Metagenomic next-generation sequencing in the diagnosis of neurocysticercosis:A case report

BACKGROUND The clinical symptoms and imaging manifestations of neurocysticercosis(NCC)are very different,and the difficulty and delay of clinical diagnoses may lead to an increase in mortality and disability.Rapid and accurate pathogen identification is important for the treatment of these patients.Metagenomic next-generation sequencing(mNGS)is a powerful tool to identify pathogens,especially in infections that are difficult to identify by conventional methods.CASE SUMMARY A 43-year-old male patient was admitted due to a recurrent headache for a few months.Imaging examinations showed hydrocephalus and cystic lesions,which were considered to be a central nervous system infection,but no etiology was found by routine examination.mNGS of the cerebrospinal fluid revealed high Taenia solium reads,and the positive results of a cysticercosis antibody test confirmed the infection.Combined with the patient’s clinical manifestations,the etiological evidence,and the imaging manifestation,the patient was finally diagnosed with NCC and he was prescribed dexamethasone,albendazole,neurotrophic drugs,and intracranial pressure reduction therapy.The headaches disappeared after anti-parasite treatment,and no associated symptoms recurred prior to the three-and six-month follow-up.CONCLUSION As an accurate and sensitivity detection method,mNGS can be a reliable approach for the diagnosis of NCC.

Simultaneous Neurocysticercosis and Cerebral Toxoplasmosis in a Patient Living with HIV—Case Report

Background: Simultaneous central nervous system infection by more than one pathogen is very uncommon, even in individuals with acquired immunodeficiency syndrome. Purpose and methods: We report a clinical case of an HIV positive patient with simultaneous biopsy-confirmed neurotoxoplasmosis and neurocysticercosis. Results and conclusion: In this report, we present a rare occurrence of two simultaneous parasitic infections of the central nervous system in a patient with advanced immunosuppression due to HIV-1 infection. Despite the limited data available regarding the prevalence of such co-infections, this case underscores the importance of maintaining a high index of suspicion and promptly identifying concurrent neurologic diseases to enable accurate diagnosis and appropriate treatment in these patients.

Neurocysticercosis:A case report and brief review

Neurocysticercosis(NCC) is one of the seven neglected endemic zoonoses targeted by the World Health Organization.It is considered a common infection of the nervous system caused by the Tanenia solium and is known to be the primary cause of preventable epilepsy in many developing countries.NCC is commonly resulted by the ingestion of Tanenia solium eggs after consuming undercooked pork,or contaminated water.The parasite can grow in the brain and spinal cord within the nervous system,causing severe headache and seizures beside other pathological manifestations.Immigration and international travel to endemic countries has made this disease common in the United States.NCC can be diagnosed with computed tomography and magnetic resonance imaging of the brain.The treatment of the NCC including cysticidal drugs(eg.,albendazole and praziquantel),and neurosurgical procedure,depending upon a the situation.A patient of Asian origin came to our clinic with complaints of dizziness,headaches and episodes seizures for the past twelve years without proper diagnosis.The computed tomography and magnetic resonance imaging scans indicated multilobulated cystic mass in the brain with the suspicion of neurocysticercosis.

Neurocysticercosis causing sudden death:a case report

We report an acute case of a native man from Bolivia suffered from cephalalgia which rapidly worsened and ended in his sudden and unexpected death.Magnetic resonance imaging(MRI) of the brain was obtained.Features demonstrated on brain MRI scan were consistent with a diagnosis of neurocysticercosis(NCC).An autopsy showed the presence of intraventricular Taenia solium(T.solium) cysts which caused blockage of cerebrospinal fluid and secondary hydrocephalus.Due to the increasing travel movements of people neurocysticercosis must be considered as a cause of unexplained sudden death.

