Central Nervous System Involvement in Trichinellosis: A Systematic Review
Abstract
:1. Introduction
2. Materials and Methods
3. Results
3.1. Clinical Findings
3.2. Clinical Findings in Patients with Reported Outcome
3.3. Cerebrospinal Fluid Analysis
3.4. Blood Eosinophils
3.5. Autopsy and Biopsy Findings
3.6. Neuroimaging Findings
3.7. Statistical Analysis
4. Discussion
Supplementary Materials
Author Contributions
Funding
Institutional Review Board Statement
Informed Consent Statement
Data Availability Statement
Conflicts of Interest
References
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Clinical Sign/Symptom | Number of Cases (% of Total; N = 162) | Deaths | |
---|---|---|---|
Headache | 40 (24.69%) | 7 | |
Neck stiffness | 22 (13.58%) | 2 | |
Kerning sign | 24 (14.8%) | 16 | |
Meningeal cry | 2 (1.23%) | 0 | |
Confusion | 23 (14.2%) | 1 | |
Delirium | 16 (9.87%) | 7 | |
Disorientation | 19 (11.73) | 3 | |
Agitation | 5 (3.08%) | 0 | |
Insomnia | 4 (2.47%) | 0 | |
Irritability | 4 (2.47%) | 1 | |
Psychiatric symptoms | 21 (12.96%) | 0 | |
Mutism | 1 (0.62%) | 0 | |
Euphoria | 2 (1.23%) | 0 | |
Depression | 8 (4.94%) | 1 | |
Anxiety | 2 (1.23%) | 0 | |
Apathy | 8 (4.94%) | 1 | |
Bradypsychia | 4 (2.47%) | 0 | |
Memory impairment (recent memory) | 17 (10.49%) | 1 | |
Impaired abstract thinking | 4 (2.47%) | 0 | |
Impaired concentration | 1 (0.62%) | 0 | |
Anosognosia | 1 (0.62%) | 0 | |
Apraxia | 1 (0.62%) | 0 | |
Acalculia | 3 (1.85%) | 1 | |
Aphasia | 11 (6.79%) | 3 | |
Tetraparesis | 17 (10.49%) | 3 | |
Hemiparesis | 31 (19.14%) | 5 | |
Paraparesis | 2 (1.23%) | 1 | |
Monoparesis | 13 (8.02%) | 1 | |
Brisk tendon reflexes | Globally | 9 (5.56%) | 1 |
On the hemiparesis side | 4 (2.47%) | 0 | |
Knee | 3 (1.85%) | 0 | |
Lower limbs | 7 (9.87%) | 0 | |
Ankle clonus | 9 (5.56%) | 0 | |
Rotulian clonus | 1 (0.62%) | 0 | |
Diminished/absent tendon reflexes | Globally | 11 (6.79%) | 4 |
Lower limbs | 5 (3.09%) | 5 | |
Knee | 8 (4.94%) | 2 | |
Ankle | 3 (1.85%) | 0 | |
Unilateral | 1 (0.62%) | 0 | |
Babinski sign | Unilateral | 13 (8.02%) | 1 |
Bilateral | 16 (9.88%) | 3 | |
Doubtful | 1 (0.62%) | 0 | |
Sensitive impairment | Hemihypoesthesia | 6 (3.70%) | 0 |
Subjective symptoms | 6 (3.70%) | 0 | |
Cerebellar signs | 15 (9.25%) | 0 | |
Cranial nerves | Third nerve palsy | 8 (4.94%) | 1 |
Sixth nerve palsy | 9 (5.56%) | 1 | |
Peripheral facial palsy | 1 (0.62%) | 0 | |
Dysphagia | 2 (1.23%) | 0 | |
Pseudobulbar dysphagia | 2 (1.23%) | 1 | |
Dysarthria | 1 (0.62%) | 0 | |
Unspecified | 2 (1.23%) | 1 | |
