Subcutaneous nodules of cysticercosis as a sign of asymptomatic neurocysticercosis in an HIV positive patient

Abstract Cysticercosis is caused by the hematogenous dissemination of the larval form (cysticercus) of Taenia solium. It can affect any organ or tissue in the body but commonly affects the subcutaneous tissue, central nervous system, eyes, and skeletal muscle. Skin lesions can assist as a marker in the diagnosis of asymptomatic neurocysticercosis in endemic areas. A 49-year-old HIV positive man presented with multiple cutaneous nodules confirmed as cysticercomas which led to the diagnosis of asymptomatic neurocysticercosis. He was successfully treated with albendazole and steroids at recommended doses with no adverse effects.

Neuropsychiatric manifestations and epidemiology of neurocysticercosis / Manifestações neuropsiquiátricas e epidemiologia de neurocisticercose

Neurocysticercosis (NCC) is the brain infection caused by larval stages of the helminth Taenia solium. The embryos of Taenia travel through the bloodstream and can reach the brain, muscles, eyes, and various organs. In the brain, the psychiatric manifestations are mood disorders, depression and anxiety, which are commonly associated with epilepsy and sensory-motor deficits. Neurocysticercosis is a frequent parasitic disease in the world population; it is endemic in Central and South America, Asia and Sub-Saharan Africa. In the present review, we report the major symptoms and signals of neurocysticercosis common to neurological and psychiatric illnesses. We briefly present Epidemiology of those manifestations and analyze the relationship between pathological changes and NCC symptomatology. OBJECTIVES AND METHODOLOGY: A literature review was conducted to characterize epidemiological, neurological and psychiatric manifestations of NCC. The final 90 papers were selected of a set of 937 publications from 2010 to 2016. RESULTS: NCC is a major cause of epilepsy in endemic areas; further- more, leads to a diversity of motor and sensitive deficits, manifestations vary from headache to severe intracranial hypertension. Potentially fatal conditions include arteritis, encephalitis and hydrocephalus. Depression and cognitive decline remain among the most important psychiatric manifestations. Neuropsychiatric manifestations, Epidemiology, and neuroimaging provide diagnostic criteria. Brain scans may reveal one or diverse cysts filled with fluid within a scolex (parasite's head). CONCLUSION: NCC's diversity of presentations encourage health professionals to consider it in diagnoses, especially in endemic countries, and also in non-endemic areas because migrants and travelers are subject to contagious. Treatment consists in use of antiparasitic drugs (albendazol, praziquantel) and drugs to treat associated conditions (anticonvulsants, corticosteroids). Surgery is reserved to extirpate the parasite from particular locations (eyes, spinal cord, cerebral ventricles) or to differentiate NCC from tumors, tuberculosis, mycosis, etc. Prevention includes treatment of intestinal helminthiasis, sanitation in animal farming, food preparing hygiene, quality control of water and food.