Diagnosis of neurocysticercosis among patients with seizures in northern coastal districts of Andhra Pradesh, India

Objective: To report cases of neurocysticercosis(NCC) from three neighboring districts of Andhra Pradesh state in India where NCC burden was never explored before.Methods: A total of 160 patients presenting with recent onset seizures were recruited from neurology, general medicine, and pediatric outpatient clinics of a local major tertiary care teaching hospital serving above districts during the period 2011–2014. Brain imaging was performed in all the above cases. A commercial immunoglobulin G-ELISA kit(sensitivity = 85%; specificity = 94%) was employed for the serological diagnosis of NCC.Results: The recruited patients presented with generalized, simple partial, and complex partial seizures(55%, 31.25% and 13.75% respectively). NCC was diagnosed in 44 of160(27.5%) seizure cases based on imaging characteristics, and a positive serum antibody ELISA. No association was detected between seropositivity with the number and location of the lesion(s) in the brain.Conclusions: The possible potentiality of NCC could be identified as an underlying cause of the recent onset of seizures in this region as explored in the present study. It is recommended that NCC should be suspected as one of the major differential in every recent onset seizure with or without a radio imaging supportive diagnosis, especially in areas endemic for taeniasis/cysticercosis.

Microsurgical Treatment of Epilepsy with Parenchymal Neurocysticercosis

Parenchymal neurocysticercosis is the most common form of neurocysticercosis in the central nervous system(CNS),which mainly causes epilepsy and usually responses well to routine medications.However,there are appreciable cases of relapses refractory to medical treatment.We investigated microsurgical treatment of epilepsy with parenchymal neurocysticercosis.Nine cases of epilepsy caused by parenchymal neurocysticercosis from 2002 to 2018 were analyzed retrospectively.Cysts in 7 cases were completely removed.No case died of operation and no new dysfunction of the nervous system was observed after surgery.Among the other 9 cases,8 cases became seizure-free or controlled by medicine according to the postoperative follow­up for 6 months to 9 years.One case was lost for followup.It was suggested that epilepsy with parenchymal neurocysticercosis can usually be controlled after routine medications.However,surgery is still indicated in some cases and careful microsurgery is associated with satisfactory clinical outcomes in appropriately selected cases.

Intraventricular neurocysticercosis: Presentation, diagnosis and management

Neurocysticercosis is thought to be the most common helminthic infection of the central nervous system and its epidemiology is changing due to increasing travel and migration.Evidence to guide management of the intraventricular form is limited.We aimed to review the clinical presentation,diagnosis and treatment of intraventricular neurocysticercosis with reference to two recent cases seen at our institution.The intraventricular variant of neurocysticercosis is less common than parenchymal disease and usually presents with acutely raised intracranial pressure and untreated it progresses rapidly with high mortality.The diagnosis is based on imaging and serological tests but more invasive testing including histopathological examination of surgically acquired tissue specimens is sometimes required.Treatment is mainly surgical,using a neuroendoscopic approach if possible.Patients should also receive antihelmintic treatment with concomitant corticosteroids to reduce the incidence of shunt failure if a ventricular shunt is inserted and to treat viable lesions elsewhere.

State of the art in neurocysticercosis

Diagnosis of neurocysticercosis(NCC)based merely on computed tomography(CT)and magnetic resonance imaging may be doubtful when considering that parenchymal and extraparenchymal NCC are practically distinct clinical and pathophysiological entities.In this letter,we comment on a recent case report by Rizvi et al.

