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Petrone L, Najafi-Fard S, Falasca L, Sbarra S, Teggi A, Nicastri E, Grillo LR, Burocchi M, Ettorre GM, Ludovisi A, Colombo D, Del Nonno F, Goletti D. Evaluation of the Local and Peripheral Immune Responses in Patients with Cystic Echinococcosis. Pathogens 2024; 13:477. [PMID: 38921775 PMCID: PMC11206897 DOI: 10.3390/pathogens13060477] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/25/2024] [Revised: 05/28/2024] [Accepted: 05/30/2024] [Indexed: 06/27/2024] Open
Abstract
BACKGROUND Cystic echinococcosis (CE) cysts may persist for decades because of immune modulation mechanisms. Here, we characterize the cysts and the blood immune responses in patients with CE. METHODS We enrolled 61 patients with CE and 19 control subjects. We received tissue samples from seven patients with CE and a control subject requiring liver cystectomy. The immunohistochemistry evaluation of the immune cell subtypes and cytokines in the pericysts and surrounding liver and the antigen B (AgB)-specific response analysis of whole blood were performed. RESULTS In CE, the pericyst and the surrounding liver parenchyma showed aggregates of CD3+ T lymphocytes, mainly CD4+. B lymphocyte aggregates were present in the liver tissue. Monocytes/granulocytes were rarely observed. Th2 cytokine expression was scarce, whereas IFN-γ expression was present in the CE tissues. The control subject did not show an inflammatory infiltrate. The IL-4-specific response to AgB was increased in the patients with CE compared to the control, and this result was confirmed in a larger cohort (p = 0.003), whereas the IFN-γ-response was similar between the two groups (p = 0.5570). CONCLUSION In patients with CE, CD4+ lymphocytes infiltrate the pericyst and the surrounding liver tissue with a low IL-4/IL-13 expression level and a moderate IFN-γ expression level; moreover, an IL-4 parasite-specific response is detected in the periphery. These results support adventitia involvement in CE immunopathogenesis.
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Affiliation(s)
- Linda Petrone
- Translational Research Unit, National Institute for Infectious Diseases (INMI) “Lazzaro Spallanzani”—IRCCS, 00149 Rome, Italy
| | - Saeid Najafi-Fard
- Translational Research Unit, National Institute for Infectious Diseases (INMI) “Lazzaro Spallanzani”—IRCCS, 00149 Rome, Italy
| | - Laura Falasca
- Laboratory of Electron Microscopy, National Institute for Infectious Diseases “Lazzaro Spallanzani”—IRCCS, 00149 Rome, Italy
| | - Settimia Sbarra
- Translational Research Unit, National Institute for Infectious Diseases (INMI) “Lazzaro Spallanzani”—IRCCS, 00149 Rome, Italy
| | - Antonella Teggi
- Department of Infectious and Tropical Diseases, Sant’Andrea Hospital University of Rome “Sapienza”, 00189 Rome, Italy
| | - Emanuele Nicastri
- Clinical Division of Infectious Diseases, National Institute for Infectious Diseases “Lazzaro Spallanzani”—IRCCS, 00149 Rome, Italy
| | | | - Mirco Burocchi
- Division of General Surgery and Liver Transplantation, San Camillo-Forlanini Hospital, 00152 Rome, Italy
| | - Giuseppe Maria Ettorre
- Division of General Surgery and Liver Transplantation, San Camillo-Forlanini Hospital, 00152 Rome, Italy
| | - Alessandra Ludovisi
- Foodborne and Neglected Parasitoses Unit, Department of Infectious Diseases, Istituto Superiore di Sanità, 00161 Rome, Italy
| | - Daniele Colombo
- Pathology Unit, National Institute for Infectious Diseases “Lazzaro Spallanzani”—IRCCS, 00149 Roma, Italy
| | - Franca Del Nonno
- Pathology Unit, National Institute for Infectious Diseases “Lazzaro Spallanzani”—IRCCS, 00149 Roma, Italy
| | - Delia Goletti
- Translational Research Unit, National Institute for Infectious Diseases (INMI) “Lazzaro Spallanzani”—IRCCS, 00149 Rome, Italy
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Erganis S, Sarzhanov F, Al FD, Cağlar K. Comparison of Methods in the Serologic Diagnosis of Cystic Echinococcosis. Acta Parasitol 2024; 69:1122-1131. [PMID: 38551763 PMCID: PMC11182860 DOI: 10.1007/s11686-024-00840-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/08/2023] [Accepted: 03/20/2024] [Indexed: 06/18/2024]
Abstract
PURPOSE Cystic echinococcosis (CE) is caused by the larval form of Echinococcus granulosus. Clinical, radiologic, pathologic, and serologic findings should be evaluated together for the diagnosis of CE. The sensitivity and specificity oalf serologic tests may vary depending on the method used. In this study, we aimed to detect IgG antibodies specific to E. granulosus using indirect hemagglutination assay (IHA), enzyme-linked immunosorbent assay (ELISA), indirect fluorescent antibodies (IFA) and western blot (WB) tests. METHODS In our study, the serum samples of 74 patients sent to our laboratory with suspicion of CE were studied using two different commercial IHA tests, ELISA, IFA and WB test. The test results were evaluated along with radiological findings and histopathological examinations, the latter being the gold standard. RESULTS Of all the patients, 51 (69%) were female and 23 (31%) were male. There was a statistically significant difference between males and females (χ2 = 9.7, p = 0.002). Out of 74 patients, positivity rates for Siemens IHA, Fumouze IHA, ELISA, IFA and WB test were positive as 33 (44.6%), 35 (47.3%), 43 (58.1%), 42 (56.7%) and 38 (51.3%), respectively. The sensitivity and specificity of the tests were as follows: 66.67 and 2.31% for Siemens IHA; 70.83% and 96.15% for Fumouze IHA; 85.42%, and 88.46% for ELISA; 83.33% and 88.46% for IFA; 72.92% and 88.46% for WB test. CONCLUSION There were statistically significant differences in between all five methods (p < 0,001). While the tests with the highest specificity was Fumouze IHA, the test with the highest sensitivity was the ELISA test. It was concluded that IHA and ELISA tests were more practical in practice because of their greater applicability.
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Affiliation(s)
- Sidre Erganis
- Department of Medical Microbiology, School of Medicine, Gazi University, 06490, Ankara, Türkiye.
| | - Fakhriddin Sarzhanov
- Division of Medical Parasitology, Department of Medical Microbiology, School of Medicine, Gazi University, 06490, Ankara, Türkiye
- Faculty of Medicine, Akhmet Yassawi International Kazakh-Turkish University, 161200, Turkestan, Kazakhstan
| | - Funda Doğruman Al
- Division of Medical Parasitology, Department of Medical Microbiology, School of Medicine, Gazi University, 06490, Ankara, Türkiye
| | - Kayhan Cağlar
- Department of Medical Microbiology, School of Medicine, Gazi University, 06490, Ankara, Türkiye
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3
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Tamarozzi F. Ultrasound diagnosis of cystic echinococcosis: updates and implications for clinical management. J Helminthol 2024; 98:e34. [PMID: 38628145 DOI: 10.1017/s0022149x2400021x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/19/2024]
Abstract
The diagnosis of cystic echinococcosis (CE) is based on imaging. Detection of a focal lesion with morphological characteristics of Echinococcus granulosus sensu lato metacestode is the starting point for the diagnostic workup. In organs explorable with ultrasound (US), this is the method of choice for both aetiological diagnosis of CE and staging of the CE cyst. Staging in terms of lesion morphology is also needed when serology is added to the diagnostic workflow when imaging alone is inconclusive. Finally, staging guides the clinical management of uncomplicated CE, especially in the liver. This commentary provides an overview of the most up-to-date evidence backing the above-mentioned role of US in the diagnosis and clinical management of CE. Finally, we outline future perspectives for the improvement of CE diagnosis.
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Affiliation(s)
- F Tamarozzi
- Department Infectious-Tropical Diseases and Microbiology, WHO Collaborating Centre on Strongyloidiasis and other Neglected Tropical Diseases, IRCCS Sacro Cuore Don Calabria Hospital, Negrar di Valpolicella, Verona, Italy
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4
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Cai S, Wang C, Tian F, Liu M, Yan H, Xu Z, Qu G. Dual-RPA assay for rapid detection and differentiation of E.granulosus and E.multilocularis. Microb Pathog 2024; 189:106600. [PMID: 38428469 DOI: 10.1016/j.micpath.2024.106600] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/27/2024] [Revised: 02/16/2024] [Accepted: 02/21/2024] [Indexed: 03/03/2024]
Abstract
Echinococcus granulosus (Eg) and Echinococcus multilocularis (Em) are the two most widely prevalent types of echinococcosis. Several diagnostic methods have been developed for detecting Eg and Em. However, some limitations, such as being time-consuming, needing expensive instruments, or exhibiting low sensitivity, make these methods unsuitable for on-site detection. In this study, a dual-RPA assay was established to detect and differentiate Eg and Em. The primer concentration ratio, reaction time, and reaction temperature of the dual-RPA were optimized. The result showed that the primer concentration ratio of Eg:Em was 400 nM:400 nM, and the best amplification efficiency was obtained by reacting at 38 °C for 20 min. The sensitivity, specificity, and repeatability of the assay were also tested. The assay's detection limit for both Eg and Em was 10 copies/μL. The assay showed reasonable specificity by testing ten parasitic nucleic acids. The assay's intra- and inter-batch coefficients of variation were below 10%, which indicates robust reproducibility of the assay. Finally, to validate the performance of the dual-RPA assay, it was compared with real-time PCR by using 86 clinical nucleic acid samples. The coincidence rate of Eg between dual-RPA and TaqMan real-time PCR was 96.51%, and the coincidence rate of Em between dual-RPA and TaqMan real-time PCR was 98.84%, indicating its potential for accurate clinical diagnosis. Therefore, this study established a rapid and sensitive dual-RPA assay that can rapidly detect and differentiate Eg and Em in one reaction tube and provided a new assay for the detection of echinococcosis in the field.
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Affiliation(s)
- Shu Cai
- College of Veterinary Medicine, Huazhong Agricultural University, Wuhan, 430070, China
| | - Changjiang Wang
- Shandong Binzhou Animal Science and Veterinary Medicine Academy, Binzhou, 256600, China
| | - Fengrong Tian
- Shandong Binzhou Animal Science and Veterinary Medicine Academy, Binzhou, 256600, China
| | - Mengxiao Liu
- Department of Animal Medicine, College of Life Science and Food Engineering, Hebei University of Engineering, Handan, 056038, China
| | - Hongbin Yan
- State Key Laboratory of Veterinary Etiological Biology, Lanzhou Veterinary Research Institute, Chinese Academy of Agricultural Sciences, Lanzhou, 730000, China.
| | - Zaiyan Xu
- College of Veterinary Medicine, Huazhong Agricultural University, Wuhan, 430070, China.
| | - Guanggang Qu
- Shandong Binzhou Animal Science and Veterinary Medicine Academy, Binzhou, 256600, China.
