The Burden of Neurocysticercosis at a Single New York Hospital

Abstract

Neurocysticercosis (NCC), a disease caused by the larval pork tapeworm Taenia solium, has emerged as an important infection in the United States. In this study, we describe the spectrum of NCC infection in eastern Long Island, where there is a growing population of immigrants from endemic countries. A retrospective study was designed to identify patients diagnosed with NCC using ICD-9 and ICD-10 codes in the electronic medical records at Stony Brook University Hospital between 2005 and 2016. We identified 52 patients (56% male, median age: 35 years) diagnosed with NCC in the only tertiary medical center in Suffolk County. Twenty-five cases were reported in the last three years of the study. Forty-eight (94%) patients self-identified as Hispanic or Latino in the electronic medical record. Twenty-two (44%) and 28 (56%) patients had parenchymal and extraparenchymal lesions, respectively. Nineteen (41.3%) patients presented with seizures to the emergency department. Six patients (11.7%) had hydrocephalus, and five of them required frequent hospitalizations and neurosurgical interventions, including permanent ventriculoperitoneal shunts or temporary external ventricular drains. No deaths were reported. The minimum accumulated estimated cost of NCC hospitalizations during the study period for all patients was approximately 1.4 million United States dollars (USD). In conclusion, NCC predominantly affects young, Hispanic immigrants in Eastern Long Island, particularly in zip codes correlating to predominantly Hispanic communities. The number of cases diagnosed increased at an alarming rate during the study period. Our study suggests a growing need for screening high-risk patients and connecting patients to care in hopes of providing early intervention and treatment to avoid potentially detrimental neurological sequelae.

Figure 1

Map of Long Island, Suffolk Country, NY, with clusters of NCC cases documented from 2005 to 2016. Cases clustered by corresponding zip code.

Figure 2

All three panels refer to the same specimen. (a) Low-power image of the larva of T solium surgically excised from the right frontal lobe (40x). (b) Detail of a region of the cyst wall reveals the characteristic undulating appearance of the microtrichia that form its outer layer, the middle cellular layer, and the inner loose reticular layer (600x). (c) Detail of the one sucker that is visible in the section (100x) (stain: hematoxylin and eosin).

Figure 3

Multiple racemose cysts within the third and fourth ventricles (white arrows).

Figure 4

This photomicrograph shows a necrotic scolex of a larva of T solium, which is the large ovoid structure that is centrally located in this image (100x). Also present is the rostellum (thick, black arrow), hooks (thin, black arrow), and two ventral suckers (white arrows). The scolex is surrounded by fingers and fronds of the necrotic cyst wall that has mild neutrophilic inflammation (stain: hematoxylin and eosin).

Figure 5

Both panels refer to same specimen.(a) This tissue, submitted as spherical lesions from the cervicomedullary junction, consists of one or more folded cyst walls of larvae of T solium. No scolex was found after examining multiple levels of the paraffin block (40x). (b) Detail of a region of the cyst wall shows the cuticular outer layer with multiple protrusions, the middle cellular layer, and the inner loose reticular layer that is characteristic of this organism (100x) (stain: hematoxylin and eosin).

Figure 6

Graph depicting numbers of NCC cases diagnosed at Stony Brook University Hospital from 2005 to 2016.