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Verma A, Kumar A, Sachan D. Clinical characteristics and risk factors for seizures to recur in calcified neurocysticercosis : Prospective cohort Study. Acta Neurol Taiwan 2024; 33(4):153-160. [PMID: 38030224] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 12/01/2023]
Abstract
AIM Calcification of degenerating neurocysticercosis (NCC) is common and likely to occur late in the degenerative process and is important for seizure foci. The present study was aimed at identifying the clinical and radiological variables associated with seizure recurrence in people with single or multiple calcified NCC lesions. MATERIAL AND METHODS We evaluated 85 adult patients with calcified NCC lesions for recurrence of seizures during the follow-up period of one year. RESULTS The mean age of the study population was 24.49 ± 9.17 years. Nocturnal seizures were present in 43.5% and serial seizures in 42.4%. A single calcified lesion was present in 61 (71.8%), and perifocal oedema surrounding the calcified lesions was present in 38 (44.7%). Recurrence of seizures was noted in 37 (43.5%) of the cases. On multivariate analysis, the factors that were significantly associated with the recurrence of seizures were: nocturnal seizures [OR: 0.054 (0.015-0.199)], serial seizures [OR: 0.141 (0.041-0.485)], and perifocal oedema [OR: 0.031 (0.008-0.129)]. CONCLUSION In our study, serial seizures, nocturnal seizures, and perifocal oedema were linked with the recurrence of seizures in calcified NCC lesions. Perilesional oedema should be treated aggressively with anti-inflammatory/immunosuppressive therapy as well as with anti-seizure medication.
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Affiliation(s)
- Archana Verma
- Professor and Head Department of Neurology, All India Institute of Medical Sciences Raebareli Munshiganj, Dalmau Road, Raebareli, India
| | - Alok Kumar
- Professor and Head, Forensic Medicine and Toxicology, UP university of Medical Sciences, Saifai, Etawah, India
| | - Divyata Sachan
- Assistant professor, Department of community medicine SMMH Medical Sciences, Saharanpur, India
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Maldonado-Barrueco A, Utrilla C, Hernández-González A, Perteguer MJ, Díaz-Pollán B, Untoria-Tabares Y, Díaz-Menéndez M, Falces-Romero I, Gutiérrez-Arroyo A, García-Rodríguez J, Montero-Vega D. Intraventricular neurocysticercosis in a migrant from Honduras. J Travel Med 2024; 31:taad090. [PMID: 37406005 DOI: 10.1093/jtm/taad090] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/04/2023] [Revised: 06/27/2023] [Accepted: 06/30/2023] [Indexed: 07/07/2023]
Abstract
We report in Madrid (Spain) a case of intraventricular neurocysticercosis in a migrant from Choluteca (Honduras), which was confirmed by epidemiological, radiological and microbiological criteria.
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Affiliation(s)
| | - Cristina Utrilla
- Radiology Department, Hospital Universitario La Paz, Madrid 28016, Spain
| | - Ana Hernández-González
- Helminth Laboratory, National Center of Microbiology, Instituto de Salud Carlos III, Majadahonda, Madrid 28016, Spain
| | - María J Perteguer
- Helminth Laboratory, National Center of Microbiology, Instituto de Salud Carlos III, Majadahonda, Madrid 28016, Spain
- CIBERINFEC ISCIII, Instituto de Salud Carlos III, Madrid 28016, Spain
| | - Beatriz Díaz-Pollán
- CIBERINFEC ISCIII, Instituto de Salud Carlos III, Madrid 28016, Spain
- Infectious Diseases Unit, Internal Medicine Department, Hospital Universitario La Paz, Madrid 28016, Spain
| | - Yeray Untoria-Tabares
- Infectious Diseases Unit, Internal Medicine Department, Hospital Universitario La Paz, Madrid 28016, Spain
| | - Marta Díaz-Menéndez
- CIBERINFEC ISCIII, Instituto de Salud Carlos III, Madrid 28016, Spain
- Imported Pathology and International Health Unit, CSUR for Adult and Pediatric Imported Tropical Pathology, High Level Isolation Unit, Hospital Universitario La Paz, Madrid 28016, Spain
| | - Iker Falces-Romero
- Clinical Microbiology Department, Hospital Universitario La Paz, Madrid 28016, Spain
- CIBERINFEC ISCIII, Instituto de Salud Carlos III, Madrid 28016, Spain
| | | | | | - Dolores Montero-Vega
- Clinical Microbiology Department, Hospital Universitario La Paz, Madrid 28016, Spain
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Ghosh R, León-Ruiz M, Dubey S, Benito-León J. Cerebral and spinal neurocysticercosis with extensive myocysticercosis presenting with new-onset convulsive status epilepticus and myopathic symptoms. Enferm Infecc Microbiol Clin (Engl Ed) 2024; 42:223-225. [PMID: 38216423 DOI: 10.1016/j.eimce.2023.11.007] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/17/2023] [Accepted: 11/16/2023] [Indexed: 01/14/2024]
Affiliation(s)
- Ritwik Ghosh
- Department of General Medicine, Burdwan Medical College and Hospital, Burdwan, West Bengal, India
| | - Moisés León-Ruiz
- Section of Clinical Neurophysiology, Department of Neurology, University Hospital "La Paz", Madrid, Spain
| | - Souvik Dubey
- Department of Neuromedicine, Bangur Institute of Neurosciences, Kolkata, West Bengal, India
| | - Julián Benito-León
- Department of Neurology, University Hospital "12 de Octubre", Madrid, Spain; Research Institute (i+12), University Hospital "12 de Octubre", Madrid, Spain; Centro de Investigación Biomédica en Red Sobre Enfermedades Neurodegenerativas (CIBERNED), Madrid, Spain; Department of Medicine, Complutense University, Madrid, Spain.
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Norcia LF, Zanini MA, Hamamoto Filho PT. Letter to the Editor Regarding: "Is Antihelminthics Necessary in Postoperative Treatment of Intraventricular Neurocysticercosis? A Systematic Review". World Neurosurg 2024; 182:229. [PMID: 38390886 DOI: 10.1016/j.wneu.2023.11.074] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/14/2023] [Accepted: 11/16/2023] [Indexed: 02/24/2024]
Affiliation(s)
- Luiz Fernando Norcia
- UNESP - Department of Neurology, Psychology and Psychiatry, University, Estadual Paulista, Botucatu Medical School, Botucatu, Brazil
| | - Marco Antônio Zanini
- UNESP - Department of Neurology, Psychology and Psychiatry, University, Estadual Paulista, Botucatu Medical School, Botucatu, Brazil
| | - Pedro Tadao Hamamoto Filho
- UNESP - Department of Neurology, Psychology and Psychiatry, University, Estadual Paulista, Botucatu Medical School, Botucatu, Brazil.
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Chakrabarty B, Gulati S, Kumar A, Jauhari P, Saini S, Pandey T, Pandey RM, Panda P, Anand V, Singh S, Kamila G. Incident Breakthrough Seizures, Serum Matrix Metalloproteinase-9 and Perfusion Magnetic Resonance Imaging Parameters in a Cohort of Children and Adolescents With Neurocysticercosis: A Longitudinal Observational Study. Pediatr Neurol 2024; 151:45-52. [PMID: 38101307 DOI: 10.1016/j.pediatrneurol.2023.11.006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/26/2022] [Revised: 09/21/2023] [Accepted: 11/19/2023] [Indexed: 12/17/2023]
Abstract
BACKGROUND The current study estimated incident breakthrough seizures, serum matrix metalloproteinase-9 (MMP-9), and perfusion magnetic resonance imaging (MRI) parameters in five- to 18-year-olds with neurocysticercosis (NCC) from colloidal or vesicular through calcified stages over at least 24 months' follow-up. METHODS Single, colloidal, or vesicular parenchymal NCC cases were treated with albendazole and steroids and followed at a tertiary care north Indian hospital. Serum MMP-9 was estimated in colloidal or vesicular treatment-naive state and in a subset of calcified cases at six-month follow-up. The same subset of calcified cases also underwent perfusion MRI of the brain at six-month follow-up. RESULTS Among 70 cases, 70% calcified at six-month follow-up. Over a median follow-up of 30 months, the incidence of breakthrough seizures was 48.6% (61.2% in calcified and 19.2% in resolved, P = 0.001; 32.9% early [within six months] and 15.7% late [beyond six months], P = 0.02). Serum MMP-9 levels were higher in colloidal and vesicular compared with calcified stage (242.5 vs 159.8 ng/mL, P = 0.007); however, there was no significant association with breakthrough seizures and/or calcification in follow-up. In a subgroup of calcified cases (n = 31), the median relative cerebral blood volume on perfusion MRI in and around the lesion was lower in those with seizures (n = 12) than in those without (n = 19) (10.7 vs 25.2 mL/100 g, P = 0.05). CONCLUSIONS In post-treatment colloidal or vesicular NCC, incident breakthrough seizures decrease beyond six months. In calcified NCC with remote breakthrough seizures, significant perilesional hypoperfusion is seen compared with those without seizures.
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Affiliation(s)
- Biswaroop Chakrabarty
- Child Neurology Division, Department of Pediatrics, All India Institute of Medical Sciences, New Delhi, New Delhi, India.
| | - Sheffali Gulati
- Child Neurology Division, Department of Pediatrics, Centre of Excellence and Advanced Research on Childhood Neurodevelopmental Disorders, All India Institute of Medical Sciences, New Delhi, New Delhi, India
| | - Atin Kumar
- Department of Radiodiagnosis, JPNA Trauma Centre, All India Institute of Medical Sciences, New Delhi, New Delhi, India
| | - Prashant Jauhari
- Child Neurology Division, Department of Pediatrics, All India Institute of Medical Sciences, New Delhi, New Delhi, India
| | - Savita Saini
- Department of Pediatrics, All India Institute of Medical Sciences, New Delhi, New Delhi, India
| | - Tapish Pandey
- Department of Pediatrics, All India Institute of Medical Sciences, New Delhi, New Delhi, India
| | - Ravindra Mohan Pandey
- Department of Biostatistics, All India Institute of Medical Sciences, New Delhi, New Delhi, India
| | - Prateek Panda
- Child Neurology Division, Department of Pediatrics, All India Institute of Medical Sciences, New Delhi, New Delhi, India
| | - Vaishakh Anand
- Child Neurology Division, Department of Pediatrics, All India Institute of Medical Sciences, New Delhi, New Delhi, India
| | - Sonali Singh
- Child Neurology Division, Department of Pediatrics, All India Institute of Medical Sciences, New Delhi, New Delhi, India
| | - Gautam Kamila
- Child Neurology Division, Department of Pediatrics, All India Institute of Medical Sciences, New Delhi, New Delhi, India
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Milenković Z, Momčilović S, Ignjatovic A, Tasić-Otašević S. Is Antihelminthics Necessary in Postoperative Treatment of Intraventricular Neurocysticercosis? A Systematic Review. World Neurosurg 2024; 181:e533-e550. [PMID: 37879434 DOI: 10.1016/j.wneu.2023.10.092] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/09/2023] [Accepted: 10/18/2023] [Indexed: 10/27/2023]
Abstract
OBJECTIVE Patients with intraventricular neurocysticercosis (IVNCC) may require cerebrospinal fluid diversion surgery for late-onset hydrocephalus in the postsurgical period. Controversy exists regarding cysticidal treatment. Our main objective was to compare surgically treated cases of IVNCC that received postoperative anthelmintics with those that did not regard the incidence and treatment of late-onset hydrocephalus. METHODS We searched the Medline database and extracted the following data: age, gender, stage of development of cysticercosis, type of operation, frequency of delayed hydrocephalus, cerebrospinal fluid diversion surgery, outcome, and follow-up. RESULTS We analyzed 130 articles on intraventricular cysticercosis and identified 117 cases of isolated IVNCC and 314 patients in the case-control series who met inclusion criteria. There was no significant difference in postoperative delayed hydrocephalus between isolated IVNCC and case-control study groups. Children under the age of 16 received anthelmintic drugs more frequently during the postoperative period. Statistical relevance was observed in all patient groups regarding the application of steroids in favor of cysticidal therapy Endoscopy was a better option than craniotomy for cases of isolated IVNCC and case-control studies. Other variables were not relevant. CONCLUSIONS Patients who received antihelminths did not show a statistically significant reduction in delayed hydrocephalus compared to individuals who did not receive after surgical resection of the parasite. Corticosteroid therapy prevailed in people who have been treated with anthelmintics. Children under the age of 16 were administered anthelmintic drugs more frequently during the postoperative period. Endoscopy was the preferred method for all groups, but some patients with cysts in the fourth ventricle required a craniotomy.
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Affiliation(s)
- Zoran Milenković
- General Hospital "Sava Surgery", Kej 29 decembra 2, Niš, Serbia.
| | - Stefan Momčilović
- Plastic and Reconstructive Surgery Clinic, Clinical Center Niš, Niš, Serbia
| | - Aleksandra Ignjatovic
- Department of Medical Statistics and Informatics, Faculty of Medicine, University of Niš, Niš, Serbia
| | - Suzana Tasić-Otašević
- Department of Microbiology and Immunology, Faculty of Medicine, University of Niš, Niš, Serbia
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7
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Wahlster S, Zunt J, Bonow R. Surgical Debulking Before Medical Management in a Patient With Massive Racemose Neurocysticercosis. Neurology 2023; 101:627-628. [PMID: 37414569 PMCID: PMC10573143 DOI: 10.1212/wnl.0000000000207465] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/25/2023] [Accepted: 04/13/2023] [Indexed: 07/08/2023] Open
Affiliation(s)
- Sarah Wahlster
- From the Department of Neurology (S.W., J.Z.), Department of Neurological Surgery (S.W., R.B.), Department of Global Health (J.Z.), and Harborview Injury Prevention Research Center (R.B.), University of Washington, Seattle.
| | - Joseph Zunt
- From the Department of Neurology (S.W., J.Z.), Department of Neurological Surgery (S.W., R.B.), Department of Global Health (J.Z.), and Harborview Injury Prevention Research Center (R.B.), University of Washington, Seattle
| | - Robert Bonow
- From the Department of Neurology (S.W., J.Z.), Department of Neurological Surgery (S.W., R.B.), Department of Global Health (J.Z.), and Harborview Injury Prevention Research Center (R.B.), University of Washington, Seattle
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8
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Nazish S, Almuhanna M. Colloidal/Calcified Neurocysticercosis at University Hospital of KSA: A Case Series. Ethiop J Health Sci 2023; 33:555-560. [PMID: 37576167 PMCID: PMC10416327 DOI: 10.4314/ejhs.v33i3.20] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/07/2022] [Accepted: 01/04/2023] [Indexed: 08/15/2023] Open
Abstract
Background Neurocysticercosis (NCC) is considered the most common central nervous system (CNS) helminthic infection. The prevalence of NCC cases in the Middle East has increased in recent years. Thirty-nine cases of NCC were reported between 2003-2011 in the Arabian Peninsula, among, five cases being from the kingdom Saudi Arabia (KSA). Most of the cases reported from the KSA were presented with seizures, and they belonged to expatriate workers or their related contacts. In this case series, we presented three cases of colloidal/calcified NCC. Cases Our patients were diagnosed with NCC based on epidemiologic exposure, clinical features, and typical radiological findings. Stool samples for ova and parasites were negative in all three cases. Among these cases, two patients were immigrants and belonged to endemic areas, and third case who is the youngest in this series was a Saudi, without any history of exposure to any source. Results The first and the third cases were treated with Albendazole and Dexamethasone. We did not offer any medication regarding NCC in the second case as he had asymptomatic NCC and the disease was inactive so did not mandate anti-helminth medication. Conclusion NCC in KSA, like in non-endemic countries, is not a rare or unusual infection anymore, presenting with seizures or incidental findings in an asymptomatic state. Vigilant diagnostic protocols with efficient diagnostic tools are required for detecting carriers of the adult form of the parasite. Timely detection of these carriers can avoid further spread and its related complications in the Saudi population.
