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Urine Antigen Detection for the Diagnosis of Human Neurocysticercosis

Neurocysticercosis (NCC) is a major cause of seizures and epilepsy. Diagnosis is based on brain imaging, supported by immunodiagnosis in serum or cerebrospinal fluid (CSF). Lumbar puncture is invasive and painful. Blood sampling is slightly painful and poorly accepted. Urine antigen detection has been used for other parasites and tried in NCC with suboptimal performance. We used a monoclonal antibody-based ELISA to detect Taenia solium antigens in urine from 87 Peruvian neurocysticercosis patients (viable cysts, N = 34; subarachnoid cysticercosis, N = 10; degenerating parasites, N = 7; calcified lesions, N = 36) and 32 volunteers from a non-endemic area of Peru. Overall sensitivity of urine antigen detection for viable parasites was 92%, which decreased to 62.5% in patients with a single cyst. Most patients (30/36, 83%) with only calcified cysticercosis were urine antigen negative. Antigen levels in paired serum/urine samples (evaluated in 19 patients) were strongly correlated. Non-invasive urine testing for T. solium antigens provides a useful alternative for NCC diagnosis.

Received June 25, 2008. Accepted for publication October 13, 2008.

Acknowledgments: The authors thank the personnel of the Cysticercosis Unit, Instituto de Ciencias Neurológicas, Lima, Perú, for hard work on sample collection and processing. Other members of The Cysticercosis Working Group in Perú who collaborated with this work include Patricia Arias, E. Javier Pretell, S. Manuel Martinez, and Herbert Saavedra (Instituto de Ciencias Neurológicas, Lima, Perú), and Manuela Verastegui (Universidad Peruana Cayetano Heredia, Lima, Perú).

Financial support: This work was partly funded by Grants D43 TW01140 and TW06581 from the National Institute of Allergy and Infectious Diseases, 063109 from The Wellcome Trust, and 23981 from the Bill and Melinda Gates Foundation (to RG, VT, AG, and HG). The funders had no role in study design, data collection and analysis, decision to publish, or preparation of the manuscript.

^* Address correspondence to Hector H. García, Cysticercosis Unit, Instituto de Ciencias Neurológicas, Jr. Ancash 1271, Barrios Altos, Lima 1, Perú. E-mail: hgarcia{at}jhsph.edu

Authors’ addresses: Yesenia Castillo, Hector H. García, Mylagritos Portocarrero and D. Paolo Melendez, Department of Microbiology, School of Science, Universidad Peruana Cayetano Heredia, Av. H. Delgado 430, SMP, Lima 31, Peru. Jef Brandt, Anke Van Hul and Pierre Dorny, Department of Animal Health, Institute of Tropical Medicine, Nationalestrat 155, B-2000, Antwerrpen, Belgium. Maria Silva and Armando E. Gonzalez, School of Veterinary Medicine, Universidad National Mayorlde San Marcos, Av. Circunvalacion s/n, San Borja, Lima 41, Peru. Richar Rodriguez-Hidalgo, Centro Internacional de Zoonosis, Universidad Central del Ecuador, Quito, Ecuador. Robert H. Gilman, Department of International Health, Johns Hopkins Bloomberg School of Public Health, 615 N. Wolfe Street, Room W5515, Baltimore, MD 21205.