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Haq SH, Shah SR, Bux J, Le AS, Golzarian H, Mueller D, Sreenan JJ, Patel SM, Laird A, Cole W. To intervene or not to intervene: A case of symptomatic neurocysticercosis complicated by ventriculitis. IDCases 2023; 31:e01702. [PMID: 36747911 PMCID: PMC9898726 DOI: 10.1016/j.idcr.2023.e01702] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/28/2022] [Revised: 01/19/2023] [Accepted: 01/19/2023] [Indexed: 01/22/2023] Open
Abstract
Although well described in the current literature, Neurocysticercosis [NCC] remains an enigma when confronted by practitioners. This is in part due to the haphazard nature of the parasitic infection on the central nervous system [CNS]. These include single or multiple anatomic sites of infection, stage of parasitosis, and the resultant inflammatory response. As a result, NCC can present with a complex constellation of symptomatic presentations, making therapeutic regiments highly individualized. Despite intervention, other impediments may arise post-therapy due to the nature of the infection. We present a case of rapidly progressive symptomatic NCC that initially was successfully treated, however would eventually succumb to complications of ventriculitis.
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Affiliation(s)
- Syed H. Haq
- Department of Internal Medicine, BonSecour Mercy Health—St. Rita’s Medical Center, Lima, OH, USA
| | - Sidra R. Shah
- Department of Internal Medicine, BonSecour Mercy Health—St. Rita’s Medical Center, Lima, OH, USA
| | - Jannet Bux
- Department of Internal Medicine, BonSecour Mercy Health—St. Rita’s Medical Center, Lima, OH, USA
| | - Anh Si Le
- Department of Internal Medicine, BonSecour Mercy Health—St. Rita’s Medical Center, Lima, OH, USA
| | - Hafez Golzarian
- Department of Internal Medicine, BonSecour Mercy Health—St. Rita’s Medical Center, Lima, OH, USA
| | - Daniel Mueller
- Department of Internal Medicine, BonSecour Mercy Health—St. Rita’s Medical Center, Lima, OH, USA
| | - Joseph J. Sreenan
- Department of Pathology Medicine, BonSecour Mercy Health—St. Rita’s Medical Center, Lima, OH, USA
| | - Sandeep M. Patel
- Department of Interventional Cardiology, BonSecour Mercy Health—St. Rita’s Medical Center, Lima, OH, USA
| | - Amanda Laird
- Department of Critical Care Medicine, BonSecour Mercy Health—St. Rita’s Medical Center, Lima, OH, USA
| | - William Cole
- Department of Critical Care Medicine, BonSecour Mercy Health—St. Rita’s Medical Center, Lima, OH, USA
- Correspondence to: Department of Critical Care, St. Rita's Medical Center (Mercy), 730 West Market Street, Lima, OH 45801, USA.
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Haddad N, Shaheen Y, Abunaib M, Melikyan G, El Sotouhy A, Wahbeh F, Nauman A, Al-Maadid F, Soliman M, Mesraoua B, Elkhider H, Mahfoud Z. Neurocysticercosis in non-endemic regions: The experience of Qatar. Front Neurol 2023; 14:1173909. [PMID: 37153684 PMCID: PMC10156967 DOI: 10.3389/fneur.2023.1173909] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/25/2023] [Accepted: 03/30/2023] [Indexed: 05/10/2023] Open
Abstract
Objective To describe the occurrence and features of Neurocystircercosis (NCC) in Qatar. Background Qatar has a mixed population of natives and expats. NCC is not endemic to the region, but clinical practice suggests its occurrence in large numbers. Design/ methods A database was created to summarize information retrospectively collected on patients with NCC seen through the national health system (HMC) between 2013 and 2018. We identified demographic and disease related variables (clinical manifestations, investigative findings, treatment and outcome) for all patients. Results Out of 420 identified NCC patients, 393 (93.6%) were men, and 98.3% were immigrants from NCC endemic countries such as Nepal (63.8%) and India (29.5%). Eighty percent of patients presented with seizures, with the majority (69%) experiencing generalized tonic-clonic seizures. Five percent presented with status epilepticus. Headaches, the second most common complaint, were reported in 18% of subjects. On imaging, 50% had a single lesion while 63% included pathology at the calcified stage. The lesions were parenchymal in 99.5% of cases, predominantly in the frontal lobe (59%). Thirteen percent were diagnosed incidentally on imaging, mainly in the form of isolated calcified non enhancing lesions. Albendazole was received by 55% of patients, and phenytoin was the most prescribed anti-seizure drug (57%). When long term follow up was available, 70% of the patients presenting with seizures were completely seizure free. Conclusion NCC is prevalent in Qatar, mainly within the large Southeast Asian immigrant population. NCC is currently a significant contributor to the epilepsy burden in Qatar, often with a good outcome regarding seizure control. NCC with intraparenchymal single lesion shares a large proportion of our cohort.
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Affiliation(s)
- Naim Haddad
- Department of Neurology, Weill Cornell Medicine-Qatar, Ar-Rayyan, Qatar
- Department of Neuroradiology, Hamad Medical Corporation, Doha, Qatar
- *Correspondence: Naim Haddad,
| | - Yanal Shaheen
- Department of Neurology, Weill Cornell Medicine-Qatar, Ar-Rayyan, Qatar
| | - Mohammed Abunaib
- Department of Neuroradiology, Hamad Medical Corporation, Doha, Qatar
| | - Gayane Melikyan
- Department of Neurology, Weill Cornell Medicine-Qatar, Ar-Rayyan, Qatar
- Department of Neuroradiology, Hamad Medical Corporation, Doha, Qatar
| | - Ahmed El Sotouhy
- Department of Neuroradiology, Hamad Medical Corporation, Doha, Qatar
| | - Farah Wahbeh
- Department of Neurology, Weill Cornell Medicine-Qatar, Ar-Rayyan, Qatar
| | - Areej Nauman
- Department of Neurology, Weill Cornell Medicine-Qatar, Ar-Rayyan, Qatar
| | - Fatima Al-Maadid
- Department of Neurology, Weill Cornell Medicine-Qatar, Ar-Rayyan, Qatar
| | - Mohamed Soliman
- Department of Neurology, Weill Cornell Medicine-Qatar, Ar-Rayyan, Qatar
| | - Boulenouar Mesraoua
- Department of Neurology, Weill Cornell Medicine-Qatar, Ar-Rayyan, Qatar
- Department of Neuroradiology, Hamad Medical Corporation, Doha, Qatar
| | - Hisham Elkhider
- Department of Neuroradiology, Hamad Medical Corporation, Doha, Qatar
| | - Ziyad Mahfoud
- Department of Population Health Sciences, Weill Cornell Medicine-Qatar, Ar-Rayyan, Qatar
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3
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Fang J, Banerjee C, Barrett A, Gilbert BC, Rutkowski MJ. Endoscope-assisted far lateral craniotomy for resection of posterior fossa neurocysticercosis: illustrative case. JOURNAL OF NEUROSURGERY. CASE LESSONS 2022; 4:CASE22307. [PMID: 36254356 PMCID: PMC9576034 DOI: 10.3171/case22307] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 07/20/2022] [Accepted: 08/25/2022] [Indexed: 11/09/2022]
Abstract
BACKGROUND Neurocysticercosis is a parasitic infection that commonly affects the ventricles, subarachnoid spaces, and spinal cord of the central nervous system. The authors report an unusual manifestation of purely posterior fossa neurocysticercosis treated with endoscope-assisted open craniotomy for resection. OBSERVATIONS A 67-year-old male presented with 2 months of progressive dizziness, gait ataxia, headaches, decreased hearing, and memory impairment. Imaging revealed an extra-axial cystic lesion occupying the foramen magnum and left cerebellopontine angle with significant mass effect and evidence of early hydrocephalus. Gross-total resection was accomplished via a left far lateral craniotomy with open endoscopic assistance, and pathological findings were consistent with neurocysticercosis. Postoperatively, he was noted to have a sixth nerve palsy, and adjuvant therapy included albendazole. By 9 months postoperatively, he exhibited complete resolution of an immediate postoperative sixth nerve palsy in addition to all preoperative symptoms. His hydrocephalus resolved and did not require permanent cerebrospinal fluid (CSF) diversion. LESSONS When combined with traditional skull base approaches, open endoscopic techniques allow for enhanced visualization and resection of complex lesions otherwise inaccessible under the microscope alone. Recognition and obliteration of central nervous system neurocysticercosis can facilitate excellent neurological recovery without the need for CSF diversion.
