A Large Case Series of Neurocysticercosis in Kuwait, a Nonendemic Arabian Gulf Country in the Middle East Region.

Jamshaid Iqbal,Mohammad Al-Awadhi,Fatima AlFarsi,Abdullah Y. Abdulrasoul,Amir Masud,Khalifa Albenwan,Zainab Mohsin,Nadia Alenezi,Suhail Ahmad

doi:10.3390/microorganisms9061221

Abstract

Neurocysticercosis (NCC), a leading global cause of severe progressive headache and epilepsy, in developed or affluent countries is mostly diagnosed among immigrants from poor or developing Taenia solium taeniasis-endemic countries. Taeniasis carriers in Kuwait are routinely screened by insensitive stool microscopy. In this study, enzyme-linked immunoelectrotransfer blot (EITB) was used as a confirmatory test for NCC. Screening was performed on 970 patients referred for suspected NCC on the basis of relevant history and/or ring-enhancing lesions on computed tomography and/or magnetic resonance imaging during a 14-year period in Kuwait. Demographic data and clinical details were retrieved from laboratory or hospital records. EITB was positive in 150 subjects (15.5%), including 98 expatriates mostly originating from taeniasis-endemic countries and, surprisingly, 52 Kuwaiti nationals. The clinical details of 48 of 50 NCC cases diagnosed during 2014–2019 were available. Most common symptoms included seizures, persistent headache with/without fever, and fits or loss of consciousness. Cysticercal lesions were located at various brain regions in 39 of 48 patients. Multiple members of 3 families with NCC were identified; infection was linked to domestic workers from taeniasis-endemic countries and confirmed in at least 1 family. Our data show that NCC is predominantly imported in Kuwait by expatriates originating from taeniasis-endemic countries who transmit the infection to Kuwaiti citizens.

Highlights

IntroductionThe ingestion of larval cysts of Taenia solium by human subjects in undercooked pork causes taeniasis, a mild intestinal infection
Introduction published maps and institutional affilThe ingestion of larval cysts of Taenia solium by human subjects in undercooked pork causes taeniasis, a mild intestinal infection
An easier and rapid ELISA, and a more specific and reliable enzyme-linked immunoelectrotransfer blot (EITB) assay (QualiCodeTM Cysticercosis Immunoblot Kit, Immunetics Inc., Boston, MA, USA manufactured under license from the U.S Government) that uses sera obtained from patients with a clinically diagnosed active disease were developed as screening tests for NCC [22,40]

Summary

Introduction

The ingestion of larval cysts of Taenia solium by human subjects in undercooked pork causes taeniasis, a mild intestinal infection. The ingestion of food or drinks contaminated with human fecal material from T. solium taeniasis patients or carriers containing parasite eggs leads to the development of cysts in different body tissue types in the recipients (cysticercosis) or to cyst development in the central nervous system (neurocysticercosis) [1,2]. Cestode T. solium is responsible for a considerable cross-sectoral health and economic burden due to human NCC and porcine cysticercosis. Organization (WHO) estimates, T. solium is recognized as a leading cause of death from a foodborne disease that causes the loss of nearly 2.8 million disability-adjusted life-years (DALYs) and is responsible for 2.56–8.30 million global NCC cases [3]. It is estimated that 80% of the world’s 50 million cysticercosis cases live in poor, developing countries.

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