Control of the taeniosis/cysticercosis complex: Future developments

Serological and molecular detection of neurocysticercosis among epileptic patients in Nagpur, Maharashtra state (India)

Neurocysticercosis (NCC), one of the most important neuroparasitic diseases in humans, is caused by Cysticercus cellulosae, the metacestode stage of digenetic zoonotic cestode Taenia solium. The present study aims at the detection of anti-cysticercus antibodies in the sera of epileptic patients (n=26) visiting a tertiary care hospital in Nagpur, Maharashtra state, India, by an in-house developed indirect IgG-ELISA and enzyme-linked immunoelectro transfer blot (EITB) assay using different antigens (namely, Whole Cyst Antigen (WCA), Cystic Fluid Antigen (CFA), Scolex Antigen (SA), Excretory-Secretory Antigen (ESA) and Membrane-Body Antigen (MBA)) prepared from T. solium metacestodes to find out the status of NCC. An attempt has also been made for molecular detection of NCC from blood samples of those patients by Polymerase Chain Reaction (PCR) assay targeted at large subunit rRNA gene of T. solium. The IgG ELISA level of anti-cysticercus antibodies against WCA, CFA, SA, ESA and MBA antigens were as follows: 19.23 %, 23.07 %, 38.46 %, 30.76 % and 15.38 %. The seroreactivity to CFA, SA and ESA was found in equal proportions in patients with ring-enhancing lesions. In the EITB assay, the lower and medium molecular weight protein bands of SA and ESA were immunodominant compared to the higher WCA and CFA peptides. PCR positivity could be observed in 34.6 % (9/26) of the patients under study. It is the first report of detecting NCC among epileptic patients of the Nagpur region of Maharashtra state in India using serological and molecular tools.

Potential control of the infective stage of Taenia pisiformis using Bacillus thuringiensis GP526 strain

The GP526 strain of Bacillus thuringiensis has been referred as an in vitro helminthicide on various stages of Dipylidium caninum and Centrocestus formosanus. Our study addresses the in vitro ovicidal activity of GP526 strain spore-crystal complex on Taenia pisiformis eggs, evaluating induced damage microscopically. The eggs exposed to the total extract containing spores and crystals show damage after 24 hours, with loss of integrity on the eggshell, and an ovicidal activity of 33% at 1mg/ml. The destruction of the embryophore was observed after 120 h with a 72% of ovicidal activity at 1 mg/ml. The LC50 was 609.6 μg/ml, dose that causes a 50% of lethality on the hexacanth embryo, altering the oncosphere membrane. The spore-crystal proteins were extracted, and the protein profile was obtained by electrophoresis, finding a major band of 100 kDa suggestive of an S-layer protein, since an S-layer was immunodetected in both, spores and extracted proteins. The protein fraction containing the S-layer protein presents adhesion to the T. pisiformis eggs, and 0.4 mg/ml of the protein induces a lethality of 21.08% at 24 h. The characterization of molecular mechanisms of ovicidal activity will be an important contribution, so the characterization of the proteins that make up the extract of the GP526 strain, would be useful to support the biological potential for control of this cestodiasis and other parasitosis. B. thuringiensis is shown as a potent helminthicide on eggs, with useful potential for biological control of this cestodiasis.

The prevalence of and contributors to neurocysticercosis in endemic regions

BACKGROUND

Neurocysticercosis is one of the most common causes of acquired epilepsy worldwide. Caused by Taenia solium, the infection uses pigs as an intermediate host and thus is often associated with proximity to and consumption of pigs.

OBJECTIVE

This review explores the epidemiology of neurocysticercosis in endemic regions across Africa, Asia, and Latin America and examines common risk factors in these areas.

METHODS

A literature review was conducted using pubmed to search for articles with key words including neurocysticercosis, Taenia, solium, epidemiology, and the names of countries and continents in the regions of interest.

FINDINGS

Multiple risk factors for neurocysticercosis were identified, including inadequate regulation of pig farms and food safety, poor sanitation, and water contamination. In addition, additional barriers to appropriate diagnosis and management were found, including resource limitations and poor health literacy.

CONCLUSION

Despite its global prevalence, effective limitation of neurocysticercosis is still achievable through projects which address common risk factors.

The Genomes of Two Strains of Taenia crassiceps the Animal Model for the Study of Human Cysticercosis

Human cysticercosis by Taenia solium is the major cause of neurological illness in countries of Africa, Southeast Asia, and the Americas. Publication of four cestode genomes (T. solium, Echinococcus multilocularis, E. granulosus and Hymenolepis microstoma) in the last decade, marked the advent of novel approaches on the study of the host-parasite molecular crosstalk for cestode parasites of importance for human and animal health. Taenia crassiceps is another cestode parasite, closely related to T. solium, which has been used in numerous studies as an animal model for human cysticercosis. Therefore, characterization of the T. crassiceps genome will also contribute to the understanding of the human infection. Here, we report the genome of T. crassiceps WFU strain, reconstructed to a noncontiguous finished resolution and performed a genomic and differential expression comparison analysis against ORF strain. Both strain genomes were sequenced using Oxford Nanopore (MinION) and Illumina technologies, achieving high quality assemblies of about 107 Mb for both strains. Dotplot comparison between WFU and ORF demonstrated that both genomes were extremely similar. Additionally, karyotyping results for both strains failed to demonstrate a difference in chromosome composition. Therefore, our results strongly support the concept that the absence of scolex in the ORF strain of T. crassiceps was not the result of a chromosomal loss as proposed elsewhere. Instead, it appears to be the result of subtle and extensive differences in the regulation of gene expression. Analysis of variants between the two strains identified 2,487 sites with changes distributed in 31 of 65 scaffolds. The differential expression analysis revealed that genes related to development and morphogenesis in the ORF strain might be involved in the lack of scolex formation.

