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Vaibhav, Sharma R, Aggarwal HK, Dahiya S, Kaliraman V. Neurocysticercosis-Induced Monoparesis: A Case Report of a Rare Neurological Manifestation. Cureus 2024; 16:e62587. [PMID: 39036192 PMCID: PMC11259459 DOI: 10.7759/cureus.62587] [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: 06/18/2024] [Indexed: 07/23/2024] Open
Abstract
Neurocysticercosis (NCC), a disease caused by the larval form of the pork tapeworm Taenia solium, is a common cause of acquired epilepsy globally, especially in areas with poor sanitation. While seizures and headaches are common manifestations, cases of NCC leading to monoparesis are exceedingly rare. Here, we describe a distinctive case of a 42-year-old male who developed sudden weakness and spasms in his left hand without prior injury or other systemic symptoms. Magnetic resonance imaging (MRI) of the brain revealed a single cystic lesion in the right frontoparietal lobe indicative of NCC, which was the cause of his pure motor monoparesis (PMM), without any sensory loss. Treatment with dexamethasone and albendazole substantially improved his motor abilities, highlighting the necessity of considering NCC in differential diagnoses for monoparesis, particularly in endemic areas. This case adds a unique perspective to the clinical spectrum of NCC, highlighting the critical role of prompt and accurate diagnosis followed by appropriate treatment in achieving favorable outcomes.
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Affiliation(s)
- Vaibhav
- Department of Neurology, Pandit Bhagwat Dayal Sharma University of Health Sciences, Rohtak, IND
| | - Rohit Sharma
- Department of Medicine, Pandit Bhagwat Dayal Sharma University of Health Sciences, Rohtak, IND
| | - H K Aggarwal
- Department of Medicine, Pandit Bhagwat Dayal Sharma University of Health Sciences, Rohtak, IND
| | - Shaveta Dahiya
- Department of Medicine, Pandit Bhagwat Dayal Sharma University of Health Sciences, Rohtak, IND
| | - Vipul Kaliraman
- Department of Medicine, Maulana Azad Medical College, New Delhi, IND
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2
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Orrego MA, Szczesniak MW, Vasquez CM, Verastegui MR, Bustos JA, Garcia HH, Nash TE. Transcriptomic analysis of subarachnoid cysts of Taenia solium reveals mechanisms for uncontrolled proliferation and adaptations to the microenvironment. Sci Rep 2024; 14:11833. [PMID: 38782926 PMCID: PMC11116493 DOI: 10.1038/s41598-024-61973-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/01/2024] [Accepted: 05/13/2024] [Indexed: 05/25/2024] Open
Abstract
Subarachnoid neurocysticercosis (SANCC) is caused by an abnormally transformed form of the metacestode or larval form of the tapeworm Taenia solium. In contrast to vesicular parenchymal and ventricular located cysts that contain a viable scolex and are anlage of the adult tapeworm, the subarachnoid cyst proliferates to form aberrant membranous cystic masses within the subarachnoid spaces that cause mass effects and acute and chronic arachnoiditis. How subarachnoid cyst proliferates and interacts with the human host is poorly understood, but parasite stem cells (germinative cells) likely participate. RNA-seq analysis of the subarachnoid cyst bladder wall compared to the bladder wall and scolex of the vesicular cyst revealed that the subarachnoid form exhibits activation of signaling pathways that promote proliferation and increased lipid metabolism. These adaptions allow growth in a nutrient-limited cerebral spinal fluid. In addition, we identified therapeutic drug targets that would inhibit growth of the parasite, potentially increase effectiveness of treatment, and shorten its duration.
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Affiliation(s)
- Miguel A Orrego
- Laboratory of Immunopathology in Neurocysticercosis, Facultad de Ciencias e Ingenierías, Universidad Peruana Cayetano Heredia, Lima, Peru.
