Occurrence of Autochthonous Neurocysticercosis in Germany: A Case Report

Occurrence of Autochthonous Neurocysticercosis in Germany: A Case Report | Research Square window.SnipcartSettings = { analytics: { enabled: false } }; (function() { var accessVector = localStorage.getItem('access_vector') || ''; window.dataLayer = window.dataLayer || []; if (accessVector) { window.dataLayer.push({ user: { profile: { profileInfo: { snid: accessVector } } } }); } })(); (function(w,d,s,l,i){w[l]=w[l]||[];w[l].push({'gtm.start':new Date().getTime(),event:'gtm.js'});var f=d.getElementsByTagName(s)[0],j=d.createElement(s),dl=l!='dataLayer'?'&l='+l:'';j.async=true;j.src='https://www.googletagmanager.com/gtm.js?id='+i+dl;f.parentNode.insertBefore(j,f);})(window,document,'script','dataLayer','GTM-K279D39R'); Browse Preprints In Review Journals COVID-19 Preprints AJE Video Bytes Research Tools Research Promotion AJE Professional Editing AJE Rubriq About Preprint Platform In Review Editorial Policies Our Team Advisory Board Help Center Sign In Submit a Preprint Cite Share Download PDF Case Report Occurrence of Autochthonous Neurocysticercosis in Germany: A Case Report Franziska Lordick, Henning Trawinski, Christoph Lübbert This is a preprint; it has not been peer reviewed by a journal. https://doi.org/ 10.21203/rs.3.rs-8220198/v1 This work is licensed under a CC BY 4.0 License Status: Published Journal Publication published 11 Feb, 2026 Read the published version in BMC Infectious Diseases → Version 1 posted 20 You are reading this latest preprint version Abstract Background Neurocysticercosis [NCC] represents a severe manifestation of parasitic infection of the central nervous system [CNS] by larvae of Taenia (T.) solium , the pork tapeworm. Although it is one of the main causes of acquired epilepsy worldwide, endemic transmission in Europe has been largely eliminated, with only isolated autochthonous cases occurring. Case presentation A 43-year-old woman from a rural region in Saxony-Anhalt, Eastern Germany, with no history of travel abroad or contact with livestock or known tapeworm carriers presented with a first-time generalized epileptic seizure. Cranial magnetic resonance imaging [cMRI] showed multiple small, partially hemorrhagic lesions with surrounding edema. Histopathological examination of a brain biopsy revealed granulomatous inflammation with eosinophilic infiltrates and giant cells. Molecular analysis using real-time polymerase chain reaction [RT-PCR] detected T. solium DNA by confirming the diagnosis of NCC. Serological test and stool microscopy for T. solium eggs were negative in both, the patient and her immediate family members. Antiparasitic treatment with albendazole and praziquantel in combination with corticosteroids was initiated and anticonvulsive therapy was continued. The patient remained seizure-free during follow-up and cMRI follow-up examinations showed significant regression of the lesions. Conclusions This case demonstrates a rare case of autochthonous NCC in Western Europe and highlights the diagnostic challenges in non-endemic regions, as well as the importance of considering NCC in the differential diagnosis of patients presenting with typical symptoms such as seizures and NCC-compatible findings in neuroimaging, even if the medical history does not suggest transmission of T. solium . Strengthening awareness among physicians and improving diagnostic tools for direct pathogen detection are crucial to enable timely diagnosis even in cases of negative serology. neurocysticercosis Taenia solium pork tapeworm autochthonous local transmission Europe case report Figures Figure 1 Figure 2 Figure 3 Background The zoonotic cestode parasite Taenia (T). solium has a life cycle between pigs, humans and the environment, which can cause both intestinal taeniasis and cysticercosis in humans. The latter refers to a systemic infection with various possible organ manifestations, including involvement of the central nervous system [CNS], known as neurocysticercosis [NCC] [ 1 ]. Taeniasis is acquired through the consumption of undercooked pork meat containing larval cysts (cysticerci), leading to intestinal infestation by the adult T. solium tapeworm. This condition is usually asymptomatic or causes only mild gastrointestinal symptoms [ 2 ]. The ingestion of embryonated eggs of T. solium , which are excreted by a tapeworm carrier, can lead to cysticercosis in humans through fecal-oral transmission; autoinfection may also be relevant [ 1 ]. After ingestion, the larvae (oncospheres) can settle in the brain (parenchyma, subarachnoid space, or ventricles) and other tissues such as the eyes, striated muscles, or heart (Fig. 1 ). Clinical manifestations of NCC vary greatly depending on location, size, and stage of the cysts. Most commonly, patients present with epileptic seizures, headaches, focal neurological deficits, or hydrocephalus. However, there usually is a long latency period of months to decades between infection and the onset of symptoms, and some individuals may remain asymptomatic [ 1 ]. The geographical distribution of NCC is concentrated in areas with poor hygiene, inadequate sanitation, and pig husbandry practices. NCC accounts for nearly one-third of epilepsy cases in highly endemic tropical and subtropical areas, particularly in Latin America and sub-Saharan Africa [ 3 , 4 ]. Before the introduction of effective prevention and control measures in the 1990s, endemic transmission also occurred in Southern and Eastern Europe, with Portugal and Spain reporting most autochthonous cases [ 5 ]. Due to the lack of specific surveillance systems, the current extent of NCC occurrence in Europe is not easily assessable. Most current cases are related to travel and migration, but sporadic autochthonous transmission still occurs. Medical literature indicates that between 2000 and 2019, fewer than 30 autochthonous cases of NCC were reported in European Union (EU) member states and associated countries, with more than half of these cases originating in Eastern European countries such as Romania and Serbia [ 6 , 7 ]. The diagnosis of NCC is based on typical clinical presentation, epidemiological context, characteristic neuroimaging findings and supportive serology (immunoblot, enzyme-linked immunoassay [ELISA]). However, serology may yield false-negative results, for instance in cases of solitary or calcified brain lesions [ 1 ]. It is essential to rule out other causes of cystic lesions (e. g. neoplasm, tuberculoma), so histopathological examination of biopsy samples may be imperative [ 8 ]. Antiparasitic treatment options include a two-week course of albendazole and/or praziquantel, administered in combination with corticosteroids to prevent worsening of the inflammation. For seizure control, antiepileptic drugs should be complemented [ 8 ]. Case presentation In July 2024, a 43-year-old female patient from a rural area in Saxony-Anhalt, Eastern Germany, presented to a regional hospital after suffering a first-time unprovoked generalized epileptic seizure with loss of consciousness. She reported no previous focal neurological deficits or headaches. The family members who shared the same household were asymptomatic. As a saleswoman at a highway service station, she had frequent contact with other people