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Mattwich C, Huber K, Bretzel G, Suerbaum S, Wieser A, Dichtl K. Head-to-Head Comparison of Nine Assays for the Detection of Anti- Echinococcus Antibodies: A Retrospective Evaluation. Ann Lab Med 2024; 44:155-163. [PMID: 37880992 PMCID: PMC10628756 DOI: 10.3343/alm.2023.0212] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/19/2023] [Revised: 07/25/2023] [Accepted: 09/12/2023] [Indexed: 10/27/2023] Open
Abstract
Background Echinococcosis is a neglected tropical disease that is severely underdiagnosed in resource-limited settings. In developed countries, diagnosing echinococcosis is challenging, and reliable serological assays are urgently needed. In the Central European Alps, EM is more common than EG; however, data on the diagnostic performance of assays for EM cases are scarce. We evaluated the suitability of nine antibody assays for routine diagnostics. Methods Nine commercially available serological assays for detecting anti-Echinococcus antibodies were compared head-to-head using samples collected from 50 patients with echinococcosis and 50 age- and sex-matched control subjects. The assays are Anti-Echinococcus ELISA (IgG) (Euroimmun), Echinococcus IgG ELISA (DRG), Echinococcus IgG ELISA (IBL International), Echinococcus Western Blot IgG (LDBIO Diagnostics), EUROLINE WB (Euroimmun), Hydatidosis ELISA IgG (VirCell), Hydatidosis VIRCLIA IgG Monotest (VirCell), Ridascreen Echinococcus IgG (R-Biopharm), and Virapid Hydatidosis (VirCell). The cases were ranked according to the WHO-Informal Working Group on Echinococcosis (WHO-IWGE) criteria as confirmed, probable, or possible. Results The performance of the assays varied greatly, with overall sensitivities ranging between 50% and 88% and specificities between 62% and 100%. We observed a trend toward better performance with cases classified as "confirmed" using the WHO-IWGE criteria. Combined analysis with sequential screening and confirmatory testing resulted in a maximum sensitivity of 84% and specificity of 100%. Differentiation between EG and EM infections is clinically relevant but was found to be unreliable. Conclusions Echinococcus serological assays are highly variable in terms of sensitivity and specificity. Knowledge of the pre-test probability in the patient cohort is required to choose a suitable assay. A combined approach with screening and confirmatory assays may be the best diagnostic strategy in many situations.
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Affiliation(s)
- Carolina Mattwich
- Max von Pettenkofer-Institut für Hygiene und Medizinische Mikrobiologie, Medizinische Fakultät, LMU München, Munich, Germany
| | - Kristina Huber
- Division of Infectious Diseases and Tropical Medicine, University Hospital Ludwig-Maximilian University Munich, Munich, Germany
| | - Gisela Bretzel
- Division of Infectious Diseases and Tropical Medicine, University Hospital Ludwig-Maximilian University Munich, Munich, Germany
| | - Sebastian Suerbaum
- Max von Pettenkofer-Institut für Hygiene und Medizinische Mikrobiologie, Medizinische Fakultät, LMU München, Munich, Germany
| | - Andreas Wieser
- Max von Pettenkofer-Institut für Hygiene und Medizinische Mikrobiologie, Medizinische Fakultät, LMU München, Munich, Germany
- Division of Infectious Diseases and Tropical Medicine, University Hospital Ludwig-Maximilian University Munich, Munich, Germany
- German Centre for Infection Research (DZIF), Munich, Germany
- Fraunhofer Institute for Translational Medicine and Pharmacology ITMP, Immunology, Infection and Pandemic Research, Munich, Germany
| | - Karl Dichtl
- Max von Pettenkofer-Institut für Hygiene und Medizinische Mikrobiologie, Medizinische Fakultät, LMU München, Munich, Germany
- Diagnostic and Research Institute of Hygiene, Microbiology and Environmental Medicine, Medical University of Graz, Graz, Austria
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Hogea MO, Ciomaga BF, Muntean MM, Muntean AA, Popa MI, Popa GL. Cystic Echinococcosis in the Early 2020s: A Review. Trop Med Infect Dis 2024; 9:36. [PMID: 38393125 PMCID: PMC10891927 DOI: 10.3390/tropicalmed9020036] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/08/2023] [Revised: 01/14/2024] [Accepted: 01/30/2024] [Indexed: 02/25/2024] Open
Abstract
Cystic echinococcosis (CE) is a zoonosis caused by metacestodes, the larval stage of Echinococcus granulosus. Although the World Health Organization (WHO) has defined CE as a neglected disease, it is the second most important foodborne parasitic disease, and it remains an important public health issue, considering its zonal endemicity and potential morbidity. The control and prevention of CE is a relevant WHO target, especially from a One Health perspective, as the disease affects not only animals and humans but also the food chain. Since not all countries have a CE surveillance strategy or reporting system and specific management guidelines, recent epidemiological data are relatively scarce, and research concerning the specific geographical distribution of the disease is ongoing. To add new information to the subject, we have analyzed and collected data from national guidelines and several medical databases. Out of the 751 research articles that were originally identified, only 52 were included in the investigation after applying specific inclusion and exclusion criteria. Notable international projects that have provided significant contributions and had a positive impact are presented. The available data were correlated with WHO recommendations on the subject, thus showcasing the measures taken and those that are still needed to properly control the disease's spread.
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Affiliation(s)
- Mihai-Octav Hogea
- Department of Microbiology II, Carol Davila University of Medicine and Pharmacy, 020021 Bucharest, Romania; (M.-O.H.); (B.-F.C.); (M.-M.M.); (A.-A.M.); (M.I.P.)
| | - Bogdan-Florin Ciomaga
- Department of Microbiology II, Carol Davila University of Medicine and Pharmacy, 020021 Bucharest, Romania; (M.-O.H.); (B.-F.C.); (M.-M.M.); (A.-A.M.); (M.I.P.)
| | - Mădălina-Maria Muntean
- Department of Microbiology II, Carol Davila University of Medicine and Pharmacy, 020021 Bucharest, Romania; (M.-O.H.); (B.-F.C.); (M.-M.M.); (A.-A.M.); (M.I.P.)
| | - Andrei-Alexandru Muntean
- Department of Microbiology II, Carol Davila University of Medicine and Pharmacy, 020021 Bucharest, Romania; (M.-O.H.); (B.-F.C.); (M.-M.M.); (A.-A.M.); (M.I.P.)
- Department of Microbiology, Cantacuzino National Military Medical Institute for Research and Development, 050096 Bucharest, Romania
| | - Mircea Ioan Popa
- Department of Microbiology II, Carol Davila University of Medicine and Pharmacy, 020021 Bucharest, Romania; (M.-O.H.); (B.-F.C.); (M.-M.M.); (A.-A.M.); (M.I.P.)
- Department of Microbiology, Cantacuzino National Military Medical Institute for Research and Development, 050096 Bucharest, Romania
| | - Gabriela Loredana Popa
- Parasitic Disease Department, Colentina Clinical Hospital, 020125 Bucharest, Romania
- Department of Microbiology, Faculty of Dentistry, Carol Davila University of Medicine and Pharmacy, 020021 Bucharest, Romania
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Siles-Lucas M, Uchiumi L, Tamarozzi F. 'No cyst, no echinococcosis': a scoping review update on the diagnosis of cystic echinococcosis after the issue of the WHO-IWGE Expert Consensus and current perspectives. Curr Opin Infect Dis 2023; 36:333-340. [PMID: 37466103 PMCID: PMC10487401 DOI: 10.1097/qco.0000000000000941] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 07/20/2023]
Abstract
PURPOSE OF REVIEW In 2010, the WHO-Informal Working Group on Echinococcosis (IWGE) published an Expert Consensus on the diagnosis and treatment of echinococcal infections. We provide an update on the diagnosis of cystic echinococcosis through a scoping review of the literature published after the release of the WHO-IWGE document. RECENT FINDINGS Ultrasound accurately and reliably depicts the pathognomonic signs of cystic echinococcosis (CE) stages compared with other imaging techniques. Among these, T2-wighted MRI is to be preferred to computed tomography, which has poor performance for the etiological diagnosis of CE. A negative serology cannot exclude the diagnosis of CE, while a positive serology, applied after the visualization of a CE-compatible lesion, may confirm a CE diagnosis. Serology alone must not be used to define 'CE' nor as 'screening' tool for infection. Other imaging and laboratory techniques did not show clinically applicable performances. SUMMARY In the absence of a focal lesion compatible with a CE cyst, no diagnosis of CE should be attempted. There is urgent need to achieve univocal CE case definitions and consensus diagnostic algorithm, as well as standardization of diagnostic methods and issue of a Target Product Profile of CE diagnostics, as advocated by the WHO in the 2021-2030 roadmap for neglected tropical diseases (NTDs).
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Affiliation(s)
- Mar Siles-Lucas
- Laboratory of Helminth Parasites of Zoonotic Importance (ATENEA), Institute of Natural Resources and Agrobiology of Salamanca (IRNASA-CSIC), Salamanca, Spain
| | - Leonardo Uchiumi
- Ramon Carrillo Hospital, Bariloche, Río Negro Province, Argentina
| | - Francesca Tamarozzi
- Department of Infectious-Tropical Diseases and Microbiology, WHO Collaborating Centre on Strongyloidiasis and other Neglected Tropical Diseases, IRCCS Sacro Cuore Don Calabria Hospital, Negrar di Valpolicella, Verona, Italy
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8
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Hadipour M, Darani HY, Talebzadeh H, Eslamian M, Aboutalebian S, Harandi MF, Mirhendi H. Sensitive detection of specific cell-free DNA in serum samples from sheep with cystic echinococcosis. PLoS Negl Trop Dis 2023; 17:e0011715. [PMID: 37856565 PMCID: PMC10617735 DOI: 10.1371/journal.pntd.0011715] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/11/2023] [Revised: 10/31/2023] [Accepted: 10/10/2023] [Indexed: 10/21/2023] Open
Abstract
BACKGROUND Developing more sensitive methods for the diagnosis of echinococcosis is essential. In this study PCR assay for sensitive detection of specific cell-free DNA (cfDNA) of Echinococcus granulosus sensu lato in the sera of the sheep naturally infected with echinococcosis was investigated. METHODS To extract cfDNA from 35 infected sheep, the modified phenol-chloroform method was used for two different volumes (0.5 and 2 ml) of serum samples. From each extracted sample, two DNA volumes (5 and 10 μl) were amplified using both standard PCR and semi-nested PCR targeting NADH dehydrogenase subunit I. RESULTS Standard and semi-nested PCR on 0.5 ml of serum samples detected Echinococcus DNA in 8 and 12 out of 35 sheep, respectively; however, using 2 ml of serum samples, they detected 24 and 27 samples. By increasing the volume of template DNA, the PCRs could detect 29 and 33 out of 35 samples. The results were confirmed by sequencing of randomly selected PCR amplicons and comparing them with GenBank databases. CONCLUSIONS Larger volumes of serum for DNA extraction, greater volumes of DNA template for PCR, and employing a semi-nested PCR protocol, increased the sensitivity of PCR to 95%. This approach can also be applied to the diagnosis of echinococcosis in humans.
