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Coyle CM, Bustos JA, Garcia HH. Current challenges in neurocysticercosis: recent data and where are we heading. Curr Opin Infect Dis 2024:00001432-990000000-00160. [PMID: 39088697 DOI: 10.1097/qco.0000000000001036] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 08/03/2024]
Abstract
PURPOSE OF REVIEW Neurocysticercosis (NCC) is still a significant contributor to neurological disease in vast regions of the world, and increasingly diagnosed in nonendemic countries because of travel and immigration from endemic settings. There is a need for clinicians in endemic and nonendemic regions to understand the complexities of its diagnosis and management. RECENT FINDINGS Recent information on the performance and use of available imaging and immunodiagnostic tools as well as antiparasitic and anti-inflammatory therapeutic regimes were assessed. SUMMARY Imaging and serology data should be assessed in the context of the specific type of NCC to improve diagnostic precision. In terms of therapeutic approaches, more controlled data is required on the efficacy and safety of combined antiparasitic therapy, and antiseizure and anti-inflammatory regimes should be optimized to minimize perilesional damage and reduce the risk of epilepsy.
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Affiliation(s)
- Christina M Coyle
- Department of Infectious Diseases, Albert Einstein College of Medicine, Bronx, New York, USA
| | - Javier A Bustos
- Center for Global Health, School of Health Sciences, Universidad Peruana de Ciencias Aplicadas (UPC)
| | - Hector H Garcia
- Center for Global Health, School of Health Sciences, Universidad Peruana de Ciencias Aplicadas (UPC)
- Cysticercosis Unit, Instituto Nacional de Ciencias Neurológicas, Lima, Perú
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Hernández-Chea R, Morales-Ramírez P, Hernández M, Hun A, Silva I, Fleury A, Sciutto E. Epidemiology of swine cysticercosis in two rural communities of Zacapa, Guatemala. Vet Parasitol Reg Stud Reports 2024; 47:100951. [PMID: 38199694 DOI: 10.1016/j.vprsr.2023.100951] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/25/2023] [Revised: 10/16/2023] [Accepted: 11/02/2023] [Indexed: 01/12/2024]
Abstract
Taeniasis/cysticercosis complex caused by Taenia solium, is a serious public health problem and causes major economic losses to swine producers in developing countries in Asia, Africa and the Americas. Despite scarce epidemiological data, Guatemala is considered endemic for T. solium. A cross-sectional study was conducted in Azacualpa and Malpais, two villages in the department of Zacapa, to assess the prevalence of swine cysticercosis and associated factors. Between March and October 2019, 149 pigs were examined by tongue palpation and serum samples were then collected to detect antibodies by ab-ELISA, and necropsy was performed on pigs that were positive by tongue palpation and/or ab-ELISA, to assess parasite load. Pig owners were asked to fill out a questionnaire on factors related to pig husbandry and occurrence of swine cysticercosis. Pearson's chi-square test and multivariate analysis were used to measure the association between serological results and other variables (p < 0.05 was considered significant). The seroprevalence of swine cysticercosis was 13.4% (13/97, 95% C.I. 6.6%-20.2%) and 25% (13/52, 95% C.I. 13.2%-36.8%) in Azacualpa and Malpais, respectively, yielding an overall seroprevalence of 17.4% (26/149, 95% C.I. 11.4%-23.5%). Parasite loads ranged from 1 to over 23,000 metacestodes per carcass. No bivariate association was found between exposure variables and seropositivity. A positive diagnosis by tongue palpation increased the odds of finding pigs seropositive for cysticercosis by a factor of 16.1 in the multivariate analysis. Despite the high prevalence and parasite load of T. solium, risk factors associated with cysticercosis were not significant in this study.
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Affiliation(s)
- Roderico Hernández-Chea
- Dirección Departamental de Redes Integradas de Servicios de Salud, Guatemala-área sur, Ministerio de Salud Pública y Asistencia Social, Guatemala, Amatitlán, Guatemala.
| | | | - Marisela Hernández
- Instituto de Investigaciones Biomédicas, Universidad Nacional Autónoma de México, Mexico City, Mexico
| | - Alejandro Hun
- Escuela de Posgrado, Facultad de Medicina Veterinaria y Zootecnia, Universidad de San Carlos de Guatemala, Guatemala, Guatemala
| | - Ilde Silva
- Facultad de Ciencias Jurídicas y Sociales, Universidad de San Carlos de Guatemala, Guatemala, Guatemala
| | - Agnès Fleury
- Instituto de Investigaciones Biomédicas, Universidad Nacional Autónoma de México, Mexico City, Mexico; Unidad Periférica del Instituto de Investigaciones Biomédicas, Departamento de Medicina Genómica y Toxicología ambiental, Universidad Nacional Autónoma de México, Mexico City, Mexico; Instituto de Neurología y Neurocirugía Manuel Velasco Suárez, Mexico City, Mexico.
| | - Edda Sciutto
- Instituto de Investigaciones Biomédicas, Universidad Nacional Autónoma de México, Mexico City, Mexico.
