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Phumrattanaprapin W, Tatiya-apiradee N, Jantaban P, Mahikul W. Assessment of knowledge and practices regarding taeniasis and cysticercosis in Pak Chong, Nakhon Ratchasima, Thailand: A cross-sectional study. PLoS One 2024; 19:e0307240. [PMID: 39008473 PMCID: PMC11249257 DOI: 10.1371/journal.pone.0307240] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/29/2023] [Accepted: 07/01/2024] [Indexed: 07/17/2024] Open
Abstract
BACKGROUND Taeniasis and cysticercosis are parasitic infections caused by Taenia spp., mainly transmitted through the consumption of undercooked pork. Prevention requires increasing knowledge and awareness, improving meat inspection and hygiene, and promoting safe food handling and sanitation. The aim of this study was to evaluate the knowledge and practice (KP) of residents in Pak Chong District, Nakhon Ratchasima, Thailand, regarding taeniasis and cysticercosis. METHODS A cross-sectional study was conducted in Pak Chong District, Nakhon Ratchasima, Thailand, and its 11 subdistrict municipalities. Study participants were selected using a stratified random sampling design. A validated questionnaire (Cronbach's alpha = 0.70) was used to collect socio-demographic information and assess knowledge and practices related to taeniasis and cysticercosis. Descriptive statistics and multiple linear regression were used for the analysis. RESULTS Of the 360 survey respondents, 65.0% (n = 234) were women, 82.2% (n = 296) were aged under 60 years, 99.2% (n = 357) identified as Buddhist, 87.5% (n = 315) had less than a bachelor's degree education level, 54.2% (n = 195) had monthly family income ≥10,000 Thai baht, 10.6% (n = 38) were unemployed, and 26.1% (n = 93) lived in a town municipality. The survey revealed that 98.3% (n = 354) of participants were categorized as having less accurate knowledge and 83.6% (n = 301) were classified as more frequently engaging in correct prevention practices. Our study revealed that pig farmers (1.7%) occasionally permitted the pigs to forage freely. The results of multiple linear regression analysis revealed that knowledge scores were positively associated with household income ≥10,000 Thai baht (βadj = 1.50, 95% confidence interval [CI] 0.65 to 2.36). Practice scores were negatively associated with age over 60 years (βadj = -1.77, 95% CI -3.14 to -0.40) and living in a subdistrict municipality (βadj = -2.58, 95% CI -3.77 to -1.39). There was no association between KP regarding taeniasis and cysticercosis in the population of Pak Chong. CONCLUSIONS Overall, participants' knowledge was lacking. Public education interventions are recommended to improve knowledge among residents with low socioeconomic status. These findings can inform the development of targeted interventions and educational programs in Pak Chong District, especially among elderly people in subdistrict municipalities, to improve practices for the prevention and control of these parasitic infections.
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Affiliation(s)
| | - Nitima Tatiya-apiradee
- Program in Veterinary Technology, Faculty of Technology, Udon Thani Rajabhat University, Udon Thani, Thailand
| | | | - Wiriya Mahikul
- Princess Srisavangavadhana College of Medicine, Chulabhorn Royal Academy, Bangkok, Thailand
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Uwibambe E, Shyaka A, Niyotwagira E, Mutoniwase J, Fèvre EM, Quinnell RJ, Trevisan C. The Vicious Worm education tool improves the knowledge of community health workers on Taenia solium cysticercosis in Rwanda. PLoS Negl Trop Dis 2024; 18:e0012140. [PMID: 38630842 PMCID: PMC11057718 DOI: 10.1371/journal.pntd.0012140] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/06/2023] [Revised: 04/29/2024] [Accepted: 04/05/2024] [Indexed: 04/19/2024] Open
Abstract
The pork tapeworm Taenia solium causes human taeniasis and cysticercosis when ingested as viable cysts and eggs, respectively. Despite its high health burden in low-income countries, knowledge of the parasite in endemic areas such as Rwanda is often limited. Here, we assess whether The Vicious Worm education software can increase knowledge in endemic areas of Rwanda. A cross-sectional mixed-methods study was conducted to evaluate knowledge about T. solium among community health workers trained using the Vicious Worm education software. Knowledge was assessed before, immediately after, and four weeks after the training. The health workers perceptions of the software were analysed thematically. A total of 207 community health workers were recruited from Nyamagabe district in Southern Province, Rwanda. Participants were composed of males (33.5%) and females (66.5%), aged between 22 and 68 years, and most (71%) had only completed primary education. Knowledge of cysticercosis at baseline was low, particularly knowledge of human cysticercosis and neurocysticercosis. The overall knowledge score increased significantly after training and was maintained four weeks after the training. Overall, insufficient knowledge was associated with neurocysticercosis-related questions, which after the training, remained relatively lower compared to questions of other categories. Participants reported the software to be user-friendly and educational. Digital illiteracy and the lack of smartphones were among the critical challenges highlighted in responses. This study has shown gaps in knowledge regarding T. solium infections within rural Rwanda, particularly neurocysticercosis. Health education using the Vicious Worm education software should be considered in integrated control programs.