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Affiliation(s)
- Mahboubeh Hadipour
- Department of Parasitology and Mycology, School of Medicine, Isfahan University of Medical Sciences, Isfahan, Iran
| | - Hossein Yousofi Darani
- Department of Parasitology and Mycology, School of Medicine, Isfahan University of Medical Sciences, Isfahan, Iran
| | - Hamid Talebzadeh
- Department of Surgery, School of Medicine, Isfahan University of Medical Sciences, Isfahan, Iran
| | - Mohammad Eslamian
- Department of Surgery, School of Medicine, Isfahan University of Medical Sciences, Isfahan, Iran
| | - Shima Aboutalebian
- Department of Parasitology and Mycology, School of Medicine, Isfahan University of Medical Sciences, Isfahan, Iran
| | - Majid Fasihi Harandi
- Research Center for Hydatid Disease in Iran; Dept. of Parasitology, School of Medicine, Kerman University of Medical Sciences, Kerman, Iran
| | - Hossein Mirhendi
- Department of Parasitology and Mycology, School of Medicine, Isfahan University of Medical Sciences, Isfahan, Iran
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Cucher MA, Mariconti M, Manciulli T, Vola A, Rosenzvit MC, Brehm K, Kamenetzky L, Brunetti E. Circulating Small RNA Profiling of Patients with Alveolar and Cystic Echinococcosis. BIOLOGY 2023; 12:biology12050715. [PMID: 37237528 DOI: 10.3390/biology12050715] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/03/2023] [Revised: 04/19/2023] [Accepted: 05/08/2023] [Indexed: 05/28/2023]
Abstract
Alveolar (AE) and cystic (CE) echinococcosis are two parasitic diseases caused by the tapeworms Echinococcus multilocularis and E. granulosus sensu lato (s. l.), respectively. Currently, AE and CE are mainly diagnosed by means of imaging techniques, serology, and clinical and epidemiological data. However, no viability markers that indicate parasite state during infection are available. Extracellular small RNAs (sRNAs) are short non-coding RNAs that can be secreted by cells through association with extracellular vesicles, proteins, or lipoproteins. Circulating sRNAs can show altered expression in pathological states; hence, they are intensively studied as biomarkers for several diseases. Here, we profiled the sRNA transcriptomes of AE and CE patients to identify novel biomarkers to aid in medical decisions when current diagnostic procedures are inconclusive. For this, endogenous and parasitic sRNAs were analyzed by sRNA sequencing in serum from disease negative, positive, and treated patients and patients harboring a non-parasitic lesion. Consequently, 20 differentially expressed sRNAs associated with AE, CE, and/or non-parasitic lesion were identified. Our results represent an in-depth characterization of the effect E. multilocularis and E. granulosus s. l. exert on the extracellular sRNA landscape in human infections and provide a set of novel candidate biomarkers for both AE and CE detection.
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Affiliation(s)
- Marcela A Cucher
- Department of Microbiology, School of Medicine, University of Buenos Aires, Buenos Aires C1121ABG, Argentina
- Institute of Research on Microbiology and Medical Parasitology (IMPaM, UBA-CONICET), University of Buenos Aires, Buenos Aires C1121ABG, Argentina
| | - Mara Mariconti
- Unit of Infectious and Tropical Diseases, San Matteo Hospital Foundation, 27100 Pavia, Italy
| | - Tommaso Manciulli
- Unit of Infectious and Tropical Diseases, San Matteo Hospital Foundation, 27100 Pavia, Italy
| | - Ambra Vola
- Microbiology and Virology Department, Fondazione IRCCS Policlinico San Matteo, 27100 Pavia, Italy
| | - Mara C Rosenzvit
- Department of Microbiology, School of Medicine, University of Buenos Aires, Buenos Aires C1121ABG, Argentina
- Institute of Research on Microbiology and Medical Parasitology (IMPaM, UBA-CONICET), University of Buenos Aires, Buenos Aires C1121ABG, Argentina
| | - Klaus Brehm
- Institute for Hygiene and Microbiology, University of Würzburg, 97080 Würzburg, Germany
| | - Laura Kamenetzky
- Instituto de Biociencias, Biotecnología y Biología traslacional (iB3), Departamento de Fisiología y Biología Molecular y Celular, Facultad de Ciencias Exactas y Naturales, Universidad de Buenos Aires, Buenos Aires C1428EGA, Argentina
| | - Enrico Brunetti
- Immunology and Infectious Diseases, San Matteo Hospital Foundation, Department of Clinical, Surgical, Diagnostic and Pediatric Sciences, University of Pavia, 27100 Pavia, Italy
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Seropositivity Pattern of Human Cystic Echinococcosis at a Tertiary Care Hospital of India. J Lab Physicians 2023; 15:169-172. [PMID: 37064974 PMCID: PMC10104716 DOI: 10.1055/s-0042-1758662] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/09/2023] Open
Abstract
AbstractCystic echinococcosis (CE), even after several control measures, causes significant morbidity throughout the world. Besides imaging investigation technology, the serological tests are essential for both diagnosis and management of this slowly progressive disease. The present study was a hospital-based retrospective study that examined the seropositivity rate for Echinococcus granulosus sensu lato antibody in patients suspected of CE at our tertiary health care center over 8 years from 2013 to 2020. Records of new visits to hospital/clinics and associated hospital discharge constituted the denominator of calculation. All samples were tested using commercially available indirect immunoglobulin G enzyme-linked immunosorbent assay kit. A total of 925 suspected patients with a clinical diagnosis of CE were screened. The age group that commonly tested positive for CE was 20 to 39 years, and liver was the predominant organ found to be affected. The seropositive rate was 41.2%. On further year-wise analysis, it was observed that the seropositivity rate had significantly declined from 61.4% in 2013 to 33.8% in 2020. This study clearly showed that there is a by 27.6% decline of CE seropositivity rate in 8 years. This declining rate may be attributed to improved socioeconomic status and better implementation of health programs.
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Hadipour M, Fasihi Harandi M, Mirhendi H, Yousofi Darani H. Diagnosis of echinococcosis by detecting circulating cell-free DNA and miRNA. Expert Rev Mol Diagn 2023; 23:133-142. [PMID: 36756744 DOI: 10.1080/14737159.2023.2178903] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/10/2023]
Abstract
INTRODUCTION Diagnosis of echinococcosis is difficult and usually performed based on clinical findings, imaging, and serological test. However, all of them have limitations, especially in follow-up approaches. AREAS COVERED Detection of cell-free DNA (cfDNA) and micro-RNA (miRNA) is currently a hot topic for diagnosis of echinococcosis diseases. For detecting cell-free DNA in echinococcosis patient's samples such as sera, some techniques are based on next-generation sequencing (NGS), DNA-deep sequencing, some are based on PCR-based methods, and a few works related to the detection of miRNA for the diagnosis of human echinococcosis. EXPERT OPINION In the detection of cell-free DNA in echinococcosis patient' samples, NGS and DNA-deep sequencing have shown high level of sensitivity, but are not suitable for routine clinical examination as they are expensive and inaccessible in the majority of endemic areas. However, PCR-based methods have shown a sensitivity of about 20-25%. To improve the sensitivity of these tests, improving the DNA extraction method, designing appropriate primers for detecting short-length fragments of circulating DNA, using a higher volume of a serum sample, and application of more sensitive PCR methods are recommended. In the field of miRNA detection, further works are recommended.
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Affiliation(s)
- Mahboubeh Hadipour
- Department of parasitology and mycology, Faculty of medicine, Isfahan University of Medical sciences, Isfahan, Iran
| | - Majid Fasihi Harandi
- Research center for Hydatid disease in Iran, School of Medicine, Kerman University of Medical Sciences, Kerman, Iran
| | - Hossein Mirhendi
- Department of parasitology and mycology, Faculty of medicine, Isfahan University of Medical sciences, Isfahan, Iran
| | - Hossein Yousofi Darani
- Department of parasitology and mycology, Faculty of medicine, Isfahan University of Medical sciences, Isfahan, Iran
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Öztürk G, Uzun MA, Özkan ÖF, Kayaalp C, Tatlı F, Eren S, Aksungur N, Çoker A, Bostancı EB, Öter V, Kaya E, Taşar P. Turkish HPB Surgery Association consensus report on hepatic cystic Echinococcosis (HCE). Turk J Surg 2022; 38:101-120. [PMID: 36483170 PMCID: PMC9714645 DOI: 10.47717/turkjsurg.2022.5757] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/30/2022] [Accepted: 05/30/2022] [Indexed: 12/24/2022]
Abstract
OBJECTIVES Cystic Echinococcosis (CE) is one of the important problems of the Eurasian region. We aimed to prepare a consensus report in order to update the treatment approaches of this disease. This study was conducted by Turkish HPB Surgery Association. MATERIAL AND METHODS This study was conducted with the modified Delphi model. For this purpose, we conducted a three-stage consensus-building approach. RESULTS Six topics, including diagnosis, medical treatment, percutaneous treatment, surgical treatment, management of complications and posttreatment follow-up and recurrences in HCE were discussed. CONCLUSION The expert panel made recommendations for every topic.
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Affiliation(s)
- Gürkan Öztürk
- Department of General Surgery, Atatürk University Faculty of Medicine, Erzurum, Türkiye
| | - Mehmet Ali Uzun
- Clinic of General Surgery, Şişli Hamidiye Etfal Education and Research Hospital, İstanbul, Türkiye
| | - Ömer Faruk Özkan
- Clinic of General Surgery, Ümraniye Education and Research Hospital, İstanbul, Türkiye
| | - Cüneyt Kayaalp
- Department of General Surgery, Yeditepe University Faculty of Medicine, İstanbul, Türkiye
| | - Faik Tatlı
- Department of General Surgery, Harran University Faculty of Medicine, Şanlıurfa, Türkiye
| | - Suat Eren
- Department of General Surgery, Atatürk University Faculty of Medicine, Erzurum, Türkiye
| | - Nurhak Aksungur
- Department of General Surgery, Atatürk University Faculty of Medicine, Erzurum, Türkiye
| | - Ahmet Çoker
- Clinic of General Surgery, Medicana International İzmir Hospital, İzmir, Türkiye
| | | | - Volkan Öter
- Clinic of Gastroenterological Surgery, Ankara State Hospital, Ankara, Türkiye
| | - Ekrem Kaya
- Department of General Surgery, Uludağ University Faculty of Medicine, Bursa, Türkiye
| | - Pınar Taşar
- Department of General Surgery, Uludağ University Faculty of Medicine, Bursa, Türkiye
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Kronenberg PA, Deibel A, Gottstein B, Grimm F, Müllhaupt B, Meyer zu Schwabedissen C, Aitbaev S, Omorov RA, Abdykerimov KK, Minbaeva G, Usubalieva J, Siles-Lucas M, Pepe P, Rinaldi L, Spiliotis M, Wang J, Müller N, Torgerson PR, Deplazes P. Serological Assays for Alveolar and Cystic Echinococcosis—A Comparative Multi-Test Study in Switzerland and Kyrgyzstan. Pathogens 2022; 11:pathogens11050518. [PMID: 35631039 PMCID: PMC9146094 DOI: 10.3390/pathogens11050518] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/06/2022] [Revised: 04/22/2022] [Accepted: 04/24/2022] [Indexed: 12/04/2022] Open
Abstract
Both alveolar (AE) and cystic echinococcosis (CE) are lacking pathognomonic clinical signs; consequently imaging technologies and serology remain the main pillars for diagnosis. The present study included 100 confirmed treatment-naïve AE and 64 CE patients that were diagnosed in Switzerland or Kyrgyzstan. Overall, 10 native Echinococcus spp. antigens, 3 recombinant antigens, and 4 commercial assays were comparatively evaluated. All native E. multilocularis antigens were produced in duplicates with a European and a Kyrgyz isolate and showed identical test values for the diagnosis of AE and CE. Native antigens and three commercial tests showed high diagnostic sensitivities (Se: 86–96%) and specificities (Sp: 96–99%) for the diagnosis of AE and CE in Swiss patients. In Kyrgyz patients, values of sensitivities and specificities were 10–20% lower as compared to the Swiss patients’ findings. For the sero-diagnosis of AE in Kyrgyzstan, a test-combination of an E. multilocularis protoscolex antigen and the recombinant antigen Em95 appears to be the most suitable test strategy (Se: 98%, Sp: 87%). For the diagnosis of CE in both countries, test performances were hampered by major cross-reactions with AE patients and other parasitic diseases as well as by limited diagnostic sensitivities (93% in Switzerland and 76% in Kyrgyzstan, respectively).
