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Comparative Study of Paired Serum and Cerebrospinal Fluid Samples from Neurocysticercosis Patients for the Detection of Specific Antibody to Taenia solium Immunodiagnostic Antigen.

Sako Y, Takayanagui OM, Odashima NS, Ito A - Trop Med Health (2015)

Bottom Line: When the serum and CSF samples were combined, the sensitivity in active NCC cases became 100%.There was no difference in test performance between serum and CSF samples.When the antibody test is negative, however, CSF should be used to confirm NCC and to rule out other medical disorders of the central nervous system.

View Article: PubMed Central - PubMed

Affiliation: Department of Parasitology, Asahikawa Medical University , Asahikawa, Japan.

ABSTRACT
Neurocysticercosis (NCC) is an important disease of the central nervous system caused by infection with Taenia solium metacestodes. In addition to the clinical findings and the imaging analysis, the results of immunological tests are informative for the diagnosis of NCC. To compare the usefulness of serum and cerebrospinal fluid (CSF) samples for antibody detection, paired serum and CSF samples from patients with NCC and other neurological diseases were examined by an enzyme-linked immunosorbent assay with low-molecular-weight antigens purified from T. solium cyst fluid in a blinded fashion. The sensitivity of both serum and CSF samples was 25.0% in inactive NCC cases (n = 4) and 90.9% in active NCC cases (n = 33), and the specificity of serum and CSF was 100% and 95.8%, respectively. When the serum and CSF samples were combined, the sensitivity in active NCC cases became 100%. There was no difference in test performance between serum and CSF samples. Based on these results, we recommend the detection of specific antibodies in serum for the diagnosis of active NCC because of the ease of collection. When the antibody test is negative, however, CSF should be used to confirm NCC and to rule out other medical disorders of the central nervous system. Antibody detection test using only serum or CSF has a limited diagnostic value and cannot be recommended for the diagnosis of suspected inactive NCC cases.

No MeSH data available.


Related in: MedlinePlus

Results of ELISA with LMWAgs using serum and CSF samples from four patients with inactive NCC (Inactive), 33 with active NCC (Active), 24 with other neurological diseases (OND), and 34 healthy persons (HP). The horizontal lines show the cut-off values (0.067 for serum sample and 0.044 for CSF sample).
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Figure 1: Results of ELISA with LMWAgs using serum and CSF samples from four patients with inactive NCC (Inactive), 33 with active NCC (Active), 24 with other neurological diseases (OND), and 34 healthy persons (HP). The horizontal lines show the cut-off values (0.067 for serum sample and 0.044 for CSF sample).

Mentions: In a blinded fashion, a total of 61 paired serum and CSF samples from 37 patients with NCC and 24 patients with OND were examined to detect specific antibodies to LMWAgs purified from T. solium cyst fluids by ELISA (Fig. 1, Table 1). Absorbance values obtained with serum and CSF samples correlated closely (Fig. 2, Spearman’s rank test; Rs = 0.791, P = 0.0000002). Six serum and seven CSF ELISA-positive samples with an absorbance value less than or equal to 0.220 were selected and analyzed by IB (Table S1). Although four CSF samples could not be analyzed due to the insufficient amount of specimen, the results obtained by IB were consistent with those of ELISA except for two serum samples with absorbance values of 0.091 and 0.110, close to the cutoff absorbance value of 0.067 (Table 2). In this study, we performed statistical analyses on diagnostic performance between serum and CSF samples based on the results of ELISA because it was not possible to test all samples by IB and because the results of ELISA were provided by objective absorbance values. In one of four inactive NCC cases, both serum and CSF were antibody-positive, resulting in 25% sensitivity. In 27 of 33 active NCC cases, both serum and CSF samples were positive, while only serum samples and only CSF samples were positive in three cases each. Out of the six cases showing discrepant results between serum and CSF samples, two cases were patients with serum IB-negative as mentioned above and five cases were patients with a single cyst. The discrepancy in results between serum and CSF samples did not seem to be related to the location of parasite infection (Table 2). As a result, the sensitivity in active NCC cases was 90.9% for both serum and CSF samples. There was no statistical difference in diagnostic performance between serum and CSF samples (Table 3). When the serum and CSF samples were combined, the sensitivity in active NCC cases became 100%. In all OND cases, both serum and CSF samples were negative except one case in which CSF was positive (Fig. 1). This case was a patient with cerebral venous thrombosis. IB analysis confirmed that this ELISA-positive CSF sample contained specific antibodies against LMWAgs (Fig. 3), indicating that the case might have been overlooked by the imaging analysis.


