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Background: Viral gastrointestinal infections remain a major public health concern in developing countries. In Burkina Faso, there are very limited updated data on the circulating viruses and their genetic diversity. Objectives: This study investigates the detection rates and characteristics of rotavirus A (RVA), norovirus (NoV), sapovirus (SaV) and human astrovirus (HAstV) in patients of all ages with acute gastrointestinal infection in urban and rural areas. Study design & Methods: From 2018 to 2021, stool samples from 1,295 patients with acute gastroenteritis were collected and screened for RVA, NoV, SaV and HAstV. Genotyping and phylogenetic analyses were performed on a subset of samples. Results: At least one virus was detected in 34.1% of samples. NoV and SaV were predominant with detection rates of respectively 10.5 and 8.8%. We identified rare genotypes of NoV GII, RVA and HAstV, recombinant HAstV strains and a potential zoonotic RVA transmission event. Conclusions: We give an up-to-date epidemiological picture of enteric viruses in Burkina Faso, showing a decrease in prevalence but a high diversity of circulating strains. However, viral gastroenteritis remains a public health burden, particularly in pediatric settings. Our data advocate for the implementation of routine viral surveillance and updated management algorithms for diarrheal disease. Author summary: Diseases of the gastrointestinal tract can be caused by a variety of pathogens, such as bacteria, viruses, fungi or parasites. Viruses play a particularly important role, especially in low-income countries, where viral gastroenteritis leads to high morbidity and mortality, particularly among children and the elderly. As part of the African Network for Improved Diagnostics, Epidemiology and Management of Common Infectious Agents (ANDEMIA), patients of all ages from four African countries with symptoms of acute gastroenteritis were tested for the most common viral, bacterial and parasitic pathogens. Samples from Burkina Faso that tested positive for noroviruses, rotaviruses, sapoviruses or astroviruses were further genotyped and characterized in the present study. In this study we described for the first time the detection of rare rotavirus and astrovirus strains circulating in Burkinabe patients. The knowledge about the circulating virus variants is essential to develop suitable vaccines and adequate pharmaceuticals. [ABSTRACT FROM AUTHOR]

The introduction of antiretroviral therapy (ART) has successfully changed the clinical course of people with HIV, leading to a significant decline in the incidence of HIV-related neurocognitive disorders. Integrase strand transferase inhibitors (INSTI) are recommended and preferred first-line ART for the treatment of HIV-1 infection in ART-naïve subjects. This type of therapy regimen is expected to have higher CNS penetration, which may bring more cognitive stability or even make significant cognitive improvement in people with HIV. The study aimed to follow up on neurocognitive performance in HIV subjects on two types of INSTI therapy regimens at two-time points, one year apart. The study sample consisted of 61 ART naïve male participants, of which 32 were prescribed raltegravir (RAL) and 29 dolutegravir (DTG). There was no significant difference between subsamples according to the main sociodemographic (age, education level) and clinical characteristics (duration of therapy, nadir CD4 cells level, CD4 cells count, CD8 cells, CD4/CD8 ratio). For neurocognitive assessment, six measures were used: general cognitive ability (MoCA test), verbal fluency (total sum score for phonemic and category fluency), verbal working memory (digit span forward), cognitive capacity (digit span backwards), sustained attention (Color Trail Test 1), and divided attention (Color Trail Test 2). In both therapy groups (RAL and DTG), there was no significant decrease in neurocognitive achievement on all used measures over a one-year follow-up in both therapy groups. A statistically significant interactive effect of time and type of therapy was found on the measure of divided attention—DTG group showed slight improvement, whereas RAL group showed slight decrease in performance. During the one-year follow-up of persons on INSTI-based regimen, no significant changes in cognitive achievement were recorded, which suggests that the existing therapy can have a potentially positive effect on the maintenance of neurocognitive achievement. [ABSTRACT FROM AUTHOR]

Human African trypanosomiasis (HAT), or sleeping sickness, continues to be a major threat to human health in 36 countries throughout sub-Saharan Africa with up to 60 million people at risk. Over the last decade, there have been several advances in this area, some of which are discussed in this overview. Due to the concerted efforts of several bodies, including better identification and treatment of cases and improved tsetse fly vector control, the number of cases of HAT has declined dramatically. The clinical heterogeneity of HAT has also been increasingly recognized, and the disease, while usually fatal if untreated or inadequately treated, does not always have a uniformly fatal outcome. Improved methods of HAT diagnosis have now been developed including rapid diagnostic tests. Novel drug treatment of HAT has also been developed, notably nifurtimox–eflornithine combination therapy (NECT) for late-stage Trypanosoma brucei gambiense , oral fexinidazole for early and the early component of the late-stage of T.b. gambiense , and the new oral compounds of the oxaborole group, which have shown considerable promise in field trials. Advances in HAT neuropathogenesis have been steady, though largely incremental, with a particular focus on the role of the blood–brain barrier in parasite entry into the central nervous system and the relevant importance of both innate and adaptive immunity. While the World Health Organization goal of elimination of HAT as a public health problem by 2020 has probably been achieved, it remains to be seen whether the second more ambitious goal of interruption of transmission of HAT by 2030 will be attained. [ABSTRACT FROM AUTHOR]

To study the rare and unusual causes of monocular elevation deficit. Five patients presenting to us with diplopia and elevation deficit were thoroughly examined and were found to have monocular elevation deficit due to rare causes. All five were found to have different underlying etiologies – iatrogenic, sphenoid wing meningioma, cysticercosis, sarcoidosis and mid brain infarct, and were managed appropriately. Monocular Elevation Deficit can occur due to a variety of causes. Having a high index of suspicion for the more serious etiologies is of utmost importance. Thorough clinical examination and imaging help clinch the diagnosis. [ABSTRACT FROM AUTHOR]

Objective Neurocysticercosis (NCC) is one of the most common parasitic infections of the central nervous system. We present a case study of a 21-year-old African man with an isolated NCC lesion to the left middle frontal gyrus, which is also known as the dorsolateral prefrontal cortex (dlPFC). Method A neuropsychological evaluation was requested by the patient's inpatient psychiatry team regarding worsening attention and depressive symptoms approximately 6 months after NCC diagnosis and treatment. Results Neuropsychological findings revealed deficits in the aspects of executive functioning, attention, working memory, and significant depressive symptoms. Conclusion To our knowledge, this is the first case study of its kind demonstrating deficits in cognitive functioning consistent with the dlPFC lesion location. Sociocultural and linguistic considerations, clinical findings, and limitations are discussed. [ABSTRACT FROM AUTHOR]

This study aimed to investigate the potential mechanisms associated with the persistence of chloramphenicol (CHP) resistance in Escherichia coli and Salmonella enterica isolated from pigs, pork, and humans in Thailand. The CHP-resistant E. coli (n = 106) and Salmonella (n = 57) isolates were tested for their CHP susceptibility in the presence and absence of phenylalanine arginine β-naphthylamide (PAβN). The potential co-selection of CHP resistance was investigated through conjugation experiments. Whole genome sequencing (WGS) was performed to analyze the E. coli (E329, E333, and E290) and Salmonella (SA448, SA461, and SA515) isolates with high CHP MIC (32–256 μg/mL) and predominant plasmid replicon types. The presence of PAβN significantly reduced the CHP MICs (≥4-fold) in most E. coli (67.9%) and Salmonella (64.9%). Ampicillin, tetracycline, and streptomycin co-selected for CHP-resistant Salmonella and E. coli-transconjugants carrying cmlA. IncF plasmids were mostly detected in cmlA carrying Salmonella (IncFIIAs) and E. coli (IncFIB and IncF) transconjugants. The WGS analysis revealed that class1 integrons with cmlA1 gene cassette flanked by IS26 and TnAs1 were located on IncX1 plasmid, IncFIA(HI1)/HI1B plasmids and IncFII/FIB plasmids. IncFIA(HI1)/HI1B/Q1in SA448 contained catA flanked by IS1B and TnAs3. In conclusion, cross resistance through proton motive force-dependent mechanisms and co-selection by other antimicrobial agents involved the persistence of CHP-resistance in E. coli in this collection. Dissemination of CHP-resistance genes was potentially facilitated by mobilization via mobile genetic elements. [ABSTRACT FROM AUTHOR]

Background: Porcine cysticercosis, a serious zoonotic parasitic disease, is caused by the larvae of Taenia solium and has been acknowledged by the World Organization for Animal Health. The current detection methods of Cysticercus cellulosae cannot meet the needs of large-scale and rapid detection in the field. We hypothesized that the immunofluorescence chromatography test strip (ICS) for detecting Cysticercus cellulosae, according to optimization of a series of reaction systems was conducted, and sensitivity, specificity, and stability testing, and was finally compared with ELISA. This method utilizes Eu3+-labeled time-resolved fluorescent microspheres (TRFM) coupled with TSOL18 antigen to detect TSOL18 antibodies in infected pig sera. Results: ICS and autopsy have highly consistent diagnostic results (n = 133), as determined by Cohen's κ analysis (κ = 0.925). And the results showed that the proposed ICS are high sensitivity (0.9459) with specificity (0.9792). The ICS was unable to detect positive samples of other parasites. It can be stored for at least six months at 4℃. Conclusions: In summary, we established a TRFM-ICS method with higher sensitivity and specificity than indirect ELISA. Results obtained from serum samples can be read within 10 min, indicating a rapid, user-friendly test suitable for large-scale field detection. [ABSTRACT FROM AUTHOR]

