You drive me crazy: a case report of acute psychosis and neurocysticercosis

Neurocysticercosis presenting as psychosis: A case report and a brief literature review

Patients with neurocysticercosis, a common infection of the central nervous system caused by Taenia solium, have been reported to develop neuropsychiatric complications. We report a unique case of recurrent psychosis caused by neurocysticercosis in a 37-year-old El Salvador immigrant woman and discuss the underlying pathophysiological mechanisms of the complications. We reviewed published case reports of neurocysticercosis that presented with psychotic features and compared their diagnostic evaluation, the underlying pathophysiology of complications and treatment regimen with our case. This review concludes that neurocysticercosis should be considered in the differential diagnosis of patients presenting with psychosis with a history of residence in an endemic area.

Psychiatric Disorders of Neurocysticercosis: Narrative Review

Neurocysticercosis, the most common type of neuroparasitosis, is a condition in which the central nervous system (CNS) is infested with the pork tapeworm Taenia solium cysticercosis' larvae. Neurocysticercosis is the most widespread parasitic CNS disease worldwide, affecting more than 50 million individuals. As neurocysticercosis is prevalent in developing countries, the growing number of migrants and travelers increases prevalence in developed countries. Possible neuropsychiatric manifestations are depression, cognitive dysfunction, dementia, and visual hallucinations. Depending on the cysts' location in the CNS, focal neurology or psychiatric symptoms manifest. The diagnosis of neurocysticercosis is based on neuroimaging and serology. The correlation between specific symptoms and the cyst's location might help better understand psychiatric disorders' pathophysiology. Nonetheless, the exact prevalence of neurocysticercosis is seldom reported in patients with psychiatric disorders, which may be due to the lack of imaging availability in developing countries with a high prevalence.

A review of cases of human cysticercosis in Canada

OBJECTIVE

Review of human cysticercosis in Canada, to estimate the magnitude of the disease and to describe the pattern of disease expression in this country.

METHODS

MEDLINE and manual search of case reports and case series of patients with cysticercosis diagnosed in Canada. Abstracted data included year of diagnosis, citizenship status, clinical manifestations, and form of cysticercosis.

FINDINGS

A total of 21 articles reporting 60 patients were found. Forty (67%) of these patients were diagnosed in the past two decades. Most cases came from Ontario (n=43) and Quebec (n=14). Immigrants accounted for 96% of the 28 cases in whom citizenship information was available. Neurocysticercosis was observed in 55 patients, and isolated compromise of striated muscles in the remaining five. Seizures was the primary or sole manifestation of the disease in 72% of patients, and most of them had parenchymal brain cysticerci (either viable cysts or calcifications). Two of seven patients were positive for Taenia eggs. In no case were household contacts of the patients investigated for taeniasis.

CONCLUSIONS

An increasing number of patients with cysticercosis have been reported from Canada in the past two decades, suggesting that the prevalence of this parasitic disease may be on the rise. While most cases occur in immigrants, it is possible that at least some of these patients had acquired the disease in Canada.

Neurocysticercosis Presenting with Psychiatric Manifestations

Cysticercosis is the most common heliminth infection of the human central nervous system Epilepsy is the most common presentation and occurs in 50-85% of patients. Psychiatric manifestations in a form of depressive disorders, cognitive decline and psychosis have been reported frequently(2). A19-year-old Nepalese male presented with severe headache, seizures, fears and anxiety for one week. A CT scan of the brain showed small calcified lesion in the right deep temporal white matter without perifocal edema. This was considered suggestive of a healed inflammatory granuloma-neurocysticercus cyst. Treatment with a combination of albendazole dexamethazone, ranitidine, phenytoin, lorazepam and hydroxyzine resulted in a rapid recovery.

Acute and transient psychotic disorders: comparison with schizophrenia

Concept and nosologic status of acute and transient psychotic disorders, as they appear in the tenth edition of the International Classification of Disease, have seen review from the standpoint of validation and delineation from schizophrenia and affective disorders. Current research, particularly on the epidemiology, course, and outcome, and family genetic studies indicate that these disorders are common among women in developing countries, as well as among lower socioeconomic status and rural subjects. These patients have greater frequency of exposure to stress before childbirth, a family history of acute and transient psychotic disorder (and not of schizophrenia), and a course and outcome that is different from that of schizophrenia. The findings so far support the argument that acute and transient psychotic disorders are different from schizophrenia.

