencias Neurológicas , Lima , Peru
| | - Héctor H García
- a Center for Global Health - Tumbes , Lima , Peru.,b Department of Microbiology, Universidad Peruana Cayetano Heredia, and Cysticercosis Unit , Instituto Nacional de Ciencias Neurológicas , Lima , Peru
| | - Oscar H Del Brutto
- c School of Medicine , Universidad Espíritu Santo - Ecuador , Guayaquil , Ecuador
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Fogang YF, Savadogo AA, Camara M, Toffa DH, Basse A, Sow AD, Ndiaye MM. Managing neurocysticercosis: challenges and solutions. Int J Gen Med 2015; 8:333-44. [PMID: 26527895 PMCID: PMC4621219 DOI: 10.2147/ijgm.s73249] [Citation(s) in RCA: 25] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022] Open
Abstract
Taenia solium neurocysticercosis (NCC) is a major cause of neurological morbidity in the world. Variability in the neuropathology and clinical presentation of NCC often make it difficult to diagnose and manage. Diagnosis of NCC can be challenging especially in endemic and resource-limited countries where laboratory and imaging techniques are often lacking. NCC management can also be challenging as current treatment options are limited and involve symptomatic agents, antiparasitic agents, or surgery. Although antiparasitic treatment probably reduces the number of active lesions and long-term seizure frequency, its efficacy is limited and strategies to improve treatment regimens are warranted. Treatment decisions should be individualized in relation to the type of NCC. Initial measures should focus on symptomatic management, with antiparasitic therapy only to be considered later on, when appropriate. Symptomatic treatment remains the cornerstone in NCC management which should not only focuses on epilepsy, but also on other manifestations that cause considerable burden (recurrent headaches, cognitive decline). Accurate patients’ categorization, better antiparasitic regimens, and definition of new clinical outcomes for trials on NCC could improve management quality and prognosis of NCC. Prevention strategies targeting tapeworm carriers and infected pigs are yielding good results in local models. If local elimination of transmission is confirmed and replicated, this will open the door to cysticercosis eradication efforts worldwide.
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Affiliation(s)
- Yannick Fogoum Fogang
- Neurology Department, Fann Teaching Hospital, Cheikh Anta Diop University, Dakar, Senegal
| | - Abdoul Aziz Savadogo
- Neurology Department, Fann Teaching Hospital, Cheikh Anta Diop University, Dakar, Senegal
| | - Massaman Camara
- Neurology Department, Fann Teaching Hospital, Cheikh Anta Diop University, Dakar, Senegal
| | | | - Anna Basse
- Neurology Department, Fann Teaching Hospital, Cheikh Anta Diop University, Dakar, Senegal
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[Disseminated cysticercosis: report of three cases in Togo]. BULLETIN DE LA SOCIETE DE PATHOLOGIE EXOTIQUE (1990) 2015; 108:165-70. [PMID: 25893814 DOI: 10.1007/s13149-015-0433-6] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/01/2015] [Accepted: 03/03/2015] [Indexed: 10/23/2022]
Abstract
We report 3 cases of disseminated cysticercosis (DC) in adult male subjects in Togo. All had consulted in dermatology for asymptomatic subcutaneous nodules. The diagnosis was confirmed by histology of a resected nodule. Computed tomography allowed us to bring out the widespread dissemination of cysticerci. The skin, brain, muscle, eye, thyroid, and pleura were the affected organs. Treatment was based on albendazole and betamethasone, with adverse side effects in 2 of our 3 patients. Our 3 observations seem to be the first of their kind in Togo. The mechanism of contamination in these disseminated forms is not yet elucidated, however ingesting a gravid proglottis could be the basis of the widespread dissemination of cysticerci in the body. No consensus has yet been established in the treatment of DC and the management should follow the guideline for treatment of neurocysticercosis and ocular cysticercosis.
