Diagnosis and Treatment of Neurocysticercosis: 2017 Clinical Practice Guidelines by the Infectious Diseases Society of America (IDSA) and the American Society of Tropical Medicine and Hygiene (ASTMH)

White, A. Clinton; Coyle, Christina M.; Rajshekhar, Vedantam; Singh, Gagandeep; Hauser, W. Allen; Mohanty, Aaron; Garcı́a, Héctor H.; Nash, Theodore E.

doi:10.4269/ajtmh.18-88751

Cited by 90 publications

(73 citation statements)

References 144 publications

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“…58 The hallmark of parenchymal NCC is the formation of a vesicular cyst that degenerates from a viable to a calcified form. 63,64 Spinal NCC is a rarer manifestation of NCC, with extramedullary arachnoid disease constituting the majority of cases. 59 Cyst degeneration occurs when the immune system detects the parasite.…”

Section: Discussion Of Pathology and Diagnosismentioning

confidence: 99%

“…Subarachnoid NCC can also cause pronounced inflammation, which can be difficult to control and treat. 63,64 Spinal NCC is a rarer manifestation of NCC, with extramedullary arachnoid disease constituting the majority of cases. 26 Intracranial disease is also evident in most cases, but our patient only had subtle leptomeningeal enhancement on brain MRI and no intraparenchymal or intraventricular lesions.…”

Section: Discussion Of Pathology and Diagnosismentioning

confidence: 99%

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Clinicopathology conference: 41‐year‐old woman with chronic relapsing meningitis

Beck

Ramachandran

Khan

et al. 2019

Annals of Neurology

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Section: Discussion Of Pathology and Diagnosismentioning

confidence: 99%

Section: Discussion Of Pathology and Diagnosismentioning

confidence: 99%

Clinicopathology conference: 41‐year‐old woman with chronic relapsing meningitis

Beck

Ramachandran

Khan

et al. 2019

Annals of Neurology

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“…The cysticidal treatment regimen used in this study has been used at the INNN for more than 10 years . It is different from what is recommended in recent guidelines, that is, to continue treatment until there is resolution of cystic lesions on neuroimaging studies; however, there are no studies that support this latter recommendation . Main adverse events of this regimen are reversible increase of liver enzymes and reversible alopecia in fewer than 10% of patients.…”

Section: Methodsmentioning

confidence: 99%

Factors Associated With Cysticidal Treatment Response in Extraparenchymal Neurocysticercosis

Osorio

Carrillo‐Mezo

Romo

et al. 2018

The Journal of Clinical Pharma

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Extraparenchymal neurocysticercosis is the most severe form of cysticercosis, and response to treatment is suboptimal. We sought to determine how demographic and clinical characteristics and albendazole sulfoxide concentrations were related to cysticidal treatment response. We conducted a longitudinal study of 31 participants with extraparenchymal vesicular parasites who received the same treatment, albendazole 30 mg/kg/day for 10 days with dexamethasone 0.4 mg/kg/day for 13 days, followed by a prednisone taper. Response to treatment was determined by parasite volumes before and 6 months after treatment. Eight participants (25.8%) had a complete treatment response, 16 (51.6%) had a treatment response > 50% but < 100%, and 7 (22.6%) had a treatment response < 50%. Complete treatment response was significantly associated with higher concentrations of albendazole sulfoxide (P = .032), younger age (P = .032), fewer cysts (P = .049) and lower pretreatment parasite volume (P = .037). Higher number of previous cysticidal treatment courses was associated with a noncomplete treatment response (P = .023). Although the large proportion of participants with less than a complete response emphasizes the need to develop more efficacious pharmacologic regimens, the association of albendazole sulfoxide concentrations with treatment response highlights the importance of optimizing existing therapeutic regimens. In addition, the association of treatment response with parasite volume emphasizes the importance of early diagnosis.

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“…To reduce the intensity of the type 1-mediated inflammation, which may severely damage brain tissues, combination therapy is recommended (especially for patients with solitary cysticercus granuloma) but might need to be implemented case by case [9,19,67]. Thus, ABZ and PZQ are generally used in combination with anti-inflammatory drugs such as corticosteroids.…”

Section: Anthelmintic Treatment Hiv and Impacts On The Immune Respomentioning

confidence: 99%

Host immune responses during Taenia solium Neurocysticercosis infection and treatment

et al. 2020

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Taenia solium cysticercosis and taeniasis (TSCT), caused by the tapeworm T. solium, is a foodborne and zoonotic disease classified since 2010 by WHO as a neglected tropical isease. It causes considerable impact on health and economy and is one of the leading causes of acquired epilepsy in most endemic countries of Latin America, Sub-Saharan Africa, and Asia. There is some evidence that the prevalence of TSCT in high-income countries has recently increased, mainly due to immigration from endemic areas. In regions endemic for TSCT, human cysticercosis can manifest clinically as neurocysticercosis (NCC), resulting in epileptic seizures and severe progressive headaches, amongst other neurological signs and/or symptoms. The development of these symptoms results from a complex interplay between anatomical cyst localization, environmental factors, parasite's infective potential, host genetics, and, especially, host immune responses. Treatment of individuals with active NCC (presence of viable cerebral cysts) with anthelmintic drugs together with steroids is usually effective and, in the majority, reduces the number and/or size of cerebral lesions as well as the neurological symptoms. However, in some cases, treatment may profoundly enhance anthelmintic inflammatory responses with ensuing symptoms, which, otherwise, would have remained silent as long as the cysts are viable. This intriguing silencing process is not yet fully understood but may involve active modulation of host responses by cyst-derived immunomodulatory components released directly into the surrounding brain tissue or by the induction of regulatory networks including regulatory T cells (Treg) or regulatory B cells (Breg). These processes might be disturbed once the cysts undergo treatment-induced apoptosis and necrosis or in a coinfection setting such as HIV. Herein, we review the current literature regarding the immunology and pathogenesis of NCC with a highlight on the mobilization of immune cells during human NCC and their interaction with viable and degenerating cysticerci. Moreover, the immunological parameters associated with NCC in people living with HIV/AIDS and treatments are discussed.

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Diagnosis and Treatment of Neurocysticercosis: 2017 Clinical Practice Guidelines by the Infectious Diseases Society of America (IDSA) and the American Society of Tropical Medicine and Hygiene (ASTMH)

Cited by 90 publications

References 144 publications

Clinicopathology conference: 41‐year‐old woman with chronic relapsing meningitis

Clinicopathology conference: 41‐year‐old woman with chronic relapsing meningitis

Factors Associated With Cysticidal Treatment Response in Extraparenchymal Neurocysticercosis

Host immune responses during Taenia solium Neurocysticercosis infection and treatment

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