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Affiliation(s)
- Saima Nazish
- Department of Neurology, College of medicine, Imam Abdulrahman Bin Faisal University, Dammam, Saudi Arabia
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Stelzle D, Abraham A, Kaminski M, Schmidt V, De Meijere R, Bustos JA, Garcia HH, Sahu PS, Bobić B, Cretu C, Chiodini P, Dermauw V, Devleesschauwer B, Dorny P, Fonseca A, Gabriël S, Morales MÁG, Laranjo-González M, Hoerauf A, Hunter E, Jambou R, Jurhar-Pavlova M, Reiter-Owona I, Sotiraki S, Trevisan C, Vilhena M, Walker NF, Zammarchi L, Winkler AS. Clinical characteristics and management of neurocysticercosis patients: a retrospective assessment of case reports from Europe. J Travel Med 2023; 30:6759132. [PMID: 36222148 DOI: 10.1093/jtm/taac102] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/13/2022] [Revised: 08/15/2022] [Accepted: 08/30/2022] [Indexed: 01/25/2023]
Abstract
OBJECTIVES Neurocysticercosis (NCC) is a parasitic disease caused by the larval stage of the tapeworm Taenia solium. NCC mainly occurs in Africa, Latin America and South-East Asia and can cause a variety of clinical signs/symptoms. Although it is a rare disease in Europe, it should nonetheless be considered as a differential diagnosis. The aim of this study was to describe clinical characteristics and management of patients with NCC diagnosed and treated in Europe. METHODS We conducted a systematic search of published and unpublished data on patients diagnosed with NCC in Europe (2000-2019) and extracted demographic, clinical and radiological information on each case, if available. RESULTS Out of 293 identified NCC cases, 59% of patients presented initially with epileptic seizures (21% focal onset); 52% presented with headache and 54% had other neurological signs/symptoms. The majority of patients had a travel or migration history (76%), mostly from/to Latin America (38%), Africa (32%) or Asia (30%). Treatment varied largely depending on cyst location and number. The outcome was favorable in 90% of the cases. CONCLUSIONS Management of NCC in Europe varied considerably but often had a good outcome. Travel and migration to and from areas endemic for T. solium will likely result in continued low prevalence of NCC in Europe. Therefore, training and guidance of clinicians is recommended for optimal patient management.
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Affiliation(s)
- Dominik Stelzle
- Department of Neurology, Center for Global Health, School of Medicine, Technical University of Munich, Munich, Germany
| | - Annette Abraham
- Department of Neurology, Center for Global Health, School of Medicine, Technical University of Munich, Munich, Germany
- Centre for Global Health, Institute of Health and Society, University of Oslo, Oslo, Norway
| | - Miriam Kaminski
- Department of Psychiatry and Psychotherapy, Charité University Medical Center, Campus Benjamin Franklin, Berlin, Germany
| | - Veronika Schmidt
- Department of Neurology, Center for Global Health, School of Medicine, Technical University of Munich, Munich, Germany
- Centre for Global Health, Institute of Health and Society, University of Oslo, Oslo, Norway
| | - Robert De Meijere
- Department of Neurology, Center for Global Health, School of Medicine, Technical University of Munich, Munich, Germany
| | - Javier A Bustos
- Cysticercosis Unit, Instituto Nacional de Ciencias Neurológicas, Lima, Peru
| | - Hector Hugo Garcia
- Cysticercosis Unit, Instituto Nacional de Ciencias Neurológicas, Lima, Peru
| | | | - Branko Bobić
- Centre of Excellence for Food- and Vector-borne Zoonoses, Institute for Medical Research, National Institute of Republic of Serbia, University of Belgrade, Belgrade, Serbia
| | - Carmen Cretu
- Department of Parasitology, Carol Davila University of Medicine, Bucharest, Romania
| | - Peter Chiodini
- Hospital for Tropical Diseases, University College London Hospitals, London, UK
- Diagnostic Parasitology Laboratory, London School of Hygiene and Tropical Medicine, London, UK
| | - Veronique Dermauw
- Department of Biomedical Sciences, Institute of Tropical Medicine, Antwerp, Belgium
| | - Brecht Devleesschauwer
- Department of Epidemiology and Public Health, Sciensano, Brussels, Belgium
- Department of Translational Physiology, Infectiology and Public Health, Faculty of Veterinary Medicine, Ghent University, Belgium
| | - Pierre Dorny
- Department of Biomedical Sciences, Institute of Tropical Medicine, Antwerp, Belgium
| | - Ana Fonseca
- Public Health Department, NOVA Medical School, NOVA University of Lisbon, Lisbon, Portugal
| | - Sarah Gabriël
- Department of Translational Physiology, Infectiology and Public Health, Faculty of Veterinary Medicine, Ghent University, Belgium
| | - Maria Ángeles Gómez Morales
- Department of Infectious Diseases, European Union Reference Laboratory for Parasites, Istituto Superiore di Sanità, Rome, Italy
| | - Minerva Laranjo-González
- IRTA, Centre de Recerca en Sanitat Animal (CReSA, IRTA-UAB), Campus de la UAB, Bellaterra (Cerdanyola del Vallès), Spain
| | - Achim Hoerauf
- Institute of Medical Microbiology, Immunology and Parasitology (IMMIP), University Hospital Bonn, Bonn, Germany
- German Center for Infection Research (DZIF), Partner Site Bonn-Cologne, Cologne, Germany
| | - Ewan Hunter
- Department of Infection and Tropical Medicine, The Newcastle-upon-Tyne Hospitals NHS Foundation Trust, Newcastle upon Tyne, UK
| | - Ronan Jambou
- Global Health Department, Institut Pasteur, Paris, France
| | - Maja Jurhar-Pavlova
- Institute for Microbiology and Parasitology, Medical faculty, University "Ss. Cyril and Methodius", Skopje, Republic of North Macedonia
| | - Ingrid Reiter-Owona
- Institute of Medical Microbiology, Immunology and Parasitology (IMMIP), University Hospital Bonn, Bonn, Germany
| | - Smaragda Sotiraki
- Veterinary Research Institute, Hellenic Agricultural Organisation DIMITRA, Thessaloniki, Greece
| | - Chiara Trevisan
- Department of Biomedical Sciences, Institute of Tropical Medicine, Antwerp, Belgium
- Department of Translational Physiology, Infectiology and Public Health, Faculty of Veterinary Medicine, Ghent University, Belgium
| | - Manuela Vilhena
- MED-Instituto Mediterrâneo para a Agricultura, Ambiente e Desenvolvimento, Universidade de Évora, Évora, Portugal
| | - Naomi F Walker
- Hospital for Tropical Diseases, University College London Hospitals, London, UK
- Department of Clinical Sciences, Liverpool School of Tropical Medicine, Liverpool, UK
| | - Lorenzo Zammarchi
- Department of Experimental and Clinical Medicine, University of Florence, Florence, Italy
| | - Andrea Sylvia Winkler
- Department of Neurology, Center for Global Health, School of Medicine, Technical University of Munich, Munich, Germany
- Centre for Global Health, Institute of Health and Society, University of Oslo, Oslo, Norway
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Sharma K, Uniyal R, Garg RK, Verma R, Paliwal VK, Malhotra HS, Sharma PK, Kumar N, Pandey S, Rizvi I. Does Calcified Neurocysticercosis Affect Migraine Characteristics and Treatment Responsiveness? A Case-Control Study. Am J Trop Med Hyg 2022; 107:1190-1195. [PMID: 36216323 PMCID: PMC9768286 DOI: 10.4269/ajtmh.22-0335] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/19/2022] [Accepted: 07/25/2022] [Indexed: 12/30/2022] Open
Abstract
Recently, inflammation and free-radical release has been described in the surrounding brain parenchyma of seemingly inert calcified lesions of neurocysticercosis. These free radicals can induce migraine by stimulating calcitonin gene-related peptide release. This stipulated mechanism led us to hypothesize that calcified neurocysticercosis may increase migraine severity. This case-control study included patients (migraine with calcified neurocysticercosis) and control subjects (migraine without calcified neurocysticercosis) in a 1:1 ratio. Headache frequency, visual analog scale (VAS) score, and Migraine Disability Assessment (MIDAS) score were assessed at baseline and at the end of 3 months. To compare treatment responsiveness between patients and control subjects, we treated both groups identically so that difference in treatment would not confound the results. Each group comprised 78 patients. Baseline headache frequency (11.3 ± 3.3 versus 7.9 ± 3.4), VAS score (7.5 ± 1.1 versus 6.0 ± 1.2), and MIDAS score (15 ± 7.6 versus 9.6 ± 4.5) were significantly greater in patients than control subjects. Interestingly, the change from baseline to the end of 3 months in headache frequency (6.0 ± 1.7 versus 2.8 ± 1.4), VAS score (2.6 ± 0.02 versus 1.4 ± 0.01), and MIDAS score (8.3 ± 5.0 versus 3.6 ± 2.0) were significantly greater in patients than control subjects. Our study emphasizes that calcified lesions of neurocysticercosis are not inert, and cause an increase in the frequency and severity of migraine attacks. Interestingly, these patients also showed a better response to treatment with amitriptyline, possibly resulting from its anti-inflammatory action. Further studies are warranted to explore possible inflammatory mechanisms in calcified neurocysticercosis, which influences migraine physiology.
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Affiliation(s)
- Kamini Sharma
- Department of Neurology, King George Medical University, Lucknow, Uttar Pradesh, India
| | - Ravi Uniyal
- Department of Neurology, King George Medical University, Lucknow, Uttar Pradesh, India
| | - Ravindra Kumar Garg
- Department of Neurology, King George Medical University, Lucknow, Uttar Pradesh, India
| | - Rajesh Verma
- Department of Neurology, King George Medical University, Lucknow, Uttar Pradesh, India
| | - Vimal Kumar Paliwal
- Department of Neurology, Sanjay Gandhi Postgraduate Institute of Medical Sciences, Lucknow, Uttar Pradesh, India
| | | | - Praveen Kumar Sharma
- Department of Neurology, King George Medical University, Lucknow, Uttar Pradesh, India
| | - Neeraj Kumar
- Department of Neurology, King George Medical University, Lucknow, Uttar Pradesh, India
| | - Shweta Pandey
- Department of Neurology, King George Medical University, Lucknow, Uttar Pradesh, India
| | - Imran Rizvi
- Department of Neurology, King George Medical University, Lucknow, Uttar Pradesh, India
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Panda PK, Ramachandran A, Sharawat IK, Sherwani P, Bhat NK. Comparison of Seizure Characteristics and Recurrence Rates in Children with Viable Parenchymal Neurocysticercosis and Tuberculoma in India. Am J Trop Med Hyg 2022; 107:833-840. [PMID: 36037862 PMCID: PMC9651522 DOI: 10.4269/ajtmh.21-1298] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/16/2021] [Accepted: 06/20/2022] [Indexed: 11/07/2022] Open
Abstract
Inflammatory granulomas (neurocysticercosis [NCC] and tuberculomas) are important causes of seizures in children and adults in the developing world. Although several studies have explored seizure characteristics individually in patients with either NCC or tuberculoma, none has compared the seizure recurrence rate between them. This study included patients aged 5 to 18 years with viable parenchymal NCC or tuberculomas who had completed regular follow-up of at least 12 months at a tertiary institute in India. Their baseline seizure and electroencephalographic characteristics, antiseizure medications (ASMs), and breakthrough seizure rates at 12, 24, and 52 weeks were noted. A total of 103 and 54 patients with active NCC and tuberculomas respectively were included. The number of patients who had at least one breakthrough seizure at 12, 24, and 52 weeks in both groups was comparable (P = 0.32, 0.27, and 0.13), and the vast majority were controlled on monotherapy (98% cases in each group). The proportion of patients who required an increase in the dose or change of ASMs or polytherapy, the proportion of children who had status epilepticus at or before 12 months, abnormal electroencephalogram at 12 months, and calcified and active granuloma in neuroimaging at 12 months were also comparable between the two groups (P > 0.05 for all). The number of patients who had ASM-related adverse events and discontinued ASM due to serious adverse events was comparable between both groups, except for hepatotoxicity in the tuberculoma group. The predictors for breakthrough seizures that were found to be statistically significant in the NCC group were the presence of perilesional edema in the baseline magnetic resonance imaging (P = 0.02) and more than five active granulomas (P = 0.01); predictors in the tuberculoma group were the presence of severe perilesional edema causing midline shift in the baseline magnetic resonance imaging (P = 0.01) and more than five active granulomas (P = 0.04). The recurrence rates of breakthrough seizures over the next 12 months in newly detected cases of active NCC and tuberculomas were comparable.
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Affiliation(s)
- Prateek Kumar Panda
- Pediatric Neurology Division, Department of Pediatrics, All India Institute of Medical Sciences, Rishikesh, India
| | - Aparna Ramachandran
- Department of Neurology, IQRAA International Hospital & Research Centre, Kozhikode, Kerala, India
| | - Indar Kumar Sharawat
- Pediatric Neurology Division, Department of Pediatrics, All India Institute of Medical Sciences, Rishikesh, India
| | - Poonam Sherwani
- Department of Radiodiagnosis and Imaging, All India Institute of Medical Sciences, Rishikesh, India
| | - Nowneet Kumar Bhat
- Department of Pediatrics, All India Institute of Medical Sciences, Rishikesh, India
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Özer Balin Ş, Enez M, Akbulut A, Çalık M, Akgün B, Balgetir F, Yıldırım H. [A Histopathologically Diagnosed Neurocysticercosis Case from Türkiye]. MIKROBIYOL BUL 2022; 56:755-762. [PMID: 36458721 DOI: 10.5578/mb.20229613] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/17/2023]
Abstract
Cysticercosis is a parasitic tissue infection caused by larval cysts of Taenia solium. Although the disease affects many tissues, it primarily affects the brain and muscles. The most common form is neurocysticercosis, a term used for human central nervous system involvement with T.solium cysts. Neurocysticercosis is an important public health problem in many parts of the world. Its prevalence is particularly high in places where T.solium tapeworms are common, such as Mexico, Central America, South America, Southeast Asia, Africa, China, India, and Nepal. Its incidence has been increasing rapidly in recent years in non-endemic countries, due to both import and local cases, while in some highly endemic areas, numbers appear to have decreased, possibly due to better sanitation and increased public awareness. It is extremely rare in Türkiye. Cysticercosis is usually caused by drinking water or eating food containing tapeworm eggs. Clinical manifestations can range from completely asymptomatic infection to severe illness or death. Although the infection can involve any part of the central nervous system, symptomatic patients mostly have spinal cord involvement, intracerebral lesion, intraventricular cyst or subarachnoid lesion. An intraparenchymal cerebral cyst typically grows slowly and causes minimal symptoms for years or decades after the onset of infection. The site of involvement and the symptoms experienced determine the diagnosis and treatment method. The current general consensus supports antihelmintic and corticosteroid therapy for viable parenchymal lesions. In this report, a neurocysticercosis case with a single brain lesion that was surgically removed and histologically examined was presented. The patient had complaints of lisp in the tongue, numbness in the lips and left face. The patient had no concomitant chronic disease. The patient did not have a travel history or a history of eating pork but had a history of contact with a dead pig two months ago. Upon detection of a central mass in the brain computed tomography examination, surgical procedure was performed on the patient. Based on the identification of a larval stage of T.solium in biopsy material neurocysticercosis was diagnosed. However, histopathologically demonstration of the parasite is not possible in most cases. The patient received an antiparasitic treatment with albendazole 1000 mg/d in combination with dexamethasone. The patient was successfully treated and is still being followed up by calling for controls.
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Affiliation(s)
- Şafak Özer Balin
- Fırat University Faculty of Medicine, Department of Infectious Diseases and Clinical Microbiology, Elazığ, Türkiye
| | - Murat Enez
- Fırat University Faculty of Medicine, Department of Infectious Diseases and Clinical Microbiology, Elazığ, Türkiye
| | - Ayhan Akbulut
- Fırat University Faculty of Medicine, Department of Infectious Diseases and Clinical Microbiology, Elazığ, Türkiye
| | - Muhammet Çalık
- Fırat University Faculty of Medicine, Department of Pathology, Elazığ, Türkiye
| | - Bekir Akgün
- Fırat University Faculty of Medicine, Department of Neurosurgery, Elazığ, Türkiye
| | - Ferhat Balgetir
- Fırat University Faculty of Medicine, Department of Neurology, Elazığ, Türkiye
| | - Hanefi Yıldırım
- Fırat University Faculty of Medicine, Department of Radiology, Elazığ, Türkiye
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Thang TD, Phuc TQ, Thanh DT, Thieu NQ, Tho TH, Loi CB, Tran-Anh L. Efficacy and safety of praziquantel in the treatment of neurocysticercosis in Vietnam. Trop Biomed 2022; 39:462-466. [PMID: 36214445 DOI: 10.47665/tb.39.3.018] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/16/2023]
Abstract
Neurocysticercosis (NCC) is a parasitic infection of the nervous system and is responsible for considerable morbidity and mortality. Praziquantel (PZQ) is one of the antiparasitics mostly used in managing NCC, however, there have been only a few studies on the treatment outcome of this drug. The present study aimed to evaluate the efficacy and safety of PZQ in patients with NCC. Sixty patients with typical characteristics of NCC received three 10-day cycles of PZQ and the interruption between these cycles was 10 days. Additional treatment included antiinflammation (steroids), antiepileptics and analgesics. Clinical and imaging studies were done at baseline and six months after therapy to assess the efficacy of treatment. Laboratory evaluation was done before and after each cycle to investigate laboratory safety profiles. By six months after finishing therapy, all patients had clinical improvement and 75% of them were free of symptoms. The rates of complete, partial or no resolution of cysts on brain magnetic resonance imaging were 61.7%, 28.3% and 10% respectively. The efficacy of therapy was not associated with the number of cysts. There was no difference between the levels of aspartate aminotransferase, alanine aminotransferase, urea and creatinine before and after treatment. Conclusion: Praziquantel is effective and safe in the treatment of patients with neurocysticercosis.