A statistical evaluation of the oral vaccine S3pvac papaya against cysticercosis of taenia psiformis

The objective of this paper is to compare and evaluate statistically the behavior of two vaccines against cysticercus in a sample of female rabbits. The two vaccines under discussion are 1) S3Pvac-Papaya12 mg and 2) Wild Type (WT) or S3P Wild and also 3) Saline Solution. The challenge is to show that the developed vaccine, S3Pvac-Papaya, produces more antibodies and with better stability than the other vaccine and saline solution. With the aim of proving this conjecture, an analysis of variance (ANOVA) and multiple Fisher comparisons at 95% confidence were performed. The vaccine of interest, S3Pvac-Papaya, revealed in the box diagram at T2 that the development of antibodies was high and showed little dispersion, which implies that the vaccine S3Pvac Papaya is statistically efficient in the production of antibodies. Finally, the mathematical contribution centers on highlighting the low use of inferential statistical techniques, comparing means of generated antibodies by a set of vaccines in order to determine which one is more efficient and reliable. Tacitly, a methodology both statistical and procedural has been proposed along this work, to apply when contrasting other kinds of vaccines in both animals and humans for diverse conditions.

Optimal control analysis of Taenia saginata bovine cysticercosis and human taeniasis

Bovine cysticercosis and human taeniasis are neglected food-borne diseases that pose challenge to food safety, human health and livelihood of rural livestock farmers. In this paper, we have formulated and analyzed a deterministic model for transmission dynamics and control of taeniasis and cysticercosis in humans and cattle respectively. The analysis shows that both the disease free equilibrium (DFE) and endemic equilibrium (EE) exist. To study the dynamics of the diseases, we derived the basic reproduction number R 0 by next generation matrix method which shows whether the diseases die or persist in humans and cattle. The diseases clear if R 0 < 1 and persist when R 0 > 1. The normalized forward sensitivity index is used to derive sensitive indices of model parameters. Sensitivity analysis results indicate that human's and cattle's recruitment rates, infection rate of cattle from contaminated environment, probability of humans to acquire taeniasis due to consumption of infected meat, defecation rate of humans with taeniasis and the consumption rate of raw or undercooked infected meat are the most positive sensitive parameters whereas the natural death rates for humans, cattle, Taenia saginata eggs and the proportion of unconsumed infected meat are the most negative sensitive parameters in diseases' transmission. These results suggest that control measures such as improving meat cooking, meat inspection and treatment of infected humans will be effective for controlling taeniasis and cysticercosis in humans and cattle respectively. The optimal control theory is applied by considering three time dependent controls which are improved meat cooking, vaccination of cattle, and treatment of humans with taeniasis when they are implemented in combination. The Pontryagin's maximum principle is adopted to find the necessary conditions for existence of the optimal controls. The Runge Kutta order four forward-backward sweep method is implemented in Matlab to solve the optimal control problem. The results indicate that a strategy which focuses on improving meat cooking and treatment of humans with taeniasis is the optimal strategy for diseases' control.

Plasminogen-binding proteins as an evasion mechanism of the host's innate immunity in infectious diseases

Pathogens have developed particular strategies to infect and invade their hosts. Amongst these strategies’ figures the modulation of several components of the innate immune system participating in early host defenses, such as the coagulation and complement cascades, as well as the fibrinolytic system. The components of the coagulation cascade and the fibrinolytic system have been proposed to be interfered during host invasion and tissue migration of bacteria, fungi, protozoa, and more recently, helminths. One of the components that has been proposed to facilitate pathogen migration is plasminogen (Plg), a protein found in the host’s plasma, which is activated into plasmin (Plm), a serine protease that degrades fibrin networks and promotes degradation of extracellular matrix (ECM), aiding maintenance of homeostasis. However, pathogens possess Plg-binding proteins that can activate it, therefore taking advantage of the fibrin degradation to facilitate establishment in their hosts. Emergence of Plg-binding proteins appears to have occurred in diverse infectious agents along evolutionary history of host–pathogen relationships. The goal of the present review is to list, summarize, and analyze different examples of Plg-binding proteins used by infectious agents to invade and establish in their hosts. Emphasis was placed on mechanisms used by helminth parasites, particularly taeniid cestodes, where enolase has been identified as a major Plg-binding and activating protein. A new picture is starting to arise about how this glycolytic enzyme could acquire an entirely new role as modulator of the innate immune system in the context of the host–parasite relationship.

Taenia solium cysticercosis in West Africa: status update

Cysticercosis is caused by the larvae of the cestode Taenia solium. Few data are available on the prevalence of this disease in pigs and humans in West African countries. The aim of this study was to provide an overview of existing data concerning the spread of this parasitosis in the countries of the Economic Community of West African States (ECOWAS) on the basis of the literature published over the last five decades. Systematic searches for publications were carried out on PubMed and Google Scholar, as well as in certain regional and local journals. From a total of 501 articles initially retrieved concerning T. solium cysticercosis in West African countries, only 120 articles were relevant for this review and therefore finally retained. For pigs, only eight out of sixteen countries of the region have reported porcine cysticercosis. Post-mortem examination of carcasses at slaughterhouses, meat inspection at butcheries or tongue inspection in herds have been the main source of data, but may not entirely reflect actual parasite distribution. For humans, only five out of sixteen countries reported epidemiological data on neurocysticercosis. Most data referred to neurocysticercosis prevalence among epileptic patients or isolated clinical cases. Furthermore, existing data are often old. Overall, T. solium cysticercosis remains largely neglected in West Africa, and its prevalence appears not to be affected by any religion in particular. There is an urgent need to promote and implement health partnerships and programs on this disease in order to collect more data and identify sensitive populations in the countries of the ECOWAS area.

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

BACKGROUND

In Colombia, taeniasis and cysticercosis have been significantly reduced over the past decades, however still reported with implications for public health and travel medicine.

