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Objective: Rare disease Background: Cysticercosis is a condition caused by infection with the larval form of Taenia solium, a pork tapeworm that uses pigs as an intermediate host. Humans become infected when they ingest water or food contaminated with tapeworm cysts. Cysticercosis is increasing in frequency in developed countries due to increased access to travel. Neurocysticercosis occurs when Taenia solium cysts embed within the nervous system. The clinical presentation of neurocysticercosis ranges from asymptomatic to life-threatening, largely depending on the brain parenchymal involvement. The diagnosis is typically made with a combination of clinical evaluation, serology, and neuroimaging. Treatment for parenchymal neurocysticercosis may involve anthelmintic agents, symptomatic agents, surgery, or a combination of methods. Case Report: A 52-year-old man with a medical history of migraine headaches, complicated type 2 diabetes mellitus, and obesity presented with a 4-month change in his migraines becoming severe, worse over his occiput bilaterally, and unresponsive to abortive therapy. His exposure history was unremarkable except for a habit of eating undercooked bacon, by which he would have developed neurocysticercosis via autoinfection. Neuroimaging and serology confirmed a diagnosis of neurocysticercosis and he was treated accordingly with antiparasitic and anti- inflammatory medications. Conclusions: This presentation is nonspecific and can easily be overlooked, especially if there is an underlying known neurological condition such as migraine. This case illustrates that neurocysticercosis should be considered when an existing neuropathological condition displays a change in presentation or requires a change in therapeutic management, even without obvious risk factors. [ABSTRACT FROM AUTHOR]

Taenia crassiceps is a parasite of wild canids and dogs that serve as definite hosts, harboring the adult cestode, whereas rodents are the intermediate hosts in which the metacestode/cysticercus/larval stage occurs. Fecal-oral transmission ensures the parasite's lifecycle. At times, dogs and humans act as accidental intermediate hosts. Despite the public health concern this parasite warrants, its epidemiology remains unclear. In this report, we document the occurrence of metacestodes of T. crassiceps in a muskrat (Ondatra zibethicus) and a domestic dog from the northeastern United States, a development that necessitates increased awareness and surveillance to tackle this disease of "one health" significance. Taenia crassiceps cysticercosis was confirmed in an adult male muskrat in February 2018 and in a 4-year-old female spayed Staffordshire Bull Terrier in December 2020. Parasitological and histopathologic examination of both cases revealed cysticerci with the characteristic rostellar hook morphology that aided in Taenia species identification. In the muskrat case specifically, partial sequencing of the mitochondrial cytochrome oxidase gene confirmed the species identity as T. crassiceps. We report T. crassiceps occurrence in a muskrat in New York State for the first time and document a case presentation in a domestic dog from New Jersey that was infected with metacestode stages of this parasite. Given the detection of this parasite in the northeastern United States, T. crassiceps infection, which otherwise is considered a rare disease, should be on the radar of veterinary, medical and wildlife biologists for timely diagnosis and interventions. [ABSTRACT FROM AUTHOR]

The article offers a case study of 17-year-old male with a past medical history of epilepsy who presented in status epilepticus. Topics discussed patient was maintained on a ventilator after admission due to concern for aspiration pneumonia with subsequent septic shock; mentions the patient underwent treatment for intensive care unit delirium; and includes diagnostic protocols for evaluating foreign-born children for infectious diseases.

This article provides information on neglected parasitic infections in the United States, focusing on their impact on impoverished individuals. The major neglected parasitic infections discussed include Chagas disease, cysticercosis, toxocariasis, toxoplasmosis, and trichomoniasis. These infections are considered neglected due to their high prevalence, chronic nature, and strong association with poverty. The article highlights the prevalence of poverty in the southern US and its role in promoting these infections. It emphasizes the importance of active surveillance, prevention, and awareness to address these neglected parasitic infections. The data presented is based on studies conducted by the CDC and NHANES III. The article calls for further research, improved diagnostic tools, and better treatment options for these infections, as well as increased efforts in awareness, surveillance, and prevention. [Extracted from the article]

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. [ABSTRACT FROM AUTHOR]