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Affiliation(s)
| | | | - Amanda Barrett
- Pathology, Medical College of Georgia at Augusta University, Augusta, Georgia; and
| | - Bruce C. Gilbert
- Department of Radiology, Division of Neuroradiology, Medical College of Georgia at Augusta University, Augusta, Georgia
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Prodjinotho UF, Gres V, Henkel F, Lacorcia M, Dandl R, Haslbeck M, Schmidt V, Winkler AS, Sikasunge C, Jakobsson PJ, Henneke P, Esser-von Bieren J, Prazeres da Costa C. Helminthic dehydrogenase drives PGE 2 and IL-10 production in monocytes to potentiate Treg induction. EMBO Rep 2022; 23:e54096. [PMID: 35357743 PMCID: PMC9066053 DOI: 10.15252/embr.202154096] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/04/2021] [Revised: 03/02/2022] [Accepted: 03/14/2022] [Indexed: 01/03/2023] Open
Abstract
Immunoregulation of inflammatory, infection‐triggered processes in the brain constitutes a central mechanism to control devastating disease manifestations such as epilepsy. Observational studies implicate the viability of Taenia solium cysts as key factor determining severity of neurocysticercosis (NCC), the most common cause of epilepsy, especially in children, in Sub‐Saharan Africa. Viable, in contrast to decaying, cysts mostly remain clinically silent by yet unknown mechanisms, potentially involving Tregs in controlling inflammation. Here, we show that glutamate dehydrogenase from viable cysts instructs tolerogenic monocytes to release IL‐10 and the lipid mediator PGE2. These act in concert, converting naive CD4+ T cells into CD127−CD25hiFoxP3+CTLA‐4+ Tregs, through the G protein‐coupled receptors EP2 and EP4 and the IL‐10 receptor. Moreover, while viable cyst products strongly upregulate IL‐10 and PGE2 transcription in microglia, intravesicular fluid, released during cyst decay, induces pro‐inflammatory microglia and TGF‐β as potential drivers of epilepsy. Inhibition of PGE2 synthesis and IL‐10 signaling prevents Treg induction by viable cyst products. Harnessing the PGE2‐IL‐10 axis and targeting TGF‐ß signaling may offer an important therapeutic strategy in inflammatory epilepsy and NCC.
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Affiliation(s)
- Ulrich Fabien Prodjinotho
- Institute for Medical Microbiology, Immunology and Hygiene, TUM School of Medicine, Technical University of Munich (TUM), Munich, Germany.,Center for Global Health, TUM School of Medicine, Technical University of Munich (TUM), Munich, Germany
| | - Vitka Gres
- Institute for Immunodeficiency, Center for Chronic Immunodeficiency, Medical Center and Faculty of Medicine, University of Freiburg, Freiburg, Germany
| | - Fiona Henkel
- Center of Allergy and Environment (ZAUM), Technical University of Munich and Helmholtz Center Munich, Munich, Germany
| | - Matthew Lacorcia
- Institute for Medical Microbiology, Immunology and Hygiene, TUM School of Medicine, Technical University of Munich (TUM), Munich, Germany
| | - Ramona Dandl
- Department of Chemistry, Technical University Munich (TUM), Garching, Germany
| | - Martin Haslbeck
- Department of Chemistry, Technical University Munich (TUM), Garching, Germany
| | - Veronika Schmidt
- Center for Global Health, TUM School of Medicine, Technical University of Munich (TUM), Munich, Germany.,Department of Neurology, University Hospital, Klinikum rechts der Isar, Technical University Munich (TUM), Munich, Germany.,Center for Global Health, Institute of Health and Society, University of Oslo, Oslo, Norway
| | - Andrea Sylvia Winkler
- Center for Global Health, TUM School of Medicine, Technical University of Munich (TUM), Munich, Germany.,Department of Neurology, University Hospital, Klinikum rechts der Isar, Technical University Munich (TUM), Munich, Germany.,Center for Global Health, Institute of Health and Society, University of Oslo, Oslo, Norway
| | - Chummy Sikasunge
- Department of Paraclinicals, School of Veterinary Medicine, University of Zambia, Lusaka, Zambia
| | - Per-Johan Jakobsson
- Rheumatology Unit, Department of Medicine, Solna, Karolinska University Hospital, Stockholm, Sweden
| | - Philipp Henneke
- Institute for Immunodeficiency, Center for Chronic Immunodeficiency, Medical Center and Faculty of Medicine, University of Freiburg, Freiburg, Germany.,Center for Pediatrics and Adolescent Medicine, Medical Center, University of Freiburg, Freiburg, Germany.,Centre for Integrative Biological Signalling Studies, University of Freiburg, Freiburg, Germany
| | - Julia Esser-von Bieren
- Center of Allergy and Environment (ZAUM), Technical University of Munich and Helmholtz Center Munich, Munich, Germany
| | - Clarissa Prazeres da Costa
- Institute for Medical Microbiology, Immunology and Hygiene, TUM School of Medicine, Technical University of Munich (TUM), Munich, Germany.,Center for Global Health, TUM School of Medicine, Technical University of Munich (TUM), Munich, Germany.,German Center for Infection and Research (DZIF), Munich, Germany
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5
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Chen B, Chen Z, Yang YS, Cai GL, Xu XJ, Guan HZ, Ren HT, Tuo HZ. Next-generation sequencing combined with serological tests based pathogen analysis for a neurocysticercosis patient with a 20-year history:a case report. BMC Neurol 2021; 21:236. [PMID: 34167488 PMCID: PMC8222500 DOI: 10.1186/s12883-021-02277-7] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/19/2020] [Accepted: 06/10/2021] [Indexed: 11/17/2022] Open
Abstract
Background Neurocysticercosis (NCC) is the most common helminthic infection of the central nervous system (CNS) caused by the larval stage of Taenia solium. Accurate and early diagnosis of NCC remains challenging due to its heterogeneous clinical manifestations, neuroimaging deficits, variable sensitivity, and specificity of serological tests. Next-generation sequencing (NGS)-based pathogen analysis in patient’s cerebrospinal fluid (CSF) with NCC infection has recently been reported indicating its diagnostic efficacy. In this case study, we report the diagnosis of a NCC patient with a symptomatic history of over 20 years using NGS analysis and further confirmation of the pathology by immunological tests. Case presentation This study reports the clinical imaging and immunological features of a patient with a recurrent headache for more than 20 years, which worsened gradually with the symptom of fever for more than 7 years and paroxysmal amaurosis for more than 1 year. By utilizing NGS technique, the pathogen was detected in patient’s CSF, and the presence of Taenia solium-DNA was confirmed by a positive immunological reaction to cysticercus IgG antibody in CSF and serum samples. The symptoms of the patient were alleviated, and the CSF condition was improved substantially after the anti-helminthic treatment. Conclusions This study suggests that combining CSF NGS with cysticercus IgG testing may be a highly promising approach for diagnosing the challenging cases of NCC. Further studies are needed to evaluate the parasitic DNA load in patients’ CSF for the diagnosis of disease severity, stage, and monitoring of therapeutic responses.
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Affiliation(s)
- Bin Chen
- Department of Neurology, Beijing Friendship Hospital, Capital Medical University, Beijing, China
| | - Zheng Chen
- Department of Neurology, Beijing Friendship Hospital, Capital Medical University, Beijing, China
| | - Yi-Shu Yang
- Department of Neurology, Beijing Friendship Hospital, Capital Medical University, Beijing, China
| | - Gui-Lan Cai
- Department of Neurology, Beijing Friendship Hospital, Capital Medical University, Beijing, China
| | - Xiao-Jiao Xu
- Department of Neurology, Beijing Friendship Hospital, Capital Medical University, Beijing, China
| | - Hong-Zhi Guan
- Department of Neurology, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | - Hai-Tao Ren
- Department of Neurology, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | - Hou-Zhen Tuo
- Department of Neurology, Beijing Friendship Hospital, Capital Medical University, Beijing, China.