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Affiliation(s)
- Esther Uwibambe
- Center for One Health, University of Global Health Equity, Butaro, Rwanda
| | - Anselme Shyaka
- Center for One Health, University of Global Health Equity, Butaro, Rwanda
| | - Egide Niyotwagira
- Center for One Health, University of Global Health Equity, Butaro, Rwanda
| | | | - Eric M. Fèvre
- Institute of Infection, Veterinary and Ecological Sciences, University of Liverpool, United Kingdom
- International Livestock Research Institute, Nairobi, Kenya
| | - Rupert J. Quinnell
- Faculty of Biological Sciences, School of Biology, University of Leeds, Leeds, United Kingdom
| | - Chiara Trevisan
- Department of Translational Physiology, Infectiology and Public Health, Faculty of Veterinary Medicine, Ghent University, Belgium
- Department of Public Health, Institute of Tropical Medicine, Antwerp, Belgium
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Arroyo G, Lescano AG, Gavidia CM, Lopez-Urbina T, Ara-Gomez M, Gomez-Puerta LA, Bustos JA, Jayashi CM, O’Neal SE, Gonzalez AE, Garcia HH. Antibody Banding Patterns on the Enzyme-Linked Immunoelectrotransfer Blot (EITB) Assay Clearly Discriminate Viable Cysticercosis in Naturally Infected Pigs. Pathogens 2023; 13:15. [PMID: 38251323 PMCID: PMC10820179 DOI: 10.3390/pathogens13010015] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/27/2023] [Revised: 12/14/2023] [Accepted: 12/19/2023] [Indexed: 01/23/2024] Open
Abstract
Enzyme-linked immunoelectrotransfer blot (EITB) detects antibodies against seven Taenia solium larvae antigens in three protein families (GP50, T24/42, and 8-kDa) with different structures and functions. EITB banding patterns against these antigens in pigs provide information about the course of infection and may discriminate viable cysticercosis. We analyzed the banding patterns and infection outcomes (presence of viable cysts, degenerated cysts, and any cysts) of 512 rural pigs. Banding patterns were grouped into homogenous classes using latent class analysis, and relationships with infection outcomes were assessed. Four classes were identified: 1 (n = 308, EITB-negative or positive for the GP50 family), 2 (n = 127, positive for GP50 (GP50 family), GP42-39 and GP24 (T24/42 family), but negative for 8-kDa antigens), 3 (n = 22, positive for GP50 and T24/42 antigens (GP42-39 and GP24), as well as to 8-kDa bands GP13, GP14, and GP18, but negative for GP21), and 4 (n = 55, positive for GP50 and T24/42 antigens, as well as to 8-kDa antigens GP21 and GP18 in combination). Pigs in classes 3 and 4 were more likely to have viable cysts (72.6% and 96.4%, respectively) than pigs in classes 1 and 2 (0.7% and 27.6%, respectively; p < 0.001). The number of infections with any cysts was higher in classes 3 and 4 (77.3% and 98.2%, respectively) and lower in classes 2 and 1 (34.7% and 4.9%, respectively; p < 0.001). Pigs with viable cysts represented >90% of pigs with any cysts in classes 3 and 4 (94.1% and 98.2%, respectively), while degenerated cysts were frequent among pigs with any cysts in classes 1, 3, and 2 (86.7%, 47.1%, and 43.2%, respectively; p < 0.001). EITB banding patterns strongly correlate with cysticercosis infection status in rural pigs, with classes 3 and 4 being more predictive of viable infections.
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Affiliation(s)
- Gianfranco Arroyo
- School of Veterinary Medicine, Universidad Nacional Mayor de San Marcos, Lima 15021, Peru; (C.M.G.); (T.L.-U.); (M.A.-G.); (L.A.G.-P.); (C.M.J.); (A.E.G.)
- Center for Global Health, Universidad Peruana Cayetano Heredia, Lima 15202, Peru; (J.A.B.); (S.E.O.); (H.H.G.)
| | - Andres G. Lescano
- School of Public Health and Administration, Universidad Peruana Cayetano Heredia, Lima 15202, Peru;
| | - Cesar M. Gavidia
- School of Veterinary Medicine, Universidad Nacional Mayor de San Marcos, Lima 15021, Peru; (C.M.G.); (T.L.-U.); (M.A.-G.); (L.A.G.-P.); (C.M.J.); (A.E.G.)
| | - Teresa Lopez-Urbina
- School of Veterinary Medicine, Universidad Nacional Mayor de San Marcos, Lima 15021, Peru; (C.M.G.); (T.L.-U.); (M.A.-G.); (L.A.G.-P.); (C.M.J.); (A.E.G.)
| | - Miguel Ara-Gomez
- School of Veterinary Medicine, Universidad Nacional Mayor de San Marcos, Lima 15021, Peru; (C.M.G.); (T.L.-U.); (M.A.-G.); (L.A.G.-P.); (C.M.J.); (A.E.G.)
| | - Luis A. Gomez-Puerta
- School of Veterinary Medicine, Universidad Nacional Mayor de San Marcos, Lima 15021, Peru; (C.M.G.); (T.L.-U.); (M.A.-G.); (L.A.G.-P.); (C.M.J.); (A.E.G.)
| | - Javier A. Bustos
- Center for Global Health, Universidad Peruana Cayetano Heredia, Lima 15202, Peru; (J.A.B.); (S.E.O.); (H.H.G.)