- Center for Global Health, Universidad Peruana Cayetano Heredia, Lima, Peru.
| | - Michal W Szczesniak
- Institute of Human Biology and Evolution, Adam Mickiewicz University in Poznan, Poznan, Poland
| | - Carlos M Vasquez
- Department of Neurosurgery, Instituto Nacional de Ciencias Neurológicas, Lima, Peru
| | - Manuela R Verastegui
- Infectious Diseases Research Laboratory, Facultad de Ciencias e Ingenierías, Universidad Peruana Cayetano Heredia, Lima, Peru
| | - Javier A Bustos
- Cysticercosis Unit, Instituto Nacional de Ciencias Neurológicas, Lima, Peru
- Center for Global Health, Universidad Peruana Cayetano Heredia, Lima, Peru
| | - Hector H Garcia
- Laboratory of Immunopathology in Neurocysticercosis, Facultad de Ciencias e Ingenierías, Universidad Peruana Cayetano Heredia, Lima, Peru
- Cysticercosis Unit, Instituto Nacional de Ciencias Neurológicas, Lima, Peru
- Center for Global Health, Universidad Peruana Cayetano Heredia, Lima, Peru
| | - Theodore E Nash
- Laboratory of Immunopathology in Neurocysticercosis, Facultad de Ciencias e Ingenierías, Universidad Peruana Cayetano Heredia, Lima, Peru
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Bustos JA, Arroyo G, Del Brutto OH, Gonzales I, Saavedra H, Guzman C, Sanchez-Boluarte SS, Thakur KT, Coyle C, O’Neal SE, Garcia HH. Calcified Neurocysticercosis: Demographic, Clinical, and Radiological Characteristics of a Large Hospital-Based Patient Cohort. Pathogens 2023; 13:26. [PMID: 38251334 PMCID: PMC10820744 DOI: 10.3390/pathogens13010026] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/03/2023] [Revised: 12/13/2023] [Accepted: 12/22/2023] [Indexed: 01/23/2024] Open
Abstract
Neurocysticercosis (NCC), the infection of the central nervous system caused by Taenia solium larvae (cysticerci), is a major cause of acquired epilepsy worldwide. Calcification in NCC is the most common neuroimaging finding among individuals with epilepsy in T. solium-endemic areas. We describe the demographic, clinical, and radiological profiles of a large hospital cohort of patients with calcified NCC in Peru (during the period 2012-2022) and compared profiles between patients with and without a previous known diagnosis of viable infection. A total of 524 patients were enrolled (mean age at enrollment: 40.2 ± 15.2 years, mean age at symptom onset: 29.1 ± 16.1 years, 56.3% women). Of those, 415 patients (79.2%) had previous seizures (median time with seizures: 5 years, interquartile range (IQR): 2-13 years; median number of seizures: 7 (IQR: 3-32)), of which 333 (80.2%) had predominantly focal to bilateral tonic-clonic seizures; and 358 (68.3%) used antiseizure medication). Patients had a median number of three calcifications (IQR: 1-7), mostly located in the frontal lobes (79%). In 282 patients (53.8%) there was a previous diagnosis of viable infection, while 242 only had evidence of calcified NCC since their initial neuroimaging. Most patients previously diagnosed with viable infection were male, had previous seizures, had seizures for a longer time, had more calcifications, and had a history of taeniasis more frequently than patients without previously diagnosed viable infection (all p < 0.05). Patients with calcified NCC were heterogeneous regarding burden of infection and clinical manifestations, and individuals who were diagnosed after parasites calcified presented with milder disease manifestations.
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Affiliation(s)
- Javier A. Bustos
- Center for Global Health, Universidad Peruana Cayetano Heredia, Lima 15202, Peru; (J.A.B.); (C.G.); (S.S.S.-B.); (H.H.G.)
- Cysticercosis Unit, Instituto Nacional de Ciencias Neurologicas, Lima 15030, Peru; (I.G.); (H.S.); (S.E.O.)
| | - Gianfranco Arroyo
- Center for Global Health, Universidad Peruana Cayetano Heredia, Lima 15202, Peru; (J.A.B.); (C.G.); (S.S.S.-B.); (H.H.G.)
