ABSTRACT
Subarachnoid neurocysticercosis (SANCC) is a severe and progressive brain infection with Taenia solium. We performed a pilot study of noninvasive screening for SANCC in two endemic villages in northern Peru using a urine antigen screen followed by brain magnetic resonance imaging for participants with elevated levels of antigen. Among the 978 participants screened, we identified eight individuals with SANCC, many of whom were asymptomatic. This represents a minimum prevalence of 0.8% of SANCC, a level higher than expected based on prior studies, and a positive predictive value of 62% for our novel urine screening test. Future studies should confirm whether early detection and management improve clinical outcomes.
Subject(s)
Antigens, Helminth/urine , Neurocysticercosis/diagnostic imaging , Subarachnoid Space/immunology , Taenia solium/immunology , Taeniasis/diagnostic imaging , Adolescent , Adult , Aged , Aged, 80 and over , Animals , Asymptomatic Diseases , Brain/diagnostic imaging , Brain/parasitology , Child , Female , Humans , Magnetic Resonance Imaging , Male , Middle Aged , Neurocysticercosis/epidemiology , Neurocysticercosis/parasitology , Peru/epidemiology , Pilot Projects , Taeniasis/epidemiology , Taeniasis/parasitology , Young AdultABSTRACT
Patients with cerebral cysticercosis (CC) have specific antibodies of the IgG type in blood and cerebrospinal fluid (CSF). In order to determine if the specific antibodies present in the CSF come from blood or synthetized in the subarachnoid space, we studied the integrity of the blood brain barrier (BBB) and the intrathecal synthesis of specific antibodies. We found a ruptured BBB with more frequency and in a higher intensity in patients with CC and hydrocephalus (malignant CC) than in patients with parenchymal CC (benign CC). The patients with malignant CC have a greater number of inflammatory cells, a higher albumin index (serum albumin/CSF albumin), a higher level of protein and a higher titre of specific antibodies in the CSF than those with benign CC. In 15 patients in both groups we could demonstrate intrathecal synthesis of antibodies. We conclude that in CC the specific antibodies are produced intrathecally, and in a lesser amount come from the blood through a ruptured blood-brain barrier.