Structural Equation Modeling (SEM) of Cysticercosis in School-Aged Children in Tibetan Rural Farming Areas of Western China: Implications for Intervention Planning

Neurocysticercosis (NCC) significantly contributes to morbidity in developing countries. We recently published a study of prevalence and risk factors in school-aged children in three mountainous areas in Sichuan province of western China. Using structural equation modeling (SEM) on data from that study to guide intervention planning, here we examine risk factors grouped into three broad interventional categories: sociodemographics, human behavior, and sources of pork and pig husbandry. Because neuroimaging is not easily available, using SEM allows for the use of multiple observed variables (serological tests and symptoms) to represent probable NCC cases. Data collected from 2608 students was included in this analysis. Within this group, seroprevalence of cysticercosis IgG antibodies was 5.4%. SEM results showed that sociodemographic factors (β = 0.33, p < 0.05), sources of pork and pig husbandry (β = 0.26, p < 0.001), and behavioral factors (β = 0.33, p < 0.05) were all directly related to probable NCC in school-aged children. Sociodemographic factors affected probable NCC indirectly via sources of pork and pig husbandry factors (β = 0.07, p < 0.001) and behavioral variables (β = 0.07, p < 0.001). Both sociodemographic factors (β = 0.07, p < 0.05) and sources of pork and pig husbandry factors (β = 0.10, p < 0.01) affected probable NCC indirectly via behavioral variables. Because behavioral variables not only had a large direct effect but also served as a critical bridge to strengthen the effect of sociodemographics and sources of pork and pig husbandry on probable NCC, our findings suggest that interventions targeting behavioral factors may be the most effective in reducing disease.

Plasma Paraoxonase, Sphingosine-1-phosphate, Total Sialic Acid, and Heat Shock Protein-27 in the Liver of the Sheep Naturally Infected with Cysticercus Tenuicollis: Evidence on Pathological Changes

The present study aimed to investigate whether sphingosine 1 phosphate (S1P), paraoxonase (PON), total sialic acid (TSA), and heat shock protein-27 (HSP27) are altered in the sheep during infection of the liver with Cysticercus tenuicollis. This study was conducted on40 healthy sheep and40 sheep with Cysticercus tenuicollis infection. The infected and non-infected animals were selected based on the observation of severe Cysticercus tenuicollis infection in the liver and absence of any hepatic cysts, respectively. All parameters were measured in serum and plasma. The results revealed a significant decrease (P&amp;lt;0.01) in PON, TSA, and albumin (Alb) in the infected group, compared with those in the healthy one. Furthermore, the infected sheep had a significant increase (P&amp;lt;0.01) in S1P, HSP-27, malondialdehyde (MDA), total bilirubin, and unconjugated bilirubin as compared with those in their non-infected counterparts. Moreover, no significant change was observed in total plasma protein level in the infected animals in comparison to that in the healthy ones. The low levels of TSA and Alb revealed liver damage in the infected sheep. Moreover, the PON reduction might have resulted from hepatic steatosis and MDA enhancement. Meanwhile, S1P elevation could be attributed to the activation of platelets. In addition, HSP-27 increase was ascribed to the disease-induced stress conditions.

Seroprevalence of Taenia solium antibodies in a cohort of Bolivian immigrants in Italy

We conducted a retrospective study aimed at estimating the seroprevalence of anti-cysticercus antibodies in a Bolivian community settled in Italy. Seroprevalence of 9% was found, testing 495 sera with immunoblot. This study contributes to outline the epidemiological scenario of cysticercosis in immigrants living in Europe.

Prevalence and risk factors for Taenia solium cysticercosis in school-aged children: A school based study in western Sichuan, People's Republic of China

Background

Taenia solium cysticercosis affects millions of impoverished people worldwide and can cause neurocysticercosis, an infection of the central nervous system which is potentially fatal. Children may represent an especially vulnerable population to neurocysticercosis, due to the risk of cognitive impairment during formative school years. While previous epidemiologic studies have suggested high prevalence in rural China, the prevalence in children as well as risk factors and impact of disease in low-resource areas remain poorly characterized.

Methodology/Principal findings

Utilizing school based sampling, we conducted a cross-sectional study, administering a questionnaire and collecting blood for T. solium cysticercosis antibodies in 2867 fifth and sixth grade students across 27 schools in west Sichuan. We used mixed-effects logistic regression models controlling for school-level clustering to study associations between risk factors and to characterize factors influencing the administration of deworming medication. Overall prevalence of cysticercosis antibodies was 6%, but prevalence was significantly higher in three schools which all had prevalences of 15% or higher. Students from households owning pigs (adjusted odds ratio [OR] 1.81, 95% CI 1.08–3.03), from households reporting feeding their pigs human feces (adjusted OR 1.49, 95% CI 1.03–2.16), and self-reporting worms in their feces (adjusted OR 1.85, 95% CI 1.18–2.91) were more likely to have cysticercosis IgG antibodies. Students attending high prevalence schools were more likely to come from households allowing pigs to freely forage for food (OR 2.26, 95% CI 1.72–2.98) and lacking a toilet (OR 1.84, 95% CI 1.38–2.46). Children who were boarding at school were less likely to have received treatment for gastrointestinal worms (adjusted OR 0.58, 95% CI 0.42–0.80).

Conclusions/Significance

Our study indicates high prevalences of cysticercosis antibodies in young school aged children in rural China. While further studies to assess potential for school-based transmission are needed, school-based disease control may be an important intervention to ensure the health of vulnerable pediatric populations in T. solium endemic areas.

The zoonotic tapeworm, Taenia solium, affects millions of impoverished people worldwide and can cause neurocysticercosis (NCC), an infection of the central nervous system which is potentially fatal. Hypothetically, children may be a vulnerable population to infection as neurological problems and cognitive impairment caused by NCC during formative school years may lead to poor academic performance, contributing to drop-out rates and, eventually, propagating cycles of poverty. We carried out a school-based study of T. solium cysticerosis in primary school-aged children in rural western Sichuan. Our results indicate high levels of T. solium exposure in young school-aged children in rural China. While further studies to assess disease transmission within schools are needed, school-based disease control may be an important intervention to ensure the health of pediatric populations at risk for infection.

