Heads Up! Lots of Interesting Neurology in the American Journal of Tropical Medicine & Hygiene Feb 2018 Issue

It is unusual for a journal focused on tropical medicine to feature a predominance of articles addressing neurologic conditions. In general, one must review numerous tables of content in tropical medicine publications to accumulate enough ‘neurologic literature’ to fill an afternoon’s reading. So it was a real treat to open the February issue of AJTMH.

For those who are not particularly familiar with the recent advances that neuroimaging have facilitated in our understanding of the pathophysiology of cerebral malaria, an editorial by Hoffman and Wassmer1 lay the groundwork as they discuss the role of increased intracranial pressure in cerebral malaria deaths and the identification of reversible cerebral vasoconstriction syndrome in cerebral malaria in a 21 year old man returning from a holiday in Kenya.2 From Zambia, Potchen et al.3 report their work using one of the few 1.5T MRIs available in a malaria endemic region to explore the pathogenic mechanisms that might be driving malaria-induced cerebral edema. Surprisingly, blood brain barrier breakdown, long thought to be a principal contributor to cerebral malaria mortality, was not seen in this Zambian cohort. The increasing availability of neuroimaging in tropical settings is highlighted several times in this AJTMH issue including in the imaging highlights section which shows the MRI findings of metronidazole-associated encephalopathy.

The ever-present conundrum of whether or not to administer agents to kill parasites living in the CNS versus giving steroids to control inflammation and hoping for the best is another major theme. Linking human and animal studies, Prociv and Turner4 offer an interesting article on the subarachnoid phase of neuroangiostrongyliasis—the number one cause of eosinophilic meningitis worldwide. Early treatment is key—and initiating anthelminthics after CNS invasion occurs may well do more harm than good. We learn that adverse neurologic events during mass distribution of ivermectin for onchocerciasis control which has previously been attributed to co-infection with Loa Loa (and hence another example of the nervous system’s intolerance for killing in situ parasites), may actually be due to an mdr-1 gene polymorphism that allows toxic levels of ivermectin to accumulate in the brain.5 And Garvey et al. utilize advanced neuroimaging in conjunction with sera test in their work with neurocysticercosis in rural Peru.6

Twelve of the 45 articles in the February issue of AJTMH are neurologic—happy reading!

References
1. Hoffmann A, Wassmer SC. New Syndromes Identified by Neuroimaging during Cerebral Malaria. Am J Trop Med Hyg 2018;98:349-350.
2. Yamamoto K, Kato Y, Shinohara K, et al. Case Report: Reversible Cerebral Vasoconstriction Syndrome in Cerebral Malaria. Am J Trop Med Hyg 2018;98:505-507.
3. Potchen MJ, Kampondeni SD, Seydel KB, et al. 1.5 Tesla Magnetic Resonance Imaging to Investigate Potential Etiologies of Brain Swelling in Pediatric Cerebral Malaria. Am J Trop Med Hyg 2018;98:497-504.
4. Prociv P, Turner M. Neuroangiostrongyliasis: The “Subarachnoid Phase” and Its Implications for Anthelminthic Therapy. Am J Trop Med Hyg 2018;98:353-359.
5. Chandler RE. Serious Neurological Adverse Events after Ivermectin-Do They Occur beyond the Indication of Onchocerciasis? Am J Trop Med Hyg 2018;98:382-388.
6. Garvey BT, Moyano LM, Ayvar V, et al. Neurocysticercosis among People Living Near Pigs Heavily Infected with Cysticercosis in Rural Endemic Peru. Am J Trop Med Hyg 2018;98:558-564.

Gretchen L. Birbeck, MD, MPH

Gretchen L. Birbeck, MD, MPH

Gretchen Birbeck is a neurologist who divides her time between the US and Africa. Her US academic home is the University of Rochester where she is the Rykenboer Professor of Neurology and Research Director for the Strong Epilepsy Center with adjunct appointments in the Center for Human Experimental Therapeutics and the Department of Public Health. Her additional skills in epidemiology, health services research, and tropical medicine are brought to bear during the 6-months annually she spends in Africa where she serves as Director for the Chikankata Epilepsy Care Team in rural Mazabuka, Zambia, an Honorary Lecturer at the University of Zambia and a consultant for the Paediatric Research Ward at Queen Elizabeth Central Hospital in Blantyre, Malawi. Gretchen’s research programs are aimed at identifying opportunities to prevent or ameliorate the medical and social morbidities of common neurologic conditions in low-income, tropical settings with the ultimate goal of developing successful interventions feasible for scale up and broad implementation. She has been recognized as an Ambassador for Epilepsy by the International League against Epilepsy, a Global Health Research Ambassador by the US Paul Rogers Society, a National Outreach Scholar by the WK Kellogg Foundation and a Leader in Medicine by the American Medical Students Association.

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