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Coral-Almeida M, Henriquez-Trujillo AR, Asanza S, Erazo C, Paucar M, Calvopiña M. Assessing the burden and spatial distribution of Taenia solium human neurocysticercosis in Ecuador (2013-2017). PLoS Negl Trop Dis 2020; 14:e0008384. [PMID: 32511228 PMCID: PMC7302800 DOI: 10.1371/journal.pntd.0008384] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/17/2019] [Revised: 06/18/2020] [Accepted: 05/12/2020] [Indexed: 12/30/2022] Open
Abstract
Background Estimating the burden of neglected tropical diseases is a valuable tool to support policymakers in the resource allocation for control and elimination of these diseases. Spatial analysis allows to identify the geographical distribution patterns of infectious and parasitic diseases within a country and allows to assess their possible correlation with other health disorders. Despite being neurocysticercosis (NCC) considered as the most important parasitic disease of the nervous system, few efforts have been addressed to assess the real burden of NCC in endemic countries, to date, there are no studies estimating the burden of NCC in South America. In this study we aimed to use the Disability Adjust Life Years (DALY) and spatial indicators as tools to measure the impact of human neurocysticercosis in Ecuador between 2013 and 2017. Methods Mortality, morbidity and spatial data from the national agency of statistics were used to estimate the burden of disease of NCC during a five-year period (2013–2017). NCC cases and its two main sequelae, epilepsy and migraine headache, were stratified by sex and age group to calculate the DALY associated to NCC using the DALY package in R. SATSCAN software was used to assess spatial clusters of NCC and its possible neurological sequelae as epilepsy, status epilepticus, migraine and hydrocephalus. Principal findings The burden of human neurocysticercosis ranged from 56201 [95% CI 29961–89333] to 59612 [95% CI 31854–94689] DALY per year, corresponding to 3.54 to 3.56 DALY per 1000 population. Average yearly incidence rates per 10 000 person-years were 0.23 [95% CI 0.21–0.26] for NCC, 4.89 [95% CI 4.78–5.00] for epilepsy, 0.130 [95% CI 0.11–0.15] for status epilepticus, 0.62 [95% CI 0.58–0.66] for migraine headache, and 1.02 [95% CI 0.98–1.07] for hydrocephalus. Most important significant spatial clusters (p<0.0001) were located in the southern region of the highlands of the country. Conclusion/Significance This is the first study in South America to calculate estimates for burden of NCC and one of the few using spatial analysis to show the importance of sequelae other than epilepsy that play an important role in the impact of human neurocysticercosis. Taenia solium-neurocysticercosis (NCC) is a neglected parasite infection in humans causing a variety of neurological sequelae like epilepsy, and chronic headache. The purpose of this study was to estimate the burden of NCC in Ecuador using official nation-wide databases from the National Institute of Statistics and Census (INEC) for the period of 2013–2017, and to assess for spatial clusters of four neurological disorders associated with NCC. The burden of NCC measured in Disability Adjusted Life Years (DALY) was estimated in 3.54 to 3.56 DALY per 1000 population. Several significant spatial clusters for augmented risk of disease were identified along the country for NCC and its sequelae, most of which converged in the southern Sierra provinces. Our study suggests a possible spatial correlation between the presence of NCC cases and a higher prevalence of neurological conditions like epilepsy, status epilepticus, migraine, and hydrocephalus in several ‘hot spots’ of the southern provinces of Ecuador, indicating possible areas where the application of preventive measures is necessary to reduce cysticercosis transmission rates.
