The effectiveness of anti-inflammatory and anti-seizure medication for individuals with single enhancing lesion neurocysticercosis: A meta-analysis and expert group-based consensus recommendations

Single brain enhancing lesions (SEL) are the most common presentation of neurocysticercosis (NCC) observed on neuroimaging in people presenting with epileptic seizures not only on the Indian sub-continent and in travelers returning from cysticercosis-endemic regions, but are also present in other parts of the world. The aim of this study, which consisted of a systematic review (CRD42019087665), a meta-analysis and an expert group consultation, was to reach consensus on the best anti-seizure medication and anti-inflammatory treatment for individuals with SEL NCC. Standard literature review methods were used. The Cochrane risk of bias tool was used and random effects model meta-analyses were performed. The quality of the body of evidence was rated using GRADE tables. The expert committee included 12 gender and geographically balanced members and recommendations were reached by applying the GRADE framework for guideline development. The 1-1.5-year cumulative incidence of seizure recurrence, cyst resolution or calcification following anti-seizure medication (ASM) withdrawal was not statistically different between ASM of 6, 12 or 24 months. In contrast, in persons whose cyst calcified post treatment, longer ASM decreased seizure recurrence. The cumulative incidence ratio (CIR) 1-1.5 years after stopping ASM was 1.79 95% CI: (1.00, 3.20) for patients given 6 versus 24 months treatment. Anti-inflammatory treatment with corticosteroids in patients treated with ASM compared to patients treated with ASM only showed a statistically significant beneficial effect on seizure reduction (CIR 0.44, 95% CI 0.23, 0.85) and cyst resolution (CIR 1.37, 95%CI: 1.07, 1.75). Our results indicate that ASM in patients with SEL NCC whose cysts resolved can be withdrawn, while patients whose cysts calcified seem to benefit from prolonged anti-seizure medication. Additional corticosteroid treatment was found to have a beneficial effect both on seizure reduction and cyst resolution.

Neurocysticercotic Calcifications and Hippocampal Sclerosis: A Case-Control Study

Objective

The exact role of calcified neurocysticercotic lesions (CNLs) in epilepsy is yet unknown and controversial. Although the relationship between CNLs, epilepsy and mesial temporal lobe epilepsy with hippocampal sclerosis (MTLE-HS) has already been addressed, to our knowledge, no study has actually provided strong statistical evidence, nor reported the ODDS ratio for these associations. Therefore, we designed this case-control study to assess the likelihood of having MTLE-HS versus other forms of epilepsy in the presence of CNLs.

Methods

In this case-control study we included 119 consecutive patients with epilepsy and 106 disease controls (headache) with previous CT scans. We subdivided cases into MTLE-HS and other epilepsies. We used brain CT scans to define presence or absence of CNLs. After exploratory analyses, we used logistic regression to analyze the association between CNLs, epilepsy subgroups and disease controls.

Results

CNLs were found in 31.09% of cases and in 11.32% of controls (p<0.001). The initial analysis comparing epilepsy versus controls revealed a significant association between CNLs and epilepsy (OR = 5.32; 95%CI = 2.43-11.54; p<0.001). However, when we compared MTLE-HS versus other epilepsies versus controls we confirmed that CNLs were associated with MTLE-HS (OR = 11.27, 95%CI = 4.73-26.85; p<0.001) but other epilepsies were not. We found no difference in the CNLs load and no difference in the location of the CNLs when we compared patients with MTLE-HS, other epilepsies and disease controls.

Significance

The inclusion of controls allowed us to estimate the likelihood of having epilepsy in the presence of CNLs. We found that patients with CNLs were 11 times more likely to have MTLE-HS; however, the presence of CNLs did not change the odds of having other types of epilepsy. These findings raise the possibility of neurocysticercosis playing a role in the pathophysiology of MTLE-HS and need further confirmation in other series.

