Comparison of bovine cysticercosis prevalence detected by antigen ELISA and visual inspection in the North East of Spain

Membrane Technology for Rapid Point-of-Care Diagnostics for Parasitic Neglected Tropical Diseases

Parasitic neglected tropical diseases (NTDs) affect over one billion people worldwide, with individuals from communities in low-socioeconomic areas being most at risk and suffering the most. Disease management programs are hindered by the lack of infrastructure and resources for clinical sample collection, storage, and transport and a dearth of sensitive diagnostic methods that are inexpensive as well as accurate. Many diagnostic tests and tools have been developed for the parasitic NTDs, but the collection and storage of clinical samples for molecular and immunological diagnosis can be expensive due to storage, transport, and reagent costs, making these procedures untenable in most areas of endemicity. The application of membrane technology, which involves the use of specific membranes for either sample collection and storage or diagnostic procedures, can streamline this process, allowing for long-term sample storage at room temperature. Membrane technology can be used in serology-based diagnostic assays and for nucleic acid purification prior to molecular analysis. This facilitates the development of relatively simple and rapid procedures, although some of these methods, mainly due to costs, lack accessibility in low-socioeconomic regions of endemicity. New immunological procedures and nucleic acid storage, purification, and diagnostics protocols that are simple, rapid, accurate, and cost-effective must be developed as countries progress control efforts toward the elimination of the parasitic NTDs.

Systematic review and meta-analysis of bovine cysticercosis in Brazil: current knowledge and way forward

Background

Taenia saginata taeniosis/cysticercosis has been well studied in several countries. Brazil is one of the most important beef exporting countries and has one of the highest cattle population size in the world. In this country, bovine cysticercosis (BCC) remains the most frequent reported zoonosis detected during post-mortem inspection, resulting in costs for the beef sector and public health. We performed a systematic literature review regarding data about BCC epidemiology in Brazil and meta-analyses for its prevalence in different administrative regions and the distribution over time, and based on this discussed possible control strategies.

Methods

A systematic review was conducted to obtain data about BCC in Brazil using the words “bovine cysticercosis” and “Brazil” to construct the search phrase. The inclusion criteria used to select articles were: (i) published from 2000 to 2018; (ii) full text available online in Portuguese or English; and (iii) contain information at least regarding one of the following aspects of BCC in Brazil: prevalence, incidence, spatial distribution, risk-factors, economic burden and measures for control.

Results

A set of 42 articles was included, covering the prevalence of BCC in Brazil, ranging between 0.01–18.75%. Prevalence results of 40 articles were included in a meta-analysis per administrative region. The highest prevalence was found in the South (3.4%; 95% CI: 2.0–5.2%), followed by the Southeast (2.7%; 95% CI: 1.9–3.6%), Northeast (1.5%; 95% CI: 0.6–2.7%), Central-western (0.9%; 95% CI: 0.3–1.7%) and North (0.0%; 95% CI: 0.0–0.6%) region. In addition, a reduction in prevalence over time was observed in all the evaluated states except for Alagoas and Pará.

Conclusions

Besides the large availability of data, a critical lack of information about BCC epidemiology remains in Brazil. Nevertheless, the available data on prevalence, high risk-areas and risk factors should contribute to a better understanding of transmission and the formulation of recommendations for control. A One Health approach will be required to reduce T. saginata taeniosis/cysticercosis prevalence and the consequent economic burden for the beef sector in Brazil, one of the most important beef exporters in the world.

Epidemiology and economic impact of bovine cysticercosis and taeniosis caused by Taenia saginata in northeastern Spain (Catalonia)

BACKGROUND

In Catalonia (north-eastern Spain), Taenia saginata has been described in cattle but its occurrence in humans is unclear. Moreover, whether cattle acquired the infection in Catalonia or outside Catalonia and its economic impact have not been investigated. This study aimed to estimate the prevalence and spatial distribution of bovine cysticercosis in Catalonia (2008-2015), and the burden from T. saginata upon the animal and human sectors in Catalonia (2013-2015).