Significance of Serology by Multi-Antigen ELISA for Tissue Helminthiases in Korea

It is clinically important to differentiate tissue-invading helminthiasis. The purpose of this study was to assess the specific immunoglobulin G (IgG) antibody positive rates for clonorchiasis, paragonimiasis, cysticercosis, and sparganosis 4 helminthiases from 1996 to 2006 using multi-antigen enzyme-linked immunosorbent assay (ELISA) in Korea. Results of 6,017 samples, which were referred to our institute for serodiagnosis, were analyzed. The subjects with positive serum IgG antibodies were 1,502 (25.0%) for any of the 4 helminthiases. The overall positive numbers for clonorchiasis, paragonimiasis, cysticercosis, and sparganosis were 728 (12.1%), 166 (2.8%), 729 (12.1%), and 263 (4.4%), respectively. The positive serologic reaction to multi-antigens was determined in 309 (20.6%) of the 1,502 total seropositive subjects. Those with multi-antigen positivity were regarded as positive for the antigen of strongest reaction but cross-reaction to others with weak positive reaction. Annual seropositive rates for those 4 tissue helminthiases ranged from 12.1% to 35.7%. The highest rate was observed in age from 60 to 69 years old and prevalence of men (27.4%; 1,030/3,763) was significantly higher than of women (19.1%; 332/1,741). Hospital records of 165 ELISA positive patients were reviewed to confirm correlation with their clinical diagnosis. Paragonimiasis was highly correlated as 81.8% (9/11), cysticercosis 29.9% (20/67), clonorchiasis 29.0% (20/69), and sparganosis 11.1% (2/18). In conclusion, the multi-antigen ELISA using 4 helminth antigens is useful to differentiate suspected tissue-invading helminthiases, especially ELISA diagnosis of paragonimiasis is reliable. The seropositivity is still high among suspected patients in Korea.

Taenia solium Human Cysticercosis: A Systematic Review of Sero-epidemiological Data from Endemic Zones around the World

Background

Taenia solium cysticercosis is a zoonotic neglected disease responsible for severe health disorders such as seizures and death. Understanding the epidemiology of human cysticercosis (HCC) in endemic regions will help to expose critical information about the transmission of the disease, which could be used to design efficient control programs. This review gathered serological data on apparent prevalence of T. solium circulating antigens and/or seroprevalence of T. solium antibodies, apparent prevalence of human taeniasis and risk factors for HCC from endemic communities in order to understand the differences in exposure to the parasite and active infections with T. solium metacestodes in endemic areas around the world.

Methods

Three databases were used to search sero-epidemiological data from community-based studies conducted between 1989 and 2014 in cysticercosis endemic communities worldwide. The search focused on data obtained from T. solium circulating antigen detection by monoclonal antibody-based sandwich ELISA and/or T. solium antibody seroprevalence determined by Enzyme-linked Immunoelectrotransfer Blot (EITB). A meta-analysis was performed per continent.

Principal Findings

A total of 39,271 participants from 19 countries, described in 37 articles were studied. The estimates for the prevalence of circulating T. solium antigens for Africa, Latin America and Asia were: 7.30% (95% CI [4.23–12.31]), 4.08% (95% CI [2.77–5.95]) and 3.98% (95% CI [2.81–5.61]), respectively. Seroprevalence estimates of T. solium antibodies were 17.37% (95% CI [3.33–56.20]), 13.03% (95% CI [9.95–16.88]) and 15.68% (95% CI [10.25–23.24]) respectively. Taeniasis reported prevalences ranged from 0 (95% CI [0.00–1.62]) to 17.25% (95% CI [14.55–20.23]).

Significance

A significant variation in the sero-epidemiological data was observed within each continent, with African countries reporting the highest apparent prevalences of active infections. Intrinsic factors in the human host such as age and immunity were main determinants for the occurrence of infections, while exposure was mostly related to environmental factors which varied from community to community.

Human cysticercosis is a neglected zoonotic disease caused by the larval stage of the parasite Taenia solium. This disease is responsible for severe health disorders such as seizures, and in some cases even death. T. solium cysticercosis is endemic in countries in Africa, Latin America and Asia where conditions such as inadequate hygiene, poor sanitary conditions, open defecation, free roaming pigs and poverty permit the transmission of the disease. Diagnostic tools are capable of detecting exposure to eggs and infection levels in a population through antibody and antigen detection, respectively. This review focused on gathering epidemiological data from endemic communities in Africa, Latin America and Asia in order to understand the causes of the observed variations in exposure/infection patterns in endemic regions. Similar antibody seroprevalences were observed worldwide while infection prevalences varied significantly within each region. Intrinsic factors such as age and immunity were determining factors for the occurrence of infections, while exposure was related to environmental factors which varied from region to region. Understanding the epidemiology of cysticercosis in endemic regions will help expose information on the transmission, which could in turn be used to design appropriate control programs.

Taenia solium metacestode preparation in rural areas of sub-Saharan Africa: a source for diagnosis and research on cysticercosis

BACKGROUND

Taenia solium metacestodes/cysts obtained from pig carcasses constitute a primary source for diagnostic tools used for the detection of human cysticercosis. Data on T. solium cyst preparation in Africa is still scarce but required to establish independent reference laboratories.

OBJECTIVES

The aim of the present study is a) to present the likely yield of T. solium cyst material by the use of two different preparation methods in the field and b) to investigate its suitability for immunodiagnosis of human cysticercosis.

METHODS

In Zambia, Uganda and Tanzania 670 pigs were screened for T. solium infection. Cysts were prepared by 'shaking method' and 'washing method'. Generated crude antigens were applied in a standard western blot assay.

RESULTS

46 out of 670 pigs (6.9%) were found positive for T. solium (Zambia: 12/367, 3.3%; Uganda: 11/217, 5.1%; Tanzania 23/86, 26.7%). Mean values of 77.7 ml whole cysts, 61.8 ml scolices/membranes and 10.9 ml cyst fluid were obtained per pig. Suitability of collected material for the use as crude antigen and molecular diagnostic techniques was demonstrated.

CONCLUSION

This study clearly shows that T. solium cyst preparation in African settings by simple field methods constitutes an effective way to obtain high quality material as source for diagnostic tools and research purposes.

[Assessment of dot blot tests and latex agglutination for cysticercosis diagnostic in Peru]

In order to evaluate dot blot tests and latex agglutination for the detection of human cysticercosis with liquid antigen of Taenia solium cysticerci, 125 human sera were used, of which 60 were from people with cysticercosis confirmed by Western Blot, 45 with other parasitic diseases and 20 apparently healthy. The optimal concentration of antigen to impregnate dot blot strips was 0.01 ug/uL, and to impregnate the latex particles was 0.092 ug/uL. For the dot blot test, a sensitivity of 100% and specificity of 87.7% was found. For latex agglutination, a sensitivity of 93.3% and specificity of 89.2% was found. Both tests may be useful and feasible to implement alternatives of serological diagnosis in laboratories in endemic areas of Peru.

