High Prevalence of Asymptomatic Neurocysticercosis in an Endemic Rural Community in Peru

Abstract

BackgroundNeurocysticercosis is a common helminthic infection of the central nervous system and an important cause of adult-onset epilepsy in endemic countries. However, few studies have examined associations between neurologic symptoms, serology and radiographic findings on a community-level.MethodologyWe conducted a population-based study of resident’s ≥2 years old in a highly endemic village in Peru (pop. 454). We applied a 14 -question neurologic screening tool and evaluated serum for antibodies against Taenia solium cysticercosis using enzyme-linked immunoelectrotransfer blot (LLGP-EITB). We invited all residents ≥18 years old to have non-contrast computerized tomography (CT) of the head.Principal findingsOf the 385 residents who provided serum samples, 142 (36.9%) were seropositive. Of the 256 residents who underwent CT scan, 48 (18.8%) had brain calcifications consistent with NCC; 8/48 (17.0%) reported a history of headache and/or seizures. Exposure to T. solium is very common in this endemic community where 1 out of 5 residents had brain calcifications. However, the vast majority of people with calcifications were asymptomatic.ConclusionThis study reports a high prevalence of NCC infection in an endemic community in Peru and confirms that a large proportion of apparently asymptomatic residents have brain calcifications that could provoke seizures in the future.

Neurocysticercosis among People Living Near Pigs Heavily Infected with Cysticercosis in Rural Endemic Peru

“…The prevalence of calcified NCC in endemic areas ranges from 9% to 19%. 12,13 Although most are asymptomatic and do not require regular treatment or clinical follow-up, in an unknown proportion, calcifications will become chronic epileptogenic foci. 31 The treatment gap of epilepsy in impoverished rural regions endemic to T. solium remains high.…”

“…[8][9][10][11] A couple of studies have applied CT to adults without prescreening and found the prevalence to be 9-19%, with the vast majority of cases being calcified NCC. 12,13 MRI is a more sensitive tool for detecting viable cysts, particularly small cysts, as well as cysts in the base of the brain, ventricles, or subarachnoid spaces. MRI does not subject the participant to radiation but is less widely available and more expensive than CT.…”

On the relationship between calcified neurocysticercosis and epilepsy in an endemic village: A large‐scale, computed tomography–based population study in rural Ecuador

“…3–5 This scenario is different at the population level, where most infected individuals are asymptomatic or remain asymptomatic for many years before presenting with symptoms. 6–8 …”

“…[3][4][5] This scenario is different at the population level, where most infected individuals are asymptomatic or remain asymptomatic for many years before presenting with symptoms. [6][7][8] Several studies have attempted to assess the relationship of this parasitic disease with epilepsy. Most of them have been based on serological tests, which are not reliable for assessing NCC prevalence in the absence of neuroimaging.…”

Optimal Treatment for Subarachnoid Neurocysticercosis: Closer, but Not There yet

“…2 In endemic villages, populationbased surveys note that it is more common to have calcified lesions from prior cystic lesions. [3][4][5] Many cases are asymptomatic, but patients may also have chronic epilepsy. A minority of patients present with extra-parenchymal disease with cysticerci in the ventricles causing obstructive hydrocephalus or with subarachnoid disease associated with arachnoiditis.…”