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Added value of antigen ELISA in the diagnosis of neurocysticercosis in resource poor settings.

Gabriël S, Blocher J, Dorny P, Abatih EN, Schmutzhard E, Ombay M, Mathias B, Winkler AS - PLoS Negl Trop Dis (2012)

Bottom Line: The addition of antigen results as a major criterion allowed the correct diagnosis of definitive NCC in 10 out of 17 patients as opposed to 0/17 without antigen results in the absence of neuroimaging.While the use of a higher cutoff improves the specificity of the test to 96%, it decreases its sensitivity to 83%.Therefore, we recommend a revision of the "Del Brutto diagnostic criteria" for use in resource poor areas and suggest the inclusion of serum antigen detection as a major criterion.

View Article: PubMed Central - PubMed

Affiliation: Department of Biomedical Sciences, Institute of Tropical Medicine, Antwerp, Belgium.

ABSTRACT

Background: Neurocysticercosis (NCC) is the most common cause of acquired epilepsy in Taenia solium endemic areas, primarily situated in low-income countries. Diagnosis is largely based upon the "Del Brutto diagnostic criteria" using the definitive/probable/no NCC diagnosis approach. Neuroimaging and specific T. solium cysticercosis antibody detection results are at the mainstay of this diagnosis, while antigen detection in serum has never been included. This study aimed at evaluating the addition of antigen detection as a major diagnostic criterion, especially in areas where neuroimaging is absent.

Methods: The B158/B60 monoclonal antibody-based enzyme-linked immunosorbent assay (ELISA) for the detection of circulating cysticercus antigen was carried out retrospectively on serum samples collected during a hospital-based study from 83 people with epilepsy (PWE) in an endemic area.

Results: The addition of antigen results as a major criterion allowed the correct diagnosis of definitive NCC in 10 out of 17 patients as opposed to 0/17 without antigen results in the absence of neuroimaging. A sensitivity of 100% and a specificity of 84% were determined for the diagnosis of active NCC using antigen ELISA. While the use of a higher cutoff improves the specificity of the test to 96%, it decreases its sensitivity to 83%.

Conclusions: In areas where neuroimaging is absent, NCC diagnosis according to the existing criteria is problematic. Taking into account its limitations for diagnosis of inactive NCC, antigen detection can be of added value for diagnosing NCC in PWE by supporting diagnostic and treatment decisions. Therefore, we recommend a revision of the "Del Brutto diagnostic criteria" for use in resource poor areas and suggest the inclusion of serum antigen detection as a major criterion.

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Related in: MedlinePlus

Neurocysticercosis diagnosis according to Del Brutto et al. (2001)22 and percentage antigen ELISA positivity.Shaded boxes indicate the “Del Brutto diagnoses” (except for *), non-shaded boxes indicate the number and percentage of antigen positive cases. NCC = neurocysticercosis, Ag pos = antigen ELISA positivity, CSF = cerebrospinal fluid, PWE = people with epilepsy. *Active, inactive or no lesions according to CT scan results.
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pntd-0001851-g001: Neurocysticercosis diagnosis according to Del Brutto et al. (2001)22 and percentage antigen ELISA positivity.Shaded boxes indicate the “Del Brutto diagnoses” (except for *), non-shaded boxes indicate the number and percentage of antigen positive cases. NCC = neurocysticercosis, Ag pos = antigen ELISA positivity, CSF = cerebrospinal fluid, PWE = people with epilepsy. *Active, inactive or no lesions according to CT scan results.

Mentions: In the group of people with NCC, 100% of active NCC cases (6/6) had a positive Ag-ELISA result in serum, which was significantly higher compared to people with inactive lesions, in whom 33.3% (8/24) were positive on antigen detection (p = 0.005, Fisher's exact test) (Figure 1).


Added value of antigen ELISA in the diagnosis of neurocysticercosis in resource poor settings.

Gabriël S, Blocher J, Dorny P, Abatih EN, Schmutzhard E, Ombay M, Mathias B, Winkler AS - PLoS Negl Trop Dis (2012)

Neurocysticercosis diagnosis according to Del Brutto et al. (2001)22 and percentage antigen ELISA positivity.Shaded boxes indicate the “Del Brutto diagnoses” (except for *), non-shaded boxes indicate the number and percentage of antigen positive cases. NCC = neurocysticercosis, Ag pos = antigen ELISA positivity, CSF = cerebrospinal fluid, PWE = people with epilepsy. *Active, inactive or no lesions according to CT scan results.
© Copyright Policy
Related In: Results  -  Collection

Show All Figures
getmorefigures.php?uid=PMC3475663&req=5

pntd-0001851-g001: Neurocysticercosis diagnosis according to Del Brutto et al. (2001)22 and percentage antigen ELISA positivity.Shaded boxes indicate the “Del Brutto diagnoses” (except for *), non-shaded boxes indicate the number and percentage of antigen positive cases. NCC = neurocysticercosis, Ag pos = antigen ELISA positivity, CSF = cerebrospinal fluid, PWE = people with epilepsy. *Active, inactive or no lesions according to CT scan results.
Mentions: In the group of people with NCC, 100% of active NCC cases (6/6) had a positive Ag-ELISA result in serum, which was significantly higher compared to people with inactive lesions, in whom 33.3% (8/24) were positive on antigen detection (p = 0.005, Fisher's exact test) (Figure 1).

Bottom Line: The addition of antigen results as a major criterion allowed the correct diagnosis of definitive NCC in 10 out of 17 patients as opposed to 0/17 without antigen results in the absence of neuroimaging.While the use of a higher cutoff improves the specificity of the test to 96%, it decreases its sensitivity to 83%.Therefore, we recommend a revision of the "Del Brutto diagnostic criteria" for use in resource poor areas and suggest the inclusion of serum antigen detection as a major criterion.

View Article: PubMed Central - PubMed

Affiliation: Department of Biomedical Sciences, Institute of Tropical Medicine, Antwerp, Belgium.

ABSTRACT

Background: Neurocysticercosis (NCC) is the most common cause of acquired epilepsy in Taenia solium endemic areas, primarily situated in low-income countries. Diagnosis is largely based upon the "Del Brutto diagnostic criteria" using the definitive/probable/no NCC diagnosis approach. Neuroimaging and specific T. solium cysticercosis antibody detection results are at the mainstay of this diagnosis, while antigen detection in serum has never been included. This study aimed at evaluating the addition of antigen detection as a major diagnostic criterion, especially in areas where neuroimaging is absent.

Methods: The B158/B60 monoclonal antibody-based enzyme-linked immunosorbent assay (ELISA) for the detection of circulating cysticercus antigen was carried out retrospectively on serum samples collected during a hospital-based study from 83 people with epilepsy (PWE) in an endemic area.

Results: The addition of antigen results as a major criterion allowed the correct diagnosis of definitive NCC in 10 out of 17 patients as opposed to 0/17 without antigen results in the absence of neuroimaging. A sensitivity of 100% and a specificity of 84% were determined for the diagnosis of active NCC using antigen ELISA. While the use of a higher cutoff improves the specificity of the test to 96%, it decreases its sensitivity to 83%.

Conclusions: In areas where neuroimaging is absent, NCC diagnosis according to the existing criteria is problematic. Taking into account its limitations for diagnosis of inactive NCC, antigen detection can be of added value for diagnosing NCC in PWE by supporting diagnostic and treatment decisions. Therefore, we recommend a revision of the "Del Brutto diagnostic criteria" for use in resource poor areas and suggest the inclusion of serum antigen detection as a major criterion.

Show MeSH
Related in: MedlinePlus