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Affiliation(s)
- Marco Coral-Almeida
- One Health Research Group, Faculty of Health Sciences, Universidad de Las Américas, Quito, Ecuador
- * E-mail:
| | | | - Sofia Asanza
- One Health Research Group, Faculty of Health Sciences, Universidad de Las Américas, Quito, Ecuador
| | - Celia Erazo
- One Health Research Group, Faculty of Health Sciences, Universidad de Las Américas, Quito, Ecuador
| | - Michelle Paucar
- One Health Research Group, Faculty of Health Sciences, Universidad de Las Américas, Quito, Ecuador
| | - Manuel Calvopiña
- One Health Research Group, Faculty of Health Sciences, Universidad de Las Américas, Quito, Ecuador
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Schmidt V, O’Hara MC, Ngowi B, Herbinger KH, Noh J, Wilkins PP, Richter V, Kositz C, Matuja W, Winkler AS. Taenia solium cysticercosis and taeniasis in urban settings: Epidemiological evidence from a health-center based study among people with epilepsy in Dar es Salaam, Tanzania. PLoS Negl Trop Dis 2019; 13:e0007751. [PMID: 31809501 PMCID: PMC6897529 DOI: 10.1371/journal.pntd.0007751] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/29/2018] [Accepted: 09/05/2019] [Indexed: 01/11/2023] Open
Abstract
In Africa, urbanization is happening faster than ever before which results in new implications for transmission of infectious diseases. For the zoonotic parasite Taenia solium, a major cause of acquired epilepsy in endemic countries, the prevalence in urban settings is unknown. The present study investigated epidemiological, neurological, and radiological characteristics of T. solium cysticercosis and taeniasis (TSCT) in people with epilepsy (PWE) living in Dar es Salaam, Tanzania, one of the fastest growing cities worldwide. A total of 302 PWE were recruited from six health centers in the Kinondoni district of Dar es Salaam. Serological testing for T. solium cysticercosis-antigen (Ag) and -antibodies (Abs) and for T. solium taeniasis-Abs was performed in all PWE. In addition, clinical and radiological examinations that included cranial computed tomography (CT) were performed. With questionnaires, demographic data from study populations were collected, and factors associated with TSCT were assessed. Follow-up examinations were conducted in PWE with TSCT. T. solium cysticercosis-Ag was detected in three (0.99%; 95% CI: 0–2.11%), -Abs in eight (2.65%; 95% CI: 0.84–4.46%), and taeniasis-Abs in five (1.66%; 95% CI: 0.22–3.09%) of 302 PWE. Six PWE (1.99%; 95% CI: 0.41–3.56%) were diagnosed with neurocysticercosis (NCC). This study demonstrates the presence of TSCT in Dar es Salaam, however, NCC was only associated with a few cases of epilepsy. The small fraction of PWE with cysticercosis- and taeniasis-Abs may suggest that active transmission of T. solium plays only a minor role in Dar es Salaam. A sufficiently powered risk analysis was hampered by the small number of PWE with TSCT; therefore, further studies are required to determine the exact routes of infection and risk behavior of affected individuals. Taenia solium cysticercosis and taeniasis is a zoonotic disease complex which affects thousands of people in sub-Saharan Africa. This parasite has a human-pig life cycle and has been considered a public health problem mainly in rural areas. As African towns and suburbs grow rapidly and disproportionally, adequate infrastructure such as sewage systems and clean water often lack while population density, trade, and travel increase. This may lead to the appearance of parasitic diseases formerly considered `rural´ in urban settings. In this study, we searched for evidence of T. solium infections in the Kinondoni district of Dar es Salaam, Tanzania. We focused on people with epilepsy (PWE) since epilepsy is one of the most common and severe disorders associated with T. solium neurocysticercosis and tested all of them serologically for T. solium cysticercosis and taeniasis. We further investigated neurological and radiological characteristics. Our findings show that in our study area in Dar es Salaam 2.65% of PWE had contracted T. solium infection at some stage. Neurocysticercosis, as confirmed by neuroimaging, was found only in 1.99% of PWE. This, in combination with the relatively small number of PWE detected with taeniasis antibodies (1.66%), points towards the fact that active transmission of T. solium seems to play only a minor role in this urban setting, suggesting that infections may mainly be contracted in rural areas. Further large-scale studies are required to investigate the infection pathways and risk behavior related to T. solium infections within urban areas of sub-Saharan Africa.
