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Neurocysticercosis hospitalizations; additional diagnoses, procedures performed and hospital utilization by gender, CA 2009 (N = 304). This figure shows that men hospitalized with neurocysticercosis have more severe symptoms requiring a longer and more costly hospitalization than women with neurocysticercosis. Specifically, men hospitalized with neurocysticercosis were more likely to have an additional diagnosis of hydrocephalus, to have a hospitalization exceeding four days and to have a hospital charge exceeding 40,000 dollars as compared to women hospitalized with neurocysticercosis.
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Author Summary
Neurocysticercosis (NCC) is considered one of the major neglected infections of poverty in the United States, with mortality studies indicating that California bears the highest burden of this disease. Although NCC is a reportable disease in California, studies indicate that this disease goes largely under-reported, contributing to t...
Citations
... Like other infectious diseases, Neurocysticercosis outbreaks financially burden countries that are economically well off as well as underdeveloped nations [4], [5]. ...
... NCC is of significant global health importance, as it is responsible for up to 60% of all epilepsy in endemic areas [1]. In recent years, nonendemic areas have recognized the increased burden of imported cases, including the United States [2,3]. ...
Background and objectives:
Subarachnoid neurocysticercosis (SANCC) is the most severe form of Taenia solium CNS infection and accounts for the majority of neurocysticercosis-associated mortality. Inflammation is important in the treatment of SANCC because overactivity can lead to serious complications, but excessive suppression may be counterproductive toward parasite eradication. A relative abundance of CSF IL-10 to IL-12 has been associated with increased treatment duration for patients with SANCC, suggesting that IL-10 plays an important role in this disease process. To better understand SANCC immunology and the major sources of IL-10 during anthelmintic treatment, we took an unbiased and comprehensive approach to phenotype the immune cell populations in the CSF and peripheral blood of patients with SANCC.
Methods:
Eight samples of CSF cells collected from 5 patients with SANCC during treatment were evaluated using single-cell RNA sequencing. Matched CSF and peripheral blood mononuclear cells from 4 patients were assessed using flow cytometry. Staining for extracellular and intracellular markers allowed for the characterization of IL-10-producing T cells.
Results:
The CSF during SANCC contains a diversity of immune cell populations including multiple myeloid and lymphoid populations. Although there were changes in the composition of CSF cells during treatment, the largest population at both early and late time points was CD4+ T cells. Within this population, we identified 3 sources of IL-10 unique to SANCC CSF compared with controls: natural regulatory T cells (nTregs), induced regulatory T cells (iTregs), and Th17 cells. The abundance and phenotype of these IL-10-producing populations differed between CSF and blood in patients with SANCC, but iTregs were the single most productive population in the CSF. During treatment, these IL-10 producers persisted in consistent proportions despite decreases in parasite antigen over time.
Discussion:
This profile of immune cell populations in the CSF provides a comprehensive blueprint of the local and systemic immunology associated with SANCC. The identification of IL-10-producing cells in the CSF and peripheral blood deepens our understanding of the immunosuppressive phenotype that deters SANCC treatment success. Finally, the discovery that these IL-10 producers persist throughout treatment highlights the endurance of these populations in the CNS.
... Since around three decades, a concern was raised on the increase of diagnosed cases in non-endemic countries (countries where the life cycle of the parasite did not take place, i.e., swine cysticercosis is not present), where cases of cysticercosis or taeniasis have been detected (Del Brutto and García 2012). Such cases have been Wertheim et al. 2012) mainly reported in the United States (O'Neal and Flecker 2015;Serpa and White 2012;Croker et al. 2012;O'Neal et al. 2011) andin Spain (Del Brutto 2012;Ruiz et al. 2011;Esquivel et al. 2005), due to the increase of human migration from endemic countries. As migration of Taenia solium carriers keeps occurring, autochthonous cysticercosis infections have been reported in these countries due to contact with T. solium eggs. ...
