Hélène Carabin, D.V.M., Ph.D.

better diagnosis key to reducing global burden

Researchers believe millions of children and adults across the globe may be impacted by infections that lead to neurological, cognitive, behavioral and mental health problems as well as death. Yet, without advances in diagnosis, we may never know the full impact of these diseases.
Hélène Carabin, D.V.M., Ph.D., a presidential professor at the University of Oklahoma College of Public Health, has devoted her career to the study of the incidence, prevalence and detection of disease as well as to the assessment of the global burden of parasitic infections. Now, she and colleagues report in the publication Nature that a better understanding of the many, varied infections that impact the nervous system hinges on improved diagnosis first.
“Even in developed countries, it is very difficult to know when an infection is in the brain in contrast to being somewhere else in the human body,” Carabin said. “While biopsies or blood tests are relatively easy to conduct, obtaining cerebrospinal fluid is delicate work and many clinicians in developing countries are scared of doing it for fear of contamination of the material or error. In addition, many health facilities would not have the proper equipment to conduct these tests.”
Infections that cause significant nervous system morbidity globally include: * Viral infections like HIV, rabies, herpes simplex virus, varicella (chicken pox), Japanese encephalitis virus, dengue virus and chikungunya virus * Bacterial infections like tuberculosis, syphilis, bacterial meningitis and sepsis * Fungal infections like cryptococcal meningitis * And parasitic infections like malaria, neurocysticercosis (a common worm infection of the central nervous system), neurochistosomiasis (also known as snail fever) and soil-transmitted parasitic worms
“Without diagnosis specific to the infection being in or affecting the brain, we are not able to conduct research, monitor the impact of clinical treatment on the health status of patients or of interventions in the community. If we can develop better diagnoses, we can then identify people affected by these infections and start treating them appropriately,” Carrabin said.
With better diagnosis, she added, epidemiological studies also could be conducted in non-clinical settings to identify risk factors that might be modified to control future infections and their neurological impacts. In addition, those studies would allow for better evaluation of the role that infections play in the burden of all neurological and mental health disease worldwide.
“At the moment, we know very little about this. A lot of these infections occur primarily in developing countries where diagnostic tools, trained personnel and financial resources are lacking. These infections also often fall into a category of diseases for which there has historically been little research investment,” Carabin said.
She added the development of vaccines targeting these infections would be the ultimate solution to potentially eradicate these devastating infections, but that requires more research and that research hinges first on better diagnosis.