Subarachnoidal Neurocysticercosis non-responsive to cysticidal drugs: a case series

Cárdenas, Graciela; Carrillo‐Mezo, Roger; Jung, Hyejin; Sciutto, Edda; Soto-Hernández, José Luís; Fleury, Agnès

doi:10.1186/1471-2377-10-16

Cited by 45 publications

(25 citation statements)

References 16 publications

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“…Although case reports and patient series have proved the usefulnes of cestocidal treatment [97][98][99][100], several cestocidal cycles are often required to destroy the parasites completely. In some patients, this approach is not sufficient, despite the use of high doses of albendazole (30 mg/kg/day) [101,102], as reported recently [96]. Considering the limitations of currently available cestocidal drugs, the need for alternative treatments to treat NCSAB patients more effectively remains a clinical and therapeutic challenge [103].…”

Section: Treatmentmentioning

confidence: 99%

“…Regarding cestocidal compounds, praziquantel and albendazole are less efficient in the treatment of NCSAB patients than when the parasite is located in the brain parenchyma [96]. Although case reports and patient series have proved the usefulnes of cestocidal treatment [97][98][99][100], several cestocidal cycles are often required to destroy the parasites completely.…”

Section: Treatmentmentioning

confidence: 99%

See 1 more Smart Citation

Subarachnoid basal neurocysticercosis: a focus on the most severe form of the disease

Fleury

Carrillo‐Mezo

Flisser

et al. 2011

Expert Review of Anti-infective Therapy

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151

142

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Neurocysticercosis is an endemic disease in Latin America, Asia and Africa with growing occurrence in industrialized countries due to the increase in migration from low- and middle-income to high-income countries. The most severe clinical presentation is when the parasite is located in the subarachnoid space at the base of the brain (NCSAB). Aside from its clinical presentation, the severity of this form of the disease is due to the difficulties in diagnosis and treatment. Although NCSAB frequency is lower than that reported for the parenchymal location of the parasite, its clinical relevance must be emphasized. We provide a critical review of the central epidemiological, clinical, diagnostic and therapeutic features of this particular form of the disease, which is still associated with unacceptably high rates of morbidity and mortality.

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Section: Treatmentmentioning

confidence: 99%

Section: Treatmentmentioning

confidence: 99%

Subarachnoid basal neurocysticercosis: a focus on the most severe form of the disease

Fleury

Carrillo‐Mezo

Flisser

et al. 2011

Expert Review of Anti-infective Therapy

Self Cite

151

142

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“…Extraparenchymal NCC disease can cause meningitis with a CSF profile similar to tuberculosis or fungi. In these cases, CSF studies usually display a lymphocytic (or, less commonly, polymorphonuclear) pleocytosis, decreased glucose and elevated protein 3. CSF eosinophil counts are elevated in only 15% of patients with NCC 4.…”

Section: Differential Diagnosismentioning

confidence: 99%

Under seize: neurocysticercosis in an immigrant woman and review of a growing neglected disease

et al. 2015

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Summary Neurocysticercosis (NCC) is a significantly neglected tropical disease and, with increasing globalisation, a notable emerging infection in the developed world. We describe a case of ventricular NCC in a 22-year-old Mexican-American woman with a history of seizures, who presented with 2 weeks of headaches and intermittent fevers progressing to altered mental status and vomiting. Initial imaging revealed a cystic mass at the posteroinferior aspect of the third ventricle superior to the aqueduct of Sylvius, calcifications scattered throughout the parenchyma, and enlargement of the lateral and third ventricles. Initial laboratories were unrevealing and serum investigations for Taenia solium antibody were negative, but T. solium antibody was subsequently returned positive from cerebrospinal fluid. This case highlights important issues regarding the clinical presentation, diagnostic evaluation and treatment of NCC relevant to providers not only in areas with endemic disease but, importantly, in locales with diverse immigrant populations.

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“…Indeed, almost one-third of patients require more than two cycles of aHD treatment to significantly damage the cysticerci [2,6]. the reasons for this poor responsiveness to the aHD are not yet elucidated [7,8], although the concomitant administration of corticosteroid to avoid frequent and severe inflammatory complications may be involved. Due to their potent immunosuppressive properties [9], corticosteroids may diminish the exacerbated specific immunity against the parasite.…”

Section: Introductionmentioning

confidence: 99%

Neurocysticercosis: the effectiveness of the cysticidal treatment could be influenced by the host immunity

Cárdenas

Fragoso

Rosetti

et al. 2014

Med Microbiol Immunol

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Neurocysticercosis, a clinically and radiologically pleomorphic parasitic disease, is still endemic to most non-developed countries of Latin America, Africa, and Asia. Anti-helminthic drugs (AHD) are generally effective and rapidly destroy parenchymal cysticerci. In contrast, several cycles of AHD are frequently necessary to damage extraparenchymally located parasites. The present study was designed to evaluate whether differences in the immunological profile of the patients is involved in the diversity of the response to AHD. To this end, a global gene expression microarray and a cytokine analysis were made. Responder patients were those showing a radiological reduction greater than 50 % in the parasite burden following AHD treatment. Microarray pre- and post-treatment comparisons showed that a total of eighteen immune-related genes were up-regulated in the five responder patients with respect the expression profile seen in the four non-responder subjects. The function of up-regulated genes exerted pro-inflammatory (RORγC, Sema4A, SLAMF3, SLAMF6), anti-inflammatory (TGFβ, TNFRSF25, TNFRS18, SLAMF1, ILF2), or immunomodulatory effects (CXCL2, RUNX3, SLAMF9, TGFBR3). To further explore the causes of the heterogeneity in the response to treatment, a wide ELISA cytokine analysis was performed in serum, PBMC supernatants, and CSF samples from 39 responder and 26 non-responder patients. Responder patients showed higher CSF IL-17A levels (P = 0.04) and higher supernatant IL-6 levels (P = 0.03) 60 days after treatment. These results suggest a possible influence of pro-inflammatory cytokines on the response to AHD as observed by radiological methods, and thus the possible participation of the host immunity in the effectiveness of AHD treatment.

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Subarachnoidal Neurocysticercosis non-responsive to cysticidal drugs: a case series

Cited by 45 publications

References 16 publications

Subarachnoid basal neurocysticercosis: a focus on the most severe form of the disease

Subarachnoid basal neurocysticercosis: a focus on the most severe form of the disease

Under seize: neurocysticercosis in an immigrant woman and review of a growing neglected disease

Neurocysticercosis: the effectiveness of the cysticidal treatment could be influenced by the host immunity

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