RESUMEN
BACKGROUND: The parasitic infection caused by Taenia solium represents a significant public health concern in developing countries. Larval invasion of body tissues leads to cysticercosis (CC), while central nervous system (CNS) involvement results in neurocysticercosis (NCC). Both conditions exhibit diverse clinical manifestations, and the potential impact of concomitant HIV infection especially prevalent in sub-Saharan Africa on peripheral and CNS immune responses remains poorly understood. This study aimed to identify the potential impact of HIV coinfection in CC and NCC patients. METHODOLOGY: A nested study within a cross-sectional analysis in two Tanzanian regions was performed and 234 participants (110 HIV+ and 124 HIV-) were tested for cysticercosis antibodies, antigens, CD4 counts and serum Th1 and Th2 cytokines via multiplex bead-based immunoassay. 127 cysticercosis seropositive individuals underwent cranial computed tomography (CCT) and clinical symptoms were assessed. Multiple regression analyses were performed to identify factors associated with cytokine modulation due to HIV in CC and NCC patients. RESULTS: Serologically, 18.8% tested positive for cysticercosis antibodies, with no significant difference HIV+ and HIV+. A significantly higher rate of cysticercosis antigen positivity was found in HIV+ individuals (43.6%) compared to HIV- (28.2%) (p = 0.016). CCT scans revealed that overall 10.3% had active brain cysts (NCC+). Our study found no significant changes in the overall cytokine profiles between HIV+ and HIV- participants coinfected CC and NCC, except for IL-5 which was elevated in HIV+ individuals with cysticercosis. Furthermore, HIV infection in general was associated with increased levels of pro-and some anti-inflammatory cytokines e.g. TNF-α, IL-8, and IFN-γ. However, based on the interaction analyses, no cytokine changes were observed due to HIV in CC or NCC patients. CONCLUSIONS: In conclusion, while HIV infection itself significantly modulates levels of key cytokines such as TNF-α, IL-8, and IFN-γ, it does not modulate any cytokine changes due to CC or NCC. This underscores the dominant influence of HIV on the immune system and highlights the importance of effective antiretroviral therapy in managing immune responses in individuals coinfected with HIV and CC/NCC.
Asunto(s)
Coinfección , Citocinas , Infecciones por VIH , Neurocisticercosis , Taenia solium , Humanos , Masculino , Neurocisticercosis/inmunología , Neurocisticercosis/complicaciones , Adulto , Femenino , Infecciones por VIH/complicaciones , Infecciones por VIH/inmunología , Estudios Transversales , Citocinas/sangre , Coinfección/inmunología , Taenia solium/inmunología , Persona de Mediana Edad , Tanzanía/epidemiología , Anticuerpos Antihelmínticos/sangre , Animales , Recuento de Linfocito CD4 , Adulto Joven , Antígenos Helmínticos/inmunología , Antígenos Helmínticos/sangreRESUMEN
BACKGROUND: Extraparenchymal neurocysticercosis (NCC) commonly presents with symptoms of raised intracranial pressure such as headache, nausea, vomiting, or delirium. Intraventricular NCC is frequently associated with obstructive hydrocephalus as well as recurrent inflammatory cascade leading to chronic meningitis. OBJECTIVE: The aim of this study was to report the novel use and benefit of B cell depleting therapy in a case of treatment-refractory cysticercal meningoencephalitis. CASE: In this article, we report about a young male with intraventricular NCC, who had recurrent meningitis (with encephalitis) and kept relapsing despite multiple cerebrospinal fluid diversion procedures, cysticidal therapy, and high-dose steroids. He finally showed clinical and radiological resolution with pulsed rituximab therapy. CONCLUSION: This off-label use of a monoclonal antibody against CD20 may be considered as a rescue therapy in steroid-refractory immune-mediated cysticercal meningitis.
