关键词: 寄生虫感染, 中枢神经系统, 临床特征, 流行病学

Abstract:

Objective To analyze the clinical characteristics, epidemiological exposure, disease spectrum, diagnosis, treatment and outcomes of individuals with parasitic infections of the central nervous system (CNS) in Jiangxi Province, so as to provide the clinical evidence for early identification of rare diseases. Methods All data pertaining to individuals with parasitic infections of the CNS receiving diagnosis and treatment in Jiangxi Provincial Institute of Parasitic Diseases from 2006 to 2025 were collected, and demographic features, epidemiological history, clinical manifestations, auxiliary examinations, discharge diagnoses, treatment modalities, and outcomes were statistically analyzed. Results A total of 174 cases with CNS parasitic infections were enrolled, including 110 men (63.2%) and 64 women (36.8%), and there were 105 cases (60.3%) at ages between 19~60 years. Farmers (40.8%, 71/174) and students (32.2%, 56/174) were predominant types of occupations, and the three mostly affected cities included Ji’an City (23.0%, 40/174), Yichun City (22.4%, 39/174) and Nanchang City (14.4%, 25/174). The positive rates of anti-Spirometra mansoni antibody, anti-Cysticercus cellulosae antibody, anti-Schistosoma antibody, anti-Paragonimus antibody, anti-Angiostrongylus cantonensis antibody, and anti-Toxoplasma antibody with HIV positivity were 67.2% (117/174), 62.6% (109/174), 8.0% (14/174), 4.6% (8/174), 5.7% (10/174) and 0.6% (1/174), respectively. Of 152 cases receiving immunological tests of cerebrospinal fluid (CSF), the detection of anti-S. mansoni antibody, anti-C. cellulosae antibody, anti-Schistosoma antibody, anti-Paragonimus antibody, and anti-Toxoplasma antibody was 62.5% (95/152), 58.6% (89/152), 9.2% (14/152), 2.9% (5/174), and 0.6% (1/174), respectively. Eosinophilia was observed in 103 cases (59.2%, 103/174). PCR assay was performed among 15 cases, in which Next-generation sequencing of CSF revealed one case with cerebral sparganosis, and parasites captured from surgical craniotomy were identified as S. mansoni among 11 cases, and one case with primary amebic meningoencephalitis, one case with Balamuthia mandrillaris encephalitis, and one case with encephalopathy caused by Babesia. All 174 patients underwent cranial magnetic resonance imaging scans, with an abnormality rate of 100%. A total of 41 cases were confirmed by etiological evidence and pathological examinations. A clear history of epidemiological exposure was present in 89.7% (156/174) of patients, with intake of raw water (32.2%, 56/174) and consumption of raw or undercooked food (28.7%, 50/174) as the two most common exposures. The leading diagnoses included central nervous system sparganosis mansoni （73.6%, 128/174）, cerebral cysticercosis (11.5%, 20/174), and cerebral schistosomiasis (8.0%, 14/174); rare diseases accounted for 6.9% (12/174). Symptoms of the CNS were the predominant clinical manifestation. Seizures or epileptic attacks were the most important initial or primary symptom (89.1%, 155/174), followed by headache and dizziness (36.8%, 64/174), and limb weakness or numbness (32.2%, 56/174). Praziquantel-based deworming was the primary treatment option, and there were 43 cases receiving deworming in combination with surgical resection, with a response rate of 92.0% (160/174). Although rare and uncommon central nervous system parasitic diseases account for a relatively small proportion, cerebral paragonimiasis, A. cantonensis encephalopathy, and cerebral toxoplasmosis could be comprehensively diagnosed by integrating epidemiological history, specific serum antibodies, and brain MRI. Cerebral babesiosis was confirmed by blood smear and PCR, whereas amoebic encephalitis was mainly diagnosed by molecular biological testing of cerebrospinal fluid. Conclusion Cerebral sparganosis mansoni predominated among CNS parasitic infections in Jiangxi Province, followed by cerebral cysticercosis and cerebral schistosomiasis. Clinical diagnosis can be established by combining epidemiological history, clinical manifestations, imaging, serological/ cerebrospinal fluid immunological tests and molecular biological test.

Key words: Parasitic infection, Central nervous system, Clinical characteristic, Epidemiology