Project Summary
Millions of individuals are infected with Taenia solium (the pork tapeworm) globally. T. solium causes two main
types of disease: (1) intestinal disease (“taeniasis”), which is acquired after ingestion of T. solium larvae
(“cysticerci”) via infected pork and is often undiagnosed as it is typically asymptomatic or only results in mild
gastrointestinal symptoms, and (2) tissue disease (“cysticercosis”), which occurs after inadvertent consumption
of T. solium eggs. Cysticercosis can develop once T. solium eggs hatch into embryonic larva in the human
intestine, migrate to various host organ systems, and develop into cystic larvae within the tissue.
Neurocysticercosis (NCC) is the most consequential form of cysticercosis, causing an estimated 2.8 million
disability-adjusted life years globally due to chronic neurologic sequela.
Most patients with NCC are asymptomatic or do not develop the classic clinical manifestations of NCC
(headaches, seizures, and focal neurologic deficits) until years after initial exposure; thus, detection of disease
prior to the onset of symptoms via screening protocols could prevent significant morbidity. However, there is
currently no consensus or guideline for screening for taeniasis or NCC. An inexpensive protocol for taeniasis
and NCC screening would facilitate identification of index cases and early diagnosis of NCC cases.
The possibility of widespread exposure to T. solium among people from endemic countries now living in the US
has clinical and public health implications because these populations have resettled in a country where the
infection is not endemic and where many clinical providers are not familiar with the disease manifestations,
diagnosis, or treatment. This research proposal describes a cross-sectional pilot study of people at risk for T.
solium exposure, with the overall objective of developing a NCC screening approach that will improve NCC
screening practices. The proposal’s specific aims are (1) to evaluate NCC prevalence in the household
contacts of NCC patients and (2) to compare a panel of T. solium biologic tests as NCC screening tools. These
aims will be achieved by recruiting the household contacts of NCC patients and evaluating them via a variety of
stool, blood, and urine T. solium-specific tests paired with gold-standard neuroimaging. High-performing
screening approaches will be compared to determine which are accurate and cost-effective.
This study will generate important preliminary data essential to development of an effective NCC screening
protocol. It will be the first to evaluate NCC screening in a non-endemic setting and the first to evaluate the
head-to-head performance of laboratory-developed cysticercosis blood and urine biomarker tests paired with
neuroimaging as NCC screening tools.