[Recent advances in the immunodiagnosis of human cystic echinococcosis]

Cerebral echinococcosis: Case report and literature review

Echinococcosis is a zoonosis caused by the larval form of the cestode Echinococcus granulosus. The cerebral affectation in the human is uncommon; only in 1-2% cases is observed encephalic involvement. This condition occurs mainly in the pediatric population and it is characterized by the presence of single and unilocular cysts. We report a case of a 29-year-old patient who came to the emergency department with a disabling headache of several weeks of evolution. In the brain imaging study a mass of unknown origin was visualized, finally it turned out to be a bilobed hydatid cyst. Regarding this case, the clinic-epidemiological, diagnostics and treatments aspects of cerebral hydatid disease will be reviewed.

Spatiotemporal monitoring of Cysticercus pisiformis in European wild rabbit (Oryctolagus cuniculus) in Mediterranean ecosystems in southern Spain

Cysticercosis in wild lagomorphs is caused by Cysticercus pisiformis, the larval stage of Taenia pisiformis. Although previous studies have reported the presence of T. pisiformis in different wild carnivore species, information about the prevalence of C. pisiformis in their intermediate hosts is still very scarce. An epidemiological surveillance program was carried out to determine the prevalence and spatiotemporal patterns of cysticercosis in wild rabbits (Oryctolagus cuniculus) from Spanish Mediterranean ecosystems. A total of 2,923 animals were sampled in 164 hunting estates from Andalusia (southern Spain) during four study periods: 2009-2012 (P1), 2012-2015 (P2), 2015-2018 (P3) and 2018-2020 (P4). The presence of cysticerci was assessed by macroscopical examination and a subset of the collected parasites were molecularly identified by conventional PCR targeting the ITS-1 and 12S rRNA partial genes of Taenia spp. Risk factors associated with cysticercus infection were assessed by generalized estimating equation (GEE) analysis. A spatial statistical analysis was carried out using a Bernoulli model to identify statistically significant spatial clusters. Cysticercus infection was confirmed in 81 (2.8 %; 95 % CI: 2.2-3.4) rabbits. Cysticerci from 18 infected animals were molecularly identified as T. pisiformis. The GEE model showed the study period as the only risk factor associated with C. pisiformis infection in wild rabbits. Significantly higher prevalence was found in P2 (6.1 %; 95 % CI: 4.4-8.4) compared to the rest of the periods. At least one cysticerci-positive animal was detected in 41 (25.0 %; 95 % CI: 18.4-31.6) out of the 164 hunting estates. No statistically significant spatial clusters of high cysticercus prevalence were identified. Our results indicate an endemic circulation of C. pisiformis in wild rabbits in southern Spain. The spatial results highlight a widespread distribution of this parasite in their populations. Further studies should focus in determining which sympatric species may act as definitive hosts for T. pisiformis and the relevance of other potential intermediate host species (e.g. hares and rodents), as the relevance of wild rabbits in the sylvatic cycle of this cestode in Mediterranean ecosystems seems to be low.

Cerebral echinococcosis: Case report and literature review

Echinococcosis is a zoonosis caused by the larval form of the cestode Echinococcus granulosus. The cerebral affectation in the human is uncommon; only in 1-2% cases is observed encephalic involvement. This condition occurs mainly in the pediatric population and it is characterized by the presence of single and unilocular cysts. We report a case of a 29-year-old patient who came to the emergency department with a disabling headache of several weeks of evolution. In the brain imaging study a mass of unknown origin was visualized, finally it turned out to be a bilobed hydatid cyst. Regarding this case, the clinic-epidemiological, diagnostics and treatments aspects of cerebral hydatid disease will be reviewed.

Evaluation of the recombinant antigens B2t and 2B2t, compared with hydatid fluid, in IgG-ELISA and immunostrips for the diagnosis and follow up of CE patients

