In neurocysticercosis (NCC) caused by Taenia solium, which serological test has the highest specificity for confirmation?
- A ELISA using crude cysticercal antigen (sensitivity ~80%, specificity 75%)
- B Complement fixation test — the original diagnostic standard
- C CSF cell count and protein — diagnostic when pleocytosis >5 cells/µL
- D Enzyme-linked immunoelectrotransfer blot (EITB) using lentil-lectin purified glycoproteins — specificity >99% ✓
Explanation
The EITB (also called LLGP-EITB or CDC EITB) using lentil-lectin purified glycoprotein antigens from T. solium cysts detects IgG antibodies with sensitivity of 94–98% and specificity >99% for confirmed NCC (particularly with multiple or active cysts; sensitivity is lower for single calcified lesions). Standard ELISA using crude antigen has high cross-reactivity with other helminths, reducing specificity. Complement fixation is outdated and non-specific. CSF findings are non-specific. Imaging (CT/MRI showing ring-enhancing lesion with scolex 'hole-with-dot' sign) combined with positive EITB provides highest diagnostic confidence.
Reference: Ananthanarayan & Paniker's Textbook of Microbiology, 11th ed.
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