The Journal of Infection in Developing Countries <p>A peer-reviewed open access journal, focusing on global health.</p> The Journal of Infection in Developing Countries en-US The Journal of Infection in Developing Countries 1972-2680 <p>Authors who publish with this journal agree to the following terms:</p> <ol type="a"> <li>Authors retain copyright and grant the journal right of first publication with the work simultaneously licensed under a <a title="Creative Commons Attribution License" href="" target="_new">Creative Commons Attribution License</a> that allows others to share the work with an acknowledgement of the work's authorship and initial publication in this journal.</li> <li>Authors are able to enter into separate, additional contractual arrangements for the non-exclusive distribution of the journal's published version of the work (e.g., post it to an institutional repository or publish it in a book), with an acknowledgement of its initial publication in this journal.</li> <li>Authors are permitted and encouraged to post their work online (e.g., in institutional repositories or on their website) prior to and during the submission process, as it can lead to productive exchanges, as well as earlier and greater citation of published work (See <a title="The Effect of Open Access" href="" target="_new">The Effect of Open Access</a>).</li> </ol> Foodborne disease outbreaks in Barbados (1998-2009): a 12-year review <p>Introduction: Microbes such as <em>Salmonella</em>, <em>Campylobacter</em> and <em>S. aureus</em> have been implicated in Foodborne disease outbreaks (FBDOs) worldwide, yet information on their occurrence in Barbados is scanty. The purpose of this study was to determine the aetiological agents, food vehicles, locations and peak seasons of FBDOs in Barbados; assess the quality of epidemiological investigations; and identify deficiencies in food production practices and laboratory detection.</p> <p>Methodology: A search of FBDOs occurring in Barbados between 1998-2009 was conducted among published and unpublished literature sources and reports. The search terms included the keywords “foodborne disease,” “outbreaks” and “Barbados”.</p> <p>Results: During the period 1998 to 2009, there were 24 foodborne outbreaks, 215 cases of illness, one hospitalisation and no deaths. Overall, 37.5% of outbreaks were associated with hotels/resorts. <em>Salmonella</em> Enteritidis phage type 8 was most commonly implicated with eggs and poultry being the primary vehicles. Three outbreak reports were available for assessment and revealed that there were deficiencies in the outbreak investigations. These reports also recorded high levels of food contamination with indicator organisms, suggesting that improvements in food hygiene and production practices were required.</p> <p>Conclusions: The number of FBDOs is low in comparison to developed countries. However, the data was likely affected by under-reporting and inadequacies in the outbreak investigations and laboratory detection. Improvements in these areas would lead to not only better detection and characterisation of FBDOs in Barbados but improved food safety control measures.</p> Carol Hull-Jackson Abiodun A Adesiyun ##submission.copyrightStatement## 2019-01-31 2019-01-31 13 01 1 10 10.3855/jidc.10404 Prevalence, antimicrobial resistance and risk factors for campylobacteriosis in Lebanon <p>Introduction: The rapid increase in <em>Campylobacter</em> strains resistant to antibiotics represents a major problem for public health. In Lebanon, campylobacteriosis is underdiagnosed since bacteria detection in stool samples is not performed routinely. This study aims to evaluate the prevalence, sources and routes of transmission, risk factors and antimicrobial susceptibility patterns of <em>Campylobacter </em>spp. in Lebanon.</p> <p>Methodology: Stool samples collected from 1000 Lebanese patients with diarrhea, and 150 meat samples taken from supermarkets and slaughterhouses were subjected to <em>Campylobacter </em>detection. Colonies were identified by Gram staining, oxidase and catalase activities. They were then differentiated at the species level by hippurate test and PCR. Susceptibility of <em>Campylobacter </em>spp. to antibiotics was studied by the disc diffusion standard method.