Subarachnoid neurocysticercosis can be challenging to recognize, which often leads to a delay in diagnosis. We report 3 cases presenting as chronic headache disorders that highlight the unique manifestations seen with this form of neurocysticercosis and the role that the infectious diseases consultant can play in ensuring a timely diagnosis. [ABSTRACT FROM AUTHOR]

The excretory–secretory proteome plays a pivotal role in both intercellular communication during disease progression and immune escape mechanisms of various pathogens including cestode parasites like Taenia solium. The cysticerci of T. solium causes infection in the central nervous system known as neurocysticercosis (NCC), which affects a significant population in developing countries. Extracellular vesicles (EVs) are 30–150‐nm‐sized particles and constitute a significant part of the secretome. However, the role of EV in NCC pathogenesis remains undetermined. Here, for the first time, we report that EV from T. solium larvae is abundant in metabolites that can negatively regulate PI3K/AKT pathway, efficiently internalized by macrophages to induce AKT and mTOR degradation through auto‐lysosomal route with a prominent increase in the ubiquitination of both proteins. This results in less ROS production and diminished bacterial killing capability among EV‐treated macrophages. Due to this, both macro‐autophagy and caspase‐linked apoptosis are upregulated, with a reduction of the autophagy substrate sequestome 1. In summary, we report that T. solium EV from viable cysts attenuates the AKT–mTOR pathway thereby promoting apoptosis in macrophages, and this may exert immunosuppression during an early viable stage of the parasite in NCC, which is primarily asymptomatic. Further investigation on EV‐mediated immune suppression revealed that the EV can protect the mice from DSS‐induced colitis and improve colon architecture. These findings shed light on the previously unknown role of T. solium EV and the therapeutic role of their immune suppression potential. [ABSTRACT FROM AUTHOR]

The pork tapeworm Taenia solium causes human taeniasis and cysticercosis when ingested as viable cysts and eggs, respectively. Despite its high health burden in low-income countries, knowledge of the parasite in endemic areas such as Rwanda is often limited. Here, we assess whether The Vicious Worm education software can increase knowledge in endemic areas of Rwanda. A cross-sectional mixed-methods study was conducted to evaluate knowledge about T. solium among community health workers trained using the Vicious Worm education software. Knowledge was assessed before, immediately after, and four weeks after the training. The health workers perceptions of the software were analysed thematically. A total of 207 community health workers were recruited from Nyamagabe district in Southern Province, Rwanda. Participants were composed of males (33.5%) and females (66.5%), aged between 22 and 68 years, and most (71%) had only completed primary education. Knowledge of cysticercosis at baseline was low, particularly knowledge of human cysticercosis and neurocysticercosis. The overall knowledge score increased significantly after training and was maintained four weeks after the training. Overall, insufficient knowledge was associated with neurocysticercosis-related questions, which after the training, remained relatively lower compared to questions of other categories. Participants reported the software to be user-friendly and educational. Digital illiteracy and the lack of smartphones were among the critical challenges highlighted in responses. This study has shown gaps in knowledge regarding T. solium infections within rural Rwanda, particularly neurocysticercosis. Health education using the Vicious Worm education software should be considered in integrated control programs. Author summary: This research assessed the usefulness of a computer-based education tool for Taenia solium taeniasis/cysticercosis to train community health workers in Rwanda. The knowledge of health workers on the disease was assessed before the training, immediately after training, and four weeks later to determine baseline knowledge, knowledge uptake, and retention, respectively. The participants' scores showed a significant improvement in knowledge immediately after the training. Four weeks later, the evaluation showed maintenance of the knowledge for at least the short term. Although digital literacy and lack of smartphones/computer to use the tool was noted as the main challenge, the participants highlighted the structure, completeness, and clarity of the information in the tool, recommending it be used in other areas. [ABSTRACT FROM AUTHOR]

Background: Antigen detection in Taenia solium cysticercosis confirms viable infection in the intermediate host (either pig or human). The reference B158/B60 monoclonal antibody (mAb)-based Ag-enzyme-linked immunosorbent assay (ELISA) has acceptable levels of sensitivity and specificity in human neurocysticercosis with multiple brain cysts, although its sensitivity is lower in cases with single brain cysts, whereas in porcine cysticercosis the assay specificity is affected by its frequent cross-reaction with Taenia hydatigena, another common cestode found in pigs. Our group has produced 21 anti-T. solium mAbs reacting against antigens of the whole cyst, vesicular fluid, and secretory/excretory products, identifying TsW8/TsW5 as the most promising pair of mAbs for an Ag-ELISA. Methods: We report the use of the TsW8/TsW5 Ag-ELISA to measure cysticercus antigen levels [expressed as optical density (OD) values] in two panels of sera collected from day 0 (baseline) to day 90 postinfection (PI) from pigs experimentally infected with T. solium (n = 26) and T. hydatigena (n = 12). At baseline and on days 28 and 90 PI, we used Bland–Altman (BA) analysis and Lin's concordance correlation coefficients (CCC) to determine the concordance between the TsW8/TsW5 and the B158/B60 Ag-ELISA. Results: The TsW8/TsW5 Ag-ELISA was able to efficiently measure circulating antigen levels in T. solium-infected pigs, similar to that obtained with the B158/B60 Ag-ELISA. Almost all paired log-OD differences between assays were within the limits of agreement (LoA) in the BA analysis at baseline and on days 28 and 90 PI (92.3%, 100%, and 100%, respectively), and a high concordance of log-ODs between assays was also found (Lin's CCC: 0.69, 0.92, and 0.96, respectively, all P < 0.001). In pigs infected with T. hydatigena, almost all paired log-OD differences were within the LoA in the BA analysis, whereas the concordance of log-ODs between assays was low at baseline (Lin's CCC: 0.24) but increased on days 28 and 90 PI (Lins' CCC: 0.88 and 0.98, P < 0.001). Conclusions/significance: The TsW8/TsW5 Ag-ELISA recognizes antigens in pigs with T. solium cysticercosis and is highly concordant with the B158/B60 Ag-ELISA. However, its diagnostic use is hampered by cross-reactions with T. hydatigena, as in other mAb-based Ag-ELISAs. [ABSTRACT FROM AUTHOR]

Introduction: Seizure is the most common paediatric neurological condition with an increased predilection for early childhood. The recent definition of epilepsy includes first-onset seizures with an increased probability of future episodes. Thus, stringent evaluation of the initial episode of seizure is essential. Hence, this study estimated the aetiology, clinical profile, treatment and outcome of the first seizure episode in children at a tertiary hospital. Materials and Methods: This prospective observational study was carried out at a tertiary hospital in Barabanki, India. Children in the age group of 1 month to 12 years who presented with the first seizure episode and those admitted for other illnesses and developed the first seizure episode during hospital stay were included. Data collected were sociodemographics, clinical presentations, laboratory tests, brain imaging studies, electroencephalography (EEG), diagnosis, treatment and short-term outcomes. Results: A total of 113 patients were enrolled presenting with first-onset seizures. There were 78 (69%) males, 86 (76.1%) were below 5 years of age and 60 (53.1%) presented with fever. Most seizures had a generalised onset (58.4%). Febrile seizures (29.2%) were the most common type, followed by neurocysticercosis (20.3%). Central nervous system (CNS)-infective aetiology (58.7%) was the most common etiological classification. Abnormal findings were observed in cerebrospinal fluid examination of 24 out of 56, in brain imaging of 53 out of 80 and in EEG of 70 out of 113 cases examined. Anti-seizure medication (ASM) was prescribed to 68 patients, of which 10 had a recurrence in the 6-month follow-up period. Conclusion: The first episode of seizure in children usually had a generalised onset, with younger children of the male sex at an increased risk. CNS infections and febrile seizures were common causes. Complete history and neurological evaluation can guide the relevant investigations. ASM tailored to the aetiology controls the seizures in most cases. [ABSTRACT FROM AUTHOR]

Racemose neurocysticercosis (RNC) is a malignant form of Taenia solium infection. It carries high mortality due to widespread intraparenchymal invasion, mass effect, and cyst rupture. Cerebellar RNC is unusual and constitutes a surgical challenge. Scarce applications of ultrasound (US) -guided resection have been reported for RNC of the posterior fossa. We report the case of a 66-year-old woman who presented with ataxia and dysmetria. Her past medical history was relevant for seizures and hydrocephalus secondary to neurocysticercosis. Because of the increasing cyst invasion and threatening mass effect in the posterior fossa, the patient underwent US-guided resection of lesions. Postoperative computed tomography (CT) demonstrated complete excision of cysts, and a 2-year follow-up magnetic resonance imaging (MRI) showed no recurrence. On neurological examination, the patient had persistent ataxia without new-onset neurological deficits. The present case study illustrates the feasibility and cost-effective approach of US-guided resection to provide enhanced operative visualization and achieve complete cyst resection. [ABSTRACT FROM AUTHOR]

