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Background: Taenia solium neurocysticercosis is a zoonotic neglected tropical disease, for which adequate diagnostic management is paramount, especially in patients with active cysts for whom improved and timely management could prove beneficial. Immunodiagnosis can potentially partially mitigate the necessity for neuroimaging, shortening the diagnostic -and treatment- pathway. An up-to-date review of immunological test performance is however lacking. Methodology/Principal findings: Searches were performed in PubMed, EMBASE, Web of Science, and Scopus (up to January 2024), with included records fitting the review scope, i.e. accuracy evaluation of an antibody-/or antigen-detecting immunological test, using serum or urine of humans confirmed via reference standard (i.e. neuroimaging or surgery/biopsy). Record data was assessed, with classification of descriptive data on cyst localization and stage according to a developed confidence scale, and with selection of tests evaluated on a sufficiently high sample size. A QUADAS-2 risk of bias assessment was performed. After screening, 169 records were included for data collection, with 53 records—corresponding to 123 tests- selected for analysis. Absence of data and large data heterogeneity complicated result interpretation. The lentil lectin-bound glycoprotein enzyme-linked immunoelectrotranfser blot seems to fulfill high accuracy standards regarding detection of parenchymal active multiple cysts; also antigen-detecting tests on serum and urine performed well, additionally in detection of extraparenchymal neurocysticercosis. A novel multi-antigen print immunoassay is highly promising, with sensitivity for detection of extraparenchymal and parenchymal active single and multiple cysts of 100.0%, and specificity of 98.5%. Point-of-care tests showed promising results, however require further evaluation in targeted resource-poor settings. Conclusions/Significance: The review highlights the importance of transparent and unambiguous data reporting. With promising immunological tests in development, the challenge before usage in targeted settings will be to perform large-scale evaluations whilst holding into account both optimized test performance and ease of use. Accessibility to validated tests and feasibility of implementation should also be considered. Author summary: Neurocysticercosis is an important, but neglected disease in many low- and middle-income countries. In resource-poor areas, management of the disease is impeded by lack of availability of, and access to, adequate diagnostic techniques. Immunological tests, performed on serum or urine of affected humans, could be tools of interest in improving the diagnostic pathway. This systematic review provides an overview of immunological tests that have been evaluated so far, and especially focusses on test performance in detection of cysts with specific localization, stage and number. Results on test accuracy proved difficult to retrieve from published records. The comparison of obtained test results was exceedingly challenging due to large heterogeneity. With usable data meticulously selected, several known test formats, such as the LLGP-EITB and the antigen ELISA, showed expected performance results, and some novel test formats, such as the multi-antigen print immunoassay, were highly promising. Also, urine-based tests could provide a non-invasive alternative to serum-based tests. Evaluation of immunological tests in non-clinical settings requires a sufficient sample size for further analysis of data. To improve management of the disease in targeted resource-poor settings, immunological test formats will have to comply with high performance and ease-of-use standards, to optimize chances of future implementation. [ABSTRACT FROM AUTHOR]

Background: In neuroimaging, Magnetic Resonance Imaging (MRI) is a cornerstone technique that allows clinicians to see fine aspects of brain architecture and pathology with unparalleled clarity. Ring-enhancing lesions (RELs) in the brain pose a particularly difficult diagnostic scenario among the many abnormalities found. Objectives: 1. To differentiate neoplastic from nonneoplastic brain lesions using conventional and advanced MR imaging techniques. 2. To study the characteristic imaging findings of various ring enhancing lesions on MRI. Material & Methods: Study Design: A prospective hospital-based observational study. Study area: Department of Radio Diagnosis, Subbaiah Institute of medical sciences, Shivamogga, Karnataka. Study Period: 1 year. Study population: All patients referred to the Department of Radio diagnosis with clinically suspected cerebral ring-enhancing lesions. Sample size: The study consisted of 60 subjects. Sampling method: Simple random technique. Results: Out of 60 patients evaluated, Seizures were the most common presenting complaint in 70% of cases. Headache (18%), fever (6.6%), vomiting (15%), ataxia (5%) and motor weakness (6%) were the other presenting complaints. Our findings were compared with the study conducted by ps mahato8 in which headache (57.5%) was the most common symptom followed by seizures (52.5%). CONCLUSION: From our study, it can be concluded thatMRI is the most sensitive modality in the characterization of intracranial ring-enhancing lesions. MRI being non-invasive and non-radiating is an ideal imaging modality. [ABSTRACT FROM AUTHOR]

Cysticercosis is a parasitic infection and neglected tropical disease caused by Taenia solium, or the pork tapeworm. Cysticercosis with central nervous system involvement, or neurocysticercosis, is a leading cause of chronic headaches and epilepsy in endemic regions, including Latin America and Asia. In the United States, the epidemiology of cysticercosis has not been well described. We conducted a cross-section serosurvey of Mexican-American adults residing along the Texas–Mexico border (Starr County, Texas) and identified an overall seroprevalence of 7.4% (45/605) for cysticercosis. Brain imaging studies conducted on seropositive study participants identified lesions consistent with calcified neurocysticercosis in 2 of the 45 seropositive individuals. Female sex (p = 0.021), employment in healthcare, caregiving, or social service (p = 0.002), and indoor occupation (p < 0.001) were found to be significantly associated with seropositivity. Further study is needed to evaluate the burden of neurocysticercosis and local transmission risk in this community. [ABSTRACT FROM AUTHOR]