Neurocisticercose é a infecção cerebral causada pelos estágios lar- vais do helminto Taenia solium. Os embriões da Taenia deslocam-se através da corrente sanguínea e podem atingir o cérebro, músculos, olhos e vários órgãos. No cérebro, as manifestações psiquiátricas são transtornos de humor, depressão e ansiedade, as quais estão comumente associados com epilepsia e deficiências sensório-motoras. Neurocisticercose é uma parasitose frequente na população mundial, é endêmica na América Central e do Sul, Ásia e África subsaariana. Na presente revisão, relatamos os principais sintomas e sinais de neurocisticercose pertinentes a doenças neurológicas e psiquiátricas. Nós brevemente apresentamos a Epidemiologia dessas manifestações, e analisamos a relação entre alterações patológicas e sintomatologia da NCC. OBJETIVOS E METODOLOGIA: Uma revisão da literatura foi conduzida para caracterizar a epidemiologia, as manifestações neurológicas e psiquiátricas de NCC. Os 90 artigos finais foram selecionados de um conjunto de 937 publicações entre 2010 a 2016. RESULTADOS: NCC é uma importante etiologia de epilepsia em áreas endêmicas, além disso causa uma diversidade de deficiências motoras e sensoriais, as manifestações variam de cefaleia a severa hipertensão intracraniana. Condições potencialmente fatais incluem arterites, encefalites e hidrocefalia. Depressão e declíneo cognitive permanecem entre as mais importantes manifestações psiquiátricas. Manifestações neuropsiquiátricas, epidemiologia e neuroimagem provêm os critérios de diagnóstico. As imagens cerebrais podem revelar um ou diversos cistos preenchidos com líquido e o escólex (cabeça) do parasito. CONCLUSÕES: A diversidade de apresentações da NCC encoraja os profissionais de saúde a considerá-la dentre os diagnósticos, especialmente em países endêmicos; e também em áreas não-endêmicas, pois migrantes e viajantes estão sujeitos ao contágio. O tratamento consiste no uso de antiparasíticos (albendazol, praziquantel) e medicamentos para tratar condições associadas (anticonvulsivantes, corticosteróides). Cirurgia é reservada para remoção do parasito de locais particulares (olhos, medula espinhal, ventrículos cerebrais) ou para diferenciar NCC de tumores, tuberculose, micose, etc. Prevenção inclui o tratamento de helmintíases intestinais, sanidade animal, higiene ao preparar alimentos, controle da qualidade da água e alimentos.

Neurocisticercosis racemosa subaracnoidea gigante y ventricular: a propósito de un caso / Giant racemose subarachnoid and intraventricular neurocysticercosis: A case report

La neurocisticercosis es la enfermedad parasitaria más frecuente del sistema nervioso central. Es causada por las larvas de Taenia solium, las cuales pueden estar alojadas en distintas localizaciones anatómicas. En países como España existe una prevalencia en ascenso debido, principalmente, a la inmigración desde regiones endémicas. Las formas extraparenquimatosas son menos frecuentes, pero más graves por su tendencia a producir complicaciones. La neuroimagen desempeña un papel primordial en el diagnóstico y seguimiento de esta enfermedad, apoyada en la serología y un contexto clínico-epidemiológico compatible. El tratamiento de elección son los fármacos cisticidas albendazol y praziquantel, habitualmente se asocian a estos corticoides y, cuando corresponde, la cirugía. Se presenta un caso de neurocisticercosis con afectación simultánea intraventricular y subaracnoidea en su forma racemosa gigante.

Neurocysticercosis is the most frequent parasitic disease of the central nervous system. It is caused by the larvae of Taenia solium, which can affect different anatomical sites. In Spain there is an increasing prevalence mainly due to immigration from endemic areas. The extraparenchymal forms are less common, but more serious because they usually develop complications. Neuroimaging plays a major role in the diagnosis and follow-up of this disease, supported by serology and a compatible clinical and epidemiological context. First-line treatments are cysticidal drugs such as albendazole and praziquantel, usually coadministered with corticosteroids, and in some cases surgery is indicated. We here report a case of neurocysticercosis with simultaneous intraventricular and giant racemose subarachnoid involvement.

The relationship between neurocysticercosis and epilepsy: an endless debate / A relação entre neurocisticercose e epilepsia: um debate interminável

Neurocysticercosis (NC), or cerebral infection with Taenia solium, is an important public health problem worldwide. Among the neurological sequelae of NC, seizures have been described as the most common symptom. Acute symptomatic seizures often result from degeneration of a viable cyst; however, not all of these patients with acute or provoked seizures will develop epilepsy (i.e., recurrent unprovoked seizures). Because of the high prevalence of epilepsy and NC, a causal, as well as incidental relationship between the two may exist. The epileptogenicity of calcified cysts as well as the potential association between NC and hippocampal sclerosis necessitates future research. Antihelminthic treatment of NC results in disappearance of viable cysts in about one-third of patients with parenchymal disease, but a reduction in seizure recurrence has not been demonstrated in randomized controlled trials. Prevention is critical to reduce the burden of seizure and epilepsy related to NC.