Intraorally, cysticercosis is regarded as uncommon and a diagnostic challenge. Here, we report a diagnostic conundrum of an unusual case of innocuous appearing lesion on the tongue presenting as moderately tender swelling finally diagnosed as lingual cysticercosis, based on USG (Ultrasound), CT (Computed Tomography) findings and characteristic histopathologic features. [ABSTRACT FROM AUTHOR]

CDKL5 deficiency disorder (CDD) is a neurodevelopmental condition characterized by global developmental delay, early-onset seizures, intellectual disability, visual and motor impairments. Unlike Rett Syndrome (RTT), CDD lacks a clear regression period. Patients with CDD frequently encounter gastrointestinal (GI) disturbances and exhibit signs of subclinical immune dysregulation. However, the underlying causes of these conditions remain elusive. Emerging studies indicate a potential connection between neurological disorders and gut microbiota, an area completely unexplored in CDD. We conducted a pioneering study, analyzing fecal microbiota composition in individuals with CDD (n = 17) and their healthy relatives (n = 17). Notably, differences in intestinal bacterial diversity and composition were identified in CDD patients. In particular, at genus level, CDD microbial communities were characterized by an increase in the relative abundance of Clostridium_AQ, Eggerthella, Streptococcus, and Erysipelatoclostridium, and by a decrease in Eubacterium, Dorea, Odoribacter, Intestinomonas, and Gemmiger, pointing toward a dysbiotic profile. We further investigated microbiota changes based on the severity of GI issues, seizure frequency, sleep disorders, food intake type, impairment in neuro-behavioral features and ambulation capacity. Enrichment in Lachnoclostridium and Enterobacteriaceae was observed in the microbiota of patients with more severe GI symptoms, while Clostridiaceae, Peptostreptococcaceae, Coriobacteriaceae, Erysipelotrichaceae, Christensenellaceae, and Ruminococcaceae were enriched in patients experiencing daily epileptic seizures. Our findings suggest a potential connection between CDD, microbiota and symptom severity. This study marks the first exploration of the gut-microbiota-brain axis in subjects with CDD. It adds to the growing body of research emphasizing the role of the gut microbiota in neurodevelopmental disorders and opens doors to potential interventions that target intestinal microbes with the aim of improving the lives of patients with CDD. [ABSTRACT FROM AUTHOR]

Background: Malaria remains a significant cause of morbidity and mortality in Ethiopia with an estimated 3.8 million cases in 2021 and 61% of the population living in areas at risk of malaria transmission. Throughout the country Plasmodium vivax and Plasmodium falciparum are co-endemic, and Duffy expression is highly heterogeneous. The public health significance of Duffy negativity in relation to P. vivax malaria in Ethiopia, however, remains unclear. This study seeks to explore the prevalence and rates of P. vivax malaria infection across Duffy phenotypes in clinical and community settings. Methods: A total of 9580 and 4667 subjects from community and health facilities from a malaria endemic site and an epidemic-prone site in western Ethiopia were enrolled and examined for P. vivax infection and Duffy expression from February 2018 to April 2021. Association between Duffy expression, P. vivax and P. falciparum infections were examined for samples collected from asymptomatic community volunteers and symptomatic subjects from health centres. Results: Infection rate of P. vivax among Duffy positives was 2–22 fold higher than Duffy negatives in asymptomatic volunteers from the community. Parasite positivity rate was 10–50 fold higher in Duffy positives than Duffy negatives among samples collected from febrile patients attending health centres and mixed P. vivax and P. falciparum infections were significantly more common than P. vivax mono infections among Duffy negative individuals. Plasmodium vivax parasitaemia measured by 18sRNA parasite gene copy number was similar between Duffy positives and Duffy negatives. Conclusions: Duffy negativity does not offer complete protection against infection by P. vivax, and cases of P. vivax in Duffy negatives are widespread in Ethiopia, being found in asymptomatic volunteers from communities and in febrile patients from health centres. These findings offer evidence for consideration when developing control and intervention strategies in areas of endemic P. vivax and Duffy heterogeneity. [ABSTRACT FROM AUTHOR]

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 solium remains among the major causes of epilepsy in sub-Saharan Africa. Understanding the geospatial distribution of the parasite is important to inform control strategies. This study assessed spatiotemporal changes in the T. solium infection among pigs from a rural area in southwestern Tanzania. Secondary data from a previous repeated cross-sectional study in the Mbeya and Mbozi districts were used, involving sixteen villages, eight from each of the two districts. Serum samples were collected from 482, 460, and 421 pigs in 221, 196, and 139 households, respectively, at seven-month intervals. Ag-ELISA was used to analyse the samples for circulating antigens. Geographic coordinates of the pig corrals adjacent to the households were also recorded using a hand-held GPS device. SatScan v9.7 software was used to perform purely spatial scan analysis, based on the Bernoulli distribution model. Spatial clustering was assumed based on the relative risk of T. solium seropositivity. Statistical significance (set at 0.05) of the cluster was determined by comparing the log-likelihood ratio with the null distribution derived by Monte Carlo simulations. The window with the highest log-likelihood ratio was regarded as a primary cluster. Results showed significant clustering of T. solium cases with the presence of a single primary cluster during each phase. The relative risk of T. solium infection among pigs within the primary cluster areas ranged from 3.0 to 6.7. The radii of the clusters expanded from 1.83 to 27.7 km before shrinking to 1.5 km, and cluster location drifted from north to central and then to the southern part of the study area. These findings suggest that with restricted resources, control measures in the area could be focused on pockets of high transmission. However, changes in the size and location of clusters suggest that to be effective, interventions should be instituted soon after clusters are identified. [ABSTRACT FROM AUTHOR]

Taenia hydatigena, an intestinal parasite of domestic and wild canids which can cause medical problems and economic losses in animals. Thirty T. hydatigena recovered from the intestine of stray dogs after T. hydatigena based on morphological characters and morphometric observations involving Scanning Electron Microscopy (SEM) and the scoleces were stained by Semichon's acid carmine and viewed on a light microscope. High-quality SEM photographs were shown the blade dimensions of both large and small hooks (83.89 µm and 48.16 µm) respectively, which was close to measurements by a digital camera. The number of hooks around the rostellum were 30 hooks, and both were equal in number (15 hooks), while the average length of the large hooks was 220.11 ±28.07 µm, and was 88.58 ±7.92, and the average length of small hooks was142.37 ±12.52 µm and was 65.73 ±6.94 µm. body surface of Taenia hydatigena presence of characteristic transverse cuticular striations. [ABSTRACT FROM AUTHOR]

Objectives: Neurocysticercosis (NC) is a heterogeneous disease particularly in terms of response to treatment and prognosis. Parasite localization is one of the main factors involved in this heterogeneity. In this study we aim to determine whether differences in the duration of the preclinical phase associated with parasite location, could contribute to said heterogeneity. Methods: Ninety‐nine patients were included, 24 with parasites in the parenchyma (PAR), 56 in the subarachnoid (SA) space and 19 in the ventricular system (IV). A questionnaire designed to assess exposure to classic NC risk factors 5, 10, 15, 20 and more than 20 years prior to diagnosis was applied. The results were compared between the three groups. Also, asymptomatic relatives of patients who had shared their living conditions in childhood or more recently were included and underwent brain scan and blood testing for specific antibodies. Results: Over the course of their lives, exposure to risk factors decreased significantly for all patients, although the decrease was more evident in patients with parasites in the SA space (p < 0.001) compared to patients with PAR (p = 0.011) or IV cysts (p = 0.020). Five years prior to diagnosis, exposure to risk factors was significantly higher in patients with PAR or IV NC than in patients with SA NC (p = 0.04). Furthermore, individuals in close contact with PAR or IV patients in the years preceding diagnosis were more likely to have asymptomatic NC, specific antibodies in sera, particularly IgM, compared to individuals in close contact with SA patients during the same period. Conclusions: All these findings are highly suggestive of the possibility of a more recent infection of patients affected by parenchymal and ventricular NC than of patients with subarachnoid NC. Consequently, subarachnoid disease could be considered a chronic disease, which, probably contributes to the severity of the disease as well as the minimal response to medical treatment. [ABSTRACT FROM AUTHOR]

Background Persistent inflammation related to aging ("inflammaging") is exacerbated by chronic infections and contributes to frailty in older adults. We hypothesized associations between Toxoplasma gondii (T. gondii), a common parasite causing an oligosymptomatic unremitting infection, and frailty, and secondarily between T. gondii and previously reported markers of immune activation in frailty. Methods We analyzed available demographic, social, and clinical data in Spanish and Portuguese older adults [ N = 601; age: mean (SD) 77.3 (8.0); 61% women]. Plasma T. gondii immunoglobulin G (IgG) serointensity was measured with an enzyme-linked immunosorbent assay. The Fried criteria were used to define frailty status. Validated translations of Mini-Mental State Examination, Geriatric Depression Scale, and the Charlson Comorbidity Index were used to evaluate confounders. Previously analyzed biomarkers that were significantly associated with frailty in both prior reports and the current study, and also related to T. gondii serointensity, were further accounted for in multivariable logistic models with frailty as outcome. Results In T. gondii -seropositives, there was a significant positive association between T. gondii IgG serointensity and frailty, accounting for age (p =.0002), and resisting adjustment for multiple successive confounders. Among biomarkers linked with frailty, kynurenine/tryptophan and soluble tumor necrosis factor receptor II were positively associated with T. gondii serointensity in seropositives (p <.05). Associations with other biomarkers were not significant. Conclusions This first reported association between T. gondii and frailty is limited by a cross-sectional design and warrants replication. While certain biomarkers of inflammaging were associated with both T. gondii IgG serointensity and frailty, they did not fully mediate the T. gondii –frailty association. [ABSTRACT FROM AUTHOR]

