High prevalence of cysticercosis in people with epilepsy in southern Rwanda
Neurocysticercosis (NCC), the central nervous system infection by Taenia solium larvae, is a preventable and treatable cause of epilepsy. In Sub-Saharan Africa, the role of NCC in epilepsy differs geographically and, overall, is poorly defined. We aimed at contributing specific, first data for Rwand...
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| creator | Rottbeck, Ruth Nshimiyimana, Jules Fidèle Tugirimana, Pierrot Düll, Uta E Sattler, Janko Hategekimana, Jean-Claudien Hitayezu, Janvier Bruckmaier, Irmengard Borchert, Matthias Gahutu, Jean Bosco Dieckmann, Sebastian Harms, Gundel Mockenhaupt, Frank P Ignatius, Ralf |
| description | Neurocysticercosis (NCC), the central nervous system infection by Taenia solium larvae, is a preventable and treatable cause of epilepsy. In Sub-Saharan Africa, the role of NCC in epilepsy differs geographically and, overall, is poorly defined. We aimed at contributing specific, first data for Rwanda, assessing factors associated with NCC, and evaluating a real-time PCR assay to diagnose NCC in cerebrospinal fluid (CSF).
At three healthcare facilities in southern Rwanda, 215 people with epilepsy (PWE) and 51 controls were clinically examined, interviewed, and tested by immunoblot for cysticerci-specific serum antibodies. Additionally, CSF samples from PWE were tested for anticysticercal antibodies by ELISA and for parasite DNA by PCR. Cranial computer tomography (CT) scans were available for 12.1% of PWE with additional symptoms suggestive of NCC. The Del Brutto criteria were applied for NCC diagnosis. Cysticerci-specific serum antibodies were found in 21.8% of PWE and 4% of controls (odds ratio (OR), 6.69; 95% confidence interval (95%CI), 1.6-58.7). Seropositivity was associated with age and lack of safe drinking water. Fifty (23.3%) PWE were considered NCC cases (definitive, based on CT scans, 7.4%; probable, mainly based on positive immunoblots, 15.8%). In CSF samples from NCC cases, anticysticercal antibodies were detected in 10% (definitive cases, 25%) and parasite DNA in 16% (definitive cases, 44%). Immunoblot-positive PWE were older (medians, 30 vs. 22 years), more frequently had late-onset epilepsy (at age >25 years; 43.5% vs. 8.5%; OR, 8.30; 95%CI, 3.5-20.0), and suffered from significantly fewer episodes of seizures in the preceding six months than immunoblot-negative PWE.
NCC is present and contributes to epilepsy in southern Rwanda. Systematic investigations into porcine and human cysticercosis as well as health education and hygiene measures for T. solium control are needed. PCR might provide an additional, highly specific tool in NCC diagnosis. |
| doi_str_mv | 10.1371/journal.pntd.0002558 |
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At three healthcare facilities in southern Rwanda, 215 people with epilepsy (PWE) and 51 controls were clinically examined, interviewed, and tested by immunoblot for cysticerci-specific serum antibodies. Additionally, CSF samples from PWE were tested for anticysticercal antibodies by ELISA and for parasite DNA by PCR. Cranial computer tomography (CT) scans were available for 12.1% of PWE with additional symptoms suggestive of NCC. The Del Brutto criteria were applied for NCC diagnosis. Cysticerci-specific serum antibodies were found in 21.8% of PWE and 4% of controls (odds ratio (OR), 6.69; 95% confidence interval (95%CI), 1.6-58.7). Seropositivity was associated with age and lack of safe drinking water. Fifty (23.3%) PWE were considered NCC cases (definitive, based on CT scans, 7.4%; probable, mainly based on positive immunoblots, 15.8%). In CSF samples from NCC cases, anticysticercal antibodies were detected in 10% (definitive cases, 25%) and parasite DNA in 16% (definitive cases, 44%). Immunoblot-positive PWE were older (medians, 30 vs. 22 years), more frequently had late-onset epilepsy (at age >25 years; 43.5% vs. 8.5%; OR, 8.30; 95%CI, 3.5-20.0), and suffered from significantly fewer episodes of seizures in the preceding six months than immunoblot-negative PWE.