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Affiliation(s)
- Veronika Schmidt
- Department of Neurology, Center for Global Health, School of Medicine, Technical University of Munich, Munich, Germany
- Centre for Global Health, Institute of Health and Society, University of Oslo, Oslo, Norway
- * E-mail:
| | - Marie-Claire O’Hara
- Department of Neurology, Center for Global Health, School of Medicine, Technical University of Munich, Munich, Germany
- Department of Neurology, Elbe Klinikum Stade, Stade, Germany
| | - Bernard Ngowi
- Muhimbili Medical Research Centre, National Institute for Medical Research (NIMR), Dar es Salaam, Tanzania
- College of Health and Allied Sciences, University of Dar es Salaam, Dar es Salaam, Tanzania
| | - Karl-Heinz Herbinger
- Division of Infectious Diseases and Tropical Medicine (DITM), Medical Center of the University of Munich, Ludwig-Maximilians-University Munich, Munich, Germany
| | - John Noh
- Division of Parasitic Diseases and Malaria, Center for Global Health, Centers for Disease Control and Prevention (CDC), Atlanta, Georgia, United States of America
| | - Patricia Procell Wilkins
- Division of Parasitic Diseases and Malaria, Center for Global Health, Centers for Disease Control and Prevention (CDC), Atlanta, Georgia, United States of America
| | - Vivien Richter
- Department of Neurology and Epileptology, Evangelical Hospital Alsterdorf, Hamburg, Germany
| | - Christian Kositz
- Department of Internal Medicine, Kantonsspital St. Gallen, St. Gallen, Schwitzerland
| | - William Matuja
- Department of Neurology, Muhimbili University of Health and Allied Sciences, Dar es Salaam, Tanzania
| | - Andrea Sylvia Winkler
- Department of Neurology, Center for Global Health, School of Medicine, Technical University of Munich, Munich, Germany
- Centre for Global Health, Institute of Health and Society, University of Oslo, Oslo, Norway
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Melki J, Koffi E, Boka M, Touré A, Soumahoro MK, Jambou R. Taenia solium cysticercosis in West Africa: status update. ACTA ACUST UNITED AC 2018; 25:49. [PMID: 30230445 PMCID: PMC6144651 DOI: 10.1051/parasite/2018048] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/24/2018] [Accepted: 08/06/2018] [Indexed: 11/22/2022]
Abstract
Cysticercosis is caused by the larvae of the cestode Taenia solium. Few data are available on the prevalence of this disease in pigs and humans in West African countries. The aim of this study was to provide an overview of existing data concerning the spread of this parasitosis in the countries of the Economic Community of West African States (ECOWAS) on the basis of the literature published over the last five decades. Systematic searches for publications were carried out on PubMed and Google Scholar, as well as in certain regional and local journals. From a total of 501 articles initially retrieved concerning T. solium cysticercosis in West African countries, only 120 articles were relevant for this review and therefore finally retained. For pigs, only eight out of sixteen countries of the region have reported porcine cysticercosis. Post-mortem examination of carcasses at slaughterhouses, meat inspection at butcheries or tongue inspection in herds have been the main source of data, but may not entirely reflect actual parasite distribution. For humans, only five out of sixteen countries reported epidemiological data on neurocysticercosis. Most data referred to neurocysticercosis prevalence among epileptic patients or isolated clinical cases. Furthermore, existing data are often old. Overall, T. solium cysticercosis remains largely neglected in West Africa, and its prevalence appears not to be affected by any religion in particular. There is an urgent need to promote and implement health partnerships and programs on this disease in order to collect more data and identify sensitive populations in the countries of the ECOWAS area.
