Riesgo y distribución geográfica de neurocisticercosis en Chile según egresos hospitalarios (2002-2019) / Epidemiology of cysticercosis in Chile

BACKGROUND: Neurocysticercosis is the most prevalent parasitic disease of the central nervous system in Chile, where sporadic cases are reported, without information about the epidemiology or distribution of the disease. AIM: To identify the main risk zones for cysticercosis in Chile. MATERIAL AND METHODS: Analysis of hospital discharge databases between 2002 and 2019, available at the website of the Chilean Ministry of Health. Cases with B69 code of the tenth international classification of diseases were identified. RESULTS: In the study period, there were 1752 discharges with the diagnoses of neurocysticercosis, ocular cysticercosis and cysticercosis of other sites. The ages of patients ranged from 0 to 89 years with a clustering between 30 and 59 years. Sixty two percent were males. The zone between the regions of Maule and Araucania concentrated 82% of cases. CONCLUSIONS: We identified the zone with the greatest concentration of cysticercosis in Chile, where preventive strategies should eventually be directed.

Experimental neurocysticercosis: absence of IL-4 induces lower encephalitis / Neurocisticercose experimental: ausência de IL-4 induz menos encefalite

ABSTRACT Neurocysticercosis (NCC) is the most severe clinical manifestation of cysticercosis. One of the factors responsible for its symptomatology is the host inflammatory response. Therefore the influence of interleukin 4 (IL-4) on the induction of encephalitis in experimental NCC was evaluated. Methods BALB/c (WT) and BALB/c (IL-4-KO) mice were inoculated intracranially with Taenia crassiceps cysticerci and euthanized at 7, 30, 60 and 90 days later, the encephala removed and histopathologically analyzed. Results The absence of IL-4 induced greater parasitism. In the initial phase of the infection, IL-4-KO showed a lower intensity in the inflammatory infiltration of polimorphonuclear cells in the host-parasite interface and intra-parenquimatous edema. The IL-4-KO animals, in the late phase of the infection, showed lower intensity of ventriculomegaly, encephalitis, and meningitis, and greater survival of the parasites in comparison with the WT animals. Conclusion The absence of IL-4 induced lower inflammatory infiltration, ventriculomegaly and perivasculitis in experimental NCC.

RESUMO A Neurocisticercose (NCC) é a manifestação clínica mais severa da cisticercose, e um dos fatores responsáveis pela sintomatologia é a resposta inflamatória do hospedeiro. Desta forma avaliou-se a influência da interleucina 4 (IL-4) na indução de encefalite na NCC experimental. Métodos Camundongos das linhagens BALB/c (WT) e BALB/c (IL-4-KO) foram inoculados intracranialmente com cisticercos de Taenia crassiceps e eutanasiados aos 7, 30, 60 e 90 dias após a infecção, os encéfalos foram removidos e analisados histopatologicamente. Resultados A ausência da IL-4 induziu um maior parasitismo nos animais. Na fase inicial da infecção os animais IL-4-KO apresentaram menor intensidade tanto de infiltrado inflamatório de polimorfonucleares na interface parasito-hospedeiro quanto de edema intraparenquimatoso. Os animais IL-4-KO, na fase tardia, apresentaram menor intensidade de ventriculomegalia, encefalite, meningite e maior sobrevivência dos cisticercos em relação aos animais WT. Conclusão A ausência da IL-4 induz menos infiltrado inflamatório, ventriculomegalia e perivasculite na NCC experimental.

Development of an experimental model of neurocysticercosis-induced hydrocephalus. Pilot study

ABSTRACT PURPOSE: To develop an experimental model of neurocysticercosis-induced hydrocephalus METHODS: There were used 17 rats. Ten animals were inoculated with Taenia crassiceps cysts into the subarachnoid. Five animals were injected with 0.1ml of 25% kaolin (a standard solution for the development of experimental hydrocephalus) and two animals were injected with saline. Magnetic resonance imaging (MRI) was used to evaluate enlargement of the ventricles after one or three months of inoculation. Volumetric study was used to quantify the ventricle enlargement. RESULTS: Seven of the 10 animals in the cyst group developed hydrocephalus, two of them within one month and five within three months after inoculation. Three of the five animals in the kaolin group had hydrocephalus and none in the saline group. Ventricle volumes were significantly higher in the 3-months MRI cyst subgroup than in the 1-month cyst subgroup. Differences between cyst subgroups and kaolin group did not reach statistical significance. CONCLUSION: The developed model may reproduce the human condition of neurocysticercosis-related hydrocephalus, which exhibits a slowly progressive chronic course.

