Prevalence studies report Taenia solium cysticercosis in pig and human populations in Uganda. However, the factors influencing occurrence in smallholder pig production systems are not well documented and little is known about farmers’ perceptions of T. solium cysticercosis or farmer practices that could reduce transmission. To determine the risk factors, perceptions and practices regarding T. solium cysticercosis, a household survey using a semi-structured questionnaire was conducted in 1185 households in the rural and urban pig production systems in Masaka, Mukono and Kamuli Districts. Logistic regression was used to measure associations of risk factors with infection. Performance scores were calculated to summarise perceptions and practices of farmers regarding taeniosis, human cysticercosis and porcine cysticercosis as well as farmer behavior related to control or breaking transmission. Pig breed type, farmers’ knowledge about transmission, sources of water used, and pig keeping homes where family members were unable to use the latrine were all significantly associated with T. solium cysticercosis in pigs. Performance scores indicated that farmers were more aware of taeniosis (63.0%; 95% Confidence Interval 60.0-65.8) than human or porcine cysticercosis; only three farmers (0.3%, 95% CI = 0.1–0.8) had knowledge on all three conditions. More farmers reported that they dewormed pigs (94.1%) than reported deworming themselves and their family members (62.0%). Albendazole was the most commonly used drug for deworming both pigs and humans (85.0 and 81.5% respectively). Just over half (54.6%) of the farmers interviewed had clean water near the latrines for washing hands. Of these, only 41.9% used water with soap to wash hands after latrine use. Factors that significantly influenced occurrence of T. solium cysticercosis in pigs were identified. Farmers had some knowledge about the disease but did not link taeniosis, human cysticercosis, and porcine cysticercosis. Therefore, there is need to employ strategies that raise awareness and interrupt transmission.

/pdf/risk-factors-perceptions-and-practices-associated-with-3sh4ntk00w.pdf

Risk factors, perceptions and practices associated with Taenia solium cysticercosis and its control in the smallholder pig production systems in Uganda: a cross-sectional survey

Taenia solium neurocysticercosis (NCC) is endemic in most of the world and contributes significantly to the burden of epilepsy and other neurological morbidity. Also present in developed countries because of immigration and travel, NCC is one of few diseases targeted for eradication. This paper reviews all aspects of its life cycle (taeniasis, porcine cysticercosis, human cysticercosis), with a focus on recent advances in its diagnosis, management, and control. Diagnosis of taeniasis is limited by poor availability of immunological or molecular assays. Diagnosis of NCC rests on neuroimaging findings, supported by serological assays. The treatment of NCC should be approached in the context of the particular type of infection (intra- or extraparenchymal; number, location, and stage of lesions) and has evolved toward combined symptomatic and antiparasitic management, with particular attention to modulating inflammation. Research on NCC and particularly the use of recently available genome data and animal models of infection should help to elucidate mechanisms of brain inflammation, damage, and epileptogenesis.

Taenia solium Cysticercosis and Its Impact in Neurological Disease.

Entre las causas de la epilepsia hay varias que se pueden prevenir en la actualidad. En esta revision, resumimos la carga de salud publica de la epilepsia derivada de tales causas y sugerimos prioridades para la prevencion primaria de la epilepsia. Realizamos una revision sistematica de estudios epidemiologicos publicados de epilepsia de 4 categorias etiologicas evitables: lesiones perinatales, lesion cerebral traumatica (TBI), infeccion del sistema nervioso central (SNC) y accidente cerebrovascular. Aplicando criterios consistentes, evaluamos la calidad de cada estudio y extrajimos los datos sobre las medidas de riesgo de aquellos con calificaciones de calidad adecuadas, resumiendo los hallazgos de los estudios como medianas y rangos intercuartil. Entre los estudios basados ​​en la poblacion de mayor calidad, la prevalencia media de epilepsia activa en todas las edades fue de 11,1 por 1000 habitantes en paises de ingresos bajos y medios (LMIC) y 7. 0 por 1000 en paises de altos ingresos (HIC). Los insultos cerebrales perinatales fueron la mayor fraccion atribuible de las etiologias prevenibles en los ninos, con fracciones medias estimadas de 17% en LMIC y 15% en HIC. El accidente cerebrovascular fue la etiologia prevenible mas comun entre los adultos mayores con epilepsia, tanto en LMIC como en HIC, lo que representa la mitad o mas de todos los casos de inicio nuevo. TBI fue la causa atribuida en casi el 5% de los casos de epilepsia en HIC y LMIC. Las infecciones del SNC fueron una causa atribuida mas comun en LMIC, representando aproximadamente el 5% de todos los casos de epilepsia. Entre algunas comunidades rurales de LMIC, la proporcion media de casos de epilepsia atribuibles a la neurocisticercosis endemica fue del 34%. Una gran proporcion de la carga general de la epilepsia para la salud publica es atribuible a causas prevenibles. La fraccion atribuible a causas perinatales, infecciones, TBI, y el trazo en suma alcanza casi el 25% tanto en LMIC como en HIC. Las intervenciones de salud publica que abordan la atencion de salud materna e infantil, las inmunizaciones, el saneamiento publico, la prevencion de lesiones cerebrales y la prevencion de accidentes cerebrovasculares tienen el potencial de reducir significativamente la carga de la epilepsia.

The primary prevention of epilepsy: A report of the Prevention Task Force of the International League Against Epilepsy.

