Case Report: Angiostrongylus cantonesis Myelitis in Thailand.

A 67-year-old man presented with headache, middle back pain that radiated to both legs, and paresthesia in the right leg for 1 day. He had eaten raw shrimp 1 week previously. Over the next week after admission, he developed urinary retention and weakness in both legs. The numbness in his right leg expanded to below the umbilicus. Magnetic resonance imaging of the spinal cord showed myelopathy with minimal cord swelling at T9 to the conus medullaris and a hemorrhagic lesion from T10 to T11. A complete blood count on day 28 after the onset of symptoms revealed leukocytosis without eosinophilia and no white blood cells in his cerebrospinal fluid. Results of an immunochromatographic test kit were positive for Angiostrongylus cantonesis but negative for Gnathostoma spinigerum. After a 4-week course of albendazole combined with a tapering dose of dexamethasone, he achieved nearly complete recovery.

Cerebral Sparganosis in Children: Epidemiologic and Radiologic Characteristics and Treatment Outcomes: A Report of 9 Cases.

BACKGROUND: Pediatric cerebral sparganosis has been seldom reported. In the current study, we retrospectively reviewed the clinicopathologic records of 9 consecutive pediatric cases of cerebral sparganosis and analyzed their epidemiologic characteristics and clinical outcomes. METHODS: Our cases included 6 boys and 3 girls, all from rural areas, and their median age at diagnosis was 9.4 (range, 5.8-12.9) years. The median duration of symptoms from onset to definite diagnosis was 21 months (range, 1 week to 3.7 years). RESULTS: Enzyme-linked immunosorbent assay revealed that serum anti-sparganosis antibody was positive in 9 of 9 patients and cerebrospinal fluid anti-sparganosis antibody was positive in 4 of 6 patients. Eight patients underwent craniotomy the removal of worms. The patients also received oral praziquantel. They were followed up for 2.2 years to 4.4 years. One patient died, and 8 patients survived. Three cases had poor outcomes whereas the outcome of the remaining 5 cases was satisfactory. CONCLUSIONS: Children are more at risk for sparganosis and cerebral sparganosis may be missed because of unclear epidemiologic history and nonspecific manifestations. Cerebrospinal fluid eosinophil counts and enzyme-linked immunosorbent assay for anti-sparganosis antibody and computed tomography/magnetic resonance imaging scans may be relied on for an early and accurate diagnosis before surgery.

Antiplatelet Drug Use and Cerebral Microbleeds: A Meta-analysis of Published Studies.

BACKGROUND: Antiplatelet therapy is a potential risk factor for intracerebral hemorrhage, and cerebral microbleeds reflect small perivascular hemorrhages without clinical symptoms. The question regarding whether antiplatelet therapy increases the risk of cerebral microbleeds has not yet reached a consensus. METHODS: We conducted a search in English database and extracted data from studies assessing the relationship between antiplatelet therapy and cerebral microbleeds. Then, we adopted the Review Manager 5.2 package to calculate pooled odds ratios (ORs) with the method of the inverse variance. RESULTS: We pooled data from 11 studies involving 10429 participants. The results revealed that there was a significant association between antiplatelet therapy and cerebral microbleeds in hemorrhagic stroke patients (OR, 1.96; 95% confidence interval [CI], 1.22-3.16) and ischemic stroke patients (OR, 1.65; 95% CI, 1.06-2.59), but not stroke-free population (OR, 1.30; 95% CI, .96-1.74). When stratified by population ethnicity, the association between antiplatelet therapy and cerebral microbleeds was significant in hemorrhagic stroke (OR, 2.26; 95% CI, 1.25-4.08) and ischemic stroke (OR, 2.18; 95% CI, 1.02-4.67) patients from Asian countries, but not significant in hemorrhagic stroke (OR, 1.95; 95% CI, .33-11.37) and ischemic stroke (OR, 1.16; 95% CI, .87-1.54) patients from European countries. CONCLUSIONS: Antiplatelet therapy may increase the risk of cerebral microbleeds in stroke population. In addition, the relationship between antiplatelet therapy and cerebral microbleeds may be influenced by ethnic factors. More and larger prospective studies are urgently required to verify our results, because the studies to date are retrospective and the available data are limited.

Emergence of neural angiostrongyliasis in eastern Australia.