NCC is present and contributes to epilepsy in southern Rwanda. Systematic investigations into porcine and human cysticercosis as well as health education and hygiene measures for T. solium control are needed. PCR might provide an additional, highly specific tool in NCC diagnosis.</description><identifier>ISSN: 1935-2735</identifier><identifier>ISSN: 1935-2727</identifier><identifier>EISSN: 1935-2735</identifier><identifier>DOI: 10.1371/journal.pntd.0002558</identifier><identifier>PMID: 24244783</identifier><language>eng</language><publisher>United States: Public Library of Science</publisher><subject>Adolescent ; Adult ; Aged ; Causes of ; Confidence intervals ; Cysticercosis ; Deoxyribonucleic acid ; Diagnosis ; DNA ; Drinking water ; Epilepsy ; Female ; Food contamination & poisoning ; Health education ; Health facilities ; Humans ; Male ; Medical imaging ; Methods ; Middle Aged ; Neurocysticercosis - cerebrospinal fluid ; Neurocysticercosis - diagnosis ; Neurocysticercosis - epidemiology ; Parasites ; Polymerase chain reaction ; Prevalence ; Public health ; Real-Time Polymerase Chain Reaction ; Rwanda - epidemiology ; Taenia ; Taenia solium ; Teaching hospitals ; Worms ; Young Adult</subject><ispartof>PLoS neglected tropical diseases, 2013-11, Vol.7 (11), p.e2558-e2558</ispartof><rights>COPYRIGHT 2013 Public Library of Science</rights><rights>2013 Rottbeck et al 2013 Rottbeck et al</rights><rights>2013 Rottbeck et al. This is an open-access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited: Rottbeck R, Nshimiyimana JF, Tugirimana P, Düll UE, Sattler J, et al. (2013) High Prevalence of Cysticercosis in People with Epilepsy in Southern Rwanda. PLoS Negl Trop Dis 7(11): e2558. doi:10.1371/journal.pntd.0002558</rights><lds50>peer_reviewed</lds50><oa>free_for_read</oa><woscitedreferencessubscribed>false</woscitedreferencessubscribed><citedby>FETCH-LOGICAL-c629t-8640361f7e65f319063dd49d215ca05438f07264de18107a46117d24b59136933</citedby><cites>FETCH-LOGICAL-c629t-8640361f7e65f319063dd49d215ca05438f07264de18107a46117d24b59136933</cites></display><links><openurl>$$Topenurl_article</openurl><openurlfulltext>$$Topenurlfull_article</openurlfulltext><thumbnail>$$Tsyndetics_thumb_exl</thumbnail><linktopdf>$$Uhttps://www.ncbi.nlm.nih.gov/pmc/articles/PMC3828157/pdf/$$EPDF$$P50$$Gpubmedcentral$$Hfree_for_read</linktopdf><linktohtml>$$Uhttps://www.ncbi.nlm.nih.gov/pmc/articles/PMC3828157/$$EHTML$$P50$$Gpubmedcentral$$Hfree_for_read</linktohtml><link.rule.ids>230,314,723,776,780,860,881,2096,2915,23847,27903,27904,53769,53771,79346,79347</link.rule.ids><backlink>$$Uhttps://www.ncbi.nlm.nih.gov/pubmed/24244783$$D View this record in MEDLINE/PubMed$$Hfree_for_read</backlink></links><search><contributor>Carabin, Hélène</contributor><creatorcontrib>Rottbeck, Ruth</creatorcontrib><creatorcontrib>Nshimiyimana, Jules Fidèle</creatorcontrib><creatorcontrib>Tugirimana, Pierrot</creatorcontrib><creatorcontrib>Düll, Uta E</creatorcontrib><creatorcontrib>Sattler, Janko</creatorcontrib><creatorcontrib>Hategekimana, Jean-Claudien</creatorcontrib><creatorcontrib>Hitayezu, Janvier</creatorcontrib><creatorcontrib>Bruckmaier, Irmengard</creatorcontrib><creatorcontrib>Borchert, Matthias</creatorcontrib><creatorcontrib>Gahutu, Jean