on a daily basis. No stays outside of Germany were reported in the past. Contact or close coexistence with farm animals was denied. Laboratory findings in blood and cerebrospinal fluid were unremarkable except for slightly elevated C-reactive protein [CRP] serum levels (21.3 mg/L). In particular, no abnormalities were found in the differential blood count, including normal eosinophil levels (0.3/nL). Cranial MRI [cMRI] was initially misinterpreted as cerebral metastases, showing a bihemispheric pattern of eight small, partially hemorrhagic lesions with surrounding white matter edema without mass effect (Fig. 2 A and B ). Histopathological examination of a brain biopsy taken from the left frontal region revealed no evidence of malignancy, but showed a granulomatous, eosinophilic inflammatory reaction with foreign-body giant cells (Fig. 3 ). Due to the suspicion of a parasitic infection and the presence of a necrotic parasitic granuloma, further molecular tests were requested from the German National Reference Center for Tropical Pathogens (Bernhard Nocht Institute, Hamburg, Germany). Although no intact parasitic structures were identified, T. solium DNA (C t value 39.03) was confirmed in formalin-fixed tissue sections using pTsol9-specific real-time PCR. Echinococcus and nematode DNA could not be detected. Simultaneously performed T. solium serology and subsequent serological follow-up tests remained negative. Microscopic examination of the patient’s stool revealed no evidence of helminth eggs. The diagnosis of NCC was made based on the clinical presentation, neuroimaging showing multiple cerebral lesions and confirmatory histological and molecular pathological findings. Further diagnostic evaluation ruled out eye involvement by means of fundoscopy. Examination of family members for tapeworm carriage, including microscopic stool examinations and T. solium serology, was unremarkable. In accordance with current guidelines, weight-adjusted anthelminthic treatment with albendazole and praziquantel as well as concomitant corticosteroid therapy was initiated on an inpatient basis and continued for a total of 14 days [ 8 ]. The already established anticonvulsive therapy with levetiracetam was maintained. During regular clinical follow-up examinations, the patient remained asymptomatic and had no further epileptic seizures. An initially abnormal EEG which indicated regional cerebral dysfunction in the right parietal area normalized over time. Follow-up cMRI showed a general reduction in cerebral lesions (Fig. 2 B to E ), with complete regression observed in only one lesion located in the left frontal gyrus. Depending on the radiological findings at the scheduled six-monthly cMRI follow-ups, antiparasitic retreatment will be reevaluated [ 8 ]. Discussion and conclusion We presented one of the very rare autochthonous NCC cases in Europe, involving a woman from a rural area in Eastern Germany who presented with a typical clinical picture and had not traveled to endemic areas. To the best of our knowledge, only three cases of T. solium NCC have been published in Germany since 2000. These include a 69-year-old male who suffered his first epileptic seizure in 2009 [ 9 ], and five years later, a 75-year-old female patient with stroke-like symptoms [ 10 ]. Neither of them had a history of traveling abroad, the former had spent his childhood on a pig farm. Although autochthonous transmission is conceivable, both individuals were significantly older than our patient, so infection with a long latency period acquired at a time, when T. solium was still largely endemic in Europe, cannot be ruled out. The third reported case involved an asymptomatic patient with a history of cured breast cancer and several trips to India, who presented with a single brain lesion and a subcutaneous nodule initially suspected to be metastases [ 11 ]. Taken together, these reports underscore the clinical heterogeneity of NCC and emphasize the importance of considering parasitic infections in the differential diagnosis of intracranial lesions, even in regions where NCC is rare. It should also be noted that cases of NCC due to other Taenia species, which are endemic in temperate regions, have rarely been reported in Europe. For instance, infection by the canid tapeworm T. crassiceps in two patients from Southern Germany showed cerebral involvement that was clinically and radiologically indistinguishable from NCC caused by T. solium [ 12 , 13 ]. This highlights the importance of molecular pathogen identification, particularly with regard to epidemiological context [ 14 ]. Our case emphasizes the diagnostic challenges of NCC in non-endemic regions. Transmission by often asymptomatic carriers of T. solium tapeworms, the frequent delay of years in the onset of symptoms, and the absence of pathognomonic clinical features increase the risk of diagnostic delay, misdiagnosis, and mistreatment. Furthermore, diagnosis of NCC can be challenging due to often missing or atypical laboratory and neuroimaging findings, as well as possible seronegativity and limited sensitivity of serological tests [ 1 , 8 ]. As shown in our case, eosinophil counts are not a reliable indicator of NCC. Since solitary cysts may not elicit an immune response and eosinophilia is frequently absent in chronic larval cestode infection, the diagnosis of invasive tapeworm infection may be overlooked [ 15 ]. Neuroimaging findings in non-endemic regions often raise suspicion of malignancy, given its much higher prevalence compared to parasitic infections [ 1 , 11 ]. In addition, serological tests for larval tapeworm infection are of limited value, as antibody production may not be detectable due to a low number of cysts, encapsulation by the host tissue or intraparenchymal location [ 13 , 16 ]. Approximately 30% to 50% of NCC cases remain seronegative [ 1 , 8 ]. Western blot–based methods have demonstrated the best balance between specificity and sensitivity. However, interlaboratory studies show that antigen detection methods continue to be used in Europe, even though they are less sensitive than antibody-based tests, suggesting a lack of standardization of molecular tests [ 16 ]. Insufficient awareness among physicians in non-endemic countries contributes to underdiagnosis of NCC, particularly in cases of autochthonous transmission in individuals without history of travel or previous residence in endemic areas [ 1 ]. Nevertheless, suspicious lesions detected by neuroimaging in combination with neurological symptoms (especially seizures and increased intracranial pressure) should prompt consideration of NCC in the differential diagnosis. Before invasive diagnostic procedures such as surgical biopsy are performed, a thorough medical history with particular attention to possible exposure to risk factors for transmission, serological tests, and examination of close contacts for tapeworm carriage are strongly recommended [ 8 ]. Targeted education and training programs on T. solium infection should be implemented for healthcare professionals in non-endemic regions. This includes the development of clear protocols for the clinical identification and subsequent treatment of NCC cases [ 6 ]. The complexity of managing cysticercosis should be emphasized in medical education to promote