Despite an apparent increase in cases of angiostrongyliasis in humans and animals in Australia, the epidemiology of infection with the two species of Angiostrongylus that co-exist in this country, namely A. cantonensis and A. mackerrasae, is poorly understood. This knowledge gap is particularly important with respect to A. mackerrasae, a species evidently native to Australia, as its ability to cause disease in humans is unknown. Likewise, there is little information on the roles of native and introduced species of rodents and molluscs as hosts of Angiostrongylus species in Australia. This review focuses on the gaps in the knowledge about the two species, highlighting the need for epidemiological and pathogenesis studies on the native lungworm A. mackerrasae.

Helminth parasitic infections of the central nervous system: a diagnostic approach.

Helminth parasitic infections of the central nervous system (CNS) occur worldwide with high prevalence in tropical and subtropical countries. Clinical evaluation of patients is mandatory, and it is convenient to group the clinical manifestations into syndromes: for example space-occupying lesions, meningitis, and encephalitis. The history should focus on residence or travel to endemic areas, diet, activities, intercurrent medical conditions, and associated clinical clues. Direct parasitological diagnosis can be reached by cerebrospinal fluid and cerebral tissue examination either by microscopy, culture, or immunological techniques. Immunodiagnosis by detection of parasite antibodies or antigens in serum could provide indirect evidence of parasitic infections. In addition, various imaging and radiological techniques e.g., computed tomography (CT) scan and magnetic resonance imaging (MRI) complement the diagnostic work-up of CNS diseases. Finally, the helminthic CNS infections of global impact, such as schistosomiasis, neurotoxocariasis, Strongyloides infection, neurotrichinosis, neurocysticercosis, and echinococcosis will be briefly discussed as regards the principal clinical and diagnostic features.

Cerebral sparganosis in children: epidemiological, clinical and MR imaging characteristics.

BACKGROUND: Cerebral sparganosis in children is an extremely rare disease of central nervous system, and caused by a tapeworm larva from the genus of Spirometra. In this study, we discussed and summarized epidemiological, clinical and MR imaging characteristics of eighteen children with cerebral sparganosis for a better diagnosis and treatment of the disease. METHODS: Eighteen children with cerebral sparganosis verified by pathology, serological tests and MR presentations were retrospectively investigated, and the epidemiologic and clinical characteristics of the disease were studied. RESULTS: Twenty-seven lesions were found in the eighteen children. Twelve lesions in twelve patients were solitary while the lesions in the rest six patients were multiple and asymmetrical. The positions of the lesions were: seven in frontal, eleven in parietal, four in temporal and two in occipital lobes, one in basal ganglia, one in cerebella hemisphere and one in pons. The lesions were presented as slight hypointensity on T1-weighted images but moderate hyperintensity on T2-weighted images with perilesional brain parenchyma edema. Enhanced MR scans by using Gadopentetic Acid Dimeglumine Salt were performed in the patients, and the images demonstrated abnormal enhancements with the patterns of a peripheral ring, or a tortuous beaded, or a serpiginous tubular shape. Follow-up MR scans were preformed for eight patients, and three out of the eight cases exposed migrations and changes in shapes of the lesion areas. CONCLUSIONS: The MR presentations in our study in general were similar to those in previous studies. However serpiginous tubular and comma-shaped enhancements of lesions have not been previously reported. The enhanced MR imaging and follow-up MR scans with the positive results from serological tests are the most important methods for the clinical diagnosis of cerebral sparganosis in children.

Clinical manifestations of eosinophilic meningitis caused by Angiostrongylus cantonensis: 18 years' experience in a medical center in southern Taiwan.

BACKGROUND: With the improvement of public health, eosinophilic meningitis associated with Angiostrongylus cantonensis infection is now seldom reported in Taiwan. Eosinophilic meningitis typically occurred sporadically in children. This study aims to analyze the clinical manifestations and change in the contemporary epidemiology of eosinophilic meningitis in Taiwan. METHODS: This is a retrospective study of patients diagnosed with eosinophilic meningitis at Kaohsiung Veterans General Hospital, from December 1991 to September 2009. The demographic characteristics, clinical presentations, laboratory data, radiographic imaging, and treatment and clinical outcome were analyzed. A PubMed search with the keywords of eosinophilic meningitis, A cantonensis, and Taiwan was performed to retrieve cases of eosinophilic meningitis caused by A cantonensis since 1960. RESULTS: Thirty-seven patients were diagnosed to have eosinophilic meningitis during a period of 18 years. The median age was 32 years (range, 2-80 years). Ninety five percent (35/37) of the patients were adults. The median incubation period was 10.5 days (range, 3-80 days). Most of the patients presented with headache (29, 78%), fever (25, 68%), and 11(30%) had hyperesthesia. Patients with hyperesthesia had longer incubation period (55 vs. 7 days, p=0.004), lower serum immunoglobulin E levels (127.5 vs. 1295 IU/mL, p<0.001), and longer duration between symptom onset and spinal taps (14 vs. 5 days, p=0.011). Three patients presented initially with lymphocytic meningitis, and eosinophilia only appeared on a second lumbar puncture. Magnetic resonance imaging of the brain disclosed leptomeningeal enhancement (17/26, 65%) and increased signal intensity (10/26, 38%) on T2-weighted and fluid-attenuated inversion recovery images. There were eight relapses and two patients died. No sequela was noted except in one 2-year-old toddler, who had weakness of both lower limbs. CONCLUSIONS: The epidemiology of eosinophilic meningitis has changed during the past two decades in Taiwan and occurs mainly in adults in the setting of outbreaks. Hyperesthesia; repeated lumbar puncture in cases with lymphocytic meningitis of uncertain cause; and a detailed history, including food consumption, are important to establish an accurate diagnosis.

