Neurocysticercosis among international travelers to disease-endemic areas

Objective. Review of neurocysticercosis in citizens from non-endemic countries who developed the disease after a travel to endemic regions, to estimate the magnitude of the disease and to determine the pattern of disease expression in travelers to disease-endemic areas. Methods. MEDLINE and manual search of international travelers with neurocysticercosis diagnosed in countries where the disease is not endemic, from 1981 to October 2011. Abstracted data included: demographic profile of patients, clinical manifestations, form of neurocysticercosis, and therapy. Results. A total of 35 articles reporting 52 patients were found. Most patients were originally from Western Europe, Australia, Israel, and Japan. Mean age was 36.5 ± 15.1 years, and 46% were women. Common places for travelling were the Indian Subcontinent, Latin America, and Southeast Asia. Mean time spent aboard was 56.6 ± 56.1 months. Most patients developed symptoms 2 years or more after returning home. Seizures were the most common clinical manifestation of the disease (73%), and all but six patients had parenchymal brain cysticercosis (a single cysticercus granuloma was the most common neuroimaging finding, in 21 patients). Twenty patients underwent surgical resection of the brain lesion for diagnostic purposes, and 22 received cysticidal drugs. Conclusions. Neurocysticercosis is rare in international travelers to endemic countries, and most often occurs in long-term travelers. It is possible that most of these patients get infected by contact with a taenia carrier. The time elapsed between disease acquisition and symptoms occurrence suggests that, at least in some patients, clinical manifestations are related to reactivation of an infection that has previously been controlled by the host immune system.