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Background: Neurocysticercosis (NCC) is a parasitic infection acquired by consuming food and water contaminated by the faeces of a Taenia solium tapeworm carrier. It is an important cause of acquired seizures and also the common identifiable cause of new-onset seizures in children., Methods: A hospital-based prospective cross-sectional study of NCC was undertaken in a medical college in north-west India. All patients aged 1-15 years admitted to the paediatric emergency room with a first-onset seizure were selected.NCC was diagnosed and staged on the basis of MRI findings. A structured, pretested schedule was administered to each patient's parent for analysis of risk factors for NCC., Results: Of 79 patients with first-onset seizure, 43 (54.4% were diagnosed with NCC based on MRI findings. The association of NCC with age and pig-rearing near the patients' homes was statistically significant ( p = 0.01 and 0.02, respectively). The association between NCC and other risk factors such as gender, religion, father's occupation, parents' literacy, source and storage of drinking water, the washing and peeling of fruit and vegetables and distance of refuse disposal from residential areas was not statistically significant. Although open defaecation is an important risk factor for transmission of NCC, there was no significant association with NCC., Conclusion: In India, NCC is a common cause of first-onset seizure. The major risk factors are poor environmental sanitation and poor food and drinking water hygiene. NCC can be controlled and prevented by generating awareness of hygienic consumption of food and water and the provision of good sanitation.

Objective: Infections caused by the human immunodeficiency virus (HIV) and by the larvae of Taenia solium (i.e., cysticercosis) are still widespread in many developing countries. Both pathologies modify host immune status and it is possible that HIV infection may modulate the frequency and pathogeny of cysticercosis of the central nervous system (i.e., neurocysticercosis [NCC]). To describe published cases of NCC among HIV-positive patients and to evaluate whether the characteristics of NCC, including frequency, symptoms, radiological appearance, and response to treatment differed between HIV-positive and HIV-negative patients., Methods: Forty cases of NCC/HIV co-infected patients were identified in the literature. Clinical and radiological characteristics, as well as response to treatment, were compared with non-matching historical series of NCC patients without HIV infection., Results: Most of these patients had seizures and multiple vesicular parasites located in parenchyma. Clinical and radiological characteristics were similar between HIV-positive and HIV-negative patients with NCC, as well as between immunocompromised and non-immunocompromised HIV-positive patients., Conclusion: Our review did not reveal clear interactions between HIV and NCC. This may be partially due to the small number of cases and reliance on published research. A systematic, multi-institutional effort aiming to report all the cases of this dual pathology is needed to confirm this finding and to clarify the possible relationship between both pathogens.

Background: Accurate and early diagnosis of neurocysticercosis (NCC) remains a challenge due to the heterogeneity of its clinical, immunological and imaging characteristics. The presence of cysticercus DNA in cerebrospinal fluid (CSF) of NCC patients has been previously detected via conventional PCR assays. To the best of our knowledge, the use of CSF Next-Generation Sequencing (NGS) based pathogen analysis in patients with NCC infection has never been reported., Case Presentation: This study reports the clinical, imaging, and immunological features of a patient initially presenting with several months of headache who further developed a pure sensory stroke. NGS was used to detect the pathogen, and her CSF demonstrated the presence of Taenia solium-DNA. This finding was confirmed by a positive reaction to CSF cysticercosis antibodies. After antiparasitic treatment, secondary CSF NGS revealed the DNA index have dropped considerably compared to the initial NGS readings., Conclusions: NGS is a promising tool for the early and accurate diagnosis of central nervous system (CNS) infection, especially in the setting of atypical clinical manifestations. Further studies are required to evaluate the persistence of DNA in the CSF of patients.