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Stelzle D, Makasi CE, Schmidt V, Van Damme I, Trevisan C, Ruether C, Fleury A, Noh J, Handali S, Dorny P, Magnussen P, Zulu G, Mwape KE, Bottieau E, Gabriël S, Ngowi BJ, Winkler AS. Evaluation of a point-of-care test for the diagnosis of Taenia solium neurocysticercosis in rural southern Tanzania: a diagnostic accuracy study. THE LANCET. INFECTIOUS DISEASES 2024; 24:98-106. [PMID: 37660709 DOI: 10.1016/s1473-3099(23)00378-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/20/2023] [Revised: 05/26/2023] [Accepted: 06/12/2023] [Indexed: 09/05/2023]
Abstract
BACKGROUND Neurocysticercosis is a common cause of epilepsy in Taenia solium-endemic areas in sub-Saharan Africa but is often undiagnosed because of an absence of affordable diagnostic tools. This study evaluated the diagnostic accuracy of a T solium cysticercosis antibody-detecting lateral-flow point-of-care assay (TS POC test) for the neuroimaging-based diagnosis of neurocysticercosis. METHODS Patients with epileptic seizures or severe progressive headache were recruited consecutively from three hospitals in southern Tanzania. All patients were tested with the TS POC test. All patients positive for cysticercosis on the TS POC test and every tenth patient who was negative for cysticercosis received a brain CT examination and underwent reference testing for T solium cysticercosis (ie, rT24H-EITB, LLGP-EITB, and antigen ELISA). The primary outcome of the study was the sensitivity of the TS POC test for the diagnosis of neurocysticercosis. FINDINGS Of the 601 recruited participants, 102 (17%) tested positive for cysticercosis with the TS POC test. Overall, 48 (62%) of the 77 patients positive for cysticercosis and five (17%) of the 29 patients negative for cysticercosis on the TS POC test had CT-confirmed neurocysticercosis. The TS POC test yielded a sensitivity of 49% (uncertainty interval [UI] 41-58) for neurocysticercosis. Sensitivity was similar to that of the rT24H-EITB (44%, UI 37-51) and the antigen ELISA (50%, 43-56). For the subset of neurocysticercosis cases with at least one active (ie, vesicular) lesion, sensitivity was above 98% for the TS POC test, the rT24H-ETIB, and the antigen ELISA. INTERPRETATION The TS POC test showed promising results for the diagnosis of neurocysticercosis in patients with vesicular lesions, which need to be confirmed in a larger study. This test could be considered to support policies on screening patients with suspected neurocysticercosis in clinical settings, which would allow appropriate referral for neuroimaging and early treatment. FUNDING German Federal Ministry of Education and Research and the European & Developing Countries Clinical Trials Partnership. TRANSLATION For the Swahili translation of the abstract see Supplementary Materials section.
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Affiliation(s)
- Dominik Stelzle
- Department of Neurology, Center for Global Health, Faculty of Medicine, Technical University of Munich, Munich, Germany.
| | - Charles E Makasi
- National Institute for Medical Research, Muhimbili Medical Research Centre, Dar es Salaam, Tanzania; Kilimanjaro Christian Medical University, College of Tumaini University, Moshi, Tanzania
| | - Veronika Schmidt
- Department of Neurology, Center for Global Health, Faculty of Medicine, Technical University of Munich, Munich, Germany
| | - Inge Van Damme
- Department of Translational Physiology, Infectiology, and Public Health, Faculty of Veterinary Medicine, Ghent University, Ghent, Belgium
| | - Chiara Trevisan
- Department of Translational Physiology, Infectiology, and Public Health, Faculty of Veterinary Medicine, Ghent University, Ghent, Belgium; Department of Biomedical Sciences, Institute of Tropical Medicine, Antwerp, Belgium
| | - Charlotte Ruether
- Department of Neuroradiology, RoMed Clinic Rosenheim, Rosenheim, Germany
| | - Agnès Fleury
- Department of Genomic Medicine and Environmental Toxicology, Instituto de Investigaciones Biomédicas - UNAM, Ciudad de México, Mexico; Neurocysticercosis Clinic, Instituto Nacional de Neurología y Neurocirugía, Ciudad de México, México
| | - John Noh
- Division of Parasitic Diseases and Malaria, Centers for Disease Control and Prevention, Atlanta, GA, USA
| | - Sukwan Handali
- Division of Parasitic Diseases and Malaria, Centers for Disease Control and Prevention, Atlanta, GA, USA
| | - Pierre Dorny
- Department of Biomedical Sciences, Institute of Tropical Medicine, Antwerp, Belgium
| | - Pascal Magnussen
- Department of Microbiology and Immunology, Faculty of Health and Medical Sciences, University of Copenhagen, Copenhagen, Denmark
| | | | - Kabemba E Mwape
- Department of Clinical Studies, School of Veterinary Medicine, University of Zambia, Lusaka, Zambia
| | - Emmanuel Bottieau
- Department of Clinical Sciences, Institute of Tropical Medicine, Antwerp, Belgium
| | - Sarah Gabriël
- Department of Translational Physiology, Infectiology, and Public Health, Faculty of Veterinary Medicine, Ghent University, Ghent, Belgium
| | - Bernard J Ngowi
- National Institute for Medical Research, Muhimbili Medical Research Centre, Dar es Salaam, Tanzania; Mbeya College of Health and Allied Sciences, University of Dar es Salaam, Mbeya, Tanzania
| | - Andrea S Winkler
- Department of Neurology, Center for Global Health, Faculty of Medicine, Technical University of Munich, Munich, Germany; Department of Community Medicine and Global Health, Institute of Health and Society, Faculty of Medicine, University of Oslo, Oslo, Norway; Department of Global Health and Social Medicine, Harvard Medical School, Boston, MA, USA.