Neurenteric cysts (NECs) are rare congenital, benign lesions of the central nervous system (CNS), predominantly located within the spinal cord. However, they may also occur less frequently within the brainstem, fourth ventricle, or cerebellopontine angle (CPA). Originating from anomalous interactions between embryonic layers, NECs are recognized for their potential to compress adjacent structures. We report a unique case of disseminated NECs exhibiting few to absent symptoms, which represents an unusual presentation of this disease, with only six similar reports in the literature. A 22‐year‐old female presented to our institute with chronic headaches resistant to nonsteroidal anti‐inflammatory drugs (NSAIDs). Initially treated for intracranial hypertension (ICH) secondary to a cyst in the quadrigeminal cistern at the age of 17 via neuroendoscopic surgery and subsequent ventriculoperitoneal shunting, she experienced transient relief. However, follow‐up at 22 years of age revealed multiple cysts in the basal and spinal cisterns, with MRI findings suggestive of neurocysticercosis. Despite treatment with albendazole and corticosteroids, subsequent MRIs showed no change in the size or number of the cysts. Six years later, symptoms had worsened, previously identified cysts had grown, and the detection of new cysts prompted surgical intervention. Histopathological examination confirmed the presence of NECs. This case highlights the diagnostic challenges posed by NECs, especially in regions endemic for neurocysticercosis, where clinical and radiological findings may initially suggest this condition. It underscores the importance of considering NECs in the differential diagnosis of cystic lesions in the CNS, even in the absence of typical symptoms of spinal cord compression. The recurrence and spread of NECs post‐treatment demand a comprehensive management approach, encompassing surgical intervention and close monitoring. [ABSTRACT FROM AUTHOR]

Porcine cysticercosis (PC) is an important public health problem, especially in sub-Saharan Africa, but limited information is available on the prevalence of infection in pigs entering the food chain. Existing diagnostic methods vary in accuracy and efficiency; whole carcass dissection is the most reliable method but is labour-intensive and destroys the carcass so can only be used in a research setting. Serological tests offer lower specificity, while meat inspection and lingual examination lack sensitivity, hampering accurate estimates and the removal of infected pigs from the food chain. Here, we provide the first estimates of PC prevalence in abattoirs in Rwanda. We use whole carcass dissection to determine the diagnostic accuracy of a commercial antigen-ELISA to estimate the true prevalence of infection across Rwanda and identify Taenia species affecting local pigs. We carried out a cross-sectional survey in 6 abattoirs across Rwanda (n = 744 pigs), with whole carcass dissection of a subset of 67 pigs. Cysts were detected in 20/67 (30%) of carcasses, with >1000 cysts in 9/20 (45%) of infected pigs. All cysts were identified as Taenia solium by PCR-RFLP, with no cysts of Taenia hydatigena found. The antigen-ELISA showed a sensitivity of 90% (95% CI: 68–99) and specificity of 85% (95% CI: 72–94), when compared to dissection. Using these estimates, the true prevalence was calculated as 25–43% in two abattoirs in south-west Rwanda, and 2–3% in the rest of the country. Fewer than half of infected pigs were detected by tongue palpation and post-mortem veterinary inspection. Our data indicate a high prevalence of PC in Rwandan abattoirs. Tongue palpation and veterinary inspections, as currently carried out, have little impact in removing cyst-infested pigs from the food chain. Additional interventions are needed, such as proper pig husbandry, treatment and vaccination against cysticercosis, health education, improved sanitation and hygiene, and improved processing and cooking of meat. Author summary: Porcine cysticercosis is a tapeworm infection with a complex life cycle involving pigs and humans. This parasite is the cause of over a third of cases of acquired epilepsy in regions of the world where sanitation is poor and free-range pigs are reared, and is a public health and economic challenge to consumers and farmers. Our study aimed to estimate the prevalence of tapeworm infection in slaughtered pigs in Rwanda, in order to support disease control. We found that porcine cysticercosis is widespread across the country with a high prevalence in the south and south-west. Pigs with very high numbers of tapeworm cysts were identified and constitute a public health concern to consumers. We showed that the locally available tests for infection such as tongue palpation and veterinary meat inspection are not efficient at preventing infected pigs from reaching consumers. Control of cysticercosis in Rwanda will require further interventions that support hygienic pig production practices and improved pork processing and cooking, ensure appropriate on-farm treatment to stop transmission of porcine cysticercosis and human taeniasis and increase community awareness and behaviour change. [ABSTRACT FROM AUTHOR]

Objective: Unusual clinical course. Background: Taeniasis is a helminthic infection caused by the Taenia species, specifically T. solium, T. saginata, and T. asiatica. Generally, the parasites infect the small intestine; however, instances of atypical migration have also been reported. Case Report: A 47-year-old Thai woman presented to Nan Hospital with epigastric pain, nausea, and vomiting. Physical examination revealed tenderness in the right upper quadrant, and laboratory analysis revealed mild direct hyperbilirubinemia. Abdominal ultrasonography revealed multiple gallstones and acute cholecystitis. During an elective cholecystectomy, a 70-cm-long tapeworm was found in the gallbladder. Histological examination confirmed the presence of parasitic infection suggestive of Taenia spp., with acute inflammation and focal mucosal necrosis of the gallbladder. Microscopic examination revealed 20 to 22 uterine branches in each of the 5 gravid proglottids, with 42 to 55 uterine twigs and an average ratio of uterine twigs to branches of 2.41, confirming that the parasite in question was possible for T. saginata or T. asiatica. The patient's symptoms resolved after surgery. She was prescribed an oral antibiotic and antiparasitic drug after the operation and experienced no post-surgical complications. Conclusions: Certain parasitic worms can migrate from the intestine to the biliary system. Although less common, T. solium, T. saginata, and T. asiatica can also be detected in the gallbladder and cause acute cholecystitis. This case stresses the potential for misdiagnosis in imaging studies and advises clinicians in endemic areas to consider Taenia spp. infections in the biliary system. [ABSTRACT FROM AUTHOR]