Comparative Study of Paired Serum and Cerebrospinal Fluid Samples from Neurocysticercosis Patients for the Detection of Specific Antibody to Taenia solium Immunodiagnostic Antigen.

Sako Y, Takayanagui OM, Odashima NS, Ito A - Trop Med Health (2015)

Results of ELISA with LMWAgs using serum and CSF samples from four patients with inactive NCC (Inactive), 33 with active NCC (Active), 24 with other neurological diseases (OND), and 34 healthy persons (HP). The horizontal lines show the cut-off values (0.067 for serum sample and 0.044 for CSF sample).
© Copyright Policy - open-access
Related In: Results  -  Collection

Show All Figures
getmorefigures.php?uid=PMC4612706&req=5

Figure 1: Results of ELISA with LMWAgs using serum and CSF samples from four patients with inactive NCC (Inactive), 33 with active NCC (Active), 24 with other neurological diseases (OND), and 34 healthy persons (HP). The horizontal lines show the cut-off values (0.067 for serum sample and 0.044 for CSF sample).
Mentions: In a blinded fashion, a total of 61 paired serum and CSF samples from 37 patients with NCC and 24 patients with OND were examined to detect specific antibodies to LMWAgs purified from T. solium cyst fluids by ELISA (Fig. 1, Table 1). Absorbance values obtained with serum and CSF samples correlated closely (Fig. 2, Spearman’s rank test; Rs = 0.791, P = 0.0000002). Six serum and seven CSF ELISA-positive samples with an absorbance value less than or equal to 0.220 were selected and analyzed by IB (Table S1). Although four CSF samples could not be analyzed due to the insufficient amount of specimen, the results obtained by IB were consistent with those of ELISA except for two serum samples with absorbance values of 0.091 and 0.110, close to the cutoff absorbance value of 0.067 (Table 2). In this study, we performed statistical analyses on diagnostic performance between serum and CSF samples based on the results of ELISA because it was not possible to test all samples by IB and because the results of ELISA were provided by objective absorbance values. In one of four inactive NCC cases, both serum and CSF were antibody-positive, resulting in 25% sensitivity. In 27 of 33 active NCC cases, both serum and CSF samples were positive, while only serum samples and only CSF samples were positive in three cases each. Out of the six cases showing discrepant results between serum and CSF samples, two cases were patients with serum IB-negative as mentioned above and five cases were patients with a single cyst. The discrepancy in results between serum and CSF samples did not seem to be related to the location of parasite infection (Table 2). As a result, the sensitivity in active NCC cases was 90.9% for both serum and CSF samples. There was no statistical difference in diagnostic performance between serum and CSF samples (Table 3). When the serum and CSF samples were combined, the sensitivity in active NCC cases became 100%. In all OND cases, both serum and CSF samples were negative except one case in which CSF was positive (Fig. 1). This case was a patient with cerebral venous thrombosis. IB analysis confirmed that this ELISA-positive CSF sample contained specific antibodies against LMWAgs (Fig. 3), indicating that the case might have been overlooked by the imaging analysis.

Bottom Line: When the serum and CSF samples were combined, the sensitivity in active NCC cases became 100%.There was no difference in test performance between serum and CSF samples.When the antibody test is negative, however, CSF should be used to confirm NCC and to rule out other medical disorders of the central nervous system.

View Article: PubMed Central - PubMed

Affiliation: Department of Parasitology, Asahikawa Medical University , Asahikawa, Japan.

ABSTRACT
Neurocysticercosis (NCC) is an important disease of the central nervous system caused by infection with Taenia solium metacestodes. In addition to the clinical findings and the imaging analysis, the results of immunological tests are informative for the diagnosis of NCC. To compare the usefulness of serum and cerebrospinal fluid (CSF) samples for antibody detection, paired serum and CSF samples from patients with NCC and other neurological diseases were examined by an enzyme-linked immunosorbent assay with low-molecular-weight antigens purified from T. solium cyst fluid in a blinded fashion. The sensitivity of both serum and CSF samples was 25.0% in inactive NCC cases (n = 4) and 90.9% in active NCC cases (n = 33), and the specificity of serum and CSF was 100% and 95.8%, respectively. When the serum and CSF samples were combined, the sensitivity in active NCC cases became 100%. There was no difference in test performance between serum and CSF samples. Based on these results, we recommend the detection of specific antibodies in serum for the diagnosis of active NCC because of the ease of collection. When the antibody test is negative, however, CSF should be used to confirm NCC and to rule out other medical disorders of the central nervous system. Antibody detection test using only serum or CSF has a limited diagnostic value and cannot be recommended for the diagnosis of suspected inactive NCC cases.

No MeSH data available.


Related in: MedlinePlus