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Castillo Y, Toribio LM, Guzman C, Arroyo G, Espinoza C, Saavedra H, Bustos JA, Dorny P, O’Neal SE, Garcia HH. Consistent Measurement of Parasite-Specific Antigen Levels in Sera of Patients with Neurocysticercosis Using Two Different Monoclonal Antibody (mAb)-Based Enzyme-Linked Immunosorbent Assays. Pathogens 2023; 12:566. [PMID: 37111451 PMCID: PMC10143799 DOI: 10.3390/pathogens12040566] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/08/2023] [Revised: 03/26/2023] [Accepted: 03/28/2023] [Indexed: 04/29/2023] Open
Abstract
Monoclonal antibody (mAb)-based enzyme-linked immunosorbent assay (ELISA) is a complementary diagnosis technique for neurocysticercosis (NCC), which detects circulating parasite antigen (Ag) indicative of viable infection and Ag levels that correlate well with the parasite burden. In this study, we compared the performance of two Ag-ELISA techniques for the detection of NCC. We assessed the agreement between our in-house TsW8/TsW5 Ag-ELISA and the widely used B158/B60 Ag-ELISA for measuring T. solium antigen levels in the sera from 113 patients with calcified, parenchymal, and subarachnoid NCC. Concordance was demonstrated evaluating the limits of agreement (LoAs) stratified by the type of NCC. Both ELISA's detected 47/48 (97.8%) subarachnoid NCC cases. In parenchymal and calcified NCC, the B158/B60 Ag-ELISA detected 19/24 (79.2%) and 18/41 (43.9%) cases, while the TsW8/TsW5 Ag-ELISA detected 21/24 (87.5%) and 13/41 (31.7%), respectively. Parenchymal and calcified NCC obtained a perfect agreement (100%), indicating that all sample results were within the predicted LoA, while for subarachnoid NCC, the agreement was 89.6%. The high concordance between the assays was confirmed by Lin's concordance coefficient (LCC = 0.97). Patients with viable parenchymal NCC (LCC = 0.95) obtained the highest concordance between assays, followed by subarachnoid NCC (LCC = 0.93) and calcified NCC (LCC = 0.92). The TsW8/TsW5 Ag-ELISA and B158/B60 Ag-ELISA showed high Ag measurement correlations across diverse types of NCC.
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Affiliation(s)
- Yesenia Castillo
- Center for Global Health, Universidad Peruana Cayetano Heredia, Lima 15202, Peru; (Y.C.)
| | - Luz M. Toribio
- Center for Global Health, Universidad Peruana Cayetano Heredia, Lima 15202, Peru; (Y.C.)
- Cysticercosis Unit, National Institute of Neurological Sciences, Lima 15030, Peru
| | - Carolina Guzman
- Center for Global Health, Universidad Peruana Cayetano Heredia, Lima 15202, Peru; (Y.C.)
- Cysticercosis Unit, National Institute of Neurological Sciences, Lima 15030, Peru
| | - Gianfranco Arroyo
- Center for Global Health, Universidad Peruana Cayetano Heredia, Lima 15202, Peru; (Y.C.)
| | - Cindy Espinoza
- Center for Global Health, Universidad Peruana Cayetano Heredia, Lima 15202, Peru; (Y.C.)
| | - Herbert Saavedra
- Cysticercosis Unit, National Institute of Neurological Sciences, Lima 15030, Peru
| | - Javier A. Bustos
- Center for Global Health, Universidad Peruana Cayetano Heredia, Lima 15202, Peru; (Y.C.)
