Abstract
IntroductionNeurocysticercosis (NCC) is one of the leading causes of epilepsy worldwide. The majority of cases in Europe are diagnosed in immigrants. Currently in Italy, routine serological screening for cysticercosis is recommended for internationally adopted children (IAC) coming from endemic countries. Methods: We retrospectively analyse the results of the serological screening for cysticercosis in IAC 16 years old or younger, attending two Italian third level paediatric clinics in 2001–16. Results: Of 2,973 children included in the study, 2,437 (82.0%) were screened by enzyme-linked immune electro transfer blot (EITB), 1,534 (51.6%) by ELISA, and 998 (33.6%) by both tests. The seroprevalence of cysticercosis ranged between 1.7% and 8.9% according to EITB and ELISA, respectively. Overall, 13 children were diagnosed with NCC accounting for a NCC frequency of 0.4% (95% confidence interval (CI): 0.2–0.6%). Among the 168 seropositive children, only seven (4.2%) were diagnosed with NCC. Of these children, three were asymptomatic and four presented epilepsy. Among seronegative children (n = 2,805), seven presented with neurological symptoms that lead to the diagnosis of NCC in six cases. The sensitivity, specificity, positive and negative predictive value for the diagnosis of NCC were 54.5%, 98.6%, 14.6%, 99.8% for EITB and 22.2%, 91.1%, 1.4%, 99.5% for ELISA. The yield of the screening programme was 437 NCC cases per 100,000. The number needed to screen to detect one NCC case was 228. The cost per NCC case detected was EUR 10,372. Conclusion: On the base of our findings we suggest the ongoing serological screening for cysticercosis to be discontinued, at least in Italy, until further evidence in support will be available.
Highlights
Neurocysticercosis (NCC) is one of the leading causes of epilepsy worldwide
The present study reveals a substantial seroprevalence of cysticercosis in internationally adopted children (IAC) ranging between 1.7% and 8.9% depending on the test used (EITB and enzyme-linked immunosorbent assay (ELISA), respectively), while the frequency of NCC was 0.4%
This finding confirms that, even if cysticerocosis/T. solium taeniasis has been considered for a long time endemic mainly in Latin America and South-East Asia, the disease is present in large areas of Sub-Saharan Africa, as suggested by accumulating evidence [4,34]
Summary
Neurocysticercosis (NCC) is one of the leading causes of epilepsy worldwide. The majority of cases in Europe are diagnosed in immigrants. In Italy, routine serological screening for cysticercosis is recommended for internationally adopted children (IAC) coming from endemic countries. Among the 168 seropositive children, only seven (4.2%) were diagnosed with NCC. Of these children, three were asymptomatic and four presented epilepsy. Among seronegative children (n = 2,805), seven presented with neurological symptoms that lead to the diagnosis of NCC in six cases. The number needed to screen to detect one NCC case was 228. The central nervous system is the most clinically relevant localisation of the parasite, which in this case causes neurocysticercosis (NCC) [1]. In Western Europe, according to the latest systematic review available, only 275 cases of cysticercosis were reported in the period 1990–2015, of whom only 5% were suspected to be autochthonous [5]
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