</p> <p>Results: <em>Campylobacter </em>spp. were detected in 21.5% of stool samples; the main isolated species being <em>C. jejuni </em>(83.2%) and <em>C. coli </em>(13.9%). The highest <em>Campylobacter </em>infection rates were detected among children (41.8%) and during summer (31.6%). Consumption of contaminated meat and salads, and contact with animals represented the major risk factors for campylobacteriosis, with poultry carcasses and bovine cuts identified as the main bacteria reservoirs. Neither demographic determinants nor season had a major effect on the prevalence of campylobacteriosis. Erythromycin was the most active agent against <em>Campylobacter </em>spp. A multi-resistance rate was observed in 35.9% of isolates.</p> <p>Conclusions: Campylobacteriosis is a major public health concern in Lebanon<em>. </em>Bacteria detection in stool culture should be performed routinely to allow an early diagnosis and a better monitoring of the disease and its burden.</p> Jose Noel Ibrahim Elias Eghnatios Ali El Roz Taher Fardoun Ghassan Ghssein ##submission.copyrightStatement## 2019-01-31 2019-01-31 13 01 11 20 10.3855/jidc.10729 Rifampicin resistant tuberculosis in presumptive pulmonary tuberculosis cases in Dubti Hospital, Afar, Ethiopia <p>Introduction: Ethiopia stood third in drug-resistant tuberculosis (TB) in Africa, and more than 5,000 MDR-TB patients are reported each year. Greater than 90% of rifampicin (RIF) resistant strains are resistant to isoniazid (INH) and hence the objective of this study was to determine the prevalence and risk factors of RIF resistant MTB among presumptive TB cases at Dubti General Hospital, Afar, Ethiopia.</p> <p>Methodology: In this cross-sectional study, 384 presumptive TB cases were recruited and a structured questionnaire was used to collect socio-demographic and clinical data. Sputum samples were collected and examined using <em>X-pertMTB/RIF</em> assay. Bivariate, multivariate logistic regressions, and fishers' exact analysis were done to assess the associations between the prevalence of TB and MDR-TB with different socio-demographic and clinical variables.</p> <p>Results: In the present study, the overall prevalence of pulmonary TB was 24.5% (94/384), of this 4 (4.3%) isolates were resistant to RIF. History of anti-TB treatment (AOR = 2.4, 95% CI: 1.3-4.4 and TB contact (AOR = 3.6, 95% CI: 2.1-6.2 were significantly associated with <em>gene X-pert</em> MTB/RIF positive TB. Moreover, resistance to rifampicin was statistically associated with the history of TB contact with multi-drug resistant TB (P = 0.027) and khat chewer cases (P = 0.04).</p> <p>Conclusions: The overall prevalence of TB and its drug-resistant were relatively higher than that of in the general population in Ethiopia. History of anti-TB treatment and TB contact were significantly associated with <em>X-pert </em>MTB/RIF positive MDR-TB.</p> Gebremedhin Bizayene Gebrehiwet Atsebeha Gebrekidan Kahsay Letmichael Negash Welekidan Amlsha Kahsay Hagos Getahun Kahsay Abay Dawit Gebreegziabiher Hagos ##submission.copyrightStatement## 2019-01-31 2019-01-31 13 01 21 27 10.3855/jidc.10462 Comparative analysis of antibodies and lymphocytes in pulmonary tuberculosis patients with negative and positive cultures <p>Introduction: The sputum smear or the culture are the definitive diagnosis of pulmonary tuberculosis. Only a fraction of clinical patients are culture-confirmed.</p> <p>Methodology: A total of 24 clinical cases (40 ± 14 years old) with positive smear and negative co-morbidity were studied. Cases were selected from 600 patients who attended the pneumology service over two years. A sputum sample was cultured in Löwenstein-Jensen medium with consequent amplification of the rrnA V2 promoter, the differentiation region 4, and the IS6110 insertion sequence of <em>Mycobacterium tuberculosis</em>. After the culture result, the patients were divided into negative (n = 14) or positive (n = 10) culture groups. In addition, 30 samples from healthy donors (45 ± 10 years) were studied. The numbers of CD4, CD8 and CD19 lymphocytes were determined by flow cytometry. Levels of IgA and IgG to <em>M. tuberculosis</em> were measured by ELISA.</p> <p>Results: IgG and IgA levels were detected in patients with positive culture, while only IgA was found in patients with negative cultures. The lymphocyte populations in the two groups were similar.&nbsp; The presence of a pleural apical cap was found more frequently in patients with negative- (57%) than with positive cultures (10%).</p> <p>Conclusions: The isotype profile in patients with positive cultures was both IgA and IgG positive, while in patients with negative culture, only IgA was found. The results will contribute to improve the diagnostic algorithm and appropriate treatment of patients with clinical tuberculosis. Further studies are needed to determine if this profile is predictive of the outcome of isolation.