Imaging of neurocysticercosis and the influence of the human immunodeficiency virus. Issue 1 (January 2020)

• Record Type: Journal Article
• Authors: Kuehnast, M.; Andronikou, S.; Hlabangana, L.T.; Menezes, C.N.
• Is Part Of: Clinical radiology. Volume 75:Issue 1(2020)
• Page Start: 77.e1
• Page End: 77.e13
• Publication Date: 2020-01
• Subjects: Medical radiology -- Periodicals; Radiotherapy -- Periodicals; Radiotherapy -- Periodicals; Radiology -- Periodicals; Societies, Medical -- Periodicals; Medical radiology; Radiotherapy; Electronic journals; Periodicals; 616.0757
• DOI: 10.1016/j.crad.2019.08.001
• Languages: English
• ISSNs: 0009-9260

Abstract

Abstract : AIM: To review the literature on the imaging appearances of neurocysticercosis (NCC) and human immunodeficiency virus (HIV) co-infection and compare it with the local cases. MATERIALS AND METHODS: Data from both published and local cases were analysed. HIV-infected cases were divided into "low" (<200 cells/mm 3 ) and "high" (≥200 cells/mm 3 ) CD4 groups. These groups were compared and the effect of treatment was evaluated. RESULTS: Thirty-three cases were evaluated: 20 of the local cases and 13 published cases. The published cases had parenchymal brain cysts, whereas the local cases had both parenchymal and subarachnoid cysts ( p =0.0050). The published cases also had intra-axial cysts, whereas the local cases had both intra- and extra-axial cysts ( p =0.012). The published cases had predominantly cystic lesions, whereas the local cases had both cystic and granulomatous lesions ( p =0.019). There were no differences between cases with a CD4 count of <200 cells/mm 3 and cases with a CD4 count of ≥200 cells/mm 3, but interestingly, 3% of the cases with a CD4 count of <500 cells/mm 3, compared with 50% of the cases with a CD4 count of ≥500 cells/mm 3, had racemose cysts. CONCLUSION: NCC is very prevalent in South Africa and may complicate the diagnosis and treatment of patients with concomitant HIV infection. Patients with a "low" CD4 count may present with atypical lesions, delaying the diagnosis of NCC. Early initiation of highly active anti-retroviral therapy (HAART) may result in patients presenting with more classical symptoms and imaging appearances, thus improving outcomes. Highlights: Imaging findings of local cases differed significantly from published cases. No differences between cases with a CD4 count <200 cells/mm 3 and cases ≥200 cells/mm 3 . Racemose cysts are more prevalent in patients with CD4 counts ≥500 cells/mm 3 . Patients with "low" CD4 counts may present with atypical lesions, delaying diagnosis.