Aspiración estereotáctica de una larva de Spirometra spp. / Stereotactic aspiration of Spirometra mansonides larvae

Brain sparganosis is a non-common parasite infection by Diphyllobothrium or Spirometra mansonoides larvae. This last one is responsible for most of the infestations in humans. We report a 19 years male patient bearer of a brain sparganosis. The patient presented with headache and left hemiparesis. CT diagnosis of right thalamic lesions was made and aspiration biopsy was performed using stereotactic system, obtaining a whole and death larvae. Histopathology confirms a CNS parasitism and it was treated initially with albendazol. ELISA test confirmed Spirometra spp. infestation. The patient developed asymptomatic with total remission of the lesions. It constitutes the second report in Cuba of brain sparganosis.

Se presenta el caso clínico de un varón con 19 años de edad y el diagnóstico de una esparganosis cerebral. Consultó por cefalea y una hemiparesia izquierda. En una tomografía computarizada cerebral con contraste se observaron lesiones talámicas derechas. Se realizó una biopsia cerebral guiada por estereotaxia con aspiración completa de un verme. En el estudio histopatológico se planteó un probable parasitismo de SNC y fue tratado inicialmente con albendazol. Se confirmó la infección por Spirometra spp. por test de ELISA. Evolucionó con regresión de síntomas y remisión imagenológica de las lesiones. Este caso constituye el segundo reporte en Cuba de una infestación cerebral por este parásito y aspiración estereotáctica de la larva de Spirometra spp.

Genetic variation in the Cytb gene of human cerebral Taenia solium cysticerci recovered from clinically and radiologically heterogeneous patients with neurocysticercosis

Neurocysticercosis (NC) is a clinically and radiologically heterogeneous parasitic disease caused by the establishment of larval Taenia solium in the human central nervous system. Host and/or parasite variations may be related to this observed heterogeneity. Genetic differences between pig and human-derived T. solium cysticerci have been reported previously. In this study, 28 cysticerci were surgically removed from 12 human NC patients, the mitochondrial gene that encodes cytochrome b was amplified from the cysticerci and genetic variations that may be related to NC heterogeneity were characterised. Nine different haplotypes (Ht), which were clustered in four haplogroups (Hg), were identified. Hg 3 and 4 exhibited a tendency to associate with age and gender, respectively. However, no significant associations were found between NC heterogeneity and the different T. solium cysticerci Ht or Hg. Parasite variants obtained from patients with similar NC clinical or radiological features were genetically closer than those found in groups of patients with a different NC profile when using the Mantel test. Overall, this study establishes the presence of genetic differences in the Cytb gene of T. solium isolated from human cysticerci and suggests that parasite variation could contribute to NC heterogeneity. .

Experimental encephalitis caused by Taenia crassiceps cysticerci in mice / Encefalite experimental causada por cisticercos de Taenia crassiceps em camundongos

OBJECTIVES: To present the experimental model of neurocysticercosis (NCC) caused by Taenia crassiceps cysticerci, to describe the inflammatory process, susceptibility, or resistance of BALB/c and C57BL/6 mice to this infection, and to describe the host-parasite relationship. METHODS: The animals were intracranially inoculated with initial stage T. crassiceps cysticerci. They were euthanized at 7, 30, 60, and 90 days after the inoculation. Their encephala were removed for the histopathologic analysis, classification of the parasites, and inflammatory lesions. RESULTS: Experimental NCC was observed on both mice lineages. BALB/c mice presented inflammatory lesions with greater intensity, inducing necrosis on late stage parasites, and with an acute inflammation pattern, while C57BL/6 mice showed greater capability on provoking early necrosis in the cysticerci, which showed a chronic inflammation pattern. CONCLUSIONS: This experimental model induced NCC on mice with characteristic inflammation and lesions. C57BL/6 mice were able to induce precocious necrosis of the parasites presenting inflammatory lesions with lower intensity.