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Affiliation(s)
- Jihen Melki
- Institut Pasteur de Côte d'Ivoire, B.P. 490, Abidjan 01, Côte d'Ivoire
| | - Eugène Koffi
- Institut Pasteur de Côte d'Ivoire, B.P. 490, Abidjan 01, Côte d'Ivoire
| | - Marcel Boka
- Direction des Services Vétérinaires, Ministère des Ressources Animales et Halieutiques, B.P. V84, Abidjan 01, Côte d'Ivoire - Université Alassane Ouattara, Ministère de l'Enseignement Supérieur et de la Recherche Scientifique, B.P. V18, Bouaké 01, Côte d'Ivoire
| | - André Touré
- Institut Pasteur de Côte d'Ivoire, B.P. 490, Abidjan 01, Côte d'Ivoire
| | | | - Ronan Jambou
- Institut Pasteur de Côte d'Ivoire, B.P. 490, Abidjan 01, Côte d'Ivoire - Institut Pasteur, 25-28 Rue du Dr Roux, 75015 Paris, France
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Gripper LB, Welburn SC. The causal relationship between neurocysticercosis infection and the development of epilepsy - a systematic review. Infect Dis Poverty 2017; 6:31. [PMID: 28376856 PMCID: PMC5381143 DOI: 10.1186/s40249-017-0245-y] [Citation(s) in RCA: 38] [Impact Index Per Article: 5.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/29/2016] [Accepted: 01/13/2017] [Indexed: 12/02/2022] Open
Abstract
BACKGROUND Neurocysticercosis (NCC) is a parasitic infection of the human central nervous system, the most common form of which involves infection of the brain parenchyma with the larval form of the Taenia solium tapeworm. A causal relationship between such an NCC infection and the development of epilepsy in infected individuals is acknowledged, in part supported by high levels of comorbidity in endemic countries worldwide. METHODS This study undertook a systematic review and critical analysis of the NCC-epilepsy relationship with the primary objective of quantifying the risk of developing epilepsy following NCC infection. A secondary aim was to analyse the proportions of NCC-associated epilepsy within different populations. Significant emphasis was placed on the importance of neuroimaging (CT or MRI) availability and use of clear guidelines for epilepsy diagnosis, in order to avoid overestimations of prevalence rates of either condition; a limitation identified in several previous studies. RESULTS A common odds ratio of 2.76 was identified from meta-analysis of case-control studies, indicating that an individual infected with NCC has almost a three times higher risk of developing epilepsy than an uninfected individual. Furthermore, meta-analysis of studies identified a common proportion of 31.54% of epilepsy cases associated with NCC infection which suggests that amongst epileptic populations in at risk countries, approximately one-third may be associated with NCC infection. CONCLUSION A significant finding was the lack of good clinical data to enable accurate determination of a causal relationship. Even studies that were included had noticeable limitations, including a general lack of consistency in diagnostics, and lack of accurate epidemiological data. This review highlights a need for consistency in research in this field. In the absence of reliable estimates of its global burden, NCC will remain of low priority in the eyes of funding agencies - a truly neglected disease.
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Affiliation(s)
- Lucy B. Gripper
- Division of Infection and Pathway Medicine, Edinburgh Infectious Diseases, Edinburgh Medical School: Biomedical Sciences, College of Medicine and Veterinary Medicine, The University of Edinburgh, Chancellor’s Building, 49 Little France Crescent, Edinburgh, EH16 4SB Scotland UK
| | - Susan C. Welburn
- Division of Infection and Pathway Medicine, Edinburgh Infectious Diseases, Edinburgh Medical School: Biomedical Sciences, College of Medicine and Veterinary Medicine, The University of Edinburgh, Chancellor’s Building, 49 Little France Crescent, Edinburgh, EH16 4SB Scotland UK
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Debacq G, Moyano LM, Garcia HH, Boumediene F, Marin B, Ngoungou EB, Preux PM. Systematic review and meta-analysis estimating association of cysticercosis and neurocysticercosis with epilepsy. PLoS Negl Trop Dis 2017; 11:e0005153. [PMID: 28267746 PMCID: PMC5340353 DOI: 10.1371/journal.pntd.0005153] [Citation(s) in RCA: 57] [Impact Index Per Article: 8.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/21/2015] [Accepted: 11/01/2016] [Indexed: 11/27/2022] Open