Paragonimiasis is a common zoonotic parasitic disease. The retinoic acid-inducible gene I (RIG-I) signaling is very important for the host to recognize invading pathogens (especially viruses and bacteria). However, the role of RIG-I signaling in the early stages of P. proliferus infection remains unclear. Therefore, in this study, Sprague-Dawley (SD) rat models with lung damage caused by P. proliferus were established. Experimental methods including Enzyme-linked Immuno Sorbent Assay (ELISA), real-time fluorescent quantitative polymerase chain reaction (PCR), western blotting, and hematoxylin and eosin (HE) staining were used to explore the mechanisms of lung injury caused by P. proliferus. As a result, the expression of the mRNA and proteins of RIG-I signal-related key target molecules, including RIG-I, tumor necrosis factor (TNF) receptor associated factor 6 (TRAF6), interferon regulatory Factor 7 (IRF7), IPS-1, and downstream C-X-C chemokine ligand 10 (CXCL10), were significantly up-regulated immediately after infection, peaked at 3 or 7 days, and showed a downward trend on after 14 days. The levels of pro-inflammatory cytokines interleukin-1 (IL-1), interferon (IFN)-a, -ß, and -1, which represent type 1 immune response, gradually increased and reached a peak by 14 days, which was consistent with the changes in the degree of inflammatory damage observed under HE staining of lung tissues. In conclusion, RIG-I signaling is activated in the early stage (before 14 days) of P. proliferus infection, it is inferred that the lung injury of the host may be related to the activation of RIG-I like signaling to induce type I immune response. [ABSTRACT FROM AUTHOR]

Background: To study the changes in intestinal flora in patients with ulcerative colitis (UC), and to explore its correlations with micro ribonucleic acid (miR)-21 and serum tumor necrosis factor-a (TNF-a). Methods: A total of 150 patients with UC were selected and divided into remission group and seizure group according to the severity of disease. At the same time, 150 healthy people receiving physical examination in the hospital during the same period were selected as control group. The levels of fecal miR-21 and TNF-a in all subjects were determined via reverse transcription-polymerase chain reaction (RT-PCR). The correlation between miR-21 and TNF-a and their associations with the changes in intestinal bacteria in UC were analyzed using Pearson correlation analysis. The risk factors affecting the occurrence of UC were explored via multivariate logistic regression analysis. Results: The levels of fecal miR-21 and TNF-a in patients with UC were significantly higher than those in control group, and they were also significantly higher in seizure group than those in remission group. There was a positive correlation between the levels of miR-21 and TNF-a. The number of fecal intestinal flora (Bifidobacterium, Lactobacillus, Enterobacterium and Enterococcus) was different in patients with varying degrees of disease. MiR-21 and TNF-a were negatively correlated with the content of Bifidobacterium and Lactobacillus, but positively correlated with the content of Enterobacterium and Enterococcus. According to multivariate logistic regression analysis, miR-21 and TNF-a were risk factors for the seizure of UC. Conclusion: MiR-21 can promote the expression of TNF-a, and lead to the alteration of intestinal flora, thereby enhancing the occurrence and development of UC. [ABSTRACT FROM AUTHOR]

Taenia solium cysticercosis and taeniosis (TSCT) are two forms of a zoonotic disease caused by T. solium tapeworm. Towards promotion of a One Health approach to the control of TSCT, we assessed TSCT reporting in the medical and veterinay sectors in Tanzania. We conducted a cross-sectional study between January and April 2020 in Babati and Mbulu districts (northern Tanzania), Kongwa district (central Tanzania), Mbinga and Nyasa districts (southern Tanzania), and the Zonal Veterinary Centres in Iringa (southern Tanzania) and Arusha (northern Tanzania) regions. A questionnaire was administered to 154 officers in charge (OsIC) of primary healthcare facilities (PHFs) and 110 meat inspectors (MIs) to collect quantitative data. Key informant interviews (KIIs) were conducted to 16 medical and 17 veterinary officers from level one healthcare facilities and district livestock offices, respectively, to their respective ministries. OsIC admitted absence of specific reporting (100%, n = 154) of T. solium taeniosis and neurocysticercosis (NCC) in the medical diseases reporting system (MDRS) despite the presence of optimum facilitation in terms of report preparation and submission (92.2%, n = 154) with 83.8% (n = 154) timely report submission rate. The veterinary diseases reporting system (VDRS) accommodated porcine cysticercosis (PCC) reporting. Nevertheless, approximately 77.3% (n = 110) of the MIs admitted inadequate facilitation in VDRS that hindered efficient reporting of PCC among other diseases. In addition, all MIs admitted that disease reports submitted were incomplete, submitted late (73.3%, n = 110), or not submitted at all (88.8%, n = 110). Similarly, KIIs results revealed suboptimal facilitation and reporting efficiency in VDRS than it was with the MDRS. It is concluded that the MDRS did not provide for specific reporting of taeniosis and NCC. Inadequate facilitation of the general VDRS hindered efficient PCC reporting despite its provision for PCC reporting. A One Health approach in strengthening the medical and veterinary diseases reporting systems for efficient TSCT reporting is recommended. [ABSTRACT FROM AUTHOR]

Ascariasis (roundworm) is the most common parasitic helminth infection globally and can lead to significant morbidity in children including chronic lung disease. Children become infected with Ascaris spp. via oral ingestion of eggs. It has long been assumed that Ascaris egg hatching and larval translocation across the gastrointestinal mucosa to initiate infection occurs in the small intestine. Here, we show that A. suum larvae hatched in the host stomach in a murine model. Larvae utilize acidic mammalian chitinase (AMCase; acid chitinase; Chia) from chief cells and acid pumped by parietal cells to emerge from eggs on the surface of gastric epithelium. Furthermore, antagonizing AMCase and gastric acid in the stomach decreases parasitic burden in the liver and lungs and attenuates lung disease. Given Ascaris eggs are chitin-coated, the gastric corpus would logically be the most likely organ for egg hatching, though this is the first study directly evincing the essential role of the host gastric corpus microenvironment. These findings point towards potential novel mechanisms for therapeutic targets to prevent ascariasis and identify a new biomedical significance of AMCase in mammals. Author summary: Ascariasis is the most common helminth infection and leads to significant global morbidity. Current therapies specifically target intraluminal adult intestinal worms and do not provide sufficient protection against the Ascaris larva. To reduce Ascaris-induced morbidity, novel interventions are needed that target Ascaris larval migration which calls for a better understanding of the Ascaris larval migration cycle. After oral ingestion of Ascaris eggs, previous studies have indicated that Ascaris larval migration initiates in the small intestine. However, our study demonstrates that Ascaris larva begin the migration cycle by hatching in the stomach by using the host's acidic mammalian chitinase and stomach acid to help degrade the chitinous egg shell. The larvae subsequently translocate across the stomach mucosa in this mouse model. Our study provides the first insight that the gastric corpus microenvironment plays a critical role in Ascaris egg hatching and initiation of infection, and will aid in the identification of novel drug targets. [ABSTRACT FROM AUTHOR]

Objective: Multiple ring-enhancing lesions of the brain are enigmatic neuroimaging abnormality. In this systematic review, we evaluated the etiological spectrum of these lesions. Methods: This systematic review adhered to the PRISMA guidelines. We searched PubMed, Embase, Scopus, and Google Scholar up until 15 June 2023. We included case reports and case series. Quality evaluation of each case was based on selection, ascertainment, causality, and reporting. The extracted information included demographic characteristics, clinical features, type and number of multiple enhancing brain lesions, diagnostic procedures, final diagnoses, treatments, and patient outcomes. Protocol Registration: PROSPERO CRD42023437081. Results: We analyzed 156 records representing 161 patients, 60 of whom were immunocompromised. The mean age was 42.6 years, and 67% of patients experienced symptoms for up to 1 month. A higher proportion of immunocompromised patients (42% vs. 30%) exhibited encephalopathy. Chest or CT thorax abnormalities were reported in 27.3% of patients, while CSF abnormalities were found in 31.7%, more frequently among the immunocompromised. Definitive diagnoses were established via brain biopsy, aspiration, or autopsy in 60% of cases, and through CSF examination or other ancillary tests in 40% of cases. Immunocompromised patients had a higher incidence of Toxoplasma gondii infection and CNS lymphoma, while immunocompetent patients had a higher incidence of Mycobacterium tuberculosis infection and immune-mediated and demyelinating disorders. The improvement rate was 74% in immunocompetent patients compared to 52% in the immunocompromised group. Conclusion: Multiple ring-enhancing lesions of the brain in immunocompromised patients are more frequently caused by Toxoplasma gondii infections and CNS lymphoma. Conversely, among immunocompetent patients, Mycobacterium tuberculosis infection and immune-related demyelinating conditions are common. [ABSTRACT FROM AUTHOR]