- Cysticercosis Unit, National Institute of Neurological Sciences, Lima 15030, Peru
| | - Pierre Dorny
- Department of Biomedical Sciences, Institute of Tropical Medicine, 2060 Antwerp, Belgium
| | - Seth E. O’Neal
- Center for Global Health, Universidad Peruana Cayetano Heredia, Lima 15202, Peru; (Y.C.)
- School of Public Health, Oregon Health & Sciences, Portland State University, Portland, OR 97207, USA
| | - Hector H. Garcia
- Center for Global Health, Universidad Peruana Cayetano Heredia, Lima 15202, Peru; (Y.C.)
- Cysticercosis Unit, National Institute of Neurological Sciences, Lima 15030, Peru
- Department of International Health, Bloomberg School for Public Health, Johns Hopkins University, Baltimore, MD 21205, USA
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Hamamoto Filho PT, Rodríguez-Rivas R, Fleury A. Neurocysticercosis: A Review into Treatment Options, Indications, and Their Efficacy. Res Rep Trop Med 2022; 13:67-79. [PMID: 36601353 PMCID: PMC9807125 DOI: 10.2147/rrtm.s375650] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/01/2022] [Accepted: 12/14/2022] [Indexed: 12/30/2022] Open
Abstract
Neurocysticercosis, due to the localization of Taenia solium larvae in the Central Nervous System, is a neglected tropical disease still endemic in much of Latin America, Asia and sub-Saharan Africa. The therapeutic management of NC has gradually improved with the establishment of neuroimaging studies (CT and MRI) in endemic countries and with the demonstration of the efficacy of albendazole and praziquantel in the 1980s. But the morbidity and mortality of this preventable disease remain an unacceptable fact. In this scoping review, we will revise the different treatment options and their indications.
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Affiliation(s)
- Pedro Tadao Hamamoto Filho
- Department of Neurology, Psychology and Psychiatry, Botucatu Medical School, UNESP –Universidad de Estadual Paulista, Botucatu, Brazil
| | - Roberto Rodríguez-Rivas
- Instituto Nacional de Neurología y Neurocirugía Manuel Velasco Suarez, Ciudad de México, México
| | - Agnès Fleury
- Departamento de Medicina Genómica y Toxicología Ambiental, Instituto de Investigaciones Biomédicas, Universidad Nacional Autónoma de México, Ciudad de México, México,Clínica de Neurocisticercosis, Instituto Nacional de Neurología Y Neurocirugía Manuel Velasco Suarez, Ciudad de México, México,Correspondence: Agnès Fleury, Insurgentes Sur 3877 CP 14269 Barrio La Fama, Tlalpan, Ciudad de México, México, Tel +52 5556063822, Email
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Bonnet G, Pizzitutti F, Gonzales-Gustavson EA, Gabriël S, Pan WK, Garcia HH, Bustos JA, Vilchez P, O’Neal SE. CystiHuman: A model of human neurocysticercosis. PLoS Comput Biol 2022; 18:e1010118. [PMID: 35587497 PMCID: PMC9159625 DOI: 10.1371/journal.pcbi.1010118] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/21/2021] [Revised: 06/01/2022] [Accepted: 04/19/2022] [Indexed: 11/19/2022] Open
Abstract
INTRODUCTION The Taenia solium tapeworm is responsible for cysticercosis, a neglected tropical disease presenting as larvae in the body of a host following taenia egg ingestion. Neurocysticercosis (NCC), the name of the disease when it affects the human central nervous system, is a major cause of epilepsy in developing countries, and can also cause intracranial hypertension, hydrocephalus and death. Simulation models can help identify the most cost-effective interventions before their implementation. Modelling NCC should enable the comparison of a broad range of interventions, from treatment of human taeniasis (presence of an adult taenia worm in the human intestine) to NCC mitigation. It also allows a focus on the actual impact of the disease, rather than using proxies as is the case for other models. METHODS This agent-based model is the first model that simulates human NCC and associated pathologies. It uses the output of another model, CystiAgent, which simulates the evolution of pig cysticercosis and human taeniasis, adding human and cyst agents, including a model of cyst location and stage, human symptoms, and treatment. CystiHuman also accounts for delays in the appearance of NCC-related symptoms. It comprises three modules detailing cyst development, seizure probability and timing, and intracranial hypertension/hydrocephalus, respectively. It has been implemented in Java MASON and calibrated in three endemic villages in Peru, then applied to another village (Rica Playa) to compare simulation results with field data in that village. RESULTS AND DISCUSSION Despite limitations in available field data, parameter values found through calibration are plausible and simulated outcomes in Rica Playa are close to actual values for NCC prevalence and the way it increases with age and cases with single lesions. Initial simulations further suggest that short-term interventions followed by a rapid increase in taeniasis prevalence back to original levels may have limited impacts on NCC prevalence.
