Background
Neurocysticercosis (NC) is one of the major parasitic diseases affecting the central nervous system and is endemic in much of Asia, sub-Saharan Africa, and Latin America. Its epidemiology is difficult to assess, although official registries are available in Brazil, Colombia, Ecuador, and Mexico.
Methodology/Principal findings
Using official statistics, we assessed trends in NC hospitalization rates during 1998–2019 in Brazil and Ecuador, during 2004–2019 in Mexico, and during 2009–2019 in Colombia. We also assessed the trend in NC mortality in Brazil (1998–2019), the trend in hospitalizations for NC in a Mexican tertiary-level hospital (Instituto Nacional de Neurología y Neurocirugía [INNN]; 1995–2019), and in Mexican primary care ambulatory clinics (1995–2019). Associations between NC hospitalization rates and the human development index (HDI) were also examined.
In Brazil, Ecuador, and Mexico, statistically significant decreases in NC hospitalization rates were observed. In Mexico, a significant increase in the age of patients at INNN was observed. Conversely, a significant increase in NC hospitalization rate was observed in Colombia. HDI was not significantly associated with NC hospitalization rates when adjusting for time.
Conclusions
The downward trends in NC cases in Brazil, Ecuador, and Mexico are encouraging, especially in the context of the PAHO/WHO plan of action to eliminate neglected tropical diseases from the region. On the other hand, in Colombia, the increased NC hospitalization rate is concerning and needs further evaluation so that the authorities can take specific measures. These results should encourage health authorities in other endemic countries to establish a system of official registries to identify where the need for a control program is most urgent. However, it is also important to remember that NC persists, although less frequently in some Latin American countries, and efforts to achieve its control must continue.
Neurocysticercosis, due to the localization of Taenia solium larvae in the Central Nervous System, is a neglected tropical disease still endemic in much of Latin America, Asia and sub-Saharan Africa. The therapeutic management of NC has gradually improved with the establishment of neuroimaging studies (CT and MRI) in endemic countries and with the demonstration of the efficacy of albendazole and praziquantel in the 1980s. But the morbidity and mortality of this preventable disease remain an unacceptable fact. In this scoping review, we will revise the different treatment options and their indications.
Objective: Rituximab (RTX) is a monoclonal antibody directed against CD20 epitope expressed on B cells used widely in neuromyelitis optica spectrum disorder (NMOsd).There are few studies evaluating anti-aquaporin-4 (AQP4) positive-to-negative seroconversion. In this series, we evaluated this phenomenon in a Latin American population.
Methods: A retrospective, longitudinal and analytic study was carried out in 19 AQP4 immunoglobulin G (IgG) + NMOsd patients. We monitored all patients with a yearly test for AQP4-IgG serum autoantibodies. Potential relationships between negative seroconversion and annualized relapse rate, Expanded Disability Status Scale score, immunosuppressive or immunoregulatory treatment were assessed. Results: We included 19 patients, 17 (89.5%) were women. The mean Expanded Disability Status Scale score and annualized relapse rate at clinical onset was 3.8 (±1.97) and 0.81 (±0.577), respectively. Disease-modifying treatment included RTX, cyclophosphamide, azathioprine and methotrexate. We documented positive-tonegative seroconversion in six of the patients in the RTX group (P = 0.047). No significant changes were observed in the annualized relapse rate (2.11 vs 1.88, P = 0.06) or Expanded Disability Status Scale scores (4.41 vs 3.1, P = 0.25) between the group of seroconverted patients from those who remained positive. Conclusions: Treatment with RTX in patients with seropositive AQP4-IgG NMOsd can lead to negative conversion, but our findings do not support a clinical reflection from this change. The role of monitoring for AQP4-IgG is yet to be defined in the Mexican NMOsd population.
We present the case of a 68-year-old woman who developed progressive visuospatial deficits in a period of 18-month leading to the loss of her independence for activities of daily living. After examination, she showed signs of Balint's Syndrome with optic ataxia, oculomotor apraxia, and simultanagnosia without visual acuity impairment. After brain imaging showing severe bilateral parieto-occipital association cortex atrophy, a diagnosis of posterior cortical atrophy was made according to the 2017 International Consortium's criteria.
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