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Affiliation(s)
- Philipp A. Kronenberg
- Institute of Parasitology, Vetsuisse and Medical Faculty, University of Zurich, 8075 Zurich, Switzerland;
- Graduate School for Cellular and Biomedical Sciences, University of Bern, 3012 Bern, Switzerland
- Correspondence: (P.A.K.); (P.D.); Tel.: +41-(0)44-635-87-01 (P.A.K.)
| | - Ansgar Deibel
- Clinics of Hepatology and Gastroenterology, University Hospital Zurich, 8091 Zurich, Switzerland; (A.D.); (B.M.); (C.M.z.S.)
| | - Bruno Gottstein
- Laboratory of Parasitology, Institute for Infectious Diseases, Medical Faculty, University of Bern, 3001 Bern, Switzerland; (B.G.); (M.S.); (J.W.)
| | - Felix Grimm
- Institute of Parasitology, Vetsuisse and Medical Faculty, University of Zurich, 8075 Zurich, Switzerland;
| | - Beat Müllhaupt
- Clinics of Hepatology and Gastroenterology, University Hospital Zurich, 8091 Zurich, Switzerland; (A.D.); (B.M.); (C.M.z.S.)
| | - Cordula Meyer zu Schwabedissen
- Clinics of Hepatology and Gastroenterology, University Hospital Zurich, 8091 Zurich, Switzerland; (A.D.); (B.M.); (C.M.z.S.)
| | - Sezdbek Aitbaev
- City Clinical Hospital #1, Surgical Department, Faculty of Surgery of the Kyrgyz State Medical Academy, Bishkek 720054, Kyrgyzstan; (S.A.); (R.A.O.)
| | - Rakhatbek A. Omorov
- City Clinical Hospital #1, Surgical Department, Faculty of Surgery of the Kyrgyz State Medical Academy, Bishkek 720054, Kyrgyzstan; (S.A.); (R.A.O.)
| | - Kubanychbek K. Abdykerimov
- Section of Epidemiology, Vetsuisse Faculty, University of Zurich, 8057 Zurich, Switzerland; (K.K.A.); (P.R.T.)
- Life Science Zürich Graduate School, University of Zürich, 8057 Zurich, Switzerland
| | - Gulnara Minbaeva
- Government Sanito-Epidemiology Unit, Kyrgyz Ministry of Health, Bishkek 720033, Kyrgyzstan; (G.M.); (J.U.)
| | - Jumagul Usubalieva
- Government Sanito-Epidemiology Unit, Kyrgyz Ministry of Health, Bishkek 720033, Kyrgyzstan; (G.M.); (J.U.)
| | - Mar Siles-Lucas
- Instituto de Recursos Naturales y Agrobiologia (IRNASA-CSIC), 37008 Salamanca, Spain;
| | - Paola Pepe
- Unit of Parasitology and Parasitic Diseases, Department of Veterinary Medicine and Animal Production, University of Naples Federico II, 80138 Naples, Italy; (P.P.); (L.R.)
| | - Laura Rinaldi
- Unit of Parasitology and Parasitic Diseases, Department of Veterinary Medicine and Animal Production, University of Naples Federico II, 80138 Naples, Italy; (P.P.); (L.R.)
| | - Markus Spiliotis
- Laboratory of Parasitology, Institute for Infectious Diseases, Medical Faculty, University of Bern, 3001 Bern, Switzerland; (B.G.); (M.S.); (J.W.)
| | - Junhua Wang
- Laboratory of Parasitology, Institute for Infectious Diseases, Medical Faculty, University of Bern, 3001 Bern, Switzerland; (B.G.); (M.S.); (J.W.)
| | - Norbert Müller
- Institute of Parasitology, Vetsuisse Faculty, University of Bern, 3012 Bern, Switzerland;
| | - Paul R. Torgerson
- Section of Epidemiology, Vetsuisse Faculty, University of Zurich, 8057 Zurich, Switzerland; (K.K.A.); (P.R.T.)
| | - Peter Deplazes
- Institute of Parasitology, Vetsuisse and Medical Faculty, University of Zurich, 8075 Zurich, Switzerland;
- Correspondence: (P.A.K.); (P.D.); Tel.: +41-(0)44-635-87-01 (P.A.K.)
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Calame P, Weck M, Busse-Cote A, Brumpt E, Richou C, Turco C, Doussot A, Bresson-Hadni S, Delabrousse E. Role of the radiologist in the diagnosis and management of the two forms of hepatic echinococcosis. Insights Imaging 2022; 13:68. [PMID: 35394226 PMCID: PMC8994011 DOI: 10.1186/s13244-022-01190-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/18/2021] [Accepted: 02/15/2022] [Indexed: 11/10/2022] Open
Abstract
Echinococcosis is a parasitic disease caused by two zoonotic tapeworms (cestodes) of the Echinocococcus genus. It can be classified as either alveolar or cystic echinococcosis. Although the two forms differ significantly in terms of imaging findings, they share similarities in terms of management and treatment. In parallel to medical treatment with albendazole (ABZ), and surgery, historically used in these diseases, various imaging-guided interventional procedures have recently emerged (drainage, stenting, or Puncture, aspiration, injection, and reaspiration (PAIR)). These options open up a new range of therapeutic options. As in oncology, multidisciplinary consultation meetings now play a major role in adapted management and patient care in hepatic echinococcosis. Consequently, diagnostic imaging and interventional expertise have brought radiologists to the fore as important members of these multidisciplinary team. The radiologist will need to evaluate parasite activity in both forms of the disease, to guide the choice of the appropriate therapy from among medical treatment, interventional radiology procedures and/or surgical treatment. Knowledge of the specific complications of the two forms of echinococcosis will also help radiologists to discuss the appropriate treatment and management. The aim of this review is to describe the core knowledge that what a radiologist should possess to actively participate in multidisciplinary meetings about hepatic echinococcosis. We discuss the role of imaging, from diagnosis to treatment, in alveolar (AE) and cystic echinococcosis (CE), respectively.
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Affiliation(s)
- Paul Calame
- Department of Radiology, University of Bourgogne Franche-Comté, University Hospital Besançon, 3 Boulevard Fleming, 25030, Besançon, France. .,EA 4662 Nanomedicine Lab, Imagery and Therapeutics, University of Bourgogne Franche-Comté, Besançon, France.
| | - Mathieu Weck
- Department of Radiology, University of Bourgogne Franche-Comté, University Hospital Besançon, 3 Boulevard Fleming, 25030, Besançon, France
| | - Andreas Busse-Cote
- Department of Radiology, University of Bourgogne Franche-Comté, University Hospital Besançon, 3 Boulevard Fleming, 25030, Besançon, France
| | - Eleonore Brumpt
- Department of Radiology, University of Bourgogne Franche-Comté, University Hospital Besançon, 3 Boulevard Fleming, 25030, Besançon, France
| | - Carine Richou
- Department of Hepatology, University of Bourgogne Franche-Comté, University Hospital Besançon, 25030, Besançon, France
| | - Celia Turco
- Department of Digestive Surgery, University of Bourgogne Franche-Comté, University Hospital Besançon, 25030, Besançon, France
| | - Alexandre Doussot
- Department of Digestive Surgery, University of Bourgogne Franche-Comté, University Hospital Besançon, 25030, Besançon, France
| | - Solange Bresson-Hadni
- Laboratoire de Parasitologie-Mycologie, University Hospital Besançon, 25030, Besançon, France.,Centre National de Référence Echinococcoses, University Hospital Besançon, 25030, Besançon, France
| | - Eric Delabrousse
- Department of Radiology, University of Bourgogne Franche-Comté, University Hospital Besançon, 3 Boulevard Fleming, 25030, Besançon, France.,EA 4662 Nanomedicine Lab, Imagery and Therapeutics, University of Bourgogne Franche-Comté, Besançon, France
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15
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Comparison and evaluation of analytic and diagnostic performances of four commercial kits for the detection of antibodies against Echinococcus granulosus and multilocularis in human sera. Comp Immunol Microbiol Infect Dis 2022; 86:101816. [PMID: 35472655 DOI: 10.1016/j.cimid.2022.101816] [Citation(s) in RCA: 8] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/04/2022] [Revised: 04/06/2022] [Accepted: 04/12/2022] [Indexed: 02/08/2023]
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16
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Ozturk EA, Manzano-Román R, Sánchez-Ovejero C, Caner A, Angın M, Gunduz C, Karaman Ü, Altintas N, Bozkaya H, Unalp O, Dokumcu Z, Divarci E, Casulli A, Altintas N, Siles-Lucas M, Unver A. Comparison of the multi-epitope recombinant antigen DIPOL and hydatid fluid for the diagnosis of patients with cystic echinococcosis. Acta Trop 2022; 225:106208. [PMID: 34687646 DOI: 10.1016/j.actatropica.2021.106208] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/12/2021] [Revised: 09/21/2021] [Accepted: 10/13/2021] [Indexed: 11/01/2022]
Abstract
The use of serological tests containing multiple immunodominant antigens rather than single antigens have the potential to improve the diagnostic performance in Cystic Echinococcoses (CE) as a complement tool to clear the inconclusive imaging data. Here, we comparatively evaluated the diagnostic value of Hydatid Fluid (HF) and the recently described recombinant multi-epitope antigen DIPOL in IgG-ELISA in a clinically defined cohort of CE patients. The serum samples from 149 CE patients were collected just before surgical or Percutaneous- Aspiration- Injection- Reaspiration (PAIR) procedures. Additionally, serum samples of patients with other parasitic infections (n=49) and healthy individuals (n=21) were also included in the study as controls. To investigate the association between the genotype of the parasite and DIPOL, cyst materials from 20 CE patients were sequenced. In terms of overall sensitivity, HF was higher than DIPOL (82.55%,78.52%, respectively). However, while the sensitivity of HF was higher than DIPOL in patients with active and transitional cysts (83.3%, 75.4%, respectively), sensitivity of DIPOL in inactive cysts was higher compared to HF (95.6%, 78.3%, respectively). The sensitivity of DIPOL depending on cyst stage was statistically significant (P= 0.041). In terms of specificity, DIPOL was found to be better than HF (97.71%, 91.43%, respectively). By genotyping, the majority of 20 patients showed G1 genotype (80%). All patients harboring G3 and G1/G3 cyst genotypes were positive with both antigens, while 87.5% of patients with G1 genotype were seropositive with HF and 75% with DIPOL. The overall sensitivity and high specificity of DIPOL suggest that this recombinant protein containing immunodominant epitopes is a potential substitute for the HF by serological tests for the diagnosis of CE.