</p> Fernando-Renato Cázares-Sosa Alejandro Hernández-Solís Atenea-Estela Andrés-Dionicio Heliodora González-González Miguel Ibáñez-Hernández Raúl Cicero-Sabido Herón Huerta Raquel Tapia-Romero Jorge-Luis de-la-Rosa-Arana ##submission.copyrightStatement## 2019-01-31 2019-01-31 13 01 28 34 10.3855/jidc.10583 Spatial and temporal analysis of severe fever with thrombocytopenia syndrome in Zhejiang Province, China, 2011 - 2015 <p>Introduction: Severe fever with thrombocytopenia syndrome (SFTS) is an emerging infectious disease first discovered in northeast and central China in 2009, and SFTS cases increased year by year in China. This study aimed to identify the spatial and temporal clusters of SFTS in Zhejiang Province, China.</p> <p>Methodology: We analyzed the surveillance data of SFTS in Zhejiang Province during 2011 - 2015. Descriptive statistics were used to analyze the general characteristics and overall trend of SFTS. Circular statistic method was utilized to identify the seasonality. Space–time scan analysis was performed to explore the high risk spatio-temporal clusters of SFTS cases at county level.</p> <p>Results: A total of 194 confirmed SFTS cases were reported in Zhejiang Province during 2011 - 2015. We found a significant increase in overall time trend since 2011. The seasonality was statistically significant (P &lt; 0.001), with a mean date (95% CI) of 21st June (12th ~ 30th in June). Totally 21 (23%) counties reported the occurrence of SFTS, which gradually spread throughout Zhejiang. Three spatio-temporal clusters were detected, with one principle cluster (Daishan County, RR 234.48, June 2013 - November 2015) and two secondary clusters (6 counties, RR 30.73, April - October in 2015; Anji County, RR 373.26, May 2014).</p> <p>Conclusions: Our results suggested that SFTS has increased and spatially expanded over the past years, with a remarkable seasonality. Three spatio-temporal clusters were identified. These findings are important for the improvement of SFTS surveillance and control strategies.</p> Fudong Li Fan He Jimin Sun Yujia Zhai Jianmin Jiang Junfen Lin ##submission.copyrightStatement## 2019-01-31 2019-01-31 13 01 35 43 10.3855/jidc.10373 Risk factors associated with horizontal transmission of hepatitis B viral infection from parents to children in Mexico <p>Introduction: Hepatitis B virus (HBV) infection in children is a health problem worldwide. In Mexico, a high prevalence rate of HBV infection and occult HBV infection have been reported in high-risk adults and children. However, studies regarding HBV infection transmitted from HBV-infected parents to children are limited. This study aimed to determine the risk factors associated with HBV transmission of HBV from parents to children in Mexico.</p> <p>Methodology: A retrospective case-control study was carried out in 24 pediatric patients with clinical HBV infection and 48 healthy controls. Bivariate and forward conditional logistic regression analysis was used to compare demographic variables, the status of HBV vaccination, and risk factors for HBV infection transmission among children and their parents.</p> <p>Results: No newborns were diagnosed with HBV infection, and no significant differences were found in age (p = 0.209) or gender (p = 0.612) compared to the control group. The independent risk factor associated with HBV transmission was the presence of a parent with a history of promiscuity (OR = 30.95, 95%CI = 3.382-283.326; p = 0.002), whereas having completed the HBV vaccination schedule for their age was a protective factor against HBV infection in the children (OR = 0.245, 95%CI = 0.079-0.764; p = 0.015).</p> <p>Conclusions: HBV infection in Mexican children is associated with close interpersonal contact with a parent engaged in high-risk sexual practices suggesting that the horizontal route could be the primary mode of infection. Child and adult vaccination campaigns should be reinforced to avoid HBV infection in Mexico.</p> Griselda Escobedo-Melendez Arturo Panduro Alfredo Celis Sonia Roman ##submission.copyrightStatement## 2019-01-31 2019-01-31 13 01 44 49 10.3855/jidc.10487 β-lactamase genes in carbapenem resistance Acinetobacter baumannii isolates from a Turkish university hospital <p>Introduction: The spread of <em>Acinetobacter</em> <em>baumannii</em>, resistant to most of the available antimicrobial agents, is a serious health problem. The high rate of carbapenem resistance among <em>Acinetobacter</em> <em>baumannii</em> isolates is considered as a threat to public health. In this study, we aimed to determine the antibiotic resistance and related genes in carbapenem-resistant <em>Acinetobacter baumannii</em> isolates.