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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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Nash TE, Mahanty S, Loeb JA, Theodore WH, Friedman A, Sander JW, Singh G, Cavalheiro E, Del Brutto OH, Takayanagui OM, Fleury A, Verastegui M, Preux PM, Montano S, Pretell EJ, White AC, Gonzales AE, Gilman RH, Garcia HH. Neurocysticercosis: A natural human model of epileptogenesis. Epilepsia 2014; 56:177-83. [PMID: 25534640 DOI: 10.1111/epi.12849] [Citation(s) in RCA: 55] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 09/24/2014] [Indexed: 12/23/2022]
Abstract
OBJECTIVE To develop a better understanding of mechanisms of seizures and long-term epileptogenesis using neurocysticercosis. METHODS A workshop was held bringing together experts in epilepsy and epileptogenesis and neurocysticercosis. RESULTS Human neurocysticercosis and parallel animal models offer a unique opportunity to understand basic mechanisms of seizures. Inflammatory responses to degenerating forms and later-stage calcified parasite granulomas are associated with seizures and epilepsy. Other mechanisms may also be involved in epileptogenesis. SIGNIFICANCE Naturally occurring brain infections with neurocysticercosis offer a unique opportunity to develop treatments for one of the world's most common causes of epilepsy and for the development of more general antiepileptogenic treatments. Key advantages stem from the time course in which an acute seizure heralds a start of the epileptogenic process, and radiographic changes of calcification and perilesional edema provide biomarkers of a chronic epileptic state.
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Affiliation(s)
- Theodore E Nash
- Laboratory of Parasitic Disease, National Institute of Allergy and Infectious Diseases, National Institutes of Health, Bethesda, Maryland, U.S.A
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Abstract
The infection of the nervous system by the cystic larvae of Taenia solium (neurocysticercosis) is a frequent cause of seizure disorders. Neurocysticercosis is endemic or presumed to be endemic in many low-income countries. The lifecycle of the worm and the clinical manifestations of neurocysticercosis are well established, and CT and MRI have substantially improved knowledge of the disease course. Improvements in immunodiagnosis have further advanced comprehension of the pathophysiology of this disease. This knowledge has led to individualised treatment approaches that account for the involvement of parenchymal or extraparenchymal spaces, the number and form of parasites, and the extent of degeneration and associated inflammation. Clinical investigations are focused on development of effective treatments and reduction of side-effects induced by treatment, such as seizures, hydrocephalus, infarcts, and neuroinjury.
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Affiliation(s)
- Hector H Garcia
- Cysticercosis Unit, Instituto Nacional de Ciencias Neurológicas, Lima, Peru; Centre for Global Health-Tumbes and Department of Microbiology, School of Sciences, Universidad Peruana Cayetano Heredia, Lima, Peru.
| | - Theodore E Nash
- Laboratory of Parasitic Diseases, National Institute of Allergy and Infectious Diseases, National Institutes of Health, Bethesda, MD, USA
| | - Oscar H Del Brutto
- School of Medicine, Universidad Espíritu Santo-Ecuador, Guayaquil, Ecuador; Department of Neurological Sciences, Hospital-Clínica Kennedy, Guayaquil, Ecuador
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Abstract
Neurocysticercosis (NCC) is the most common helminthic disease of the nervous system in humans and a major cause of acquired epilepsy worldwide. The presentation of the disease is dependent on both the immunological response of the host against the parasite as well as the location of the encysted organisms within the central nervous system (CNS). The principles of management utilized for intraparenchymal disease cannot be applied to extraparenchymal NCC. An advance in management of intraparenchymal NCC, the most common form encountered by physicians, is the use of both albendazole and praziquantel as a treatment strategy. Patients with subarachnoid NCC (SANCC) require months of treatment with both an antiparasitic agent and steroids to avoid complications such as hydrocephalus and vascular events during treatment. The determinants of successful treatment in SANCC have not been established, but response to therapy can be determined by evaluating several endpoints related to disease evolution including radiographic changes, serum antigen, and CSF antigen. Intraventricular NCC is primarily a surgical disease and data supports minimally invasive endoscopic removal of cysts in many of these patients. NCC is increasingly recognized in non-endemic countries due to increased immigration making it important for physicians to become familiar with the management of this disease.
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Affiliation(s)
- Christina M Coyle
- Albert Einstein College of Medicine, Yeshiva University, Bronx, New York, USA,
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