A neurocisticercose (NC) ou infecção cerebral pela Taenia solium é importante problema de saúde pública em todo o mundo. Entre as sequelas neurológicas da NC, as crises convulsivas têm sido descritas como os sintomas mais frequentes. Crises convulsivas sintomáticas agudas resultam, muitas vezes, da degeneração de cistos viáveis; entretanto, nem todos os pacientes com NC e crises agudas ou provocadas desenvolvem epilepsia (i.e., crises recorrentes não provocadas). Pode haver uma relação entre epilepsia e NC, causal ou incidental, devido à alta prevalência de ambas. O potencial epileptogênico dos cistos calcificados assim como a possível associação entre NC e esclerose hipocampal ainda necessitam de futuras pesquisas. O tratamento anti-helmíntico da NC resulta no desaparecimento de cistos viáveis em cerca de 1/3 dos pacientes com a doença parenquimatosa, mas não foi demonstrada redução nas taxas de recorrência das crises convulsivas em estudos randomizados controlados. A prevenção é crítica para reduzir o contingente de crises convulsivas e epilepsia relacionadas à NC.

Neurocisticercosis con lesiones cerebrales únicas. Presentación de dos casos documentados por Resonancia Magnética y revisión de la literatura / Neurocysticercosis with single brain lesions. Report of two cases documented by Magnetic Resonance Imaging and literature review

La neurocisticercosis (NCC) es una infección del sistema nervioso central (SNC) originada por el estadio larvario de Taenia solium. Esta importante parasitosis es la causa más frecuente de epilepsia adquirida del adulto.Las manifestaciones clínicas más comunes de las formas parenquimatosas son la cefalea y las convulsiones,mientras que las formas extraparenquimatosas suelen presentarse con hidrocefalia. En este aspecto, es importante destacar que las manifestaciones clínicas de la enfermedad son el resultado de la muerte de la larva del cestodo y de la reacción inflamatoria perilesional que se produce en el SNC. El diagnóstico de NCC se basa en la epidemiología, las manifestaciones clínicas, los hallazgos de las neuroimágenes y la serología, y su tratamiento incluye el uso de fármacos antiepilépticos, corticoesteroides y drogas antiparasitarias, como el albendazol o el praziquantel. En este trabajo se describen dos casos de neurocisticercosis parenquimatosa con lesiones únicas que se manifestaron con cefalea y convulsiones...

Neurocisticercosis: una enfermedad desatendida en Chile / Neurocysticercosis: an neglected disease in Chile

Neurocysticercosis (NCC) is not a notifiable disease in Chile and has received little attention on the national medical literature. In order to evaluate the relevance and clinical features of the disease, we performed a retrospective analysis in a general hospital of five cases of NCC during a 11 years period. Age ranged from 3 to 63 years and all had history of living or visiting southern Chile. Three patients had a solitary parenchymal cyst in vesicular or granulomatous stages and presented with generalized seizures. Their outcome was favorable after anticonvulsant and albendazole therapy and cysts reduced in size and calcified during follow-up. The other 2 patients had extra-parenchymal or mixed forms, including a pregnant woman with intraventricular cysts who developed endocraneal hypertension and recurrent dysfunction of her ventriculoperitoneal shunt. This patient died after discharge despite an initial favorable evolution with steroids and high-dose albendazole. This case series showed that NCC is still an epidemiological and clinical problem in Chile, affects patients within a wide range of age including children, requires multidisciplinary therapeutic interventions, and has two clinical presentations with different prognosis including one malignant form. To control this infection, a surveillance or reporting system should be initiated.