Neurocysticercosis causes substantial neurologic morbidity in endemic regions around the world. In this cross-sectional study, we describe the frequency of neurocysticercosis among a presumed high-risk group of people in an endemic community in northern Peru. Participants who screened positive on a nine-question seizure survey were evaluated clinically to diagnose epilepsy using International League Against Epilepsy criteria. Those with epilepsy were offered a noncontrast computerized tomography (CT) of the head. We also tested sera from all participants using the lentil lectin-bound glycoprotein enzyme-linked immunoelectrotransfer blot (EITB) to detect anti-cysticercus antibodies and enzyme-linked immunosorbent assay (ELISA) B60/B158 to detect cysticercosis antigens. Participants with strongly positive ELISA (ratio ≥ 3) were offered a noncontrast magnetic resonance imaging (MRI) of the brain. We diagnosed 16 cases of epilepsy among 527 people screened (lifetime prevalence 30 per 1,000). Twelve with epilepsy accepted CT scan and five (41.7%) had parenchymal calcifications. None had viable cysts. Of the 514 who provided a blood sample, 241 (46.9%) were seropositive by EITB and 12 (2.9%) were strongly positive by ELISA (ratio ≥ 3). Eleven accepted MRI and eight (72.3%) had neurocysticercosis, including five with extraparenchymal cysts, five with parenchymal vesicular cysts, and two with parenchymal granulomas. These findings show that clinically relevant forms of neurocysticercosis and epilepsy can be found by applying screening interventions in communities endemic to Taenia solium . Longitudinal controlled studies are needed to better understand which subgroups are at highest risk and which are most likely to have improved prognosis as a result of screening.

Solitary cysticercus granuloma is a common neuroimaging abnormality in Indian patients with new-onset epilepsy. Calcific transformation of cysticercus granuloma is frequently associated with seizure recurrence. We evaluated predictors of lesion calcification in patients with solitary cysticercus granuloma and new-onset seizures. One hundred twenty-two patients, with new-onset seizures and a solitary cysticercus granuloma of the brain, were enrolled. All patients were clinically and radiologically evaluated and were treated with antiepileptic drug drugs. No patient received albendazole or corticosteroids. The follow-up period was of 1 year. Follow-up computed tomography was performed after 3 and 6 months. In 68 (54.8%) patients, solitary cysticercus granuloma had transformed into a calcified lesion. On logistic regression analysis, moderate-to-severe edema was a significant factor that predicted calcific transformation of the cysticercus granuloma (odds ratio: 3.325; 95% confidence interval: 1.502-7.362). During 1 year of follow-up, 19 (15.6%) patients experienced seizure recurrence. In 16 patients with seizure recurrence, cysticercus granuloma had transformed in to a calcified lesion. In conclusion, in solitary cysticercus granuloma, calcification of the lesion can be predicted if larger amount of perilesional edema is present. Calcification of the granuloma significantly predicts seizure recurrence., (© The American Society of Tropical Medicine and Hygiene.)

We tested refugee camp residents on the Thailand-Myanmar border for Taenia solium infection. Taeniasis prevalence was consistent with that for other disease-endemic regions, but seropositivity indicating T. solium taeniasis was rare. Seropositivity indicating cysticercosis was 5.5% in humans, and 3.2% in pigs. Corralling pigs and providing latrines may control transmission of these tapeworms within this camp.

Background: Neurocysticercosis (NCC) is an important cause of adult-onset seizures in endemic areas, whereas it is emerging in some nonendemic areas as well because of extensive immigration., Method: We describe three cases of imported NCC recently admitted to San Bortolo Hospital in Vicenza, located in Northern Italy., Results: All patients were immigrants. One patient was human immunodeficiency virus positive with severe immunosuppression. The diagnosis of NCC was made on the basis of magnetic resonance results; failure of anti-Toxoplasma, antitubercular, and antifungal therapy; and regression of the cystic lesions after empiric therapy with albendazole. Serology was positive in only one case. In one patient, NCC was diagnosed by biopsy of the brain lesion., Conclusion: In nonendemic countries, NCC should be included in the differential diagnosis of all patients coming from endemic areas with seizures, hydrocephalus, and compatible lesions on brain imaging. Long-term follow-up is required but may be difficult to implement because these patients tend to move in search of employment. Screening of patient's household contacts for Taenia solium infection should always be carried out., (© 2013 International Society of Travel Medicine.)

We report disseminated cysticercosis concurrent with taeniasis in a 31-year-old male Japanese, who had visited India three times and stayed for 1 month each time during the previous 1 year. The patient presented increasing numbers of subcutaneous nodules and expelled proglottids, although numerous cysts were also found in the brain in imaging findings, though no neurological symptoms were observed. Histopathological and serological findings strongly indicated cysticercosis. We found taeniid eggs in his stool by microscopic examination and revealed them as the Indian haplotype of Taenia solium by mitochondrial DNA analysis. We concluded that disseminated cysticercosis was caused by the secondary autoinfection with eggs released from the tapeworm carrier himself. After confirming the absence of adult worms in the intestine by copro-polymerase chain reaction, the patient was successfully treated with albendazole at a dose of 15 mg/kg/day for 28 days. Subcutaneous and intracranial lesions had completely disappeared by the end of the treatment period.

