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Gottstein B, Lachenmayer A, Beldi G, Wang J, Merkle B, Vu XL, Kurath U, Müller N. Diagnostic and follow-up performance of serological tests for different forms/courses of alveolar echinococcosis. Food Waterborne Parasitol 2019; 16:e00055. [PMID: 32095626 PMCID: PMC7034017 DOI: 10.1016/j.fawpar.2019.e00055] [Citation(s) in RCA: 24] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/27/2019] [Revised: 04/15/2019] [Accepted: 04/16/2019] [Indexed: 02/07/2023] Open
Abstract
Diagnosis of alveolar echinococcosis (AE) is predominantly based on imaging procedures combined with immunodiagnostic testing. In the present study, we retrospectively analyzed the performance of four serological tests (EgHF-ELISA, Em2-ELISA, recEm18-ELISA and Em-Immunoblotting) for initial diagnosis and subsequent monitoring of AE patients. Overall, 101 AE patients were included, grouped according to treatment options and immune status as follows: (A) curative surgical treatment (n = 45 patients), (B) non-radical or palliative surgical treatment (n = 11), (C) benzimidazoles only (n = 20), (D) immunocompromised with radical surgical treatment (n = 11), (E) immunocompromised with benzimidazoles only (n = 4), and finally a group of 10 AE patients (F) that were considered to present so-called “abortive” lesions. Initial (i.e. pretreatment) ELISA-based diagnosis for patients in groups A to E revealed overall diagnostic sensitivities of 95% for EgHF, 86% for Em2, and 80% for recEm18, respectively. Comparatively, the diagnostic sensitivity of Em-Immunoblotting was higher with an overall value of 98%. In group F, only Em-Immunoblotting had an excellent diagnostic sensitivity (100%), whereas the ELISAs had poor sensitivities of 30% (EgHF- and Em2-ELISA) or even 0% (recEm18-ELISA). Serological monitoring of AE patients showed a clear association between a curative development of disease (induced either by surgery or benzimidazole medication) and a negativization in the ELISAs. This effect was most pronounced for the recEm18-ELISA, where 56% negativized following diagnosis/treatment, as compared to 36% for the EgHF-ELISA, and 37% for the Em2-ELISA, respectively. After radical surgery, the mean time until negativization in the recEm18-ELISA was 2.4 years (SD 1.6). This was significantly shorter than the mean 3.9 years (SD 2.5) in those AE patients with non-radical, palliative surgery or ABZ treatment who were able to negativize during the study period (p = 0.048). Conclusively, Em-Immunoblotting appears as the most sensitive test to diagnose active as well as inactive (“abortive”) AE-cases. The inclusion of the ELISAs completes the initial diagnostic picture and offers valuable additional information. Conversely, recEm18-ELISA appears as the currently best serological tool to monitor a regressive and putatively curative course of AE in treated patients. EgHF-ELISA plus Em-Immunoblotting results in most sensitive initial AE serodiagnosis. Em2- and recEm18-ELISA allow differentiation between AE and CE. recEm18-ELISA is currently the best monitoring test for assessing curative course of AE. Presumably inactive (“abortive”) AE cases were all positive by Em-Immunoblotting.
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Key Words
- ABZ, Albendazole
- AE, Alveolar echinococcosis
- CE, Cystic echinococcosis
- Diagnosis
- ELISA
- ELISA, Enzyme-linked immunosorbent assay
- Echinococcus multilocularis
- EgHF, Echinococcus granulosus hydatid fluid
- Em, Echinococcus multilocularis
- EmVF, Echinococcus multilocularis vesicular fluid
- FDG-PET/CT, fluorodeoxyglucose Positron Emission Tomography/Computed Tomography
- Follow-up serology
- Immunoblotting
- MRI, Magnetic Resonance Imaging
- US, Ultrasonography
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Affiliation(s)
- Bruno Gottstein
- Institute of Parasitology, Department of Infectious Diseases and Pathobiology, Vetsuisse Faculty, University of Bern, Bern, Switzerland
- Institute for Infectious Diseases, Medical Faculty, University of Bern, Bern, Switzerland
- Corresponding author at: Institute for Infectious Diseases, Medical Faculty, University of Bern, Bern, Switzerland.
