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      Histological and molecular biology diagnosis of neurocysticercosis in a patient without history of travel to endemic areas – Case report Translated title: Diagnostic histologique et moléculaire d’une neurocysticercose atypique chez un patient français n’ayant jamais voyagé en zone d’endémie

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          Background: in endemic areas, neurocysticercosis appears mainly as a single, large, spherical and non-enhancing intracranial cyst. Case presentation: an atypical case of neurocysticercosis (NCC) in a French Caucasian, without history of travel to endemic areas, was confirmed by histology and molecular speciation. Imaging was atypical, showing several hook-bearing scolices visible in the cyst, while the serology employed was non-contributary. Conclusions: NCC should be considered when multiple taeniid scolices are observed within the same cystic lesion.

          Translated abstract

          Contexte : en zone endémique, les lésions kystiques intra-crâniales de neurocysticercose sont classiquement uniques, étendues, sphériques et sans prise de contraste. Cas clinique : un cas atypique de neurocysticercose (NCC) chez un caucasien français n’ayant jamais voyagé en zone d’endémie a été confirmé par histologie et biologie moléculaire. L’imagerie était atypique, montrant plusieurs scolex surmontés de crochets et localisés au sein d’une même lésion kystique. La sérologie était non contributive pour le diagnostic. Conclusions : le diagnostic de NCC doit être évoqué lorsque plusieurs scolex sont observés au sein d’une même lésion kystique.

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          Most cited references 12

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          Taenia solium cysticercosis.

           Marcio Garcia,  ,  E Gonzalez (2003)
          The larval stage of the pork tapeworm (Taenia solium) infects the human nervous system, causing neurocysticercosis. This disease is one of the main causes of epileptic seizures in many less developed countries and is also increasingly seen in more developed countries because of immigration from endemic areas. Little information is available on the natural evolution of taeniasis or cysticercosis. Available therapeutic measures include steroids, treatments for symptoms, surgery, and, more controversially, antiparasitic drugs to kill brain parasites. Efforts to control and eliminate this disease are underway through antiparasitic treatment of endemic populations, development of pig vaccines, and other measures.
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            Proposed diagnostic criteria for neurocysticercosis.

            Neurocysticercosis is the most common helminthic infection of the CNS but its diagnosis remains difficult. Clinical manifestations are nonspecific, most neuroimaging findings are not pathognomonic, and some serologic tests have low sensitivity and specificity. The authors provide diagnostic criteria for neurocysticercosis based on objective clinical, imaging, immunologic, and epidemiologic data. These include four categories of criteria stratified on the basis of their diagnostic strength, including the following: 1) absolute--histologic demonstration of the parasite from biopsy of a brain or spinal cord lesion, cystic lesions showing the scolex on CT or MRI, and direct visualization of subretinal parasites by funduscopic examination; 2) major--lesions highly suggestive of neurocysticercosis on neuroimaging studies, positive serum enzyme-linked immunoelectrotransfer blot for the detection of anticysticercal antibodies, resolution of intracranial cystic lesions after therapy with albendazole or praziquantel, and spontaneous resolution of small single enhancing lesions; 3) minor--lesions compatible with neurocysticercosis on neuroimaging studies, clinical manifestations suggestive of neurocysticercosis, positive CSF enzyme-linked immunosorbent assay for detection of anticysticercal antibodies or cysticercal antigens, and cysticercosis outside the CNS; and 4) epidemiologic--evidence of a household contact with Taenia solium infection, individuals coming from or living in an area where cysticercosis is endemic, and history of frequent travel to disease-endemic areas. Interpretation of these criteria permits two degrees of diagnostic certainty: 1) definitive diagnosis, in patients who have one absolute criterion or in those who have two major plus one minor and one epidemiologic criterion; and 2) probable diagnosis, in patients who have one major plus two minor criteria, in those who have one major plus one minor and one epidemiologic criterion, and in those who have three minor plus one epidemiologic criterion.
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              Current consensus guidelines for treatment of neurocysticercosis.

              Taenia solium neurocysticercosis is a common cause of epileptic seizures and other neurological morbidity in most developing countries. It is also an increasingly common diagnosis in industrialized countries because of immigration from areas where it is endemic. Its clinical manifestations are highly variable and depend on the number, stage, and size of the lesions and the host's immune response. In part due to this variability, major discrepancies exist in the treatment of neurocysticercosis. A panel of experts in taeniasis/cysticercosis discussed the evidence on treatment of neurocysticercosis for each clinical presentation, and we present the panel's consensus and areas of disagreement. Overall, four general recommendations were made: (i) individualize therapeutic decisions, including whether to use antiparasitic drugs, based on the number, location, and viability of the parasites within the nervous system; (ii) actively manage growing cysticerci either with antiparasitic drugs or surgical excision; (iii) prioritize the management of intracranial hypertension secondary to neurocysticercosis before considering any other form of therapy; and (iv) manage seizures as done for seizures due to other causes of secondary seizures (remote symptomatic seizures) because they are due to an organic focus that has been present for a long time.

                Author and article information

                EDP Sciences
                November 2012
                15 November 2012
                : 19
                : 4 ( publisher-idID: parasite/2012/04 )
                : 441-444
                [1 ] Parasitology department, University Hospital Dijon France
                [2 ] Pathology department, University Hospital Dijon France
                [3 ] Infectious diseases department, University Hospital Dijon France
                [4 ] Parasitology department, Centro Nacional de Microbiología Madrid Spain
                [5 ] Histotechnology and Pathology department, Institut Pasteur Paris France
                [6 ] University of Edinburgh, Royal (Dick) School of Veterinary Medicine, Easter Bush Veterinary Centre, The Sir Alexander Robertson Building, Easter Bush Roslin, Midlothian Scotland
                Author notes
                [* ]Correspondence: Frédéric Dalle, Département de Parasitologie Mycologie, Centre Hospitalier Universitaire de Dijon, 2, rue Angélique Ducoudray, 21000 Dijon, France. Tel.: 33 (3) 80 29 50 14 – Fax: 33 (3) 80 29 32 80. E-mail: frederic.dalle@ 123456u-bourgogne.fr
                parasite2012194p441 10.1051/parasite/2012194441
                © PRINCEPS Editions, Paris, 2012

                This is an Open Access article distributed under the terms of the Creative Commons Attribution License ( http://creativecommons.org/licenses/by/2.0), which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.

                Page count
                Figures: 1, Tables: 0, Equations: 0, References: 12, Pages: 4
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