... Since around three decades, a concern was raised on the increase of diagnosed cases in non-endemic countries (countries where the life cycle of the parasite did not take place, i.e., swine cysticercosis is not present), where cases of cysticercosis or taeniasis have been detected (Del Brutto and García 2012). Such cases have been Wertheim et al. 2012) mainly reported in the United States (O'Neal and Flecker 2015;Serpa and White 2012;Croker et al. 2012;O'Neal et al. 2011) andin Spain (Del Brutto 2012;Ruiz et al. 2011;Esquivel et al. 2005), due to the increase of human migration from endemic countries. As migration of Taenia solium carriers keeps occurring, autochthonous cysticercosis infections have been reported in these countries due to contact with T. solium eggs. ...
... 21 However, individuals with cysticercosis, particularly with a history of migration, also search for medical assistance outside of endemic areas, where cysticercosis might be easily missed or only be identified accidentally. [22][23][24][25][26] Furthermore, individuals without a history of eating pork or traveling to endemic areas have been described as experiencing neurocysticercosis. 26 Epidemiologic studies have demonstrated that tight clustering in households and household contacts of patients with neurocysticercosis poses a threefold higher risk of positive serology for cysticercosis than controls. ...
Neurocysticercosis, the most common type of neuroparasitosis, is a condition in which the central nervous system (CNS) is infested with the pork tapeworm Taenia solium cysticercosis’ larvae. Neurocysticercosis is the most widespread parasitic CNS disease worldwide, affecting more than 50 million individuals. As neurocysticercosis is prevalent in developing countries, the growing number of migrants and travelers increases prevalence in developed countries. Possible neuropsychiatric manifestations are depression, cognitive dysfunction, dementia, and visual hallucinations. Depending on the cysts’ location in the CNS, focal neurology or psychiatric symptoms manifest. The diagnosis of neurocysticercosis is based on neuroimaging and serology. The correlation between specific symptoms and the cyst’s location might help better understand psychiatric disorders’ pathophysiology. Nonetheless, the exact prevalence of neurocysticercosis is seldom reported in patients with psychiatric disorders, which may be due to the lack of imaging availability in developing countries with a high prevalence.
... NCC is of significant global health importance, as it is responsible for up to 60% of all epilepsy in endemic areas [1]. In recent years, nonendemic areas have recognized the increased burden of imported cases, including the United States [2,3]. ...
Background
Subarachnoid neurocysticercosis (SANCC) represents the most severe and difficult to treat form of neurocysticercosis. The inflammatory response contributes significantly to the morbidity and mortality of the disease. This study sought to understand the nature and evolution of the inflammation associated with SANCC, and evaluate for predictors of time to cure.
Methods
There were 16 subjects with SANCC (basilar cistern, sylvian fissure, and/or spinal involvement) during active infection who had cerebrospinal fluid (CSF) cytokine and chemokine profiling, of whom 9 had a second CSF sample at (or following) the time of cure. The relationships between clinical parameters and cytokine/chemokine results were assessed.
Results
Compared to pools of healthy donor CSF, those with active SANCC showed a significant (P < .05) increase in chemokines and cytokines associated with Type 1 immunity (interferon [IFN] γ, interleukin [IL] 12p70, C-X-C Motif Ligand 10 CXCL-10); Type 2 immunity (IL-10, IL-13); IFNα2; and the chemokines Macrophage inflammatory protein MIP-1α/CCL3, MIP-1ß/CCL4, and Vascular Endothelial Growth Factor VEGF that appears to be locally (central nervous system [CNS]) produced. Compared to those with active disease, those with CSF taken at the time of cure showed a significant decrease in most of these chemokines and cytokines. Despite this, CSF from cured SANCC patients had levels of IL-10 (P = .039), CXCL-10 (P = .039), and IL-12p70 (P = .044) above those seen in CSF from uninfected subjects. High ratios of IL-12p70/IL-10 early in infections were associated with a shorter time to cure (r = −0.559; P = .027), and a high Taenia solium burden (by quantitative polymerase chain reaction) was associated with longer times to cure (r = 0.84; P = .003).
Conclusions
SANCC is associated with a marked, CNS-localized cytokine-/chemokine-driven inflammatory response that largely decreases with curative therapy, though some analytes persisted above the normal range. The relative balance between proinflammatory and regulatory cytokines may be an important determinant for a cure in SANCC.