Immunoblot diagnostic test for neurognathostomiasis.

Neurognathostomiasis is a rare but severe form of human gnathostomiasis. Diagnosis of neurognathostomiasis is made presumably by using clinical manifestations. Serologic tests for neurognathostomiasis are not widely available and limited. We studied 12 patients with diagnoses of neurognathostomiasis at Srinagarind Hospital, Khon Kaen University, Thailand. There were three types of neurognathostomiasis (five patients with intracerebral hemorrhage, one patient with subarachnoid hemorrhage, and six patients with myelitis). All patients were tested for antibodies against Gnathostoma spinigerum by an immunoblotting technique. The sensitivity and specificity of the 21-kD and 24-kD diagnostic bands were 83.3% and 100%, and 91.7% and 100%, respectively. The sensitivity, specificity, positive predictive value, and negative predictive value for the 21-kD and 24-kD diagnostic bands were all 100%. Both diagnostic bands are a helpful diagnostic tool for neuro gnathostomiasis and show good diagnostic properties.

Serological studies of neurologic helminthic infections in rural areas of southwest cameroon: toxocariasis, cysticercosis and paragonimiasis.

BACKGROUND: Both epilepsy and paragonimiasis had been known to be endemic in Southwest Cameroon. A total of 188 people (168 and 20 with and without symptoms confirmed by clinicians, respectively, 84.6% under 20 years old) were selected on a voluntary basis. Among 14 people (8.3%) with history of epilepsy, only one suffered from paragonimiasis. Therefore, we challenged to check antibody responses to highly specific diagnostic recombinant antigens for two other helminthic diseases, cysticercosis and toxocariasis, expected to be involved in neurological diseases. Soil-transmitted helminthic infections were also examined. METHODOLOGY/PRINCIPAL FINDINGS: Fecal samples were collected exclusively from the 168 people. Eggs of Ascaris lumbricoides, Trichuris trichiura and hookworms were found from 56 (33.3%), 72 (42.8%), and 19 (11.3%) persons, respectively. Serology revealed that 61 (36.3%), 25 (14.9%) and 2 (1.2%) of 168 persons showed specific antibody responses to toxocariasis, paragonimiasis and cysticercosis, respectively. By contrast, 20 people without any symptoms as well as additional 20 people from Japan showed no antibody responses. Among the 14 persons with epilepsy, 5 persons were seropositive to the antigen specific to Toxocara, and one of them was simultaneously positive to the antigens of Paragonimus. The fact that 2 children with no history of epilepsy were serologically confirmed to have cysticercosis strongly suggests that serological survey for cysticercosis in children is expected to be useful for early detection of asymptomatic cysticercosis in endemic areas. CONCLUSIONS/SIGNIFICANCE: Among persons surveyed, toxocariasis was more common than paragonimiasis, but cysticercosis was very rare. However, the fact that 2 children were serologically confirmed to have cysticercosis was very important, since it strongly suggests that serology for cysticercosis is useful and feasible for detection of asymptomatic cysticercotic children in endemic areas for the early treatment.

[Case report of Elaphostrongylus cervi in a goat in north Italy]. / Segnalazione di Elaphostrongylus cervi in una capra in nord-Italia.

A case of cerebral nematodiasis in a goat from Lombardy (north Italy) is described. Clinical signs, histopathological lesions and the finding of a nematode in cerebral tissue sections of the affected animal confirmed the diagnosis of infection with Elaphostrongylus cervi.

[Cerebrospinal nematodosis in sheep in Switzerland]. / Zerebrospinale Nematodose beim Schaf in der Schweiz.