OBJETIVOS: Apresentar o modelo experimental de neurocisticercose (NCC) com cisticercos de Taenia crassiceps, descrever a inflamação, suscetibilidade e resistência em camundongos BALB/c e C57BL/6, caracterizando melhor a relação parasito-hospedeiro. MÉTODOS: Os animais foram inoculados intracranialmente com cisticercos de T. crassiceps em estádio inicial e eutanasiados aos 7, 30, 60 e 90 dias após a infecção. Retiraram-se os encéfalos para análise histopatológica, classificação dos parasitos e lesões inflamatórias. RESULTADOS: Foi possível induzir NCC nas duas linhagens de camundongos utilizados como modelo experimental. Os animais BALB/c apresentaram lesões inflamatórias mais intensas do que os camundongos C57BL/6 e induziram nos parasitos necrose na fase tardia com padrão inflamatório agudo. Os C57BL/6 mostraram-se mais hábeis em provocar necrose precocemente nos cisticercos, mas com padrão inflamatório crônico. CONCLUSÕES: Este modelo experimental induziu NCC nos animais com inflamações e lesões. Os camundongos C57BL/6 foram hábeis em induzir precocemente necrose nos parasitos, apresentando lesões inflamatórias com menor intensidade.

The role of 3D volumetric MR sequences in diagnosing intraventricular neurocysticercosis: preliminar results / Papel das sequencias volumétricas 3D de RM no diagnóstico da neurocisticercose intraventricular: resultados preliminares

OBJECTIVE: The purpose of this paper was to investigate the role of two three-dimensional magnetic resonance (MRI) sequences: enhanced spoiled gradient recalled echo (SPGR), and fast imaging employing steady-state acquisition (FIESTA) in the evaluation of intraventricular neurocysticercosis cysts and scolices. METHOD: Seven neurocysticercosis patients suspected of presenting intraventricular lesions were evaluated by magnetic resonance imaging using enhanced SPGR, and FIESTA. RESULTS: Enhanced SPGR detected eight cystic lesions, with scolices in four. Contrast enhancement was observed in three cysts. FIESTA also detected eight cystic lesions with the presence of scolices in seven of those cystic lesions. Four patients presented parenchymal involvement, while the remaining three presented the racemose form. CONCLUSION: FIESTA and SPGR are sequences that can detect intraventricular cysts of neurocysticercosis, and FIESTA also is good for the detection of the scolex. Considering this information we suggest that FIESTA and SPGR should be included in the MRI protocol for the investigation of intraventricular neurocysticercosis.

OBJETIVO: O objetivo deste trabalho foi investigar o papel de duas sequências de ressonância magnética (RM) volumétricas tridimensionais: spoiled gradient recalled echo (SPGR) pós-contraste e fast imaging employing steady-state acquisition (FIESTA) na avaliação de cistos e escólex na neurocisticercose intraventricular. MÉTODO: Sete pacientes suspeitos de neurocisticercose intraventricular foram avaliados pela ressonância magnética com SPGR pós-contraste e FIESTA. RESULTADOS: SPGR pós-contraste evidenciou oito lesões císticas com presença de escólex em quatro. Realce foi observado em três destes cistos. FIESTA também detectou oito lesões císticas, com presença de escólex em sete destas lesões. Envolvimento do parênquima cerebral foi observado em quatro pacientes e forma racemosa em três. CONCLUSÃO: FIESTA e SPGR são sequências que permitem a detecção de cistos intraventriculares de neurocisticercose e FIESTA é uma boa sequência para a detecção de escólex. Considerando estes achados nós sugerimos que estas sequências (FIESTA e SPGR) devam ser incluídas no protocolo de RM na investigação de neurocisticercose intraventricular.

Neurological disorders in children and adolescents.