Background: This study was conducted to assess the usefulness of diffusion weighted imaging and magnetic resonance spectroscopy in diagnosing intracranial peripherally enhancing lesions. Methods: This was a hospital-based observational prospective study conducted among 68 patients with the diagnosis of cerebral ring enhancing lesions at the Department of Radiodiagnosis at Shri B.M. Patil Medical College, Hospital and Research Centre, BLDE (DU), situated at Vijayapura, Karnataka, from September 2022 to April 2024, after obtaining clearance from the institutional ethics committee and written informed consent from the study participants. Results: In the distribution of patients showing different metabolites on MR spectroscopy in various ring enhancing lesions of the brain, NAA was decreased in 50% of patients with metastasis, neurocysticercosis, in 71% of patients with primary brain tumors, and in 52.6% of patients with tuberculoma, and increased in 50% of patients with cerebral abscess. There was a significant difference in NAA change with respect to diagnosis. Cho was increased in 50% of patients with cerebral abscess and metastasis, in 100% of patients with neurocysticercosis and primary brain tumors, and in 78.9% of patients with tuberculomas. There was a significant difference in Cho with respect to the diagnosis. Similarly, Lip-Lac was increased in 100% of patients with cerebral abscess and tuberculoma, 30% of patients with metastasis and primary brain tumors, and 50% of patients with neurocysticercosis. There was a significant difference in lip-lac change with respect to diagnosis. Creatine was decreased in 12.9% of subjects with primary brain tumors and 10.5% of patients with tuberculoma. There was a significant difference in creatine change with respect to diagnosis. Metabolite ratios in various intracranial ring-enhancing lesions: the mean Cho/Cr ratio was high in primary brain tumors [4.3 ± 0.36], followed by metastasis and tuberculoma. The mean Cho/NAA ratio was high in primary brain tumors [1.7 ± 1.3], followed by tuberculoma and metastasis. The mean NAA/Cho ratio was high in cerebral abscess [1.65± 0.06] and low in primary tumors. The mean NAA/Cr ratio was high in cerebral abscess [2.2± 0.06], followed by metastasis. There was a significant difference in the mean Cho/Cr, Cho/NAA ratio, NAA/Cho, and NAA/Cr with respect to diagnosis. Conclusion: MRS is not the only criteria for diagnosing ring enhancing lesions. The combination of MRS and diffusion weighted imaging has yielded synergetic potency in detecting various ring-enhancing lesions, leading to accurate diagnosis and thus helping in management and prognosis. [ABSTRACT FROM AUTHOR]

Abstract Background To report a case of IgG4-related pachymeningitis presenting with cystic lesions mimicking neurocysticercosis. Case presentation A 40-year-old female patient with tetraparesis, dysphagia and dysphonia was evaluated with clinical examination, magnetic resonance imaging, and meningeal biopsy. Magnetic resonance imaging (MRI) revealed diffuse pachymeningeal enhancement involving the cranial, cervical, thoracic, and lumbar segments with spinal cord compression and cystic lesions. CSF immunology was initially positive for cysticercus cellulosae. After disease progression a meningeal biopsy was compatible with IgG4 related disease. The patient had partial response to rituximab and needed multiple surgical procedures for spinal cord decompression and CSF shunting. Conclusions This case highlights the possibility of IgG4-related disease in patients with diffuse pachymeningitis causing spinal cord compression, even with cystic lesions on MRI. Diagnosis of IgG4-related pachymeningitis is paramount due to the possibility of treatment response to immunotherapy, particularly to anti-CD20 agents.

Neurocysticercosis (NCC), a parasitic infection of the central nervous system caused by the larval stage of Taenia solium, presents a diagnostic conundrum due to its rare and often nonspecific clinical manifestations. This paper aims to unravel the diagnostic mystery surrounding NCC, shedding light on its epidemiology, pathophysiology, clinical presentation, and the challenges encountered in its diagnosis. Despite being considered a rare disease, NCC is the leading cause of acquired epilepsy worldwide, underscoring its clinical significance. The complexity of NCC diagnosis lies in its diverse clinical presentations, which can range from headaches, dizziness, and seizures to more severe neurological cognitive deficits. This diversity often leads to misdiagnosis. Furthermore, the limitations of current diagnostic methods, including serological tests and neuroimaging, contribute to the diagnostic dilemma. This paper emphasises the need for improved diagnostic criteria and novel diagnostic tools to enable early and accurate detection of NCC. By enhancing our understanding of NCC, we can pave the way for better management strategies, ultimately improving patient outcomes in this under-recognised disease.