METHODS

Data on cattle diagnosed with cysticercosis at meat inspection were collected and analysed. Cattle movement history was used to identify the most likely place of bovine cysticercosis infection and to investigate its spatial distribution. Data on taeniosis treatment (niclosamide and praziquantel) costs and their supply in Catalonia as well as data on patients attending primary care with diagnosis of taeniosis were collected. The financial impact associated with T. saginata due to carcasses condemned and frozen, meat inspection and human taeniosis was estimated.

RESULTS

During 2008-2015, between 18 and 107 cattle were found positive for cysticercosis each year (prevalence at slaughter of 0.010%). Movement history was available for 44% of the infected cattle and in 53% of them Catalonia was identified as the place where the infection was acquired with highest probability. Two significant bovine cysticercosis clusters were detected. The number of patients diagnosed with taeniosis in primary care during the period 2013-2016 was 41-63/year. The overall economic impact of T. saginata (2013-2015) amounted to 154,903 €/year (95% CI: 113,075-196,762). Meat inspection accounted for 81.9% (95% CI: 75.8-86.2%) of the costs, followed by costs due to carcass condemnation and freezing (9.4%; 95% CI: 6.9-12.8%), and taeniosis-associated costs (8.7%; 95% CI: 6.7-11.6%). Costs due to freezing and condemnation of carcasses reached 19,442 €/year (95% CI: 17,528-21,391) (509 €/lightly infected carcass and 1,140 €/heavily infected carcass). Taeniosis-associated costs were estimated at 12,848.5 €/year (237 €/patient).

CONCLUSIONS

The public health risk of T. saginata in the area seems to be low. The economic impact due to T. saginata was mainly attributed to meat inspection. The cost due to carcass condemnation and freezing was limited compared to the revenue of the beef sector. Developing and implementing risk-based surveillance is needed to lower the costs of meat inspection. Considering cattle movements might be useful in the development of such a strategy.

Development of the multi-epitope chimeric antigen rqTSA-25 from Taenia saginata for serological diagnosis of bovine cysticercosis

Bovine cysticercosis is a worldwide distributed zoonosis caused by the larval form of Taenia saginata present in bovine muscles. The diagnosis is based on the postmortem inspection at slaughterhouses and consists of the macroscopic visualization of lesions caused by cysticercosis in muscle sites. However, parasitized animals can pass unnoticed during sanitary inspection. Thus, the objective of this study was to characterize and evaluate the performance of different peptides from different regions of T. saginata for the cysticercosis diagnosis using enzyme-linked immunosorbent assay. We generated and evaluated a new recombinant protein chimera derived from the fusion of different peptides. We selected three distinct regions of T. saginata and predicted six peptides with antigenic potential (EP2–EP7). These peptides were analyzed individually and selected for generating a new chimeric recombinant protein. The new protein was termed rqTSA-25, and its performance rates were: 93.3% sensitivity (confidence interval (CI) = 76–98%), 95.3% specificity (CI = 82–99%), 93% positive predictive value (CI = 76–98%), 95% negative predictive value (CI = 82–99%), and 95% accuracy. In the immunoblot, this protein showed no false positive or false negative reaction. Thus, the use of rqTSA-25 is recommended for the diagnosis of bovine cysticercosis.

Taenia saginata cysticercosis occurs worldwide. The prevalence related is higher mainly in developing countries, causing damage to public health and economic losses. Through our study, a new antigen with high diagnostic potential was developed for use in laboratory serological tests, aiming at the detection of bovine cysticercosis. In this way, it was possible to contribute significantly to the improvement of the diagnosis of this disease.

