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A special issue of Pathogens (ISSN 2076-0817). This special issue belongs to the section "Parasitic Pathogens".

Deadline for manuscript submissions: 30 June 2025 | Viewed by 25789

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Special Issue Editors

Prof. Dr. Hector H. Garcia

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Guest Editor

1. Cysticercosis Unit, Institute of Neurological Sciences, Lima, Peru
2. Center for Global Health, University Peruana Cayetano Heredia, Lima, Peru
Interests: parasitic disease of the nervous system; cysticercosis and neurocysticercosis; cystic echinococcosis

Prof. Dr. Christina M. Coyle

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Guest Editor

Department of Medicine, Albert Einstein College of Medicine, Jack and Pearl Resnick Campus, 1300 Morris Park Avenue, Bronx, NY 10461, USA
Interests: infectious diseases; expertise in parasitology

Prof. Dr. Gagandeep Singh

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Guest Editor

1. Department of Neurology, Dayanand Medical College, Ludhiana, India
2. NIHR University College London Hospitals Biomedical Research Centre, UCL Queen Square Institute of Neurology, London, UK
Interests: neurology; survival in neurocysticercosis

Prof. Dr. Oscar H. Del Brutto

E-Mail Website
Guest Editor

School of Medicine and Research Center, Universidad Espíritu Santo – Ecuador, Samborondón, Ecuador
Interests: neurocysticercosis; cysticercosis; epilepsy; neurology and neurosurgery

Special Issue Information

Dear Colleagues,

Taenia solium is still endemic in most of the developing world. Neurocysticercosis (NCC), the invasion of the human central nervous system by its larval stage or cysticercus, is a major cause of seizures and epilepsy in endemic regions, where it accounts for approximately 30% of cases. While the clinical expression of NCC has been studied for many years, its pathogenesis is not well-understood, in particular the mechanisms leading to brain inflammation, brain damage and epileptogenesis. This Special Issue will collate articles on epidemiology/control, pathogenesis, clinical expression, diagnosis, and the treatment of human and animal neurocysticercosis to provide readers with an updated body of information that reflects the advances made in this field of research over the past decades.

Prof. Dr. Hector H. Garcia
Prof. Dr. Christina M. Coyle
Prof. Dr. Gagandeep Singh
Prof. Dr. Oscar H. Del Brutto
Guest Editors

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Keywords

Taenia solium
taeniasis
cysticercosis
neurocysticercosis
epilepsy
nervous system
central nervous system
diagnostics

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Published Papers (10 papers)

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Research

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13 pages, 291 KiB

Open AccessArticle

The Frequency of Porcine Cysticercosis and Factors Associated with Taenia solium Infection in the Municipality of Tuchín-Córdoba, Colombia

by Margarita M. Arango-Londoño, Sara López-Osorio, Fernando Rojas-Bermudéz and Jenny J. Chaparro-Gutiérrez

Pathogens 2024, 13(4), 311; https://doi.org/10.3390/pathogens13040311 - 11 Apr 2024

Viewed by 1977

Abstract

Taeniasis and cysticercosis are parasitic infections that affect humans and pigs. Their global distribution constitutes a serious public health issue with significant implications for pork production. The purpose of this study was to evaluate the presence of porcine cysticercosis in backyard swine from 42 indigenous communities throughout Tuchín-Córdoba, Colombia. Between December 2020 and March 2021, free-range pigs (n = 442) were assessed using the ELISA cysticercosis Ag test; 85 pigs were examined through sublingual visual evaluation, and 4 slaughtered pig carcasses were subjected to standard operation inspection. The collected cysticercus underwent histological and PCR analysis. Furthermore, 192 surveys of knowledge, attitudes, and practices (KAP) were used to identify the factors that facilitate infection transmission. Serological investigation revealed that 9.7% (46/472) of the animals were positive for cysticerci Ag. Sublingual inspection identified cysticercus in 28.7% (25/87) of the animals, while PCR analysis indicated that cysticercus corresponded to the T. solium American/African genotype. The factors associated with T. solium infection in the pigs in the surveyed areas numbered 14. The majority are associated with factors that promote the active persistence of Taenia solium’s life cycle in an area, such as lack of environmental sanitation, a lack of coverage or care for drinking water and wastewater treatment services, and no solid waste disposal. Full article

