Mapping the residual incidence of taeniasis and cysticercosis in Colombia, 2009-2013, using geographical information systems: Implications for public health and travel medicine

A case report of disseminated cysticercosis in Guangxi Zhuang Autonomous Region, Southwest China

BACKGROUND

Cysticercosis is a zoonotic parasitic disease that poses a serious threat to public health. It is widely distributed and has a high incidence rate in China. Reports of disseminated cysticercosis worldwide are rare. This article presents a case of disseminated cysticercosis in the Guangxi Zhuang Autonomous Region of southwestern China.

CASE PRESENTATION

The patient, a 46-year-old male belonging to the Miao ethnic group, hailed from a region in Guangxi Zhuang Autonomous Region known for its high incidence of cysticercosis. He had a habit of consuming raw pork and beef. With a history of recurrent consciousness disturbances and limb convulsions for five years, he presented with headaches and dizziness nine days prior. Comprehensive examinations were conducted on the patient. Ultimately, based on epidemiological history, imaging findings, pathogen testing, and pathological results, he was diagnosed with disseminated cysticercosis. Following anthelmintic treatment, the patient was discharged with clear consciousness, free from headaches, dizziness, nausea, vomiting, and seizures. The patient is currently under follow-up care.

CONCLUSION

It is crucial to enhance public awareness, promote health education, and cultivate good hygiene habits, as these are essential measures in reducing the incidence of cysticercosis.

The Frequency of Porcine Cysticercosis and Factors Associated with Taenia solium Infection in the Municipality of Tuchín-Córdoba, Colombia

Taeniasis and cysticercosis are parasitic infections that affect humans and pigs. Their global distribution constitutes a serious public health issue with significant implications for pork production. The purpose of this study was to evaluate the presence of porcine cysticercosis in backyard swine from 42 indigenous communities throughout Tuchín-Córdoba, Colombia. Between December 2020 and March 2021, free-range pigs (n = 442) were assessed using the ELISA cysticercosis Ag test; 85 pigs were examined through sublingual visual evaluation, and 4 slaughtered pig carcasses were subjected to standard operation inspection. The collected cysticercus underwent histological and PCR analysis. Furthermore, 192 surveys of knowledge, attitudes, and practices (KAP) were used to identify the factors that facilitate infection transmission. Serological investigation revealed that 9.7% (46/472) of the animals were positive for cysticerci Ag. Sublingual inspection identified cysticercus in 28.7% (25/87) of the animals, while PCR analysis indicated that cysticercus corresponded to the T. solium American/African genotype. The factors associated with T. solium infection in the pigs in the surveyed areas numbered 14. The majority are associated with factors that promote the active persistence of Taenia solium's life cycle in an area, such as lack of environmental sanitation, a lack of coverage or care for drinking water and wastewater treatment services, and no solid waste disposal.

Preformulation and Long-Term Stability Studies of an Optimized Palatable Praziquantel Ethanol-Free Solution for Pediatric Delivery

To date, the treatment for cysticercosis and neurocysticercosis consists of a single oral intake of praziquantel (5-10 mg/kg), which since it is only available as tablets, hinders its administration to pediatric patients. Praziquantel is a poorly water-soluble drug which represents a challenge for its formulation in solution, particularly for the pediatric population. Thus, this study aimed to develop a palatable solution for praziquantel using pharmaceutical-accepted co-solvent systems. A design of experiments approach was applied to identify the optimal conditions for achieving a suitable amount of praziquantel in solution using co-solvent mixtures. Thus, praziquantel solubility increased from 0.38 up to 43.50 mg/mL in the optimized system. A taste masking assay in healthy human volunteers confirmed a successful reduction of drug bitterness after the addition of selected flavors and a sweetener. Stability studies were also conducted at different temperatures (4, 25, and 40 °C) for 12 months Even though the presence of the three known impurities of praziquantel was observed, their amounts never exceeded the acceptance criteria of the USP. Thus, this novel approach should be considered a valuable alternative for further preclinical studies considering the high prevalence of this infection worldwide.

Neurocysticercosis in Latin America: Current epidemiological situation based on official statistics from four countries

Background

Neurocysticercosis (NC) is one of the major parasitic diseases affecting the central nervous system and is endemic in much of Asia, sub-Saharan Africa, and Latin America. Its epidemiology is difficult to assess, although official registries are available in Brazil, Colombia, Ecuador, and Mexico.