OBJECTIVE: To ascertain the prevalence of active epilepsy, febrile seizures (FS), cerebral palsy (CP) and tic disorders (TD) in aged 19 years or less. METHODS: This was a cross-sectional observational study conducted as a two-stage door-to-door survey of a stratified randomly selected population in 2003-04. Trained field workers screened the population followed by case examination by the field neurologist. RESULTS: A total of 16979 (male 8898, female 8081) subjects aged <or= 19 years were surveyed. The prevalence rates per 100,000 population of active epilepsy, FS, CP and TD with 95% confidence intervals are 700.87 (580.60-838.68), 1113.14 (960.07-1283.59), 282.70 (CI 208.43-374.82) and 35.34 (12.96-76.92) respectively. Active epilepsy prevalence shows a rising trend and that of other disorders a declining trend with age. Of the epileptics who had brain CT scans, 23.4% showed single or multiple lesions suggestive of neurocysticercosis. Regarding treatment, 23.5% of the epileptics never received any antiepileptic drugs. Among those with history of FS, 9.5% developed epilepsy later on. The prevalence of FS among slum dwellers is lower than in the non-slum population. Among CP cases, 39.6% gave history of birth anoxia, 16.7% kernicterus and 31.3% epilepsy. Prevalence of CP is significantly associated with lower education status. CONCLUSION: The prevalence of CP and TD is lower than reported from western countries. CP prevalence is also comparatively lower than in many community studies from India. Compared to western nations, higher proportion of FS cases develops epilepsy. A third of the CP cases have seizures which is higher than in many Indian studies. Birth anoxia is a common cause of CP and educational underachievement is frequent.

Neurocisticercosis en pediatría / Pediatric neurocysticercosis

Cisticercosis: enfermedad parasitaria que afecta en México al 3% de la población. Se considera que hay más de 50 millones de infectados en el mundo, endémica en México, Centro y Sudamérica, Africa, Asia e India. Considerada la enfermedad infecciosa neurológica más importante mundialmente por sus manifestaciones clínicas. El agente causal en cerdos y humanos es el cisticerco de la Taenia solium, que puede alojarse en músculo, cerebro y ventrículos. Si se ingiere carne de cerdo contaminada con cisticercos, se adquiere la solitaria, que vive en los intestinos del ser humano y genera miles de huevecillos que se excretan por la materia fecal. Al ingerir alimentos contaminados con materia fecal por el humano y el cerdo, se adquiere la cisticercosis que compromete distintas partes del organismo, especialmente el SNC. El ser humano es el único hospedero de la solitaria y el cerdo es intermediario, por lo que la prevalencia de la teniasis-cisticercosis depende de este vínculo. Se diagnostica en zonas endémicas por la presencia de crisis convulsivas, cefalea, síntomas neurológicos focales, trastornos de visión, hipertensión endocraneal y tomografía cerebral con zonas hipodensas o quiste con un anillo hiperdenso. El tratamiento con antiparasitarios es controversial en pediatría, se sugiere administrarse en la fase quística no calcificada y en casos de epilepsia asociada. Pocos son los casos que ameritan tratamiento quirúrgico por hidrocefalia o por cisticerco intraventricular, que es muy raro.

Cysticercosis: parasitic disease which affects 3% of the population in Mexico. It is considered that there are more than 50 million infected people in the world, endemic in Mexico, Central and South America, Africa, Asia and India. It is considered the most important neurological infectious disease world-wide for its clinical manifestations. The causal agent in pigs and humans is the cysticercus of the Taenia solium, that can lodge in muscle, brain and ventricles. If pork meat contaminated with cysticercus is eaten, the tapeworm will live in the human intestine and create thousands of eggs that are excreted by the feces. When food contaminated with fecal matter is consumed by man or pig, the cisticercosis is disseminated in several parts of the organism, specially CNS. Man is the only host of the tapeworm and the pig is the only intermediary, reason why the prevalence of the teniasis-cisticercosis depends on this bond. It is diagnosed in endemic zones by the presence of convulsion crises, focal migraine, neurological symptoms, disorders of vision, endocraneal hypertension and CT scan with hypodense zones or cysts with a hyperdense ring. The antiparasitic treatment in children is controversial among pediatricians; it is suggested to use it only in the non calcified cystic phase and in cases associated with epilepsy. Few are the cases of hydrocephalic or intraventricular cysticercus that need surgical treatment.

