Semin Neurol 2011; 31(3): 231-244
DOI: 10.1055/s-0031-1287651
© Thieme Medical Publishers

Neurologic Parasitic Infections in Immigrants and Travelers

Kiran Thakur1 , 2 , 3 , Joseph Zunt4
  • 1Department of Neurology, Massachusetts General Hospital, Boston, Massachusetts
  • 2Department of Neurology, Brigham and Women's Hospital, Boston, Massachusetts
  • 3Harvard Medical School, Boston, Massachusetts
  • 4Departments of Neurology, Global Health, Medicine (Infectious Diseases) and Epidemiology, University of Washington, Harborview Medical Center, Seattle, Washington
Further Information

Publication History

Publication Date:
30 September 2011 (online)

ABSTRACT

Infectious diseases are increasingly common in modern clinical practice and the contemporary neurologist must be aware of the clinical manifestations, potential complications, and management of common travel-related infections. The authors provide an approach to patients who present with neurologic symptoms, with a history of travel to or residence in tropical and developing countries. Although many other infections are important in this demographic, they focus on three parasitic infections that neurologists may encounter: cerebral malaria, neuroschistosomiasis, and neurocysticercosis. The epidemiology, pathophysiology, clinical manifestations, diagnostic evaluation, and treatment are discussed for each infection.

