Abstract
A high epilepsy prevalence has been reported in onchocerciasis meso- and hyper-endemic regions in sub-Saharan Africa, including in the Democratic Republic of Congo (DRC). We investigated whether onchocerciasis-associated epilepsy can also be suspected in onchocerciasis hypo-endemic regions. Stored serum samples from 342 patients admitted with recent onset neurological symptoms admitted to Mosango general hospital, in the Kwilu province, DRC, between 2012 and 2015 were screened for onchocerciasis (OV16) antibodies by ELISA and Taenia solium antigen (using an in-house B158/B60 antigen test). Eighty-one (23.7%; 95% CI 19.5–28.5%) of these samples were positive for OV16 antibodies and 43/340 (12.6%; 95% CI 9.5–16.6%) were positive for T. solium antigen. Of the 58 persons clinically diagnosed with late onset epilepsy of unknown etiology, 19 (32.8%) were OV16 positive and nine (16%) T. solium antigen positive. In total, 16 persons with epilepsy were OV16 positive and T. solium negative, of whom 12 (75%) were between the ages seven to 31 years old, an age rage in which onchocerciasis-associated epilepsy is observed. Our study suggests that in onchocerciasis hypo-endemic areas, in T. solium antigen negative persons with epilepsy, onchocerciasis should be considered as a potential trigger of epilepsy.
Highlights
Neurological disorders in low and middle income countries have a variety of causes, including various infectious diseases [1,2]
Eighty-one (23.7%; 95% CI 19.5–28.5%) of these samples were positive for the presence of OV16 antibodies and 43/340 (12.6%; 95% CI 9.3–16.7%) were positive for T. solium antigen
This study among patients with neurological disorders enrolled at the Mosango hospital, a rural hospital located in an onchocerciasis hypo-endemic area of the Democratic Republic of Congo (DRC), revealed that 23.7% were OV16 enzyme-linked immunosorbent assay (ELISA) test positive, with no other evidence of infectious etiologies including cysticercosis
Summary
Neurological disorders in low and middle income countries have a variety of causes, including various infectious diseases [1,2] Many of these diseases, such as cerebral malaria, bacterial meningitis, and human African trypanosomiasis (HAT) are treatable when the correct diagnosis is made in time [1,2]. The latter remains challenging in the rural settings where these diseases are most prevalent, especially in the early stages where most people have nonspecific symptoms and advanced diagnostic tools are absent. Patients above five years old who were admitted to the hospital with recent-onset neurological symptoms were recruited [3]. In a post-hoc study using the stored samples of these neurological patients, we determined the presence of Taenia solium antigens and found 12.6% positivity in the whole neurological cohort and 16% positivity in the subset with clinical diagnosis of epilepsy [4]
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