PET reveals inflammation around calcified Taenia solium granulomas with perilesional edema

OBJECTIVE

Neurocysticercosis, an infection with the larval form of the tapeworm, Taeniasolium, is the cause of 29% of epilepsy in endemic regions. Epilepsy in this population is mostly associated with calcified granulomas; at the time of seizure recurrence 50% of those with calcifications demonstrate transient surrounding perilesional edema. Whether edema is consequence of the seizure, or a result of host inflammation directed against parasite antigens or other processes is unknown. To investigate whether perilesional edema is due to inflammation, we imaged a marker of neuroinflammation, translocater protein (TSPO), using positron emission tomography (PET) and the selective ligand (11)C-PBR28.

METHODS

In nine patients with perilesional edema, degenerating cyst or both, PET findings were compared to the corresponding magnetic resonance images. Degenerating cysts were also studied because unlike perilesional edema, degenerating cysts are known to have inflammation. In three of the nine patients, changes in (11)C-PBR28 binding were also studied over time. (11)C-PBR28 binding was compared to the contralateral un-affected region.

RESULTS

(11)C-PBR28 binding increased by a mean of 13% in perilesional edema or degenerating cysts (P = 0.0005, n = 13 in nine patients). Among these 13 lesions, perilesional edema (n=10) showed a slightly smaller increase of 10% compared to the contralateral side (P = 0.005) than the three degenerating cysts. In five lesions with perilesional edema in which repeated measurements of (11)C-PBR28 binding were done, increased binding lasted for 2-9 months.

CONCLUSIONS

Increased TSPO in perilesional edema indicates an inflammatory etiology. The long duration of increased TSPO binding after resolution of the original perilesional edema and the pattern of periodic episodes is consistent with intermittent exacerbation from a continued baseline presence of low level inflammation. Novel anti-inflammatory measures may be useful in the prevention or treatment of seizures in this population.

Porocephalosis due to encysted Armillifer nymph presenting as an acute abdominal emergency: case report and review of literature

A rare case of porocephalosis infection presenting with an acute abdominal emergency in a 60 year old Nigerian is presented. The characteristic radiologic appearance of Armillifer nymph is described, and clinical findings which may be caused by this parasite are reviewed. A brief review of the epidemiology of porocephalosis is also included.

Management of multiple echinococcosis in childhood with albendazole and surgery

BACKGROUND/PURPOSE

Multiple echinococcosis (ME) is a severe disease in childhood inaccessible to an initial radical surgical treatment. The aim of this study was to evaluate the efficacy of Albendazole in ME and to discuss the role of surgery in this pathology.

METHODS

Eleven patients were included in a prospective study between 1996 and 2004. ME was defined by the presence of 10 or more cysts in the same organ. Albendazole was given as 10 mg/kg daily continuously. Treatment outcome was defined as cure, improvement, stabilization or deterioration. Surgery was discussed after 1 year of treatment.

RESULTS

Our patients totalized 296 cysts located essentially on the liver (178 cysts) and the lungs (78 cysts). With exclusive Albendazole therapy, 57.7% pulmonary cysts and 96% peritoneal cysts were considered as cured. This rate was only 31.5% in hepatic localization. After surgical therapy, 67.4% of hepatic cysts were cured. No productive biliary fistula was observed. Two patients were operated laparoscpically. The total treatment duration ranged between 1 and 5 years. Parasitologic examination of operated cysts showed that 30% of them were viable even after 3 years of treatment.

CONCLUSION

Albendazole has proven a strong efficacy in pulmonary and peritoneal localizations. A complementary surgical treatment is often necessary in hepatic localizations and it is facilitated with previous Albenazole therapy. Combination of ABZ and surgery seems to have encouraging results and must be applied for those patients. The high rate of viable cysts after medical therapy is problematic and must incite to develop new antihelminthic agents.