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Affiliation(s)
- Gabrielle Bonnet
- Independent Consultant for the School of Public Health, Oregon Health & Science University, Portland, Oregon, United States of America
| | - Francesco Pizzitutti
- Independent Consultant for the School of Public Health, Oregon Health & Science University, Portland, Oregon, United States of America
| | | | - Sarah Gabriël
- Department of Veterinary Public Health and Food Safety, Ghent University, Gent, Belgium
| | - William K. Pan
- Nicholas School of Environment and Duke Global Health Institute, Duke University, Durham, North Carolina, United States of America
| | - Hector H. Garcia
- Center for Global Health Tumbes, Universidad Peruana Cayetano Heredia, Lima, Peru
- Cysticercosis Unit, National Institute of Neurological Sciences, Lima, Peru
| | - Javier A. Bustos
- Center for Global Health Tumbes, Universidad Peruana Cayetano Heredia, Lima, Peru
| | - Percy Vilchez
- Center for Global Health Tumbes, Universidad Peruana Cayetano Heredia, Lima, Peru
| | - Seth E. O’Neal
- Center for Global Health Tumbes, Universidad Peruana Cayetano Heredia, Lima, Peru
- School of Public Health, Oregon Health & Science University and Portland State University, Portland, Oregon, United States of America
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Mukendi D, Kalo JRL, Lutumba P, Barbé B, Jacobs J, Yansouni CP, Gabriël S, Dorny P, Chappuis F, Boelaert M, Winkler AS, Verdonck K, Bottieau E. High frequency of Taenia solium antigen positivity in patients admitted for neurological disorders in the Rural Hospital of Mosango, Democratic Republic of Congo. BMC Infect Dis 2021; 21:359. [PMID: 33865327 PMCID: PMC8052782 DOI: 10.1186/s12879-021-06032-8] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/15/2019] [Accepted: 04/05/2021] [Indexed: 12/23/2022] Open
Abstract
Background The epidemiology of human cysticercosis and neurocysticercosis, caused by the larval stage of the pork tapeworm Taenia solium, is not well known in the Democratic Republic of Congo (DRC). Within a multicenter etiological and diagnostic study conducted by the NIDIAG consortium (“Better Diagnosis for Neglected Infections”) and investigating several challenging syndromes, we consecutively evaluated from 2012 to 2015 all patients older than 5 years presenting with neurological disorders (neurology cohort) and with fever > 7 days (persistent fever cohort) at the rural hospital of Mosango, province of Kwilu, DRC. In both cohorts, etiological diagnosis relied on a systematic set of reference laboratory assays and on pre-established clinical case definitions. No neuroimaging was available in the study hospital. In this study, we determined the frequency of T. solium infection in both cohorts and explored in the neurology cohort its association with specific neurological presentations and final etiological diagnoses. Methods We conducted a post-hoc descriptive and analytic study on cysticercosis in the neurology and persistent fever cohorts, based on the presence in serum samples of circulating T. solium antigen using the B158/B60 enzyme-linked immunosorbent assay (ELISA) and of cysticercosis IgG using the LDBIO Cysticercosis Western Blot IgG assay. Results For the neurology cohort, 340 samples (of 351 enrolled patients) were available for analysis (males: 46.8%; mean age: 38.9 years). T. solium antigen positivity was found in 43 participants (12.6%; 95% confidence interval [CI] 9.3–16.7%), including 9 of 60 (15%) patients with epilepsy. Among the 148 samples available from the persistent fever cohort (males: 39.9%; mean age: 19.9 years), 7 were positive in the T. solium antigen ELISA (4.7%; 95% CI 1.9–9.5%; P = 0.009 when compared to the neurology cohort). No significant association was found within the neurology cohort between positivity and clinical presentation or final diagnoses. Of note, the IgG antibody-detecting assay was found positive in only four (1.3%) of the participants of the neurology cohort and in none of the persistent fever cohort. Conclusions T. solium antigen positivity was found in at least 10% of patients admitted with neurological disorders in the Kwilu province, DRC, with no specific pattern of presentation. Further neuroimaging studies should be used to confirm whether neurocysticercosis is prevalent in this region.
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Affiliation(s)
- Deby Mukendi
- Institut National de Recherche Biomédicale, Kinshasa, Democratic Republic of the Congo. .,Départment de Neurologie, Université de Kinshasa, Kinshasa, Democratic Republic of the Congo.