- Direccion de Investigacion, Desarrollo e Innovacion, Universidad Cientifica del Sur, Lima 15067, Peru
| | - Oscar H. Del Brutto
- School of Medicine and Research Center, Universidad Espiritu Santo-Ecuador, Samborondon 092301, Ecuador;
| | - Isidro Gonzales
- Cysticercosis Unit, Instituto Nacional de Ciencias Neurologicas, Lima 15030, Peru; (I.G.); (H.S.); (S.E.O.)
| | - Herbert Saavedra
- Cysticercosis Unit, Instituto Nacional de Ciencias Neurologicas, Lima 15030, Peru; (I.G.); (H.S.); (S.E.O.)
| | - Carolina Guzman
- Center for Global Health, Universidad Peruana Cayetano Heredia, Lima 15202, Peru; (J.A.B.); (C.G.); (S.S.S.-B.); (H.H.G.)
- Cysticercosis Unit, Instituto Nacional de Ciencias Neurologicas, Lima 15030, Peru; (I.G.); (H.S.); (S.E.O.)
| | - Sofia S. Sanchez-Boluarte
- Center for Global Health, Universidad Peruana Cayetano Heredia, Lima 15202, Peru; (J.A.B.); (C.G.); (S.S.S.-B.); (H.H.G.)
- Cysticercosis Unit, Instituto Nacional de Ciencias Neurologicas, Lima 15030, Peru; (I.G.); (H.S.); (S.E.O.)
| | - Kiran T. Thakur
- Department of Neurology, Columbia University Irving Medical Center/New York Presbyterian Hospital, New York, NY 10032, USA;
| | - Christina Coyle
- Division of Infectious Diseases, Albert Einstein College of Medicine, Bronx, NY 10461, USA;
| | - Seth E. O’Neal
- Cysticercosis Unit, Instituto Nacional de Ciencias Neurologicas, Lima 15030, Peru; (I.G.); (H.S.); (S.E.O.)
- School of Public Health, Oregon Health & Science University-Portland State University, Portland, OR 97207, USA
| | - Hector H. Garcia
- Center for Global Health, Universidad Peruana Cayetano Heredia, Lima 15202, Peru; (J.A.B.); (C.G.); (S.S.S.-B.); (H.H.G.)
- Cysticercosis Unit, Instituto Nacional de Ciencias Neurologicas, Lima 15030, Peru; (I.G.); (H.S.); (S.E.O.)
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da Silva Santana RC, Prudente TP, de Sousa Guerra CH, de Lima NF, de Souza Lino Junior R, Vinaud MC. Albendazole - Ivermectin combination decreases inflammation in experimental neurocysticercosis. Exp Parasitol 2023:108568. [PMID: 37327965 DOI: 10.1016/j.exppara.2023.108568] [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: 10/18/2022] [Revised: 06/13/2023] [Accepted: 06/13/2023] [Indexed: 06/18/2023]
Abstract
Neurocysticercosis (NCC) is a public health issue in endemic regions and is considered the main preventable cause of neurologic disease. It is caused by the presence of Taenia solium cysticercus in the central nervous system. The current treatment is performed with anthelminthic drugs - albendazole (ABZ) or praziquantel - associated with anti-inflammatory and corticosteroids in order to prevent the negative effects of the inflammatory reaction to the parasite's death. Ivermectin (IVM) is an anthelminthic drug that has been shown to present an anti-inflammatory effect. The aim of this study was to was to evaluate the histopathologic aspects of experimental NCC after in vivo treatment with a combination of ABZ-IVM. Balb/c mice were intracranially inoculated with T. crassiceps cysticerci and after 30 days of infection were treated with a single dose of NaCl 0.9% (control group), ABZ monotherapy (40 mg/kg), IVM monotherapy (0.2 mg/kg) or a combination of ABZ-IVM. 24h after the treatment the animals were euthanized and the brain was removed for histopathologic analysis. The IVM monotherapy and ABZ-IVM combination showed more degenerated cysticerci, less inflammatory infiltration, meningitis and hyperemia than the other groups. Therefore, it is possible to recommend the combination of albendazole and ivermectin as alternative chemotherapy for NCC due to its antiparasitic and anti-inflammatory effects, with potential to decrease the negative effects of the inflammatory burst when the parasite is killed within the CNS.