(This article belongs to the Special Issue Recent Advances in Taeniasis and Cysticercosis)

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15 pages, 1317 KiB

Open AccessFeature PaperArticle

Calcified Neurocysticercosis: Demographic, Clinical, and Radiological Characteristics of a Large Hospital-Based Patient Cohort

by Javier A. Bustos, Gianfranco Arroyo, Oscar H. Del Brutto, Isidro Gonzales, Herbert Saavedra, Carolina Guzman, Sofia S. Sanchez-Boluarte, Kiran T. Thakur, Christina Coyle, Seth E. O’Neal and Hector H. Garcia

Pathogens 2024, 13(1), 26; https://doi.org/10.3390/pathogens13010026 - 27 Dec 2023

Cited by 1 | Viewed by 2446

Abstract

Neurocysticercosis (NCC), the infection of the central nervous system caused by Taenia solium larvae (cysticerci), is a major cause of acquired epilepsy worldwide. Calcification in NCC is the most common neuroimaging finding among individuals with epilepsy in T. solium-endemic areas. We describe the demographic, clinical, and radiological profiles of a large hospital cohort of patients with calcified NCC in Peru (during the period 2012–2022) and compared profiles between patients with and without a previous known diagnosis of viable infection. A total of 524 patients were enrolled (mean age at enrollment: 40.2 ± 15.2 years, mean age at symptom onset: 29.1 ± 16.1 years, 56.3% women). Of those, 415 patients (79.2%) had previous seizures (median time with seizures: 5 years, interquartile range (IQR): 2–13 years; median number of seizures: 7 (IQR: 3–32)), of which 333 (80.2%) had predominantly focal to bilateral tonic-clonic seizures; and 358 (68.3%) used antiseizure medication). Patients had a median number of three calcifications (IQR: 1–7), mostly located in the frontal lobes (79%). In 282 patients (53.8%) there was a previous diagnosis of viable infection, while 242 only had evidence of calcified NCC since their initial neuroimaging. Most patients previously diagnosed with viable infection were male, had previous seizures, had seizures for a longer time, had more calcifications, and had a history of taeniasis more frequently than patients without previously diagnosed viable infection (all p < 0.05). Patients with calcified NCC were heterogeneous regarding burden of infection and clinical manifestations, and individuals who were diagnosed after parasites calcified presented with milder disease manifestations. Full article

(This article belongs to the Special Issue Recent Advances in Taeniasis and Cysticercosis)

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14 pages, 743 KiB

Open AccessEditor’s ChoiceArticle

Clinical Characteristics of Neurocysticercosis in a Peruvian Population-Based Epilepsy Cohort: A Descriptive Cross-Sectional Study of Baseline Clinical Intake

by Samantha E. Allen, Luz M. Moyano, Melissa T. Wardle, Carolina Guzman, Sofia S. Sanchez-Boluarte, Gabrielle Bonnet, Javier A. Bustos, Seth O’Neal and Hector H. Garcia

Pathogens 2023, 12(11), 1313; https://doi.org/10.3390/pathogens12111313 - 3 Nov 2023

Cited by 2 | Viewed by 1573

Abstract

(1) Background: This study presents the baseline characteristics of a community-level population of people with epilepsy (n = 1975) living in an area endemic for Taenia solium, the pathogen responsible for neurocysticercosis (NCC). (2) Methods: Participants were sequentially enrolled in a clinical cohort from 2007 to 2020 in Tumbes, Peru. All participants provided demographic and clinical history and received clinical evaluations. Diagnostics, including neuroimaging, cysticercosis serologies, and EEG, were obtained where possible. The data presented are from the cross-sectional baseline assessment of cohort participants. (3) Results: Approximately 38% of participants met the criteria for NCC. Those with NCC were more likely to have adult-onset epilepsy, as well as a longer duration of epilepsy, as compared to their counterparts without NCC. Overall, the data indicate a large treatment gap, with only approximately a quarter of the baseline population with prescriptions for anti-seizure medications. (4) Conclusions: These data reveal a high proportion of NCC among people living with epilepsy in these communities, with limited health care resources. At baseline, 74% of the population were not receiving anti-seizure treatments. Further analyses of these data will clarify the natural history of the disease for this population. Full article

