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VIEWS & REVIEWS: Mitchell T. Wallin and John F. Kurtzke Neurocysticercosis in the United States: Review of an important emerging infection Neurology 2004; 63: 1559-1564 [Abstract] [Full text] [PDF]

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Reply to DeGiorgio et al

Mitchell T. Wallin, John F. Kurtzke   (22 December 2004)

Neurocysticercosis in the United States: Review of an important emerging infection

Christopher M. DeGiorgio M.D., Frank Sorvillo Ph.D., Susan Pietsch Escueta M.P.H.   (22 December 2004)

Reply to DeGiorgio et al 22 December 2004
Mitchell T. Wallin, VAMC-Washington, DC & Georgetown University 50 Irving St, NW, Washington, DC 20422, John F. Kurtzke Send Correspondence to journal: Re: Reply to DeGiorgio et al mitchell.wallin{at}med.va.gov Mitchell T. Wallin, et al.	We appreciate the comments by Dr. DeGiorgio et al regarding evidence that supports an increase in the prevalence of neurocysticercosis (NCC) in the United States. He points out that recent hospital-based data, population-based data and mortality rates from California lend further support for this temporal trend. A NCC prevalence of nearly 3% in Ventura County was reported by Sorvillo et al [2], a rate that is similar to that found in NCC endemic regions. [3] While not a common cause of death, Latinos have a high relative risk of mortality from NCC compared to other ethnic groups. In our paper, we reviewed the risk factors for developing seizures in the context of NCC covered by Ong et al [1] but did not highlight the emergency room admission data as noted by DeGiorgio. The data on increasing admission rates at Los Angeles County/USC and Olive View/UCLA Medical Centers is new. The paper by Sorvillo, et al [2] provides new epidemiologic information that was published after our article was in press. It is a welcome addition to the literature providing more population-based data on NCC within the United States. While this information adds to the argument for an increasing prevalence for NCC in the United States, these data are isolated to California. Moreover, higher admission rates for NCC and higher mortality rates may not necessarily correlate with higher prevalence rates. A broader regional or national reporting system for NCC capable of producing prevalence and incidence rates adjusted to a standard population would provide the best means for judging temporal trends within the United States. We trust the recent paper cited by Dr. DeGiorgio [2] and our publication [4] will help stimulate initiating such a system. References 1. Ong S, Talan DA, Moran GJ, Mower W, Newdow M, Tsang VC, Pinner RW; EMERGENCY ID NET Study Group. Neurocysticercosis in radiographically imaged seizure patients in U.S. emergency departments. Emerg Infect Dis. 2002;8:608-13. 2. Sorvillo FJ, Portigal L, DeGiorgio C, Smith L, Waterman SH, Berlin GW, Ash LR. Cysticercosis-related deaths, California. Emerg Infect Dis. 2004;10:465-9. 3. Garcia HH, Del Brutto OH. Taenia Solium Cysticercosis. Infect Dis Clin North Am 2000;4:97-119. 4. Wallin MT, Kurtzke JF. Neurocysticercosis in the United States. Review of an Important Emerging Infection. Neurology. 2004;63:1559-1564.
Neurocysticercosis in the United States: Review of an important emerging infection 22 December 2004
Christopher M. DeGiorgio M.D., UCLA Department of Neurology-Geffen School of Medicine 710 Westwood Plaza, Los Angeles, CA 90095, Frank Sorvillo Ph.D., Susan Pietsch Escueta M.P.H. Send Correspondence to journal: Re: Neurocysticercosis in the United States: Review of an important emerging infection cmd{at}ucla.edu Christopher M. DeGiorgio M.D., et al.	Wallin and Kurtzke should be commended for directing neurologists' attention to the growing problem of neurocysticercosis in the United States. They indicated that indirect evidence supports an increase in the prevalence of neurocysticercosis in the US. Recent data directly support their assertion including hospital-based data, a population-based study, and vital records data. Hospital-based data from Los Angeles County/USC Medical Center from 1994-1999 indicate that 10% of neurology and neurosurgery admissions were due to neurocysticercosis, a significant increase from year’s prior. Between 1994 and 1998, 468 patients (average = 94 per year) were admitted for neurocysticercosis (ICD 9 code 123.1), [1] compared with 238 patients between 1981-1986 (average = 48 per year). [2] Data from a sister hospital, Olive View/UCLA Medical Center, indicates a 14% increase in neurocysticercosis admissions between the years 1994 and 1999. Data from Olive View/UCLA also indicates that neurocysticercosis now accounts for 10% of all seizures presenting to the emergency room. [3] New epidemiological data supports the idea that T. solium cysticercosis is becoming endemic in the Latino population in California. We recently completed the first population-based study in a Hispanic community in Ventura County, California. In 449 subjects, we found the prevalence of T. solium cysticercosis to be 2.8% in adult Latinos, similar to prevalence data from some endemic regions of Latin America. Lastly, a review of death certificates in California indicates that neurocysticercosis is a major cause of death among Latinos. The crude death rate among Latinos was 13 deaths per million Californians, (relative risk 43.3, CI 17.7 - 106). [4] The data support Wallin and Kurzke’s contention that neurocysticercosis, caused by T. solium cysticercosis, is a growing cause of seizures, hydrocephalus, and death in the United States. Further studies and interventions are indicated for this preventable and treatable disease. References 1. DeGiorgio CM, Houston I, Oveido S, Sorvillo F. Deaths Associated with Cysticercosis. Neurosurgical Focus 2002;12:article 2. 2. Scharf D. Neurocysticercosis. Two hundred thirty eight cases from a California hospital. Archives of Neurology 1988;45:777-780. 3. Ong S, Talan DA, Moran GJ, Mower W, Newdow M, Tsang VC, Pinner RW; EMERGENCY ID NET Study Group. Neurocysticercosis in radiographically imaged seizure patients in U.S. emergency departments. Emerg Infect Dis. 2002;8:608-13. 4. Sorvillo FJ, Portigal L, DeGiorgio C, Smith L, Waterman SH, Berlin GW, Ash LR. Cysticercosis-related deaths, California. Emerg Infect Dis. 2004;10:465-9.