Background: in endemic areas, neurocysticercosis appears mainly as a single, large, spherical and non-enhancing intracranial cyst., Case Presentation: an atypical case of neurocysticercosis (NCC) in a French Caucasian, without history of travel to endemic areas, was confirmed by histology and molecular speciation. Imaging was atypical, showing several hook-bearing scolices visible in the cyst, while the serology employed was non-contributary., Conclusions: NCC should be considered when multiple taeniid scolices are observed within the same cystic lesion.

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.

Histopathological specimen of a neurocysticercosis patient, who had been living in several endemic countries, was retrospectively analyzed for assessing the origin of the infection. Mitochondrial DNA analysis strongly suggested that the patient became infected with the parasite in Nepal at least 10 years before the onset of the disease.

Parasitic organisms are incapable of de novo fatty acid synthesis due to a down-regulated expression of enzymes involved in the oxygen-dependent pathway. We investigated the uptake of host lipids by a 150-kDa hydrophobic ligand-binding protein (HLBP) of Taenia solium metacestode, an agent causative of neurocysticercosis. The protein was found to be a hetero-oligomeric complex consisting of multiple subunits (M(r) 7, 10, and 15 kDa within pH 8.0-9.7), which may originate from four unique genes of 7- and 10-kDa gene families with 2-3 polymorphic alleles/paralogs. The 15-kDa protein represented glycosylated forms of the 10-kDa. With high binding affinity to lipid analogs, these subunits evidenced high-level sequence identity with other cestode HLBPs and form a novel clade associated with excretory-secretory type HLBP. In vitro experiments with viable worms suggested that the excreted 150-kDa protein might bind to lipids, and participate in the translocation of host lipids across the syncytial membrane. This process was substantially inhibited by the specific anti-150 kDa antibodies. The protein was localized in the parasite syncytium and in the lipid droplets within host granuloma wall, where significant lipase activity was expressed. HLBP-mediated uptake of the host lipid may be critical for the parasite survival and thus could be targeted by chemotherapeutics and/or vaccine.

The blood brain barrier (BBB) and the blood-cerebrospinal fluid barrier (BCB) limit the influx of immune mediators and bloodstream compounds into the central nervous system (CNS). Upon injury or infection, the integrity of these barriers is compromised and leukocyte infiltration occurs. The BCB is located in the choroid plexuses (CPs) found within ventricles of the brain, and it is considered one of the main routes of cellular infiltration into the CNS into healthy individuals. Our group recently showed that in a murine model of neurocysticercosis (NCC), there is a moderate increase in infiltration of leukocytes into ventricles, but the BCB is hardly compromised. To elucidate the role played by CPs and surrounding ependyma in leukocyte infiltration at ventricular sites, we analyzed changes in the expression of junctional complex proteins in animals intracranially infected with Mesocestoides corti. The results indicate that infection does not change the expression pattern of junctional complex proteins in CPs, but structural alterations and disappearance of these proteins were evident in ependyma adjacent to the internal leptomeninges. The kinetics and magnitude of these changes directly correlated with the extent of leukocyte infiltration through ependyma and with the expression and activity of MMPs. The results of this study indicate that the anatomical elements of the BCB are minimally disrupted during the course of murine NCC. Thus, most of the leukocytes infiltrating ventricles appear to extravasate through pial vessels located in the internal leptomeninges juxtaposed to the ependyma layer and then traverse the ependyma cells. In addition, MMP activity seems to be involved in this process. These results provide evidence for a previously undescribed entry route for leukocytes into the CNS.

Neurocysticercosis is the most common cause of late-onset epilepsy in developing countries. The larval stage of Taenia solium is the causative agent of the disease. Recent advances in neuroimaging and serologic diagnostic techniques have led to increased recognition of its importance, but its pathogenesis is just beginning to be clarified. Experts now agree that the clinical manifestations, pathogenic mechanisms and optimal treatment vary with the number of parasites, their location and the degree of host inflammation. Symptomatic therapy (i.e., antiepileptic medications and, when indicated, surgery) is critically important but there are also important roles for antiparasitic and anti-inflammatory drugs. Neurocysticercosis is a potentially eradicable disease but this is probably unlikely to be achieved in the short term.

