Serological ecreening for cysticercosis

NeTropical Medicine and International Health volume 7 no 6 pp 532–538 june 2002

Serological screening for cysticercosis in mentally altered individuals
´ ´ Fernando Sanzon1, Ana M. Osorio2, Jose P. Morales2, Rodrigo Isaza3, Edgar Cardona3, Luis C. Moncayo4, ´ez ´ Guido E. Villota1, Olga T. Zapata5, Carlos A. Palacio5,6, Marıa P. Arbela 5 and Blanca I. Restrepo7
1 2 3 4 5 6 7 Universidad deNarin Centro de Estudios en Salud, San Juan de Pasto, Colombia ˜o, School of Medicine, Universidad Pontificia Bolivariana, Medellı´n, Colombia Neurology Service, Hospital Pablo Tobo Uribe, Medellı´n, Colombia ´n San Pedro and Perpetuo Socorro Mental Hospitals, San Juan de Pasto-Narin Colombia ˜o, Universidad de Antioquia, Medellı´n, Colombia Hospital Universitario San Vicente de Paul, ColombiaMolecular Parasitology Group, Corporacio para Investigaciones Biolo ´n ´gicas, Medellı´n, Colombia

Summary

The parasitic infection neurocysticercosis may give rise to a variety of psychiatric manifestations that resemble, but are different from, primary psychiatric disorders. The aim of this study was to determine if among individuals from a neurocysticercosis-endemic area of Colombia whoapparently had a psychiatric manifestation with associated neurological finding (‘cases’), some could have been infected with Taenia solium cysticerci. This case–control study was done in individuals hospitalized in two mental institutions. The control-1 individuals were those classified with primary psychiatric disease, and the control-2 group consisted of healthy, non-hospitalized individuals. Aserological test for cysticercosis was positive in 5/96 (5.1%) cases, 4/153 (2.6%) psychiatric controls, and 5/246 (2%) healthy controls. The data analysis indicated a weak association between the cases and a positive serology for neurocysticercosis (odds ratio > 2; P > 0.05). The lower education level of the cases influenced this association. keywords neurocysticercosis, psychosis, seizures, serology,mental alteration, education level, psychiatric correspondence Blanca Restrepo, UT Houston-School of Public Health-Brownsville Campus, The University of Texas at Brownsville, 80 Ft. Brown SPH 2nd Floor Rm. 2.202B, Brownsville, TX 78520, USA. E-mail: blancos@sc2000.net

Introduction Cysticercosis (CC) is caused by the metacestode stage or cysticercus of the parasite Taenia solium in humans and pigs.In humans, the central nervous system infection of the metacestode is referred to as neurocysticercosis (NCC), while the intestinal infection with the adult T. solium is known as taeniosis. This fecal–oral infection is transmitted between humans by free ranging pigs are raised under inadequate sanitary conditions (Flisser et al. 1982). NCC occurs primarily in the developing countries of LatinAmerica (including Colombia), Africa and Asia. It causes an estimated 50 000 deaths per year, and leaves many of the surviving patients permanently disabled by recurrent

seizures or other neurological damage (Schantz 1999). The clinical spectrum of NCC can range from asymptomatic (up to 44%) to life threatening (Botero et al. 1993). The most common clinical manifestations are late onset seizures,signs and symptoms associated with increased intracerebral pressure, focal neurological findings (e.g. aphasia, visual loss), chronic meningitis and altered mental state (Shriqui & Milette 1992; Botero et al. 1993; Forlenza et al. 1997). The latter category affects 9–65% of NCC patients, depending on the literature cited, with the most frequent manifestations being dementia and confusion (Botero1994; Sotelo et al. 1996; Forlenza et al. 1997). In Brazil, Forlenza and collaborators found a

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Ó 2002 Blackwell Science Ltd

Tropical Medicine and International Health F. Sanzon et al. Cysticercosis serology and mental alterations ´

volume 7 no 6 pp 532–538 june 2002

variety of psychiatric manifestations that included affective disorders, chronic psychosis, neurotic alterations,...