213 results on '"Hector H. Garcia"'
Search Results
2. From laboratory to clinical practice: an update of the immunological and molecular tools for neurocysticercosis diagnosis
- Author
-
Luz M. Toribio, Javier A. Bustos, and Hector H. Garcia
- Subjects
neurocysticercosis ,immunodiagnosis ,molecular diagnosis ,Taenia solium ,Peru ,Infectious and parasitic diseases ,RC109-216 - Abstract
Neurocysticercosis (NCC) is caused by the invasion of Taenia solium larvae in the central nervous system (CNS) and stands as the predominant cause of epilepsy and other neurological disorders in many developing nations. NCC diagnosis is challenging because it relies on brain imaging exams (CT or MRI), which are poorly available in endemic rural or resource-limited areas. Moreover, some NCC cases cannot be easily detected by imaging, leading to inconclusive results. Multiple laboratory assays, principally immunological, have been developed to support the diagnosis and/or monitor the treatment efficacy, but its production can be costly, laborious, and non-globally accessible because they depend on parasite material. Therefore, recent advances have been focused on the implementation of recombinant or synthetic antigens as well as monoclonal antibodies for NCC immunodiagnosis purposes. Similarly, molecular diagnosis has been explored, obtaining promising results. Here we described the recent progress in the development of immunological and molecular diagnostic tools for NCC diagnosis over the past 13 years, discussing their potential application to address important challenges and how to focus future directions to improve NCC diagnosis with emphasis on enhance accessibility and the importance of test validation to provide an adequate support for clinical decisions.
- Published
- 2024
- Full Text
- View/download PDF
3. Calcified Neurocysticercosis: Demographic, Clinical, and Radiological Characteristics of a Large Hospital-Based Patient Cohort
- Author
-
Javier A. Bustos, Gianfranco Arroyo, Oscar H. Del Brutto, Isidro Gonzales, Herbert Saavedra, Carolina Guzman, Sofia S. Sanchez-Boluarte, Kiran T. Thakur, Christina Coyle, Seth E. O’Neal, and Hector H. Garcia
- Subjects
Neurocysticercosis ,Taenia solium ,calcification ,epilepsy ,Peru ,Medicine - Abstract
Neurocysticercosis (NCC), the infection of the central nervous system caused by Taenia solium larvae (cysticerci), is a major cause of acquired epilepsy worldwide. Calcification in NCC is the most common neuroimaging finding among individuals with epilepsy in T. solium-endemic areas. We describe the demographic, clinical, and radiological profiles of a large hospital cohort of patients with calcified NCC in Peru (during the period 2012–2022) and compared profiles between patients with and without a previous known diagnosis of viable infection. A total of 524 patients were enrolled (mean age at enrollment: 40.2 ± 15.2 years, mean age at symptom onset: 29.1 ± 16.1 years, 56.3% women). Of those, 415 patients (79.2%) had previous seizures (median time with seizures: 5 years, interquartile range (IQR): 2–13 years; median number of seizures: 7 (IQR: 3–32)), of which 333 (80.2%) had predominantly focal to bilateral tonic-clonic seizures; and 358 (68.3%) used antiseizure medication). Patients had a median number of three calcifications (IQR: 1–7), mostly located in the frontal lobes (79%). In 282 patients (53.8%) there was a previous diagnosis of viable infection, while 242 only had evidence of calcified NCC since their initial neuroimaging. Most patients previously diagnosed with viable infection were male, had previous seizures, had seizures for a longer time, had more calcifications, and had a history of taeniasis more frequently than patients without previously diagnosed viable infection (all p < 0.05). Patients with calcified NCC were heterogeneous regarding burden of infection and clinical manifestations, and individuals who were diagnosed after parasites calcified presented with milder disease manifestations.
- Published
- 2023
- Full Text
- View/download PDF
4. Clinical Characteristics of Neurocysticercosis in a Peruvian Population-Based Epilepsy Cohort: A Descriptive Cross-Sectional Study of Baseline Clinical Intake
- Author
-
Samantha E. Allen, Luz M. Moyano, Melissa T. Wardle, Carolina Guzman, Sofia S. Sanchez-Boluarte, Gabrielle Bonnet, Javier A. Bustos, Seth O’Neal, and Hector H. Garcia
- Subjects
epidemiology ,epilepsy ,neurocysticercosis ,Medicine - Abstract
(1) Background: This study presents the baseline characteristics of a community-level population of people with epilepsy (n = 1975) living in an area endemic for Taenia solium, the pathogen responsible for neurocysticercosis (NCC). (2) Methods: Participants were sequentially enrolled in a clinical cohort from 2007 to 2020 in Tumbes, Peru. All participants provided demographic and clinical history and received clinical evaluations. Diagnostics, including neuroimaging, cysticercosis serologies, and EEG, were obtained where possible. The data presented are from the cross-sectional baseline assessment of cohort participants. (3) Results: Approximately 38% of participants met the criteria for NCC. Those with NCC were more likely to have adult-onset epilepsy, as well as a longer duration of epilepsy, as compared to their counterparts without NCC. Overall, the data indicate a large treatment gap, with only approximately a quarter of the baseline population with prescriptions for anti-seizure medications. (4) Conclusions: These data reveal a high proportion of NCC among people living with epilepsy in these communities, with limited health care resources. At baseline, 74% of the population were not receiving anti-seizure treatments. Further analyses of these data will clarify the natural history of the disease for this population.
- Published
- 2023
- Full Text
- View/download PDF
5. New animal models of neurocysticercosis can help understand epileptogenesis in neuroinfection
- Author
-
Hector H. Garcia, Manuela R. Verastegui, Gianfranco Arroyo, Javier A. Bustos, Robert H. Gilman, and for The Cysticercosis Working Group in Peru
- Subjects
Taenia solium ,larval cestodes ,cysticercosis ,neurocysticercosis ,epilepsy ,Peru ,Neurosciences. Biological psychiatry. Neuropsychiatry ,RC321-571 - Published
- 2022
- Full Text
- View/download PDF
6. Cellular and molecular basis associated with metacestode proliferation in subarachnoid neurocysticercosis
- Author
-
Miguel A. Orrego, Manuela R. Verastegui, and Hector H. Garcia
- Subjects
Taenia solium ,neurocysticercosis ,subarachnoid cyst ,proliferation ,germinative cells ,Immunologic diseases. Allergy ,RC581-607 - Published
- 2022
- Full Text
- View/download PDF
7. Geographically Targeted Interventions versus Mass Drug Administration to Control Taenia solium Cysticercosis, Peru
- Author
-
Seth E. O’Neal, Ian W. Pray, Percy Vilchez, Ricardo Gamboa, Claudio Muro, Luz Maria Moyano, Viterbo Ayvar, Cesar M. Gavidia, Robert H. Gilman, Armando E. Gonzalez, and Hector H. Garcia
- Subjects
Neglected tropical diseases ,pork tapeworm ,zoonoses ,One Health ,taeniasis ,neurocysticercosis ,Medicine ,Infectious and parasitic diseases ,RC109-216 - Abstract
Optimal control strategies for Taenia solium taeniasis and cysticercosis have not been determined. We conducted a 2-year cluster randomized trial in Peru by assigning 23 villages to 1 of 3 geographically targeted intervention approaches. For ring screening (RS), participants living near pigs with cysticercosis were screened for taeniasis; identified cases were treated with niclosamide. In ring treatment (RT), participants living near pigs with cysticercosis received presumptive treatment with niclosamide. In mass treatment (MT), participants received niclosamide treatment every 6 months regardless of location. In each approach, half the villages received targeted or mass oxfendazole for pigs (6 total study arms). We noted significant reductions in seroincidence among pigs in all approaches (67.1% decrease in RS, 69.3% in RT, 64.7% in MT; p
- Published
- 2021
- Full Text
- View/download PDF
8. Consistent Measurement of Parasite-Specific Antigen Levels in Sera of Patients with Neurocysticercosis Using Two Different Monoclonal Antibody (mAb)-Based Enzyme-Linked Immunosorbent Assays
- Author
-
Yesenia Castillo, Luz M. Toribio, Carolina Guzman, Gianfranco Arroyo, Cindy Espinoza, Herbert Saavedra, Javier A. Bustos, Pierre Dorny, Seth E. O’Neal, and Hector H. Garcia
- Subjects
neurocysticercosis ,Taenia solium ,Ag-ELISA ,monoclonal antibodies ,agreement ,Medicine - Abstract
Monoclonal antibody (mAb)-based enzyme-linked immunosorbent assay (ELISA) is a complementary diagnosis technique for neurocysticercosis (NCC), which detects circulating parasite antigen (Ag) indicative of viable infection and Ag levels that correlate well with the parasite burden. In this study, we compared the performance of two Ag-ELISA techniques for the detection of NCC. We assessed the agreement between our in-house TsW8/TsW5 Ag-ELISA and the widely used B158/B60 Ag-ELISA for measuring T. solium antigen levels in the sera from 113 patients with calcified, parenchymal, and subarachnoid NCC. Concordance was demonstrated evaluating the limits of agreement (LoAs) stratified by the type of NCC. Both ELISA’s detected 47/48 (97.8%) subarachnoid NCC cases. In parenchymal and calcified NCC, the B158/B60 Ag-ELISA detected 19/24 (79.2%) and 18/41 (43.9%) cases, while the TsW8/TsW5 Ag-ELISA detected 21/24 (87.5%) and 13/41 (31.7%), respectively. Parenchymal and calcified NCC obtained a perfect agreement (100%), indicating that all sample results were within the predicted LoA, while for subarachnoid NCC, the agreement was 89.6%. The high concordance between the assays was confirmed by Lin’s concordance coefficient (LCC = 0.97). Patients with viable parenchymal NCC (LCC = 0.95) obtained the highest concordance between assays, followed by subarachnoid NCC (LCC = 0.93) and calcified NCC (LCC = 0.92). The TsW8/TsW5 Ag-ELISA and B158/B60 Ag-ELISA showed high Ag measurement correlations across diverse types of NCC.
- Published
- 2023
- Full Text
- View/download PDF
9. Seroprevalence of Antibodies against Taenia solium Cysticerci among Refugees Resettled in United States
- Author
-
Seth E. O’Neal, John M. Townes, Patricia P. Wilkins, John C. Noh, Deborah Lee, Silvia Rodriguez, Hector H. Garcia, and William M. Stauffer
- Subjects
cysticercosis ,neurocysticercosis ,Taenia solium ,tapeworm ,refugees ,Bhutan ,Medicine ,Infectious and parasitic diseases ,RC109-216 - Abstract
Neurocysticercosis (NCC) is a disease caused by central nervous system infection by the larval stage of the pork tapeworm, Taenia solium. In developing countries, NCC is a leading cause of adult-onset epilepsy. Case reports of NCC are increasing among refugees resettled to the United States and other nations, but the underlying prevalence among refugee groups is unknown. We tested stored serum samples from the Centers for Disease Control and Prevention Migrant Serum Bank for antibodies against T. solium cysts by using the enzyme-linked immunoelectrotransfer blot. Seroprevalence was high among all 4 populations tested: refugees from Burma (23.2%), Lao People’s Democratic Republic (18.3%), Bhutan (22.8%), and Burundi (25.8%). Clinicians caring for refugee populations should suspect NCC in patients with seizure, chronic headache, or unexplained neurologic manifestations. Improved understanding of the prevalence of epilepsy and other associated diseases among refugees could guide recommendations for their evaluation and treatment before, during, and after resettlement.
- Published
- 2012
- Full Text
- View/download PDF
10. Diagnóstico y manejo de la neurocisticercosis en el Perú Neurocysticercosis diagnosis and management in Peru
- Author
-
Herbert Saavedra, Isidro Gonzales, Manuel A. Alvarado, Miguel A. Porras, Victor Vargas, Román A. Cjuno, Hector H. Garcia, and S. Manuel Martinez
- Subjects
Neurocisticercosis ,Albendazol ,Praziquantel ,Taenia solium ,Perú ,Neurocysticercosis ,Albendazole ,Peru ,Medicine ,Medicine (General) ,R5-920 - Abstract
La neurocisticercosis (NCC) es la parasitosis humana más frecuente del sistema nervioso central y es causada por las larvas del céstodo Taenia solium. La NCC es endémica en prácticamente todos los paises en vías de desarrollo. En general se presenta como formas intraparenquimales asociadas con convulsiones o formas extraparenquimales asociadas con hipertensión endocraneana. La sospecha clínica y epidemiológica es importante pero el diagnóstico se realiza primariamente por imágenes y se confirma con serología. La tomografía axial computarizada y la resonancia magnética son las pruebas imagenológicas usadas. Como prueba confirmatoria se usa el diagnóstico inmunológico a través de western blot, que actualmente se pude realizar en el Instituto Nacional de Ciencias Neurológicas tanto en suero como en líquido cefalorraquídeo. El tratamiento involucra medidas sintomáticas (control de convulsiones o hipertensión endocraneana según sea el caso) y tratamiento antiparasitario (albendazol o praziquantel). El tratamiento antiparasitario debe hacerse bajo condiciones de hospitalización y en hospitales de tercer nivel.Neurocysticercosis (NCC) is the most common parasitic disease of the central nervous system and is caused by larvae of the tapeworn Taenia solium. NCC is endemic in almost all developing countries. It presents as intraparenchymal forms associated with seizures or as extraparenchymal forms associated with intracranial hypertension. The clinical and epidemiological suspicion are important but the diagnosis is made primarily by images and confirmed by serology. Computed tomography (CT) and magnetic resonance imaging tests are used. Inmunodiagnosis by Western Blot, which is currently perform in the Instituto Nacional de Ciencias Neurológicas in serum and cerebrospinal fluid serves as confirmatory test. Treatment involves symptomatic measures (control of seizures or intracranial hypertension) and anticysticercal medications (albendazole and praziquantel). Anticysticercal treatment should be used under hospital conditions because of secondary effects.
