Epidemiological, clinical and radiological characteristics of people with neurocysticercosis in Tanzania-A cross-sectional study

Dominik Stelzle; Charles Makasi; Veronika Schmidt; Chiara Trevisan; Inge van Damme; Tamara M Welte; Charlotte Ruether; Agnes Fleury; Pierre Dorny; Pascal Magnussen; Gideon Zulu; Kabemba E Mwape; Emmanuel Bottieau; Sarah Gabriël; Bernard J Ngowi; Andrea S Winkler; SOLID collaborators

doi:10.1371/journal.pntd.0010911

Epidemiological, clinical and radiological characteristics of people with neurocysticercosis in Tanzania-A cross-sectional study

PLoS Negl Trop Dis. 2022 Nov 28;16(11):e0010911. doi: 10.1371/journal.pntd.0010911. eCollection 2022 Nov.

Authors

Dominik Stelzle¹, Charles Makasi², Veronika Schmidt^{1

3}, Chiara Trevisan^{4

5}, Inge van Damme⁴, Tamara M Welte^{1

6}, Charlotte Ruether⁷, Agnes Fleury⁸, Pierre Dorny⁴, Pascal Magnussen⁹, Gideon Zulu¹⁰, Kabemba E Mwape¹¹, Emmanuel Bottieau¹², Sarah Gabriël⁴, Bernard J Ngowi^{2

13}, Andrea S Winkler^{1

3}; SOLID collaborators

Affiliations

¹ Department of Neurology, Center for Global Health, Faculty of Medicine, Technical University of Munich, Munich, Germany.
² National Institute for Medical Research, Muhimbili Medical Research Centre, Dar es Salaam, Tanzania.
³ Centre for Global Health, Institute of Health and Society, Faculty of Medicine, University of Oslo, Oslo, Norway.
⁴ Department of Translational Physiology, Infectiology and Public Health, Faculty of Veterinary Medicine, Ghent University, Ghent, Belgium.
⁵ Department of Biomedical Sciences, Institute of Tropical Medicine, Antwerp, Belgium.
⁶ Epilepsy Center, Department of Neurology, University Hospital Erlangen, Erlangen, Germany.
⁷ Department of Radiology, Faculty of Medicine, Technical University of Munich, Munich, Germany.
⁸ Departamento de Medicina Genómica y Toxicología ambiental, Instituto de Investigaciones Biomédicas-UNAM / Clínica de neurocisticercosis, Instituto Nacional de Neurología y Neurocirugía, Ciudad de México, Mexico.
⁹ Faculty of Health and Medical Sciences, University of Copenhagen, Copenhagen, Denmark.
¹⁰ Ministry of Health, Lusaka, Zambia.
¹¹ Department of Clinical Studies, School of Veterinary Medicine, University of Zambia, Lusaka, Zambia.
¹² Department of Clinical Sciences, Institute of Tropical Medicine, Antwerp, Belgium.
¹³ University of Dar es Salaam, Mbeya College of Health and Allies Sciences, Mbeya, Tanzania.

Abstract

Background: Neurocysticercosis (NCC) is common among people with epilepsy in low-resource settings. Prevalence of NCC and radiological characteristics of patients with NCC vary considerably even within small areas but differences have been poorly characterized so far.

Methods: We conducted a cross-sectional study between August 2018 and April 2020 in three district hospitals in southern Tanzania (Ifisi, Tukuyu and Vwawa). Patients with and without epileptic seizures were included in this study. All patients were tested with a novel antibody-detecting point-of-care test for the diagnosis of Taenia solium cysticercosis. All test positives and a subset of test negatives had a further clinical work-up including medical examination and computed tomography of the brain. NCC was defined according to the Del Brutto criteria. We assessed epidemiological, clinical and radiological characteristics of patients with NCC by presence of epileptic seizures and by serology status.

Results: In all three district hospitals, more than 30% of all people with epileptic seizures (PWE) had NCC lesions in their brain (38% in Vwawa, 32% in Tukuyu and 31% in Ifisi). Most PWE with NCC had multiple lesions and mostly parenchymal lesions (at least 85%). If patients were serologically positive, they had in the median more lesions than serologically negative patients (15 [interquartile range 8-29] versus 5 [1.8-11]), and only serologically positive patients had active stage lesions. Furthermore, serologically positive PWE had more lesions than serologically positive people without epileptic seizures (10.5 [7-23]), and more often had active lesions. PWE diagnosed with NCC (n = 53) were older, and more commonly had focal onset seizures (68% versus 44%, p = 0.03) and headache episodes (34% versus 14%, p = 0.06), which were also stronger than in PWE without NCC (p = 0.04).

Conclusion: NCC is common among PWE. A combination of clinical and serological factors could help to establish an algorithm to identify patients potentially suffering from active NCC, who benefit from further clinical investigation including neuroimaging.

Copyright: © 2022 Stelzle 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.

Publication types

Research Support, Non-U.S. Gov't

MeSH terms

Cross-Sectional Studies
Humans
Neurocysticercosis* / complications
Neurocysticercosis* / diagnostic imaging
Neurocysticercosis* / epidemiology
Radiography
Seizures / diagnostic imaging
Seizures / epidemiology
Tanzania / epidemiology

Grants and funding

This research was funded by the German Federal Ministry of Education and Research (BMBF) [grant number: 01KA1617] and the European & Developing Countries Clinical Trials Partnership (EDCTP) [grant number DRIA2014-308] within the research grant “Evaluation of an antibody detecting point-of-care test for the diagnosis of Taenia solium taeniosis, and (neuro)cysticercosis in communities and primary care settings of highly endemic, resource-poor areas in Tanzania and Zambia, including training of—and technology transfer to the Regional Reference Laboratory and health centers (SOLID)”. The funders had no role in study design, data collection and analysis, decision to publish, or preparation of the manuscript.