The prevalence of and contributors to neurocysticercosis in endemic regions

Efficiency of Cysticidal Therapy Impacted by the Host's Immune Response in Neurocysticercosis Patients

Neurocysticercosis (NCC) is a neurological condition caused by the presence of cysts of Taenia solium in the brain, which manifests with a range of clinical symptoms. The severity of NCC and its prognosis following anti-helminth drug (AHD) treatment are closely linked to peripheral and local inflammation. The study aimed to analyse the efficiency of cysticidal therapy impacted by the host's immune response in NCC patients. A total of 104 patients were screened in this study, and blood samples were collected from 30 patients. The follow-up samples within 3 to 6 months of treatment were collected. Patients were categorised as Responder (R) and Non-Responder (NR). Cytokines IL-6, IL-10, IFN-γ and TNF-α were estimated using ELISA kits in PBMC cells. T0 is the time point before the AHD treatment begins, and T1 is between 3 to 6 months after the treatment starts. The responder patients showed significantly lower IL-10 and IL-6 levels in the supernatants at T0 as compared to T1, while in non-responder patients, IL-10 and IL-6 levels were higher at T0 as compared to T1. The IFN-γ and TNF-α levels were found to be higher in the supernatants at T0 as compared to T1 in both the responder and non-responder patients. These observations imply that these cytokines might have an impact on the efficacy of AHD treatment in NCC patients.

Differential diagnosis of suspected multiple sclerosis: global health considerations

The differential diagnosis of multiple sclerosis can present specific challenges in patients from Latin America, Africa, the Middle East, eastern Europe, southeast Asia, and the Western Pacific. In these areas, environmental factors, genetic background, and access to medical care can differ substantially from those in North America and western Europe, where multiple sclerosis is most common. Furthermore, multiple sclerosis diagnostic criteria have been developed primarily using data from North America and western Europe. Although some diagnoses mistaken for multiple sclerosis are common regardless of location, a comprehensive approach to the differential diagnosis of multiple sclerosis in Latin America, Africa, the Middle East, eastern Europe, southeast Asia, and the Western Pacific regions requires special consideration of diseases that are prevalent in those locations. A collaborative effort has therefore assessed global differences in multiple sclerosis differential diagnoses and proposed recommendations for evaluating patients with suspected multiple sclerosis in regions beyond North America and western Europe.

Current Role of Surgery in the Treatment of Neurocysticercosis

Neurocysticercosis (NCC) is a common parasitic disease of the central nervous system (CNS) in low- and middle-income countries. The infection is pleomorphic, caused by the larval form of the cestode, Taenia solium, and part of the heterogeneity of its clinical presentations is associated with the localization of the parasite within the CNS. Changes in the current epidemiological trends of NCC indicate that extra-parenchymal NCC is proportionally becoming more frequent. Extraparenchymal NCC is commonly accompanied by raised intracranial hypertension due to hydrocephalus, which is an emergency requiring cyst extirpation by surgical intervention to relieve the symptoms. Although less frequent, parenchymal cysts may also reach giant sizes requiring urgent surgical treatment. Finally, there is an advancement in the comprehension of the association between NCC and epilepsy-and patients with drug-resistant seizures are candidates for surgical treatment. In this narrative review, we summarize the present state of knowledge to update the current trends in the role of surgery in the treatment of NCC.

Worm in the Eye: A Case Report of Ocular Neurocysticercosis With Adherent Retinal Cyst

Neurocysticercosis is caused by cysticercus cellulosae, the larval stage of Taenia solium, commonly referred to as the pork tapeworm. These larvae form cysts in several organs, including the brain, spinal cord, and eye. Neurocysticercosis is recognized by the World Health Organization as a public health issue and stands as the foremost preventable cause of epilepsy worldwide. Ocular neurocysticercosis refers to the concurrent involvement of the eyes and brain with cysticercus lesions. Neurological symptoms include focal deficits, intracranial hypertension, or cognitive decline. In the eye, the orbital type commonly presents with periocular swelling, ptosis, diplopia, restriction of ocular motility, or decreased vision. The ocular type shows signs of retinal detachment, a macular hole, and inflammation. A 45-year-old female presented with pain in his right eye with blurred vision for 15 days. On USG and MRI of the eye, a thin-walled lesion was noted. The brain showed a few calcified granulomas in the right parietal lobe on MRI. The left eye was normal. If left untreated, the cysts can lead to a severe inflammatory reaction in the eye, which may eventually lead to blindness. This blindness caused by cysticercus is preventable, and hence, early diagnosis and prompt medical or surgical treatment are essential.

How parasitic larvae affect the brain

The release of the neurotransmitter glutamate by the parasitic tapeworm Taenia solium appears to be implicated in the pathophysiology of a widespread, but neglected, form of adult-onset epilepsy.

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.

Albendazole - Ivermectin combination decreases inflammation in experimental neurocysticercosis

Neurocysticercosis (NCC) is a public health issue in endemic regions and is considered the main preventable cause of neurologic disease. It is caused by the presence of Taenia solium cysticercus in the central nervous system. The current treatment is performed with anthelminthic drugs - albendazole (ABZ) or praziquantel - associated with anti-inflammatory and corticosteroids in order to prevent the negative effects of the inflammatory reaction to the parasite's death. Ivermectin (IVM) is an anthelminthic drug that has been shown to present an anti-inflammatory effect. The aim of this study was to was to evaluate the histopathologic aspects of experimental NCC after in vivo treatment with a combination of ABZ-IVM. Balb/c mice were intracranially inoculated with T. crassiceps cysticerci and after 30 days of infection were treated with a single dose of NaCl 0.9% (control group), ABZ monotherapy (40 mg/kg), IVM monotherapy (0.2 mg/kg) or a combination of ABZ-IVM. 24h after the treatment the animals were euthanized and the brain was removed for histopathologic analysis. The IVM monotherapy and ABZ-IVM combination showed more degenerated cysticerci, less inflammatory infiltration, meningitis and hyperemia than the other groups. Therefore, it is possible to recommend the combination of albendazole and ivermectin as alternative chemotherapy for NCC due to its antiparasitic and anti-inflammatory effects, with potential to decrease the negative effects of the inflammatory burst when the parasite is killed within the CNS.