Major human brain parasites: a narrative review of clinical, diagnostic and therapeutic strategies.

We discuss some of the major cerebral parasites responsible for neglected diseases affecting humanity, especially in low-income countries. The World Health Organization states that cerebral malaria caused by Plasmodium falciparum is responsible for over 20% of deaths, especially in paediatric age. In addition to microscopy and molecular techniques, diagnosis can also be made with fundus magnetic resonance imaging and retinal fluorescein angiography, which have recently proven useful for assessing and understanding the clinical status of brain malaria. Currently, the best available treatment is combination therapy with artemisinin derivatives. Experimental drugs that prevent the development of malaria and blood-brain barrier dysfunction will be discussed. Neurocysticercosis is the most common helminthic infection of the central nervous system and a major cause of acquired epilepsy in resource-limited countries. Imported cases are increasing in Europe. Neuroimaging supported by immunodiagnostic tests with purified parasite antigens is the most important diagnostic test. Clinical management includes antiparasitic treatment, antiepileptic drugs, anti-inflammatories and surgery for obstructive hydrocephalus. In cerebral hydatidosis, brain involvement occurs primarily in childhood. Diagnosis is usually made through clinical, laboratory and imaging tests. The opportunistic toxoplasmic encephalitis is due to reactivation and can still be observed in AIDS patients with low access to antiretroviral therapy. Less common cerebral parasitic diseases include schistosomiasis, toxocariasis and amoebiasis, of which primary amoebic meningoencephalitis (Naegleria fowleri) has a very high mortality rate and treatment remains challenging in the absence of new drugs. The modification of existing drugs using nanotechnology offers promising prospects in the development of therapeutic interventions against these parasitic diseases.