T. solium cysticerci antigen from a different region as is the case with commercially available immunoblots. Whether this is at all relevant for routine diagnosis needs to be established and currently is evaluated in studies conducted in Zambia, Tanzania, and Uganda.Diagnosis of NCC in Sub-Saharan AfricaDiagnosis of NCC has been well established and is mainly based on neuroimaging and immunodiagnosis.45,74 Diagnostic testing should be initiated if NCC is suspected on clinical grounds, e.g. epileptic seizures in people coming from areas endemic for cysticercosis. In sub-Saharan Africa, due to the lack of diagnostic facilities, this is only possible in a minority of cases. The analysis of cerebrospinal fluid of patients with NCC may indicate parasitic disease or show mononuclear pleocytosis and eosinophilia, depending on disease activity and the location of lesions. CellPathogens and Global HealthVOL .NO .WinklerNeurocysticercosis in sub-Saharan Africacounts rarely exceed 100 cells/ml. Protein DactinomycinMedChemExpress Dactinomycin levels can be increased to within the range of 50?00 mg/dl, but glucose levels are usually normal.75 In addition to or instead of a standard analysis of cerebrospinal fluid, the diagnostic value of which is debatable and unremarkable in most cases, serological tests for T. solium cysticercosis should be performed in suspected cases. Antigen/antibody enzyme-linked immunosorbent assay (ELISA) and immunoblots in serum and/ or cerebrospinal fluid are available, whereby a positive antigen ELISA indicates active disease with viable cysticerci and a positive antibody ELISA and/ or immunoblot demonstrates exposure to the parasite, but not necessarily active disease.18,22,74,76?9 Also, a positive test only indicates cysticercosis but not necessarily NCC, and the sensitivity and specificity can vary considerably according to the test used.74,76 In addition, most of these tests are unavailable in sub-Saharan Africa, although the capacity has been Dactinomycin solubility transferred to some African centres.22 Furthermore, a DNA-based method of diagnosis of T. solium cysticercosis is under development. Preliminary results in cerebrospinal fluid indicate variable levels of sensitivity but 100 specificity.80,81 Again, these techniques, with highcost equipment, might not be available in African countries. Although positive serological and/or DNA-based tests may give the first indication, the gold standard of NCC diagnosis is neuroimaging, including cCT and/or cerebral magnetic resonance imaging, both of which are generally not available in sub-Saharan Africa. Serology may help in areas without CT scanners or may indicate who should go for cCT examination and thus save resources. A recent study from Tanzania indicated a sensitivity of 100 and a specificity of 84 for diagnosis of active NCC using T. solium cysticercosis antigen ELISA, whereas a study from South Africa demonstrated much lower sensitivity and specificity using the same T. solium cysticercosis antigen ELISA in a different study population.7,82 Neuroimaging not only is essential for confirmation of diagnosis, but also represents the only method that differentiates between active and inactive disease. Active NCC is defined as the presence of at least one NCC-like cystic lesion (a round shaped hypodensity on cCT with or without a hyperdense dot representing the head of the cysticercus (5scolex) usually no bigger than 1 cm in diameter and without perifocal inflammatory reaction (5oedema)) or at least one ring- or fully enhanci.T. solium cysticerci antigen from a different region as is the case with commercially available immunoblots. Whether this is at all relevant for routine diagnosis needs to be established and currently is evaluated in studies conducted in Zambia, Tanzania, and Uganda.Diagnosis of NCC in Sub-Saharan AfricaDiagnosis of NCC has been well established and is mainly based on neuroimaging and immunodiagnosis.45,74 Diagnostic testing should be initiated if NCC is suspected on clinical grounds, e.g. epileptic seizures in people coming from areas endemic for cysticercosis. In sub-Saharan Africa, due to the lack of diagnostic facilities, this is only possible in a minority of cases. The analysis of cerebrospinal fluid of patients with NCC may indicate parasitic disease or show mononuclear pleocytosis and eosinophilia, depending on disease activity and the location of lesions. CellPathogens and Global HealthVOL .NO .WinklerNeurocysticercosis in sub-Saharan Africacounts rarely exceed 100 cells/ml. Protein levels can be increased to within the range of 50?00 mg/dl, but glucose levels are usually normal.75 In addition to or instead of a standard analysis of cerebrospinal fluid, the diagnostic value of which is debatable and unremarkable in most cases, serological tests for T. solium cysticercosis should be performed in suspected cases. Antigen/antibody enzyme-linked immunosorbent assay (ELISA) and immunoblots in serum and/ or cerebrospinal fluid are available, whereby a positive antigen ELISA indicates active disease with viable cysticerci and a positive antibody ELISA and/ or immunoblot demonstrates exposure to the parasite, but not necessarily active disease.18,22,74,76?9 Also, a positive test only indicates cysticercosis but not necessarily NCC, and the sensitivity and specificity can vary considerably according to the test used.74,76 In addition, most of these tests are unavailable in sub-Saharan Africa, although the capacity has been transferred to some African centres.22 Furthermore, a DNA-based method of diagnosis of T. solium cysticercosis is under development. Preliminary results in cerebrospinal fluid indicate variable levels of sensitivity but 100 specificity.80,81 Again, these techniques, with highcost equipment, might not be available in African countries. Although positive serological and/or DNA-based tests may give the first indication, the gold standard of NCC diagnosis is neuroimaging, including cCT and/or cerebral magnetic resonance imaging, both of which are generally not available in sub-Saharan Africa. Serology may help in areas without CT scanners or may indicate who should go for cCT examination and thus save resources. A recent study from Tanzania indicated a sensitivity of 100 and a specificity of 84 for diagnosis of active NCC using T. solium cysticercosis antigen ELISA, whereas a study from South Africa demonstrated much lower sensitivity and specificity using the same T. solium cysticercosis antigen ELISA in a different study population.7,82 Neuroimaging not only is essential for confirmation of diagnosis, but also represents the only method that differentiates between active and inactive disease. Active NCC is defined as the presence of at least one NCC-like cystic lesion (a round shaped hypodensity on cCT with or without a hyperdense dot representing the head of the cysticercus (5scolex) usually no bigger than 1 cm in diameter and without perifocal inflammatory reaction (5oedema)) or at least one ring- or fully enhanci.