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17
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Ferrer-Inaebnit E, Molina-Romero FX, Segura-Sampedro JJ, González-Argenté X, Morón Canis JM. A review of the diagnosis and management of liver hydatid cyst. REVISTA ESPANOLA DE ENFERMEDADES DIGESTIVAS 2021; 114:35-41. [PMID: 34034501 DOI: 10.17235/reed.2021.7896/2021] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
Hydatidosis is a zoonosis caused by Echinococcus in the larval stage. Humans are accidental intermediary hosts where cystic lesions develop, primarily in the liver and lungs. It is usually asymptomatic, hence it is usually incidentally identified. Symptoms result from cyst expansion and/or host inflammatory reaction. Hepatomegaly is the most common sign. Hydatidosis induces no specific changes in lab tests, but immunodiagnostics are available that may complement its study, with antibody detection being the method of choice. While ultrasound is the main diagnostic technique, tomography offers more accurate information regarding characteristics and anatomical relations. A number of therapy options are presently available. Treatment with albendazole, whether combined or not with praziquantel, is useful for smaller, uncomplicated cysts (< 5 cm). Only 30 % of cysts disappear with medical treatment alone. Surgery is indicated for bigger liver cysts (> 10 cm), at risk for rupture and/or complicated; the laparoscopic approach is scarcely widespread. The radical technique (total cystopericystectomy) is preferable because o its lower risk for postoperative abdominal infection, biliary fistula, and overall morbidity. Conservative techniques are appropriate in endemic areas where surgery is performed by nonspecialist surgeons. PAIR (puncture-aspiration-injection-reaspiration) is an innovative technique representing an alternative to surgery. It is indicated for inoperable cases and/or patients who reject surgery, for recurrence after surgery, and for lack of response to medical treatment. Active surveillance without treatment may be indicated for quiescent or inactive, uncomplicated liver cysts.
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18
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Manciulli T, Enríquez-Laurente R, Tamarozzi F, Lissandrin R, Elizalde M, Sedano C, Bardales K, Vola A, De Silvestri A, Tinelli C, Brunetti E, Santivanez S, Mariconti M. Field Performance of a Rapid Diagnostic Test for the Serodiagnosis of Abdominal Cystic Echinococcosis in the Peruvian Highlands. Am J Trop Med Hyg 2021; 105:181-187. [PMID: 34029208 PMCID: PMC8274789 DOI: 10.4269/ajtmh.21-0045] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/12/2021] [Accepted: 02/11/2021] [Indexed: 11/07/2022] Open
Abstract
We evaluated the performance of a commercial rapid diagnostic test (RDT) in a field setting for the diagnosis of abdominal cystic echinococcosis (CE) using sera collected during an ultrasound population screening in a highly endemic region of the Peruvian Andes. Abdominal CE was investigated by ultrasonography. Sera collected from individuals with abdominal CE (cases) and age- and gender-matched volunteers with no abdominal CE (controls) were tested independently in two laboratories (Peru and Italy) using the VIRapid® HYDATIDOSIS RDT and RIDASCREEN® Echinococcus IgG enzyme-linked immunosorbent assay. Performance indexes of single and serially combined tests were calculated and applied to hypothetical screening and clinical scenarios. Test concordance was also evaluated. Prevalence of abdominal CE was 6.00% (33 of 546) by ultrasound. Serum was obtained from 33 cases and 81 controls. The VIRapid test showed similar sensitivity (76% versus 74%) and lower specificity (79% versus 96%) than results obtained in a hospital setting. RDTs showed better performance when excluding subjects reporting surgery for CE and if weak bands were considered negative. Concordance between tests was moderate to very good. In hypothetical screening scenarios, ultrasound alone or confirmed by RDTs provided more reliable prevalence figures than serology alone, which overestimated it by 5 to 20 times. In a simulation of case diagnosis with pre-test probability of CE of 50%, positive and negative post-test probabilities of the VIRapid test were 78% and 22%, respectively. The application of the VIRapid test alone would not be reliable for the assessment of population prevalence of CE, but could help clinical decision making in resource-limited settings.
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Affiliation(s)
- Tommaso Manciulli
- PhD School of Experimental Medicine, University of Pavia, Pavia, Italy
- Department of Clinical, Surgical, Diagnostic and Pediatric Sciences, University of Pavia, Pavia, Italy
| | | | - Francesca Tamarozzi
- Department of Infectious-Tropical Diseases and Microbiology, IRCCS Sacro Cuore Don Calabria Hospital, Negrar, Verona, Italy
| | - Raffaella Lissandrin
- Department of Clinical, Surgical, Diagnostic and Pediatric Sciences, University of Pavia, Pavia, Italy
| | - Maira Elizalde
- Instituto Peruano de Parasitologia Clinica y Experimental, Lima, Peru
| | - Cesar Sedano
- Instituto Peruano de Parasitologia Clinica y Experimental, Lima, Peru
| | - Karina Bardales
- Instituto Peruano de Parasitologia Clinica y Experimental, Lima, Peru
| | - Ambra Vola
- Unit of Infectious and Tropical Diseases, IRCCS San Matteo Hospital Foundation, Pavia, Italy
| | - Annalisa De Silvestri
- Unit of Epidemiology and Biostatistics, IRCCS San Matteo Hospital Foundation, Pavia, Italy
| | - Carmine Tinelli
- Unit of Epidemiology and Biostatistics, IRCCS San Matteo Hospital Foundation, Pavia, Italy
| | - Enrico Brunetti
- Department of Clinical, Surgical, Diagnostic and Pediatric Sciences, University of Pavia, Pavia, Italy
- Unit of Infectious and Tropical Diseases, IRCCS San Matteo Hospital Foundation, Pavia, Italy
| | - Saul Santivanez
- Instituto Peruano de Parasitologia Clinica y Experimental, Lima, Peru
| | - Mara Mariconti
- Department of Clinical, Surgical, Diagnostic and Pediatric Sciences, University of Pavia, Pavia, Italy
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Tamarozzi F, Silva R, Fittipaldo VA, Buonfrate D, Gottstein B, Siles-Lucas M. Serology for the diagnosis of human hepatic cystic echinococcosis and its relation with cyst staging: A systematic review of the literature with meta-analysis. PLoS Negl Trop Dis 2021; 15:e0009370. [PMID: 33909640 PMCID: PMC8081258 DOI: 10.1371/journal.pntd.0009370] [Citation(s) in RCA: 27] [Impact Index Per Article: 9.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/13/2020] [Accepted: 04/07/2021] [Indexed: 01/13/2023] Open
Abstract
Background The diagnosis of cystic echinococcosis (CE) is primarily based on imaging, while serology should be applied when imaging is inconclusive. CE cyst stage has been reported among the most important factors influencing the outcome of serodiagnosis. We performed a systematic review and meta-analysis of the relation between cyst stage of hepatic CE and diagnostic sensitivity of serological tests, to evaluate whether their relation is a consistent finding and provide guidance for the interpretation of results of serological tests. Methodology/Principal findings MEDLINE, EMBASE, CENTRAL, and Lilacs databases were searched on December 1st 2019. Original studies published after 2003 (year of publication of the CE cyst classification), reporting sensitivity of serological tests applied to the diagnosis of human hepatic CE, as diagnosed and staged by imaging, were included. The quality of studies was assessed using the Newcastle-Ottawa Scale. Data from 14 studies were included in the meta-analysis. Summary estimates of sensitivities and 95% confidence intervals were obtained using random effects meta-analysis. Overall, test sensitivity was highest in the presence of CE2 and CE3 (CE3a and/or CE3b), and lowest in the presence of CE5 and CE4 cysts. ELISA, ICT and WB showed the highest sensitivities, while IHA performed worst. Conclusions/Significance The results of our study confirm the presence of a clear and consistent relation between cyst stage and serological tests results. Limitations of evidence included the heterogeneity of the antigenic preparations used, which prevented to determine whether the relation between cyst stage and sensitivity was influenced by the type of antigenic preparation, the paucity of studies testing the same panel of sera with different assays, and the lack of studies assessing the performance of the same assay in both field and hospital-based settings. Our results indicate the absolute need to consider cyst staging when evaluating serological results of patients with hepatic CE. Cystic echinococcosis is a neglected zoonosis induced by the development of parasitic cysts in intermediate hosts, including humans, mostly in the liver. The diagnosis of CE is based on imaging. As CE cysts may assume different aspects (stages), the range of differential diagnoses is broad, from harmless simple cysts to neoplasms. Serological assays for the detection of serum antibodies are applied when imaging is inconclusive, but their performance depend on a number of factors, among which cyst stage has been reported as important. If this was a robust finding, it would be absolutely required to interpret serological findings in the light of CE cyst staging. The results of our systematic review and meta-analysis of the relation between cyst stage of hepatic CE and diagnostic sensitivity of serological tests confirmed that such relation is clear and consistent, and indicate the absolute need to consider cyst staging when evaluating serology results of patients with hepatic CE.
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Affiliation(s)
- Francesca Tamarozzi
- Department of Infectious-Tropical Diseases and Microbiology, IRCCS Sacro Cuore Don Calabria Hospital, Negrar, Verona, Italy
- * E-mail:
| | - Ronaldo Silva
- Department of Infectious-Tropical Diseases and Microbiology, IRCCS Sacro Cuore Don Calabria Hospital, Negrar, Verona, Italy
| | - Veronica Andrea Fittipaldo
- Department of Infectious-Tropical Diseases and Microbiology, IRCCS Sacro Cuore Don Calabria Hospital, Negrar, Verona, Italy
| | - Dora Buonfrate
- Department of Infectious-Tropical Diseases and Microbiology, IRCCS Sacro Cuore Don Calabria Hospital, Negrar, Verona, Italy
| | - Bruno Gottstein
- Institute of Infectious Diseases, Faculty of Medicine, University of Bern, Bern, Switzerland
| | - Mar Siles-Lucas
- Instituto de Recursos Naturales y Agrobiología de Salamanca (IRNASA-CSIC), Salamanca, Spain
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Tamarozzi F, Longoni SS, Vola A, Degani M, Tais S, Rizzi E, Prato M, Scarso S, Silva R, Brunetti E, Bisoffi Z, Perandin F. Evaluation of Nine Commercial Serological Tests for the Diagnosis of Human Hepatic Cyst Echinococcosis and the Differential Diagnosis with Other Focal Liver Lesions: A Diagnostic Accuracy Study. Diagnostics (Basel) 2021; 11:diagnostics11020167. [PMID: 33503986 PMCID: PMC7911993 DOI: 10.3390/diagnostics11020167] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/05/2021] [Revised: 01/19/2021] [Accepted: 01/21/2021] [Indexed: 12/19/2022] Open
Abstract
The differential diagnosis of hepatic cystic echinococcosis (CE) may be challenging. When imaging is insufficient, serology can be applied, but no consensus diagnostic algorithm exists. We evaluated the performances of nine serological tests commercialized in Europe for the diagnosis of “echinococcosis”. We performed a diagnostic accuracy study using a panel of sera from patients with hepatic CE (n = 45 “liquid” content stages, n = 25 “solid” content stages) and non-CE focal liver lesions (n = 54 with “liquid” content, n = 11 with “solid” content). The diagnosis and staging of CE were based on ultrasound (gold standard). Nine commercial seroassays (5 ELISA, 2 WB, 1 Chemiluminescence Immunoassay [CLIA] and 1 Immunochromatographic test [ICT]) were the index tests. Sensitivity (Se) ranged from 43 to 94% and from 31 to 87%, and specificity (Sp) from 68 to 100% and from 94 to 100%, when borderline results were considered positive or negative, respectively. Three seroassays (2 ELISA, 1 WB) were excluded from further analyses due to poor performances. When tests were combined, Sp was 98–100%. The best results were obtained using the WB-LDBIO alone (Se 83%) or as a third test after two non-WB tests (Se 67–86%). A validated WB or two non-WB tests, read with stringent criteria (borderline = negative and considered positive only if concordant positive), possibly confirmed by the WB, appear sensible approaches.