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Shah MV, Olowoyo O, Chandna S, Gurland I. Shigellosis Presenting as Meningism. Cureus 2021; 13:e14707. [PMID: 34055547 PMCID: PMC8155794 DOI: 10.7759/cureus.14707] [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: 11/11/2022] Open
Abstract
Shigella is a common cause of gastroenteritis and can also lead to serious complications such as dehydration, seizures, hemolytic uremic syndrome, and neurological complications. In this paper, we describe a case of a 39-year-old man who was admitted septic, with altered mental status and gastrointestinal symptoms. During the evaluation, he was found to have positive meningeal signs, non-anion gap metabolic acidosis, enteric panel positive for Shigella flexneri, positive IgG for Strongyloides, and pancolitis on computed tomography (CT) of the abdomen and pelvis. He was treated for infectious colitis and initially treated empirically for meningitis, but antibiotics were later discontinued due to rapid improvement of meningeal signs. To reduce the risk of disseminated infection, the patient was also treated for Strongyloides.
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Affiliation(s)
- Monarch V Shah
- Internal Medicine, Saint Peter's University Hospital, New Brunswick, USA
| | | | - Sanya Chandna
- Internal Medicine, Saint Peter's University Hospital, New Brunswick, USA
| | - Ira Gurland
- Infectious Diseases, Saint Peter's University Hospital, New Brunswick, USA
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7
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Siddiqua T, Habeeb A. Neurocysticercosis. SAUDI JOURNAL OF KIDNEY DISEASES AND TRANSPLANTATION 2021; 31:254-258. [PMID: 32129220 DOI: 10.4103/1319-2442.279948] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Abstract
Neurocysticercosis (NCC) is one of the common parasitic central nervous system (CNS) infections. Improperly cooked pork and eggs of the tapeworm Taenia solium, entering the body through the feco-oral route, are the common sources of its infection. Affected person may remain asymptomatic for long periods and can present with a variety of neurological manifestations, including focal neurological deficits and generalized seizures. Neuroimaging along with serological test can aid in its diagnosis. Treatment of NCC varies from case to case and must always be individualized based on the patients' condition. Common therapeutic strategies include surgery and treatment with drugs, such as antiparasitic agents (albendazole) and corticosteroids (hydrocortisone), apart from other agents which are based on the patient presentation. Proper prevention strategy has to be followed to control the spread of infection within and among the individuals. We herewith present a case of NCC in a tertiary care hospital of Hyderabad, India.
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Affiliation(s)
- Tayyaba Siddiqua
- Department of Pharmacology, Shadan Women's College of Pharmacy, Hyderabad, Telangana, India
| | - Ayesha Habeeb
- Department of Pharmacy Practice, Deccan School of Pharmacy, Hyderabad, Telangana, India
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8
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Cuellar-Hernandez JJ, Valadez-Rodriguez A, Olivas-Campos R, Tabera-Tarello P, Juan-Orta DS, Segura-López R, Fleury A. Intrasellar cysticercosis cyst treated with a transciliary supraorbital keyhole approach - A case report. Surg Neurol Int 2020; 11:436. [PMID: 33365198 PMCID: PMC7749933 DOI: 10.25259/sni_755_2020] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/23/2020] [Accepted: 11/21/2020] [Indexed: 11/07/2022] Open
Abstract
Background: Neurocysticercosis is the most common parasitic disease affecting the central nervous system. Isolated sellar cysticercosis cysts are rare and can mimic other sellar lesion as cystic pituitary adenoma, arachnoid cyst, Rathke cleft cyst, or craniopharyngioma. The surgical resection is mandatory because the cysticidal drugs are ineffective, however, new microsurgical approaches are emerging to reduce complications and need to test in this condition. We present a patient with a sellar cysticercosis cyst treated by transciliar supraorbital keyhole approach. Case Description: A 45-year-old female with presented with chronic severe headaches, progressive deterioration of 6 months in visual acuity and bitemporal hemianopia. The pituitary hormonal levels were normal. Magnetic resonance findings showed a sellar and suprasellar cyst and underwent a microsurgical supraorbital transciliar keyhole approach for lesion resection. Pathologically, the lesion demonstrated a parasitic wall characterized by wavy, dense cuticle, and focal globular structure, surrounding inflammatory reaction with plasma cells. Postoperatively, the patient recovery fully neurologically. Conclusion: Intrasellar cysticercosis cyst causes significant neurological deficits due to its proximity to the chiasm, optic nerves, pituitary stalk, and the pituitary gland. Surgical section is an effective treatment. The supraorbital keyhole craniotomy offers satisfactory exposure, possibility of total resection with dissection of the supra and parasellar structures, short operative time, less blood loss, short hospital stay, and good overall surgical outcome.
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Affiliation(s)
| | - Alan Valadez-Rodriguez
- Department of Neurosurgery, Northeast National Medical Center, Monterrey, Nuevo Leon, Mexico
| | - Ramon Olivas-Campos
- Department of Neurosurgery, Northeast National Medical Center, Monterrey, Nuevo Leon, Mexico
| | - Paulo Tabera-Tarello
- Department of Neurosurgery, Northeast National Medical Center, Monterrey, Nuevo Leon, Mexico
| | - Daniel San Juan-Orta
- Department of Epilepsy, National Institute of Neurology and Neurosurgery, Mexico City, Mexico
| | - Roberto Segura-López
- Department of Neurosurgery, Northeast National Medical Center, Monterrey, Nuevo Leon, Mexico
| | - Agnès Fleury
- Department of Neurocysticercosis, National Institute of Neurology and Neurosurgery, Mexico City, Mexico
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Hamamoto Filho PT, Singh G, Winkler AS, Carpio A, Fleury A. Could Differences in Infection Pressure Be Involved in Cysticercosis Heterogeneity? Trends Parasitol 2020; 36:826-834. [DOI: 10.1016/j.pt.2020.07.003] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/03/2020] [Revised: 07/03/2020] [Accepted: 07/05/2020] [Indexed: 12/13/2022]
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10
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Pesantes MA, Moyano LM, Sommerville C. Neurocysticercosis in Northern Peru: Qualitative Insights from men and women about living with seizures. PLoS Negl Trop Dis 2020; 14:e0008715. [PMID: 33035212 PMCID: PMC7577431 DOI: 10.1371/journal.pntd.0008715] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/12/2019] [Revised: 10/21/2020] [Accepted: 08/14/2020] [Indexed: 02/05/2023] Open
Abstract
BACKGROUND Neurocysticercosis (NCC) is a helminthic disease of the central nervous system, and it is one of the leading causes of seizures and symptomatic epilepsy in countries with tropical regions like Peru. Studies of people with epilepsy in Peru's northern coast have consistently found that between 30% and 50% of epilepsy cases is associated with NCC. There are few studies that report on the differences in incidence and prevalence of NCC by sex, and to our knowledge, none that consider the gendered dimensions of having epilepsy. METHODOLOGY This qualitative study based on individual interviews (n = 9) and focus group discussions (n = 12) explored the challenges of diagnosis and the implications for everyday activities among men and women with epilepsy as well as the views of their family members on the impact of such condition. PRINCIPAL FINDINGS The explanatory models used by women to discuss their condition reflect low levels of decision-making power in areas such a reproductive health, health care access and treatment. For some women domestic violence is also a probable cause for seizures among women. The implications of living with neurocysticercosis and the accompanying seizures were reported differently by men and women. While women were mostly concerned about their capacity to perform their domestic responsibilities and their roles as mothers and caregivers; men were mostly concerned about the impact on their income generation activities. Women and men shared concern about the consequences of their condition on the wellbeing of their families. CONCLUSIONS/SIGNIFICANCE NCC is a disrupting experience for men and women in ways that reflect their position and roles in society: Women as caregivers within the home, men as income generators outside the home. Further gender research is needed to better understand and address the differential impacts of NCC and health system responses as well as gendered dimensions of prevalence and incidence. (268 words).