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Affiliation(s)
- T D Thang
- Thai Thuong Hoang hospital, Vinh, Nghe An, Vietnam
| | - T Q Phuc
- National Institute of Malaria, Parasitology and Entomology, Ha Noi, Vietnam
| | - D T Thanh
- National Institute of Malaria, Parasitology and Entomology, Ha Noi, Vietnam
| | - N Q Thieu
- National Institute of Malaria, Parasitology and Entomology, Ha Noi, Vietnam
| | - T H Tho
- National Institute of Malaria, Parasitology and Entomology, Ha Noi, Vietnam
| | - C B Loi
- National Institute of Malaria, Parasitology and Entomology, Ha Noi, Vietnam
| | - L Tran-Anh
- Department of Parasitology, Vietnam Military Medical University, Ha Noi, Vietnam
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Arroyo G, Toribio L, Vargas-Calla A, Calcina JF, Bernal E, Chile N, Zambrano M, Gomez-Puerta LA, Chacaltana J, Marzal M, Bustos JA, Verastegui MR, Gilman RH, O’Neal SE, Gonzalez AE, Garcia HH. Porcine model of neurocysticercosis by intracarotid injection of Taenia solium oncospheres: Dose assessment, infection outcomes and serological responses. PLoS Negl Trop Dis 2022; 16:e0010449. [PMID: 35653367 PMCID: PMC9162370 DOI: 10.1371/journal.pntd.0010449] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/12/2022] [Accepted: 04/26/2022] [Indexed: 01/11/2023] Open
Abstract
BACKGROUND Neurocysticercosis (NCC) is the infection of the human central nervous system (CNS) by Taenia solium larvae that cause significant neurological morbidity. Studies on NCC pathophysiology, host-parasite interactions or therapeutic agents are limited by the lack of suitable animal models. We have previously reported that carotid injection of activated T. solium oncospheres directs parasites into the CNS and consistently reproduces NCC. This study assessed the minimal dose required to consistently obtain NCC by intracarotid oncosphere injection and compared antigen and antibody response profiles by dose-group. METHODS/PRINCIPAL FINDINGS Three groups of pigs were infected with either 2500 (n = 10), 5000 (n = 11), or 10000 (n = 10) oncospheres. Two pigs died during the study. Necropsy exam at day 150 post-infection (PI) demonstrated viable NCC in 21/29 pigs (72.4%), with higher NCC rates with increasing oncosphere doses (4/9 [44.4%], 9/11 [81.8%] and 8/9 [88.9%] for 2500, 5000, and 10000 oncospheres respectively, P for trend = 0.035). CNS cyst burden was also higher in pigs with increasing doses (P for trend = 0.008). Viable and degenerated muscle cysticerci were also found in all pigs, with degenerated cysticerci more frequent in the 2500 oncosphere dose-group. All pigs were positive for circulating parasite antigens on ELISA (Ag-ELISA) from day 14 PI; circulating antigens markedly increased at day 30 PI and remained high with plateau levels in pigs infected with either 5000 or 10000 oncospheres, but not in pigs infected with 2500 oncospheres. Specific antibodies appeared at day 30 PI and were not different between dose-groups. CONCLUSION/SIGNIFICANCE Intracarotid injection of 5000 or more oncospheres produces high NCC rates in pigs with CNS cyst burdens like those usually found in human NCC, making this model appropriate for studies on the pathogenesis of NCC and the effects of antiparasitic treatment.
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Affiliation(s)
- Gianfranco Arroyo
- Center for Global Health, Universidad Peruana Cayetano Heredia, Lima, Peru
- Cysticercosis Unit, Instituto Nacional de Ciencias Neurologicas, Lima, Peru
| | - Luz Toribio
- Center for Global Health, Universidad Peruana Cayetano Heredia, Lima, Peru
- * E-mail:
| | - Ana Vargas-Calla
- Faculty of Veterinary Medicine, Universidad Nacional Mayor de San Marcos, Lima, Peru
| | - Juan F. Calcina
- Faculty of Veterinary Medicine, Universidad Nacional Mayor de San Marcos, Lima, Peru
| | - Edson Bernal
- Infectious Diseases Laboratory Research-LID, Faculty of Sciences and Philosophy, Universidad Peruana Cayetano Heredia, Lima, Peru
| | - Nancy Chile
- Infectious Diseases Laboratory Research-LID, Faculty of Sciences and Philosophy, Universidad Peruana Cayetano Heredia, Lima, Peru
| | - Miguel Zambrano
- Faculty of Veterinary Medicine, Universidad Nacional Mayor de San Marcos, Lima, Peru
| | - Luis A. Gomez-Puerta
- Center for Global Health, Universidad Peruana Cayetano Heredia, Lima, Peru
- Faculty of Veterinary Medicine, Universidad Nacional Mayor de San Marcos, Lima, Peru
| | - Juan Chacaltana
- Department of Imaging Diagnosis, Instituto Nacional de Ciencias Neurologicas de Lima, Lima, Peru
| | - Miguel Marzal
- School of Medical Technology, Faculty of Medicine, 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
| | - Manuela R. Verastegui
- Infectious Diseases Laboratory Research-LID, Faculty of Sciences and Philosophy, Universidad Peruana Cayetano Heredia, Lima, Peru
| | - Robert H. Gilman
- Department of International Health, Bloomberg School of Public Health, Johns Hopkins University, Baltimore, Maryland, United States of America
| | - Seth E. O’Neal
- School of Public Health, Oregon Health & Sciences University-Portland State University, Portland, Oregon, United States of America
| | - Armando E. Gonzalez
- Faculty of Veterinary Medicine, Universidad Nacional Mayor de San Marcos, Lima, Peru
| | - Hector H. Garcia
- Center for Global Health, Universidad Peruana Cayetano Heredia, Lima, Peru
- Cysticercosis Unit, Instituto Nacional de Ciencias Neurologicas, Lima, Peru
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Ganaraja HV, Mahadevan A, Saini J, Nalini A, Pal PK, Satishchandra P, Netravathi M. Disseminated Cysticercosis in Indian Scenario - Experience from a Teaching University Hospital. Neurol India 2022; 70:1032-1040. [PMID: 35864635 DOI: 10.4103/0028-3886.349634] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/15/2023]
Abstract
BACKGROUND AND OBJECTIVES Neurocysticercosis (NCC) due to Taenia Solium is a major public health problem. Our objective was to study patients with disseminated cysticercosis (DCC) who had NCC in the brain along with an additional site in the body and assess their clinical, radiological profile, and response to therapy. MATERIALS AND METHODS A chart review of DCC with a high lesion load of NCC ≥20 (DNCC) in the brain was performed. RESULTS Sixteen (M:F = 13:3) patients were diagnosed with DNCC with a mean age of presentation of 35.1 ± 14.2 years. Headache was the predominant symptom, followed by seizures (93.75%), vomiting (43.75%), behavioral disturbances (31.25%), fever (12.5%), encephalopathy (12.5%), visual disturbances (6.25%), and muscle pain and limb weakness (6.25%). CT brain showed multiple active parenchymal cysts in all, and calcifications in 68.75%. MRI brain revealed involvement of cortex and subcortical structures in all, followed by cerebellum (81.25%) and brainstem (75%). Intramedullary spinal lesion was observed in 12.5% cases. Albendazole with steroids was used in 15 patients. In 93.3% patients, there was complete improvement in seizures; 12.5% subjects had persistent memory and behavioral abnormalities. One subject required decompressive craniectomy; mortality was observed in two subjects. CONCLUSIONS We hereby report one of the largest case series on disseminated cysticercosis with a high lesion load of NCC in the brain. A comprehensive clinical, imaging, therapeutic response with repeat imaging and long-term follow-up has given us a better understanding of this difficult-to-treat neurological disorder. We suggest cautious use of anti-parasitic therapy under the cover of corticosteroids to prevent irreversible neurological sequelae.
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Affiliation(s)
- Harikrishna V Ganaraja
- Department of Neurology, National Institute of Mental Health and Neurosciences (NIMHANS), Bengaluru, Karnataka, India
| | - Anita Mahadevan
- Department of Neuropathology, National Institute of Mental Health and Neurosciences (NIMHANS), Bengaluru, Karnataka, India
| | - Jitender Saini
- Department of Neuroimaging and Interventional Neuroradiology (NIIR), National Institute of Mental Health and Neurosciences (NIMHANS), Bengaluru, Karnataka, India
| | - Atchayaram Nalini
- Department of Neurology, National Institute of Mental Health and Neurosciences (NIMHANS), Bengaluru, Karnataka, India
| | - Pramod K Pal
- Department of Neurology, National Institute of Mental Health and Neurosciences (NIMHANS), Bengaluru, Karnataka, India
| | - Parthasarathy Satishchandra
- Department of Neurology, National Institute of Mental Health and Neurosciences (NIMHANS), Bengaluru, Karnataka, India
| | - Manjunath Netravathi
- Department of Neurology, National Institute of Mental Health and Neurosciences (NIMHANS), Bengaluru, Karnataka, India
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Bhattarai S, Thapa L, Maharjan AM, Shrestha AM, Shrestha S, Ghimire MR, Upadhyaya S, Thapa M. Impact of Albendazole Therapy on Clinical and Radiological Outcomes at One Month in Patients with Active Solitary Neurocysticercosis Patients. Kathmandu Univ Med J (KUMJ) 2022; 20:61-65. [PMID: 36273293] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/16/2023]
Abstract
Background Cerebral neurocysticerosis is a common parasitic disease of human nervous system but evidence on duration of albendazole therapy and their outcomes in this condition is inadequate Objective To evaluate the impact of varying duration of albendazole therapy on the clinical and radiological outcomes at one month in patients with active solitary neurocysticercosis. Method This is an interventional study conducted at Upendra Devkota Memorial National Institute of Neurological and Allied sciences, Bansbari over 1 year (2017 March - 2018 February). One hundred eighteen patients with new onset seizure secondary to active solitary cysticercal granuloma either received albendazole therapy for 1, 3, 9 or 21 days with the usual care or only received the usual care. Clinical and radiological outcomes were observed at one month follow-up. The difference in the proportion of the outcome measures between intervention and control groups were assessed using chi-square test. Result Our study included 118 patients with male predominance of 61.9%. Albendazole therapy for 3, 9 and 21 days reduced headache by 57.2%, 70.0% and 63.1% respectively which was higher than those with 1-day therapy or without the therapy. This difference in the proportion was statistically significant at p=0.001. Though seizure recurrence also declined but the difference was not significant (p=0.406) between groups. However, at one-month follow-up, majority of patients who received albendazole for 9 days (14, 70%) and 21 days (14, 73.7%) had normal lesion, while most calcified lesion (21, 67.7%) was observed in those who did not receive albendazole therapy. The difference between lesion among the groups was significant (p < 0.001). Conclusion Albendazole therapy in patients with active solitary neurocysticercosis for 9 days is as effective as 21 days and better than 3 days in headache control and lesion dissolution but seizure control could be achieved irrespective of the treatment.
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Affiliation(s)
- S Bhattarai
- Department of Neurology, Upendra Devkota Memorial National Institute of Neurological and Allied Sciences, Bansbari, Kathmandu, Nepal
| | - L Thapa
- Department of Neurology, Upendra Devkota Memorial National Institute of Neurological and Allied Sciences, Bansbari, Kathmandu, Nepal
| | - A Ms Maharjan
- Department of Neurology, Upendra Devkota Memorial National Institute of Neurological and Allied Sciences, Bansbari, Kathmandu, Nepal
| | - A M Shrestha
- Department of Neurology, Upendra Devkota Memorial National Institute of Neurological and Allied Sciences, Bansbari, Kathmandu, Nepal
| | - S Shrestha
- Department of Neurology, Upendra Devkota Memorial National Institute of Neurological and Allied Sciences, Bansbari, Kathmandu, Nepal
| | - M R Ghimire
- Department of Neurology, Upendra Devkota Memorial National Institute of Neurological and Allied Sciences, Bansbari, Kathmandu, Nepal
| | - S Upadhyaya
- Department of Neurology, Upendra Devkota Memorial National Institute of Neurological and Allied Sciences, Bansbari, Kathmandu, Nepal
| | - M Thapa
- Department of Neurology, Upendra Devkota Memorial National Institute of Neurological and Allied Sciences, Bansbari, Kathmandu, Nepal
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Affiliation(s)
- Andrew J Cole
- From the Departments of Neurology (A.J.C.), Emergency Medicine (J.E.S.), Medicine (E.T.R.), Radiology (M.H.L.), and Pathology (G.E.), Massachusetts General Hospital, and the Departments of Neurology (A.J.C.), Emergency Medicine (J.E.S.), Medicine (E.T.R.), Radiology (M.H.L.), and Pathology (G.E.), Harvard Medical School - both in Boston
| | - Jonathan E Slutzman
- From the Departments of Neurology (A.J.C.), Emergency Medicine (J.E.S.), Medicine (E.T.R.), Radiology (M.H.L.), and Pathology (G.E.), Massachusetts General Hospital, and the Departments of Neurology (A.J.C.), Emergency Medicine (J.E.S.), Medicine (E.T.R.), Radiology (M.H.L.), and Pathology (G.E.), Harvard Medical School - both in Boston
| | - Edward T Ryan
- From the Departments of Neurology (A.J.C.), Emergency Medicine (J.E.S.), Medicine (E.T.R.), Radiology (M.H.L.), and Pathology (G.E.), Massachusetts General Hospital, and the Departments of Neurology (A.J.C.), Emergency Medicine (J.E.S.), Medicine (E.T.R.), Radiology (M.H.L.), and Pathology (G.E.), Harvard Medical School - both in Boston
| | - Michael H Lev
- From the Departments of Neurology (A.J.C.), Emergency Medicine (J.E.S.), Medicine (E.T.R.), Radiology (M.H.L.), and Pathology (G.E.), Massachusetts General Hospital, and the Departments of Neurology (A.J.C.), Emergency Medicine (J.E.S.), Medicine (E.T.R.), Radiology (M.H.L.), and Pathology (G.E.), Harvard Medical School - both in Boston
| | - George Eng
- From the Departments of Neurology (A.J.C.), Emergency Medicine (J.E.S.), Medicine (E.T.R.), Radiology (M.H.L.), and Pathology (G.E.), Massachusetts General Hospital, and the Departments of Neurology (A.J.C.), Emergency Medicine (J.E.S.), Medicine (E.T.R.), Radiology (M.H.L.), and Pathology (G.E.), Harvard Medical School - both in Boston
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18
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Bustos JA, Arroyo G, Gilman RH, Soto-Becerra P, Gonzales I, Saavedra H, Pretell EJ, Nash TE, O’Neal SE, Del Brutto OH, Gonzalez AE, Garcia HH. Frequency and Determinant Factors for Calcification in Neurocysticercosis. Clin Infect Dis 2021; 73:e2592-e2600. [PMID: 32556276 PMCID: PMC8563199 DOI: 10.1093/cid/ciaa784] [Citation(s) in RCA: 20] [Impact Index Per Article: 6.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/06/2020] [Accepted: 06/11/2020] [Indexed: 11/14/2022] Open
Abstract
BACKGROUND Neurocysticercosis is a major cause of acquired epilepsy. Larval cysts in the human brain eventually resolve and either disappear or leave a calcification that is associated with seizures. In this study, we assessed the proportion of calcification in parenchymal neurocysticercosis and risk factors associated with calcification. METHODS Data for 220 patients with parenchymal NCC from 3 trials of antiparasitic treatment were assessed to determine what proportion of the cysts that resolved 6 months after treatment ended up in a residual calcification at 1 year. Also, we evaluated the risk factors associated with calcification. RESULTS The overall proportion of calcification was 38% (188/497 cysts, from 147 patients). Predictors for calcification at the cyst level were cysts larger than 14 mm (risk ratio [RR], 1.34; 95% confidence interval [CI], 1.02-1.75) and cysts with edema at baseline (RR, 1.39; 95% CI, 1.05-1.85). At the patient level, having had more than 24 months with seizures (RR, 1.25; 95% CI, 1.08-1.46), mild antibody response (RR, 1.14; 95% CI, 1.002-1.27), increased dose albendazole regime (RR, 1.26; 95% CI, 1.14-1.39), lower doses of dexamethasone (RR, 1.36; 95% CI, 1.02-1.81), not receiving early antiparasitic retreatment (RR, 1.45; 95% CI, 1.08-1.93), or complete cure (RR, 1.48; 95% CI, 1.29-1.71) were associated with a increased risk of calcification. CONCLUSIONS Approximately 38% of parenchymal cysts calcify after antiparasitic treatment. Some factors associated with calcification are modifiable and may be considered to decrease or avoid calcification, potentially decreasing the risk for seizure relapses.