Estimating prevalence and diagnostic test characteristics of bovine cysticercosis in Belgium in the absence of a 'gold standard' reference test using a Bayesian approach

A Bayesian model was developed to estimate values for the prevalence and diagnostic test characteristics of bovine cysticercosis (Taenia saginata) by combining results of four imperfect tests. Samples of 612 bovine carcases that were found negative for cysticercosis during routine meat inspection collected at three Belgian slaughterhouses, underwent enhanced meat inspection (additional incisions in the heart), dissection of the predilection sites, B158/B60 Ag-ELISA and ES Ab-ELISA. This Bayesian approach allows for the combination of prior expert opinion with experimental data to estimate the true prevalence of bovine cysticercosis in the absence of a gold standard test. A first model (based on a multinomial distribution and including all possible interactions between the individual tests) required estimation of 31 parameters, while only allowing for 15 parameters to be estimated. Including prior expert information about specificity and sensitivity resulted in an optimal model with a reduction of the number of parameters to be estimated to 8. The estimated bovine cysticercosis prevalence was 33.9% (95% credibility interval: 27.7-44.4%), while apparent prevalence based on meat inspection is only 0.23%. The test performances were estimated as follows (sensitivity (Se) - specificity (Sp)): enhanced meat inspection (Se 2.87% - Sp 100%), dissection of predilection sites (Se 69.8% - Sp 100%), Ag-ELISA (Se 26.9% - Sp 99.4%), Ab-ELISA (Se 13.8% - Sp 92.9%).

High prevalence of bovine cysticercosis found during evaluation of different post-mortem detection techniques in Belgian slaughterhouses

Bovine cysticercosis (BCC), caused by the helminth Taenia saginata, is currently diagnosed solely by official meat inspection (MI) based on macroscopic detection of viable cysticerci or typical lesions of degenerated larvae. MI has a known low sensitivity (<16%), leading to a large proportion of infected cattle carcasses entering the human food chain and posing a risk to public health. Prevalence in Belgium based on MI results is estimated at around 0.22%. Due to the low sensitivity of MI, alternative techniques to detect BCC should be considered. This study evaluates MI, MI with additional incisions in the heart, specific antibody detection against excretory/secretory (E/S) in the Ab-ELISA and circulating antigens in the B158/B60 Ag-ELISA on 715 (101 MI-positive and 614 MI-negative) samples collected from carcasses at slaughterhouses in Belgium. Full dissection of the predilection sites was considered the reference test. During the study, mostly carcasses with (very) light infections were detected containing predominantly degenerated or calcified cysticerci and only few viable cysticerci. Dissection of the predilection sites detected 144 (23%) additional infections in the 614 MI-negative carcasses. When sequentially performing first the dissection of the predilection sites, followed by the Ag-ELISA and the Ab-ELISA, an additional 36% of MI-negative carcasses were found positive for BCC, resulting in a prevalence very much higher than the above mentioned 0.22%. The B158/B60 Ag-ELISA showed a sensitivity of 40% for the detection of carcasses containing viable cysticerci and a specificity of 100%, and detected 70 positive carcasses of which only 14 had been identified as positive during MI. If Ag-ELISA were implemented as a detection technique for BCC in the slaughterhouses, many infected carcasses would still not be detected due to the sensitivity of 40%. But as sensitivity increases with increasing number of cysticerci in the carcass, the infected carcasses passing inspection will be the ones containing only a few viable cysticerci and thus posing a smaller food safety problem. Ag-ELISA is preferred over the ES Ab-ELISA in this study, which had a sensitivity of 13.3% and a specificity of 91.7% in a population with overall low infection burdens.

Identifying wildlife reservoirs of neglected taeniid tapeworms: Non-invasive diagnosis of endemic Taenia serialis infection in a wild primate population