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Affiliation(s)
- Maria Amalia Pesantes
- CRONICAS, Centre of Excellence in Chronic Conditions, Universidad Peruana Cayetano Heredia, Miraflores, Lima, Peru
| | - Luz Maria Moyano
- Center for Global Health, Tumbes Facilities, Universidad Peruana Cayetano Heredia, Puerto el Cura Pizarro, Tumbes, Peru
| | - Claire Sommerville
- Gender Centre, Graduate Institute of International and Development Studies, Switzerland
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11
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Morales-Sandoval JDJ, Téllez-Arellano CA, Fleury A. Neurocisticercosis extraparenquimatosa: reto terapéutico A propósito de un caso de la glándula parótida. REVISTA DE LA FACULTAD DE MEDICINA 2020. [DOI: 10.22201/fm.24484865e.2020.63.4.03] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022] Open
Abstract
Introduction:Neurocysticercosis is a parasitosis of the central nervous system, caused by the intake of eggs from taenia solium. It has a high prevalence in certain regions of Latin America, the southeast of Asia, and sub-Saharan Africa, where unhealthy situations still prevail. Clinical case: A 55-year-old woman with clinical symptoms of 2 years of evolution, such as recurrent headaches that had increased recently in addition to tonic-clonic seizures. In these conditions she was admitted to the hospital’s emergency department. Neuroimaging studies (tomography and magnetic resonance imaging) showed the presence of subarachnoid vesicular structures compatible with neurocysticercosis. Therefore, a cestocidal treatment was administered but the patient did not return to her follow-up appointments for 4 years. When she finally went to her appointment, she was very symptomatic and required the administration of 8 cycles of treatment to eradicate the parasites. Discussion: The great heterogeneity and the non-specificity of the signs and symptoms difficult making a diagnosis of neurocysticercosis. Therefore, it is important to look for complementary laboratory and imaging evidence to confirm it. The treatment of neurocysticercosis represents a challenge for the physician. Particularly, when the parasite is located outside the brain parenchyma, subarachnoid cisterns and ventricular system. In less than a third of these patients the parasites disappear with a single cycle of cestocidal treatment. Conclusion: Neurocysticercosis is a disease closely related to poverty, but it is preventable. Research focused on treatments for neurocysticercosis is still necessary.
Key words:Neurocysticercosis; taenia solium; seizures; magnetic
resonance; cestocidal.
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Affiliation(s)
- José de Jesús Morales-Sandoval
- Universidad Nacional Autónoma de México (UNAM). Instituto de Investigaciones Biomédicas. Unidad Periférica para el Estudios de la Neuroinflamación. Ciudad de México. México; Secretaría de Salud (Ssa). Instituto Nacional de Neurología y Neurocirugía. Ciudad de México. México; Universidad Nacional Autónoma de México (UNAM). Facultad de Medicina. Ciudad de México. México
| | - Carlos Alejandro Téllez-Arellano
- Universidad Nacional Autónoma de México (UNAM). Instituto de Investigaciones Biomédicas. Unidad Periférica para el Estudios de la Neuroinflamación. Ciudad de México. México: Universidad Nacional Autónoma de México (UNAM). Facultad de Medicina UNAM, Ciudad de México, México. Universidad Nacional Autónoma de México (UNAM). Facultad de Medicina. Programa de Apoyo y Fomento a la Investigación (AFINES). Ciudad de México, México
| | - Agnés Fleury
- Universidad Nacional Autónoma de México (UNAM). Instituto de Investigaciones Biomédicas. Unidad Periférica para el Estudios de la Neuroinflamación. Ciudad de México. México; Secretaría de Salud (SSa). Instituto Nacional de Neurología y Neurocirugía. Ciudad de México, México
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12
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Zoonotic and vector-borne parasites and epilepsy in low-income and middle-income countries. Nat Rev Neurol 2020; 16:333-345. [PMID: 32427939 DOI: 10.1038/s41582-020-0361-3] [Citation(s) in RCA: 12] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 04/15/2020] [Indexed: 12/22/2022]
Abstract
Zoonotic and vector-borne parasites are important preventable risk factors for epilepsy. Three parasitic infections - cerebral malaria, Taenia solium cysticercosis and onchocerciasis - have an established association with epilepsy. Parasitoses are widely prevalent in low-income and middle-income countries, which are home to 80% of the people with epilepsy in the world. Once a parasitic infection has taken hold in the brain, therapeutic measures do not seem to influence the development of epilepsy in the long term. Consequently, strategies to control, eliminate and eradicate parasites represent the most feasible way to reduce the epilepsy burden at present. The elucidation of immune mechanisms underpinning the parasitic infections, some of which are parasite-specific, opens up new therapeutic possibilities. In this Review, we explore the pathophysiological basis of the link between parasitic infections and epilepsy, and we consider preventive and therapeutic approaches to reduce the burden of epilepsy attributable to parasitic disorders. We conclude that a concerted approach involving medical, veterinary, parasitological and ecological experts, backed by robust political support and sustainable funding, is the key to reducing this burden.
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13
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Histopathologic evaluation of experimental murine neurocysticercosis after treatment with albendazole/nitazoxanide combination. Parasitology 2020; 147:822-827. [PMID: 32234089 DOI: 10.1017/s0031182020000505] [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: 11/06/2022]
Abstract
Neurocysticercosis (NCC) is the most common helminthic brain infection related to epilepsy. Only albendazole (ABZ) and praziquantel are used in its treatment. The development of new therapeutics has been encouraged. Taenia crassiceps cysticerci intracranial infection is the experimental model used in NCC studies. This study evaluated the histopathology of the brains of BALB/c mice experimentally infected with T. crassiceps cysticerci after the treatment with the ABZ/nitazoxanide (NTZ) combination. Thirty days after the inoculation the mice received an oral single dose of the ABZ/NTZ combination (40 mg kg-1 each). The control groups were treated with: NaCl 0.9%; ABZ or NTZ. The histopathologic evaluation of the brains was performed 24 h after treatment. The ABZ treatment induced discrete mononuclear inflammatory infiltration, meningitis, gliosis, hyperaemia and hippocampus compression; moderate ependimitis and oedema. The NTZ treatment induced accentuated inflammatory infiltration, foamy macrophages, ependimitis, choroiditis, gliosis and hyperaemia and moderate oedema. The ABZ/NTZ combination treatment induced a significant decrease in the polymorphonuclear inflammatory infiltration, ependimitis, choroiditis, gliosis, hyperaemia and ventriculomegaly in comparison with the other groups. The cysticerci showed destruction of the tegument not observed in other groups. The ABZ/NTZ combination is efficient as the parasite showed signs of destruction and lower damage to the host's tissue.
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14
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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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15
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Millogo A, Kongnyu Njamnshi A, Kabwa-PierreLuabeya M. Neurocysticercosis and epilepsy in sub-Saharan Africa. Brain Res Bull 2019; 145:30-38. [DOI: 10.1016/j.brainresbull.2018.08.011] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/09/2018] [Revised: 06/20/2018] [Accepted: 08/16/2018] [Indexed: 10/28/2022]
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16
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Beck ES, Ramachandran PS, Khan LM, Sample HA, Zorn KC, O'Connell EM, Nash T, Reich DS, Venkatesan A, DeRisi JL, Nath A, Wilson MR. Clinicopathology conference: 41-year-old woman with chronic relapsing meningitis. Ann Neurol 2019; 85:161-169. [PMID: 30565288 PMCID: PMC6370480 DOI: 10.1002/ana.25400] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/07/2018] [Revised: 12/11/2018] [Accepted: 12/13/2018] [Indexed: 01/04/2023]
Affiliation(s)
- Erin S Beck
- National Institute of Neurologic Disorders and Stroke, National Institutes of Health, Bethesda, MD
| | - Prashanth S Ramachandran
- Weill Institute for Neurosciences, University of California, San Francisco, San Francisco, CA.,Department of Neurology, University of California, San Francisco, San Francisco, CA
| | - Lillian M Khan
- Department of Biochemistry and Biophysics, University of California, San Francisco, San Francisco, CA
| | - Hannah A Sample
- Department of Biochemistry and Biophysics, University of California, San Francisco, San Francisco, CA
| | - Kelsey C Zorn
- Department of Biochemistry and Biophysics, University of California, San Francisco, San Francisco, CA
| | - Elise M O'Connell
- National Institute of Allergy and Infectious Diseases, National Institutes of Health, Bethesda, MD
| | - Theodore Nash
- National Institute of Allergy and Infectious Diseases, National Institutes of Health, Bethesda, MD
| | - Daniel S Reich
- National Institute of Neurologic Disorders and Stroke, National Institutes of Health, Bethesda, MD
| | - Arun Venkatesan
- Department of Neurology, Johns Hopkins University, Baltimore, MD
| | - Joseph L DeRisi
- Department of Biochemistry and Biophysics, University of California, San Francisco, San Francisco, CA.,Chan Zuckerberg Biohub, San Francisco, CA
| | - Avindra Nath
- National Institute of Neurologic Disorders and Stroke, National Institutes of Health, Bethesda, MD
| | - Michael R Wilson
- Weill Institute for Neurosciences, University of California, San Francisco, San Francisco, CA.,Department of Neurology, University of California, San Francisco, San Francisco, CA
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17
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Delgado-García G, Méndez-Zurita VA, Bayliss L, Flores-Rivera J, Fleury A. Neurocysticercosis: mimics and chameleons. Pract Neurol 2018; 19:88-95. [PMID: 30282762 DOI: 10.1136/practneurol-2017-001788] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/17/2022]
Abstract
Neurocysticercosis is the most common parasitic neurological disease worldwide, yet in Europe, it remains relatively uncommon, with many practitioners rarely seeing a case. However, immigration and international travel mean that it is becoming increasingly recognised and diagnosed in developed countries. Being a treatable condition, it is essential to be familiar with the diagnosis and to appreciate its mimics and breadth of its possible clinical presentations.
