AN EVALUATION BY CT, MRI AND SEROLOGY IN THE DIAGNOSIS OF NEUROCYSTICERCOSIS IN PEDIATRIC AGE GROUP OF RURAL AREAS OF FARRUKHABAD DISTRICT, UTTAR PRADESH.

Mohammad Shamim Ahmad, Reyaz Anjum, Sharaf Alam, Mohammad Zakiuddin

Abstract


BACKGROUND        Neurocysticercosis is the most common parasitic disease of the central nervous system. The prevalence of Neurocysticercosis in some of these developing countries exceeds 10%, where it accounts for up to 50% of cases of late onset epilepsy. Seizures are the most frequent and often the only clinical manifestation of Neurocysticercosis, they occur in 70% to 90% of cases.

AIMS AND OBJECTIVE           To evaluate the diagnostic significance of Neuro-imaging technique and Serology in Neurocysticercosis and to determine the intestinal carriers of the Parasite in Neurocysticercosis in Pediatric age group.

METHODS AND MATERIAL            The study was done of 100 patients in Major S.D .Singh Medical College from July 2016 to June 2017 of paediatric population of age group ranging from 06 years to 16 years. CT scan and MRI are done only in the suspected cases and serology was done with ELISA, the most specific test is Enzyme Linked Immuno Electro Transfer Blot (EITB) technique.

RESULT            Abnormal neuroimaging was seen in 100% of the cases whereas confirmation of diagnosis by neuroimaging alone could be made only in 36% of the cases based on diagnostic criteria. Single ring enhancing lesion was the most common finding (64%) in CT scan. The most common site of occurrence of the lesion within the brain was Parietal in 48% followed by frontal in 27%, occipital 13%, and temporal 09%. ELISA detected antibodies in 87% of the cases of Neurocysticercosis.

CONCLUSION          Neuroimaging (CT scan) was abnormal in 100% of the cases. Single parenchymal lesion was the most common findings. Diagnosis could be confirmed based on CT scan only in 36% of the cases. Neuroimaging techniques, including computed tomography (CT) and magnetic resonance imaging (MRI) and serology have improved the accuracy of the diagnosis of Neurocysticercosis by providing objective evidence on the number and topography of lesions, their stage of involution, and the degree of inflammatory reaction of the host against the parasites. The sensitivity of the ELISA was higher in cases with active neurological lesion (97.5%) and in cases with multiple parenchymal lesions (94.25%).


Keywords


Neurocysticercosis, Taenia solium, cysticercosis, seizures.

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References


Roman G, Sotelo J, DelBrutto O, et al. A proposal to declare Neurocysticercosis an international reportable disease; Bull World Health Orga. ;2000; 78: 399- 406

Del Brutto OH, Sotelo J, Roman GC. Neurocysticercosis: a clinical handbook. Lisse, Netherlands, Swetz & Zeitlinger Publisher, 1998.

Garcia HH and Del Brutto OH, Taenia solium cysticercosis, Infect Dis Clin North Am 14 (2000), pp. 97–119.

García HH, Gonzalez AE, Evans CAW, Gilman RH and for the Cysticercosis Working Group in Peru: Taenia solium cysticercosis; Lancet; 2003, 362, Pages 547-556

Garcia HH, Gonzalez AE, Gilman RH. The Cysticercosis Working Group in Peru. Diagnosis, treatment and control of Taenia solium cysticercosis. Curr Opin Infect Dis 2003; 16: 411-419.

Nash TE, Neva FA, Recent advances in the diagnosis and treatment of cerebral cysticercosis, N Engl J Med; 311:1492-96

Garcia HH, Martinez M, Gilman R, et al. Diagnosis of cysticercosis in endemic regions. The Cysticercosis Working Group in Peru; Lancet; 1991; 338; 549- 551.

Del Brutto OH, Rajshekhar V, White AC Jr, et al. Proposed diagnostic criteria for Neurocysticercosis; Neurology; 2001; 57: 177-183. 58

Carpio A, Neurocysticercosis: an update, Lancet Infect. Dis. 2 (2002), pp. 751– 762

Del Brutto OH, Neurocysticercosis, Curr. Opin. Neurol. 10 (1997), pp. 268– 272.