Despite the global distribution and public health consequences of Taenia tapeworms, the life cycles of taeniids infecting wildlife hosts remain largely undescribed. The larval stage of Taenia serialis commonly parasitizes rodents and lagomorphs, but has been reported in a wide range of hosts that includes geladas (Theropithecus gelada), primates endemic to Ethiopia. Geladas exhibit protuberant larval cysts indicative of advanced T. serialis infection that are associated with high mortality. However, non-protuberant larvae can develop in deep tissue or the abdominal cavity, leading to underestimates of prevalence based solely on observable cysts. We adapted a non-invasive monoclonal antibody-based enzyme-linked immunosorbent assay (ELISA) to detect circulating Taenia spp. antigen in dried gelada urine. Analysis revealed that this assay was highly accurate in detecting Taenia antigen, with 98.4% specificity, 98.5% sensitivity, and an area under the curve of 0.99. We used this assay to investigate the prevalence of T. serialis infection in a wild gelada population, finding that infection is substantially more widespread than the occurrence of visible T. serialis cysts (16.4% tested positive at least once, while only 6% of the same population exhibited cysts). We examined whether age or sex predicted T. serialis infection as indicated by external cysts and antigen presence. Contrary to the female-bias observed in many Taenia-host systems, we found no significant sex bias in either cyst presence or antigen presence. Age, on the other hand, predicted cyst presence (older individuals were more likely to show cysts) but not antigen presence. We interpret this finding to indicate that T. serialis may infect individuals early in life but only result in visible disease later in life. This is the first application of an antigen ELISA to the study of larval Taenia infection in wildlife, opening the doors to the identification and description of infection dynamics in reservoir populations.

Although tapeworm parasites of the genus Taenia are globally distributed and inflict enormous socioeconomic and health costs on their hosts, which include humans, little is known about taeniid tapeworms that infect wildlife. This gap in knowledge prevents an assessment of the potential for these parasites to infect humans and production animals and is largely due to the difficulty of conducting standard diagnostic tests on wildlife. To address this gap, we adapted a standard diagnostic assay to be used with dried urine samples. We used urine from geladas, primates endemic to Ethiopia, which are frequently infected with the larval stage of a taeniid tapeworm and exhibit protuberant cysts during advanced infection. The use of this diagnostic test in a wild gelada population allowed us to detect that individuals can be infected without exhibiting observable cysts, and that some individuals may control infection in its early stages. This tool provides information about how a neglected tapeworm functions in a wildlife system and opens the door to the non-invasive identification of tapeworm reservoir hosts that may threaten humans.

Evaluation of a synthetic peptide from the Taenia saginata 18kDa surface/secreted oncospheral adhesion protein for serological diagnosis of bovine cysticercosis

Bovine cysticercosis is a zoonotic infection widely spread throughout Brazil, creating a burden on hygiene maintenance and the economy. Diagnosis of cysticercosis usually relies on post mortem inspection of carcasses in slaughterhouses. This detection method provides only low sensitivity. Recent advancements have improved the performance of serologic tests, such as ELISA, providing greater sensitivity and specificity. The objective of the current study was to identify and evaluate a synthetic peptide derived from the Taenia saginata 18kDa oncospheric surface protein for the diagnosis of bovine cysticercosis in ELISA. Test performance of the identified peptide was compared to an ELISA based on a heterologous crude Taenia crassiceps antigen (Tcra), widely used for the sero-diagnosis of bovine cysticercosis. Based on the primary sequence of an in silico structural model of the 18kDa protein, an epitope region designated EP1 was selected (46-WDTKDMAGYGVKKIEV-61). The peptide derived from this region yielded 91.6% (CI=80-96%) sensitivity and 90% (CI=82-95%) specificity when used in an ELISA, whereas the crude antigen yielded 70% (CI=56-8%) sensitivity and 82% (CI=73-89%) specificity. Thus, we conclude that EP1 has higher diagnostic potential for detecting bovine cysticercosis than the crude antigen Tcra.

Risk factors for Taenia saginata cysticercus infection in cattle in the United Kingdom: A farm-level case-control study and assessment of the role of movement history, age and sex