- Published
- 2010
11. Advances in the treatment, diagnosis, control and scientific understanding of taeniid cestode parasite infections over the past 50 years
- Author
-
Peter Kern, Robin B. Gasser, Thomas Romig, Francesca Tamarozzi, Peter Deplazes, Paul R. Torgerson, Hector H. Garcia, Andrew Hemphill, and Marshall W. Lightowlers
- Subjects
medicine.medical_specialty ,Neurocysticercosis ,Dogs ,Echinococcosis ,parasitic diseases ,Taenia solium ,medicine ,Animals ,Parasites ,Parasite Infections ,610 Medicine & health ,Echinococcus granulosus ,Intensive care medicine ,630 Agriculture ,biology ,Transmission (medicine) ,500 Science ,Cestode Infections ,biology.organism_classification ,Echinococcoses ,medicine.drug_formulation_ingredient ,Infectious Diseases ,Echinococcus ,Cestoda ,570 Life sciences ,590 Animals (Zoology) ,Taenia ,Parasitology - Abstract
In the past 50 years, enormous progress has been made in the diagnosis, treatment and control of taeniid cestode infections/diseases and in the scientific understanding thereof. Most interest in this group of parasites stems from the serious diseases that they cause in humans. It is through this lens that we summarize here the most important breakthroughs that have made a difference to the treatment of human diseases caused by these parasites, reduction in transmission of the taeniid species associated with human disease, or understanding of the parasites’ biology likely to impact diagnosis or treatment in the foreseeable future. Key topics discussed are the introduction of anti-cestode drugs, including benzimidazoles and praziquantel, and the development of new imaging modalities that have transformed the diagnosis and post-treatment monitoring of human echinococcoses and neurocysticercosis. The availability of new anti-cestode drugs for use in dogs and a detailed understanding of the transmission dynamics of Echinococcus granulosus sensu lato have underpinned successful programs that have eliminated cystic echinococcosis in some areas of the world and greatly reduced the incidence of infection in others. Despite these successes, cystic and alveolar echinococcosis and neurocysticercosis continue to be prevalent in many parts of the world, requiring new or renewed efforts to prevent the associated taeniid infections. Major advances made in the development of practical vaccines against E. granulosus and Taenia solium will hopefully assist in this endeavour, as might the understanding of the parasites’ biology that have come from an elucidation of the nuclear genomes of each of the most important taeniid species causing human diseases.
- Published
- 2021
12. Improved Diagnosis of Viable Parenchymal Neurocysticercosis by Combining Antibody Banding Patterns on Enzyme-Linked Immunoelectrotransfer Blot (EITB) with Antigen Enzyme-Linked Immunosorbent Assay (ELISA)
- Author
-
Pierre Dorny, John Noh, Gianfranco Arroyo, Robert H. Gilman, Sukwan Handali, Hector H. Garcia, E. Javier Pretell, Erika Perez, Armando E. Gonzalez, Yesenia Castillo, Seth E. O’Neal, Javier A. Bustos, Isidro Gonzales, Herbert Saavedra, and Andres G. Lescano
- Subjects
Microbiology (medical) ,chemistry.chemical_classification ,urogenital system ,Neurocysticercosis ,Antibodies, Helminth ,Enzyme-Linked Immunosorbent Assay ,Biology ,Sensitivity and Specificity ,Serology ,Blot ,Exact test ,Enzyme ,Antigen ,chemistry ,Antigens, Helminth ,Taenia solium ,Immunology ,Parenchyma ,biology.protein ,Animals ,Humans ,Parasitology ,Antibody - Abstract
The diagnosis of neurocysticercosis (NCC) depends on neuroimaging and serological confirmation. While antibody detection by enzyme-linked immunoelectrotransfer blot (EITB) fails to predict viable NCC, EITB banding patterns provide information about the host’s infection course. Adding antigen enzyme-linked immunosorbent assay (Ag-ELISA) results to EITB banding patterns may improve their ability to predict or rule out of viable NCC. We assessed whether combining EITB banding patterns with Ag-ELISA improves discrimination of viable infection in imaging-confirmed parenchymal NCC. EITB banding patterns were grouped into classes using latent class analysis. True-positive and false-negative Ag-ELISA results in each class were compared using Fisher’s exact test. Four classes were identified: 1, EITB negative or positive to GP50 alone (GP50 antigen family); 2, positive to GP42-39 and GP24 (T24/42 family), with or without GP50; and 3 and 4, positive to GP50, GP42-39, and GP24 and reacting to bands in the 8-kDa family. Most cases in classes 3 and 4 had viable NCC (82% and 88%, respectively) compared to classes 2 and 1 (53% and 5%, respectively). Adding positive Ag-ELISA results to class 2 predicted all viable NCC cases (22/22 [100%]), whereas 11/40 patients (27.5%) Ag-ELISA negative had viable NCC (P < 0.001). Only 1/4 patients (25%) Ag-ELISA positive in class 1 had viable NCC, whereas 1/36 patients (2.8%) Ag-ELISA negative had viable NCC (P = 0.192). In classes 3 and 4, adding Ag-ELISA was not contributory. Combining Ag-ELISA with EITB banding patterns improves discrimination of viable from nonviable NCC, particularly for class 2 responses. Together, these complement neuroimaging more appropriately for the diagnosis of viable NCC.
- Published
- 2022
13. Urine 1H-NMR Metabolomics to Discriminate Neurocysticercosis Patients from Healthy Controls: An Exploratory Study
- Author
-
Juan M. Lopez, Vanessa E. Leyva, Javier A. Bustos, Erika Perez, Sofía S. Sanchez, Herbert Saavedra, Isidro Gonzales, Helena Maruenda, and Hector H. Garcia
- Subjects
Infectious Diseases ,Virology ,Urine 1H-NMR ,Short Report ,Metabolomics ,Exploratory Study ,Parasitology ,Neurocysticercosis - Abstract
The diagnosis of neurocysticercosis (NCC) is principally based on neuroimaging (magnetic resonance imaging or computed tomography), instrumentation that is scarcely available in the rural regions where Taenia solium transmission, primarily occurs due to poor sanitation conditions. Immunological assays for antigen or antibody detection complement the neuroimaging approach. However, no field-applicable assays to diagnose viable NCC or to guide the referral of cases for neuroimaging or for appropriate management are available. We performed an exploratory study on urine and serum samples using 1H-nuclear magnetic resonance (NMR)-based metabolomics to discriminate NCC patients (n = 14) from healthy control subjects (n = 22). Metabolic profiles demonstrated a discrimination between the urines of NCC patients and noninfected control subjects with a moderate predictive accuracy (R2 = 0.999, Q2 = 0.434). NMR metabolomics analysis has been proven useful in depicting biomarkers linked to other infectious diseases, various types of cancer, and other disorders. Our results, albeit preliminary, open a door to the development of better methods for detecting NCC through the identification of biomarkers participating in disturbed metabolic pathways.
- Published
- 2022
14. A recombinant monoclonal-based Taenia antigen assay that reflects disease activity in extra-parenchymal neurocysticercosis
- Author
-
Madelynn Corda, Joshua Sciurba, Jiana Blaha, Siddhartha Mahanty, Adriana Paredes, Hector H. Garcia, Theodore E. Nash, Thomas B. Nutman, and Elise M. O’Connell
- Subjects
Hybridomas ,Public Health, Environmental and Occupational Health ,Antibodies, Helminth ,Enzyme-Linked Immunosorbent Assay ,Urine ,Blood plasma ,Neurocysticercosis ,Antigen isotypes ,Sensitivity and Specificity ,Recombinant Proteins ,Mice ,Infectious Diseases ,Cerebrospinal fluid ,Immunoglobulin M ,Antigens, Helminth ,Immunoglobulin G ,Comparators ,Taenia solium ,Animals ,Humans ,Enzyme-linked immunoassays - Abstract
Background Antigen tests for diagnosis and disease monitoring in some types of neurocysticercosis (NCC) are useful but access to testing has been limited by availability of proprietary reagents and/or kits. Methods/Principal findings Three previously identified IgM-secreting hybridomas whose IgM products demonstrated specificity to Taenia solium underwent variable heavy and light chain sequencing and isotype conversion to mouse IgG. Screening of these recombinantly expressed IgG anti-Ts hybridomas, identified one (TsG10) with the highest affinity to crude Taenia antigen. TsG10 was then used as a capture antibody in a sandwich antigen detection immunoassay in combination with either a high titer polyclonal anti-Ts antibody or with biotinylated TsG10 (termed TsG10*bt). Using serum, plasma, and CSF samples from patients with active NCC and those from NCC-uninfected patients, ROC curve analyses demonstrated that the TsG10-TsG10-*bt assay achieved a 98% sensitivity and 100% specificity in detecting samples known to be antigen positive and outperformed the polyclonal based assay (sensitivity of 93% with 100% specificity). By comparing levels of Ts antigen (Ag) in paired CSF (n = 10) or plasma/serum (n = 19) samples from well-characterized patients with extra-parenchymal NCC early in infection and at the time of definitive cure, all but 2 (1 from CSF and 1 from plasma) became undetectable. There was a high degree of correlation (r = 0.98) between the Ag levels detected by this new assay and levels found by a commercial assay. Pilot studies indicate that this antigen can be detected in the urine of patients with active NCC. Conclusions/Significance A newly developed recombinant monoclonal antibody-based Ts Ag detection immunoassay is extremely sensitive in the detection of extra-parenchymal NCC and can be used to monitor the success of treatment in the CSF, serum/plasma and urine. The ability to produce recombinant TsG10 at scale should enable use of this antigen detection immunoassay wherever NCC is endemic. Clinical Trial Registration ClinicalTrials.gov Identifiers: NCT00001205 - & NCT00001645.
- Published
- 2022
15. Frequency and Determinant Factors for Calcification in Neurocysticercosis
- Author
-
Theodore E. Nash, Armando E. Gonzalez, Herbert Saavedra, Gianfranco Arroyo, Isidro Gonzales, Seth E. O’Neal, Percy Soto-Becerra, Oscar H. Del Brutto, Robert H. Gilman, Javier A. Bustos, Hector H. Garcia, and E. Javier Pretell
- Subjects
Microbiology (medical) ,medicine.medical_specialty ,030231 tropical medicine ,Neurocysticercosis ,purl.org/pe-repo/ocde/ford#3.03.08 [https] ,Gastroenterology ,Albendazole ,calcification ,Perú ,03 medical and health sciences ,0302 clinical medicine ,Internal medicine ,Taenia solium ,medicine ,risk factors ,Cyst ,Dexamethasone ,Cysticercosis ,business.industry ,medicine.disease ,medicine.drug_formulation_ingredient ,Infectious Diseases ,Concomitant ,business ,030217 neurology & neurosurgery ,medicine.drug ,Calcification - Abstract
Background Neurocysticercosis is a major cause of acquired epilepsy. Larval cysts in the human brain eventually resolve and either disappear or leave a calcification that is associated with seizures. In this study, we assessed the proportion of calcification in parenchymal neurocysticercosis and risk factors associated with calcification. Methods Data for 220 patients with parenchymal NCC from 3 trials of antiparasitic treatment were assessed to determine what proportion of the cysts that resolved 6 months after treatment ended up in a residual calcification at 1 year. Also, we evaluated the risk factors associated with calcification. Results The overall proportion of calcification was 38% (188/497 cysts, from 147 patients). Predictors for calcification at the cyst level were cysts larger than 14 mm (risk ratio [RR], 1.34; 95% confidence interval [CI], 1.02–1.75) and cysts with edema at baseline (RR, 1.39; 95% CI, 1.05–1.85). At the patient level, having had more than 24 months with seizures (RR, 1.25; 95% CI, 1.08–1.46), mild antibody response (RR, 1.14; 95% CI, 1.002–1.27), increased dose albendazole regime (RR, 1.26; 95% CI, 1.14–1.39), lower doses of dexamethasone (RR, 1.36; 95% CI, 1.02–1.81), not receiving early antiparasitic retreatment (RR, 1.45; 95% CI, 1.08–1.93), or complete cure (RR, 1.48; 95% CI, 1.29–1.71) were associated with a increased risk of calcification. Conclusions Approximately 38% of parenchymal cysts calcify after antiparasitic treatment. Some factors associated with calcification are modifiable and may be considered to decrease or avoid calcification, potentially decreasing the risk for seizure relapses.
- Published
- 2020
16. The many facets of disseminated parenchymal brain cysticercosis: A differential diagnosis with important therapeutic implications
- Author
-
Hector H. Garcia and Oscar H. Del Brutto
- Subjects
Nervous system ,Pathology ,Physiology ,Neurocysticercosis ,RC955-962 ,Disease ,Steroid Therapy ,Diagnostic Radiology ,Medical Conditions ,Arctic medicine. Tropical medicine ,Taenia solium ,Medicine and Health Sciences ,Edema ,Tomography ,Pharmaceutics ,Radiology and Imaging ,Brain ,Cysticercosis ,Magnetic Resonance Imaging ,Viewpoints ,medicine.drug_formulation_ingredient ,Infectious Diseases ,medicine.anatomical_structure ,Helminth Infections ,Computed axial tomography ,embryonic structures ,Public aspects of medicine ,RA1-1270 ,Neglected Tropical Diseases ,medicine.medical_specialty ,Imaging Techniques ,Corticosteroid Therapy ,Neuroimaging ,Research and Analysis Methods ,Calcification ,Diagnosis, Differential ,Immune system ,Magnetic resonance imaging ,Signs and Symptoms ,Drug Therapy ,Diagnostic Medicine ,Parenchyma ,parasitic diseases ,medicine ,Parasitic Diseases ,Animals ,Humans ,Inflammation ,business.industry ,urogenital system ,Public Health, Environmental and Occupational Health ,Biology and Life Sciences ,medicine.disease ,Tropical Diseases ,Computed Axial Tomography ,Lesions ,Differential diagnosis ,Clinical Medicine ,business ,Physiological Processes ,Neuroscience - Abstract
Neurocysticercosis (NCC), the infection of the nervous system by the cystic larvae of Taenia solium, is a highly pleomorphic disease because of differences in the number and anatomical location of lesions, the viability of parasites, and the severity of the host immune response. Most patients with parenchymal brain NCC present with few lesions and a relatively benign clinical course, but massive forms of parenchymal NCC can carry a poor prognosis if not well recognized and inappropriately managed. We present the main presentations of massive parenchymal NCC and their differential characteristics.
