One of the most well-characterized tests for diagnosing neurocysticercosis (NCC) is the enzyme-linked immunoelectrotransfer blot (EITB) assay developed at the CDC, which uses lentil lectin-bound glycoproteins (LLGP) extracted from Taenia solium cysticerci. Although the test is very reliable, the purification process for the LLGP antigens has been difficult to transfer to other laboratories because of the need for expensive equipment and technical expertise. To develop a simpler assay, we previously purified and cloned the diagnostic glycoproteins in the LLGP fraction. In this study, we evaluated three representative recombinant or synthetic antigens from the LLGP fraction, individually and in different combinations, using an immunoblot assay (recombinant EITB). Using a panel of 249 confirmed NCC-positive and 401 negative blood serum samples, the sensitivity of the recombinant EITB assay was determined to be 99% and the specificity was 99% for diagnosing NCC. We also tested a panel of 239 confirmed NCC-positive serum samples in Lima, Peru, and found similar results. Overall, our data show that the performance characteristics of the recombinant EITB assay are comparable to those of the LLGP-EITB assay. This new recombinant-and synthetic antigen-based assay is sustainable and can be easily transferred to other laboratories in the United States and throughout the world.T he diagnosis of neurocysticercosis (NCC), a condition caused by the larvae Taenia solium, is reliably established using results from both imaging and serological tests. The guidelines proposed for making a diagnosis of presumptive NCC (1, 2) define cases as definitive, probable, or possible based on computed tomography (CT) or magnetic resonance imaging (MRI) findings, exposure risk, and serological results. These guidelines specifically define the lentil lectin-bound glycoprotein enzyme-linked immunoelectrotransfer blot assay (LLGP-EITB) as the serological reference standard for diagnosing NCC (3).The LLGP-EITB assay is an immunoblot method that detects antibodies to one or more of seven lentil lectin-bound glycoproteins, which are present in the soluble fraction of an extract of T. solium cysts. In patients with multiple enhancing intracranial lesions, the LLGP-EITB assay is 100% specific and 95% sensitive using blood serum or cerebrospinal fluid (CSF) samples (3-6). The original study that described and evaluated the LLGP-EITB assay was performed using serum samples from biopsy-proven cases of NCC, most with multiple lesions, as detected by skeletal radiographs, and reported a sensitivity of 98% and a specificity of 100% (3). Continued monitoring of the test performance compared with clinical findings using newer imaging techniques, such as CT and MRI, revealed that the sensitivity of the assay was lower, between 50 to 80%, in cases with a single lesion or calcified cysts (6-10). The specificity of the LLGP-EITB assay has been remarkable at essentially 100%, with only rare anecdotal reports of falsepositive results (11)(12)(13).Although the LLGP-...

Taeniasis/cysticercosis caused by Taenia solium is a frequent parasitic infection of the human brain in most of the world. Rapid and simple screening tools to identify taeniasis and cysticercosis cases are needed for control programs, mostly to identify tapeworm carriers which are the source of infection and need to be treated, or as tools for point-of-care case detection or confirmation. These screening assays should be affordable, reliable, rapid, and easy to perform. Immunochromatographic tests meet these criteria. To demonstrate proof of principle, we developed and evaluated two magnetic immunochromatographic tests (MICTs) for detection of human Taenia solium taeniasis antibodies (ES33-MICT) and neurocysticercosis antibodies (T24-MICT). These assays detected stage-specific antibodies by using two recombinant proteins, rES33 for detection of taeniasis antibodies and rT24H for detection of cysticercosis antibodies. The sensitivity and specificity of the ES33-MICT to detect taeniasis infections were 94.5% and 96%, respectively, and those of the T24-MICT to detect cases of human cysticercosis with two or more viable brain cysts were 93.9% and 98.9%, respectively. These data provide proof of principle that the ES33-and T24-MICTs provide rapid and suitable methods to identify individuals with taeniasis and cysticercosis.