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Affiliation(s)
| | | | - Leo Bayliss
- Division of Neurology, National Institute of Neurology and Neurosurgery, Mexico City, Mexico
| | - José Flores-Rivera
- Division of Neurology, National Institute of Neurology and Neurosurgery, Mexico City, Mexico.,Demyelinating Diseases Clinic, National Institute of Neurology and Neurosurgery, Mexico City, Mexico
| | - Agnès Fleury
- Neurocysticercosis Clinic, National Institute of Neurology and Neurosurgery, Mexico City, Mexico .,Neuroinflammation Unit, Institute of Biomedical Research, National Autonomous, University of Mexico, Mexico City, Mexico
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18
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Gómez-Morales MA, Gárate T, Blocher J, Devleesschauwer B, Smit GSA, Schmidt V, Perteguer MJ, Ludovisi A, Pozio E, Dorny P, Gabriël S, Winkler AS. Present status of laboratory diagnosis of human taeniosis/cysticercosis in Europe. Eur J Clin Microbiol Infect Dis 2017; 36:2029-2040. [PMID: 28669015 PMCID: PMC5653711 DOI: 10.1007/s10096-017-3029-1] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/05/2017] [Accepted: 05/23/2017] [Indexed: 11/08/2022]
Abstract
Human cysticercosis (CC) is a parasitic zoonosis caused by the larval stage (cyst) of the Taenia solium. Cysts can establish in the human central nervous system (neurocysticercosis, NCC) and other organs and tissues; they also develop in pigs, the natural intermediate host. Human taeniosis may be caused by T. solium, Taenia saginata and Taenia asiatica tapeworms; these infections are usually asymptomatic, but show a significant relevance as they perpetuate the parasites’ life cycle, and, in the case of T. solium, they are the origin of (N)CC. In European Union (EU) member states and associated countries, the occurrence of autochthonous T. solium cases is debated, and imported cases have significantly increased lately; the status of T. asiatica has been never reported, whereas T. saginata is prevalent and causes an economic impact due to condemned carcasses. Based on their effects on the EU society, the specific diagnosis of these pathologies is relevant for their prevention and control. The aims of this study were to know the diagnostic tests used in European laboratories for human taeniosis/cysticercosis by means of a questionnaire, to determine potential gaps in their detection, and to obtain preliminary data on the number of diagnosed taeniosis/CC cases.
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Affiliation(s)
- M A Gómez-Morales
- Department of Infectious Diseases, Istituto Superiore di Sanità, viale Regina Elena 299, 00161, Rome, Italy.
| | - T Gárate
- Instituto de Salud Carlos III, Centro Nacional de Microbiología, Majadahonda, 28220, Madrid, Spain.
| | - J Blocher
- Institute of Acute Neurology, Academic Teaching Hospital Feldkirch, Carinagasse 47, 6800, Feldkirch, Austria
| | - B Devleesschauwer
- Department of Public Health and Surveillance, Scientific Institute of Public Health (WIV-ISP), Rue Juliette Wytsmanstraat 14, 1050, Brussels, Belgium
| | - G S A Smit
- Department of Biomedical Sciences, Institute of Tropical Medicine, Nationalestraat 155, 2000, Antwerp, Belgium.,Faculty of Veterinary Medicine, Department of Virology, Parasitology and Immunology, Ghent University, Merelbeke, Belgium.,Institute of Health and Society (IRSS), Université Catholique de Louvain, Brussels, Belgium
| | - V Schmidt
- Department of Neurology, Klinikum rechts der Isar, Technical University Munich, Ismaninger Straße 22, 81675, Munich, Germany.,Centre for Global Health, Institute of Health and Society, University of Oslo, Kirkeveien 166, 0450, Oslo, Norway
| | - M J Perteguer
- Instituto de Salud Carlos III, Centro Nacional de Microbiología, Majadahonda, 28220, Madrid, Spain
| | - A Ludovisi
- Department of Infectious Diseases, Istituto Superiore di Sanità, viale Regina Elena 299, 00161, Rome, Italy
| | - E Pozio
- Department of Infectious Diseases, Istituto Superiore di Sanità, viale Regina Elena 299, 00161, Rome, Italy
| | - P Dorny
- Department of Biomedical Sciences, Institute of Tropical Medicine, Nationalestraat 155, 2000, Antwerp, Belgium
| | - S Gabriël
- Faculty of Veterinary Medicine, Department of Veterinary Public Health and Food Safety, Ghent University, Ghent, Belgium
| | - A S Winkler
- Department of Neurology, Klinikum rechts der Isar, Technical University Munich, Ismaninger Straße 22, 81675, Munich, Germany. .,Centre for Global Health, Institute of Health and Society, University of Oslo, Kirkeveien 166, 0450, Oslo, Norway.
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19
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Fragoso YD. Differential diagnosis of multiple sclerosis in Latin America. Mult Scler J Exp Transl Clin 2017; 3:2055217317714279. [PMID: 28979790 PMCID: PMC5617098 DOI: 10.1177/2055217317714279] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/13/2017] [Revised: 05/06/2017] [Accepted: 05/15/2017] [Indexed: 12/19/2022] Open
Abstract
Improvement of multiple sclerosis (MS) diagnoses leads to earlier and correct disease management. The differential diagnostic workup for MS comprises a large variety of medical conditions. There are general guidelines and criteria for diagnosing MS worldwide, but awareness of regional differences needs to be kept in mind. Latin American patients who are screened for MS diagnoses may require an approach that is not exactly the same as that used for patients in North America, western Europe or Asia. In the present review, the conditions that are important for the differential diagnoses of MS in Latin America are reviewed. They include infections, metabolic diseases, nutritional deficits and other autoimmune conditions that physicians in charge of these patients need to be familiar with.
