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CC BY-NC-ND 4.0 · Arq Neuropsiquiatr 2022; 80(03): 248-254
DOI: 10.1590/0004-282X-ANP-2021-0001
Article

Mortality associated with cysticercosis in a historical cohort from Britain

Mortalidade associada à cisticercose em uma coorte histórica da Grã-Bretanha

Authors

  • Gagandeep Singh 

    1   Dayanand Medical College, Department of Neurology, Ludhiana, India.
    2   University College London, Hospitals Biomedical Research Centre, Queen Square Institute of Neurology, London, WC1N 3BG, UK.

  • Peter Chiodini 

    3   Hospital for Tropical Diseases and London School of Hygiene and Tropical Medicine, Department of Clinical Parasitology, London, UK.

  • Josemir W. Sander 

    2   University College London, Hospitals Biomedical Research Centre, Queen Square Institute of Neurology, London, WC1N 3BG, UK.
    4   Chalfont Centre for Epilepsy, Chalfont St Peter, United Kingdom.
    5   Stichting Epilepsie Instellingen Nederland, Heemstede, Netherlands.
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ABSTRACT

Background: The burden of premature mortality associated with human cysticercosis is largely ignored mainly due to poor record-keeping in Taenia solium endemic regions. Objective: To document mortality and survival characteristics of an historical cohort with cysticercosis. Methods: The years of onset of symptoms and death untill 1957 were extracted from published reports of a British military cohort (n=450) examined in London in the early twentieth century. Data were entered into a Kaplan Meier survival analysis with the presence (or absence) of clinical manifestations as independent variables, which were then fitted into a Cox proportional hazards model to determine their significance. Results: Cysticercosis was responsible for 24 (52.2%) of 46 deaths in the first 15 years of follow-up in comparison to 7 (19.4%) of 36 deaths in the 20-40 years of follow-up period. In the univariate and Cox analyses, intracranial hypertension (hazard ratio [HR]: 8.26; CI: 4.71, 14.49), ocular cysticercosis (HR: 6.60; CI: 3.04, 14.33), and mental disorder (HR: 3.98; CI: 2.22, 7.13) but not epilepsy (HR: 0.66; CI: 0.20, 2.18) were associated with mortality. Over half of all deaths in the first 15 years of follow-up were attributed to cysticercosis. Conclusions: Several deaths occurred early after acquiring cysticercotic infection. Intracranial hypertension, ocular cysticercosis, and mental disorder but not epilepsy were predictors of mortality in this cohort.

RESUMO

Antecedentes: O fardo da mortalidade prematura associada à cisticercose humana é amplamente ignorado, principalmente devido à má manutenção de registros nas regiões endêmicas de Taenia solium. Objetivo: Documentar as características de mortalidade e sobrevivência de uma coorte histórica com cisticercose. Métodos: Os anos de início dos sintomas e morte até 1957 foram extraídos de relatórios publicados de uma coorte militar britânica (n = 450) examinada em Londres no início do século XX. Os dados foram inseridos em uma análise de sobrevida de Kaplan Meier com a presença (ou ausência) de manifestações clínicas como variáveis independentes, que foram então ajustadas em um modelo de risco proporcional de Cox para determinar sua significância. Resultados: A cisticercose foi responsável por 24 (52,2%) de 46 óbitos nos primeiros 15 anos de seguimento em comparação com 7 (19,4%) de 36 óbitos nos 20-40 anos de seguimento. Nas análises univariadas e de Cox, hipertensão intracraniana (razão de risco [HR]: 8,26; IC: 4,71, 14,49), cisticercose ocular (HR: 6,60; IC: 3,04, 14,33) e transtorno mental (HR: 3,98; IC: 2,22 , 7,13), mas não epilepsia (HR: 0,66; IC: 0,20, 2,18) foram associados com mortalidade. Mais da metade de todas as mortes nos primeiros 15 anos de acompanhamento foram atribuídas à cisticercose. Conclusões: Várias mortes ocorreram logo após a aquisição da infecção cisticercótica. Hipertensão intracraniana, cisticercose ocular e transtorno mental, mas não epilepsia, foram preditores de mortalidade nesta coorte.

Keywords:

Taenia solium - Epilepsy - Intracranial Hypertension - Survival - Mortality

Palavras-chave:

Taenia solium - Epilepsia - Hipertensão Intracraniana - Sobrevida - Mortalidade

Authors’ contributions:

GS and JWS: conceived the study; GS undertook the statistical analysis and drafted the paper; GS, PC and JWS critically reviewed, revised the manuscript and provided substantial intellectual input.




Publication History

Received: 27 February 2021

Accepted: 13 May 2021

Article published online:
30 January 2023

© 2022. Academia Brasileira de Neurologia. This is an open access article published by Thieme under the terms of the Creative Commons Attribution-NonDerivative-NonCommercial License, permitting copying and reproduction so long as the original work is given appropriate credit. Contents may not be used for commecial purposes, or adapted, remixed, transformed or built upon. (https://creativecommons.org/licenses/by-nc-nd/4.0/)

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