- Published
- 2021
17. Parasitic Infections of the Nervous System
- Author
-
Hector H Garcia
- Subjects
Nervous system ,Central Nervous System ,education.field_of_study ,Epilepsy ,business.industry ,Neurocysticercosis ,Population ,Malaria, Cerebral ,Brain ,Schistosomiasis ,medicine.disease ,Toxoplasmosis ,Article ,medicine.anatomical_structure ,Cerebral Malaria ,Immunology ,medicine ,Humans ,Neurology (clinical) ,education ,business ,Genetics (clinical) ,Malaria ,Encephalitis - Abstract
Purpose of review This article reviews how parasites affect the human nervous system, with a focus on four parasitic infections of major public health importance worldwide, two caused by protozoa (malaria and toxoplasmosis) and two by helminths (neurocysticercosis and schistosomiasis). Recent findings Parasitic infections in humans are common, and many can affect the central nervous system where they may survive unnoticed or may cause significant pathology that can even lead to the death of the host. Neuroparasitoses should be considered in the differential diagnosis of neurologic lesions, particularly in individuals from endemic regions or those with a history of travel to endemic regions. Summary Cerebral malaria is a significant cause of mortality, particularly in African children, in whom infected red blood cells affect the cerebral vessels, causing severe encephalopathy. Neurocysticercosis is the most common cause of acquired epilepsy worldwide and has varied clinical presentations, depending on the number, size, and location of the parasites in the nervous system as well as on the host's inflammatory response. Toxoplasmosis is distributed worldwide, affecting a significant proportion of the population, and may reactivate in patients who are immunosuppressed, causing encephalitis and focal abscesses. Schistosomiasis causes granulomatous lesions in the brain or the spinal cord.
- Published
- 2021
18. Validation of a spatial agent-based model for Taenia solium transmission ('CystiAgent') against a large prospective trial of control strategies in northern Peru
- Author
-
Ian W Pray, Francesco Pizzitutti, Gabrielle Bonnet, Eloy Gonzales-Gustavson, Wayne Wakeland, William K Pan, William E Lambert, Armando E Gonzalez, Hector H Garcia, Seth E O'Neal, and Cysticercosis Working Group in Peru.
- Subjects
Rural Population ,Swine ,Physiology ,Eggs ,RC955-962 ,Psychological intervention ,Binomials ,Polynomials ,Geographical locations ,law.invention ,Medical Conditions ,sensitivity analysis ,law ,Pig Models ,Animal Products ,Reproductive Physiology ,Zoonoses ,Arctic medicine. Tropical medicine ,Peru ,Taenia solium ,Medicine and Health Sciences ,Taeniasis ,Pork ,spatiotemporal analysis ,Prospective Studies ,travel ,parasite control ,Agent-based model ,Mammals ,Swine Diseases ,adult ,parasite transmission ,Eukaryota ,neurocysticercosis ,Cysticercosis ,Agriculture ,Animal Models ,simulation ,medicine.drug_formulation_ingredient ,Transmission (mechanics) ,Infectious Diseases ,Experimental Organism Systems ,Helminth Infections ,Vertebrates ,Physical Sciences ,Female ,Public aspects of medicine ,RA1-1270 ,Research Article ,Neglected Tropical Diseases ,prospective study ,taeniasis ,Meat ,Biology ,Research and Analysis Methods ,World health ,Article ,foraging ,Environmental health ,parasitic diseases ,medicine ,Parasitic Diseases ,Animals ,Humans ,controlled study ,human ,Nutrition ,Spatial Analysis ,nonhuman ,Public Health, Environmental and Occupational Health ,Organisms ,Biology and Life Sciences ,South America ,medicine.disease ,Tropical Diseases ,calibration ,Diet ,enzyme linked immunosorbent assay ,Algebra ,Prospective trial ,Food ,sensitivity and specificity ,validation process ,Amniotes ,randomized controlled trial ,Animal Studies ,Epidemiological Models ,People and places ,Zoology ,Mathematics - Abstract
Background The pork tapeworm (Taenia solium) is a parasitic helminth that imposes a major health and economic burden on poor rural populations around the world. As recognized by the World Health Organization, a key barrier for achieving control of T. solium is the lack of an accurate and validated simulation model with which to study transmission and evaluate available control and elimination strategies. CystiAgent is a spatially-explicit agent based model for T. solium that is unique among T. solium models in its ability to represent key spatial and environmental features of transmission and simulate spatially targeted interventions, such as ring strategy. Methods/Principal findings We validated CystiAgent against results from the Ring Strategy Trial (RST)–a large cluster-randomized trial conducted in northern Peru that evaluated six unique interventions for T. solium control in 23 villages. For the validation, each intervention strategy was replicated in CystiAgent, and the simulated prevalences of human taeniasis, porcine cysticercosis, and porcine seroincidence were compared against prevalence estimates from the trial. Results showed that CystiAgent produced declines in transmission in response to each of the six intervention strategies, but overestimated the effect of interventions in the majority of villages; simulated prevalences for human taenasis and porcine cysticercosis at the end of the trial were a median of 0.53 and 5.0 percentages points less than prevalence observed at the end of the trial, respectively. Conclusions/Significance The validation of CystiAgent represented an important step towards developing an accurate and reliable T. solium transmission model that can be deployed to fill critical gaps in our understanding of T. solium transmission and control. To improve model accuracy, future versions would benefit from improved data on pig immunity and resistance, field effectiveness of anti-helminthic treatment, and factors driving spatial clustering of T. solium infections including dispersion and contact with T. solium eggs in the environment., Author summary Neurocysticercosis, caused by the ingestion of Taenia solium eggs, is a major cause of human epilepsy around the world. A wide spectrum of tools to fight T. solium is are now available and include antiparasitic treatment for pigs and humans, porcine vaccines, and sanitation improvements; however, the ideal combination of interventions applied to populations to maximize effectiveness and feasibility is not known. Transmission models are one tool that can be used to compare and evaluate different intervention strategies, but no currently available T. solium models have been tested for accuracy. In this research, we validated our model (“CystiAgent”) by comparing simulations of the model to the results of a large-scale trial testing a variety of T. solium control interventions. The model was calibrated using observed epidemiological data from these villages and evaluated for its ability to reproduce the effect of T. solium control interventions. The validation showed that the model was able to reproduce the baseline levels of disease, but generally overestimated the effect that each intervention would have on transmission. These results will allow us to identify limitations of the current model to improve future versions, and represent a step forward in the creation of a tool to design and evaluate future programs to control and eliminate T. solium.
- Published
- 2021
19. Endoscopic endonasal surgery for massive subarachnoid neurocysticercosis: illustrative case
- Author
-
Luis J. Saavedra, Jesús Félix, Jose Calderon, Yelimer Caucha, Jorge E. Medina, Luis A. Antonio, Juan Luis Gómez-Amador, Carlos M. Vásquez, William W. Lines, Elías Lira, and Hector H. Garcia
- Subjects
medicine.medical_specialty ,Endoscopic endonasal surgery ,urogenital system ,business.industry ,embryonic structures ,parasitic diseases ,Neurocysticercosis ,Medicine ,General Medicine ,business ,Surgery - Abstract
BACKGROUND Subarachnoid neurocysticercosis (NCC) is associated with high morbidity and mortality rates. Conventional transcranial approaches and transventricular endoscopy have been previously reported for extraparenchymal NCC and ventricular NCC, respectively. By October 2019, endonasal endoscopic approaches had not been used for the treatment of NCC. OBSERVATIONS A 54-year-old-woman with NCC was admitted with acute neurological deterioration due to severe intracranial hypertension caused by massive subarachnoid NCC cysts, as evidenced on magnetic resonance imaging (MRI) with great brainstem compression. The case was discussed, and an endoscopic endonasal resection of the NCC cysts was scheduled. The diagnosis was confirmed by pathological anatomy. There were no complications in the surgery, with marked neurological improvement. Control MRIs demonstrated a significant reduction of NCC cysts. LESSONS Minimally invasive approaches are an excellent alternative for skull-base tumoral and infectious pathology. Prior knowledge of the pathophysiology and the authors’ experience in the management of patients with NCC allowed them to propose this approach, with optimal results.
- Published
- 2021
20. Stereotactic surgery for neurocysticercosis of the 4th ventricle: illustrative cases
- Author
-
William W. Lines, Yelimer Caucha, Luis A. Antonio, Hector H. Garcia, Carlos M. Vásquez, Jorge E. Medina, Luis J. Saavedra, and Jesús Félix
- Subjects
medicine.medical_specialty ,Stereotactic surgery ,medicine.anatomical_structure ,Ventricle ,business.industry ,Neurocysticercosis ,medicine ,General Medicine ,Radiology ,business - Abstract
BACKGROUND Neurocysticercosis, caused by the larval stage of Taenia solium, affects the cerebral ventricles in 20–30% of cases and may lead to hydrocephalus and other neurological morbidity. Conventional treatment for cysts in the 4th ventricle includes open surgery (suboccipital approach) and neuroendoscopy, with the latter being the option of choice. Stereotactic surgery, minimally invasive, offers a good alternative for this type of deep lesion. OBSERVATIONS The authors report the cases of two women, 30 and 45 years old, who presented with headache, dizziness, and ataxia and were diagnosed with 4th ventricle cysticercosis. Magnetic resonance imaging (MRI) revealed dilated 4th ventricles (approximately 2.5 cm in both cases, with cystic images inside the ventricular cavity). Both patients were treated with stereotactic surgery via a suboccipital transcerebellar approach. Cyst material was extracted, and the diagnosis was confirmed by pathological examination. The surgeries had no complications and resulted in clinical improvement. Control MRI scans showed reduction of the volume of the ventricle without residual cysts. LESSONS Minimally invasive stereotactic surgery provided a safe alternative for 4th ventricle neurocysticercosis cysts, with more benefits than risks in comparison with conventional techniques.
- Published
- 2021
21. Neurocysticercosis and HIV/AIDS co-infection: A scoping review
- Author
-
Javier A. Bustos, Martin Walker, Matthew A. Dixon, Veronika Schmidt, Paul D Jewell, Bernard Ngowi, Hector H. Garcia, María-Gloria Basáñez, Kevin G Buell, Annette Abraham, Andrea Sylvia Winkler, and Medical Research Council (MRC)
- Subjects
medicine.medical_specialty ,Pediatrics ,LIVER ,Neurocysticercosis ,CYSTICERCOSIS ,PROGRESSION ,HIV Infections ,DIAGNOSIS ,Global Health ,DISEASE ,1117 Public Health and Health Services ,co-infection ,MALARIA ,Acquired immunodeficiency syndrome (AIDS) ,Tropical Medicine ,Taenia solium ,INFECTION ,Epidemiology ,medicine ,Humans ,Disease burden ,Public, Environmental & Occupational Health ,Science & Technology ,business.industry ,Coinfection ,Public Health, Environmental and Occupational Health ,HIV ,medicine.disease ,ddc ,AIDS ,medicine.drug_formulation_ingredient ,Infectious Diseases ,Systematic review ,taeniosis ,Parasitology ,Observational study ,Headaches ,medicine.symptom ,business ,Life Sciences & Biomedicine - Abstract
Objectives Neurocysticercosis (NCC) and human immunodeficiency virus (HIV) have high disease burden and are prevalent in overlapping low- and middle-income areas. Yet, treatment guidance for people living with HIV/AIDS (PLWH/A) co-infected with NCC is currently lacking. This study aims to scope the available literature on HIV/AIDS and NCC co-infection, focusing on epidemiology, clinical characteristics, diagnostics, and treatment outcomes. Methods The scoping literature review methodological framework, and the Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines were followed. A total of 16,969 records identified through database searching and 45 additional records from other sources were reduced to 52 included studies after a standardised selection process. Results Two experimental studies, ten observational studies, 23 case series/case reports and 17 reviews or letters were identified. Observational studies demonstrated similar NCC seroprevalence in PLWH/A and their HIV-negative counterparts. Of 29 PLWH/A and NCC co-infection, 17 (59%) suffered from epileptic seizures, 15 (52%) from headaches, and 15 (52%) had focal neurological deficits. Eighteen (62%) had viable vesicular cysts and six (21%) had calcified cysts. Fifteen (52%) were treated with albendazole, of which 11 (73%) responded well to treatment. Five individuals potentially demonstrated an immune-reconstitution inflammatory syndrome after commencing anti-retroviral therapy, although this was in the absence of immunological and neuroimaging confirmation. Conclusions There is a paucity of evidence to guide treatment of PLWH/A and NCC co-infection. There is a pressing need for high-quality studies in this patient group to appropriately inform diagnostic and management guidelines for HIV-positive patients with NCC.
- Published
- 2021
22. Neurocysticercosis. A frequent cause of seizures, epilepsy, and other neurological morbidity in most of the world
- Author
-
I. Gonzales, Sukwan Handali, H. Saavedra, Javier A. Bustos, and Hector H. Garcia
- Subjects
medicine.medical_specialty ,Pediatrics ,Neurology ,Neurological morbidity ,Neurocysticercosis ,Disease ,Article ,03 medical and health sciences ,Epilepsy ,Therapeutic approach ,0302 clinical medicine ,Seizures ,Taenia solium ,medicine ,Animals ,Humans ,030212 general & internal medicine ,business.industry ,Cysticercosis ,medicine.disease ,medicine.drug_formulation_ingredient ,Neurology (clinical) ,Morbidity ,business ,human activities ,030217 neurology & neurosurgery - Abstract
Neurocysticercosis is endemic in most of the world and in endemic areas it accounts for approximately 30% of cases of epilepsy. Appropriate diagnosis and management of neurocysticercosis requires understanding the diverse presentations of the disease since these will vary in regards to clinical manifestation, sensitivity of diagnostic tests, and most importantly, therapeutic approach. This review attempts to familiarize tropical neurology practitioners with the diverse types of neurocysticercosis and the more appropriate management approaches for each.