The current study estimated incident breakthrough seizures, serum matrix metalloproteinase-9 (MMP-9), and perfusion magnetic resonance imaging (MRI) parameters in five- to 18-year-olds with neurocysticercosis (NCC) from colloidal or vesicular through calcified stages over at least 24 months' follow-up. Single, colloidal, or vesicular parenchymal NCC cases were treated with albendazole and steroids and followed at a tertiary care north Indian hospital. Serum MMP-9 was estimated in colloidal or vesicular treatment-naive state and in a subset of calcified cases at six-month follow-up. The same subset of calcified cases also underwent perfusion MRI of the brain at six-month follow-up. Among 70 cases, 70% calcified at six-month follow-up. Over a median follow-up of 30 months, the incidence of breakthrough seizures was 48.6% (61.2% in calcified and 19.2% in resolved, P = 0.001; 32.9% early [within six months] and 15.7% late [beyond six months], P = 0.02). Serum MMP-9 levels were higher in colloidal and vesicular compared with calcified stage (242.5 vs 159.8 ng/mL, P = 0.007); however, there was no significant association with breakthrough seizures and/or calcification in follow-up. In a subgroup of calcified cases (n = 31), the median relative cerebral blood volume on perfusion MRI in and around the lesion was lower in those with seizures (n = 12) than in those without (n = 19) (10.7 vs 25.2 mL/100 g, P = 0.05). In post-treatment colloidal or vesicular NCC, incident breakthrough seizures decrease beyond six months. In calcified NCC with remote breakthrough seizures, significant perilesional hypoperfusion is seen compared with those without seizures. [ABSTRACT FROM AUTHOR]

Background. In India, Trichinella nematode worm remains highly neglected due to the paucity of research. Recent trichinellosis outbreaks in humans associated with pork meal in north India have highlighted an emerging food safety concern due to this neglected parasite. Aim. This study aimed to ascertain the existence of Trichinella species and to identify them in slaughtered pigs intended for human consumption in the Punjab and Uttaranchal regions of North India. Materials and Methods. A total of 1,194 slaughter pig tongue samples were screened in 239 pools using the double separatory funnel method for recovery of Trichinella larvae. The species of recovered larvae were confirmed by multiplex PCR assay and sequencing. A phylogenetic tree was constructed to ascertain the closest lineage. Results. This study reported 3.77% and 1.26% Trichinella positivity in pooled and individual pig samples, respectively. Pigs slaughtered in Punjab reported higher positivity (1.73%) than pigs in Uttaranchal (0.81%). Among all places, Jalandhar recorded highest positivity of 5.66%, followed by 2.22% in Nainital and 0.8% in Patiala, whereas none of the pig samples from Chandigarh, Ludhiana, Bathinda, Tehri Garhwal, Pauri Garhwal, Kashipur, Haridwar was positive. Molecular confirmation by PCR and sequencing confirmed the recovered Trichinella larvae as T. britovi and T. nelsoni. Conclusion. Trichinella parasite remained highly neglected in India; however, the detection of sylvatic Trichinella species in pigs intended for human consumption indicated the emergence of zoonotic foodborne risk at wild animal-domestic pig and human interfaces. To the best of our knowledge, this is the first study reporting T. britovi and T. nelsoni in pigs of North India. Trichinella positivity in slaughtered pigs is an early alarm for the emergence of foodborne risk from this neglected parasitic worm. Considering the importance of pigs as a source of meat and their role as a reservoir for Trichinella raised the food safety concern that warrants strict meat inspection and extensive studies on neglected parasites in India. [ABSTRACT FROM AUTHOR]

Despite being a leading cause of acquired seizures in endemic regions, the pathological mechanisms of neurocysticercosis are still poorly understood. This study aims to investigate the impact of anthelmintic treatment on neuropathological features in a rat model of neurocysticercosis. Rats were intracranially infected with Taenia solium oncospheres and treated with albendazole + praziquantel (ABZ), oxfendazole + praziquantel (OXF), or untreated placebo (UT) for 7 days. Following the last dose of treatment, brain tissues were evaluated at 24 h and 2 months. We performed neuropathological assessment for cyst damage, perilesional brain inflammation, presence of axonal spheroids, and spongy changes. Both treatments showed comparable efficacy in cyst damage and inflammation. The presence of spongy change correlated with spheroids counts and were not affected by anthelmintic treatment. Compared to white matter, gray matter showed greater spongy change (91.7% vs. 21.4%, p < 0.0001), higher spheroids count (45.2 vs. 0.2, p = 0.0001), and increased inflammation (72.0% vs. 21.4%, p = 0.003). In this rat model, anthelmintic treatment destroyed brain parasitic cysts at the cost of local inflammation similar to what is described in human neurocysticercosis. Axonal spheroids and spongy changes as markers of damage were topographically correlated, and not affected by anthelmintic treatment. [ABSTRACT FROM AUTHOR]

Traumatic brain injury (TBI) is a key contributor to global morbidity that lacks effective treatments. Microbial infections are common in TBI patients, and their presence could modify the physiological response to TBI. It is estimated that one-third of the human population is incurably infected with the feline-borne parasite, Toxoplasma gondii, which can invade the central nervous system and result in chronic low-grade neuroinflammation, oxidative stress, and excitotoxicity—all of which are also important pathophysiological processes in TBI. Considering the large number of TBI patients that have a pre-existing T. gondii infection prior to injury, and the potential mechanistic synergies between the conditions, this study investigated how a pre-existing T. gondii infection modified TBI outcomes across acute, sub-acute and chronic recovery in male and female mice. Gene expression analysis of brain tissue found that neuroinflammation and immune cell markers were amplified in the combined T. gondii + TBI setting in both males and females as early as 2-h post-injury. Glutamatergic, neurotoxic, and oxidative stress markers were altered in a sex-specific manner in T. gondii + TBI mice. Structural MRI found that male, but not female, T. gondii + TBI mice had a significantly larger lesion size compared to their uninfected counterparts at 18-weeks post-injury. Similarly, diffusion MRI revealed that T. gondii + TBI mice had exacerbated white matter tract abnormalities, particularly in male mice. These novel findings indicate that a pre-existing T. gondii infection affects the pathophysiological aftermath of TBI in a sex-dependent manner, and may be an important modifier to consider in the care and prognostication of TBI patients. [ABSTRACT FROM AUTHOR]

Background and Aim: Streptococcus suis is a zoonotic pathogen that is highly associated with contact between live pigs and raw pig material. In view of the recent reports of human infections in Malaysia, epidemiological data on the status of S. suis in the human population, especially among people working closely with pigs and/or raw pork, should be provided. The aim of this study was to detect S. suis among individuals working in the swine industry in several major pig production areas in Peninsular Malaysia. Materials and Methods: Demographic information, exposure determinants, and oral swabs were collected from swine personnel, including farmers, butchers, and veterinarians. Oral swabs were subjected to bacterial isolation and conventional polymerase chain reaction (PCR) assays for S. suis detection. Results: The study included 40 participants working in the swine industry, with a predominant representation of males (62.5%) and Malaysian Chinese individuals (60.0%) who consumed pork (92.5%). Notably, none of the participants reported consuming raw or partially cooked pork. In spite of their occupational exposure risk, none of the oral swabs showed positive results for S. suis infection. Conclusion: To the best of our knowledge, this is the first report and detection study of S. suis using oral swabs obtained from swine personnel in Peninsular Malaysia. [ABSTRACT FROM AUTHOR]

Patients with intraventricular neurocysticercosis (IVNCC) may require cerebrospinal fluid diversion surgery for late-onset hydrocephalus in the postsurgical period. Controversy exists regarding cysticidal treatment. Our main objective was to compare surgically treated cases of IVNCC that received postoperative anthelmintics with those that did not regard the incidence and treatment of late-onset hydrocephalus. We searched the Medline database and extracted the following data: age, gender, stage of development of cysticercosis, type of operation, frequency of delayed hydrocephalus, cerebrospinal fluid diversion surgery, outcome, and follow-up. We analyzed 130 articles on intraventricular cysticercosis and identified 117 cases of isolated IVNCC and 314 patients in the case-control series who met inclusion criteria. There was no significant difference in postoperative delayed hydrocephalus between isolated IVNCC and case-control study groups. Children under the age of 16 received anthelmintic drugs more frequently during the postoperative period. Statistical relevance was observed in all patient groups regarding the application of steroids in favor of cysticidal therapy Endoscopy was a better option than craniotomy for cases of isolated IVNCC and case-control studies. Other variables were not relevant. Patients who received antihelminths did not show a statistically significant reduction in delayed hydrocephalus compared to individuals who did not receive after surgical resection of the parasite. Corticosteroid therapy prevailed in people who have been treated with anthelmintics. Children under the age of 16 were administered anthelmintic drugs more frequently during the postoperative period. Endoscopy was the preferred method for all groups, but some patients with cysts in the fourth ventricle required a craniotomy. [ABSTRACT FROM AUTHOR]

