Cysticercosis in Peace Corps Volunteers in Madagascar
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《新英格兰医药杂志》
To the Editor: Cysticercosis is a tissue infection with the larval stage (cysticercus) of the tapeworm Taenia solium. Neurocysticercosis is considered to be the most common parasitic disease of the central nervous system and the main cause of late-onset epilepsy in areas where the infection is endemic.1 Cases of neurocysticercosis are increasingly being reported in the United States.2 Improved diagnostic techniques and immigration from areas where the infection is endemic are factors that have contributed to this increase, but also frequently reported cases among travelers suggest that this is a group at particular risk for cysticercosis.3 Neurocysticercosis is diagnosed on the basis of neuroimaging, either computed tomographic (CT) scanning or magnetic resonance imaging (MRI), and serologic testing by means of an enzyme-linked immunoelectrotransfer blot (EITB) assay with purified glycoprotein antigens.4
Cysticercosis is endemic in Madagascar, where U.S. Peace Corps volunteers live and work under the same conditions as the local population. We determined whether Peace Corps volunteers in Madagascar are at risk for contracting cysticercosis. Testing was performed with the use of an EITB assay as part of the physical-examination protocol at the end of two years of service. Oral informed consent was obtained from each Peace Corps volunteer before testing. Stool samples from three consecutive days were also examined for ova and parasites.
Of 73 Peace Corps volunteers (median age, 24 years) who underwent EITB serologic testing between February 2001 and January 2002, 6 (8.2 percent) were positive for the 50-kD band, and of these 6, 1 was also positive for the 24-kD band. None of the six subjects had been traveling outside the United States before they went to Madagascar to serve as Peace Corps volunteers. Although they were asymptomatic at the time of the serologic test, each of them was offered a complete neurologic examination, including cerebral CT or MRI scanning, on return to the United States three to six months after being tested. In one of the six Peace Corps volunteers, two intraparenchymal noncalcified cysts were detected in the frontal cerebral lobe, and this person was treated with a prophylactic course of albendazole. Examination of the other five Peace Corps volunteers did not reveal any abnormalities. Proglottids or eggs were not detected in any of the stool specimens from the 73 volunteers.
Our findings demonstrate that Peace Corps volunteers serving in Madagascar are at risk for contracting cysticercosis. The risk is plausibly associated with the status of the volunteers as long-term residents in a region where cysticercosis is endemic. We suggest that screening for cysticercosis be routinely performed in Peace Corps volunteers and long-term travelers returning from areas where the infection is endemic and in immigrants from such areas.
Peter Leutscher, M.D., Ph.D., D.T.M.H.
Abel Andriantsimahavandy, M.D., Ph.D.
Pasteur Institute
Antananarivo 101, Madagascar
References
Garcia HH, Gonzalez AE, Evans CAW. Taenia solium cysticercosis. Lancet 2003;362:547-556.
Ong S, Talan DA, Moran GJ, et al. Neurocysticercosis in radiographically imaged seizure patients in U.S. emergency departments. Emerg Infect Dis 2002;8:608-613.
Chatel G, Gulletta M, Scolari C, et al. Neurocysticercosis in an Italian traveler to Latin America. Am J Trop Med Hyg 1999;60:255-256.
Wilkins PP, Wilson M, Allan JC, Tsang VCW. Taenium solium cysticercosis: immunodiagnosis of neurocysticercosis and taeniasis. In: Singh G, Prabhakar S, eds. Taenia solium cysticercosis: from basic to clinical science. Wallingford, England: CABI Publishing, 2002:329-41.
Cysticercosis is endemic in Madagascar, where U.S. Peace Corps volunteers live and work under the same conditions as the local population. We determined whether Peace Corps volunteers in Madagascar are at risk for contracting cysticercosis. Testing was performed with the use of an EITB assay as part of the physical-examination protocol at the end of two years of service. Oral informed consent was obtained from each Peace Corps volunteer before testing. Stool samples from three consecutive days were also examined for ova and parasites.
Of 73 Peace Corps volunteers (median age, 24 years) who underwent EITB serologic testing between February 2001 and January 2002, 6 (8.2 percent) were positive for the 50-kD band, and of these 6, 1 was also positive for the 24-kD band. None of the six subjects had been traveling outside the United States before they went to Madagascar to serve as Peace Corps volunteers. Although they were asymptomatic at the time of the serologic test, each of them was offered a complete neurologic examination, including cerebral CT or MRI scanning, on return to the United States three to six months after being tested. In one of the six Peace Corps volunteers, two intraparenchymal noncalcified cysts were detected in the frontal cerebral lobe, and this person was treated with a prophylactic course of albendazole. Examination of the other five Peace Corps volunteers did not reveal any abnormalities. Proglottids or eggs were not detected in any of the stool specimens from the 73 volunteers.
Our findings demonstrate that Peace Corps volunteers serving in Madagascar are at risk for contracting cysticercosis. The risk is plausibly associated with the status of the volunteers as long-term residents in a region where cysticercosis is endemic. We suggest that screening for cysticercosis be routinely performed in Peace Corps volunteers and long-term travelers returning from areas where the infection is endemic and in immigrants from such areas.
Peter Leutscher, M.D., Ph.D., D.T.M.H.
Abel Andriantsimahavandy, M.D., Ph.D.
Pasteur Institute
Antananarivo 101, Madagascar
References
Garcia HH, Gonzalez AE, Evans CAW. Taenia solium cysticercosis. Lancet 2003;362:547-556.
Ong S, Talan DA, Moran GJ, et al. Neurocysticercosis in radiographically imaged seizure patients in U.S. emergency departments. Emerg Infect Dis 2002;8:608-613.
Chatel G, Gulletta M, Scolari C, et al. Neurocysticercosis in an Italian traveler to Latin America. Am J Trop Med Hyg 1999;60:255-256.
Wilkins PP, Wilson M, Allan JC, Tsang VCW. Taenium solium cysticercosis: immunodiagnosis of neurocysticercosis and taeniasis. In: Singh G, Prabhakar S, eds. Taenia solium cysticercosis: from basic to clinical science. Wallingford, England: CABI Publishing, 2002:329-41.