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Affiliation(s)
- Javier A Bustos
- Cysticercosis Unit, Instituto Nacional de Ciencias Neurológicas, Lima, Perú
- Center for Global Health, School of Public Health and Management, and School of Sciences and Philosophy, Universidad Peruana Cayetano Heredia, Lima, Perú
| | - Gianfranco Arroyo
- Cysticercosis Unit, Instituto Nacional de Ciencias Neurológicas, Lima, Perú
- Center for Global Health, School of Public Health and Management, and School of Sciences and Philosophy, Universidad Peruana Cayetano Heredia, Lima, Perú
| | - Robert H Gilman
- Department of International Health, Bloomberg School of Public Health, Johns Hopkins University, Baltimore, Maryland, USA
| | - Percy Soto-Becerra
- Center for Global Health, School of Public Health and Management, and School of Sciences and Philosophy, Universidad Peruana Cayetano Heredia, Lima, Perú
| | - Isidro Gonzales
- Cysticercosis Unit, Instituto Nacional de Ciencias Neurológicas, Lima, Perú
| | - Herbert Saavedra
- Cysticercosis Unit, Instituto Nacional de Ciencias Neurológicas, Lima, Perú
| | - E Javier Pretell
- Cysticercosis Unit, Instituto Nacional de Ciencias Neurológicas, Lima, Perú
- Department of Neurology, Hospital Alberto Sabogal, Callao, Perú
| | - Theodore E Nash
- Laboratory of Parasitic Diseases, National Institute of Allergy and Infectious Diseases, National Institutes of Health, Bethesda, Maryland, USA
| | - Seth E O’Neal
- Center for Global Health, School of Public Health and Management, and School of Sciences and Philosophy, Universidad Peruana Cayetano Heredia, Lima, Perú
- School of Public Health, Oregon Health and Science University and Portland State University, Portland, Oregon, USA
| | - Oscar H Del Brutto
- School of Medicine, Universidad Espíritu Santo–Ecuador, Samborondón, Ecuador
| | - Armando E Gonzalez
- Center for Global Health, School of Public Health and Management, and School of Sciences and Philosophy, Universidad Peruana Cayetano Heredia, Lima, Perú
| | - Hector H Garcia
- Cysticercosis Unit, Instituto Nacional de Ciencias Neurológicas, Lima, Perú
- Center for Global Health, School of Public Health and Management, and School of Sciences and Philosophy, Universidad Peruana Cayetano Heredia, Lima, Perú
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Abstract
BACKGROUND Neurocysticercosis is the most common parasitic infection of the brain. Epilepsy is the most common clinical presentation, though people may also present with headache, symptoms of raised intracranial pressure, hydrocephalus, and ocular symptoms depending upon the localisation of the parasitic cysts. Anthelmintic drugs, antiepileptic drugs (AEDs), and anti-oedema drugs, such as steroids, form the mainstay of treatment. This is an updated version of the Cochrane Review previously published in 2019. OBJECTIVES To assess the effects (benefits and harms) of AEDs for the primary and secondary prevention of seizures in people with neurocysticercosis. For the question of primary prevention, we examined whether AEDs reduce the likelihood of seizures in people who had neurocysticercosis but had not had a seizure. For the question of secondary prevention, we examined whether AEDs reduce the likelihood of further seizures in people who had had at least one seizure due to neurocysticercosis. As part of primary prevention studies, we also aimed to examine which AED was beneficial in people with neurocysticercosis in terms of duration, dose, and side-effect profile. SEARCH METHODS For the 2021 update of this review, we searched the Cochrane Register of Studies (CRS Web), MEDLINE, and LILACS to January 2021. CRS Web includes randomised or quasi-randomised, controlled trials from CENTRAL, the Specialised Registers of Cochrane Review Groups, including Epilepsy, PubMed, Embase, ClinicalTrials.gov, and the World Health Organisation International Clinical Trials Registry Platform. We also checked the reference lists of identified studies, and contacted experts and colleagues in the field to search for additional and ongoing studies. SELECTION CRITERIA Randomised and quasi-randomised controlled trials. Single-blind, double-blind, or unblinded studies were eligible for inclusion. DATA COLLECTION AND ANALYSIS We followed standard methodological procedures expected by Cochrane. Two review authors independently selected trials for inclusion and extracted the relevant data. The primary outcomes of interest were: proportion of individuals experiencing seizures, and time to first seizure post randomisation. Secondary outcomes included: seizure freedom, number of withdrawals, side effects, number of people seizure free with short or long durations of treatment, quality of life, therapy costs, hospitalisations, and mortality. We used an intention-to-treat analysis for the primary analysis. We calculated odds ratio (OR) for dichotomous data (proportion of individuals who experienced seizures, were seizure free for a specific time period (12 or 24 months), withdrew from treatment, developed drug-related side effects or complications, were seizure-free with each treatment policy, mortality), and planned to use mean difference (MD) for continuous data, if any continuous data were identified (quality of life, cost of treatment). We intended to evaluate time to first seizure after randomisation by calculating hazard ratios (HRs). We assessed precision using 95% confidence intervals (CIs). We stratified the analysis by treatment comparison. We also considered the duration of drug usage, co-medications, and the length of follow-up. MAIN RESULTS We did not find any trials that investigated the role of AEDs in preventing seizures among people with neurocysticercosis, presenting with symptoms other than seizures. We did not find any trials that directly compared individual AEDs for primary prevention in people with neurocysticercosis. We included four trials that evaluated the efficacy of short-term versus longer-term AED treatment for people with solitary neurocysticercosis (identified on computed tomography (CT) scan) who presented with seizures. In total, 466 people were enrolled. These studies compared AED treatment durations of 6, 12, and 24 months. The risk of seizure recurrence with six months of treatment compared with 12 to 24 months of treatment was inconclusive (odds ratio (OR) 1.34, 95% confidence interval (CI) 0.73 to 2.47; three studies, 360 participants; low-certainty evidence). The risk of seizure recurrence with six to 12 months of treatment compared with 24 months of treatment was inconclusive (OR 1.36, 95% CI 0.72 to 2.57; three studies, 385 participants; very low-certainty evidence). Two studies compared seizure recurrence with CT findings, and suggested that persistent and calcified lesions had a higher recurrence risk, and suggest longer duration of treatment with AEDs. One study reported no side effects, while the rest did not comment on side effects of the drugs. None of the studies addressed the quality of life of the participants. These studies had methodological deficiencies, such as small sample sizes, and a possibility of bias due to lack of blinding, which affect the results of the review. AUTHORS' CONCLUSIONS Despite neurocysticercosis being the most common cause of epilepsy worldwide, there is currently no evidence available regarding the use of AEDs as seizure prophylaxis among people presenting with symptoms other than seizures. For those presenting with seizures, there is no reliable evidence regarding the duration of treatment required. Therefore, there is a need for large scale randomised controlled trials to address these questions.
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Affiliation(s)
- Dean Walton
- Department of Neurology, The Walton Centre NHS Foundation Trust, Liverpool, UK
| | - Hannah Castell
- Department of Neurology, The Walton Centre NHS Foundation Trust, Liverpool, UK
| | - Ceryce Collie
- Department of Neurology, The Walton Centre NHS Foundation Trust, Liverpool, UK
| | - Greta Karen Wood
- Department of Neurology, The Walton Centre NHS Foundation Trust, Liverpool, UK
| | - Monika Sharma
- Department of Pediatrics, Christian Medical College, Ludhiana, India
| | - Tejinder Singh
- Department of Pediatrics, SGRD Institute of Medical Sciences and Research, Amritsar, India
| | - Benedict D Michael
- Department of Neurology, The Walton Centre NHS Foundation Trust, Liverpool, UK
- Clinical Infection Microbiology and Neuroimmunology, Institute of Infection, Veterinary and Ecological Science, Liverpool, UK
- NIHR Health Protection Research Unit for Emerging and Zoonotic Infection, Liverpool, UK
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20
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Abstract
BACKGROUND Neurocysticercosis is the most common parasitic infection of the brain. Epilepsy is the most common clinical presentation, though people may also present with headache, symptoms of raised intracranial pressure, hydrocephalus, and ocular symptoms depending upon the localisation of the parasitic cysts. Anthelmintic drugs, antiepileptic drugs (AEDs), and anti-oedema drugs, such as steroids, form the mainstay of treatment. This is an updated version of the Cochrane Review previously published in 2019. OBJECTIVES To assess the effects (benefits and harms) of AEDs for the primary and secondary prevention of seizures in people with neurocysticercosis. For the question of primary prevention, we examined whether AEDs reduce the likelihood of seizures in people who had neurocysticercosis but had not had a seizure. For the question of secondary prevention, we examined whether AEDs reduce the likelihood of further seizures in people who had had at least one seizure due to neurocysticercosis. As part of primary prevention studies, we also aimed to examine which AED was beneficial in people with neurocysticercosis in terms of duration, dose, and side-effect profile. SEARCH METHODS For the 2021 update of this review, we searched the Cochrane Register of Studies (CRS Web), MEDLINE, and LILACS to January 2021. CRS Web includes randomised or quasi-randomised, controlled trials from CENTRAL, the Specialised Registers of Cochrane Review Groups, including Epilepsy, PubMed, Embase, ClinicalTrials.gov, and the World Health Organisation International Clinical Trials Registry Platform. We also checked the reference lists of identified studies, and contacted experts and colleagues in the field to search for additional and ongoing studies. SELECTION CRITERIA Randomised and quasi-randomised controlled trials. Single-blind, double-blind, or unblinded studies were eligible for inclusion. DATA COLLECTION AND ANALYSIS We followed standard methodological procedures expected by Cochrane. Two review authors independently selected trials for inclusion and extracted the relevant data. The primary outcomes of interest were: proportion of individuals experiencing seizures, and time to first seizure post randomisation. Secondary outcomes included: seizure freedom, number of withdrawals, side effects, number of people seizure free with short or long durations of treatment, quality of life, therapy costs, hospitalisations, and mortality. We used an intention-to-treat analysis for the primary analysis. We calculated odds ratio (OR) for dichotomous data (proportion of individuals who experienced seizures, were seizure free for a specific time period (12 or 24 months), withdrew from treatment, developed drug-related side effects or complications, were seizure-free with each treatment policy, mortality), and planned to use mean difference (MD) for continuous data, if any continuous data were identified (quality of life, cost of treatment). We intended to evaluate time to first seizure after randomisation by calculating hazard ratios (HRs). We assessed precision using 95% confidence intervals (CIs). We stratified the analysis by treatment comparison. We also considered the duration of drug usage, co-medications, and the length of follow-up. MAIN RESULTS We did not find any trials that investigated the role of AEDs in preventing seizures among people with neurocysticercosis, presenting with symptoms other than seizures. We did not find any trials that directly compared individual AEDs for primary prevention in people with neurocysticercosis. We included four trials that evaluated the efficacy of short-term versus longer-term AED treatment for people with solitary neurocysticercosis (identified on computed tomography (CT) scan) who presented with seizures. In total, 466 people were enrolled. These studies compared AED treatment durations of 6, 12, and 24 months. The risk of seizure recurrence with six months of treatment compared with 12 to 24 months of treatment was inconclusive (odds ratio (OR) 1.34, 95% confidence interval (CI) 0.73 to 2.47; three studies, 360 participants; low-certainty evidence). The risk of seizure recurrence with six to 12 months of treatment compared with 24 months of treatment was inconclusive (OR 1.36, 95% CI 0.72 to 2.57; three studies, 385 participants; very low-certainty evidence). Two studies compared seizure recurrence with CT findings, and suggested that persistent and calcified lesions had a higher recurrence risk, and suggest longer duration of treatment with AEDs. One study reported no side effects, while the rest did not comment on side effects of the drugs. None of the studies addressed the quality of life of the participants. These studies had methodological deficiencies, such as small sample sizes, and a possibility of bias due to lack of blinding, which affect the results of the review. AUTHORS' CONCLUSIONS Despite neurocysticercosis being the most common cause of epilepsy worldwide, there is currently no evidence available regarding the use of AEDs as seizure prophylaxis among people presenting with symptoms other than seizures. For those presenting with seizures, there is no reliable evidence regarding the duration of treatment required. Therefore, there is a need for large scale randomised controlled trials to address these questions.
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Affiliation(s)
- Dean Walton
- Department of Neurology, The Walton Centre NHS Foundation Trust, Liverpool, UK
| | - Hannah Castell
- Department of Neurology, The Walton Centre NHS Foundation Trust, Liverpool, UK
| | - Ceryce Collie
- Department of Neurology, The Walton Centre NHS Foundation Trust, Liverpool, UK
| | - Greta Karen Wood
- Department of Neurology, The Walton Centre NHS Foundation Trust, Liverpool, UK
| | - Monika Sharma
- Department of Pediatrics, Christian Medical College, Ludhiana, India
| | - Tejinder Singh
- Department of Pediatrics, SGRD Institute of Medical Sciences and Research, Amritsar, India
| | - Benedict D Michael
- Department of Neurology, The Walton Centre NHS Foundation Trust, Liverpool, UK
- Clinical Infection Microbiology and Neuroimmunology, Institute of Infection, Veterinary and Ecological Science, Liverpool, UK
- NIHR Health Protection Research Unit for Emerging and Zoonotic Infection, Liverpool, UK
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Sankhyan N, Kadwa RA, Kamate M, Kannan L, Kumar A, Passi GR, Sharawat IK, Singhi P. Management of Neurocysticercosis in Children: Association of Child Neurology Consensus Guidelines. Indian Pediatr 2021; 58:871-880. [PMID: 34338221] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/13/2023]
Abstract
JUSTIFICATION Neurocysticercosis (NCC) is a significant problem in India and other developing countries; however, several aspects of this disease have no clear, practical guidelines. There is a need for pragmatic guidelines, summarizing the available evidence, and filling in the gaps in evidence with expert advice to manage children with neurocysticercosis. PROCESS An expert group (16 members) and a writing group (8 members) was constituted, consisting of members with varied expertise. It included pediatric neurologists (18), neurologist (1), Neuroradiologists (4), and a parasitologist (1). The writing group divided the six topics and reviewed the literature on the topics individually to determine the clinical questions for which no clear guidance was available from the literature. The experts were then contacted and opinions were obtained online. The Delphi consensus method was adopted to arrive at a general consensus regarding various questions, with both the experts and the writing group members contributing. The final guidelines were then drafted by the writing group. RECOMMENDATIONS Diagnosis of NCC should be based on clinical history and neuroimaging. Contrast-enhanced magnetic resonance imaging of the brain is the modality of choice. For single enhancing lesion, albendazole therapy for 10-14 days is recommended, and it should be combined with praziquantel for 10-14 days for more than one ring-enhancing lesions. For persistent lesion, the same dose and duration of albendazole or concurrent administration of albendazole and praziquantel should be given. Pulse intravenous steroids should be used to reduce the acute symptomatic edema in children with cysticercal encephalitis. Carbamazepine or oxcarbazepine are best suited for seizure prophylaxis for those who present with seizures; phenytoin and levetiracetam are the other alternatives. In the case of NCC presenting with symptoms other than seizures, there appears to be no role for routine anti-seizure medication prophylaxis. For a single ring-enhancing lesion, six months of anti-seizure medication is sufficient if the lesion resolves on follow-up. Those with persistent lesions, calcification, or multiple lesions, require a longer treatment duration of at least 24 months.
