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Background   Taenia solium  is a zoonotic parasite responsible for neurocysticercosis—a major cause of late-onset acquired epilepsy in humans. Lack of affordable, specific and sensitive diagnostic tools hampers control of the parasite. This study assessed the performance of an antigen detection enzyme-linked immunosorbent assay (Ag-ELISA) in the diagnosis of viable  T. solium  cysticercosis in naturally infected slaughter-age pigs in an endemic area in Tanzania.    Methods  A total of 350 pigs were bled before they were slaughtered and their carcases examined. Serum was analyzed for circulating antigens by using a monoclonal antibody-based B158/B60 Ag-ELISA. Each carcase was examined for the presence of  Taenia hydatigena  cysticerci and half carcase musculature together with the whole brain, head muscles, tongue, heart and diaphragm were sliced with fine cuts (< 0.5 cm) to reveal and enumerate  T. solium  cysticerci. Half carcase dissection can detect at least 84% of infected pigs. Prevalence and their 95% confidence intervals (CI) were calculated in Stata 12. Sensitivity, specificity, predictive values and likelihood ratios were determined.    Results  Twenty–nine pigs (8.3%, 95% CI: 5.6–11.7%) had viable  T. solium  cysticerci while 11 pigs had  T. hydatigena  cysticerci (3.1%, 95% CI: 1.6–5.5%). No co-infection was observed. Sixty-eight pigs (19.4%, 95% CI: 15.4–20%) tested positive on Ag-ELISA; of these, 24 had  T. solium  cysticerci and 7 had  T. hydatigena  cysticerci. Sensitivity and specificity were determined to be 82.7% and 86.3%, respectively. Positive and negative predictive values were 35.2% and 98.2%, respectively. Likelihood ratios for positive and negative Ag-ELISA test results were 6.0 and 0.2, respectively. There was a significant positive correlation between the titre of circulating antigens and intensity of  T. solium  cysticerci ( r  (348)  = 0.63,  P  < 0.001).    Conclusions  The Ag-ELISA test characteristics reported in this study indicate that the test is more reliable in ruling out  T. solium  cysticercosis in pigs, than in confirming it. Hence, a negative result will almost certainly indicate that a pig has no infection, but a positive result should always be interpreted with caution. Estimates of  T. solium  prevalence based on Ag-ELISA results should, therefore, be adjusted for test performance characteristics and occurrence of  T. hydatigena .

Performance of Ag-ELISA in the diagnosis of Taenia solium cysticercosis in naturally infected pigs in Tanzania