appropriate referrals and expert supervision. The involvement of various specialties, including infectious diseases, radiology, and neurology, underscores the need for diverse expertise in managing NCC across different settings [ 5 ]. Several reviews have highlighted the challenges of reliable epidemiological data collection in Europe on T. solium infections in both human and animal hosts. This challenge is primarily attributable to the fact that neither taeniasis nor human cysticercosis are routinely notifiable in most countries. As a result, surveillance is inconsistent, and current data likely underestimate the prevalence of infection. The implementation of a standardized European surveillance system could enable systematic case detection and facilitate efficient contact tracing [ 6 , 7 , 14 ]. The occurrence of autochthonous NCC infection in industrialized countries raises questions about potential routes of transmission. One explanation is fecal-oral transmission by asymptomatic tapeworm carriers who became infected in endemic regions and subsequently introduced the infection into non-endemic countries [ 15 ]. This is highlighted by outbreaks of NCC in non-endemic communities, such as the spread among orthodox Jews in New York City or, more recently, among schoolchildren in Belgium [ 17 , 18 ]. Epidemiological studies also show a significant discrepancy in the proportion of autochthonous infections, with 5% reported in Western Europe [ 14 ] compared to 17% in Eastern Europe [ 19 ]. Since surveillance systems in Eastern Europe are less well established and reports are often sporadic, local transmission may be more common than currently assumed [ 6 , 19 ]. Therefore, originating from or traveling to this region could represent an additional risk factor for infection with T. solium . Poor hygiene conditions, such as inadequate sanitation and handwashing practices, promote fecal-oral transmission in humans, either directly or via contaminated food and water [ 20 ]. In our case, transmission could have occurred through direct hand contact or indirect fecal-oral transmission during occupational activities at the highway service station, which explains why close contacts of the patient showed no abnormalities in T. solium screening. Furthermore, medical literature indicates that living in rural areas is associated with an increased risk of environmental contamination with T. solium eggs, as traditional pig-rearing practices, free-range farming, and limited access to sanitation facilities prevail there [ 20 ]. GPS tracking studies confirm that pigs spend most of their time within 100 meters of their barn, where contact with human feces is highest, especially in communities where open defecation is practiced [ 21 ]. In addition, the growing trend toward organic pork production in Europe through free-range pig farming and home slaughtering without adequate veterinary supervision, promotes the spread of infected pork, which increases the risk of transmission and poses a potential challenge to the control of cysticercosis [ 5 ]. These factors show that local transmission in non-endemic countries is still possible, especially when veterinary controls, hygienic standards and clinical awareness are insufficient. Prevention strategies for possible local transmission include strengthening hygiene monitoring, veterinary controls and targeted public health education. Moreover, targeted screening of risk groups could help identify undiagnosed tapeworm carriers [ 22 ]. Migrants frequently face barriers to accessing healthcare, which can delay the diagnosis of infectious diseases. Therefore, greater attention should be paid to improving the health of migrants and raising awareness of diseases that disproportionately affect migrant populations [ 6 ]. It is important that these considerations do not lead to the stigmatization of migrants. In the long term, such measures could not only promote earlier diagnosis and appropriate treatment, but also help to interrupt potential local transmission cycles. Possible perspectives include the development of mathematical models for the transmission of T. solium , which can help predict the effects of various control strategies and optimize the planning of intervention measures [ 23 ]. In conclusion, this case underscores the importance of recognizing NCC as a possible diagnosis in non-endemic regions, particularly when neurological symptoms and suggestive imaging findings are present. Strengthening clinical awareness, improving surveillance and addressing structural barriers in health care access are essential steps toward timely diagnosis, effective treatment and prevention of local transmission. Abbreviations cMRI Cranial magnetic resonance imaging CNS Central nervous system CRP C-reactive protein C t Threshold cycle DNA Deoxyribonucleic acid EU European Union EEG Electroencephalography ELISA Enzyme-linked immunoassay FLAIR Fluid attenuated inversion recovery NCC Neurocysticercosis RT-PCR Real-time polymerase chain reaction Declarations Acknowledgements The authors acknowledge support from the German Research Foundation (DFG) and the Leipzig University within the program of Open Access Publishing. The funders had no role in study design, data collection and analysis, decision to publish, or preparation of the manuscript. We also acknowledge Dr. Maria Lehning (Department of Neuropathology, Leipzig University Medical Center, Germany) and Dr. Cordula Scherlach (Department of Neuroradiology, Leipzig University Medical Center, Germany) for providing the diagnostic images. Authors’ contributions FL suggested this clinical case. She was involved in the bibliographic research, the drafting, proofreading and submission of the article. HT was involved in the drafting, proofreading and correction of the article. CL was involved in the bibliographic research, proofreading and correction of this article. All authors read and approved the final manuscript. Funding This research received no external funding. Data Availability The datasets generated and analyzed during the current study are not publicly available as they contain sensitive personal data, but are available from the corresponding author on reasonable request. Ethics approval and consent to participate Not applicable. Consent for publication Written informed consent was obtained from the patient for publication of this case report and accompanying images. A copy of the written consent is available for review by the Editor-in-Chief of this journal on request. Competing interests The authors declare that they have no competing interests. 