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Neurology in Tropics (E-book)
Tropical neurology refers to those diseases of the nervous system which prevail in between the Tropics of Cancer and Capricorn. Developments in speed and ease of travel and globalisation of economy have resulted in large scale migration rendering the boundaries of tropical regions less distinct.
Tropical neurology refers to those diseases of the nervous system which prevail in between the Tropics of Cancer and Capricorn. Developments in speed and ease of travel and globalisation of economy have resulted in large scale migration rendering the boundaries of tropical regions less distinct. Wars, famines, natural disasters and economic sanctions have added to the problem of infection and aggravated the preexisting nutritional deficiency disorders in many tropical countries. This book is aimed at residents, practicing physicians, health workers and physicians from western countries who are visiting the tropical countries.
Cysticercosis, an infection caused by the cystic larvae of the pork tapeworm Taenia solium, is one of the most frequent parasitic infections of the human nervous system (neurocysticercosis). It is endemic in most of Latin America, the sub-Saharan Africa, and vast parts of Asia, including the Indian subcontinent. It has also been increasingly diagnosed in developed countries because of migration of people from endemic zones and exposure in travelers. The life cycle involves the development of the adult tapeworm in the human small intestine (after ingesting infected pork with cysts) and larval infection in pig tissues (after ingesting human stools containing the eggs of the tapeworm). Humans get infected by the fecal-oral route, most often from a direct contact with an asymptomatic Taenia carrier. Most common clinical presentations are seizures (particularly late-onset seizures), chronic headaches, and intracranial hypertension. However, cysticerci can locate anywhere in the human nervous system, thus potentially causing almost any neurological syndrome and making clinical diagnosis a difficult task. Neuroimaging is the main diagnostic tool, and specific serology confirms the diagnosis and helps to define the diagnosis when images are unclear. Factors such as location (extraparenchymal versus intraparenchymal), number, size and evolutive stage of the parasites determine the clinical manifestations, therapeutic approach, and prognosis. Management includes symptomatic drugs (analgesics, antiepileptic drugs, anti-inflammatory agents) and in many cases cysticidal drugs, either albendazole or praziquantel. In recent years, efforts have focused on transmission control and potential elimination in endemic regions.
Neuroparasitology and Tropical Neurology, a new volume in The Handbook of Clinical Neurology, provides a comprehensive and contemporary reference on parasitic infections of the human nervous system. Parasitic infections are varied and some are resolved by the host's immune system, other infections may become established even though unnoticed, and some cause severe disease and death. In our modern world, neuroparasitoses are no longer geographically isolated and these infections now appear worldwide. Outside of a very few well understood pathologies, most parasitic infections have been neglected in the neurological literature and most neurologists have never diagnosed such an infection. This volume details how, with the advent of modern neuroimaging techniques, improved diagnostic applications of molecular biology, more accurate immunodiagnosis, and minimally invasive neurosurgery, human nervous system parasitoses are now diagnosed and treated, with increasing frequency. The book is divided into six sections, and begins with an introduction to the mechanisms of infection, diagnosis, and pathology of parasitic diseases. Subsequent chapters detail protozoan diseases and a section covering each of the major classes of human-infecting helminths: nematodes (roundworms), trematodes (flukes), and cestodes (tapeworms). The final section contains chapters on other important areas of tropical clinical medicine including the neurological complications of venomous bites and tropical nutritional deficiencies. Neuroparasitology and Tropical Neurology will be of interest to neurologists, neurosurgeons and other health professionals encountering patients with parasitic infections. - A comprehensive reference resource on the diagnosis and treatment of parasitic infections of the human nervous system - Focuses on the impact of modern neuroimaging techniques, improved diagnostic applications of molecular biology, more accurate immunodiagnosis, and minimally invasive neurosurgery to diagnose parasitoses - International list of contributors including the leading workers in the field
Many cestodes are capable of invading the central nervous system (CNS), and several are highly prevalent in the developing world. Neurocysticercosis due to Taenia solium and echinococcosis due to Echinoccocus granulosus are two of the most common parasitic infections affecting humans, but other less well-known parasites can also infect the nervous system. Coenurosis, caused by Taenia spp. such as T. multiceps, T. serialis, or T. brauni; sparganosis, caused by Spirometra spp., and neurocysticercosis caused by T. crassiceps are three less frequent zoonotic conditions that should be considered in the differential diagnosis of patients presenting with CNS infection – especially if they have lived in or traveled through areas where these infections are endemic. Diagnosis of these infections is typically made through a combination of serological testing, histopathology, and neuroimaging.
Neuroepidemiology in Tropical Health covers major neurological diseases of relevance in tropical settings and examines the specificities of epidemiology of neurological diseases in the context of tropical countries that face many challenges when compared to the developed world. Part One focuses on methods and their eventual specificities, and how such methods, like sampling, can be adapted for specific scenarios. Parts Two and Three discuss environmental factors and their consequences for neurology in the tropical world, as well as large geographical areas and their specificities. Finally, Part Four presents relevant neurological diseases in in-depth chapters. This invaluable information will help readers recognize the various neurological conditions presented, with the inclusion of their aetiologies and treatment in tropical areas. The book therefore fills a gap in the neuroepidemiology literature, with chapters written by an international collection of experienced authors in the field. Highlights differences and similarities between neuroepidemiology in tropical areas and temperate zones with a focus on methods and underlying factors Covers environmental factors in the tropical world and their consequences for neurology Chapters include references (key articles, books, protocols) for additional detailed study Includes wide topics of neurological disease in the tropics, not only infectious diseases, but also nutrition and public health
About three-fourths of the total world population live in the tropics but consume only 6% of worldwide food production and contribute 15% of the world's net revenue explaining the short life expectancy, high infantile mortality, and poor daily caloric intake; moreover, lack of clean drinking water and deficient sanitation promote water-borne infections, diarrhea, and risk of malabsorption that contribute to the prevalence of malnutrition in the tropics. One-third of the world's population consumes insufficient iodine increasing the risk for mental retardation and deafness due to maternal hypothyroidism. The main nutritional syndromes comprise protein-energy malnutrition (marasmus and kwashiorkor); nutritional neuropathies, myelopathies and neuromyelopathies, as well as specific deficiencies of vitamins and micronutrients including iodine, iron, zinc, and selenium.
Baylisascaris procyonis is a roundworm of the raccoon found primarily in North America but also known to occur in other parts of the world including South America, Europe, and Japan. Migration of the larvae of this parasite is recognized as a cause of clinical neural larva migrans (NLM) in humans, primarily children. It is manifested as meningoencephalitis associated with marked eosinophilia of the cerebrospinal fluid and peripheral blood. Diagnosis is made by recovering and identifying larvae in or from the tissues, epidemiological history, serology, and imaging of the central nervous system. Treatment is with albendazole and steroids, although the prognosis is generally poor. This parasite can also cause ocular larva migrans (OLM) which usually presents as diffuse unilateral subacute neuroretinitis (DUSN). The ocular diagnosis can be made by visualizing the larva in the eye and by serology. Intraocular larvae can be destroyed by photocoagulation although albendazole and steroids may also be used. However, once visual disturbance is established the prognosis for improved vision is poor. Related Baylisascaris species occur in skunks, badgers, and certain other carnivores, although most cases of NLM are caused by B. procyonis. Baylisascaris procyonis has also been found in kinkajous in the USA and South America and may also occur in related procyonids (coatis, olingos, etc.).