Methodology/Principal findings

Using official statistics, we assessed trends in NC hospitalization rates during 1998–2019 in Brazil and Ecuador, during 2004–2019 in Mexico, and during 2009–2019 in Colombia. We also assessed the trend in NC mortality in Brazil (1998–2019), the trend in hospitalizations for NC in a Mexican tertiary-level hospital (Instituto Nacional de Neurología y Neurocirugía [INNN]; 1995–2019), and in Mexican primary care ambulatory clinics (1995–2019). Associations between NC hospitalization rates and the human development index (HDI) were also examined.

In Brazil, Ecuador, and Mexico, statistically significant decreases in NC hospitalization rates were observed. In Mexico, a significant increase in the age of patients at INNN was observed, suggesting a decreasing incidence of recent infection. Conversely, a significant increase in NC hospitalization rate was observed in Colombia. HDI was not significantly associated with NC hospitalization rates when adjusting for time.

Conclusions

The downward trends in NC cases in Brazil, Ecuador, and Mexico are encouraging, especially in the context of the PAHO/WHO plan of action to eliminate neglected tropical diseases from the region. On the other hand, in Colombia, the increased NC hospitalization rate is concerning and needs further evaluation so that the authorities can take specific measures. These results should encourage health authorities in other endemic countries to establish a system of official registries to identify where the need for a control program is most urgent. However, it is also important to remember that NC persists, although less frequently in some Latin American countries, and efforts to achieve its control must continue.

The present work shows the current trends in the frequency of neurocysticercosis hospitalizations in four endemic Latin American countries. Neurocysticercosis is a parasitic disease of the central nervous system that has been historically linked to poverty and poor sanitation. It is one of the neglected tropical diseases included in the PAHO/WHO action plan for their elimination. We compiled official data available from Brazil, Colombia, Ecuador, and Mexico. Our results show a clear and significant reduction in the disease burden in 3 of the 4 countries included. On the other hand, in Colombia, an increase in incidence was observed. These mixed results are of great relevance. They allow us to be optimistic about the possibility of eliminating this disease in some countries, but also allow us to consider why the disease does not seem to be controlled in other countries and direct public health measures aimed at eliminating this parasite in the countries that need it most.

Spatial distribution and risk factors for human cysticercosis in Colombia

Background

Cysticercosis is a zoonotic neglected tropical disease (NTD) that affects humans and pigs following the ingestion of Taenia solium eggs. Human cysticercosis poses a substantial public health burden in endemic countries. The World Health Organization (WHO) aims to target high-endemicity settings with enhanced interventions in 17 countries by 2030. Between 2008 and 2010, Colombia undertook a national baseline serosurvey of unprecedented scale, which led to an estimated seroprevalence of T. solium cysticercus antibodies among the general population of 8.6%. Here, we use contemporary geostatistical approaches to analyse this unique dataset with the aim of understanding the spatial distribution and risk factors associated with human cysticercosis in Colombia to inform how best to target intervention strategies.

Methods

We used a geostatistical model to estimate individual and household risk factors associated with seropositivity to T. solium cysticercus antibodies from 29,253 people from 133 municipalities in Colombia. We used both independent and spatially structured random effects at neighbourhood/village and municipality levels to account for potential clustering of exposure to T. solium. We present estimates of the distribution and residual correlation of seropositivity at the municipality level.

Results

High seroprevalence was identified in municipalities located in the north and south of Colombia, with spatial correlation in seropositivity estimated up to approximately 140 km. Statistically significant risk factors associated with seropositivity to T. solium cysticercus were related to age, sex, educational level, socioeconomic status, use of rainwater, consumption of partially cooked/raw pork meat and possession of dogs.

Conclusions

In Colombia, the distribution of human cysticercosis is influenced by socioeconomic considerations, education and environmental factors related to the spread of T. solium eggs. This information can be used to tailor national intervention strategies, such as targeting spatial hotspots and more highly exposed groups, including displaced people and women. Large-scale seroprevalence surveys accompanied by geospatial mapping are an essential step towards reaching the WHO’s 2021‒2030 NTD roadmap targets.

Graphical Abstract

Supplementary Information

The online version contains supplementary material available at 10.1186/s13071-021-05092-8.