Neurocysticercosis results from the infestation of the central nervous system with invading tapeworm larvae. Though uncommon in the US prior to 1965, new cases are currently being diagnosed at an unprecedented rate. Drawing on environmental health, intervention and risk data retrieved from standard/alternative databases and in-country sources, we present an update and summary of modifiable risk factors and field-tested primary prevention measures. While points of intervention, subpopulations at risk and overall magnitude of the problem are addressed, particular attention is paid to defining risk reduction measures that can be adopted by individuals and high risk groups in the near-term to interrupt or eliminate pathways of exposure leading to disease transmission. Though global eradication is not attainable in the near future, effective preventative measures exist and should be taken now by international travellers and workers, US/foreign government agencies, and individuals living in endemic regions to reduce human suffering. [ABSTRACT FROM AUTHOR]

Neurocysticercosis, caused by Taenia solium, is a common cause of neurologic disease in developing countries and among immigrants to the United States. Seizures are the most common clinical manifestation of neurocysticercosis. Imaging studies of patients with seizures from neurocysticercosis typically reveal evidence of an inflammatory reaction associated with the parasite or calcified granulomas. This study investigated whether a substance produced by the host granulomatous reaction to the dying parasite, in a mouse model of the infection, is sufficient to induce epileptiform activity. Granulomas associated with Taenia crassiceps cysticerci were removed from the peritoneal cavity of infected mice. One piece of the granuloma was used for blinded histological staging of the dying parasite. The second piece was used to generate extracts, which were injected into the hippocampus of an anesthetized Sprague-Dawley rat. Positive controls included animals injected with kainic acid, picrotoxin, or bicuculline. Seizures were recorded after injection of extracts from 6 out of 6 early stage granulomas, but only 1 out of 9 late stage granulomas. Injections of buffered saline, extracts from non-stimulated mouse spleen cells, and homogenates of viable parasite material caused no epileptiform activity. The data suggest that a substance in the granulomas early in the inflammatory response to the dying parasite is capable of inducing seizure activity. Further experiments are needed to dissect out the exact seizure mediator in the granuloma extracts. [Copyright &y& Elsevier]

Abstract. Cerebral cysticercosis is being diagnosed with increasing frequency in children in the United States. A total of 52 patients with intraparenchymal cerebral cysticercosis, 21 months to 20 years of age, were observed for 2 to 72 months. Actively inflamed acute lesions, with or without coexisting chronic calcified lesions, were seen in 42 patients. Solitary lesions were seen in 39 patients, multiple lesions in 13. Chronic inactive calcified lesions were seen in ten children. A total of 51 patients had seizures that were either partial or partial with secondary generalization. Patients were treated with anticonvulsants. Praziquantel was not used. All active lesions resolved completely or with punctate calcification in 2 to 9 months, according to radiographic findings. Seizures were easily controlled. Patients were gradually weaned from anticonvulsants and in 60% no seizures recurred. Prognosis was generally good. Characteristics of the CT scans are detailed. [ABSTRACT FROM AUTHOR]

The author reflects on the cases of neurocysticercosis among immigrant populations. He says that O'Neal and colleagues reported two cases on the family from Burma who migrated in Thailand and in the U.S. He added that the occurrence of multiple neurocysticercosis in the family demonstrates the transmission of cysticercosis, which suggests that household members should be diagnosed for symptomatic cysticercosis and intestinal taeniasis.

