Semin Neurol 2019; 39(03): 358-368
DOI: 10.1055/s-0039-1693036
Review Article
Thieme Medical Publishers 333 Seventh Avenue, New York, NY 10001, USA.

Parasitic Infections of the Nervous System

Hector H. Garcia
1   Instituto Nacional de Ciencias Neurológicas, Lima, Peru
2   Center for Global Health, Universidad Peruana Cayetano Heredia, Lima, Peru
,
Avindra Nath
3   National Institute of Neurological Disorders and Stroke (NINDS), National Institutes of Health, Bethesda, Maryland
,
Oscar H. Del Brutto
4   School of Medicine, Universidad Espiritu Santo Ecuador, Samborondon, Ecuador
› Author Affiliations
Further Information

Publication History

Publication Date:
02 August 2019 (online)

Abstract

Parasitic infections of the central nervous system are much more common than suspected, although most infections are asymptomatic. For example, parasites like the ubiquitous protozoa Toxoplasma gondii or the nematode larvae Toxocara canis infect significant proportions of the human population. Other parasitic infections such as malaria and neurocysticercosis are widespread in developing countries and become major causes of neurological morbidity in these regions as well in immigrants and travelers. This article reviews parasitic pathogens causing neurological morbidity and mortality, including an extensive list of less common parasitic infections of the human nervous system.

