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Prevalence of Epilepsy, Human Cysticercosis, and Porcine Cysticercosis in Western Kenya

Monica M. DiazYale University, New Haven, Connecticut;
University of North Carolina at Chapel Hill, Chapel Hill, North Carolina;

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Dilraj SokhiInternational Livestock Research Institute, Nairobi, Kenya;

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John NohCenters for Disease Control and Prevention, Atlanta, Georgia;

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Anthony K. NgugiAga Khan University East Africa, Nairobi, Kenya;

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Frank J. MinjaEmory School of Medicine, Atlanta, Georgia;

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Prabhakhar ReddiAga Khan University East Africa, Nairobi, Kenya;
Aga Khan Hospital, Kisumu, Kenya;

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Eric M. FèvreInternational Livestock Research Institute, Nairobi, Kenya;
University of Liverpool, Liverpool, United Kingdom;

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Ana-Claire L. MeyerYale University, New Haven, Connecticut;
Johns Hopkins University School of Medicine, Baltimore, Maryland

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ABSTRACT.

Cysticercosis is the leading cause of acquired epilepsy worldwide and has been shown to be highly prevalent in pig populations in western Kenya. We conducted a community-based door-to-door survey in a region of western Kenya with a high proportion of pig-keeping households. Persons with epilepsy (PWE) were determined using a screening questionnaire followed by a neurologist evaluation. Cysticercosis serum apDia antigen ELISAs and Western blot for LLGP and rT24h antigen were performed on all PWE and 2% of screen-negative patients. All PWE or people with positive apDia underwent contrast-enhanced brain computed tomography (CT). Of a sample of 810 village residents, 660 (81%) were present in the homestead, of whom 648 (98%) participated. Of these, 17 were confirmed to have lifetime epilepsy, an estimated crude prevalence of 2.6%. No humans with (N = 17) or without (N = 12) epilepsy had serological evidence of cysticercosis infection. Fourteen PWE and one individual with borderline positive apDia antigen ELISA underwent brain CT; none had radiographic findings consistent with neurocysticercosis. Nearly 30% of households kept pigs, with 69% always tethered in both wet and dry seasons. More than 8% (6/72) of pigs had palpable lingual cysts; these pigs all originated from homesteads with latrines, one-third of which were free-ranging at least some of the time. Epilepsy prevalence in our study was greater than the national prevalence, but we found no individuals with epilepsy attributable to cysticercosis. Additional studies are required to identify causes of epilepsy, human and porcine cysticercosis, the role of spatial clustering, and protective factors like host-pathogen immunity.

Author Notes

Address correspondence to Ana-Claire L. Meyer, 601 N Caroline Street, 5th floor, Baltimore, MD 21287. E-mail: ameyer31@jhu.edu

These authors are co-senior authors.

Financial support: This study was supported by the Global Health Equity Scholars Program (R25TW009338) and Consultative Group for International Agricultural Research (CGIAR) Program on Agriculture for Nutrition and Health (A4NH) led by International Food Policy Research Institute (IFPRI) (Fèvre). M. M. D. was additionally supported by the Fogarty International Center at the National Institutes of Health (D43TW009343) and by the Alzheimer’s Disease Resource Center for advancing Minority Aging Research at the University of California, San Diego (P30AG059299, National Institute on Aging). D. S. was additionally supported by the International League Against Epilepsy, UK Chapter, Association of British Neurologists, Epilepsy Research UK. L. M. was additionally supported by Fogarty International Center of the National Institutes of Health (K01TW008764).

Authors’ addresses: Monica M. Diaz, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina, E-mail: monica.diaz@neurology.unc.edu. Dilraj Sokhi, International Livestock Research Institute, Nairobi, Kenya, E-mail: doxoki@gmail.com. John Noh, Centers for Disease Control and Prevention, Atlanta, GA, E-mail: jxn1@cdc.gov. Anthony K. Ngugi, Aga Khan University East Africa, Nairobi, Kenya, E-mail: anthony.ngugi@aku.edu. Frank J. Minja, Emory School of Medicine, Atlanta, GA, E-mail: frank.minja@emory.edu. Prabhakar Reddi, Aga Khan University East Africa, Nairobi, Kenya, E-mail: prabhakar93@yahoo.com. Eric M. Fèvre, University of Liverpool, Liverpool, UK, and International Livestock Research Institute, Kenya, E-mail: eric.fevre@liverpool.ac.uk. Ana-Claire L. Meyer, Johns Hopkins University School of Medicine, Baltimore, MD, E-mail: ameyer31@jhu.edu.

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