This study evaluates five synthetic peptides derived from four, potentially protective, Taenia saginata oncosphere molecules for the serodiagnosis of T. solium cysticercosis/neurocysticercosis in three distinct Venezuelan endemic regions. The peptides, all of which have been described previously, are designated HP6-3, Ts45W-1, Ts45W-5, Ts45S-10 and TEG-1. In clinically verified and seropositive hospital cases, combining the results of three of the individual peptide-based ELISAs (HP6-3, Ts45W-1 and Ts45W-5) afforded the best balance between sensitivity (85%) and specificity (83.5%), a significant improvement on the 63.6% specificity obtained with the routinely employed T. solium cyst-fluid-based ELISA. Similarly, in the seropositive Venezuelan endemic zone samples, 89.09% of Amerindians, 77.27% of symptomatic rural subjects and 67.83% of non-symptomatic rural subjects were also classed as seropositive by the combined peptide-based ELISAs. The profile of antibody recognition to individual peptides varied between the different groups of samples examined. The relevance of the above findings for the serology and prognosis of T. solium cysticercosis/neurocysticercosis in hospital- and field-based situations is discussed.

A serological study was undertaken in 1998 to evaluate levels of Taenia solium cysticercosis in 3 rural Venezuelan communities. Infection with viable metacestodes was diagnosed with a trapping enzyme-linked immunosorbent assay (ELISA) that detects a secreted product of viable parasites. Anti-metacestode antibodies were assayed by ELISA using T. solium vesicular fluid as antigen. A total of 1254 sera was collected from 3 communities (Canoabo, Sanare, and Rio Tocuyo) where previous studies had suggested the presence of T. solium. Our results demonstrate an unusually high seroprevalence of cysticercosis, indicating an attendant risk of transmitting the disease to other areas. The seroprevalence of infection with viable cysts, as indicated by detection of circulating parasite antigen, was 9.1% in Canoabo, 6.1% in Sanare, and 5.7% in Rio Tocuyo. The corresponding frequency of antibodies to T. solium cyst antigens was 36.5% in Canoabo, 36.5% in Sanare, and 4% in Rio Tocuyo. As these communities are probably representative of many others in Venezuela, T. solium cysticercosis may be a significant public health problem and more work is certainly indicated. An important finding was that local knowledge of the disease and its transmission do not necessarily guarantee diminished disease prevalence, indicating a lack of appropriate vigilance towards disease control.

No abstract

Diagnosis of Taenia solium cysticercosis in endemic rural communities depends on serological tests, as typically there is no access to imaging facilities. The HP10 antigen ELISA (HP10 Ag ELISA), which detects a high molecular weight secreted protein of viable metacestodes, has been employed for the diagnosis of both human and porcine cysticercosis in such communities. In this communication, we formally demonstrate that the HP10 Ag ELISA, already known to function for the detection of T. saginata and T. solium cysticercosis, also detects a similar high molecular weight antigen of T. hydatigena. Thus, the HP10 Ag assay, while specific for human cysticercosis, may not be recommended for the diagnosis of porcine cysticercosis where there is co-infection of pigs with T. solium and T. hydatigena.

No abstract

No abstract

Background; Surgery for portal hypertension has a low rebleeding rate. Patients that rebleed can be grossly divided into those who die as a consequence of the episode, those who don't die but develop liver failure (remaining as Child-Pugh C) and those who, in spite of the bleeding episode, retain good liver function (Child-Pugh A or B). At our hospital, the latter group is considered for further surgical treatment. We report here the results of surgical rescue of surgical failures. Methods; In a twenty year period, 36 patients (30 Child-Pugh A, 6 Child-Pugh B) were reoperated. The files of these patients were reviewed. Results; Average age was 33 years. Cirrhosis was present in 31 cases. All patients were electively reoperated with portal blood flow preserving procedures. Operative mortality for the whole group was 12% and for the Child-Pugh A group 6.6%. Rebleeding was observed in 5.5%. Postoperative incapacitating encephalopathy was recorded in one case (2.7%). Good quality of life was recorded in 84% of the cases. Survival (Kaplan-Meier) was 78% at 6 months and 69% at 5 years. Conclusions; Surgical failures in low risk patients (Child-Pugh A or B) can be treated by means of surgery, and a low mortality, re-bleeding and encephalopathy rate can be expected. The performance of a portal blood flow preserving procedure is recommended.

No abstract