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

Abstract

Background The epidemiology of human cysticercosis and neurocysticercosis, caused by the larval stage of the pork tapeworm Taenia solium, is not well known in the Democratic Republic of Congo (DRC). Within a multicenter etiological and diagnostic study conducted by the NIDIAG consortium (“Better Diagnosis for Neglected Infections”) and investigating several challenging syndromes, we consecutively evaluated from 2012 to 2015 all patients older than 5 years presenting with neurological disorders (neurology cohort) and with fever > 7 days (persistent fever cohort) at the rural hospital of Mosango, province of Kwilu, DRC. In both cohorts, etiological diagnosis relied on a systematic set of reference laboratory assays and on pre-established clinical case definitions. No neuroimaging was available in the study hospital. In this study, we determined the frequency of T. solium infection in both cohorts and explored in the neurology cohort its association with specific neurological presentations and final etiological diagnoses. Methods We conducted a post-hoc descriptive and analytic study on cysticercosis in the neurology and persistent fever cohorts, based on the presence in serum samples of circulating T. solium antigen using the B158/B60 enzyme-linked immunosorbent assay (ELISA) and of cysticercosis IgG using the LDBIO Cysticercosis Western Blot IgG assay. Results For the neurology cohort, 340 samples (of 351 enrolled patients) were available for analysis (males: 46.8%; mean age: 38.9 years). T. solium antigen positivity was found in 43 participants (12.6%; 95% confidence interval [CI] 9.3–16.7%), including 9 of 60 (15%) patients with epilepsy. Among the 148 samples available from the persistent fever cohort (males: 39.9%; mean age: 19.9 years), 7 were positive in the T. solium antigen ELISA (4.7%; 95% CI 1.9–9.5%; P = 0.009 when compared to the neurology cohort). No significant association was found within the neurology cohort between positivity and clinical presentation or final diagnoses. Of note, the IgG antibody-detecting assay was found positive in only four (1.3%) of the participants of the neurology cohort and in none of the persistent fever cohort. Conclusions T. solium antigen positivity was found in at least 10% of patients admitted with neurological disorders in the Kwilu province, DRC, with no specific pattern of presentation. Further neuroimaging studies should be used to confirm whether neurocysticercosis is prevalent in this region.

Evaluation of an Antibody Detecting Point of Care Test for Diagnosis of Taenia solium Cysticercosis in a Zambian Rural Community: A Prospective Diagnostic Accuracy Study

“…For now, it is not immediately clear why there were more positives on the antigen test than the antibody test. This phenomenon was also observed in another study in DR Congo [34].…”

The burden of T. solium cysticercosis and selected neuropsychiatric disorders in Mocuba district, Zambézia province, Mozambique

“…The disease is emerging as a serious threat to public health, inflicting significant economic losses and disabilities in low-income countries of sub-Saharan Africa, Latin America and Asia where T. solium is endemic. It is also of increasing concern in non-endemic countries due to globalization and the immigration of tapeworm carriers [1][2][3][4][5].…”

“…Humans are the definitive host and thus carriers of the adult tapeworm which develops after ingestion of measly raw or undercooked pork. However, humans may also become intermediate hosts and develop TSC following direct or indirect ingestion of T. solium eggs which develop into cystic larvae in various parts of the body [1,[5][6][7][8]. When the larva lodges in the central nervous system (CNS), the disease is called neurocysticercosis (NCC).…”

“…The most frequent neurological manifestations include epileptic seizures and epilepsy. In endemic areas, up to 30% of people with epilepsy may suffer from NCC [1][2][3][4][5]9]. Other neurological signs and symptoms include severe headache, intracranial hypertension, dementia, blindness, or chronic meningitis.…”

“…Other neurological signs and symptoms include severe headache, intracranial hypertension, dementia, blindness, or chronic meningitis. Also, different neuropsychiatric disorders have been associated with NCC although there is only limited data available [1,5,7,8,10].…”