REFERENCES

  • 1 Poser C, Poser J. Neurology in the developing world (book review).  Brain. 2006;  129 (6) 1624-1629
  • 2 Han M H, Zunt J R. Neurologic aspects of infections in international travelers.  Neurologist. 2005;  11 (1) 30-44
  • 3 Talisuna A O, Bloland P, D'Alessandro U. History, dynamics, and public health importance of malaria parasite resistance.  Clin Microbiol Rev. 2004;  17 (1) 235-254
  • 4 World Health Organization .World Malaria report 2010. Available at: http://www.who.int/malaria_world_malaria_report_2010/en/index.html Accessed December 14, 2010
  • 5 Lou J, Lucas R, Grau G E. Pathogenesis of cerebral malaria: recent experimental data and possible applications for humans.  Clin Microbiol Rev. 2001;  14 (4) 810-820
  • 6 World Health Organization. Malaria. In: International Travel and Health 2003. Geneva: World Health Organization; 2003
  • 7 National Institute of Allergy and Infectious Diseases. The Life Cycle of the Malaria Parasite. Available at: http://www.niaid.nih.gov/topics/malaria/pages/lifecycle.aspx Accessed December 14, 2010
  • 8 Idro R, Jenkins N E, Newton C R. Pathogenesis, clinical features, and neurological outcome of cerebral malaria.  Lancet Neurol. 2005;  4 (12) 827-840
  • 9 Snow R W, Guerra C A, Noor A M, Myint H Y, Hay S I. The global distribution of clinical episodes of Plasmodium falciparum malaria.  Nature. 2005;  434 (7030) 214-217
  • 10 Walker M, Kublin J G, Zunt J R. Parasitic central nervous system infections in immunocompromised hosts: malaria, microsporidiosis, leishmaniasis, and African trypanosomiasis.  Clin Infect Dis. 2006;  42 (1) 115-125
  • 11 Magowan C, Wollish W, Anderson L, Leech J. Cytoadherence by Plasmodium falciparum-infected erythrocytes is correlated with the expression of a family of variable proteins on infected erythrocytes.  J Exp Med. 1988;  168 (4) 1307-1320
  • 12 Brown H C, Chau T T, Mai N T et al.. Blood-brain barrier function in cerebral malaria and CNS infections in Vietnam.  Neurology. 2000;  55 (1) 104-111
  • 13 WHO . Severe falciparum malaria.  Trans R Soc Trop Hyg. 2000;  94 (Suppl 1) 1-90
  • 14 Newton C R, Hien T T, White N. Cerebral malaria.  J Neurol Neurosurg Psychiatry. 2000;  69 (4) 433-441
  • 15 Han M H, Walker M, Zunt J R. Neurological infections in the returning international traveler.  Continuum: Lifelong learning in neurology. 2006;  12 (2) 133-158
  • 16 Molyneux M E, Taylor T E, Wirima J J, Borgstein A. Clinical features and prognostic indicators in paediatric cerebral malaria: a study of 131 comatose Malawian children.  Q J Med. 1989;  71 (265) 441-459
  • 17 Crawley J, Smith S, Kirkham F, Muthinji P, Waruiru C, Marsh K. Seizures and status epilepticus in childhood cerebral malaria.  QJM. 1996;  89 (8) 591-597
  • 18 Crawley J, English M, Waruiru C, Mwangi I, Marsh K. Abnormal respiratory patterns in childhood cerebral malaria.  Trans R Soc Trop Med Hyg. 1998;  92 (3) 305-308
  • 19 Marsh K, English M, Crawley J, Peshu N. The pathogenesis of severe malaria in African children.  Ann Trop Med Parasitol. 1996;  90 (4) 395-402
  • 20 Olumese P E, Gbadegesin R A, Adeyemo A A, Brown B, Walker A. Neurological features of cerebral malaria in Nigerian children.  Ann Trop Paediatr. 1999;  19 (4) 321-325
  • 21 Beare N A, Taylor T E, Harding S P, Lewallen S, Molyneux M E. Malarial retinopathy: a newly established diagnostic sign in severe malaria.  Am J Trop Med Hyg. 2006;  75 (5) 790-797
  • 22 Maude R J, Beare N A, Abu Sayeed A et al.. The spectrum of retinopathy in adults with Plasmodium falciparum malaria.  Trans R Soc Trop Med Hyg. 2009;  103 (7) 665-671
  • 23 Holding P A, Stevenson J, Peshu N, Marsh K. Cognitive sequelae of severe malaria with impaired consciousness.  Trans R Soc Trop Med Hyg. 1999;  93 (5) 529-534
  • 24 Patankar T F, Karnad D R, Shetty P G, Desai A P, Prasad S R. Adult cerebral malaria: prognostic importance of imaging findings and correlation with postmortem findings.  Radiology. 2002;  224 (3) 811-816
  • 25 Looareesuwan S, Wilairatana P, Krishna S et al.. Magnetic resonance imaging of the brain in patients with cerebral malaria.  Clin Infect Dis. 1995;  21 (2) 300-309
