Correspondence

Neurocysticercosis Uncovered by Single-Dose Albendazole

N Engl J Med 2007; 356:1277-1278March 22, 2007

Article

To the Editor:

A 23-year-old woman noticed “worms” (small, flat, ribbonlike material) in her stool. She self-medicated with a single 400-mg dose of albendazole. The next day, more parasitic material was eliminated in her feces. By noon she had malaise, mild headache, feverishness, episodic left-sided facial numbness, and weakness of the left arm. That night she was awakened by a headache with profuse sweating, which was partially responsive to analgesics. The following morning she had vomiting and an episode of disorientation, with abnormal tonic–clonic movements of her left hand and arm. On arrival at our center, she reported headache; she was disoriented and was having partial seizures, which secondarily generalized. She had no history of trauma or alcohol ingestion. Physical examination was unremarkable. Computed tomography of the head revealed approximately 20 small, viable cysts, which were consistent with neurocysticercosis; 2 lesions were edematous. The patient was treated with analgesics and corticosteroids. Two weeks later, a 1-month course of albendazole, at a dose of 15 mg per kilogram of body weight per day, was administered without complications.

Periodic school-based administration of antiparasitic chemotherapy for soil-transmitted infections is advocated by the World Health Organization as a major control strategy, with a goal of regularly treating at least 75% of school-age children in target areas by 2010.1 Albendazole, with a half-life of 8 to 12 hours and good penetration in cerebrospinal fluid, is the chief agent used in these mass chemotherapy programs. Reported side effects are minimal.2 Most target populations are in developing countries where Taenia solium is endemic; larvae of this parasite can lodge in the brain and cause seizures and other neurologic symptoms. T. solium cysticercosis accounts for approximately 30% of all cases of seizures in areas where the species is endemic. Treatment of symptomatic neurocysticercosis with albendazole may cause seizures in the initial days. Field studies using brain imaging in regions where the disease is endemic show residual calcifications in 10 to 20% of the general population and asymptomatic live cysts in 1 to 2%.3,4 Mass use of praziquantel in areas where cysticercosis is endemic can trigger seizures in persons with latent brain cysts,5 a potential concern for mass deworming campaigns involving albendazole. Those designing or executing deworming programs should carefully consider the possibility of this complication.

Hector H. Garcia, M.D., Ph.D.
Isidro Gonzalez, M.D.
Universidad Peruana Cayetano Heredia, Lima 31, Peru
hgarcia@jhsph.edu

Lizardo Mija, M.D.
Instituto Nacional de Ciencias Neurologicas, Lima 1, Peru

for the Cysticercosis Working Group in Peru

5 References

1. 1

   United Nations. Resolution presented at the 54th World Health Assembly, Geneva, May 19, 2001.
   

2. 2

   Urbani C, Albonico M. Anthelminthic drug safety and drug administration in the control of soil-transmitted helminthiasis in community campaigns. Acta Trop 2003;86:215-221
   CrossRef | Web of Science | Medline

3. 3

   Montano SM, Villaran MV, Ylquimiche L, et al. Neurocysticercosis: association between seizures, serology, and brain CT in rural Peru. Neurology 2005;65:229-233
   CrossRef | Web of Science | Medline

4. 4

   Sanchez AL, Lindback J, Schantz PM, et al. A population-based, case-control study of Taenia solium taeniasis and cysticercosis. Ann Trop Med Parasitol 1999;93:247-258
   CrossRef | Web of Science | Medline

5. 5

   Flisser A, Madrazo I, Plancarte A, et al. Neurological symptoms in occult neurocysticercosis after single taeniacidal dose of praziquantel. Lancet 1993;342:748-748
   CrossRef | Web of Science | Medline

Citing Articles (1)

Citing Articles

1. 1

   Seth E. O’Neal, John M. Townes, Patricia P. Wilkins, John C. Noh, Deborah Lee, Silvia Rodriguez, Hector H. Garcia, William M. Stauffer. (2012) Seroprevalence of Antibodies against Taenia solium Cysticerci among Refugees Resettled in United States. Emerging Infectious Diseases 18:3,
   CrossRef