Asunto(s)
Neurocisticercosis , Humanos , Masculino , Neurocisticercosis/complicaciones , Neurocisticercosis/inmunología , Rituximab/uso terapéutico , Meningitis/inmunología , Meningitis/tratamiento farmacológico , Meningitis/terapia , Linfocitos B/inmunología , Factores Inmunológicos/uso terapéutico , AdultoRESUMEN
Human cysticercosis caused by Taenia soliun (T. soliun) is endemic in certain areas of Latin America, Asia and Sub-Saharan Africa. Neurocysticercosis (NCC) is mainly diagnosed by neuroimaging, which, in most cases, is unavailable in endemic areas. Due to their high sensitivity and specificity, serological tests such as enzyme-linked immunosorbent assay (ELISA) and Western blot (WB) based on the glycosylated fraction of the cyst CS50 are widely used for the detection of the anti-cysticercus IgG antibodies despite their significant cost and the need of cysticercus material. Given their cost-effectivess and simplicity, immunoassays based on recombinant proteins could provide new alternatives for human cysticercosis diagnosis: such tests would be aimed at screening those people living in remote areas who need further examination. To date, however, no test using recombinant antigens is commercially available. Herein, five recombinant proteins (R14, R18, R93.1, R914.1, and R915.2) were produced, three of which (R93.1, R914.1, and R915.2) were newly identified from the cyst fluid. Evaluation of the diagnostic performance of these recombinant antigens by ELISA was done using sera from 200 epileptic and non-epileptic individuals in comparison with the WB-CS50 as the reference serological method. Recombinant proteins-based ELISA showed a level of diagnostic performance that is inferior than the reference serological method, but similar to that of the native antigen ELISA for human cysticercosis (commonly used for screening). Further optimization of expression conditions is still needed in order to improve proteins solubility and enhance diagnostic performance for human cysticercosis detection. However, this preliminary evaluation of the recombinant antigens has shown their potential valuable use for screening cysticercosis in patients with epilepsy attending dispensaries in remote areas. Future studies should be conducted to evaluate our recombinant antigens in a large group of patients with different stages of NCC, and in correlation with imaging findings.
Asunto(s)
Anticuerpos Antihelmínticos , Antígenos Helmínticos , Western Blotting , Cisticercosis , Ensayo de Inmunoadsorción Enzimática , Proteínas Recombinantes , Sensibilidad y Especificidad , Taenia solium , Humanos , Proteínas Recombinantes/inmunología , Antígenos Helmínticos/inmunología , Antígenos Helmínticos/genética , Cisticercosis/diagnóstico , Animales , Taenia solium/inmunología , Taenia solium/genética , Anticuerpos Antihelmínticos/sangre , Inmunoglobulina G/sangre , Neurocisticercosis/diagnóstico , Neurocisticercosis/inmunología , Epilepsia/diagnóstico , Adulto , Masculino , Pruebas Serológicas/métodos , FemeninoRESUMEN
Neurocysticercosis is the leading cause for acquired epilepsy worldwide, and it is caused by the larval stage of the parasite Taenia solium. Several proteins of this stage have been characterized and studied to understand the parasite-host interaction, however, the proteins from the early cysticercus stages (the postoncospheral form) have not yet been characterized. The study of the postoncospheral form proteins is important to understand the host-parasite relationship in the early stages of infection. The aim of this work was to identify postoncospheral form antigenic proteins using sera from neurocysticercosis patients. T. solium activated oncospheres were cultured in HCT-8 cells to obtain the postoncospheral form. Soluble total and excretory/secretory proteins were obtained from the postoncospheral form and were incubated with both pool sera and individual serum of neurocysticercosis positive human patients. Immunoblotting showed target antigenic proteins with apparent molecular weights of 23â¯kDa and 46-48â¯kDa. The 46-48â¯kDa antigen bands present in soluble total and excretory/secretory postoncospheral form proteins were analyzed by LC-MS/MS; proteins identified were: nuclear elongation factor 1 alpha, enolase, unnamed protein product/antigen diagnostic GP50, calcium binding protein calreticulin precursor and annexin. The postoncospheral form expresses proteins related to interaction with the host, some of these proteins are predicted to be exosomal proteins. In conclusion, postoncospheral proteins are consistent targets of the humoral immune response in human and may serve as targets for diagnosis and vaccines.
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Antígenos Helmínticos , Proteínas del Helminto , Neurocisticercosis , Taenia solium , Taenia solium/inmunología , Taenia solium/genética , Antígenos Helmínticos/inmunología , Animales , Humanos , Neurocisticercosis/inmunología , Neurocisticercosis/parasitología , Neurocisticercosis/diagnóstico , Proteínas del Helminto/inmunología , Proteínas del Helminto/genética , Proteínas del Helminto/química , Espectrometría de Masas en Tándem , Anticuerpos Antihelmínticos/sangre , Anticuerpos Antihelmínticos/inmunología , Cromatografía Liquida , Peso MolecularRESUMEN
We explored the association between serological status for hepatitis E and neurocysticercosis (NCC) in neurologic patients attending a national neurological referral center in Lima, Perú, between the years 2008 and 2012. Anti-hepatitis E antibodies were evaluated in patients with and without NCC, and a control group of rural general population. Anti-hepatitis E IgG was found in 23.8% of patients with NCC, compared with 14.3% in subjects without NCC from a general rural population (P = 0.023) and 14.4% in subjects with neurological complaints without NCC (P = 0.027). Seropositive patients had a median age of 44 years compared with 30 years in seronegative patients (P <0.001). No significant differences in sex, region of residence, or liver enzyme values were found. Seropositivity to hepatitis E was frequent in this Peruvian population and higher in patients with NCC, suggesting shared common routes of infection.
