Cysticercosis: imported and autochthonous infections in Kuwait.
Intracerebral and non-central nervous system (non-CNS) cysticercosis caused by the larval pork tapeworm Taenia solium was diagnosed in patients in an Islamic state. The mode of transmission and challenges in diagnosis are highlighted. Sixteen patients with neurocysticercosis and six with non-CNS lesions were diagnosed by imaging studies (computerized tomography [CT]/magnetic resonance imaging [MRI]) and serology (ELISA and/or enzyme-linked immunoelectrotransfer blot assay [EITB]). Four of 55 family members, including servants, tested for antibodies were positive by the EITB and ELISA. Only one of these sera tested for antibodies to adult T. solium was positive: that of the cook, the probable source of the infection. We postulate a similar mode of transmission in the other Kuwaitis. Evaluation of several commercially available ELISA kits showed they were of poor specificity. Even in countries where pork consumption is proscribed by religious laws, physicians should include cysticercosis in their differential diagnosis in patients with neurological symptoms or non-CNS lesions, especially in non-endemic countries with a large expatriate population such as Kuwait. In children particularly, and in this region, suspected tuberculous lesions on CT must be investigated to rule out cysticerci by a more diligent use of the sensitive and specific EITB assay. Failure to understand the local epidemiology leads to empirical, inappropriate and prolonged therapy for chronic disease.
Hira
Parsotam R
PR
Department of Microbiology, Faculty of Medicine, Kuwait University, PO Box 24923, Safat 13110, Kuwait. Hira@hsc.kuniv.edu.kw
Francis
Issam
I
Abdella
Nabila A
NA
Gupta
Renu
R
Ai-Ali
Faiza M
FM
Grover
Saroj
S
Khalid
Nabila
N
Abdeen
Suad
S
Iqbal
Jamshaid
J
Wilson
Marianna
M
Tsang
Victor C W
VC
D000293:Adolescent; D000328:Adult; D002648:Child; D002675:Child, Preschool; D003551:Cysticercosis / Q000175:diagnosis / Q000453:epidemiology* / Q000635:transmission; D004797:Enzyme-Linked Immunosorbent Assay; D005260:Female; D006801:Humans; D007730:Kuwait / Q000453:epidemiology; D008279:Magnetic Resonance Imaging / Q000379:methods; D008297:Male; D008875:Middle Aged; D020019:Neurocysticercosis / Q000175:diagnosis / Q000453:epidemiology; D014057:Tomography, X-Ray Computed / Q000379:methods