Taenia taeniaeformis in rat favors protracted skin lesions caused by Sporothrix schenckii infection: Dectin-1 and IL-17 are dispensable for clearance of this fungus

We occasionally found that cestode Taenia taeniaeformis in rats favored Sporothrix schenckii infection and survival, causing protracted cutaneous lesions. In this study, we compared the pathology and cytokines profile of rats co-infected with the two pathogens and infected with S. schenckii alone to explore underlying mechanisms. In the co-infection group, there was high expression of β-glucan receptor Dectin-1 in the cutaneous lesions and no multinucleated giant cells, but in the S. schenckii infection group the opposite was observed. Cytokines profiles demonstrated an expected finding that IL-4, commonly expressed in helminth and fungus infection, is undetectable in the two infection groups. In the single fungal infection group, cytokines IFN-γ, IL-10 and IL-17 kept increasing in the first few weeks of infection to a peak which was followed by gradual decrease. This study showed that Dectin-1 and IL-17, which were believed to be the major anti-fungus mechanisms, are Th2 independent and dispensable for clearance of S. schenckii infection, suggesting that S. schenckii has a different molecular recognition pattern and evokes anti-infection mechanisms other than Dectin-1 and IL-17.

Taeniasis in Mongolia, 2002-2006

Survey on secondary data of taeniasis/cysticercosis was carried out in Mongolia in 2002-2006. A total of 118 taeniid proglottids, a diphyllobothriid segment, and 59 serum samples from 118 taeniasis cases were collected at National Center for Communicable Diseases, Ulaanbaatar, Mongolia. In 2006, 14 serum samples were collected from local people who had histories of epileptic seizures in Selenge Province where pig husbandry was the main business. The 118 proglottids were confirmed to be Taenia saginata by mitochondrial DNA analysis using cytochrome c oxidase subunit 1 and cytochrome b genes. T. saginata taeniasis was widely distributed at least in 10 of 21 provinces. No variation in the nucleotide sequences of the two genes was observed among T. saginata isolates from Mongolia. There was no evidence of Taenia solium taeniasis/cysticercosis or Taenia asiatica taeniasis. A diphyllobothriid segment was confirmed to be Diphyllobothrium latum by mitochondrial DNA analysis.

Risk factors for epilepsy in rural Lao PDR: a case-control study

The objective of this study was to assess the major etiologic categories of epilepsy in a rural district of the Lao PDR. Thirty-one newly identified patients with confirmed active epilepsy were compared with 124 controls, matched for gender, age and village residence. Risk factors for epilepsy were investigated with particular focus on cysticercosis serology. A history of head trauma (OR=4.7, p=0.05), family history of epilepsy (OR=12.8, p=0.03), and the use of human feces to fertilize domestic vegetable gardens (OR=4.9, p=0.04) were significantly associated with epilepsy. The study did not confirm any direct relation between epilepsy and cysticercosis serology. The cysticercosis seroprevalence was nil in the epilepsy group. This is the first study in the Lao PDR on epilepsy risk factors representing important data for the subregion. Parasitic, environmental, and behavioral factors of this traditional population deserve further studies to explain the missing link between epilepsy and cysticercosis.

Evaluation of a serological method for the detection of Taenia saginata cysticercosis using serum and meat juice samples

Two peptides, HP6-2 and Ts45S-10, were used as antigens for the detection of antibodies against Taenia saginata cysticercosis in serum and meat juice samples using enzyme-linked immunosorbent assay (ELISA). Positive control samples were obtained from animals experimentally infected (serum) and from animals naturally infected (meat juice). The two peptides and a pooled preparation of both peptides were evaluated, and their cut-off points with both sample categories were calculated. ELISA results from these different peptides were compared. Sensitivity and specificity of HP6-2 using serum were calculated as being 100 and 98%, respectively, showing to be higher than the values for the other antigens used. The average optical density (OD) value for negative samples was 0.646, whereas it was 1.702 for the positive control samples. This peptide was used to examine serum samples from animals with cysts and random field serum samples. For meat juice samples the pooled peptides showed the highest sensitivity and specificity, as they were 100 and 95%, respectively. The average OD values for the negative and the positive reference meat juice samples were 0.379 and 1.291, respectively. The optimal dilution of the meat juice samples for the ELISA was very low, as it was 1:20 using the pooled peptides, compared with 1:800 serum dilution using HP6-2. To the authors' knowledge, this is the first report of a successful testing for T. saginata cysticercosis using meat juice.

[Cysticercus tenuicollis infection in a goat farm]

An outbreak of acute cysticercosis occurred in six female goats 2-4 years old and three 50 days old kids from a goat farm in northern Italy. Goats were usually recovered in stable with an outdoor paddock. Post-mortem examination showed a massive infection of Taenia hydatigena larvae in the liver, lungs and on the peritoneum. All recovered Cysticercus tenuicollis were at immature stage.

[Combined expression of TSO45W-4BX from Taenia solium and porcine CD58 in Escherichia coli]

OBJECTIVE

To express the TSO45W-4BX of Taenia solium in combination with CD58 as a molecular adjuvant for improving the protective efficacy of the TSO45W-4BX recombinant vaccine.

METHODS

TSO45W-4BX and porcine CD58 genes were amplified by PCR, using recombinant plasmids pGEM-4B and pGEM-CD58 as template respectively. The CD58 fragment was inserted into the recombinant plasmid pGEX-4T-1 with directly ligated TSO45W-4BX. The transformant was induced with IPTG and followed by identifying the integrity of the recombinant containing TS045W-4BX and porcine CD58 with PCR and sequencing. The products were analyzed by SDS-PAGE and Western blotting.

RESULTS

The expression products of Mr 69,000 GST-4BX/CD58 and Mr 41,000 GST-4BX were present mainly in the form of inclusion bodies and soluble substance respectively, and both were recognized by sera of cysticercosis patients.

CONCLUSIONS

The TSO45W-4BX co-expressed with porcine CD58 conserves its immune reactivity.

Lack of specificity of a single positive 50-kDa band in the electroimmunotransfer blot (EITB) assay for cysticercosis

Diagnosis of the parasitic infection cysticercosis is usually confirmed by serological assays. The electroimmunotransfer blot (EITB) for cysticercosis is a sensitive and specific assay, which uses six glycoprotein antigens on a strip to detect antibodies to Taenia solium cysticerci. Although the appearance of bands at any of these six sites is considered to be a positive result, a growing body of evidence suggests that the presence of a single 50-kDa band in this assay may not indicate infection. An audit of 984 samples tested over a 3-year period showed that only two (15.4%) of 13 samples with a single 50-kDa band were associated with a diagnosis of cysticercosis. Possible reasons for this include technical problems, cross-reactivity with other parasites or other diseases, or the presence of a non-specific band. The results suggest that the finding of a single 50-kDa band should be interpreted with caution.