(This article belongs to the Special Issue Recent Advances in Taeniasis and Cysticercosis)

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11 pages, 439 KiB

Open AccessEditor’s ChoiceArticle

Neurocysticercosis Diagnosis in a Non-Endemic Country: France

by Ines Zemmour, Marie-Fleur Durieux, Etienne Herault, Célia Rouges, Barbara Šoba, Aurélien Mercier, Frédéric Ariey, Pierre-Marie Preux, Hélène Yera and on behalf of Collaborators Group

Pathogens 2023, 12(10), 1205; https://doi.org/10.3390/pathogens12101205 - 29 Sep 2023

Cited by 1 | Viewed by 1481

Abstract

Diagnosing neurocysticercosis (NCC) is difficult due to its variable clinical presentations and the different imaging techniques used to detect brain damage. This study aimed to evaluate the use of cerebrospinal fluid serology and PCR for diagnosing biological neurocysticercosis in a non-endemic country. We tested samples from patients living in France with suspected NCC and confirmed that 45 of the patients presented with the disease. A total of 89% of patients had previously traveled to countries where the disease was endemic. The sensitivity of Western blots compared to ELISA was not significantly different (80% vs. 60%) (p > 0.05), and neither was the sensitivity of Western blots vs. PCR (78% vs. 56%) (p > 0.05). The PCR sensitivity was 78% and 47% in definitive NCC and in probable NCC. PCR tests using cerebrospinal fluid should be considered as a diagnostic criterion for identifying NCC. Full article

(This article belongs to the Special Issue Recent Advances in Taeniasis and Cysticercosis)

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9 pages, 1599 KiB

Open AccessArticle

Can sPD-1 and sPD-L1 Plasma Concentrations Predict Treatment Response among Patients with Extraparenchymal Neurocysticercosis?

by Andrea Toledo, Gladis Fragoso, Roger Carrillo-Mezo, Matthew L. Romo, Edda Sciutto and Agnès Fleury

Pathogens 2023, 12(9), 1116; https://doi.org/10.3390/pathogens12091116 - 1 Sep 2023

Cited by 1 | Viewed by 1335

Abstract

Extraparenchymal neurocysticercosis (EP-NC) is a chronic, potentially life-threatening disease that responds poorly to initial anthelmintic drug therapy. A depressed specific reactivity of peripheral lymphocytes and an increased level of specific Tregs accompanies EP-NC. The immune checkpoint pathway PD-1 and its ligand PD-L1 downregulates effector T cells, causing specific immune suppression in chronic diseases. This study explored whether their soluble forms, sPD-1/sPD-L1, are present in plasma among patients with EP-NC and if their levels could be associated with treatment response. A total of 21 patients with vesicular EP-NC and 22 healthy controls were included. Patients received standard treatment and were followed for six months to assess treatment response by assessing changes in cyst volume determined with 3D MRI. The presence of both sPD-1 and sPD-L1 was more frequently detected among patients with EP-NC than in healthy controls and had higher concentrations. Among patients, higher pre-treatment levels of both markers were associated with a poor treatment response, and the sensitivity and specificity of the sPD-1/sPD-L1 ratio for predicting any response to treatment were high. Our results are consistent with the presence of lymphocyte exhaustion and open new research perspectives to improve the prognosis of patients with this severe disease. Full article

(This article belongs to the Special Issue Recent Advances in Taeniasis and Cysticercosis)

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13 pages, 1416 KiB

Open AccessArticle

Evaluating the Role of Corrals and Insects in the Transmission of Porcine Cysticercosis: A Cohort Study

by Eloy Gonzales-Gustavson, Ian W. Pray, Ricardo Gamboa, Claudio Muro, Percy Vilchez, Luis Gomez-Puerta, Ana Vargas-Calla, Gabrielle Bonnet, Francesco Pizzitutti, Hector H. Garcia, Armando E. Gonzalez and Seth E. O’Neal