Abstract
Background We reviewed studies that analyzed cysticercosis (CC), neurocysticercosis (NCC) and epilepsy across Latin America, Asia and Sub-Saharan Africa, to estimate the odds ratio and etiologic fraction of epilepsy due to CC in tropical regions. Methodology We conducted a systematic review of the literature on cysticercosis and epilepsy in the tropics, collecting data from case-control and cross-sectional studies. Exposure criteria for CC included one or more of the following: serum ELISA or EITB positivity, presence of subcutaneous cysts (both not verified and unverified by histology), histology consistent with calcified cysts, and brain CT scan consistent with NCC. A common odds-ratio was then estimated using meta-analysis. Principal findings 37 studies from 23 countries were included (n = 24,646 subjects, 14,934 with epilepsy and 9,712 without epilepsy). Of these, 29 were case-control (14 matched). The association between CC and epilepsy was significant in 19 scientific articles. Odds ratios ranged from 0.2 to 25.4 (a posteriori power 4.5–100%) and the common odds ratio was 2.7 (95% CI 2.1–3.6, p <0.001). Three subgroup analyses performed gave odds ratios as: 2.2 (EITB-based studies), 3.2 (CT-based studies), 1.9 (neurologist-confirmed epilepsy; door-to-door survey and at least one matched control per case). Etiologic fraction was estimated to be 63% in the exposed group among the population. Significance Despite differences in findings, this meta-analysis suggests that cysticercosis is a significant contributor to late-onset epilepsy in tropical regions around the world, and its impact may vary depending on transmission intensity. Cysticercosis is a helminthic infection of the central nervous system (CNS) and the leading cause of late onset epilepsy in low-and middle-income countries. This neurological disease is a public health problem in Sub-Saharan Africa, Asia and Latin America, affecting impoverished rural and peri-urban populations where sanitation is inadequate. Diagnostic criteria for NCC vary according to regional availability and access to imaging and serological tests. This systematic review highlights the lack of appropriate methodology in most observational studies, with few studies including control groups, a basic epidemiological criteria needed to demonstrate an association. EITB for cysticercosis was widely used to measure exposure, and brain CT scan was a non-invasive alternative used to identify cysts. Neurocysticercosis (NCC) is a preventable neurological condition in the tropics despite resource limitations in LMIC regions. Well-designed studies are needed to provide quality evidence to support control interventions and surveillance systems for this important zoonotic disease.
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Affiliation(s)
- Gabrielle Debacq
- INSERM, Univ. Limoges, CHU Limoges, UMR_S 1094, Tropical Neuroepidemiology, Institute of Neuroepidemiology and Tropical Neurology, CNRS FR 3503 GEIST, Limoges, France
| | - Luz M. Moyano
- INSERM, Univ. Limoges, CHU Limoges, UMR_S 1094, Tropical Neuroepidemiology, Institute of Neuroepidemiology and Tropical Neurology, CNRS FR 3503 GEIST, Limoges, France
- Center for Global Health, Universidad Peruana Cayetano Heredia, Lima, Perú
- Epidemiology Unit. Hospital Regional II-2 Tumbes, Perú
- * E-mail:
| | - Héctor H. Garcia
- Center for Global Health, Universidad Peruana Cayetano Heredia, Lima, Perú
- Instituto Nacional de Ciencias Neurológicas. Unidad de Cisticercosis. Lima, Perú
| | - Farid Boumediene
- INSERM, Univ. Limoges, CHU Limoges, UMR_S 1094, Tropical Neuroepidemiology, Institute of Neuroepidemiology and Tropical Neurology, CNRS FR 3503 GEIST, Limoges, France
| | - Benoit Marin
- INSERM, Univ. Limoges, CHU Limoges, UMR_S 1094, Tropical Neuroepidemiology, Institute of Neuroepidemiology and Tropical Neurology, CNRS FR 3503 GEIST, Limoges, France
| | - Edgard B. Ngoungou
- INSERM, Univ. Limoges, CHU Limoges, UMR_S 1094, Tropical Neuroepidemiology, Institute of Neuroepidemiology and Tropical Neurology, CNRS FR 3503 GEIST, Limoges, France
- Université des Sciences de la Santé, EA NEMIT, Faculté de Médecine, Libreville, Gabon
| | - Pierre-Marie Preux
- INSERM, Univ. Limoges, CHU Limoges, UMR_S 1094, Tropical Neuroepidemiology, Institute of Neuroepidemiology and Tropical Neurology, CNRS FR 3503 GEIST, Limoges, France