Mydriasis | 5 (3.09%) | 3 | |
Anisocoria | 5 (3.09%) | 2 | |
Absent/slow light reaction | 8 (4.94%) | 3 | |
Ocular bobbing | 1 (0.62%) | 0 | |
Horner syndrome | 1 (0.62%) | 0 | |
Visual impairment | 10 (6.17%) | 0 | |
Hemiballismus | 1 (0.62%) | 0 | |
Seizures | Generalized | 4 (2.46%) | 1 |
Jacksonian type | 3 (1.85%) | 1 | |
Petit mal | 2 (1.23%) | 0 | |
Psychomotor | 3 (1.85%) | 1 | |
Unspecified | 2 (1.23%) | 1 | |
Coma | 11 (6.79%) | 3 | |
Stupor | 4 (2.47%) | 1 | |
Somnolence | 10 (6.17%) | 0 | |
Lethargy | 10 (6.17%) | 1 | |
Obnubilation | 1 (0.62%) | 0 | |
Drowsiness | 10 (6.17%) | 3 | |
Dizziness | 5 (3.09%) | 0 | |
Frontal signs (unspecified) | 3 (1.85%) | 0 | |
Encephalitic signs (unspecified) | 2 (1.23%) | 0 |
Clinical Sign/Symptom | Number of Cases with Outcome Death (% of Total; N = 17) | Number of Cases with Outcome Improvement (N = 103) | |
---|---|---|---|
Headache | 7 (41.17%) | 33 | |
Neck stiffness | 2 (11.76%) | 20 | |
Kerning sign | 2 (17.65%) | 8 | |
Confusion | 1 (5.88%) | 22 | |
Delirium | 7 (41.17%) | 8 | |
Disorientation | 3 (17.65%) | 17 | |
Depression | 1 (5.88%) | 7 | |
Apathy | 1 (5.88%) | 7 | |
Memory impairment (recent memory) | 1 (5.88%) | 10 | |
Acalculia | 1 (5.88%) | 2 | |
Aphasia | 3 (17.65%) | 8 | |
Tetraparesis | 3 (17.65%) | 14 | |
Hemiparesis | 6 (35.29%) | 22 | |
Paraparesis | 1 (5.88%) | 1 | |
Monoparesis | 1 (5.88%) | 12 | |
Brisk tendon reflexes | Globally | 1 (5.88%) | 5 |
Diminished/absent tendon reflexes | Globally | 4 (23.53%) | 7 |
Knee | 2 (11.76%) | 4 | |
Present tendon reflexes | 1 (5.88%) | 1 | |
Babinski sign | Unilateral | 1 (5.88%) | 11 |
Bilateral | 3 (17.65%) | 14 | |
Cranial nerves | Third nerve palsy | 1 (5.88%) | 5 |
Sixth nerve palsy | 1 (5.88%) | 8 | |
Dysphagia | 1 (5.88%) | 1 | |
Mydriasis | 3 (17.65%) | 2 | |
Anisocoria | 2 (11.76%) | 3 | |
Absent/slow light reaction | 3 (17.65%) | 5 | |
Seizures | Generalized | 1 (5.88%) | 2 |
Jacksonian type | 1 (5.88%) | 3 | |
Psychomotor | 1 (5.88%) | 1 | |
Unspecified | 1 (5.88%) | 0 | |
Coma | 3 (17.65%) | 8 | |
Stupor | 1 (5.88%) | 3 | |
Lethargy | 1 (5.88%) | 8 | |
Drowsiness | 3 (17.65%) | 7 |
CSF Parameter | No. of Cases (% of Total; N = 107) | |
---|---|---|
Pressure | increased | 11 (10.28%) |
decreased | 3 (2.80%) | |
Cells | Lymphocytes | 16 (14.95) |
Erythrocytes | 4 (3.74%) | |
Unspecified | 3 (2.80) | |
Proteins | Increased | 16 (14.95%) |
Decreased | 6 (5.60%) | |
Glucose | Increased | 5 (4.67%) |
Decreased | 1 (0.93%) | |
Positive for Trichinella sp. larvae | 20 (18.69%) | |