Needs of exploring the burden of recent onset seizures due to neurocysticercosis and challenges in southeast Asia focusing on scenario in Malaysia

Seizures due to neurocysticercosis(NCC) is a neglected human-to-human transmitted disorder and an emerging problem worldwide.A substantial portion of recent onset seizures is known to be attributed to NCC in Taenia solium(T.solium) endemic areas where populations which neither raise pigs nor eat pig meat are also at risk.High prevalence of NCC causing epilepsy has been reported in the underdeveloped areas of Southeast Asia(SEA) however,only fragmentary information on its incidence is available in countries like Malaysia.In Malaysia T.solium infection was previously thought to be infrequent due to Muslim population majority and the religious prohibition of consuming pork,but it is not totally absent There is an evident lack of knowledge and awareness of the actual burden,routes of transmission,and the impact of NCC in this region.The problem is assumed to be more prevalent particularly in cities because of the frequent inflow of possibly T.solium infected individuals or carriers among those who migrate from neighboring endemic countries to Malaysia.The issue of imported cases that are likely to be emerging in Malaysia is highlighted here.An accurate quantification of regional burdens of epilepsy due to NCC in Malaysia is warranted considering the disease emergence in its neighboring countries.It is suggested that the importance of NCC be recognized through quantification of its burden,and also to collect epidemiological data for its subsequent elimination in line of World Health Organization's mission for control of cysticercosis as a neglected tropical disease.In this review the need as well as a strategy for neurc-care center screening of epilepsy cases,and various issues with possible explanations are discussed.It is also proposed that NCC be declared as a reportable disease which is one of the eradicable public health problems in SEA.

Epileptiform seizures revealing neurocysticercosis:report of two clinical cases in Libreville,Gabon

Neurocysticercosis(NCC) is recognized as a cause of neurologic disease worldwide.We reported two cases(one co-infected with the HIV) of NCC.Medical treatment led to recovery.NCC should be considered in tropical countries as a cause of epilepsy and included in the diagnosis of neurologic infections in HIV patients.

Neurocysticercosis Association with Cognitive and Aberrant Behavioural Symptoms: A Case Report and Review

Neurocysticercosis (NCC) is a leading cause of seizures and epilepsy worldwide. Its clinical manifestations are varied, non specific and pleomorphic, depending on multiple factors. Since NCC mimic large number of neurological disorders, it is important that clinicians should be familiar with these rare presentations to avoid delay in diagnosis and management. We herein describe an unusual case of multiple NCC’s involving entire cortex with only cognitive and behavioural manifestations and review pertinent literature.

Neurocysticercosis in Iran: An Unexpected Case and Literature Review

Neurocysticercosis is a significant public health issue worldwide. Even though cysticercosis was once thought to have been eradicated in the United States, it is currently a growing public health problem in the United States, and immigrants from endemic areas are at the highest risk of acquiring this disease. In Iran, there was no report from this worrisome infection. The clinical presentation of neurocysticercosis is variable and vague. In this article, we will explain a case of neurocysticercosis encountered in the Shohada Hospital pathology department, and then we will review neurologic and radiologic symptoms, laboratory and pathologic findings, as well as medication for treatment, briefly.

Taeniosis/Neurocysticercosis Control as a Medical Problem—A Discussion Paper

Taenia solium taeniosis is a zoonosis transmitted by cysticerci from pigs. Neurocysticercosis is a fecal-borne infection spread exclusively by T. soliumeggs in a tapeworm carrier or around. Neurocysticercosis is frequently fatal and debilitating disease and a common cause of late epilepsy. Taeniosis/neurocysticercosis (t/nc) can be prevented both by control of meat-borne zoonosis, which is a traditional responsibility of veterinarians, and by chemotherapy of human taeniosis, which is usually underestimated by medical profession. Elimination of T. solium taenosis is not only the matter of organized control projects but also of routine, daily medical and veterinary services. In order to promote more effective control by treatment of human T. solium carriers the following suggestions are proposed to be discussed: 1) accept that leaving untreated any detected human carrier of T. soliumtaeniosis, the only source of neurocysticercosis, is a medical error. This statement concerns both clinical settings and field interventions;2) accept as the clinical and public health standards a search for T. solium carrier in any possible t/nc foci and treat both detected and suspected cases of taeniosis;3) make the diagnosis and treatment of T. solium infections in humans widely accessible and possibly free;4) improve easy applicable tools detecting T. solium taeniosis;5) make modern and traditional taenicides available. There is a need to improve the stability and efficacy of niclosamide and elaborate an instruction how to avoid neurological side- effects of praziquantel;6) include prevention of t/nc into professional training, especially in mental health, public health and primary health care professions;7) intensify preventive education adapted to the local endemic situation.