- Cysticercosis Unit, Instituto Nacional de Ciencias Neurologicas, Lima 15030, Peru
| | - Cesar M. Jayashi
- School of Veterinary Medicine, Universidad Nacional Mayor de San Marcos, Lima 15021, Peru; (C.M.G.); (T.L.-U.); (M.A.-G.); (L.A.G.-P.); (C.M.J.); (A.E.G.)
| | - Seth E. O’Neal
- Center for Global Health, Universidad Peruana Cayetano Heredia, Lima 15202, Peru; (J.A.B.); (S.E.O.); (H.H.G.)
- School of Public Health, Oregon Health & Sciences University-Portland State University, Portland, OR 97207, USA
| | - Armando E. Gonzalez
- School of Veterinary Medicine, Universidad Nacional Mayor de San Marcos, Lima 15021, Peru; (C.M.G.); (T.L.-U.); (M.A.-G.); (L.A.G.-P.); (C.M.J.); (A.E.G.)
| | - Hector H. Garcia
- Center for Global Health, Universidad Peruana Cayetano Heredia, Lima 15202, Peru; (J.A.B.); (S.E.O.); (H.H.G.)
- Cysticercosis Unit, Instituto Nacional de Ciencias Neurologicas, Lima 15030, Peru
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Wilson C, Nonga HE, Mdegela RH, Churi AJ, Mkupasi EM, Winkler AS, Ngowi HA. Knowledge, attitudes and practices regarding porcine cysticercosis control among smallholder pig farmers in Kongwa and Songwe districts, Tanzania: A cross-sectional study. Vet Parasitol Reg Stud Reports 2023; 44:100912. [PMID: 37652629 DOI: 10.1016/j.vprsr.2023.100912] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/02/2023] [Revised: 06/24/2023] [Accepted: 07/13/2023] [Indexed: 09/02/2023]
Abstract
Taenia solium taeniasis/cysticercosis (TSTC) is a parasitic zoonotic disease that is endemic in several developing countries, causing serious public health and economic impacts. A cross-sectional study was conducted to assess knowledge, attitudes and practices (KAP) related to porcine cysticercosis (PCC) transmission, prevention and control among smallholder pig farmers in Kongwa and Songwe Districts in Tanzania. A semi-structured questionnaire was administered to 692 smallholder pig farmers from randomly selected households. STATA software version 17 was used to analyse quantitative data, summarize farmers' KAP about PCC and calculate performance scores. Nearly half (42%) of the respondents had little knowledge regarding PCC, only 17% of the respondents had good practices towards prevention/control of PCC and 72% had a positive attitude towards PCC- prevention/control measures. The majority (73%) of smallholder pig farmers admitted deworming their pigs regularly, whereas 76% reported deworming themselves and their family members regularly. Albendazole and ivermectin are the most commonly used medications for deworming people and pigs, respectively. According to the findings, the majority of smallholder pig farmers in Kongwa and Songwe Districts showed a good attitude towards PCC prevention/control measures but had limited knowledge of the PCC life cycle and control. In addition, only one in five farmers was engaged in good practices. The findings revealed further that farmers are engaged in risky behaviours that aid the spread and perpetuation of the T. solium parasite in the study area. It is recommended that farmers should be given proper health education on the T. solium transmission cycle and preventive/control practices to limit PCC transmission.
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Affiliation(s)
- C Wilson
- Department of Microbiology, Parasitology and Biotechnology, College of Veterinary Medicine and Biomedical Sciences, Sokoine University of Agriculture, P. O. Box 3019, Chuo Kikuu, Morogoro, Tanzania; Department of Veterinary Medicine and Public Health, College of Veterinary Medicine and Biomedical Sciences, Sokoine University of Agriculture, P. O. Box 3021, Chuo Kikuu, Morogoro, Tanzania.