- Published
- 2021
23. CystiHuman: A model of human neurocysticercosis
- Author
-
Gabrielle, Bonnet, Francesco, Pizzitutti, Eloy A, Gonzales-Gustavson, Sarah, Gabriël, William K, Pan, Hector H, Garcia, Javier A, Bustos, Percy, Vilchez, and Seth E, O'Neal
- Subjects
Epilepsy ,Ecology ,Cysts ,Swine ,Cysticercosis ,Eggs ,Neurocysticercosis ,Medical risk factors ,Cellular and Molecular Neuroscience ,Computational Theory and Mathematics ,Modeling and Simulation ,Lesions ,Genetics ,Animals ,Humans ,Intracranial Hypertension ,Surgical and invasive medical procedures ,Molecular Biology ,Ecology, Evolution, Behavior and Systematics ,Hydrocephalus ,Taeniasis - Abstract
Introduction The Taenia solium tapeworm is responsible for cysticercosis, a neglected tropical disease presenting as larvae in the body of a host following taenia egg ingestion. Neurocysticercosis (NCC), the name of the disease when it affects the human central nervous system, is a major cause of epilepsy in developing countries, and can also cause intracranial hypertension, hydrocephalus and death. Simulation models can help identify the most cost-effective interventions before their implementation. Modelling NCC should enable the comparison of a broad range of interventions, from treatment of human taeniasis (presence of an adult taenia worm in the human intestine) to NCC mitigation. It also allows a focus on the actual impact of the disease, rather than using proxies as is the case for other models. Methods This agent-based model is the first model that simulates human NCC and associated pathologies. It uses the output of another model, CystiAgent, which simulates the evolution of pig cysticercosis and human taeniasis, adding human and cyst agents, including a model of cyst location and stage, human symptoms, and treatment. CystiHuman also accounts for delays in the appearance of NCC-related symptoms. It comprises three modules detailing cyst development, seizure probability and timing, and intracranial hypertension/hydrocephalus, respectively. It has been implemented in Java MASON and calibrated in three endemic villages in Peru, then applied to another village (Rica Playa) to compare simulation results with field data in that village. Results and discussion Despite limitations in available field data, parameter values found through calibration are plausible and simulated outcomes in Rica Playa are close to actual values for NCC prevalence and the way it increases with age and cases with single lesions. Initial simulations further suggest that short-term interventions followed by a rapid increase in taeniasis prevalence back to original levels may have limited impacts on NCC prevalence.
- Published
- 2022
24. Blood-brain barrier disruption and angiogenesis in a rat model for neurocysticercosis
- Author
-
Rogger P Carmen-Orozco, Charles R. Sterling, Nancy Chile, Manuela Verastegui, Hector H. Garcia, Danitza G Dávila-Villacorta, Graham L. Sutherland, Yudith Cauna, Robert H. Gilman, Rensson H. Céliz, Maria C. Ferrufino-Schmidt, Leandra Bitterfeld, Edson G. Bernal-Teran, and Cesar M. Gavidia
- Subjects
Vascular Endothelial Growth Factor A ,0301 basic medicine ,Pathology ,medicine.medical_specialty ,Angiogenesis ,Biology ,Neurocysticercosis ,Fibroblast growth factor ,VEGF-A ,Article ,Umbilical vein ,Rats, Sprague-Dawley ,angiogenesis ,03 medical and health sciences ,Cellular and Molecular Neuroscience ,chemistry.chemical_compound ,0302 clinical medicine ,Taenia solium ,parasitic diseases ,Human Umbilical Vein Endothelial Cells ,medicine ,Animals ,Humans ,BBB disruption ,Tube formation ,Neovascularization, Pathologic ,neurocysticercosis ,Brain ,Endothelial Cells ,purl.org/pe-repo/ocde/ford#3.01.04 [https] ,Rats ,Fibroblast Growth Factors ,Vascular endothelial growth factor ,Endothelial stem cell ,medicine.drug_formulation_ingredient ,030104 developmental biology ,chemistry ,Blood-Brain Barrier ,Immunoglobulin G ,Blood Vessels ,Immunohistochemistry ,purl.org/pe-repo/ocde/ford#3.04.02 [http] ,030217 neurology & neurosurgery ,T. solium - Abstract
Neurocysticercosis (NCC) is a helminth infection affecting the central nervous system caused by the larval stage (cysticercus) of Taenia solium. Since vascular alteration and blood–brain barrier (BBB) disruption contribute to NCC pathology, it is postulated that angiogenesis could contribute to the pathology of this disease. This study used a rat model for NCC and evaluated the expression of two angiogenic factors called vascular endothelial growth factor (VEGF-A) and fibroblast growth factor (FGF2). Also, two markers for BBB disruption, the endothelial barrier antigen and immunoglobulin G, were evaluated using immunohistochemical and immunofluorescence techniques. Brain vasculature changes, BBB disruption, and overexpression of angiogenesis markers surrounding viable cysts were observed. Both VEGF-A and FGF2 were overexpressed in the tissue surrounding the cysticerci, and VEGF-A was overexpressed in astrocytes. Vessels showed decreased immunoreactivity to endothelial barrier antigen marker and an extensive staining for IgG was found in the tissues surrounding the cysts. Additionally, an endothelial cell tube formation assay using human umbilical vein endothelial cells showed that excretory and secretory antigens of T. solium cysticerci induce the formation of these tubes. This in vitro model supports the hypothesis that angiogenesis in NCC might be caused by the parasite itself, as opposed to the host inflammatory responses alone. In conclusion, brain vasculature changes, BBB disruption, and overexpression of angiogenesis markers surrounding viable cysts were observed. This study also demonstrates that cysticerci excretory-secretory processes alone can stimulate angiogenesis. © 2018 Wiley Periodicals, Inc.
- Published
- 2018
25. Changes in inflammatory gene expression in brain tissue adjacent and distant to a viable cyst in a rat model for neurocysticercosis
- Author
-
Robert H. Gilman, Manuela Verastegui, Danitza G Dávila-Villacorta, Rogger P Carmen-Orozco, Grace Trompeter, Ana D Delgado-Kamiche, Hector H. Garcia, Graham L. Sutherland, Rensson H. Céliz, and Cesar M. Gavidia
- Subjects
0301 basic medicine ,Cell signaling ,Pathology ,Physiology ,RC955-962 ,Neurocysticercosis ,Gene Expression ,Signal transduction ,Biochemistry ,Hippocampus ,Medical Conditions ,0302 clinical medicine ,Fibrosis ,Immune Physiology ,Arctic medicine. Tropical medicine ,Taenia solium ,Gene expression ,Medicine and Health Sciences ,Cyst ,Immune Response ,neurocisticercosis ,Innate Immune System ,Brain ,Signaling cascades ,Parasitic diseases ,medicine.drug_formulation_ingredient ,Infectious Diseases ,Metabolic pathways ,Cytokines ,Metabolic Pathways ,Anatomy ,Public aspects of medicine ,RA1-1270 ,medicine.symptom ,purl.org/pe-repo/ocde/ford#3.03.06 [https] ,Research Article ,Cell biology ,medicine.medical_specialty ,purl.org/pe-repo/ocde/ford#3.01.02 [http] ,Immunology ,Inflammation ,Biology ,Proinflammatory cytokine ,03 medical and health sciences ,Signs and Symptoms ,Atrophy ,parasitic diseases ,Genetics ,Parasitic Diseases ,medicine ,Animals ,Public Health, Environmental and Occupational Health ,Biology and Life Sciences ,Molecular Development ,medicine.disease ,Rats ,Metabolism ,030104 developmental biology ,TGF-beta signaling cascade ,Immune System ,Clinical Medicine ,030217 neurology & neurosurgery ,Developmental Biology - Abstract
Background The parasite Taenia solium causes neurocysticercosis (NCC) in humans and is a common cause of adult-onset epilepsy in the developing world. Hippocampal atrophy, which occurs far from the cyst, is an emerging new complication of NCC. Evaluation of molecular pathways in brain regions close to and distant from the cyst could offer insight into this pathology. Methods Rats were inoculated intracranially with T. solium oncospheres. After 4 months, RNA was extracted from brain tissue samples in rats with NCC and uninfected controls, and cDNA was generated. Expression of 38 genes related to different molecular pathways involved in the inflammatory response and healing was assessed by RT-PCR array. Results Inflammatory cytokines IFN-γ, TNF-α, and IL-1, together with TGF-β and ARG-1, were overexpressed in tissue close to the parasite compared to non-infected tissue. Genes for IL-1A, CSF-1, FN-1, COL-3A1, and MMP-2 were overexpressed in contralateral tissue compared to non-infected tissue. Conclusions The viable cysticerci in the rat model for NCC is characterized by increased expression of genes associated with a proinflammatory response and fibrosis-related proteins, which may mediate the chronic state of infection. These pathways appear to influence regions far from the cyst, which may explain the emerging association between NCC and hippocampal atrophy., Author summary Taenia solium is a parasite that can infect human brain causing neurocysticercosis. Neurocysticercosis is a common cause of adult-onset epilepsy in the developing world. This infection elicits several cellular and molecular changes as a result of inflammation or parasite-host interaction, which can cause clinical symptoms, such as seizures. Most of these changes have been found in the tissue surrounding to the cysticercus, however, some pathologies, like hippocampal atrophy, which occurs in parts of the brain far from the cyst, are emerging as new complication in NCC patients. Using a rat model, the authors assessed the expression of genes related to different molecular pathways involved in the inflammatory response and healing by the RT-PCR array technique. They found increased expression of genes associated with inflammation and scar tissue formation in tissue surrounding the cyst, as well as tissue far from the cyst, when compared to non-infected brain tissue. This study provides new insights into the inflammatory changes that occur in brain tissue far from viable cysts and may provide evidence for the emerging association between NCC and hippocampal atrophy.
- Published
- 2021
26. Neurocysticercosis as an Eradicable Cause of Epilepsy: A Plan and Actions Are Needed
- Author
-
Robert H. Gilman, Armando E. Gonzalez, and Hector H. Garcia
- Subjects
Epilepsy ,CNS Infections ,business.industry ,Neurocysticercosis ,MEDLINE ,Plan (drawing) ,medicine.disease ,Article ,Infectious Diseases ,Neurology ,Epilepsy and Seizures ,parasitic diseases ,medicine ,Humans ,Neurology (clinical) ,Medical emergency ,Disease Eradication ,business - Abstract
Between 1930 and 1960, 450 British soldiers who were being assessed for epilepsy and other neurological disease after returning from duty in India were found to be affected by neurocysticercosis (NCC), the infection of the human nervous system by the cystic larvae of the pork tapeworm Taenia solium. This unexpectedly frequent finding brought attention to a globally common but yet poorly known disease. Introduction of the computed tomography scan in the 1970s substantially improved the premortem diagnosis of NCC and slowly began to unveil the scope of the problem. T solium is now known to be endemic in wide areas of the world, including Latin America, sub-Saharan Africa, Eastern Europe, and parts of Asia, including the Indian subcontinent, Southeast Asia, and large regions of China. Endemicity of T solium is deeply rooted in poverty and involves domestic pig raising and poor sanitary conditions. As such, the burden of neurologic disease associated with continued transmission falls mainly on impoverished rural populations. However, NCC cases are diagnosed worldwide, even where transmission is not endemic...
- Published
- 2021
27. Multimodal minimally invasive surgery in the treatment of neurocysticercosis
- Author
-
William W. Lines-Aguilar, Héctor H. García, Jorge E. Medina, Luis J. Saavedra, Evelyn Vela, Miguel Lozano, John Vargas, César Cuya, Dennis Heredia, Alejandro Apaza-Tintaya, and Mao Vásquez
- Subjects
Minimally invasive surgery ,Neurocysticercosis ,Endonasal endoscopy surgery ,Stereotactic surgery ,Surgery ,RD1-811 ,Neurology. Diseases of the nervous system ,RC346-429 - Abstract
Objective: Neurocysticercosis (NCC) is still a frequent cause of neurosurgical consultations in most developing countries. Conventional approaches for the resection of large cysts have been used for many years. We report here our experience in the neurosurgical management of NCC using diverse minimally invasive approaches according to the localization of lesions: minimal craniotomy for lesions in the Sylvian fissure, stereotactic surgery for lesions in the posterior fossa, and endonasal neuroendoscopy for lesions in the basal cisterns. Methods: We reviewed the charts of 24 consecutive NCC patients who had minimally invasive surgery to resect NCC lesions in a neurological referral center in Lima, Peru. Three approaches were used: microcraneotomies through the anterior Sylvian point (n = 16), stereotactic surgery (n = 6), and endonasal endoscopy (n = 2), between January 1, 2016, and July 31, 2022. Demographic and clinical data as well as post-surgical evolution are presented using descriptive statistics. Results: Clinical improvement was observed in 23 out of 24 cases, with complete resolution of symptoms in nine and partial in 14. One patient evolved poorly and worsened his symptoms. Twenty-two patients received antiparasitic treatment after surgery. Relapse of NCC lesions was observed in three patients. There were no significant complications in any of the cases. Conclusions: Minimally invasive surgical approaches provide an excellent alternative for the management of patients with NCC, with good surgical and functional results, also markedly reducing the parasitic mass for further antiparasitic treatment.