Asunto(s)
Virus de la Hepatitis E , Hepatitis E , Neurocisticercosis , Humanos , Neurocisticercosis/epidemiología , Neurocisticercosis/inmunología , Neurocisticercosis/complicaciones , Masculino , Adulto , Femenino , Hepatitis E/epidemiología , Hepatitis E/inmunología , Virus de la Hepatitis E/inmunología , Persona de Mediana Edad , Perú/epidemiología , Adulto Joven , Prevalencia , Inmunoglobulina G/sangre , Anticuerpos Antihepatitis/sangre , Estudios Seroepidemiológicos , Adolescente , AncianoRESUMEN
BACKGROUND: Neurocysticercosis (NCC) is the most common helminthic infection of the central nervous system (CNS) caused by the larval stage of Taenia solium. Accurate and early diagnosis of NCC remains challenging due to its heterogeneous clinical manifestations, neuroimaging deficits, variable sensitivity, and specificity of serological tests. Next-generation sequencing (NGS)-based pathogen analysis in patient's cerebrospinal fluid (CSF) with NCC infection has recently been reported indicating its diagnostic efficacy. In this case study, we report the diagnosis of a NCC patient with a symptomatic history of over 20 years using NGS analysis and further confirmation of the pathology by immunological tests. CASE PRESENTATION: This study reports the clinical imaging and immunological features of a patient with a recurrent headache for more than 20 years, which worsened gradually with the symptom of fever for more than 7 years and paroxysmal amaurosis for more than 1 year. By utilizing NGS technique, the pathogen was detected in patient's CSF, and the presence of Taenia solium-DNA was confirmed by a positive immunological reaction to cysticercus IgG antibody in CSF and serum samples. The symptoms of the patient were alleviated, and the CSF condition was improved substantially after the anti-helminthic treatment. CONCLUSIONS: This study suggests that combining CSF NGS with cysticercus IgG testing may be a highly promising approach for diagnosing the challenging cases of NCC. Further studies are needed to evaluate the parasitic DNA load in patients' CSF for the diagnosis of disease severity, stage, and monitoring of therapeutic responses.
Asunto(s)
Secuenciación de Nucleótidos de Alto Rendimiento , Neurocisticercosis , Pruebas Serológicas , Taenia solium , Animales , Anticuerpos Antihelmínticos/sangre , ADN de Helmintos/genética , Humanos , Técnicas de Diagnóstico Molecular , Neurocisticercosis/diagnóstico , Neurocisticercosis/inmunología , Neurocisticercosis/parasitología , Taenia solium/genética , Taenia solium/inmunologíaRESUMEN
Background: Neurocysticercosis (NCC) is an acquired infection of central nervous system associated with epileptic seizures. The parasite 'Taenia solium' causes this disease and has a complex life cycle and molts into various stages that influence the host-parasite interaction. The disease has a long asymptomatic phase with viable cyst and degeneration of cyst and leaking cyst fluid has been associated with symptomatic phase. The parasite proteome holds the answers and clues to this complex clinical presentation and hence unraveling of proteome of parasite antigens is needed for better understanding of host-parasite interactions. Objective: To understand the proteome make-up of T. solium cyst vesicular fluid (VF) and excretory secretory proteins (ESPs). Methodology: The VF and ESPs for the study were prepared from cyst harvested from naturally infected swine. The samples were prepared for nano LC-MS by in-tube digestion of proteins. The spectra obtained were annotated and enrichment analysis was performed and in silico analysis was done. Results:T. solium VF and ESPs have 206 and 247 proteins of varied make-up including pro-inflammatory and anti-inflammatory nature. Conclusions: Due to varied make-up of VF and ESPs it can generate complex humoral and cellular immune response.
Asunto(s)
Interacciones Huésped-Parásitos/genética , Neurocisticercosis/genética , Proteoma/genética , Taenia solium/genética , Animales , Antígenos Helmínticos/genética , Antígenos Helmínticos/inmunología , Humanos , Espectrometría de Masas , Neurocisticercosis/inmunología , Neurocisticercosis/parasitología , Neurocisticercosis/veterinaria , Proteoma/inmunología , Porcinos/genética , Porcinos/inmunología , Porcinos/parasitología , Taenia solium/patogenicidadRESUMEN
Parasitic diseases affect more than one billion people worldwide, and most of them are chronic conditions in which the treatment and prevention are difficult. The appearance of granulomas, defined as organized and compact structures of macrophages and other immune cells, during various parasitic diseases is frequent, since these structures will only form when individual immune cells do not control the invading agent. Th2-typering various parasitic diseases are frequent, since these structures will only form when individual immune cells do not control the invading agent. The characterization of granulomas in different parasitic diseases, as well as recent findings in this field, is discussed in this review, in order to understand the significance of the granuloma and its modulation in the host-parasite interaction and in the immune, pathological, and parasitological aspects of this interaction. The parasitic granulomatous diseases granulomatous amebic encephalitis, toxoplasmosis, leishmaniasis, neurocysticercosis, and schistosomiasis mansoni are discussed as well as the mechanistic and dynamical aspects of the infectious granulomas.