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Affiliation(s)
| | - Tiago Paiva Prudente
- Medicine School, Federal University of Goias, Goiânia, Goiás, CEP: 74605-050, Brazil
| | | | - Nayana Ferreira de Lima
- Tropical Pathology and Public Health Institute, Federal University of Goias, Goiânia, Goiás, CEP: 74605-050, Brazil
| | - Ruy de Souza Lino Junior
- Tropical Pathology and Public Health Institute, Federal University of Goias, Goiânia, Goiás, CEP: 74605-050, Brazil
| | - Marina Clare Vinaud
- Tropical Pathology and Public Health Institute, Federal University of Goias, Goiânia, Goiás, CEP: 74605-050, Brazil.
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5
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Nateros F, Saenz E, Saavedra H, Gonzales I, Pretell EJ, Perez E, Castillo Y, Bustos JA, Garcia HH. Older Age in Subarachnoid Neurocysticercosis Reflects a Long Prepatent Period. Am J Trop Med Hyg 2023; 108:1188-1191. [PMID: 37127275 PMCID: PMC10540123 DOI: 10.4269/ajtmh.22-0791] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/20/2022] [Accepted: 03/07/2023] [Indexed: 05/03/2023] Open
Abstract
Patients with subarachnoid neurocysticercosis (NCC) are usually older than those with parenchymal disease. Whether this difference reflects a prolonged presymptomatic period or a delay in diagnosis is not clear. From 408 eligible patients, we retrospectively compared the age at symptom onset in 140 patients diagnosed with parenchymal (pure viable or pure calcified) and subarachnoid NCC who had a confirmatory image available not more than 2 years after the beginning of symptoms. Patients with mixed (parenchymal and subarachnoid) NCC or those with parenchymal cysts at different stages (viable and/or degenerating and/or calcified) were not included. After controlling by sex and residence in rural endemic regions, the mean age at symptom onset in patients with subarachnoid disease was 13.69 years older than those with viable parenchymal disease. A long incubation period is a major contributing factor to older age at presentation in subarachnoid NCC, independent of delayed diagnosis or access to care.
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Affiliation(s)
- Fernando Nateros
- Facultad de Medicina Alberto Hurtado, Universidad Peruana Cayetano Heredia, Lima, Peru
- Centro Básico de Investigación en Exámenes Auxiliares en Parasitosis del Sistema Nervioso Central, Instituto Nacional de Ciencias Neurológicas, Lima, Peru
| | - Edith Saenz
- Centro Básico de Investigación en Exámenes Auxiliares en Parasitosis del Sistema Nervioso Central, Instituto Nacional de Ciencias Neurológicas, Lima, Peru
| | - Herbert Saavedra
- Centro Básico de Investigación en Exámenes Auxiliares en Parasitosis del Sistema Nervioso Central, Instituto Nacional de Ciencias Neurológicas, Lima, Peru
| | - Isidro Gonzales
- Centro Básico de Investigación en Exámenes Auxiliares en Parasitosis del Sistema Nervioso Central, Instituto Nacional de Ciencias Neurológicas, Lima, Peru
- Unidad de Investigación, Instituto Nacional de Ciencias Neurológicas, Lima, Peru
| | | | - Erika Perez
- Centro Básico de Investigación en Exámenes Auxiliares en Parasitosis del Sistema Nervioso Central, Instituto Nacional de Ciencias Neurológicas, Lima, Peru
| | - Yesenia Castillo
- Centro de Salud Global, Universidad Peruana Cayetano Heredia, Lima, Peru
| | - Javier A. Bustos
- Centro Básico de Investigación en Exámenes Auxiliares en Parasitosis del Sistema Nervioso Central, Instituto Nacional de Ciencias Neurológicas, Lima, Peru
