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Specific protein recognition by
EITB

Evaluating the scenario against SA, 9 out of the 26
epileptic patients revealed positivity in EITB against scolex antigen (SA) with
lower molecular range bands (13-50 kDa), medium range bands (50-100 kDa) and
higher molecular weight bands (>100 kDa) in 8, 2 and 1 patients respectively
(some showed multiple bands) (figure 4). Out of 9 EITB positive patients
against SA, six patients had calcified granular lesions and two patients had
shown ring enhancing lesion on brain imaging (CT/MRI). The exhibition of
positive EITB against SA was noted more among vegetarian than non-vegetarian
patients (Data not shown).

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Against the ESA, of the 26 epileptic patients, 7
patients revealed positivity in EITB  with lower molecular range bands (13-50 kDa),
medium range bands (50-100 kDa) and higher molecular weight bands (>100 kDa)
in 2, 5 and 3 patients respectively (some showed multiple bands)  (figure 4). Out of these seven EITB positive
patients against ESA, five had shown calcified granular lesions and two ring
enhancing lesions on brain imaging (CT/MRI). With respect to food habits the exhibition
of positive EITB against ESA was noted equally among vegetarian and
non-vegetarian patients (Data not shown).

The EITB exhibition against membrane body antigen
(MBA) revealed 9 patients to be positive with lower molecular range bands
(13-50 kDa), medium range bands (50-100 kDa) in 4 and 6 patients respectively
(some showed multiple bands). However, higher molecular weight bands (100 kDa
above) were not recognized in any of the patients (figure 4). Out of these 9
EITB positive patients against MBA, five had calcified granular lesions and
three had shown ring enhancing lesions on brain imaging (CT/MRI). With respect
to food habits the exhibition of positive EITB against MBA was noted mostly
among vegetarian patients (Data not shown).

None of the negative controls showed any
immunodominant bands against any of the antigens. The
lower and medium molecular weight bands were found to be more immunodominant
and more frequently recognized against the antigens among epileptic patients
(figure 5).

Correlation between ELISA results
and immunodominant bands in EITB

Out
of 26 epileptic patients included in this study, 10, 8 and 4 patients showed
ELISA positivity while 9, 7 and 9 patients showed EITB positivity against SA,
ESA and MBA respectively. Out of these, 7, 6 and 4 patients exhibited good
correlation with those of the ELISA and EITB results for SA, ESA and MBA
respectively (table 6).

Efficacy of PCR in diagnosis of
cysticercosis

In
general, the molecular assays like PCR have been stated to have good
specificity for detection of diseases. Based on the literatures available, it
seems to be the first attempt for evaluation of blood samples for detection of
neurocysticercosis in epileptic patients by PCR targeting large subunit rRNA gene of Taenia
solium. Out of 26 human epileptic patients’ samples, seven samples revealed
specific amplification product (286 bp) upon electrophoresis in 1.5% agarose
(figure 6).

Comparative efficacy of the three
diagnostic tests

Of
the 26 epileptic patients, 5 samples were positive for all the three diagnostic
tests i.e. ELISA, EITB and PCR. Different combination of results among the
three diagnostic tests employed in this study can be summarized in the table 7.

Discussion

            The mean age group of the patients
in our study (26.84 ± 11.62 years) was lower than the participants studied by different
researchers (Kirmani et al., 2016;
Mwanjali et al., 2013; Mwape
et al., 2013; Mwang’onde
et al., 2012) where the
mean age group was around 35 years. Majority (73.07%) of the patients recruited
in our study were males. A higher percentage of male patients in the study were
also found in the study conducted by Mwanjali et al. (2013), Mwang’onde et al. (2012).

Most
cases from the Indian subcontinent present with single degenerating lesions
(Singh, 1997; Prasad et al., 2008)
which supports our findings in this study. Seizure is the commonest clinical
picture observed in all the cases in this study. NCC is considered the major
cause of adult onset seizures worldwide (Garcia et al., 2014). Seizures were reported in the range of 62.5-100% in
clinically and radiologically positive NCC patients from different sates of
India (Singhi et al., 2000; Varma et
al. 2002; Kotokey et al., 2006; Atluri et al., 2009; Sahu et al., 2009). In this study, 50% of the patients showed calcified
granular lesions and 23.07% showed ring enhancing lesions in CT/MRI. Most cases
of human infection in population-based studies correspond to calcified lesions
(Garcia et al., 2014). Viable
infections are associated with a higher likelihood of symptoms and more severe
disease (Del Brutto and Garcia, 2014).

The
exhibition of seropositivity was found to be more among patients with
vegetarian food habit in our study. Vegetarians in India have been found to be
at high risk of infection from tapeworm infected food preparers (Rajshekar et
al., 2003).

The observations on 38.46%
seroprevalence by SA as evaluated in the present study was found to be much on
lower side when compared with Shukla
et al. (2008) who reported 88% positivity
by SA while working on 50 confirmed NCC patients at Lucknow as well as with
Nascimento et al. (1987) and Yong et al. (1993) who detected 91% and 82.1%
seropositivity  respectively among NCC
patients. The variation might be contributed to the fact that the cases
included in their studies were confirmed cases of NCC as against the suspected
in the present investigation. 

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