High prevalence of cysticercosis in people with epilepsy in southern Rwanda.
BACKGROUND
Neurocysticercosis (NCC), the central nervous system infection by Taenia solium larvae, is a preventable and treatable cause of epilepsy. In Sub-Saharan Africa, the role of NCC in epilepsy differs geographically and, overall, is poorly defined. We aimed at contributing specific, first data for Rwanda, assessing factors associated with NCC, and evaluating a real-time PCR assay to diagnose NCC in cerebrospinal fluid (CSF).


RESULTS
At three healthcare facilities in southern Rwanda, 215 people with epilepsy (PWE) and 51 controls were clinically examined, interviewed, and tested by immunoblot for cysticerci-specific serum antibodies. Additionally, CSF samples from PWE were tested for anticysticercal antibodies by ELISA and for parasite DNA by PCR. Cranial computer tomography (CT) scans were available for 12.1% of PWE with additional symptoms suggestive of NCC. The Del Brutto criteria were applied for NCC diagnosis. Cysticerci-specific serum antibodies were found in 21.8% of PWE and 4% of controls (odds ratio (OR), 6.69; 95% confidence interval (95%CI), 1.6-58.7). Seropositivity was associated with age and lack of safe drinking water. Fifty (23.3%) PWE were considered NCC cases (definitive, based on CT scans, 7.4%; probable, mainly based on positive immunoblots, 15.8%). In CSF samples from NCC cases, anticysticercal antibodies were detected in 10% (definitive cases, 25%) and parasite DNA in 16% (definitive cases, 44%). Immunoblot-positive PWE were older (medians, 30 vs. 22 years), more frequently had late-onset epilepsy (at age >25 years; 43.5% vs. 8.5%; OR, 8.30; 95%CI, 3.5-20.0), and suffered from significantly fewer episodes of seizures in the preceding six months than immunoblot-negative PWE.


CONCLUSIONS
NCC is present and contributes to epilepsy in southern Rwanda. Systematic investigations into porcine and human cysticercosis as well as health education and hygiene measures for T. solium control are needed. PCR might provide an additional, highly specific tool in NCC diagnosis.
Department of Internal Medicine/Neurology, Butare University Teaching Hospital, Butare, Rwanda.
Ruth
R
Rottbeck
Jules Fidèle
JF
Nshimiyimana
Pierrot
P
Tugirimana
Uta E
UE
Düll
Janko
J
Sattler
Jean-Claudien
JC
Hategekimana
Janvier
J
Hitayezu
Irmengard
I
Bruckmaier
Matthias
M
Borchert
Jean Bosco
JB
Gahutu
Sebastian
S
Dieckmann
Gundel
G
Harms
Frank P
FP
Mockenhaupt
Ralf
R
Ignatius
D000293:Adolescent; D000328:Adult; D000368:Aged; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D020019:Neurocysticercosis / Q000134:cerebrospinal fluid / Q000175:diagnosis / Q000453:epidemiology*; D015995:Prevalence; D060888:Real-Time Polymerase Chain Reaction; D012432:Rwanda / Q000453:epidemiology; D055815:Young Adult