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Affiliation(s)
- Francesca Tamarozzi
- Department of Infectious Tropical Diseases and Microbiology, IRCCS Sacro Cuore Don Calabria Hospital, 37024 Verona, Italy; (S.S.L.); (M.D.); (S.T.); (E.R.); (M.P.); (S.S.); (R.S.); (Z.B.); (F.P.)
- Correspondence: ; Tel.: +39-0456013226
| | - Silvia Stefania Longoni
- Department of Infectious Tropical Diseases and Microbiology, IRCCS Sacro Cuore Don Calabria Hospital, 37024 Verona, Italy; (S.S.L.); (M.D.); (S.T.); (E.R.); (M.P.); (S.S.); (R.S.); (Z.B.); (F.P.)
| | - Ambra Vola
- Department of Medical Sciences and Infectious Diseases, IRCCS San Matteo Hospital Foundation, 27100 Pavia, Italy; (A.V.); (E.B.)
| | - Monica Degani
- Department of Infectious Tropical Diseases and Microbiology, IRCCS Sacro Cuore Don Calabria Hospital, 37024 Verona, Italy; (S.S.L.); (M.D.); (S.T.); (E.R.); (M.P.); (S.S.); (R.S.); (Z.B.); (F.P.)
| | - Stefano Tais
- Department of Infectious Tropical Diseases and Microbiology, IRCCS Sacro Cuore Don Calabria Hospital, 37024 Verona, Italy; (S.S.L.); (M.D.); (S.T.); (E.R.); (M.P.); (S.S.); (R.S.); (Z.B.); (F.P.)
| | - Eleonora Rizzi
- Department of Infectious Tropical Diseases and Microbiology, IRCCS Sacro Cuore Don Calabria Hospital, 37024 Verona, Italy; (S.S.L.); (M.D.); (S.T.); (E.R.); (M.P.); (S.S.); (R.S.); (Z.B.); (F.P.)
| | - Marco Prato
- Department of Infectious Tropical Diseases and Microbiology, IRCCS Sacro Cuore Don Calabria Hospital, 37024 Verona, Italy; (S.S.L.); (M.D.); (S.T.); (E.R.); (M.P.); (S.S.); (R.S.); (Z.B.); (F.P.)
| | - Salvatore Scarso
- Department of Infectious Tropical Diseases and Microbiology, IRCCS Sacro Cuore Don Calabria Hospital, 37024 Verona, Italy; (S.S.L.); (M.D.); (S.T.); (E.R.); (M.P.); (S.S.); (R.S.); (Z.B.); (F.P.)
| | - Ronaldo Silva
- Department of Infectious Tropical Diseases and Microbiology, IRCCS Sacro Cuore Don Calabria Hospital, 37024 Verona, Italy; (S.S.L.); (M.D.); (S.T.); (E.R.); (M.P.); (S.S.); (R.S.); (Z.B.); (F.P.)
| | - Enrico Brunetti
- Department of Medical Sciences and Infectious Diseases, IRCCS San Matteo Hospital Foundation, 27100 Pavia, Italy; (A.V.); (E.B.)
- Department of Clinical, Surgical, Diagnostic and Pediatric Sciences, University of Pavia, 27100 Pavia, Italy
| | - Zeno Bisoffi
- Department of Infectious Tropical Diseases and Microbiology, IRCCS Sacro Cuore Don Calabria Hospital, 37024 Verona, Italy; (S.S.L.); (M.D.); (S.T.); (E.R.); (M.P.); (S.S.); (R.S.); (Z.B.); (F.P.)
- Department of Diagnostics and Public Health, University of Verona, 37129 Verona, Italy
| | - Francesca Perandin
- Department of Infectious Tropical Diseases and Microbiology, IRCCS Sacro Cuore Don Calabria Hospital, 37024 Verona, Italy; (S.S.L.); (M.D.); (S.T.); (E.R.); (M.P.); (S.S.); (R.S.); (Z.B.); (F.P.)
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Sánchez-Ovejero C, Akdur E, Manzano-Román R, Hernández-González A, González-Sánchez M, Becerro-Recio D, González-Miguel J, Akhan O, Cretu CM, Vutova K, Tamarozzi F, Mariconti M, Brunetti E, Vola A, Fabiani M, Casulli A, Siles-Lucas M. Evaluation of the sensitivity and specificity of GST-tagged recombinant antigens 2B2t, Ag5t and DIPOL in ELISA for the diagnosis and follow up of patients with cystic echinococcosis. PLoS Negl Trop Dis 2020; 14:e0008892. [PMID: 33253168 PMCID: PMC7728171 DOI: 10.1371/journal.pntd.0008892] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/12/2019] [Revised: 12/10/2020] [Accepted: 10/14/2020] [Indexed: 12/23/2022] Open
Abstract
Cystic echinococcosis (CE) is a neglected zoonotic disease caused by Echinococcus granulosus sensu lato. Diagnosis and monitoring of CE rely primarily on imaging while serology is used as a confirmatory test. However, imaging is not always conclusive and currently available serological assays have suboptimal sensitivity and specificity, lack standardization, and are not useful for patients´ follow-up. Seroassays for CE are usually based on hydatid fluid (HF), a complex, variable antigenic mixture, and cross-reactivity exists especially with alveolar echinococcosis. Recombinant proteins based on immunogenic antigens most abundant in HF, such as AgB1, AgB2 and Ag5, have been used to overcome these limitations. None of them so far showed potential to replace HF; however, their performance have been largely tested on a limited number of samples, and comparison of different antigens using the same cohort has been rarely performed. The combination of several immunogenic epitopes in a single recombinant protein could enhance test sensitivity. For the diagnosis and follow-up of patients with CE, we compared the performance of the crude HF, previously described recombinant 2B2t antigen, and GST-tagged version of 2B2t, and novel designed recombinants (GST-Ag5t and the GST-DIPOL chimera containing AgB1, AgBB2 and Ag5 epitopes) by IgG-ELISA format. Samples belong to a retrospective cohort of 253 well-characterized patients with CE, previously described for the evaluation of the 2B2t antigen, 92 patients with alveolar echinococcosis, and 82 healthy donors. The reference standard for CE diagnosis was the presence of a CE lesion as diagnosed by ultrasonography. The highest sensitivity was obtained with HF [86.7%, 95% confidence interval (CI): 81.2–91.0], followed by GST-2B2t (70.0%, 95% CI: 63.1–76.2), 2B2t (65.5%, 95% CI: 58.5–72.0), GST-Ag5t (64.5%, 95% CI: 57.5–71.1) and GST-DIPOL (63.1%, 95% CI: 56.0–69.7). The GST-2B2t had the best specificity (95.8%, 95% CI: 88.3–99.1) and the lowest cross-reactivity (38.7%, 95% CI: 27.6–50.6). Good response to treatment also correlated to negative test results in the GST-2B2t ELISA. While none of the tested recombinant antigen appears suitable to replace HF for the diagnosis of CE, GST-2B2t should be further explored as a confirmation test, based on its high specificity and low cross-reactivity, and for the follow-up after treatment in those patients with positive serology for this antigen. Cystic echinococcosis (CE) is a neglected parasitic zoonosis. Its diagnosis and follow-up require evaluation with imaging. Currently available serological tests are applied to confirm the diagnosis in doubtful cases, although having limitations in diagnostic accuracy, and they are not useful for patients’ follow-up. Seroassays for CE are usually based on hydatid fluid (HF) obtained from infected animals, with consequent problems of heterogeneity and low specificity. The use of semi-purified HF derivatives or recombinant antigens has been attempted to improve these aspects, but with an unacceptable loss in sensitivity. Most newly developed antigens have been tested on a limited number of samples, not always well characterized, and have been rarely compared using the same samples cohort. Here, we tested and compared three recombinant antigens (2B2t, GST-2B2t and GST-Ag5t), and a recombinant chimeric antigen (DIPOL) based on three highly immunogenic components of HF (B1, B2 and Ag5), in an attempt to increase the sensitivity of recombinant antigen-based seroassays for the diagnosis and follow-up of patients with CE. We found that GST-2B2t had higher sensitivity than the other antigenic preparations, but still not as high as HF, and that GST-2B2t and GST-DIPOL had statistically higher specificity than any of the other tested antigens. GST-2B2t also showed potential for the follow-up of patients with CE after drug treatment.