Anti-trichinella antibodies | 1 (0.93%) | |
Normal findings | 44 (41.12%) |
Symptom | TP | FP | FN | TN | LR+ | LR− | |
---|---|---|---|---|---|---|---|
Headache | 7 | 33 | 10 | 70 | 1.28 | 0.86 | |
Neck stiffness | 2 | 20 | 15 | 83 | 0.60 | 1.09 | |
Kerning sign | 2 | 8 | 15 | 95 | 1.51 | 0.95 | |
Confusion | 1 | 22 | 16 | 81 | 0.27 | 1.19 | |
Delirium | 7 | 8 | 10 | 95 | 5.30 | 0.63 | |
Disorientation | 3 | 17 | 14 | 86 | 1.06 | 0.98 | |
Depression | 1 | 7 | 16 | 96 | 0.86 | 1.00 | |
Apathy | 1 | 7 | 16 | 96 | 0.86 | 1.00 | |
Memory impairment | 1 | 10 | 16 | 93 | 0.60 | 1.04 | |
Acalculia | 1 | 2 | 16 | 101 | 3.02 | 0.95 | |
Aphasia | 3 | 8 | 14 | 95 | 2.27 | 0.89 | |
Tetraparesis | 3 | 14 | 14 | 89 | 1.29 | 0.95 | |
Hemiparesis | 6 | 22 | 11 | 81 | 1.65 | 0.82 | |
Paraparesis | 1 | 1 | 16 | 102 | 6.05 | 0.95 | |
Monoparesis | 1 | 12 | 16 | 91 | 0.50 | 1.06 | |
Brisk tendon reflexes (globally) | 1 | 5 | 16 | 98 | 1.21 | 0.98 | |
Diminished tendon reflexes | Globally | 4 | 7 | 13 | 96 | 3.46 | 0.82 |
Knee | 2 | 4 | 15 | 99 | 3.02 | 0.91 | |
Babinski sign | Unilateral | 1 | 11 | 16 | 92 | 0.55 | 1.05 |
Bilateral | 3 | 14 | 14 | 89 | 1.29 | 0.95 | |
Third cranial nerve palsy | 1 | 5 | 16 | 98 | 1.21 | 0.98 | |
Sixth cranial nerve palsy | 1 | 8 | 16 | 95 | 0.75 | 1.02 | |
Dysphagia | 1 | 1 | 16 | 102 | 6.05 | 0.95 | |
Mydriasis | 3 | 2 | 14 | 101 | 9.08 | 0.83 | |
Anisocoria | 2 | 3 | 15 | 100 | 4.03 | 0.90 | |
Absent/slow light reflex | 3 | 5 | 14 | 98 | 3.63 | 0.86 | |
Jacksonian seizures | 1 | 3 | 16 | 100 | 2.01 | 0.96 | |
Psychomotor seizures | 1 | 1 | 16 | 102 | 6.05 | 0.95 | |
Any type of seizures | 4 | 6 | 13 | 97 | 4.03 | 0.81 | |
Coma | 3 | 8 | 14 | 96 | 2.27 | 0.89 | |
Stupor | 1 | 3 | 16 | 100 | 2.01 | 0.96 | |
Lethargy | 1 | 8 | 16 | 95 | 0.75 | 1.02 | |
Drowsiness | 3 | 7 | 14 | 96 | 2.59 | 0.88 |
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Rosca, E.C.; Tudor, R.; Cornea, A.; Simu, M. Central Nervous System Involvement in Trichinellosis: A Systematic Review. Diagnostics 2021, 11, 945. https://doi.org/10.3390/diagnostics11060945
Rosca EC, Tudor R, Cornea A, Simu M. Central Nervous System Involvement in Trichinellosis: A Systematic Review. Diagnostics. 2021; 11(6):945. https://doi.org/10.3390/diagnostics11060945
Chicago/Turabian StyleRosca, Elena Cecilia, Raluca Tudor, Amalia Cornea, and Mihaela Simu. 2021. "Central Nervous System Involvement in Trichinellosis: A Systematic Review" Diagnostics 11, no. 6: 945. https://doi.org/10.3390/diagnostics11060945