Simple Summary: Bovine cysticercosis is considered one of the major parasitic zoonoses that carry an important food safety concern. The disease can lead to a range of symptoms and health problems based on the location and number of cysts. Moreover, bovine cysticercosis can cause considerable economic losses in livestock production. Clearly, there is an urgent need for a practical and sensitive method for the detection of infected carcasses. Little information is known about the prevalence of cardiac cysticercosis in bovines from Upper Egypt and the potential use of histopathological and immunohistochemical methods in the localization of the pathogen. The present study used a set of morphological, morphometric, histopathological and immunohistochemical techniques to investigate the distribution of the cardiac cysticercosis in cattle from Upper Egypt. Furthermore, the measurement of various biochemical markers was performed to identify their possible association with the infection. Bovine cysticercosis is categorized as a serious parasitic zoonotic infestation. The infection is mainly caused by the tapeworm Taenia saginata, which infects cattle and humans. The larval stage, Cysticercus bovis (C. bovis), is found in the skeletal and cardiac muscles of infected cattle. Despite its potential public health concern, few studies have been conducted on cardiac cysticercosis in Upper Egypt. This study investigates the prevalence, epidemiology, and impact of cardiac cysticercosis in Upper Egypt, emphasizing how histopathological changes in cardiac muscle and physiological parameters might be associated with the infection. From December 2022 to October 2023, a total of 941 animals from Assiut province, Upper Egypt, were slaughtered and their cardiac muscles were examined for the presence of C. bovis. Cysts were classified as viable or degenerated through macroscopic inspection. The overall prevalence of C. bovis infected hearts made up 10.8% of the total examined. The highest prevalence rate was in the summer season followed by spring; winter had the lowest infections. The histopathological examination of infected tissues revealed immune cell infiltration around Cysticercus-infected areas. Additionally, Bax immunostaining demonstrated the apoptotic effect of cysticercosis. Regarding the measured physiological parameters, there were non-significant changes in plasma levels of total protein and albumin in cattle infected with cysticercosis compared with control animals. Moreover, there was a significant decrease in total antioxidant capacity (TAC) combined with a significant increase in lipid peroxide (Malondialdehyde) (MDA), troponin T, and lactate dehydrogenase (LDH) activity in infected animals. The present work documented a set of epidemiological and pathological findings, revealing that C. bovis is a potentially harmful parasite and can cause significant health problems in both cattle and humans. [ABSTRACT FROM AUTHOR]

Background: Toxocariasis and coccidiosis are common parasitic diseases affecting both farm animals and various species. While clinicians frequently diagnose these diseases in calves, mixed infections of toxocariasis and coccidiosis are exceptionally rare. Methods: A 44-day-old Anatolian black breed calf, presenting with tonic-clonic convulsions and abdominal pain, underwent laboratory and ultrasonographic examinations. Results: The laboratory findings indicated leukocytosis and hyperlactatemia in the calf. Ultrasonographic examination demonstrated intestinal dilatation and decreased motility. Stool analysis confirmed the presence of both toxocariasis and coccidiosis. Treatment with albendazole and toltrazuril led to the calf's recovery without complications. Conclusions: This case report represents the first documented instance detailing laboratory and ultrasound findings, as well as the treatment outcomes, of a calf concurrently afflicted with toxocariasis and coccidiosis. The successful treatment with albendazole and toltrazuril suggests potential therapeutic efficacy against mixed infections of these parasitic diseases. [ABSTRACT FROM AUTHOR]

Neurocysticercosis is a common cause of epilepsy in Taenia solium -endemic areas in sub-Saharan Africa but is often undiagnosed because of an absence of affordable diagnostic tools. This study evaluated the diagnostic accuracy of a T solium cysticercosis antibody-detecting lateral-flow point-of-care assay (TS POC test) for the neuroimaging-based diagnosis of neurocysticercosis. Patients with epileptic seizures or severe progressive headache were recruited consecutively from three hospitals in southern Tanzania. All patients were tested with the TS POC test. All patients positive for cysticercosis on the TS POC test and every tenth patient who was negative for cysticercosis received a brain CT examination and underwent reference testing for T solium cysticercosis (ie, rT24H-EITB, LLGP-EITB, and antigen ELISA). The primary outcome of the study was the sensitivity of the TS POC test for the diagnosis of neurocysticercosis. Of the 601 recruited participants, 102 (17%) tested positive for cysticercosis with the TS POC test. Overall, 48 (62%) of the 77 patients positive for cysticercosis and five (17%) of the 29 patients negative for cysticercosis on the TS POC test had CT-confirmed neurocysticercosis. The TS POC test yielded a sensitivity of 49% (uncertainty interval [UI] 41–58) for neurocysticercosis. Sensitivity was similar to that of the rT24H-EITB (44%, UI 37–51) and the antigen ELISA (50%, 43–56). For the subset of neurocysticercosis cases with at least one active (ie, vesicular) lesion, sensitivity was above 98% for the TS POC test, the rT24H-ETIB, and the antigen ELISA. The TS POC test showed promising results for the diagnosis of neurocysticercosis in patients with vesicular lesions, which need to be confirmed in a larger study. This test could be considered to support policies on screening patients with suspected neurocysticercosis in clinical settings, which would allow appropriate referral for neuroimaging and early treatment. German Federal Ministry of Education and Research and the European & Developing Countries Clinical Trials Partnership. For the Swahili translation of the abstract see Supplementary Materials section. [ABSTRACT FROM AUTHOR]

Neurocysticercosis is an infection of the central nervous system caused by the larval stage of Taenia solium. Although endemic in sub‐Saharan Africa, it is neglected but remains a significant cause of preventable seizure in adults. Its diagnosis is challenging and is frequently missed due to its variable clinical manifestations and lack of diagnostic facilities in most areas of sub‐Saharan Africa. This report discusses two cases of parenchymal neurocysticercosis in Ghanaians who presented to the emergency unit of a District Hospital with adult‐onset seizures. The two cases highlight the need for a high index of suspicion and also underscore the important role of neuroimaging in the evaluation of patients presenting with adult‐onset seizures in neurocysticercosis endemic areas. This is necessary for prompt detection and initiation of appropriate therapy in order to improve prognosis. [ABSTRACT FROM AUTHOR]

Adenovirus is a major pathogen causing febrile illness among children. It may also cause acute encephalitis/encephalopathy. This study aimed to elucidate the clinical features of adenovirus-associated encephalitis/encephalopathy (AdVE) among children in Japan. A nationwide survey of children with AdVE was conducted. An initial survey was distributed among pediatricians to obtain information about children with AdVE treated between January 2014 and March 2019. A second survey was used to obtain the clinical information of children with AdVE from hospitals that responded to the initial survey and those identified from a literature search of the reported cases. We collected demographic data and information about symptoms of infection, neurological symptoms, laboratory parameters, treatment, and outcomes. Outcomes were determined using the Pediatric Cerebral Performance Category Score. Clinical information was available for 23 children with a median age of 39 months. Two had preexisting neurological disorders and six had a history of febrile seizures. The outcome was good in 15 patients and poor in eight patients. Serum lactate dehydrogenase, glucose, and ammonia levels were higher among children with a poor outcome compared to those with a good outcome. Clinically mild encephalitis/encephalopathy with a reversible splenial lesion was the most common type (n = 8), followed by acute encephalopathy with biphasic seizures and late reduced diffusion (n = 7). A prior history of febrile seizures was frequent in children with AdVE. Several different subtypes of acute encephalopathy were seen in children with AdVE, and the outcome was poor in those with acute encephalopathy with biphasic seizures and late reduced diffusion and hemorrhagic shock and encephalopathy syndrome. Elevated lactate dehydrogenase, glucose, and ammonia levels on admission were found to correlate with a poor outcome. [ABSTRACT FROM AUTHOR]

Coronavirus disease 2019 (COVID-19) has significantly impacted medical services worldwide. During the Omicron variant-predominant era, febrile seizure (FS) in patients with COVID-19 increased compared to that in the pre-Omicron variant era. Therefore, this study aimed to demonstrate the clinical characteristics of FS in patients with COVID-19. We surveyed patients aged < 16 years who presented with FS to the emergency room of Tottori University Hospital. The patients were divided into two groups: FS patients with COVID-19 (FS with COVID-19 group) and FS patients without COVID-19 (FS without COVID-19 group) as per the results of the respiratory multiplex array test. Patients with positive results for both SARS-CoV-2 and other microorganisms were excluded. We obtained data on the patients' clinical backgrounds, symptoms, seizure duration, type of FS (simple or complex), diagnostic examinations, laboratory test results, and treatment. We compared the data between the FS with and without COVID-19 groups. A total of 128 patients with FS met the inclusion criteria. Of these, 18 patients and 110 patients were included in the FS with COVID-19 group and without COVID-19 group, respectively. The late FS onset (>60 months) were significantly more common in the FS with COVID-19 group than that in the FS without COVID-19 group. Moreover, patients in the FS with COVID-19 group had significantly longer seizure durations than those in the FS without COVID-19 group. A diazepam (DZP) suppository was administered to 72% of FS patients with COVID-19 after the first seizure during a febrile episode. FS patients with COVID-19 had different distributions of age at onset and seizure duration than those without COVID-19. The use of DZP suppositories was more frequent in FS patients with COVID-19 compared to those without COVID-19. [ABSTRACT FROM AUTHOR]