Abstract Background This study aimed at describing the epidemiology of (neuro)cysticercosis as well as its clinical and radiological characteristics in a Taenia solium endemic district of Zambia. Methods This was part of a cross-sectional community-based study conducted in Sinda district to evaluate an antibody-detecting T. solium point-of-care (TS POC) test for taeniosis and (neuro)cysticercosis. All TS POC cysticercosis positive (CC+) participants and a subset of the TS POC cysticercosis negative (CC-) received a clinical evaluation and cerebral computed tomography (CT) examination for neurocysticercosis (NCC) diagnosis and staging. Results Of the 1249 participants with a valid TS POC test result, 177 (14%) were TS POC CC+ . Cysticercosis sero-prevalence was estimated to be 20.1% (95% confidence intervals [CI] 14.6–27.0%). In total, 233 participants received a CT examination (151 TS POC CC+ , 82 TS POC CC-). Typical NCC lesions were present in 35/151 (23%) TS POC CC+ , and in 10/82 (12%) TS POC CC- participants. NCC prevalence was 13.5% (95% CI 8.4–21.1%) in the study population and 38.0% (95% CI 5.2–87.4%) among people reporting epileptic seizures. Participants with NCC were more likely to experience epileptic seizures (OR = 3.98, 95% CI 1.34–11.78, p = 0.01) than those without NCC, although only 7/45 (16%) people with NCC ever experienced epileptic seizures. The number of lesions did not differ by TS POC CC status (median: 3 [IQR 1–6] versus 2.5 [IQR 1–5.3], p = 0.64). Eight (23%) of the 35 TS POC CC+ participants with NCC had active stage lesions; in contrast none of the TS POC CC- participants was diagnosed with active NCC. Conclusion NCC is common in communities in the Eastern province of Zambia, but a large proportion of people remain asymptomatic.

Background Arteritis is a complication of neurocysticercosis (NCC), which is not well known and could trigger strokes. The transcranial Doppler ultrasound (TCD) is a noninvasive method for detecting, staging, and monitoring cerebrovascular diseases. Nonetheless, the utility of TCD to evaluate cerebral hemodynamic changes, suggesting vasculitis associated with NCC remains uncertain.

Abstract Background Cysticercosis is a zoonotic parasitic disease that poses a serious threat to public health. It is widely distributed and has a high incidence rate in China. Reports of disseminated cysticercosis worldwide are rare. This article presents a case of disseminated cysticercosis in the Guangxi Zhuang Autonomous Region of southwestern China. Case presentation The patient, a 46-year-old male belonging to the Miao ethnic group, hailed from a region in Guangxi Zhuang Autonomous Region known for its high incidence of cysticercosis. He had a habit of consuming raw pork and beef. With a history of recurrent consciousness disturbances and limb convulsions for five years, he presented with headaches and dizziness nine days prior. Comprehensive examinations were conducted on the patient. Ultimately, based on epidemiological history, imaging findings, pathogen testing, and pathological results, he was diagnosed with disseminated cysticercosis. Following anthelmintic treatment, the patient was discharged with clear consciousness, free from headaches, dizziness, nausea, vomiting, and seizures. The patient is currently under follow-up care. Conclusion It is crucial to enhance public awareness, promote health education, and cultivate good hygiene habits, as these are essential measures in reducing the incidence of cysticercosis.

Background: To report a case of IgG4-related pachymeningitis presenting with cystic lesions mimicking neurocysticercosis. Case presentation: A 40-year-old female patient with tetraparesis, dysphagia and dysphonia was evaluated with clinical examination, magnetic resonance imaging, and meningeal biopsy. Magnetic resonance imaging (MRI) revealed diffuse pachymeningeal enhancement involving the cranial, cervical, thoracic, and lumbar segments with spinal cord compression and cystic lesions. CSF immunology was initially positive for cysticercus cellulosae. After disease progression a meningeal biopsy was compatible with IgG4 related disease. The patient had partial response to rituximab and needed multiple surgical procedures for spinal cord decompression and CSF shunting. Conclusions: This case highlights the possibility of IgG4-related disease in patients with diffuse pachymeningitis causing spinal cord compression, even with cystic lesions on MRI. Diagnosis of IgG4-related pachymeningitis is paramount due to the possibility of treatment response to immunotherapy, particularly to anti-CD20 agents. [ABSTRACT FROM AUTHOR]

A 61-year-old female diagnosed with neurocysticercosis was evaluated in the interventional neuroradiology department. Cerebrospinal fluid by cervical puncture was requested by the attending physician, and informed consent was obtained. The process was completed satisfactorily; fluid samples were obtained on the first attempt, and no complications were noted. Despite their drawbacks, both cisternal and cervical punctures continue to be techniques of great value and scope for various types of patients, whose descriptions and procedures must be remembered. This article describes a case report and a bibliographic review of the procedures, history and progress, indications and contraindications, as well as their probable complications. [ABSTRACT FROM AUTHOR]

Neurocysticercosis (NCC), a parasitic infection of the central nervous system caused by the larval stage of Taenia solium, presents a diagnostic conundrum due to its rare and often nonspecific clinical manifestations. This paper aims to unravel the diagnostic mystery surrounding NCC, shedding light on its epidemiology, pathophysiology, clinical presentation, and the challenges encountered in its diagnosis. Despite being considered a rare disease, NCC is the leading cause of acquired epilepsy worldwide, underscoring its clinical significance. The complexity of NCC diagnosis lies in its diverse clinical presentations, which can range from headaches, dizziness, and seizures to more severe neurological cognitive deficits. This diversity often leads to misdiagnosis. Furthermore, the limitations of current diagnostic methods, including serological tests and neuroimaging, contribute to the diagnostic dilemma. This paper emphasises the need for improved diagnostic criteria and novel diagnostic tools to enable early and accurate detection of NCC. By enhancing our understanding of NCC, we can pave the way for better management strategies, ultimately improving patient outcomes in this under-recognised disease. [ABSTRACT FROM AUTHOR]