METHODS

An observational, retrospective study, in which the incidence of taeniasis and cysticercosis (ICD-10 codes B68s/B69s) in Colombia, 2009-2013, was estimated based on data extracted from the Individual Health Records System (Registro Individual de Prestación de Servicios, RIPS) was performed. The Geographic Information System (GIS) generated national maps showing the distribution of taeniasis and cysticercosis by department by year.

RESULTS

During the period, 3626 cases were reported (median 796/year), for a cumulative crude national rate of 7.7 cases/100,000pop; 58.2% corresponded to male; 57% were <40 year-old (10.2% < 9.9 year-old). Cases were 57.6% neurocysticercosis, the rest were taeniasis due to T. solium, T. saginata, ocular cysticercosis and cysticerci in other organs. Bolivar, a touristic department, had the highest cumulated incidence rate (16.17 cases/100,000pop), as also evident across the map series developed in this study.

CONCLUSION

Despite the limitations of this study, data presented provide recent estimates of national taeniasis and cysticercosis incidence in the country useful in public health and for travel medicine practitioners, as some highly touristic areas presented higher disease incidence. Improved control, particularly of taeniasis, should be an attainable goal, which among other strategies would require improved sanitation and health education to prevent transmission, but also enhanced surveillance.

Reducing zoonotic and internal parasite burdens in pigs using a pig confinement system

Aim

This study was designed to validate the effectiveness of the pig confinement system (PCS) in reducing the prevalence of zoonotic and internal parasite burdens in pigs.

Materials and Methods

Ten PCS households were selected together with 10 households practising traditional scavenging systems. Five pigs were monitored per household every 3 months for 15 months and blood and feces collected. Pigs received a single dose of oxfendazole at 30 mg/kg at baseline. Qualitative fecal examinations for intestinal parasite stages were performed, and serum was tested for antibodies to cysticercus of Taenia solium, Trichinella spp., and Toxoplasma gondii.

Results

Based on fecal examination, the prevalence of pigs positive for parasite eggs was reduced in PCS pigs over consecutive samplings (Ascaris suum [14.3% to 0%], Trichuris suis [46.9% to 8.3%], Strongyle-type eggs [81.6% to 8.3%], Physocephalus spp. [6.1% to 0%], and Metastrongylus apri [20.8% to 0%]) compared with increases in the number of pigs positive for parasite eggs in non-PCS pigs (T. suis [20-61.5%], Strongyle-type [60.4-80.8%], Physocephalus spp. [8.3-15.4%], and M. apri [20.8-34.6%]) and little change in pigs positive for A. suum (18.8-19.2%). While the prevalence of pigs with antibodies against to cysticerci of T. solium reduced in PCS pigs from 18% to 14%, the prevalence in non-PCS pigs increased from 42% to 52%. Antibodies to Trichinella were not detected, but the prevalence of T. gondii antibodies increased from 6% to 10% in PCS pigs and from 7% to 24% in non-PCS pigs.

Conclusion

These data demonstrate the potential of a PCS to reduce the prevalence of pigs infected with zoonotic and internal parasites and thus the risk to human and pig health.

Human cysticercosis in Portugal: long gone or still contemporary?

Cysticercosis, a leading cause of acquired epilepsy in developing countries, has been controlled or eradicated in industrialized countries. This paradigm has recently been challenged, with human neurocysticercosis (NCC) being increasingly diagnosed in these countries. In order to assess the NCC burden in Portugal, a retrospective study on NCC hospitalizations (2006–2013) was conducted based on the national database on hospital morbidity: 357 hospitalized cases were detected. NCC was most frequent in the following age groups: 20–64 years (n = 197, 55·2%) >64 years (n = 111, 31·1%), and <20 years (n = 49, 13·7%). In the Norte and Centro regions cases tended to be older than in the Lisboa and Vale do Tejo Region. The results raise concerns for imported and autochthonous disease, suggesting the Lisboa and Vale do Tejo Region, due to its higher frequency of cases at younger ages, as a priority for research and intervention, and further suggest that NCC should be under surveillance (notifiable). The National Observatory of Cysticercosis and Taeniasis has been established and will define NCC cases as well as monitoring and surveillance.

Evaluation of activity of triclabendazole against Taenia solium metacestode in naturally infected pigs

OBJECTIVE

To assess the efficacy of triclabendazole (TCBZ) in porcine cysticercosis.

METHODS

Eighteen naturally infected cysticercosis pigs were divided into 3 groups of 6 individuals each. The first group was treated orally with TCBZ at a single dose of 30 mg/kg of body weight, the second group was treated orally with oxfendazole at a single dose of 30 mg/kg of body weight and the third group received a placebo (control group). All animals were kept under the same management conditions. The pigs were euthanized 17 wk post-treatment and the number of surviving cysts in muscles was assessed and compared between groups.

RESULTS

All pigs treated with oxfendazole had only degenerated cysts in their carcasses. In contrast, TCBZ had very little effect against the parasitic cysts. Cysts from pigs in the TCBZ group looked apparently normal after treatment. However, histological evaluation showed a mild to moderate degree of inflammation.

CONCLUSIONS

TCBZ is not an efficacious drug against Taenia solium cysticercosis in swine using a single dose.

Taenia solium Human Cysticercosis: A Systematic Review of Sero-epidemiological Data from Endemic Zones around the World

Background

Taenia solium cysticercosis is a zoonotic neglected disease responsible for severe health disorders such as seizures and death. Understanding the epidemiology of human cysticercosis (HCC) in endemic regions will help to expose critical information about the transmission of the disease, which could be used to design efficient control programs. This review gathered serological data on apparent prevalence of T. solium circulating antigens and/or seroprevalence of T. solium antibodies, apparent prevalence of human taeniasis and risk factors for HCC from endemic communities in order to understand the differences in exposure to the parasite and active infections with T. solium metacestodes in endemic areas around the world.

