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Southall WR, Southall MS, Aldaas MB, Sagi V, Akella PV. Triggered: Discovery of Neurocysticercosis Following Self-Administered Albendazole. Cureus 2023; 15:e43746. [PMID: 37727167 PMCID: PMC10506364 DOI: 10.7759/cureus.43746] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 08/19/2023] [Indexed: 09/21/2023] Open
Abstract
A 25-year-old man with no medical history presented with a seizure one month after taking a self-administered dose of albendazole. Magnetic resonance imaging (MRI) of the brain revealed multiple ring-enhancing lesions, and the workup confirmed neurocysticercosis (NCC). Treatment with antiparasitics was delayed due to concern for worsening symptoms from the presence of cysts in the midbrain and hippocampus. The balance between treating NCC and limiting cerebral inflammation is delicate and relies on judgment from a multispecialty clinical team. In this case, corticosteroids and antiepileptics alone prevented additional seizures but failed to reduce the overall inflammation of cysts and the progression of the disease. Evidence of new cysts on MRI at week 13 from the onset of symptoms was evidence of an acute, evolving infectious process. Treatment with albendazole and praziquantel was initiated at 13 weeks from the onset of symptoms, and by 31 weeks, nearly all cysts had resolved with minimal residual inflammation.
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Affiliation(s)
| | | | - Mohamad B Aldaas
- Infectious Diseases, University of Louisville School of Medicine, Louisville, USA
| | - Vishwanath Sagi
- Neurology, University of Louisville School of Medicine, Louisville, USA
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Kumar A, Mandal A, Sinha S, Singh A, Das RR. Prevalence, Response to Cysticidal Therapy, and Risk Factors for Persistent Seizure in Indian Children with Neurocysticercosis. Int J Pediatr 2017; 2017:8983958. [PMID: 28167968 PMCID: PMC5259654 DOI: 10.1155/2017/8983958] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/18/2016] [Revised: 12/02/2016] [Accepted: 12/18/2016] [Indexed: 01/01/2023] Open
Abstract
Background. Neurocysticercosis (NCC) is the commonest cause of childhood acquired epilepsy in developing countries. The use of cysticidal therapy in NCC, except "single lesion NCC," is still debated in view of its doubtful usefulness and potential adverse effects. Methods. Children presenting with first episode of seizure or acute focal neurological deficit without fever were screened for NCC and received appropriate therapy (followup done for 1 year to look for the response and side effects). Results. The prevalence of NCC was 4.5%. Most common presenting feature was generalized seizure and commonest imaging finding was single small enhancing lesion in the parietal lobe. Abnormal EEG and CSF abnormalities were found in almost half of the children. The response to therapy was very good with infrequent recurrence of seizure and adverse effects of therapy were encountered rarely. No risk factors for persistent seizure could be identified. Conclusion. Present study shows that the response to cysticidal therapy is very good in NCC as seizure recurrence was observed in only 5%, 4.2%, and 4.2% of cases at 3-month, 6-month, and 1-year followup. Adverse effects of therapy were observed in 20% of cases during therapy but they were mild and self-limiting.
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Affiliation(s)
- Animesh Kumar
- Department of Pediatrics, All India Institute of Medical Sciences, New Delhi 110029, India
| | - Anirban Mandal
- Department of Pediatrics, Sitaram Bhartia Institute of Science and Research, New Delhi 110016, India
| | - Sheela Sinha
- Department of Pediatrics, Patna Medical College and Hospital, Patna 800004, India
| | - Amitabh Singh
- Department of Pediatrics, Chacha Nehru Bal Chikitsalaya, New Delhi 110031, India
| | - Rashmi Ranjan Das
- Department of Pediatrics, All India Institute of Medical Sciences, Bhubaneswar 751019, India
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Sarria Estrada S, Frascheri Verzelli L, Siurana Montilva S, Auger Acosta C, Rovira Cañellas A. Neurocisticercosis. Hallazgos radiológicos. RADIOLOGIA 2013; 55:130-41. [PMID: 22632836 DOI: 10.1016/j.rx.2011.11.009] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/02/2011] [Revised: 11/20/2011] [Accepted: 11/23/2011] [Indexed: 10/28/2022]
