Fungal and Parasitic Infections of the CNS - Inova Health System

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Neurocysticercosis Epidemiology • The most common parasitic CNS infection: 50 million people infected • In certain areas, up to 46% of population p is seropositive and 18% have calcifications on CT • NCC causes of 10% of new seizures in areas of Los Angeles and 6% in Albuquerque Prevalence Map • Most cases seen in the US are import cases • Estimated that up to 1000 new cases in US per year • A striking example is an outbreak in a orthodox Jewish community in New York in 1990 Epidemiology, cont. CNS Parenchymal infection • The cysticercus develop a cyst ~10 mm with a thin wall and a scolex formation. No significant immune response • After a several (3-30) years the cyst starts degenerating. Wall thickens due to inflammation. Cyst fluid becomes denser • The cyst shrinks with an increasing surrounding immune response. This can take months to years • Finally the cyst resolves and is often replaced by a small calcification 24
T1 Diagnosis Radiology • Scolex is pathognomonic • Viable cysts are non enhancing, degenerating are enhancing • Calcifications CT T1 enhanced • Normally unattached and can occasionally move between ventricles • Most frequently located in the fourth ventricle, followed by the third • Can block circulation of cerebrospinal fluid Ventricular infection Picture from case CYSTICERCOSIS 25
Page 1 and 2: Fungal and Parasitic Infections of
Page 3 and 4: Taxonomy simplified for the rest of
Page 5 and 6: Am J Surg Path 2007; 31:615-623 Bla
Page 7 and 8: Uncommon, localized granuloma in CN
Page 9 and 10: Coccidioides immitis can be vasoinv
Page 11 and 12: Spectrum exists from bland infarcti
Page 13 and 14: Aspergillus look-alikes • Cannot
Page 15 and 16: • Morphology: - Broad hyphae 10-1
Page 17 and 18: Candida look-alikes • Torulopsis
Page 19 and 20: Nocardia and Actinomyces • Morpho
Page 21 and 22: CNS Metazoal infections: trematodes
Page 23: Lifecycle Adult tapeworm Cysticercu
Page 27 and 28: Ameba • Entamoeba histolytica - S
Page 29 and 30: Balamuthia mandrillaris • Childre
Page 31: cysticercosis, toxoplasmosis, and t

Fungal and Parasitic Infections of the CNS - Inova Health System

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