Bosco</creatorcontrib><creatorcontrib>Dieckmann, Sebastian</creatorcontrib><creatorcontrib>Harms, Gundel</creatorcontrib><creatorcontrib>Mockenhaupt, Frank P</creatorcontrib><creatorcontrib>Ignatius, Ralf</creatorcontrib><title>High prevalence of cysticercosis in people with epilepsy in southern Rwanda</title><title>PLoS neglected tropical diseases</title><addtitle>PLoS Negl Trop Dis</addtitle><description>Neurocysticercosis (NCC), the central nervous system infection by Taenia solium larvae, is a preventable and treatable cause of epilepsy. In Sub-Saharan Africa, the role of NCC in epilepsy differs geographically and, overall, is poorly defined. We aimed at contributing specific, first data for Rwanda, assessing factors associated with NCC, and evaluating a real-time PCR assay to diagnose NCC in cerebrospinal fluid (CSF).
At three healthcare facilities in southern Rwanda, 215 people with epilepsy (PWE) and 51 controls were clinically examined, interviewed, and tested by immunoblot for cysticerci-specific serum antibodies. Additionally, CSF samples from PWE were tested for anticysticercal antibodies by ELISA and for parasite DNA by PCR. Cranial computer tomography (CT) scans were available for 12.1% of PWE with additional symptoms suggestive of NCC. The Del Brutto criteria were applied for NCC diagnosis. Cysticerci-specific serum antibodies were found in 21.8% of PWE and 4% of controls (odds ratio (OR), 6.69; 95% confidence interval (95%CI), 1.6-58.7). Seropositivity was associated with age and lack of safe drinking water. Fifty (23.3%) PWE were considered NCC cases (definitive, based on CT scans, 7.4%; probable, mainly based on positive immunoblots, 15.8%). In CSF samples from NCC cases, anticysticercal antibodies were detected in 10% (definitive cases, 25%) and parasite DNA in 16% (definitive cases, 44%). Immunoblot-positive PWE were older (medians, 30 vs. 22 years), more frequently had late-onset epilepsy (at age >25 years; 43.5% vs. 8.5%; OR, 8.30; 95%CI, 3.5-20.0), and suffered from significantly fewer episodes of seizures in the preceding six months than immunoblot-negative PWE.
NCC is present and contributes to epilepsy in southern Rwanda. Systematic investigations into porcine and human cysticercosis as well as health education and hygiene measures for T. solium control are needed. PCR might provide an additional, highly specific tool in NCC diagnosis.</description><subject>Adolescent</subject><subject>Adult</subject><subject>Aged</subject><subject>Causes of</subject><subject>Confidence intervals</subject><subject>Cysticercosis</subject><subject>Deoxyribonucleic acid</subject><subject>Diagnosis</subject><subject>DNA</subject><subject>Drinking water</subject><subject>Epilepsy</subject><subject>Female</subject><subject>Food contamination & poisoning</subject><subject>Health education</subject><subject>Health facilities</subject><subject>Humans</subject><subject>Male</subject><subject>Medical imaging</subject><subject>Methods</subject><subject>Middle Aged</subject><subject>Neurocysticercosis - cerebrospinal fluid</subject><subject>Neurocysticercosis - diagnosis</subject><subject>Neurocysticercosis - epidemiology</subject><subject>Parasites</subject><subject>Polymerase chain reaction</subject><subject>Prevalence</subject><subject>Public