| | - H E Nonga
- Department of Veterinary Medicine and Public Health, College of Veterinary Medicine and Biomedical Sciences, Sokoine University of Agriculture, P. O. Box 3021, Chuo Kikuu, Morogoro, Tanzania
| | - R H Mdegela
- Department of Veterinary Medicine and Public Health, College of Veterinary Medicine and Biomedical Sciences, Sokoine University of Agriculture, P. O. Box 3021, Chuo Kikuu, Morogoro, Tanzania
| | - A J Churi
- Department of Informatics and Information Technology, Sokoine University of Agriculture, P.O. Box 3218, Chuo Kikuu, Morogoro, Tanzania
| | - E M Mkupasi
- Department of Veterinary Medicine and Public Health, College of Veterinary Medicine and Biomedical Sciences, Sokoine University of Agriculture, P. O. Box 3021, Chuo Kikuu, Morogoro, Tanzania
| | - A S Winkler
- Center for Global Health, Department of Neurology, Technical University of Munich, 81675, Munich, Germany; Department of Community Medicine and Global Health, Institute of Health and Society, University of Oslo, 0318, Oslo, Norway
| | - H A Ngowi
- Department of Veterinary Medicine and Public Health, College of Veterinary Medicine and Biomedical Sciences, Sokoine University of Agriculture, P. O. Box 3021, Chuo Kikuu, Morogoro, Tanzania
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Makingi G, Ngowi B, Mkupasi E, Wilson C, Winkler AS, Nzalawahe J, Ngowi H. Community Health-Education Intervention Trial against Human Taenia solium Taeniasis/Cysticercosis in Central and Southern Zones of Tanzania. Pathogens 2023; 12:955. [PMID: 37513802 PMCID: PMC10386120 DOI: 10.3390/pathogens12070955] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/03/2023] [Revised: 04/18/2023] [Accepted: 06/09/2023] [Indexed: 07/30/2023] Open
Abstract
Poor knowledge of human T. solium taeniasis/cysticercosis and insufficient sanitary and hygienic practices have been associated with the persistence of human T. solium infections in endemic areas. Community health education intervention measures were implemented in 42 villages of Kongwa and Songwe Districts to increase knowledge, improve good practices against infection and reduce incidences of human cysticercosis transmission using a health education package. The health education package comprised of leaflet, poster and a booklet The 42 villages were allocated into intervention group and control group, and each group consisted of 21 villages. Baseline and post-intervention information on social demography, knowledge, safe practices and incidences of human cysticercosis was collected from both village groups. The impact of the intervention was evaluated by comparing changes in knowledge, preventive practices related to human T. solium infections and the cumulative incidence of human cysticercosis between intervention and control villages. There was no significant difference in mean knowledge scores and preventive practice mean scores between the control and intervention groups at baseline. However, there were significantly higher knowledge mean scores in the intervention group compared to the control group at one year post-intervention (2.06 ± 1.45 vs. 0.94 ± 1.18, p < 0.001). There was no significant difference in the mean practice scores between the intervention and the control group at one year post-intervention (2.49 ± 1.13 vs. 2.40 ± 1.13, p = 0.31). Furthermore, there was no significant difference in the prevalence of human T. solium cysticercosis between the intervention and the control group at the baseline (1.4% vs. 1.4%, p = 0.97) by Ag-Elisa, and at one year post-intervention the cumulative incidence of human cysticercosis was 1.9 and 1.2 per cent in the control and intervention group, respectively. There was no significant difference in the cumulative incidence of human cysticercosis between the intervention and the control group at one year post-intervention (p > 0.05). Community health-education intervention is effective at improving the knowledge of human T. solium infections. The improvement in preventive practices and reduction in incidences of human cysticercosis are a gradual process, they may require sanitary and hygienic improvement and more time after the intervention to see improved changes. The study recommends a sustainable public health education on T. solium infections using the health education package through one health approach.