Background: Epilepsy is a multifactorial neurological disorder, including parasitic infections of the brain such as neurocysticercosis (NCC). People with epileptic seizures (PWES) in low and middle-income countries often do not receive appropriate treatment, which besides epileptic seizures, may also lead to reduced quality of life and possibly death. The objective of this study was to describe gaps in treatment of epileptic seizures in a Zambian rural area. Methods: A cross-sectional study was conducted in Sinda district of Zambia between August and October 2018. PWES identified from clinic records and with the help of community healthcare workers were recruited. Two questionnaires, one to PWES and the other to local healthcare workers, were administered to describe the treatment gap. Results: A total of 146 PWES and 43 healthcare workers were interviewed. Of the 146 PWES, 131 had taken anti-seizure medication (ASM) at some point since their seizure onset, of which 49.6% were on current treatment. Only 18.3% were on continuous ASM, an overall treatment gap of 83.6%. Over 55% of healthcare workers did not know the relationship between epilepsy and NCC. The risk factors associated with lack of appropriate treatment were stock-outs of ASMs, lack of diagnostic equipment, poor patient follow-up, and PWES opting for traditional medicine. Conclusion: The treatment gap is substantial in Sinda district. The causes are multifactorial, involving shortcomings at the level of healthcare facilities, communities, and individuals. Directed training of healthcare workers and significant improvements in the supply and dispensing of ASMs will be key in substantially reducing the gap. [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]

Oxidative stress is associated with several infectious diseases, as well as the severity of inflammatory reactions. The control of inflammation during parasite destruction is a target of neurocysticercosis treatment, as inflammation is strongly related to symptom severity. In this study, we investigated the presence of malondialdehyde and protein carbonyl, two by-products of reactive oxygen species (ROS), in an experimental model of extraparenchymal neurocysticercosis. Twenty male and twenty female rats were inoculated with 50 cysts of Taenia crassiceps in the subarachnoid space of the cisterna magna. Ten animals (five males and five females) were used as controls. Three months after inoculation, their brains were harvested for oxidative stress and histological assessments. Infected animals had higher scores for inflammatory cell infiltrates, malondialdehyde, and protein carbonyl. These results encourage future efforts to monitor oxidative stress status in neurocysticercosis, particularly in the context of controlling inflammation. [ABSTRACT FROM AUTHOR]

Background: This study aimed at describing the epidemiology of (neuro)cysticercosis as well as its clinical and radiological characteristics in a Taenia solium endemic district of Zambia. Methods: This was part of a cross-sectional community-based study conducted in Sinda district to evaluate an antibody-detecting T. solium point-of-care (TS POC) test for taeniosis and (neuro)cysticercosis. All TS POC cysticercosis positive (CC+) participants and a subset of the TS POC cysticercosis negative (CC-) received a clinical evaluation and cerebral computed tomography (CT) examination for neurocysticercosis (NCC) diagnosis and staging. Results: Of the 1249 participants with a valid TS POC test result, 177 (14%) were TS POC CC+. Cysticercosis sero-prevalence was estimated to be 20.1% (95% confidence intervals [CI] 14.6–27.0%). In total, 233 participants received a CT examination (151 TS POC CC+ , 82 TS POC CC-). Typical NCC lesions were present in 35/151 (23%) TS POC CC+ , and in 10/82 (12%) TS POC CC- participants. NCC prevalence was 13.5% (95% CI 8.4–21.1%) in the study population and 38.0% (95% CI 5.2–87.4%) among people reporting epileptic seizures. Participants with NCC were more likely to experience epileptic seizures (OR = 3.98, 95% CI 1.34–11.78, p = 0.01) than those without NCC, although only 7/45 (16%) people with NCC ever experienced epileptic seizures. The number of lesions did not differ by TS POC CC status (median: 3 [IQR 1–6] versus 2.5 [IQR 1–5.3], p = 0.64). Eight (23%) of the 35 TS POC CC+ participants with NCC had active stage lesions; in contrast none of the TS POC CC- participants was diagnosed with active NCC. Conclusion: NCC is common in communities in the Eastern province of Zambia, but a large proportion of people remain asymptomatic. [ABSTRACT FROM AUTHOR]

Background: Cysticercosis is a zoonotic parasitic disease that poses a serious threat to public health. It is widely distributed and has a high incidence rate in China. Reports of disseminated cysticercosis worldwide are rare. This article presents a case of disseminated cysticercosis in the Guangxi Zhuang Autonomous Region of southwestern China. Case presentation: The patient, a 46-year-old male belonging to the Miao ethnic group, hailed from a region in Guangxi Zhuang Autonomous Region known for its high incidence of cysticercosis. He had a habit of consuming raw pork and beef. With a history of recurrent consciousness disturbances and limb convulsions for five years, he presented with headaches and dizziness nine days prior. Comprehensive examinations were conducted on the patient. Ultimately, based on epidemiological history, imaging findings, pathogen testing, and pathological results, he was diagnosed with disseminated cysticercosis. Following anthelmintic treatment, the patient was discharged with clear consciousness, free from headaches, dizziness, nausea, vomiting, and seizures. The patient is currently under follow-up care. Conclusion: It is crucial to enhance public awareness, promote health education, and cultivate good hygiene habits, as these are essential measures in reducing the incidence of cysticercosis. [ABSTRACT FROM AUTHOR]