- CHU, CEBIMER, Limoges, France
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Chacha M, Yohana C, Nkwengulila G. Indigenous Knowledge, Practices, Beliefs and Social Impacts of Porcine Cysticercosis and Epilepsy in Iringa Rural. Health (London) 2014. [DOI: 10.4236/health.2014.621328] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
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Rottbeck R, Nshimiyimana JF, Tugirimana P, Düll UE, Sattler J, Hategekimana JC, Hitayezu J, Bruckmaier I, Borchert M, Gahutu JB, Dieckmann S, Harms G, Mockenhaupt FP, Ignatius R. High prevalence of cysticercosis in people with epilepsy in southern Rwanda. PLoS Negl Trop Dis 2013; 7:e2558. [PMID: 24244783 PMCID: PMC3828157 DOI: 10.1371/journal.pntd.0002558] [Citation(s) in RCA: 30] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/19/2012] [Accepted: 10/11/2013] [Indexed: 01/24/2023] Open
Abstract
Background Neurocysticercosis (NCC), the central nervous system infection by Taenia solium larvae, is a preventable and treatable cause of epilepsy. In Sub-Saharan Africa, the role of NCC in epilepsy differs geographically and, overall, is poorly defined. We aimed at contributing specific, first data for Rwanda, assessing factors associated with NCC, and evaluating a real-time PCR assay to diagnose NCC in cerebrospinal fluid (CSF). Methodology/Principal findings At three healthcare facilities in southern Rwanda, 215 people with epilepsy (PWE) and 51 controls were clinically examined, interviewed, and tested by immunoblot for cysticerci-specific serum antibodies. Additionally, CSF samples from PWE were tested for anticysticercal antibodies by ELISA and for parasite DNA by PCR. Cranial computer tomography (CT) scans were available for 12.1% of PWE with additional symptoms suggestive of NCC. The Del Brutto criteria were applied for NCC diagnosis. Cysticerci-specific serum antibodies were found in 21.8% of PWE and 4% of controls (odds ratio (OR), 6.69; 95% confidence interval (95%CI), 1.6–58.7). Seropositivity was associated with age and lack of safe drinking water. Fifty (23.3%) PWE were considered NCC cases (definitive, based on CT scans, 7.4%; probable, mainly based on positive immunoblots, 15.8%). In CSF samples from NCC cases, anticysticercal antibodies were detected in 10% (definitive cases, 25%) and parasite DNA in 16% (definitive cases, 44%). Immunoblot-positive PWE were older (medians, 30 vs. 22 years), more frequently had late-onset epilepsy (at age >25 years; 43.5% vs. 8.5%; OR, 8.30; 95%CI, 3.5–20.0), and suffered from significantly fewer episodes of seizures in the preceding six months than immunoblot-negative PWE. Conclusions/Significance NCC is present and contributes to epilepsy in southern Rwanda. Systematic investigations into porcine and human cysticercosis as well as health education and hygiene measures for T. solium control are needed. PCR might provide an additional, highly specific tool in NCC diagnosis. Neurocysticercosis (NCC) is the infection of the brain with larvae of the pig tapeworm (Taenia solium), which results from the ingestion of, e.g., food or water contaminated with the eggs of this helminth. Seizures and epilepsy are the most often reported clinical manifestations. The diagnosis is based on various clinical, radiological, microbiological, and epidemiological criteria. NCC is treatable and preventable. Knowledge about its contribution to epilepsy in a given region therefore helps to manage and prevent the disease. Our study aimed at investigating the prevalence of and risk factors associated with NCC in southern Rwanda. Additionally, we evaluated a new diagnostic method based on the detection of parasite DNA in the cerebrospinal fluid of people with epilepsy for its usefulness. By applying well-established diagnostic criteria for NCC, we identified 16 definitive and 34 probable NCC cases among 215 people with epilepsy in southern Rwanda. The risk of NCC was higher in those lacking access to safe drinking water. This highlights opportunities for the prevention of NCC, and consequently, epilepsy in this region. Parasite DNA could be detected in the cerebrospinal fluid of 16% of the NCC patients. Thus, this method might help to identify NCC cases, particularly when radiology cannot be performed easily.
