Friday, May 16, 2025
5/16/2025
EVALUATING NEUROCYSTICERCOSIS SCREENING PRACTICES AND EPIDEMIOLOGY. - 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.
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