Radiological screening for neurocysticercosis in asymptomatic siblings of children with neurocysticercosis: An observational cohort study

Abstract

Introduction: Neurocysticercosis (NCC) is the most common helminthic infection of the central nervous system and a leading cause of acquired epilepsy worldwide. Tuberculosis (TB) is transmitted through droplet infection to index pediatric case from only sputum acid-fast bacilli -positive patients while NCC in an index child can result from fecal–oral route from other family members who are Taenia carriers or through autoinfection as well. Objective: Similar to universal practice of TB screening of asymptomatic family members with chest X-ray which poses radiation hazard, radiation-free radiological screening by magnetic resonance imaging (MRI) brain of asymptomatic siblings of children with NCC was carried out in the present study in addition to evaluation of family members for taeniasis. Methods: Siblings (between 1 and 18 years of age) of children attending the pediatric NCC clinic at a tertiary care hospital in Chandigarh, India, with clinically suspected and radiologically confirmed the diagnosis of NCC, were enrolled. Contrast-enhanced MRI brain was obtained free of cost to detect the presence of asymptomatic NCC in siblings enrolled in the study. Stool analysis of family members of children with NCC was carried out to detect Taenia solium carriers. Results: Of 39 enrolled asymptomatic siblings, 4 (10.3%) children were detected to have solitary intraparenchymal NCC lesion. Of the aforementioned four siblings, 3 (75%) had viable lesions, while 1 (25%) had calcified lesion. Only 2 (1.7%) of 118 stool samples of family members tested were positive for T. solium eggs. Conclusions: The results from the present study suggest clustering of NCC cases in the family and that majority of children with NCC may continue to remain asymptomatic. Targeted family screening for NCC in asymptomatic family members of children with NCC may prove more cost effective than routine mass screening. Based on the results of this study, targeted deworming of community food handlers and caution in conducting routine deworming of children are suggested.