Background: Geographically targeted Taenia solium ring approaches consisting of treating individuals within a radius of 100-meter of a cysticercosis positive pig have been trialled in Peru. This study explored if a similar approach could be proposed to control T. solium transmission in a post elimination setting in Zambia, focussing on community members' willingness to be sampled and treated. Methodology and Principal findings: The study was conducted in a community where elimination of active T. solium transmission was achieved. All eligible pigs and people were sampled, at 4- to 6-monthly intervals, followed by implementation of the ring treatment approach. This implied that whenever a pig was seropositive for cysticercosis during sampling, every human and pig residing in a radius of 50-meters of the seropositive pig would be treated. The results of the positive human stool samples were used to create the rings, whenever no pigs were positive. From June 2018 to October 2019, four samplings, followed by ring treatments were conducted. Between 84% and 91% of the willing people provided a stool sample, covering 46% to 59% of the total population living in the study area. Between 78% and 100% of the eligible pigs got sampled. Three ring treatments were based on porcine seropositivity and one on taeniosis results. Two to four rings were opened per sampling. During the ring treatments, between 89% and 100% of the eligible human and pig population living within a ring was treated. Conclusions: Participants were willing to participate and get treatment, once the rings were opened. However, the utility of ring treatment approaches in a post elimination setting needs further evaluation, given the lack of highly accurate diagnostic tools for porcine cysticercosis and the challenges in obtaining stool samples. The ring treatment approach adopted should be further improved before recommendations to public health authorities can be given. Author summary: In this study, we looked at whether a method used to control the spread of the pork tapeworm, a parasite transmitted between pig and people, in Peru could also work in Zambia. The method involved treating people and pigs living near animals infected with tapewormlarvae. We conducted the study in a community where the spread of the parasite via infected meat had been successfully stopped. Every few months, we sampled pigs and people in the area and treated those who were found to be infected or at risk. If a pig tested positive for the parasite, everyone within 50 meters of that pig was treated. Between June 2018 and October 2019, we did four rounds of sampling and treatment. Most people were willing to provide stool samples, and a large percentage of pigs were sampled as well. During treatment, most eligible people and pigs within the affected area received treatment. The study found that people were willing to participate and get treated once the treatment rings were set up. However, there are challenges with accurately diagnosing the parasite in pigs and getting stool samples from people. Before recommending this method to health authorities, further improvements are needed. [ABSTRACT FROM AUTHOR]

Background: The ring enhancing lesions of the brain are one of the most commonly encountered abnormalities on neuroimaging and pose a challenging group of lesions with the variable possibilities of diagnosis under conventional Magnetic Resonance Imaging (MRI). Employing advanced techniques such as Magnetic Resonance Spectroscopy (MRS) could increase the success rates of the diagnosis. Materials and Methods: 40 patients were evaluated in this study who are referred to department of radiodiagnosis, Kurnool Medical college from December 2023 to May 2024 over a period of 6 months. MRI along with MRS was performed on PHILIPS INGENIA 1.5 T. Inclusion Criteria: All suspected cerebral ring enhancing lesions detected on MR studies were taken up for MR Spectroscopy. Exclusion Criteria: Patient having contraindications to MRI. Results: Out of the 40 patients who were evaluated, tuberculoma 18 (45%) is the most common pathology followed by NCC 10(25%), Abscesses 5 (12.5%), metastases 5(12.5%) and primary brain tumors 2(5%). Conclusion: MRI along with MRS is the most sensitive modality in the characterization of intracranial ring enhancing lesions. [ABSTRACT FROM AUTHOR]

Retrospective cohort studies in Cameroon found an association between Onchocerca volvulus microfilarial load in childhood (measured in 1991–1993) and risk of developing epilepsy later in life (measured in 2017). We parameterised and integrated this relationship (across children aged 3–15 years) into the previously published, stochastic transmission model, EPIONCHO-IBM, for Simulium damnosum sensu lato-transmitted onchocerciasis. We simulated 19 years (1998–2017) of annual ivermectin mass drug administration (MDA) reflecting coverage in the study area, and modelled epilepsy prevalence and incidence. Scenario-based simulations of 25 years of (annual and biannual) MDA in hyper- and holoendemic settings, with 65% and 80% therapeutic coverage, were also conducted. EPIONCHO-IBM predicted 7.6% epilepsy prevalence (compared to 8.2% in the Cameroon study) and incidence of 317 cases/100,000 person-years (compared to 350). In hyperendemic areas, 25 years of biannual MDA (80% coverage) eliminated onchocerciasis-associated epilepsy (OAE) and protected untreated under-fives from its development. Strengthening onchocerciasis programmes, implementing alternative strategies, and evaluating treatment for under-fives and school-age children are crucial to prevent OAE in highly-endemic settings. Onchocerciasis is a vector-borne disease endemic to parts of sub-Saharan Africa and associated with substantial morbidity including reports of onchocerciasis-associated epilepsy. Here, the authors use mathematical modelling to assess the impact of community-directed treatment with ivermectin on onchocerciasis-associated epilepsy. [ABSTRACT FROM AUTHOR]

