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Table of Contents   
LETTER TO THE EDITOR  
Year : 2012  |  Volume : 5  |  Issue : 4  |  Page : 406-407
Neurocysticercosis in travellers: An exotic disease


Department of Infections Diseases, Ramóny Cajal Hospital, Madrid, Spain

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Date of Web Publication8-Oct-2012
 

How to cite this article:
Díaz-Menéndez M, Monge-Maillo B, Norman F, Pérez-Molina JA. Neurocysticercosis in travellers: An exotic disease. Ann Trop Med Public Health 2012;5:406-7

How to cite this URL:
Díaz-Menéndez M, Monge-Maillo B, Norman F, Pérez-Molina JA. Neurocysticercosis in travellers: An exotic disease. Ann Trop Med Public Health [serial online] 2012 [cited 2018 May 22];5:406-7. Available from: http://www.atmph.org/text.asp?2012/5/4/406/102093
Sir,

Imported neurocysticercosis (NCC) in travellers is a rare phenomenon that can present months to years after leaving an endemic region, and only few cases are described in the literature. [1] We would like to report on our experience with imported NCC in travellers to emphasize the rarity of this disease, which, nevertheless, needs to be considered in subjects with suggestive symptoms and risk of exposure.

From 1999 to June 2011, we diagnosed only one case of NCC in a traveller. During this period, we attended 2387 travellers presenting with a medical problem after their return to Spain. The patient was a 42-year-old female, born in Spain, with no remarkable past medical history, who was admitted to our hospital because of seizures in January 2011. From April 2008 to February 2009, she had been travelling (work and leisure) with her family in India, Thailand, Indonesia and Malaysia. The patient was diagnosed with NCC based on magnetic resonance imaging findings: four cystic lesions with a scolex inside were found (three frontotemporal lesions and one cerebellar lesion) [Figure 1]. There were no muscular or subcutaneous lesions. The patient was treated with albendazole 400 mg twice a day for 14 days, dexamethasone for 30 days and phenytoin. Radiological improvement was observed 5 months later and the patient presented no more seizures (she continued treatment with phenytoin). A health exam including blood count, biochemistry, basic urinalysis, HIV and hepatitis B and C virus serology was normal/negative. Repeated stool examinations for ova, cysts and parasites were negative. Her husband also had a normal health exam with no evidence of T. solium eggs in the feces.
Figure 1: Cerebral magnetic resonance imaging showing multiple parenchymal cystic lesions, one with a scolex inside (arrowhead)

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Cysticercosis is acquired by ingesting T. solium eggs shed in the feces of a human tapeworm carrier and, thus, may also occur in people who do not eat pork and have no contact with pigs. [2] Epidemiological studies conclude that direct contact is the greatest source of contamination (which occurs person-to-person by sharing/handling food, shared living space, direct contact, etc.), challenging the classic concept that the greatest contamination source lies in the environment. In endemic areas, up to 12% of the population have antibodies against cysticercosis with no evidence of active disease. [3] Because diseases transmitted via the fecal-oral route are very common among travellers, we would expect NCC to be more prevalent in travellers than that currently documented. Therefore, other factors must contribute to the acquisition of NCC besides prolonged exposure to poor sanitary conditions.

NCC was previously considered an endemic disease in Spain, but, nowadays, it is only detected in immigrants from endemic areas. [4],[5] In the period from 1999 to June 2011, 26 patients were diagnosed with NCC at our unit. All but three cases (the present case, one immigrant from Equatorial Guinea and another from India) were imported cases in Latin American immigrants, reflecting the changing epidemiology of this parasitosis in our country.

 
   References Top

1.Leshem E, Kliers I, Bakon M, Gomori M, Karplus R, Schwartz E. Neurocysticercosis in travelers: A nation-wide study in Israel. J Trav Med 2011;18:191-7.  Back to cited text no. 1
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2.Schantz PM, Moore AC, Munoz JL, Hartman BJ, Schaefer JA, Aron AM, et al. Neurocysticercosis in an Orthodox Jewish community in New York City. N Eng J Med 1992;327:692-5.  Back to cited text no. 2
    
3.Carpio A. Neurocysticercosis: An update. Lancet Infect Dis 2002;2:751-62.  Back to cited text no. 3
[PUBMED]    
4.Monge-Maillo B, Jimenez BC, Perez-Molina JA, Norman F, Navarro M, Perez-Ayala A, et al. Imported infectious diseases in mobile populations, Spain. Emerg Infectious Dis 2009;15:1745-52.  Back to cited text no. 4
    
5.Roca C, Gascon J, Font B, Pujol T, Valls ME, Corachan M. Neurocysticercosis and population movements: analysis of 23 imported cases in Spain. Eur J Clin Microbiol Infect Dis 2003;22:382-4.  Back to cited text no. 5
    

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Correspondence Address:
Marta Díaz-Menéndez
Department of Infections Diseases, Ramón y Cajal Hospital, Madrid, Cra Colmenar Km 9.100, Madrid-28034
Spain
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Source of Support: None, Conflict of Interest: None


DOI: 10.4103/1755-6783.102093

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