[Contribution of Western blotting to the diagnosis of hydatidosis]

The aim of this study is to evaluate the contribution of the immunoWesternblot for the diagnosis and the post surgical follow-up of the hydatidosis. 71 sera from patients with hydatidosis confirmed by surgery were studied. All had a negative hydatic serology by screening tests (enzyme-linked immunosorbent assay, hemagglutination, electrosyneresis). 12 patients with sera in pre and post operative were monitored for 2 years. The Echinococcus Western blot IgG permitted to rectify the diagnosis of hydatidosis in 67.6 %. The rate of positivity was 100 % for the multivesicular liver cysts, 60 % for the young cysts and 50 % for the calcified cysts. Western blot permitted to rectify the diagnosis of lung cysts in 62.5 % of cases and in 50 % of cranial-spinal localizations. Analysis of Western Blot evolution in the 12 patients followed in pre and post-surgical revealed the disappearance of the bands 16, 18 and 26-28kDa in 8 month in the 8 patients with complete exeresis. This study proved the value added of Western blot compared to the other traditional techniques for the immunodiagnostic and the post-surgical monitoring of hydatidosis.

Contrast-enhanced CT and MRI findings of atypical hepatic Echinococcus alveolaris infestation

Diagnosis of liver infestation by Echinococcus alveolaris (EA) is based on serological and radiological findings. In this report, we present a 15-year-old girl with atypical hepatic EA infestation showing central punctate calcifications and contrast enhancement on the portal and late phases of CT and MRI. CT showed a hypodense mass involving more than half of the liver with prominent central calcifications. MRI revealed hypointense signal of the infiltrative mass on both T1- and T2-weighted images. Contrast enhancement is a unique finding in hepatic EA infestation that may cause difficulties with diagnosis. MRI may provide invaluable information in the diagnosis of EA infestation of the liver, either by disclosing the infiltrative pattern of infestation without significant effect to vascular structures, or by the signal characteristics.

Too Late Prenatal Diagnosis of Fetal Toxoplasmosis: A Case Report

OBJECTIVE

We describe a case of severe fetal hydrocephalus due to toxoplasmosis which could not be diagnosed until late gestational age due to the lack of a serologic surveillance program during pregnancy; moreover, this case points to the usefulness of molecular biology tools in the diagnostic process. Abnormal ultrasound in the 2nd trimester was noticed and Toxoplasma gondii was demonstrated in amniotic fluid at the 28th week of gestation both by PCR and by mice inoculation. Fansidar and folinic acid were administered. The newborn suffered from progressive hydrocephalus, seizures, and pathological muscular tonus; ultrasound examination showed massive cerebral calcifications. Ophthalmologic examination revealed bilateral choroidoretinitis. Congenital toxoplasmosis was confirmed by the detection of anti- T. gondii IgM and IgA in the neonatal serum.

CONCLUSION

The presented case is an example of severe fetal toxoplasmosis diagnosed and treated in utero.

[Calcified cerebral hydatid cyst: a case report]

Hydatid cysts are rarely located in the brain (1 to 3% of all cases), and these are even more rarely in calcified form. We report one case of a 20-year-old woman. She had undergone surgery for a pulmonary hydatid cyst at the age of four years. She had been subject to general epileptic seizures refractory to standard anticonvulsive drugs for the past four years. Cerebral computed tomography showed calcification in the left occipital region. A calcified hydatid cyst was discovered and removed during surgery. Subsequent course has been good and the epileptic seizures have disappeared. A calcified hydatid cyst in the brain is very rare and presents diagnostic and therapeutic problems.

Calcific neurocysticercosis and epileptogenesis

Neurocysticercosis is responsible for increased rates of seizures and epilepsy in endemic regions. The most common form of the disease, chronic calcific neurocysticercosis, is the end result of the host's inflammatory response to the larval cysticercus of Taenia solium. There is increasing evidence indicating that calcific cysticercosis is not clinically inactive but a cause of seizures or focal symptoms in this population. Perilesional edema is at times also present around implicated calcified foci. A better understanding of the natural history, frequency, epidemiology, and pathophysiology of calcific cysticercosis and associated disease manifestations is needed to define its importance, treatment, and prevention.

Surgical treatment for mesial temporal lobe epilepsy in the presence of massive calcified neurocysticercosis

BACKGROUND

Neurocysticercosis (NCC) is the most common parasitic disease of the human central nervous system and a major health problem for most developing countries. The most common clinical manifestations of NCC are epileptic seizures. Whenever epilepsy and NCC coexist in the same patient, an uncertainty may rise about a causal relationship between them.