[Adjuvant effect of CpG DNA recombinant plasmid on antigen of Cysticercus cellulosae]

In order to prove the adjuvant effect of CpG DNA recombinant plasmid, the total antibodies and their IgG2a subtype induced by antigen of Cysticercus cellulosae, and content of IL-4 and IFN-gamma secreted from splenic cell of mouse immunized were measured. The recombinant plasmids showed an adjuvant effect, and CpG2 was the best adjuvant among the plasmids. It is proved that the CpG DNA possesses a synergistic effect with AI(OH)3 and 206 adjuvant, and is an effective Th1 type adjuvant in mice.

Cysticercus antibodies and antigens in serum from blood donors from Pondicherry, India

The aim of the present study was to screen the serum of blood donors, which are apparently healthy and residing in Pondicherry or its neighboring districts of Tamil Nadu State, for specific detection of Cysticercus antigens and antibodies. A total of 216 blood samples were collected from blood donors at the Central Blood Bank, JIPMER Hospital, Pondicherry, India during January and February 2004. Enzyme-linked immunosorbent assay (ELISA) was used to demonstrate anti-Cysticercus antibodies and the Co-agglutination (CoA) was used to detect antigen in sera. 14 (6.48 %) males were positive for either anti-Cysticercus antibodies or antigens. Of these eight sera were positive for anti-Cysticercus antibodies and six were positive for antigens. Results of the present study show that serum Cysticercus antigen detection may be a useful adjunct to antibody testing for seroprevalence studies of cysticercosis in the community. The present study is the first kind of study, carried out to determine both cysticercal antibodies as well as antigens in the serum samples collected from the healthy blood donors.

[Cysticercosis and epilepsy: a case-control study in Mbam Valley, Cameroon]

The impact of neurocysticercosis in Africa is not well known, and its role in the occurrence of epilepsy is not well defined. The concomitant high prevalence of both diseases in this region suggests a causal association of cysticercosis and epilepsy. The few attempts to find such a link in Africa have yielded discordant data. In order to answer this question, we conducted a case-control study between June and August 1998 in the Bilomo village in Central Cameroon, where a recent study had demonstrated very high epilepsy prevalence of 58/1000. Ninety-three epilepsy patients and eighty-one age matched controls were included. All subjects were examined by a neurologist and serology for cysticercosis was performed using an ELISA method. Serologies for cysticercosis were positive in twenty-nine out of one hundred and seventy four patients (16.7%; 95% CI: 11.6-23.2). Seventeen cases (18.3%) and twelve controls (14.8%) had a positive serology The odd ratio was 1.3 (95% CI: 0.6-3.0). This study was not in favour of an epidemiological relationship between cysticercosis infection and epileptic disorders.

Cysticercosis: IgG-ELISA evaluations of peak1 antigen and <30 kDa antigen of delipidized extract of Taenia solium metacestodes

The antigenicity of ether-delipidized Taenia solium metacestode extract (DLPAg) was investigated by IgG-ELISA. The antigen showed higher antigenicity than that of non-delipidized antigen (NDLPAg). Then the DLPAg was subjected to Sephacryl S-200 gel chromatography and a partially purified antigen (DLPP1Ag) was identified as the promised antigen by IgG-ELISA using 25 sera from cysticercosis cases, 177 cases of 24 heterologous infections, and healthy controls. Sensitivity was 52% and specificity was 91.8% at the cut-off value (X + 7SD), 0.399. Cross-reactivity occurred with 17 cases of eight diseases: cystic echinococcosis (7/11), taeniasis (1/16), gnathostomiasis (2/8), strongyloidiasis (1/12), angiostrongyliasis (1/12), paragonimiasis heterotremus (2/15), opisthorchiasis (1/9) and fascioliasis (2/7). When DLPP1Ag was fractionated through Ultra free centrifugal tube (retained 30 kDa) and Amicon (PM10), MWCOP1Ag (<30-10> kDa) was obtained; the antigen showed better results than DLPP1Ag with 88% sensitivity and 95.6% specificity at the cut-off value (X + 4SD), 0.264. Nine cases of six diseases cross-reacted with this antigen: cystic echinococcosis (2/11), gnathostomiasis (2/8), trichinellosis (2/12), toxocariasis (1/5), schistosomiasis (1/6), and fascioliasis (1/7). MWCOP1Ag gave higher sensitivity than that of DLPP1Ag but some cross-reactivity occurred.

A serological study of human cysticercosis in Pondicherry, South India

The present study was carried out to determine the extent of the problem of cysticercosis in Pondicherry by assessing the antibody response to porcine cysticercus antigen by the indirect haemagglutination (IHA) in people residing in and around Pondicherry and in patients clinically suspected to have cysticercosis. Serum samples were collected from 1442 persons apparently normal in respect to cysticercosis, 91 cases of clinically suspected cases of cysticercosis, and 100 normal healthy students and blood donors. These sera were tested for cysticercus antibodies by IHA test using whole porcine cysticercus antigen sensitised RBCs. An antibody titre of 1:64 and above by the IHA was considered to be diagnostic of cysticercosis. At this diagnostic titre, 88 (6.10 %) of 1442 apparently normal population sera were seropositive. Of these 88 seropositive subjects, 16 (18.18 %), 33 (37.5 %) and 32 (36.36 %) were in the age groups of 1-13 yrs, 14-40 years and above 40 years respectively. 52 (59.1%) were males and 36 (40.9 %) were females. Twenty (21.97%) out of 91 clinically suspected cases were found to be seropositive out of which 14 (70 %) were males and 6 (30 %) females. 4 cases were in the age group of 6-13 years, 14 cases in 14-40 years and 2 cases were in the age group of 40 years and more. Cysticercus antibodies were not detected in any of the sera from healthy peoples including students. A positive antibody response in 6.1 % of population residing in and around Pondicherry and in 21.97 % of patients clinically suspected cases of cysticercosis show that cysticercosis may be more common in Pondicherry than believed.

Anti-Taenia solium metacestodes antibodies in serum from blood donors from four cities of Triângulo Mineiro area, Minas Gerais, Brazil, 1995

Serological survey was performed to detect IgG antibodies anti-Taenia solium metacestodes in blood donors of Hemocentro Regional de Uberlândia, Minas Gerais, Brazil. A total of 1133 sera from blood donors coming from four cities of Triângulo Mineiro area were analyzed by the indirect fluorescence antibody test (IFAT) and the enzyme linked immunosorbent assay (ELISA). Specific IgG antibodies were found in 5.6% of the studied population, showing differences in the positive rates according to their origin: Araguari (13.5%), Tupaciguara (5.0%), Monte Alegre de Minas (4.8%) and Uberlândia (4.7%). The results indicate the probable endemicity of cysticercosis in this population.

Taeniasis and cysticercosis prevalence in a small village from Northeastern Brazil

Although not considered as an endemic region, the Northeast of Brazil has the necessary conditions for the development of taeniasis-cysticercosis complex. In a previous paper, we demonstrated that Mulungu do Morro municipality, in the State of Bahia, has a high seroprevalence to cysticercosis in epileptic patients.

