Urine Screening for Early Detection of Subarachnoid Neurocysticercosis

脑囊虫病（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。它是由猪带绦虫（猪肉绦虫）幼虫包囊引起的中枢神经感染。虽然大多数NCC病例具有相对良性的临床过程，但涉及蛛网膜下腔（SANCC）的感染预后很差。需要新的方法来改善这种毁灭性恶性感染患者的预后。一个有希望的办法是通过人口筛查进行早期发现，这将允许在感染负担较低和患者保持相对良好健康的情况下进行早期干预。我们最近开发了一种检测T。尿液中排泄的solium抗原，并且现在已经在试点研究中显示，该测定可用于在社区环境中检测患有SANCC的无症状患者。 在这个为期5年的项目中，我们将通过在北方秘鲁（30，000人）的大型横断面研究中应用新检测方法来验证该方法，使用脑磁共振成像（MRI）作为确诊的金标准。随后诊断为无症状SANCC和其他形式NCC的受试者将入组18个月的前瞻性观察队列，以确定疾病进展的风险。此外，我们将开发一个原型点的护理格式的测定和验证它与样本收集的社区。这些研究的结果将提供必要的信息和工具，以进行一项确定性的随机临床试验，评价筛查和早期干预作为改善SANCC患者临床结局的方法的疗效。我们还将为来自秘鲁北方地区的学生提供一系列教学和动手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.