OBSERVATION

We described a female patient with disseminated calcified NCC lesions and intractable epilepsy. Her medical history included cysticercotic meningoencephalitis and status epilepticus caused by active NCC. Fundoscopy showed the ocular presence of parasite; computed tomography of the brain showed evidence of cystic lesions with the scolex and calcified lesions; enzyme-linked immunosorbent assay of the cerebrospinal fluid was positive for cysticercosis. Epileptic seizures started after an 8-year silent period. Magnetic resonance imaging showed left hippocampal sclerosis. Plain x-ray film showed calcifications in muscles and subcutaneous tissue. Video-electroencephalography and ictal and interictal single-photon emission computed tomography disclosed left mesial temporal lobe epilepsy. The patient underwent left temporal lobectomy and has been seizure free since surgery, for a follow-up of 4 years.

CONCLUSION

This case report highlights and supports surgical therapy in patients with epileptic seizures and calcified NCC, even when there are several calcifications, provided that clear localization of epilepsy has been determined by means of a presurgical workup.

Imaging diagnosis of schistosomiasis japonica--the use in Japan and application for field study in the present endemic area

For detecting lesions-related schistosomiasis japonica, X-rays, scintillation scanning, ultrasonography (US), computed tomography (CT), magnetic resonance (MR) and endoscopic examinations with biopsies have been used in Japan. Liver fibrosis and calcified changes are detected by US and CT. Most of the lesions that are detected by endoscopic examinations are due to deposited ova of Schistosoma japonicum. Portal hypertension is detected by US, CT and gastroscopic examination. Because schistosome infection decreased rapidly in Japan, most of the studies on imaging diagnosis were performed on chronic lesions or sequelae of schistosomiasis. Most of the techniques were used on admitted patients in well-equipped hospitals. US was introduced in the 1970s as a safe, rapid, non-invasive and inexpensive technique and has been used for diagnosis in hospitals and screening in the fields. As a typical US image of the liver, septal formation by high echogenic bands like mosaic was described, and this network pattern was reported in the other endemic countries; China and Philippines. As an appropriate technique, US has been broadly used in developing countries. Not only for diagnosis in a hospital, but also for monitoring changes of morbidity, US is used in the community level. Network pattern related to the severity of S. japonicum infection, has not been described in S. mansoni or S. haematobium infection. Appearance of network pattern depends on pathological changes such as periportal fibrosis, postnecrotic fibrosis and calcified ova. For advanced studies on morbidity of schistosomiasis japonica, further research on pathological basis of network pattern and standardization of US diagnosis are necessary.

[Polycystic hydatidosis: casual finding of calcified hydatid cyst simulating mesenteric neoplasm]

A case of abdominal hydatidosis, without hepatic involvement, in a patient from the State of Acre is reported. The hydatid, already in degeneration and partially calcified, was discovered incidentally by a radiologic examination of the vertebral column, carried out for evaluating the state of an intervertebral disk prolapse. Although the images suggested a mesenteric tumor, attached to the intestinal wall, the finding of rostellar hooklets in the dense contents of the cyst, after surgical removal, revealed the parasitic nature of the lesion.

Demonstration of scolex in calcified cysticercus lesion using gradient echo with or without corrected phase imaging and its clinical implications

AIM

This study was performed to determine the magnetic resonance imaging (MRI) sequence that was best suited to demonstrate the scolex in a calcified lesion and to seek the explanation for the appearance of a negative phase in a calcified scolex on corrected gradient refocused echo (GRE) phase imaging.

MATERIALS AND METHODS

Forty-nine patients with single/multiple computed tomography (CT) documented homogeneous calcified lesions and/or calcified scolices in cysts were studied with conventional spin echo and corrected GRE phase imaging. Calcium and different paramagnetic substances from cysticerci scolices of a sample of infected swine muscle were quantified.

