The diagnostic challenges of neuroparasitological infections: The experience of the Hospital for Tropical Diseases (London) neuroparasitology multidisciplinary team between 2015–2020

Abstract

Introduction: In the UK, neuroparasitological infections are rare but important diagnoses. Diagnostic delay can result in significant morbidity. The Hospital for Tropical Diseases (HTD) runs a neuroparasitology multidisciplinary team meeting (MDT) consisting of two consultant parasitologists, neurologist and neuroradiologist, both with specialist interests in neuroinfection, and registrars, working closely with the reference parasitology service. Clinical history, imaging and laboratory results are reviewed to recommend a differential diagnosis and management plan. Methods: We reviewed MDT records between 1st October 2015 and 31st August 2020. We collected data on demographics, referring specialties, travel history and exposures, final diagnoses and MDT outcomes. Results: Overall, 162 patients were discussed in 51 MDTs. Referrals were made by 54 different hospitals, 3 outside the UK. The median age was 40 (IQR 29,53) and 45% were female. Parasitic infections accounted for 43%, including neurocysticercosis (75%, 52/69), hydatid (9%, 6/69), neuroschistosomiasis (6%, 4/69) and non-HIV associated cerebral toxoplasmosis (3%, 2/69). Non-parasitological diagnoses included other infection (e.g. HSV, cryptococcus), ADEM and malignancy. The MDT recommended further investigation in 28% (45/162) including imaging, serological tests or brain biopsy. For 8% (13/162) treatment was recommended under the home team, 9% (15/162) were treated as an HTD outpatient, 4% (7/162) were admitted for anti-parasitic treatment at HTD. In 5 patients with neurocysticercosis, unnecessary brain biopsy was avoided. Discussion: The HTD neuroparasitology MDT consults on complex neuroinfections from around the UK. Specialist review helps establish or exclude parasitological diagnoses, leading to appropriate parasitological treatment, saving patients from invasive procedures such as brain biopsy.