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1327. The Diagnosis of Subarachnoid Neurocysticercosis Is Often Delayed And Other Findings of a Multicenter Retrospective in the USA

BACKGROUND: Subarachnoid (racemose) neurocysticercosis (SANCC) is an uncommon but severe form of Taenia solium infection. There is limited evidence to guide clinical management of these patients. METHODS: We performed a multicenter retrospective chart review of 15 U.S. sites. A total of 69 subjects...

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Autores principales: Guzmán, Janitzio J, Herrick, Jesica A, Hatlen, Timothy, Weatherhead, Jill E, Clark, Eva, Serpa, Jose, Chow, Felicia, Allyn, Paul R, Wald-Dickler, Noah, Rodriguez, Jorge M, Bowman, Natalie M, Cervantes-Arslanian, Anna, Coyle, Christina, White, A Clinton Clinton, Amusu, Senate, Martin, Dannae, Duffey, Megan M, Larsen, Travis, Welford, Elliott M, Jenks, Jeffrey D, Cowell, Anne, Henao Martínez, Andrés F, Franco-Paredes, Carlos, Mathisen, Glenn, Lichtenberger, Paola, Bouzigard, Rory, Castellino, Laila M, O’Connell, Elise M
Formato: Online Artículo Texto
Lenguaje:English
Publicado: Oxford University Press 2023
Materias:
Acceso en línea:https://www.ncbi.nlm.nih.gov/pmc/articles/PMC10678458/
http://dx.doi.org/10.1093/ofid/ofad500.1165
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author Guzmán, Janitzio J
Herrick, Jesica A
Hatlen, Timothy
Weatherhead, Jill E
Clark, Eva
Serpa, Jose
Chow, Felicia
Allyn, Paul R
Wald-Dickler, Noah
Rodriguez, Jorge M
Bowman, Natalie M
Cervantes-Arslanian, Anna
Coyle, Christina
White, A Clinton Clinton
Amusu, Senate
Martin, Dannae
Duffey, Megan M
Larsen, Travis
Welford, Elliott M
Jenks, Jeffrey D
Cowell, Anne
Henao Martínez, Andrés F
Franco-Paredes, Carlos
Mathisen, Glenn
Lichtenberger, Paola
Bouzigard, Rory
Castellino, Laila M
O’Connell, Elise M
author_facet Guzmán, Janitzio J
Herrick, Jesica A
Hatlen, Timothy
Weatherhead, Jill E
Clark, Eva
Serpa, Jose
Chow, Felicia
Allyn, Paul R
Wald-Dickler, Noah
Rodriguez, Jorge M
Bowman, Natalie M
Cervantes-Arslanian, Anna
Coyle, Christina
White, A Clinton Clinton
Amusu, Senate
Martin, Dannae
Duffey, Megan M
Larsen, Travis
Welford, Elliott M
Jenks, Jeffrey D
Cowell, Anne
Henao Martínez, Andrés F
Franco-Paredes, Carlos
Mathisen, Glenn
Lichtenberger, Paola
Bouzigard, Rory
Castellino, Laila M
O’Connell, Elise M
author_sort Guzmán, Janitzio J
collection PubMed
description BACKGROUND: Subarachnoid (racemose) neurocysticercosis (SANCC) is an uncommon but severe form of Taenia solium infection. There is limited evidence to guide clinical management of these patients. METHODS: We performed a multicenter retrospective chart review of 15 U.S. sites. A total of 69 subjects with racemose disease were entered. RESULTS: The most common region of exposure was Mexico (67%) followed by Central America (24%). Median age was 43 years (range 15-76) and 71% were male. Common symptoms at the time of index admission were headache (80%), nausea/vomiting (46%), dizziness (44%), and blurry vision (33%). Cysts were intracranial in 64 (93%) subjects and exclusively intraspinal in 4. One patient had meningitis without visible cystic lesions. Incident admission magnetic resonance imaging (MRI) demonstrated ventriculomegaly in 41 (59%) and focal findings in 9 (13%) including ischemic infarct, subarachnoid hemorrhage, and/or arterial aneurysm. For 55 (80%), SANCC was first diagnosed during the index admission. Of these, 23 (42%) had prior medical visits and substantial delay in diagnosis (i.e. previously seen with hydrocephalus [27%], stroke [5.5%], and/or meningitis [11%], missed diagnostic radiologic features [4%], or inadequate imaging [5.5%]). Of the 69 subjects, 54% underwent a neurosurgical procedure during index admission (cyst removal n=16, EVD/shunt/ventriculostomy n=24). At the time of discharge, 6 (8.6%) patients were not given albendazole and/or praziquantel due to cost or availability. Six months following discharge, < 10% of follow up MRIs demonstrated cyst resolution. Planned treatment course of < 4 weeks at discharge compared to >4 weeks was associated with increased risk for new cyst development on follow up imaging at a median of 3.8 years following discharge (range 2.6 months-8 years). Those with a delayed diagnosis received a significantly longer duration of corticosteroids (median 8 weeks) than those without a delay (median 5 weeks, p=0.047). CONCLUSION: The diagnosis of SANCC is often missed, and most patients require neurosurgical intervention. Antiparasitic therapy is suboptimal, especially with regimens developed for parenchymal NCC. DISCLOSURES: Jeffrey D. Jenks, MD, MPH, Astellas: Grant/Research Support|F2G: Grant/Research Support|Pfizer: Grant/Research Support