Serological screening for cysticercosis in mentally altered individuals

The parasitic infection neurocysticercosis may give rise to a variety of psychiatric manifestations that resemble, but are different from, primary psychiatric disorders. The aim of this study was to determine if among individuals from a neurocysticercosis-endemic area of Colombia who apparently had a psychiatric manifestation with associated neurological finding ('cases'), some could have been infected with Taenia solium cysticerci. This case-control study was done in individuals hospitalized in two mental institutions. The control-1 individuals were those classified with primary psychiatric disease, and the control-2 group consisted of healthy, non-hospitalized individuals. A serological test for cysticercosis was positive in 5/96 (5.1%) cases, 4/153 (2.6%) psychiatric controls, and 5/246 (2%) healthy controls. The data analysis indicated a weak association between the cases and a positive serology for neurocysticercosis (odds ratio > 2; P > 0.05). The lower education level of the cases influenced this association.

Eradication of Taenia solium cysticercosis: a role for vaccination of pigs

Neurocysticercosis due to Taenia solium is an important cause of human morbidity and mortality, particularly in Latin America and parts of Africa and Asia. The disease has been recognised as potentially eradicable. Emphasis has been placed on control of the parasite through mass chemotherapy of human populations to remove tapeworm carriers. This strategy does not control the source of tapeworm infections, cysticercosis in pigs, and parasite transmission may continue due to incomplete chemotherapy coverage of human tapeworm carriers or because of immigration of tapeworm carriers into control areas. Exceptionally effective, practical vaccines have been developed against cysticercosis in sheep and cattle and a recent trial has proved recombinant antigens to be effective against Taenia solium cysticercosis in pigs. A new strategy for eradication of Taenia solium is proposed, based principally on a combined approach of chemotherapy of human tapeworm carriers and vaccination of all pigs at risk of infection.

Onset of acute psychotic states in India: a study of sociodemographic, seasonal and biological factors

This is a comparative study of patients with acute-onset, non-affective, non-organic, remitting psychoses and with non-remitting or schizophrenic psychoses in India. Two groups of patients with acute remitting and non-remitting or schizophrenic psychoses were compared with regard to the following variables: month of onset of psychosis; presence of stress, particularly fever, within 4 weeks preceding the onset of psychosis; childbirth within 12 weeks preceding the onset of psychosis; gender differences. It was found that the acute remitting psychoses showed an overrepresentation of females, a higher frequency of associated stress preceding the onset of psychosis, more often had onset during the summer months, i.e. between May and September, and had fever and childbirth preceding the onset of psychosis in a significantly higher proportion of patients, compared to acute non-remitting psychoses or schizophrenia. The implications of the findings which point towards biological factors in the aetiology of acute remitting psychoses are discussed.

Human cysticercosis: parasitology, pathology, clinical manifestations and available treatment

Human cysticercosis is a global health problem and neurocysticercosis a serious clinical syndrome. The diagnosis of neurocysticercosis can now be made with a high degree of accuracy by scrutiny of clinical signs and symptoms in combination with X-ray, computed tomography or magnetic resonance imaging, serological tests and laboratory examinations. Differential clinical diagnosis with tumor, and vascular and inflammatory conditions, may however, prove difficult in nonendemic areas. The management of cysticercosis has been radically changed by the advent of effective chemotherapy. Both the heterocyclic pyrazinoisoquinoline compound, praziquantel and the benzimidazole carbamate, albendazole, have now been extensively tested and successfully used for treatments of neurocysticercosis, usually in combination with corticosteroids. The definition of appropriate criteria and guidelines for the use of chemotherapy, may however, require further research. Surgical interventions continue to play an important role in certain clinical presentations. Recent advances in immunological research hold realistic promise for the development of a vaccine against Taenia solium.