In December 2005 three sheep, originating from Canton Tessin, were presented with cerebrospinal nematodosis. The animals had a history of progressive pelvic limb ataxia and recumbency. The most important clinical findings were an abnormal gait (wide stance, pelvic limb paresis) and decreased sensitivity of the pelvic limbs. The general condition was slightly or moderately disturbed, appetite was normal. Examination of the cerebrospinal fluid revealed mononuclear cells and eosinophils, suggesting a helminthic infection of the central nervous system. Postmortem findings confirmed the clinical diagnosis in one animal as parts of a nematode were found in the thoracic spinal cord. Even though the nematode could not be identified, infection with Elaphostrongylus cervi seems very likely, as the sheep are in close contact with deer on the pastures and the parasite is known to infect goats in Switzerland. This is the first description of cerebrospinal nematodosis in sheep in Switzerland.

Raccoon roundworm encephalitis.

The raccoon roundworm, Baylisascaris procyonis, is increasingly recognized as a cause of zoonotic visceral, ocular, and neural larva migrans and, in particular, of devastating encephalitis in young children. Exposure occurs mainly at raccoon latrines, where large numbers of infective eggs may be accidentally ingested. Risk factors for infection include contact with raccoon latrines, pica/geophagia, age of <4 years, and male sex. The severity of central nervous system (CNS) disease depends on the number of eggs ingested, the extent and location of larval migration, and the severity of ensuing inflammation and necrosis. Diagnosis of Baylisascaris encephalitis is based on clinical CNS disease, peripheral and cerebrospinal fluid eosinophilia, deep white matter lesions visible by magnetic resonance imaging, and positive results of serologic tests. Treatment efficacy in clinical cases is poor, but albendazole prevents disease if given promptly after infection. Considering the seriousness of this disease and limitations of diagnosis and treatment, prevention of infection with eggs is of utmost importance.

Epidemiology of cerebrospinal Elaphostrongylus cervi infection in red deer in central Spain.

Elaphostrongylus cervi produces a subclinical cerebrospinal disease in many wild and domestic ruminants from Europe, North America and New Zealand and has recently been described in Spain. To determine some aspects of its epidemiology, 121 red deer (Cervus elaphus) from central Spain were sampled during 2000. The prevalence (7%) and mean worm burden (3.8 worms per brain) were similar to the values previously recorded in other European areas. The infection was only detected in young deer during the winter. The estimation of larval production in the faeces was not a reliable method of diagnosing E. cervi infection.

Hydatidosis of central nervous system and its coverings in the pediatric and adolescent age groups in Turkey during the last century: a critical review of 137 cases.

INTRODUCTION: Hydatid disease is still a major problem in infested areas of the world, especially in the rural areas, including Turkey. OBJECTIVE: The objective of this review was to analyze the literature on the management of central nervous system (CNS) hydatidosis with an emphasis on their specificities in childhood and adolescence, with the aim of determining the clinical and neuroradiological findings and treatment modalities, medical or surgical, in these age groups. MATERIALS AND METHODS: To establish some guidelines for the diagnosis and treatment of this controversial condition, publications reported from Turkey in national ( n=33) and international ( n=55) journals during the last century and databases containing medical literature were used. Strikingly, the numbers of articles produced by Turkish authors on CNS hydatidosis have risen tremendously during the study period. Although a total of 272 cases of intracranial and intraspinal hydatid cysts were reported from Turkey, only 137 cases for which detailed information was available were selected for further analysis, in keeping with our inclusion and exclusion criteria. RESULTS AND DISCUSSION: Despite the inherent limitations, this type of study indicates that the incidence of hydatidosis has not decreased in Turkey in recent years. The clinical findings were mostly atypical, and it was interesting that 4 patients were described as having cerebrovascular occlusive disease and 3 as having symptoms of movement disorders. Computed tomography and/or MRI techniques were extremely useful, both in reaching the correct diagnosis and for proper surgical management of hydatid disease, because of the absence of a pathognomonic clinical picture of this disease. The treatment of choice for hydatid disease of the CNS and its coverings was complete intact removal of the cyst. In contrast to that in intracranial hydatid cysts, however, surgical intervention was palliative, not curative, in almost all cases of intraspinal hydatidosis. According to this critical review of the literature, CNS hydatidosis is therefore still a life-threatening condition, in spite of all the advances in imaging techniques and therapeutic methods. The most important factors in prognosis are the localization of the focus of infection, rupture and of the cyst and dissemination of its content, and treatment modality. At present, surgical intervention preceded by careful neuroradiological evaluation remains the best surgical therapy, and this plus adjuvant chemotherapy is advocated in some cases as the gold standard for therapy.