- Published
- 2024
- Full Text
- View/download PDF
28. Identification and culture of proliferative cells in abnormal Taenia solium larvae: Role in the development of racemose neurocysticercosis
- Author
-
Miguel A Orrego, Manuela R Verastegui, Carlos M Vasquez, Uriel Koziol, Juan P Laclette, Hector H Garcia, Theodore E Nash, and Cysticercosis Working Group in Peru
- Subjects
0301 basic medicine ,Life Cycles ,RC955-962 ,Neurocysticercosis ,Flatworms ,Cell Culture Techniques ,complementary DNA ,Gene Expression ,Parasitic intestinal diseases ,Biochemistry ,0302 clinical medicine ,Larvae ,Endocrinology ,Medical Conditions ,Arctic medicine. Tropical medicine ,Taenia solium ,Medicine and Health Sciences ,Insulin ,Cyst ,Cancers and neoplasms ,biology ,Brain ,Eukaryota ,beta actin ,Cell biology ,medicine.drug_formulation_ingredient ,Infectious Diseases ,Larva ,Biological Cultures ,Public aspects of medicine ,RA1-1270 ,medicine.symptom ,Anatomy ,parasite antigen ,purl.org/pe-repo/ocde/ford#3.03.06 [https] ,Research Article ,Cell Culturing Techniques ,Bladder ,030231 tropical medicine ,Primary Cell Culture ,Inflammation ,In situ hybridization ,Research and Analysis Methods ,03 medical and health sciences ,protein serine threonine kinase ,Helminths ,parasitic diseases ,medicine ,Parasitic Diseases ,Genetics ,Animals ,Humans ,Primary cell culture ,Cell Proliferation ,Taenia crassiceps ,Diabetic Endocrinology ,polo like kinase 1 ,Cestodes ,Public Health, Environmental and Occupational Health ,Organisms ,Biology and Life Sciences ,Renal System ,Cell Cultures ,Cell cultures ,biology.organism_classification ,medicine.disease ,Invertebrates ,Hormones ,030104 developmental biology ,Cell culture ,Antigens, Helminth ,Parasitic Intestinal Diseases ,Developmental biology ,Zoology ,purl.org/pe-repo/ocde/ford#4.04.01 [http] ,Developmental Biology - Abstract
Racemose neurocysticercosis is an aggressive disease caused by the aberrant expansion of the cyst form of Taenia solium within the subarachnoid spaces of the human brain and spinal cord resulting in a mass effect and chronic inflammation. Although expansion is likely caused by the proliferation and growth of the parasite bladder wall, there is little direct evidence of the mechanisms that underlie these processes. Since the development and growth of cysts in related cestodes involves totipotential germinative cells, we hypothesized that the expansive growth of the racemose larvae is organized and maintained by germinative cells. Here, we identified proliferative cells expressing the serine/threonine-protein kinase plk1 by in situ hybridization. Proliferative cells were present within the bladder wall of racemose form and absent from the homologous tissue surrounding the vesicular form. Cyst proliferation in the related model species Taenia crassiceps (ORF strain) occurs normally by budding from the cyst bladder wall and proliferative cells were concentrated within the growth buds. Cells isolated from bladder wall of racemose larvae were established in primary cell culture and insulin stimulated their proliferation in a dose-dependent manner. These findings indicate that the growth of racemose larvae is likely due to abnormal cell proliferation. The different distribution of proliferative cells in the racemose larvae and their sensitivity to insulin may reflect significant changes at the cellular and molecular levels involved in their tumor-like growth. Parasite cell cultures offer a powerful tool to characterize the nature and formation of the racemose form, understand the developmental biology of T. solium, and to identify new effective drugs for treatment., Author summary Racemose neurocysticercosis is the most aggressive and lethal form of the disease characterized by progressive expansion of the larval stage of Taenia solium within the subarachnoid spaces of the brain. Currently, the cellular or molecular events that promote its formation and development are unknown. Our observations, employing tissue samples, revealed the presence of mitotically active cells in the bladder wall of the racemose larvae. Finally, we isolated and established primary cell cultures and observed that these cells are sensitive (proliferate in response to insulin). These results suggest that the proliferative cells stimulated by host biomolecules like hormones would be responsible for the abnormal growth of racemose larvae. Further studies are needed to identify all genes and pathways altered in the racemose form. The primary cell cultures will be used as a therapeutic target and allow us in future works to understand the developmental biology of the parasite.
- Published
- 2020
29. Mortality in Parenchymal and Subarachnoid Neurocysticercosis
- Author
-
Jesus Abanto, Daniel Blanco, Herbert Saavedra, Isidro Gonzales, Diego Siu, E. Javier Pretell, Javier A. Bustos, and Hector H. Garcia
- Subjects
Male ,demography ,all cause mortality ,Kaplan Meier method ,proportional hazards model ,Neurocysticercosis ,calcified parenchymal neurocysticercosis ,mortality rate ,Controlled studies ,Gastroenterology ,survival analysis ,hazard ratio ,Peru ,Taenia solium ,Medicine ,adult ,Mortality rate ,Hazard ratio ,neurocysticercosis ,viable parenchymal neurocysticercosis ,Articles ,Middle Aged ,cohort analysis ,Neurological referral ,female ,Infectious Diseases ,Female ,Adult ,medicine.medical_specialty ,Neurological morbidity ,subarachnoid neurocysticercosis ,Article ,Subarachnoid Space ,educational status ,male ,Virology ,Internal medicine ,Parenchyma ,parasitic diseases ,follow up ,Animals ,Humans ,controlled study ,In patient ,human ,nonhuman ,business.industry ,urogenital system ,major clinical study ,age ,Parasitology ,business - Abstract
Neurocysticercosis (NCC) is endemic in many parts of the world, carrying significant neurological morbidity that varies according to whether lesions are located inside the cerebral parenchyma or in extraparenchymal spaces. The latter, in particular subarachnoid NCC, is assumed to be more severe, but no controlled studies comparing mortality between types of NCC exist. The aim of this study was to compare all-cause mortality between patients with intraparenchymal NCC and those with subarachnoid NCC. Vital status and sociodemographic characteristics were evaluated in patients with intraparenchymal viable, intraparenchymal calcified, and subarachnoid NCC attending a neurological referral hospital in Lima, Perú. Survival analyses using Kaplan–Meier curves and Cox proportional regression models were carried out to compare mortality rates between groups. From 840 NCC patients followed by a median time of 82.3 months, 42 (5.0%) died, six (1.8%) in the intraparenchymal viable group, four (1.3%) in the calcified group, and 32 (16.6%) in the subarachnoid group (P < 0.001). Older age and lower education were significantly associated with mortality. The age-adjusted hazard ratio for death in the subarachnoid group was 13.6 (95% CI: 5.6–33.0, P < 0.001) compared with the intraparenchymal viable group and 10.7 (95% CI: 3.7–30.8, P < 0.001) when compared with the calcified group. We concluded that subarachnoid disease is associated with a much higher mortality in NCC.
- Published
- 2020
30. A new method for detecting brain fibrosis in microscopy images using the neurocysticercosis pig model
- Author
-
Javier A. Bustos, Juan J. Lozano, Manuel G. Forero, Laura E. Baquedano, and Hector H. Garcia
- Subjects
Pathology ,medicine.medical_specialty ,business.industry ,Neurocysticercosis ,Pig model ,Image processing ,Cysticercosis ,medicine.disease ,medicine.drug_formulation_ingredient ,Trichrome ,Fibrosis ,Taenia solium ,Medicine ,Cyst ,business - Abstract
Neurocysticercosis (NCC) is considered a major cause of acquired epilepsy in most developing countries. Humans and pigs acquire cysticercosis ingesting T. solium eggs by the fecal-oral route. After ingestion, oncospheres disperse throughout the body producing cysts mainly in the central nervous system and striated muscles. The treatment is focused on antiparasitic, anti-inflammatory, and antiepileptic drugs; however, new drugs are being studied in animal models recently. The aim of this study was to perform histological image analysis of pig brains with NCC after antiparasitic treatment to develop future tools to study brain inflammation since usually the evaluation of fibrosis is obtained manually on microscopy images in a long, inaccurate, poorly reproducible, and tedious process. For this purpose, the slides of pig brains with NCC were stained with Masson's Trichrome, and high quality photographic images were taken. Then, image processing and machine learning were performed to detect the presence and extension of collagen fibers around the cyst as markers of fibrosis. The process includes the use of color normalization and probabilistic classification implemented in Java language as a plugin to the free access program ImageJ. This paper presents a new method to detect cerebral fibrosis, assessing the amount of fibrosis in the images with accuracy above 75% in 12 seconds. A manual editing tool allows us to raise the results above 90% faster and efficiently.
- Published
- 2020
31. Fake news in neglected tropical diseases: The case of neurocysticercosis
- Author
-
Oscar H. Del Brutto and Hector H. Garcia
- Subjects
Life Cycles ,Swine ,Physiology ,Neurocysticercosis ,RC955-962 ,Eating ,Animal Products ,Arctic medicine. Tropical medicine ,Medicine and Health Sciences ,Medicine ,Pork ,Health Education ,Mammals ,Ingestion ,Neglected Diseases ,Eukaryota ,Cysticercosis ,Agriculture ,Viewpoints ,Infectious Diseases ,Helminth Infections ,Vertebrates ,Neglected tropical diseases ,Fake news ,Public aspects of medicine ,RA1-1270 ,Neglected Tropical Diseases ,Deception ,Meat ,Environmental health ,Disease Transmission, Infectious ,Parasitic Diseases ,Humans ,Animals ,Adults ,Nutrition ,business.industry ,Information Dissemination ,Public Health, Environmental and Occupational Health ,Organisms ,Biology and Life Sciences ,medicine.disease ,Tropical Diseases ,Diet ,Food ,Age Groups ,Amniotes ,People and Places ,Population Groupings ,business ,Physiological Processes ,Developmental Biology - Published
- 2020
32. Taenia solium Cysticercosis and Its Impact in Neurological Disease
- Author
-
Hector H. Garcia, Armando E. Gonzalez, and Robert H. Gilman
- Subjects
Microbiology (medical) ,Epidemiology ,Swine ,030231 tropical medicine ,Neurocysticercosis ,Context (language use) ,Disease ,Review ,Epileptogenesis ,03 medical and health sciences ,Epilepsy ,0302 clinical medicine ,Taenia solium ,parasitic diseases ,Medicine ,Taeniasis ,Animals ,Humans ,Swine Diseases ,General Immunology and Microbiology ,Antiparasitic Agents ,business.industry ,urogenital system ,Cysticercosis ,Public Health, Environmental and Occupational Health ,medicine.disease ,medicine.drug_formulation_ingredient ,Infectious Diseases ,Immunology ,business ,030217 neurology & neurosurgery - Abstract
Taenia solium neurocysticercosis (NCC) is endemic in most of the world and contributes significantly to the burden of epilepsy and other neurological morbidity. Also present in developed countries because of immigration and travel, NCC is one of few diseases targeted for eradication. This paper reviews all aspects of its life cycle (taeniasis, porcine cysticercosis, human cysticercosis), with a focus on recent advances in its diagnosis, management, and control. Diagnosis of taeniasis is limited by poor availability of immunological or molecular assays. Diagnosis of NCC rests on neuroimaging findings, supported by serological assays. The treatment of NCC should be approached in the context of the particular type of infection (intra- or extraparenchymal; number, location, and stage of lesions) and has evolved toward combined symptomatic and antiparasitic management, with particular attention to modulating inflammation. Research on NCC and particularly the use of recently available genome data and animal models of infection should help to elucidate mechanisms of brain inflammation, damage, and epileptogenesis.
- Published
- 2020
33. Epidemiology and surveillance of human (neuro)cysticercosis in Europe: is enhanced surveillance required?
- Author
-
Pierre Dorny, Lorenzo Zammarchi, Ana Glória Fonseca, Veronika Schmidt, Miriam Kaminski, Javier A. Bustos, Dominik Stelzle, Carmen Michaela Cretu, Brecht Devleesschauwer, Gunita Deksne, Maria Angeles Gómez-Morales, Naomi F. Walker, Hector H. Garcia, Sarah Gabriël, Peter L. Chiodini, Manuela Vilhena, Chiara Trevisan, Andrea Sylvia Winkler, Priyadarshi Soumyaranjan Sahu, Minerva Laranjo-González, Annette Abraham, Veronique Dermauw, István Kucsera, Branko Bobić, Robert de Meijere, Producció Animal, and Sanitat Animal
- Subjects
COUNTRIES ,medicine.medical_specialty ,030231 tropical medicine ,Neurocysticercosis ,HUMAN CYSTICERCOSIS ,GLIOBLASTOMA-MULTIFORME ,DIAGNOSIS ,03 medical and health sciences ,0302 clinical medicine ,Epidemiology ,medicine ,International Statistical Classification of Diseases and Related Health Problems ,Taeniasis ,media_common.cataloged_instance ,Humans ,Veterinary Sciences ,European union ,media_common ,business.industry ,Cysticercosis ,Public health ,Environmental and Occupational Health ,Public Health, Environmental and Occupational Health ,neurocysticercosis ,Mandatory Reporting ,medicine.disease ,3. Good health ,ddc ,TIME ,Europe ,Systematic review ,Infectious Diseases ,Family medicine ,DISEASES ,Population Surveillance ,STILL ,Parasitology ,epidemiology ,Public Health ,business - Abstract
To report on relevant national surveillance systems of (N)CC and taeniasis (the infection with the adult tapeworm) in the European Union/European Economic Area and to assess the magnitude of (N)CC occurrence by retrieving information on cases for the period 2000-2016.(N)CC cases were retrieved via national reporting systems, a systematic literature search, contact with clinicians and a search for relevant 'International Statistical Classification of Diseases and Related Health Problems' (ICD)-based data.Mandatory notification systems for (N)CC were found in Hungary, Iceland and Poland. Ten cases were reported in Poland and none in Hungary and Iceland. Through the systematic literature review and information given by clinicians, 263 individual and 721 aggregated (N)CC cases from 19 European countries were identified. ICD-based data were obtained from five countries. From 2000 to 2016, a total of 3489 cases (N)CC cases were coded: 832 in Italy, eight in Latvia, 357 in Portugal, 2116 in Spain and 176 in Sweden.Despite being classified as a possible eradicable disease, (N)CC is still diagnosed across Europe, yet its true extent and impact remain unclear.Rapporter sur les systèmes nationaux de surveillance pertinents de la (neuro)cysticercose (N)CC et de la téniase (infection par le ténia adulte) dans l'Union européenne/l'Espace économique européen, et évaluer l'ampleur de l'occurrence de la (N)CC en reprenant des informations sur les cas durant la période 2000-2016. MÉTHODES: Les cas de (N)CC ont été repris à partir des systèmes nationaux de notification, une recherche systématique de la littérature, des contacts avec des cliniciens et une recherche de données pertinentes basées sur la ‘Classification Statistique Internationale des Maladies et Problèmes de Santé Connexes’ (ICD). RÉSULTATS: Des systèmes de notification obligatoires pour la (N)CC ont été trouvés en Hongrie, en Islande et en Pologne. Dix cas ont été rapportés en Pologne et aucun en Hongrie et en Islande. Grâce à la revue systématique de la littérature et aux informations fournies par les cliniciens, 263 cas individuels et 721 cas agrégés de (N)CC de 19 pays européens ont été identifiés. Des données ICD ont été obtenues de cinq pays. De 2000 à 2016, un total de 3489 cas de (N)CC ont été codés: 832 en Italie, 8 en Lettonie, 357 au Portugal, 2116 en Espagne et 176 en Suède.Bien qu'elle soit classée comme une maladie pouvant être éradiquée, la (N)CC est toujours diagnostiquée à travers l'Europe, mais sa véritable ampleur et son impact restent incertains .
