Correlation of serum screening and neuroimaging studies: A comparative analysis for diagnostic evaluation of neurocysticercosis among people with epilepsy attending mental health clinics in selected district hospitals of Tanzania.

BACKGROUND

Involvement of Taenia solium cysts in the nervous system (Neurocysticercosis -NCC), is responsible for about 30% of preventable acquired epilepsy among people with epilepsy in endemic areas. The diagnosis of NCC involves a set of criteria including immunodiagnostics and neuroimaging. The gold standard immunodiagnostics is not clearly established and the available tests are commercial and not commonly practiced in our settings. We conducted this study to establish the correlation between serum cysticercosis screening tests and neuroimaging studies in the diagnosis of neurocysticercosis among people with epilepsy attending mental health clinics in endemic areas of Tanzania.

METHODS

We evaluated the serum cysticercosis diagnostic tests through parallel tests and performed multiple analysis methods including sensitivity and specificity, positive and negative likelihood ratio (LR+, LR-). Others were positive predictive value (PPV), negative predictive value (NPV), and receiver operating characteristics (ROC) curve. These were done to establish the efficiency of serum cysticercosis tests in the diagnosis of NCC.

RESULTS

Our findings showed a sensitivity of 87.5%; [95%CI (76.7-98.3)] and specificity of 60.7%; [95%CI (44.8-76.7)]. The LR+ = 2.23 and LR- = 0.21. The PPV was 38.9% [95%CI (23.0-54.8)], NPV was 94.4%; [95%CI (87.0-101.9)] and area under the ROC curve was 0.78.

DISCUSSION

Increasing sensitivity and decreasing false negatives, parallel testing of multiple serum cysticercosis diagnostic tests enhances negative predictive values. It is important to assess the diagnostic tests using a variety of analytical techniques to confirm that they are capable of producing the desired diagnosis.