Parasitoses of the human central nervous system

Abstract

Cerebral involvement in parasitoses is an important clinical manifestation of most of the human parasitoses. Parasites that have been described to affect the central nervous system (CNS), either as the dominant or as a collateral feature, include cestodes (Taenia solium (neurocysticerciasis), Echinococcus granulosus (cerebral cystic echinococcosis), E. multilocularis (cerebral alveolar echinococcosis), Spirometra mansoni (neurosparganosis)), nematodes (Toxocara canis and T. cati (neurotoxocariasis), Trichinella spiralis (neurotrichinelliasis), Angiostrongylus cantonensis and A. costaricensis (neuroangiostrongyliasis), Gnathostoma spinigerum (gnathostomiasis)), trematodes (Schistosoma mansoni (cerebral bilharziosis), Paragonimus westermani (neuroparagonimiasis)), or protozoa (Toxoplasma gondii (neurotoxoplasmosis), Acanthamoeba spp. or Balamuthia mandrillaris (granulomatous amoebic encephalitis), Naegleria (primary amoebic meningo-encephalitis), Entamoeba histolytica (brain abscess), Plasmodium falciparum (cerebral malaria), Trypanosoma brucei gambiense/rhodesiense (sleeping sickness) or Trypanosoma cruzi (cerebral Chagas disease)). Adults or larvae of helminths or protozoa enter the CNS and cause meningitis, encephalitis, ventriculitis, myelitis, ischaemic stroke, bleeding, venous thrombosis or cerebral abscess, clinically manifesting as headache, epilepsy, weakness, cognitive decline, impaired consciousness, confusion, coma or focal neurological deficits. Diagnosis of cerebral parasitoses is dependent on the causative agent. Available diagnostic tools include clinical presentation, blood tests (eosinophilia, plasmodia in blood smear, antibodies against the parasite), cerebrospinal fluid (CSF) investigations, imaging findings and occasionally cerebral biopsy. Treatment relies on drugs and sometimes surgery. Outcome of cerebral parasitoses is highly variable, depending on the effect of drugs, whether they are self-limiting (e.g. Angiostrongylus costaricensis) or whether they remain undetected or asymptomatic, like 25% of neurocysticerciasis cases.

Environmental contamination with Toxocara eggs and seroprevalence of toxocariasis in children of northeastern Poland

“…Traditionally, visceral larva migrans (VLM), ocular larva migrans (OLM) and the most common covert (occult) toxocariasis are described (Smith et al 2009;Rubinsky-Elefant et al 2010). Neurological manifestation of the infection is referred to as neurotoxocarosis (Finsterer and Auer 2013).…”

Chronic Infectious Inflammatory Diseases of the Central Nervous System

“…Common sources of human infection are consumption of undercooked lamb or pork meat that contains viable tissue cysts or direct ingestion of oocytes from contaminated soil, water, goat's milk or unwashed vegetables (Finsterer and Auer 2013 ). In immunocompetent adults, most T. gondii infections are subclinical, but severe clinical manifestations occur in immunocompromised patients (Patil et al 2011 ).…”

“…The basal ganglia, thalamus and corticomedullar junction are most frequently affected (Finsterer and Auer 2013 ). Neurotoxoplasmosis is diagnosed upon clinical, serological, CSF or imaging investigations.…”

Helminths and helminthoses in Central Europe: diseases caused by nematodes (roundworms)

“…4); CT by bronchitis, sleeping disturbances, hyperactivity and aggressivity disorders with or without eosinophilia; GT by weakness, pruritis, rash, breath disorders and abdominal pain and, finally, NT by any kind of neurological symptoms (dementia, meningo-encephalitis, myelitis, cerebral vasculitis, epilepsy or optic neuritis [47][48][49].…”