OBJECTIVE

to determine the prevalence of taeniasis and positive cysticercosis serology in the population of Mulungu do Morro.

METHOD

blood and stool samples were collected from a random sampling of the population, by family. The identification of antibodies against T. solium cysticerci was made by EITB and T. solium antigens were identified using a polyclonal antibody-capture ELISA.

RESULTS

the cysticercosis seroprevalence was 1.6% (C.I. = 0.8 to 2.8%) and the taeniasis prevalence 4.5% (C.I. = 3.0 to 6.5%). Seropositivity to cysticercosis was higher among those who lived in a house of a person testing positive for coproantigen, p=0.017.

CONCLUSION

our results demonstrate that the taeniasis-cysticercosis complex is endemic in Mulungu do Morro. We believe that all areas in the world with the same socio-economic and sanitary characteristics are likely to have high prevalence of this parasite.

Taenia solium cysticercosis in a village in northern Viet Nam: seroprevalence study using an ELISA for detecting circulating antigen

An enzyme-linked immunosorbent assay (ELISA) for detecting circulating Taenia solium antigen was evaluated in Viet Nam; 12 of 210 people gave a positive result, including 5 persons with epilepsy. Cysticercosis was confirmed in 9 persons. Agreement between the ELISA, computerized tomography scanning and biopsy examination was high.

Frequency of serum anti-cysticercus antibodies in the population of a rural Brazilian community (Cássia dos coqueiros, SP) determined by Elisa and immunoblotting using Taenia crassiceps antigens

Considering the impact of cysticercosis on public health, especially the neurologic form of the disease, neurocysticercosis (NC), we studied the frequency of positivity of anti-Taenia solium cysticercus antibodies in serum samples from 1,863 inhabitants of Cássia dos Coqueiros, SP, a municipal district located 80 km from Ribeirão Preto, an area considered endemic for cysticercosis. The 1,863 samples were tested by enzyme linked immunosorbent assay (ELISA) using an antigenic extract from Taenia crassiceps vesicular fluid (Tcra). The reactive and inconclusive ELISA samples were tested by immunoblotting. Of the 459 samples submitted to immunoblotting, 40 were strongly immunoreactive to the immunodominant 18 and 14 kD peptides. Considering the use of immunoblotting as confirmatory due to its high specificity, the anti-cysticercus serum prevalence in this population was 2.1%.

Community prevalence study of taeniasis and cysticerosis in Bail, Indonesia

Taenia solium, a human cestode parasite endemic throughout most of South-east Asia, causes a number of public health and economic problems. The parasite is endemic in Bali due to a mix of cultural and religious practices. Immunoepidemiological investigation of three rural communities revealed a taeniasis prevalence of 0.72% (3/415). One of the three cases was due to Taenia solium, the other two to Taenia saginata. A further nine cases of Taenia infection were identified from patients from villages surrounding the chosen communities, suggesting that prevalence levels may be higher in other areas. Seroprevalence of human cysticercosis by immunoblot was 1.65% (6/363), though all cases were detected within a single community (6/115; prevalence 5.22%). Several other cases of subcutaneous cysticercosis were identified from local clinics, suggesting continued transmission of Taenia solium in the region. Other intestinal helminth parasites identified within the communities were Ascaris lumbricoides (29.9%), Trichuris trichiuria (33.9%) and hookworm (8.2%).

Clinico-pathological studies in cattle experimentally infected with Taenia saginata eggs

Calves 1-2 months old were experimentally infected with eggs of Taenia saginata and clinical and haematological deviations, development and distribution of cysticerci and pathological changes were recorded. The calves infected with 5,000, 10,000 or 50,000 eggs showed an increase in pulse and respiratory rates. The animals that received 50,000 eggs had significantly increased pulse (p < 0.05) and respiratory rates (p < 0.005). The symptoms were more severe in young, 30-day-old calves infected with 50,000 eggs. Haemoglobin concentration, haematocrit values and red blood cell count decreased, but white blood cell count increased slightly. Lymphocytes and eosinophils also increased up to 88% and 14% (p < 0.05), respectively. Most of the cysticerci were not fully formed 1 month post-infection, but at 2 months the cysts were fully mature and at 4 months, some cysts had degenerated. There was no uniform pattern of distribution of cysticerci in the body of infected calves, but the most commonly affected sites were masseter and heart muscles, followed by diaphragm, tongue and other skeletal muscles. The maximum concentration of 8-14 cysticerci per 10 g of tissue was recorded in masseter muscles and heart. The affected parts revealed tissue reactions that included pressure atrophy, necrosis and fibrosis. Microscopically, the lesions comprised infiltration with lymphocytes, plasma cells, eosinophils and macrophages, fibrosis, necrosis and calcification. The tissue reaction was severe in calves infected with 50,000 eggs. The severity of clinical signs, haematological and pathological changes depended mostly on the age of the animals and dose of infection.

Limitations of current diagnostic procedures for the diagnosis of Taenia solium cysticercosis in rural pigs

The aim of the present study was to evaluate diagnostic procedures for porcine cysticercosis. Sera were obtained from 32 pigs reared in commercial farms, 47 pigs before and after experimental infection, 42 carefully necropsied rural pigs and 191 slaughtered pigs from rural communities in which the presence of the Taenia solium metacestode was assessed by tongue dissection. Sera were analyzed by ELISA to detect antibodies against T. solium antigens and to detect parasite antigens. Most sera from the necropsied rural pigs were also evaluated by the Western blot method. Antigen and antibody ELISA detection assays showed high sensitivity and specificity when applied to sera from pigs reared in commercial farms. In contrast, all methods (Ag-ELISA, Ab-ELISA assays, EITB and tongue inspection) showed lower sensitivity and specificity when applied to the generally lightly infected rurally reared pigs. The probability distribution of cysts in carcasses were also determined. These results emphasize the difficulties in detecting cysticercosis in rural pigs with low levels of cyst burdens.

Elevated concentrations of eotaxin and interleukin-5 in human neurocysticercosis

Symptomatic neurocysticercosis, a major cause of epilepsy worldwide, results from inflammation around Taenia solium larvae, but the mechanisms are unknown. Eotaxin, not previously reported in cases of human infection, and interleukin-5 (IL-5) but not IL-8 concentrations were elevated in patient serum, and IL-5 levels were also elevated in cerebrospinal fluid (CSF). Eosinophil-selective mediators may be involved in the pathogenesis of cysticercosis. IL-6 concentrations were also elevated in patient CSF, possibly indicative of an acute-phase response.