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Affiliation(s)
- George Makingi
- The College of Veterinary Medicine and Biomedical Sciences, Sokoine University of Agriculture, Morogoro P.O. Box 3021, Tanzania
| | - Bernard Ngowi
- Muhimbili Medical Research Centre, National Institute for Medical Research, Dar es Salaam P.O. Box 3436, Tanzania
- Mbeya College of Health and Allied Sciences, University of Dar es Salaam, Mbeya P.O. Box 608, Tanzania
| | - Ernatus Mkupasi
- The College of Veterinary Medicine and Biomedical Sciences, Sokoine University of Agriculture, Morogoro P.O. Box 3021, Tanzania
| | - Christina Wilson
- The College of Veterinary Medicine and Biomedical Sciences, Sokoine University of Agriculture, Morogoro P.O. Box 3021, Tanzania
| | - Andrea Sylvia Winkler
- Center for Global Health, Department of Neurology, Technical University of Munich, 81675 Munich, Germany
- Department of Community Medicine and Global Health, Institute of Health and Society, University of Oslo, 0373 Oslo, Norway
| | - Jahashi Nzalawahe
- The College of Veterinary Medicine and Biomedical Sciences, Sokoine University of Agriculture, Morogoro P.O. Box 3021, Tanzania
| | - Helena Ngowi
- The College of Veterinary Medicine and Biomedical Sciences, Sokoine University of Agriculture, Morogoro P.O. Box 3021, Tanzania
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Bibi S, Kamran M, Ahmad H, Bibi K, Naqvi SKUH, Zuo Q, Shah NA, Cao J. Knowledge, Attitudes and Practices Regarding Taeniasis in Pakistan. Diseases 2023; 11:95. [PMID: 37489447 PMCID: PMC10366766 DOI: 10.3390/diseases11030095] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/19/2023] [Revised: 06/16/2023] [Accepted: 06/22/2023] [Indexed: 07/26/2023] Open
Abstract
Taeniasis is a neglected zoonotic disease responsible for serious health disorders, such as seizures, and may even cause death. Humans are the definitive host for the three species Taenia solium (pork tapeworm), T. saginata (beef tapeworm), and T. asiatica, harboring the adult tapeworm in the small intestine. In this study, a structured questionnaire was circulated to assess the knowledge, attitudes, and practices (KAPs) regarding taeniasis among the rural and urban communities of Rawalpindi and Islamabad, Pakistan. A total of 770 individuals participated in the study. Of the total respondents, 44.4% had little knowledge about the disease and its impact, while the majority (70%) of respondents showed a willingness to participate in elimination campaigns by providing fecal samples. Most respondents kept raw meat separated from clean utensils (81.6%) and checked the internal temperature of meat when cooking it (75.1%). Regression analysis showed a significant association between age and knowledge, especially in the 20-30 years (p < 0.05; OR 0.574) and 30 to 40 years (p < 0.05; OR 0.553) age groups, and being a resident in Rawalpindi (p < 0.05; OR 0.68) and other cities (p < 0.05; OR 2.43), except Islamabad. Income ranges of 31,000-50,000 PKR (p < 0.05; OR: 0.574), 51,000-70,000 PKR (p < 0.05; OR 0.531), and above 70,000 PKR (p < 0.05; OR 0.42) were significantly related to attitude, compared with individuals with incomes of 10,000-30,000 PKR. Income above 70,000 PKR (p < 0.05; OR 0.87) and living in an urban area (p < 0.05; OR 0.616) compared to a rural area were significant with practices. A positive attitude was observed regarding awareness and prevention of the disease. Awareness campaigns and providing health education could be key approaches to manage this disease in the general population of developing countries.
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Affiliation(s)
- Saba Bibi
- Department of Biosciences, COMSATS University Islamabad (CUI), Park Road, Chak Shahzad, Islamabad 45550, Pakistan
| | - Muhammad Kamran
- Department of Biosciences, COMSATS University Islamabad (CUI), Park Road, Chak Shahzad, Islamabad 45550, Pakistan
- Department of Medical Laboratory Technology, Islamabad Medical and Dental College, Islamabad 45400, Pakistan
| | - Haroon Ahmad
- Department of Biosciences, COMSATS University Islamabad (CUI), Park Road, Chak Shahzad, Islamabad 45550, Pakistan
| | - Kainat Bibi
- Department of Biosciences, COMSATS University Islamabad (CUI), Park Road, Chak Shahzad, Islamabad 45550, Pakistan
| | - Syed Kamran Ul Hassan Naqvi
- Department of Biosciences, COMSATS University Islamabad (CUI), Park Road, Chak Shahzad, Islamabad 45550, Pakistan
| | - Qingqiu Zuo
- National Institute of Parasitic Diseases, Chinese Center for Disease Control and Prevention (Chinese Center for Tropical Diseases Research), Shanghai 200025, China
- Key Laboratory of Parasite and Vector Biology, National Health Commission of the People's Republic of China, Shanghai 200025, China
- WHO Collaborating Center for Tropical Diseases, Shanghai 200025, China
| | - Naseer Ali Shah
- Department of Biosciences, COMSATS University Islamabad (CUI), Park Road, Chak Shahzad, Islamabad 45550, Pakistan
| | - Jianping Cao
- National Institute of Parasitic Diseases, Chinese Center for Disease Control and Prevention (Chinese Center for Tropical Diseases Research), Shanghai 200025, China
- Key Laboratory of Parasite and Vector Biology, National Health Commission of the People's Republic of China, Shanghai 200025, China
- WHO Collaborating Center for Tropical Diseases, Shanghai 200025, China
- The School of Global Health, Chinese Center for Tropical Diseases Research, Shanghai Jiao Tong University School of Medicine, Shanghai 200025, China
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Stelzle D, Makasi C, Welte TM, Ruether C, Schmidt V, Gabriel S, Bottieau E, Fleury A, Ngowi BJ, Winkler AS. Report of three patients with extensive neurocysticercosis in rural southern Tanzania: neurological, serological and neuroradiological findings. J Med Case Rep 2023; 17:311. [PMID: 37408061 DOI: 10.1186/s13256-023-03974-2] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/06/2022] [Accepted: 05/05/2023] [Indexed: 07/07/2023] Open
