Infections of the human nervous system with larval stages of the pork tapeworm are the most common cause of epileptic seizures in Africa. Researchers at the Technical University of Munich (TUM) have partnered with colleagues in three African countries to establish a large-scale project to fight this parasite. This cross-border, interdisciplinary alliance against the tapeworm brings together not only neurologists and immunologists, but also specialists in veterinary medicine and computer science.
A full-grown pork tapeworm (Taenia solium) can be 7 meters long. These parasites live and grow in human intestines after their larvae are ingested in food, mainly pork.
Although this sounds very unpleasant, the adult tapeworm actually causes few serious symptoms in the human host. The larvae are much more problematic, however. They normally live in pigs. When they accidentally enter the human body, they can form cysts in the brain, which may cause neurocysticercosis. Symptoms can include epileptic seizures, chronic headaches and, in the most serious cases, the patient may fall into a coma.
Disease responds well to treatment
"30 percent of epilepsy cases worldwide are caused by pork tapeworms," says Prof. Andrea Winkler, head of the Global Neurology Working Group at TUM's Klinikum rechts der Isar. "In principle, neurocysticercosis responds well to treatment. However, it is a poverty-related disease that spreads rapidly as a result of poor hygiene and a lack of education." Andrea Winkler is the co-director of the project CYSTINET-Africa, which has been granted 8 million euros in funding by the German Federal Ministry of Education and Research.
In cooperation with scientists from Tanzania, Mozambique and Zambia, the TUM working groups plan to combat and study pork tapeworm infections. "We are following the One Health concept," says Andrea Winkler. "That means that we are focusing equally on the health of humans and animals." The project is headed by Dr. Helena Ngowi, a veterinary medicine expert at the Sokoine University of Agriculture in Morogoro, Tanzania. At the Morogoro site, strategies are being developed for preventing infections of humans and animals, for example through educational campaigns tailored to local needs.
Larvae deceive the immune system
Prof. Clarissa Prazeres da Costa of the Institute for Medical Microbiology, Immunology and Hygiene at TUM will investigate the effects of the pork tapeworm on the immune system of infected patients. The larvae apparently have a way of tricking the human immune system. "We do not yet understand why these complex organisms with their own metabolism trigger practically no immune response as long as they are alive, but only after dying, for example after treatment with medication," says Prazeres da Costa. "Our hypothesis is that the larvae actively suppress the immune response, both directly through parasite proteins, but also using the body's own suppressor cells."
To learn more, the immunologist and her team will collect cells from infected patients as part of a large-scale study in Mozambique. These samples will then be investigated using the technical resources of TUM's Institute for Medical Microbiology.
Support from the Department of Informatics
Along with subprojects for the study, prevention and treatment of tapeworm infections, the project also has a technical side. That is where Prof. Bernd Brügge comes in. "We are investigating methods to facilitate the secure transmission of patient data," says Brügge, a professor of applied software engineering with the Department of Informatics at TUM. This is often a challenge simply as a result of the inferior mobile data connections and hardware resources at the local level. "We will also model the working processes and the exchange of medical data between the teams at the various locations," adds Brügge.
In addition, he plans to work with students to study a hypothesis, namely that the larvae may also be causing epileptic seizures in pigs. The team is developing a device with the working title "iPig" that will use an ear clip to record possible seizures and provide information on their duration, intensity and frequency.
The CYSTINET-Africa project began with a kick-off meeting attended by all participants in Tanzania in mid-January and is initially planned for a five-year timeframe. "In the future, we want to cooperate more closely on global health issues and intend to launch further projects," says Andrea Winkler. For that purpose, Andrea Winkler, Clarissa Prazeres da Costa and the heads of the Chairs for Neurology and Medical Microbiology are working to establish the Centre for Global Health at the Faculty of Medicine.
Schmidt V, Kositz C, Herbinger KH, Carabin H, Ngowi B, Naman E, Wilkins PP, Noh J, Matuja W, Winkler AS. Association between Taenia solium infection and HIV/AIDS in northern Tanzania: a matched cross sectional-study. Infectious Disease of Poverty. 2016 Dec 1;5(1):111. DOI:10.1186/s40249-016-0209-7
Winkler AS, Richter R. Landscape analysis: management of neurocysticercosis with emphasis on low- and middle-income countries. World Health Organization 2015.
Winkler AS, Blocher J, Auer H, Gotwald T, Matuja W, Schmutzhard E. Epilepsy and neurocysticercosis in rural Tanzania – an imaging study. Epilepsia 2009; 50: 987-993. DOI: 10.1111/j.1528-1167.2008.01867.x
Prof. Dr. Dr. Andrea Winkler
Klinikum rechts der Isar
Technical University of Munich
Tel: +49 89/45815015