Concordance between a New Rapid Point-Of-Care Assay and Standard ELISA in the Detection of Cysticercosis Antigens in Urine

Luz M. Toribio Center for Global Health, Universidad Peruana Cayetano Heredia, Lima, Peru;
Cysticercosis Unit, Instituto Nacional de Ciencias Neurologicas, Lima, Peru;
Infection and Immunity Institute, St. George’s University of London, London, United Kingdom;

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Alessandra Vásquez Center for Global Health, Universidad Peruana Cayetano Heredia, Lima, Peru;

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Yesenia Castillo Center for Global Health, Universidad Peruana Cayetano Heredia, Lima, Peru;

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S. Mathof Salas Cysticercosis Unit, Instituto Nacional de Ciencias Neurologicas, Lima, Peru;

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Erika Perez Cysticercosis Unit, Instituto Nacional de Ciencias Neurologicas, Lima, Peru;

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Javier A. Bustos Center for Global Health, Universidad Peruana Cayetano Heredia, Lima, Peru;

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Seth E. O’Neal School of Public Health, Oregon Health & Sciences University-Portland State University, Portland, Oregon;

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Hector H. Garcia Center for Global Health, Universidad Peruana Cayetano Heredia, Lima, Peru;
Cysticercosis Unit, Instituto Nacional de Ciencias Neurologicas, Lima, Peru;
Asociacion Benefica PRISMA, Lima, Peru;
Department of International Health, Johns Hopkins School of Public Health, Baltimore, Maryland

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for The Cysticercosis Working Group in Peru
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ABSTRACT.

Neurocysticercosis is a parasitic disease of major public health importance. Definitive diagnosis requires neuroimaging, which is typically unavailable in rural impoverished regions of endemicity. Screening immunoassays can support diagnosis in this setting by identifying individuals most likely to have severe forms of disease for referral to imaging. Urine sampling is convenient, painless, and generally well accepted. We developed a rapid point-of-care (POC) assay to detect urinary antigens and assessed concordance with a standard antigen ELISA (Ag-ELISA), both using monoclonal antibodies TsW8/TsW5. From 28,145 stored community samples with Ag-ELISA results, we selected 843 for comparison, 281 each from nonreactive (ratio <1), reactive-below-cutoff (ratio 1:3), and positive (ratio ≥3) samples. Overall agreement was 73.6%, with strong agreement observed in the nonreactive (280/281, 99.6%) and positive (255/281, 90.8%) groups. This affordable noninvasive POC test can be applied to identify individuals in the community most at risk of developing severe disease.

Author Notes

Financial support: H. H. Garcia received funding from the Fogarty Internation Center under NIH grant number D43TW001140 and from the National Institute of Allergy and Infectious Diseases under grant number 5U19AI129909.

Disclosure: Both the parent study and the current study were approved by the institutional review board of the Universidad Peruana Cayetano Heredia (#161-14-23).

Current contact information: Luz M. Toribio, Center for Global Health, Universidad Peruana Cayetano Heredia, Lima, Peru, Cysticercosis Unit, Instituto Nacional de Ciencias Neurologicas, Lima, Peru, and Infection and Immunity Institute, St. George’s University of London, London, United Kingdom, E-mail: ltoribio@sgul.ac.uk. Alessandra Vásquez and Yesenia Castillo, Center for Global Health, Universidad Peruana Cayetano Heredia, Lima, Peru, E-mails: alessandra.vasquez@upch.pe and yesenia.castillo.b@upch.pe. S. Mathof Salas and Erika Perez, Cysticercosis Unit, Instituto Nacional de Ciencias Neurologicas, Lima, Peru, E-mails: selene.salas@upch.pe and perez.paredes.e@gmail.com. Javier A. Bustos, Center for Global Health, Universidad Peruana Cayetano Heredia, Lima, Peru, and Cysticercosis Unit, Instituto Nacional de Ciencias Neurologicas, Lima, Peru, E-mail: javier.bustos.p@upch.pe. Seth E. O’Neal, School of Public Health, Oregon Health & Sciences University-Portland State University, Portland, OR, E-mail: natseth7@gmail.com. Hector H. Garcia, Center for Global Health, Universidad Peruana Cayetano Heredia, Lima, Peru, Cysticercosis Unit, Instituto Nacional de Ciencias Neurologicas, Lima, Peru, Asociacion Benefica PRISMA, Lima, Peru, and Department of International Health, Johns Hopkins School of Public Health, Baltimore, MD, E-mail: hgarcia@jhsph.edu.

Address correspondence to Luz M. Toribio, Infection and Immunity Institute, St. George’s University of London, London SW170RE, United Kingdom. E-mails: ltoribio@sgul.ac.uk or luz.toribio.salazar@upch.pe
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