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Affiliation(s)
- YD Fragoso
- MS Unit, Department of Neurology, Universidade Metropolitana de Santos, SP, Brazil
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20
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Marcin Sierra M, Arroyo M, Cadena Torres M, Ramírez Cruz N, García Hernández F, Taboada D, Galicia Martínez Á, Govezensky T, Sciutto E, Toledo A, Fleury A. Extraparenchymal neurocysticercosis: Demographic, clinicoradiological, and inflammatory features. PLoS Negl Trop Dis 2017; 11:e0005646. [PMID: 28599004 PMCID: PMC5479594 DOI: 10.1371/journal.pntd.0005646] [Citation(s) in RCA: 50] [Impact Index Per Article: 7.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/07/2016] [Revised: 06/21/2017] [Accepted: 05/17/2017] [Indexed: 12/24/2022] Open
Abstract
Background Extraparenchymal neurocysticercosis (ExPNCC), an infection caused by Taenia solium cysticerci that mainly occurs in the ventricular compartment (Ve) or the basal subarachnoid space (SAb), is more severe but less frequent and much less studied than parenchymal neurocysticercosis (ParNCC). Demographic, clinical, radiological, and lumbar cerebrospinal fluid features of patients affected by ExPNCC are herein described and compared with those of ParNCC patients. Methodology and principal findings 429 patients with a confirmed diagnosis of neurocysticercosis, attending the Instituto Nacional de Neurología y Neurocirugía, a tertiary reference center in Mexico City, from 2000 through 2014, were included. Demographic information, signs and symptoms, radiological patterns, and lumbar cerebrospinal fluid (CSF) laboratory values were retrieved from medical records for all patients. Data were statistically analyzed to assess potential differences depending on cyst location and to determine the effects of age and sex on the disease presentation. In total, 238 ExPNCC and 191 ParNCC patients were included. With respect to parenchymal cysts, extraparenchymal parasites were diagnosed at an older age (P = 0.002), chiefly caused intracranial hypertension (P < 0.0001), were more frequently multiple and vesicular (P < 0.0001), and CSF from these patients showed higher protein concentration and cell count (P < 0.0001). SAb patients were diagnosed at an older age than Ve patients, and showed more frequently seizures, vesicular cysticerci, and higher CSF cellularity. Gender and age modulated some traits of the disease. Conclusions This study evidenced clear clinical, radiological, and inflammatory differences between ExPNCC and ParNCC, and between SAb and Ve patients, and demonstrated that parasite location determines different pathological entities. Neurocysticercosis (NCC) is caused by the establishment of Taenia solium larvae in the human central nervous system. While NCC diagnosis, treatment, and prevention have clearly improved in the last 40 years, the disease still causes significant morbidity and mortality in endemic regions of Latin America, Asia, and Africa. Herein we described demographic, clinical, radiological, and cerebrospinal fluid features of a large series of NCC patients, and evaluated the relevance of parasite location on disease presentation. 191 patients with parenchymal parasites, 125 patients with extraparenchymal cysts, and 113 patients lodging parasites in both locations were included. Our results clearly demonstrated that differences in parasite location actually determines distinct diseases, with wide variations in severity. This is particularly evident when comparing parenchymal with extraparenchymal patients and ventricular with subarachnoid patients. Gender and age also modulate some characteristics of the disease. In conclusion, parasite location is one of the most important features of the disease, which must be considered when approaching an NCC patient.
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Affiliation(s)
- Mariana Marcin Sierra
- Research Unit on Neuroinflammation, Instituto de Investigaciones Biomédicas - Universidad Nacional Autónoma de México / Facultad de Medicina – Universidad Nacional Autónoma de México / Instituto Nacional de Neurología y Neurocirugía, México City, México
| | - Mariana Arroyo
- Research Unit on Neuroinflammation, Instituto de Investigaciones Biomédicas - Universidad Nacional Autónoma de México / Facultad de Medicina – Universidad Nacional Autónoma de México / Instituto Nacional de Neurología y Neurocirugía, México City, México
| | - May Cadena Torres
- Research Unit on Neuroinflammation, Instituto de Investigaciones Biomédicas - Universidad Nacional Autónoma de México / Facultad de Medicina – Universidad Nacional Autónoma de México / Instituto Nacional de Neurología y Neurocirugía, México City, México
| | - Nancy Ramírez Cruz
- Research Unit on Neuroinflammation, Instituto de Investigaciones Biomédicas - Universidad Nacional Autónoma de México / Facultad de Medicina – Universidad Nacional Autónoma de México / Instituto Nacional de Neurología y Neurocirugía, México City, México
| | - Fernando García Hernández
- Research Unit on Neuroinflammation, Instituto de Investigaciones Biomédicas - Universidad Nacional Autónoma de México / Facultad de Medicina – Universidad Nacional Autónoma de México / Instituto Nacional de Neurología y Neurocirugía, México City, México
| | - Diana Taboada
- Research Unit on Neuroinflammation, Instituto de Investigaciones Biomédicas - Universidad Nacional Autónoma de México / Facultad de Medicina – Universidad Nacional Autónoma de México / Instituto Nacional de Neurología y Neurocirugía, México City, México
| | - Ángeles Galicia Martínez
- Research Unit on Neuroinflammation, Instituto de Investigaciones Biomédicas - Universidad Nacional Autónoma de México / Facultad de Medicina – Universidad Nacional Autónoma de México / Instituto Nacional de Neurología y Neurocirugía, México City, México
| | - Tzipe Govezensky
- Immunology Department, Instituto de Investigaciones Biomédicas – Universidad Nacional Autónoma de México, México City, México
| | - Edda Sciutto
- Immunology Department, Instituto de Investigaciones Biomédicas – Universidad Nacional Autónoma de México, México City, México
| | - Andrea Toledo
- Research Unit on Neuroinflammation, Instituto de Investigaciones Biomédicas - Universidad Nacional Autónoma de México / Facultad de Medicina – Universidad Nacional Autónoma de México / Instituto Nacional de Neurología y Neurocirugía, México City, México
| | - Agnès Fleury
- Research Unit on Neuroinflammation, Instituto de Investigaciones Biomédicas - Universidad Nacional Autónoma de México / Facultad de Medicina – Universidad Nacional Autónoma de México / Instituto Nacional de Neurología y Neurocirugía, México City, México
- Neurocysticercosis Clinic, Instituto Nacional de Neurología y Neurocirugía, México City, México
- * E-mail:
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21
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Gripper LB, Welburn SC. Neurocysticercosis infection and disease-A review. Acta Trop 2017; 166:218-224. [PMID: 27880878 DOI: 10.1016/j.actatropica.2016.11.015] [Citation(s) in RCA: 62] [Impact Index Per Article: 8.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/25/2016] [Revised: 11/15/2016] [Accepted: 11/15/2016] [Indexed: 10/20/2022]
Abstract
Neurocysticercosis (NCC) is the most common parasitic disease of the human central nervous system (CNS), a pleomorphic disease with a diverse array of clinical manifestations. The infection is pleomorphic and dependent on a complex range of interconnecting factors, including number and size of the cysticerci, their stage of development and localisation within the brain with resulting difficulties in accurate diagnosis and staging of the disease. This review examines the factors that contribute to the accurate assessment of NCC distribution and transmission that are critical to achieving robust disease burden calculations. Control and prevention of T. solium transmission should be a key priority in global health as intervention can reduce the substantial healthcare and economic burdens inflicted by both NCC and taeniasis. Surveillance systems need to be better established, including implementing obligatory notification of cases. In the absence of reliable estimates of its global burden, NCC will remain-along with other endemic zoonoses, of low priority in the eyes of funding agencies-a truly neglected disease.
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22
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Chavan SS, Mahajan A, Talbar SN, Desai S, Thakur M, D'cruz A. Nonsubsampled rotated complex wavelet transform (NSRCxWT) for medical image fusion related to clinical aspects in neurocysticercosis. Comput Biol Med 2016; 81:64-78. [PMID: 28013026 DOI: 10.1016/j.compbiomed.2016.12.006] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/18/2016] [Revised: 12/03/2016] [Accepted: 12/08/2016] [Indexed: 02/08/2023]
Abstract
Neurocysticercosis (NCC) is a parasite infection caused by the tapeworm Taenia solium in its larvae stage which affects the central nervous system of the human body (a definite host). It results in the formation of multiple lesions in the brain at different locations during its various stages. During diagnosis of such symptomatic patients, these lesions can be better visualized using a feature based fusion of Computed Tomography (CT) and Magnetic Resonance Imaging (MRI). This paper presents a novel approach to Multimodality Medical Image Fusion (MMIF) used for the analysis of the lesions for the diagnostic purpose and post treatment review of NCC. The MMIF presented here is a technique of combining CT and MRI data of the same patient into a new slice using a Nonsubsampled Rotated Complex Wavelet Transform (NSRCxWT). The forward NSRCxWT is applied on both the source modalities separately to extract the complementary and the edge related features. These features are then combined to form a composite spectral plane using average and maximum value selection fusion rules. The inverse transformation on this composite plane results into a new, visually better, and enriched fused image. The proposed technique is tested on the pilot study data sets of patients infected with NCC. The quality of these fused images is measured using objective and subjective evaluation metrics. Objective evaluation is performed by estimating the fusion parameters like entropy, fusion factor, image quality index, edge quality measure, mean structural similarity index measure, etc. The fused images are also evaluated for their visual quality using subjective analysis with the help of three expert radiologists. The experimental results on 43 image data sets of 17 patients are promising and superior when compared with the state of the art wavelet based fusion algorithms. The proposed algorithm can be a part of computer-aided detection and diagnosis (CADD) system which assists the radiologists in clinical practices.