</p> <p>Methodology: Ninety six isolates of <em>A.</em> <em>baumannii</em> were included. Antimicrobial susceptibility was performed by Phoenix Automated System and disk diffusion method. Carbapenem resistane was characterized by scrneeing of resistance genes such as <em>bla</em><sub>TEM</sub>, <em>bla</em><sub>SHV</sub>, <em>bla</em><sub>CTX-M1-2</sub>, <em>bla</em><sub>PER</sub>, <em>bla</em><sub>VEB</sub>, <em>bla</em><sub>KPC</sub>, <em>bla</em><sub>GES</sub>, <em>bla</em><sub>NDM</sub>, <em>bla</em><sub>VIM</sub>, <em>bla</em><sub>IMP </sub>and <em>bla</em><sub>OXA23-24-51-58</sub> using multiplex polymerase chain reaction.</p> <p>Results: Resistance for the levofloxacin, gentamicin, amikacin, and tigecycline were determined as 96.9%, 93.7%, 72.9% and 45.8% respectively. Colistin was the only susceptible antibiotic against all clinical isolates. All isolates were defined as multidrug resistance and of these, 31.2% were extensively drug-resistant (sensitive only to colistin). <em>Bla</em><sub>OXA-51­</sub> <em>&nbsp;</em>and<em> bla</em><sub>OXA-23 </sub>genes were detected in 100% strains while <em>bla</em><sub>TEM </sub>was found in only 2% strains. There was no amplification for the <em>bla</em><sub>SHV</sub>, <em>bla</em><sub>CTX-M1-2</sub>, <em>bla</em><sub>PER</sub>, <em>bla</em><sub>VEB</sub>, <em>bla</em><sub>KPC</sub>, <em>bla</em><sub>GES</sub> <em>bla</em><sub>NDM</sub>, <em>bla</em><sub>VIM</sub>, <em>bla</em><sub>IMP </sub>and <em>bla</em><sub>OXA24-58</sub> genes.</p> <p>Conclusions: The high frequency of <em>bla</em><sub>OXA-23 </sub>and low frequency of <em>bla</em><sub>TEM</sub> gene was observed that indicate prevalence of a variety of <em>A.</em> <em>baumannii </em>strains. The rates of resistance genes vary from region to region. Studies are required for the prevention and control of <em>A. baumannii </em>infection and to formulate the strategies of antibiotic usage.</p> Umut Safiye Say Coskun Emel Caliskan Asegul Copur Cicek Halbay Turumtay Cemal Sandalli ##submission.copyrightStatement## 2019-01-31 2019-01-31 13 01 50 55 10.3855/jidc.10556 Knowledge, attitude, behaviour of the future healthcare professionals towards the self-medication practice with antibiotics <p>Introduction: Self-medication with antibiotics (SMA) is a major health problem in the developing world including the kingdom of Saudi Arabia (KSA). This practice remains an emerging challenge for the healthcare providers. A few previous studies have estimated the prevalence of SMA among the general population of KSA, but there had been no such studies on healthcare students.</p> <p>We aimed to estimate the prevalence of SMA among medical, non-medical students and to evaluate its determinants.</p> <p>Methodology: A survey-based cross-sectional study using validated questionnaire was conducted amongst students at King Faisal University in KSA. Chi-square test and logistic regression analysis were applied to identify the determinants of SMA.</p> <p>Results: The prevalence of SMA was 58.4% with significantly lower proportion among medical students. Tonsillitis was the most common symptom for which SMA was used and was reported by a significantly higher proportion of medical (54.1%) students. Despite, the awareness of medical students about SMA is unsafe and mal-practice (79.9%), the prevalence of SMA practice remains high. Logistic regression analysis showed that students who incorrectly, identified the effectiveness of antibiotics in treating bacterial infections, the reasons of the antibiotics discontinuation had a higher likelihood to SMA. (OR = 2.16, 95% CI: 1.52-4.503, P = 0.001), (OR = 1.575, 95% CI: 0.923-2.686, P = 0.09), respectively.</p> <p>Conclusions: SMA remains noticeably high among the medical students. To overcome this problem, we highly recommend improving the health education to better address this malpractice and improve the students’ knowledge, attitudes and awareness towards the antibiotics use and prescription pattern.</p> Tarek Benameur Hassan Al-Bohassan Abdullah Al-Aithan Abdullah Al-Beladi Hassan Al-Ali Hassan Al-Omran Neji Saidi ##submission.copyrightStatement## 2019-01-31 2019-01-31 13 01 56 66 10.3855/jidc.10574 Variations of Glossina sp. and trypanosome species frequency within different habitats in a sleeping sickness focus, Gabon <p>Introduction: Knowledge of the infectious status of the Glossina is an indicator of risk of resurgence of Human African Trypanosomiasis (HAT). Environmental conditions have an impact on the density and diversity of both vector and Trypanosoma. The aim of the study was to determine the diversity and the infection rate of Glossina as well as the diversity of trypanosome species within habitats of an old HAT focus, in Gabon.