Neurocysticercosis (NCC) vs Central Nervous System (CNS) Tuberculoma in Children—Dilemma over Clinico-Radiological Diagnosis?

Background: Neurocysticercosis (NCC) and central nervous system (CNS) tuberculomas often overlap in clinical presentation and imaging. Though the aetio-pathology entirely differs in both the scenarios but there is great confusion in their clinico-radiological evaluation as the findings and appearances are similar in many ways. The stress should be laid out over the salient features of each entity in the background of their presentation. The study was conducted to highlight the differentiation of the clinico-radiological findings in both the entities. Material and Methods: Ten patients between 5 - 15 years (mean age 10.4 years) with complaints of headache and with or without seizures had undergone MRI alone or with CT examinations. Basic sequences of T1W, T2W, T2W FLAIR and T1W contrast studies were carried out in all the cases. CT was carried out in only three cases and contrast was given in two cases. Results: Eight patients were having ring enhancing lesions in post contrast studies in MRI and two had only cystic lesions ranging from 1 - 3 cm in diameter. Conclusion: Seven cases having tuberculomas were confirmed by both the modalities with one case inconclusive. Two cases were diagnosed as neurocysticercosis as per the results. The reasonable achievable target was the goal to differentiate between NCC and tuberculomas in the brain and it was achieved. Contrast MRI and spectroscopy brought out many findings for the distinct features in many cases.

A case report on subarachnoid and intraventricular neurocysticercosis

Neurocysticercosis is the most common central nervous system helminthic infection in humans.We hereby present a case combining two rare manifestations of neurocysticercosis:the subarachnoid and intraventricular forms.The patient presented with hydrocephalus and neurologic deficits and although endoscopic removal of the cysts and two cycles of postoperative cysticidal drugs resulted in resolution of symptoms,they later recurred.Ventriculoperitoneal shunt placement and a further cycle of albendazole plus dexamethasone led to substantial clinical improvement.Extraparenchymal neurocysticercosis may be challenging to diagnose and treat and is usually associated with a poorer prognosis.Clinicians should be aware of this condition.

Good recovery of a patient with neurocysticercosis using two antihelminthic drugs combined with steroid

Neurocysticercosis is the most common parasitic infection of the central nervous system.We present a case report of a neurocysticercosis patient with multiple cysts,who presented with new onset generalized tonic-clonic seizures.A 4-cycle treatment of 2 different antihelminthic drugs with dexamethasone and sodium valproate led to clinical improvement without any adverse reactions.The manifestations of neurocysticercosis are protean and the diagnosis should be considered whenever multiple cysts are seen on computed tomography or magnetic resonance imaging.The antihelminthic treatment of neurocysticercosis should be individualized,especially for patients with multiple cysts.

Original article Preliminary analysis of cerebrospinal fluid proteome in patients with neurocysticercosis