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17:03:11","extension":"xml","order_by":18,"title":"","display":"","copyAsset":false,"role":"acdc-reference","size":69425,"visible":true,"origin":"","legend":"","description":"","filename":"543ffc1a994542209c9909088111376e1structuring.xml","url":"https://assets-eu.researchsquare.com/files/rs-8220198/v1/0315f904d1e2091815de47f8.xml"},{"id":98439379,"identity":"b10345e7-9eb0-4e00-8a81-3ebb02a4ad60","added_by":"auto","created_at":"2025-12-17 17:01:45","extension":"html","order_by":19,"title":"","display":"","copyAsset":false,"role":"acdc-reference","size":78583,"visible":true,"origin":"","legend":"","description":"","filename":"earlyproof.html","url":"https://assets-eu.researchsquare.com/files/rs-8220198/v1/23e856ee9d9082707e56dd30.html"},{"id":98350188,"identity":"58298eb9-b7b4-405f-82c4-1a03343bd2a1","added_by":"auto","created_at":"2025-12-16 20:19:20","extension":"jpg","order_by":1,"title":"Figure 1","display":"","copyAsset":false,"role":"figure","size":405690,"visible":true,"origin":"","legend":"\u003cp\u003eIllustration depicting the life cycle of variuos species of parasitic tapeforms of the genus \u003cem\u003eTaenia\u003c/em\u003e, the causative agents of cysticercosis. CDC/ Alexander J. da Silva, PhD; Melanie Moser\u003c/p\u003e","description":"","filename":"Figure1.jpg","url":"https://assets-eu.researchsquare.com/files/rs-8220198/v1/2654762b41e5a390293d869b.jpg"},{"id":98437976,"identity":"85640c3c-b0c4-4c1c-ad43-abed2cf1df95","added_by":"auto","created_at":"2025-12-17 16:58:21","extension":"jpg","order_by":2,"title":"Figure 2","display":"","copyAsset":false,"role":"figure","size":2293188,"visible":true,"origin":"","legend":"\u003cp\u003eMRI scans showing a rim-like contrast-enhancing lesion (orange arrows) with surrounding edema in the left postcentral gyrus, decreasing in size from 8 mm to 4 mm within a 12-month time span. \u003cstrong\u003eA:\u003c/strong\u003e MRI scan, axial plane, flair. \u003cstrong\u003eB–E:\u003c/strong\u003eMRI scans, T1 weighted, axial plane, contrast enhanced.\u003c/p\u003e","description":"","filename":"Figure2.jpg","url":"https://assets-eu.researchsquare.com/files/rs-8220198/v1/0a631d518ea521e52f9401cf.jpg"},{"id":98439484,"identity":"0a6f8077-e7df-4afa-a6e1-454f419bb65f","added_by":"auto","created_at":"2025-12-17 17:01:58","extension":"jpg","order_by":3,"title":"Figure 3","display":"","copyAsset":false,"role":"figure","size":3500085,"visible":true,"origin":"","legend":"\u003cp\u003eRepresentative images of the brain lesion showing a granulomatous inflammatory reaction.\u003cstrong\u003e A:\u003c/strong\u003eHematoxylin and eosin staining reveals a granulomatous inflammatory reaction with presumed parasitic remnants in the center (star). \u003cstrong\u003eB:\u003c/strong\u003e Giemsa staining highlights the parasitic larvae (star) and the surrounding giant cell reaction (triangle). \u003cstrong\u003eC: I\u003c/strong\u003emmunohistochemical CD68 staining marks multinucleated giant cells (triangle) and the associated macrophages within the granuloma. Scale bar: 100 μm.\u003c/p\u003e","description":"","filename":"Figure3.jpg","url":"https://assets-eu.researchsquare.com/files/rs-8220198/v1/f91ed1aca720d4a644307bd1.jpg"},{"id":102785271,"identity":"8da44510-6d7c-4da8-8536-4694cace11ea","added_by":"auto","created_at":"2026-02-16 16:03:50","extension":"pdf","order_by":0,"title":"","display":"","copyAsset":false,"role":"manuscript-pdf","size":6639405,"visible":true,"origin":"","legend":"","description":"","filename":"manuscript.pdf","url":"https://assets-eu.researchsquare.com/files/rs-8220198/v1/12909e04-a188-40eb-b2c4-046c79a91b7b.pdf"}],"financialInterests":"No competing interests reported.","formattedTitle":"Occurrence of Autochthonous Neurocysticercosis in Germany: A Case Report","fulltext":[{"header":"Background","content":"\u003cp\u003eThe zoonotic cestode parasite \u003cem\u003eTaenia (T). solium\u003c/em\u003e has a life cycle between pigs, humans and the environment, which can cause both intestinal taeniasis and cysticercosis in humans. The latter refers to a systemic infection with various possible organ manifestations, including involvement of the central nervous system [CNS], known as neurocysticercosis [NCC] [\u003cspan citationid=\"CR1\" class=\"CitationRef\"\u003e1\u003c/span\u003e].\u003c/p\u003e \u003cp\u003eTaeniasis is acquired through the consumption of undercooked pork meat containing larval cysts (cysticerci), leading to intestinal infestation by the adult \u003cem\u003eT. solium\u003c/em\u003e tapeworm. This condition is usually asymptomatic or causes only mild gastrointestinal symptoms [\u003cspan citationid=\"CR2\" class=\"CitationRef\"\u003e2\u003c/span\u003e].\u003c/p\u003e \u003cp\u003eThe ingestion of embryonated eggs of \u003cem\u003eT. solium\u003c/em\u003e, which are excreted by a tapeworm carrier, can lead to cysticercosis in humans through fecal-oral transmission; autoinfection may also be relevant [\u003cspan citationid=\"CR1\" class=\"CitationRef\"\u003e1\u003c/span\u003e]. After ingestion, the larvae (oncospheres) can settle in the brain (parenchyma, subarachnoid space, or ventricles) and other tissues such as the eyes, striated muscles, or heart (Fig.\u0026nbsp;\u003cspan refid=\"Fig1\" class=\"InternalRef\"\u003e1\u003c/span\u003e). Clinical manifestations of NCC vary greatly depending on location, size, and stage of the cysts. Most commonly, patients present with epileptic seizures, headaches, focal neurological deficits, or hydrocephalus. However, there usually is a long latency period of months to decades between infection and the onset of symptoms, and some individuals may remain asymptomatic [\u003cspan citationid=\"CR1\" class=\"CitationRef\"\u003e1\u003c/span\u003e].\u003c/p\u003e \u003cp\u003eThe geographical distribution of NCC is concentrated in areas with poor hygiene, inadequate sanitation, and pig husbandry practices. NCC accounts for nearly one-third of epilepsy cases in highly endemic tropical and subtropical areas, particularly in Latin America and sub-Saharan Africa [\u003cspan citationid=\"CR3\" class=\"CitationRef\"\u003e3\u003c/span\u003e, \u003cspan citationid=\"CR4\" class=\"CitationRef\"\u003e4\u003c/span\u003e]. Before the introduction of effective prevention and control measures in the 1990s, endemic transmission also occurred in Southern and Eastern Europe, with Portugal and Spain reporting most autochthonous cases [\u003cspan citationid=\"CR5\" class=\"CitationRef\"\u003e5\u003c/span\u003e]. Due to the lack of specific surveillance systems, the current extent of NCC occurrence in Europe is not easily assessable. Most current cases are related to travel and migration, but sporadic autochthonous transmission still occurs. Medical literature indicates that between 2000 and 2019, fewer than 30 autochthonous cases of NCC were reported in European Union (EU) member states and associated countries, with more than half of these cases originating in Eastern European countries such as Romania and Serbia [\u003cspan citationid=\"CR6\" class=\"CitationRef\"\u003e6\u003c/span\u003e, \u003cspan citationid=\"CR7\" class=\"CitationRef\"\u003e7\u003c/span\u003e].\u003c/p\u003e \u003cp\u003eThe diagnosis of NCC is based on typical clinical presentation, epidemiological context, characteristic neuroimaging findings and supportive serology (immunoblot, enzyme-linked immunoassay [ELISA]). However, serology may yield false-negative results, for instance in cases of solitary or calcified brain lesions [\u003cspan citationid=\"CR1\" class=\"CitationRef\"\u003e1\u003c/span\u003e]. It is essential to rule out other causes of cystic lesions (e. g. neoplasm, tuberculoma), so histopathological examination of biopsy samples may be imperative [\u003cspan citationid=\"CR8\" class=\"CitationRef\"\u003e8\u003c/span\u003e].