Bovine cysticercosis is caused by Taenia saginata cysticercus, the larval stage of the human tapeworm Taenia saginata. Recent European initiatives have highlighted the poor sensitivity of current surveillance for this parasite in cattle at slaughter; calling for more targeted, risk based and cost effective methods of T. saginata cysticercus detection. The aim of this study was to provide evidence that could inform such improved meat inspection activities in the United Kingdom (UK). The study included three components: (i) a farm-level case control study; (ii) the characterization of the network of movements of T. saginata cysticercus infected and non-infected animals, and an assessment of the strength of association between having passed through a farm that had previously originated an infected animal and the risk of infection; (iii) the assessment of the relationship between bovine age and gender and risk of infection. Abattoir records and cattle movement history data were used to identify farms of likely acquisition of infection (case farms) and a suitable control group. A questionnaire was used to gather farm-level characteristics and logistic regression was carried out to identify farm-level risk factors for the production of cattle found to be infected at slaughter. The case-control study provided evidence that farms situated close to a permanent potential source of human faecal contamination, and farms which used manure from animals other than cattle, were at higher risk of producing cattle later found to be infected with T. saginata cysticercus at slaughter. No other farm characteristics were identified as a risk factor for this. Analysis of the networks of animal movements showed that some individual farms played a key role as a source of T. saginata cysticercus infection; it was estimated that cattle with a history of being on a farm which previously appeared in the movement history of an infected animal were 4.27 times (P<0.001; 95% CI: 3.3-5.52) more likely to be diagnosed with T. saginata cysticercus infection at meat inspection. Male cattle aged 20 months or younger at the time of slaughter were found at lower risk of T. saginata cysticercus infection by comparison to other sex or age groups of cattle. These results, in combination with the consultation of experts and stakeholders, led to the conclusion that abattoir-based surveillance in low T. saginata cysticercus prevalence settings, such as Great Britain, could be made more targeted by stratifying cattle based on their individual movement history, sex and age characteristics.

Assessment of the repeatability and border-plate effects of the B158/B60 enzyme-linked-immunosorbent assay for the detection of circulating antigens (Ag-ELISA) of Taenia saginata

The monoclonal antibody-based circulating antigen detecting ELISA (B158/B60 Ag-ELISA) has been used elaborately in several studies for the diagnosis of human, bovine and porcine cysticercosis. Interpretation of test results requires a good knowledge of the test characteristics, including the repeatability and the effect of the borders of the ELISA plates. Repeatability was tested for 4 antigen-negative and 5 antigen-positive reference bovine serum samples by calculating the Percentage Coefficient of Variation (%CV) within and between plates, within and between runs, overall, for two batches of monoclonal antibodies and by 2 laboratory technicians. All CV values obtained were below 20% (except one: 24.45%), which indicates a good repeatability and a negligible technician error. The value of 24.45% for indicating the variability between batches of monoclonal antibodies for one positive sample is still acceptable for repeatability measures. Border effects were determined by calculating the %CV values between the inner and outer wells of one plate for 2 positive serum samples. Variability is a little more present in the outer wells but this effect is very small and no significant border effect was found.

Epidemiology, impact and control of bovine cysticercosis in Europe: a systematic review

BACKGROUND

Bovine cysticercosis in Europe has been known for centuries but the data showing the occurrence of this zoonosis are scarce. The aim of this paper is to review and present the current knowledge on bovine cysticercosis in Europe.

METHODS

We conducted a systematic review of studies published between 1990 and November 2014. Qualitative and quantitative data on prevalence, risk factors, burden and interventions were extracted and analysed.

RESULTS

Reports on prevalence were available for 23 European countries, mostly from western and central Europe; for a few of these only data before 1990 were available. Prevalence based on meat inspection was generally low (below 6.2% in 95% of the records) and varied between and within countries. Serology and detailed meat inspection provided a higher prevalence range (0.41-14%). Only few studies analysing risk factors were identified. Reported factors related to access to pastures and risky waters, dairy production and uncontrolled human defecation in the proximity of the farm among others. Only one estimate of the economic impact of the disease could be identified. Recommended interventions were focused on increasing diagnostic tests sensitivity or the application of risk based surveillance strategies.

CONCLUSIONS

There is a lack of complete and updated data on most countries, especially in eastern Europe. Further risk factor studies might be needed together with estimates on the burden of the disease in all European countries. Risk-based interventions are being encouraged but current data are limited to guide this approach.