health</subject><subject>Real-Time Polymerase Chain Reaction</subject><subject>Rwanda - epidemiology</subject><subject>Taenia</subject><subject>Taenia solium</subject><subject>Teaching hospitals</subject><subject>Worms</subject><subject>Young Adult</subject><issn>1935-2735</issn><issn>1935-2727</issn><issn>1935-2735</issn><fulltext>true</fulltext><rsrctype>article</rsrctype><creationdate>2013</creationdate><recordtype>article</recordtype><sourceid>EIF</sourceid><sourceid>DOA</sourceid><recordid>eNqNkl1rFDEUhgdRbK3-A9EBQbzZNd-T3AilqC0WBNHrkEnO7GTJJmMy07L_3ll3W3bBC8lFwslz3pOc91TVa4yWmDb44zpNOZqwHOLolgghwrl8Up1jRfmCNJQ_PTqfVS9KWSPEFZf4eXVGGGGskfS8-nbtV309ZLgzAaKFOnW13ZbRW8g2FV9qH-sB0hCgvvdjX8PgAwxlu4uXNI095Fj_uDfRmZfVs86EAq8O-0X168vnn1fXi9vvX2-uLm8XVhA1LqRgiArcNSB4R7FCgjrHlCOYW4M4o7JDDRHMAZYYNYYJjBtHWMsVpkJRelG93esOIRV96EPRmAnJpUCMzcTNnnDJrPWQ_cbkrU7G67-BlFfa5PmPAXQrgXIBkne2Zc42LcIIs4YJhYEZ185anw7VpnYDzkIcswknoqc30fd6le40lURi3swCHw4COf2eoIx644uFEEyENO3erYigSlH5H-jsIJecqBl9t0dXs3Haxy7Nxe0O15eUE8kRb8hMLf9BzcvBxtsUoZvdPE14f5TQgwljX1KYRp9iOQXZHrQ5lZKhe-wIRno3oA_G6N2A6sOAzmlvjrv5mPQwkfQPd5vgag</recordid><startdate>20131101</startdate><enddate>20131101</enddate><creator>Rottbeck, Ruth</creator><creator>Nshimiyimana, Jules Fidèle</creator><creator>Tugirimana, Pierrot</creator><creator>Düll, Uta E</creator><creator>Sattler, Janko</creator><creator>Hategekimana, Jean-Claudien</creator><creator>Hitayezu, Janvier</creator><creator>Bruckmaier, Irmengard</creator><creator>Borchert, Matthias</creator><creator>Gahutu, Jean Bosco</creator><creator>Dieckmann, Sebastian</creator><creator>Harms, Gundel</creator><creator>Mockenhaupt, Frank P</creator><creator>Ignatius, Ralf</creator><general>Public Library of Science</general><general>Public Library of Science (PLoS)</general><scope>CGR</scope><scope>CUY</scope><scope>CVF</scope><scope>ECM</scope><scope>EIF</scope><scope>NPM</scope><scope>AAYXX</scope><scope>CITATION</scope><scope>7X8</scope><scope>7TV</scope><scope>7U1</scope><scope>7U2</scope><scope>C1K</scope><scope>F1W</scope><scope>H95</scope><scope>H97</scope><scope>L.G</scope><scope>5PM</scope><scope>DOA</scope></search><sort><creationdate>20131101</creationdate><title>High prevalence of cysticercosis in people with epilepsy in southern Rwanda</title><author>Rottbeck, Ruth ; Nshimiyimana, Jules Fidèle ; Tugirimana, Pierrot ; Düll, Uta E ; Sattler, Janko ; Hategekimana, Jean-Claudien ; Hitayezu, Janvier ; Bruckmaier, Irmengard ; Borchert, Matthias ; Gahutu, Jean Bosco ; Dieckmann, Sebastian ; Harms, Gundel ; Mockenhaupt, Frank P ; Ignatius, Ralf</author></sort><facets><frbrtype>5</frbrtype><frbrgroupid>cdi_FETCH-LOGICAL-c629t-8640361f7e65f319063dd49d215ca05438f07264de18107a46117d24b59136933</frbrgroupid><rsrctype>articles</rsrctype><prefilter>articles</prefilter><language>eng</language><creationdate>2013</creationdate><topic>Adolescent</topic><topic>Adult</topic><topic>Aged</topic><topic>Causes of</topic><topic>Confidence intervals</topic><topic>Cysticercosis</topic><topic>Deoxyribonucleic acid</topic><topic>Diagnosis</topic><topic>DNA</topic><topic>Drinking water</topic><topic>Epilepsy</topic><topic>Female</topic><topic>Food contamination & poisoning</topic><topic>Health education</topic><topic>Health