Pathogens 2023, 12(4), 597; https://doi.org/10.3390/pathogens12040597 - 14 Apr 2023

Viewed by 1689

Abstract

The widespread dispersion of pigs infected with cysticercosis across endemic villages, low cyst burden among infected pigs, and low prevalence of taeniasis all suggest that pig ingestion of human feces is not the only mode of transmission for Taenia solium. Our objective was to evaluate the risk of porcine cysticercosis associated with exposure to human feces, dung beetles, and flies in an endemic community setting. We used a cluster-randomized cohort design to compare the risk of developing antibodies and infection among 120 piglets raised in either free-roaming (FR), standard corral (SC), or netted corral environments (NC). We collected monthly blood samples to detect serum antibodies and necropsied all pigs after 10 months to identify cysts. A total of 66 piglets developed antibodies with the relative risk of seropositivity in FR vs. all corralled pigs increasing significantly after 18 weeks. Of 108 necropsied pigs, 15 had T. solium cysts, all belonging to the FR group. Corrals were protective against infection but less so against seropositivity. NC, which did not completely exclude insects, did not provide added protection against seropositivity as compared to SC. The results of this study suggest that dung beetles and flies do not play an important role in infection. Full article

(This article belongs to the Special Issue Recent Advances in Taeniasis and Cysticercosis)

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11 pages, 1446 KiB

Open AccessArticle

Consistent Measurement of Parasite-Specific Antigen Levels in Sera of Patients with Neurocysticercosis Using Two Different Monoclonal Antibody (mAb)-Based Enzyme-Linked Immunosorbent Assays

by Yesenia Castillo, Luz M. Toribio, Carolina Guzman, Gianfranco Arroyo, Cindy Espinoza, Herbert Saavedra, Javier A. Bustos, Pierre Dorny, Seth E. O’Neal and Hector H. Garcia

Pathogens 2023, 12(4), 566; https://doi.org/10.3390/pathogens12040566 - 6 Apr 2023

Cited by 3 | Viewed by 1728

Abstract

Monoclonal antibody (mAb)-based enzyme-linked immunosorbent assay (ELISA) is a complementary diagnosis technique for neurocysticercosis (NCC), which detects circulating parasite antigen (Ag) indicative of viable infection and Ag levels that correlate well with the parasite burden. In this study, we compared the performance of two Ag-ELISA techniques for the detection of NCC. We assessed the agreement between our in-house TsW8/TsW5 Ag-ELISA and the widely used B158/B60 Ag-ELISA for measuring T. solium antigen levels in the sera from 113 patients with calcified, parenchymal, and subarachnoid NCC. Concordance was demonstrated evaluating the limits of agreement (LoAs) stratified by the type of NCC. Both ELISA’s detected 47/48 (97.8%) subarachnoid NCC cases. In parenchymal and calcified NCC, the B158/B60 Ag-ELISA detected 19/24 (79.2%) and 18/41 (43.9%) cases, while the TsW8/TsW5 Ag-ELISA detected 21/24 (87.5%) and 13/41 (31.7%), respectively. Parenchymal and calcified NCC obtained a perfect agreement (100%), indicating that all sample results were within the predicted LoA, while for subarachnoid NCC, the agreement was 89.6%. The high concordance between the assays was confirmed by Lin’s concordance coefficient (LCC = 0.97). Patients with viable parenchymal NCC (LCC = 0.95) obtained the highest concordance between assays, followed by subarachnoid NCC (LCC = 0.93) and calcified NCC (LCC = 0.92). The TsW8/TsW5 Ag-ELISA and B158/B60 Ag-ELISA showed high Ag measurement correlations across diverse types of NCC. Full article

(This article belongs to the Special Issue Recent Advances in Taeniasis and Cysticercosis)

