Urine Screening for Early Detection of Subarachnoid Neurocysticercosis

神经囊虫病(NCC)是一种常见的神经系统疾病，也是发展中国家可预防癫痫的主要原因。它是由中枢神经感染猪带绦虫(猪带虫)幼虫包囊引起的。虽然大多数NCC的临床病程相对良性，但蛛网膜下腔感染(SANCC)的预后是严峻的。需要新的方法来改善这种毁灭性的恶性感染患者的预后。一种有希望的方法是通过人群筛查进行早期检测，这将允许在感染负担较低且患者保持相对良好的健康的情况下进行早期干预。我们最近开发了一种检测尿液中排出的沙门氏菌抗原的方法，现在在试点研究中表明，这种方法可以用于在社区环境中检测无症状的SANCC患者。 -- 在这个为期5年的项目中，我们将在秘鲁北部(30,000人)进行一项大型横断面研究，以脑部磁共振成像(MRI)作为确认诊断的金标准，从而验证新的检测方法。随后被诊断为无症状SANCC和其他形式的NCC的参与者将参加为期18个月的前瞻性观察队列，以确定疾病进展的风险。此外，我们将开发该检测的原型护理点格式，并使用从社区收集的样本进行验证。这些研究的结果将提供必要的信息和工具，以进行明确的随机临床试验，评估筛查和早期干预作为改善SANCC患者临床结果的方法的有效性。我们还将为来自秘鲁北部地区的学生提供一系列教学和动手的实验室和临床研究培训机会。

Neurocysticercosis (NCC) is a common neurologic disease and a leading cause of preventable epilepsy across the developing world. It is caused by central nervous infection with Taenia solium (the pork tapeworm) larval cysts. While most cases of NCC have a relatively benign clinical course, the prognosis is grim for infections involving the subarachnoid space (SANCC). New approaches are needed to improve outcomes for patients with this devastating malignant form of infection. One promising approach involves early detection through population screening, which would allow early intervention while the burden of infection is low and while the patient retains relatively good health. We recently developed an assay that detects T. solium antigens excreted in the urine, and have now shown in pilot studies that this assay can be used to detect asymptomatic people with SANCC in the community setting.    In this 5-year project we will validate the new assay by applying it in a large cross-sectional study in northern Peru (30,000), using magnetic resonance imaging (MRI) of the brain as the gold standard to confirm diagnosis. Participants subsequently diagnosed with asymptomatic SANCC, and other forms on NCC, will be enrolled in an 18-month prospective observational cohort to determine risk of disease progression. Furthermore, we will develop a prototype point-of-care format of the assay and validate it with samples gathered from the community. The results of these studies will provide information and tools necessary to conduct a definitive randomized clinical trial evaluating the efficacy of screening and early intervention as an approach to improve clinical outcomes of patients with SANCC. We will also provide a series of didactic and hands-on laboratory and clinical research training opportunities for students from northern regions of Peru.