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Affiliation(s)
- Ruth Rottbeck
- Department of Internal Medicine/Neurology, Butare University Teaching Hospital, Butare, Rwanda
| | | | - Pierrot Tugirimana
- Department of Internal Medicine/Neurology, Butare University Teaching Hospital, Butare, Rwanda
| | | | - Janko Sattler
- Institute of Tropical Medicine and International Health, Charité – Universitätsmedizin Berlin, Berlin, Germany
| | | | - Janvier Hitayezu
- Department of Internal Medicine/Neurology, Butare University Teaching Hospital, Butare, Rwanda
| | - Irmengard Bruckmaier
- Department of Internal Medicine/Neurology, Butare University Teaching Hospital, Butare, Rwanda
| | - Matthias Borchert
- Institute of Tropical Medicine and International Health, Charité – Universitätsmedizin Berlin, Berlin, Germany
| | - Jean Bosco Gahutu
- Clinical Department, Medical Biology, Butare University Teaching Hospital, Butare, Rwanda
| | - Sebastian Dieckmann
- Institute of Tropical Medicine and International Health, Charité – Universitätsmedizin Berlin, Berlin, Germany
| | - Gundel Harms
- Institute of Tropical Medicine and International Health, Charité – Universitätsmedizin Berlin, Berlin, Germany
| | - Frank P. Mockenhaupt
- Institute of Tropical Medicine and International Health, Charité – Universitätsmedizin Berlin, Berlin, Germany
| | - Ralf Ignatius
- Institute of Tropical Medicine and International Health, Charité – Universitätsmedizin Berlin, Berlin, Germany
- * E-mail:
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Millogo A, Nitiéma P, Carabin H, Boncoeur-Martel MP, Rajshekhar V, Tarnagda Z, Praet N, Dorny P, Cowan L, Ganaba R, Hounton S, Preux PM, Cissé R. Prevalence of neurocysticercosis among people with epilepsy in rural areas of Burkina Faso. Epilepsia 2012; 53:2194-202. [PMID: 23148555 DOI: 10.1111/j.1528-1167.2012.03687.x] [Citation(s) in RCA: 33] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Abstract
PURPOSE To estimate the lifetime prevalence of neurocysticercosis (NCC)-associated epilepsy and the proportion of NCC among people with epilepsy in three Burkina Faso villages. METHODS Three villages were selected to represent three types of pig-rearing methods: (1) Batondo, where pigs are left to roam; (2) Pabré, where pigs are mostly tethered or penned; and (3) Nyonyogo, where the majority of residents are Muslim and few pigs are raised. In Batondo and Nyonyogo, all concessions (a group of several households) were included. Half of the concessions in Pabré were randomly chosen. All households of selected concessions were included, and one person per household was randomly selected for epilepsy screening and serologic testing for cysticercosis. Self-reported cases of epilepsy were also examined and confirmed cases included in analyses other than the estimate of NCC-associated epilepsy prevalence. Epilepsy was defined as ever having had more than one episode of unprovoked seizures. Individuals with medically confirmed epilepsy had a computerized tomography (CT) scan of the brain before and after contrast medium injection. The diagnosis of NCC was made using a modification of the criteria of Del Brutto et al. KEY FINDINGS Thirty-nine (4%) of 888 randomly selected villagers and 33 (94%) of 35 self-reported seizures cases were confirmed to have epilepsy by medical examination. Among the 68 participants with epilepsy who had a CT scan, 20 patients were diagnosed with definitive or probable NCC for a proportion of 46.9% (95% confidence interval [CI] 30.2-64.1) in Batondo and 45.5% (95% CI 19.0-74.1) in Pabré. No cases of NCC were identified in Nyonyogo. SIGNIFICANCE All the definitive and probable cases of NCC were from the two villages where pig breeding is common. Prevention policies intended to reduce the burden of epilepsy in this country should include measures designed to interrupt the life cycle of Taenia solium.
