Parasitic Infections of the Nervous System

Hector H. Garcia, MD, PhD Neuroinfectious Diseases p. 943-962 August 2021, Vol.27, No.4 doi: 10.1212/CON.0000000000000986
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PURPOSE OF REVIEW This article reviews how parasites affect the human nervous system, with a focus on four parasitic infections of major public health importance worldwide, two caused by protozoa (malaria and toxoplasmosis) and two by helminths (neurocysticercosis and schistosomiasis).

RECENT FINDINGS Parasitic infections in humans are common, and many can affect the central nervous system where they may survive unnoticed or may cause significant pathology that can even lead to the death of the host. Neuroparasitoses should be considered in the differential diagnosis of neurologic lesions, particularly in individuals from endemic regions or those with a history of travel to endemic regions.

SUMMARY Cerebral malaria is a significant cause of mortality, particularly in African children, in whom infected red blood cells affect the cerebral vessels, causing severe encephalopathy. Neurocysticercosis is the most common cause of acquired epilepsy worldwide and has varied clinical presentations, depending on the number, size, and location of the parasites in the nervous system as well as on the host’s inflammatory response. Toxoplasmosis is distributed worldwide, affecting a significant proportion of the population, and may reactivate in patients who are immunosuppressed, causing encephalitis and focal abscesses. Schistosomiasis causes granulomatous lesions in the brain or the spinal cord.

Address correspondence to Dr Hector H. Garcia, Cysticercosis Unit, Instituto Nacional de Ciencias Neurologicas, Jr. Ancash 1271, Barrios Altos, Lima, Peru, [email protected].

RELATIONSHIP DISCLOSURE: Dr Garcia has served as an associate editor for the American Journal of Tropical Medicine and Hygiene and PLOS Neglected Tropical Diseases and as a board member of the Oxfendazole Development Group and has received research grants from the Fogarty International Center (D43TW001140), National Institute of Allergy and Infectious Disease (U19AI129909), and National Institute of Neurological Disorders and Stroke (U01NS086974).

UNLABELED USE OF PRODUCTS/INVESTIGATIONAL USE DISCLOSURE: Dr Garcia reports no disclosure.

© 2021 American Academy of Neurology.