| | - Anja Lachenmayer
- Department of Visceral Surgery and Medicine, Visceral Surgery, Inselspital University Hospital Bern and University Bern, Bern, Switzerland
| | - Guido Beldi
- Department of Visceral Surgery and Medicine, Visceral Surgery, Inselspital University Hospital Bern and University Bern, Bern, Switzerland
| | - Junhua Wang
- Institute of Parasitology, Department of Infectious Diseases and Pathobiology, Vetsuisse Faculty, University of Bern, Bern, Switzerland
| | - Bernadette Merkle
- Institute of Parasitology, Department of Infectious Diseases and Pathobiology, Vetsuisse Faculty, University of Bern, Bern, Switzerland
| | - Xuan Lan Vu
- Institute of Parasitology, Department of Infectious Diseases and Pathobiology, Vetsuisse Faculty, University of Bern, Bern, Switzerland
| | - Ursula Kurath
- Institute of Parasitology, Department of Infectious Diseases and Pathobiology, Vetsuisse Faculty, University of Bern, Bern, Switzerland
| | - Norbert Müller
- Institute of Parasitology, Department of Infectious Diseases and Pathobiology, Vetsuisse Faculty, University of Bern, Bern, Switzerland
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Yamashita M, Imagawa T, Sako Y, Okamoto M, Yanagida T, Okamoto Y, Tsuka T, Osaki T, Ito A. Serological validation of an alveolar echinococcosis rat model with a single hepatic lesion. J Vet Med Sci 2016; 79:308-313. [PMID: 27890868 PMCID: PMC5326935 DOI: 10.1292/jvms.16-0513] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/25/2023] Open
Abstract
Serology is important for the diagnosis and follow-up of human alveolar echinococcosis
(AE). However, patient conditions are highly variable among those with AE, and antibody
responses in serological follow-up have not been well-defined. We recently described a new
AE rat model established by implantation of small AE tissue into a single arbitrary
location in the liver; no metastasis and dissemination were observed. In the present
study, we examined the serological characteristics in our rat model before and after
surgical treatment. The results showed that antibody responses against crude antigens were
increased at one month after transplantation and similar to those of other model animals.
For the antigen Em18, antibody responses were slower in our rat model than in other animal
models. After surgical resection, changes in antibody responses against Em18 were similar
to those observed in human patients with AE. Because of the slow growth of lesions,
establishment of a single hepatic lesion and patterns of antibody responses, our rat model
may be useful for clarifying follow-up serodiagnoses in human AE and determining the
mechanisms of multi-organ involvement by primary infection with oncospheres rather than
metastasis.
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Affiliation(s)
- Masamichi Yamashita
- Department of Veterinary Diagnostic Imaging, School of Veterinary Medicine, Faculty of Agriculture, Tottori University, Tottori 680-8553, Japan
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Cisak E, Sroka J, Wójcik-Fatla A, Zając V, Dutkiewicz J. Evaluation of reactivity to Echinococcus spp. among rural inhabitants in Poland. Acta Parasitol 2015. [PMID: 26204192 DOI: 10.1515/ap-2015-0074] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/28/2022]
Abstract
A group of 172 rural inhabitants from eastern Poland (68 males and 104 females, mean age 49.0 ± 12.0 years) was examined for the presence of antibodies against Echinococcus granulosus and Echinococcus multilocularis. A population of 38 healthy urban dwellers from the city of Lublin (17 males and 21 females, mean age 36.2 ± 9.6 years) were examined as a control group. Sera of 22 rural inhabitants (12.8%) reacted positively to Echinococcus granulosus hydatid fluid antigen in the screening test. A cross-reactivity was observed with two serum samples that tested positive in ELISA for E. granulosus. Three serum samples were tested positive for E. multilocularis using the Em2plus ELISA assay and also positive for Western blot. None of the members of control group showed the presence of a seropositive reaction to Echinococcus spp. The reactivity to Echinococcus spp. among rural inhabitants decreased with age and this correlation was statistically significant (R = -0.197151, p = 0.009535). The percentage of positive findings was the highest (50.0%) in the youngest age group (14-20). No significant correlations were found between responses to interview questions (possession of domestic and farm animals, contact with wild animals, eating unwashed berries, drinking unboiled water) and the presence of seropositive reactions to Echinococcus spp. The presented results seem to indicate that echinococcosis is still a current problem in Poland that should not be neglected and, moreover, indicates the need for improvement in the routine laboratory diagnostics of Echinococcus spp. by standardizing the ELISA and Western blot tests.
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Yamano K, Kouguchi H, Uraguchi K, Mukai T, Shibata C, Yamamoto H, Takaesu N, Ito M, Makino Y, Takiguchi M, Yagi K. First detection of Echinococcus multilocularis infection in two species of nonhuman primates raised in a zoo: a fatal case in Cercopithecus diana and a strongly suspected case of spontaneous recovery in Macaca nigra. Parasitol Int 2014; 63:621-6. [PMID: 24780141 DOI: 10.1016/j.parint.2014.04.006] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/10/2013] [Revised: 03/31/2014] [Accepted: 04/17/2014] [Indexed: 10/25/2022]
Abstract
The causative parasite of alveolar echinococcosis, Echinococcus multilocularis, maintains its life cycle between red foxes (Vulpes vulples, the definitive hosts) and voles (the intermediate hosts) in Hokkaido, Japan. Primates, including humans, and some other mammal species can be infected by the accidental ingestion of eggs in the feces of red foxes. In August 2011, a 6-year-old zoo-raised female Diana monkey (Cercopithecus diana) died from alveolar echinococcosis. E. multilocularis infection was confirmed by histopathological examination and detection of the E. multilocularis DNA by polymerase chain reaction (PCR). A field survey in the zoo showed that fox intrusion was common, and serodiagnosis of various nonhuman primates using western blotting detected a case of a 14-year-old female Celebes crested macaque (Macaca nigra) that was weakly positive for E. multilocularis. Computed tomography revealed only one small calcified lesion (approximately 8mm) in the macaque's liver, and both western blotting and enzyme-linked immunosorbent assay (ELISA) showed a gradual decline of antibody titer. These findings strongly suggest that the animal had recovered spontaneously. Until this study, spontaneous recovery from E. multilocularis infection in a nonhuman primate had never been reported.