Depressive symptoms are a common comorbidity among adults with epilepsy (AWE). Prior estimates regarding prevalence and treatment of depressive symptoms in AWE have been largely based on samples of tertiary care cohorts that may not be generalizable. We aimed to provide a representative population estimate of the prevalence and treatment of depressive symptoms over time in AWE in the United States as measured by a validated depression screen. Data from the Medical Expenditure Panel Survey (MEPS) were analyzed from 2004 to 2015 to determine the prevalence of "screen positive" depressive symptoms (SPDS) among AWE as evaluated by the Patient Health Questionnaire-2 (PHQ-2). We defined pharmacotherapy for depressive symptoms as the prescription of any antidepressant, antipsychotic, anxiolytic, or central nervous system stimulant for the "Clinical Classification Code" of mood disorders within the year sampled, and psychotherapy as any outpatient or office-based visit for "mood disorders" for that year sampled. We analyzed temporal trends and explanatory variables for treatment using the Cochran–Armitage test and logistic regression, respectively. Our sample included 2024 AWE, representing 1,736,023 patients nationwide. This included 517 AWE with SPDS (AWE-SPDS), representing 401,452 AWE, and 1507 AWE who screened negative for depressive symptoms (AWE-SNDS), representing 1,334,571 AWE. The prevalence of SPDS was 23.1% (95% confidence interval [CI]: 20.6%–25.8%). Women (odds ratio [OR]: 1.40, 95% CI: 1.05–1.87), patients ages 35–49 (OR: 1.83, 95% CI: 1.23–2.72; compared with patients ages 18–34), and patients with Charlson Comorbidity Index ≥ 1 (OR: 1.92, 95% CI: 1.41–2.61) had higher odds of SPDS. There was no significant change in depressive symptoms' prevalence or treatment in AWE between the epochs of 2004–2006 and 2013–2015. Despite a quarter of AWE in the United States with SPDS, fewer than half received treatment. This indicates a need for improved efforts to screen AWE for depression and treat appropriately. • On the Patient's Health Questionnaire-2, 23.1% of adults with epilepsy screen positive. • Of those who screen positive, 40.2% receive either pharmacotherapy or psychotherapy. • The prevalence of depression over time as well as treatment for depression from 2004 to 2015 has not significantly increased. [ABSTRACT FROM AUTHOR]

Abstract. A case of cerebral cysticercosis in an American child is described. The patient was only 2 years old and had never left the United States. IIer symptoms began with febrile seizures and progressed to focal motor seizures. Cerebrospinal fuid pleocytosis with eosinophilia, candle-guttering of the walls of the ventricles on pneumoencephalography, and a titer of 1:4,096 against cysticercosis antigen in her blood led to the diagnosis. Over a five-year follow-up period, the patient's course has been one of resolution of her symptoms, improvement in her electroencephalogram, and excellent seizure control with anticonvulsant therapy. Cysticercosis should be considered in the differential diagnosis of a child who shows CSF pleocytosis with eosinophilia, particularly if accompanied by focal seizures. [ABSTRACT FROM AUTHOR]

The Federal Food, Drug, and Cosmetic Act (the FD&C Act) authorizes the Food and Drug Administration (FDA or Agency) to award priority review vouchers (PRVs) to tropical disease product applicants when the applications meet certain criteria. The FD&C Act lists the diseases that are considered to be tropical diseases for purposes of obtaining PRVs, and also provides for Agency expansion of that list to include other diseases that satisfy the definition of ``tropical diseases'' as set forth in the FD&C Act. FDA has determined that Chagas disease and neurocysticercosis satisfy this definition, and therefore is adding them to the list of designated tropical diseases whose product applications may result in the award of PRVs. Sponsors submitting certain applications for the treatment of Chagas disease and neurocysticercosis may be eligible to receive a PRV if such applications are approved by FDA.

Neurocysticercosis, brain infection with Taenia solium larval cysts, causes substantial neurologic illness around the world. To assess the effect of neurocysticercosis in the United States, we reviewed hospitalization discharge data in the Nationwide Inpatient Sample for 2003-2012 and found an estimated 18,584 hospitalizations for neurocysticercosis and associated hospital charges totaling >US $908 million. The risk for hospitalization was highest among Hispanics (2.5/100,000 population), a rate 35 times higher than that for the non-Hispanic white population. Nearly three-quarters of all hospitalized patients with neurocysticercosis were Hispanic. Male sex and age 20-44 years also incurred increased risk. In addition, hospitalizations and associated charges related to cysticercosis far exceeded those for malaria and were greater than for those for all other neglected tropical diseases combined. Neurocysticercosis is an increasing public health concern in the United States, especially among Hispanics, and costs the US health care system a substantial amount of money.