Radiological evolution of porcine neurocysticercosis after combined antiparasitic treatment with praziquantel and albendazole

Abstract

BackgroundThe onset of anthelmintic treatment of neurocysticercosis (NCC) provokes an acute immune response of the host, which in human cases is associated with exacerbation of neurological symptoms. This inflammation can occur at the first days of therapy. So, changes in the brain cysts appearance may be detected by medical imaging. We evaluated radiological changes in the appearance of brain cysts (enhancement and size) on days two and five after the onset of antiparasitic treatment using naturally infected pigs as a model for human NCC.Methods and resultsContrast T1-weighted magnetic resonance imaging with gadolinium was performed before and after antiparasitic treatment. Eight NCC-infected pigs were treated with praziquantel plus albendazole and euthanized two (n = 4) and five (n = 4) days after treatment; another group of four infected pigs served as untreated controls. For each lesion, gadolinium enhancement intensity (GEI) and cyst volume were measured at baseline and after antiparasitic treatment. Volume and GEI quantification ratios (post/pre-treatment measures) were used to appraise the effect of treatment. Cysts from untreated pigs showed little variations between their basal and post treatment measures. At days 2 and 5 there were significant increases in GEI ratio compared with the untreated group (1.32 and 1.47 vs 1.01, p = 0.021 and p = 0.021). Cyst volume ratios were significantly lower at days 2 and 5 compared with the untreated group (0.60 and 0.22 vs 0.95, p = 0.04 and p = 0.02). Cysts with lower cyst volume ratios showed more marked post-treatment inflammation, loss of vesicular fluid and cyst wall wrinkling.Conclusion/SignificanceA significant and drastic reduction of cyst size and increased pericystic enhancement occur in the initial days after antiparasitic treatment as an effect of acute perilesional immune response. These significant changes showed that early anthelmintic efficacy (day two) can be detected using magnetic resonance imaging.

Porcine model of neurocysticercosis by intracarotid injection of Taenia solium oncospheres: Dose assessment, infection outcomes and serological responses

“…Oncospheres invaded and developed into vesicular cysticerci in the parenchymal and corticomeningeal regions of the brain, similar to what has been previously observed in the natural pig model of NCC and in human NCC [ 2 , 51 ]. This suggests that the carotid oncosphere-injection model can be used to study the immunopathological processes according to brain location and its effects in neuroinflammation [ 52 ].…”

A Large Cohort of Neurocysticercosis in Shandong Province, Eastern China, 1997–2015

“…Then, the cysticercus gradually became fibrosis and calcified. The absorption of calcification was quite difficult, so some patients still had mild brain symptoms after treatment (Jia et al 2003, Wang et al 2008, Cangalaya et al 2017, Singh et al 2017). Therefore, once the diagnosis of NCC was confirmed, treatment should be taken promptly so that the lesions could be completely absorbed.…”

Efficacy of Combination Therapy of Albendazole and Praziquantel vs Albendazole Monotherapy in Children With Persistent Neurocysticercosis: A Randomized Controlled Trial

“…20 A significant and drastic reduction of cyst size and increased pericystic enhancement in the initial days after antiparasitic treatment has been inferred as early anthelmintic efficacy. 21 In conclusion, our randomized, placebo-controlled study demonstrates the efficacy of albendazole and praziquantel combined for complete resolution of persistent neurocysticercosis in children compared with albendazole monotherapy or placebo. The combination therapy did not result in increased seizure recurrence or adverse drug reaction compared with albendazole monotherapy.…”