Identifying probable cases of neurocysticercosis at an urban community hospital in Los Angeles through active surveillance: A local application addressing the under-reporting of a WHO "major neglected disease"

Jennifer Garland RN, MSN, PHN, PhD (c.) Jennifer Bradbury RN, BSN, PHNUCLA School of Nursing

Results ConclusionBackground

Methods

Neurocysticercosis (NCC) is an infection of the central nervous system caused by the presence of larval stage, Taenia solium, the pork tapeworm. It is a major cause of worldwide epilepsy and disability.

Methods: A pilot study was conducted at a community hospital in urban Los Angeles utilizing active surveillance to identify probable cases of NCC (defined by Del Brutto, et al. 2001) by reviewing CT Brain scan reports and the corresponding medical records from January 1, 2012 to August 18, 2012.

Authors identified probable cases through verbage on CT Brain scan reports.

Examples:

“large calcification consistent with old cysticercosis”“probable old neurocysticercosis infection”“scattered calcifications consistent with old cycsticercosis”“punctuate calcifications consistent with neurocysticercosis”“muliple large calcifications indicating old cysticercosis infection”“scattered, punctuate calcifications consistent with neurocysticercosis”“calcified lesions indicating probable neurocysticercosis”-Plus other variations of these statements

All probable living cases were forwarded to the local county health department for follow up confirmation and contact testing.

191 probable neurocysticercosis cases were identified. All probable living cases were forwarded to the local county health department for follow up confirmation and contact testing

172 (90.05%) of identified cases were Hispanic

126 (65.97%) cases were born in Mexico

Only 14 (7.33%) of cases had a history of seizure activity

7 (4.19%) cases died while hospitalized

Neurocysticercosis is vastly under-reported given the large number of probable cases identified by the authors within the 8 month period. Ethnicity of probable cases was comparable to existing literature.

Presentation of seizure activity was significantly lower in identified hospital cases (7.33%) when compared to the literature (78.8%) (Carabin, et al. 2011).

Identifying barriers to reporting must be identified and implementing strategies to overcome these barriers and improve reporting must be initiated.

Anonymous (2011) Report of the WHO Expert Consultation on foodborne trematode infections and Taeniasis/Cysticercosis. Geneva: World Health Organization.

Carabin H, Ndimubanzi PC, Budke CM, Nguyen H, Qian Y, et al. (2011) Clinical Manifestations Associated with Neurocysticercosis: A Systematic Review. PLoS Negl Trop Dis 5(5): e1152. doi:10.1371/journal.pntd.0001152

Coyle CM, Mahanty S, Zunt JR, Wallin MT, Cantey PT, et al. (2012) Neurocysticercosis: neglected but not forgotten. PLoS Negl Trop Dis 6: e1500. doi:10.1371/journal.pntd.0001500.

Del Brutto OH. Diagnostic criteria for neurocysticercosis, revisited. Pathog Glob Health. 2012 Sep;106(5):299-304.

Del Brutto OH, et al. Proposed diagnostic criteria for neurocysticercosis. Neurology. 2001 Jul 24;57(2):177-83.

Doyle, et al. (2002). Completeness of Notifiable Infectious Disease Reporting in the United States:An Analytical Literature Review. American Journal of Epidemiology 155:866–74.

Serpa, JA & White, AC. (2012). Neurocysticercosis in the United States. Pathog Glob Health. Sep;106(5):256-60. doi: 10.1179/2047773212Y.0000000028.

Jennifer GarlandUCLA School of Nursing Box 951702 Los Angeles, CA 90095-1702jenngarl@ucla.edu

References

Contact Information

This infection is endemic in the developing world, however, due to immigration, is being increasingly identified in immigration hub areas of developed countries. NCC is associated with acquired seizure disorder, cognitive decline, and disability (Del Brutto, 2012).

The World Health Organization (WHO) has recently categorized NCC as one of several “major neglected diseases.”

-Neglected tropical diseases (NTDs) are a diverse group of infections which tend to affect the poorest of the poor

-Without something being done for the NTDs, Millenium Development Goals will not be attainable

-Endemic and neighboring countries should increase awareness about cysticercosis and put up effective surveillance and reporting systems(Doyle, et al. 2002).

Neurocysticercosis (NCC) Hispanic vs. Non-Hispanic

Hispanic (90.05%)Non-Hispanic (9.95%)

Neurocysticercosis (NCC) Born in Mexico vs. Other Countries

Mexico (65.97%)Other (34.03%)

Neurocysticercosis (NCC) History of Seizures vs. No History of Seizures

Seizures (7.33%)No Seizures (92.67%)

Neurocysticercosis (NCC) Died vs. Survived

Died (4.19%)Survived (95.81%)

Reproduced from: Del Brutto, 2012, with permission.

Reproduced from: Del Brutto, 2012, with permission.

The United States has seen a rise in the number of NCC cases largely due to the flood of immigrants from endemic to non-endemic areas and the improved access to neuroimaging (Serpa & White, 2012).

The authors noted that no cases of NCC at an urban community hospital were reported to the local health department, despite serving a largely Hispanic/Latino immigrant population, demonstrating a pervasive underreporting of disease.

Cysticercosis is a reportable disease in Los Angeles County [Title 17, California Code of Regulations (CCR), 2500]

In order to identify outbreaks and prevent transmission of communicable disease; timely notification of reportable diseases is critical

Reproduced from: Del Brutto, 2012, with permission

T. Solium egg

T. solium scolex