 
  • References

  • 1 Garcia HH, Nash TE, Del Brutto OH. Clinical symptoms, diagnosis, and treatment of neurocysticercosis. Lancet Neurol 2014; 13 (12) 1202-1215
  • 2 Ndimubanzi PC, Carabin H, Budke CM. , et al. A systematic review of the frequency of neurocyticercosis with a focus on people with epilepsy. PLoS Negl Trop Dis 2010; 4 (11) e870
  • 3 Thakur K, Zunt J. Tropical neuroinfectious diseases. Continuum (Minneap Minn) 2015; 21 (6 Neuroinfectious Disease): 1639-1661
  • 4 Pappas G, Roussos N, Falagas ME. Toxoplasmosis snapshots: global status of Toxoplasma gondii seroprevalence and implications for pregnancy and congenital toxoplasmosis. Int J Parasitol 2009; 39 (12) 1385-1394
  • 5 Torgerson PR, Mastroiacovo P. The global burden of congenital toxoplasmosis: a systematic review. Bull World Health Organ 2013; 91 (07) 501-508
  • 6 Soldati D, Meissner M. Toxoplasma as a novel system for motility. Curr Opin Cell Biol 2004; 16 (01) 32-40
  • 7 Tenter AM, Heckeroth AR, Weiss LM. Toxoplasma gondii: from animals to humans. Int J Parasitol 2000; 30 (12-13): 1217-1258
  • 8 Correa-Nazco VJ, Miguélez M, Laynez P, Linares M. Multiple hemorrhagic cerebral toxoplasmosis and AIDS [in Spanish]. Enferm Infecc Microbiol Clin 1999; 17 (10) 531-532
  • 9 Kotresha D, Noordin R. Recombinant proteins in the diagnosis of toxoplasmosis. APMIS 2010; 118 (08) 529-542
  • 10 Montoya JG, Rosso F. Diagnosis and management of toxoplasmosis. Clin Perinatol 2005; 32 (03) 705-726
  • 11 Remington JS, Thulliez P, Montoya JG. Recent developments for diagnosis of toxoplasmosis. J Clin Microbiol 2004; 42 (03) 941-945
  • 12 Swisher CN, Boyer K, McLeod R. ; The Toxoplasmosis Study Group. Congenital toxoplasmosis. Semin Pediatr Neurol 1994; 1 (01) 4-25
  • 13 Dard C, Fricker-Hidalgo H, Brenier-Pinchart MP, Pelloux H. Relevance of and new developments in serology for toxoplasmosis. Trends Parasitol 2016; 32 (06) 492-506
  • 14 Villard O, Cimon B, L'Ollivier C. , et al. Help in the choice of automated or semiautomated immunoassays for serological diagnosis of toxoplasmosis: evaluation of nine immunoassays by the French National Reference Center for Toxoplasmosis. J Clin Microbiol 2016; 54 (12) 3034-3042
  • 15 Nath A, Sinai AP. Cerebral toxoplasmosis. Curr Treat Options Neurol 2003; 5 (01) 3-12
  • 16 Christensen SS, Eslick GD. Cerebral malaria as a risk factor for the development of epilepsy and other long-term neurological conditions: a meta-analysis. Trans R Soc Trop Med Hyg 2015; 109 (04) 233-238
  • 17 Marsh K, English M, Peshu N, Crawley J, Snow R. Clinical algorithm for malaria in Africa. Lancet 1996; 347 (9011): 1327-1328 , author reply 1328–1329
  • 18 Postels DG, Birbeck GL. Cerebral malaria. Handb Clin Neurol 2013; 114: 91-102
  • 19 Newton CR, Warrell DA. Neurological manifestations of falciparum malaria. Ann Neurol 1998; 43 (06) 695-702
  • 20 Newton CR, Krishna S. Severe falciparum malaria in children: current understanding of pathophysiology and supportive treatment. Pharmacol Ther 1998; 79 (01) 1-53
  • 21 Idro R, Marsh K, John CC, Newton CR. Cerebral malaria: mechanisms of brain injury and strategies for improved neurocognitive outcome. Pediatr Res 2010; 68 (04) 267-274
  • 22 Taylor TE, Molyneux ME. The pathogenesis of pediatric cerebral malaria: eye exams, autopsies, and neuroimaging. Ann N Y Acad Sci 2015; 1342: 44-52
  • 23 Birbeck GL, Molyneux ME, Kaplan PW. , et al. Blantyre Malaria Project Epilepsy Study (BMPES) of neurological outcomes in retinopathy-positive paediatric cerebral malaria survivors: a prospective cohort study. Lancet Neurol 2010; 9 (12) 1173-1181
  • 24 Villaverde C, Namazzi R, Shabani E, Opoka RO, John CC. Clinical comparison of retinopathy-positive and retinopathy-negative cerebral malaria. Am J Trop Med Hyg 2017; 96 (05) 1176-1184
  • 25 Potchen MJ, Birbeck GL, Demarco JK. , et al. Neuroimaging findings in children with retinopathy-confirmed cerebral malaria. Eur J Radiol 2010; 74 (01) 262-268
  • 26 Vyas S, Gupta V, Hondappanavar A. , et al. Magnetic resonance imaging of cerebral malaria. J Emerg Med 2012; 42 (05) e117-e119
  • 27 Warrell DA, Looareesuwan S, Warrell MJ. , et al. Dexamethasone proves deleterious in cerebral malaria. A double-blind trial in 100 comatose patients. N Engl J Med 1982; 306 (06) 313-319
  • 28 Ngoungou EB, Preux PM. Cerebral malaria and epilepsy. Epilepsia 2008; 49 (Suppl. 06) 19-24