Background Neurocysticercosis is the infection of the nervous system by the larvae of Taenia solium （T. solium）. Despite continuous effort, the experimental diagnosis of neurocysticercosis remains unresolved. Since the cerebrospinal fluid （CSF） contacts with the brain, dynamic information about pathological processes of the brain is likely to be reflected in CSF. Therefore, CSF may serve as a rich source of putative biomarkers related to neurocysticercosis. Comparative proteomic analysis of CSF of neurocysticercosis patients and control subjects may find differentially expressed proteins.Methods Two-dimensional difference in gel electrophoresis （2D-DIGE） was used to investigate differentially expressed proteins in CSF of patients with neurocysticercosis by comparing the protein profile of CSF from neurocysticercosis patients with that from control subjects. The differentially expressed spots/proteins were recognized with matrix-assisted laser desorption/ionization-time of flight-time of flight （MALDI-TOF-TOF） mass spectrometry.Results Forty-four enzyme digested peptides were obtained from 4 neurocysticercotic patients. Twenty-three were identified through search of the NCBI protein database with Mascot software, showing 19 up-expressed and 4 down-expressed. Of these proteins, 26S proteosome related to ATP- and ubiquitin-dependent degradation of proteins and lipocalin type prostaglandin D synthase involved in PGD2-synthesis and extracellular transporter activities were up-expressed, while transferrin related to iron metabolism within the brain was down-expressed.Conclusions This study established the proteomic profile of pooled CSF from 4 patients with neurocysticercosis, suggesting the potential value of proteomic analysis for the study of candidate biomarkers involved in the diagnosis or pathogenesis of neurocysticercosis.

Neurocysticercosis and hippocampal damage: a causal link favored by epileptogenesis or neuroinflammation?

Cysticercosis is a frequent parasitic infection of the nervous system that occurs when humans become intermediate hosts of the pork tapeworm Taenia solium (T. solium), after ingesting its eggs. The disease is usually transmitted person-to-person, from Taenia carriers to healthy individuals, through non-hygienic handling of food or by direct contact with human feces. Ingestion of undercooked pork contaminated with cysticerci as the cause of human cysticercosis is a common misconception, since the role of pigs is to maintain the infection cycle by causing human taeniasis.

Neurocysticercosis in Nepal:a retrospective clinical analysis

Aim:The prevalence of epilepsy is higher in Nepal.This study was conducted to analyze the clinical manifestations of neurocysticercosis(NCC)among seizure patients admitted to our center.Methods:We retrospectively studied all the NCC patients admitted to Neurology Department,Bir Hospital,Kathmandu,Nepal from April 2012 to February 2014.Computer tomography/magnetic resonance imaging(CT/MRI)head,clinical profile,lab investigations and exclusion of other causes were the basis of the NCC diagnosis.Chi-square and Student’s t-test were used for comparison of variables.Results:Out of 131 seizure patients admitted,21 patients were diagnosed with NCC[mean age:33.95±16.41;male:15(71.4%),female:6(28.6%)].Generalized tonic clonic seizure was the most common seizure type in NCC patients(18 patients;85.7%),two of them had status epilepticus during presentation in Emergency Department.Three patients had focal seizure,one with epilepsia partialis continua.Neuroimaging showed multiple NCC lesions in 8(38.1%)and a single NCC lesion in 13(61.9%)patients.Seven of them(33.3%)sought traditional healers before being presented to our center.Eight patients(38.1%)were treated with antiepileptics in local health-post without neuroimaging studies done.Calcified stage of NCC was the most frequent CT/MRI findings(12 patients;57.1%).Phenytoin was preferred both by physicians and patients due to its low cost.Conclusion:NCC is a common finding among seizure patients in Nepal.Poor economic status,illiteracy and underdeveloped rural society are the major challenges in prevention and treatment of NCC.

Disseminated cysticercosis incidentally diagnosed in a patient of low backache:A case report and concise review of literature

Disseminated cysticercosis is an uncommon presentation of a common disease.Asymptomatic disseminated cysticercosis is rarely reported in literature.Here,we are reporting a case of asymptomatic disseminated cysticercosis incidentally diagnosed in a patient of low backache. Magnetic resonance imaging of lumbosacral spine and neuroimaging done subsequently during the course of evaluation revealed diffuse cysticercosis involving abdominal,paraspinal,pelvic and gluteal muscles along with neurocysticercosis.Such a disseminated cysticercosis was diagnosed incidentally in this patient of low backache with right sciatica and radiculopathy at L5-S1 prolapsed intervertebral disc and was subsequently managed by L5-S1 interlaminar fenestration and discectomy.