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Sarria Estrada S, Frascheri Verzelli L, Siurana Montilva S, Auger Acosta C, Rovira Cañellas A. Imaging findings in neurocysticercosis. RADIOLOGIA 2013. [DOI: 10.1016/j.rxeng.2011.11.003] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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Millogo A, Nitiéma P, Carabin H, Boncoeur-Martel MP, Rajshekhar V, Tarnagda Z, Praet N, Dorny P, Cowan L, Ganaba R, Hounton S, Preux PM, Cissé R. Prevalence of neurocysticercosis among people with epilepsy in rural areas of Burkina Faso. Epilepsia 2012; 53:2194-202. [PMID: 23148555 PMCID: PMC5459323 DOI: 10.1111/j.1528-1167.2012.03687.x] [Citation(s) in RCA: 33] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Abstract
PURPOSE To estimate the lifetime prevalence of neurocysticercosis (NCC)-associated epilepsy and the proportion of NCC among people with epilepsy in three Burkina Faso villages. METHODS Three villages were selected to represent three types of pig-rearing methods: (1) Batondo, where pigs are left to roam; (2) Pabré, where pigs are mostly tethered or penned; and (3) Nyonyogo, where the majority of residents are Muslim and few pigs are raised. In Batondo and Nyonyogo, all concessions (a group of several households) were included. Half of the concessions in Pabré were randomly chosen. All households of selected concessions were included, and one person per household was randomly selected for epilepsy screening and serologic testing for cysticercosis. Self-reported cases of epilepsy were also examined and confirmed cases included in analyses other than the estimate of NCC-associated epilepsy prevalence. Epilepsy was defined as ever having had more than one episode of unprovoked seizures. Individuals with medically confirmed epilepsy had a computerized tomography (CT) scan of the brain before and after contrast medium injection. The diagnosis of NCC was made using a modification of the criteria of Del Brutto et al. KEY FINDINGS Thirty-nine (4%) of 888 randomly selected villagers and 33 (94%) of 35 self-reported seizures cases were confirmed to have epilepsy by medical examination. Among the 68 participants with epilepsy who had a CT scan, 20 patients were diagnosed with definitive or probable NCC for a proportion of 46.9% (95% confidence interval [CI] 30.2-64.1) in Batondo and 45.5% (95% CI 19.0-74.1) in Pabré. No cases of NCC were identified in Nyonyogo. SIGNIFICANCE All the definitive and probable cases of NCC were from the two villages where pig breeding is common. Prevention policies intended to reduce the burden of epilepsy in this country should include measures designed to interrupt the life cycle of Taenia solium.
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Affiliation(s)
- Athanase Millogo
- Department of Internal Medicine, Centre Hospitalier Universitaire Sourou Sanou, Bobo-Dioulasso, Burkina Faso
| | - Pascal Nitiéma
- Department of Biostatistics and Epidemiology, University of Oklahoma Health Sciences Center, OK, USA
| | - Hélène Carabin
- Department of Biostatistics and Epidemiology, University of Oklahoma Health Sciences Center, OK, USA
| | | | - Vedantam Rajshekhar
- Department of Neurological Sciences, Christian Medical College, Vellore, India
| | - Zékiba Tarnagda
- Institut de Recherche en Sciences de la Santé, Bobo-Dioulasso, Burkina Faso
| | - Nicolas Praet
- Department of Animal Health, Institute of Tropical Medicine, Antwerp, Belgium
| | - Pierre Dorny
- Department of Animal Health, Institute of Tropical Medicine, Antwerp, Belgium
| | - Linda Cowan
- Department of Biostatistics and Epidemiology, University of Oklahoma Health Sciences Center, OK, USA
| | - Rasmané Ganaba
- Agence de Formation, de Recherche et d’Expertise en Santé pour l’Afrique (AFRICSanté), Bobo-Dioulasso, Burkina Faso
| | - Sennen Hounton
- Sexual and Reproductive Health Branch, Technical Division, UNFPA, New York, USA
| | - Pierre-Marie Preux
- Institut d’Épidémiologie neurologique et de Neurologie Tropicale (IENT), Université de Limoges, France
| | - Rabiou Cissé
- Department of radiodiagnosis and medical imagery, Centre Hospitalier Universitaire Yalgado Ouédraogo, Ouagadougou, Burkina Faso
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6
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Mittal P, Mittal G. Intraventricular and subarachnoid racemose cysticercosis. Trop Parasitol 2011; 1:111-2. [PMID: 23508622 PMCID: PMC3593483 DOI: 10.4103/2229-5070.86950] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/18/2011] [Accepted: 10/31/2011] [Indexed: 11/26/2022] Open
Abstract
Cysticercosis is endemic in India. Neurocysticercosis most commonly affects the brain parenchyma, which presents as focal lesions with the surrounding edema which later calcify. Rarely, it may affect the ventricular system and subarachnoid spaces and this form is known as racemose cysticercosis. We present magnetic resonance findings in a case of racemose cysticercosis.
