712. Neurocysticercosis at a Large Academic Center in the USA

Abstract Background Neurocysticercosis (NCC) is a parasitic infection that results from the ingestion of eggs from the adult tapeworm Taenia solium that develops when cysticercoids migrate into the central nervous system. In addition, this infection has been found to affect over 50 million individuals worldwide. In the United States, NCC mainly affects immigrants from Latin America, where the disease is endemic with seroprevalence rates ranging from 5% to 11%. Most data regarding NCC in the United States comes from hospital reports from California and Texas. We are undertaking this study to determine the differences seen in a higher Latin American and Haitian population compared to a previously seen predominantly Mexican population. In this retrospective review, we characterized the population diagnosed with NCC at one large tertiary medical center in South Florida, University of Miami Hospital. Methods This retrospective chart review included adult patients from January 2009 to December 2019 with the admission or discharge diagnosis of neurocysticercosis (ICD 10 Code B 69.0 Neurocysticercosis and CPT code 86682 Cysticercosis). We extracted data on demographics, clinical symptoms, recurrence, treatment, resolution and follow up. Results Forty-seven patients were analyzed to completion. Most of the cases were seen in Hispanics 72.3 % and from Central America 40.4%. The most common symptom was headache 53.2% followed by seizures 42.6%. Normal physical exam was noted in 93.6% of the cases. Most of the cases have 1-10 lesions (98%), located in the brain parenchyma (75%). Serum serology, CSF antibody or stool studies were not obtained in around 90% of the cases. Treatment was indicated in 70.2% of cases and recurrence was low at 17.0%. Refer to Tables 1-5 for full results. Figure 1. Demographics and Clinical Symptoms Figure 2. History and Imaging Figure 3. Laboratory Evidence and Follow up Conclusion NCC is a neglected tropical disease which is preventable. Our study noted that the majority of the affected population were immigrants that had been in the US for more than 10 years and came from central America and the Caribbean. With appropriate treatment, most of the symptoms and CNS lesions resolved, with a low mortality. Public health efforts to identify and treat the tapeworm carrier could be improved to allow for public health follow-up of cases. Although not yet considered endemic in Florida, we hope to bring awareness in this state. Disclosures All Authors: No reported disclosures


Conclusion. Conclusion:
Patients with histoplasmosis have a unique secondary metabolite breath signature that can be used for the noninvasive diagnosis of pulmonary and disseminated histoplasmosis. Many patients in this cohort did not undergo urine antigen testing or other diagnostic workup for histoplasmosis, which may have affected our specificity estimates. Background. Neurocysticercosis (NCC) is a parasitic infection that results from the ingestion of eggs from the adult tapeworm Taenia solium that develops when cysticercoids migrate into the central nervous system. In addition, this infection has been found to affect over 50 million individuals worldwide. In the United States, NCC mainly affects immigrants from Latin America, where the disease is endemic with seroprevalence rates ranging from 5% to 11%. Most data regarding NCC in the United States comes from hospital reports from California and Texas. We are undertaking this study to determine the differences seen in a higher Latin American and Haitian population compared to a previously seen predominantly Mexican population. In this retrospective review, we characterized the population diagnosed with NCC at one large tertiary medical center in South Florida, University of Miami Hospital.
Methods. This retrospective chart review included adult patients from January 2009 to December 2019 with the admission or discharge diagnosis of neurocysticercosis (ICD 10 Code B 69.0 Neurocysticercosis and CPT code 86682 Cysticercosis). We extracted data on demographics, clinical symptoms, recurrence, treatment, resolution and follow up.
Results. Forty-seven patients were analyzed to completion. Most of the cases were seen in Hispanics 72.3 % and from Central America 40.4%. The most common symptom was headache 53.2% followed by seizures 42.6%. Normal physical exam was noted in 93.6% of the cases. Most of the cases have 1-10 lesions (98%), located in the brain parenchyma (75%). Serum serology, CSF antibody or stool studies were not obtained in around 90% of the cases. Treatment was indicated in 70.2% of cases and recurrence was low at 17.0%. Refer to Tables 1-5 for full results.  Conclusion. NCC is a neglected tropical disease which is preventable. Our study noted that the majority of the affected population were immigrants that had been in the US for more than 10 years and came from central America and the Caribbean. With appropriate treatment, most of the symptoms and CNS lesions resolved, with a low mortality. Public health efforts to identify and treat the tapeworm carrier could be improved to allow for public health follow-up of cases.
Although not yet considered endemic in Florida, we hope to bring awareness in this state.
Disclosures. Background. Coccidioidal meningitis is a severe form of coccidioidomycosis associated with significant morbidity and mortality. Published literature in the pediatric population is limited, particularly on coccidioidal meningitis. Here we describe a large case series of pediatric coccidioidal meningitis followed at a tertiary care center in an endemic region.
Methods. We performed a retrospective case review of patients ≤21 years old followed at our facility with a diagnosis of coccidioidal meningitis from January 1, 2000, to December 31, 2018.

Conclusion.
Pediatric coccidioidal meningitis is an uncommon and sometimes devastating complication of disseminated coccidioidomycosis. Many patients present with relatively low CF titers, and communicating hydrocephalus and long term neurologic complications are common. Fluconazole treatment failures are common, and management remains difficult despite recent advances in therapy. Most patients do well once the disease is stabilized and require lifelong therapy. Newer therapeutic agents are needed.
Disclosures. Background. Invasive fungal infections (IFIs) are uncommon infections that account for approximately 27.2/100,000 cases per year in the United States. One form of IFI is chronic invasive fungal sinusitis (CIFS). If untreated, invasion into neighboring structures may cause altered mental status, seizures, strokes, proptosis, and intracranial complications.
Case Report. An afebrile 43-year-old female with a history of polysubstance abuse presented to the ED due to altered mental status, left sided facial droop, right sided hemiparesis, and slurred speech. The patient was somnolent but arousable to stimuli and appeared acutely ill. The patient's mother reported a history of cocaine abuse, which was confirmed on urine toxicology. A CT head and neck with contrast revealed subacute basal ganglia lacunar infarcts and a left sphenoid opacity with scattered hyperintensities and erosive changes [ Figure 2]. One month prior, she had been diagnosed with a left superior pole kidney mass and a left-sided enlarged periaortic lymph node containing multiple noncaseating granulomas and GMS stains positive for fungal hyphae [ Figure 1].
The patient underwent nasal endoscopy with tissue biopsy. Tissue showed necrotizing invasive fungal sinusitis with granuloma formation and foreign-body giant cell reaction. Fungal speciation of the tissue culture showed Curvularia species was placed on IV voriconazole. While the infection stabilized, her neurologic deficits did not significantly improve. She was discharged to inpatient rehabilitation.