Abstract
BACKGROUND Neurocysticercosis (NCC) is common in eastern Africa, but disease presentation varies considerably. Most patients have single or few NCC-typical lesions in their brain but some present with a large number of lesions. We present three patients with positive antibody-based serology for Taenia solium cysticercosis screened at the Vwawa district hospital, Mbozi district, southern Tanzania, in whom extensive NCC was confirmed by neuroimaging. CASE PRESENTATIONS Patient 1 was a 55-year-old female from the tribe Malila smallholder farmer who has had four generalized tonic-clonic epileptic seizures over a period of 11 years and one episode of transient left hemiparesis one year before seizure onset. The patient also reported monthly to weekly episodes of severe, progressive, unilateral headache. The computed tomography (CT) scan of the brain showed 25 NCC lesions of which 15 were in the vesicular stage. Patient 2 was a 30-year-old male from tribe Nyha mechanic who reported monthly episodes of moderate to severe, progressive, bilateral headache, but no epileptic seizures. The CT scan showed 63 NCC lesions of which 50 were in the vesicular stage. Patient 3 was a 54-year-old female from the tribe Malila smallholder farmer who suffered from frequent generalized tonic-clonic epileptic seizures with potential signs of focal seizure onset. She also reported weekly to daily episodes of severe, progressive, unilateral headache. The CT scan showed 29 NCC lesions of which 28 were in the vesicular stage. CONCLUSIONS Clinical presentation of NCC with multiple brain lesions varies considerably ranging from few epileptic seizures and severe headache to severe epilepsy with frequent epileptic seizures. Individuals with neurological signs/symptoms that may be due to NCC, based for example on epidemiological criteria or serological evidence of cysticercosis, are recommended to undergo neuroimaging before anthelminthic treatment is considered.
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Affiliation(s)
- D Stelzle
- Center for Global Health, Department of Neurology, School of Medicine, Technical University of Munich, Munich, Germany.
| | - C Makasi
- Muhimbili Medical Research Centre, National Institute for Medical Research, Dar es Salaam, Tanzania
- Faculty of Medicine, Kilimanjaro Christian Medical University College, Moshi, Tanzania
| | - T M Welte
- Center for Global Health, Department of Neurology, School of Medicine, Technical University of Munich, Munich, Germany
- Epilepsy Center, Department of Neurology, University Hospital Erlangen, Erlangen, Germany
| | - C Ruether
- Department of Neuroradiology, RoMed Clinic Rosenheim, Rosenheim, Germany
| | - V Schmidt
- Center for Global Health, Department of Neurology, School of Medicine, Technical University of Munich, Munich, Germany
| | - S Gabriel
- Department of Translational Physiology, Infectiology and Public Health, Faculty of Veterinary Medicine, Ghent University, Ghent, Belgium
| | - E Bottieau
- Department of Clinical Sciences, Institute of Tropical Medicine, Antwerp, Belgium
| | - A Fleury
- Departamento de Medicina Genómica y Toxicología ambiental, Instituto de Investigaciones Biomédicas, Universidad Nacional Autónoma de México/Instituto Nacional de Neurología y Neurocirugía, Ciudad de Mexico, Mexico
| | - B J Ngowi
- Muhimbili Medical Research Centre, National Institute for Medical Research, Dar es Salaam, Tanzania
- University of Dar Es Salaam, Mbeya College of Health and Allies Sciences, Mbeya, Tanzania
| | - A S Winkler
- Center for Global Health, Department of Neurology, School of Medicine, Technical University of Munich, Munich, Germany
- Department of Community Medicine and Global Health, Institute of Health and Society, Faculty of Medicine, University of Oslo, Oslo, Norway
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Stelzle D, Makasi C, Schmidt V, Trevisan C, Van Damme I, Ruether C, Dorny P, Magnussen P, Zulu G, Mwape KE, Bottieau E, Prazeres da Costa C, Prodjinotho UF, Carabin H, Jackson E, Fleury A, Gabriël S, Ngowi BJ, Winkler AS. Efficacy and safety of antiparasitic therapy for neurocysticercosis in rural Tanzania: a prospective cohort study. Infection 2023:10.1007/s15010-023-02021-y. [PMID: 36961623 PMCID: PMC10037392 DOI: 10.1007/s15010-023-02021-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/17/2022] [Accepted: 03/11/2023] [Indexed: 03/25/2023]
Abstract
PURPOSE Neurocysticercosis is common in regions endemic for Taenia solium. Active-stage neurocysticercosis can be treated with antiparasitic medication, but so far no study on efficacy and safety has been conducted in Africa. METHODS We conducted a prospective cohort study on treatment of neurocysticercosis in Tanzania between August 2018 and January 2022. Patients were initially treated with albendazole (15 mg/kg/d) for 10 days and followed up for 6 months. Additionally in July 2021, all participants who then still had cysts were offered a combination therapy consisting of albendazole (15 mg/kg/d) and praziquantel (50 mg/kg/d). Antiparasitic treatment was accompanied by corticosteroid medication and anti-seizure medication if the patient had experienced epileptic seizures before treatment. RESULTS Sixty-three patients were recruited for this study, of whom 17 had a complete follow-up after albendazole monotherapy. These patients had a total of 138 cysts at baseline, of which 58 (42%) had disappeared or calcified by the end of follow-up. The median cyst reduction was 40% (interquartile range 11-63%). Frequency of epileptic seizures reduced considerably (p < 0.001). Three patients had all active cysts resolved or calcified and of the remaining 14, eight received the combination therapy which resolved 63 of 66 cysts (95%). Adverse events were infrequent and mild to moderate during both treatment cycles. CONCLUSION Cyst resolution was unsatisfactory with albendazole monotherapy but was very high when it was followed by a combination of albendazole and praziquantel.