La neurocisticercosis (NCC) no es una enfermedad de notificación obligatoria en Chile y ha recibido poca atención en la literatura médica local. Para evaluar su importancia y perfil clínico se hizo un análisis retrospectivo en un hospital general. Cinco casos de NCC fueron identificados en un período de 11 años. El rango de edad fue de 3 a 63 años y todos tenían antecedentes de visita o residencia en el sur del país. Tres pacientes tenían quistes únicos parenquimatosos en etapas granulomatosas o vesiculares y se presentaron con convulsiones generalizadas. Su evolución fue favorable con terapia anticonvulsivante y albendazol y los quistes se redujeron de tamaño y calcificaron durante el seguimiento. Los otros pacientes presentaron formas extra-parenquimatosas o mixtas e incluían a una mujer embarazada con quistes intraven-triculares quien desarrolló hipertensión endocraneana y disfunción recurrente de su válvula. Ella falleció después del alta a pesar de una evolución inicial favorable con corticoesteroides y albendazol. La NCC es un problema vigente en nuestro país pero de epidemiología desconocida, afecta a un amplio grupo etario, requiere múltiples intervenciones terapéuticas y presenta dos formas de diferente pronóstico, una de ellas maligna. Para controlarla es necesario incluirla en las enfermedades notificables.

Persistence of viable cysts in neurocysticercosis: a serial imaging study / Persistência de cistos viáveis na neurocisticercose: um estudo seriado de imagem

Introduction: Cysticercosis is an endemic disease in developing countries and is the most common parasitic infection of the central nervous system. The diagnosis is difficult and imaging may contribute to the confirmation. Objective: To report the evolution of brain lesions and the clinical response of a patient with a definitive diagnosis of neurocysticercosis (NCC). Methods: We analyzed six computed tomography (CT) and three magnetic resonance imaging (MRI) exams, performed in a period of six years. Results: The serial imaging study revealed the involution of nine viable cysts and two degenerating cysts out of 39 lesions. It occurred after six years of disease and four courses of treatment with Albendazole. The other 28 lesions were calcified. Clinically, there was reduction in frequency of seizures after treatment with Albendazole and the onset of regular use of anticonvulsants (six per year to 1.8 per year). Conclusion: This case illustrates an instance of partial NCC efficacy to antiparasitic therapy, and demonstrates the role of serial imaging studies in the monitoring the evolution of NCC lesions and in characterizing the diversity of lesion appearance over time.

Introdução: A cisticercose é uma doença endêmica nos países em desenvolvimento. Representa a infecção parasitária mais comum dosistema nervoso central. O diagnóstico é difícil e o exame de imagem pode contribuir para a confirmação. Objetivo: Relatar a evolução das lesõesencefálicas, assim como avaliar a resposta clínica de um paciente com um diagnóstico definitivo do NCC. Métodos: Foram analisadas seistomografias computadorizadas (TC) e três ressonâncias magnéticas (RM) realizadas durante o período de seis anos. Resultados: O estudode imagem seriada revelou a involução de nove cistos viáveis e dois cistos em degeneração de 39 lesões. Isso ocorreu após seis anos de evolução da doença e quatro cursos de tratamento com albendazol. As outras 28 lesões encontravam-se calcificadas e aumentaram para 36 em número. Clinicamente, houve redução na frequência das crises após o tratamento com albendazol e do início do uso regular de anticonvulsivantes (seis por ano para 1,8 por ano). Conclusão: O caso demonstra a importância dos estudos da imagem seriada no acompanhamento das lesões da neurocisticercose (NCC), considerando a possibilidade de resistência medicamentosa e a necessidade da repetição do tratamento.

Estudio comparativo de prazicuantel frente a albendazol en el tratamiento de neurocisticercosis infantil: servicio clinica pediatrica, Hospital Rebagliati - 2003 / Comparative study of prazicuantel against albendazol in the treatment of infantile neurocysticercosis: pediatric clinical service, Hospital Rebagliati - 2003

Entre julio del 2003 y junio del 2009 en el Servicio de Clínica Pediátrica del Hospital E. Rebagliati M. fueron hospitalizados 31 pacientes que reunían criterios clínicos y radiográficos compatibles con neurocisticercosis. Aplicando los criterios de inclusión y exclusión, la muestra final estuvo constituida por 25 niños de los cuales 8 fueron hombres y 17 mujeres. Trece pacientes recibieron tratamiento con albendazol (5 niños y 8 niñas) y doce pacientes recibieron prazicuantel (3 niños y 9 niñas). En el presente estudio el tratamiento con prazicuantel en un solo día fue tan efectivo como el tratamiento con albendazol por siete días. La administración de prazicuantel fue bien tolerado por los niños. Sólo uno de ellos presentó dolor de cabeza que remitió luego de la administración de dexametasona.

