Neurocysticercosis in Bhutan: a cross-sectional study in people with epilepsy

Brizzi, Kate; Pelden, Sonam; Tshokey, Tshokey; Nirola, Damber Kumar; Diamond, Megan; Klein, Joshua P.; Tshering, Lhab; Deki, Sonam; Nidup, Dechen; Bruno, Verónica; Dorny, Pierre; Garcı́a, Héctor H.; Mateen, Farrah J.

doi:10.1093/trstmh/trw066

Cited by 14 publications

(8 citation statements)

References 30 publications

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“…Bhutan was selected as a representative lower middle income country with a predominantly rural and remote population, dearth of practicing neurologists, lack of access to routine standard EEG, and endemic neurocysticercosis as a cause of epilepsy9. Participant enrolment and data collection took place at the Jigme Dorji Wangchuck National Referral Hospital in Thimphu, the capital city (July 2014-April 2015).…”

Section: Methodsmentioning

confidence: 99%

Validation of a smartphone-based EEG among people with epilepsy: A prospective study

McKenzie

Lim

Leung

et al. 2017

Sci Rep

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Our objective was to assess the ability of a smartphone-based electroencephalography (EEG) application, the Smartphone Brain Scanner-2 (SBS2), to detect epileptiform abnormalities compared to standard clinical EEG. The SBS2 system consists of an Android tablet wirelessly connected to a 14-electrode EasyCap headset (cost ~ 300 USD). SBS2 and standard EEG were performed in people with suspected epilepsy in Bhutan (2014–2015), and recordings were interpreted by neurologists. Among 205 participants (54% female, median age 24 years), epileptiform discharges were detected on 14% of SBS2 and 25% of standard EEGs. The SBS2 had 39.2% sensitivity (95% confidence interval (CI) 25.8%, 53.9%) and 94.8% specificity (95% CI 90.0%, 97.7%) for epileptiform discharges with positive and negative predictive values of 0.71 (95% CI 0.51, 0.87) and 0.82 (95% CI 0.76, 0.89) respectively. 31% of focal and 82% of generalized abnormalities were identified on SBS2 recordings. Cohen’s kappa (κ) for the SBS2 EEG and standard EEG for the epileptiform versus non-epileptiform outcome was κ = 0.40 (95% CI 0.25, 0.55). No safety or tolerability concerns were reported. Despite limitations in sensitivity, the SBS2 may become a viable supportive test for the capture of epileptiform abnormalities, and extend EEG access to new, especially resource-limited, populations at a reduced cost.

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Section: Methodsmentioning

confidence: 99%

Validation of a smartphone-based EEG among people with epilepsy: A prospective study

McKenzie

Lim

Leung

et al. 2017

Sci Rep

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“…Camera trapping records of the Nature Conservation Division shows that the home range of this tiger extended to the outskirts of Thimphu, which is the most populated city in Bhutan with a population of around 115,000 inhabitants. Bhutan is known to be an endemic area of T. solium neurocysticercosis with cases throughout the country including urban populations ( Brizzi et al, 2016 ). Open defecation in forests or bushes is a common practice.…”

Section: Discussionmentioning

confidence: 99%

“…Bhutan is considered part of an endemic area of infection with northern India and Nepal ( Ito et al, 2019 ). In Bhutan, there has recently been an increasing number of epilepsy cases among human patients attributed to neurocysticercosis ( Brizzi et al, 2016 ; Bruno et al, 2017 ; Health, 2016 ). The life cycle of the tapeworm T. solium takes place in two hosts, with humans acting as the definitive host and domestic pigs as the intermediate host.…”

Section: Introductionmentioning

confidence: 99%

Cerebral cysticercosis in a wild Bengal tiger (Panthera tigris tigris) in Bhutan: A first report in non-domestic felids