Neurocysticercosis (NCC) is caused by the invasion of Taenia solium larvae in the central nervous system (CNS) and stands as the predominant cause of epilepsy and other neurological disorders in many developing nations. NCC diagnosis is challenging because it relies on brain imaging exams (CT or MRI), which are poorly available in endemic rural or resource-limited areas. Moreover, some NCC cases cannot be easily detected by imaging, leading to inconclusive results. Multiple laboratory assays, principally immunological, have been developed to support the diagnosis and/or monitor the treatment efficacy, but its production can be costly, laborious, and non-globally accessible because they depend on parasite material. Therefore, recent advances have been focused on the implementation of recombinant or synthetic antigens as well as monoclonal antibodies for NCC immunodiagnosis purposes. Similarly, molecular diagnosis has been explored, obtaining promising results. Here we described the recent progress in the development of immunological and molecular diagnostic tools for NCC diagnosis over the past 13 years, discussing their potential application to address important challenges and how to focus future directions to improve NCC diagnosis with emphasis on enhance accessibility and the importance of test validation to provide an adequate support for clinical decisions. [ABSTRACT FROM AUTHOR]

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]

Neurocysticercosis (NCC), a major cause of global acquired epilepsy, results from Taenia solium larval brain infection. T. solium adult worms release large numbers of infective eggs into the environment contributing to high levels of exposure in endemic areas. This study identifies T. solium proteins in the sera of individuals with and without NCC using mass spectrometry to examine exposure in endemic regions. Forty‐seven patients (18–51 years), 24 parenchymal NCC (pNCC), 8 epilepsy of unknown aetiology, 7 glioma, 8 brain tuberculoma, and 7 healthy volunteers were studied. Trypsin digested sera were subject to liquid chromatography–tandem mass spectrometry and spectra of 375–1700 m/z matched against T. solium WormBase ParaSite database with MaxQuant software to identify T. solium proteins. Three hundred and nineteen T. solium proteins were identified in 87.5% of pNCC and 56.6% of non‐NCC subjects. Three hundred and four proteins were exclusive to pNCC sera, seven to non‐NCC sera and eight in both. Ten percent, exhibiting immune‐modulatory properties, originated from the oncosphere and cyst vesicular fluid. In conclusion, in endemic regions, T. solium proteins are detected in sera of individuals with and without pNCC. The immunomodulatory nature of these proteins may influence susceptibility and course of infection. [ABSTRACT FROM AUTHOR]

BACKGROUND: Neurocysticercosis (NCC) is the most common parasitic infection of the central nervous system and is typically diagnosed through visualization of the cysts in the cerebral parenchyma by neuro-imaging. However, neuro-imaging may not detect extraparenchymal neurocysticercosis (EPNCC), which is a rare manifestation of the disease involving the subarachnoid, meningeal, and intraventricular spaces. We report 2 cases of extraparenchymal neurocysticercosis, and discuss the diagnostic challenges and management of this entity. METHODS: Two cases were identified through clinical records. RESULTS: Both patients had an insidious onset with slow progression of disease, and presented with papilledema and cerebrospinal fluid (CSF) eosinophilia. One case was diagnosed with spinal cord biopsy. The other was diagnosed with CSF serology and next-generation sequencing-based pathogen analysis. Both patients were treated with ventriculoperitoneal shunt, systemic antiparasitic agents, and immunosuppression. CONCLUSIONS: EPNCC is less common than parenchymal NCC. A high level of clinical suspicion is required given its rarity, long incubation period, and slow progression. Diagnosis and treatment can be challenging and requires a multidisciplinary approach.

A rare case of widespread disseminated cysticercosis was identified in a 32-year-old female patient from the Eastern Cape province, South Africa. Initially, she displayed generalised nonspecific symptoms, leading to a misinterpretation of disseminated tuberculosis (TB). However, further radiological, haematological and pathological investigations revealed extensive dissemination of cysticercosis. Contribution: Disseminated cysticercosis (DC) is a rare condition that can mimic symptoms of other diseases, including tuberculosis, highlighting the importance of considering it in endemic areas.

Context: The efficacy of the combination of albendazole and praziquantel has not been thoroughly studied in multiple neurocysticercosis in children. Objective: To compare the efficacy and safety of albendazole and praziquantel combination versus albendazole alone in the treatment of children with multiple neurocysticercosis in terms of proportion of cysts undergoing complete resolution or calcification at 6-month follow-up. Materials and Methods: A total of 52 children, aged 1–14 years, with newly diagnosed two or more active neurocysticercosis were randomized to either group A or B. Group A (n = 26) received albendazole plus praziquantel, and Group B (n = 26) received albendazole alone. At the end of 6 months, a repeat MRI brain was performed to see for the resolution of cysts and was classified as complete resolution, calcified, or persistence of viable and noncalcified cysts. Results: The proportion of cysts undergoing complete resolution was higher in Group A (23/60 [38.33%]) than in Group B (19/65 [29.23%]), but the difference was not statistically significant. The proportion of cysts undergoing calcification was also comparable in Group A (20/60 [33.33%]) and Group B (20/65 [30.77%]). Both groups had comparable safety profiles. Conclusion: Albendazole and praziquantel combination therapy is as effective as albendazole alone in terms of complete resolution of viable cysts and calcification of cysts. Trial registration: CTRI/2021/12/038492.