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Affiliation(s)
| | - Eylem Akdur
- Cukurova Univeristy, Department of Parasitology, Sarıçam/Adana, Turkey
| | - Raúl Manzano-Román
- Proteomic Unit, Center for Cancer Research, University of Salamanca, Campus Miguel de Unamuno, Salamanca
| | - Ana Hernández-González
- Instituto de Salud Carlos III, Centro Nacional de Microbiología, Majadahonda, Madrid, Spain
| | - María González-Sánchez
- Instituto de Recursos Naturales y Agrobiología de Salamanca (IRNASA-CSIC), Cordel de Merinas, Salamanca, Spain
| | - David Becerro-Recio
- Instituto de Recursos Naturales y Agrobiología de Salamanca (IRNASA-CSIC), Cordel de Merinas, Salamanca, Spain
| | - Javier González-Miguel
- Instituto de Recursos Naturales y Agrobiología de Salamanca (IRNASA-CSIC), Cordel de Merinas, Salamanca, Spain
| | - Okan Akhan
- Faculty of Medicine, Hacettepe University, Ankara, Turkey
| | - Carmen M. Cretu
- University of Medicine and Pharmacy, Colentina Clinical Hospital—Parasitology, Bucharest, Romania
| | - Kamenna Vutova
- Specialised Hospital of Infectious and Parasitic Diseases "Prof. Ivan Kirov", Department of Infectious, Parasitic and Tropical Diseases, Medical University, Sofia, Bulgaria
| | - Francesca Tamarozzi
- WHO Collaborating Centre for the epidemiology, detection and control of cystic and alveolar echinococcosis, Istituto Superiore di Sanità, Rome, Italy
| | - Mara Mariconti
- Department of Clinical Surgical Diagnostic and Paediatric Sciences, University of Pavia, Via Taramelli 5, Pavia, Italy
| | - Enrico Brunetti
- Department of Clinical Surgical Diagnostic and Paediatric Sciences, University of Pavia, and Division of Infectious and Tropical Diseases, San Matteo Hospital Foundation, Via Taramelli 5, Pavia, Italy
| | - Ambra Vola
- San Matteo Hospital Foundation, Via Taramelli 5, Pavia, Italy
| | - Massimo Fabiani
- Infectious Diseases Department, Istituto Superiore di Sanità, Rome, Italy
| | - Adriano Casulli
- WHO Collaborating Centre for the epidemiology, detection and control of cystic and alveolar echinococcosis, Istituto Superiore di Sanità, Rome, Italy
- European Reference Laboratory for Parasites (EURLP), Istituto Superiore di Sanità, Rome, Italy
| | - Mar Siles-Lucas
- Instituto de Recursos Naturales y Agrobiología de Salamanca (IRNASA-CSIC), Cordel de Merinas, Salamanca, Spain
- * E-mail:
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Santucciu C, Bonelli P, Peruzzu A, Fancellu A, Marras V, Carta A, Mastrandrea S, Bagella G, Piseddu T, Profili S, Porcu A, Masala G. Cystic Echinococcosis: Clinical, Immunological, and Biomolecular Evaluation of Patients from Sardinia (Italy). Pathogens 2020; 9:E907. [PMID: 33143032 PMCID: PMC7693143 DOI: 10.3390/pathogens9110907] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/20/2020] [Revised: 10/27/2020] [Accepted: 10/28/2020] [Indexed: 02/07/2023] Open
Abstract
Cystic echinococcosis (CE), a zoonotic disease caused by the larval stage of the tapeworm Echinococcus granulosus sensu lato (s.l.), is a worldwide public health problem. Echinococcus granulosus sensu stricto (s.s.), associated with G1 and G3 genotypes, is endemic with high prevalence in the Mediterranean basin. The parasite's life cycle comprises definitive hosts (canids) and intermediate hosts (ruminants) and can occasionally involve humans. The main aim of this research was to confirm the diagnosis of 13 patients suspected of CE who presented different complications and needed the surgical removal of the cysts. We also wanted to understand and clarify more the diagnosis of echinococcosis in humans. For this purpose, the patients first underwent cyst evaluation by ultrasound (US), immunological analysis, and then total pericystectomy, followed by parasitological, histopathological, and molecular biology examinations of the cysts. US stadiated one CE1, one CE2, eight CE3b, one CE4, and two CE5; immunology evidenced nine positives; histopathology confirmed 11 CE cysts, of which 8 fertile presenting protoscoleces were identified as E. granulosus s.s. by molecular biology, genotyped as three G1 and four G3 by neighbor-joining (NJ) phylogenetic tree. In conclusion, the results showed that 11 patients were affected by E. granulosus s.s. G1 orG3, and 2 cystic neoformations were of non-parasitic origin.
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Affiliation(s)
- Cinzia Santucciu
- OIE Reference Laboratory for Echinococcosis, National Reference Center for Echinococcosis (CeNRE), IZS della Sardegna, 07100 Sassari, Italy; (P.B.); (A.P.); (S.M.); (T.P.); (G.M.)
| | - Piero Bonelli
- OIE Reference Laboratory for Echinococcosis, National Reference Center for Echinococcosis (CeNRE), IZS della Sardegna, 07100 Sassari, Italy; (P.B.); (A.P.); (S.M.); (T.P.); (G.M.)
| | - Angela Peruzzu
- OIE Reference Laboratory for Echinococcosis, National Reference Center for Echinococcosis (CeNRE), IZS della Sardegna, 07100 Sassari, Italy; (P.B.); (A.P.); (S.M.); (T.P.); (G.M.)
| | - Alessandro Fancellu
- Department of Medical, Surgical and Experimental Sciences, University of Sassari, 07100 Sassari, Italy; (A.F.); (A.P.)
| | - Vincenzo Marras
- Department of Biomedical Sciences, Institute of Pathology, University of Sassari, 07100 Sassari, Italy;
| | - Antonello Carta
- U.O.C. di Radiologia, A.O.U., 07100 Sassari, Italy; (A.C.); (S.P.)
| | - Scilla Mastrandrea
- OIE Reference Laboratory for Echinococcosis, National Reference Center for Echinococcosis (CeNRE), IZS della Sardegna, 07100 Sassari, Italy; (P.B.); (A.P.); (S.M.); (T.P.); (G.M.)
- U.O.C. di Malattie Infettive, A.O.U., 07100 Sassari, Italy
| | - Giorgio Bagella
- Radiology Unit, University Hospital of Sassari, 07100 Sassari, Italy;
| | - Toni Piseddu
- OIE Reference Laboratory for Echinococcosis, National Reference Center for Echinococcosis (CeNRE), IZS della Sardegna, 07100 Sassari, Italy; (P.B.); (A.P.); (S.M.); (T.P.); (G.M.)
| | - Stefano Profili
- U.O.C. di Radiologia, A.O.U., 07100 Sassari, Italy; (A.C.); (S.P.)
| | - Alberto Porcu
- Department of Medical, Surgical and Experimental Sciences, University of Sassari, 07100 Sassari, Italy; (A.F.); (A.P.)
| | - Giovanna Masala
- OIE Reference Laboratory for Echinococcosis, National Reference Center for Echinococcosis (CeNRE), IZS della Sardegna, 07100 Sassari, Italy; (P.B.); (A.P.); (S.M.); (T.P.); (G.M.)
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Dorjsuren T, Ganzorig S, Dagvasumberel M, Tsend-Ayush A, Ganbold C, Ganbat M, Tsogzolbaatar EO, Tsevelvaanchig U, Narantsogt G, Boldbaatar C, Mundur B, Khand-Ish M, Agvaandaram G. Prevalence and risk factors associated with human cystic echinococcosis in rural areas, Mongolia. PLoS One 2020; 15:e0235399. [PMID: 32614862 PMCID: PMC7331993 DOI: 10.1371/journal.pone.0235399] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/31/2020] [Accepted: 06/15/2020] [Indexed: 12/11/2022] Open
Abstract
Cystic echinococcosis is a chronic, complex and neglected zoonotic disease with considerable socio-economic impact on the affected population. Even though Mongolia is included in the list of high cystic echinococcosis risk countries, there has been very limited research and evidence on the prevalence or prevention of cystic echinococcosis. This field-based cross-sectional study to investigate the prevalence of cystic echinococcosis and its potential risk factors in Mongolia was conducted from April 2016 to March 2018. A total of 1,993 people were examined by ultrasound in five provinces of Mongolia. All cystic echinococcosis positive cases were classified according to the WHO-IWGE expert recommendations. The logistic regression model was used to detect the association between the presence of echinococcus infection and each potential risk factor. This was the first community survey based on ultrasound screening in Mongolia. We found 98 cystic echinococcosis cases (prevalence = 4.9%), including 85 abdominal ultrasound cystic echinococcosis positive cases and 13 abdominal ultrasound cystic echinococcosis negative cases (surgically treated cystic echinococcosis cases 11, and 2 confirmed cases of lung cystic echinococcosis by chestcomputed tomography in hospital of Ulaanbaatar). The prevalence of cystic echinococcosis varied greatly among different provinces, ranging from 2.0% to 13.1%. Children, elderly people and those with lower education had higher chances of getting cystic echinococcosis. Rather than dog ownership itself, daily practice for cleaning dog feces was associated with increased odds of cystic echinococcosis. The results of the present study show very high endemicity of cystic echinococcosis in Umnugovi province. Evaluation of potential risk factors associated with cystic echinococcosisshow high significance for following factors: demographics (age), social condition (education level) and hygiene practices (cleaning dog feces and use of gloves). Children under 18 and elderly people are considered as the most risk age groups in Mongolia.
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Affiliation(s)
- Temuulen Dorjsuren
- Department of Biology, Mongolian National University of Medical Sciences, Ulaanbaatar, Mongolia
- * E-mail:
| | - Sumiya Ganzorig
- Laboratory of space and biological resources, National University of Mongolia, Ulaanbaatar, Mongolia
| | | | - Altansukh Tsend-Ayush
- Department of Molecular Biology and Genetics, Mongolian National University of Medical Sciences, Ulaanbaatar, Mongolia
| | - Chimedlkhamsuren Ganbold
- Department of Molecular Biology and Genetics, Mongolian National University of Medical Sciences, Ulaanbaatar, Mongolia
| | - Mandukhai Ganbat
- Department of Epidemiology and Biostatistics, Mongolian National University of Medical Sciences, Ulaanbaatar, Mongolia
| | - Enkh-Oyun Tsogzolbaatar
- Department of Epidemiology and Biostatistics, Mongolian National University of Medical Sciences, Ulaanbaatar, Mongolia
| | | | - Giimaa Narantsogt
- Department of Biology, Mongolian National University of Medical Sciences, Ulaanbaatar, Mongolia
| | | | - Burnee Mundur
- Department of Biology, Mongolian National University of Medical Sciences, Ulaanbaatar, Mongolia
| | - Munkhgerel Khand-Ish
- Department of Biology, Mongolian National University of Medical Sciences, Ulaanbaatar, Mongolia
| | - Gurbadam Agvaandaram
- Department of Biology, Mongolian National University of Medical Sciences, Ulaanbaatar, Mongolia
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Comprehensive characterization of plasma cell-free Echinococcus spp. DNA in echinococcosis patients using ultra-high-throughput sequencing. PLoS Negl Trop Dis 2020; 14:e0008148. [PMID: 32282820 PMCID: PMC7209354 DOI: 10.1371/journal.pntd.0008148] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/10/2019] [Revised: 05/08/2020] [Accepted: 02/18/2020] [Indexed: 12/18/2022] Open
Abstract
Background Echinococcosis is a life-threatening parasitic disease caused by Echinococcus spp. tapeworms with over one million people affected globally at any time. The Echinococcus spp. tapeworms in the human body release DNA to the circulatory system, which can be a biomarker for echinococcosis. Cell-free DNA (cfDNA) is widely used in medical research and has been applied in various clinical settings. As for echinococcosis, several PCR-based tests had been trialed to detect cell-free Echinococcus spp. DNA in plasma or serum, but the sensitivity was about 20% to 25%. Low sensitivity of PCR-based methods might be related to our limited understanding of the features of cell-free Echinococcus spp. DNA in plasma, including its concentration, fragment pattern and release source. In this study, we applied ultra-high-throughput sequencing to comprehensively investigate the characteristics of cell-free Echinococcus spp. DNA in plasma of echinococcosis patients. Methodology/Principal findings We collected plasma samples from 23 echinococcosis patients. Total plasma cfDNA was extracted and sequenced with a high-throughput sequencing platform. An average of 282 million read pairs were obtained for each plasma sample. Sequencing data were analyzed with bioinformatics workflow combined with Echinococcus spp. sequence database. After identification of cell-free Echinococcus spp. reads, we found that the cell-free Echinococcus spp. reads accounted for 1.8e-5 to 4.0e-9 of the total clean reads. Comparing fragment length distribution of cfDNA between Echinococcus spp. and humans showed that cell-free Echinococcus spp. DNA of cystic echinococcosis (CE) had a broad length range, while that of alveolar echinococcosis (AE) had an obvious peak at about 135 bp. We found that most of the cell-free Echinococcus spp. DNA reads were from the nuclear genome with an even distribution, which might indicate a random release pattern of cell-free Echinococcus spp. DNA. Conclusions/Significance With ultra-high-throughput sequencing technology, we analyzed the concentration, fragment length, release source, and other characteristics of cell-free Echinococcus spp. DNA in the plasma of echinococcosis patients. A better understanding of the characteristics of cell-free Echinococcus spp. DNA in plasma may facilitate their future application as a biomarker for diagnosis. Echinococcosis is one of the most neglected tropical diseases caused by the metacestodes of Echinococcus spp. tapeworms, which affect both humans and livestock. Plasma cell-free DNA (cfDNA) consists of nucleic acid fragments found extracellularly and may contain DNA released from the parasites. Research shows that a variety of parasites can be detected from plasma cfDNA. Cell-free Echinococcus spp. DNA in plasma or serum had been tested with PCR-based methods, but these PCR methods had low sensitivity ranged from 20% to 25%. Low sensitivity may be due to our limited understanding of cell-free Echinococcus spp. DNA in plasma. Here, we take advantage of high-throughput sequencing to get a comprehensive characterization of cell-free Echinococcus spp. DNA. Our results showed that with high-throughput sequencing we could detect cell-free Echinococcus spp. DNA in all samples, though at a very low level. Based on the sequencing data, we found that cell-free Echinococcus spp. DNA in plasma had a different fragment length distribution to cell-free human DNA, and fragment length distribution of cell-free Echinococcus spp. DNA is also different between cystic echinococcosis (CE) and alveolar echinococcosis (AE). The sequencing data can also help trace the release source of cell-free Echinococcus spp. DNA from the genome. According to the mapping results of cell-free Echinococcus spp. DNA reads, we found that most of them were from the nuclear genome rather than the mitochondrial genome, and their release position showed an even distribution on the genome. These characteristics of cell-free Echinococcus spp. DNA in echinococcosis patients’ plasma could facilitate their future application in research or clinical settings.