Aim of the Study: Multiple ring-enhancing lesions are commonly experienced group of brain pathologies which we come across in day-to-day practice. Clinical symptoms in these lesions are quite non-specific, and hence, it is difficult to reach a final diagnosis. However, these lesions have a varied group of differential diagnosis and it is sometimes difficult to have an accurate diagnosis on conventional MRI. This article was written with the objective of discussing the demographical study and etiology, clinical diagnosis and management for these patients. Materials and Methods: It is a prospective study carried out at the Department of Neurosurgery, Dr. D Y Patil Medical College and Hospital, Pune, from September 2019 to August 2022 and included 50 patients who presented to us multiple ring-enhancing brain lesions. Results: In our study, 50 patients between age (1-70 years) with multiple ring-enhancing lesions were analyzed. Majority of the patients were between age group 30-39 years. Males (76%) were majority in our study than females (24%). Most common pathology was primary neoplasm (glioma) and metastasis, followed by nine patients of pyogenic abscess and tuberculosis each. Neurocysticercosis was seen in eight patients and three patients were diagnosed with CNS lymphoma. Most of our patients presented with headache (38 patients) and a subset of patients had associated seizures (28 patients). Two patients with primary neoplasm were diagnosed to have WHO grade 3 glioma and seven patients were diagnosed to have WHO grade 4 glioma. Glioblastoma multiforme presented as multifocal and multicentric lesions. Among the patients with primary neoplasm, three patients underwent stereotactic biopsy for diagnosis and the rest of seven patients underwent maximum safe resection followed by chemotherapy and radiotherapy. Ten patients were diagnosed with metastatic lesions, among them six patients underwent stereotactic biopsy for histopathological diagnosis and immunohistochemistry, and rest of the patients were managed on the basis of the primary lesion. Five patients were immune-compromised, among them two patients presented with abscess and three patients presented with primary neoplastic lesion. Thirty-six patients underwent biopsy, among them seven patients underwent frameless, seven patients underwent frame stereotactic biopsy, and the rest 22 patients underwent excision biopsy. Conclusion: Multiple ring-enhancing lesions of brain pose a challenge in terms of achieving an accurate diagnosis and planning further treatment. It is of utmost importance to have a diagnosis in mind based on radiological investigations, so that surgical intervention can be planned accordingly be it by invasive or minimal invasive techniques. An idea toward the diagnosis also helps in prognosticating these patients which could avoid costly whole-body scans and unnecessary surgical intervention. [ABSTRACT FROM AUTHOR]

This article from the journal Microbiologia Medica provides information on various parasitic infections that can affect the Central Nervous System (CNS). It discusses the diagnostic methods and treatment options for each infection, including the use of serological tests and imaging techniques. Some of the infections mentioned include cerebral malaria, neurocysticercosis, echinococcosis, paragonimiasis, coenurosis, sparganosis, free-living amoebae infections, toxocariasis, neurotrichinellosis, and cerebral toxoplasmosis. The article emphasizes the importance of accurate diagnosis and early treatment for these infections. [Extracted from the article]

Blastocystis sp. are the most common, unicellular, anaerobic parasites of the intestinal tract of many animal and human species that can cause various digestive diseases. Metronidazole has long been used as a first-line treatment for blastocystosis, but recent clinical and in vitro studies have demonstrated its low efficacy against Blastocystis sp. The aim of this study was to determine the in vitro sensitivity of Blastocystis sp. clinical isolates to carbonic acid hop extracts and alcohol hop extracts in comparison with metronidazole. Five cultures of Blastocystis sp. were isolated from faecal samples from patients with irritable bowel syndrome with predominant diarrhoea (IBS-D, Rome IV). The parasites were identified by microscopy of faecal smears permanently stained with trichrome, Wheatley’s modification and Heidenhain’s iron-haematoxylin. Blastocystis sp. was cultivated at 37°C under anaerobic conditions on RPMI-1640 with antibiotics and horse serum, taking into account their growth characteristics. To detect the antiblastocystic activity hop extracts and metronidazole were tested in the range from 1000 μg/ml to 1 μg/ml.The presence and number of viable Blastocystis sp. cells were determined after 24, 48, 72 and 96 hours. Blastocystis sp. cells were counted in a hemocytometer using the trypan blue dye exclusion test. All experiments were performed in triplicate. According to the results of in vitro sensitivity of 5 clinical isolates of Blastocystis sp. to the action of carbonic acid hop extract, alcohoicl hop extract and metronidazole, a direct positive pattern in the dose-response and contact time-response effects was established. Alcoholic hop extract showed the highest level of antiblastocystic activity with indicators (for 72- hour parasite cultures) of the minimum inhibitory concentration (which inhibits the parasite cultures growth by 50%) (2.8±0,8) μg/ml and the minimum lethal concentration (which destroys parasite cells by 100%) – 8 μg/ml, being 2.4 and 4.5 times lower than the minimum inhibitory concentration and 8 and 62.5 times lower, than the minimum lethal concentration for hop extract and metronidazole, respectively (p<0.05). It has been shown that alcoholic hop extract (≥16 μg/ml) causes gradual morphological changes in Blastocystis sp. cells, leading to their complete destruction.In contrast to metronidazole, subinhibitory concentrations of hop extract (<2 μg/ml) do not stimulate the proliferation of Blastocystis sp. cells in vitro. [ABSTRACT FROM AUTHOR]

Introduction: Cysticercosis is a parasitic infestation caused by Taenia solium, which is a pork tape worm. Humans are the definitive host, and pigs are the intermediate host. It is more prevalent in low socioeconomic regions with poor hygiene and among populations where undercooked pork is consumed. Case Presentation: We hereby report an uncommon site of cyst lodgment and duration of presentation in a 24-year-old male who presented with a firm, non-tender mass over the superomedial aspect of the right orbital rim, superior to the medial canthal tendon for the last 9 years. Chronic presentation and location of the mass led to the tentative diagnosis of a dermoid cyst. Hence, a CECT orbit was advised to assess the extent and attachment of the mass. Unexpectedly, a cystic lesion with hyperdense nidus, suggestive of cysticercosis, was identified. Histopathology of the excised mass confirmed the diagnosis of cysticercosis. Conclusion: Our case emphasizes the importance of an uncommon site and chronic presentation in cases of cysticercosis. [ABSTRACT FROM AUTHOR]

Background: Helminth infections are a global health menace affecting 24% of the world population. They continue to increase global disease burden as their unclear pathology imposes serious challenges to patient management. Neurocysticercosis is classified as neglected tropical disease and is caused by larvae of helminthic cestode Taenia solium. The larvae infect humans and localize in central nervous system and cause NCC; a leading etiological agent of acquired epilepsy in the developing world. The parasite has an intricate antigenic make-up and causes active immune suppression in the residing host. It communicates with the host via its secretome which is complex mixture of proteins also called excretory secretory products (ESPs). Understanding the ESPs interaction with host can identify therapeutic intervention hot spots. In our research, we studied the effect of T. solium ESPs on human macrophages and investigated the post-translation switch involved in its immunopathogenesis. Methodology: T. solium cysts were cultured in vitro to get ESPs and used for treating human macrophages. These macrophages were studied for cellular signaling and miR expression and quantification at transcript and protein level. Conclusion: We found that T. solium cyst ESPs treatment to human macrophages leads to activation of Th2 immune response. A complex cytokine expression by macrophages was also observed with both Th1 and Th2 cytokines in milieu. But, at the same time ESPs modulated the macrophage function by altering the host miR expression as seen with altered ROS activity, apoptosis and phagocytosis. This leads to activated yet compromised functional macrophages, which provides a niche to support parasite survival. Thus T. solium secretome induces Th2 phenomenon in macrophages which may promote parasite's survival and delay their recognition by host immune system. Author summary: This article discusses the research conducted on the effect of Taenia solium excretory secretory proteins (ESPs) on human macrophages and its role in the immunopathogenesis of Neurocysticercosis (NCC). NCC is a neglected tropical disease caused by larvae of T. solium, which infect humans and localizes in the central nervous system. The larvae cause NCC, a leading cause of acquired epilepsy in the developing world. The study found that T. solium ESPs induce a Th2 immune response in macrophages, which may promote parasite survival and delay their recognition by the host immune system. The research further showed that ESPs modulate macrophage function by altering host miR expression, leading to activated yet compromised functionality that provides a niche for parasite survival. This study provides insights into the interaction of ESPs with the host, revealing therapeutic intervention hot spots to manage NCC and other helminthic infections. In the absence of suitable animal model for NCC, our study elucidates important and novel finding of parasite mediated suppression of host immune system. [ABSTRACT FROM AUTHOR]