Phuentshok¹,

Choden

Rojas

et al. 2021

International Journal for Parasitology: Parasites and Wildlife

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The endangered Bengal tiger ( Panthera tigris tigris ) is a keystone species playing an essential role in ecology as well as in the social and spiritual lives of the Himalayan people. The latest estimate of the Bengal tiger population in Bhutan accounts for 103 individuals. Infectious organisms, including zoonotic parasites causing high burden in human health, have received little attention as a cause of mortality in tigers. Taeniosis/cysticercosis, caused by the cestode Taenia solium , is considered one of the major neglected tropical diseases in Southeast Asia. We present here a case of neurocysticercosis in a Bengal tiger showing advanced neurological disease outside Thimphu, the capital city of Bhutan. After palliative care, the animal died, and necropsy revealed multiple small cysts in the brain. Here we show the presence of two genetic variants of T . solium in the parasite material collected based on PCR and sequencing of the complete cox1 and cytB genes. The sequences form a discrete branch within the Asia plus Madagascar cluster of the parasite. On other hand, tests for feline morbillivirus, feline calicivirus, canine distemper virus, Nipah, rabies, Japanese encephalitis, feline leukaemia and feline immunodeficiency virus were negative. In contrast, PCR for feline herpesvirus was positive and a latex agglutination test revealed an elevated antibody titer against Toxoplasma gondii (titer 1:256). The molecular examination of taeniid eggs isolated from the tiger faeces produced sequences for which the highest homology in GenBank is between 92% and 94% with T. regis and T. hydatigena . This fatal case of T. solium neurocysticercosis, a disease previously unrecorded in tigers or other non-domestic felids, demonstrates an anthropogenically driven transmission of a deadly pathogen which could become a serious threat to the tiger population.

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“…In Bhutan, people with epilepsy were investigated for NCC by ELISA and EITB. Results showed that 6% were definitely infected with NCC ( 44 ). Twenty percent were reported as probable NCC.…”

Section: Methodsmentioning

confidence: 99%

Human Cysticercosis in Asia: A Systematic Review and Meta-Analysis

Bizhani¹,

Hafshejani²,

Rezaei³

et al. 2020

ijph

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Background: Cysticercosis in among the neglected tropical disease caused by eating the egg of parasite Taenia solium. In this review, we aimed to verify the prevalence of human cysticercosis in different countries of Asia using systematic review and meta-analysis approach. Methods: Based of the protocol, reliable databases including PubMed, SCOPUS, Science Direct, Embase, and Cochrane Library from 1990-2018 were searched using a panel of keywords. Overall, 48 countries of Asia were searched in turn and data were analyzed using a category of statistical tests. Results: Out of 28 included studies, 586175 samples were collected and included in the data analysis. Based on the meta-analysis results, the overall pooled percent of cysticercosis was estimated 3.8% (95% CI: [2.0, 7.0]). According to the result of heterogeneity statistics including I-squared, chi-square, and tau-squared, it was statistically significant (Tau2 = 2.94, chi2 = 12733.31, P<0.001, I2 = 100%) therefore a random effect model was used to handle the heterogeneity of studies. To evaluate the trend of cysticercosis over the time, Cumulative meta-analysis was performed and the result showed that there was a minor upward tendency in the prevalence of cysticercosis over the time. Conclusion: Although, considering the religious culture and food habits in Asia, we might have expected to witness a low prevalence of human cysticercosis, but we noticed more or less significant infection in some countries of the region. Regarding the new feature of immigration and travel between countries, all authorities are advised to take measures on controlling and monitoring the disease.

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Neurocysticercosis in Bhutan: a cross-sectional study in people with epilepsy

Abstract: Neurocysticercosis was associated with 6-25% of epilepsy in a Bhutanese cohort. Combining EITB and MRI would aid the diagnosis of neurocysticercosis among PWE since no test identified all cases.

Cited by 14 publications

References 30 publications

Validation of a smartphone-based EEG among people with epilepsy: A prospective study

Validation of a smartphone-based EEG among people with epilepsy: A prospective study

Cerebral cysticercosis in a wild Bengal tiger (Panthera tigris tigris) in Bhutan: A first report in non-domestic felids

Human Cysticercosis in Asia: A Systematic Review and Meta-Analysis

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