Brizzi Kate, Pelden Sonam, Tshokey Tshokey, Nirola Damber K, Diamond Megan B, Klein Joshua P, Tshering Lhab, Deki Sonam, Nidup Dechen, Bruno Veronica, Dorny Pierre, Garcia Hector Hugo, Mateen Farrah J
Massachusetts General Hospital, Boston, MA, USA.
Department of Laboratory Medicine, Jigme Dorji Wangchuck National Referral Hospital, Bhutan.
Trans R Soc Trop Med Hyg. 2016 Sep;110(9):517-526. doi: 10.1093/trstmh/trw066.
We sought to provide an assessment of the burden of neurocysticercosis among people with epilepsy (PWE) in Bhutan and evaluate the yield of various tests for Taenia solium.
PWE were enrolled at the National Referral Hospital in Thimphu (2014-2015). Serum was tested for anti-Taenia solium IgG using ELISA (Ab-ELISA), enzyme-linked immunoelectrotransfer blot (EITB), and parasite antigen. Results were compared to brain MRI. Participants were categorized as definite neurocysticercosis (MRI and EITB positive), probable neurocysticercosis (MRI or EITB positive), or without neurocysticercosis. Logistic regression models were constructed to explore clinicodemographic associations.
There were 12/205 (6%, 95% CI 2%, 9%) definite and 40/205 (20%, 95% CI 14%, 25%) probable neurocysticercosis cases. 25/205 (12%) with positive EITB did not have neurocysticercosis on MRI, and 15/205 (7%) participants with positive MRI had negative EITB. Participants with neurocysticercosis-suggestive lesions on MRI had an average of 1.2 cysts (parenchymal 26/27; nodular/calcified stage 21/27). In a multivariable analysis, present age (OR 1.05, 95% CI 1.01,1.09, p=0.025) was positively associated with (combined probable or definite) neurocysticercosis while mesial temporal sclerosis on MRI (OR 0.294, 95% CI 0.144, 0.598, p=0.001) was negatively associated.
Neurocysticercosis was associated with 6-25% of epilepsy in a Bhutanese cohort. Combining EITB and MRI would aid the diagnosis of neurocysticercosis among PWE since no test identified all cases.
我们试图评估不丹癫痫患者中神经囊尾蚴病的负担，并评估各种猪带绦虫检测方法的检出率。
在廷布的国家转诊医院招募癫痫患者（2014 - 2015年）。采用酶联免疫吸附试验（Ab - ELISA）、酶联免疫电转移印迹法（EITB）和寄生虫抗原检测血清中的抗猪带绦虫IgG。将结果与脑部磁共振成像（MRI）进行比较。参与者被分类为确诊神经囊尾蚴病（MRI和EITB均阳性）、可能神经囊尾蚴病（MRI或EITB阳性）或无神经囊尾蚴病。构建逻辑回归模型以探索临床人口统计学关联。
有12/205例（6%，95%可信区间2%，9%）确诊和40/205例（20%，95%可信区间14%，25%）可能神经囊尾蚴病病例。25/205例（12%）EITB阳性者MRI检查无神经囊尾蚴病，15/205例（7%）MRI阳性参与者EITB阴性。MRI上有神经囊尾蚴病提示性病变的参与者平均有1.2个囊肿（实质期26/27；结节/钙化期21/27）。在多变量分析中，当前年龄（比值比1.05，95%可信区间1.01，1.09，p = 0.025）与（合并可能或确诊）神经囊尾蚴病呈正相关，而MRI上的内侧颞叶硬化（比值比0.294，95%可信区间0.144，0.598，p = 0.001）呈负相关。
在不丹队列中，6 - 25%的癫痫与神经囊尾蚴病有关。由于没有一种检测方法能识别所有病例，联合EITB和MRI将有助于癫痫患者中神经囊尾蚴病的诊断。