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Affiliation(s)
- Athanase Millogo
- Department of Internal Medicine, Sourou Sanou University Hospital Center, Bobo-Dioulasso, Burkina Faso
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Nitiéma P, Carabin H, Hounton S, Praet N, Cowan LD, Ganaba R, Kompaoré C, Tarnagda Z, Dorny P, Millogo A, ÉFÉCAB. Prevalence case-control study of epilepsy in three Burkina Faso villages. Acta Neurol Scand 2012; 126:270-8. [PMID: 22289127 DOI: 10.1111/j.1600-0404.2011.01639.x] [Citation(s) in RCA: 28] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 12/06/2011] [Indexed: 11/28/2022]
Abstract
PURPOSE To estimate the association between the prevalence of epilepsy and potential risk factors in three Burkina Faso villages. METHODS Three villages were selected based on local reports of high numbers of epilepsy cases and pig-rearing practices. One person aged 7 or older was selected at random from all households of selected concessions for epilepsy screening and blood sampling. Epilepsy was confirmed by a physician using the ILAE definition. The cross-sectional associations between epilepsy and selected factors and seroresponse to the antigens of Taenia solium were estimated using a Bayesian hierarchical logistic regression. Prevalence odds ratios (POR) and their 95% Bayesian Credible Intervals (95% BCI) were estimated. RESULTS Of 888 individuals interviewed, 39 of 70 screened positive were confirmed to have epilepsy for a lifetime prevalence of 4.5% (95% CI: 3.3; 6.0). The prevalence of epilepsy was associated with a positive reaction to cysticercosis Ag-ELISA serology (POR = 3.1, 95% BCI = 1.0; 8.3), past pork consumption (POR = 9.7, 95% BCI = 2.5; 37.9), and being salaried or a trader compared to a farmer or housewife (POR = 2.9, 95% BCI = 1.2; 6.4). DISCUSSION Several factors were associated with prevalent epilepsy, with Ag-ELISA suggesting the presence of neurocysticercosis. The association between epilepsy and some occupations may reflect differences in local attitudes toward epilepsy and should be further explored.
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Affiliation(s)
- P. Nitiéma
- Department of Biostatistics and Epidemiology; University of Oklahoma Health Sciences Center; Oklahoma City; OK; USA
| | - H. Carabin
- Department of Biostatistics and Epidemiology; University of Oklahoma Health Sciences Center; Oklahoma City; OK; USA
| | - S. Hounton
- Sexual and Reproductive Health Branch Technical Division; UNFPA; New York; NY; USA
| | - N. Praet
- Department of Animal Health, Institute of Tropical Medicine; Nationalestraat; 155, B-2000 Antwerp, Belgium
| | - L. D. Cowan
- Department of Biostatistics and Epidemiology; University of Oklahoma Health Sciences Center; Oklahoma City; OK; USA
| | - R. Ganaba
- Agence de Formation, de Recherche et d' Expertise en Santé pour l'Afrique (AFRICSanté); Bobo Dioulasso; Burkina Faso
| | | | - Z. Tarnagda
- Institut de Recherche en Sciences de la Santé; Bobo-Dioulasso; Burkina Faso
| | - P. Dorny
- Department of Animal Health, Institute of Tropical Medicine; Nationalestraat; 155, B-2000 Antwerp, Belgium
| | - A. Millogo
- Department of Internal Medecine; Centre Hospitalier Universitaire Sourou Sanou de Bobo-Dioulasso; Burkina Faso
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