Parasites and the Nervous System: Diagnostic Approaches and Possible Therapeutic Strategies in the Human Setting Contini - Infectious Diseases, Ferrara, Italy Keywords: brain malaria, Cisticercosis and hydatidosis, Amebiasis. Invasion of the central nervous system (CNS) is a devastating complication of a parasitic infection. Al- though the most common route of CNS invasion is done through the blood and between the blood and the brain parenchyma, (blood brain barrier - bbb), the portal entry is also provided by the skin and ep- ithelial cells of the gastrointestinal tract or by the olfactory neuroepithelium of the nasal mucosa. Neu- ropathologic changes depend on the type and size and virulence of the parasite, geographic parasitic strain variations and immune evasion by the parasite. Some infections may present as an expanding mass lesion. brain parasites (bP) can cause symptomatic disease or run asymptomatically. The most common parasitic infection of the CNS is cerebral malaria (CM) followed by neurocysticercosis (NC). Other relatively common infections include toxoplasmosis, cystic and alveolar echinococcosis and schis- tosomiasis. Rarer bP include entamoeba histolytica, free-living amoebae including Naegleria fowleri (NF) and Cryptosporidium spp. This presentation addresses some of the most important bP including CM, NC, Hydatidosis, NF. According to the Malaria Report for 2017, CM accounts for 90% of the deaths. In Europe/USA it is mainly related to travel to tropical areas and increased migration flows. The brain in patients with CM is increased from sequestration of parasitized erythrocytes. Diagnosis consists in microscopy, mRDT, and advanced PCR. Currently, the best available treatment, particularly for p. fal- ciparum malaria, is artemisinin derivative combination therapy (ACT). Experimental drugs including those to prevent bbb dysfunction yet will be discussed. NC is the most common helminthic infection of the CNS and a major cause of acquired epilepsy in resource-limited countries. Imported cases are in- creasing in Europe. NC diagnosed by neuroimaging which is supported by immunodiagnostic tests (western blot test with purified parasite antigens). Management of NC requires a multidisciplinary ap- proach that includes drugs to control symptoms, anti-inflammatories, anti- antiepileptics, antiparasitic treatment and sometimes surgery. Hydatic cyst (HC) is a zoonotic infection caused by e. granulosus widely endemic in regions where live- stock farming is prevalent. brain involvement is seen in only 1-2% of HC cases. 80% of patients with cerebral HC are in the pediatric age group. HC is usually diagnosed by clinical findings, serological (often false negative) and imaging methods which may give better results. NF is an amoeba commonly found in warm freshwater environments such as lakes, hot springs and poorly chlorinated swimming pools especially in United States. Commonly known as brain-eating amoeba, has mortality rate of > 90%; treatment remains problematic with common drugs such as azoles, amphotericin b and miltefo- sine. Modifying existing drugs using nanotechnology offers promise in the development of therapeutic interventions against these parasitic infections.
Parasites and the Nervous System: Diagnostic Approaches and Possible Therapeutic Strategies in the Human Setting
Contini C
Primo
Writing – Original Draft Preparation
2024
Abstract
Parasites and the Nervous System: Diagnostic Approaches and Possible Therapeutic Strategies in the Human Setting Contini - Infectious Diseases, Ferrara, Italy Keywords: brain malaria, Cisticercosis and hydatidosis, Amebiasis. Invasion of the central nervous system (CNS) is a devastating complication of a parasitic infection. Al- though the most common route of CNS invasion is done through the blood and between the blood and the brain parenchyma, (blood brain barrier - bbb), the portal entry is also provided by the skin and ep- ithelial cells of the gastrointestinal tract or by the olfactory neuroepithelium of the nasal mucosa. Neu- ropathologic changes depend on the type and size and virulence of the parasite, geographic parasitic strain variations and immune evasion by the parasite. Some infections may present as an expanding mass lesion. brain parasites (bP) can cause symptomatic disease or run asymptomatically. The most common parasitic infection of the CNS is cerebral malaria (CM) followed by neurocysticercosis (NC). Other relatively common infections include toxoplasmosis, cystic and alveolar echinococcosis and schis- tosomiasis. Rarer bP include entamoeba histolytica, free-living amoebae including Naegleria fowleri (NF) and Cryptosporidium spp. This presentation addresses some of the most important bP including CM, NC, Hydatidosis, NF. According to the Malaria Report for 2017, CM accounts for 90% of the deaths. In Europe/USA it is mainly related to travel to tropical areas and increased migration flows. The brain in patients with CM is increased from sequestration of parasitized erythrocytes. Diagnosis consists in microscopy, mRDT, and advanced PCR. Currently, the best available treatment, particularly for p. fal- ciparum malaria, is artemisinin derivative combination therapy (ACT). Experimental drugs including those to prevent bbb dysfunction yet will be discussed. NC is the most common helminthic infection of the CNS and a major cause of acquired epilepsy in resource-limited countries. Imported cases are in- creasing in Europe. NC diagnosed by neuroimaging which is supported by immunodiagnostic tests (western blot test with purified parasite antigens). Management of NC requires a multidisciplinary ap- proach that includes drugs to control symptoms, anti-inflammatories, anti- antiepileptics, antiparasitic treatment and sometimes surgery. Hydatic cyst (HC) is a zoonotic infection caused by e. granulosus widely endemic in regions where live- stock farming is prevalent. brain involvement is seen in only 1-2% of HC cases. 80% of patients with cerebral HC are in the pediatric age group. HC is usually diagnosed by clinical findings, serological (often false negative) and imaging methods which may give better results. NF is an amoeba commonly found in warm freshwater environments such as lakes, hot springs and poorly chlorinated swimming pools especially in United States. Commonly known as brain-eating amoeba, has mortality rate of > 90%; treatment remains problematic with common drugs such as azoles, amphotericin b and miltefo- sine. Modifying existing drugs using nanotechnology offers promise in the development of therapeutic interventions against these parasitic infections.I documenti in SFERA sono protetti da copyright e tutti i diritti sono riservati, salvo diversa indicazione.