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Affiliation(s)
- D Stelzle
- Center for Global Health, TUM School of Medicine, Technical University of Munich (TUM), Munich, Germany.
- Department of Neurology, TUM School of Medicine, Technical University of Munich (TUM), Munich, Germany.
| | - C Makasi
- National Institute for Medical Research, Muhimbili Medical Research Centre, Dar es Salaam, Tanzania
| | - V Schmidt
- Center for Global Health, TUM School of Medicine, Technical University of Munich (TUM), Munich, Germany
- Department of Neurology, TUM School of Medicine, Technical University of Munich (TUM), Munich, Germany
| | - C Trevisan
- Department of Translational Physiology, Infectiology and Public Health, Faculty of Veterinary Medicine, Ghent University, Merelbeke, Belgium
- Department of Biomedical Sciences, Institute of Tropical Medicine, Antwerp, Belgium
| | - I Van Damme
- Department of Translational Physiology, Infectiology and Public Health, Faculty of Veterinary Medicine, Ghent University, Merelbeke, Belgium
- Service of Foodborne Pathogens, Sciensano, Brussels, Belgium
| | - C Ruether
- Department of Neuroradiology, Faculty of Medicine, Technical University of Munich, Munich, Germany
| | - P Dorny
- Department of Biomedical Sciences, Institute of Tropical Medicine, Antwerp, Belgium
| | - P Magnussen
- Faculty of Health and Medical Sciences, University of Copenhagen, Copenhagen, Denmark
| | - G Zulu
- Ministry of Health, Lusaka, Zambia
| | - K E Mwape
- Department of Clinical Studies, School of Veterinary Medicine, University of Zambia, Lusaka, Zambia
| | - E Bottieau
- Department of Clinical Sciences, Institute of Tropical Medicine, Antwerp, Belgium
| | - C Prazeres da Costa
- Institute for Medical Microbiology, Immunology and Hygiene, Center for Global Health, Technical University of Munich, Munich, Germany
- German Center for Infection and Research (DZIF), Munich, Germany
| | - U F Prodjinotho
- Center for Global Health, TUM School of Medicine, Technical University of Munich (TUM), Munich, Germany
- Institute for Medical Microbiology, Immunology and Hygiene, Center for Global Health, Technical University of Munich, Munich, Germany
| | - H Carabin
- Département de Pathologie et Microbiologie, Faculté de Médecine Vétérinaire, Université de Montréal, Saint-Hyacinthe, QC, J2S 2M2, Canada
- Département de Médecine Sociale et Préventive, École de Santé Publique de l'université de Montréal, Montréal, QC, H3N 1X9, Canada
- Centre de Recherche en Santé Publique (CReSP) de l'université de Montréal et du CIUSS du Centre Sud de Montréal, Montréal, QC, H3N 1X9, Canada
- Groupe de Recherche en Épidémiologie des Zoonoses et Santé Publique (GREZOSP), Université de Montréal, Saint-Hyacinthe, QC, J2S 2M2, Canada
| | - E Jackson
- Département de Pathologie et Microbiologie, Faculté de Médecine Vétérinaire, Université de Montréal, Saint-Hyacinthe, QC, J2S 2M2, Canada
- Centre de Recherche en Santé Publique (CReSP) de l'université de Montréal et du CIUSS du Centre Sud de Montréal, Montréal, QC, H3N 1X9, Canada
- Groupe de Recherche en Épidémiologie des Zoonoses et Santé Publique (GREZOSP), Université de Montréal, Saint-Hyacinthe, QC, J2S 2M2, Canada
| | - A Fleury
- Instituto de Investigaciones Biomédicas-UNAM/Instituto Nacional de Neurología y Neurocirugía/Facultad de Medicina-UNAM, Ciudad de Mexico, Mexico
| | - S Gabriël
- Department of Translational Physiology, Infectiology and Public Health, Faculty of Veterinary Medicine, Ghent University, Merelbeke, Belgium
| | - B J Ngowi
- National Institute for Medical Research, Muhimbili Medical Research Centre, Dar es Salaam, Tanzania
- University of Dar es Salaam, Mbeya College of Health and Allies Sciences, Mbeya, Tanzania
| | - A S Winkler
- Center for Global Health, TUM School of Medicine, Technical University of Munich (TUM), Munich, Germany
- Centre for Global Health, Institute of Health and Society, Faculty of Medicine, University of Oslo, Oslo, Norway
- Department of Neurology, TUM School of Medicine, Technical University of Munich (TUM), Munich, Germany
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Makasi CE, Kilale AM, Ngowi BJ, Lema Y, Katiti V, Mahande MJ, Msoka EF, Stelzle D, Winkler AS, Mmbaga BT. Knowledge and misconceptions about epilepsy among people with epilepsy and their caregivers attending mental health clinics: A qualitative study in Taenia solium endemic pig-keeping communities in Tanzania. Epilepsia Open 2023. [PMID: 36896648 DOI: 10.1002/epi4.12720] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/18/2022] [Accepted: 03/04/2023] [Indexed: 03/11/2023] Open