  • 26 Tran T H, Day N P, Nguyen H P et al.. A controlled trial of artemether or quinine in Vietnamese adults with severe falciparum malaria.  N Engl J Med. 1996;  335 (2) 76-83
  • 27 White N J. The treatment of malaria.  N Engl J Med. 1996;  335 (11) 800-806
  • 28 Riddle M S, Jackson J L, Sanders J W, Blazes D L. Exchange transfusion as an adjunct therapy in severe Plasmodium falciparum malaria: a meta-analysis.  Clin Infect Dis. 2002;  34 (9) 1192-1198
  • 29 McIntosh H M, Olliaro P. Treatment of severe malaria with artemisinin derivatives. A systematic review of randomised controlled trials.  Med Trop (Mars). 1998;  58 (3, Suppl) 61-62
  • 30 Eichenlaub D, Rogler G, Hoffmann H G, Weise H J. Falciparum malaria despite pyrimethamine/suifadoxine in five tourists to East Africa.  Lancet. 1982;  2 (8306) 1041-1042
  • 31 Newton C R, Crawley J, Sowumni A et al.. Intracranial hypertension in Africans with cerebral malaria.  Arch Dis Child. 1997;  76 (3) 219-226
  • 32 Di Perri G, Di Perri I G, Monteiro G B et al.. Pentoxifylline as a supportive agent in the treatment of cerebral malaria in children.  J Infect Dis. 1995;  171 (5) 1317-1322
  • 33 Ross A G, Bartley P B, Sleigh A C et al.. Schistosomiasis.  N Engl J Med. 2002;  346 (16) 1212-1220
  • 34 Pollner J H, Schwartz A, Kobrine A, Parenti D M. Cerebral schistosomiasis caused by Schistosoma haematobium: case report.  Clin Infect Dis. 1994;  18 (3) 354-357
  • 35 Betting L E, Pirani Jr C, de Souza Queiroz L, Damasceno B P, Cendes F. Seizures and cerebral schistosomiasis.  Arch Neurol. 2005;  62 (6) 1008-1010
  • 36 Chitsulo L, Engels D, Montresor A, Savioli L. The global status of schistosomiasis and its control.  Acta Trop. 2000;  77 (1) 41-51
  • 37 Scrimgeour E M. Non-traumatic paraplegia in northern Tanzania.  Br Med J (Clin Res Ed). 1981;  283 (6297) 975-978
  • 38 Chen M G, Mott K E. Progress in the assessment of morbidity due to Schistosoma japonicum infection: a review of recent literature.  Trop Dis Bull. 1989;  86 R1-R36
  • 39 Betting L E, Pirani Jr C, de Souza Queiroz L, Damasceno B P, Cendes F. Seizures and cerebral schistosomiasis.  Arch Neurol. 2005;  62 (6) 1008-1010
  • 40 Peregrino A JP, Oliviera R P, Porto C A et al.. Meningomieloradiculite por Schistosoma mansoni protocolo de investigação e registro de 21 casos.  Arq Neuropsiquiatr. 2002;  46 49-60
  • 41 Pittella J E. The relation between involvement of the central nervous system in Schistosomiasis mansoni and the clinical forms of the parasitosis. A review.  J Trop Med Hyg. 1991;  94 (1) 15-21
  • 42 Scrimgeour E M, Gajdusek D C. Involvement of the central nervous system in Schistosoma mansoni and S. haematobium infection. A review.  Brain. 1985;  108 (Pt 4) 1023-1038
  • 43 Nascimento-Carvalho C M, Moreno-Carvalho O A. Neuroschistosomiasis due to Schistosoma mansoni: a review of pathogenesis, clinical syndromes and diagnostic approaches.  Rev Inst Med Trop Sao Paulo. 2005;  47 (4) 179-184
  • 44 Ropper A H, Samuels M A. Adams and Victor's Principles of Neurology. 9th ed. New York, NY: McGraw-Hill Professional; 2005
  • 45 Shu K, Zhang S, Han L, Lei T. Surgical treatment of cerebellar schistosomiasis.  Neurosurgery. 2009;  64 (5) 941-943 discussion 943-944
  • 46 Pittella J E, Lana-Peixoto M A. Brain involvement in hepatosplenic Schistosomiasis mansoni .  Brain. 1981;  104 (3) 621-632
  • 47 Carod Artal F J, Vargas A P, Horan T A, Marinho P B, Coelho Costa P H. Schistosoma mansoni myelopathy: clinical and pathologic findings.  Neurology. 2004;  63 (2) 388-391
  • 48 Gellido C L, Onesti S, Llena J, Suarez M. Spinal schistosomiasis.  Neurology. 2000;  54 (2) 527
  • 49 Selwa L M, Brunberg J A, Mandell S H, Garofalo E A. Spinal cord schistosomiasis: a pediatric case mimicking intrinsic cord neoplasm.  Neurology. 1991;  41 (5) 755-757
  • 50 Shu K, Zhang S, Han L, Lei T. Surgical treatment of cerebellar schistosomiasis.  Neurosurgery. 2009;  64 (5) 941-943 discussion 943-944
  • 51 Betting L E, Pirani Jr C, de Souza Queiroz L, Damasceno B P, Cendes F. Seizures and cerebral schistosomiasis.  Arch Neurol. 2005;  62 (6) 1008-1010
