Parasitic brain infections

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Differential Diagnosis

Parasite Disease Lesion Clinical Clues
Protozoa
Balamuthia mandrillaris and Acanthamoeba species Granulomatous amoebic encephalitis single or multiple ring-enhancing lesions in the gray and white matter with surrounding edema and mass effect exposure to warm water
Leishmania species Leishmaniasis travel to endemic country
Microsporidia species Microsporidiasis
Naegleria fowleri Primary amebic meningoencephalitis global edema, stroke, and elevated intracranial pressure, most commonly in the base of the brain exposure to warm water, rapid progression
Plasmodium species Malaria
Toxoplasma gondii Toxoplasmosis
Trypanosoma brucei African trypanosomiasis diffuse hyperintensity on T1 usually involving bilateral basal ganglia
Trypanosoma cruzi Chagas disease contrast-enhancing hypointense T1 lesions involving only the parietal and frontal lobes, with edema on T2
Metazoa: Trematodes
Paragonimus species Paragonimiasis inflammatory changes surrounding clusters of contrast-enhancing lesions, most commonly in the frontal and temporal gray and white matter
Schistosoma species Schistosomiasis central linear enhancement, clustered with arborized appearance, and commonly involves spinal cord with Schistosoma haematobium
Metazoa: Cestodes
Echinococcus granulosus Intracranial hydatidosis multiple thin-walled, large, round cysts, or one large cyst with smaller surrounding cysts, most commonly in the parietal lobe
Echinococcus multilocularis Alveolar hydatid disease contrast-enhancing round, solid lesions with surrounding edema on T2
Taenia solium Neurocysticercosis single or multiple ring-enhancing lesions, with calcifications if older
Taenia species Coenurosis
Spirometra species Sparganosis T2 edema, sometimes with T1 mass or linear or curvilinear contrast-enhancing lesions, most commonly involving frontal and parietal lobes
Metazoa: Nematodes
Gnathostoma species Gnathostomiasis
Angiostrongylus cantonensis Angiostrongyliasis
Toxocara species Toxocariasis
Strongyloides stercoralis Strongyloidiasis
multiple Filariasis
Baylisascaris procyonis Baylisascariasis
Dracuncula medinensis Dracunculiasis
Dicrocoelium dendriticum Dicrocoeliasis
Lagochilascaris species Lagochilascariasis

Further Reading

  • Parasitic diseases of the central nervous system: lessons for clinicians and policy makers. Expert Rev Neurother. 2016;16(4): 401–414. doi: 10.1586/14737175.2016.1155454