Methods

Three databases were used to search sero-epidemiological data from community-based studies conducted between 1989 and 2014 in cysticercosis endemic communities worldwide. The search focused on data obtained from T. solium circulating antigen detection by monoclonal antibody-based sandwich ELISA and/or T. solium antibody seroprevalence determined by Enzyme-linked Immunoelectrotransfer Blot (EITB). A meta-analysis was performed per continent.

Principal Findings

A total of 39,271 participants from 19 countries, described in 37 articles were studied. The estimates for the prevalence of circulating T. solium antigens for Africa, Latin America and Asia were: 7.30% (95% CI [4.23–12.31]), 4.08% (95% CI [2.77–5.95]) and 3.98% (95% CI [2.81–5.61]), respectively. Seroprevalence estimates of T. solium antibodies were 17.37% (95% CI [3.33–56.20]), 13.03% (95% CI [9.95–16.88]) and 15.68% (95% CI [10.25–23.24]) respectively. Taeniasis reported prevalences ranged from 0 (95% CI [0.00–1.62]) to 17.25% (95% CI [14.55–20.23]).

Significance

A significant variation in the sero-epidemiological data was observed within each continent, with African countries reporting the highest apparent prevalences of active infections. Intrinsic factors in the human host such as age and immunity were main determinants for the occurrence of infections, while exposure was mostly related to environmental factors which varied from community to community.

Human cysticercosis is a neglected zoonotic disease caused by the larval stage of the parasite Taenia solium. This disease is responsible for severe health disorders such as seizures, and in some cases even death. T. solium cysticercosis is endemic in countries in Africa, Latin America and Asia where conditions such as inadequate hygiene, poor sanitary conditions, open defecation, free roaming pigs and poverty permit the transmission of the disease. Diagnostic tools are capable of detecting exposure to eggs and infection levels in a population through antibody and antigen detection, respectively. This review focused on gathering epidemiological data from endemic communities in Africa, Latin America and Asia in order to understand the causes of the observed variations in exposure/infection patterns in endemic regions. Similar antibody seroprevalences were observed worldwide while infection prevalences varied significantly within each region. Intrinsic factors such as age and immunity were determining factors for the occurrence of infections, while exposure was related to environmental factors which varied from region to region. Understanding the epidemiology of cysticercosis in endemic regions will help expose information on the transmission, which could in turn be used to design appropriate control programs.

Recent advances and perspectives in molecular epidemiology of Taenia solium cysticercosis

Cysticercosis caused by accidental ingestion of eggs of Taenia solium is spreading all over the world through globalization and is one of the most neglected, neglected tropical diseases (NTDs) or neglected zoonotic diseases (NZDs). In the present study, the reason why T. solium cysticercosis has been neglected is discussed at first, and followed with an overview on the most recent advances and perspectives in molecular approaches for epidemiology of T. solium taeniasis/cysticercosis, since although taeniasis does not constitute recognized zoonoses, transmission and complete development are dependent on human definitive hosts. Main topics are discussions on (1) the two, Asian and Afro/American, genotypes of T. solium, (2) comparative analysis of mitochondrial (haploid) and nuclear (diploid) genes, and (3) the presence of hybrids of these two genotypes which indicates out-crossing of two genotypes in hermaphrodite tapeworms in Madagascar. Additional topics are on (4) the usefulness of phylogeographic analyses to discuss where the infection was acquired from, and (5) miscellaneous unsolved topics around these genetic diversity of T. solium.

Occurrence of porcine cysticercosis in free-ranging pigs delivered to slaughter points in Arapai, Soroti district, Uganda

Poverty, hunger and the need for production of pigs with meagre or zero inputs have made most farmers release their pigs to range freely, thus creating a pig-human cycle that maintains Taenia solium, the pig tapeworm and cause of porcine cysticercosis, in the ecosystem. A preliminary study was designed to establish the prevalence of porcine cysticercosis by postmortem examination of the tongue and carcass of free-range pigs from February to April 2014 in Arapai subcounty, Soroti district, eastern Uganda. The tongue of each pig was extended and examined before deep incisions were made and the cut surfaces were examined. The rest of the carcasses were examined for cysts. Out of 178 pigs examined, 32 were qualitatively positive for porcine cysticercosis, representing a prevalence of 18.0%. This high prevalence represents a marked risk to the communities in the study area of neurocysticercosis, a debilitating parasitic zoonosis. Proper human waste disposal by use of pit latrines, confinement of free-range pigs and treatment with albendazole and oxfendazole are recommended.

Incidence of porcine cysticercosis in Angónia District, Mozambique

A total of 108 pigs from an endemic area in Mozambique were selected and followed for 8 months to estimate the prevalence and incidence of Taenia solium cysticercosis as indicators of ongoing transmission of the disease. The pigs were sampled and tested repeatedly for cysticercosis by Ag-ELISA at 4, 9 and 12 months of age. Porcine cysticercosis was diagnosed in 5.6% (95% CI: 2.1-11.7%), 33.3% (95% CI: 23.7-44.1%) and 66.7% (95% CI: 55.5-76.9%) of the animals, for the first, second and third sampling rounds, respectively, and varied by village. The mean incidence rate of the disease increased significantly from 6.2 cases per 100 pig-months between 4 and 9 months of age, to 21.2 cases per 100 pig-months between 9 and 12 months of age (incidence rate difference=15.0; 95% CI: 6.8-23.3). Risk factors for the disease are present in the study area, thus control and educational programmes for the community should be initiated to build awareness of the transmission and impact of T. solium infections.