\u003c/p\u003e \u003cp\u003eAntiparasitic treatment options include a two-week course of albendazole and/or praziquantel, administered in combination with corticosteroids to prevent worsening of the inflammation. For seizure control, antiepileptic drugs should be complemented [\u003cspan citationid=\"CR8\" class=\"CitationRef\"\u003e8\u003c/span\u003e].\u003c/p\u003e"},{"header":"Case presentation","content":"\u003cp\u003eIn July 2024, a 43-year-old female patient from a rural area in Saxony-Anhalt, Eastern Germany, presented to a regional hospital after suffering a first-time unprovoked generalized epileptic seizure with loss of consciousness. She reported no previous focal neurological deficits or headaches. The family members who shared the same household were asymptomatic. As a saleswoman at a highway service station, she had frequent contact with other people on a daily basis. No stays outside of Germany were reported in the past. Contact or close coexistence with farm animals was denied.\u003c/p\u003e \u003cp\u003eLaboratory findings in blood and cerebrospinal fluid were unremarkable except for slightly elevated C-reactive protein [CRP] serum levels (21.3 mg/L). In particular, no abnormalities were found in the differential blood count, including normal eosinophil levels (0.3/nL). Cranial MRI [cMRI] was initially misinterpreted as cerebral metastases, showing a bihemispheric pattern of eight small, partially hemorrhagic lesions with surrounding white matter edema without mass effect (Fig.\u0026nbsp;\u003cspan refid=\"Fig2\" class=\"InternalRef\"\u003e2\u003c/span\u003eA \u003cb\u003eand B\u003c/b\u003e). Histopathological examination of a brain biopsy taken from the left frontal region revealed no evidence of malignancy, but showed a granulomatous, eosinophilic inflammatory reaction with foreign-body giant cells (Fig.\u0026nbsp;\u003cspan refid=\"Fig3\" class=\"InternalRef\"\u003e3\u003c/span\u003e). Due to the suspicion of a parasitic infection and the presence of a necrotic parasitic granuloma, further molecular tests were requested from the German National Reference Center for Tropical Pathogens (Bernhard Nocht Institute, Hamburg, Germany). Although no intact parasitic structures were identified, \u003cem\u003eT. solium\u003c/em\u003e DNA (C\u003csub\u003et\u003c/sub\u003e value 39.03) was confirmed in formalin-fixed tissue sections using pTsol9-specific real-time PCR. \u003cem\u003eEchinococcus\u003c/em\u003e and nematode DNA could not be detected. Simultaneously performed \u003cem\u003eT. solium\u003c/em\u003e serology and subsequent serological follow-up tests remained negative. Microscopic examination of the patient’s stool revealed no evidence of helminth eggs.\u003c/p\u003e \u003cp\u003eThe diagnosis of NCC was made based on the clinical presentation, neuroimaging showing multiple cerebral lesions and confirmatory histological and molecular pathological findings. Further diagnostic evaluation ruled out eye involvement by means of fundoscopy. Examination of family members for tapeworm carriage, including microscopic stool examinations and \u003cem\u003eT. solium\u003c/em\u003e serology, was unremarkable.\u003c/p\u003e \u003cp\u003eIn accordance with current guidelines, weight-adjusted anthelminthic treatment with albendazole and praziquantel as well as concomitant corticosteroid therapy was initiated on an inpatient basis and continued for a total of 14 days [\u003cspan citationid=\"CR8\" class=\"CitationRef\"\u003e8\u003c/span\u003e]. The already established anticonvulsive therapy with levetiracetam was maintained.\u003c/p\u003e \u003cp\u003eDuring regular clinical follow-up examinations, the patient remained asymptomatic and had no further epileptic seizures. An initially abnormal EEG which indicated regional cerebral dysfunction in the right parietal area normalized over time. Follow-up cMRI showed a general reduction in cerebral lesions (Fig.\u0026nbsp;\u003cspan refid=\"Fig2\" class=\"InternalRef\"\u003e2\u003c/span\u003eB \u003cb\u003eto E\u003c/b\u003e), with complete regression observed in only one lesion located in the left frontal gyrus. Depending on the radiological findings at the scheduled six-monthly cMRI follow-ups, antiparasitic retreatment will be reevaluated [\u003cspan citationid=\"CR8\" class=\"CitationRef\"\u003e8\u003c/span\u003e].\u003c/p\u003e "},{"header":"Discussion and conclusion","content":"\u003cp\u003eWe presented one of the very rare autochthonous NCC cases in Europe, involving a woman from a rural area in Eastern Germany who presented with a typical clinical picture and had not traveled to endemic areas.\u003c/p\u003e\u003cp\u003eTo the best of our knowledge, only three cases of \u003cem\u003eT. solium\u003c/em\u003e NCC have been published in Germany since 2000. These include a 69-year-old male who suffered his first epileptic seizure in 2009 [\u003cspan citationid=\"CR9\" class=\"CitationRef\"\u003e9\u003c/span\u003e], and five years later, a 75-year-old female patient with stroke-like symptoms [\u003cspan citationid=\"CR10\" class=\"CitationRef\"\u003e10\u003c/span\u003e]. Neither of them had a history of traveling abroad, the former had spent his childhood on a pig farm. Although autochthonous transmission is conceivable, both individuals were significantly older than our patient, so infection with a long latency period acquired at a time, when \u003cem\u003eT. solium\u003c/em\u003e was still largely endemic in Europe, cannot be ruled out. The third reported case involved an asymptomatic patient with a history of cured breast cancer and several trips to India, who presented with a single brain lesion and a subcutaneous nodule initially suspected to be metastases [\u003cspan citationid=\"CR11\" class=\"CitationRef\"\u003e11\u003c/span\u003e]. Taken together, these reports underscore the clinical heterogeneity of NCC and emphasize the importance of considering parasitic infections in the differential diagnosis of intracranial lesions, even in regions where NCC is rare.\u003c/p\u003e\u003cp\u003eIt should also be noted that cases of NCC due to other \u003cem\u003eTaenia\u003c/em\u003e species, which are endemic in temperate regions, have rarely been reported in Europe. For instance, infection by the canid tapeworm \u003cem\u003eT. crassiceps\u003c/em\u003e in two patients from Southern Germany showed cerebral involvement that was clinically and radiologically indistinguishable from NCC caused by \u003cem\u003eT. solium\u003c/em\u003e [\u003cspan citationid=\"CR12\" class=\"CitationRef\"\u003e12\u003c/span\u003e, \u003cspan citationid=\"CR13\" class=\"CitationRef\"\u003e13\u003c/span\u003e]. This highlights the importance of molecular pathogen identification, particularly with regard to epidemiological context [\u003cspan citationid=\"CR14\" class=\"CitationRef\"\u003e14\u003c/span\u003e].