Differential expression of the estrogen-regulated proto-oncogenes c-fos, c-jun, and bcl-2 and of the tumor-suppressor p53 gene in the male mouse chronically infected with Taenia crassiceps cysticerci

Chronic infection with Taenia crassiceps cysticerci produces a 200-fold increase in serum estradiol levels in male mice. The aim of this study was to investigate the expression pattern of c-fos and c-jun, two estradiol-regulated genes, as well as that of p53 and bcl2 in the testes, spleen, and thymus of male mice infected with T. crassiceps cysticerci. In parasitized animals the c-fos mRNA content was significantly increased in all tissues studied, whereas the c-jun mRNA content was increased only in the thymus. The p53 mRNA content was markedly reduced in all tissues of the parasitized animals analyzed, whereas bcl-2 gene expression was abolished in the thymus. On the other hand, thymic cell analysis performed by flow cytometry showed a diminution in the content of CD3+, CD4+, and CD8+ subpopulations in the parasitized mice. Our results suggest that the increase in estradiol levels of the host should change the expression pattern of several genes that participate in apoptosis regulation in the thymus of male mice during chronic infection with T. crassiceps cysticerci.

Simultaneous determination of albendazole sulfoxide enantiomers and albendazole sulfone in plasma

A high-performance liquid chromatographic method has been developed for the simultaneous determination of albendazole sulfoxide (ABZSO) enantiomers and albendazole sulfone (ABZSO2) in human plasma. The resolution of ABZSO enantiomers and ABZSO2 was obtained on a Chiralpak AD column using hexane-isopropanol-ethanol (81:14.25:4.75, v/v/v) as the mobile phase. The drugs were detected by fluorescence (lambda(exc) = 280 nm, lambda(em) = 320 nm). The drugs were extracted from 500 microl plasma with ethyl acetate, and after solvent evaporation, the residues were dissolved in the mobile phase and chromatographed. The method was precise and accurate for the three compounds, as judged by the coefficients of variation and relative errors observed. Linear standard curves were obtained in the concentration range of 5-2500 ng/ml for ABZSO enantiomers and 1-500 ng/ml for ABZSO2. A typical plasma concentration-time profile is presented for one patient under treatment for neurocysticercosis.

Comparative evaluation of purified Taenia solium glycoproteins and crude metacestode extracts by immunoblotting for the serodiagnosis of human T. solium cysticercosis

A lentil-lectin purified glycoprotein (LL-Gp) and a crude saline extract of Taenia solium metacestodes were compared for the immunodiagnosis of human cysticercosis by immunoblotting. The LL-Gp preparation was 95% sensitive for antibodies against a range of seven antigens with molecular masses of 50 to 13 kDa, whereas the sensitivity of the crude saline extract for the detection of antibodies against two major polypeptide molecules (26 and 8 kDa) was 91%. Specificity was 100% with both sets of diagnostic antigens. Affinity-purified antibodies against the 26-kDa molecule from the crude saline extract recognized the 24-kDa diagnostic region in the LL-Gp-purified extract and vice versa, suggesting that the antigens had common epitopes recognized by cysticercotic sera. In addition, in a preliminary community study of 115 randomly selected people from Bali (Indonesia), seroprevalence by immunoblot assay varied from 7.8% (with the crude saline antigen extract) to 9.6% (with the LL-Gp-purified extract). The results of this study demonstrate that both antigenic preparations are applicable for the immunodiagnosis of T. solium cysticercosis. The crude T. solium metacestode antigen extract was as specific as the purified LL-Gp T. solium metacestode extract and simpler to produce but slightly less sensitive.

Therapy for neurocysticercosis: pharmacokinetic interaction of albendazole sulfoxide with dexamethasone

Albendazole is considered the drug of choice for neurocysticercosis. It is frequently used in combination with dexamethasone to prevent the acute inflammatory reaction due to cysticercal death. It has been reported that dexamethasone increases the plasma level of albendazole sulfoxide, the active metabolite of albendazole. The pharmacokinetic interaction of albendazole sulfoxide with dexamethasone, associated or not with cimetidine, was investigated in 24 patients with active intraparenchymal brain cysticercosis. Eight of these patients received albendazole alone, eight received it in combination with dexamethasone, and eight received it in combination with both dexamethasone and cimetidine. The pharmacokinetic parameters maximum plasma concentration, time to maximum plasma concentration, absorption half-life, and absorption rate constant did not differ between groups, suggesting that the formation of albendazole sulfoxide was not altered by the administration of dexamethasone, combined or not with cimetidine. There were significant differences, however, in the parameters plasma concentration-time curve, oral clearance, elimination half-life, and elimination rate constant, suggesting that dexamethasone, combined or not with cimetidine, decreases the rate of elimination of albendazole sulfoxide.

[Diagnosis of human neurocysticercosis by ELISA-IgG using a purified antigen]

An analysis of immunodiagnosis data for human neurocysticercosis (NC) by ELISA-IgG, complement fixation test (CFT) and indirect hemagglutination test (IHAT) in 67 serum samples and 54 cerebrospinal fluids (CSF) from confirmed cases of different hospitals from the Metropolitan Area of Santiago, Chile, was performed. The cut-off value was determined by using serum samples from 60 apparently healthy persons, whose absorbance values were the mean plus three standard deviations. The sensitivity of ELISA was 97.0% and 100% for serum samples and CSF respectively. This assay was considered of statistical significance (p < 0.05) when it was compared with CFT. Specificity was established by testing a purified antigen over 109 different helminthiasis serum samples, 185 neurological affections other than NC and 60 control samples. A 98.3% of global specificity was found. The use of ELISA-IgG and a purified antigen in the approach of immune diagnosis of NC is considered a useful assay, particularly if it is performed on paired serum/CSF samples.

[Frequency of anti-Cysticercus cellulosae antibodies in individuals from five counties in the Northern region of Brazil]

An epidemiological and serological study was carried out on a sample of 2,180 individuals, in five counties in the north of Paraná State-Brazil, using the indirect immunofluorescence test to detect anti-Cysticercus cellulosae antibodies. These individuals, 69 (3.2%) showed significant titers of antibodies. No single significant difference between the proportion of reactivity in Sarandi (6.6%) and in Marialva (4.7%) was observed (Z = 1,319, P = 0.0936), but it was significantly higher than that observed in Mandaguaçu, Paiçandu and Maringá (P < 0.01). Of these individuals, 47.9% were within 21-49 years old and 79.4% were of female sex. "Headache" (70.6%), "faintness" (57.4%), and "convulsions" (7.4%) were among the most frequent by reported, moreover, cases of Taenia infections (22.1%) and the custom of eating uncooked beef (41.2%) or pork (27.9%) and meat containing cysticerci (25.0%) were also related.