facilities</topic><topic>Humans</topic><topic>Male</topic><topic>Medical imaging</topic><topic>Methods</topic><topic>Middle Aged</topic><topic>Neurocysticercosis - cerebrospinal fluid</topic><topic>Neurocysticercosis - diagnosis</topic><topic>Neurocysticercosis - epidemiology</topic><topic>Parasites</topic><topic>Polymerase chain reaction</topic><topic>Prevalence</topic><topic>Public health</topic><topic>Real-Time Polymerase Chain Reaction</topic><topic>Rwanda - epidemiology</topic><topic>Taenia</topic><topic>Taenia solium</topic><topic>Teaching hospitals</topic><topic>Worms</topic><topic>Young Adult</topic><toplevel>peer_reviewed</toplevel><toplevel>online_resources</toplevel><creatorcontrib>Rottbeck, Ruth</creatorcontrib><creatorcontrib>Nshimiyimana, Jules Fidèle</creatorcontrib><creatorcontrib>Tugirimana, Pierrot</creatorcontrib><creatorcontrib>Düll, Uta E</creatorcontrib><creatorcontrib>Sattler, Janko</creatorcontrib><creatorcontrib>Hategekimana, Jean-Claudien</creatorcontrib><creatorcontrib>Hitayezu, Janvier</creatorcontrib><creatorcontrib>Bruckmaier, Irmengard</creatorcontrib><creatorcontrib>Borchert, Matthias</creatorcontrib><creatorcontrib>Gahutu, Jean Bosco</creatorcontrib><creatorcontrib>Dieckmann, Sebastian</creatorcontrib><creatorcontrib>Harms, Gundel</creatorcontrib><creatorcontrib>Mockenhaupt, Frank P</creatorcontrib><creatorcontrib>Ignatius, Ralf</creatorcontrib><collection>Medline</collection><collection>MEDLINE</collection><collection>MEDLINE (Ovid)</collection><collection>MEDLINE</collection><collection>MEDLINE</collection><collection>PubMed</collection><collection>CrossRef</collection><collection>MEDLINE - Academic</collection><collection>Pollution Abstracts</collection><collection>Risk Abstracts</collection><collection>Safety Science and Risk</collection><collection>Environmental Sciences and Pollution Management</collection><collection>ASFA: Aquatic Sciences and Fisheries Abstracts</collection><collection>Aquatic Science & Fisheries Abstracts (ASFA) 1: Biological Sciences & Living Resources</collection><collection>Aquatic Science & Fisheries Abstracts (ASFA) 3: Aquatic Pollution & Environmental Quality</collection><collection>Aquatic Science & Fisheries Abstracts (ASFA) Professional</collection><collection>PubMed Central (Full Participant titles)</collection><collection>DOAJ Directory of Open Access Journals</collection><jtitle>PLoS neglected tropical diseases</jtitle></facets><delivery><delcategory>Remote Search Resource</delcategory><fulltext>fulltext</fulltext></delivery><addata><au>Rottbeck, Ruth</au><au>Nshimiyimana, Jules Fidèle</au><au>Tugirimana, Pierrot</au><au>Düll, Uta E</au><au>Sattler, Janko</au><au>Hategekimana, Jean-Claudien</au><au>Hitayezu, Janvier</au><au>Bruckmaier, Irmengard</au><au>Borchert, Matthias</au><au>Gahutu, Jean Bosco</au><au>Dieckmann, Sebastian</au><au>Harms, Gundel</au><au>Mockenhaupt, Frank P</au><au>Ignatius, Ralf</au><au>Carabin, Hélène</au><format>journal</format><genre>article</genre><ristype>JOUR</ristype><atitle>High prevalence of cysticercosis in people with epilepsy in southern Rwanda</atitle><jtitle>PLoS neglected tropical diseases</jtitle><addtitle>PLoS Negl Trop