Advanced

AJNR - American Journal of Neuroradiology

Published ahead of print on October 10, 2007
doi: 10.3174/ajnr.A0769

This Article Figures Only Full Text Full Text (PDF) Supplemental Online Tables All Versions of this Article: ajnr.A0769v1 29/1/170    most recent Alert me when this article is cited Alert me if a correction is posted Citation Map Services Similar articles in this journal Similar articles in PubMed Alert me to new issues of the journal Download to citation manager Citing Articles Citing Articles via CrossRef Citing Articles via Google Scholar Google Scholar Articles by Handique, S.K. Articles by Saikia, P. Search for Related Content PubMed PubMed Citation Articles by Handique, S.K. Articles by Saikia, P.

American Journal of Neuroradiology 29:170-175, January 2008
© 2008 American Society of Neuroradiology

BRAIN

Coinfection of Japanese Encephalitis with Neurocysticercosis: An Imaging Study

S.K. Handique^a, R.R. Das^b, B. Saharia^a, P. Das^a, R. Buragohain^a and P. Saikia^c

^a Departments of Radiology and Imaging, Institute of Neurological Sciences, Dispur, Assam, India
^b Department of Neurology, Institute of Neurological Sciences, Dispur, Assam, India
^c Department of Microbiology, Institute of Neurological Sciences, Dispur, Assam, India

Please address correspondence to Sanjeev K. Handique, Department of Radiology and Imaging, Institute of Neurological Sciences, Dispur-781006, Assam, India; e-mail: sanjeevhandique{at}hotmail.com or sanjeev_handique{at}yahoo.co.in

BACKGROUND AND PURPOSE: Coinfection of neurocysticercosis (NCC) and Japanese encephalitis (JE) has been advocated as more than a chance occurrence resulting in poor outcome. We undertook this study to determine whether the association of the 2 infections is more than a chance occurrence, to define the imaging characteristics of coinfections, and to explore the synergistic effect of NCC in JE.

MATERIALS AND METHODS: Sixty-two patients with JE were studied by MR imaging and CT. CT was done in 53 and MR imaging in 53 patients. The diagnosis of JE was established by CSF JE virus immunoglobulin M capture (MAC) enzyme-linked immunosorbent assay (ELISA). NCC was diagnosed from imaging. A control group of 385 patients was evaluated by imaging for prevalence of NCC in the general population.

RESULTS: A significantly high association of NCC with JE (19.3%) was observed in comparison with prevalence of NCC in control subjects (1.04%; P = .0003). JE lesions in coinfection were significantly asymmetric with lateralization to the side of the brain having the maximum NCC or a cyst with edema. The JE lesions in coinfections were more florid, with a significantly higher proportion of abnormal CT scans and more abnormal MR imaging. Coinfections were significantly more common in children. Significantly lower CSF MAC-ELISA units in patients with coinfection reflected low CSF IgM levels, suggesting altered immune status.

CONCLUSION: In our series, there was a strong association between JE and NCC, and, thus, this coinfection was more than a chance occurrence.