Introduction: Neurocysticercosis is an important cause of neurological disease in the world. Owing to massive emigration from endemic areas, its frequency has increased in developed countries. The present article reviews some of the specific features of this disease., Development: Cysticercosis occurs when man becomes the intermediary host of Taenia solium. The clinical presentation is pleomorphic and depends on the type, stage, location and number of lesions in the nervous system, as well as the host's response. For a correct diagnostic approach, an adequate interpretation of the clinical manifestations, neuro-imaging and immunodiagnosis conducted in an appropriate epidemiological context is required. The most frequent clinical manifestations are epilepsy, focal deficit, intra-cranial hypertension, and cognitive impairment. Imaging studies show pathognomic signs such as escolex and others that are not specific. The features of this parasitosis may be different in children. Partial crises and single parenchymatous cysts are the most frequent clinical and imaging manifestations of neurocysticercosis in children. Immunobiological tests in blood and cerebrospinal fluid have constraints in terms of sensitivity and specificity. Praziquantel and albendazole are the cyst-killing drugs that have proven to be most effective. Surgery plays an especially important role in hydrocephalus and ventricular cysts. Extra-parenchymatous neurocysticercosis has a poor prognosis., Conclusion: Neurocysticercosis is a potentially eradicable disease. Health measures and the improvement of health systems can control transmission to man.

Neurocysticercosis (NC), a parasitic disease caused by Taenia solium, may be either asymptomatic or have mild to severe symptoms due to several factors. In this study, the immunological factors that underlie NC pleomorphism were studied. Ten of the 132 inhabitants of a rural community in Mexico (Tepez) had a computerized tomography (CT) scan compatible with calcified NC, and all were asymptomatic. Their immunological profiles were compared with those of 122 CT scan negative (non-NC) subjects from the same village. NC was associated with a TH2 response (IgG4, IL-4, IL-5, IL-13). Subjects from Tepez had higher levels of specific antibodies (IgG1, IgG2, IgG4, IgE) and specific cell proliferation than subjects from an area with low exposure (Ensenada). This suggests that non-NC subjects from Tepez had been exposed to T. solium and resisted infection in the brain. Distinct immunological profiles in equally exposed individuals differing in outcome of infection support the hypothesis of host-related factors in resistance to and pathogenesis of NC. This is the first study reporting the immunological profile associated with the asymptomatic form of NC.

Epidemiologic data suggest that 30-40% of Taenia solium-seropositive people become spontaneously negative without acquiring cysticercosis. To compare the responses of these individuals with those of patients with neurocysticercosis, we screened seropositive persons among family members of 16 patients. We searched for specific antibodies in patients and their 118 households by an enzyme-linked immunoelectrotransfer blot assay using specific glycoproteins of T. solium metacestodes. We found six seropositive individuals without neurocysticercosis among members of four families. The matching patients were young, harbored viable cysts, and had short evolution of disease. The baseline response of healthy seropositive individuals was scarce and showed a low frequency of antibodies against glycoproteins GP39-42 and GP24, which are immunodominant in patients with neurocysticercosis. Moreover, they became spontaneously negative in few months. The response of patients was heterogeneous as shown in other studies. The results of this work support a highly dynamic host-parasite immunologic interaction and suggest individual susceptibility or level of exposure among family members.

In the neurosurgical services in many developing countries, treatment of neurocysticercosis (NCC) accounts for greater than 10% of brain surgical procedures and approximately 15% of neurological consultations. In these areas brain cysticercosis is the leading cause of hydrocephalus in adults and the first cause of late-onset epilepsy. During the last two decades, successful medical treatment has been established. Additionally, neuroimaging and immunological studies have clearly defined the topography, pathophysiological mechanisms, and biological status of these lesions. Thus, selection of cases for medical or surgical treatment has improved; in a significant number of cases, both interventions are required. New therapies with either albendazole or praziquantel have respectively reduced to 8 days and to 1 day the course of anticysticidal therapy, which now is fast, effective, inexpensive, atoxic, and convenient, particularly in endemic areas where most patients belong to the lower socioeconomic groups. Additionally, the rational use of steroid agents facilitates the treatment of inflammation, a conspicuous accompaniment in cases of NCC. A major effort, however, is still required to eradicate this disease.

