Abstract
Recognition, diagnosis and quantification of human neurocysticercosis (NCC) cystic echinococcosis (CE) or alveolar echinococcosis (AE) is relatively difficult compared to most other parasitic helminth infections. Predominant location of larval cestode biomass in liver (CE, AE), lungs (CE), brain (NCC) or other tissue requires imaging (X-ray, ultrasound, CT, MRI) as the choice diagnostic approach 1. Variable availability of such techniques in endemic areas is a major problem for clinical and community studies. Immunoserological detection of specific antibodies is important for confirmation of a clinical diagnosis and for community screening and epidemiology, but importantly seropositives require follow-up. Correlation of antibody responses with active infection as well as with the natural history of larval cestodiasis requires elucidation . Community based studies to quantify human disease caused by these cestode zoonoses indicate the following optimal approaches: (1) CE — abdominal scan (liver, spleen, kidneys, peritoneal cavity) by portable ultrasound (US), serological testing (AgB-ELlSA, immunoblot) of image positives and of filter-paper blood spots for whole sample, X-ray and US follow-up of seropositives3; (2) AE — as above with US scan (liver) and serologic confirmation (EgCF/EmC/Em2-ELlSA, Em18/immunoblot), US follow-up of primary seropositives , (3) NCC serological screening (EITB/26KDa immunoblot), and clinical examination with neurological questionnaire, positives followed-up by brain CT scan In addition, KAP (knowledge, attitudes and practices) questionnaires should be used during community registration, together with veterinary public health considerations to ascertain risk factors. Clinical follow-up and treatment of confirmed cases of CE, AE or NCC should be part of any community study. Human prevalence data can be used to help initiate control programmes and provide baseline data. 1. Craig, P.s., Rogan, M.T., Allan, J.C. 1996. Adv. Parasitol 38, 169-250. 2. Daeki, A.O., Craig, P.S. and Shambesh, M.K. 2000. Ann. Trop. Med Parasit. 94, 319-328. 3. Cohen, H. et al. 1998. Am. J. Trop. Med Hyg. 59, 620-627. 4. Craig, P.S., Giraudoux, P. et al. 2000. Acta Trop. In press 5 Garcia-Noval J. et al. 1996. Am. J. Trop. Med. Hyg. 55, 282-289