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GENERAL INTRODUCTION
Taenia solium, Taenia saginata and Taenia saginata asiatica are important tapeworms causing taeniosis in man who is the definitive host for these cestodes, while cattle (T. saginata) and pigs (T. solium and T. s. asiatica) are the intermediate hosts, in which the metacestode larval stages (cysticerci) develop resulting in cysticercosis. Unlike T. saginata and T. s. asiatica, the metacestodes of T. solium can also infect man, who then acts as an accidental host and acquires human cysticercosis. Man acquires taeniosis following ingestion of undercooked meat contaminated with cysticerci. These develop into adult intestinal tapeworms which when mature release proglottids laden with eggs or just eggs in the faeces. The excreted eggs are immediately
infective to the intermediate host (Murrell, 2005).
The lodging of the metacestodes of T. solium in the brain results in neurocysticercosis (NCC), one of the most important neurological parasitoses in man and the main preventable cause of acquired epilepsy in endemic areas (Carabin et al., 2011). It is for this reason, that T. solium has a potentially higher public health impact than T. saginata, which mainly has economic implications (Gajadhar et al., 2006). Adult tapeworm infections are largely asymptomatic, though some people may experience abdominal discomfort, nausea, diarrhea and loss of appetite and in the case of T. saginata, itchiness of the anal area due to the actively migrating proglottids (Muller, 1975).
While T. saginata has a more cosmopolitan distribution, T. solium is mostly reported in developing countries of Africa, Asia and Latin America, and T. s. asiatica, also known as the Asian Taenia, is restricted to East Asian countries and has not been reported elsewhere in the world including Africa (Eom et al., 2009). T. solium endemicity in developing countries is reported to be associated with poverty, free ranging pigs and poor sanitary conditions especially lack of latrines (Phiri et al., 2003; Murrell, 2005; Sikasunge et al., 2007). Many reports have documented T. solium infection in pigs in Africa with prevalence rates as high as 64% (Dorny et al., 2004b). The cysticercosis/taeniosis disease complex remains a neglected tropical disease with very little information on the disease status in humans and, like many parasitic zoonoses, its true burden still needs to be determined (Carabin et al., 2005; Praet et al., 2009). The current global burden of T. solium cysticercosis in terms of Disability Adjusted Life Years (DALYs) has been estimated at 2-5 x 106, an estimate comparable to other neglected parasitic zoonoses but less than the “big three” global infectious diseases malaria, HIV and tuberculosis (Torgerson & Macpherson, 2011).
The estimated burden for cysticercosis could be an underestimate as the calculations are done based on the few available data. Although epidemiological studies have contributed to the growing body of evidence on endemicity in some countries such as Mexico (Flisser and Gyorkos, 2007), this has not been the case in many endemic countries such as those in sub-Saharan Africa. A lot of information is still urgently needed in terms of disease prevalence in humans, transmission dynamics in endemic populations and NCC related clinical symptoms (Praet et al., 2009). However, epidemiological and hospital based studies to provide such data require affordable, reliable and easy to apply diagnostic techniques which are currently insufficiently used in endemic countries.
CHAPTER 1 GENERAL INTRODUCTION .
CHAPTER 2 LITERATURE REVIEW
2.1 Introduction
2.2 History
2.3 Morphology of Taenia spp.
2.4 The importance of taeniosis and cysticercosis
2.5 Diagnosis .
2.6 Epidemiology and risk factors of T. solium infection
2.7 Treatment of taeniosis in humans and cysticercosis in humans and pigs
2.8 Prevention and control of taeniosis and cysticercosis
2.9 Justification for the study.
2.10 Aim and objectives
CHAPTER 3 Taenia solium infections in a rural area of eastern Zambia-A community based study
3.1 Introduction
3.2 Materials and methods
3.2.1 Study area and population.
3.2.2 Study design
3.3 Results
CHAPTER 4 The incidence of human cysticercosis in a rural community in Katete district of eastern Zambia
4.1 Introduction
4.2 Materials and methods
4.3 Results
4.4 Discussion.
CHAPTER 5 Study and ranking of determinants of Taenia solium infections by classification tree models
CHAPTER 6 Field evaluation of urine antigen detection for the diagnosis of Taenia solium cysticercosis
CHAPTER 7 Improving the diagnosis of taeniosis, a worldwide parasitic disease of public health and economic importance
CHAPTER 8 General discussion and conclusions
REFERENCES