Spatio-temporal distribution characteristics of cysticercosis from 2000 to 2014 in Dali, Yunnan province, China

Cysticercosis remains a public health problem in China, with disease prevalence attributed to poor socio-economic and public health conditions. This parasitic food-borne disease was prioritized for effective control following implementation of the national surveys on parasitic diseases carried out in China. We predicted the cysticercosis distribution in Dali, Yunnan Province by assessing spatio-temporal distribution characteristics between 2000 and 2014 to better understand the trend of the disease incidence. A database of cysticercosis cases was provided by the clinical department at the Dali Prefectural Institute of Research and Control of Schistosomiasis. Describing the epidemiological features of cysticercosis and analyzing its spatiotemporal distribution of cases using mapping, scanning and spatial autocorrelation analysis, our findings found a total of 3,347 patients with cysticercosis infection, neurocysticercosis in particular. Cysticercosis prevalence was the highest among young and middle-aged male farmers, and also predominant among the Bai nationality. Three aggregation areas were identified during the period 2000-2014. Hotspot analysis implicated Dali City, Eryuan County and Yangbi County between 2000 and 2007, with areas gradually shifting towards the western and northern parts of the province. The hotspot map indicated that Eryuan County was a constant problem with respect to cysticercosis. The results indicated three cysticercosis clusters in Dali that could be attributed to environmental factors and unhealthy lifestyles. Multi-sectoral control initiatives are, therefore, recommended in these areas to effectively control and prevent cysticercosis among the population.

Zoonotic Taenia infections with focus on cysticercosis due to Taenia solium in swine and humans

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.

Availability of secondary healthcare data for conducting pharmacoepidemiology studies in Colombia: A systematic review

Real-world evidence (RWE) is emerging as a fundamental component of the post-marketing evaluation of medicinal products. Even though the focus on RWE studies has increased in Colombia, the availability of secondary data sources to perform this type of research is not well documented. Thus, we aimed at identifying and characterizing secondary data sources available in Colombia. We performed a systematic literature review on PubMed, EMBASE, and VHL using a combination of controlled vocabulary and keywords for the concepts of electronic health records, epidemiologic studies and Colombia. A total of 323 publications were included. These comprised 123 identified secondary data sources including pharmacy dispensing databases, government datasets, disease registries, insurance databases, and electronic heath records, among others. These data sources were mostly used for cross-sectional studies focused on disease epidemiology in a specific population. Almost all databases (95%) contained demographic information, followed by pharmacological treatment (44%) and diagnostic tests (39%). Even though the database owner was identifiable in 94%, access information was only available in 44% of the articles. Only a pharmacy-dispensing database, local cancer registries, and government databases included a description regarding the quality of the information available. The diversity of databases identified shows that Colombia has a high potential to continue enhancing its RWE strategy. Greater efforts are required to improve data quality and accessibility. The linkage between databases will expand data pooling and integration to boost the translational potential of RWE.

Imported cysticercosis in Spain: A retrospective case series from the +REDIVI Collaborative Network

BACKGROUND

Neurocysticercosis (NCC) is the most common parasitic neurological disease worldwide and a major cause of epilepsy. Spain is the country reporting the highest number of NCC imported cases in Europe.

METHODOLOGY

Retrospective case series of NCC patients registered in the +REDIVI Network from October 1, 2009 to July 2018. A specific questionnaire, including clinical and diagnostic characteristics, was created and sent to the collaborator centers.

RESULTS

46 cases were included in the analysis. 55% were male, mean age of 40 years. 95.6% were migrants. The median duration since migration from an endemic area was 10 years. Predominant nationalities were Ecuadorians (50%) and Bolivians (30.4%). Frequent locations were parenchymal (87%), subarachnoid (26.1%) and intraventricular cysts (10.9%). Serological analysis was performed in 91.3%, being 54.8% positive. Most prevalent clinical manifestations were persistent headache (60.9%), epilepsy (43.5%) and visual changes (13%). Patients were mainly treated with albendazole (76.1%), corticosteroids (67.4%), and anticonvulsionants (52.2%). 82.5% had a favorable clinical outcome.

CONCLUSIONS

Most NCC cases were long-standing migrants. Few clinical differences were observed depending on the cysticerci location. The treatment was often not according to current recommendations, and no uniform criteria were followed when it came to the therapeutic regimen. NCC case management in Spain (including clinician awareness and laboratory capacity improvements) needs to be strengthened.

Human taeniasis infection (Taenia saginata): a complex public health problem. Case report

Introduction: Taeniasis is a zoonosis that can be found worldwide. It is relatively easy to diagnose and its treatment is currently effective. This paper describes the follow-up of a case with persistent refractory taeniasis.Case description: A 31-year-old female patient, street-food seller, was diagnosed with taeniasis when she was 21 years old. Since she was diagnosed, multiple treatments were administered, including albendazole, secnidazole, pirantel pamoato and several metronidazole schemes, which resulted in a partial improvement of the symptoms. In 2018, she expelled a parasite of ~1 meter in length, later described as Taenia saginata; praziquantel was prescribed, but it is not available in Colombia. The patient was referred to the Parasitology Service, and based on her medical history and a scientific review of literature, nitazoxanide (500mg, twice a day, for 3 days) and albendazole (400mg per day, for 3 days) were administered, eliminating the infection and improving the patient’s quality of life.Discussion: This case exposes two important clinical aspects. The first is the difficulty of monitoring and treating taeniasis cases. The second is the presence of persistent refractory taeniasis cases.Conclusion: Secondary, tertiary and combination drugs are available for effective and safe treatment of taeniasis. However, there is a need to conduct further studies to achieve better diagnosis, prevention, education and control.

