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.

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.

Disseminated cysticercosis presenting with bilateral proptosis: A case report

Rationale: Disseminated cysticercosis is characterized by presence of cysts in multiple body organs, like brain, skin, eyes, muscles and rarely heart and lungs.Patient concerns: A 22-year-old man presented with bilateral proptosis of 1-year duration. He also had two episodes of cysticercosis encephalitis. In the second episode of encephalopathy, the patient died.Diagnosis: Disseminated cysticercosis.Interventions: Corticosteroids(Initially intravenous dexamethasone 0.4 mg/kg/day for 2 weeks, followed by oral prednisolone 1.0 mg/kg/day).Outcomes: The patient died of cysticercosis encephalitis approximately 2 months later.Lessons: Disseminated cysticercosis in our case presented only with proptosis as he had very heavy infestation of the brain and eyes. Heavy larval infestation in a patient with disseminated cysticercosis can be life-threatening.

A Review of Human Cysticercosis and Diagnostic Challenges in Endemic Resource Poor Countries

Human cysticercosis is a neglected tropical parasitic zoonotic disease with high public health concerns. Infection of Taenia solium cysticerci in the brain commonly known as neurocysticercosis is a cause to over 29% of all epileptic cases in endemic countries. Unfortunately, this infection can go unnoticed for over 10 years. The objective of this review was to characterize the diagnostic approaches accessible in endemic poor resource countries. The review sought literature from library catalogues and public databases for studies on epidemiology and diagnosis challenges of human cysticercosis. The search key words included “Taenia solium, T. solium cysticercosis, human cysticercosis, neurocysticercosis and diagnosis”. Most of the diagnostic procedures rely on serology. Neuroimaging tools which would confirm and thus enable the assessment of the burden of the disease in endemic countries are rarely used. Therefore assessing the estimate on prevalence and burden of the disease fallacious is owing to the low sensitivity of serological tools and the inhibition of humoral, cellular immune responses, inflammatory reaction and cytokines by the living cysticerci.

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.

28例脑囊虫病手术治疗方法及效果分析

目的总结脑囊虫病的手术治疗方法,并分析治疗效果。方法脑囊虫病患者28例,采用开颅显微镜下囊虫摘除术治疗6例、脑室-腹腔分流术(VP)治疗6例、第三脑室底造瘘术(ETV)治疗14例、单纯行内镜下脑室囊虫摘除2例。术后随访,观察治疗效果。结果术后出现颅内感染2例、头痛6例、一过性动眼神经麻痹2例、硬膜下积液1例、脑积水加重1例。出院后23例经12~84个月随访,临床症状、体征改善19例,无变化3例,死亡1例。采用开颅显微镜下囊虫摘除及单纯行内镜下脑室囊虫摘除患者的临床症状、体征均改善。行VP治疗的6例患者中,2例因分流管梗阻需再次手术治疗;行ETV治疗的14例患者中,6例因脑积水导致颅内压增高,症状缓解不理想,再次行VP治疗;再次治疗后症状、体征均改善。结论脑囊虫病根据囊虫部位及临床、影像学表现个性化选择手术治疗方案的治疗效果较好。

脑积水型脑囊虫病的外科手术治疗研究

目的:探讨脑积水型脑囊虫病的外科手术治疗方法及疗效。方法:经手术病理证实的脑积水型脑囊虫病73例,回顾分析其治疗过程。结果:对诊断明确的73例脑积水型脑囊虫病患者实施了脑室或脑池囊虫摘除术,术后进行抗脑囊虫病治疗,其中13例脑积水症状改善效果不佳,二次行脑室-腹腔分流术,手术均获成功,术后均未出现新的神经损害症状,脑室恢复正常。结论:脑积水型脑囊虫病一旦诊断明确,应积极手术切除脑囊虫,解除梗阻性脑积水术后再进行抗囊虫治疗,必要时再行脑室腹腔分流手术,临床效果明确安全。

脑囊虫病18例MRI的诊断分析

目的:探讨MRI诊断脑囊虫病分期的价值。方法:对18例脑囊虫患者MRI影像进行回顾性分析。结果:脑囊虫病分为三期:囊虫存活期10例,此期特征是头节、囊壁和囊液并存,T1WI表现为圆形低信号内小点样中等信号影,T2WI囊腔为高信号;囊虫变性期5例,头节消失,囊腔胀大,大小不均,囊周围出现水肿带,T1WI为不均匀低信号,T2WI呈为高信号;囊虫死亡期3例,虫体死亡后发生钙化或纤维化,T2WI呈小圆形边界清楚的低信号,T1WI呈等信号或低信号。结论:MRI对于不同时期的脑囊虫病诊断价值较高,反映脑囊虫病的病理学过程,对鉴别诊断及指导临床治疗有重要意义。

Association between Taenia solium infection and HIV/AIDS in northern Tanzania: a matched cross sectional-study

Background:The frequency of Taenia solium,a zoonotic helminth,is increasing in many countries of sub-Saharan Africa,where the prevalence of the human immunodeficiency virus(HIV)is also high.However,little is known about how these two infections interact.The aim of this study was to compare the proportion of HIV positive(+)and negative(−)individuals who are infected with Taenia solium(TSOL)and who present with clinical and neurological manifestations of cysticercosis(CC).Methods:In northern Tanzania,170 HIV+individuals and 170 HIV–controls matched for gender,age and village of origin were recruited.HIV staging and serological tests for TSOL antibodies(Ab)and antigen(Ag)were performed.Neurocysticercosis(NCC)was determined by computed tomography(CT)using standard diagnostic criteria.Neurological manifestations were confirmed by a standard neurological examination.In addition,demographic,clinical and neuroimaging data were collected.Further,CD4^(+)cell counts as well as information on highly active antiretroviral treatment(HAART)were noted.Results:No significant differences between HIV+and HIV–individuals regarding the sero-prevalence of taeniosis-Ab(0.6%vs 1.2%),CC-Ab(2.4%vs 2.4%)and CC-Ag(0.6%vs 0.0%)were detected.A total of six NCC cases(3 HIV+and 3 HIV–)were detected in the group of matched participants.Two individuals(1 HIV+and 1 HIV–)presented with headaches as the main symptom for NCC,and four with asymptomatic NCC.Among the HIV+group,TSOL was not associated with CD4+cell counts,HAART duration or HIV stage.Conclusions:This study found lower prevalence of taeniosis,CC and NCC than had been reported in the region to date.This low level of infection may have resulted in an inability to find cross-sectional associations between HIV status and TSOL infection or NCC.Larger sample sizes will be required in future studies conducted in that area to conclude if HIV influences the way NCC manifests itself.