Preliminary evaluation of Community-Led Total Sanitation for the control of Taenia solium cysticercosis in Katete District of Zambia

Taenia solium taeniasis/cysticercosis is a zoonotic disease endemic in sub-Saharan Africa. It is associated with poor sanitary practices, free-range pig husbandry and lack of disease awareness in endemic communities. A comparative research was conducted with pre and post-intervention assessments in nine villages to evaluate Community-Led Total Sanitation (CLTS) as an intervention measure for the control of porcine cysticercosis in Katete District in the Eastern Province of Zambia. Blood samples were collected from pigs for circulating antigen detection and a questionnaire focused on the household was administered to a total of 153 respondents whose pigs were examined (64 pre-intervention, 89 post-intervention), in order to obtain information on general demographic characteristics, pig husbandry practices, sanitation practices and associated knowledge and awareness of T. solium infections. The first sampling was conducted prior to the implementation of the CLTS and second sampling eight months after triggering of CLTS in the selected villages. A total of 379 pig serum samples were examined using the B158/B60 Ag-ELISA to detect T. solium cysticercosis, 104 pre-intervention and 275 post-intervention, of which 14 (13.5%) and 45 (16.4%) were positive, respectively. Wald test p-values were computed to assess significant differences in the variables of interest mentioned above for the pre and post CLTS. The research revealed that CLTS as a control measure did not significantly improve T. solium infections in pigs. The research also revealed that the sanitation practices and awareness of cysticercosis did not change. It is recommended that a longer term evaluation be undertaken when the villages have been declared open defaecation free. In addition, the research recommends that health education, mass drug treatment and pig vaccination be incorporated, as an essential component of prevention and control programmes for T. solium infections.

Prevalence of porcine cysticercosis in the Lake Kyoga Basin, Uganda

Background

Taenia solium is a zoonotic helminth with the potential to cause life threatening epilepsy in people through the aberrant larval infection of the brain called Neurocysticercosis (NCC). The pig is the intermediate host for T. solium where the larval form, cysticercus cellulosae, normally develops after the pig eats eggs of the parasite. Humans are the definitive host where the adult tapeworm develops and are infected through the consumption of poorly cooked, infected meat. T. solium has been acknowledged by the World Health Organization (WHO), Food and Agriculture Organization (FAO) and UK Department for International Development (DFID) as being a neglected zoonotic disease, and was recently included in the WHO roadmap for control of neglected tropical diseases. This neglect encompasses a lack of epidemiological data and a lack of validated, effective control strategies being adopted. Understanding the epidemiology of this parasite in the intermediate host is the first step towards designing suitable intervention strategies for the improvement of public health. This study was undertaken to provide an accurate and up-to-date estimate for the prevalence of porcine cysticercosis in the Lake Kyoga basin.

Results

Sera from 378 pigs were analysed with the HP10 Antigen Enzyme Linked Immunosorbant Assay (ELISA) and the prevalence was found to be 25.7% (95% confidence interval 21.0% to 30.0%). Previous sero- surveillance in this region, using the B158/B60 Ag Elisa had indicated a prevalence of 8.6% in 2005 indicating a dramatic increase in prevalence (J. Parasitol Res, Article ID 375493, 2009) within a 6 year period.

Conclusion

This increasing prevalence in the disease indicates to us that there is currently no effective control of this parasite and that in this region of Uganda at least; cysticercosis remains a neglected zoonotic disease.

Human neurocysticercosis: immunological features involved in the host's susceptibility to become infected and to develop disease

Human neurocysticercosis (NC) is a clinically and radiologically heterogeneous disease caused by the establishment of Taenia solium larvae in the central nervous system. Herein, the immunological and endocrinological features involved in resistance to infection and severe forms of the disease are reviewed, and their clinical relevance is discussed.

State of the art of Taenia solium as compared to Taenia asiatica

Three species of tapeworms infect humans in their adult stage (Taenia solium, Taenia saginata and Taenia asiatica). The 3 are flat, opaque white or yellowish, and exceptional long segmented parasites, measuring 1 to 12 m in their adult stage. In this review, the development of the knowledge regarding the first species, mainly focused on understanding how the larval stage or cysticercus is transmitted to humans, is described. The second species is a cosmopolitan parasite that only causes taeniosis and not cysticercosis; therefore, it will not be included. Information on the third species, which is presently being produced, since this species was recognized as such only at the end of the 20th century, will be discussed at the end of this review.

A review on diagnostic and preventive aspects of cystic echinococcosis and human cysticercosis

Cystic echinococcosis and human cysticercosis have recently been included in the list of "neglected tropical diseases" by the World Health Organization (WHO). Both are zoonoses which are prevalent throughout the world and lead to considerable mortality, morbidity, and economic losses as well. This review deals with the disease burden of these two neglected cestode infections. Diagnostic modalities with their specific advantages and disadvantages have also been discussed. Recent developments in immunodiagnostic assays for the two diseases have been dealt with. Various control strategies including the use of veterinary vaccines have been highlighted.

Characterization of hydrophobic-ligand-binding proteins of Taenia solium that are expressed specifically in the adult stage

Taenia solium, a causative agent of taeniasis and cysticercosis, has evolved a repertoire of lipid uptake mechanisms. Proteome analysis of T. solium excretory-secretory products (TsESP) identified 10 kDa proteins displaying significant sequence identity with cestode hydrophobic-ligand-binding-proteins (HLBPs). Two distinct 362- and 352-bp-long cDNAs encoding 264- and 258-bp-long open reading frames (87 and 85 amino acid polypeptides) were isolated by mining the T. solium expressed sequence tags and a cDNA library screening (TsHLBP1 and TsHLBP2; 94% sequence identity). They clustered into the same clade with those found in Moniezia expansa and Hymenolepis diminuta. Genomic structure analysis revealed that these genes might have originated from a common ancestor. Both the crude TsESP and bacterially expressed recombinant proteins exhibited binding activity toward 1-anilinonaphthalene-8-sulfonic acid (1,8-ANS), which was competitively inhibited by oleic acid. The proteins also bound to cis-parinaric acid (cPnA) and 16-(9-anthroyloxy) palmitic acid (16-AP), but showed no binding activity against 11-[(5-dimethylaminonaphthalene-1-sulfonyl) amino] undecanoic acid (DAUDA) and dansyl-DL-α-aminocaprylic acid (DACA). Unsaturated fatty acids (FAs) showed greater affinity than saturated FAs. The proteins were specifically expressed in adult worms throughout the strobila. The TsHLBPs might be involved in uptake and/or sequestration of hydrophobic molecules provided by their hosts, thus contributing to host-parasite interface interrelationships.