- Centro de Salud Global, Universidad Peruana Cayetano Heredia, Lima, Peru
| | - Hector H. Garcia
- Centro Básico de Investigación en Exámenes Auxiliares en Parasitosis del Sistema Nervioso Central, Instituto Nacional de Ciencias Neurológicas, Lima, Peru
- Centro de Salud Global, Universidad Peruana Cayetano Heredia, Lima, Peru
| | - for the Cysticercosis Working Group in Peru
- Facultad de Medicina Alberto Hurtado, Universidad Peruana Cayetano Heredia, Lima, Peru
- Centro Básico de Investigación en Exámenes Auxiliares en Parasitosis del Sistema Nervioso Central, Instituto Nacional de Ciencias Neurológicas, Lima, Peru
- Unidad de Investigación, Instituto Nacional de Ciencias Neurológicas, Lima, Peru
- Hospital Nacional Alberto Sabogal, Callao, Peru
- Centro de Salud Global, Universidad Peruana Cayetano Heredia, Lima, Peru
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Romo ML, Osorio R, Toledo A, Carrillo-Mezo R, Valdez R, Romano MC, Sciutto E, Fragoso G, Fleury A. Low responsiveness of peripheral lymphocytes in extraparenchymal neurocysticercosis. PLoS Negl Trop Dis 2023; 17:e0011386. [PMID: 37262055 DOI: 10.1371/journal.pntd.0011386] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/19/2023] [Accepted: 05/16/2023] [Indexed: 06/03/2023] Open
Abstract
BACKGROUND The morbidity and mortality of extraparenchymal neurocysticercosis (EP-NC) remain high and effectiveness of current medical treatment is suboptimal. Various factors have been implicated in the severity of EP-NC and in the poor response to treatment, but the possible role of host immune and endocrine systems has not yet been examined thoroughly. METHODOLOGY/PRINCIPAL FINDINGS 42 participants with EP-NC before receiving standard treatment and 25 healthy controls were included in the study. Treatment response was assessed by comparing pre/post treatment parasite volumes from 3D MRI. Prior to treatment among participants with EP-NC, specific stimulation induced an increased specific proliferative response accompanied by a significant increase in IL-4, NK, NKT, Bregs and Tregs cells, whereas in healthy controls, specific stimulation induced a significant increase in IL-1β, IL-5, CCL5, IL-6, TNF-α, NK and Bregs cells. Significant differences between participants with EP-NC and healthy controls in the specific inflammatory response were observed. Participants with EP-NC prior to treatment had significantly weaker responses of proinflammatory cytokines (IL-6, TNF-α) and NK cells, and stronger IL-4 response. Anthelmintic treatment did not promote significant peripheral immunological changes at any time, although inflammation was sustained in the cerebrospinal fluid. Serum estradiol concentration significantly decreased after anthelmintic treatment among males, and cortisol correlated negatively with IL-6 and positively with IFN-γ levels. No pre-treatment immunologic or endocrinologic parameters were significantly associated with response to treatment. CONCLUSION/SIGNIFICANCE Prior to anthelmintic treatment, EP-NC was characterized by low lymphocyte reactivity accompanied by a regulatory response, which may be involved in the lack of peripheral immunological changes during and after treatment, although a central inflammatory response was present. This weak specific peripheral response could favor the chronicity of the infection and the poor response to treatment. Our findings highlight the need for new anti-inflammatory treatment focused on the central nervous system with less systemic immunosuppressive effects.
