Epidemiological and clinical characteristics of 174 cases with parasitic infections of the central nervous system in Jiangxi Province

doi:10.12140/j.issn.1000-7423.2026.04.014

Abstract

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

CLC Number:

XU Yun, GONG Zhihong, CHEN Xiaowei, XU Hui, ZHOU Feng, LIU Junpu, FU Ziyang, XIONG Yuping, XIE Huiqun, DING Sheng. Epidemiological and clinical characteristics of 174 cases with parasitic infections of the central nervous system in Jiangxi Province[J]. CHINESE JOURNAL OF PARASITOLOGY AND PARASITIC DISEASES, 2026, 44(4): 550-556.

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References 29

[1]	王维治. 神经病学[M]. 北京: 人民卫生出版社, 2006: 691-695.
	Wang WZ. Neurology[M]. Beijing: People’s Medical Publishing House, 2006: 691-695. (in Chinese)
[2]	谢慧群, 龚, 曾红, 等. 江西省癫痫患者脑部寄生虫病的流行病学调查[J]. 江西医学院学报, 2009, 49(11): 103-105, 120.
	Xie HQ, Gong Y, Zeng H, et al. Epidemiologic investigation on cerebral parasitic diseases in patients with epilepsy in Jiangxi Province[J]. Acta Acad Med Jiangxi, 2009, 49(11): 103-105, 120. (in Chinese)
[3]	陈峰, 王洁, 张玉琴. 27例脑寄生虫病的临床与影像学分析[J]. 中国现代医生, 2014, 52(25): 48-50.
	Chen F, Wang J, Zhang YQ. The clinical and imaging analysis of 27 cases of parasitic encephalopathy[J]. China Mod Dr, 2014, 52(25): 48-50. (in Chinese)
[4]	尹春煜, 石尧忠. 食物源性脑寄生虫病住院病例分析[J]. 中国寄生虫学与寄生虫病杂志, 2002, 20(3): 177-179.
	Yin CY, Shi YZ. Investigation of inpatient cases of food-borne parasitic encephalopathy[J]. Chin J Parasitol Parasit Dis, 2002, 20(3): 177-179. (in Chinese)
[5]	王淑梅, 杨飞飞, 黄玉仙, 等. 78例脑寄生虫病病例分析[J]. 中国寄生虫学与寄生虫病杂志, 2009, 27(3): 245-248.
	Wang SM, Yang FF, Huang YX, et al. Clinical analysis of 78 cases of parasitic encephalopathy[J]. Chin J Parasitol Parasit Dis, 2009, 27(3): 245-248. (in Chinese)
[6]	龚志红, 龚红卡, 徐芸, 等. 江西省2011-2020年并殖吸虫病病例回顾性分析[J]. 中国寄生虫学与寄生虫病杂志, 2022, 40(2): 247-251.
	Gong ZH, Gong HK, Xu Y, et al. Retrospective analysis of paragonimiasis cases in Jiangxi Province from 2011 to 2020[J]. Chin J Parasitol Parasit Dis, 2022, 40(2): 247-251. (in Chinese)
[7]	吴忠道. 我国人体寄生虫病与少见或罕见寄生虫病[J]. 热带病与寄生虫学, 2022, 20(3): 121-125.
	Wu ZD. Human parasitic diseases and uncommon or rare parasitic diseases in China[J]. J Trop Dis Parasitol, 2022, 20(3): 121-125. (in Chinese)
[8]	Pozio E. How globalization and climate change could affect foodborne parasites[J]. Exp Parasitol, 2020, 208: 107807.
[9]	York EM, Butler CJ, Lord WD. Global decline in suitable habitat for Angiostrongylus (= Parastrongylus) cantonensis: the role of climate change[J]. PLoS One, 2014, 9(8): e103831.
[10]	Stahl LM, Olson JB. Environmental abiotic and biotic factors affecting the distribution and abundance of Naegleria fowleri[J]. FEMS Microbiol Ecol, 2020, 97(1): 238.
[11]	de Souza WM, Weaver SC. Effects of climate change and human activities on vector-borne diseases[J]. Nat Rev Microbiol, 2024, 22(8): 476-491.
[12]	中国疾病预防控制中心, 国家卫生标准委员会寄生虫病标准专业委员会. 寄生虫病标准实用指南[M]. 北京: 中国标准出版社, 2019.
	Chinese Center for Disease Control and Prevention, Parasitic Disease Standards Committee of National Health Standards Committee. Practical guide to the standard of parasitic diseases[M]. Beijing: Standards Press of China, 2019. (in Chinese)
[13]	徐芸, 万慧, 洪道俊, 等. 123例曼氏裂头蚴病的临床特点及治疗观察[J]. 江西医药, 2017, 52(4): 286-289.
	Xu Y, Wan H, Hong DJ, et al. Cerebral clinical features and outcomeof 123 patients with sparganosis[J]. Jiangxi Med J, 2017, 52(4): 286-289. (in Chinese)
[14]	谢慧群, 龙勇, 徐芸, 等. 脑曼氏裂头蚴病患者42例的临床、影像与病理特点分析[J]. 中华神经科杂志, 2015, 48(2): 108-113.
	Xie HQ, Long Y, Xu Y, et al. Clinical features, radiological characteristics, and pathological changes in 42 patients with cerebral sparganosis[J]. Chin J Neurol, 2015, 48(2): 108-113. (in Chinese)
[15]	Song T, Wang WS, Zhou BR, et al. CT and MR characteristics of cerebral sparganosis[J]. AJNR Am J Neuroradiol, 2007, 28(9): 1700-1705.
[16]	张敏, 汪顺如, 陆志前, 等. 脑血吸虫病的MRI表现特征[J]. 中国CT和MRI杂志, 2012, 10(6): 19-21.
	Zhang M, Wang SR, Lu ZQ, et al. MRI features of cerebral schistosomiasis[J]. Chin J CT MRI, 2012, 10(6): 19-21. (in Chinese)
[17]	李传明, 王健, 陈康, 等. 脑血吸虫与脑肺吸虫病的MRI诊断与鉴别诊断[J]. 现代生物医学进展, 2011, 11(19): 3697-3699.
	Li CM, Wang J, Chen K, et al. MRI diagnosis and differential diagnosis of cerebral schistosomiasis and cerebral paragonimiasis[J]. Prog Mod Biomed, 2011, 11(19): 3697-3699. (in Chinese)
[18]	Maleewong W. Recent advances in diagnosis of paragonimiasis[J]. Southeast Asian J Trop Med Public Health, 1997, 28(Suppl 1): 134-138.
[19]	Li Z, Li WQ, Li YY, et al. A case report of Balamuthia mandrillaris encephalitis[J]. Heliyon, 2024, 10(5): e26905.
[20]	徐慧, 费妍, 龚志红, 等. 以多脏器梗死为特征的人感染巴贝虫1例[J]. 中国寄生虫学与寄生虫病杂志, 2024, 42(2): 275-278.
	Xu H, Fei Y, Gong ZH, et al. A human Babesia infection case characterized by multiple organ infarctions[J]. Chin J Parasitol Parasit Dis, 2024, 42(2): 275-278. (in Chinese)
[21]	Barratt J, Chan D, Sandaradura I, et al. Angiostrongylus cantonensis: a review of its distribution, molecular biology and clinical significance as a human pathogen[J]. Parasitology, 2016, 143(9): 1087-1118.
[22]	Schuster FL, Visvesvara GS. Free-living amoebae as opportunistic and non-opportunistic pathogens of humans and animals[J]. Int J Parasitol, 2004, 34(9): 1001-1027.
[23]	Locke S, O’Bryan J, Zubair AS, et al. Neurologic complications of babesiosis, United States, 2011-2021[J]. Emerg Infect Dis, 2023, 29(6): 1127-1135.
[24]	Krause PJ. Human babesiosis[J]. Int J Parasitol, 2019, 49(2): 165-174.
[25]	李清玉, 金勇, 马伟琼, 等. 广州管圆线虫致颅脑及胸部感染1例[J]. 中国寄生虫学与寄生虫病杂志, 2025, 43(2): 307-310.
	Li QY, Jin Y, Ma WQ, et al. A case of central nervous system and pulmonary infection caused by Angiostrongylus cantonensis[J]. Chin J Parasitol Parasit Dis, 2025, 43(2): 307-310. (in Chinese)
[26]	Chen JY, Chen Z, Lin JK, et al. Cerebral paragonimiasis: a retrospective analysis of 89 cases[J]. Clin Neurol Neurosurg, 2013, 115(5): 546-551.
[27]	Grace E, Asbill S, Virga K. Naegleria fowleri: pathogenesis, diagnosis, and treatment options[J]. Antimicrob Agents Chemother, 2015, 59(11): 6677-6681.
[28]	成骢, 许传军, 池云, 等. 艾滋病合并弓形虫脑病11例临床分析[J]. 东南大学学报(医学版), 2016, 35(5): 767-770.
	Cheng C, Xu CJ, Chi Y, et al. Clinical analysis of 11 AIDS patients complicated with toxoplasmic encephalitis[J]. J Southeast Univ (Med Sci Ed), 2016, 35(5): 767-770. (in Chinese)
[29]	Keiser J, Utzinger J. Chemotherapy for major food-borne trematodes: a review[J]. Expert Opin Pharmacother, 2004, 5(8): 1711-1726.

