Neurocysticercosis in nonendemic countries: time for a reappraisal.

get in contact with human feces by visiting rural villages, where open-air defecation is common. It is also possible that travelers first become Taenia carriers (by ingesting undercooked pork infected by cysticerci) and then infected themselves by the fecal-oral route. The most common pattern of NCC expression in travelers (single cysticercus granuloma) suggests that the most common form of disease acquisition is through contact with Taenia carriers’ food handlers [3] . Otherwise, travelers would more often develop disseminated infections, as those observed in Taenia carriers who infect themselves or in those who ingest heavy loads of T. solium eggs directly from nature [1] . Among the traditionally considered nonendemic countries, it was in the USA where the increasing prevalence of NCC was first studied. Mass immigration of people from Latin America increased the number of NCC patients in the Southwestern USA during the eighties [7] . This was followed by the occurrence of NCC in other states, as well as by the appearance of autochthonous cases, which constitute about 5% of NCC patients diagnosed in the USA [8, 9] . NCC should be currently considered prevalent in the USA, as more than 5,000 patients have been reported over the past years. Recent evidence also indicates an increasing frequency of NCC in other countries that were apparently free of the disease until the past years, including Australia, Canada, Israel, Japan, Western European countries and Muslim countries of the Arab World. The current epidemiological scenario in these regions is similar to what was observed in the USA, as 70–80% of more than 1,000 NCC patients diagnosed in these countries were reported during the past two decades [3–6] . The increasing number of NCC patients in nonendemic countries is of concern. Physicians working in these regions may not be familiar with the different aspects of NCC, which in turn may cause diagnostic pitfalls (leading to the practice of unnecessary invasive procedures). Improved physician’s awareness of the possibility of NCC among populations at risk (travelers, immigrants, refugees), as well as a compulsory report of cases, should allow a better assessment of the problem and identify subgroups at higher risk [10] . Also, compulsory search of Taenia carriers among household contacts of NCC patients will allow the detection of a potential source of infection, and will reduce further spread of the disease.