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Affiliation(s)
- Matthew L Romo
- Department of Epidemiology & Biostatistics, CUNY Graduate School of Public Health and Health Policy, City University of New York, New York, United States of America
| | - Rocio Osorio
- Unidad de Neuro inflamación, Departamento de Medicina Genómica y Toxicología ambiental, Instituto de Investigación Biomédicas, Universidad Nacional Autónoma de México (UNAM) / Instituto Nacional de Neurología y Neurocirugía, Ciudad de México, México
- Neurocysticercosis Clinic, Instituto Nacional de Neurología y Neurocirugía, Ciudad de México, México
| | - Andrea Toledo
- Unidad de Neuro inflamación, Departamento de Medicina Genómica y Toxicología ambiental, Instituto de Investigación Biomédicas, Universidad Nacional Autónoma de México (UNAM) / Instituto Nacional de Neurología y Neurocirugía, Ciudad de México, México
- División de Investigación, Facultad de Medicina, Universidad Nacional Autónoma de México, Ciudad de México, México
| | - Roger Carrillo-Mezo
- Neuroradiology Department, Instituto Nacional de Neurología y Neurocirugía, Ciudad de México, México
| | - Ricardo Valdez
- CINVESTAV, Departamento de Fisiología, Biofísica y Neurociencias, México
| | - Marta C Romano
- CINVESTAV, Departamento de Fisiología, Biofísica y Neurociencias, México
| | - Edda Sciutto
- Departamento de Inmunología, Instituto de Investigación Biomédicas, Universidad Nacional Autónoma de México (UNAM), Ciudad de México, México
| | - Gladis Fragoso
- Departamento de Inmunología, Instituto de Investigación Biomédicas, Universidad Nacional Autónoma de México (UNAM), Ciudad de México, México
| | - Agnès Fleury
- Unidad de Neuro inflamación, Departamento de Medicina Genómica y Toxicología ambiental, Instituto de Investigación Biomédicas, Universidad Nacional Autónoma de México (UNAM) / Instituto Nacional de Neurología y Neurocirugía, Ciudad de México, México
- Neurocysticercosis Clinic, Instituto Nacional de Neurología y Neurocirugía, Ciudad de México, México
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Toribio L, Handali S, Marin Y, Perez E, Castillo Y, Bustos JA, O’Neal SE, Garcia HH. A Rapid Point-of-Care Assay for Cysticercosis Antigen Detection in Urine Samples. Am J Trop Med Hyg 2023; 108:578-580. [PMID: 36746658 PMCID: PMC9978566 DOI: 10.4269/ajtmh.22-0598] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/13/2022] [Accepted: 11/23/2022] [Indexed: 02/08/2023] Open
Abstract
We report a proof-of-concept study using a dipstick assay to detect Taenia solium antigen in urine samples of 30 patients with subarachnoid neurocysticercosis and 10 healthy control subjects. Strips were read in blind by two readers. The assay detected antigen in 29 of 30 cases and was negative in all 10 control samples. Although this study was performed in samples from individuals with subarachnoid neurocysticercosis who likely had high circulating antigen levels, it provides the proof of concept for a functional urine antigen point-of-care assay that detects viable cysts. Such an assay could serve to support a clinical diagnosis of suspect neurocysticercosis or to identify patients at risk of developing severe disease in areas where medical resources are limited, providing evidence to refer these individuals for imaging and specialized care as needed.
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Affiliation(s)
- Luz Toribio
- Center for Global Health, Universidad Peruana Cayetano Heredia, Lima, Peru
- Cysticercosis Unit, Instituto Nacional de Ciencias Neurologicas, Lima, Peru
| | - Sukwan Handali
- Division of Parasitic Diseases and Malaria, Centers for Disease Control and Prevention, Atlanta, Georgia
| | - Yazmin Marin
- Cysticercosis Unit, Instituto Nacional de Ciencias Neurologicas, Lima, Peru
| | - Erika Perez
- Cysticercosis Unit, Instituto Nacional de Ciencias Neurologicas, Lima, Peru
| | - Yesenia Castillo
- Center for Global Health, Universidad Peruana Cayetano Heredia, Lima, Peru
- Parasite Immunology Laboratory, Universidad Peruana Cayetano Heredia, Lima, Peru
| | - Javier A. Bustos
- Center for Global Health, Universidad Peruana Cayetano Heredia, Lima, Peru
- Cysticercosis Unit, Instituto Nacional de Ciencias Neurologicas, Lima, Peru
| | - Seth E. O’Neal
- School of Public Health, Oregon Health & Sciences University-Portland State University, Portland, Oregon
| | - Hector H. Garcia
- Center for Global Health, Universidad Peruana Cayetano Heredia, Lima, Peru
- Cysticercosis Unit, Instituto Nacional de Ciencias Neurologicas, Lima, Peru
- Asociación Benéfica PRISMA, Lima, Peru
- Department of International Health, Johns Hopkins School of Public Health, Baltimore, Maryland
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Abstract
Neurocysticercosis (NCC) is an important cause of neurological disease worldwide, including imported cases in nonendemic countries. PURPOSE OF REVIEW The purpose of this review is to update information on diagnosis, management, and prevention of neurocysticercosis. RECENT FINDINGS WHO and Infectious Diseases Society of America/American Society of Tropical Medicine and Hygiene guidelines emphasize the importance of corticosteroids and antiparasitic drugs for viable parenchymal disease and single enhancing lesions. Subarachnoid NCC is associated with a high fatality rate unless optimally treated. Advances in subarachnoid NCC include use of prolonged antiparasitic and anti-inflammatory courses and the increasing use of antigen-detection and quantitative PCR assays in diagnosis and follow-up. Emerging data support the safety and efficacy of minimally invasive surgery in ventricular cases. Calcified neurocysticercosis continues to be associated with a high burden of disease. Field studies are demonstrating the feasibility of eradication using a combination of mass chemotherapy for human tapeworms and vaccination/treatment of porcine cysticercosis. SUMMARY NCC remains an important and challenging cause of neurological disease with significant morbidity despite advances in treatment and prevention.
