Clinical characteristics and management of neurocysticercosis patients: a retrospective assessment of case reports from Europe.

OBJECTIVES: Neurocysticercosis (NCC) is a parasitic disease caused by the larval stage of the tapeworm Taenia solium. NCC mainly occurs in Africa, Latin America and South-East Asia and can cause a variety of clinical signs/symptoms. Although it is a rare disease in Europe, it should nonetheless be considered as a differential diagnosis. The aim of this study was to describe clinical characteristics and management of patients with NCC diagnosed and treated in Europe. METHODS: We conducted a systematic search of published and unpublished data on patients diagnosed with NCC in Europe (2000-2019) and extracted demographic, clinical and radiological information on each case, if available. RESULTS: Out of 293 identified NCC cases, 59% of patients presented initially with epileptic seizures (21% focal onset); 52% presented with headache and 54% had other neurological signs/symptoms. The majority of patients had a travel or migration history (76%), mostly from/to Latin America (38%), Africa (32%) or Asia (30%). Treatment varied largely depending on cyst location and number. The outcome was favorable in 90% of the cases. CONCLUSIONS: Management of NCC in Europe varied considerably but often had a good outcome. Travel and migration to and from areas endemic for T. solium will likely result in continued low prevalence of NCC in Europe. Therefore, training and guidance of clinicians is recommended for optimal patient management.

The birth of a Trichinella britovi focus on the Mediterranean island of Sardinia (Italy).

For 60 years, the islands of the Mediterranean basin were considered to be Trichinella-free. In April 2005, an outbreak of human trichinellosis due to the consumption of infected pork involved 11 persons in the villages of Orgosolo and Lanusei (Nuoro province) on the island of Sardinia (Italy). We conducted an investigation to identify free-range and backyard pigs and other humans with Trichinella infection in the area of the 2005 outbreak. We also tested wild animals from various parts of Sardinia. In December 2005, eight persons were found to have been infected, and in May 2007 there was a single case of infection. The sources of all infections were domestic pigs. Artificial digestion of muscle samples from 681 pigs (325 free-range and 356 backyard pigs) revealed Trichinella sp. larvae in four sows (1.2%). All larvae, including those from the consumed pork products, were identified as Trichinella britovi. All infected pigs originated from the Orgosolo municipality. None of the 6188 wild boars (Sus scrofa) or 13 red foxes (Vulpes vulpes) examined were positive for Trichinella sp., suggesting that this parasite is restricted to free-range pigs. The origin of infected animals on Sardinia remains to be determined, although it could be related to the presence of T. britovi-infected animals on the island of Corsica (France).

Trichinella zimbabwensis in wild reptiles of Zimbabwe and Mozambique and farmed reptiles of Ethiopia.

In 1995, a new species of Trichinella (Trichinella zimbabwensis) was discovered in farmed Nile crocodiles (Crocodylus niloticus) in Zimbabwe, where the mode of transmission was the consumption of the meat of slaughtered crocodiles, used as feed. To determine whether T. zimbabwensis affects poikilotherm vertebrates in the wild, monitor lizards (Varanus niloticus) and Nile crocodiles were collected in Zimbabwe and Mozambique. In 5 (17.6%) of the 28 monitor lizards from Zimbabwe, T. zimbabwensis larvae were identified. For the wild Nile crocodiles from Mozambique, species-level identification was not possible, yet immunohistochemical analysis revealed that 8 (20%) of the 40 animals harboured non-encapsulated Trichinella sp. larvae, which probably belonged to T. zimbabwensis. This is the first report of T. zimbabwensis in wild reptiles, and the findings are consistent with reports that vertebrates with scavenger and cannibalistic behaviour are the most important hosts of Trichinella spp. The wide distribution of monitor lizards and crocodiles in Africa and the development of national crocodile breeding programs in many African countries should be taken into consideration when evaluating the risk of transmission of this parasite to mammals, including humans.

2-Hydroxypropyl-beta-cyclodextrin improves the effectiveness of albendazole against encapsulated larvae of Trichinella spiralis in a murine model.

OBJECTIVES: We evaluated whether the effectiveness of albendazole against encapsulated larvae increases when 2-hydroxypropyl-beta-cyclodextrin (HP-betaCD) is added to improve bioavailability. METHODS: Mice were infected with Trichinella spiralis and treated with albendazole alone, albendazole plus HP-betaCD or not at all (controls) (Experiment I). Both immediately after treatment [76 days post-infection (p.i.)] and later (139 days p.i.) larvae were recovered, and the mean count was expressed in proportion to the larva count for controls. To evaluate the infectivity of the recovered larvae, the larvae recovered at 76 days p.i. and 139 days p.i. were used to infect another three groups (Experiments II and III, respectively). RESULTS: At 76 days p.i., the percentage of larvae recovered was 77.4% for mice treated with albendazole alone and 61.2% for those treated with albendazole plus HP-betaCD; at 139 days p.i., these percentages were 67.4% and 40.9%, respectively (Experiment I). In Experiments II and III, the percentage of larvae collected from the albendazole group and the combined-treatment group was 55.2% and 27.6%, and 53.1% and 26.6%, respectively. The ABZSO active metabolite was analysed to determine the bioavailability of albendazole. For the combined-treatment group, the area under the plasma concentration-time curve between 0 and 6 h was higher than that for the albendazole group. CONCLUSIONS: These data suggest that HP-betaCD increases the bioavailability and consequently the effectiveness of albendazole against encapsulated Trichinella larvae.

The impact of HIV-protease inhibitors on opportunistic parasites.

Opportunistic parasitic infections are an important cause of morbidity and mortality in people infected with HIV. Since the introduction of highly active antiretroviral therapy (HAART), there has been a marked reduction in the occurrence and clinical course of these parasitic infections. Although these changes have been attributed to the restoration of cell-mediated immunity induced by either non-nucleoside reverse transcriptase inhibitors or HIV protease inhibitors, in combination with at least two nucleoside reverse transcriptase inhibitors included in HAART, there is evidence that HIV protease inhibitors have a direct inhibitory effect on the proteases of parasites. The results of studies on opportunistic parasitic infections conducted both before and during the HAART era indicate the need to develop clinical trials on the efficacy of HIV protease inhibitors in controlling parasitic infections in individuals with HIV or other immunocompromised individuals and laboratory investigations on aspartyl proteases of parasites as an important target for the development of new drugs.

Increased CD8(+)-T-cell expression and a type 2 cytokine pattern during the muscular phase of Trichinella infection in humans.

Cell-mediated immunity during the muscular phase of Trichinella infection in humans was studied. Cell proliferation, the phenotypic changes in the T-cell population, and expression and production of cytokines were examined by using peripheral blood mononuclear cells (PBMC) collected at different times postinfection from 10 individuals who had acquired Trichinella spiralis and five individuals who had acquired Trichinella britovi in two distinct outbreaks. T. spiralis and T. britovi crude worm extracts induced proliferation of PBMC from T. spiralis- and T. britovi-infected donors. Cytokine gene expression showed a predominant type 2 pattern for the entire period of infection studied, although gamma interferon (IFN-gamma) was expressed. Interleukin-2 (IL-2), IL-5, IL-10, and IFN-gamma production was found in PBMC of all donors. There was a good correspondence between the cytokine expression and production patterns. Changes in PBMC composition, with a trend toward an increase in CD8(+) lymphocyte counts, were observed.