Extensive Inactive Neurocysticercosis: A Case Report in Mbeya, Southern Highlands of Tanzania

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Background: Neurocysticercosis (NCC) and Acquired Human Immunodeficiency Syndrome (AIDS) are both highly prevalent in Africa. Clinical presentation of NCC ranges from asymptomatic to manifestations, including epileptic seizures, severe progressive headache, and focal neurological deficits. It is influenced by the number, size, location, and stage of the cysts, as well as the parasite’s potential to cause inflammation and the immunological response of the host. So far, little is known about how Human Immunodeficiency Virus (HIV) co-infection modifies clinical NCC presentation. We report the case of a person living with HIV presenting with extensive calcified NCC on neuroimaging without any associated signs/ symptoms. Purpose: To contribute to the medical literature and enhance understanding of the disease’s manifestation and progression by providing a thorough documentation of a specific case of extensive inactive neurocysticercosis. Case Presentation: A 47-year-old male African patient was recruited in the CYSTINET Africa study at Chunya District Hospital, Mbeya. He was an artisan and has been living with HIV since 2012, and he has been compliant with antiretroviral treatment, hence with undetectable viral load during 2018, 2020, and 2021. Taenia solium serology was done by LDBIO Cysticercosis IgG Western Blot test, which tested positive for antibodies, but the apDia Cysticercosis Antigen (Ag) ELISA antigen test was negative. His computed tomography (CT) scan of the brain showed approximately 138 calcified neurocysticercosis typical lesions, 108 being located in the parenchyma, 15 in the extra parenchyma, and 15 in the subarachnoid space, consistent with a diagnosis of extensive calcified NCC. He reported no history of headaches or epileptic seizures. Neurological examination did not reveal any deficit. Conclusion: Intensively, patients with a large number of neurocysticercosis lesions may be completely asymptomatic throughout the disease. In our patient,the HIV co-infection might have contributed to the high lesion load and/or to less severe clinical signs/symptoms due to modulation of the immune system. Plain Language Summary: An important parasite that is spread between people and pigs is the pork tapeworm. The larvae from tapeworm infections that settle in the brain are known as neurocysticercosis (NCC) and have been found to infect approximately 17 out of every 100 individuals in areas of Tanzania, where the pork tapeworm is present. There has been the assumption that NCC is more prevalent in the areas of Tanzania with a higher burden of Human Immunodeficiency Virus (HIV)/Acquired Immunodeficiency Syndrome (AIDS). The neurological signs/symptoms of NCC depend on the number, size, location, and stage of the larvae as well as the host’s immune system and the parasite’s strength to cause inflammation. Whether an HIV co-infection affects the clinical presentation of NCC is still poorly understood. We describe a case of an HIV-positive individual who showed a large number of calcified larvae from the pork tapeworm on his brain scan but without neurological manifestations. Through this comprehensive account of a particular patient with widespread inactive larvae from the pork tapeworm, we hope to add to the knowledge of why some patients with NCC and not others develop neurological manifestations. Keywords: case study, calcified neurocysticercosis, HIV, CYSTINET Africa, Taenia solium

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