Parasitic Eosinophilic Meningoencephalitis: Part 2

Although they are uncommon, parasitic infections that affect the central nervous system can have a substantial morbidity and mortality. In order to guide proper therapy and improve patient outcomes, an early and correct diagnosis is essential.Diagnostic tests include a lumbar puncture to analyse cerebrospinal fluids for signs of infection, imaging scans like Computerized Tomography scan (CT) or Magnetic Resonance Imaging (MRI) to identify any structural abnormalities and specific laboratory tests to detect the presence of parasites in the body. 

Since parasites are rarely found in Cerebrospinal Fluid (CSF), a definitive parasitological diagnosis is difficult to make. For the same reason, a lack of thorough evaluation of sensitivity and specificity undermines the standardization of immunological techniques. Currently, serology is the most reliable source of information to support the diagnosis.

However, detection of antibodies will never be confirmatory, but it may certainly give additional diagnostic information. It is necessary to actively look for practical panels of well-defined and purified antigens, ideally recombinant molecules. Standardization of nucleic acid detection techniques applicable to CSF samples is also needed in order to improve the detection of eosinophilic meningoencephalitis.

The necessity for comprehensive methods is underscored by the complexity of these illnesses and their severe consequences. So, the diagnostic efforts to parasitic meningoencephalitis entail the collaboration of the neurologist, neurosurgeon, radiologist and last but not the least, the clinical microbiologist.

References

1. Graeff-Teixeira C, da Silva AC, Yoshimura K. Update on eosinophilic meningoencephalitis and its clinical relevance. Clin Microbiol Rev. 2009;22(2):322-348. 

2. O'Connell EM, Nutman TB. Eosinophilia in Infectious Diseases. Immunol Allergy Clin North Am. 2015;35(3):493-522.

3. Sawanyawisuth K, Chotmongkol V. Eosinophilic meningitis. Handb Clin Neurol. 2013;114:207-215.

4. Abdoli Amir. Parasitic encephalitis in immunocompetent individuals. The Lancet 2019; 394(10202):914–915.

5. Tunali V, Korkmaz M. Emerging ad Re- Emerging Parasitic Infections of the Central Nervous System (CNS) in Europe. Infectious Disease Reports. 2023;15(6):679-699.