[Development of an immunoenzyme test for the diagnosis of human cysticercosis using a heterologous antigen]

Serological tests for the immunodiagnosis of human cysticercosis (an indirect ELISA test) and for the detection of Taenia solium antigen(s) in liquor samples (a sandwich ELISA test) have been developed using a heterologous antigen from the cyst fluid of T. hydatigena. Antibodies to T. solium were detected in 20 Italian subjects out of 113 with cerebral lesions of unknown etiology, and T. solium antigen(s) were detected in three of them, from 1991 to 1994. Case history of the positive patients showed that 17 of them probably acquired the infection in Italy. These results point out that cysticercosis is still present in Italy, and physicians have to consider this helminthic infection in a differential diagnosis.

Investigation of cross-reactions against Trichinella spiralis antigens by enzyme-linked immunosorbent assay and enzyme-linked immunoelectrotransfer blot assay in patients with various diseases

Data regarding cross-reactions against Trichinella spiralis in humans are scarce and controversial. For this reason, we tested serum samples from patients with typhoid fever, brucellosis, toxoplasmosis, amoebiasis, cysticercosis, trichocephaliasis, ascariasis, and onchocerciasis against an antigenic extract of T. spiralis infective larvae in an enzyme-linked immunosorbent assay (ELISA) and an enzyme-linked immunoelectrotransfer blot (EITB) assay. All except one serum sample from the group of patients with onchocerciasis were negative in the ELISA; in the EITB assay, only faint bands were observed with the samples from patients with onchocerciasis and ascariasis and negative results were obtained with the samples from patients with other diseases. In conclusion, cross-reactions were found only in the groups of patients with other nematode infections and were of very low magnitude, most of them virtually negative.

Cysticercosis as a major cause of epilepsy in Peru. The Cysticercosis Working Group in Peru (CWG)

In countries where cysticercosis is endemic, the proportion of epilepsy due to cysticercosis is not well documented. To investigate the association between cysticercosis and epilepsy, we used the enzyme-linked immunoelectrotransfer blot (EITB) assay to detect serum antibodies to Taenia solium in 498 consecutive outpatients at a neurology clinic in Lima, Peru. Every patient was classified as epileptic (n = 189) or non-epileptic (n = 309) after neurological, and where possible electroencephalographic, examination. A substantially higher proportion of epileptic than non-epileptic patients was seropositive in the EITB (22 [12%] vs 8 [3%], p < 0.001). 19% of epileptic patients born outside Lima, 20% of those with late-onset epilepsy, and 29% of patients with both these characteristics were seropositive. Thus, in Peru, cysticercosis is an important aetiological factor for epilepsy.

Some studies on the experimental infection of golden hamsters with Taenia solium

Golden hamsters were infected orally with viable cysticerci of Taenia solium obtained from infected pigs. After two weeks of infection implanted scolices of about 4 mm were found in exactly the same number as the number of ingested cysticerci. At six weeks 66% of the ingested cysticerci were found as implanted tapeworms (average size: 5.7 cm). At ten weeks 16% of the ingested cysticerci were found as implanted tapeworms (average size: 5.8 cm). At 14 weeks no tapeworms were found. Skin tests with taenia extracts were positive after 9 weeks of infection peaked at 12 and 14 weeks and declined afterwards becoming negative after 27 weeks. Skin test with cysticercus extracts were weaker, peaked at 8 and 10 weeks, were very low after 12 weeks and became negative after 16 weeks. Histological studies in the attachment site at the small intestine showed at 2 weeks a cellular infiltrate formed by macrophages, epithelioid cells and some plasma cells, there was very little alteration of epithelium. At 6 and 8 weeks the epithelium was damaged and necrotized. At 17 and 19 weeks the lesion started to resolve. We conclude that the golden hamster can be used to reproduce in the laboratory at least part of the life cycle of Taenia solium.

Comparison of cysticercus extract, cyst fluid and Taenia saginata extract for use in ELISA for serodiagnosis of neurocysticercosis

Cysticercus cellulosae extract (CS), cyst fluid (CF), and an extract of Taenia saginata adult worm (TS) were evaluated for use in an enzyme-linked immunosorbent assay (ELISA) for serodiagnosis of human neurocysticercosis in Thai patients. ELISA sensitivity was found to be 78.13%, 81.25% and 62.50%, respectively. False positivity was 6.66% with CS and 0% with other antigens. CF gave positivity with a pooled visceral gnathostomiasis serum and 3 of 10 (30%) of angiostrongyliasis sera. CS produced weakly positive ELISA with pooled opisthorchiasis and visceral gnathostomiasis sera. TS gave weak positive ELISA with a pooled opisthorchiasis serum. It was concluded that CF was the best antigen for use in ELISA for serodiagnosis of human neurocysticercosis.

[Evaluation of 2 serological techniques in the diagnosis of neurocysticercosis: complement fixation reaction and Western blot]

Evaluation of two serological techniques for diagnosis cysticercosis: complement fixation reaction and Western blot. Comparative study that includes 49 sera samples and 30 CSF samples belonging to 35 patients with clinical diagnosis of cysticercosis of the CNS. As a control group we used 10 sera samples of patients with Trichinella spiralis infection, 33 sera samples of patients with hydatid cyst disease, 9 sera samples from patients with oxyuriasis, 52 sera samples of healthy blood donors and 22 additional CSF samples from patients with different CNS disorders. Thirty-one samples were positive by Western blot technique and 21 samples by complement fixation reaction technique. Agreement between both techniques was 76%. Gathering clinical and laboratory information we believe that a total of 11 patients had cysticercosis of the CNS (33 samples), and three additional patients remain with indeterminate diagnosis. We have also detected cross-reactions with Western blot techniques (reactivity to more than one band) in 43% of patients with hydatid disease and in 20% of patients with Trichinella spiralis infection, but none in oxyuriasis patients. The CFR technique had cross-reaction with 33% of sera samples from hydatid disease patients and 20% of those from oxyuriasis patients. No cross-reactions were seen in any of control patients with both techniques. The two different techniques tested can be of help, together with clinical and radiology data, in the diagnosis of cysticercosis of the CNS. However, both techniques showed strong cross-reactions with hydatid disease.

Plasma and CSF levels of albendazole and praziquantel in patients with neurocysticercosis

Albendazole or praziquantel were measured in plasma and cerebrospinal fluid (CSF) in 29 patients with neurocysticercosis. Mean levels of albendazole in plasma were 0.918 microgram/ml and in CSF were 0.392 microgram/ml and levels of praziquantel were 1.640 micrograms/ml in plasma and 0.398 microgram/ml in CSF, after doses of 15 and 50 mg/kg, respectively. Drug concentrations in CSF were 43% for albendazole and 24% for praziquantel. The drug levels obtained for both drugs showed ample individual variations that were not related to age, sex, presence of inflammation in the subarachnoid space, or therapeutic effectiveness; such variations seem to be due to individual differences in pharmacokinetics. Both drugs were effective and the doses currently used of each drug seem to be optimal for therapy of neurocysticercosis.

