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      Teniasis/Cisticercosis: Avances en diagnóstico inmunológico y molecular Translated title: Taeniasis/cysticercosis: Advances in immunological and molecular diagnosis

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          Abstract

          La teniasis es la infección parasitaria producida por el adulto de Taenia solium y T. saginata, mientras que la cisticercosis es causada por el estadío larvario (cisticerco) de estos ténidos en hospedadores intermediarios; el hombre puede de forma accidental adquirir la cisticercosis. El binomio teniasis/cisticercosis causa graves problemas de salud pública y económicos en las zonas endémicas de África, Asia, y Latinoamérica, además de otras áreas como consecuencia de los viajes y las migraciónes. La neurocisticercosis es la enfermedad parasitaria más importante del sistema nervioso nentral. El diagnóstico de la teniasis se logra generalmente mediante examenes coprológicos, mientras que el diagnóstico de la cisticercosis se lleva a cabo por métodos parasitológicos, por técnicas de imágenes y una amplia variedad de ensayos inmunológicos. Los métodos de diagnóstico inmunológico convencional presentan graves limitaciones, baja sensibilidad y especificidad, no estandarizados convenientemente y basados en la utilización como antígeno del siempre escaso material parasitario. Actualmente se están utilizando nuevas herramientas y técnicas que permiten un mejor diagnóstico de estas enfermedades, por ejemplo, anticuerpos monoclonales, antígenos recombinantes, péptidos sintéticos, PCR, cuya manipulación es de fácil estandarización e independientes de las fuentes del siempre preciado material parasitario.

          Translated abstract

          Taeniasis is a parasitic infection caused by the adult of Taenia solium and T. saginata, while cysticercosis is caused by the larval stage (Cysticercus) of these parasites in intermediary hosts; humans can accidentally acquire cysticercosis. Taeniasis/ cysticercosis causes serious public health and economic problems in endemic areas of Africa, Asia, and Latin America, in addition to other areas as a result of the travel and migration. Neurocysticercosis is the most important parasitic disease of the central nervous system. Taeniasis diagnosis is obtained generally by stool exams, whereas cysticercosis diagnosis is carried out by parasitological methods, imaging techniques and several immunological tests. Conventional methods of diagnosis have serious limitations, such as poor sensitivity and low specificity, are not standardized properly and are based on the parasitic material which is difficult to obtain. At present new technical tools are being used that allow a better diagnosis of these diseases, for example, monoclonal antibodies, recombinant antigens, synthetic peptides, PCR, whose manipulation is easily standardized and independent of the sources of the always valuable parasitic material.

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          Most cited references152

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          Neurocysticercosis in an Orthodox Jewish community in New York City.

          From June 1990 through July 1991, intracerebral infection with the larval stage of the pork tapeworm Taenia solium was diagnosed in four unrelated persons in an Orthodox Jewish community in New York City. None of the patients had eaten pork, and only one had traveled to a country in which T. solium infection was endemic. We investigated this outbreak, screened serum samples from family members and household contacts for antibodies to cysticercosis, and examined stool specimens from household employees for eggs of taenia species. The four patients had recurrent seizures and brain lesions that were radiologically consistent with the presence of cysticerci. The diagnosis was confirmed in two patients by a brain biopsy, and in two by immunoblot assays for cysticercus antibodies. Of 17 immediate family members screened serologically, 7 from two families had cysticercus antibodies. Magnetic resonance imaging of the brain showed cystic lesions in two of the seropositive family members, one of whom had had a seizure. Examinations of six domestic employees from all four households revealed an active infection with taenia species in one and a positive serologic test in another. Since these women had recently emigrated from Latin American countries where T. solium infection is endemic, they were the most likely sources of infection in the members of these households. A diagnosis of neurocysticercosis should be considered in patients with seizures and radiologic evidence of cystic brain lesions, even in those who do not eat pork and who have not traveled to a country in which T. solium infection is endemic. Recent emigrants from countries in which T. solium infection is endemic should be screened for tapeworm infection in their stools before they are employed as housekeepers or food handlers.
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            Clinical evaluation of the cysticercosis enzyme-linked immunoelectrotransfer blot in patients with neurocysticercosis.

            During the 3 years that the enzyme-linked immunoelectrotransfer blot (EITB) assay for the diagnosis of human cysticercosis has been in use at the Centers for Disease Control, 50 patients with both pathologically confirmed neurocysticercosis and computed tomographic (CT) or magnetic resonance imaging (MRI) scan results were identified. Of 32 patients with two or more lesions, 94% had detectable antibodies by EITB compared with 28% of 18 patients with single lesions. Patients with only calcified cysts (single or multiple) were less likely to have EITB-positive results than were those with noncalcified, enhancing lesions. Antibody was detectable more frequently in serum than in cerebrospinal fluid, regardless of the number or apparent condition of the cysts. These findings confirm that the EITB assay for cysticercosis antibodies is highly sensitive in patients with multiple, enhancing intracranial lesions but is less sensitive in patients with single lesions and in those with calcified lesions.
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              DNA differential diagnosis of taeniasis and cysticercosis by multiplex PCR.

              Multiplex PCR was established for differential diagnosis of taeniasis and cysticercosis, including their causative agents. For identification of the parasites, multiplex PCR with cytochrome c oxidase subunit 1 gene yielded evident differential products unique for Taenia saginata and Taenia asiatica and for American/African and Asian genotypes of Taenia solium with molecular sizes of 827, 269, 720, and 984 bp, respectively. In the PCR-based detection of tapeworm carriers using fecal samples, the diagnostic markers were detected from 7 of 14 and 4 of 9 T. solium carriers from Guatemala and Indonesia, respectively. Test sensitivity may have been reduced by the length of time (up to 12 years) that samples were stored and/or small sample volumes (ca. 30 to 50 mg). However, the diagnostic markers were detected by nested PCR in five worm carriers from Guatemalan cases that were found to be negative by multiplex PCR. It was noteworthy that a 720 bp-diagnostic marker was detected from a T. solium carrier who was egg-free, implying that it is possible to detect worm carriers and treat before mature gravid proglottids are discharged. In contrast to T. solium carriers, 827-bp markers were detected by multiplex PCR in all T. saginata carriers. The application of the multiplex PCR would be useful not only for surveillance of taeniasis and cysticercosis control but also for the molecular epidemiological survey of these cestode infections.
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                Author and article information

                Contributors
                Role: ND
                Journal
                bmsa
                Boletín de Malariología y Salud Ambiental
                Bol Mal Salud Amb
                Instituto de Altos Estudios en Salud Pública Dr. Arnoldo Gabaldon (Maracay )
                1690-4648
                July 2006
                : 46
                : 1
                : 1-13
                Affiliations
                [1 ] Universidad de Carabobo Venezuela
                Article
                S1690-46482006000100001
                8a3dec0d-7b06-47ca-b56b-4d2f46e7fad7

                http://creativecommons.org/licenses/by/4.0/

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                SciELO Venezuela

                Self URI (journal page): http://www.scielo.org.ve/scielo.php?script=sci_serial&pid=1690-4648&lng=en
                Categories
                INFECTIOUS DISEASES
                PARASITOLOGY

                Parasitology,Infectious disease & Microbiology
                taeniasis,cysticercosis,diagnosis,recombinant antigen,synthetic peptide,PCR,teniasis,cisticercosis,diagnóstico,antígeno recombinante,péptido sintético

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