- Published
- 2020
34. Case report: Three cases of neurocysticercosis in central Africa
- Author
-
Hector H. Garcia, Marcellin Bugeme, Olivier Mukuku, and Sofía S Sánchez
- Subjects
Adult ,Male ,Population ,Neurocysticercosis ,Developing country ,Case Report ,Virology ,parasitic diseases ,Medicine ,Humans ,Africa, Central ,education ,Socioeconomics ,education.field_of_study ,Consulting room ,Central Africa ,Health professionals ,Geography ,business.industry ,urogenital system ,Central africa ,Articles ,Middle Aged ,Infectious Diseases ,embryonic structures ,Democratic Republic of the Congo ,Parasitology ,Female ,business ,Tomography, X-Ray Computed ,purl.org/pe-repo/ocde/ford#3.03.06 [https] - Abstract
Neurocysticercosis (NCC) is an infection prevalent in developing countries; however, it is neglected in the Democratic Republic of the Congo (DRC) and in sub-Saharan Africa. Here, we present three different cases seen in a consulting room in Lubumbashi. These cases are evidence that NCC is more common than it was previously thought in sub-Saharan Africa. Neurocysticercosis is a pathology-neglected and ignored infection, not only by the population but also by health professionals and health authorities in the DRC, and because of that, it is important to increase the research about NCC in the DRC to assess the prevalence and risk factors for NCC to assess the severity of the phenomenon and to help designing appropriate prevention and control measures.
- Published
- 2020
35. Larval Cestode Infections (Cysticercosis)
- Author
-
Hector H. Garcia and Robert H. Gilman
- Subjects
Pathology ,medicine.medical_specialty ,medicine.diagnostic_test ,business.industry ,Neurocysticercosis ,Magnetic resonance imaging ,Cysticercosis ,medicine.disease ,Hydrocephalus ,Albendazole ,Serology ,Praziquantel ,medicine.drug_formulation_ingredient ,parasitic diseases ,Taenia solium ,Medicine ,business ,medicine.drug - Abstract
Neurocysticercosis is the invasion of the human nervous system by larvae of the pork tapeworm Taenia solium; it is a major cause of seizures and neurologic morbidity worldwide. Parenchymal brain disease results in seizures and can follow a benign course, whereas extraparenchymal (intraventricular or subarachnoid) cysticercosis presents with hydrocephalus or intracranial hypertension, is progressive, and carries a poor prognosis. Diagnosis is based on brain imaging (computed tomography and magnetic resonance imaging) and supported by specific serology (Western blot with purified antigens). Management should be individualized and includes symptomatic treatment (analgesics, anti-epileptic drugs, anti-inflammatory drugs) and selected use of anti-parasitic therapy with albendazole and/or praziquantel.
- Published
- 2020
36. Population Screening for Urine Antigens to Detect Asymptomatic Subarachnoid Neurocysticercosis: A Pilot Study in Northern Peru
- Author
-
Hector H. Garcia, Ellen McCleery, Claudio Muro, Ricardo Gamboa, Luz Maria Moyano, Percy Vilchez, Yesenia Castillo, Pierre Dorny, Samantha E. Allen, and Seth E. O’Neal
- Subjects
Adult ,Male ,medicine.medical_specialty ,Adolescent ,030231 tropical medicine ,Neurocysticercosis ,Pilot Projects ,Urine ,Asymptomatic ,Subarachnoid Space ,Young Adult ,03 medical and health sciences ,0302 clinical medicine ,Antigen ,Virology ,Internal medicine ,Peru ,Taenia solium ,medicine ,Urine Antigens ,Animals ,Humans ,Young adult ,Child ,Aged ,Taeniasis ,Asymptomatic Diseases ,Aged, 80 and over ,medicine.diagnostic_test ,business.industry ,Brain ,Magnetic resonance imaging ,Articles ,Middle Aged ,Northern Peru ,Asymptomatic Subarachnoid Neurocysticercosis ,Magnetic Resonance Imaging ,medicine.drug_formulation_ingredient ,Infectious Diseases ,Antigens, Helminth ,Female ,Parasitology ,medicine.symptom ,business ,purl.org/pe-repo/ocde/ford#3.03.06 [https] - Abstract
Subarachnoid neurocysticercosis (SANCC) is a severe and progressive brain infection with Taenia solium. We performed a pilot study of noninvasive screening for SANCC in two endemic villages in northern Peru using a urine antigen screen followed by brain magnetic resonance imaging for participants with elevated levels of antigen. Among the 978 participants screened, we identified eight individuals with SANCC, many of whom were asymptomatic. This represents a minimum prevalence of 0.8% of SANCC, a level higher than expected based on prior studies, and a positive predictive value of 62% for our novel urine screening test. Future studies should confirm whether early detection and management improve clinical outcomes.
- Published
- 2020
37. Barriers to Participation in a Community-Based Program to Control Transmission of Taenia solium in Peru
- Author
-
Viterbo Ayvar, Ricardo Gamboa, Lauralee Fernandez, Hector H. Garcia, Armando E. Gonzalez, Ruth Atto, Angela G. Spencer, Michelle Beam, Claudio Muro, Percy Vilchez, Sandra Olaya, and Seth E. O’Neal
- Subjects
030231 tropical medicine ,Neurocysticercosis ,Psychological intervention ,03 medical and health sciences ,0302 clinical medicine ,Virology ,Environmental health ,Taenia solium ,Peru ,Medicine ,Taeniasis ,030212 general & internal medicine ,Control Transmission ,Mass screening ,business.industry ,Transmission (medicine) ,Cysticercosis ,medicine.disease ,medicine.drug_formulation_ingredient ,Infectious Diseases ,Community-Based Program ,Disease Notification ,Parasitology ,business ,Barriers ,purl.org/pe-repo/ocde/ford#3.03.06 [https] - Abstract
Infection of the brain with Taenia solium larvae (neurocysticercosis) is a leading cause of preventable epilepsy worldwide. Effective and sustainable strategies to control parasite transmission in rural endemic communities are needed to prevent the disease. Surveillance and targeted intervention around infected pigs (ring control strategy) have been shown to be effective when carried out by research teams. However, this strategy has not been implemented or tested as a community-based program. In this small trial in northern Peru, eight villages were randomly assigned to community-led surveillance and treatment (five villages, 997 residents) or control (three villages, 1,192 residents). In intervention villages, community-led surveillance and reporting were promoted by community health workers, radio advertisement, and school and household education. Each suspected pig infection was verified, with confirmed cases resulting in treatment with niclosamide for taeniasis and oxfendazole for pigs in clusters of homes nearby. No incentives beyond human and pig treatment were offered. Control villages received basic disease education but no treatment intervention in response to reports. Despite 14 case reports, community-based replication of ring control strategy did not replicate prior results. After 12 months, there was no change in seroincidence in intervention villages between the baseline and study end, and no difference compared with control villages. There was no difference in prevalence of taeniasis or porcine cysticercosis at study end. Community members described lack of knowledge as the main reason for not reporting infected pigs. Further exploration of methods to transfer ring strategy and other control interventions for cysticercosis to the community is needed.
- Published
- 2018
38. Low sensitivity and frequent cross-reactions in commercially available antibody detection ELISA assays forTaenia soliumcysticercosis
- Author
-
Hector H. Garcia, Louis Jacob, Patricia P. Wilkins, Yesenia Castillo, Javier A. Bustos, Robert H. Gilman, Armando E. Gonzalez, Oscar H. Del Brutto, Isidro Gonzales, and Herbert Saavedra
- Subjects
0301 basic medicine ,Hymenolepiasis ,030106 microbiology ,030231 tropical medicine ,Neurocysticercosis ,Heterologous ,Enzyme-Linked Immunosorbent Assay ,Immunologic Tests ,Sensitivity and Specificity ,Article ,Serology ,03 medical and health sciences ,0302 clinical medicine ,Antigen ,antibody ,Peru ,Taenia solium ,parasitic diseases ,Animals ,Medicine ,neurocysticercose ,biology ,Immunomagnetic Separation ,business.industry ,cysticercosis ,Public Health, Environmental and Occupational Health ,neurocysticercosis ,Cysticercosis ,medicine.disease ,Virology ,medicine.drug_formulation_ingredient ,Infectious Diseases ,cysticercose ,Antigens, Helminth ,anticorps ,Pérou ,biology.protein ,ELISA ,Parasitology ,Antibody ,business ,purl.org/pe-repo/ocde/ford#3.03.06 [https] - Abstract
Objective To evaluate the diagnostic performance of two commercially available ELISA kits, Novalisa® and Ridascreen® , for the detection of antibodies to Taenia solium, compared to serological diagnosis of neurocysticercosis (NCC) by LLGP-EITB (electro-immunotransfer blot assay using lentil-lectin purified glycoprotein antigens). Methods Archive serum samples from patients with viable NCC (n = 45) or resolved, calcified NCC (n = 45), as well as sera from patients with other cestode parasites (hymenolepiasis, n = 45 and cystic hydatid disease, n = 45), were evaluated for cysticercosis antibody detection using two ELISA kits, Novalisa® and Ridascreen® . All NCC samples had previously tested positive, and all samples from heterologous infections were negative on LLGP-EITB for cysticercosis. Positive rates were calculated by kit and sample group and compared between the two kits. Results Compared to LLGP-EITB, the sensitivity of both ELISA assays to detect specific antibodies in patients with viable NCC was low (44.4% and 22.2%), and for calcified NCC, it was only 6.7% and 4.5%. Sera from patients with cystic hydatid disease were highly cross-reactive in both ELISA assays (38/45, 84.4%; and 25/45, 55.6%). Sera from patients with hymenolepiasis cross-reacted in five cases in one of the assays (11.1%) and in only one sample with the second assay (2.2%). Conclusions The performance of Novalisa® and Ridascreen® was poor. Antibody ELISA detection cannot be recommended for the diagnosis of neurocysticercosis.
- Published
- 2017
39. Antiparasitic treatment of neurocysticercosis - The effect of cyst destruction in seizure evolution
- Author
-
Hector H. Garcia and Oscar H. Del Brutto
- Subjects
medicine.medical_specialty ,Pathology ,030231 tropical medicine ,Neurocysticercosis ,Scars ,Albendazole ,Praziquantel ,Article ,03 medical and health sciences ,Behavioral Neuroscience ,Epilepsy ,0302 clinical medicine ,Seizures ,parasitic diseases ,Taenia solium ,medicine ,Humans ,Cyst ,Inflammation ,Antiparasitic Agents ,Cysts ,business.industry ,Anticestodal Agents ,Brain ,Cysticercosis ,medicine.disease ,Antiparasitic agent ,Dermatology ,medicine.drug_formulation_ingredient ,Treatment Outcome ,Neurology ,Female ,Neurology (clinical) ,medicine.symptom ,business ,030217 neurology & neurosurgery ,medicine.drug - Abstract
Antiparasitic agents against Taenia solium cysticercosis have been in use since 1979, although its use has been questioned on the basis that cysts would die naturally and thus treatment-induced inflammation is unnecessary. In addition, isolated reports have also questioned whether neurocysticercosis (NCC) is a cause of epilepsy. After more than three and a half decades, a large body of evidence is available. Little if any doubt exists about NCC as a cause of seizures - NCC is consistently associated with seizures when appropriate groups are compared, and in a large subset of cases, seizure semiology correlates with the anatomical location of lesions. Cyst degeneration and the subsequent inflammatory reaction increase seizure expression, although patients with non-inflamed cysts may have seizures, as do patients with long-standing, not inflamed calcified scars. Assessment of the evidence on cysticidal efficacy, safety, and the impact of cyst destruction in decreasing seizures leads to the conclusion that the benefits of antiparasitic treatment in parenchymal brain cysticercosis clearly outweigh the risks, and have provided substantive evidence of the role of NCC as a cause of seizures and epilepsy. Antiparasitic therapy should be considered a primary option in the management of patients with live or degenerating brain NCC cysts. This article is part of a Special Issue entitled "Neurocysticercosis and Epilepsy".