| | - Jean-Roger Lilo Kalo
- Institut National de Recherche Biomédicale, Kinshasa, Democratic Republic of the Congo
| | - Pascal Lutumba
- Institut National de Recherche Biomédicale, Kinshasa, Democratic Republic of the Congo.,Départment de Neurologie, Université de Kinshasa, Kinshasa, Democratic Republic of the Congo
| | - Barbara Barbé
- Department of Clinical Sciences, Institute of Tropical Medicine, Antwerp, Belgium
| | - Jan Jacobs
- Department of Clinical Sciences, Institute of Tropical Medicine, Antwerp, Belgium.,Department of Microbiology and Immunology, KU Leuven, Leuven, Belgium
| | - Cedric P Yansouni
- JD MacLean Centre for Tropical Diseases, McGill University Health Centre, Montreal, Canada
| | - Sarah Gabriël
- Department of Veterinary Public Health, Faculty of Veterinary Medicine, Ghent University, Ghent, Belgium
| | - Pierre Dorny
- Department of Biomedical Sciences, Institute of Tropical Medicine, Antwerp, Belgium
| | - François Chappuis
- Division of Tropical and Humanitarian Medicine, Geneva University Hospitals and University of Geneva, Geneva, Switzerland
| | - Marleen Boelaert
- Department of Public Health, Institute of Tropical Medicine, Antwerp, Belgium
| | - Andrea S Winkler
- Center for Global Health, Department of Neurology, Technical University of Munich, Munich, Germany.,Center for Global Health, University of Oslo, Oslo, Norway
| | - Kristien Verdonck
- Department of Public Health, Institute of Tropical Medicine, Antwerp, Belgium
| | - Emmanuel Bottieau
- Department of Clinical Sciences, Institute of Tropical Medicine, Antwerp, Belgium
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Mendlovic F, Fleury A, Flisser A. Zoonotic Taenia infections with focus on cysticercosis due to Taenia solium in swine and humans. Res Vet Sci 2020; 134:69-77. [PMID: 33321377 DOI: 10.1016/j.rvsc.2020.11.015] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/02/2020] [Revised: 11/17/2020] [Accepted: 11/20/2020] [Indexed: 01/12/2023]
Abstract
Zoonotic taeniasis caused by the adult stage of Taenia solium, Taenia saginata or Taenia asiatica are considered neglected tropical diseases by the World Health Organization. The life cycle of these 3 metazoan species is very similar and includes an intermediate host: pigs in the case of T. solium and T. asiatica, and cattle in the case of T. saginata. By eating meat (pork/T. solium, T. asiatica; beef/T. saginata) containing live cysticerci, humans develop taeniasis, which is practically asymptomatic but is the main risk factor for intermediate hosts to become infected. T. saginata causes bovine cysticercosis, while T. solium and T. asiatica cause swine cysticercosis, of veterinary and economic importance. T. solium cysticerci cause neurological disease in humans: neurocysticercosis. Cysticerci develop after ingesting microscopic eggs released from a human tapeworm carrier. Here we describe the life stages of the parasites, diagnosis, pathogenesis, symptomatology of neurocysticercosis, and prevention and control measures. Highlighting the need to validate diagnostic tools, treatments and vaccination in endemic areas, with the challenge of addressing the most vulnerable populations that lack resources. If people understand the transmission route, avoid eating uncooked or insufficiently cooked meat and have adequate hygienic habits, the life cycle of the 3 zoonotic Taenia species may be interrupted. In addition, we describe the growing field of immune response and immunomodulation elicited by the parasites, which may provide essential tools for diagnosis, treatment, control of taeniasis/cysticercosis, as well as for identification of parasite-derived immunomodulators that could aid in the treatment of emerging inflammatory diseases worldwide.
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Affiliation(s)
- Fela Mendlovic
- Facultad de Medicina, UNAM, Av. Universidad 3000, Col. Copilco-Universidad, Ciudad de México 04510, Mexico; Facultad de Ciencias de la Salud, Universidad Anáhuac México Norte, Huixquilucan, Estado de México, Mexico
| | - Agnes Fleury
- Instituto Nacional de Neurología y Neurocirugia "Manuel Velasco Suárez", SSA, Av. Insurgentes sur 3877, Col. La Fama, Tlalpan, Ciudad de México 14269, Mexico; Instituto de Investigaciones Biomédicas, UNAM, Av. Universidad 3000, Col. Copilco-Universidad, Ciudad de México 04510, Mexico
| | - Ana Flisser
- Facultad de Medicina, UNAM, Av. Universidad 3000, Col. Copilco-Universidad, Ciudad de México 04510, Mexico.
