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Neurocysticercosis (NCC) has attained the importance of one of the most common cause of focal brain lesions in patients infected with HIV (human immunodeficiency virus). Adequate data regarding the rate of this co-infection is lacking. Therefore, the present study was carried out to determine the prevalence of cysticercosis among HIV patients residing in Puducherry or its neighboring districts of Tamil Nadu State, India. A total of one hundred blood samples were collected from HIV seropositive cases visiting JIPMER hospital, Puducherry, between June 2007 and May 2008. Enzyme immunotransfer blot (EITB) and enzyme linked immunosorbent assay (ELISA) were used to demonstrate anti- T. solium larval stage antibodies and Co-agglutination (Co-A) test was used to detect T. solium larval stage antigens in sera. Two HIV seropositive cases were found positive for anti-T. solium larval stage antibody by EITB and four were positive by ELISA. Only one sample was positive by both EITB and ELISA. No serum sample was found positive for T. solium larval stage antigen by Co-A test. The overall seropositivity detected by all the methods was 5% in this study group. The accurate clinical diagnosis of NCC in HIV is difficult due to deranged immunological parameters in the HIV infected patients. The results of this study provides important data on the prevalence of cysticercosis in HIV positive patients in Puducherry and neighboring areas which was previously unknown. This study will also increase awareness among physicians and public health agencies about T. solium cysticercosis in the selected group.

In developing countries hydatidosis is both a medical and economic problem related to environmental hygiene and healthy veterinary practice. This cestode parasitic infestation, uncommonly involving the nervous system, presents with varied clinical manifestation, at times causing diagnostic dilemmas. Multiple intracranial and spinal hydatidosis is rare. A series of 29 histologically confirmed cases of hydatidosis of neuraxis (21 intracranial and 8 spinal) from South India are presented. Among the 21 cases of intracranial hydatidosis, 12 cases were in pediatric age, while only 1 spinal lesion was noted in a 5-year-old child. The clinical presentation of intracranial lesions was predominantly that of raised intracranial pressure and visual symptoms, while spinal hydatidosis manifested with severe back pain, weakness and sphincter disturbances. The cranial cysts were usually single and uniloculated (12 cases), multiple in 7 and single but multiloculated in 2. In spinal hydatidosis, the cysts are usually multiple and extradural, rare ones being intramedullary and intradural. Based on clinical features and imaging, the differential diagnosis for intracranial lesions were cystic tumors and arachnoid cyst while metastasis and tuberculosis were considered in cases of spinal hydatidosis because of vertebral bony involvement. The majority of the cysts could be surgically resected totally and some were aspirated under control suction and resected. None of the cases had anaphylactic reaction, with no significant post-operative morbidity and no mortality. One intracranial and 2 spinal lesions caused by fertile cysts recurred to undergo repeated surgery.

Objective: To evaluate a set of clinical and computed tomographic (CT) criteria (previously described by us) to predict the diagnosis of a solitary cerebral cysticercus granuloma (SCCG) at initial presentation, in patients presenting with seizures., Material and Methods: The diagnostic criteria were applied prospectively to patients presenting with seizures and solitary lesion on the CT scan. The clinical diagnostic criteria were as follows: seizures should be the presenting complaint; there should be no evidence of persistent raised intracranial pressure, progressive neurological deficit or an active systemic disease. The CT diagnostic criteria were: evidence of a solitary contrast enhancing lesion measuring 20 mm or less in its maximal dimension without a shift of the midline structures due to the surrounding oedema. A diagnosis of SCCG was made only when all the clinical and CT criteria were fulfilled. Over a period of 36 months, we managed 401 patients presenting with seizures and a solitary mass on the CT scan; 215 met the criteria for the diagnosis of an SCCG., Results: Of the 215 patients initially diagnosed to have an SCCG, 197 were ultimately determined to have that diagnosis (true positive diagnosis) while 16 were excluded because of lack of follow-up CT assessment. Two of the 215 patients with the initial diagnosis of an SCCG subsequently had histological diagnosis of a secondary metastasis and a pyogenic abscess (false positive diagnosis). Our set of diagnostic criteria for SCCG had a sensitivity of 99.5%; specificity of 98.9%; a positive predictive value of 99%; and a negative predictive value of 99.5%. The likelihood ratios for the positive and negative tests were 92.99 and 0.005 respectively., Conclusions: Our diagnostic criteria help in not only accurately identifying an SCCG but also in differentiating it from a solitary tuberculoma and other brain masses. However, confirmation of the diagnosis of an SCCG is only obtained at follow-up evaluation and therefore careful clinical and CT re-evaluation is essential in all patients initially diagnosed to have an SCCG.

The findings of fine needle aspiration cytology (FNAC) of subcutaneous cysticercosis are described. Nine patients had a single subcutaneous nodule. One patient had multiple skin and cerebral nodules that were clinically suspected due to cysticercus. Patients with a single nodule in the extremities and trunk were clinically diagnosed as having lipoma (1), fibroma (3) and neurofibroma (3). Tuberculous lymphadenitis was suspected in two cases with a single cervical nodule. The characteristic cytomorphology of parasitic tegument and parenchyma helped identify the larvae in the cytological smears, as did a polymorphous inflammatory reaction. Biopsy was done in four cases. Six patients were lost to follow-up. Histopathology of the nonaspirated nodule from the case with multiple skin nodules showed cysticercus. The other three biopsies showed a parasitic granuloma only. Of the four biopsied cases, only two underwent computed tomographic scans, which showed cerebral involvement. In a developing country like India, a rapid, safe and reliable cytologic diagnosis of subcutaneous cysticercus by FNAC on an outpatient basis proves to be a cost-effective procedure since it obviates the need for open biopsy.

A total of 21 cases of childhood neurocysticercosis seen over five years (1985-89) at JIPMER hospital Pondicherry, are reported. Nine of these patients were males and twelve females. Their age ranged between 5 to 15 years. The presenting features were convulsive seizures (14), features of raised intracranial pressure (6) and meningoencephalitis syndrome (1). Diagnosis of neurocysticercosis was based on positive CSF serological tests (11), CT morphology (11), brain biopsy (1) and autopsy (1). Praziquantel therapy was given in 4 cases, 3 of them showed remarkable improvement in neurological status and one died of acute reaction.

Cysticercosis of the central nervous system is seen infrequently in Australia. Most cases occur in adults, but two imported cases of neurocysticercosis in children are described. A 10-year-old Anglo-Indian girl presented with aseptic meningitis, raised intracranial pressure and a block to the flow of cerebrospinal fluid in the lumbar region. Laminectomy showed two cysticerci in the spinal subdural space. A three-year-old boy from Zimbabwe suffered a focal seizure. A granuloma that contained a degenerate cysticercus was found in the left parietal cortex. Serological examination of blood for cysticercosis was performed only in the second case and gave negative results. Examination of stools in both children gave negative results for the presence of parasites, cysts and ova.