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Corda M, Sciurba J, Blaha J, Mahanty S, Paredes A, Garcia HH, Nash TE, Nutman TB, O’Connell EM. A recombinant monoclonal-based Taenia antigen assay that reflects disease activity in extra-parenchymal neurocysticercosis. PLoS Negl Trop Dis 2022; 16:e0010442. [PMID: 35617367 PMCID: PMC9176767 DOI: 10.1371/journal.pntd.0010442] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/11/2022] [Revised: 06/08/2022] [Accepted: 04/21/2022] [Indexed: 11/19/2022] Open
Abstract
BACKGROUND Antigen tests for diagnosis and disease monitoring in some types of neurocysticercosis (NCC) are useful but access to testing has been limited by availability of proprietary reagents and/or kits. METHODS/PRINCIPAL FINDINGS Three previously identified IgM-secreting hybridomas whose IgM products demonstrated specificity to Taenia solium underwent variable heavy and light chain sequencing and isotype conversion to mouse IgG. Screening of these recombinantly expressed IgG anti-Ts hybridomas, identified one (TsG10) with the highest affinity to crude Taenia antigen. TsG10 was then used as a capture antibody in a sandwich antigen detection immunoassay in combination with either a high titer polyclonal anti-Ts antibody or with biotinylated TsG10 (termed TsG10*bt). Using serum, plasma, and CSF samples from patients with active NCC and those from NCC-uninfected patients, ROC curve analyses demonstrated that the TsG10-TsG10-*bt assay achieved a 98% sensitivity and 100% specificity in detecting samples known to be antigen positive and outperformed the polyclonal based assay (sensitivity of 93% with 100% specificity). By comparing levels of Ts antigen (Ag) in paired CSF (n = 10) or plasma/serum (n = 19) samples from well-characterized patients with extra-parenchymal NCC early in infection and at the time of definitive cure, all but 2 (1 from CSF and 1 from plasma) became undetectable. There was a high degree of correlation (r = 0.98) between the Ag levels detected by this new assay and levels found by a commercial assay. Pilot studies indicate that this antigen can be detected in the urine of patients with active NCC. CONCLUSIONS/SIGNIFICANCE A newly developed recombinant monoclonal antibody-based Ts Ag detection immunoassay is extremely sensitive in the detection of extra-parenchymal NCC and can be used to monitor the success of treatment in the CSF, serum/plasma and urine. The ability to produce recombinant TsG10 at scale should enable use of this antigen detection immunoassay wherever NCC is endemic. CLINICAL TRIAL REGISTRATION ClinicalTrials.gov Identifiers: NCT00001205 - & NCT00001645.