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. 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. 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. 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.

/pdf/the-causal-relationship-between-neurocysticercosis-infection-34cveauzrx.pdf

The causal relationship between neurocysticercosis infection and the development of epilepsy - a systematic review

Taenia solium is a neglected zoonotic parasite. The performances of existing tools for the diagnosis of porcine cysticercosis need further assessment, and their shortcomings call for alternatives. The objective of this study was to evaluate the performance of tongue palpation and circulating antigen detection for the detection of porcine cysticercosis in naturally infected pigs of slaughter age compared to full carcass dissections (considered the gold standard). Additionally, alternative postmortem dissection procedures were investigated. A total of 68 rural pigs of slaughter age randomly selected in the Eastern Province of Zambia were dissected. Dissections were conducted on full carcasses (or half carcass in case cysticerci were already detected in the first half), including all the organs. Total cysticercus counts, location and stages were recorded and collected cysticerci were identified morphologically and molecularly. All sera were analysed with the B158/B60 antigen detecting ELISA (Ag-ELISA). Key findings were the high occurrence of T. solium infected pigs (56%) and the presence of T. solium cysticerci in the livers of 26% of infected animals. More than half of the infected carcasses contained viable cysticerci. Seven carcasses had T. hydatigena cysticerci (10%), out of which five carcasses were co-infected with T. hydatigena and T. solium; two carcasses (3%) had only T. hydatigena cysticerci. Compared to full carcass dissection, the specificity of the Ag-ELISA to detect infected carcasses was estimated at 67%, the sensitivity at 68%, increasing to 90% and 100% for the detection of carcasses with one or more viable cysticerci, and more than 10 viable cysts, respectively. Tongue palpation only detected 10% of the cases, half carcass dissection 84%. Selective dissection of the diaphragm, tongue and heart or masseters can be considered, with an estimated sensitivity of 71%, increasing to 86% in carcasses with more than 10 cysticerci. Depending on the aim of the diagnosis, a combination of Ag-ELISA and selective dissection, including investigating the presence of T. hydatigena, can be considered. Full carcass dissection should include the dissection of the liver, kidneys, spleen and lungs, and results should be interpreted carefully, as small cysticerci can easily be overlooked.

https://biblio.ugent.be/publication/8538441/file/8538442.pdf

Re-visiting the detection of porcine cysticercosis based on full carcass dissections of naturally Taenia solium infected pigs.

Cognitive impairment and quality of life of people with epilepsy and neurocysticercosis in Zambia.

Zusammenfassung Eine 59-jährige Patientin entwickelte neurologische Defizite nach vorheriger rituximabhaltiger Lymphomtherapie. Die Konstellation aus Marklagerläsionen ohne Schrankenstörung in Groß- und Kleinhirn und DNA-Nachweis des John Cunningham Virus (JCV) aus Liquor führte zur Diagnose einer progressiven multifokalen Enzephalopathie (PML). Die PML ist eine seltene, aber tödliche Infektion des zentralen Nervensystems hervorgerufen durch eine Reaktivierung des JC-Virus, die nicht nur bei HIV-Infektionen, sondern auch iatrogen nach Einsatz monoklonaler Antikörper auftreten kann. 

/pdf/fatal-neurological-side-effect-of-anti-cd20-antibody-3o46dt9q.pdf

[Fatal neurological side effect of anti-CD20 antibody treatment].

Zambia is endemic for Taenia solium taeniosis and cysticercosis. In this single-centered, cross-sectional, community-based study, the role of neurocysticercosis (NCC) as a cause of epilepsy was examined. People with epilepsy (PWE, n = 56) were identified in an endemic area using a screening questionnaire followed by in-depth interviews and neurological examination. Computed tomography (CT) was performed on 49 people with active epilepsy (PWAE) and their sera (specific antibody and antigen detection, n = 56) and stools (copro-antigen detection, n = 54) were analyzed. The CT scan findings were compared to a group of 40 CT scan controls. Of the PWE, 39.3% and 23.2% were positive for cysticercal antibodies and antigens, respectively, and 14.8% for coproantigens (taeniosis). Lesions highly suggestive of NCC were detected in 24.5% and definite NCC lesions in 4.1% of CT scans of PWAE. This compares to 2.5% and 0%, respectively, in the control CT scans. Using the Del Brutto diagnostic criteria, 51.8% of the PWAE were diagnosed with probable or definitive NCC and this rose to 57.1% when the adapted criteria, as proposed by Gabriel et al. (adding the sero-antigen ELISA test as a major criterion), were used. There was no statistically significant relationship between NCC, current age, age at first seizure and gender. This study suggests that NCC is the single most important cause of epilepsy in the study area. Additional large-scale studies, combining a community based prevalence study for epilepsy with neuroimaging and serological analysis in different areas are needed to estimate the true impact of neurocysticercosis in endemic regions and efforts should be instituted to the control of T. solium.

/pdf/prevalence-of-neurocysticercosis-in-people-with-epilepsy-in-4sr2uzouua.pdf

Prevalence of Neurocysticercosis in People with Epilepsy in the Eastern Province of Zambia.

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Cognitive impairment and quality of life of people with epilepsy and neurocysticercosis in Zambia.

[Fatal neurological side effect of anti-CD20 antibody treatment].

Prevalence of Neurocysticercosis in People with Epilepsy in the Eastern Province of Zambia.