- Published
- 2017
40. Revised diagnostic criteria for neurocysticercosis
- Author
-
Robert H. Gilman, C.M. Vasquez, Theodore E. Nash, O. H. Del Brutto, Gagandeep Singh, Hector H. Garcia, P. Salgado, P.P. Wilkins, Arthur Clinton White, and Vedantam Rajshekhar
- Subjects
medicine.medical_specialty ,Pathology ,030231 tropical medicine ,Neurocysticercosis ,Clinical Neurology ,Neuroimaging ,Indirect evidence ,03 medical and health sciences ,0302 clinical medicine ,Taenia solium ,parasitic diseases ,Humans ,Medicine ,Cyst ,biology ,Cysticercosis ,business.industry ,Brain ,Diagnostic criteria, epilepsy, intracranial hypertension ,medicine.disease ,biology.organism_classification ,3. Good health ,Hydrocephalus ,medicine.drug_formulation_ingredient ,Neurology ,Taenia ,Neurology (clinical) ,Radiology ,business ,030217 neurology & neurosurgery - Abstract
Background A unified set of criteria for neurocysticercosis (NCC) has helped to standardize its diagnosis in different settings. Methods Cysticercosis experts were convened to update current diagnostic criteria for NCC according to two principles: neuroimaging studies are essential for diagnosis, and all other information provides indirect evidence favoring the diagnosis. Recent diagnostic advances were incorporated to this revised set. Results This revised set is structured in absolute, neuroimaging and clinical/exposure criteria. Absolute criteria include: histological confirmation of parasites, evidence of subretinal cysts, and demonstration of the scolex within a cyst. Neuroimaging criteria are categorized as major (cystic lesions without scolex, enhancing lesions, multilobulated cysts, and calcifications), confirmative (resolution of cysts after cysticidal drug therapy, spontaneous resolution of single enhancing lesions, and migrating ventricular cysts on sequential neuroimaging studies) and minor (hydrocephalus and leptomeningeal enhancement). Clinical/exposure criteria include: detection of anticysticercal antibodies or cysticercal antigens by well-standardized tests, systemic cysticercosis, evidence of a household Taenia carrier, suggestive clinical manifestations, and residency in endemic areas. Besides patients having absolute criteria, definitive diagnosis can be made in those having two major neuroimaging criteria (or one major plus one confirmative criteria) plus exposure. For patients presenting with one major and one minor neuroimaging criteria plus exposure, definitive diagnosis of NCC requires the exclusion of confounding pathologies. Probable diagnosis is reserved for individuals presenting with one neuroimaging criteria plus strong evidence of exposure. Conclusions This revised set of diagnostic criteria provides simpler definitions and may facilitate its more uniform and widespread applicability in different scenarios.
- Published
- 2017
41. Disease Centered Around Calcified Taenia solium Granuloma
- Author
-
Hector H. Garcia, Javier A. Bustos, and Theodore E. Nash
- Subjects
Pathology ,medicine.medical_specialty ,030231 tropical medicine ,Neurocysticercosis ,Disease ,Article ,03 medical and health sciences ,Epilepsy ,0302 clinical medicine ,Seizures ,Calcinosis ,Edema ,Taenia solium ,parasitic diseases ,medicine ,Animals ,Humans ,Granuloma ,business.industry ,Brain ,medicine.disease ,Natural history ,medicine.drug_formulation_ingredient ,Infectious Diseases ,Parasitology ,medicine.symptom ,business ,030217 neurology & neurosurgery - Abstract
Taenia solium (the pork tapeworm) is present in most developing countries, where it is a frequent cause of seizures and other neurological disease. Parasitic larvae invade the human brain, establish, and eventually resolve, leaving a calcified scar. While these lesions are common in endemic regions, and most of these are clinically silent, a proportion of individuals with calcified cysticerci develop seizures from these lesions, and 30-65% of these cases are associated with perilesional edema (PE), likely due to host inflammation. This manuscript summarizes the importance, characteristics, natural history, and potential prevention and treatments of symptomatic calcified neurocysticercosis (NCC).
- Published
- 2017
42. The Association Between Neurocysticercosis and Hippocampal Atrophy is Related to Age
- Author
-
Victor J. Del Brutto, Hector H. Garcia, Mauricio Zambrano, Naoum P. Issa, Oscar H. Del Brutto, P. Salgado, and Julio Lama
- Subjects
Adult ,Male ,Rural Population ,0301 basic medicine ,Neurocysticercosis/parasitology/pathology ,Aging ,medicine.medical_specialty ,Pathology ,030106 microbiology ,Neurocysticercosis ,Hippocampal formation ,Hippocampus ,03 medical and health sciences ,0302 clinical medicine ,McNemar's test ,Risk Factors ,Virology ,Internal medicine ,Odds Ratio ,medicine ,Humans ,Atrophy/parasitology/pathology ,Association (psychology) ,Aged ,medicine.diagnostic_test ,business.industry ,Magnetic resonance imaging ,Articles ,Odds ratio ,Middle Aged ,Confidence interval ,Hippocampal atrophy ,Infectious Diseases ,Case-Control Studies ,Hippocampus/parasitology/pathology ,Female ,Parasitology ,Atrophy ,business ,purl.org/pe-repo/ocde/ford#3.03.06 [https] ,030217 neurology & neurosurgery - Abstract
Neurocysticercosis (NCC) has been associated with hippocampal atrophy, but the prevalence and pathogenic mechanisms implicated in this relationship are unknown. Using a population-based, case–control study design, residents in a rural village (Atahualpa) aged ≥ 40 years with calcified NCC were identified as cases and paired to NCC-free individuals (control subjects) matched by age, sex, and level of education. Cases and control subjects underwent magnetic resonance imaging for hippocampal rating according to the Scheltens' scale for medial temporal atrophy and were interviewed to identify those with a clinical seizure disorder. The prevalence of hippocampal atrophy was compared between cases and control subjects by the use of the McNemar's test for correlated proportions. Seventy-five individuals with calcified NCC and their matched control subjects were included in the analysis. Hippocampal atrophy was noted in 26 (34.7%) cases and nine (12%) control subjects (odds ratio: 4.4; 95% confidence interval: 1.6–14.9, P < 0.0021). Stratification of pairs according to tertiles of age revealed an age-related trend in this association, which became significant only in those aged ≥ 68 years (P = 0.027). Only five cases and one control had recurrent seizures (P = 0.221); three of these five cases had hippocampal atrophy, and the single control subject had normal hippocampi. This study confirms an association between NCC and hippocampal atrophy, and shows that this association is stronger in older age groups. This suggests that NCC-related hippocampal atrophy takes a long time to develop.
- Published
- 2016
43. Spontaneously Arrested Transmission of Cysticercosis in a Highly Endemic Village with a Very Low Migration Rate
- Author
-
Pierre Dorny, Seth E. O’Neal, Hector H. Garcia, and Oscar H. Del Brutto
- Subjects
Adult ,Male ,Rural Population ,Endemic Diseases ,Swine ,030231 tropical medicine ,Neurocysticercosis ,Antibodies, Helminth ,Physiology ,Neuroimaging ,Feces ,03 medical and health sciences ,0302 clinical medicine ,Antigen ,Virology ,Taenia solium ,parasitic diseases ,Prevalence ,Animals ,Humans ,Medicine ,Societal development ,Animal Husbandry ,Swine Diseases ,biology ,Cysticercosis ,business.industry ,Transmission (medicine) ,Articles ,medicine.disease ,Highly Endemic Village ,Domestic pig ,medicine.drug_formulation_ingredient ,Low Migration Rate ,Infectious Diseases ,Antigens, Helminth ,biology.protein ,Female ,Parasitology ,Ecuador ,Antibody ,business ,purl.org/pe-repo/ocde/ford#3.03.06 [https] ,030217 neurology & neurosurgery - Abstract
Taenia solium cysticercosis is difficult to eliminate without interventions or societal development. Atahualpa is a rural Ecuadorian village with documented low migration rate, where domestic pig raising is common and human cysticercosis is endemic. To assess neurocysticercosis (NCC) prevalence, 1,273 villagers aged ≥ 20 years underwent neuroimaging studies, which showed calcified lesions in 121 (9.5%) individuals, but no active disease. Likewise, positive reactions, apparently nonspecific, were found in only 3/200 subjects by the use of a monoclonal antibody-based enzyme-linked immunosorbent assay to detect T. solium antigens in urine. Only 2/418 pigs reacted to three antibody bands on serum western blot and none to more than three bands. This is the first time that spontaneously arrested T. solium transmission is documented in a known endemic village. Understanding why active transmission stopped could provide insights on potential targets for control interventions. Atahualpa could provide an optimal scenario for longitudinal studies on the consequences of calcified NCC.
- Published
- 2018
44. Parasitic Infections of the Nervous System
- Author
-
Oscar H. Del Brutto, Hector H. Garcia, and Avindra Nath
- Subjects
Chagas disease ,trypanosomiasis ,purl.org/pe-repo/ocde/ford#3.02.25 [https] ,gnathostomiasis ,Neurocysticercosis ,Paragonimus ,Acanthamoeba ,morbidity ,030204 cardiovascular system & hematology ,Central Nervous System Parasitic Infections ,Schistosoma japonicum ,toxocariasis ,0302 clinical medicine ,Taenia solium ,sparganosis ,Trypanosoma brucei ,Toxocara cati ,Naegleria fowleri ,parasitic infections ,education.field_of_study ,biology ,Antiparasitic Agents ,paragonimiasis ,nervous system ,neurocysticercosis ,Toxocara canis ,Cysticercosis ,Schistosoma mansoni ,head nodding syndrome ,neurologic disease ,Gnathostoma spinigerum ,medicine.drug_formulation_ingredient ,trichinosis ,Strongyloidiasis ,priority journal ,Neurology ,Toxoplasmosis, Cerebral ,parasitosis ,Schistosoma haematobium ,cerebral malaria ,Taenia multiceps ,coenurosis ,Paragonimus skrjabini ,toxoplasmosis ,Trypanosoma cruzi ,Plasmodium falciparum ,Population ,malaria ,Malaria, Cerebral ,Toxoplasma gondii ,Article ,Balamuthia mandrillaris ,Strongyloides stercoralis ,03 medical and health sciences ,angiostrongyliasis ,Paragonimus westermani ,schistosomiasis ,parasitic diseases ,medicine ,Humans ,human ,strongyloidiasis ,Spirometra ,education ,Paragonimus mexicanus ,Trichinella spiralis ,nodding syndrome ,Echinococcus granulosus ,business.industry ,cysticercosis ,Angiostrongylus cantonensis ,central nervous system ,medicine.disease ,biology.organism_classification ,mortality ,Toxoplasmosis ,echinococcosis ,Immunology ,Echinococcus multilocularis ,Neurology (clinical) ,business ,Trypanosomiasis ,030217 neurology & neurosurgery - Abstract
Parasitic infections of the central nervous system are much more common than suspected, although most infections are asymptomatic. For example, parasites like the ubiquitous protozoa Toxoplasma gondii or the nematode larvae Toxocara canis infect significant proportions of the human population. Other parasitic infections such as malaria and neurocysticercosis are widespread in developing countries and become major causes of neurological morbidity in these regions as well in immigrants and travelers. This article reviews parasitic pathogens causing neurological morbidity and mortality, including an extensive list of less common parasitic infections of the human nervous system.
- Published
- 2019
45. Performance of a sandwich antigen-detection ELISA for the diagnosis of porcine Taenia solium cysticercosis
- Author
-
Susan Y Yang, Armando E. Gonzalez, Hector H. Garcia, Pierre Dorny, Sarah Gabriël, Berenice Ninaquispe, Robert H. Gilman, Silvia Rodriguez, Yesenia Castillo, and Javier A. Bustos
- Subjects
pig ,Taenia hydatigena ,Swine ,Neurocysticercosis ,NEUROCYSTICERCOSIS ,SERUM ,parasite load ,0302 clinical medicine ,Taenia solium ,PIGS ,cross reaction ,Swine Diseases ,biology ,Intermediate host ,Cysticercosis ,Articles ,unclassified drug ,PREVALENCE ,medicine.drug_formulation_ingredient ,Infectious Diseases ,INFECTIONS ,disease severity ,purl.org/pe-repo/ocde/ford#3.03.06 [https] ,taeniasis ,EXCRETORY-SECRETORY ANTIGENS ,animal experiment ,030231 tropical medicine ,UNITED-STATES ,Enzyme-Linked Immunosorbent Assay ,Sensitivity and Specificity ,Article ,03 medical and health sciences ,Antigen ,Virology ,parasitic diseases ,monoclonal antibody 60H8 ,medicine ,follow up ,Animals ,Helminths ,controlled study ,Veterinary Sciences ,ANTIBODY-BASED ELISA ,Taenia hydatigena infection ,nonhuman ,business.industry ,animal model ,cysticercosis ,treatment response ,biology.organism_classification ,medicine.disease ,enzyme linked immunosorbent assay ,monoclonal antibody 158C11 ,GLYCOPROTEINS ,echinococcosis ,experimental infection ,Parasitology ,monoclonal antibody ,sensitivity and specificity ,Antigens, Helminth ,CIRCULATING ANTIGEN ,business - Abstract
The pig is the natural intermediate host of Taenia solium, a parasite causing significant burden of disease in both humans and pigs. Porcine cysticercosis is traditionally detected via tongue palpation and slaughterhouse meat inspection, both with limited sensitivity. Serum antibody detection has a better performance; however, it does not discriminate past from present infection. Serum antigen detection can demonstrate viable infection and gives a good estimate of parasitic load. This study evaluated a sandwich antigen-detection ELISA using monoclonal antibodies (MoAbs) 158C11 and 60H8 for the diagnosis of viable cysticercosis in pigs. Serum samples were used from 35 naturally T. solium cysticerci–infected pigs, 31 cysticercosis-negative pigs, and 22 pigs with Taenia hydatigena infection (to assess cross-reactions). Positive cysticercosis samples were subcategorized at necropsy according to parasitic burden as mild (1–10 viable cysts, n = 10), moderate (11–100 cysts, n = 5), or severe infection (more than 100 cysts, n = 20). This Ag-ELISA showed a sensitivity of 82.9% and a specificity of 96.8% when not considering cross-reactions with T. hydatigena. Hundred percentage of severely infected, 80% of moderately infected, and 50% of mildly T. solium–infected pigs tested positive. Twenty of 22 pigs with only T. hydatigena infections were positive, with 13 reaching saturating levels in the ELISA. The Ag-ELISA revealed the presence of live cysts and is, thus, a fairly reliable test to monitor experimental infection, response to treatment, and follow-up in animal models of cysticercosis. It should, however, be carefully interpreted when used in regions where T. hydatigena is endemic in pigs.
