Evolution of Neuroparasitic Infections in the South of Madrid Region, Spain: A Hospital-Based Study

Parasitic infections of the central nervous system (CNS) constitute a diverse group of diseases, many of which the World Health Organization classifies as neglected tropical diseases. This study aimed to analyze trends in diagnosis, clinical profile, and epidemiology of these infections through a retrospective review of cases at a secondary hospital in southern Madrid, Spain, from January 1992 to December 2024. Among the 74 patients diagnosed, 58 (78.4%) had neurotoxoplasmosis (NT), 14 (18.9%) neurocysticercosis (NC), and the remaining two cases were cerebral malaria and disseminated amoebiasis with CNS involvement. Diagnosis primarily relied on neuroimaging, which suggested differences in parasite locations within the CNS. All NT patients were HIV-associated immunocompromised, whereas all NC patients were immunocompetent. NT incidence has declined substantially since the late 20th century, following the introduction of highly active antiretroviral therapy, which has also reduced recurrences and mortality. Conversely, NC shifted from a locally endemic disease to an imported one, with all cases diagnosed after 2001 involving patients from Latin America, reflecting both the success of Taenia solium control measures in Spain and the impact of migration. These findings underscore the importance of epidemiological surveillance and control strategies tailored to at-risk populations and the demographic shifts associated with migration.