  • 29 Garcia HH, Gilman R, Martinez M. , et al; The Cysticercosis Working Group in Peru (CWG). Cysticercosis as a major cause of epilepsy in Peru. Lancet 1993; 341 (8839): 197-200
  • 30 Garcia HH, O'Neal SE, Gilman RH. ; Cysticercosis Working Group in Peru. Elimination of Taenia solium transmission in Peru. N Engl J Med 2016; 375 (12) 1196-1197
  • 31 Flisser A. Taeniasis and cysticercosis due to Taenia solium. Prog Clin Parasitol 1994; 4: 77-116
  • 32 Del Brutto OH, Nash TE, White Jr AC. , et al. Revised diagnostic criteria for neurocysticercosis. J Neurol Sci 2017; 372: 202-210
  • 33 White Jr AC, Coyle CM, Rajshekhar V. , et al. Diagnosis and treatment of neurocysticercosis: 2017 Clinical Practice Guidelines by the Infectious Diseases Society of America (IDSA) and the American Society of Tropical Medicine and Hygiene (ASTMH). Clin Infect Dis 2018; 66 (08) 1159-1163
  • 34 Rodriguez S, Wilkins P, Dorny P. Immunological and molecular diagnosis of cysticercosis. Pathog Glob Health 2012; 106 (05) 286-298
  • 35 Garcia HH, Castillo Y, Gonzales I. , et al; Cysticercosis Working Group in Peru. Low sensitivity and frequent cross-reactions in commercially available antibody detection ELISA assays for Taenia solium cysticercosis. Trop Med Int Health 2018; 23 (01) 101-105
  • 36 Dixon HB, Lipscomb FM. Cysticercosis: an Analysis and Follow-up of 450 cases. London: H.M. Stationery Office; 1961
  • 37 Robles C, Chavarría Chavarría M. Report of a clinical case of cerebral cysticercosis treated medically with a new drug: praziquantel [in Spanish]. Salud Publica Mex 1979; 21 (05) 603-618
  • 38 Garcia HH, Pretell EJ, Gilman RH. , et al; Cysticercosis Working Group in Peru. A trial of antiparasitic treatment to reduce the rate of seizures due to cerebral cysticercosis. N Engl J Med 2004; 350 (03) 249-258
  • 39 Garcia HH, Gonzales I, Lescano AG. , et al; Cysticercosis Working Group in Peru. Efficacy of combined antiparasitic therapy with praziquantel and albendazole for neurocysticercosis: a double-blind, randomised controlled trial. Lancet Infect Dis 2014; 14 (08) 687-695
  • 40 Martinez AJ, Visvesvara GS. Free-living, amphizoic and opportunistic amebas. Brain Pathol 1997; 7 (01) 583-598
  • 41 Visvesvara GS, Moura H, Schuster FL. Pathogenic and opportunistic free-living amoebae: Acanthamoeba spp., Balamuthia mandrillaris, Naegleria fowleri, and Sappinia diploidea. FEMS Immunol Med Microbiol 2007; 50 (01) 1-26
  • 42 Khan NA. Acanthamoeba invasion of the central nervous system. Int J Parasitol 2007; 37 (02) 131-138
  • 43 Visvesvara GS. Infections with free-living amebae. Handb Clin Neurol 2013; 114: 153-168
  • 44 Bravo FG, Seas C. Balamuthia mandrillaris amoebic encephalitis: an emerging parasitic infection. Curr Infect Dis Rep 2012; 14 (04) 391-396
  • 45 Abdel Razek AA, Watcharakorn A, Castillo M. Parasitic diseases of the central nervous system. Neuroimaging Clin N Am 2011; 21 (04) 815-841 , viii
  • 46 Cope JR, Conrad DA, Cohen N. , et al. Use of the novel therapeutic agent miltefosine for the treatment of primary amebic meningoencephalitis: report of 1 fatal and 1 surviving case. Clin Infect Dis 2016; 62 (06) 774-776
  • 47 Büscher P, Cecchi G, Jamonneau V, Priotto G. Human African trypanosomiasis. Lancet 2017; 390 (10110): 2397-2409
  • 48 Carod-Artal FJ. American trypanosomiasis. Handb Clin Neurol 2013; 114: 103-123
  • 49 Pérez-Molina JA, Molina I. Chagas disease cardiomyopathy treatment remains a challenge - authors' reply. Lancet 2018; 391 (10136): 2209-2210
  • 50 Malik LH, Singh GD, Amsterdam EA. The epidemiology, clinical manifestations, and management of Chagas heart disease. Clin Cardiol 2015; 38 (09) 565-569
  • 51 Román GC. The neurology of parasitic diseases and malaria. Continuum (Minneap Minn) 2011; 17 (1 Neurologic Complications of Systemic Disease): 113-133
  • 52 Rozman M, Brugués R, Feliu E, Rozman C. Mott cells, a suspicious sign of African trypanosomiasis [in Spanish]. Sangre (Barc) 1986; 31 (03) 367-369
  • 53 Kennedy PG. Clinical features, diagnosis, and treatment of human African trypanosomiasis (sleeping sickness). Lancet Neurol 2013; 12 (02) 186-194
  • 54 Fan CK, Holland CV, Loxton K, Barghouth U. Cerebral toxocariasis: silent progression to neurodegenerative disorders?. Clin Microbiol Rev 2015; 28 (03) 663-686
  • 55 Finsterer J, Auer H. Neurotoxocarosis. Rev Inst Med Trop São Paulo 2007; 49 (05) 279-287