暴露类型 Types of exposure history	病例数（构成比/%） No. patient（Proportion/%）	病种 Types of diseases
饮生水 Drink raw water	56（32.2）	脑曼氏裂头蚴病、脑并殖吸虫病 Cerebral sparganosis mansoni, cerebral paragonimiasis
生食/半生食（蛙、虾蟹等）Eat raw/undercooked frogs,shrimps or crabs	50（28.7）	脑曼氏裂头蚴病、脑并殖吸虫病 Cerebral sparganosis mansoni, cerebral paragonimiasis
养猪/屠宰史/生食猪肉 Raise pigs/pig slaughter/eat raw pork	32（18.4）	脑猪囊尾蚴病、脑曼氏裂头蚴病 Cerebral cysticercosis cellulosaei, cerebral sparganosis mansoni
抓玩/捕食蛙、螃蟹 Catch/eat frogs or crabs	15（8.6）	脑曼氏裂头蚴病、脑并殖吸虫病 Cerebral sparganosis mansoni, cerebral paragonimiasis
血吸虫疫水接触史 Exposure to schistosome-infected water	14（8.0）	脑血吸虫病 Cerebral schistosomiasis
生食蛞蝓/接触福寿螺 Eat raw slugs/contact with Pomacea canaliculata	2（1.1）	广州管圆线虫脑病 Angiostrongylus cantonensis encephalopathy
接触污染水源 Exposure to contaminated water	2（1.1）	自由生活阿米巴脑炎 Free-living amoebic encephalitis
免疫低下 + 不明接触史 Weakened immune system + unknown exposure history	1（0.6）	巴贝虫脑病 Babesia encephalopathy
无明确暴露史 No clear exposure history	18（10.3）	主要为脑囊虫病和曼氏裂头蚴病 Cerebral cysticercosis and sparganosis mansoni are the predominant types