Cystic echinococcosis (CE) is one of the most widespread helminthic zoonoses and is caused by the tapeworm Echinococcus granulosus complex. CE diagnosis and monitoring primarily rely on imaging techniques, complemented by serology. This is usually approached by the detection of IgG antibodies against hydatid fluid (HF), but the use of this heterogeneous antigenic mixture results in a variable percentage of false positive and negative results, and has shown to be useless for follow-up due to the long persistence of anti-HF antibodies in cured patients. To improve test performances and standardization, a number of recombinant antigens mainly derived from HF have been described, among them the B2t and 2B2t antigens. The performance of these antigens in the diagnosis and follow up of patients with CE has been so far evaluated on a limited number of samples. Here, we evaluated the performances of tests based on B2t and 2B2t recombinant antigens compared to HF in IgG-ELISA and immunochromatography (IC) for the diagnosis and follow-up of patients with CE in a retrospective cohort study. A total of 721 serum samples were collected: 587 from 253 patients with CE diagnosed by ultrasonography (US), 42 from patients with alveolar echinococcosis and 92 from healthy donors from Salamanca (Spain). The highest overall sensitivity was obtained with HF in ELISA (85.5%), followed by IC containing HF and 2B2t-HF (83.0% and 78.2%, respectively). The lowest sensitivity was obtained with B2t and 2B2t in ELISA (51.8%). The highest specificity was obtained with IC containing 2B2t-HF (100%), and the lowest with HF-ELISA (78.0%). The lowest cross-reactivity with sera from patients with alveolar echinococcosis was detected with the recombinant antigens in ELISA (9.5% - 16.7%) and the highest with the HF-IC (64.3%). The results of B2t and 2B2t-ELISA were influenced by cyst stage, as classified by US according to the WHO-Informal Working Group on Echinococcosis (WHO-IWGE), with low sensitivity for inactive (CE4 and CE5) cysts, and by the drug treatment, with higher sensitivity in patients after drug treatment compared with patients not subjected to drug treatment. The two recombinant antigens in ELISA provided promising results for monitoring patients in follow-up, although their use is limited to patients with positive serology against them at the beginning of the follow-up. Potential biological reasons behind the low sensitivity of the recombinant antigens and possible strategies to enhance the performance of CE serology are discussed.

Cystic echinococcosis (CE) is a helminthic zoonosis caused by Echinococcus granulosus sensu lato. CE diagnosis and monitoring is of paramount importance for the clinical management of patients and primarily rely on imaging techniques, complemented by serology. CE serology is usually based on the detection of antibodies against hydatid fluid (HF), but the use of this heterogeneous antigenic mixture shows several drawbacks, including false positive and negative results, unsatisfied predictive values, and long persistence of detectable antibody levels in cured patients. As an alternative, to improve test performances and standardization, several recombinant antigens have been described, but these have been so far evaluated only on a limited number of samples. Here, two recombinant antigens derived from one of the immunodominant HF antigens (antigen B2) have been tested in enzyme-linked immunosorbent assay (ELISA) and in immunochromatographic strips (IC) against 721 serum samples. Although more specific than the HF, the recombinant antigens in ELISA showed low sensitivity for patients with inactive (CE4 and CE5) cysts and for patients not subjected to drug treatment. This limited their use for follow-up, although promising, to those patients with positive serology at the beginning of the follow-up period. These results will aid in the future development of a serological test with enhanced performance in the diagnosis and follow-up of patients with CE.

Evaluation of a New Immunochromatographic Test Using Recombinant Antigen B8/1 for Diagnosis of Cystic Echinococcosis

Diagnosis of cystic echinococcosis (CE) is based on the identification of the cyst(s) by imaging, using immunodiagnostic tests mainly as complementary tools in clinical settings. Among the antigens used for immunodiagnosis, previous studies described a good performance of the recombinant antigen B8/1 (rAgB) in an enzyme-linked immunosorbent assay (ELISA) format; however, in remote parts of areas where the disease is endemic, the implementation of an ELISA is difficult, so a more simple, rapid, and reliable method such as the immunochromatographic test (ICT) is required. In this study, using a set of 50 serum samples from patients with surgically confirmed CE, we compared the performance of an ICT and that of an ELISA using the rAgB. The overall sensitivities of ICT and ELISA were not statistically different (78% versus 72%; P = 0.36). The overall agreement between both tests was moderate (κ = 0.41; P < 0.01). Concordance between ICT and ELISA was substantial or almost perfect for patients with liver involvement (κ = 0.65; P < 0.001) and patients with more than one hydatid cyst (κ = 0.82; P < 0.001), respectively. Moreover, specificity analysis using a total of 88 serum samples from healthy individuals (n = 20) and patients (n = 68) with other parasitic infections revealed that ICT had a specificity of 89.8%. ICT and ELISA had similar performance for the detection of specific antibodies to E. granulosus, and ICT had a high specificity, opening the possibility of using ICT as a screening tool in rural settings.

Mass spectrometric analysis of the immunodominant glycan epitope of Echinococcus granulosus antigen Ag5

In previous work we showed that Ag5, a major diagnostic antigen from the metacestode of Echinococcus granulosus, possesses a dominant sugar epitope that upon removal results in abolition of most of the antigen immunoreactivity with patient sera. Analysis of this glycan modification has now been performed by western blotting and mass spectrometry. Reactivity to both a specific monoclonal antibody (TEPC15) and human C-reactive protein as well as the presence of a modification of 165 mass units, as detected by mass spectrometry of both glycopeptides and released N-glycans, indicated that the immunodominant sugar epitope of the Ag5 38 kDa subunit is a biantennary structure modified by phosphorylcholine. We believe this is the first time that such a modification has been proven in cestodes and provides the structural basis for understanding the antigenicity of this major E. granulosus component.