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Affiliation(s)
- Puneet Mittal
- Department of Radiodiagnosis, Punjab Institute of Medical Sciences, Jalandhar, Punjab, India
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Foyaca-Sibat H, Cowan LD, Carabin H, Targonska I, Anwary MA, Serrano-Ocaña G, Krecek RC, Willingham AL. Accuracy of serological testing for the diagnosis of prevalent neurocysticercosis in outpatients with epilepsy, Eastern Cape Province, South Africa. PLoS Negl Trop Dis 2009; 3:e562. [PMID: 19997629 PMCID: PMC2780704 DOI: 10.1371/journal.pntd.0000562] [Citation(s) in RCA: 31] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/23/2009] [Accepted: 10/30/2009] [Indexed: 11/19/2022] Open
Abstract
BACKGROUND Few studies have estimated prevalence of neurocysticercosis (NCC) among persons with epilepsy in sub-Saharan Africa. While the limitations of serological testing in identification of NCC are well known, the characteristics of persons who are misdiagnosed based on serology have not been explored. The first objective of this pilot study was to estimate the prevalence of NCC in epilepsy outpatients from an area of South Africa endemic for cysticercosis. The second objective was to estimate the accuracy of serological testing in detecting NCC in these outpatients and characterize sources of disagreement between serology and neuroimaging. METHODOLOGY/PRINCIPAL FINDINGS All out-patients aged 5 or older attending the epilepsy clinic of St. Elizabeth's Hospital in Lusikisiki, Eastern Cape Province, between July 2004 and April 2005 were invited to participate. Epidemiological data were collected by local study staff using a standardized questionnaire. Blood samples were tested by ELISA for antibody and antigen for Taenia solium. Four randomly chosen, consenting participants were transported each week to Mthatha for brain CT scan. The proportion of persons with epilepsy attending St. Elizabeth clinic with CT-confirmed NCC was 37% (95% CI: 27%-48%). Using CT as the gold standard, the sensitivity and specificity of antibody testing for identifying NCC were 54.5% (36.4%-71.9%) and 69.2% (52.4%-83.0%), respectively. Sensitivity improved to 78.6% (49.2%-95.3%) for those with active lesions. Sensitivity and specificity of antigen testing were considerably poorer. Compared to false negatives, true positives more often had active lesions. False positives were more likely to keep pigs and to have seizure onset within the past year than were true negatives. CONCLUSIONS/SIGNIFICANCE The prevalence of NCC in South African outpatients with epilepsy is similar to that observed in other countries where cysticercosis is prevalent. Errors in classification of NCC using serology alone may reflect the natural history of NCC.
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Affiliation(s)
| | - Linda D. Cowan
- Department of Biostatistics and Epidemiology, College of Public Health, University of Oklahoma Health Sciences Center, Oklahoma City, Oklahoma, United States
| | - Hélène Carabin
- Department of Biostatistics and Epidemiology, College of Public Health, University of Oklahoma Health Sciences Center, Oklahoma City, Oklahoma, United States
- * E-mail:
| | | | | | | | - Rosina C. Krecek
- Ross University School of Veterinary Medicine, Basseterre, Saint Kitts and Nevis
- Department of Zoology, University of Johannesburg, Auckland Park Campus, Auckland Park, South Africa
| | - A. Lee Willingham
- WHO/FAO Collaborating Center for Parasitic Zoonoses, Danish Center for Experimental Parasitology, Faculty of Life Sciences, University of Copenhagen, Frederiksberg, Denmark
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Restrepo CS, Raut AA, Riascos R, Martinez S, Carrillo J, Prasad SR. Imaging Manifestations of Tropical Parasitic Infections. Semin Roentgenol 2007; 42:37-48. [PMID: 17174173 DOI: 10.1053/j.ro.2006.08.007] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Affiliation(s)
- Carlos S Restrepo
- Radiology Department, University of Texas Health Science Center at San Antonio, 7703 Floyd Curl Drive, San Antonio, TX 78229, USA.