... While few studies have specifically examined differences between men and women in the prevalence of NCC, some have documented sex differences in the susceptibility and severity of this disease [5,[15][16][17][18]. For example, a study in Ecuador among NCC hospitalized patients found the odds of having transitional cysts were 1.5-fold higher for female patients than for male patients, even after controlling for healthcare access [15]. ...
... Findings from different studies are often contradictory. For instance, a study of NCC hospitalized individuals in California found that men were more likely to have a lengthy hospital stays (>4 days) as compared to women and the severity of NCC appeared associated with male sex [16]. Yet, a previous study in Mexico found that Cysticercotic encephalitis was more frequent among young women [17]. ...
Background
Neurocysticercosis (NCC) is a helminthic disease of the central nervous system, and it is one of the leading causes of seizures and symptomatic epilepsy in countries with tropical regions like Peru. Studies of people with epilepsy in Peru’s northern coast have consistently found that between 30% and 50% of epilepsy cases is associated with NCC. There are few studies that report on the differences in incidence and prevalence of NCC by sex, and to our knowledge, none that consider the gendered dimensions of having epilepsy.
Methodology
This qualitative study based on individual interviews (n = 9) and focus group discussions (n = 12) explored the challenges of diagnosis and the implications for everyday activities among men and women with epilepsy as well as the views of their family members on the impact of such condition.
Principal findings
The explanatory models used by women to discuss their condition reflect low levels of decision-making power in areas such a reproductive health, health care access and treatment. For some women domestic violence is also a probable cause for seizures among women. The implications of living with neurocysticercosis and the accompanying seizures were reported differently by men and women. While women were mostly concerned about their capacity to perform their domestic responsibilities and their roles as mothers and caregivers; men were mostly concerned about the impact on their income generation activities. Women and men shared concern about the consequences of their condition on the wellbeing of their families.
Conclusions/Significance
NCC is a disrupting experience for men and women in ways that reflect their position and roles in society: Women as caregivers within the home, men as income generators outside the home. Further gender research is needed to better understand and address the differential impacts of NCC and health system responses as well as gendered dimensions of prevalence and incidence. (268 words)
... 5 Immigration is increasing the number of cases seen in Europe and the United States. [6][7][8][9] Approximately 18,600 hospitalizations for neurocysticercosis occurred in the United States between 2003 and 2012, with the highest risk among Hispanics (although only 15.5% of these cases were reported in the northeastern United States 10 ). While there is evidence to suggest that neurocysticercosis is underreported, 11 most data available are from inpatient samples, so the underreporting is likely greater at outpatient clinics. ...
... Moreover, little is known about the role of the parasite as a causal agent of epilepsy and headaches [5]. All the patients in our series were male, which is consistent with the finding of other studies that cerebral cysticercosis is slightly more likely to be found in males than females [9,10]. ...
Cerebral cysticercosis is the most common parasitic disease of the human nervous system. It is endemic to some tropical countries but has rarely been described in Vietnam. We report three cases of neurocysticercosis in patients from north-west Vietnam presenting with recurrent epileptic seizures. Hypereosinophilia and positive immunoglobulin G (IgG) antibodies to cysticercosis were detected in two patients and three patients, respectively. The brain MRI showed multiple ring-enhancing cerebral lesions with a well-defined border. Scolexes were demonstrated on fluid attenuation inversion recovery (FLAIR) sequence as small images associated with a hyperintense cyst wall. Treatment of cerebral cysticercosis infection with albendazole 15 mg/kg/day x 21 days along with antiepileptic drug therapy usually results in a favorable outcome. These results highlight that cerebral cysticercosis should be suspected in patients from an endemic area who present with headaches and/or epileptic seizures.
... Croker et. al determined that there were about 300 cases of NCC in Southern California in 2009, in which men were more likely to be affected as compared to women [6]. This study demonstrated the economic toll of treatment for NCC. ...
... This study demonstrated the economic toll of treatment for NCC. The cost for hospitalization was 5.1 million dollars and average length of stay was 6.5 days as compared to 4.6 days average LOS for all US admissions [6]. In terms of average cost of hospitalization, total inflation-adjusted hospitalization charges [for NCC] over the 10-year study period were $908,238,000, increasing 27% in 2003 to 2012 [7]. ...