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Granuloma/inmunología , Granuloma/patología , Macrófagos/inmunología , Neurocisticercosis/inmunología , Esquistosomiasis mansoni/inmunología , Toxoplasmosis/inmunología , Animales , Granuloma/parasitología , Interacciones Huésped-Parásitos/inmunología , Humanos , Macrófagos/patología , Neurocisticercosis/patología , Schistosoma mansoni/inmunología , Esquistosomiasis mansoni/patología , Taenia solium/inmunología , Toxoplasma/inmunología , Toxoplasmosis/patologíaRESUMEN
Neurocysticercosis is a neglected and usually poverty-related disease of high public importance. The mechanisms by which the calcified lesions cause epilepsy are not known, but have been attributed to residual perilesional gliosis or an inflammatory process. This case shows that an inflammatory response to a calcified granuloma may be associated with the development of epilepsy. The increase in glutamate and kinin B1 (pro-epileptogenic) receptors added by reduced expression of kinin B2 (anti-epileptogenic) receptors may explain the chronic epileptogenesis associated with the lesion, corroborating the hypothesis of inflammatory mechanisms involved in the pathophysiology of epilepsy in these patients.
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Epilepsia Refractaria , Neurocisticercosis , Biomarcadores , Niño , Epilepsia Refractaria/diagnóstico , Epilepsia Refractaria/etiología , Epilepsia Refractaria/inmunología , Electroencefalografía , Femenino , Humanos , Inmunohistoquímica , Imagen por Resonancia Magnética , Neurocisticercosis/complicaciones , Neurocisticercosis/diagnóstico , Neurocisticercosis/inmunología , Neurocisticercosis/patologíaRESUMEN
The parasitic helminth infection neurocysticercosis (NCC) is the most common cause of adult-acquired epilepsy in the world. Despite the serious consequences of epilepsy due to this infection, an in-depth review of the distinct characteristics of epilepsy due to neurocysticercosis has never been conducted. In this review, we evaluate the relationship between NCC and epilepsy and the unique characteristics of epilepsy caused by NCC. We also discuss recent advances in our understanding of NCC-related epilepsy, including the importance of anti-inflammatory therapies, the association between NCC and temporal lobe epilepsy, and the recent discovery of biomarkers of severe epilepsy development in individuals with NCC and seizures.
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Encéfalo/fisiopatología , Epilepsia/fisiopatología , Neurocisticercosis/fisiopatología , Encéfalo/diagnóstico por imagen , Encéfalo/inmunología , Calcinosis/diagnóstico por imagen , Calcinosis/inmunología , Calcinosis/fisiopatología , Citocinas/inmunología , Epilepsia/etiología , Epilepsia/inmunología , Hipocampo/diagnóstico por imagen , Hipocampo/inmunología , Hipocampo/patología , Hipocampo/fisiopatología , Humanos , Inflamación/inmunología , Inflamación/fisiopatología , Neurocisticercosis/complicaciones , Neurocisticercosis/diagnóstico por imagen , Neurocisticercosis/inmunología , Factores de Riesgo , EsclerosisRESUMEN
Taenia solium cysticercosis and taeniasis (TSCT), caused by the tapeworm T. solium, is a foodborne and zoonotic disease classified since 2010 by WHO as a neglected tropical isease. It causes considerable impact on health and economy and is one of the leading causes of acquired epilepsy in most endemic countries of Latin America, Sub-Saharan Africa, and Asia. There is some evidence that the prevalence of TSCT in high-income countries has recently increased, mainly due to immigration from endemic areas. In regions endemic for TSCT, human cysticercosis can manifest clinically as neurocysticercosis (NCC), resulting in epileptic seizures and severe progressive headaches, amongst other neurological signs and/or symptoms. The development of these symptoms results from a complex interplay between anatomical cyst localization, environmental factors, parasite's infective potential, host genetics, and, especially, host immune responses. Treatment of individuals with active NCC (presence of viable cerebral cysts) with anthelmintic drugs together with steroids is usually effective and, in the majority, reduces the number and/or size of cerebral lesions as well as the neurological symptoms. However, in some cases, treatment may profoundly enhance anthelmintic inflammatory responses with ensuing symptoms, which, otherwise, would have remained silent as long as the cysts are viable. This intriguing silencing process is not yet fully understood but may involve active modulation of host responses by cyst-derived immunomodulatory components released directly into the surrounding brain tissue or by the induction of regulatory networks including regulatory T cells (Treg) or regulatory B cells (Breg). These processes might be disturbed once the cysts undergo treatment-induced apoptosis and necrosis or in a coinfection setting such as HIV. Herein, we review the current literature regarding the immunology and pathogenesis of NCC with a highlight on the mobilization of immune cells during human NCC and their interaction with viable and degenerating cysticerci. Moreover, the immunological parameters associated with NCC in people living with HIV/AIDS and treatments are discussed. Eventually, we propose open questions to understand the role of the immune system and its impact in this intriguing host-parasite crosstalk.
