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      Neurocysticercosis: A Review

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      1, 2 , *
      The Scientific World Journal
      Hindawi Publishing Corporation

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          Abstract

          Neuroysticercosis is the most common helminthic infection of the nervous system, and a leading cause of acquired epilepsy worldwide. The disease occurs when humans become intermediate hosts of Taenia solium by ingesting its eggs from contaminated food or, most often, directly from a taenia carrier by the fecal-to-oral route. Cysticerci may be located in brain parenchyma, subarachnoid space, ventricular system, or spinal cord, causing pathological changes that are responsible for the pleomorphism of neurocysticercosis. Seizures are the most common clinical manifestation, but many patients present with focal deficits, intracranial hypertension, or cognitive decline. Accurate diagnosis of neurocysticercosis is possible after interpretation of clinical data together with findings of neuroimaging studies and results of immunological tests. The introduction of cysticidal drugs have changed the prognosis of most patients with neurocysticercosis. These drugs have shown to reduce the burden of infection in the brain and to improve the clinical course of the disease in most patients. Further efforts should be directed to eradicate the disease through the implementation of control programs against all the interrelated steps in the life cycle of T. solium, including human carriers of the adult tapeworm, infected pigs, and eggs in the environment.

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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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            Neurocysticercosis: updated concepts about an old disease.

            Neurocysticercosis, the infection of the human brain by the larvae of Taenia solium, is a major cause of acquired epilepsy in most low-income countries. Cases of neurocysticercosis are becoming more common in high-income countries because of increased migration and travel. Diagnosis by neuroimaging and serological assessment has greatly improved over the past decade, and the natural progression of the disease and response to antiparasitic drugs is now much better understood. Neurocysticercosis is potentially eradicable, and control interventions are underway to eliminate this infection. Meanwhile, updated information on diagnosis and management of neurocysticercosis is required, especially for clinicians who are unfamiliar with its wide array of clinical presentations.
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              An Enzyme-Linked Immunoelectrotransfer Blot Assay and Glycoprotein Antigens for Diagnosing Human Cysticercosis (Taenia solium)

              An enzyme-linked immunoelectrotransfer blot (EITB) assay was developed for immunodiagnosing human cysticercosis. The assay uses lentil-lectin, affinity-purified glycoprotein antigens. A battery of 532 serum and 46 cerebrospinal fluid (CSF) samples (148 cases of parasitologically confirmed cysticercosis, 54 healthy controls, and 18 types of heterologous infections [376 cases]) were used to ascertain the assay's efficacy. All but three of the samples from cases of confirmed cysticercosis were positive; none of the samples from healthy controls or heterologous infections reacted to any of the diagnostic bands. Thus, the assay is 98% sensitive and 100% specific. We identified seven major glycoprotein bands that are commonly recognized by virtually all serum and/or CSF samples from patients with confirmed cysticercosis. There was no significant difference in test performance when CSF was compared with serum. The EITB assay is highly reproducible and simple to perform, and the reagents (including the antigens blotted onto strips) are very stable.
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                Author and article information

                Journal
                ScientificWorldJournal
                ScientificWorldJournal
                TSWJ
                The Scientific World Journal
                Hindawi Publishing Corporation
                1537-744X
                2012
                4 January 2012
                : 2012
                : 159821
                Affiliations
                1Department of Neurological Sciences, Hospital—Clinica Kennedy, Guayaquil, Ecuador
                2Air Center 3542, P.O. Box 522970, Miami, Fl 33152-2970, USA
                Author notes

                Academic Editors: D. Bates, M. Brunanska, and P. L. Moro

                Article
                10.1100/2012/159821
                3261519
                22312322
                126c94e9-3852-4669-be53-eb36325d4d79
                Copyright © 2012 Oscar H. Del Brutto.

                This is an open access article distributed under the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.

                History
                : 3 October 2011
                : 1 November 2011
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                Review Article

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