Dorny P, Brandt A. Z. and Geerts S, Immunodiagnostic tools for human and porcine cysticercosis, Acta Tropica Volume 87, Issue 1 , June 2003, Pages 79- 86

Rosas, N., Sotelo, J. and Nieto, D., ELISA in the diagnosis of neurocysticercosis. Arch. Neurol. 43 (1986), pp. 353–356

Mandal J, Singhi PD, Khandelwal N, Malla N. Evaluation of ELISA and dot blots for the serodiagnosis of neurocysticercosis, in children found to have single or multiple enhancing lesions in computerized tomographic scans of the brain: Ann Trop Med Parasitol.; 2006 Jan;100(1):39-48.

Chang KH, Kim WS, Cho SY, Han MC and Kim CW, Comparative evaluation of brain CT and ELISA in the diagnosis of neurocysticercosis. Am. J. Neuroradiol. 1988, 9, pp. 125–130.

Del Brutto OH., Wadia NH, Dumas M, Cruz M, Tsang VC and Schantz, PM, Proposal of diagnostic criteria for human cysticercosis and neurocysticercosis. J. Neurol. Sci. 1996, 142, pp. 1–6.

O. H. Del Brutto, J. Sotelo, and G. Roman, Neurocysticercosis: A Clinical Handbook, Swets & Zeitlinger, Lisse, the Netherlands, 1998.

O. H. Del Brutto, R. Santibanez, C. A. Noboa, R. Aguirre, E. Diaz, and T. A. Alarcon, “Epilepsy due to neurocysticercosis: analysis of 203 patients,” Neurology, vol. 42, no. 2, pp. 389–392, 1992.

G. F. McCormick, C. S. Zee, and J. Heiden, “Cysticercosis cerebri. Review of 127 cases,” Archives of Neurology, vol. 39, no. 9, pp. 534–539, 1982.

Garcia HH et al. Heavy nonencephalitic cerebral cysticercosis in tapeworm carriers. Neurology, 1993, 53: 1582-1584.

T. E. Nash, O. H. Del Brutto, J. A. Butman et al., “Calcific neurocysticercosis and epileptogenesis,” Neurology, vol. 62, no. 11, pp. 1934–1938, 2004.

A. Fleury, T. Gomez, I. Alvarez et al., “High prevalence of calcified silent neurocysticercosis in a rural village of Mexico,” Neuroepidemiology, vol. 22, no. 2, pp. 139–145, 2003.

J. Garcia-Noval, E. Moreno, F. de Mata et al., “An epidemiological study of epilepsy and epileptic seizures in two rural Guatemalan communities,” Annals of Tropical Medicine and Parasitology, vol. 95, no. 2, pp. 167–175, 2001.

T. E. Nash, J. Pretell, and H. H. Garcia, “Calcified cysticerci provoke perilesional edema and seizures,” Clinical Infectious Diseases, vol. 33, no. 10, pp. 1649–1653, 2001.

S. A. Antoniuk, I. Bruck, L. H. Coutinho Dos Santos et al., “Seizures associated with calcifications and edema in neurocysticercosis,” Pediatric Neurology, vol. 25, no. 4, pp. 309–311, 2001.

A. Thussu, A. Arora, S. Prabhakar, V. Lal, and I. M. S. Sawhney, “Acute symptomatic seizures due to single CT lesions: how long to treat with antiepileptic drugs?” Neurology India, vol. 50, no. 2, pp. 141–144, 2002.

S. Rajadhyaksha, K. N. Shah, S. Kanhere, N. Naik, and R. Mehta, “Does treatment change the outcome of seizures and computerized tomographic lesions in intracranial granulomas?” Journal of Tropical Pediatrics, vol. 45, no. 3, pp. 161–165, 1999.

M. Wilson, R. T. Bryan, J. A. Fried et al., “Clinical evaluation of the cysticercosis enzyme-linked immunoelectrotransfer blot in patients with neurocysticercosis,” Journal of Infectious Diseases, vol. 164, no. 5, pp. 1007–1009, 1991.


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