Asunto(s)
Antihelmínticos/uso terapéutico , Antiinflamatorios/uso terapéutico , Inmunidad Celular , Neurocisticercosis/tratamiento farmacológico , Neurocisticercosis/inmunología , Taenia solium/inmunología , Animales , Interacciones Huésped-Parásitos , Humanos , Neurocisticercosis/fisiopatologíaRESUMEN
Objective: Taenia solium is a neglected tropical disease; larvae of this parasite infect central nervous system i.e. Neurocysticercosis, and adults mature and survive into intestine i.e. Taeniasis. Globally more than 50 million people are at the risk of infection. This is one of the main etiological agents for onset of new early epilepsy in developing countries. However, there is no vaccine available to protect human from its infection. Hence, there is an urgent need for a good vaccine.Methods: We applied immune-informatics approach to design a multi-epitope chimeric vaccine consisting of both B and T-cell epitopes.Results: From the whole transcriptome of Taenia, we identified five suitable peptides present on cell membrane, epitope identification on these peptides were done by using various immunoinformatic software. Physiochemical properties were determined and the tertiary structure of vaccine was predicted, validated and refined, and to increase antigenicity we added linker to them. Best-modeled protein-complex was used for docking study with TLR1-2, TLR4, TLR3 and TLR7 and stability of molecular complex was determined by molecular dynamics simulation.Conclusions: Overall, we attempted to design an efficient subunit chimeric vaccine, which could stimulate humoral and cellular immune responses and could protect against both neurocysticercosis and taeniasis.
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Neurocisticercosis/prevención & control , Teniasis/prevención & control , Vacunas/administración & dosificación , Animales , Simulación por Computador , Epítopos de Linfocito B/inmunología , Epítopos de Linfocito T/inmunología , Humanos , Inmunidad Celular , Inmunidad Humoral , Simulación del Acoplamiento Molecular , Neurocisticercosis/inmunología , Taenia solium/inmunología , Teniasis/inmunología , Vacunas/inmunología , Vacunas de SubunidadRESUMEN
PURPOSE OF THE STUDY: Among various immunological tests available for diagnosis of neurocysticercosis (NCC), only EITB (Electroimmunotransfer blot for detection of anticysticercal antibodies) had gained widespread acceptance. However EITB is not available widely and is costly (Indian rupees 15,000/- approximately). We evaluated utility of Loop mediated isothermal amplification (LAMP) assay for detection of Taenia solium cox1 gene in blood of patients with NCC. PATIENTS AND METHODS: Current study included 100 consecutive patients of NCC at a tertiary teaching hospital in Northern India. All the patients underwent detailed history and examinations as well as gadolinium enhanced magnetic resonance imaging of brain. LAMP assay was performed in all the patients. The results were compared with 50 controls. RESULTS: LAMP detected Taenia Solium cox1 gene in 74% of all blood samples in patients of NCC.T he overall sensitivity of LAMP assay for detection of cox1 gene was 74% in all patients with NCC, 71.8% in patients with intraparenchymal brain cysts only and 86.7% of patients with extraparenchymal brain cysts with or without intraparenchymal brain cysts. The overall specificity of LAMP assay was 90% in all these three subgroups. The positive predictive value of real time LAMP assay was close to 93% for almost all forms of NCC- both solitary and multiple while negative predictive value ranged from 57 to 64%. CONCLUSION: Real time LAMP assay of blood for detection of Taenia solium cox1 gene appears to be a promising toll for diagnosis of NCC.
