High frequency of Taenia solium antigen positivity in patients admitted for neurological disorders in the Rural Hospital of Mosango, Democratic Republic of Congo.

Abstract

Abstract Background The epidemiology of human cysticercosis and neurocysticercosis, caused by the larval stage of the pork tapeworm Taenia solium , is not well known in the Democratic Republic of Congo (DRC). As part of an etiological study, we consecutively evaluated from 2012 to 2016 all patients older than 5 years admitted for neurological disorders (neurology cohort) at the rural hospital of Mosango, province of Kwilu, DRC. No neuroimaging was available. A similar study was conducted among patients presenting with persistent fever (> 7 days) during the same period in the same hospital. In both studies, etiological diagnosis relied on a systematic set of reference laboratory assays and on pre-established clinical case definitions. The aim of this post-hoc analysis was to determine the frequency of T. solium infection in these neurology and persistent fever cohorts and to explore its association with specific neurological presentations and final etiological diagnoses. Methods We conducted a descriptive and analytic study between the group of neurological syndrome patients and persistent fever based on the presence or not the cysticercosis IgG using the B158/B60 enzyme-linked immunosorbent assay and of the LDBIO Cysticercosis Western Blot IgG assay, respectively.. Results For the neurology cohort, 340 samples (of 351 enrolled patients) were available for analysis (males: 46.8%; mean age: 38.9 years). T. solium antigen positivity was found in 43 participants (12.6%; 95% confidence interval [CI] 9.3-16.7%), including 9 of 60 (15%) patients with epilepsy. Of the 148 evaluated samples from the persistent fever cohort (males: 39.9%; mean age: 19.9 years), 7 had positive T. solium antigen (4.7%; 95% CI 1.9-9.5%; P=0.009 when compared to the neurology cohort). No significant association was found within the neurology cohort between positivity and clinical presentation or final diagnoses. Of note, the antibody-based assay was found positive in only four (1.3%) of the participants of the neurology cohort and in none of the persistent fever cohort. Conclusions T. solium antigen positivity was frequent in patients admitted with neurological disorders in the Kwilu province, DRC. Further neuroimaging studies should explore whether neurocysticercosis is prevalent in this region.