Oroya Fever, Verruga Peruana, and Other Bartonelloses Incidence Rates in Colombia (2009-2013)

Background

Bartonella bacilliformis, the etiological agent of Carrion's disease and presumed to be transmitted by phlebotomine sandflies, is endemic to the high-altitude valleys of the South American Andes, including Colombia.

Methods

This observational, retrospective study in which the incidence of bartonelloses (International Classification of Diseases, 10th revision (ICD-10) codes A44.0-A44.9) in Colombia, from 2009-2013, was estimated based on data extracted from the personal health records system (Registro Individual Prestación Servicios, RIPS). Using the official population estimates of the National Statistics Department (Departamento Administrativo Nacional de Estadísticas, DANE), crude and adjusted incidence rates were estimated (cases/100,000 population).

Results

A total of 1,389 cases were reported (median 289/year), for a cumulative national rate of 3.02 cases/100,000 population; 91.2% were female; 66.8% were <40-year-old (3.8% <9.9-year-old). The cases were 2.9% Oroya fever (A44.0), 13.1% verruga peruana (A44.1), and the rest (85.3%) were other forms of bartonelloses (A44.8-A44.9). The highest rates of Oroya fever were reported in Bolivar (2.5 cases/1,000,000 population). For verruga peruana highest number of cases were reported in Antioquia (32; 17.8%; 5.21 cases/1,000,000 population) and the highest rate at Magdalena (11.54 cases/1,000,000 population) (Risaralda, 6.45; Caldas, 5.1). For other forms of bartonelloses, the highest rates were reported at Magdalena (48.65 cases/1,000,000 population), followed by Huila (32.8) and La Guajira (18.9). At Nariño, Putumayo, Amazonas, Cauca, and Valle del Cauca, 11.7% of the cases of the country were reported.

Conclusions

Lutzomyia columbiana, the potential vector of Bartonella bacilliformis in Colombia, is distributed not only in Nariño, Cauca, and Valle del Cauca but also in the Antioquia, Caldas, Huila, La Guajira, Risaralda, Cordoba, and Caribbean areas. Given this distribution, the transmission would be occurring, as seen in reported cases, in more areas than previously described by classic reports of these diseases in the country.

Epidemiology of Taenia saginata taeniosis/cysticercosis: a systematic review of the distribution in the Americas

BACKGROUND

The distribution of Taenia saginata in the Americas is unclear. Establishing the distribution, economic burden, and potentials for control of bovine cysticercosis is increasingly important due to the growing demand for beef. This paper aims to take the first step and reviews the recent distribution of T. saginata taeniosis and bovine cysticercosis on a national level within the Americas.

METHODS

We undertook a systematic review of published and grey literature for information on the occurrence, prevalence, and geographical distribution of bovine cysticercosis and human taeniosis in the 54 countries and territories of the Americas between January 1st, 1990 and December 31st, 2017. Data on bovine cysticercosis from OIE reports from 1994 to 2005 were also included.

RESULTS

We identified 66 papers from the Americas with data on the occurrence of taeniosis or bovine cysticercosis and an additional 19 OIE country reports on bovine cysticercosis. Taeniosis was reported from 13 countries, with nine of these countries reporting specifically T. saginata taeniosis, and four countries reporting non-species specific taeniosis. The reported prevalence of taeniosis ranged between 0.04-8.8%. Bovine cysticercosis was reported from 19 countries, nine identified through the literature search, and an additional 10 identified through the OIE country reports for notifiable diseases. The reported prevalence of bovine cysticercosis ranged between 0.1-19%. Disease occurrence was restricted to 21 countries within the Americas, the majority from the mainland, with the only island nations reporting either bovine cysticercosis or taeniosis being Cuba, Haiti, and the US Virgin Islands.

CONCLUSIONS

Taenia saginata is widely distributed across 21 of the 54 countries in the Americas, but insufficient epidemiological data are available to estimate the subnational spatial distribution, prevalence, incidence and intensity of infections. This needs to be addressed through active surveillance and disease detection programmes. Such programmes would improve the data quantity and quality, and may enable estimation of the economic burden due to bovine cysticercosis in the region in turn determining the requirement for and cost-effectiveness of control measures.