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Affiliation(s)
- Satishkumar S Chavan
- Don Bosco Institute of Technology, Kurla (W), Mumbai 400070, Maharashtra, India.
| | - Abhishek Mahajan
- Tata Memorial Hospital, Parel, Mumbai 400012, Maharashtra, India
| | - Sanjay N Talbar
- SGGS Institute of Engineering and Technology, Nanded 431606, Maharashtra, India
| | - Subhash Desai
- Tata Memorial Hospital, Parel, Mumbai 400012, Maharashtra, India
| | - Meenakshi Thakur
- Tata Memorial Hospital, Parel, Mumbai 400012, Maharashtra, India
| | - Anil D'cruz
- Tata Memorial Hospital, Parel, Mumbai 400012, Maharashtra, India
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23
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Ocular parasitoses: A comprehensive review. Surv Ophthalmol 2016; 62:161-189. [PMID: 27720858 DOI: 10.1016/j.survophthal.2016.09.005] [Citation(s) in RCA: 48] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/21/2016] [Revised: 09/27/2016] [Accepted: 09/29/2016] [Indexed: 12/14/2022]
Abstract
Parasitic infections of the eyes are a major cause of ocular diseases across the globe. The causative agents range from simple organisms such as unicellular protozoans to complex metazoan helminths. The disease spectrum varies depending on the geographic location, prevailing hygiene, living and eating habits of the inhabitants, and the type of animals that surround them. They cause enormous ocular morbidity and mortality not because they are untreatable, but largely due to late or misdiagnosis, often from unfamiliarity with the diseases produced. We provide an up-to-date comprehensive overview of the ophthalmic parasitoses. Each section describes the causative agent, mode of transmission, geographic distribution, ocular pathologies, and their management for common parasites with brief mention of the ones that are rare.
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24
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Carpio A, Fleury A, Romo ML, Abraham R, Fandiño J, Durán JC, Cárdenas G, Moncayo J, Leite Rodrigues C, San-Juan D, Serrano-Dueñas M, Takayanagui O, Sander JW. New diagnostic criteria for neurocysticercosis: Reliability and validity. Ann Neurol 2016; 80:434-42. [PMID: 27438337 PMCID: PMC5053253 DOI: 10.1002/ana.24732] [Citation(s) in RCA: 82] [Impact Index Per Article: 10.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/21/2015] [Revised: 06/29/2016] [Accepted: 07/10/2016] [Indexed: 11/26/2022]
Abstract
Objective The diagnosis of neurocysticercosis (NCC) remains problematic because of the heterogeneity of its clinical, immunological, and imaging characteristics. Our aim was to develop and assess a new set of diagnostic criteria for NCC, which might allow for the accurate detection of, and differentiation between, parenchymal and extraparenchymal disease. Methods A group of Latin American NCC experts developed by consensus a new set of diagnostic criteria for NCC. A multicenter, retrospective study was then conducted to validate it. The reference standard for diagnosis of active NCC was the disappearance or reduction of cysts after anthelmintic treatment. In total, three pairs of independent neurologists blinded to the diagnosis evaluated 93 cases (with NCC) and 93 controls (without NCC) using the new diagnostic criteria. Mixed‐effects logistic regression models were used to estimate sensitivity and specificity. Results Inter‐rater reliability (kappa) of diagnosis among evaluators was 0.60. For diagnosis of NCC versus no NCC, the new criteria had a sensitivity of 93.2% and specificity of 81.4%. For parenchymal NCC, the new criteria had a sensitivity of 89.8% and specificity of 80.7% and for extraparenchymal NCC, the new criteria had a sensitivity of 65.9% and specificity of 94.9%. Interpretation These criteria have acceptable reliability and validity and could be a new tool for clinicians and researchers. An advantage of the new criteria is that they consider parasite location (ie, parenchymal or extraparenchymal), which is an important factor determining the clinical, immunological, and radiological presentation of the disease, and importantly, its treatment and prognosis. Ann Neurol 2016;80:434–442
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Affiliation(s)
- Arturo Carpio
- Facultad de Ciencias Médicas, Universidad de Cuenca, Cuenca, Ecuador. .,G.H. Sergievsky Center, Columbia University, New York, NY.
| | - Agnès Fleury
- Instituto Nacional de Neurología y Neurocirugía, Secretaría de Salud, México, DF, México.,Instituto de Investigaciones Biomédicas, Universidad Nacional Autónoma, México, DF, México
| | - Matthew L Romo
- Facultad de Ciencias Médicas, Universidad de Cuenca, Cuenca, Ecuador.,CUNY Graduate School of Public Health and Health Policy, New York, NY
| | | | - Jaime Fandiño
- Fundación Centro Colombiano de Epilepsia y Enfermedades Neurológicas, FIRE, Cartagena, Colombia
| | - Juan C Durán
- Hospital de Clínicas, Unidad de Neurología, La Paz, Bolivia
| | - Graciela Cárdenas
- Instituto Nacional de Neurología y Neurocirugía, Secretaría de Salud, México, DF, México
| | - Jorge Moncayo
- Escuela de Medicina, Universidad Internacional del Ecuador, Quito, Ecuador
| | | | - Daniel San-Juan
- Instituto Nacional de Neurología y Neurocirugía, Secretaría de Salud, México, DF, México
| | - Marcos Serrano-Dueñas
- Facultad de Medicina de la Pontificia Universidad Católica del Ecuador, Servicio de Neurología del Hospital Carlos Andrade Marin del Instituto Ecuatoriano de Seguridad Social (IESS), Quito, Ecuador
| | - Oswaldo Takayanagui
- Faculdade de Medicina, Universidade de São Paulo, Ribeirão Preto, SP, Brazil
| | - Josemir W Sander
- NIHR University College London Hospitals Biomedical Research Centre, UCL Institute of Neurology, London, United Kingdom.,Stichting Epilepsie Instellingen Nederland (SEIN), Heemstede, The Netherlands
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25
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Carpio A, Romo ML, Parkhouse RME, Short B, Dua T. Parasitic diseases of the central nervous system: lessons for clinicians and policy makers. Expert Rev Neurother 2016; 16:401-14. [PMID: 26894629 PMCID: PMC4926779 DOI: 10.1586/14737175.2016.1155454] [Citation(s) in RCA: 33] [Impact Index Per Article: 4.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022]
Abstract
Parasitic diseases of the central nervous system are associated with high mortality and morbidity, especially in resource-limited settings. The burden of these diseases is amplified as survivors are often left with neurologic sequelae affecting mobility, sensory organs, and cognitive functions, as well as seizures/epilepsy. These diseases inflict suffering by causing lifelong disabilities, reducing economic productivity, and causing social stigma. The complexity of parasitic life cycles and geographic specificities, as well as overlapping clinical manifestations in the host reflecting the diverse pathogenesis of parasites, can present diagnostic challenges. We herein provide an overview of these parasitic diseases and summarize clinical aspects, diagnosis, therapeutic strategies and recent milestones, and aspects related to prevention and control.
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Affiliation(s)
- Arturo Carpio
- a Escuela de Medicina , Universidad de Cuenca , Cuenca , Ecuador.,b GH Sergievsky Center, College of Physicians and Surgeons , Columbia University , New York , NY , USA.,c Consultorios Sta Inés, F. Proaño y D. Cordova (esquina) , Cuenca , Ecuador
| | - Matthew L Romo
- d Epidemiology and Biostatistics Program, CUNY School of Public Health, Hunter College , New York , NY , USA.,e Dirección de Investigación , Universidad de Cuenca , Cuenca , Ecuador
| | | | - Brooke Short
- g World Health Organization (WHO Geneva) , Geneva , Switzerland
| | - Tarun Dua
- g World Health Organization (WHO Geneva) , Geneva , Switzerland
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26
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Carpio A, Romo ML. Multifactorial basis of epilepsy in patients with neurocysticercosis. Epilepsia 2015; 56:973-4. [PMID: 26040532 DOI: 10.1111/epi.12978] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/14/2023]
Affiliation(s)
- Arturo Carpio
- School of Medicine, University of Cuenca, Cuenca, Ecuador. .,GH Sergievsky Center, College of Physicians and Surgeons, Columbia University, New York, New York, U.S.A..
