Neurocysticercosis: HP10 Antigen Detection Is Useful for the Follow-up of the Severe Patients

Abstract

BackgroundThe most severe clinical form of neurocysticercosis (NC) occurs when cysticerci are located in the subarachnoid space at the base of the brain (SaB). The diagnosis, monitoring and treatment of NC-SaB, constitutes a severe clinical challenge. Herein we evaluate the potential of the HP10 antigen detection enzyme-linked immunosorbent assay (HP10 Ag-ELISA) in the long term follow-up of NC-SaB cases. Assay performance was compared with that of Magnetic Resonance Imaging (MRI). In addition, the robustness of the HP10 Ag-ELISA was evaluated independently at two different institutions.Methodology/Principal FindingsA double-blind prospective cohort trial was conducted involving 38 NC-SaB cases and a total of 108 paired serum and cerebrospinal fluid (CSF) samples taken at intervals of 4 to 8 months for up to 43 months. At each medical visit, results of sera and CSF HP10 Ag-ELISA and MRI obtained at last visit were compared and their accuracy was evaluated retrospectively, considering radiological evolution between appointments. In the long-term follow-up study, HP10 Ag-ELISA had a better agreement than MRI with retrospective radiological evaluation. High reproducibility of HP10 Ag-ELISA between laboratories was also demonstrated.ConclusionsResults reported in this study establish for the first time the usefulness of the comparatively low cost HP10 Ag-ELISA for long term follow-up of NC-SaB patients.

Successful Antiparasitic Treatment for Cysticercosis is Associated with a Fast and Marked Reduction of Circulating Antigen Levels in a Naturally Infected Pig Model

“…Extraparenchymal NCC, on the other hand, presents very high antigen levels, which have already been shown to reflect the evolution of the disease. 14,15,27,41 Antigen detection by a monoclonal antibody-based ELISA is a reliable tool to evaluate the response to antiparasitic treatment in the porcine model and may prove useful to monitor the efficacy of antiparasitic treatment in human NCC, guiding medical decisions along patient follow-up.…”

Clinical symptoms, diagnosis, and treatment of neurocysticercosis

“…Circulating antigens are present only in the serum of patients with viable parasitic tissue, and serum concentrations rapidly decrease after successful antiparasitic treatment or surgery. 95,96 Initial reports used this assay in CSF specimens, 97 but the duration of antigens in CSF is not known. 92,98 The sensitivity of this test in serum for parenchymal neurocysticercosis is poor—ranges from 72% to 86%—and is commonly negative in patients with one or a few live cysts.…”

“…ELISA could be useful to monitor the decrease in parasite burden in response to antiparasitic treatment in people with extensive disease and, in particular, those with subarachnoid neurocysticercosis. 92,95,96 Circulating anti gens are almost always present in patients with basal subarachnoid neurocysticercosis and in most patients with racemose involvement of the subarachnoid spaces. In our experience, quantitative serial serum ELISA assays are helpful to determine a response to treatment in sub arachnoid neurocysticercosis.…”

Factors Associated With Cysticidal Treatment Response in Extraparenchymal Neurocysticercosis

“…A major problem in both clinical practice and research has been the difficulty of accurately diagnosing extraparenchymal NC. However, recent advances, such as assays for the detection of a secreted antigen in serum and cerebrospinal fluid (CSF), 9 3-dimensional (3-D) magnetic resonance imaging (MRI) sequences (FIESTA, CISS), 10 and validated diagnostic criteria 11 have improved this situation.…”