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Improved diagnosis of viable parenchymal neurocysticercosis by combining antibody banding patterns on enzyme-linked immunoelectrotransfer blot (EITB) with antigen ELISA assay.

  • Arroyo, Gianfranco1, 2
  • Bustos, Javier A1, 2
  • Lescano, Andres G1
  • Gonzales, Isidro2
  • Saavedra, Herbert2
  • Pretell, E Javier3
  • Castillo, Yesenia1
  • Perez, Erika2
  • Handali, Sukwan4
  • Noh, John4
  • Dorny, Pierre5
  • Gilman, Robert H6
  • O'Neal, Seth1, 7
  • Gonzalez, Armando8
  • Garcia, Hector1, 2
  • 1 Center for Global Health, Universidad Peruana Cayetano Heredia, Lima, Peru. , (Peru)
  • 2 Cysticercosis Unit, Instituto Nacional de Ciencias Neurologicas, Lima, Peru. , (Peru)
  • 3 Department of Neurology, Hospital Nacional Alberto Sabogal, Callao, Peru. , (Peru)
  • 4 Centers for Disease Control and Prevention, Atlanta, Georgia, USA. , (Georgia)
  • 5 Department of Biomedical Sciences, Institute of Tropical Medicine, Antwerp, Belgium. , (Belgium)
  • 6 Department of International Health, Bloomberg School of Public Health, Johns Hopkins University, Baltimore, Maryland, USA.
  • 7 School of Public Health, Oregon Health & Science University-Portland State University, Portland, Oregon, USA.
  • 8 School of Veterinary Medicine, Universidad Nacional Mayor de San Marcos, Lima, Peru. , (Peru)
Published Article
Journal of Clinical Microbiology
American Society for Microbiology
Publication Date
Dec 01, 2021
DOI: 10.1128/JCM.01550-21
PMID: 34851685


The diagnosis of NCC depends on neuroimaging and serological confirmation. While antibody detection by enzyme-linked immunoelectrotransfer blot (EITB) fails to predict viable NCC, EITB banding patterns provide information about the host's infection course. Adding antigen ELISA results on EITB banding patterns may improve their ability to predict or rule out of viable NCC. We assessed whether combining EITB banding patterns with Ag-ELISA improves discrimination of viable infection in imaging-confirmed parenchymal NCC. EITB banding patterns were grouped into classes using latent class analysis. True-positive and false-negative Ag-ELISA results in each class were compared using Fisher's exact test. Four classes were identified: 1 (EITB-negative or positive to GP50 alone [GP50 antigen family]), 2 (positive to GP42-39 and GP24 [T24/42 family], with or without GP50), 3 and 4 (positive to GP50, GP42-39 and GP24, and reacting to bands in the 8-kDa family). Most cases in classes 3 and 4 had viable NCC (82% and 88%) compared to classes 2 and 1 (53% and 5%). Adding positive Ag-ELISA results to class 2 predicted all viable NCC cases (22/22 [100%]), whereas 11/40 patients (27.5%) Ag-ELISA negative had viable NCC (P < 0.001). Only 1/4 patients (25%) Ag-ELISA positive in class 1 had viable NCC, whereas 1/36 patients (2.8%) Ag-ELISA negative had viable NCC (P = 0.192). In classes 3 and 4, adding Ag-ELISA was not contributory. Combining Ag-ELISA with EITB banding patterns improves discrimination of viable from non-viable NCC, particularly for class-2 responses. Together, these complement neuroimaging more appropriately for the diagnosis of viable NCC.

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