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Affiliation(s)
- Naveen Sankhyan
- Pediatric Neurology Unit, Department of Pediatrics, Post Graduate Institute of Medical Education and Research, Chandigarh
| | - Razia Adam Kadwa
- Department of Pediatrics, Ankura Hospital for Women and Children, Hyderabad, Telangana
| | - Mahesh Kamate
- Division of Pediatric Neurology, Department of Pediatrics, KAHER's Jawaharlal Nehru Medical College, Belagavi, Belgaum, Karnataka
| | | | - Atin Kumar
- Department of Radiodiagnosis and Imaging, All India Institute of Medical Sciences, New Delhi
| | - Gouri Rao Passi
- Pediatric Neurology Division, Department of Pediatrics, Choithram Hospital and Research Centre, Indore, Madhya Pradesh
| | - Indar Kumar Sharawat
- Pediatric Neurology Division, Department of Pediatrics, All India Institute of Medical Sciences, Rishikesh, Uttarakhand
| | - Pratibha Singhi
- Pediatric Neurology and Neurodevelopment, Medanta the Medicity, Gurugram, Haryana. Correspondence to: Prof Pratibha Singhi, Professor and Chief, Pediatric Neurology and Neurodevelopment, Medanta the Medicity, Gurugram, India.
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22
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Abstract
BACKGROUND Neurocysticercosis is a parasitic infection of the central nervous system by the larval stage of the pork tapeworm and is a common cause of seizures and epilepsy in endemic areas. Anthelmintics (albendazole or praziquantel) may be given alongside supportive treatment (antiepileptics/analgesia) with the aim of killing these larvae (cysticerci), with or without corticosteroid treatment. However, there are potential adverse effects of these drugs, and the cysticerci may eventually die without directed anthelminthic treatment. OBJECTIVES To assess the effects of anthelmintics on people with neurocysticercosis. SEARCH METHODS We searched the Cochrane Infectious Diseases Group Specialized Register, the Cochrane Central Register of Controlled Trials (CENTRAL), MEDLINE, Embase, LILACS, the WHO ICTRP, and ClinicalTrials.gov, up to 21 October 2020. SELECTION CRITERIA Randomized controlled trials comparing anthelmintics and supportive treatment (+/- corticosteroids) with supportive treatment alone (+/- corticosteroids) for people with neurocysticercosis. DATA COLLECTION AND ANALYSIS Two review authors independently screened the title and abstract of all articles identified by the search. We obtained full-text articles to confirm the eligibility of all studies that passed screening. One review author extracted data, which a second review author checked. Two review authors assessed the risk of bias of each trial and performed GRADE assessments. In cases of disagreement at consensus discussion stage between review authors, we consulted a third review author. We calculated risk ratios (RR) for dichotomous variables, with 95% confidence intervals (CIs) for pooled data from studies with similar interventions and outcomes. MAIN RESULTS We included 16 studies in the review. Only two studies investigated praziquantel and did not report data in a format that could contribute to meta-analysis. Most results in this review are therefore applicable to albendazole versus placebo or no anthelmintic. The aggregate analysis across all participants with neurocysticercosis did not demonstrate a difference between groups in seizure recurrence, but heterogeneity was marked (RR 0.94, 95% CI 0.78 to 1.14; 10 trials, 1054 participants; I2 = 67%; low-certainty evidence). When stratified by participants with a single cyst or multiple cysts, pooled analysis suggests that albendazole probably improves seizure recurrence for participants with a single cyst (RR 0.61, 95% CI 0.4 to 0.91; 5 trials, 396 participants; moderate-certainty evidence). All studies contributing to this analysis recruited participants with non-viable, intraparenchymal cysts only, and most participants were children. We are uncertain whether or not albendazole reduces seizure recurrence in participants with multiple cysts, as the certainty of the evidence is very low, although the direction of effect is towards albendazole causing harm (RR 2.05, 95% CI 1.28 to 3.31; 2 trials, 321 participants; very low-certainty evidence). This analysis included a large study containing a highly heterogeneous population that received an assessment of unclear risk for multiple 'Risk of bias' domains. Regarding radiological outcomes, albendazole probably slightly improves the complete radiological clearance of lesions (RR 1.22, 95% CI 1.07 to 1.39; 13 trials, 1324 participants; moderate-certainty evidence) and the evolution of cysts (RR 1.27, 95% CI 1.10 to 1.47; 6 trials, 434 participants; moderate-certainty evidence). More adverse events appeared to be observed in participants treated with either albendazole or praziquantel compared to those receiving placebo or no anthelmintic. The most commonly reported side effects were headache, abdominal pain, and nausea/vomiting. AUTHORS' CONCLUSIONS For participants with a single cyst, there was less seizure recurrence in the albendazole group compared to the placebo/no anthelmintic group. The studies contributing to this evidence only recruited participants with a non-viable intraparenchymal cyst. We are uncertain whether albendazole reduces seizure recurrence for participants with multiple cysts. We also found that albendazole probably increases radiological clearance and evolution of lesions. There were very few studies reporting praziquantel outcomes, and these findings apply to albendazole only.
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Affiliation(s)
- Edward J M Monk
- Department of Clinical Sciences, Liverpool School of Tropical Medicine, Liverpool, UK
| | - Katharine Abba
- Department of Primary Care and Mental Health, University of Liverpool, Liverpool, UK
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23
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Ruíz Márquez MJ, Cabra Rodríguez R, Ruíz Márquez D. Reactivation of neurocysticercosis in patient under study on suspicion of dengue. Rev Esp Quimioter 2021; 34:162-163. [PMID: 33611883 PMCID: PMC8019458 DOI: 10.37201/req/128.2020] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Affiliation(s)
- M J Ruíz Márquez
- María José Ruíz Márquez. UGC de Análisis Clínicos. Área de Gestión Sanitaria Norte de Huelva. Spain.
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24
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Hanas JS, Hocker JRS, Evangeline B, Prabhakaran V, Oommen A, Rajshekhar V, Drevets DA, Carabin H. Distinguishing patients with idiopathic epilepsy from solitary cysticercus granuloma epilepsy and biochemical phenotype assessment using a serum biomolecule profiling platform. PLoS One 2020; 15:e0237064. [PMID: 32823271 PMCID: PMC7527271 DOI: 10.1371/journal.pone.0237064] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/13/2020] [Accepted: 06/24/2020] [Indexed: 11/19/2022] Open
Abstract
A major source of epilepsy is Neurocysticercosis (NCC), caused by Taenia solium infection. Solitary cysticercus granuloma (SCG), a sub-group of NCC induced epilepsy, is the most common form of NCC in India. Current diagnostic criteria for SCG epilepsy require brain imaging which may not be available in communities where the disease is endemic. Identification of serum changes and potential biomolecules that could distinguish SCG epilepsy from idiopathic generalized epilepsy (IE), without the initial need for imaging, could assist in disease identification, understanding, and treatment. The objective here was to investigate, using mass spectrometry (MS), sera biomolecule differences between patients with SCG epilepsy or IE to help distinguish these disorders based on physiological differences, to understand underlying phenotypes and mechanisms, and to lay ground work for future therapeutic and biomarker analyses. Sera were obtained from patients with SCG or IE (N = 29 each group). Serum mass peak profiling was performed with electrospray ionization (ESI) MS, and mass peak area means in the two groups were compared using leave one [serum sample] out cross validation (LOOCV). Serum LOOCV analysis identified significant differences between SCG and IE patient groups (p = 10-20), which became non-significant (p = 0.074) when the samples were randomly allocated to the groups and reanalyzed. Tandem MS/MS peptide analysis of serum mass peaks from SCG or IE patients was performed to help identify potential peptide/protein biochemical and phenotypic changes involving these two forms of epilepsy. Bioinformatic analysis of these peptide/protein changes suggested neurological, inflammatory, seizure, blood brain barrier, cognition, ion channel, cell death, and behavior related biochemical systems were being altered in these disease states. This study provides groundwork for aiding in distinguishing SCG and IE patients in minimally invasive, lower-cost manners, for improving understanding of underlying epilepsy mechanisms, and for further identifying discriminatory biomarkers and potential therapeutic targets.
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Affiliation(s)
- Jay S. Hanas
- Department of Biochemistry, University of Oklahoma Health Sciences Center, Oklahoma City, OK, United States of America
| | - James Randolph Sanders Hocker
- Department of Biochemistry, University of Oklahoma Health Sciences Center, Oklahoma City, OK, United States of America
| | - Betcy Evangeline
- Department of Neurological Sciences, Christian Medical College, Vellore, India
| | | | - Anna Oommen
- Department of Neurological Sciences, Christian Medical College, Vellore, India
| | - Vedantam Rajshekhar
- Department of Neurological Sciences, Christian Medical College, Vellore, India
| | - Douglas A. Drevets
- Department of Internal Medicine, University of Oklahoma Health Sciences Center, and the Veterans Administration Medical Center, Oklahoma City, OK, United States of America
| | - Hélène Carabin
- Department of Biostatistics and Epidemiology, University of Oklahoma Health Sciences Center, Oklahoma City, OK, United States of America
- Department of Pathology and Microbiology, Faculty of Veterinary Medicine, Université de Montréal, Saint-Hyacinthe, Canada
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25
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Abstract
Taenia solium neurocysticercosis (NCC) is endemic in most of the world and contributes significantly to the burden of epilepsy and other neurological morbidity. Also present in developed countries because of immigration and travel, NCC is one of few diseases targeted for eradication. This paper reviews all aspects of its life cycle (taeniasis, porcine cysticercosis, human cysticercosis), with a focus on recent advances in its diagnosis, management, and control. Diagnosis of taeniasis is limited by poor availability of immunological or molecular assays. Diagnosis of NCC rests on neuroimaging findings, supported by serological assays. The treatment of NCC should be approached in the context of the particular type of infection (intra- or extraparenchymal; number, location, and stage of lesions) and has evolved toward combined symptomatic and antiparasitic management, with particular attention to modulating inflammation. Research on NCC and particularly the use of recently available genome data and animal models of infection should help to elucidate mechanisms of brain inflammation, damage, and epileptogenesis.
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Affiliation(s)
- Hector H Garcia
- Center for Global Health, Universidad Peruana Cayetano Heredia, Lima, Peru
- Cysticercosis Unit, Instituto Nacional de Ciencias Neurológicas, Lima, Peru
| | - Armando E Gonzalez
- Center for Global Health, Universidad Peruana Cayetano Heredia, Lima, Peru
- School of Veterinary Medicine, Universidad Nacional Mayor de San Marcos, Lima, Peru
| | - Robert H Gilman
- Department of International Health, Johns Hopkins School of Public Health, Baltimore, Maryland, USA
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Francisca PA, Javier LMF, Guadalupe PH, Fernanda GM, Nelly C, Helgi JC, Iliana GH, Susana RTI. Cysticidal activity of praziquantel-mebendazole combination: In vitro and in vivo studies. Acta Trop 2020; 202:105238. [PMID: 31669532 DOI: 10.1016/j.actatropica.2019.105238] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/26/2019] [Revised: 10/21/2019] [Accepted: 10/23/2019] [Indexed: 12/27/2022]
Abstract
The current pharmacological treatment of neurocysticercosis is based on two drugs, praziquantel (PZQ) and albendazole; however, suboptimal efficacy has been documented. Previous studies, have documented the activity of mebendazole (MBZ) against Taenia sp, and its capability to cross the blood-brain barrier. Considering this information and in an effort to search other options for neurocysticercosis treatment, the present study was designed to assess the in vitro and in vivo activity of the PZQ-MBZ combination against Taenia crassiceps metacestodes. For the in vitro studies T. crassiceps cysticerci (ORF strain) were used and the analysis of the combinations was performed using the Surface of Synergistic Interaction (SSI). For the in vivo evaluation the experimental infection model of T. crassiceps ORF in Balb-C mice was used. In vitro results showed that the combination of PZQ 121.6 nM-MBZ 5.1 nM exhibited the highest synergic cysticidal effect. In vivo, the PZQ-MBZ combination (25 mg/kg - 50 mg/kg, respectively) was more effective than each drug alone. The findings indicate that PZQ in combination with MBZ could be a promising alternative for the treatment of neurocysticercosis. Complementary studies are required to confirm its clinical applicability.
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Affiliation(s)
- Palomares-Alonso Francisca
- Laboratorio de Neuropsicofarmacología, Instituto Nacional de Neurología y Neurocirugía, C.P. 14269, Tlalpan, Ciudad de México, México
| | | | - Palencia Hernández Guadalupe
- Laboratorio de Neuroinmunología, Instituto Nacional de Neurología y Neurocirugía, C.P. 14269, Tlalpan, Ciudad de México, México
| | - Gurrusqueta-Miranda Fernanda
- Laboratorio de Neuropsicofarmacología, Instituto Nacional de Neurología y Neurocirugía, C.P. 14269, Tlalpan, Ciudad de México, México
| | - Castro Nelly
- Laboratorio de Neuropsicofarmacología, Instituto Nacional de Neurología y Neurocirugía, C.P. 14269, Tlalpan, Ciudad de México, México
| | - Jung-Cook Helgi
- Laboratorio de Neuropsicofarmacología, Instituto Nacional de Neurología y Neurocirugía, C.P. 14269, Tlalpan, Ciudad de México, México; Facultad de Química, Departamento de Farmacia, Universidad Nacional Autónoma de México, CP. 04510, Tlalpan, Ciudad de México, México.
| | - González-Hernández Iliana
- Laboratorio de Neuropsicofarmacología, Instituto Nacional de Neurología y Neurocirugía, C.P. 14269, Tlalpan, Ciudad de México, México
| | - Rojas-Tomé Irma Susana
- Laboratorio de Neuropsicofarmacología, Instituto Nacional de Neurología y Neurocirugía, C.P. 14269, Tlalpan, Ciudad de México, México
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27
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da Silva Miranda CC, Fernandes Dos Santos CFS, Cordeiro de Medeiros AB. Neurocysticercosis Presenting as Acute Psychosis: An Unusual Case. Psychiatr Danub 2020; 32:445-446. [PMID: 33370750] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/12/2023]
Affiliation(s)
- Carolina Colaço da Silva Miranda
- Department of Psychiatry and Mental Health, Hospital Garcia de Orta, CDC Building - 1st Floor, Av. Torrado da Silva, 2805-267 Almada, Portugal
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28
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Fabbri J, Espinosa JP, Pensel PE, Medici SK, Gamboa GU, Benoit JP, Elissondo MC. Do albendazole-loaded lipid nanocapsules enhance the bioavailability of albendazole in the brain of healthy mice? Acta Trop 2020; 201:105215. [PMID: 31600525 DOI: 10.1016/j.actatropica.2019.105215] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/29/2019] [Revised: 10/04/2019] [Accepted: 10/05/2019] [Indexed: 01/23/2023]
Abstract
Neurocysticercosis is a neglected tropical disease that affects the central nervous system and is the most common cause of human epilepsy acquired in developing countries. Therapeutic failures attributed to medical management of neurocysticercosis with albendazole (ABZ) have been primarily linked to the poor drug absorption rate resulting in low drug level in plasma and brain tissue. The aim of the current work was to characterize and compare the brain pharmacokinetic behavior of ABZ formulated as a suspension or lipid nanocapsules (ABZ-LNCs) in healthy mice. The relative availability in brain tissue of the active metabolite ABZ sulphoxide increased 183% when ABZ was administered as LNCs, in relation to ABZ suspension. The parent drug was also detected for a short period of time. The bioavailability of ABZ in ABZ-LNCs treated mice increased more than 2 fold compared with ABZ suspension group. The enhanced drug brain exposure observed after administration of ABZ-LNCs to healthy mice has potential usefulness for the treatment of human neurocysticercosis.
