Clínica de neurocisticercosis, Instituto Nacional de Neurologia y Neurocirugía Manuel Velasco Suarez, Ciudad de México, Mexico.
Departamento de Neurología, Instituto Nacional de Ciencias Médicas y Nutrición Salvador Zubirán, Ciudad de México, Mexico.
Trop Med Int Health. 2024 Mar;29(3):226-232. doi: 10.1111/tmi.13964. Epub 2024 Jan 10.
Neurocysticercosis (NC) is a heterogeneous disease particularly in terms of response to treatment and prognosis. Parasite localization is one of the main factors involved in this heterogeneity. In this study we aim to determine whether differences in the duration of the preclinical phase associated with parasite location, could contribute to said heterogeneity.
Ninety-nine patients were included, 24 with parasites in the parenchyma (PAR), 56 in the subarachnoid (SA) space and 19 in the ventricular system (IV). A questionnaire designed to assess exposure to classic NC risk factors 5, 10, 15, 20 and more than 20 years prior to diagnosis was applied. The results were compared between the three groups. Also, asymptomatic relatives of patients who had shared their living conditions in childhood or more recently were included and underwent brain scan and blood testing for specific antibodies.
Over the course of their lives, exposure to risk factors decreased significantly for all patients, although the decrease was more evident in patients with parasites in the SA space (p < 0.001) compared to patients with PAR (p = 0.011) or IV cysts (p = 0.020). Five years prior to diagnosis, exposure to risk factors was significantly higher in patients with PAR or IV NC than in patients with SA NC (p = 0.04). Furthermore, individuals in close contact with PAR or IV patients in the years preceding diagnosis were more likely to have asymptomatic NC, specific antibodies in sera, particularly IgM, compared to individuals in close contact with SA patients during the same period.
All these findings are highly suggestive of the possibility of a more recent infection of patients affected by parenchymal and ventricular NC than of patients with subarachnoid NC. Consequently, subarachnoid disease could be considered a chronic disease, which, probably contributes to the severity of the disease as well as the minimal response to medical treatment.
神经囊虫病（NC）是一种异质性疾病，尤其是在治疗反应和预后方面。寄生虫定位是导致这种异质性的主要因素之一。本研究旨在确定与寄生虫位置相关的临床前期持续时间的差异是否有助于这种异质性。
共纳入 99 例患者，其中 24 例寄生虫位于实质（PAR），56 例位于蛛网膜下腔（SA），19 例位于脑室系统（IV）。应用问卷评估诊断前 5、10、15、20 年及 20 年以上暴露于经典 NC 危险因素的情况。将结果在三组之间进行比较。此外，还纳入了与有寄生虫的患者在童年或更近时期共同生活的无症状亲属，并进行了脑部扫描和特异性抗体血液检测。
在他们的一生中，所有患者接触危险因素的情况明显减少，尽管与 PAR 患者（p=0.011）或 IV 囊肿患者（p=0.020）相比，SA 空间寄生虫患者的减少更为明显（p<0.001）。诊断前 5 年，PAR 或 IV NC 患者接触危险因素的情况明显高于 SA NC 患者（p=0.04）。此外，与 SA 患者在同一时期密切接触的个体相比，与 PAR 或 IV 患者在诊断前几年密切接触的个体更有可能患有无症状 NC 和血清特异性抗体，尤其是 IgM。
所有这些发现都高度提示，与 SA 型 NC 患者相比，PAR 或 IV 型 NC 患者的感染可能更为近期。因此，SA 疾病可能被认为是一种慢性疾病，这可能导致疾病的严重程度以及对药物治疗的最小反应。