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Morales-Sandoval JDJ, Téllez-Arellano CA, Fleury A. Neurocisticercosis extraparenquimatosa: reto terapéutico A propósito de un caso de la glándula parótida. REVISTA DE LA FACULTAD DE MEDICINA 2020. [DOI: 10.22201/fm.24484865e.2020.63.4.03] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022] Open
Abstract
Introduction:Neurocysticercosis is a parasitosis of the central nervous system, caused by the intake of eggs from taenia solium. It has a high prevalence in certain regions of Latin America, the southeast of Asia, and sub-Saharan Africa, where unhealthy situations still prevail. Clinical case: A 55-year-old woman with clinical symptoms of 2 years of evolution, such as recurrent headaches that had increased recently in addition to tonic-clonic seizures. In these conditions she was admitted to the hospital’s emergency department. Neuroimaging studies (tomography and magnetic resonance imaging) showed the presence of subarachnoid vesicular structures compatible with neurocysticercosis. Therefore, a cestocidal treatment was administered but the patient did not return to her follow-up appointments for 4 years. When she finally went to her appointment, she was very symptomatic and required the administration of 8 cycles of treatment to eradicate the parasites. Discussion: The great heterogeneity and the non-specificity of the signs and symptoms difficult making a diagnosis of neurocysticercosis. Therefore, it is important to look for complementary laboratory and imaging evidence to confirm it. The treatment of neurocysticercosis represents a challenge for the physician. Particularly, when the parasite is located outside the brain parenchyma, subarachnoid cisterns and ventricular system. In less than a third of these patients the parasites disappear with a single cycle of cestocidal treatment. Conclusion: Neurocysticercosis is a disease closely related to poverty, but it is preventable. Research focused on treatments for neurocysticercosis is still necessary.
Key words:Neurocysticercosis; taenia solium; seizures; magnetic
resonance; cestocidal.
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Affiliation(s)
- José de Jesús Morales-Sandoval
- Universidad Nacional Autónoma de México (UNAM). Instituto de Investigaciones Biomédicas. Unidad Periférica para el Estudios de la Neuroinflamación. Ciudad de México. México; Secretaría de Salud (Ssa). Instituto Nacional de Neurología y Neurocirugía. Ciudad de México. México; Universidad Nacional Autónoma de México (UNAM). Facultad de Medicina. Ciudad de México. México
| | - Carlos Alejandro Téllez-Arellano
- Universidad Nacional Autónoma de México (UNAM). Instituto de Investigaciones Biomédicas. Unidad Periférica para el Estudios de la Neuroinflamación. Ciudad de México. México: Universidad Nacional Autónoma de México (UNAM). Facultad de Medicina UNAM, Ciudad de México, México. Universidad Nacional Autónoma de México (UNAM). Facultad de Medicina. Programa de Apoyo y Fomento a la Investigación (AFINES). Ciudad de México, México
| | - Agnés Fleury
- Universidad Nacional Autónoma de México (UNAM). Instituto de Investigaciones Biomédicas. Unidad Periférica para el Estudios de la Neuroinflamación. Ciudad de México. México; Secretaría de Salud (SSa). Instituto Nacional de Neurología y Neurocirugía. Ciudad de México, México
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10
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Romo ML, Hernández M, Astudillo OG, Diego G, de-la-Rosa-Arana JL, Meza-Lucas A, García-Rodea R, Toledo A, Parkhouse RME, Garate T, Sciutto E, Fleury A. Diagnostic value of glycoprotein band patterns of three serologic enzyme-linked immunoelectrotransfer blot assays for neurocysticercosis. Parasitol Res 2020; 119:2521-2529. [PMID: 32591864 DOI: 10.1007/s00436-020-06750-z] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/01/2020] [Accepted: 06/02/2020] [Indexed: 11/27/2022]
Abstract
The enzyme-linked immunoelectrotransfer blot (EITB) assay to detect antibodies in serum is a complementary tool for the diagnosis of neurocysticercosis (NCC). Presence of at least one glycoprotein band corresponding to a Taenia solium (T. solium) antigen indicates a positive result; however, EITB assays have multiple glycoprotein bands, and previous work has suggested that band patterns may have additional diagnostic value. We included 58 participants with a definitive diagnosis of NCC who received care at the Instituto Nacional de Neurología y Neurocirugía in Mexico City. Three different EITB tests were applied to participants' serum samples (LDBio, France; US Centers for Disease Control and Prevention [CDC]; and Instituto de Diagnóstico y Referencia Epidemiológicos [InDRE]). There was substantial variability in specific glycoprotein band patterns among the three assays. However, in age- and sex-adjusted logistic regression models, the number of glycoprotein bands was positively associated with the presence of vesicular extraparenchymal cysts (InDRE adjusted odds ratio [aOR] 1.60 p < 0.001; CDC aOR 6.31 p < 0.001; LDBio aOR 2.45 p < 0.001) and negatively associated with the presence of calcified parenchymal cysts (InDRE aOR 0.63 p < 0.001; CDC aOR 0.25 p < 0.001; LDBio aOR 0.44 p < 0.001). In a sensitivity analysis also adjusting for cyst count, results were similar. In all three EITB serum antibody tests, the number of glycoprotein bands consistently predicted cyst stage and location, although magnitude of effect differed.
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Affiliation(s)
- Matthew L Romo
- CUNY Graduate School of Public Health and Health Policy and Institute for Implementation Science in Population Health, City University of New York, New York, NY, 10027, USA.