Neurocysticercosis, caused by the invasion of the central nervous system (CNS) by Taenia solium larvae, poses a significant global health burden. Despite its prevalence and severe neurological consequences, understanding of the molecular and signalling pathways facilitating parasite dissemination and CNS invasion is limited. The lack of comprehensive knowledge of host-parasite interactions and associated proteins involved in T. solium infection hinders the development of targeted interventions to mitigate its ability to cross the epithelia barrier. This is complicated by reduced oxygen availability in the intestine, a phenomenon called hypoxia. Hypoxia can result in epithelial barrier disruption and cell damage, thereby promoting the translocation and dissemination of T. solium. This study aims to establish the role of hypoxia in T. solium invasion and disseminated infections. The effect of hypoxia on the migration, viability and morphological characteristics of T. solium would be determined using transwell invasion assays, flow cytometry and microscopy. T. solium oncosphere development and dissemination under hypoxic and normoxic conditions will be monitored using animal models. Also, host-parasite transcriptome and proteome profiling will be performed to determine pathways triggered under hypoxic conditions. It is expected that hypoxia would promote the invasion and dissemination of T. solium by enhancing epithelial and endothelial cell permeability. , hypoxia will induce the expression of binding and adhesion proteins and other virulence markers such as enolase, serpin, and glutathione transferases that are involved in host invasion. Understanding the role of hypoxia in the translocation mechanism of T. solium can be leveraged to provide insights into host tissues dissemination and the development of appropriate interventions.

Certain clinical features, like changes in presentation, the presence of neurological signs, and a poor response to treatment, mandate an organic evaluation of psychiatric illnesses. In this case series, four cases with established mental illnesses who presented with psychiatric symptoms, on evaluation by neuroimaging, were found to have neurological disorders like neurocysticercosis, sub-arachnoid hemorrhage, sub-dural hemorrhage, and lacunar infarction. They were managed with a combination of medical and surgical treatment and psychotropics, and no relapse of symptoms was noted at follow-up. The formulation of clinical practice guidelines can be a way forward in holistic management for such patients.

Neurocysticercosis is one of the most encountered infectious diseases caused by parasites. This condition is caused by an infection of the larvae (cysticercus) of the tapeworm Taenia Solium in the central nervous system. One of the many clinical manifestations of this condition is recurrent seizures that can eventually lead to damage to brain tissue and its functions. This literature review aims to discuss the effect of seizures on the cognitive function of patients diagnosed with neurocysticercosis. The method used in this study is a systematic review with search engines (PubMed and the Cochrane Library) using the keywords “neurocysticercosis” and “seizure” and “cognitive”. Inclusion criteria for this literature review include articles and journals published in the last 10 years with full-text access. We found 6 articles comparing the cognitive abilities of neurocysticercosis-diagnosed patients with healthy control. This literature review concluded that neurocysticercosis patients tend to have lower cognitive function in certain aspects compared to healthy controls.

Abstract There are limited data on first seizure (FS) among adults in low and middle‐income countries. We describe findings from a prospective cohort study involving 180 adults presenting with seizures in emergency departments in five Latin American countries. Overall, 102 participants (56.7%) had acute symptomatic seizures (ASyS) while 78 (43.3%) had unprovoked seizures (UPS). Among patients with ASyS, 55 (53.9%) had structural causes, with stroke (n = 24, 23.5%), tumor (n = 10, 9.8%), and trauma (n = 3, 3%) being the most frequent. Nineteen patients (18.6%) had infectious causes, including four (4%) with meningoencephalitis, three (3%) neurocysticercosis, and two (2%) bacterial meningoencephalitis. Twenty patients (19.6%) had metabolic/toxic evidence, including four (4%) with uremic encephalopathy, two (2%) hyponatremia, and three (3%) acute alcohol intoxication. Immune dysfunction was present in seven (7%) patients and neurodegenerative in two (2%). Among participants with UPS, 45 (57.7%) had unknown etiology, 24 (30.7%) had evidence of structural disorders (remote symptomatic), four (5%) were related to infectious etiology (>7 days before the seizure), and five (6.4%) had genetic causes. During the 3‐ and 6‐month follow‐up, 29.8% and 14% of patients with UPS, respectively, experienced seizure recurrence, while 23.9% and 24.5% of patients with ASyS had seizure recurrence. Longer follow‐up is necessary to assess seizure recurrence for patients with ASyS after the acute cause is resolved and to determine the 10‐year risk of recurrence, which is part of the definition of epilepsy. Plain Language Summary We monitored 180 adults who presented with their first seizure in emergency departments across five Latin American countries. Among these patients, 57% had acute symptomatic seizures, with structural causes such as stroke (23%), infection (17%), or tumor (10%) being more prevalent. Among the 43% with unprovoked seizures, 58% showed no identifiable acute cause, while 6.4% were due to genetics. Within 3 months after their initial seizure, 26.6% of individuals experienced a second seizure, with 11.9% continuing to have seizures in Months 3–6. Between Months 3 and 6, an additional 20% of patients encountered a second seizure. Research is needed to better understand the cause and prognosis of these patients to improve outcomes.

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]

Introduction: Human cysticercosis occurs when humans ingest Taenia solium eggs from the fecal-oral route. The infection in the central nervous system is called neurocysticercosis and is considered the principal cause of late-onset epilepsy in endemic countries in Latin America, Asia, and Africa. Case report: 71-year-old female in a state of neglect with a medical history of untreated rheumatoid arthritis. She presented her first seizure episode. Cerebral magnetic resonance imaging with contrast reported parenchymal and subarachnoid neurocysticercosis in different stages. Discussion: The high incidence of neurocysticercosis in endemic countries is associated with poverty conditions such as less hygienic conditions and permanent contact with domestic animals. The four stages of classification of neurocysticercosis is useful for pathologists and radiologists to identify the life cycle of the parasite within the body and the specific imaging findings of each phase. After diagnosis, treatment includes the use of niclosamide or praziquantel. Conclusions: neurocysticercosis is a public health problem in endemic countries that requires further attention. Clinical manifestations are variable and neuroimaging findings are essential to making a correct diagnosis. [ABSTRACT FROM AUTHOR]