Use of oxfendazole to control porcine cysticercosis in a high-endemic area of Mozambique

A randomized controlled field trial to evaluate the effectiveness of a single oral dose of 30 mg/kg of oxfendazole (OFZ) treatment for control of porcine cysticercosis was conducted in 4 rural villages of Angónia district, north-western Mozambique. Two hundred and sixteen piglets aged 4 months were selected and assigned randomly to OFZ treatment or control groups. Fifty-four piglets were treated at 4 months of age (T1), while another 54 piglets were treated at 9 months of age (T2) and these were matched with 108 control pigs from the same litters and raised under the same conditions. Baseline data were collected on the prevalence of porcine cysticercosis using antigen ELISA (Ag-ELISA), as well as knowledge and practices related to Taenia solium transmission based on questionnaire interviews and observations. All animals were followed and re-tested for porcine cysticercosis by Ag-ELISA at 9 and 12 months of age when the study was terminated. Overall prevalence at baseline was 5.1% with no significant difference between groups. At the end of the study, 66.7% of the controls were found positive, whereas 21.4% of the T1 and 9.1% of the T2 pigs were positive, respectively. Incidence rates of porcine cysticercosis were lower in treated pigs as compared to controls. Necropsy of 30 randomly selected animals revealed that viable cysts were present in none (0/8) of T2 pigs, 12.5% (1/8) of T1 pigs and 42.8% (6/14) of control pigs. There was a significant reduction in the risk of T. solium cysticercosis if pigs were treated with OFZ either at 4 months (OR = 0.14; 95% CI: 0.05-0.36) or at 9 months of age (OR = 0.05; 95% CI: 0.02-0.16). Strategic treatment of pigs in endemic areas should be further explored as a means to control T. solium cysticercosis/taeniosis.

Hydrocephalus in neurocysticercosis

INTRODUCTION

Cysticercosis (CC) is the most important of the parasitic diseases of the central nervous system due to its high incidence in the world. CC is the infection with the larval cysts of Taenia solium. It is the most common helminthic infection of the nervous system and is endemic in most underdeveloped countries as well as in industrialized nations. It is estimated that approximately 50,000 people die every year from neurocysticercosis (NCC) worldwide.

DISCUSSION

Humans with CC are incidental intermediate hosts, which replace the pig in the life cycle of the T. solium. Children are more frequently affected by parenchyma infestation of cysticercus, of which the main clinical manifestation is epilepsy. Hydrocephalus is more common in adults and is caused by cerebrospinal fluid blockage by ventricular cysts and inflammatory reactions (ependimitis/arachnoiditis). Treatment should be individualized based on clinical presentation, degree of infestation, location and viability of cysticercus, and host response. Hydrocephalus can be controlled only by removal of obstructive intraventricular cysts or associated with either ventriculoperitoneal shunt or endoscopic third ventriculostomy. The degree of infestation and complications related to the shunt represents the most important prognostic factors in the outcome of NCC.

Immunolocalization of TSOL18 and TSOL45-1A, the successful protective peptides against porcine cysticercosis, in Taenia solium oncospheres

Taenia solium life cycle includes humans as definitive hosts and pigs as intermediate hosts. One of the measures to stop the life cycle of this parasite is by vaccination of pigs. In experiments performed in pigs with TSOL18 and TSOL45-1A, two recombinant T. solium proteins, 99.5% and 97.0% protection was induced, respectively. The purpose of this paper was to localize these antigens in all stages of the parasite (adult worms, oncospheres and cysticerci) by immunofluorescence, with the use of antibodies against TSOL18 and TSOL45-1A that were obtained from the pigs used in the vaccination experiment. Results show that TSOL18 and TSOL45-1A are expressed on the surface of T. solium oncospheres and not in tapeworms or cysticerci, indicating that they are stage-specific antigens. This, therefore, might explain the high level of protection these antigens induce against pig cysticercosis.

Neurocysticercosis: risk and primary prevention strategies update

Neurocysticercosis results from the infestation of the central nervous system with invading tapeworm larvae. Though uncommon in the US prior to 1965, new cases are currently being diagnosed at an unprecedented rate. Drawing on environmental health, intervention and risk data retrieved from standard/alternative databases and in-country sources, we present an update and summary of modifiable risk factors and field-tested primary prevention measures. While points of intervention, subpopulations at risk and overall magnitude of the problem are addressed, particular attention is paid to defining risk reduction measures that can be adopted by individuals and high risk groups in the near-term to interrupt or eliminate pathways of exposure leading to disease transmission. Though global eradication is not attainable in the near future, effective preventative measures exist and should be taken now by international travellers and workers, US/foreign government agencies, and individuals living in endemic regions to reduce human suffering.

Eradication of Taenia solium cysticercosis: a role for vaccination of pigs

Taenia solium is the causative agent of neurocysticercosis, a disease responsible for substantial human morbidity and mortality. It is a zoonotic parasite, involving pigs as intermediate hosts. The parasite's full life cycle is restricted to poor people in developing countries. Attempts to date to control transmission of the parasite have been relatively poorly effective and not sustainable. Over the past decade research has been undertaken to develop practical vaccines for use in pigs to prevent transmission of T. solium. The most effective of these vaccines in controlled experimental trials has been the TSOL18 vaccine. More recently, TSOL18 has been proven to be highly effective against naturally acquired infection with T. solium in pigs. Application of TSOL18 together with a single treatment of pigs with oxfendazole achieved the complete elimination of transmission of the parasite by pigs involved in the field trial. This strategy may provide a relatively low cost and sustainable control tool which could assist towards the goal of achieving eradication of the parasite. An assessment is made of the potential value of various control measures that are available for T. solium, and two options are suggested as potential parasite control programs.