- School of Public Health, Li Ka Shing Faculty of Medicine, The University of Hong Kong, Hong Kong, Hong Kong SAR.
| | - Marisela Hernández
- Departamento de Inmunología, Instituto de Investigaciones Biomédicas, Universidad Nacional Autónoma de México, Mexico City, Mexico
| | - Osvaldo-Germán Astudillo
- Administración Nacional de Laboratorios e Institutos de Salud (ANLIS) "Dr. Carlos Malbrán", Buenos Aires, Argentina
| | - Gustavo Diego
- Administración Nacional de Laboratorios e Institutos de Salud (ANLIS) "Dr. Carlos Malbrán", Buenos Aires, Argentina
| | | | - Antonio Meza-Lucas
- Instituto de Diagnóstico y Referencia Epidemiológicos (InDRE), Secretaria de Salud, Mexico City, Mexico
| | - Ricardo García-Rodea
- Instituto de Diagnóstico y Referencia Epidemiológicos (InDRE), Secretaria de Salud, Mexico City, Mexico
| | - Andrea Toledo
- Unidad de Neuroinflamación, Instituto de Investigaciones Biomédicas-Universidad Nacional Autónoma de México/Instituto Nacional de Neurología y Neurocirugía/Facultad de Medicina-Universidad Nacional Autónoma de México, Mexico City, Mexico
| | | | - Teresa Garate
- Instituto de Salud Carlos III, Majadahonda, Madrid, Spain
| | - Edda Sciutto
- Departamento de Inmunología, Instituto de Investigaciones Biomédicas, Universidad Nacional Autónoma de México, Mexico City, Mexico
| | - Agnès Fleury
- Unidad de Neuroinflamación, Instituto de Investigaciones Biomédicas-Universidad Nacional Autónoma de México/Instituto Nacional de Neurología y Neurocirugía/Facultad de Medicina-Universidad Nacional Autónoma de México, Mexico City, Mexico.
- Neurocysticercosis Clinic, Instituto Nacional de Neurología y Neurocirugía, Mexico City, Mexico.
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11
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Ursini T, Di Giacomo R, Caldrer S, Angheben A, Zammarchi L, Filipponi S, Pizio NR, Bisoffi Z, Buonfrate D. Neurocysticercosis-related seizures in the post-partum period: two cases and a review of the literature. THE LANCET. INFECTIOUS DISEASES 2020; 20:e204-e214. [PMID: 32569624 DOI: 10.1016/s1473-3099(20)30240-1] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/07/2020] [Revised: 03/13/2020] [Accepted: 03/16/2020] [Indexed: 12/21/2022]
Abstract
Neurocysticercosis, the infection of the CNS with larval cysts of Taenia solium, is a leading cause of seizures in low-income countries. The clinical presentation of neurocysticercosis is variable and depends on the number, size, and location of cysticerci, and on the immune response of the host. In most patients, the affected site is the brain parenchyma, where cysts can precipitate seizures. Neurocysticercosis has seldom been described in pregnant women. In this Grand Round, we report two cases of pregnant women who immigrated to Italy from Bolivia and Ecuador, and who developed seizures in the early post-partum period, due to calcified parenchymal neurocysticercosis lesions. We discuss the complex interactions between neurocysticercosis and the immune system in pregnancy and the post-partum period. Building on this scenario, we propose practices for the management of neurocysticercosis in pregnancy and the post-partum period, highlighting important gaps in the literature that should be addressed.
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Affiliation(s)
- Tamara Ursini
- Department of Infectious - Tropical Diseases and Microbiology, IRCCS Sacro Cuore Don Calabria Hospital, Negrar, Italy.
| | - Roberta Di Giacomo
- Epilepsy Unit, Fondazione IRCCS Istituto Neurologico Carlo Besta, Milan, Italy
| | - Sara Caldrer
- Department of Infectious - Tropical Diseases and Microbiology, IRCCS Sacro Cuore Don Calabria Hospital, Negrar, Italy
| | - Andrea Angheben
- Department of Infectious - Tropical Diseases and Microbiology, IRCCS Sacro Cuore Don Calabria Hospital, Negrar, Italy
| | - Lorenzo Zammarchi
- Department of Experimental and Clinical Medicine, University of Florence, Florence, Italy; Referral Centre for Tropical Diseases of Tuscany, Infectious and Tropical Diseases Unit, Careggi University Hospital, Florence, Italy
| | - Stefania Filipponi
- Stroke Unit, Department of Neurological Disorders, Santa Chiara Hospital, Trento, Italy
| | | | - Zeno Bisoffi
- Department of Infectious - Tropical Diseases and Microbiology, IRCCS Sacro Cuore Don Calabria Hospital, Negrar, Italy; Department of Diagnostics and Public Health, University of Verona, Verona, Italy
| | - Dora Buonfrate
- Department of Infectious - Tropical Diseases and Microbiology, IRCCS Sacro Cuore Don Calabria Hospital, Negrar, Italy
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