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Arruda GC, Quagliato EMAB, Rossi CL. Intrathecal synthesis of specific immunoglobulin G antibodies in neurocysticercosis: evaluation of antibody concentrations by enzyme-linked immunosorbent assay using a whole cysticercal extract and cyst vesicular fluid as antigens. Diagn Microbiol Infect Dis 2006; 54:45-9. [PMID: 16290026 DOI: 10.1016/j.diagmicrobio.2005.08.007] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/12/2005] [Accepted: 08/16/2005] [Indexed: 11/23/2022]
Abstract
The demonstration of intrathecal antibody production has proven useful for showing the involvement of the central nervous system (CNS) in several diseases. In the present study, the intrathecal synthesis of cysticercus-specific immunoglobulin G (IgG) antibodies was investigated in 30 patients with neurocysticercosis based on calculation of the specific IgG antibody index (AI(IgG)). An AI(IgG) > or =1.5 was considered to be indicative of intrathecal antibody production. Antibody concentrations in serum and cerebrospinal fluid samples were evaluated using an enzyme-linked immunosorbent assay with 2 antigen preparations from Taenia solium cysticerci, namely, a whole cysticercal extract (TsoW) and the vesicular fluid of the parasite (TsoVF). Intrathecal, cysticercus-specific IgG antibody synthesis was observed in 21 (70%) and 23 (76.6%) patients using the TsoW and TsoVF antigens, respectively. The detection of the intrathecal synthesis of specific antibodies may be a potentially useful tool in establishing the involvement of CNS in cysticercosis.
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Affiliation(s)
- Gisele C Arruda
- Department of Clinical Pathology, Faculty of Medical Sciences, State University of Campinas (UNICAMP), P.O. Box 6111, Campinas 13083-970, São Paulo, Brazil
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Arruda GC, da Silva ADT, Quagliato EMAB, Maretti MA, Rossi CL. Evaluation of Taenia solium and Taenia crassiceps cysticercal antigens for the serodiagnosis of neurocysticercosis. Trop Med Int Health 2005; 10:1005-12. [PMID: 16185235 DOI: 10.1111/j.1365-3156.2005.01480.x] [Citation(s) in RCA: 21] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Abstract
We evaluated the usefulness of seven cysticercal antigen extracts, four from Taenia solium cysticerci (whole parasite-TsoW, membrane-TsoMe, vesicular fluid-TsoVF and scolex-TsoSc) and three from T. crassiceps cysticerci (whole parasite-TcraW, membrane-TcraMe and vesicular fluid-TcraVF), for serodiagnosis of neurocysticercosis with an enzyme-linked immunosorbent assay (ELISA). Cysticercus-specific IgG were screened in serum samples from 23 patients with neurocysticercosis, 32 patients with other infections and 48 healthy persons. The best results were obtained with the TsoVF-ELISA (91.3% sensitivity; 96.2% specificity) and TcraVF-ELISA (91.3% sensitivity; 95% specificity). The ELISA done with whole parasite and membrane extracts from cysts of T. solium and T. crassiceps and the scolex extract from T. solium cysts showed a low performance in terms of sensitivity, ranging from 47.8% to 73.9%. None of the antigen preparations from T. solium and T. crassiceps cysticerci used in this study showed outstanding performance for the serodiagnosis of neurocysticercosis. However, considering the results obtained with the seven antigen preparations, vesicular fluid from T. solium and T. crassiceps cysticerci may be useful for detecting specific antibodies in sera from patients with neurocysticercosis.
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Affiliation(s)
- G C Arruda
- Department of Clinical Pathology, Faculty of Medical Sciences, State University of Campinas (UNICAMP), Campinas, São Paulo, Brazil
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do Amaral LLF, Ferreira RM, da Rocha AJ, Ferreira NPDF. Neurocysticercosis: evaluation with advanced magnetic resonance techniques and atypical forms. Top Magn Reson Imaging 2005; 16:127-44. [PMID: 16340333 DOI: 10.1097/01.rmr.0000189106.78146.98] [Citation(s) in RCA: 59] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/05/2023]
Abstract
Neurocysticercosis (NCC) is the most common helminthic infection of the central nervous system, but its diagnosis remains difficult. The purpose of this article is to perform a critical analysis of the literature and show our experience in the evaluation of NCC. We discuss the advanced MR technique applications such as diffusion and perfusion-weighted imaging, spectroscopy, cisternography with FLAIR, and supplemental O2 and 3D-CISS. The typical manifestations of NCC are described; emphasis is given to the unusual presentations. The atypical forms of neurocysticercosis were divided into: intraventricular, subarachnoid, spinal, orbital, and intraparenchymatous. Special attention was also given to reactivation of previously calcified lesions and neurocysticercosis associated with mesial temporal sclerosis.
