Urine Antigen Detection for the Diagnosis of Human Neurocysticercosis

Abstract

Neurocysticercosis (NCC) is a major cause of seizures and epilepsy. Diagnosis is based on brain imaging, supported by immunodiagnosis in serum or cerebrospinal fluid (CSF). Lumbar puncture is invasive and painful. Blood sampling is slightly painful and poorly accepted. Urine antigen detection has been used for other parasites and tried in NCC with suboptimal performance. We used a monoclonal antibody-based ELISA to detect Taenia solium antigens in urine from 87 Peruvian neurocysticercosis patients (viable cysts, N = 34; subarachnoid cysticercosis, N = 10; degenerating parasites, N = 7; calcified lesions, N = 36) and 32 volunteers from a non-endemic area of Peru. Overall sensitivity of urine antigen detection for viable parasites was 92%, which decreased to 62.5% in patients with a single cyst. Most patients (30/36, 83%) with only calcified cysticercosis were urine antigen negative. Antigen levels in paired serum/urine samples (evaluated in 19 patients) were strongly correlated. Non-invasive urine testing for T. solium antigens provides a useful alternative for NCC diagnosis.

Successful Antiparasitic Treatment for Cysticercosis is Associated with a Fast and Marked Reduction of Circulating Antigen Levels in a Naturally Infected Pig Model

“…Extraparenchymal NCC, on the other hand, presents very high antigen levels, which have already been shown to reflect the evolution of the disease. 14,15,27,41 Antigen detection by a monoclonal antibody-based ELISA is a reliable tool to evaluate the response to antiparasitic treatment in the porcine model and may prove useful to monitor the efficacy of antiparasitic treatment in human NCC, guiding medical decisions along patient follow-up.…”

“…[21][22][23] Antigen-ELISA has been widely used to detect cysticercosis in humans as well as in pigs. 14,15,[24][25][26][27] Using serial posttreatment serum circulating antigen levels in pigs, we assessed whether the changes in circulating antigen levels correlate with the response to antiparasitic treatment, and whether antigen levels at the time of necropsy correlate with the final infection burden.…”

Immunological and molecular diagnosis of cysticercosis

“…162 We have found 92% sensitivity in patients with two or more viable cysts, and 62.5% in single lesion cases using the MoAbs described by Van Kerckhoven et al, 136 as well as a strong correlation between serum and urine levels of antigen. 163 Mwape et al 164 tested paired urine and serum samples collected in Zambia and Ecuador. A very high agreement (90%) was found between samples of the same individual, but lower specificity when urine samples were tested.…”

Taeniosis and Cysticercosis

“…The system has been used for cattle and porcine diagnosis, seroepidemiological surveys in endemic regions, and NCC detection and differentiation between active and inactive NCC (Dorny et al 2003;Nguekam et al 2003;Mwape et al 2013). Recently, these authors have confirmed the utility of urine samples for cysticercosis diagnosis (Castillo et al 2009;Mwape et al 2011).…”