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spelling pubmed-106784582023-11-27 1327. The Diagnosis of Subarachnoid Neurocysticercosis Is Often Delayed And Other Findings of a Multicenter Retrospective in the USA Guzmán, Janitzio J Herrick, Jesica A Hatlen, Timothy Weatherhead, Jill E Clark, Eva Serpa, Jose Chow, Felicia Allyn, Paul R Wald-Dickler, Noah Rodriguez, Jorge M Bowman, Natalie M Cervantes-Arslanian, Anna Coyle, Christina White, A Clinton Clinton Amusu, Senate Martin, Dannae Duffey, Megan M Larsen, Travis Welford, Elliott M Jenks, Jeffrey D Cowell, Anne Henao Martínez, Andrés F Franco-Paredes, Carlos Mathisen, Glenn Lichtenberger, Paola Bouzigard, Rory Castellino, Laila M O’Connell, Elise M Open Forum Infect Dis Abstract BACKGROUND: Subarachnoid (racemose) neurocysticercosis (SANCC) is an uncommon but severe form of Taenia solium infection. There is limited evidence to guide clinical management of these patients. METHODS: We performed a multicenter retrospective chart review of 15 U.S. sites. A total of 69 subjects with racemose disease were entered. RESULTS: The most common region of exposure was Mexico (67%) followed by Central America (24%). Median age was 43 years (range 15-76) and 71% were male. Common symptoms at the time of index admission were headache (80%), nausea/vomiting (46%), dizziness (44%), and blurry vision (33%). Cysts were intracranial in 64 (93%) subjects and exclusively intraspinal in 4. One patient had meningitis without visible cystic lesions. Incident admission magnetic resonance imaging (MRI) demonstrated ventriculomegaly in 41 (59%) and focal findings in 9 (13%) including ischemic infarct, subarachnoid hemorrhage, and/or arterial aneurysm. For 55 (80%), SANCC was first diagnosed during the index admission. Of these, 23 (42%) had prior medical visits and substantial delay in diagnosis (i.e. previously seen with hydrocephalus [27%], stroke [5.5%], and/or meningitis [11%], missed diagnostic radiologic features [4%], or inadequate imaging [5.5%]). Of the 69 subjects, 54% underwent a neurosurgical procedure during index admission (cyst removal n=16, EVD/shunt/ventriculostomy n=24). At the time of discharge, 6 (8.6%) patients were not given albendazole and/or praziquantel due to cost or availability. Six months following discharge, < 10% of follow up MRIs demonstrated cyst resolution. Planned treatment course of < 4 weeks at discharge compared to >4 weeks was associated with increased risk for new cyst development on follow up imaging at a median of 3.8 years following discharge (range 2.6 months-8 years). Those with a delayed diagnosis received a significantly longer duration of corticosteroids (median 8 weeks) than those without a delay (median 5 weeks, p=0.047). CONCLUSION: The diagnosis of SANCC is often missed, and most patients require neurosurgical intervention. Antiparasitic therapy is suboptimal, especially with regimens developed for parenchymal NCC. DISCLOSURES: Jeffrey D. Jenks, MD, MPH, Astellas: Grant/Research Support|F2G: Grant/Research Support|Pfizer: Grant/Research Support Oxford University Press 2023-11-27 /pmc/articles/PMC10678458/ http://dx.doi.org/10.1093/ofid/ofad500.1165 Text en © The Author(s) 2023. Published by Oxford University Press on behalf of Infectious Diseases Society of America. https://creativecommons.org/licenses/by/4.0/This is an Open Access article distributed under the terms of the Creative Commons Attribution License (https://creativecommons.org/licenses/by/4.0/), which permits unrestricted reuse, distribution, and reproduction in any medium, provided the original work is properly cited.
spellingShingle Abstract
Guzmán, Janitzio J
Herrick, Jesica A
Hatlen, Timothy
Weatherhead, Jill E
Clark, Eva
Serpa, Jose
Chow, Felicia
Allyn, Paul R
Wald-Dickler, Noah
Rodriguez, Jorge M
Bowman, Natalie M
Cervantes-Arslanian, Anna
Coyle, Christina
White, A Clinton Clinton
Amusu, Senate
Martin, Dannae
Duffey, Megan M
Larsen, Travis
Welford, Elliott M
Jenks, Jeffrey D
Cowell, Anne
Henao Martínez, Andrés F
Franco-Paredes, Carlos
Mathisen, Glenn
Lichtenberger, Paola
Bouzigard, Rory
Castellino, Laila M
O’Connell, Elise M
1327. The Diagnosis of Subarachnoid Neurocysticercosis Is Often Delayed And Other Findings of a Multicenter Retrospective in the USA
title 1327. The Diagnosis of Subarachnoid Neurocysticercosis Is Often Delayed And Other Findings of a Multicenter Retrospective in the USA
title_full 1327. The Diagnosis of Subarachnoid Neurocysticercosis Is Often Delayed And Other Findings of a Multicenter Retrospective in the USA
title_fullStr 1327. The Diagnosis of Subarachnoid Neurocysticercosis Is Often Delayed And Other Findings of a Multicenter Retrospective in the USA
title_full_unstemmed 1327. The Diagnosis of Subarachnoid Neurocysticercosis Is Often Delayed And Other Findings of a Multicenter Retrospective in the USA
title_short 1327. The Diagnosis of Subarachnoid Neurocysticercosis Is Often Delayed And Other Findings of a Multicenter Retrospective in the USA
title_sort 1327. the diagnosis of subarachnoid neurocysticercosis is often delayed and other findings of a multicenter retrospective in the usa
topic Abstract
url https://www.ncbi.nlm.nih.gov/pmc/articles/PMC10678458/
http://dx.doi.org/10.1093/ofid/ofad500.1165
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