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Affiliation(s)
- Julia Fabbri
- Laboratorio de Zoonosis Parasitarias, Instituto de Investigaciones en Producción, Sanidad y Ambiente (IIPROSAM), Facultad de Ciencias Exactas y Naturales, Universidad Nacional de Mar del Plata. Funes 3250, 7600 Mar del Plata, Argentina; Consejo Nacional de Investigaciones Científicas y Técnicas (CONICET), Argentina
| | - Juan Pablo Espinosa
- Fares Taie Instituto de Análisis, Magallanes 3019, 7600 Mar del Plata, Argentina
| | - Patricia Eugenia Pensel
- Laboratorio de Zoonosis Parasitarias, Instituto de Investigaciones en Producción, Sanidad y Ambiente (IIPROSAM), Facultad de Ciencias Exactas y Naturales, Universidad Nacional de Mar del Plata. Funes 3250, 7600 Mar del Plata, Argentina; Consejo Nacional de Investigaciones Científicas y Técnicas (CONICET), Argentina
| | - Sandra Karina Medici
- Consejo Nacional de Investigaciones Científicas y Técnicas (CONICET), Argentina; Fares Taie Instituto de Análisis, Magallanes 3019, 7600 Mar del Plata, Argentina
| | - Gabriela Ullio Gamboa
- Unidad de Investigación y Desarrollo en Tecnología Farmacéutica, UNITEFA-CONICET - Departamento de Ciencias Farmacéuticas, Facultad de Ciencias Químicas, Universidad Nacional de Córdoba. Ciudad Universitaria, 5000 HUA-Córdoba, Argentina
| | - Jean Pierre Benoit
- INSERM U1066, MINT-Micro et Nanomédecines biomimétiques, IBS-CHU Angers, 49933 Angers cedex 9, France
| | - María Celina Elissondo
- Laboratorio de Zoonosis Parasitarias, Instituto de Investigaciones en Producción, Sanidad y Ambiente (IIPROSAM), Facultad de Ciencias Exactas y Naturales, Universidad Nacional de Mar del Plata. Funes 3250, 7600 Mar del Plata, Argentina; Consejo Nacional de Investigaciones Científicas y Técnicas (CONICET), Argentina.
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Nayak S, Sharma P, Gaur N, Takkar B. Secondary optic atrophy in a patient with miliary neurocysticercosis. Natl Med J India 2019; 32:377. [PMID: 33380640 DOI: 10.4103/0970-258x.303627] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/12/2023]
Affiliation(s)
- Shreya Nayak
- Dr Rajendra Prasad Centre for Ophthalmic Sciences, All India Institute of Medical Sciences, New Delhi, India
| | - Pradeep Sharma
- Dr Rajendra Prasad Centre for Ophthalmic Sciences, All India Institute of Medical Sciences, New Delhi, India
| | - Nripen Gaur
- Dr Rajendra Prasad Centre for Ophthalmic Sciences, All India Institute of Medical Sciences, New Delhi, India
| | - Brijesh Takkar
- Dr Rajendra Prasad Centre for Ophthalmic Sciences, All India Institute of Medical Sciences, New Delhi, India
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Al-Saeed WM, Oleiwi Al-Kuraishi AH, Dahash SL, Al-Gareeb AI, Alkuraishy HM. Neurocysticercosis: A new concept and insight into basic and future pharmacotherapy. J PAK MED ASSOC 2019; 69(Suppl 3):S113-S118. [PMID: 31603890] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/10/2023]
Abstract
Neurocysticercosis is a neurological infection caused by the larva of taenia solium. The larva infection may affect different parts of the human brain and spinal cord, leading to focal neurological deficit with/without inflammatory reactions. Neurocysticercosis is one of the major causes of epilepsy in the developing countries. It is of two types. One is extra-parenchymal neurocysticercosis in which cysticerci cysts at subarachinoid space and ventricles lead to obstructive hydrocephalus and increase in the intracranial pressure. The other type is intra-parenchymal neurocysticercosis in which the cysticerci cyst grows inside the brain parenchyma, causing the feature of space-occupying lesion. The common presentation of intra-parenchymal neurocysticercosis is secondary epilepsy which is due to focal lesion and/or local inflammatory reactions. Cysticidal therapy increases the risk of seizure due to the induction of host inflammatory reactions. Therefore, coadministration of corticosteroids reduces the risk of seizure through attenuation of inflammatory reactions and brain oedema. Praziquantel alone or in combination with albendazole is regarded as the basic cysticidal therapy against neurocysticercosis. Newer drugs and agents are recommended to overcome the partial failure of standard cysticidal therapy.
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Affiliation(s)
- Wisam Mahdi Al-Saeed
- Department of Clinical Pharmacology, Medicine and Therapeutic, Al- Mustansiriya University, Baghdad, Iraq
| | | | - Salma Luaiby Dahash
- Department of Clinical Pharmacology, Medicine and Therapeutic, Al- Mustansiriya University, Baghdad, Iraq
| | - Ali Ismail Al-Gareeb
- Department of Clinical Pharmacology, Medicine and Therapeutic, Al- Mustansiriya University, Baghdad, Iraq
| | - Hayder Mutter Alkuraishy
- Department of Clinical Pharmacology, Medicine and Therapeutic, Al- Mustansiriya University, Baghdad, Iraq
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Rodríguez-Hidalgo R, Carpio A, Van den Enden E, Benítez-Ortiz W. Monitoring treatment of Taenia solium- neurocysticercosis by detection of circulating antigens: a case report. BMC Neurol 2019; 19:52. [PMID: 30943908 PMCID: PMC6446330 DOI: 10.1186/s12883-019-1282-x] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/10/2018] [Accepted: 03/22/2019] [Indexed: 12/03/2022] Open
Abstract
BACKGROUND Parenchymal neurocysticercosis is a frequent cause of seizures in areas endemic for Taenia solium. At present there is scarce data on the evolution of the levels of circulating metacestodal antigen before, during and after treatment with anthelmintic drugs. CASE PRESENTATION A patient with paucisymptomatic neurocysticercosis (NCC) diagnosed by Ag-ELISA, and confirmed by MRI images, was treated with praziquantel, albendazole and dexamethasone. The level of circulating T. solium antigen was determined weekly. Circulating antigen disappeared from his blood within 14 days after the start of the treatment and correlated with the involution of the cysticerci in the brain shown by imaging. Seventeen years later, the patient has not shown any side effect nor symptoms related to the treatment or to NCC. CONCLUSIONS If this encouraging finding is confirmed in a larger series of patients, this technique could be used to determine parasitological cure after treatment and might complement or sometimes replace sequential MRI-imaging of the brain.
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Affiliation(s)
- Richar Rodríguez-Hidalgo
- Instituto de Investigación en Salud Pública y Zoonosis, Universidad Central del Ecuador, Quito, Ecuador
- Facultad de Medicina Veterinaria y Zootecnia, Universidad Central del Ecuador, Quito, Ecuador
| | - Arturo Carpio
- Facultad de Ciencias Médicas, Universidad de Cuenca, Cuenca, Ecuador
- G.H. Sergievsky Center, Columbia University, New York, USA
| | - Erwin Van den Enden
- Department of Clinical Sciences, Institute of Tropical Medicine, Antwerp, Belgium
| | - Washington Benítez-Ortiz
- Instituto de Investigación en Salud Pública y Zoonosis, Universidad Central del Ecuador, Quito, Ecuador
- Facultad de Medicina Veterinaria y Zootecnia, Universidad Central del Ecuador, Quito, Ecuador
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Lima NF, Picanço GA, Alves DDSMM, Silva LD, Isac E, Costa TL, Lino Junior RDS, Vinaud MC. Oral nitazoxanide treatment of experimental neurocysticercosis induces gluconeogenesis in Taenia crassiceps cysticerci. Acta Trop 2019; 190:361-364. [PMID: 30553893 DOI: 10.1016/j.actatropica.2018.12.017] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/07/2018] [Revised: 12/04/2018] [Accepted: 12/09/2018] [Indexed: 12/27/2022]
Abstract
Neurocysticercosis is the most frequent helminthiasis of the central nervous system and is caused by the presence of Taenia solium cysticerci. Nitazoxanide (NTZ) is an antifolate containing the pyrrolopyrimidine-based nucleus that exerts its antiprotozoal activity due to interference with the pyruvate:ferredoxin oxidoreductase (PFOR) enzyme which is essential to anaerobic energy metabolism. The aim of this work was to determine the effect of NTZ on the energetic metabolism of Taenia crassiceps cysticerci intracranially inoculated BALB /c mice. The infected animals were treated with a single oral dose of NTZ 30 days after the inoculation. Analysis of the organic acids was performed through high performance liquid chromatography. Glucose was detected only in the treated groups, alongside with a significant decrease in lactate, pyruvate and oxaloacetate concentrations which indicate an increase in gluconeogenesis. The non-detection of alpha-ketoglutarate indicated the use of the fumarate reductase pathway in all groups. It was possible to confirm the drugs mode of action due to the non-detection of acetate in the treated groups. There was an increase in the fatty acids oxidation. Therefore it was possible to observe that NTZ induces gluconeogenesis as well as the increase of alternative energetic pathways such as fatty acids oxidation in T. crassiceps cysticerci.
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Affiliation(s)
- Nayana F Lima
- Tropical Pathology and Public Health Institute, Federal University of Goias, Rua 235, s/n, Setor Leste Universitário, CEP: 74605-050, Goiás, Brazil.
| | - Guaraciara A Picanço
- Tropical Pathology and Public Health Institute, Federal University of Goias, Rua 235, s/n, Setor Leste Universitário, CEP: 74605-050, Goiás, Brazil.
| | - Daniella de S M M Alves
- Tropical Pathology and Public Health Institute, Federal University of Goias, Rua 235, s/n, Setor Leste Universitário, CEP: 74605-050, Goiás, Brazil.
| | - Luciana D Silva
- State University of Goias, Br 153, Km 99, Anápolis, Goiás, Brazil.
| | - Eliana Isac
- Tropical Pathology and Public Health Institute, Federal University of Goias, Rua 235, s/n, Setor Leste Universitário, CEP: 74605-050, Goiás, Brazil.
| | - Tatiane L Costa
- Tropical Pathology and Public Health Institute, Federal University of Goias, Rua 235, s/n, Setor Leste Universitário, CEP: 74605-050, Goiás, Brazil.
| | - Ruy de S Lino Junior
- Tropical Pathology and Public Health Institute, Federal University of Goias, Rua 235, s/n, Setor Leste Universitário, CEP: 74605-050, Goiás, Brazil.
| | - Marina C Vinaud
- Tropical Pathology and Public Health Institute, Federal University of Goias, Rua 235, s/n, Setor Leste Universitário, CEP: 74605-050, Goiás, Brazil.
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Tao Y, Feng-Quan X, Yan W, Yu-Guang F, Jun D, Ting-Xia F. [Study on diagnosis of atypical cerebral cysticercosis]. Zhongguo Xue Xi Chong Bing Fang Zhi Za Zhi 2018; 30:424-427. [PMID: 30350507 DOI: 10.16250/j.32.1374.2018015] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/08/2023]
Abstract
OBJECTIVE To analyze the characteristics of the results of serum immunological tests and brain CT image examinations of atypical cerebral cysticercosis patients, so as to provide the reference for improving the diagnosis of the disease. METHODS Totally 446 suspected cerebral cysticercosis patients were chosen as the study objects, all of them were given experimental treatment with praziquantel, and then the patients with atypical cerebral cysticercosis were diagnosed according to the treatment effect and review results of brain CT or MRI. Meanwhile, all the 446 patients were tested for serum specific IgG and IgG4 antibodies and cysticercus circulating antigen (CAg) by ELISA, McAb ELISA and PEG-ELISA respectively, and the IHA test was also performed. All the patients received the brain CT examinations. The test results were analyzed statistically and the test performances of the methods above-mentioned were calculated. RESULTS Among the 446 suspected cerebral cysticercosis patients, after the praziquantel treatment, there were 315 patients whose symptoms were alleviated, and they were diagnosed as atypical cerebral cysticercosis. Among the 446 suspected cerebral cysticercosis patients, the positive rates of specific IgG and IgG4 antibodies, and CAg were 15.47%, 15.02%, and 11.21% respectively, and the positive rate of IHA was 28.47% (χ2 = 52.45, P < 0.01). The brain CT examinations showed that there were 79.14% (353/446) of patients with suspected cysticercus foci. The sensitivities of ELISA, McAb-ELISA, PEG-ELISA, IHA test and brain CT examination (suspected cysticercus foci) for the diagnosis of atypical cerebral cysticercosis were 15.36%-96.82%, the specificities were 63.36%-99.24%, the positive predictive values were 86.40%-98.52%, the negative predictive values were 32.83%-98.25%, the positive likelihood ratios were 2.64-27.86, the negative likelihood ratios were 0.05-0.81, and the OR values were 7.16-52.80. The consolidation of the five tests above-mentioned showed the OR value was 108.00, which was 2 times of the OR value of CT examination. CONCLUSIONS Atypical cerebral cysticercosis is definitely diagnosed mainly by means of evaluating the effect of the diagnostic therapy (anti-cysticercus), and the serum immunological examinations and brain CT examination also have important reference values.
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Affiliation(s)
- Yu Tao
- Shandong Institute of Parasitical Diseases, Jining 272000, China
| | - Xu Feng-Quan
- Shandong Institute of Parasitical Diseases, Jining 272000, China
| | - Wang Yan
- Shandong Institute of Parasitical Diseases, Jining 272000, China
| | - Fu Yu-Guang
- Shandong Institute of Parasitical Diseases, Jining 272000, China
| | - Dai Jun
- Department of Immunology and Molecular Medicine, Jining Medical University, China
| | - Fu Ting-Xia
- Shandong Institute of Parasitical Diseases, Jining 272000, China
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Arce-Sillas A, Cárdenas G, Álvarez-Luquín D, Hernandez M, Del Rey A, Besedovsky H, Gómez-Fuentes S, Fragoso G, Fleury A, Sciutto E, Adalid-Peralta L. Treatment-Resistant Human Extraparenchymal Neurocysticercosis: An Immune-Inflammatory Approach to Cysticidal Treatment Outcome. Neuroimmunomodulation 2018; 25:103-109. [PMID: 30041237 DOI: 10.1159/000491394] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/22/2018] [Accepted: 06/19/2018] [Indexed: 11/19/2022] Open
Abstract
OBJECTIVE The aim of this study is to analyze the immune-endocrine profile in neurocysticercosis (NC) patients resistant to cysticidal treatment. METHODS The inflammatory and regulatory responses of 8 resistant NC patients with extraparenchymal parasites and 5 healthy controls were evaluated through flow cytometry. Serum interleukin levels were measured by ELISA and catecholamines levels by high performance liquid chromatography. RESULTS Higher percentages of Tr1, CD4+CD25+FOXP3+CD127- and CD4+CD45RO+FOXP3HI were found in NC patients compared with healthy controls, but no difference was found in catecholamine levels. Antigen-specific proliferative immune response was observed in NC patients. Neither anti-inflammatory nor pro-inflammatory cytokines showed differences between patients and controls, but IL-6 levels were lower in treatment-resistant NC patients. In addition, TGFβ showed a significant negative correlation with dopamine. CONCLUSIONS Altogether, these results may point to a modulation of the neuroinflammation in these patients that could indirectly favor cysticercal survival in CNS microenvironment.