Seroprevalence of cysticercosis in children and young adults living in a helminth endemic community in leyte, the Philippines

Cysticercosis is a significant public health problem in countries where pigs are raised for consumption and remains an important cause of neurological disease worldwide. The Philippines is considered an endemic area for cysticercosis because cases in both humans and pigs have been reported; however, epidemiologic information stays limited. We conducted a pilot survey of the seroprevalence of human cysticercosis in a village in Leyte, the Philippines, by measuring antibody specific for Taenia solium cyst-fluid antigen. There were 497 subjects aged 7–30 years in our study and most subjects were infected with one or more helminths. The overall cysticercosis seroprevalence in this population was 24.6% (95% CI: 20.82% ~ 28.58%) with no significant difference based on age, sex, or other helminth coinfection status. Although the sample may not be representative of the whole community, the findings suggest that cysticercosis is a significant, but underrecognized public health concern in the Philippines.

Standardization of an experimental model of human taeniosis for oral vaccination

Neurocysticercosis in humans is caused by the tapeworm Taenia solium and generates substantial morbidity in Latin America, Africa and Asia.The life cycle of T. solium includes pigs as intermediate hosts and human beings as definitive hosts. Tapeworm carriers are the main risk factor for acquiring cysticercosis in the household, thus prevention and control programs are being developed. Infected people have no symptoms, therefore are difficult to identify and treat, thus vaccination against the adult tapeworm is an alternative control measure. Since the infection occurs naturally only in human beings, experimental models have been standardized. Hamsters are believed to be good models to study the infection but they have not been properly evaluated for vaccination. Since taeniosis is gained by ingesting pork meat with cysticerci, oral vaccination was evaluated, and given that intestinal immunity is enhanced with adjuvants, cholera toxin was used, because it is one of the most potent adjuvants, in view of the fact that it increases epithelium permeability enhancing entrance of the co-administered unrelated antigens. Recombinant functional T. solium calreticulin was employed for the standardization of the methodology and the evaluation of oral vaccination. Protection was associated with the type of cysticerci and the age of the hamsters used. When reddish bigger parasites were orally introduced in hamsters as challenge, protection was around 40%, while when yellowish small parasites were used, protection increased to 100%, suggesting that the characteristics of cysticerci are determinant. Protection was gained in 9month old hamsters, but not in 3month old animals.

Transcriptome analysis of Taenia solium cysticerci using Open Reading Frame ESTs (ORESTES)

BACKGROUND

Human infection by the pork tapeworm Taenia solium affects more than 50 million people worldwide, particularly in underdeveloped and developing countries. Cysticercosis which arises from larval encystation can be life threatening and difficult to treat. Here, we investigate for the first time the transcriptome of the clinically relevant cysticerci larval form.

RESULTS

Using Expressed Sequence Tags (ESTs) produced by the ORESTES method, a total of 1,520 high quality ESTs were generated from 20 ORESTES cDNA mini-libraries and its analysis revealed fragments of genes with promising applications including 51 ESTs matching antigens previously described in other species, as well as 113 sequences representing proteins with potential extracellular localization, with obvious applications for immune-diagnosis or vaccine development.

CONCLUSION

The set of sequences described here will contribute to deciphering the expression profile of this important parasite and will be informative for the genome assembly and annotation, as well as for studies of intra- and inter-specific sequence variability. Genes of interest for developing new diagnostic and therapeutic tools are described and discussed.

Contribution of immunodiagnostic tests to epidemiological/intervention studies of cysticercosis/taeniosis in Mexico

Cysticercosis is acquired when swine ingest human faeces contaminated with Taenia solium eggs. Humans become tapeworm carriers when they ingest infected pork meat. They can also develop cysticercosis after inadvertently swallowing T. solium eggs. Human neurocysticercosis (NCC) is considered as a public health problem in Mexico and in several countries around the world, mainly developing ones. The development of immunodiagnostic techniques has promoted the conduct of seroepidemiological studies. This review provides insight into the evolution of these techniques, their predictive values and their use in field studies, and summarizes evidence supporting health care practice and policy related to cysticercosis/taeniosis in Mexico. Serological studies in rural and urban settings have demonstrated that close proximity with a tapeworm carrier is the main risk factor for acquiring cysticercosis. Research focusing on the tapeworm carrier generated an ELISA for the detection of Taenia coproantigens and facilitated the evaluation of intervention measures. Health education and self-identification of tapeworm carriers were shown to be successful. However, cestodial treatment as a community-based intervention was not as successful. Current immunodiagnostic techniques can be used to pinpoint transmission foci so that appropriate and effective interventions can be applied. In this way, sustainable control, and even eradication of T. solium may be envisioned.

Intestinal cestodes

PURPOSE OF REVIEW

This review summarizes the biology, clinical aspects, diagnosis, treatment and epidemiology for the common and rarer (zoonotic) intestinal cestodes of humans.

RECENT FINDINGS

Mass drug application to eliminate Taenia solium carriers may have only temporary effects on cysticercosis transmission. At least two major world genotypes of T. solium have been identified and greater genetic heterogeneity may occur at the regional level. A new human taeniid T. asiatica has been confirmed which occurs sympatrically with T. saginata and T. solium in Southeast Asia. Coproantigen and PCR tests for Taenia spp. have greatly improved diagnostic efficacy and epidemiological studies. There appears to be an increase in human diphyllobothriasis in Europe, Japan and the Americas.