This study examined the seroprevalence and serum antibody isotype profile for Taenia solium cysticercosis in an Amerindian community in the Amazonas state of Venezuela. An antigen-trapping enzyme-linked immunosorbent assay (Ag-ELISA) was used to detect viable cysticercosis. Indirect ELISA (Ab-ELISA) and enzyme-linked immunoelectrotransfer blot (EITB) was performed by using antigens prepared from T. solium metacestodes to detect anti-parasite antibodies. The Ag-ELISA and Ab-ELISAs revealed 64.7% and 79.0% seropositivity, respectively, in the Amerindian population. Immunoglobulin (Ig) M was the predominant antibody class, suggesting recent infection. In comparison sera from, clinically defined, hospital neurocysticercosis cases revealed only 27% seropositivity by Ag-ELISA, compared with 86-92% seropositivity by Ab-ELISA, and IgG4 was the predominant antibody subclass detected. The EITB antigen recognition patterns of the hospitalized patients were very similar to that of the Amerindians, confirming exposure to the parasite. These results, combined with the predominance of IgM antibody responses and the marked detection of secreted products of viable parasites, strongly suggest that recent exposure to T. solium had occurred in the Amerindian population.

Neurocysticercosis is now recognized as a common cause of neurologic disease in developing countries and the United States. The pathogenesis and clinical manifestations vary with the site of infection and accompanying host response. Inactive infection should be treated symptomatically. Active parenchymal infection results from an inflammatory reaction to the degenerating cysticercus and will also respond to symptomatic treatment. Controlled trials have not demonstrated a clinical benefit for antiparasitic drugs. Ventricular neurocysticercosis often causes obstructive hydrocephalus. Surgical intervention, especially cerebrospinal fluid diversion, is the key to management of hydrocephalus. Shunt failure may be less frequent when patients are treated with prednisone and/or antiparasitic drugs. Subarachnoid cysticercosis is associated with arachnoiditis. The arachnoiditis may result in meningitis, vasculitis with stroke, or hydrocephalus. Patients should be treated with corticosteroids, antiparasitic drugs, and shunting if hydrocephalus is present.

Neurocysticercosis is an infection of the nervous system caused by Taenia solium. It is the most important human parasitic neurological disease and a common cause of epilepsy in Africa, Asia, and Latin America, representing enormous costs for anticonvulsants, medical resources and lost production. Neurocysticercosis is a human-to-human infection, acquired by the faecal-enteric route from carriers of intestinal T. solium, most often in areas with deficient sanitation. Intestinal tapeworms cause few symptoms, but adult taeniae carried by humans release large numbers of infective eggs and are extremely contagious. Ingestion of poorly cooked pig meat infested with T. solium larvae results in intestinal taeniosis but not neurocysticercosis. With a view to hastening the control of taeniosis and neurocysticercosis we propose that neurocysticercosis be declared an international reportable disease. New cases of neurocysticercosis should be reported by physicians or hospital administrators to their health ministries. An epidemiological intervention could then be launched to interrupt the chain of transmission by: (1) searching for, treating and reporting the sources of contagion, i.e. human carriers of tapeworms; (2) identifying and treating other exposed contacts; (3) providing health education on parasite transmission and improvement of hygiene and sanitary conditions; and (4) enforcing meat inspection policies and limiting the animal reservoir by treatment of pigs. We believe that the first step required to solve the problem of neurocysticercosis is to implement appropriate surveillance mechanisms under the responsibility of ministries of health. Compulsory notification also has the major advantage of providing accurate quantification of the incidence and prevalence of neurocysticercosis at regional level, thus permitting the rational use of resources in eradication campaigns.

To identify epitopes for antibodies present in cerebrospinal fluid (CSF) samples from two patients with confirmed neurocysticercosis, we used a phage peptide library that displayed random dodecapeptides as a fusion to the minor coat protein (pIII) of phage M13. To increase the specificity of selection, plates coated with anti-human Fc antibody were used in five rounds of biopanning. The DNA inserts of 30 selected clones were determined and the deduced amino acid sequences were analyzed. Sequence similarities between affinity-selected clones and three known T. solium and T. crassiceps proteins were encountered. Two phage clones have been shown to react in enzyme-linked immunosorbent assay with CSF samples from other patients with neurocysticercosis, and no reaction was observed with CSF samples from patients with other neurological disorders used as negative controls. Our results suggest that affinity selection of peptides from phage libraries using CSF samples from patients is an attractive tool for the development of novel reagents for a simple and sensitive immunodiagnostic test and for understanding the molecular mechanisms participating in the pathogenesis of neurocysticercosis.

Neurocysticercosis is rarely reported in short-term travelers, although the disease remains a major public health problem in tropical regions. We present a case of neurocysticercosis that was probably acquired by ingestion of Taenia solium eggs contained in the stomach of a pig butchered by the traveler. Complete clinical resolution was obtained by medical treatment, underlying the importance of early suspicion and diagnosis of the disease.