Abstract
OBJECTIVE Taenia solium (T. solium) neurocysticercosis (NCC) affects the central nervous system and is associated with 30% of acquired epilepsy in some endemic areas. Epilepsy is a stigmatizing disease in many societies and people with epilepsy (PWE) and their families experience discrimination. This study aimed to explore the knowledge, perceptions, and experiences of epilepsy among PWE and their caregivers attending mental health clinics. METHODS In T. solium endemic areas of Tanzania, PWE and their caregivers attending mental health clinics were identified and their informed consent was sought prior to study participation. In-depth interviews were conducted in Swahili language and analyzed thematically. The coding was undertaken by two independent researchers using NVivo (Version 12, QSR International). RESULTS Thirty-eight participants were interviewed. Three themes were identified during the analysis, namely, knowledge about epilepsy; perception of epilepsy; and experience with epilepsy among PWE and their caregivers. Participants commonly defined epilepsy as a "falling disease," perceived to be caused by witchcraft, and were unaware of the association between T. solium and epilepsy. Stigmatization of epilepsy was reported as a problem. Reported treatment patterns after the initial onset of epilepsy varied widely; however, patients usually began treatment with traditional healing methods, and only later opted for biomedical treatment. Patients had generally poor adherence to antiseizure medication, which could be caused by inadequate knowledge or irregular supply. SIGNIFICANCE Level of knowledge about epilepsy was low, and NCC was not mentioned as a cause of epilepsy among participants. Epilepsy was generally perceived to be the result of witchcraft, evil spirits, or curses. Health education is needed, including an explanation of the model of T. solium transmission and the insistence on hygiene measures. This could reduce the number of new infections with T. solium, improve access to prompt biomedical treatment, and improve the lives of PWE.
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Affiliation(s)
- Charles E Makasi
- National Institute for Medical Research, Muhimbili Research Centre, Dar es Salaam, Tanzania.,Kilimanjaro Christian Medical University College of Tumaini University, Moshi, Tanzania
| | - Andrew M Kilale
- National Institute for Medical Research, Muhimbili Research Centre, Dar es Salaam, Tanzania
| | - Bernard J Ngowi
- National Institute for Medical Research, Muhimbili Research Centre, Dar es Salaam, Tanzania.,Mbeya College of Health and Allied Sciences, University of Dar es Salaam, Mbeya, Tanzania
| | - Yakobo Lema
- National Institute for Medical Research, Muhimbili Research Centre, Dar es Salaam, Tanzania
| | - Victor Katiti
- Department of Epidemiology and Biostatistics, Institute of Public Health, Kilimanjaro Christian Medical University College, Moshi, Tanzania.,Kilimanjaro Clinical Research Institute, Kilimanjaro Christian Medical Centre, Moshi, Tanzania
| | - Michael J Mahande
- Kilimanjaro Christian Medical University College of Tumaini University, Moshi, Tanzania.,Department of Epidemiology and Biostatistics, Institute of Public Health, Kilimanjaro Christian Medical University College, Moshi, Tanzania
| | - Elizabeth F Msoka
- Kilimanjaro Christian Medical University College of Tumaini University, Moshi, Tanzania.,Kilimanjaro Clinical Research Institute, Kilimanjaro Christian Medical Centre, Moshi, Tanzania
| | - Dominik Stelzle
- Center for Global Health, Department of Neurology, Faculty of Medicine, Technical University Munich, Munich, Germany
| | - Andrea S Winkler
- Center for Global Health, Department of Neurology, Faculty of Medicine, Technical University Munich, Munich, Germany.,Centre for Global Health, Institute of Health and Society, University of Oslo, Oslo, Norway
| | - Blandina T Mmbaga
- Kilimanjaro Christian Medical University College of Tumaini University, Moshi, Tanzania.,Kilimanjaro Clinical Research Institute, Kilimanjaro Christian Medical Centre, Moshi, Tanzania
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