Utility of cysticercus fasciolaris antigen in Dot ELISA for the diagnosis of neurocysticercosis

Background: Clinical diagnosis of neurocysticercosis (NC) is established by CT scan and MRI. However, absolute diagnosis is not possible in a fair number of cases, and serological assays are used as adjunct. Besides, CT scan and MR imaging are resource-intensive tests and not practical for screening in endemic areas. Aim: To provide a low-cost, efficient, and reproducible assay for the detection of antibodies against cysticerci. Hence we have attempted to standardize and evaluate the diagnostic utility of the cysticercus fasciolaris antigen in a Dot ELISA assay for diagnosis of NC. Setting and Design: Tertiary hospital-based, case-control series. Materials and Methods: Confirmed cases of NC diagnosed by presence of ring lesions in CT scan or MR imaging with presence of scolex were taken as positive controls (n = 50). Negative controls (n = 50) included subjects with normal CT scan studies (n = 30) and diseased controls with ring lesions in CT scan confirmed to be neurotuberculosis (n = 20). Dot ELISA was standardized and validated with commercially available ELISA (UBI, USA) using sera from the study groups. Statistical Analysis: Chi-square test was used to compare the immunodiagnostic performance of the two tests. P value less than .05 (P < 0.05) was considered significant. Results: The Dot ELISA had a sensitivity of 88% and specificity of 74% with a positive predictive value of 77.19% and negative predictive value of 81.06%. Likelihood ratios for a positive and a negative test were 3.4 and 0.2. The sensitivity and specificity of commercial ELISA were 92% and 84% respectively. Difference between the performances of the two tests was not significant statistically. Conclusions: Dot ELISA has sensitivity and specificity comparable to ELISA for the diagnosis of NC. The test is simpler, not requiring expertise and instrumentation. Further validation of the test as a screening tool is required.