\u003c/p\u003e\u003cp\u003eOur case emphasizes the diagnostic challenges of NCC in non-endemic regions. Transmission by often asymptomatic carriers of \u003cem\u003eT. solium\u003c/em\u003e tapeworms, the frequent delay of years in the onset of symptoms, and the absence of pathognomonic clinical features increase the risk of diagnostic delay, misdiagnosis, and mistreatment. Furthermore, diagnosis of NCC can be challenging due to often missing or atypical laboratory and neuroimaging findings, as well as possible seronegativity and limited sensitivity of serological tests [\u003cspan citationid=\"CR1\" class=\"CitationRef\"\u003e1\u003c/span\u003e, \u003cspan citationid=\"CR8\" class=\"CitationRef\"\u003e8\u003c/span\u003e]. As shown in our case, eosinophil counts are not a reliable indicator of NCC. Since solitary cysts may not elicit an immune response and eosinophilia is frequently absent in chronic larval cestode infection, the diagnosis of invasive tapeworm infection may be overlooked [\u003cspan citationid=\"CR15\" class=\"CitationRef\"\u003e15\u003c/span\u003e]. Neuroimaging findings in non-endemic regions often raise suspicion of malignancy, given its much higher prevalence compared to parasitic infections [\u003cspan citationid=\"CR1\" class=\"CitationRef\"\u003e1\u003c/span\u003e, \u003cspan citationid=\"CR11\" class=\"CitationRef\"\u003e11\u003c/span\u003e]. In addition, serological tests for larval tapeworm infection are of limited value, as antibody production may not be detectable due to a low number of cysts, encapsulation by the host tissue or intraparenchymal location [\u003cspan citationid=\"CR13\" class=\"CitationRef\"\u003e13\u003c/span\u003e, \u003cspan citationid=\"CR16\" class=\"CitationRef\"\u003e16\u003c/span\u003e]. Approximately 30% to 50% of NCC cases remain seronegative [\u003cspan citationid=\"CR1\" class=\"CitationRef\"\u003e1\u003c/span\u003e, \u003cspan citationid=\"CR8\" class=\"CitationRef\"\u003e8\u003c/span\u003e]. Western blot–based methods have demonstrated the best balance between specificity and sensitivity. However, interlaboratory studies show that antigen detection methods continue to be used in Europe, even though they are less sensitive than antibody-based tests, suggesting a lack of standardization of molecular tests [\u003cspan citationid=\"CR16\" class=\"CitationRef\"\u003e16\u003c/span\u003e].\u003c/p\u003e\u003cp\u003eInsufficient awareness among physicians in non-endemic countries contributes to underdiagnosis of NCC, particularly in cases of autochthonous transmission in individuals without history of travel or previous residence in endemic areas [\u003cspan citationid=\"CR1\" class=\"CitationRef\"\u003e1\u003c/span\u003e]. Nevertheless, suspicious lesions detected by neuroimaging in combination with neurological symptoms (especially seizures and increased intracranial pressure) should prompt consideration of NCC in the differential diagnosis. Before invasive diagnostic procedures such as surgical biopsy are performed, a thorough medical history with particular attention to possible exposure to risk factors for transmission, serological tests, and examination of close contacts for tapeworm carriage are strongly recommended [\u003cspan citationid=\"CR8\" class=\"CitationRef\"\u003e8\u003c/span\u003e]. Targeted education and training programs on \u003cem\u003eT. solium\u003c/em\u003e infection should be implemented for healthcare professionals in non-endemic regions. This includes the development of clear protocols for the clinical identification and subsequent treatment of NCC cases [\u003cspan citationid=\"CR6\" class=\"CitationRef\"\u003e6\u003c/span\u003e]. The complexity of managing cysticercosis should be emphasized in medical education to promote appropriate referrals and expert supervision. The involvement of various specialties, including infectious diseases, radiology, and neurology, underscores the need for diverse expertise in managing NCC across different settings [\u003cspan citationid=\"CR5\" class=\"CitationRef\"\u003e5\u003c/span\u003e].\u003c/p\u003e\u003cp\u003eSeveral reviews have highlighted the challenges of reliable epidemiological data collection in Europe on \u003cem\u003eT. solium\u003c/em\u003e infections in both human and animal hosts. This challenge is primarily attributable to the fact that neither taeniasis nor human cysticercosis are routinely notifiable in most countries. As a result, surveillance is inconsistent, and current data likely underestimate the prevalence of infection. The implementation of a standardized European surveillance system could enable systematic case detection and facilitate efficient contact tracing [\u003cspan citationid=\"CR6\" class=\"CitationRef\"\u003e6\u003c/span\u003e, \u003cspan citationid=\"CR7\" class=\"CitationRef\"\u003e7\u003c/span\u003e, \u003cspan citationid=\"CR14\" class=\"CitationRef\"\u003e14\u003c/span\u003e].\u003c/p\u003e\u003cp\u003eThe occurrence of autochthonous NCC infection in industrialized countries raises questions about potential routes of transmission. One explanation is fecal-oral transmission by asymptomatic tapeworm carriers who became infected in endemic regions and subsequently introduced the infection into non-endemic countries [\u003cspan citationid=\"CR15\" class=\"CitationRef\"\u003e15\u003c/span\u003e]. This is highlighted by outbreaks of NCC in non-endemic communities, such as the spread among orthodox Jews in New York City or, more recently, among schoolchildren in Belgium [\u003cspan citationid=\"CR17\" class=\"CitationRef\"\u003e17\u003c/span\u003e, \u003cspan citationid=\"CR18\" class=\"CitationRef\"\u003e18\u003c/span\u003e]. Epidemiological studies also show a significant discrepancy in the proportion of autochthonous infections, with 5% reported in Western Europe [\u003cspan citationid=\"CR14\" class=\"CitationRef\"\u003e14\u003c/span\u003e] compared to 17% in Eastern Europe [\u003cspan citationid=\"CR19\" class=\"CitationRef\"\u003e19\u003c/span\u003e]. Since surveillance systems in Eastern Europe are less well established and reports are often sporadic, local transmission may be more common than currently assumed [\u003cspan citationid=\"CR6\" class=\"CitationRef\"\u003e6\u003c/span\u003e, \u003cspan citationid=\"CR19\" class=\"CitationRef\"\u003e19\u003c/span\u003e]. Therefore, originating from or traveling to this region could represent an additional risk factor for infection with \u003cem\u003eT. solium\u003c/em\u003e.\u003c/p\u003e\u003cp\u003ePoor hygiene conditions, such as inadequate sanitation and handwashing practices, promote fecal-oral transmission in humans, either directly or via contaminated food and water [\u003cspan citationid=\"CR20\" class=\"CitationRef\"\u003e20\u003c/span\u003e]. In our case, transmission could have occurred through direct hand contact or indirect fecal-oral transmission during occupational activities at the highway service station, which explains why close contacts of the patient showed no abnormalities in \u003cem\u003eT. solium\u003c/em\u003e screening. Furthermore, medical literature indicates that living in rural areas is associated with an increased risk of environmental contamination with \u003cem\u003eT. solium\u003c/em\u003e eggs, as traditional pig-rearing practices, free-range farming, and limited access to sanitation facilities prevail there [\u003cspan citationid=\"CR20\" class=\"CitationRef\"\u003e20\u003c/span\u003e]. GPS tracking studies confirm that pigs spend most of their time within 100 meters of their barn, where contact with human feces is highest, especially in communities where open defecation is practiced [\u003cspan citationid=\"CR21\" class=\"CitationRef\"\u003e21\u003c/span\u003e]. In addition, the growing trend toward organic pork production in Europe through free-range pig farming and home slaughtering without adequate veterinary supervision, promotes the spread of infected pork, which increases the risk of transmission and poses a potential challenge to the control of cysticercosis [\u003cspan citationid=\"CR5\" class=\"CitationRef\"\u003e5\u003c/span\u003e]. These factors show that local transmission in non-endemic countries is still possible, especially when veterinary controls, hygienic standards and clinical awareness are insufficient.