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Parasitic Infection
of the CNS |
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Parasitic infection of the nervous system by
protozoa and metazoa is increasing in Western countries
Infection of the nervous system by protozoa was formerly uncommon in Western
countries, but is being seen increasingly because of international travel and
increased risk of infection in patients with immunosuppression.
Toxoplasma can cause a congenital infection resulting in hydrocephalus and
cerebral calcifications. It is also now frequently seen in patients with AIDS,
causing cerebritis and brain abscesses.
Worldwide, Malaria is the most common protozoan disease to involve the brain
(particularly infection with Plasmodium falciparum), causing vascular thromboses
with petechial haemorrhages (cerebral malaria). Trypanosomiasis may be
associated with an encephalomyelitis in acute disease.
Entamoeba histolytica can cause an amoebic abscess by spread from the gut,
whereas a meningitis is caused by free-living amoebae such as Naegleria, usually
acquired by swimming in contaminated pools in warm climates.
The two main metazoan parasites to infect the brain are {\I Echinococcus
granulosus} (causing hydatid disease) and the larval form of the pork tapeworm,
Taenia solium (causing cysticercosis).
TUBERCULOSIS OF THE BRAIN
Infection of the nervous system with TB may cause meningitis or abscess.
Infection of the CNS by Mycobacterium tuberculosis is by blood spread from a
site of primary infection, most commonly the lung. There are two main types of
infection.
Meningitis is characterized by numerous granulomas in the leptomeninges, with
features of a chronic meningitis. Infection is most marked around the base of
the brain and, even when infection is treated, there is often development of
meningeal fibrosis to cause hydrocephalus.
Tuberculous abscess (tuberculoma) forms with infection of the brain parenchyma.
A tuberculoma is typically a firm, lobulated mass of granulomatous inflammation
with central caseous necrosis, up to several centimetres in diameter, and walled
off by fibrous tissue. Lesions occur within the cerebral hemispheres, but are
most common in the cerebellum. Treatment with antibiotics is usually ineffective
and surgical excision is required. |
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