Laboratory Diagnosis of Neurocysticercosis (Taenia solium)

Abstract

Neurocysticercosis accounts for approximately 30% of all epilepsy cases in most developing countries. The immunodiagnosis of cysticercosis is complex and strongly influenced by the course of infection, the disease burden, the cyst location, and the immune response of the host. The main approach to immunodiagnosis should thus be to evaluate whether the serological results are consistent with the diagnosis suggested by imaging. Antibody detection is performed using lentil lectin-purified parasite antigens in an enzyme-linked immunoelectrotransfer blot format, while antigen detection uses a monoclonal antibody-based enzyme-linked immunosorbent assay (ELISA). Promising new assay configurations have been developed for the detection of both antibody and antigen, including assays based on synthetic or recombinant antigens that may reduce costs and improve assay reproducibility and multiplex bead-based assays that may provide simultaneous quantitative results for several target antigens or antibodies.

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

“…Second, seropositivity to cysticercal antigens was used as a proxy for NCC. Serological tests for circulating cysticercal antigens are not very sensitive for the detection of non-viable parenchymal cysts and low number of cysts [44]. However, imaging such as CT-scans could only be offered to people with symptoms, and in the context of Burkina Faso, several people with symptoms refused to travel to receive imaging for fear of stigmatization.…”

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

“…However, transport and storage were rigorously monitored during the study and other serological investigations on the same stored samples did provide plausible results [22]. Alternatively, this may have been related to differences in the circulating strains of T solium, parasitic load or host characteristics compared to settings where the antibody-detection assay was validated [23]. A failure of the LDBIO assay itself is unlikely since it performed well with positive and negative controls.…”

“…Neuroimaging is absolutely necessary not only to accurately diagnose neurocysticercosis, but also to safely manage the potential risk of clinical deterioration due to anti-helminthic treatment (albendazole and/or praziquantel). While proven useful for epidemiological surveys and under study for public health interventions (such as mass drug administration with anti-helminthic drugs in endemic regions), the utility of immunoassays is more questionable for clinical care, since no therapeutic decision can exclusively rely on their results [23,33]. Antigen-or antibody-based assays, whenever available at the point-of-care [34,35], could however be explored as an operational screening tool to select the subset of neurological patients who might bene t most from neuroimaging (37).…”

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

“…However, transport and storage were rigorously monitored during the study and other serological investigations on the same stored samples did provide plausible results [22]. Alternatively, this may have been related to differences in the circulating strains of T solium, parasitic load or host characteristics compared to settings where the antibody-detection assay was validated [23]. A failure of the LDBIO assay itself is unlikely since it performed well with positive and negative controls.…”

“…Neuroimaging is absolutely necessary not only to accurately diagnose neurocysticercosis, but also to safely manage the potential risk of clinical deterioration due to anti-helminthic treatment (albendazole and/or praziquantel). While proven useful for epidemiological surveys and under study for public health interventions (such as mass drug administration with anti-helminthic drugs in endemic regions), the utility of immunoassays is more questionable for clinical care, since no therapeutic decision can exclusively rely on their results [23,33]. Antigen-or antibody-based assays, whenever available at the point-of-care [34,35], could however be explored as an operational screening tool to select the subset of neurological patients who might benefit most from neuroimaging.…”