\u003c/p\u003e\u003cp\u003ePrevention strategies for possible local transmission include strengthening hygiene monitoring, veterinary controls and targeted public health education. Moreover, targeted screening of risk groups could help identify undiagnosed tapeworm carriers [\u003cspan citationid=\"CR22\" class=\"CitationRef\"\u003e22\u003c/span\u003e]. Migrants frequently face barriers to accessing healthcare, which can delay the diagnosis of infectious diseases. Therefore, greater attention should be paid to improving the health of migrants and raising awareness of diseases that disproportionately affect migrant populations [\u003cspan citationid=\"CR6\" class=\"CitationRef\"\u003e6\u003c/span\u003e]. It is important that these considerations do not lead to the stigmatization of migrants. In the long term, such measures could not only promote earlier diagnosis and appropriate treatment, but also help to interrupt potential local transmission cycles. Possible perspectives include the development of mathematical models for the transmission of \u003cem\u003eT. solium\u003c/em\u003e, which can help predict the effects of various control strategies and optimize the planning of intervention measures [\u003cspan citationid=\"CR23\" class=\"CitationRef\"\u003e23\u003c/span\u003e].\u003c/p\u003e\u003cp\u003eIn conclusion, this case underscores the importance of recognizing NCC as a possible diagnosis in non-endemic regions, particularly when neurological symptoms and suggestive imaging findings are present. Strengthening clinical awareness, improving surveillance and addressing structural barriers in health care access are essential steps toward timely diagnosis, effective treatment and prevention of local transmission.\u003c/p\u003e"},{"header":"Abbreviations","content":"\u003cp\u003ecMRI\u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp;Cranial magnetic resonance imaging\u003c/p\u003e\n\u003cp\u003eCNS\u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp;Central nervous system\u0026nbsp;\u003c/p\u003e\n\u003cp\u003eCRP\u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp;C-reactive protein\u003c/p\u003e\n\u003cp\u003eC\u003csub\u003et\u003c/sub\u003e\u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp;Threshold cycle\u0026nbsp;\u003c/p\u003e\n\u003cp\u003eDNA\u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp;\u0026nbsp;Deoxyribonucleic acid\u003c/p\u003e\n\u003cp\u003eEU\u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp;\u0026nbsp;European Union\u0026nbsp;\u003c/p\u003e\n\u003cp\u003eEEG\u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp;Electroencephalography\u003c/p\u003e\n\u003cp\u003eELISA\u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp;\u0026nbsp;Enzyme-linked immunoassay\u003c/p\u003e\n\u003cp\u003eFLAIR\u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp;Fluid attenuated inversion recovery\u003c/p\u003e\n\u003cp\u003eNCC\u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp;Neurocysticercosis\u003c/p\u003e\n\u003cp\u003eRT-PCR \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp;Real-time polymerase chain reaction\u003c/p\u003e"},{"header":"Declarations","content":"\u003cp\u003e\u003cstrong\u003eAcknowledgements\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThe authors acknowledge support from the German Research Foundation (DFG) and the Leipzig University within the program of Open Access Publishing. The funders had no role in study design, data collection and analysis, decision to publish, or preparation of the manuscript. We also acknowledge Dr. Maria Lehning (Department of Neuropathology, Leipzig University Medical Center, Germany) and Dr. Cordula Scherlach (Department of Neuroradiology, Leipzig University Medical Center, Germany) for providing the diagnostic images.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eAuthors’ contributions\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eFL suggested this clinical case. She was involved in the bibliographic research, the drafting, proofreading and submission of the article.\u003c/p\u003e\n\u003cp\u003eHT was involved in the drafting, proofreading and correction of the article.\u0026nbsp;\u003c/p\u003e\n\u003cp\u003eCL was involved in the bibliographic research, proofreading and correction of this article.\u003c/p\u003e\n\u003cp\u003eAll authors read and approved the final manuscript.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eFunding\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThis research received no external funding.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eData Availability\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThe datasets generated and analyzed during the current study are not publicly available as they contain sensitive personal data, but are available from the corresponding author on reasonable request.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eEthics approval and consent to participate\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eNot applicable.\u0026nbsp;\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eConsent for publication\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eWritten informed consent was obtained from the patient for publication of this case report and accompanying images. A copy of the written consent is available for review by the Editor-in-Chief of this journal on request.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eCompeting interests\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThe authors declare that they have no competing interests.\u0026nbsp;\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eClinical trial number\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eNot applicable.\u003c/p\u003e"},{"header":"References","content":"\u003col\u003e\u003cli\u003e\u003cspan\u003eGarcia HH, Nash TE, Del Brutto OH. Clinical symptoms, diagnosis, and treatment of neurocysticercosis. 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Bull World Health Organ. 2020;98:198\u0026ndash;205. \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003e10.2471/BLT.19.238485\u003c/span\u003e\u003cspan address=\"10.2471/BLT.19.238485\" targettype=\"DOI\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e.