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Affiliation(s)
- Kimiaki Yamano
- Department of Infectious Diseases, Hokkaido Institute of Public Health, North 19, West 12, Kitaku, Sapporo 060-0819, Hokkaido, Japan.
| | - Hirokazu Kouguchi
- Department of Infectious Diseases, Hokkaido Institute of Public Health, North 19, West 12, Kitaku, Sapporo 060-0819, Hokkaido, Japan
| | - Kohji Uraguchi
- Department of Infectious Diseases, Hokkaido Institute of Public Health, North 19, West 12, Kitaku, Sapporo 060-0819, Hokkaido, Japan
| | - Takeshi Mukai
- Sapporo Maruyama Zoo, Miyagaoka 3-1, Chuoku, Sapporo 064-0959, Hokkaido, Japan
| | - Chikako Shibata
- Sapporo Maruyama Zoo, Miyagaoka 3-1, Chuoku, Sapporo 064-0959, Hokkaido, Japan
| | - Hideaki Yamamoto
- Sapporo Maruyama Zoo, Miyagaoka 3-1, Chuoku, Sapporo 064-0959, Hokkaido, Japan
| | - Noboru Takaesu
- Sapporo Maruyama Zoo, Miyagaoka 3-1, Chuoku, Sapporo 064-0959, Hokkaido, Japan
| | - Masaki Ito
- Sapporo Maruyama Zoo, Miyagaoka 3-1, Chuoku, Sapporo 064-0959, Hokkaido, Japan
| | - Yoshinori Makino
- Hamamatsu Zoological Gardens, Kanzanjicho 199, Nishiku, Hamamatsu 431-1209, Shizuoka, Japan
| | - Mitsuyoshi Takiguchi
- Laboratory of Veterinary Internal Medicine, Department of Veterinary Clinical Sciences, Graduate School of Veterinary Medicine, Hokkaido University, North 18, West 9, Kitaku, Sapporo 060-0818, Hokkaido, Japan
| | - Kinpei Yagi
- Department of Infectious Diseases, Hokkaido Institute of Public Health, North 19, West 12, Kitaku, Sapporo 060-0819, Hokkaido, Japan
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Time course of the antibody response in humans compared with rats experimentally infected with hepatic alveolar echinococcosis. J Helminthol 2012; 88:24-31. [PMID: 23137748 DOI: 10.1017/s0022149x12000685] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
Human alveolar echinococcosis (AE) is caused by the accidental ingestion of Echinococcus multilocularis eggs. Early detection is essential as surgical resection is the only treatment for a complete cure. However, details are unclear about changes in the antibody response during the initial stages of infection, yet such information is useful for early serodiagnosis. Therefore, a long-term investigation was performed into the time course of the antibody response before 'positive' detection. Patient sera were used for enzyme-linked immunosorbent assay (ELISA) and Western blotting (WB) analysis using crude antigens extracted from E. multilocularis protoscoleces. Rats were experimentally infected with AE and similarly analysed by ELISA and WB. Among the markers for diagnoses, the 18 kDa band (main marker) appeared last in the preoperative stages and disappeared first after operation in a WB test. Although the 18 kDa antigen can be useful as a marker for AE diagnosis, it cannot contribute to the detection of some patients before the 18 kDa band appearance. To avoid misdiagnosis, different diagnostic antigens such as the 26-28 and 7-8 kDa bands should also be considered. These bands tend to appear earlier than the 18 kDa band and thus offer the potential for early detection of AE. We first observed changes in the antibody response in a relatively early stage after infection in human AE cases. Notably, changes in the antibody response of two intermediate species were similar. These findings provide valuable information for the early detection of human AE cases in the future.
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Yamano K, Koizumi A, Takeda T, Kiuchi F, Hada N. Galα1-4Galβ1-3GalNAc is the dominant epitope of Em2 antigen, the mucin-type glycoprotein from Echinococcus multilocularis. Parasitol Res 2012; 111:795-805. [DOI: 10.1007/s00436-012-2902-1] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/16/2011] [Accepted: 03/19/2012] [Indexed: 12/16/2022]
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YAMANO K, GOTO A, NAKAMURA-UCHIYAMA F, NAWA Y, HADA N, TAKEDA T. Galβ1-6Gal, antigenic epitope which accounts for serological cross-reaction in diagnosis ofEchinococcus multilocularisinfection. Parasite Immunol 2009; 31:481-7. [DOI: 10.1111/j.1365-3024.2009.01129.x] [Citation(s) in RCA: 22] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
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