SUMMARY

Human intestinal cestode infections are globally primarily caused by species in three genera: Taenia, Hymenolepis or Diphyllobothrium. Sporadic zoonotic infections caused by nontaeniids are usually food-borne or due to accidental ingestion of invertebrate hosts. Intestinal cestode infections generally result in only mild symptoms characterized chiefly by abdominal discomfort and diarrhoea. Most human intestinal cestode infections can be treated with a single oral dose of praziquantel or niclosamide.

Genetic polymorphism in Taenia solium cysticerci recovered from experimental infections in pigs

Taenia solium cysticerci recovered from naturally infected pigs from Mexico, Honduras and Tanzania show a clonal structure and local lineages with probable events of genetic recombination without genetic flow within them, as revealed by RAPD. To evaluate genetic polymorphism from cysticerci recovered from experimental infections, 4 pigs were infected with T. solium eggs obtained from tapeworms released by 3 human carriers, a 10-year-old female, a 25-year-old female, and a 44-year-old male, the 4th pig was infected with a mixture of eggs from the 3 tapeworms. Each pig was orally inoculated with 50,000 eggs. After 16 weeks pigs were humanely euthanized and cysticerci were excised. Parasites recovered from each pig were analyzed by RAPD. The proportion of polymorphic loci and the mean heterozygosity as well as a dendogram and an analysis of principal coordinate and minimum spanning tree were obtained. All four pigs developed viable cysticerci; the percent infection was obtained from the ratio of the number of eggs used for infection and the number of cysticerci counted in each pig after necropsy. Infection varied from 0.2 to 4.2%. The values obtained for the proportion of polymorphic loci (0.14-0.55) and the average of expected heterozygosity (0.06-0.22) in the present experimental infection had a broader range than those reported in the literature from natural infections. The dendogram obtained clustered cysticerci into two main groups; the minimum spanning tree allowed to corroborate the data obtained in the dendogram and gave a better discrimination because in a three-dimensional plot it was easier to see that all cysticerci from each tapeworm were clustered amongst themselves. The results obtained could be hypothetically explained because environmental factors and genetic selection agents present in nature influence natural infections but do not participate in experimental ones.

Characterization of Taenia madoquae and Taenia regis from carnivores in Kenya using genetic markers in nuclear and mitochondrial DNA, and their relationships with other selected taeniids

In the present study, we have extended earlier taxonomic, biochemical and experimental investigations to characterize two species of Taenia from carnivores in Kenya by use of the sequences of a variable domain (D1) of nuclear ribosomal DNA and the cytochrome c oxidase subunit 1 and NADH dehydrogenase 1 genes of mitochondrial DNA. Emphasis was placed on the characterization of Taenia madoquae from the silver-backed jackal (Canis mesomelas) and Taenia regis from the lion (Panthera leo), given the previous absence of any DNA sequence data for them, and on assessing their genetic relationships with socioeconomically important taeniids. The study showed that T. regis was genetically most closely related to T. hydatigena, and T. madoquae to T. serialis, T. multiceps or T. saginata. The present findings provide a stimulus for future work on the systematic relationships and epidemiology of lesser-known taeniid cestodes in Africa and other continents, employing mitochondrial sequence data sets.

Research approaches for improved pro-poor control of zoonoses

BACKGROUND

Developing countries face difficulties in sustainably utilizing tools to effectively implement control measures for zoonoses. This is mainly due to dispersed and heterogeneous smallholder livestock systems, predominance of informal markets, poor infrastructure and lack of resources to deliver information, interventions, and regulations. In addition, developing countries lack an evidence base for planning and targeting control efforts. Zoonotic infections are receiving more and more international attention as diseases of neglected and impoverished communities, at the intersection between livestock production, human health, and poverty.

OBJECTIVE

To review research innovations and trends that can help identify and test targeted control strategies for zoonoses tailored to poor communities, focusing particularly on Africa.

METHODS

Review of recommendations of relevant working groups and scientific literature.

RESULTS

New and innovative research approaches promise to better capture the impact of zoonoses from a societal perspective and the perspective of poor livestock owners through more comprehensive frameworks that consider benefits of the control of zoonoses to the public health, livestock, and private sectors. It is challenging to better assure food safety in informal markets. Risk-based approaches with participatory elements provide a framework in which stakeholders can decide an appropriate level of protection to balance the needs for safe food, cheap food, and pro-poor economic growth. Appropriate information for all stakeholders and capacity-building of national and regional authorities is an important element of this process. New diagnostic tools that are accurate and easily used in developing-country health centers and markets can assist in reporting of cases, detection of patients, and testing of control strategies.

CONCLUSIONS

A research agenda on zoonoses of the livestock sector should be interdisciplinary and participatory and include intersectoral collaborations, notably between the livestock and public health sectors.

Taenia solium and Taenia saginata: identification of sequence characterized amplified region (SCAR) markers

Cysticercosis is one of the most important zoonosis, not only because of the effects on animal health and its economic consequences, but also due to the serious danger it poses to humans. The two main parasites involved in the taeniasis-cysticercosis complex in Brazil are Taenia saginata and Taenia solium. Differentiating between these two parasites is important both for disease control and for epidemiological studies. The purpose of this work was to identify genetic markers that could be used to differentiate these parasites. Out of 120 oligonucleotide decamers tested in random amplified polymorphic DNA (RAPD) assays, 107 were shown to discriminate between the two species of Taenia. Twenty-one DNA fragments that were specific for each species of Taenia were chosen for DNA cloning and sequencing. Seven RAPD markers were converted into sequence characterized amplified region (SCAR) markers with two specific for T. saginata and five specific for T. solium as shown by agarose gel electrophoresis. These markers were developed as potential tools to differentiate T. solium from T. saginata in epidemiological studies.