Improving Neurocysticercosis Diagnosis: Neurocysticercosis Diagnostic Practices at a Large Public Hospital System in...

Neurocysticercosis (NCC) is a cestode infection of the central nervous system caused by the larval form of Taenia solium. Diagnosis is often delayed because of low health care provider awareness of the disease. This study evaluated contemporary provider practices within a large county health care system in the United States. We retrospectively identified adult patients with NCC between 2017 and 2021 through the International Classification of Diseases 10 diagnostic code and extracted variables from their electronic medical records using a standardized data collection form. We compared provider actions with those recommended by the 2017 Infectious Disease Society of America (IDSA) NCC guidelines. Of 174 patients identified, 113 met definitive or probable criteria for NCC diagnosis. Most were Hispanic, from Mexico, and living in the United States for more than 5 years. Fifty-four (48%) had calcified lesions, and 59 (52%) had viable lesions, including 26 with extraparenchymal NCC. Although all patients underwent neuroimaging, many (n = 44, 39%) did not undergo both magnetic resonance imaging and computed tomography of the head. Few patients underwent gold-standard confirmatory serology. Twenty-four percent (n = 8) of patients with viable parenchymal NCC and 80% (n = 21) of patients with extraparenchymal NCC were not treated according to IDSA guidelines or were untreated. To address the gaps identified by our research, future work should include implementation of medical education strategies to improve knowledge of NCC diagnostic and management practices among frontline health care providers serving at-risk U.S. communities.