  • 52 da Rocha A J, Maia Jr A C, Ferreira N P, do Amaral L L. Granulomatous diseases of the central nervous system.  Top Magn Reson Imaging. 2005;  16 (2) 155-187
  • 53 Liu H C, Lim C C, Feng X et al.. MRI in cerebral schistosomiasis: characteristic nodular enhancement in 33 patients.  AJR Am J Roentgenol. 2008;  191 (2) 582-588
  • 54 Bill P L, Shakir R A, Newman P K, Posner C M eds.. Schistosomiasis. Tropical Neurology. Philadelphia, PA: WB Saunders Co; 1996: 295-316
  • 55 Lighter J, Kim M, Krasinski K. Intramedullary schistosomiasis presenting in an adolescent with prolonged intermittent back pain.  Pediatr Neurol. 2008;  39 (1) 44-47
  • 56 Silva L C, Maciel P E, Ribas J G, Souza-Pereira S R, Antunes C M, Lambertucci J R. Treatment of schistosomal myeloradiculopathy with praziquantel and corticosteroids and evaluation by magnetic resonance imaging: a longitudinal study.  Clin Infect Dis. 2004;  39 (11) 1618-1624
  • 57 Ross A G, Bartley P B, Sleigh A C et al.. Schistosomiasis.  N Engl J Med. 2002;  346 (16) 1212-1220
  • 58 Fowler R, Lee C, Keystone J S. The role of corticosteroids in the treatment of cerebral schistosomiasis caused by Schistosoma mansoni: case report and discussion.  Am J Trop Med Hyg. 1999;  61 (1) 47-50
  • 59 Carod Artal F J, Vargas A P, Horan T A, Marinho P B, Coelho Costa P H. Schistosoma mansoni myelopathy: clinical and pathologic findings.  Neurology. 2004;  63 (2) 388-391
  • 60 Ferrari T C. Involvement of central nervous system in the schistosomiasis.  Mem Inst Oswaldo Cruz. 2004;  99 (5, Suppl 1) 59-62
  • 61 García H H, Gonzalez A E, Evans C AW, Gilman R H. Cysticercosis Working Group in Peru . Taenia solium cysticercosis.  Lancet. 2003;  362 (9383) 547-556
  • 62 Román G, Sotelo J, Del Brutto O et al.. A proposal to declare neurocysticercosis an international reportable disease.  Bull World Health Organ. 2000;  78 (3) 399-406
  • 63 Senanayake N, Román G C. Epidemiology of epilepsy in developing countries.  Bull World Health Organ. 1993;  71 (2) 247-258
  • 64 Pittella J E. Neurocysticercosis.  Brain Pathol. 1997;  7 (1) 681-693
  • 65 Ong S, Talan D A, Moran G J EMERGEncy ID NET Study Group et al. Neurocysticercosis in radiographically imaged seizure patients in U.S. emergency departments.  Emerg Infect Dis. 2002;  8 (6) 608-613
  • 66 Schantz P M, Moore A C, Muñoz J L et al.. Neurocysticercosis in an Orthodox Jewish community in New York City.  N Engl J Med. 1992;  327 (10) 692-695
  • 67 Garg R K. Diagnostic criteria for neurocysticercosis: some modifications are needed for Indian patients.  Neurol India. 2004;  52 (2) 171-177
  • 68 Wallin M T, Kurtzke J F. Neurocysticercosis in the United States: review of an important emerging infection.  Neurology. 2004;  63 (9) 1559-1564
  • 69 Allan J C, Wilkins P P, Tsang V C, Craig P S. Immunodiagnostic tools for taeniasis.  Acta Trop. 2003;  87 (1) 87-93
  • 70 Garcia H H, Del Brutto O H. Cysticercosis Working Group in Peru . Neurocysticercosis: updated concepts about an old disease.  Lancet Neurol. 2005;  4 (10) 653-661
  • 71 Evans C AW. The Cysticercosis Working Group in Peru .The immunology of the host-parasite relationship in Taenia solium cysticercoids: implications for prevention and therapy. In: Garcia H H, Martinez S M, eds. Taenia Solium Taeniasis/Cysticercoids. 2nd ed. Lima: Ed Universo; 1999: 25-37
  • 72 Garcia H H, Del Brutto O H. Cysticercosis Working Group in Peru . Neurocysticercosis: updated concepts about an old disease.  Lancet Neurol. 2005;  4 (10) 653-661
  • 73 Flisser A. Taeniasis and cysticercosis due to Taenia solium .  Prog Clin Parasitol. 1994;  4 77-116
  • 74 Flisser A, Correa D, Evans C AW. Taenia solium cysticercoids: new and revisited immunological aspects. In: Singh G, Prabhakar S, eds. Taenia Solium Cysticercoids: From Basic to Clinical Science. Wallingford: CABI Publishing; 2002: 15-24
  • 75 Pittella J E. Neurocysticercosis.  Brain Pathol. 1997;  7 (1) 681-693
  • 76 Hawk M W, Shahlaie K, Kim K D, Theis J H. Neurocysticercosis: a review.  Surg Neurol. 2005;  63 (2) 123-132 discussion 132
  • 77 Del Brutto O H, Sotelo J. Neurocysticercosis: an update.  Rev Infect Dis. 1988;  10 (6) 1075-1087