Asunto(s)
Técnicas de Diagnóstico Molecular/métodos , Neurocisticercosis/genética , Neurocisticercosis/inmunología , Técnicas de Amplificación de Ácido Nucleico/métodos , Taenia solium/genética , Taenia solium/inmunología , Adolescente , Adulto , Animales , Cysticercus/genética , Cysticercus/inmunología , ADN/sangre , ADN/genética , ADN/inmunología , Femenino , Humanos , Pruebas Inmunológicas/métodos , Pruebas Inmunológicas/normas , Masculino , Persona de Mediana Edad , Técnicas de Diagnóstico Molecular/normas , Neurocisticercosis/sangre , Neurocisticercosis/diagnóstico por imagen , Técnicas de Amplificación de Ácido Nucleico/normas , Reproducibilidad de los Resultados , Adulto JovenRESUMEN
Human neurocysticercosis (NCC) is a worldwide neglected disease caused by Taenia solium metacestode and responsible for various complications and neurological disorders. This study aimed to evaluate the use of specific immunoglobulin Y (IgY) produced by laying hens immunized with a hydrophobic fraction of Taenia crassiceps metacestodes (hFTc) in NCC diagnosis. Egg yolk IgY antibodies were fractionated, purified and characterized. Enzyme-linked immunosorbent assay (ELISA) was carried out to evaluate the production kinetics and avidity maturation of anti-hFTc IgY antibodies throughout the IgY obtention process. Antigen recognition tests were carried out by Western blotting and immunofluorescence antibody test using purified and specific anti-hFTc IgY antibodies for detection of parasitic antigens of T. crassiceps and T. solium metacestodes. Sandwich ELISA was performed to detect circulating immune complexes formed by IgG and parasitic antigens in human sera. The results showed high diagnostic values (93.2% sensitivity and 94.3% specificity) for immune complexes detection in human sera with confirmed NCC. In conclusion, specific IgY antibodies produced from immunized hens with hFTc antigens were efficient to detect T. solium immune complexes in human sera, being an innovative and potential tool for NCC immunodiagnosis.
Asunto(s)
Antígenos Helmínticos/inmunología , Inmunoglobulinas/sangre , Pruebas Inmunológicas/métodos , Neurocisticercosis/parasitología , Taenia/aislamiento & purificación , Animales , Afinidad de Anticuerpos , Pollos , Femenino , Humanos , Ratones , Ratones Endogámicos BALB C , Neurocisticercosis/inmunología , Óvulo , Taenia/inmunologíaRESUMEN
Neurocysticercosis is a neurological infection caused by the larva of taenia solium. The larva infection may affect different parts of the human brain and spinal cord, leading to focal neurological deficit with/without inflammatory reactions. Neurocysticercosis is one of the major causes of epilepsy in the developing countries. It is of two types. One is extra-parenchymal neurocysticercosis in which cysticerci cysts at subarachinoid space and ventricles lead to obstructive hydrocephalus and increase in the intracranial pressure. The other type is intra-parenchymal neurocysticercosis in which the cysticerci cyst grows inside the brain parenchyma, causing the feature of space-occupying lesion. The common presentation of intra-parenchymal neurocysticercosis is secondary epilepsy which is due to focal lesion and/or local inflammatory reactions. Cysticidal therapy increases the risk of seizure due to the induction of host inflammatory reactions. Therefore, coadministration of corticosteroids reduces the risk of seizure through attenuation of inflammatory reactions and brain oedema. Praziquantel alone or in combination with albendazole is regarded as the basic cysticidal therapy against neurocysticercosis. Newer drugs and agents are recommended to overcome the partial failure of standard cysticidal therapy.
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Neurocisticercosis/diagnóstico , Neurocisticercosis/tratamiento farmacológico , Taenia solium/crecimiento & desarrollo , Animales , Antiplatelmínticos/uso terapéutico , Humanos , Estadios del Ciclo de Vida , Neurocisticercosis/inmunología , Neurocisticercosis/transmisión , Progesterona/uso terapéuticoRESUMEN
We developed a novel and portable fluorescent sensor that integrates a lateral flow assay with a quantum dot (Qdots) label and a mobile phone reader for detection of specific antibodies in human serum. We evaluated the utility of this assay to test for antibodies to the Taenia solium rT24H antigen. It was a retrospective study by examining 112 positive human sera from patients with neurocysticercosis (NCC) including samples from patients with single viable cyst (n = 18), two or more viable cysts (n = 71), and subarachnoid (racemose) cysts (n = 23). These samples were collected from previous study subjects in Lima, Peru under an approved study protocol in Peru. The sera were made anonymous under a protocol approved by the CDC Institutional Review Board. Definitive diagnosis of the subject was established by computed-tomography and/or magnetic resonance imaging. To test the specificity of the assay, we evaluated a panel of serum samples obtained from patients with other infections (n = 24), and serum samples from persons in the United States and Egypt who had not traveled outside their country, and therefore are presumed negative for cysticercosis (n = 128). The assay specificity in the negative panel was 99% (95-100%) while assay sensitivity was 89% (79-95%) in NCC patients with two or more viable cysts. Our assay has performance characteristics similar to those of traditional platforms for the detection of NCC and shows promise as a mobile phone reader-based point-of-care test for antibody detection.