  • 56 Glickman LT, Schantz PM. Epidemiology and pathogenesis of zoonotic toxocariasis. Epidemiol Rev 1981; 3: 230-250
  • 57 Nicoletti A. Toxocariasis. Handb Clin Neurol 2013; 114: 217-228
  • 58 Sánchez SS, García HH, Nicoletti A. Clinical and magnetic resonance imaging findings of neurotoxocariasis. Front Neurol 2018; 9: 53
  • 59 Magnaval JF, Fabre R, Maurières P, Charlet JP, de Larrard B. Application of the western blotting procedure for the immunodiagnosis of human toxocariasis. Parasitol Res 1991; 77 (08) 697-702
  • 60 Quattrocchi G, Nicoletti A, Marin B, Bruno E, Druet-Cabanac M, Preux PM. Toxocariasis and epilepsy: systematic review and meta-analysis. PLoS Negl Trop Dis 2012; 6 (08) e1775
  • 61 Singh G, Bawa J, Chinna D. , et al. Association between epilepsy and cysticercosis and toxocariasis: a population-based case-control study in a slum in India. Epilepsia 2012; 53 (12) 2203-2208
  • 62 Wang QP, Lai DH, Zhu XQ, Chen XG, Lun ZR. Human angiostrongyliasis. Lancet Infect Dis 2008; 8 (10) 621-630
  • 63 Lv S, Zhou XN, Andrews JR. Eosinophilic meningitis caused by Angiostrongylus cantonensis. ACS Chem Neurosci 2017; 8 (09) 1815-1816
  • 64 Lilic N, Addison B. Angiostrongylus meningitis associated with intraparenchymal cerebral haemorrhage. N Z Med J 2013; 126 (1386): 98-102
  • 65 Kanpittaya J, Sawanyawisuth K, Intapan PM, Khotsri P, Chotmongkol V, Maleewong W. A comparative study of neuroimaging features between human neuro-gnathostomiasis and angiostrongyliasis. Neurol Sci 2012; 33 (04) 893-898
  • 66 Natrajan K, Medisetty M, Gawali R. , et al. Strongyloidosis hyperinfection syndrome in an HIV-infected patient: a rare manifestation of immune reconstitution inflammatory syndrome. Case Rep Infect Dis 2018; 2018: 6870768
  • 67 Toledo R, Muñoz-Antoli C, Esteban JG. Strongyloidiasis with emphasis on human infections and its different clinical forms. Adv Parasitol 2015; 88: 165-241
  • 68 Masdeu JC, Tantulavanich S, Gorelick PP. , et al. Brain abscess caused by Strongyloides stercoralis. Arch Neurol 1982; 39 (01) 62-63
  • 69 Gay T, Pankey GA, Beckman EN, Washington P, Bell KA. Fatal CNS trichinosis. JAMA 1982; 247 (07) 1024-1025
  • 70 Fourestie V, Douceron H, Brugieres P, Ancelle T, Lejonc JL, Gherardi RK. Neurotrichinosis. A cerebrovascular disease associated with myocardial injury and hypereosinophilia. Brain 1993; 116 (Pt 3): 603-616
  • 71 Rosca EC, Simu M. Border zone brain lesions due to neurotrichinosis. Int J Infect Dis 2018; 67: 43-45
  • 72 Xia Y, Chen J, Ju Y, You C. Characteristic CT and MR imaging findings of cerebral paragonimiasis. J Neuroradiol 2016; 43 (03) 200-206
  • 73 Kashida Y, Niiro M, Maruyama H, Hanaya R. Cerebral paragonimiasis with hemorrhagic stroke in a developed country. J Stroke Cerebrovasc Dis 2018; 27 (10) 2648-2649
  • 74 Carod Artal FJ. Cerebral and spinal schistosomiasis. Curr Neurol Neurosci Rep 2012; 12 (06) 666-674
  • 75 Benger A, Rennie RP, Roberts JT, Thornley JH, Scholten T. A human coenurus infection in Canada. Am J Trop Med Hyg 1981; 30 (03) 638-644
  • 76 Antonios SN, Mina SN. A case report of human coenurus cerebralis in Tanta, Egypt. J Egypt Soc Parasitol 2000; 30 (03) 959-960
  • 77 Jacquet G, Godard J, Czorny A. Cerebral alveolar echinococcosis. Apropos of a surgically-treated case. Review of the literature [in French]. Neurochirurgie 1992; 38 (06) 362-367
  • 78 Batçık OE, Öğrenci A, Koban O, Ekşi MS, Bilge T. Cerebral alveolar echinococcosis concomitant with liver and lung lesions in a young adult patient: case report and literature review. Turkiye Parazitol Derg 2016; 40 (03) 169-171
  • 79 Yadav VK, Sudhakar SV, Panwar J. Pathognomonic MRI and MR spectroscopy findings in cerebral hydatid cyst. Acta Neurol Belg 2016; 116 (03) 353-355
  • 80 Chang KH, Chi JG, Cho SY, Han MH, Han DH, Han MC. Cerebral sparganosis: analysis of 34 cases with emphasis on CT features. Neuroradiology 1992; 34 (01) 1-8
  • 81 Yu Y, Shen J, Yuan Z. , et al. Cerebral sparganosis in children: epidemiologic and radiologic characteristics and treatment outcomes: a report of 9 cases. World Neurosurg 2016; 89: 153-158
  • 82 Johnson TP, Tyagi R, Lee PR. , et al. Nodding syndrome may be an autoimmune reaction to the parasitic worm Onchocerca volvulus. . Sci Transl Med 2017; 9 (377) eaaf6953
  • 83 Pollanen MS, Onzivua S, Robertson J. , et al. Nodding syndrome in Uganda is a tauopathy. Acta Neuropathol 2018; 136 (05) 691-697