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Affiliation(s)
- Asiel Arce-Sillas
- Unidad Periférica para el Estudio de Neuroinflamación en Patologías Neurológicas del Instituto de Investigaciones Biomédicas de la UNAM en el Instituto Nacional de Neurología y Neurocirugía, Mexico, Mexico
- Instituto Nacional de Neurología y Neurocirugía, Mexico, Mexico
| | - Graciela Cárdenas
- Department of Neuroinfectology, Instituto Nacional de Neurología y Neurocirugía, Mexico, Mexico
| | - Diana Álvarez-Luquín
- Unidad Periférica para el Estudio de Neuroinflamación en Patologías Neurológicas del Instituto de Investigaciones Biomédicas de la UNAM en el Instituto Nacional de Neurología y Neurocirugía, Mexico, Mexico
- Instituto Nacional de Neurología y Neurocirugía, Mexico, Mexico
| | - Marisela Hernandez
- Unidad Periférica para el Estudio de Neuroinflamación en Patologías Neurológicas del Instituto de Investigaciones Biomédicas de la UNAM en el Instituto Nacional de Neurología y Neurocirugía, Mexico, Mexico
- Department of Immunology, Instituto de Investigaciones Biomédicas, Universidad Nacional Autónoma de Mexico, Mexico, Mexico
| | - Adriana Del Rey
- Research Group Immunophysiology Division of Neurophysiology, Institute of Physiology and Pathophysiology, Philipps Universität, Marburg, Germany
| | - Hugo Besedovsky
- Research Group Immunophysiology Division of Neurophysiology, Institute of Physiology and Pathophysiology, Philipps Universität, Marburg, Germany
| | - Sandra Gómez-Fuentes
- Unidad Periférica para el Estudio de Neuroinflamación en Patologías Neurológicas del Instituto de Investigaciones Biomédicas de la UNAM en el Instituto Nacional de Neurología y Neurocirugía, Mexico, Mexico
- Instituto Nacional de Neurología y Neurocirugía, Mexico, Mexico
| | - Gladis Fragoso
- Unidad Periférica para el Estudio de Neuroinflamación en Patologías Neurológicas del Instituto de Investigaciones Biomédicas de la UNAM en el Instituto Nacional de Neurología y Neurocirugía, Mexico, Mexico
- Department of Immunology, Instituto de Investigaciones Biomédicas, Universidad Nacional Autónoma de Mexico, Mexico, Mexico
| | - Agnes Fleury
- Unidad Periférica para el Estudio de Neuroinflamación en Patologías Neurológicas del Instituto de Investigaciones Biomédicas de la UNAM en el Instituto Nacional de Neurología y Neurocirugía, Mexico, Mexico
- Department of Immunology, Instituto de Investigaciones Biomédicas, Universidad Nacional Autónoma de Mexico, Mexico, Mexico
| | - Edda Sciutto
- Unidad Periférica para el Estudio de Neuroinflamación en Patologías Neurológicas del Instituto de Investigaciones Biomédicas de la UNAM en el Instituto Nacional de Neurología y Neurocirugía, Mexico, Mexico
- Department of Immunology, Instituto de Investigaciones Biomédicas, Universidad Nacional Autónoma de Mexico, Mexico, Mexico
| | - Laura Adalid-Peralta
- Unidad Periférica para el Estudio de Neuroinflamación en Patologías Neurológicas del Instituto de Investigaciones Biomédicas de la UNAM en el Instituto Nacional de Neurología y Neurocirugía, Mexico, Mexico
- Instituto Nacional de Neurología y Neurocirugía, Mexico, Mexico
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Affiliation(s)
| | - Rizwan Khan
- Great Western Hospitals NHS Foundation Trust, Acute Medicine, Swindon, UK
| | - Vinod Dibbur
- Great Western Hospitals NHS Foundation Trust, Acute Medicine, Swindon, UK
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Mugundhan K, Balamurugan N, Chandrasekar P, Sivakumar S, Mayan MCV, Nidhin PD. Giant Intraparanchymal Neurocysticercosis. J Assoc Physicians India 2017; 65:85-86. [PMID: 29322717] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/07/2023]
Affiliation(s)
| | | | | | | | - M C Vasif Mayan
- Post graduates in General Medicine, Govt. Mohan Kumaramangalam Medical College Hospital, Salem, Tamil Nadu
| | - P D Nidhin
- Post graduates in General Medicine, Govt. Mohan Kumaramangalam Medical College Hospital, Salem, Tamil Nadu
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Garcia HH, Del Brutto OH. Antiparasitic treatment of neurocysticercosis - The effect of cyst destruction in seizure evolution. Epilepsy Behav 2017; 76:158-162. [PMID: 28606690 PMCID: PMC5675823 DOI: 10.1016/j.yebeh.2017.03.013] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/04/2017] [Revised: 03/06/2017] [Accepted: 03/06/2017] [Indexed: 11/20/2022]
Abstract
Antiparasitic agents against Taenia solium cysticercosis have been in use since 1979, although its use has been questioned on the basis that cysts would die naturally and thus treatment-induced inflammation is unnecessary. In addition, isolated reports have also questioned whether neurocysticercosis (NCC) is a cause of epilepsy. After more than three and a half decades, a large body of evidence is available. Little if any doubt exists about NCC as a cause of seizures - NCC is consistently associated with seizures when appropriate groups are compared, and in a large subset of cases, seizure semiology correlates with the anatomical location of lesions. Cyst degeneration and the subsequent inflammatory reaction increase seizure expression, although patients with non-inflamed cysts may have seizures, as do patients with long-standing, not inflamed calcified scars. Assessment of the evidence on cysticidal efficacy, safety, and the impact of cyst destruction in decreasing seizures leads to the conclusion that the benefits of antiparasitic treatment in parenchymal brain cysticercosis clearly outweigh the risks, and have provided substantive evidence of the role of NCC as a cause of seizures and epilepsy. Antiparasitic therapy should be considered a primary option in the management of patients with live or degenerating brain NCC cysts. This article is part of a Special Issue entitled "Neurocysticercosis and Epilepsy".
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Affiliation(s)
- Hector H Garcia
- Center for Global Health, Tumbes and the Department of Microbiology, School of Sciences, Universidad Peruana Cayetano Heredia, Lima, Peru; Cysticercosis Unit, Instituto Nacional de Ciencias Neurológicas, Lima, Peru.
| | - Oscar H Del Brutto
- School of Medicine, Universidad Espíritu Santo - Ecuador, Guayaquil, Ecuador
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Abstract
Seizures are the commonest manifestation of brain parenchymal cysticercosis. In terms of pathophysiological basis and prognostic significance of the seizures, a distinction might be applied between viable cysts, solitary cysticercus granuloma and calcific cysticerci. A number of uncertainties shroud the management of seizures in people with neurocysticercosis (NCC). Although antihelminthic treatment is effective in eliminating viable cysts and possibly cysticercus granulomas, its effect on seizure outcome remains uncertain. Corticosteroids and combinations of antihelminthic and corticosteroid treatments reduce the incidence of seizures in the short term at least. Although antiepileptic drugs (AEDs) are routinely employed in the treatment of seizures associated with NCC, there is no clear consensus regarding the choice and optimal duration of AED treatment. Long-term AED treatment is warranted in people with calcific residue following involution of brain parenchymal cysticercosis. This article is part of a Special Issue entitled "Neurocysticercosis and Epilepsy".
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Affiliation(s)
- Gagandeep Singh
- Department of Neurology, Dayanand Medical College, Ludhiana, India.
| | - Ravina Sharma
- Department of Neurology, Dayanand Medical College, Ludhiana, India
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Yadav K, Garg D, Kaushik JS, Vaswani ND, Dubey R, Agarwal S. Intramedullary Neurocysticercosis Successfully Treated with Medical Therapy. Indian J Pediatr 2017; 84:725-726. [PMID: 28466406 DOI: 10.1007/s12098-017-2353-x] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/13/2017] [Accepted: 04/10/2017] [Indexed: 11/28/2022]
Affiliation(s)
- Kuldeep Yadav
- Department of Pediatrics, Pt B D Sharma Postgraduate Institute of Medical Sciences, Rohtak, Haryana, 124001, India
| | - Deepali Garg
- Department of Pediatrics, Pt B D Sharma Postgraduate Institute of Medical Sciences, Rohtak, Haryana, 124001, India
| | - Jaya Shankar Kaushik
- Department of Pediatrics, Pt B D Sharma Postgraduate Institute of Medical Sciences, Rohtak, Haryana, 124001, India.
| | - N D Vaswani
- Department of Pediatrics, Pt B D Sharma Postgraduate Institute of Medical Sciences, Rohtak, Haryana, 124001, India
| | - Rachana Dubey
- Department of Pediatrics, Mahatma Gandhi Memorial Medical College, Indore, Madhya Pradesh, 452001, India
| | - Shalini Agarwal
- Department of Radiodiagnosis, Pt B D Sharma Postgraduate Institute of Medical Sciences, Rohtak, Haryana, 124001, India
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Cangalaya C, Bustos JA, Calcina J, Vargas-Calla A, Mamani J, Suarez D, Arroyo G, Gonzalez AE, Chacaltana J, Guerra-Giraldez C, Mahanty S, Nash TE, García HH. Radiological evolution of porcine neurocysticercosis after combined antiparasitic treatment with praziquantel and albendazole. PLoS Negl Trop Dis 2017; 11:e0005624. [PMID: 28575043 PMCID: PMC5470720 DOI: 10.1371/journal.pntd.0005624] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/10/2016] [Revised: 06/14/2017] [Accepted: 05/04/2017] [Indexed: 11/18/2022] Open
Abstract
BACKGROUND The onset of anthelmintic treatment of neurocysticercosis (NCC) provokes an acute immune response of the host, which in human cases is associated with exacerbation of neurological symptoms. This inflammation can occur at the first days of therapy. So, changes in the brain cysts appearance may be detected by medical imaging. We evaluated radiological changes in the appearance of brain cysts (enhancement and size) on days two and five after the onset of antiparasitic treatment using naturally infected pigs as a model for human NCC. METHODS AND RESULTS Contrast T1-weighted magnetic resonance imaging with gadolinium was performed before and after antiparasitic treatment. Eight NCC-infected pigs were treated with praziquantel plus albendazole and euthanized two (n = 4) and five (n = 4) days after treatment; another group of four infected pigs served as untreated controls. For each lesion, gadolinium enhancement intensity (GEI) and cyst volume were measured at baseline and after antiparasitic treatment. Volume and GEI quantification ratios (post/pre-treatment measures) were used to appraise the effect of treatment. Cysts from untreated pigs showed little variations between their basal and post treatment measures. At days 2 and 5 there were significant increases in GEI ratio compared with the untreated group (1.32 and 1.47 vs 1.01, p = 0.021 and p = 0.021). Cyst volume ratios were significantly lower at days 2 and 5 compared with the untreated group (0.60 and 0.22 vs 0.95, p = 0.04 and p = 0.02). Cysts with lower cyst volume ratios showed more marked post-treatment inflammation, loss of vesicular fluid and cyst wall wrinkling. CONCLUSION/SIGNIFICANCE A significant and drastic reduction of cyst size and increased pericystic enhancement occur in the initial days after antiparasitic treatment as an effect of acute perilesional immune response. These significant changes showed that early anthelmintic efficacy (day two) can be detected using magnetic resonance imaging.
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Affiliation(s)
- Carla Cangalaya
- Laboratorio de Inmunopatología en Neurocisticercosis, Facultad de Ciencias y Filosofía, Universidad Peruana Cayetano Heredia, Lima, Peru
- Facultad de Medicina Humana, Universidad Nacional Mayor de San Marcos, Lima, Peru
- * E-mail:
| | - Javier A. Bustos
- Unidad de Cisticercosis, Instituto Nacional de Ciencias Neurológicas, Lima, Peru
| | - Juan Calcina
- Facultad de Medicina Veterinaria, Universidad Nacional Mayor de San Marcos, Lima, Peru
| | - Ana Vargas-Calla
- Facultad de Medicina Veterinaria, Universidad Nacional Mayor de San Marcos, Lima, Peru
| | - Javier Mamani
- Facultad de Medicina Veterinaria y Zootecnia, Universidad Peruana Cayetano Heredia, Lima, Peru
| | - Diego Suarez
- Facultad de Medicina, Universidad Peruana Cayetano Heredia, Lima, Peru
| | - Gianfranco Arroyo
- Unidad de Cisticercosis, Instituto Nacional de Ciencias Neurológicas, Lima, Peru
| | - Armando E. Gonzalez
- Facultad de Medicina Veterinaria, Universidad Nacional Mayor de San Marcos, Lima, Peru
| | - Juan Chacaltana
- Departamento de Diagnóstico por imágenes, Instituto Nacional de Ciencias Neurológicas, Lima, Peru
| | - Cristina Guerra-Giraldez
- Laboratorio de Inmunopatología en Neurocisticercosis, Facultad de Ciencias y Filosofía, Universidad Peruana Cayetano Heredia, Lima, Peru
- Departamento de Ciencias Celulares y Moleculares, Facultad de Ciencias y Filosofía, Universidad Peruana Cayetano Heredia, Lima, Peru
| | - Siddhartha Mahanty
- Laboratorio de Inmunopatología en Neurocisticercosis, Facultad de Ciencias y Filosofía, Universidad Peruana Cayetano Heredia, Lima, Peru
- Laboratory of Parasitic Diseases, National Institute of Allergy and Infectious Diseases, National Institutes of Health, Bethesda, Maryland, United States of America
| | - Theodore E. Nash
- Laboratorio de Inmunopatología en Neurocisticercosis, Facultad de Ciencias y Filosofía, Universidad Peruana Cayetano Heredia, Lima, Peru
- Laboratory of Parasitic Diseases, National Institute of Allergy and Infectious Diseases, National Institutes of Health, Bethesda, Maryland, United States of America
| | - Héctor H. García
- Unidad de Cisticercosis, Instituto Nacional de Ciencias Neurológicas, Lima, Peru
- Departamento de Ciencias Celulares y Moleculares, Facultad de Ciencias y Filosofía, Universidad Peruana Cayetano Heredia, Lima, Peru
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Ertel RL, Braae UC, Ngowi HA, Johansen MV. Assessment of a computer-based Taenia solium health education tool 'The Vicious Worm' on knowledge uptake among professionals and their attitudes towards the program. Acta Trop 2017; 165:240-245. [PMID: 26536396 DOI: 10.1016/j.actatropica.2015.10.022] [Citation(s) in RCA: 26] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/18/2015] [Revised: 10/25/2015] [Accepted: 10/29/2015] [Indexed: 11/17/2022]
Abstract
Health education has been recognised as a specific intervention tool for control of Taenia solium taeniosis/cysticercosis but evaluation of the efficacy of the tool remains. The aim of our study was to assess the effect of a computer-based T. solium health education tool 'The Vicious Worm' on knowledge uptake among professionals and investigate attitudes towards the program. The study was carried out between March and May 2014 in Mbeya Region, Tanzania, where T. solium is endemic. The study was a pre and post assessment of a health education tool based on questionnaire surveys and focus group discussions to investigate knowledge and attitudes. A total of 79 study subjects participated in the study including study subjects from both health- and agriculture sector. The health education consisted of 1½h individual practice with the computer program. The baseline questionnaire showed an overall knowledge on aspects of acquisition and transmission of T. solium infections (78%), porcine cysticercosis treatment (77%), human tapeworm in general (72%), neurocysticercosis in general (49%), and porcine cysticercosis diagnosis (48%). However, there was a lack of knowledge on acquisition of neurocysticercosis (15%), prevention of T. solium taeniosis/cysticercosis (28%), and relation between porcine cysticercosis, human cysticercosis, and taeniosis (32%). Overall, the study subject's knowledge was significantly improved both immediately after (p=0.001) and two weeks after (p<0.001) the health education and knowledge regarding specific aspects was significantly improved in most aspects immediately after and two weeks after the health education. The focus group discussions showed positive attitudes towards the program and the study subjects found 'The Vicious Worm' efficient, simple, and appealing. The study revealed a good effect of 'The Vicious Worm' suggesting that it could be a useful health education tool, which should be further assessed and thereafter integrated in T. solium taeniosis/cysticercosis control.
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Affiliation(s)
- Rebekka Lund Ertel
- Department of Veterinary Disease Biology, Faculty of Health and Medical Sciences, University of Copenhagen, Denmark.
| | - Uffe Christian Braae
- Department of Veterinary Disease Biology, Faculty of Health and Medical Sciences, University of Copenhagen, Denmark
| | - Helena Aminiel Ngowi
- Department of Veterinary Medicine and Public Health, Faculty of Veterinary Medicine, Sokoine University of Agriculture, P.O. Box 3021 Morogoro, Tanzania
| | - Maria Vang Johansen
- Department of Veterinary Disease Biology, Faculty of Health and Medical Sciences, University of Copenhagen, Denmark
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Lattuada E, Lanzafame M, Concia E, Vento S. Intracranial mass lesions in HIV/AIDS patients from developing countries endemic for neurocysticercosis. Int J STD AIDS 2016; 18:144-5. [PMID: 17331296 DOI: 10.1258/095646207779949754] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
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Singh A, Prasad KN, Singh AK, Singh SK, Gupta KK, Paliwal VK, Pandey CM, Gupta RK. Human Glutathione S-Transferase Enzyme Gene Polymorphisms and Their Association With Neurocysticercosis. Mol Neurobiol 2016; 54:2843-2851. [PMID: 27021019 DOI: 10.1007/s12035-016-9779-4] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/21/2015] [Accepted: 02/04/2016] [Indexed: 01/01/2023]
Abstract
Neurocysticercosis (NCC), caused by cysticerci of Taenia solium is the most common helminthic infection of the central nervous system. Some individuals harboring different stages of cysticerci in the brain remain asymptomatic, while others with similar cysticerci lesions develop symptoms and the reasons remain largely unknown. Inflammatory response to antigens of dying parasite is said to be responsible for symptomatic disease. Reactive oxygen species (ROS) that are generated in inflammatory conditions can damage cellular macromolecules such as lipids, DNA, and proteins. The glutathione S-transferases (GSTs) are critical for the protection of cells from ROS. A total of 250 individuals were included in the study: symptomatic NCC = 75, asymptomatic NCC = 75, and healthy controls = 100. The individuals carrying the deletions of GSTM1 and GSTT1 were at risk for NCC (OR = 2.99, 95 %CI = 1.31-6.82, p = 0.0073 and OR = 1.94, 95 %CI = 0.98-3.82, p = 0.0550 respectively). Further, the individuals with these deletions were more likely to develop symptomatic disease (OR = 5.08, 95 % CI = 2.12-12.18, p = 0.0001 for GSTM1 and OR = 3.25, 95 %CI = 1.55-6.82, p = 0.0018 for GSTT1). Genetic variants of GSTM3 and GSTP1 were not associated with NCC. The total GST activity and levels of GSTM1, GSTT1, and GSTM3 were significantly higher in asymptomatic subjects than in symptomatic and healthy controls. Lower GST activity was observed in individuals with GSTM1 and GSTT1 deletions. The present study suggests that the individuals with GSTM1 and GSTT1 deletions are at higher risk to develop symptomatic disease. The higher GST activity and levels of GSTM1, GSTT1, and GSTM3 are likely to play role in maintaining asymptomatic condition.