Between July 2003 and June 2009 in the Service of the Paediatric Clinic of the Hospital E. Rebagliati M. were hospitalized 31 patients who met clinical and radiographic criteria consistent with neurocysticercosis. Applying criteria of inclusion and exclusion final sample consisted of 25 children of whom 8 were men and 17 women. Thirteen patients were treated with albendazole (5 boys and 8 girls) and twelve patients received prazicuantel (3 boys and 9 girls). In this study, treatment with praziquantel in a single day was as effective as treatment with albendazole for seven days. The administration of praziquantel was well tolerated by children. Only one of them presented headache that sent after dexamethasone administration.

Neurocysticercosis in children.

Neurocysticercosis (NCC) is a common cause of seizures and neurologic disease. Although there may be variable presentations depending on the stage and location of cysts in the nervous system, most children (> 80%) present with seizures particularly partial seizures. About a third of cases have headache and vomiting. Diagnosis is made by either CT or MRI. Single enhancing lesions are the commonest visualization of a scolex confirms the diagnosis. Some cases have multiple cysts with a characterstic starry-sky appearance. Management involves use of anticonvulsants for seizures and steroids for cerebral edema. The use of cysticidal therapy continues to be debated. Controlled studies have shown that cysticidal therapy helps in increased and faster resolution of CT lesions. Improvement in long - term seizure control has not yet been proven. Children with single lesions have a good outcome and seizure recurrence rate is low. Children with multiple lesions have recurrent seizures. Extraparenchymal NCC has a guarded prognosis but it is rare in children. In endemic areas NCC must be considered in the differential diagnosis of seizures and various other neurological disorders.

Human neurocysticercosis managed at Nepalganj Medical College, Teaching Hospital, Kohalpur, Nepal.

INTRODUCTION: Neurocysticercosis is the most common parasitic infection of the central nervous system. It is endemic in Central Europe, South Africa, South America and parts of Asia including Nepal. OBJECTIVE: This study has been conducted with the objectives to know the diagnostic criteria for neurocysticercosis and the outcome of treated cases. METHODOLOGY: This retrospective study was done at Nepalganj Medical College, Teaching Hospital, Kohalpur, by reviewing the record of the patients managed as case of neurocysticercosis in one financial year. RESULTS: All patients presented with seizure as a main symptom started in adult life. The mean age was 21 years; 80% were male and 20% female. The diagnosis seemed to be based on clinical presentation, CT scan findings and high index of suspicion. All were put on albendazole, steroids and anticonvulsant drugs; 93% was discharged when fits got controlled, one patient left against medical advice. Follow up record was not available to comment on resolution. CONCLUSION: Neurocysticercosis is difficult to diagnose and has a significant socioeconomic impact because of chronic morbidity, variable mortality, decreased productivity of affected persons, and high cost of medical diagnosis and treatment. It is therefore suggested to develop criteria for diagnosis of neurocysticercosis to be followed at national level.

Clinical tomographic correlations of 220 patients with neurocisticercosis, Bahia, Brazil

Neurocysticercosis (NCC) is a common parasitic disease in our region, presenting diversity of neurological symptoms and signs. The present study has as primary objective an evaluation of the NCC's clinical and epidemiological profile within Bahia State, by means of a prospective study of 220 patients diagnosed from March 1988 to March 1999, with a follow-up of six months. Exams, such as Computed Cranial Tomography Scan (CT), Cerebral Spine Fluid (CSF) and Electroencephalogram (EEG), were accomplished in three distinct moments of these patients' evolution: at starting or diagnostic point (zero time), at after-intervention period (one month after treatment), and at control period (six months after treatment).

