Mortality in Parenchymal and Subarachnoid Neurocysticercosis

Abanto, Jesus; Blanco, Daniel Rodrigues; Saavedra, Herbert; Gonzáles, Isidro; Siu, Diego; Pretell, E. Javier; Bustos, Javier A.; Garcı́a, Héctor H.

doi:10.4269/ajtmh.20-1330

Cited by 14 publications

(10 citation statements)

References 29 publications

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“…It is associated with hydrocephalus and intracranial hypertension and results in high mortality rates if not recognized and treated appropriately. 11 We used urine from patients with subarachnoid NCC for the initial testing phase of this prototype dipstick because of the consistently high levels of parasite antigens characteristic of subarachnoid NCC. Clearly, this preliminary series does not assess the performance of the test in other types of NCC, such as parenchymal NCC, in which antigen levels may be much lower and test sensitivity could decrease significantly.…”

Section: Discussionmentioning

confidence: 99%

A Rapid Point-of-Care Assay for Cysticercosis Antigen Detection in Urine Samples

Toribio

Handali

Marin

et al. 2023

The American Journal of Tropical Medicine and Hygiene

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We report a proof-of-concept study using a dipstick assay to detect Taenia solium antigen in urine samples of 30 patients with subarachnoid neurocysticercosis and 10 healthy control subjects. Strips were read in blind by two readers. The assay detected antigen in 29 of 30 cases and was negative in all 10 control samples. Although this study was performed in samples from individuals with subarachnoid neurocysticercosis who likely had high circulating antigen levels, it provides the proof of concept for a functional urine antigen point-of-care assay that detects viable cysts. Such an assay could serve to support a clinical diagnosis of suspect neurocysticercosis or to identify patients at risk of developing severe disease in areas where medical resources are limited, providing evidence to refer these individuals for imaging and specialized care as needed.

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Section: Discussionmentioning

confidence: 99%

A Rapid Point-of-Care Assay for Cysticercosis Antigen Detection in Urine Samples

Toribio

Handali

Marin

et al. 2023

The American Journal of Tropical Medicine and Hygiene

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“…Recurrent and protracted disease in the racemose/subarachnoid phenotype and the unreliability in following clinical and radiologic changes [ 2 ]. Despite the high morbidity [ 11 ] and mortality [ 12 ] reported in this patient population, our group has previously demonstrated the utility of using a comparator assay to determine durable cure, which enables the safe discontinuation of treatment [ 13 ]. Here we demonstrate that TsG10-TsG10*bt was 95% sensitive in the serum and 100% sensitive in the CSF in detecting active extra-parenchymal disease in our patient population.…”

Section: Discussionmentioning

confidence: 99%

A recombinant monoclonal-based Taenia antigen assay that reflects disease activity in extra-parenchymal neurocysticercosis

et al. 2022

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Background Antigen tests for diagnosis and disease monitoring in some types of neurocysticercosis (NCC) are useful but access to testing has been limited by availability of proprietary reagents and/or kits. Methods/Principal findings Three previously identified IgM-secreting hybridomas whose IgM products demonstrated specificity to Taenia solium underwent variable heavy and light chain sequencing and isotype conversion to mouse IgG. Screening of these recombinantly expressed IgG anti-Ts hybridomas, identified one (TsG10) with the highest affinity to crude Taenia antigen. TsG10 was then used as a capture antibody in a sandwich antigen detection immunoassay in combination with either a high titer polyclonal anti-Ts antibody or with biotinylated TsG10 (termed TsG10*bt). Using serum, plasma, and CSF samples from patients with active NCC and those from NCC-uninfected patients, ROC curve analyses demonstrated that the TsG10-TsG10-*bt assay achieved a 98% sensitivity and 100% specificity in detecting samples known to be antigen positive and outperformed the polyclonal based assay (sensitivity of 93% with 100% specificity). By comparing levels of Ts antigen (Ag) in paired CSF (n = 10) or plasma/serum (n = 19) samples from well-characterized patients with extra-parenchymal NCC early in infection and at the time of definitive cure, all but 2 (1 from CSF and 1 from plasma) became undetectable. There was a high degree of correlation (r = 0.98) between the Ag levels detected by this new assay and levels found by a commercial assay. Pilot studies indicate that this antigen can be detected in the urine of patients with active NCC. Conclusions/Significance A newly developed recombinant monoclonal antibody-based Ts Ag detection immunoassay is extremely sensitive in the detection of extra-parenchymal NCC and can be used to monitor the success of treatment in the CSF, serum/plasma and urine. The ability to produce recombinant TsG10 at scale should enable use of this antigen detection immunoassay wherever NCC is endemic. Clinical Trial Registration ClinicalTrials.gov Identifiers: NCT00001205 - & NCT00001645.

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“…Subarachnoid NCC represents the most lethal form of NCC. In a study of 840 NCC patients seen at the National Institute of Neurological Sciences in Peru, Abanto et al [11] identified 42 deaths. Most deaths were among the minority with subarachnoid NCC (32/193, 16.6% of subarachnoid cases).…”

Section: Treatment Approachmentioning

confidence: 99%

“…Subarachnoid NCC is considered the most severe form of disease and carries the highest mortality rates [11,12 ▪▪ ]. Enlarging cysts can cause mass effect and focal deficits.…”

Section: Clinical Presentationmentioning

confidence: 99%

Neurocysticercosis: an update on diagnosis, treatment, and prevention

Pineda-Reyes

White

2022

Current Opinion in Infectious Diseases

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Neurocysticercosis (NCC) is an important cause of neurological disease worldwide, including imported cases in nonendemic countries.Purpose of reviewThe purpose of this review is to update information on diagnosis, management, and prevention of neurocysticercosisRecent findingsWHO and Infectious Diseases Society of America/American Society of Tropical Medicine and Hygiene guidelines emphasize the importance of corticosteroids and antiparasitic drugs for viable parenchymal disease and single enhancing lesions. Subarachnoid NCC is associated with a high fatality rate unless optimally treated. Advances in subarachnoid NCC include use of prolonged antiparasitic and anti-inflammatory courses and the increasing use of antigen-detection and quantitative PCR assays in diagnosis and follow-up. Emerging data support the safety and efficacy of minimally invasive surgery in ventricular cases. Calcified neurocysticercosis continues to be associated with a high burden of disease. Field studies are demonstrating the feasibility of eradication using a combination of mass chemotherapy for human tapeworms and vaccination/treatment of porcine cysticercosis.SummaryNCC remains an important and challenging cause of neurological disease with significant morbidity despite advances in treatment and prevention.

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Mortality in Parenchymal and Subarachnoid Neurocysticercosis

Cited by 14 publications

References 29 publications

A Rapid Point-of-Care Assay for Cysticercosis Antigen Detection in Urine Samples

A Rapid Point-of-Care Assay for Cysticercosis Antigen Detection in Urine Samples

A recombinant monoclonal-based Taenia antigen assay that reflects disease activity in extra-parenchymal neurocysticercosis

Neurocysticercosis: an update on diagnosis, treatment, and prevention

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