Asunto(s)
Anticuerpos Antihelmínticos/sangre , Formación de Anticuerpos , Teléfono Celular , Pruebas Inmunológicas/métodos , Neurocisticercosis/diagnóstico , Pruebas en el Punto de Atención , Puntos Cuánticos , Animales , Antígenos Helmínticos/inmunología , Cisticercosis , Estudios de Factibilidad , Humanos , Imagen por Resonancia Magnética , Neurocisticercosis/inmunología , Estudios Retrospectivos , Sensibilidad y Especificidad , Taenia soliumRESUMEN
Taenia solium is a helminth parasite that causes 2 diseases in humans: cysticercosis and taeniasis. The establishment of T. solium metacestodes in the central nervous system causes neurocysticercosis, while development of the adult tapeworm in the small intestine causes taeniasis. Serological diagnosis of neurocysticercosis is performed by Western blot with an enriched fraction of glycoproteins that has been extensively used for clinical diagnosis and epidemiological surveys. The lectin-bound fraction that is used for this assay contains 7 antigenic glycoproteins. These antigenic proteins are considered to be highly specific for cysticercosis when tested with heterologous parasitic diseases. However, recent studies show that people with taeniasis have cross-reactive antibodies against the neurocysticercosis diagnostic glycoproteins and vice versa. Nevertheless, it is not known if these diagnostic proteins are expressed in the adult stage of the parasite. In this paper, we describe the location of 3 of these glycoproteins in T. solium adults and cysticerci using polyclonal antibodies raised against a synthetic peptide based on the amino acid sequence of TS14, a recombinant protein T24H, and the native GP50. The glycoproteins' distribution was different in invaginated and evaginated cysticerci as well as in adult tapeworms. Specifically, the 3 glycoproteins studied were differentially expressed during embryogenesis. Our findings indicate that expression of the diagnostic glycoproteins is developmentally regulated; this is noteworthy since these glycoproteins are considered specific for the diagnosis of neurocysticercosis but nevertheless are present in different structures throughout the development of T. solium. Here we describe the glycoprotein expression and localization, which can be important in understanding their biological functions. In addition, our results help clarify the cross-reaction observed between people with neurocysticercosis and taeniasis to TS14, T24H, and GP50, which are used as diagnostic antigens for neurocysticercosis.
Asunto(s)
Glicoproteínas/análisis , Neurocisticercosis/diagnóstico , Taenia solium/química , Teniasis/diagnóstico , Animales , Anticuerpos Antihelmínticos/inmunología , Antígenos Helmínticos/análisis , Antígenos Helmínticos/inmunología , Antígenos Helmínticos/metabolismo , Western Blotting , Reacciones Cruzadas , Cysticercus/anatomía & histología , Cysticercus/química , Cysticercus/aislamiento & purificación , Glicoproteínas/inmunología , Glicoproteínas/metabolismo , Cabras , Humanos , Sueros Inmunes/inmunología , Inmunohistoquímica , Neurocisticercosis/inmunología , Conejos , Taenia solium/crecimiento & desarrollo , Taenia solium/aislamiento & purificación , Teniasis/inmunologíaRESUMEN
Immunodiagnosis has a supportive role in the diagnosis of neurocysticercosis (NCC). The aim of this study was to compare the validity of seven immunodiagnostic tests among serum samples from 58 patients with NCC, 26 patients with neurological diseases other than NCC, and 15 healthy controls. One test for viable parasite detection (HP10 antigen assay) and six for antibody detection were evaluated. For the entire sample, sensitivities ranged from 55.2% (NOVALISA) to 81.0% (enzyme-linked immunosorbent assay [ELISA] Taenia solium antibody), with the sensitivity of the latter test significantly higher than that of the in-house ELISA Taenia crassiceps, NOVALISA, enzyme-linked immunoelectrotransfer blot (EITB) CDC, and HP10. Overall, specificities were high, ranging from 85.4% (ELISA Ts) to 97.1% (NOVALISA), with no statistically significant differences. Detection of HP10 antigen was significantly associated with the presence of vesicular parasites. The simple and low-cost ELISA Taenia solium antibody Ab instead of EITB is recommended to support NCC diagnosis in both rural and hospital settings in Mexico.