\u003c/span\u003e\u003c/li\u003e\u003c/ol\u003e"}],"fulltextSource":"","fullText":"","funders":[],"hasAdminPriorityOnWorkflow":false,"hasManuscriptDocX":true,"hasOptedInToPreprint":true,"hasPassedJournalQc":"","hasAnyPriority":false,"hideJournal":false,"highlight":"","institution":"","isAcceptedByJournal":true,"isAuthorSuppliedPdf":false,"isDeskRejected":"","isHiddenFromSearch":false,"isInQc":false,"isInWorkflow":false,"isPdf":false,"isPdfUpToDate":true,"isWithdrawnOrRetracted":false,"journal":{"display":true,"email":"[email protected]","identity":"bmc-infectious-diseases","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":false,"externalIdentity":"infd","sideBox":"Learn more about [BMC Infectious Diseases](http://bmcinfectdis.biomedcentral.com/)","snPcode":"","submissionUrl":"https://www.editorialmanager.com/infd","title":"BMC Infectious Diseases","twitterHandle":"#bmcinfectdis","acdcEnabled":true,"dfaEnabled":false,"editorialSystem":"em","reportingPortfolio":"BMC Series","inReviewEnabled":true,"inReviewRevisionsEnabled":true},"keywords":"neurocysticercosis, Taenia solium, pork tapeworm, autochthonous, local transmission, Europe, case report","lastPublishedDoi":"10.21203/rs.3.rs-8220198/v1","lastPublishedDoiUrl":"https://doi.org/10.21203/rs.3.rs-8220198/v1","license":{"name":"CC BY 4.0","url":"https://creativecommons.org/licenses/by/4.0/"},"manuscriptAbstract":"\u003ch2\u003eBackground\u003c/h2\u003e \u003cp\u003eNeurocysticercosis [NCC] represents a severe manifestation of parasitic infection of the central nervous system [CNS] by larvae of \u003cem\u003eTaenia (T.) solium\u003c/em\u003e, the pork tapeworm. Although it is one of the main causes of acquired epilepsy worldwide, endemic transmission in Europe has been largely eliminated, with only isolated autochthonous cases occurring.\u003c/p\u003e\u003ch2\u003eCase presentation\u003c/h2\u003e \u003cp\u003eA 43-year-old woman from a rural region in Saxony-Anhalt, Eastern Germany, with no history of travel abroad or contact with livestock or known tapeworm carriers presented with a first-time generalized epileptic seizure. Cranial magnetic resonance imaging [cMRI] showed multiple small, partially hemorrhagic lesions with surrounding edema. Histopathological examination of a brain biopsy revealed granulomatous inflammation with eosinophilic infiltrates and giant cells. Molecular analysis using real-time polymerase chain reaction [RT-PCR] detected \u003cem\u003eT. solium\u003c/em\u003e DNA by confirming the diagnosis of NCC. Serological test and stool microscopy for \u003cem\u003eT. solium\u003c/em\u003e eggs were negative in both, the patient and her immediate family members. Antiparasitic treatment with albendazole and praziquantel in combination with corticosteroids was initiated and anticonvulsive therapy was continued. The patient remained seizure-free during follow-up and cMRI follow-up examinations showed significant regression of the lesions.\u003c/p\u003e\u003ch2\u003eConclusions\u003c/h2\u003e \u003cp\u003eThis case demonstrates a rare case of autochthonous NCC in Western Europe and highlights the diagnostic challenges in non-endemic regions, as well as the importance of considering NCC in the differential diagnosis of patients presenting with typical symptoms such as seizures and NCC-compatible findings in neuroimaging, even if the medical history does not suggest transmission of \u003cem\u003eT. solium\u003c/em\u003e. Strengthening awareness among physicians and improving diagnostic tools for direct pathogen detection are crucial to enable timely diagnosis even in cases of negative serology.\u003c/p\u003e","manuscriptTitle":"Occurrence of Autochthonous Neurocysticercosis in Germany: A Case Report","msid":"","msnumber":"","nonDraftVersions":[{"code":1,"date":"2025-12-16 20:19:15","doi":"10.21203/rs.3.rs-8220198/v1","editorialEvents":[{"type":"communityComments","content":0},{"type":"decision","content":"Revision requested","date":"2026-01-05T06:47:44+00:00","index":"","fulltext":""},{"type":"editorInvitedReview","content":"","date":"2026-01-05T04:19:24+00:00","index":"hide","fulltext":""},{"type":"editorInvitedReview","content":"","date":"2026-01-01T16:42:32+00:00","index":"hide","fulltext":""},{"type":"reviewerAgreed","content":"24911770205638133074219394324101086102","date":"2026-01-01T14:31:57+00:00","index":"hide","fulltext":""},{"type":"editorInvitedReview","content":"","date":"2026-01-01T13:47:39+00:00","index":"hide","fulltext":""},{"type":"editorInvitedReview","content":"","date":"2025-12-29T05:15:27+00:00","index":"hide","fulltext":""},{"type":"editorInvitedReview","content":"","date":"2025-12-26T20:43:35+00:00","index":"hide","fulltext":""},{"type":"editorInvitedReview","content":"","date":"2025-12-26T06:54:32+00:00","index":"hide","fulltext":""},{"type":"reviewerAgreed","content":"225534156344251083505017128843956243292","date":"2025-12-18T08:11:50+00:00","index":"hide","fulltext":""},{"type":"reviewerAgreed","content":"66665680475125980250377152018722747804","date":"2025-12-16T20:07:58+00:00","index":"hide","fulltext":""},{"type":"reviewerAgreed","content":"118121162479392989769771580285703531210","date":"2025-12-16T11:26:41+00:00","index":"hide","fulltext":""},{"type":"reviewerAgreed","content":"84364086849625077559491885572191855827","date":"2025-12-15T10:43:06+00:00","index":"hide","fulltext":""},{"type":"reviewerAgreed","content":"265870598935154560341363553939820941841","date":"2025-12-15T07:04:52+00:00","index":"hide","fulltext":""},{"type":"reviewerAgreed","content":"271016533856916458725101723544475435915","date":"2025-12-15T07:02:54+00:00","index":"hide","fulltext":""},{"type":"reviewerAgreed","content":"329921839212723370143360212636762302822","date":"2025-12-13T14:21:00+00:00","index":"hide","fulltext":""},{"type":"reviewersInvited","content":"","date":"2025-12-11T02:20:39+00:00","index":"","fulltext":""},{"type":"editorInvited","content":"","date":"2025-12-01T08:26:15+00:00","index":"","fulltext":""},{"type":"editorAssigned","content":"","date":"2025-11-28T10:01:57+00:00","index":"","fulltext":""},{"type":"checksComplete","content":"","date":"2025-11-28T10:00:04+00:00","index":"","fulltext":""},{"type":"submitted","content":"BMC Infectious Diseases","date":"2025-11-27T08:59:06+00:00","index":"","fulltext":""}],"status":"published","journal":{"display":true,"email":"[email protected]","identity":"bmc-infectious-diseases","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":false,"externalIdentity":"infd","sideBox":"Learn more about [BMC Infectious Diseases](http://bmcinfectdis.biomedcentral.com/)","snPcode":"","submissionUrl":"https://www.editorialmanager.com/infd","title":"BMC Infectious Diseases","twitterHandle":"#bmcinfectdis","acdcEnabled":true,"dfaEnabled":false,"editorialSystem":"em","reportingPortfolio":"BMC Series","inReviewEnabled":true,"inReviewRevisionsEnabled":true}}],"origin":"","ownerIdentity":"cee70002-ebfd-4445-b6a6-0a2c5cf7f644","owner":[],"postedDate":"December 16th, 2025","published":true,"recentEditorialEvents":[],"rejectedJournal":[],"revision":"","amendment":"","status":"published-in-journal","subjectAreas":[],"tags":[],"updatedAt":"2026-02-16T16:01:09+00:00","versionOfRecord":{"articleIdentity":"rs-8220198","link":"https://doi.org/10.1186/s12879-026-12859-w","journal":{"identity":"bmc-infectious-diseases","isVorOnly":false,"title":"BMC Infectious Diseases"},"publishedOn":"2026-02-11 15:57:51","publishedOnDateReadable":"February 11th, 2026"},"versionCreatedAt":"2025-12-16 20:19:15","video":"","vorDoi":"10.1186/s12879-026-12859-w","vorDoiUrl":"https://doi.org/10.1186/s12879-026-12859-w","workflowStages":[]},"version":"v1","identity":"rs-8220198","journalConfig":"researchsquare"},"__N_SSP":true},"page":"/article/[identity]/[[...version]]","query":{"redirect":"/article/rs-8220198","identity":"rs-8220198","version":["v1"]},"buildId":"8U1c8b4HqxoKbykW_rLl7","isFallback":false,"isExperimentalCompile":false,"dynamicIds":[84888],"gssp":true,"scriptLoader":[]}