Dexamethasone increases plasma levels of albendazole

Therapy of neurocysticercosis with cysticidal drugs is frequently complicated by the exacerbation of symptoms that follows the inflammation triggered by the acute destruction of cysticerci. Treatment of such adverse reactions with dexamethasone is highly effective. However, it has been shown that dexamethasone lowers the plasma levels of praziquantel, thus reducing its cysticidal efficacy. We measured plasma levels of albendazole, another strong cysticidal drug, when dexamethasone was given simultaneously. We found that dexamethasone increased the plasma levels of albendazole by about 50% (P less than 0.002); hence, it seems that cysticercosis and the ensuing inflammation can be treated simultaneously with albendazole and dexamethasone without diminishing the efficacy of the cysticidal drug.

[Comparison of the yield of indirect hemagglutination reaction and complement fixation reaction in the diagnosis of neurocysticercosis]

Two variations of an indirect hemagglutination test (IHAT) and a complement fixation test (CFT) for the diagnosis of human cysticercosis were compared and evaluated. For the IHAT, a cysticerci crude total saline extract (SE) and a cysticerci lyophylized and delipidized veronal bicarbonate saline buffer (VBS) extract were used, comparing their diagnosis yieldings with that of a CFT in 57 confirmed cysticercosis patients: 45 serum samples and 32 cerebrospinal fluid (CSF). Sera and CSF from 29 patients with other neurological diseases and 25 sera from healthy volunteers were also compared. Both types of methods presented an overall average concordance of 91.5% and 97.0% with CSF and sera respectively. With respect to the sensitivity observed with CFT was 85.2% and 93.3% for CSF and sera, whereas that of IHAT was 96.9% in CSF and 97.8% in sera, when SE antigen was used; with the VBS antigen for IHAT 96.9% and 95.6% were detected in CSF and sera respectively. In order to determine the specificity of the IHAT, besides the study in healthy volunteers, in patients with other neurological diseases and in 156 serum samples from individuals with other parasitoses, such as hydatidosis (43), trichinosis (56), fascioliasis (31) and Chagas' disease (26) were also tested. A high reactivity with the hydatidosis group was found. The specificity, using a titre > or = 1:16 as a diagnostic value and without considering hydatidic sera was 99.4% for RHAI (SE), 100.0% for RHAI (VBS). The use of IHAT and CFT in diagnosis of human cysticercosis is discussed.

Comparison of two assays (EIA and EITB) and two samples (saliva and serum) for the diagnosis of neurocysticercosis

The enzyme immunoassay (EIA), standardized with a crude extract, and the enzyme-linked immunoelectrotransfer blot assay (ETIB) with glycoprotein antigens, were compared by using saliva and serum in the search for specific antibodies against Taenia solium larvae, for the diagnosis of neurocysticercosis. Saliva was slightly more sensitive in EIA (82.1%) than serum (74.1%). In EITB serum was far more sensitive (100%) than saliva (70.4%). The use of EITB with serum is thus an excellent choice for diagnosis of clinical cases of neurocysticercosis, while EIA using saliva represents a useful combination for diagnosis and, especially, epidemiology, because saliva is easily obtained by a painless and non-invasive procedure and the technique is simpler to perform. Furthermore, cross-reactivity of EIA with Echinococcus does not interfere in countries like Mexico where human hydatid disease is not present.

[Integrity of the blood-brain barrier and intrathecal synthesis of IgG in parenchymatous and subarachnoid cerebral cysticercosis]

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.

[Immunologic diagnosis of the cerebrospinal fluid and serum in developing brain cysticercosis]

ELISA detection of specific antibodies in the serum (IgG) and cerebrospinal fluid (IgG, IgM and IgA) was evaluated in 28 patients. Diagnosis of cerebral cysticercosis and evaluation of disease activity was based on CT scan findings. Specific IgG antibodies were found in the serum in 83.3% of patients with active disease and 10% of those with inactive disease. Cerebrospinal fluid tests evidenced specific antibodies in all patients with active disease and none of the patients with inactive disease. The specific CSF antibodies were IgG (94.4%), IgM (66.6%) or IgA (66.6%). Antibody titers were significantly higher in patients with an intraventricular vesicle or cyst.

Lymphocyte subpopulations of sheep in protective immunity to Taenia hydatigena

Lymphocyte subpopulations entering the liver and surrounding the rejection sites during a 9-day period after infection of immune sheep with Taenia hydatigena were identified with the aid of monoclonal antibodies against lymphocyte cell surface markers. Viable lymphocytes were isolated from the liver tissue and stained by indirect immunofluorescence for subsequent flow cytometry analysis. Over the first 6 days after challenge infection a marked increase in the ratio of T-helper to T-suppressor/cytotoxic lymphocytes was observed. SBU-T19+ lymphocytes, a CD5+ T-cell subpopulation uniquely identified in the sheep, were present in small numbers in sheep liver both before and after infection. There was a large, continuous increase of sIg+ B-cells over the 9-day observation period after infection. Eosinophils were the predominant granulocytes in the liver of infected sheep. The exact location of the leucocyte subpopulations in respect to the rejection sites in infected liver was determined by in-situ immunoperoxidase staining of frozen liver sections. The evolution of the parasite-induced leucocyte response was characterized by the appearance of a central core of eosinophils surrounded by increasing numbers of CD4+ helper T-cells. CD8+ (suppressor/cytotoxic) and SBU-T19+ T-lymphocytes were present in much smaller numbers and by day 9 after infection were located predominantly around the periphery of the lesions. Distinct foci of tightly packed B-cells developed within the lesions and increased dramatically in size over the 9-day observation period. At this time, lesions appeared as compact aggregations of leucocytes encircled by a second band of eosinophils. Both T- and B-lymphocytes within the lesions stained positive for class II major histocompatibility antigens.

Experimental infection in a human subject by a possibly undescribed species of Taenia in Taiwan

A cysticercus of a possibly undescribed species of Taenia which occurs commonly in Taiwan aborigines was used to establish an experimental infection in a human volunteer. Symptomatic effects attributed to the infection included diarrhoea, upper abdominal pain, and increase or loss of appetite over a four-month period. After an expelled proglottid was observed 122 days post-exposure, eggs and proglottids were found continuously until the patient was treated with anthelmintics. Antibody titres measured by enzyme-linked immunosorbent assay and levels of eosinophilia seemed to correlate with symptoms. Haematological analyses revealed an abnormal lipid metabolism during the entire symptomatic period.

Cerebral cysticercosis in a 22-month-old infant

A case of cerebral cysticercosis is described in a 22-month-old infant from northern California who presented with a right-sided focal seizure. Unusual features were her young age; a single, enlarging, frontoparietal mass lesion; and apparent lack of history of exposure to an endemic area.