Estimating the association between being seropositive for cysticercosis and the prevalence of epilepsy and severe chronic headaches in 60 villages of rural Burkina Faso

Abstract

BackgroundIndividuals diagnosed with neurocysticercosis often present with epilepsy and sometimes with progressively worsening severe chronic headaches (WSCH). While cross-sectional associations between seropositivity to cysticercal antigens and epilepsy have been reported, few large scale studies have been conducted in West Africa and none have measured the association between seropositivity to cysticercal antigens and headaches. This study aimed at filling these knowledge gaps by estimating the strength of the cross-sectional association between seropositivity to cysticercal antigens and the prevalence of epilepsy and WSCH in 60 villages of Burkina Faso, West Africa.Methodology/Principal findingsBaseline data from a cluster randomized controlled trial collected from January 2011 to February 2012 in 60 villages across three provinces in Burkina Faso were used. Between 78 and 80 individuals were screened for epilepsy and WSCH in each village, and those screened positive were confirmed by a physician. Seventy-five percent of all participants were asked to provide a blood sample to test for Taenia solium cysticercus circulating antigens. Hierarchical multivariable logistic models were used to measure the association between seropositivity to cysticercal antigens and epilepsy (lifetime and active) as well as WSCH. Among 3696 individuals who provided a blood sample, 145 were found to have epilepsy only, 140 WSCH only and 19 both. There were positive associations between seropositivity to cysticercal antigens and active epilepsy (prevalence odds ratio (POR): 2.40 (95%CI: 1.15–5.00)) and WSCH (POR: 2.59 (1.34–4.99)).Conclusions/SignificanceOur study is the first to demonstrate a cross-sectional association between seropositivity to cysticercal antigens and WSCH in a large community-based study conducted in West Africa. The measured cross-sectional association had a strength similar to the ones previously observed between seropositivity to cysticercal antigens and lifetime or active epilepsy. As a result, preventing new cysticercosis cases in communities may reduce the prevalence of these two important neurological disorders.

High frequency of Taenia solium antigen positivity in patients admitted for neurological disorders in the Rural Hospital of Mosango, Democratic Republic of Congo.

“…Also, the high frequency of antigen positivity in patients with neurological disorders is compatible with the hypothesis that this infection plays some causal role [4,31]. It is worth reminding in addition that neurocysticercosis tends to become clinically apparent when the cystic lesions degenerate, through local in ammatory reactions, while active cysts alone usually cause little neurological symptoms [32].…”

High frequency of Taenia solium antigen positivity in patients admitted for neurological disorders in the Rural Hospital of Mosango, Democratic Republic of Congo.

“…Additional studies performed later on in Africa revealed that the proportion of neurocysticercosis in patients with epilepsy varied a lot according to the setting and could range from 15-50% [24,[28][29][30]. in patients with neurological disorders is compatible with the hypothesis that this infection plays some causal role [4,31]. It is worth reminding in addition that neurocysticercosis tends to become clinically apparent when the cystic lesions degenerate, through local inflammatory reactions, while active cysts alone usually cause little neurological symptoms [32].…”

Modelling for Taenia solium control strategies beyond 2020

“…• true prevalence of T. solium infection in humans and pigs because of poor diagnostic methods • adult tapeworm life span • effect of pig-to-people population ratio on transmission • processes regulating parasite acquisition in humans and pigs 26 • health and economic burden 2,3 and cost-effectiveness of interventions (DALYs likely to underestimate disease burden); possible use of the zoonotic zDALY metric 21 • linking infection to disease models, particularly to human neurocysticercosis and epilepsy 27 What are the biggest risks?…”