RESULTS

The scolex could be demonstrated in 29/39 patients with single calcified lesion. GRE imaging with an echo time of 35ms was the only sequence that demonstrated scolex in all these 29 cases. 15/29 patients with a single calcified lesion, in all 10 patients with multiple calcified lesions and infected swine muscle with multiple cysts and calcified scolex, corrected GRE phase imaging showed negative phase in all these scolices. Estimation of minerals from the calcified scolices from the swine muscle showed by spectroscopic techniques 41.2% of the total mineral contents as paramagnetic substances.

CONCLUSION

We conclude that GRE imaging is the imaging method of choice for demonstration of the scolex in a CT calcified lesion. The negative phase on corrected GRE phase imaging is due to the presence of large amount of paramagnetic substances.

[Calcified cerebral hydatid cyst. Report of a case]

The cerebral localization of the hydatid cyst is still rare (1 to 4% of the cases). The calcified cerebral hydatid cyst is exceptional. We report one case collected in our department. It is about a patient of 28 years old, that the case histories consist in convulsive attacks since the age of 8 years old, hospitalized because of a left hemiparesis with progressive installation. The cerebral computerized tomography showed a right parieto-occipital that is largely calcified. During the operation, a calcified hydatid cyst discovered with various daughter vesicles and a cerebral gliosis, the latter has been extracted entirely. The evolution has been favourable with improvement of the left hemiparesis. The calcified hydatid cyst of brain is still exceptional, its symptomatology is the same as the safe CHC, but it poses some diagnostic and therapeutic problems.

Calcified cysticerci provoke perilesional edema and seizures

In cases of cysticercosis, seizures and other symptoms occur in persons with only calcified brain lesions. The presence of perilesional edema has been documented in association with calcified lesions in symptomatic patients, but the frequency of this complication and characteristics of the patients who develop it are not known. Patients in Peru and the United States with neurocysticercosis, documented by positive results of serological testing and with only calcified lesions as shown using computerized tomography, were studied using magnetic resonance imaging. Perilesional edema was observed in slightly more than one-third of the patients, and some patients had frequent, severely disabling episodes. Those with an increased proportion of enhancing calcified lesions were more likely to show perilesional edema. Edema around calcified lesions is common in this population and is associated with seizures and neurological morbidity.

Seizures associated with calcifications and edema in neurocysticercosis

We describe eight cases of pediatric patients whose neuroimages performed after seizures revealed abnormalities that were compatible with edema surrounding calcified lesions and which disappeared in subsequent examinations.

Spinal toxoplasmic arachnoiditis associated with osteoid formation: a rare presentation of toxoplasmosis

STUDY DESIGN

An extremely rare presentation of an isolated spinal toxoplasmic arachnoiditis is described.

OBJECTIVE

To draw attention to the fact that spinal arachnoid membranes may be a potential reservoir for Toxoplasma gondii.

SUMMARY OF BACKGROUND DATA

Central nervous system toxoplasmosis is a common manifestation in patients who are immunodeficient. Reports on the spinal toxoplasmosis are rare and focused on spinal cord involvement.

METHODS

An adult patient presented with symptoms of spastic paraparesis that had begun 13 years before admission. Thoracic spinal magnetic resonance imaging showed small lesions in posterior subarachnoid space at Th7-Th8. A Th7-Th8 laminectomy was performed. Intradural-extramedullary lesions were excised.

RESULTS

Clinical, immunologic, and pathologic examinations showed adhesive spinal arachnoiditis associated with osteoid formation caused by past toxoplasmic infection. There was no impairment of the immunologic defense system.

CONCLUSION

Where no causative factor is found in serious spinal adhesive arachnoiditis, the possibility of spinal toxoplasmosis should also be investigated.

[Schistosomiasis: an unusual cause of breast microcalcifications]

We report a unusual case of mammary schistosomiasis revealed by breast microcalcifications. This localisation of schistosomiasis is exceptional but should be suspected in women who come from endemic areas. Other cases previously reported in the literature are also described.

Treatment of toxoplasmosis during pregnancy: a multicenter study of impact on fetal transmission and children's sequelae at age 1 year

OBJECTIVE

Toxoplasmosis during pregnancy can cause fetal infection, with unpredictable sequelae in later life. We measured the effects of prenatal antibiotic therapy on the fetomaternal transmission of Toxoplasma gondii and on the appearance of sequelae in the congenitally infected child at age 1 year.