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13 pages, 6336 KiB

Open AccessReview

Current Role of Surgery in the Treatment of Neurocysticercosis

by Pedro Tadao Hamamoto Filho, Luiz Fernando Norcia, Agnès Fleury and Marco Antônio Zanini

Pathogens 2024, 13(3), 218; https://doi.org/10.3390/pathogens13030218 - 29 Feb 2024

Cited by 3 | Viewed by 2121

Abstract

Neurocysticercosis (NCC) is a common parasitic disease of the central nervous system (CNS) in low- and middle-income countries. The infection is pleomorphic, caused by the larval form of the cestode, Taenia solium, and part of the heterogeneity of its clinical presentations is associated with the localization of the parasite within the CNS. Changes in the current epidemiological trends of NCC indicate that extra-parenchymal NCC is proportionally becoming more frequent. Extraparenchymal NCC is commonly accompanied by raised intracranial hypertension due to hydrocephalus, which is an emergency requiring cyst extirpation by surgical intervention to relieve the symptoms. Although less frequent, parenchymal cysts may also reach giant sizes requiring urgent surgical treatment. Finally, there is an advancement in the comprehension of the association between NCC and epilepsy—and patients with drug-resistant seizures are candidates for surgical treatment. In this narrative review, we summarize the present state of knowledge to update the current trends in the role of surgery in the treatment of NCC. Full article

(This article belongs to the Special Issue Recent Advances in Taeniasis and Cysticercosis)

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13 pages, 1003 KiB

Open AccessReview

Human Neurocysticercosis: An Overview

by Oscar H. Del Brutto

Pathogens 2022, 11(10), 1212; https://doi.org/10.3390/pathogens11101212 - 20 Oct 2022

Cited by 17 | Viewed by 6042

Abstract

Human cysticercosis is caused by ingestion of T. solium eggs from taenia carriers. Neurocysticercosis (NCC), defined as the infection of the CNS and the meninges by the larval stage of Taenia solium, is the most common helminthic infection of the CNS worldwide. Parasites may lodge in brain parenchyma, subarachnoid space, ventricular system, or spinal cord, causing pathological changes that account for the pleomorphism of this disease. Seizures/epilepsy are the most common clinical manifestation, but other patients present with headache, focal deficits, intracranial hypertension, or cognitive decline. Accurate diagnosis of NCC is possible after interpretation of clinical data together with findings of neuroimaging studies and results of immunological tests. However, neuroimaging studies are fundamental for diagnosis because immunological test and clinical manifestations only provide circumstantial evidence of NCC. The introduction of cysticidal drugs changed the prognosis of most NCC patients. These drugs have been shown to reduce the burden of infection and to improve the clinical course of the disease in many patients. Efforts should be directed to eradicate the disease through the implementation of control programs against all the steps in the life cycle of T. solium, including carriers of the adult tapeworm, infected pigs, and eggs in the environment. Full article

(This article belongs to the Special Issue Recent Advances in Taeniasis and Cysticercosis)

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9 pages, 3447 KiB

Open AccessPerspective

Epilepsy Due to Solitary Calcified Cysticercus Granuloma

by Jagarlapudi M. K. Murthy

Pathogens 2023, 12(8), 1037; https://doi.org/10.3390/pathogens12081037 - 14 Aug 2023

Cited by 1 | Viewed by 3724

Abstract

The calcified stage of the neurocysticercosis (NCC) is the common cause of acquired epilepsy in low and middle income countries in people aged > 20 years. Approximately 30% of adult onset seizures and epilepsy are attributable to NCC. In India and some of the Latin American countries, epilepsy due to solitary calcified NCC is the common adult onset epilepsy. The current evidence suggests that the calcified cysticercus granuloma is probably the epileptogenic focus. The mechanisms involved in the epileptogenic process are not well understood; Focal-onset seizures with or without impaired awareness are the common seizure type. Focal-onset seizure can evolve to bilateral tonic-clonic seizure. Seizure outcome with anti-seizure medication, most often with monotherapy, is very good. The seizure disorders associated with various stages of NCC can be preventable. Full article

(This article belongs to the Special Issue Recent Advances in Taeniasis and Cysticercosis)

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