Evaluation of enzyme-linked immunosorbent assay in serological diagnosis of human neurocysticercosis using paired samples of serum and cerebrospinal fluid

, Cho, Seung Yull; , Kim, Suk Il; , Kang, Shin Yong; , Choi, Duck Young; , Suk, Jong Sik; , Choi, Kil Soo; , Ha, Young Soo; , Chung, Chin Sang; , Myung, Ho Jin

doi:1986.24.1.25

Korean J Parasito > Volume 24(1):1986 > Article

Original Article


Korean J Parasitol. 1986 Jun;24(1):25-41. English. Published online Mar 20, 1994. http://dx.doi.org/10.3347/kjp.1986.24.1.25
Copyright © 1986 by The Korean Society for Parasitology


Evaluation of enzyme-linked immunosorbent assay in serological diagnosis of human neurocysticercosis using paired samples of serum and cerebrospinal fluid
Seung-Yull Cho,¹Suk Il Kim,¹Shin Yong Kang,¹Duck Young Choi,²Jong Sik Suk,²Kil Soo Choi,³Young Soo Ha,⁴Chin Sang Chung,⁵ and Ho Jin Myung⁵
¹Department of Parasitology, College of Medicine, Chung-Ang University, Seoul 151, Korea.
²Department of Neurosurgery, College of Medicine, Chung-Ang University, Seoul 140, Korea.
³Department of Neurosurgery, College of Medicine, Seoul National University, Seoul 110, Korea.
⁴Department of Neurosurgery, St. Mary's Hospital, Catholic Medical College, Seoul 150, Korea.
⁵Department of Neurology, College of Medicine, Seoul National University, Seoul 110, Korea.


Abstract
The applicability of micro-ELISA was evaluatd in human neuro-cysticercosis using paired samples of serum and CSF. A total of 355 cases who were mostly neurologic patients was subjected. Cystic fluid of C. cellulosae was used as antigen in protein concentration of 2.5 µg/ml. Serum was diluted to 1:100 and CSF was undiluted in the assay for the specific IgG antibody level. The differential criterion of the positive reaction was the abs. of 0.18 in both samples. The results were summarized as follows: The overall sensitivity of the micro-ELISA in 71 confirmed neurocysticercosis was 90.1%; the sensitivity by serum was 77.5% and that by CSF was 83.1%. CSF was a more sensitive and valuable material. Most of the false negative cases of neuro-cysticercosis showed far lower level of abs. rather than marginal. The overall specificity of the micro-ELISA in 52 confirmed other neurologic diseases was 88.5% ; the specificities by serum and by CSF were 94.2% respectively. Cases of other neurologic diseases did not show false positive reactions in both samples. When serum was assayed, taeniasis(2/18), sparganosis(2/20), paragonimiasis(1/56), clonorchiasis(1/15) and fascioliasis(1/1) cases showed cross reactions. When CSF was assayed, 2 of 10 neuro-sparganosis showed cross reactions while none of 9 neuro-paragonimiasis showed it. Out of 71 confirmed neuro-cysticercosis cases, 6 and 11 showed cross reactions by serum and CSF to crude extract antigen of sparganum; but no case did show it to crude extract antigen of Paragonimus westermani. Ventricular CSF showed low or negative levels of IgG antibody than lumbar CSF unless the lesion was at the lateral ventricle itself. Out of 4 racemose cysticercosis cases, 3 showed positive reaction in serum while all of 3 examined CSF were positive. The above results indicated that the serological test for detecting the specific IgG antibody by micro-ELISA using paired samples of serum and CSF was very helpful for clinical differentiation of neuro-cysticercosis from neurologic diseases of other causes.

Figures


	Fig. 1 General scheme of grouping in the present study.


	Fig. 2 Results of preliminary observation for Cysticercus-specific IgG antibody level in serum of 13 clinically diagnosed neurocysticercosis and 70 cases of normal controls.


	Fig. 3 Ferquency distribution of 355 cases by the abs.(level of Cysticercus-specific IgG antibody) interval in serum and CSF.

Fig. 4
Distribution of the abs. (specific IgG antibody level) in serum and CSF in confirmed neurocysticercosis patients (Group I). Open circle (○) : Neurosurgery confirmed (Group Ia), Closed triangle (▼) : Subcutaneous nodule biopsy and brain CT positive (Group Ib). Closed circle(●) :Multiple low densities in brain CT (Group Ic). Transverse and vertical dotted lines at the abs. of 0.18 are positive criteria.


	Fig. 5 Distribution of the abs. (specific IgG antibody level) in serum and CSF in confirmed other neurologic diseases (Group II). Closed circle (●) : Surgically Diagnosed other neurologic diseases (Group IIa), Open Circle(○) : Medically diagnosed other neurologic diseases(Group IIb). Dotted lines at abs. of 0.18 are the differential criteria of the positive reaction.

Fig. 6
Distribution of the abs. in serum and CSF in the remaining cases (Group III). Closed circle(●) : Clinically diagnosed as neurocysticercosis by follow-up CT after praziquantel treatment. Closed triangle(▼) : Biopsy confirmed muscular cysticercosis without neurologic symptoms or with normal brain CT. Open Circle(○) : Not confirmed cases of neuro-cysticercosis or other neurologic diseases. Dotted lines are differential criteria of the positive reaction.

Fig. 7
Relations of the abs. in serum and CSF in other parasitic infections to Cysticercus and homologous antigens. Transverse line at abs. of 0.25 is the positive criterion of other parasitic infections. Vertical line at abs. of 0.18 is criterion for cysticercosis. Dotted oblique line is y=x. Open circle(○) : Abs. in serum of paragonimiasis cases. Open triangle (▵) : Abs. is CSF of paragonimiasis cases. Closed circle (●) : Abs. in serum of sparganosis cases. Closed chiasis cases. Inverted open triangle (▿) : Abs. in serum of taeniasis cases. Double circle (◎) : Abs. in a serum of fascioliasis.

Tables


	Table 1 The sensitivity of micro-ELISA in neuro-cysticercosis


	Table 2 The specificity of micro-ELISA in neuro-cysticercosis


	Table 3 Incidence of cross reactions in sera and CSF of other parasitic infections to Cysticercus antigen


	Table 4 Incidence of cross-reaction in 71 cases of neuro-cysticercosis(Group I) to Paragonimus and sparganum antigens


	Table 5 Results of serological tests in 4 racemose cysticercosis form the specific IgG antibody by micro-ELISA

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