</p> <p>Methodology: <em>Glossina</em> were captured in September 2012 in three ecological sites. Vavoua traps were installed for twelve days. All captured flies were identified. Glossina were selected for trypanosome identification by Polymerase Chain Reaction.</p> <p>Results: 1178 <em>Glossina</em> were captured: 55.8% in degraded forest, 28.9% in flood area and 15.4% in secondary forest. <em>Glossina fusca congolensis</em> (37%) and <em>G.palpalis palpalis</em> (36.4%) were the most abundant vector species. <em>G. fusca congolensis</em> was predominant in secondary forest and in flood area, while in degraded forest, it was <em>G.palpalis palpalis</em>. <em>Trypanosoma</em> infection rate was 30.7%, 42% in secondary forest, 32% in degraded forest and 18% in flood area. <em>Trypanosoma congolense savannah</em> was the main species detected (18.7%) followed by <em>T.brucei brucei</em> (10.7%) and <em>T. brucei gambiense</em> (4%). <em>T. congolense</em> <em>savannah</em> type was predominant in the secondary forest and in degraded forest (66.7% versus 55.5%).</p> <p>Conclusion: <em>Glossina</em> density and trypanosome infection rate varied according to the habitat within HAT focus. The density of tsetse was the highest in degraded forest while the infection rate was highest in secondary forest. Continuous disease surveillance and control measures are needed.</p> Ornella Mbang Nguema Marielle Bouyou Akotet Jacques Mavoungou Denise Patricia Mawili Mboumba ##submission.copyrightStatement## 2019-01-31 2019-01-31 13 01 67 72 10.3855/jidc.9654 Fosfomycin in the treatment of extended spectrum beta-lactamase-producing Enterobacteriaceae- related urinary tract infections <p>Introduction: We aimed to demonstrate if fosfomycin tromethamine (FT) treatment could be the treatment of choice in ESBL-producing Enterobacteriaceae strains as an alternative to carbapenem particularly in patients who we would like to treat on an outpatient basis.</p> <p>Methodology; We retrospectively analyzed the medical records of all patients who admitted to infectious disease outpatient clinic with complaints of dysuria and frequency and received FT for lower UTI between May 2016 and May 2017.</p> <p>Results: A total of 48 patients, 19 females (39.6%) and 29 males (60.4%), with a mean age of 62.5 (ranging from 27 to 85) years were included the study. 26 (76.4%) of patients with a history of urinary operation or intervention had also a history of antibiotic use within the past 3 months. The isolated pathogens included <em>Escherichia Coli</em> (n = 32), <em>Klebsiella</em> spp. (n = 12), Enterobacter spp. (n = 4). The overall microbiological response after treatment was 70.8% (34/48) and the clinical response was 75% (36/48). Clinical and microbiological response rates of patients with and without urinary operation/intervention, diabetes mellitus, history of antibiotic use and malignancy were found similar (p &gt; 0.05). However, patients with a urinary stone disease history had significantly higher response rates than those without a urinary stone disease history (P = 0.042).</p> <p>Conclusion: Oral fosfomycin tromethamine might be the treatment of choice in ESBL-producing enterobactericea related UTIs especially caused by <em>Escherichia Coli</em>.</p> Ayhanim Tumturk Senol Tonyali Ayse Yasemin Tezer Tekce Levent Isikay Hakan Cime ##submission.copyrightStatement## 2019-01-31 2019-01-31 13 01 73 76 10.3855/jidc.10658 Argentinian multicenter study on urinary tract infections due to Streptococcus agalactiae in adult patients <p>Introduction: <em>Streptococcus agalactiae</em> (group B streptococcus, GBS) is a recognized urinary pathogen both in males and pregnant or non-pregnant women. Data regarding GBS serotypes recovered from urinary tract infections (UTIs) are scarce. The aim of this study was to describe the clinical and microbiological characteristics of UTIs caused by GBS in adult patients in Argentina.</p> <p>Methodology: A prospective multicenter study involving 86 centers was conducted in Argentina between July 1<sup>st</sup>, 2014 and June 30<sup>th</sup>, 2015. Antimicrobial susceptibility and serotype distribution of GBS isolated from the urinary tract of adult patients were determined. Susceptibility tests were performed by the disk diffusion and/or agar dilution methods. Epidemiological and clinical characteristics of the patients were considered to identify associated comorbilities.