STUDY DESIGN

In a multicenter study we investigated consecutive women with Toxoplasma seroconversion during pregnancy. Data were obtained from 144 women recruited in 5 different Toxoplasma reference centers. Through multivariate analysis we assessed the association between transmission and appearance of sequelae as a function of the following parameters: estimated gestational age at infection, administration of antibiotic therapy, duration of antibiotic therapy, and time lapse between infection and the start of antibiotic therapy.

RESULTS

Sixty-four of the 144 women (44%) gave birth to a congenitally infected infant. Multivariate analysis showed that transmission was predicted neither by whether antibiotics had been administered nor by the time lapse between infection and the start of antibiotic therapy, but only by the gestational age at which maternal infection occurred (P <.0001). Sequelae were found in 19 children (13%), 9 of whom (6%) had severe sequelae. Administration of antibiotics was predictive of the absence of sequelae (P =.026, odds ratio 0.30, 95% confidence interval 0.104-0.863), in particular the absence of severe sequelae (P =.007, odds ratio 0.14, 95% confidence interval 0.036-0.584). The sooner antibiotics were given after the infection, the less frequently sequelae were seen (P =. 021).

CONCLUSION

Prenatal antibiotic therapy after toxoplasmosis during pregnancy had no impact on the fetomaternal transmission rate but reduced the rate of sequelae among the infected infants. The early start of treatment resulted in a significant reduction in the number of severely affected infants.

The Rocky liver: radiologic-pathologic correlation of calcified hepatic masses

Although relatively uncommon in daily clinical practice, calcification may be found in inflammatory hepatic lesions and in benign and malignant liver neoplasms. The most common source of calcified hepatic lesions is inflammatory conditions such as granulomatous diseases (e.g., tuberculosis). The calcification typically involves the entire lesion and appears as a dense mass that can produce artifacts on computed tomographic (CT) scans. Echinococcus cysts have curvilinear or ring calcification. Hemangiomas, especially large ones, may contain large, coarse calcifications that are centrally located in areas of fibrosis; these may be seen at CT (20% of cases) or radiography (10%). In hepatocellular adenoma, calcifications may be solitary or multiple and are usually located eccentrically within a complex heterogeneous mass. Calcifications in fibrolamellar carcinoma have been reported in 15%-25% of cases at CT and occur in a wide variety of patterns. Calcifications in intrahepatic cholangiocarcinoma are typically accompanied by a desmoplastic reaction and are visible at CT in about 18% of cases. Calcified hepatic metastases are most frequently associated with mucin-producing neoplasms such as colon carcinoma. Knowledge of the pathologic features of each entity helps radiologists to better recognize the shape, size, density, number, location, and distribution of hepatic calcifications seen on images and to narrow the differential diagnosis.

Case report: calcified pancreas and bile ducts from schistosomiasis

Schistosomiasis is one of the commonest parasitic diseases affecting mankind. Egyptian schistosomiasis (mansoni and haematobium) is capable of producing fibrosis and/or calcification, resulting in striking radiological features in target organs. Our two cases with biliary and pancreatic calcification provide a combination of features not documented previously.

[Neurocysticercosis: benign natural course]

In a waiter aged 51 without clinical symptoms, but with a history of sporadic epileptic seizures in young age, radiological examination demonstrated multiple calcifications in the brain corresponding to calcified cysticerci. Similar lesions were found in the muscles of the thighs and left lower leg. After another 18 years without cerebral symptoms these calcifications were demonstrated in CT. The case indicates that the natural course of cerebral cysticercosis may be asymptomatic or oligosymptomatic, and that it is useful to distinguish between active and inactive cysticercosis.

Blepharospasm associated with neurocysticercosis

We report a case of a 48-year-old woman who had a 4 years history of bilateral blepharospasm. CT-scan showed multiple intracranial calcifications (two of them in the left thalamus) corresponding to neurocysticerosis, and a lacunar infarction in right internal capsule area. To our knowledge this case is the first one reported in the literature of blepharospasm associated with (and perhaps symptomatic of?) neurocysticercosis.