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27
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Kasundra GM, Bhargava AN, Bhushan B, Khichar S, Sood I. Disseminated neurocysticercosis presenting as isolated acute monocular painless vision loss. J Neurosci Rural Pract 2014; 5:S89-92. [PMID: 25540557 PMCID: PMC4271400 DOI: 10.4103/0976-3147.145224] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022] Open
Abstract
Neurocysticercosis, the most common parasitic infection of the nervous system, is known to affect the brain, eyes, muscular tissues and subcutaneous tissues. However, it is very rare for patients with ocular cysts to have concomitant cerebral cysts. Also, the dominant clinical manifestation of patients with cerebral cysts is either seizures or headache. We report a patient who presented with acute monocular painless vision loss due to intraocular submacular cysticercosis, who on investigation had multiple cerebral parenchymal cysticercal cysts, but never had any seizures. Although such a vision loss after initiation of antiparasitic treatment has been mentioned previously, acute monocular vision loss as the presenting feature of ocular cysticercosis is rare. We present a brief review of literature along with this case report.
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Affiliation(s)
- Gaurav M Kasundra
- Department of Neurology, Dr. Sampurnanand Medical College and Mahatma Gandhi Hospital, Jodhpur, Rajasthan, India
| | - Amita Narendra Bhargava
- Department of Neurology, Dr. Sampurnanand Medical College and Mahatma Gandhi Hospital, Jodhpur, Rajasthan, India
| | - Bharat Bhushan
- Department of Neurology, Dr. Sampurnanand Medical College and Mahatma Gandhi Hospital, Jodhpur, Rajasthan, India
| | - Subhakaran Khichar
- Department of Neurology, Dr. Sampurnanand Medical College and Mahatma Gandhi Hospital, Jodhpur, Rajasthan, India
| | - Isha Sood
- Department of Medicine, Dr. Sampurnanand Medical College and Mahatma Gandhi Hospital, Jodhpur, Rajasthan, India
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28
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Bianchin MM, Velasco TR, Wichert-Ana L, Alexandre V, Araujo D, Santos ACD, Carlotti CG, Takayanagui OM, Sakamoto AC. Characteristics of mesial temporal lobe epilepsy associated with hippocampal sclerosis plus neurocysticercosis. Epilepsy Res 2014; 108:1889-95. [DOI: 10.1016/j.eplepsyres.2014.09.018] [Citation(s) in RCA: 28] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/20/2014] [Revised: 09/11/2014] [Accepted: 09/13/2014] [Indexed: 11/30/2022]
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29
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Kumar S. Commentary. J Neurosci Rural Pract 2014; 5:S94. [PMID: 25540559 PMCID: PMC4271402] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/27/2022] Open
Affiliation(s)
- Sunil Kumar
- Department of Medicine, Jawahar Lal Nehru Medical College, Datta Meghe Institute of Medical Sciences (DMIMS), Wardha, Maharashtra, India,Address for correspondence: Dr. SunilKumar, Department of Medicine, Jawahar Lal Nehru Medical College, Datta Meghe Institute of Medical Sciences, Sawangi, Wardha, Maharashtra, India. E-mail:
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30
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Carpio A. Commentary. J Neurosci Rural Pract 2014; 5:S92-3. [PMID: 25540558 PMCID: PMC4271401] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022] Open
Affiliation(s)
- Arturo Carpio
- Department of Neurology School of Medicine, University of Cuenca, Ecuador, G.H. Sergievsky Center, Columbia University, NY, USA,Address for correspondence: Prof. Arturo Carpio, School of Medicine, Av, 12 de Abril s/n, El Paraiso, Cuenca, Ecuador. E-mail:
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Abstract
Cysticercosis in one of the most common parasitic infections in the central nervous system. The complex and unpredictable nature of the host immune reaction against cysticercosis as well as the pleomorphism of your injuries make the disease neurocysticercosis interesting and fascinating to study. Imaging studies play an important role in the diagnosis of this disease. Advanced imaging techniques have improved detection and visualization of scolex cysts extraparenchymal spaces.
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Affiliation(s)
- Rosa Delia Delgado Hernández
- From the *Radiology Department, Manuel Velasco Suarez National Institute of Neurology Neurosurgery, National Institute of Medical Science Nutrition Salvador Zubiran, Mexico City; †Mexican Academy of Surgery, Mérida, Yucatán; and ‡Neuroradiology Department and Teaching Division, National Institute of Neurology and Neurosurgery Manuel Velasco Suarez, Mexico City, Mexico
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32
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Carpio A, Romo ML. The relationship between neurocysticercosis and epilepsy: an endless debate. ARQUIVOS DE NEURO-PSIQUIATRIA 2014; 72:383-90. [DOI: 10.1590/0004-282x20140024] [Citation(s) in RCA: 34] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/27/2014] [Accepted: 02/17/2014] [Indexed: 11/22/2022]
Abstract
Neurocysticercosis (NC), or cerebral infection with Taenia solium, is an important public health problem worldwide. Among the neurological sequelae of NC, seizures have been described as the most common symptom. Acute symptomatic seizures often result from degeneration of a viable cyst; however, not all of these patients with acute or provoked seizures will develop epilepsy (i.e., recurrent unprovoked seizures). Because of the high prevalence of epilepsy and NC, a causal, as well as incidental relationship between the two may exist. The epileptogenicity of calcified cysts as well as the potential association between NC and hippocampal sclerosis necessitates future research. Antihelminthic treatment of NC results in disappearance of viable cysts in about one-third of patients with parenchymal disease, but a reduction in seizure recurrence has not been demonstrated in randomized controlled trials. Prevention is critical to reduce the burden of seizure and epilepsy related to NC.
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Affiliation(s)
- Arturo Carpio
- University of Cuenca, Ecuador; Columbia University, USA
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33
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Machado LDR. Neurocysticercosis: still some unanswered questions. ARQUIVOS DE NEURO-PSIQUIATRIA 2014; 72:329-330. [PMID: 24863505 DOI: 10.1590/0004-282x20140074] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/04/2014] [Accepted: 04/11/2014] [Indexed: 06/03/2023]
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34
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Romo ML, Carpio A, Kelvin EA. Routine drug and food interactions during antihelminthic treatment of neurocysticercosis: a reason for the variable efficacy of albendazole and praziquantel? J Clin Pharmacol 2014; 54:361-7. [PMID: 24443292 DOI: 10.1002/jcph.269] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/07/2013] [Accepted: 01/16/2014] [Indexed: 11/10/2022]
Abstract
Neurocysticercosis (NC) or infection of the central nervous system with Taenia solium larvae is a leading cause of preventable seizures and epilepsy in endemic regions across the globe. Albendazole and praziquantel are commonly used antihelminthic agents to treat NC; however, viable cysts persist in the majority of patients, putting them at risk for future seizures and other neurological complications. Because of their pharmacokinetic profiles, albendazole and praziquantel have the potential to interact with many different drugs. During antihelminthic treatment, antiepileptic drugs and corticosteroids are commonly co-administered to manage seizures and cerebral edema; however, the most commonly used agents from these drug classes are known to significantly alter plasma concentrations of albendazole and praziquantel. The overarching issue with drug interactions during the treatment of NC is whether or not they have clinical relevance, as the plasma concentrations of albendazole and praziquantel have not been directly linked with eradication of viable cysts. Future studies should attempt to evaluate the validity of a causal relationship between antihelminthic plasma concentrations and outcomes so that drug interactions can be better understood and managed and so that treatment can be optimized.
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35
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Wiens AL. Neurocysticercosis and Sudden Death. Acad Forensic Pathol 2013. [DOI: 10.23907/2013.060] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022]
Affiliation(s)
- Andrea L. Wiens
- Oklahoma Office of the Chief Medical Examiner, Eastern Division
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