</p> <p>Results: Seven hundred and one GBS were sent to the reference laboratory in the above mentioned period, however, only 211 fulfilled our selection criteria (demographic data availability, underlying diseases reported, colony counts greater than 10<sup>5</sup> CFU/mL, single organism isolated from the urine sample). No penicillin-resistant GBS was found but fluoroquinolone resistance was high (12.8%), especially among GBS isolated from men and non-pregnant women. UTIs due to GBS were associated to underlying diseases in men and non-pregnant women, particularly <em>diabetes mellitus</em>. Most of the isolates showed serotypes Ia and III.</p> <p>Conclusions: GBS are still susceptible to penicillin but fluoroquinolone resistance is a growing concern, at least in Argentina. There are underlying conditions that could be associated to urinary infections caused by GBS.</p> Laura Vigliarolo Barbara Arias Mariana Suárez Evert van Haute Verónica Kovacec Horacio Lopardo Laura Bonofiglio Marta Mollerach ##submission.copyrightStatement## 2019-01-31 2019-01-31 13 01 77 82 10.3855/jidc.10503 Influenza A (H1N1)-associated severe complications; hemolytic uremic syndrome, myocarditis, acute necrotizing encephalopathy <p>Influenza is a generally self-limited infection agent that only rarely causes severe complications. To increase awareness about its serious complications, we report three cases of influenza A (H1N1) infection complicated with hemolytic uremic syndrome, myocarditis and acute necrotizing encephalopathy. In all three cases, nasopharyngeal samples confirmed influenza A (H1N1) infection by antigen test and multiplex PCR detection. The first case, a 3-year-old girl, had respiratory distress, anemia, thrombocytopenia and renal failure at admission, and was diagnosed with hemolytic uremic syndrome. Supportive treatment and oseltamivir did not prevent the development of chronic renal failure. The second case, a 5-year-old girl admitted with lethargia and flu-like symtoms and was diagnosed with myocarditis and cardiogenic shock. Oseltamivir and supportive treatment including extra-corporeal membrane oxygenation (ECMO) failed. She died on the 3rd day of admission. The third case, a 21-month-old boy, presented with decreased level of consciousness and was diagnosed with acute necrotizing encephalopathy with the aid of cranial magnetic resonance imagining (MRI). He was discharged without any neurological sequelae three weeks after admission. It should be kept in mind that influenza virus does not always cause a self-limited flu. Multidisciplinary management, early diagnosis and antiviral treatment are critical for the disease and to prevent its life-threatening complications.</p> Sevliya Öcal Demir Serkan Atıcı Eda Kepenekli Kadayifci Gülşen Akkoç Nurhayat Yakut Feyza İnceköy Girgin Nilüfer Yalındağ Öztürk Ahmet Soysal ##submission.copyrightStatement## 2019-01-31 2019-01-31 13 01 83 86 10.3855/jidc.10049 Long-lasting undetected neurocysticercosis <p>Neurocysticercosis is the most common parasitic disease of the nervous system, nevertheless, it can remain undetected for a long period of time, especially if it occurs in non endemic areas and regions with low-endemicity. Inadequate diagnostic procedures and lack of clinician’s dedication towards this health issue can lead to a missed diagnose.</p> <p>Herein, we present a case of a 51-year-old male, with a missed diagnosis of neurocysticercosis for more than two decades. A history of epilepsy had started twenty-one years earlier and was of unclear etiology. Recently, after neurological worsening and headaches, brain computed tomography and magnet resonance imaging was performed as well as Western blot immunoassay of serum and cerebrospinal fluid, surgery, and pathohistological examination of the extracted cysts. Neurocysticercosis was confirmed. Combined therapy that consisted of albendazole and prednisolone was administered for a period of four weeks. Also, antiepileptic therapy was continued. Both clinical status and brain imaging showed the apparent improvement in the patient’s condition.</p> <p>Review of the literature was implemented in the discussion that deals with proper and adequate therapy option and outcome factors in neurocysticercosis patients. Over a long period of time, the majority of patients develop seizures as the most common symptom, which requires the administration of medications. Proper diagnostic procedures and adequate combination of surgery and conservative treatment areessential.</p> Aleksandar Kostić Nataša Vidović Nataša Miladinović-Tasić Jovana Kostić Vesna Nikolov Nebojša Stojanović Miljana Pavlović ##submission.copyrightStatement## 2019-01-31 2019-01-31 13 01 87 92 10.3855/jidc.10176