Intracranial tuberculomas or neurocysticercosis: differentiated by cervical lymph node pathology.

Background: Diagnosis of tuberculomas can be difficult in the absence of pulmonary involvement due to numerable mimics. Case report: We report an immunocompetent 20-year-old female patient, who was admitted with new-onset generalized seizure. Cranial magnetic resonance imaging (MRI) revealed multiple ring-enhancing lesions. There was no reported systemic symptom such as weight loss, fever or night sweating. Polymerase chain reaction for SARS-COV-2 was negative. Computed tomography of thorax was normal. With an initial diagnosis of neurocysticercosis, she was treated with albendazole for one month. Follow-up cranial MRI showed no improvement. On follow-up visit, an enlarged cervical lymph node was recognized. Biopsy of the lymph node led to the diagnosis of tuberculosis. Two months after the onset of anti-tuberculosis therapy, follow-up cranial MRI showed near-complete resolution. Conclusion: Investigation of any involvement of disease other than the central nervous system can enable accurate and timely diagnosis of tuberculomas in the absence of pulmonary involvement.

What about infection in travellers, migrants and refugees

Several factors have been linked to emerging infectious diseases including new agents (coronaviruses, zika virus), extension of geographical areas (schistosomiasis, dengue, West Nile, zika virus), increase in incidence (HIV, tuberculosis) and travel/migration (Chagas disease, cysticercosis). According to the World Migration Report 2020, the number of international migrants reached 272 million globally in 2019, and nearly two-thirds were labour migrants. Epidemiological evidence about infectious diseases and neuroinfection among travellers, migrants and refugees will be reviewed. Traveller's diarrhoea, dengue fever and other tropical diseases are reported in travellers. Re-emergence of infections in Europe includes chikungunya, dengue and malaria. Migration of asymptomatic people spread American trypanosomiasis in non-endemic areas and cases have been reported in Europe, Japan, and North-America. Neurocysticercosis is a common cause of seizures among South American migrants in USA. Migrants may be asymptomatic carriers (Chagas, HTLV-1). The involvement of CNS may occur in viral infections (HIV, HTLV-1, dengue, zika), malaria, schistosomiasis (myeloradiculopathy), Chagas disease (encephalitis, stroke), etc. Refugees may be at slightly higher risk of infectious diseases including tuberculosis, HIV, hepatitis and schistosomiasis. Systematic reviews have found that tuberculosis and hepatitis B and C prevalence is higher among migrants arriving in Europe, and the prevalence of antimicrobial resistance and infections was higher in refugees and asylum seekers than in other migrant groups. Infectious diseases in migrants may be explained by a higher prevalence in migrants' countries of origin, barriers to health care in host/transit countries, and poor living conditions. These factors are especially relevant in vulnerable populations (refugees, documented migrants).

Neurocysticercosis, Epilepsy, COVID-19 and a Novel Hypothesis: Cases Series and Systematic Review

Background: There have been many patients with neurological manifestations reported in medical literature following a COVID-19 infection. We conducted a literature review to identify patients with coronavirus disease (COVID-19) who presented with Neurocysticercosis (NCC) and associated seizure disorders/ epilepsy. Currently, there is a new variant of the COVID-19 virus strain invading South Africa and no indication when this pandemic will end and what kind of tardive sequelae may occur going forward. Case: We searched the medical literature looking for all publications regarding NCC, Status Epilepticus (SE), Epileptic Seizures (ES), and Epilepsy (Ep), in patients infected by COVID-19. Based on the therapeutic response of our series, we propose a novel approach for patients presenting NCC, epilepsy and associated with COVID-19. We have hypothesized on the pathogenesis of ES and SE from the NCC/Cytokine Release Syndrome (CRS), SARS-CoV-2/CRS, including the role played by gut microbiota from the enteric nervous system (gut hormones, gut metabolites, inflammatory factors, neuroactive substances, and microbiota-derived products) to the medulla oblongata/hypothalamus-pituitary-adrenal axis via microbiota gut brain axis in ES, Ep and associated depression, plus the mechanism of hyperferritinemia on the overall process. This article is the first publication approaching this comorbidity as far as we know.