Diagnostic Performance of a Multiantigen Print ImmunoAssay (MAPIA) for Antibody Detection in Human Neurocysticercosis

Neurocysticercosis (NCC) is the most prevalent helminth infection affecting the human central nervous system. Although neuroimaging is required for definitive diagnosis, serology supports case confirmation and clarifies diagnostic doubts. Serology gold standard is antibody detection using the enzyme-linked immunoelectrotransfer blot assay, which uses 7 antigenic lentil-lectin purified parasite glycoproteins (LLGP-EITB). LLGP-EITB is poorly accessible to low-resource settings due to its technical complexity and costs, and it is inaccessible in many settings in which parasitic material to produce antigens is not readily available. We recently developed a 3-antigen multiantigen print immunoassay (MAPIA) based on recombinant/synthetic antigens (rGP50, rT24H, and sTs14), corresponding to the 3 principal diagnostics antigenic families from LLGP-EITB, that is simpler and does not require parasite-derived materials.

MAPIA performance was evaluated using a well-defined set of serum samples from NCC patients confirmed by imaging, including 73 samples from subarachnoid NCC, 72 with >5 parenchymal cysts, 59 with 3-5 parenchymal cysts, 95 with 1-2 parenchymal cysts, and 77 healthy negative controls and compared it with the LLGP-EITB performance.

Overall, our MAPIA presented a sensitivity of 97.7% and a specificity of 97.4%. Subgroup analyses by NCC type demonstrated a sensitivity of 100% for subarachnoid and parenchymal NCC with >5 cysts and a slight decrease for the groups with 3-5 cysts (96.6%) and 1-2 cysts (94.7%). Observed agreement with the LLGP-EITB assay was 98.33%.

Our 3-antigen MAPIA obtained comparable results to LLGP-EITB and emerges as a simpler, reproducible, and easy-access alternative tool for antibody diagnosis in NCC.