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Affiliation(s)
- Madelynn Corda
- Laboratory of Parasitic Diseases, National Institute of Allergy and Infectious Diseases, Bethesda, Maryland, United States of America
| | - Joshua Sciurba
- Laboratory of Parasitic Diseases, National Institute of Allergy and Infectious Diseases, Bethesda, Maryland, United States of America
| | - Jiana Blaha
- Laboratory of Parasitic Diseases, National Institute of Allergy and Infectious Diseases, Bethesda, Maryland, United States of America
| | - Siddhartha Mahanty
- The Peter Doherty Institute for Infection and Immunity, University of Melbourne & The Royal Melbourne Hospital, Melbourne, Victoria, Australia
| | | | | | - Theodore E. Nash
- Laboratory of Parasitic Diseases, National Institute of Allergy and Infectious Diseases, Bethesda, Maryland, United States of America
| | - Thomas B. Nutman
- Laboratory of Parasitic Diseases, National Institute of Allergy and Infectious Diseases, Bethesda, Maryland, United States of America
| | - Elise M. O’Connell
- Laboratory of Parasitic Diseases, National Institute of Allergy and Infectious Diseases, Bethesda, Maryland, United States of America
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Himwaze C, Mucheleng'anga LA, Telendiy V, Hamukale A, Tembo J, Kapata N, Ntoumi F, Zumla A. Cardiac cysticercosis and neurocysticercosis in sudden and unexpected community deaths in Lusaka, Zambia: a descriptive medico-legal post-mortem examination study. Int J Infect Dis 2021; 115:195-200. [PMID: 34896266 DOI: 10.1016/j.ijid.2021.11.042] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/07/2021] [Revised: 11/25/2021] [Accepted: 11/27/2021] [Indexed: 11/15/2022] Open
Abstract
BACKGROUND Cysticercosis is a World Health Organization designated neglected human zoonosis worldwide. Data on cardiac cysticercosis and its contribution to sudden and unexpected community deaths are scarce and require study. METHODS A study was performed of cysticercosis-related deaths and other incidental cases of cysticercosis seen at forensic post-mortem examination over a period of 12 months, in individuals who died suddenly and unexpectedly in the community in Lusaka, Zambia. Whole-body post-mortem examinations were performed according to standard operating procedures for post-mortem examinations. Representative samples were obtained from all body organs and subjected to histopathological examination. Information was obtained on circumstances surrounding the death. Data were collated on patient demographics, history, co-morbidities, pathological gross and microscopic findings, and forensic autopsy cause(s) of death. The available literature on cardiac cysticercosis was also reviewed. RESULTS Nine cases of cysticercosis were identified. Eight of the nine cases had cardiac cysticercosis. There was no prior history of cysticercosis before death. All were male, aged between 28 and 56 years, and from high population density and low socioeconomic communities. There was no community case clustering identified. CONCLUSIONS Cardiac cysticercosis and neurocysticercosis are important incidental findings in sudden and unexpected deaths in the community and can easily be missed antemortem. More investment in forensic autopsy services is required to define the undiagnosed burden of deaths due to treatable communicable diseases.
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Affiliation(s)
- Cordilia Himwaze
- University Teaching Hospital, Department of Pathology and Microbiology, Lusaka, Zambia.
| | - Luchenga Adam Mucheleng'anga
- Ministry of Home Affairs, Office of the State Forensic Pathologist, Lusaka, Zambia; UNZA-UCLMS, PANDORA-ID-NET and HERPEZ R&D Program, University Teaching Hospital, Lusaka, Zambia
| | - Victor Telendiy
- Ministry of Home Affairs, Office of the State Forensic Pathologist, Lusaka, Zambia
| | - Amos Hamukale
- Zambia Field Epidemiology Training Program, Lusaka, Zambia
| | - John Tembo
- UNZA-UCLMS, PANDORA-ID-NET and HERPEZ R&D Program, University Teaching Hospital, Lusaka, Zambia
| | - Nathan Kapata
- UNZA-UCLMS, PANDORA-ID-NET and HERPEZ R&D Program, University Teaching Hospital, Lusaka, Zambia
| | - Francine Ntoumi
- Fondation Congolaise pour la Recherche Médicale (FCRM), Faculty of Sciences and Technology, University Marien Ngouabi, Brazzaville, Republic of Congo
| | - Alimuddin Zumla
- UNZA-UCLMS, PANDORA-ID-NET and HERPEZ R&D Program, University Teaching Hospital, Lusaka, Zambia; Division of Infection and Immunity, University College London; NIHR Biomedical Research Centre, UCLHospitals NHS Foundation Trust, London, UK
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