Six-Year Follow-up of Slaughterhouse Surveillance (2008-2013): The Catalan Slaughterhouse Support Network (SESC)

Meat inspection has the ultimate objective of declaring the meat and offal obtained from carcasses of slaughtered animals fit or unfit for human consumption. This safeguards the health of consumers by ensuring that the food coming from these establishments poses no risk to public health. Concomitantly, it contributes to animal disease surveillance. The Catalan Public Health Protection Agency (Generalitat de Catalunya) identified the need to provide its meat inspectors with a support structure to improve diagnostic capacity: the Slaughterhouse Support Network (SESC). The main goal of the SESC was to offer continuing education to meat inspectors to improve the diagnostic capacity for lesions observed in slaughterhouses. With this aim, a web-based application was designed that allowed meat inspectors to submit their inquiries, images of the lesions, and samples for laboratory analysis. This commentary reviews the cases from the first 6 years of SESC operation (2008-2013). The program not only provides continuing education to inspectors but also contributes to the collection of useful information on animal health and welfare. Therefore, SESC complements animal disease surveillance programs, such as those for tuberculosis, bovine cysticercosis, and porcine trichinellosis, and is a powerful tool for early detection of emerging animal diseases and zoonoses.

Usefulness of serological ELISA assay for Taenia saginata to detect naturally infected bovines

Bovine cysticercosis, a cosmopolitan disease caused by Taenia saginata, leads to economic losses due to carcass devaluation at slaughter. Sanitary inspection at slaughterhouses, the routine diagnostic method in Brazil, lacks the necessary sensitivity to detect the mildly infected cattle that are typically encoutered in Brazil. In this study we have tested cattle sera from animals diagnosed as positive and negative by veterianry inspection for (1) anti-parasite antibodies using metacestodes antigens (T. solium vesicular fluid and T. saginata secretions) and (2) the HP10 secreted antigen of viable metacestodes. The cut-off values were calculated by ROC curve for intense and mild infections conditions, and by the classical method ( for negative samples). The sensitivity and specificity of these diagnostic tests were different depending on the assumed cut-off value and, importantly, whether the infection was mild or intense. In spite of these observations, however, such ELISA assays for serum antibodies and parasite antigens constitute an important tool for epidemiological porposes, and in establishing priorities for the control of bovine cysticercosis.

Multi-test analysis and model-based estimation of the prevalence of Taenia saginata cysticercus infection in naturally infected dairy cows in the absence of a 'gold standard' reference test

The diagnostic values of seven serological tests (ELISAs) and of the obligatory European Union-approved routine visual meat inspection for the detection of Taenia saginata cysticercosis were investigated. A total of 793 slaughtered dairy cows were selected in three European Union approved abattoirs in Switzerland, an endemic area (apparent prevalence by enhanced meat inspection up to 4.5%) with typically low parasite burdens. ELISAs based on a somatic larval antigen, isoelectric focused somatic larval antigen, larval excretory/secretory antigens, peptide HP6-2, peptide Ts45S-10, pooled peptide solution and a monoclonal antibody antigen capture assay were initially screened. As there is no perfect diagnostic 'gold standard' reference test, the obligatory meat inspection and four selected serological tests were further analysed using Bayesian inference to estimate the "true" prevalence and the diagnostic test sensitivities and specificities. The ELISA for specific antibody detection based on excretory/secretory antigens showed highest sensitivity and specificity with 81.6% (95% credible interval: 70-92) and 96.3% (95% credible interval: 94-99), respectively. The Bayesian model estimated the specificity of the ELISA, based on the synthetic peptide Ts45S-10 as 55.2% (95% credible interval: 46-65) and sensitivity as 84.7% (95% credible interval: 82-88). The sensitivity of the ELISA based on mAbs, detecting circulating antigen, was 14.3% (95% credible interval: 9-23) with a specificity of 93.7% (95% credible interval: 92-96). The diagnostic sensitivity of the obligatory standard European Union meat inspection procedure for the detection of T. saginata cysticercus infection at the abattoir was estimated to be 15.6% (95% credible interval: 10-23). Based on these data, the modelled prevalence of cysticercosis in dairy cows presented at abattoirs in Switzerland was estimated to be 16.5% (95% credible interval: 13-21). These cattle also had a high prevalence of infection with Dicrocoelium dendriticum (60.8%) and Fasciola hepatica (13.5%).