Dis</addtitle><date>2013-11-01</date><risdate>2013</risdate><volume>7</volume><issue>11</issue><spage>e2558</spage><epage>e2558</epage><pages>e2558-e2558</pages><issn>1935-2735</issn><issn>1935-2727</issn><eissn>1935-2735</eissn><abstract>Neurocysticercosis (NCC), the central nervous system infection by Taenia solium larvae, is a preventable and treatable cause of epilepsy. In Sub-Saharan Africa, the role of NCC in epilepsy differs geographically and, overall, is poorly defined. We aimed at contributing specific, first data for Rwanda, assessing factors associated with NCC, and evaluating a real-time PCR assay to diagnose NCC in cerebrospinal fluid (CSF).
At three healthcare facilities in southern Rwanda, 215 people with epilepsy (PWE) and 51 controls were clinically examined, interviewed, and tested by immunoblot for cysticerci-specific serum antibodies. Additionally, CSF samples from PWE were tested for anticysticercal antibodies by ELISA and for parasite DNA by PCR. Cranial computer tomography (CT) scans were available for 12.1% of PWE with additional symptoms suggestive of NCC. The Del Brutto criteria were applied for NCC diagnosis. Cysticerci-specific serum antibodies were found in 21.8% of PWE and 4% of controls (odds ratio (OR), 6.69; 95% confidence interval (95%CI), 1.6-58.7). Seropositivity was associated with age and lack of safe drinking water. Fifty (23.3%) PWE were considered NCC cases (definitive, based on CT scans, 7.4%; probable, mainly based on positive immunoblots, 15.8%). In CSF samples from NCC cases, anticysticercal antibodies were detected in 10% (definitive cases, 25%) and parasite DNA in 16% (definitive cases, 44%). Immunoblot-positive PWE were older (medians, 30 vs. 22 years), more frequently had late-onset epilepsy (at age >25 years; 43.5% vs. 8.5%; OR, 8.30; 95%CI, 3.5-20.0), and suffered from significantly fewer episodes of seizures in the preceding six months than immunoblot-negative PWE.
NCC is present and contributes to epilepsy in southern Rwanda. Systematic investigations into porcine and human cysticercosis as well as health education and hygiene measures for T. solium control are needed. PCR might provide an additional, highly specific tool in NCC diagnosis.</abstract><cop>United States</cop><pub>Public Library of Science</pub><pmid>24244783</pmid><doi>10.1371/journal.pntd.0002558</doi><oa>free_for_read</oa></addata></record> |
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| source | MEDLINE; DOAJ Directory of Open Access Journals; Elektronische Zeitschriftenbibliothek - Frei zugängliche E-Journals; PubMed Central; PubMed Central Open Access; Public Library of Science (PLoS) |
| subjects | Adolescent Adult Aged Causes of Confidence intervals Cysticercosis Deoxyribonucleic acid Diagnosis DNA Drinking water Epilepsy Female Food contamination & poisoning Health education Health facilities Humans Male Medical imaging Methods Middle Aged Neurocysticercosis - cerebrospinal fluid Neurocysticercosis - diagnosis Neurocysticercosis - epidemiology Parasites Polymerase chain reaction Prevalence Public health Real-Time Polymerase Chain Reaction Rwanda - epidemiology Taenia Taenia solium Teaching hospitals Worms Young Adult |
| title | High prevalence of cysticercosis in people with epilepsy in southern Rwanda |
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