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Abstract
The diagnosis and management of parasitic diseases of the central nervous system (CNS) is difficult, even for infectious diseases physicians and neurologists. Furthermore, few overviews of the spectrum of causative helminths and clinical syndromes have been published. In the present study, we review the seven most common parasitic diseases of the CNS: (i) cysticercosis, (ii) neuroschistosomiasis, (iii) paragonimiasis, (iv) angiostrongyliasis, (v) hydatid disease, (vi) sparganosis and (vii) gnathostomiasis. Major syndromes of parasitic disease of the CNS and their differential causes are discussed, including: (i) cystic lesions, (ii) enhancing granulomas (with and without creeping subcutaneous eruptions), (iii) eosinophilic meningoencephalitis and (iv) spinal cord disease. Specific risk factors that predispose to these infections are also discussed and particular attention is drawn to the situation in Australia.
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Affiliation(s)
- A J Hughes
- University of Malaya Medical Centre, Kuala Lumpur, Malaysia
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Sheehan JP, Sheehan J, Lopes MB, Jane JA. Intramedullary spinal cysticercosis. Case report and review of the literature. Neurosurg Focus 2002; 12:e10. [PMID: 15926780 DOI: 10.3171/foc.2002.12.6.11] [Citation(s) in RCA: 15] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
Cysticercosis is the most common parasitic infection of the central nervous system. It infrequently affects the spine, but when it does, it can present with symptoms similar to other more common spinal diseases. The authors present a case of isolated intramedullary cysticercosis of the cervical spine and review the literature.
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Affiliation(s)
- Jason P Sheehan
- Department of Neurological Surgery, University of Virginia Health Sciences Center, Charlottesville, Virginia 22908, USA.
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Rocha SM, Suzuki LA, Silva ADTD, Arruda GC, Rossi CL. A rapid latex agglutination test for the detection of anti-cysticercus antibodies in cerebrospinal fluid (CSF). Rev Inst Med Trop Sao Paulo 2002; 44:57-8. [PMID: 11896415 DOI: 10.1590/s0036-46652002000100011] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022] Open
Abstract
Simple and rapid latex-based diagnostic tests have been used for detecting specific antigens or antibodies in several diseases. In this article, we present the preliminary results obtained with a latex agglutination test (LAT) for diagnosing neurocysticercosis by detection of antibodies in CSF. A total of 43 CSF samples were assayed by the LAT: 19 CSF samples from patients with neurocysticercosis and 24 CSF samples from patients with other neurologic disorders (neurosyphilis, n = 8; neurotoxoplasmosis, n = 3; viral meningitis, n = 4, chronic headache, n = 9). The LAT exhibited 89.5% sensitivity and 75% specificity. The use of LAT seems to be an additional approach for the screening of neurocysticercosis with advantage of simplicity and rapidity. Further studies could be performed using purified antigens and serum samples.
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Affiliation(s)
- Sérgio M Rocha
- Departamento de Patologia Clínica, Faculdade de Ciências Médicas, Universidade Estadual de Campinas, São Paulo, Brasil
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da Silva AD, Quagliato EM, Rossi CL. A quantitative enzyme-linked immunosorbent assay (ELISA) for the immunodiagnosis of neurocysticercosis using a purified fraction from Taenia solium cysticerci. Diagn Microbiol Infect Dis 2000; 37:87-92. [PMID: 10863102 DOI: 10.1016/s0732-8893(00)00137-1] [Citation(s) in RCA: 13] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/17/2022]
Abstract
A quantitative enzyme-linked immunosorbent assay (ELISA) for the immunodiagnosis of neurocysticercosis is described. The ELISA was standardized using a purified Taenia solium cysticerci fraction (PCF) obtained by ion exchange chromatography. The ELISA using PCF (PCF-ELISA) and a qualitative ELISA using a whole extract from T. solium cysticerci (WEC-ELISA) were used to screen for cysticercus-specific IgG antibodies in cerebrospinal fluid (CSF) samples from 57 patients with neurocysticercosis and 50 patients with other neurologic disorders. The sensitivity of both assays was 95%, whereas the specificities of PCF-ELISA and WEC-ELISA were 100% and 92%, respectively. The excellent sensitivity and specificity of the PCF-ELISA make this assay a potentially useful tool in screening for antibodies against T. solium cysticerci.
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Affiliation(s)
- A D da Silva
- Department of Clinical Pathology, Faculty of Medical Sciences, State University of Campinas (Unicamp), Campinas, São Paulo, Brazil
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Rosahl S, Samii M. Spinale intramedulläre Neurozystizerkose. Clin Neuroradiol 1998. [DOI: 10.1007/bf03043441] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
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