Intramedullary spinal cysticercosis simulating a conus medullaris tumor: case report

Cisticercose é uma doença endêmica em vários países em desenvolvimento. Embora seja a doença parasitária mais freqüente do sistema nervoso central, o acometimento medular por cisticercos é raro. Pode ocorrer nas formas intradural extramedular, intramedular isolada, intramedular em associação com intradural extramedular, além da forma vertebral. Relatamos o caso de mulher de 53 anos de idade que se apresentou com dor lombar de início agudo, sem outros sintomas. Ressonância magnética (RM) identificou imagem cística na região do cone medular que, no estudo histopatológico, foi diagnosticada como cisticerco. A paciente recusou tratamento pós-operatório com anti-helmínticos e corticosteróides. Após oito anos de seguimento, a paciente exerce suas atividades quotidianas sem dificuldades, e estudos de RM anuais não mostram sinais de doença residual. Aspectos clínicos, fisiopatológicos, diagnósticos e terapêuticos da cisticercose intramedular são discutidos.

Molecular identification of Taenia solium cysticercus genotype in the histopathological specimens.

PCR-based molecular diagnosis was done for identification of causative agents found in paraffin-embedded specimens that were resected from two suspected neurocysticercosis patients. DNA samples were extracted from tissues or sections and cytochrome c oxidase subunit 1 gene and cytochrome b gene were amplified for the detection of taeniid DNA. Two different genes were successfully amplified in both specimens, but the sizes of amplified products seemed to depend on the quality of DNA. Based on the nucleotide sequences of the PCR-amplified genes, the causative agents from two cases were identified as T. solium Asian genotype. When infection with T. solium is not confirmed by histopathological examination, molecular diagnosis will be more useful for definitive diagnosis.

Neurocisticercose / Neurocysticercosis

Os autores relatam o caso clínico de um paciente de 24 anos de idade, suinocultor, portador de neurocisticercose. O paciente apresentou um episódio de crise convulsiva e sua tomografia computadorizada de crãnio revelou lesões parenquimatosas sugestivas de neurocisticercose nos quatro estágios da doença (vesicular, vesicular coloidal, granular nodular e nodular calcificado). A neurocisticercose é a doença parasitária mais comum do sistema nervoso, sendo também a causa mais comum de crises epilépticas nos países em desenvolvimento, onde a prevalência das crises é duas vezes maior que nos países desenvolvidos.

It has been reported a clinical case of 24 years-old patient, farmer with neurocysticercosis. The patient presented a epileptic seizure and his computed tomography showed intraparenchymal lesions in the four stages of disease. Neurocysticercosis is the most common parasitic disease of the nervous system in humans and the single most common cause of acquired epileptic seizures in the developing world, where prevalence rates of active epilepsy are twice those in developed countries.

Características evolutivas do Cysticercus cellulosae no encéfalo e no coração humanos / Developmental characteristics of Cysticercus cellulosae in the human brain and heart

O presente estudo teve como objetivos avaliar a prevalência de cisticercose, classificar as etapas evolutivas dos cisticercos encontrados nos encéfalos e coraçöes humanos, diferenciá-las de acordo com os aspectos macro e microscópicos dos processos patológicos gerais e comparar os processos encontrados nos encéfalos e coraçöes. Foram revisados protocolos de autópsias realizadas no Hospital Escola da Faculdade de Medicina do Triângulo Mineiro, Uberaba, MG, Brasil, no período de 1970 a 2000. Verificou-se a prevalência da cisticercose em 71 casos, sendo 18 (25,4 por cento) de cisticercose cardíaca e 53 (74,6 por cento) de encefálica. Foram analisados 19 cisticercos, sendo 9 de encéfalos e 10 de coraçöes. Os cisticercos foram classificados, de acordo com sua fase evolutiva, em etapas: vesicular, vesicular coloidal, granular nodular e nodular calcificada, com similaridade entre os diagnósticos macro e microscópico. Entre os processos patológicos destacaram-se a beta-fibrilose e a fibroelastose endocárdica. Adicionalmente, demonstrou-se que a classificaçäo pode ser aplicada tanto na cisticercose encefálica como na cardíaca