Background: Plasmodium knowlesi is an established experimental model for basic and pre-clinical malaria vaccine research. Historically, rhesus macaques have been the most common host for malaria vaccine studies with P. knowlesi parasites. However, rhesus are not natural hosts for P. knowlesi, and there is interest in identifying alternative hosts for vaccine research. The study team previously reported that pig-tailed macaques (PTM), a natural host for P. knowlesi, could be challenged with cryopreserved P. knowlesi sporozoites (PkSPZ), with time to blood stage infection equivalent to in rhesus. Here, additional exploratory studies were performed to evaluate PTM as potential hosts for malaria vaccine studies. The aim was to further characterize the parasitological and veterinary health outcomes after PkSPZ challenge in this macaque species. Methods: Malaria-naïve PTM were intravenously challenged with 2.5 × 103 PkSPZ and monitored for blood stage infection by Plasmodium 18S rRNA RT-PCR and thin blood smears. Disease signs were evaluated by daily observations, complete blood counts, serum chemistry tests, and veterinary examinations. After anti-malarial drug treatment, a subset of animals was re-challenged and monitored as above. Whole blood gene expression analysis was performed on selected animals to assess host response to infection. Results: In naïve animals, the kinetics of P. knowlesi blood stage replication was reproducible, with parasite burden rising linearly during an initial acute phase of infection from 6 to 11 days post-challenge, before plateauing and transitioning into a chronic low-grade infection. After re-challenge, infections were again reproducible, but with lower blood stage parasite densities. Clinical signs of disease were absent or mild and anti-malarial treatment was not needed until the pre-defined study day. Whole blood gene expression analysis identified immunological changes associated with acute and chronic phases of infection, and further differences between initial challenge versus re-challenge. Conclusions: The ability to challenge PTM with PkSPZ and achieve reliable blood stage infections indicate this model has significant potential for malaria vaccine studies. Blood stage P. knowlesi infection in PTM is characterized by low parasite burdens and a benign disease course, in contrast with the virulent P. knowlesi disease course commonly reported in rhesus macaques. These findings identify new opportunities for malaria vaccine research using this natural host-parasite combination. [ABSTRACT FROM AUTHOR]

Objective: Unusual clinical course. Background: Splenic cysts are classified as either parasitic or non-parasitic cysts, with both types sharing similarities in their clinical presentation and imaging findings. Most splenic cysts are of parasitic origin, while non-parasitic splenic cysts are less common. Splenic epidermoid cysts (SECs) are a rare subtype of non-parasitic cysts and compromise only around 10% of them. Case Report: In this paper we present a case of 22-year-old man with no significant past clinical history, who presented with non-specific, vague symptoms, including persistent left upper-quadrant pain and discomfort for the last 2 years. A physical examination and extensive laboratory tests were inconclusive. Subsequently, the patient underwent multiple imaging studies including ultrasonography and computed tomography (CT) scan of the abdomen. His ultrasonographic findings were consistent with the diagnosis of hydatid cyst, which was further emphasized by its frequent occurrence in clinical practice, as our country is considered an endemic region. In light of this, he underwent laparoscopic splenectomy following percutaneous cyst drainage. The consequent histopathological examination revealed the diagnosis of splenic epidermoid cysts. Conclusions: When encountering splenic cysts in regions where parasitic infections are endemic, special attention is needed, as physical examination, laboratory tests, and imaging studies alone are insufficient to differentiate among the types of cysts. Histopathological examination remains the diagnostic tool of choice, particularly when imaging findings are inconclusive. Splenectomy, with either a laparoscopic or open approach, is the treatment of choice for splenic cysts to prevent recurrence as well as other potential catastrophic complications. [ABSTRACT FROM AUTHOR]

Background: Neurocysticercosis (NCC) is thought to be the most common helminthic infection of central nervous system in India. In children, it has pleomorphic clinical and radiological presentations depending on location and stage of lesion. Solitary cystic granuloma appearing as a single ring enhancing lesion is the most frequently encountered neuroimaging finding in patients with neurocysticercosis or tuberculoma in India. This series reports unusual clinico-radiological aspects of pediatric neurocysticercosis patients of Asian ethnicity. Case presentation: In the present case series, we have described socio-demographic and clinico-radiological profile of eight cases of neurocysticercosis with parenchymal lesions in varying stages of development. Among these two had single discrete ring enhancing lesion (SDREL), two had single conglomerated ring enhancing lesion (SCREL), and five cases reported to have multiple ring enhancing lesions (MREL). Two cases with recurrent neurocysticercosis have been reported which is quite rare. Magnetic resonance spectroscopy helps to differentiate between neurocysticercosis and tuberculoma and may avoid brain biopsies or unnecessary anti-tubercular treatment. Magnetic resonance spectroscopy (MRS) was done in three cases with findings of absence of lipid peak and choline/creatinine ratio less than 1.2. Conclusion: Despite the advances in neuroimaging, accurate diagnosis of NCC is still sometimes difficult, which is related to the pleomorphic nature of disease and significant overlapping features with tuberculoma. A combination of proper diagnostic criteria and neuroimaging findings are helpful in making the diagnosis without invasive and potentially harmful investigations in paediatric patients. [ABSTRACT FROM AUTHOR]

Objective: Rare disease. Background: Angiostrongylus cantonensis, also known as the rat lungworm, is the most common parasitic cause of human eosinophilic meningitis. A. cantonensis infection is an emergent disease causing permanent neurological injury or even death when not diagnosed and treated promptly. Usually, human infection occurs through ingestion of food contaminated by intermediated hosts or the third stage larvae of A. cantonensis. Indicators for diagnosis include clinical signs of meningitis; contact history, such as that from eating raw or improperly cooked intermediated hosts or contaminated vegetables; and cerebrospinal fluid (CSF) eosinophilia. However, diagnosis is now primarily defined through polymerase chain reaction (PCR) assay of CSF or serum. Case Report: A 66-year-old homeless man with unclear exposure history presented with fever and conscious change. The initial hemogram showed eosinophilia without neutrophilic leukocytosis. Non-contrast computed tomography (CT) and magnetic resonance imaging (MRI) of the head revealed no evidence of stroke. A lumbar puncture was performed and showed eosinophilic meningitis. The patient was ultimately diagnosed through PCR and sequencing for A. cantonensis infection, and dexamethasone treatment was started immediately. Although his general condition improved after dexamethasone treatment, his mental status did not improve completely. Conclusions: Our report highlights the importance of applying molecular techniques in diagnosis of angiostrongylosis, especially in individuals who have unknown contact history. [ABSTRACT FROM AUTHOR]

In a rapidly evolving global landscape characterized by increased international travel, migration, and ecological shifts, this study sheds light on the emergence of protozoal and helminthic infections targeting the central nervous system (CNS) within Europe. Despite being traditionally associated with tropical regions, these infections are progressively becoming more prevalent in non-endemic areas. By scrutinizing the inherent risks, potential outcomes, and attendant challenges, this study underscores the intricate interplay between diagnostic limitations, susceptibility of specific population subsets, and the profound influence of climate fluctuations. The contemporary interconnectedness of societies serves as a conduit for introducing and establishing these infections, warranting comprehensive assessment. This study emphasizes the pivotal role of heightened clinician vigilance, judicious public health interventions, and synergistic research collaborations to mitigate the potential consequences of these infections. Though rare, their profound impact on morbidity and mortality underscores the collective urgency required to safeguard the neurological well-being of the European populace. Through this multifaceted approach, Europe can effectively navigate the complex terrain posed with these emergent infections. [ABSTRACT FROM AUTHOR]

Neurocysticercosis is a leading cause of acquired epilepsy. Calcified granulomas are known to cause seizure recurrence. Researchers have reported that vitamin D deficiency is associated with brain calcification and reduction in calcification occurs with vitamin D receptor agonist calcitriol through upregulation of SLC20A2. Based on these observations, a hypothesis was proposed that the occurrence of calcification could be reduced by optimizing vitamin D levels, resulting in early resolution of neurocysticercosis. A case-control (retrospective and prospective) study on 60 children with solitary intraparenchymal neurocysticercosis, 20 new cases prior to starting cysticidal therapy and other 40 resolved cases was carried out. Among new cases, children deficient in vitamin D were given megadose of vitamin D and vitamin D levels were rechecked after 30 days. Children having normal vitamin D were taken as cases and the deficient ones were taken as controls. Standard treatment for neurocysticercosis was given. Three monthly MRI scans were done. Outcome was evaluated as resolution/persistence of neurocysticercosis at 3, 6, 9 and 12 months. Pearson chi square/Fisher's exact test was used along with Kaplan Meier and log rank test. Of 60 patients, at 6 months 3 cases and 4 controls (p value 0.43), at 9 months 2 cases and 6 controls (p value 0.037) and at 12 months 3 cases and 6 controls (p value 0.029) had complete resolution of NCC. The results do not show that adequate vitamin D levels result in early resolution of neurocysticercosis. [ABSTRACT FROM AUTHOR]

Key Clinical Message: A hydatid cyst is a parasitic infestation most frequently caused by the larval tapeworm known as Echinococcus granulosus. Breast hydatidosis is a very uncommon condition that may be the main site or one of its components in cases of extensive hydatidosis. We discussed a 28‐year‐old female patient who had been experiencing left breast pain for a year prior to her presentation. [ABSTRACT FROM AUTHOR]