  • 78 Carpio A, Escobar A, Hauser W A. Cysticercosis and epilepsy: a critical review.  Epilepsia. 1998;  39 (10) 1025-1040
  • 79 Del Brutto O H, Santibañez R, Noboa C A, Aguirre R, Díaz E, Alarcón T A. Epilepsy due to neurocysticercosis: analysis of 203 patients.  Neurology. 1992;  42 (2) 389-392
  • 80 Cantú C, Barinagarrementeria F. Cerebrovascular complications of neurocysticercosis. Clinical and neuroimaging spectrum.  Arch Neurol. 1996;  53 (3) 233-239
  • 81 Couldwell W T, Zee C S, Apuzzo M L. Definition of the role of contemporary surgical management in cisternal and parenchymatous cysticercosis cerebri.  Neurosurgery. 1991;  28 (2) 231-237
  • 82 Escobar A. The pathology of neurocysticercosis. In: Palacios E, Rodriguez-Carbajal J, Taveras J M, eds. Cysticercosis of the Central Nervous System. Springfield, IL: Charles C. Thomas; 1983: 27-54
  • 83 Latovitzki N, Abrams G, Clark C, Mayeux R, Ascherl G, Sciarra D. Cerebral cysticercosis.  Neurology. 1978;  28 (8) 838-842
  • 84 Gogia S, Talukdar B, Choudhury V, Arora B S. Neurocysticercosis in children: clinical findings and response to albendazole therapy in a randomized, double-blind, placebo-controlled trial in newly diagnosed cases.  Trans R Soc Trop Med Hyg. 2003;  97 (4) 416-421
  • 85 Akiguchi I, Fujiwara T, Matsuyama H, Muranaka H, Kameyama M. Intramedullary spinal cysticercosis.  Neurology. 1979;  29 (11) 1531-1534
  • 86 Garcia H H, Martinez S M. Taenia Solium Taeniasis/Cysticercoids. 2nd ed. Lima, Peru: Editorial Universo; 1999
  • 87 Webbe G. Human cysticercosis: parasitology, pathology, clinical manifestations and available treatment.  Pharmacol Ther. 1994;  64 (1) 175-200
  • 88 Del Brutto O H, Wadia N H, Dumas M, Cruz M, Tsang V C, Schantz P M. Proposal of diagnostic criteria for human cysticercosis and neurocysticercosis.  J Neurol Sci. 1996;  142 (1-2) 1-6
  • 89 Wilson M, Bryan R T, Fried J A et al.. Clinical evaluation of the cysticercosis enzyme-linked immunoelectrotransfer blot in patients with neurocysticercosis.  J Infect Dis. 1991;  164 (5) 1007-1009
  • 90 Garcia H H, Del Brutto O H. Cysticercosis Working Group in Peru . Neurocysticercosis: updated concepts about an old disease.  Lancet Neurol. 2005;  4 (10) 653-661
  • 91 Garcia H H, Del Brutto O H, Nash T E, White Jr A C, Tsang V C, Gilman R H. New concepts in the diagnosis and management of neurocysticercosis (Taenia solium).  Am J Trop Med Hyg. 2005;  72 (1) 3-9
  • 92 Schantz P M, Moore A C, Muñoz J L et al.. Neurocysticercosis in an Orthodox Jewish community in New York City.  N Engl J Med. 1992;  327 (10) 692-695
  • 93 Chang K H, Lee J H, Han M H, Han M C. The role of contrast-enhanced MR imaging in the diagnosis of neurocysticercosis.  AJNR Am J Neuroradiol. 1991;  12 (3) 509-512
  • 94 Sheth T N, Pillon L, Keystone J, Kucharczyk W. Persistent MR contrast enhancement of calcified neurocysticercosis lesions.  AJNR Am J Neuroradiol. 1998;  19 (1) 79-82
  • 95 Escobar A. The pathology of neurocysticercosis. In: Palacios E, Rodriguez-Carbajal J, Taveras J M, eds. Cysticercosis of the Nervous System. Springfield, IL: Charles C Thomas; 1983
  • 96 Del Brutto O H, Wadia N H, Dumas M, Cruz M, Tsang V C, Schantz P M. Proposal of diagnostic criteria for human cysticercosis and neurocysticercosis.  J Neurol Sci. 1996;  142 (1-2) 1-6
  • 97 Takayanagui O M, Jardim E. Therapy for neurocysticercosis. Comparison between albendazole and praziquantel.  Arch Neurol. 1992;  49 (3) 290-294
  • 98 Vazquez V, Sotelo J. The course of seizures after treatment for cerebral cysticercosis.  N Engl J Med. 1992;  327 (10) 696-701
  • 99 Apuzzo M L, Dobkin W R, Zee C S, Chan J C, Giannotta S L, Weiss M H. Surgical considerations in treatment of intraventricular cysticercosis. An analysis of 45 cases.  J Neurosurg. 1984;  60 (2) 400-407
  • 100 Singh G, Rajshekhar V, Murthy J M et al.. A diagnostic and therapeutic scheme for a solitary cysticercus granuloma.  Neurology. 2010;  75 (24) 2236-2245

Kiran ThakurM.D. 

Massachusetts General Hospital

55 Fruit Street, Boston, MA 02115

Email: kthakur@partners.org