CT findings of cerebral paragonimiasis in the chronic state

The CT findings in 5 patients with cerebral paragonimiasis in the chronic state are presented. The findings were: 1) multiple, densely calcified areas with a variety of round or nodular shapes in the brain, 2) a large low density area surrounding or connecting with the calcified areas, and 3) cortical atrophy and ventricular dilatation. The relation between the CT findings and the previously reported plain skull X-ray findings or neuropathological findings are discussed.

Recurrent pancreatitis caused by a calcified ascaris in the duct of Wirsung

A case report of recurrent pancreatitis in a 20-yr-old woman due to an impacted calcified Ascaris remnant within the duct of Wirsung is presented. Endoscopic retrograde cholangiography identified a filling defect in the proximal main pancreatic duct. Transampullary endoscopic retrieval failed to extract the calculus and operative intervention was required to remove the calcified worm remnant.

The radiographic evaluation of appendiceal calcification due to schistosomiasis

In a 6-month period, 25 appendices with histological involvement by schistosomiasis were radiographed. Eleven showed varying degrees of radiographically detectable calcification having a spotty, linear, or amorphous pattern affecting either a short segment or the whole appendix. Four of these appendices had a mixed pattern and one also had nodular calcification in the mesoappendix. In only 1 patient was the appendiceal calcification visible on preoperative abdominal radiographs. In 5 asymptomatic patients, not submitted to surgery, appendiceal calcification was detected during radiologic evaluation of urinary schistosomiasis.

Parasitic rheumatism: rheumatic manifestations associated with calcified guinea worm

We prospectively studied 20 Saudi and Yamani patients with calcified guinea worm who presented with different rheumatic manifestations. Localized myalgia (55%), chronic monoarthralgia (35%) and chronic synovitis of the knee (10%) were the main presentations. Two cases with synovial fluid eosinophilia were seen. In spite of the absence of active infestation, the clinical, laboratory and radiological findings suggested the possibility of a causal relationship. The condition should be considered among other causes of parasitic rheumatism particularly in endemic areas.

Neurocysticercosis: a new classification based on active and inactive forms. A study of 753 cases

Cysticercosis of the central nervous system, because of the combination of inflammatory response, topography of lesions, degree of parasitic infestation, and sequelae of previous infestations produces a most variable clinical picture. The symptomatology may range from a discrete neurological disturbance to the most dramatic brain disorder. Severity of the disease, prognosis, and medical or surgical decision for treatment largely depend on the individual amalgam of the above-referred factors. An improved classification of neurocysticercosis (NCC) that delineates active from inactive forms of the disease will eventually be important in the research of immunodiagnosis and in therapeutic trials. In this report, a classification is presented that separates active from nonactive forms of NCC and is based on our experience with 735 patients studied. Characteristics of each form of NCC, frequency of principal signs and symptoms, and findings in cerebrospinal fluid analysis are discussed.

Trichinella spiralis: acceleration and inhibition of cyst calcification in rats

Daily administration of vitamin D3 (75,000 IU/kg b. wt) for 7 days accelerated Trichinella spiralis cyst calcification in rats with a 14-week-old infection. When disodium ethane-1-hydroxy-1, 1-diphosphonate (EHDP) was administered (50 mg/kg b. wt) from 2 days before until 2 days after vitamin D3 treatment, cyst calcification was inhibited. Thus, the ability to inhibit E. spiralis calcification has demonstrated for the first time.

Calcification of Schistosoma haematobium eggs: relation of radiologically demonstrable calcification to eggs in tissues and passage of eggs in urine

The extent of calcification of the bladder in schistosome infected patients is roughly correlated with the number of calcified schistosome eggs present in the bladder. The focal concentration of eggs in the bladder appears to be one major variable, and we estimate that as few as 100,000 eggs per cm2 might be detected in a clinical radiograph. The excretion of calcified eggs in the urine was related to the activity of the schistosome infection and was unaffected by the presence or extent of bladder calcification.