Tratamiento de la neurocisticercosis: revisión critica / Treatment of neurocysticercosis: a review

Neurocysticercosis (NCC) is the most common parasitic disease of the central nervous system. Several drugs, such as drugs against tapeworms, praziquantel or albendazole associated to corticosteroids, have been tested for the treatment of this condition. Although some have claimed the reduction or involution of cystic or granulomatous lesions, there is no consensus about the efficacy of these treatments. The natural evolution of the disease is not clear and this hampers the assessment of treatment effects. Moreover, there are no good imaging or clinical indicators that can predict the progression or spontaneous resolution of lesions, specially at the meningeal or ventricular compartment. Therefore, evidence based medicine does not have a definitive answer about the treatment, neither of seizures, the most common manifestation of NCC, or the varied and complex meningeal and ventricular involvement. This review includes experts opinions to give the clinician some clues for decision making in the treatment of NCC.

Neurocisticercose em zona urbana do estado do Piauí: relato de caso / Neurocysticercosis in a State of Piauí urban area: case report

A neurocisticercose é grave problema de saúde pública que acomete predominantemente locais com condições sanitárias e de higiene precárias. O Piauí não faz parte do mapa da neurocisticercose no Brasil mas, como ilustra este estudo, apenas por falta de dados epidemiológicos. Demonstramos a presença desta patologia no Estado através do relato de caso de um homem de 39 anos, acompanhado por 17 meses. O diagnóstico foi realizado através de tomografia tomputadorizada de crânio (TC) e o paciente foi tratado com albendazol por 10 dias. Uma nova TC mostrou ausência de lesões. Ele precisou ser tratado novamente após recorrência do quadro clínico, ocorrida 6 meses após o primeiro tratamento, com posterior desaparecimento das novas lesões.

Diagnostico e tratamento da neurocisticercose / Diagnosis and treatment of neurocysticercosis

Objetivo: Estudo da neurocisticercose (NC) abrangendo o período 3 janeiro de 1980 a outubro de 2001 em pacientes atendidos nos hospitais Vera Cruz e Alberto Cavalcanti de Belo Horizonte - MG. Metodologia: foram estudados 398 pacientes, sendo que 318 apresentavam a forma inativa da doença e 80 a forma ativa. Em arte da casuística (32 pacientes) foi avaliado o efeito terapêutico a dexametazona associada a drogas parasiticidas sobre a forma ativa parenquimatosa da NC. Resultados: as manifestações clínicas mais frequentes foram a epilepsia (57,8%), hidrocefalia (11,0%) e hipertensão intracraniana (6,0%). Radiografia do crânio, tomografia computadorizada cerebral e ressonância magnética foram positivas para o diagnóstico da NC em 10,5%, 63,0% e 100,0% dos casos, respectivamente. Melhores resultados terapêuticos sobre a forma ativa parenquimatosa foram obtidos com a associação de corticosteróide com os parasiticidas. Conclusões: a classificação da NC em formas ativas e inativas é essencial para decidir a terapia. O tratamento com associação de corticosteróide e droga parasiticida mostrou-se mais eficaz para normas intra-parenquimatosas em relação ao uso exclusivo de corticostereóides. A NC não está erradicada em nosso meio.

The experience with 398 patients with neurocysticercosis during 20 years is reported. The inactive and active forms of the disease were diagnosed in 318 and 80 patients, respectively. The most frequent clinical manifestations were epilepsy (57.8%), hydrocephalus (11.6%) and intra-cranial hypertension (6.1%). Skull X-ray, cerebral computerized tomography, and magnetic resonance imaging were positive for the diagnosis of neurocysticercosis in 10.5%, 63.0% and 100% of the cases, respectively. In 32 patients with the active form of the disease the therapeutic effects of dexametasone alone (16 patients) and the combination of dexametasone and parasiticidal drugs (16 patients) were evaluated. Best therapeutic results were obtained with the combination of corticosteroids and parasiticidal drugs.