- Published
- 2019
46. Albendazole sulfoxide plasma levels and efficacy of antiparasitic treatment in patients with parenchymal neurocysticercosis
- Author
-
Hector H. Garcia, Gianfranco Arroyo, Osvaldo Massaiti Takayanagui, Vera Lucia Lanchote, Robert H. Gilman, Javier A. Bustos, Pierina Sueli Bonato, John R. Horton, E. Javier Pretell, Silvia Rodriguez, Andres G. Lescano, Herbert Saavedra, Armando E. Gonzalez, and Isidro Gonzales
- Subjects
0301 basic medicine ,Microbiology (medical) ,Adult ,Male ,medicine.medical_specialty ,Adolescent ,030106 microbiology ,030231 tropical medicine ,Neurocysticercosis ,albendazole ,purl.org/pe-repo/ocde/ford#3.03.08 [https] ,Albendazole ,Gastroenterology ,Mass Spectrometry ,Praziquantel ,03 medical and health sciences ,Young Adult ,0302 clinical medicine ,Internal medicine ,parasitic diseases ,Medicine ,Humans ,Cyst ,Articles and Commentaries ,Chromatography, High Pressure Liquid ,Aged ,Anthelmintics ,CISTOS ,business.industry ,praziquantel ,neurocysticercosis ,Middle Aged ,medicine.disease ,albendazole sulfoxide ,Antiparasitic agent ,Confidence interval ,Infectious Diseases ,Concomitant ,Relative risk ,Female ,business ,medicine.drug - Abstract
BackgroundThe efficacy of albendazole therapy in patients with parenchymal neurocysticercosis (NCC) is suboptimal. Plasma levels of albendazole sulfoxide (ASOX), the active metabolite of albendazole, are highly variable among patients. We hypothesized that high ASOX plasma levels during albendazole therapy may be associated with an increased antiparasitic efficacy.MethodsASOX plasma levels were measured at treatment day 7 in 118 patients with parenchymal NCC enrolled in a treatment trial. The relationships between increasing ASOX plasma levels with the proportion of cysts resolved and the proportion of patients with complete cyst resolution (evaluated by 6-month brain magnetic resonance) were assessed.ResultsThere was a trend toward a higher proportion of cysts resolved and a higher proportion of patients cured with increasing quartiles of ASOX plasma levels. In patients with 3 or more brain cysts, the regression analysis adjusted by the concomitant administration of praziquantel (PZQ) showed a 2-fold increase in the proportion of cysts resolved (risk ratio [RR], 1.98; 95% confidence interval [CI], 1.01–3.89; P = .048) and 2.5-fold increase in the proportion of patients cured (RR, 2.45; 95% CI, .94–6.36; P = .067) when ASOX levels in the highest vs the lowest quartile were compared. No association was found in patients with 1–2 brain cysts.ConclusionsWe suggest an association between high ASOX plasma levels and increased antiparasitic efficacy in patients with parenchymal NCC. Nonetheless, this association is also influenced by other factors including parasite burden and concomitant administration of PZQ. These findings may serve to individualize and/or adjust therapy schemes to avoid treatment failure.
- Published
- 2019
47. No confirmed cases of Taenia solium taeniasis in a group of recently arrived Sub-Saharan migrants to Italy
- Author
-
Sara Boccalini, Yesenia Castillo, Antonia Mantella, Alessandra Nicoletti, Hector H. Garcia, Alessandro Bartoloni, D. Aquilini, Annarita Botta, Marta Tilli, and Lorenzo Zammarchi
- Subjects
Microbiology (medical) ,Veterinary medicine ,Sub saharan ,Neurocysticercosis ,Cysticercosis ,Migrants ,Sub-Saharan Africa ,Taenia solium ,Taeniasis ,Biology ,mental disorders ,parasitic diseases ,medicine ,Immunology and Allergy ,Molecular Biology ,General Immunology and Microbiology ,Taenia species ,cysticercosis ,migrants ,neurocysticercosis ,taeniasis ,Taenia solium taeniasis ,medicine.disease ,False-positive result ,medicine.drug_formulation_ingredient ,Infectious Diseases - Abstract
One-hundred and sixty-four migrants from Sub-Saharan Africa to Italy were screened with the Taenia solium specific enzyme-linked immunosorbent assay coproantigen (ELISA CoAg) and four (2.4%) were recorded as positive, but with optical density values near to the cut-off. No ELISA CoAg positive samples were confirmed by parasitological methods. Low positivity could be attributed to false positive result or cross-reaction with other Taenia species. Further studies are needed to assess the role of migration on sporadic autochthonous transmission of T. solium taeniasis/cysticercosis in Europe.
- Published
- 2019
48. Detection of Taenia solium DNA in the Urine of Neurocysticercosis Patients
- Author
-
Alan L. Scott, Luz Toribio, Miryam de Los Angeles Romano, Herbert Saavedra, Isidro Gonzales, Hector H. Garcia, and Clive Shiff
- Subjects
Central Nervous System ,brain calcification ,polymerase chain reaction ,urinalysis ,Neurocysticercosis ,Ciencias de la Salud ,cell free nucleic acid ,Helminth genetics ,Urine ,REAL TIME PCR ,NEUROCYSTICERCOSIS ,Polymerase Chain Reaction ,Serology ,0302 clinical medicine ,sensitivity analysis ,Peru ,Taenia solium ,Medicine ,Taeniasis ,clinical article ,neuroimaging ,cell free DNA ,Cysticercosis ,Articles ,DNA, Helminth ,unclassified drug ,medicine.drug_formulation_ingredient ,Infectious Diseases ,Cell-free fetal DNA ,Larva ,purl.org/becyt/ford/3 [https] ,diagnostic value ,Cell-Free Nucleic Acids ,purl.org/pe-repo/ocde/ford#3.03.06 [https] ,CIENCIAS MÉDICAS Y DE LA SALUD ,030231 tropical medicine ,TAENIA SOLIUM ,DNA determination ,Neuroimaging ,Article ,purl.org/becyt/ford/3.3 [https] ,03 medical and health sciences ,Virology ,parasitic diseases ,Animals ,Humans ,controlled study ,Cognitive Dysfunction ,human ,nonhuman ,business.industry ,medicine.disease ,clinical feature ,enzyme linked immunosorbent assay ,Enfermedades Infecciosas ,DNA IN URINE ,Immunology ,Parasitology ,business - Abstract
Neurocysticercosis (NCC), caused by Taenia solium larvae that reside in the central nervous system, results in serious public health and medical issues in many regions of the world. Current diagnosis of NCC is complex requiring both serology and costly neuroimaging of parasitic cysts in the brain. This diagnostic pipeline can be problematic in resource-constrained settings. There is an unmet need for a highly sensitive and clinically informative diagnostic test to complement the present diagnostic approaches. Here, we report that T. solium–derived cell-free DNA is readily detectable in the urine of patients with the subarachnoid and parenchymal forms of NCC, and discuss the potential utility of this approach in enhancing and refining T. solium diagnostics. Fil: Toribio, Luz. Universidad Peruana Cayetano Heredia; Perú Fil: Romano, Miryam de Los Angeles. Consejo Nacional de Investigaciones Científicas y Técnicas. Centro Científico Tecnológico Conicet - Salta. Instituto de Patología Experimental. Universidad Nacional de Salta. Facultad de Ciencias de la Salud. Instituto de Patología Experimental; Argentina. University Johns Hopkins; Estados Unidos Fil: Scott, Alan L.. University Johns Hopkins; Estados Unidos Fil: Gonzales, Isidro. Instituto Nacional de Ciencias Neurológicas; Perú Fil: Saavedra, Herbert. Instituto Nacional de Ciencias Neurológicas; Perú Fil: Garcia, Hector H.. Universidad Peruana Cayetano Heredia; Perú. Instituto Nacional de Ciencias Neurológicas; Perú Fil: Shiff, Clive. University Johns Hopkins; Estados Unidos
- Published
- 2018
49. Evaluating Urban Taeniasis as a Threat to Cysticercosis Elimination in Northern Peru
- Author
-
Percy Vilchez, Brian Garvey, Ricardo Gamboa, Lauralee Fernandez, Luz Maria Moyano, Hector H. Garcia, Ian Pray, Angela Spencer, Claudio Muro, Michelle Beam, Seth E. O’Neal, and Ruth Atto
- Subjects
pig ,Male ,Urban Population ,clinical evaluation ,Prevalence ,contaminated animal ,Risk Factors ,middle aged ,Peru ,Taenia solium ,environmental sanitation ,Taeniasis ,animal ,disease elimination ,Child ,geography.geographical_feature_category ,parasite clearance ,risk assessment ,Cysticercosis ,Articles ,Middle Aged ,medicine.drug_formulation_ingredient ,Infectious Diseases ,female ,risk factor ,Female ,Risk assessment ,purl.org/pe-repo/ocde/ford#3.03.06 [https] ,Adult ,taeniasis ,prevalence ,complication ,rural area ,Urban area ,Neurocysticercosis ,Article ,Young Adult ,evaluation study ,Virology ,Environmental health ,parasitic diseases ,medicine ,Helminths ,cross-sectional study ,Animals ,Humans ,human ,infection risk ,sewer ,endemic disease ,Aged ,geography ,isolation and purification ,cysticercosis ,medicine.disease ,Cross-Sectional Studies ,Parasitology ,Rural area - Abstract
Reintroduction of Taenia solium into a region in Peru where it had been eliminated prompted evaluation of the possibility of reintroduction from an urban reservoir of taeniasis. In a cross-sectional study of an adjacent urban area, we found low prevalence of taeniasis (4/1,621; 0.25%), suggesting minimal risk of parasite reintroduction into rural areas through this route.
- Published
- 2018
50. The effectiveness of anti-inflammatory and anti-seizure medication for individuals with single enhancing lesion neurocysticercosis: A meta-analysis and expert group-based consensus recommendations
- Author
-
Robert de Meijere, A. Clinton White, Bernard Ngowi, Annette Abraham, Hector H. Garcia, Xiao-Nong Zhou, Sarah Gabriël, Gagandeep Singh, Mamoun M. A. Homeida, Hélène Carabin, Theodore E. Nash, Javier A. Bustos, Vedantam Rajshekhar, Christina M. Coyle, Andrea Sylvia Winkler, Priyadarshi Soumyaranjan Sahu, and Peter L. Chiodini
- Subjects
Male ,Epidemiology ,Physiology ,RC955-962 ,Neurocysticercosis ,Anti-Inflammatory Agents ,Steroid Therapy ,Database and Informatics Methods ,Mathematical and Statistical Techniques ,0302 clinical medicine ,Adrenal Cortex Hormones ,Antiparasitic Therapy ,Arctic medicine. Tropical medicine ,Medicine and Health Sciences ,Enhancing Lesion ,Medicine ,Public and Occupational Health ,Cumulative incidence ,Cyst ,Database Searching ,Brain Diseases ,Pharmaceutics ,Statistics ,Calcinosis ,Metaanalysis ,Vaccination and Immunization ,Treatment Outcome ,Infectious Diseases ,Meta-analysis ,Physical Sciences ,Anticonvulsants ,Female ,Public aspects of medicine ,RA1-1270 ,Research Article ,medicine.medical_specialty ,Consensus ,Corticosteroid Therapy ,Immunology ,030231 tropical medicine ,MEDLINE ,Research and Analysis Methods ,Calcification ,03 medical and health sciences ,Signs and Symptoms ,Text mining ,Pharmacotherapy ,Drug Therapy ,Seizures ,Internal medicine ,Animals ,Humans ,Statistical Methods ,Epilepsy ,Taenia ,business.industry ,Public Health, Environmental and Occupational Health ,Biology and Life Sciences ,medicine.disease ,Medical Risk Factors ,Lesions ,Preventive Medicine ,Clinical Medicine ,Physiological Processes ,business ,Mathematics ,030217 neurology & neurosurgery - Abstract
Single brain enhancing lesions (SEL) are the most common presentation of neurocysticercosis (NCC) observed on neuroimaging in people presenting with epileptic seizures not only on the Indian sub-continent and in travelers returning from cysticercosis-endemic regions, but are also present in other parts of the world. The aim of this study, which consisted of a systematic review (CRD42019087665), a meta-analysis and an expert group consultation, was to reach consensus on the best anti-seizure medication and anti-inflammatory treatment for individuals with SEL NCC. Standard literature review methods were used. The Cochrane risk of bias tool was used and random effects model meta-analyses were performed. The quality of the body of evidence was rated using GRADE tables. The expert committee included 12 gender and geographically balanced members and recommendations were reached by applying the GRADE framework for guideline development. The 1–1.5-year cumulative incidence of seizure recurrence, cyst resolution or calcification following anti-seizure medication (ASM) withdrawal was not statistically different between ASM of 6, 12 or 24 months. In contrast, in persons whose cyst calcified post treatment, longer ASM decreased seizure recurrence. The cumulative incidence ratio (CIR) 1–1.5 years after stopping ASM was 1.79 95% CI: (1.00, 3.20) for patients given 6 versus 24 months treatment. Anti-inflammatory treatment with corticosteroids in patients treated with ASM compared to patients treated with ASM only showed a statistically significant beneficial effect on seizure reduction (CIR 0.44, 95% CI 0.23, 0.85) and cyst resolution (CIR 1.37, 95%CI: 1.07, 1.75). Our results indicate that ASM in patients with SEL NCC whose cysts resolved can be withdrawn, while patients whose cysts calcified seem to benefit from prolonged anti-seizure medication. Additional corticosteroid treatment was found to have a beneficial effect both on seizure reduction and cyst resolution., Author summary Neurocysticercosis is an infection of the brain with the tapeworm Taenia solium. On the Indian sub-continent, the majority of people suffering from neurocysticercosis only show one cyst (larval form of the parasite) in their brain and often present at clinics with epileptic seizures. There is still some debate on the best way to treat these cases to reduce the risk for seizure recurrence. The goal of this study was to review the literature on how well different durations of treatment with anti-seizure medication (ASM), combined or not with corticosteroids, work in order to reduce the seizure recurrence and eliminate the cyst from the brain. The results show that ASM for 24 months compared to 6 months favors reduced seizure recurrence in patients whose cysts calcified post treatment. Concerning anti-inflammatory treatment, corticosteroids were also found to have beneficial effects on seizure reduction. However, further high-quality randomized controlled trials with adequately long follow-up time are required for better evidence on best drug(s), dose and duration of ASM and corticosteroids for individuals with SEL NCC.
- Published
- 2021
Catalog
Discovery Service for Jio Institute Digital Library
For full access to our library's resources, please sign in.