Asunto(s)
Anticuerpos Antihelmínticos/sangre , Antígenos Helmínticos/inmunología , Pruebas Diagnósticas de Rutina/métodos , Neurocisticercosis/diagnóstico , Taenia solium/inmunología , Adulto , Animales , Ensayo de Inmunoadsorción Enzimática/métodos , Femenino , Humanos , Pruebas Inmunológicas/métodos , Masculino , México , Neurocisticercosis/inmunología , Población Rural , Sensibilidad y EspecificidadRESUMEN
OBJECTIVE: Infections caused by the human immunodeficiency virus (HIV) and by the larvae of Taenia solium (i.e., cysticercosis) are still widespread in many developing countries. Both pathologies modify host immune status and it is possible that HIV infection may modulate the frequency and pathogeny of cysticercosis of the central nervous system (i.e., neurocysticercosis [NCC]). To describe published cases of NCC among HIV-positive patients and to evaluate whether the characteristics of NCC, including frequency, symptoms, radiological appearance, and response to treatment differed between HIV-positive and HIV-negative patients. METHODS: Forty cases of NCC/HIV co-infected patients were identified in the literature. Clinical and radiological characteristics, as well as response to treatment, were compared with non-matching historical series of NCC patients without HIV infection. RESULTS: Most of these patients had seizures and multiple vesicular parasites located in parenchyma. Clinical and radiological characteristics were similar between HIV-positive and HIV-negative patients with NCC, as well as between immunocompromised and non-immunocompromised HIV-positive patients. CONCLUSION: Our review did not reveal clear interactions between HIV and NCC. This may be partially due to the small number of cases and reliance on published research. A systematic, multi-institutional effort aiming to report all the cases of this dual pathology is needed to confirm this finding and to clarify the possible relationship between both pathogens.
Asunto(s)
Coinfección , Infecciones por VIH/complicaciones , Neurocisticercosis/etiología , Infecciones Oportunistas Relacionadas con el SIDA/inmunología , Recuento de Linfocito CD4 , Coinfección/inmunología , Coinfección/terapia , Femenino , Infecciones por VIH/inmunología , Infecciones por VIH/terapia , Humanos , Inmunocompetencia , Masculino , Neurocisticercosis/inmunología , Neurocisticercosis/terapia , Resultado del TratamientoRESUMEN
ABSTRACT Infections caused by the human immunodeficiency virus (HIV) and by the larvae of Taenia solium (i.e., cysticercosis) are still widespread in many developing countries. Both pathologies modify host immune status and it is possible that HIV infection may modulate the frequency and pathogeny of cysticercosis of the central nervous system (i.e., neurocysticercosis [NCC]). Objective: To describe published cases of NCC among HIV-positive patients and to evaluate whether the characteristics of NCC, including frequency, symptoms, radiological appearance, and response to treatment differed between HIV-positive and HIV-negative patients. Methods: Forty cases of NCC/HIV co-infected patients were identified in the literature. Clinical and radiological characteristics, as well as response to treatment, were compared with non-matching historical series of NCC patients without HIV infection. Results: Most of these patients had seizures and multiple vesicular parasites located in parenchyma. Clinical and radiological characteristics were similar between HIV-positive and HIV-negative patients with NCC, as well as between immunocompromised and non-immunocompromised HIV-positive patients. Conclusion: Our review did not reveal clear interactions between HIV and NCC. This may be partially due to the small number of cases and reliance on published research. A systematic, multi-institutional effort aiming to report all the cases of this dual pathology is needed to confirm this finding and to clarify the possible relationship between both pathogens.
RESUMO Las infecciones causadas por el virus de inmunodeficiencia humana (VIH) y la larva de la Tenia solium siguen estando diseminadas en países en vías de desarrollo. Ambas patologías modifican el estado inmune y es posible que la infección por el VIH module la frecuencia y la patología de la neurocisticercosis (NCC). Objetivo: Describir los casos publicados de NCC en los pacientes VIH positivos y evaluar si las características de la NCC, incluyendo frecuencia, síntomas, presentación radiológica, respuesta a tratamiento, difieren entre los sujetos VIH positivos y VIH negativos. Métodos: Cuarenta casos con coinfección NCC/VIH fueron identificados en la literatura. Se compararon sus características clínico-radiológicas, así como su respuesta al tratamiento con diferentes series de casos históricos no pareados. Resultados: La mayoría de los pacientes NCC/VIH tenían epilepsia y múltiples parásitos vesiculares en el parénquima. Las características clínico-radiológicas de la NCC así como la evolución de los pacientes fueron similares entre pacientes VIH positivos y negativos, así como entre pacientes VIH inmunocomprometidos y no inmunocomprometidos. Conclusión: No encontramos interacciones claras entre VIH y NCC. Este resultado puede haber sido influenciado por el pequeño número de casos y la parcialidad de la información publicada. Un esfuerzo multiinstitucional, sistemático encaminado a reportar todos los casos de esta patología dual es necesario para confirmar estos resultados y esclarecer la relación entre patógenos.