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Affiliation(s)
- Amrita Singh
- Department of Microbiology, Sanjay Gandhi Postgraduate Institute of Medical Sciences, Lucknow, U.P, 226014, India
| | - Kashi N Prasad
- Department of Microbiology, Sanjay Gandhi Postgraduate Institute of Medical Sciences, Lucknow, U.P, 226014, India.
| | - Aloukick K Singh
- Department of Microbiology, Sanjay Gandhi Postgraduate Institute of Medical Sciences, Lucknow, U.P, 226014, India
| | - Satyendra K Singh
- Department of Microbiology, Sanjay Gandhi Postgraduate Institute of Medical Sciences, Lucknow, U.P, 226014, India
| | - Kamlesh K Gupta
- Department of Microbiology, Sanjay Gandhi Postgraduate Institute of Medical Sciences, Lucknow, U.P, 226014, India
| | - Vimal K Paliwal
- Department of Neurology, Sanjay Gandhi Postgraduate Institute of Medical Sciences, Lucknow, U.P, 226014, India
| | - Chandra M Pandey
- Department of Biostatistics, Sanjay Gandhi Postgraduate Institute of Medical Sciences, Lucknow, U.P, 226014, India
| | - Rakesh K Gupta
- Department of Radiodiagnosis, Sanjay Gandhi Postgraduate institute of Medical Sciences, Lucknow, U.P, 226014, India
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Vedantam A, Daniels B, Lam S. Intraventricular Cyst Causing Acute Obstructive Hydrocephalus: Neurocysticercosis Managed With Neuroendoscopy. Pediatr Neurol 2016; 55:71-3. [PMID: 26548593 DOI: 10.1016/j.pediatrneurol.2015.09.015] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/31/2015] [Revised: 09/08/2015] [Accepted: 09/12/2015] [Indexed: 11/18/2022]
Affiliation(s)
- Aditya Vedantam
- Division of Pediatric Neurosurgery, Department of Neurosurgery, Baylor College of Medicine, Texas Children's Hospital, Houston, Texas
| | - Bradley Daniels
- Division of Pediatric Neurosurgery, Department of Neurosurgery, Baylor College of Medicine, Texas Children's Hospital, Houston, Texas
| | - Sandi Lam
- Division of Pediatric Neurosurgery, Department of Neurosurgery, Baylor College of Medicine, Texas Children's Hospital, Houston, Texas.
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Abstract
We report a case of neurocysticercosis concurrent with taeniasis in a 31-year-old woman. The patient presented with a headache and diplopia. Oculomotor disturbances with a left adduction deficit were observed. Fundoscopy revealed papilledema. Additionally, computed tomography of the brain revealed more than 20 small cysts within the parenchyma, most of which were associated with ring enhancement. Moreover, serum antibody testing (Western blotting) for Taenia solium-cysticerci was positive. The patient received albendazole and corticosteroids, and progressive resolution of the neurological symptoms and papilledema was observed starting approximately three days after administration. This patient has been asymptomatic for more than one year.
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Affiliation(s)
- Akihiro Sato
- Department of Infection Prevention and Control, Tokyo Medical University Hospital, Japan
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Ghasemi R, Rowe A, Shah R, Venkatesan P, England TJ. Neurocysticercosis presenting as a 'Stroke Mimic'. Acute Med 2016; 15:79-83. [PMID: 27441309] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/06/2023]
Abstract
A 62 year old Nepalese gentleman presented with left sided weakness and sensory loss. Initial brain CT scanning was suggestive of acute infarction but a subsequent MRI scan showed cysts with oedema. Cysticercosis serology was positive and a diagnosis of neurocysticercosis was made. The patient made almost a complete recovery after treatment with albendazole, praziquantel and steroids. Neurocysticercosis should be considered in the diffierential diagnosis when patients originating from endemic areas present with focal neurological deficit.
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Affiliation(s)
- Reza Ghasemi
- MRCP PhD, Consultant Acute Physician, Royal Derby Hospital, Derby, DE22 3NE, UK
| | - Aimee Rowe
- BSc BMBS, Junior Doctor, Postgraduate Education Centre, Royal Derby Hospital
| | - Rajiv Shah
- BmedSci, BMBS, MRCP, DTMH, M.Sc, Department of Infectious Diseases, Nottingham University Hospitals
| | - Pradhib Venkatesan
- MA PhD FRCP DTM&H, Department of Infectious Diseases, Nottingham University Hospitals
| | - Timothy J England
- MBChB MRCP PhD, Vascular Medicine, School of Medicine, Royal Derby Hospital Centre, University of Nottingham
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Cangalaya C, Zimic M, Marzal M, González AE, Guerra-Giraldez C, Mahanty S, Nash TE, García HH. Inflammation Caused by Praziquantel Treatment Depends on the Location of the Taenia solium Cysticercus in Porcine Neurocysticercosis. PLoS Negl Trop Dis 2015; 9:e0004207. [PMID: 26658257 PMCID: PMC4689503 DOI: 10.1371/journal.pntd.0004207] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/28/2015] [Accepted: 10/12/2015] [Indexed: 12/04/2022] Open
Abstract
Background Neurocysticercosis (NCC), infection of the central nervous system by Taenia solium cysticerci, is a pleomorphic disease. Inflammation around cysticerci is the major cause of disease but is variably present. One factor modulating the inflammatory responses may be the location and characteristics of the brain tissue adjacent to cysticerci. We analyzed and compared the inflammatory responses to cysticerci located in the parenchyma to those in the meninges or cysticerci partially in contact with both the parenchyma and the meninges (corticomeningeal). Methodology/Principal Findings Histological specimens of brain cysticerci (n = 196) from 11 pigs naturally infected with Taenia solium cysticerci were used. Four pigs were sacrificed after 2 days and four after 5 days of a single dose of praziquantel; 3 pigs did not receive treatment. All pigs were intravenously injected with Evans Blue to assess disruption of the blood-brain barrier. The degree of inflammation was estimated by use of a histological score (ISC) based on the extent of the inflammation in the pericystic areas as assessed in an image composed of several photomicrographs taken at 40X amplification. Parenchymal cysticerci provoked a significantly greater level of pericystic inflammation (higher ISC) after antiparasitic treatment compared to meningeal and corticomeningeal cysticerci. ISC of meningeal cysticerci was not significantly affected by treatment. In corticomeningeal cysticerci, the increase in ISC score was correlated to the extent of the cysticercus adjacent to the brain parenchyma. Disruption of the blood-brain barrier was associated with treatment only in parenchymal tissue. Significance Inflammatory response to cysticerci located in the meninges was significantly decreased compared to parenchymal cysticerci. The suboptimal inflammatory response to cysticidal drugs may be the reason subarachnoid NCC is generally refractory to treatment compared to parenchymal NCC. The cystic larvae of the pork tapeworm Taenia solium may affect the human brain causing neurocysticercosis (NCC), a very frequent cause of neurological symptoms in developing countries. The clinical expression and response to treatment of human NCC are related to the location of cysticerci inside (intraparenchymal) or outside the brain parenchyma (extraparenchymal NCC). We used a naturally infected pig model to assess the characteristics of inflammation around brain cysticerci of parenchymal, meningeal and mixed locations. There were no major differences in inflammation without treatment. After antiparasitic treatment with praziquantel, inflammation around parenchymal brain cysticerci increased in comparison to meningeal located cysticerci. Cysticerci partially surrounded by both brain parenchyma and meninges showed increased inflammation in relation to the extent of the cysticercus in the brain parenchyma. The location of cysticerci within the brain is a factor that determines the extent and degree of the immune response following anticysticidal treatment. Similar changes may occur in treated human infections. Our work could contribute to explain the differences in response to antiparasitic treatment in different forms of human neurocysticercosis.
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Affiliation(s)
- Carla Cangalaya
- Laboratorio de Inmunopatología en Neurocisticercosis, Facultad de Ciencias y Filosofía, Universidad Peruana Cayetano Heredia, Lima, Perú
- * E-mail:
| | - Mirko Zimic
- Laboratorio de Bioinformática y Biología Molecular, Facultad de Ciencias y Filosofía, Universidad Peruana Cayetano Heredia, Lima, Perú
- Departamento de Ciencias Celulares y Moleculares, Facultad de Ciencias y Filosofía, Universidad Peruana Cayetano Heredia, Lima, Perú
| | - Miguel Marzal
- Laboratorio de Inmunopatología en Neurocisticercosis, Facultad de Ciencias y Filosofía, Universidad Peruana Cayetano Heredia, Lima, Perú
| | - Armando E. González
- Facultad de Medicina Veterinaria, Universidad Nacional Mayor de San Marcos, Lima, Perú
| | - Cristina Guerra-Giraldez
- Laboratorio de Inmunopatología en Neurocisticercosis, Facultad de Ciencias y Filosofía, Universidad Peruana Cayetano Heredia, Lima, Perú
- Departamento de Ciencias Celulares y Moleculares, Facultad de Ciencias y Filosofía, Universidad Peruana Cayetano Heredia, Lima, Perú
| | - Siddhartha Mahanty
- Laboratorio de Inmunopatología en Neurocisticercosis, Facultad de Ciencias y Filosofía, Universidad Peruana Cayetano Heredia, Lima, Perú
- Laboratory of Parasitic Diseases, National Institute of Allergy and Infectious Diseases, National Institutes of Health, Bethesda, Maryland, United States of America
| | - Theodore E. Nash
- Laboratorio de Inmunopatología en Neurocisticercosis, Facultad de Ciencias y Filosofía, Universidad Peruana Cayetano Heredia, Lima, Perú
- Laboratory of Parasitic Diseases, National Institute of Allergy and Infectious Diseases, National Institutes of Health, Bethesda, Maryland, United States of America
| | - Hector H. García
- Departamento de Ciencias Celulares y Moleculares, Facultad de Ciencias y Filosofía, Universidad Peruana Cayetano Heredia, Lima, Perú
- Unidad de Cisticercosis, Instituto Nacional de Ciencias Neurológicas, Lima, Perú
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Li Y, Sun L, Chen C, Yang CM. [Clinical application of diagnostic therapy of praziquantel for suspected cere- bral cysticercosis]. Zhongguo Xue Xi Chong Bing Fang Zhi Za Zhi 2015; 27:517-519. [PMID: 26930940] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/05/2023]
Abstract
OBJECTIVE To explore the clinical application value of diagnostic therapy of praziquantel for suspected cerebral cysticercosis. METHODS The suspected cerebral cysticercosis patients were collected and treated with the diagnostic therapy [praziquantel, 50 mg/(kg · d)], and followed up for 1-2 years. RESULTS Totally 94 suspected cerebral cysticercosis patients were collected. After the diagnostic therapy, 78 (82.98%) cases were confirmed as cerebral cysticercosis, 13 (13.83%) were diagnosed as other diseases, and 3 (3.19%) were not definitely diagnosed. CONCLUSION The diagnostic therapy for suspected cerebral cysticercosis can reduce or avoid the missed diagnosis and misdiagnosis in some atypical cerebral cysticercosis patients.
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Abstract
PURPOSE The debut study was aimed to develop Lactic acid (LA)-conjugated solid lipid nanoparticles (SLN-LA) bearing albendazole (ALB) and prednisolone (PRD) for effective management of neurocysticercosis (NCC). METHODS LA was coupled to SLN by post-insertion technique. SLNs were characterized for particle size and size distribution, shape, and percent drug entrapment efficiency. In vitro drug release kinetics, fluorescence study and in vitro transendothelial transport, hematological studies and pharmacokinetic studies were carried out to predict the fullest drug delivery potential. RESULTS Spherical SLNs (~100 nm) with good drug entrapments (~64 and ~78% for ALB and PRD, respectively) showed in vitro initial fast release (i.e., 20-40% drugs release in 4 h) followed by sustained release for more than 48 h. Fluorescence study and in vitro transendothelial transport depicted selective brain uptake of SLN-LA compared to SLN attributed to carrier mediated transport via monocarboxylic acid transporters (MCT - 1/2/3). Pharmacokinetic parameters such as AUC0-t and AUMC0-t and Cllast showed good drugs withholding capacity of SLNs. Organ distribution studies reflected high accumulation of drugs (ALB, 7.6 ± 0.31%; PRD, 5.21 ± 0.24%) in the brain after 24 h in case of SLN-LA as compared to plain drugs solution. SLN-LA in hematological studies revealed insignificant toxicity to blood cells. CONCLUSIONS The overall study paved the potential advances in brain targeting with synergistic acting drugs for effective management of NCC.
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Affiliation(s)
- Rekha Devi
- Pharmaceutics Research Projects Laboratory, Department of Pharmaceutical Sciences, Dr. Hari Singh Gour Vishwavidyalaya, Sagar, (M.P.), 470 003, India
| | - Ankit Jain
- Pharmaceutics Research Projects Laboratory, Department of Pharmaceutical Sciences, Dr. Hari Singh Gour Vishwavidyalaya, Sagar, (M.P.), 470 003, India
| | - Pooja Hurkat
- Pharmaceutics Research Projects Laboratory, Department of Pharmaceutical Sciences, Dr. Hari Singh Gour Vishwavidyalaya, Sagar, (M.P.), 470 003, India
| | - Sanjay K Jain
- Pharmaceutics Research Projects Laboratory, Department of Pharmaceutical Sciences, Dr. Hari Singh Gour Vishwavidyalaya, Sagar, (M.P.), 470 003, India.
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Garcia HH, Gonzales I, Bustos JA, Saavedra H, Gavidia M, Rodriguez L, Najar E, Umeres H, Pretell EJ. Combined antiparasitic treatment for neurocysticercosis - Authors' reply. Lancet Infect Dis 2015; 15:266-7. [PMID: 25749227 DOI: 10.1016/s1473-3099(15)70047-2] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
Affiliation(s)
- Hector H Garcia
- Cysticercosis Unit, Instituto Nacional de Ciencias Neurológicas, Barrios Altos, Lima 1, Peru; Department of Microbiology, Universidad Peruana Cayetano Heredia, Lima, Perú; Center for Global Health - Tumbes, Universidad Peruana Cayetano Heredia, Lima, Perú.
| | - Isidro Gonzales
- Cysticercosis Unit, Instituto Nacional de Ciencias Neurológicas, Barrios Altos, Lima 1, Peru
| | - Javier A Bustos
- Department of Microbiology, Universidad Peruana Cayetano Heredia, Lima, Perú
| | - Herbert Saavedra
- Cysticercosis Unit, Instituto Nacional de Ciencias Neurológicas, Barrios Altos, Lima 1, Peru
| | - Martin Gavidia
- Hospital Nacional Edgardo Rebagliatti, ESSALUD, Lima, Perú
| | | | - Enrique Najar
- Hospital Nacional Cayetano Heredia, Ministerio de Salud, Lima, Perú
| | - Hugo Umeres
- Hospital Nacional Cayetano Heredia, Ministerio de Salud, Lima, Perú
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