Intracranial mass lesions in HIV/AIDS patients from developing countries endemic for neurocysticercosis

Imaging of neurocysticercosis and the influence of the human immunodeficiency virus

AIM

To review the literature on the imaging appearances of neurocysticercosis (NCC) and human immunodeficiency virus (HIV) co-infection and compare it with the local cases.

MATERIALS AND METHODS

Data from both published and local cases were analysed. HIV-infected cases were divided into "low" (<200 cells/mm³) and "high" (≥200 cells/mm³) CD4 groups. These groups were compared and the effect of treatment was evaluated.

RESULTS

Thirty-three cases were evaluated: 20 of the local cases and 13 published cases. The published cases had parenchymal brain cysts, whereas the local cases had both parenchymal and subarachnoid cysts (p=0.0050). The published cases also had intra-axial cysts, whereas the local cases had both intra- and extra-axial cysts (p=0.012). The published cases had predominantly cystic lesions, whereas the local cases had both cystic and granulomatous lesions (p=0.019). There were no differences between cases with a CD4 count of <200 cells/mm³ and cases with a CD4 count of ≥200 cells/mm³, but interestingly, 3% of the cases with a CD4 count of <500 cells/mm³, compared with 50% of the cases with a CD4 count of ≥500 cells/mm³, had racemose cysts.

CONCLUSION

NCC is very prevalent in South Africa and may complicate the diagnosis and treatment of patients with concomitant HIV infection. Patients with a "low" CD4 count may present with atypical lesions, delaying the diagnosis of NCC. Early initiation of highly active anti-retroviral therapy (HAART) may result in patients presenting with more classical symptoms and imaging appearances, thus improving outcomes.

Three cases of imported neurocysticercosis in Northern Italy

BACKGROUND

Neurocysticercosis (NCC) is an important cause of adult-onset seizures in endemic areas, whereas it is emerging in some nonendemic areas as well because of extensive immigration.

METHOD

We describe three cases of imported NCC recently admitted to San Bortolo Hospital in Vicenza, located in Northern Italy.

RESULTS

All patients were immigrants. One patient was human immunodeficiency virus positive with severe immunosuppression. The diagnosis of NCC was made on the basis of magnetic resonance results; failure of anti-Toxoplasma, antitubercular, and antifungal therapy; and regression of the cystic lesions after empiric therapy with albendazole. Serology was positive in only one case. In one patient, NCC was diagnosed by biopsy of the brain lesion.

CONCLUSION

In nonendemic countries, NCC should be included in the differential diagnosis of all patients coming from endemic areas with seizures, hydrocephalus, and compatible lesions on brain imaging. Long-term follow-up is required but may be difficult to implement because these patients tend to move in search of employment. Screening of patient's household contacts for Taenia solium infection should always be carried out.