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Vola A, Manciulli T, De Silvestri A, Lissandrin R, Mariconti M, Siles-Lucas M, Brunetti E, Tamarozzi F. Diagnostic Performances of Commercial ELISA, Indirect Hemagglutination, and Western Blot in Differentiation of Hepatic Echinococcal and Non-Echinococcal Lesions: A Retrospective Analysis of Data from a Single Referral Centre. Am J Trop Med Hyg 2020; 101:1345-1349. [PMID: 31674293 DOI: 10.4269/ajtmh.19-0556] [Citation(s) in RCA: 19] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022] Open
Abstract
The diagnosis of cystic echinococcosis (CE) is based on imaging. Serology supports imaging in suspected cases, but no consensus exists on the algorithm to apply when imaging is inconclusive. We performed a retrospective analysis of serology results of patients with untreated hepatic CE and non-CE lesions, seen from 2005 to 2017, to evaluate their accuracy in the differential diagnosis of hepatic CE. Serology results of three seroassays for echinococcosis (ELISA RIDASCREEN, indirect hemagglutination (IHA) Cellognost, and Western blot LDBIO) and clinical characteristics of eligible patients were retrieved. Patients were grouped as having active or inactive CE and liquid or solid non-CE lesions. Sensitivity, specificity, and diagnostic accuracy were compared between scenarios encompassing different test combinations. Eligible patients included 104 patients with CE and 257 with non-CE lesions. Sensitivity and diagnostic accuracy of Western blot (WB) were significantly higher than those of the following: 1) IHA or ELISA alone, 2) IHA+ELISA interpreted as positive if both or either tests positive, and 3) IHA+ELISA confirmed by WB if discordant. The best performances were obtained when WB was applied on discordant or concordant negative IHA+ELISA. Analyses performed within "active CE (n = 52) versus liquid non-CE (n = 245)" and "inactive CE (n = 52) versus solid non-CE (n = 12)" groups showed similar results. Specificity was high for all tests (0.99-1.00) and did not differ between test combination scenarios. WB may be the best test to apply in a one-test approach. Two first-level tests confirmed by WB seem to provide the best diagnostic accuracy. Further studies should be performed in different settings, especially where lower test specificity is likely.
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Affiliation(s)
- Ambra Vola
- Unit of Infectious and Tropical Diseases, San Matteo Hospital Foundation, Pavia, Italy
| | - Tommaso Manciulli
- Department of Clinical, Surgical, Diagnostic and Pediatric Sciences, University of Pavia, Pavia, Italy
| | - Annalisa De Silvestri
- Clinical Epidemiology and Biometric Unit, San Matteo Hospital Foundation, Pavia, Italy
| | - Raffaella Lissandrin
- Department of Clinical, Surgical, Diagnostic and Pediatric Sciences, University of Pavia, Pavia, Italy.,Unit of Infectious and Tropical Diseases, San Matteo Hospital Foundation, Pavia, Italy
| | - Mara Mariconti
- Department of Clinical, Surgical, Diagnostic and Pediatric Sciences, University of Pavia, Pavia, Italy.,Unit of Infectious and Tropical Diseases, San Matteo Hospital Foundation, Pavia, Italy
| | - Mar Siles-Lucas
- Instituto de Recursos Naturales y Agrobiología de Salamanca, Consejo Superior de Investigaciones Científicas, Salamanca, Spain
| | - Enrico Brunetti
- Department of Clinical, Surgical, Diagnostic and Pediatric Sciences, University of Pavia, Pavia, Italy.,Unit of Infectious and Tropical Diseases, San Matteo Hospital Foundation, Pavia, Italy
| | - Francesca Tamarozzi
- Department of Infectious Diseases, WHO Collaborating Centre for the Epidemiology, Detection and Control of Cystic and Alveolar Echinococcosis, Istituto Superiore di Sanità, Rome, Italy
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Petrone L, Albrich WC, Tamarozzi F, Frischknecht M, Gomez-Morales MA, Teggi A, Hoffmann M, Goletti D. Species specificity preliminary evaluation of an IL-4-based test for the differential diagnosis of human echinococcosis. Parasite Immunol 2020; 42:e12695. [PMID: 31884696 PMCID: PMC7154717 DOI: 10.1111/pim.12695] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/12/2019] [Revised: 12/18/2019] [Accepted: 12/20/2019] [Indexed: 12/14/2022]
Abstract
The diagnosis of cystic echinococcosis (CE) is based on imaging, while serology is a complementary test of particular use when imaging is inconclusive. Serology has several limitations. Among them, false‐positive results are often obtained in subjects with alveolar echinococcosis (AE), rendering difficult the differential diagnosis. We set up an immune assay based on IL‐4‐specific production after stimulating whole blood with an antigen B (AgB)‐enriched fraction from E granulosus that associates with CE and CE cysts in active stage. We aimed to evaluate potential cross‐reactivity of this test using samples from patients with AE. Twelve patients with AE were recruited; IL‐4 levels ranged from 0 to 0.07 pg/mL. Based on the previously identified cut‐off of 0.39 pg/mL using samples from patients with CE, none of samples from AE patients scored positive. In contrast, almost 80% of samples from AE patients scored positive in serology tests based on different E granulosus‐derived antigenic preparations. Our preliminary data show that this experimental whole‐blood assay has no cross‐reactivity in our cohort of patients with AE, in turn indicating a high specificity of the assay for CE diagnosis. This result supports further work towards the development of improved diagnostic tests for CE.
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Affiliation(s)
- Linda Petrone
- Translational Research Unit, Department of Epidemiology and Preclinical Research, National Institute for Infectious Diseases Lazzaro Spallanzani-IRCCS, Rome, Italy
| | - Werner C Albrich
- Division of Infectious Diseases and Hospital Epidemiology, Cantonal Hospital St. Gallen, St. Gallen, Switzerland
| | - Francesca Tamarozzi
- Foodborne and Neglected Parasitoses Unit, Department of Infectious Diseases, Istituto Superiore di Sanità, Rome, Italy
| | - Manuel Frischknecht
- Division of Infectious Diseases and Hospital Epidemiology, Cantonal Hospital St. Gallen, St. Gallen, Switzerland
| | - Maria Angeles Gomez-Morales
- Foodborne and Neglected Parasitoses Unit, Department of Infectious Diseases, Istituto Superiore di Sanità, Rome, Italy
| | - Antonella Teggi
- Department of Infectious and Tropical Diseases, Sant'Andrea Hospital University of Rome "Sapienza", Rome, Italy
| | - Matthias Hoffmann
- Division of Infectious Diseases and Hospital Epidemiology, Cantonal Hospital St. Gallen, St. Gallen, Switzerland.,Medical Department, Infectious Diseases Services, Kantonsspital Olten, Olten, Switzerland
| | - Delia Goletti
- Translational Research Unit, Department of Epidemiology and Preclinical Research, National Institute for Infectious Diseases Lazzaro Spallanzani-IRCCS, Rome, Italy
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Cattaneo L, Manciulli T, Cretu CM, Giordani MT, Angheben A, Bartoloni A, Zammarchi L, Bartalesi F, Richter J, Chiodini P, Godbole G, Junghanss T, Stojkovic M, Sammarchi L, Dore R, Vercelli A, Benazzo F, Cuzzocrea F, Tamarozzi F, Brunetti E. Cystic Echinococcosis of the Bone: A European Multicenter Study. Am J Trop Med Hyg 2020; 100:617-621. [PMID: 30693857 DOI: 10.4269/ajtmh.18-0758] [Citation(s) in RCA: 17] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/01/2023] Open
Abstract
Cystic echinococcosis (CE) is a zoonosis caused by the larval stage of the tapeworm Echinococcus granulosus. In humans, the infection induces the formation of parasitic cysts mostly in the liver and lungs, but virtually any organ can be affected. CE of the bone is one of the rarest forms of the disease, yet it is also extremely debilitating for patients and hard to manage for clinicians. Unlike abdominal CE, there is currently no expert consensus on the management of bone CE. In this study, we conducted a survey of the clinical records of seven European referral centers for the management of patients with CE and retrieved data on the clinical management of 32 patients with a diagnosis of bone CE. Our survey confirmed that the patients endured chronic debilitating disease with a high rate of complications (84%). We also found that diagnostic approaches were highly heterogeneous. Surgery was extensively used to treat these patients, as well as albendazole, occasionally combined with praziquantel or nitaxozanide. Treatment was curative only for two patients, with one requiring amputation of the involved bone. Our survey highlights the need to conduct systematic studies on bone CE, both retrospectively and prospectively.
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Affiliation(s)
- Letizia Cattaneo
- Department of Clinical, Surgical, Diagnostic and Pediatric Science, University of Pavia, Pavia, Italy
| | - Tommaso Manciulli
- PhD School of Experimental Medicine, University of Pavia, Pavia, Italy.,Department of Clinical, Surgical, Diagnostic and Pediatric Science, University of Pavia, Pavia, Italy
| | - Carmen-Michaela Cretu
- Parasitology Department, Colentina Clinical Hospital, Carol Davila University of Medicine and Pharmacy, Bucharest, Romania
| | | | - Andrea Angheben
- Centre for Tropical Diseases, Istituto di Ricovero e Cura a Carattere Scientifico (IRCCS) Sacro Cuore-Don Calabria Hospital, Verona, Italy
| | - Alessandro Bartoloni
- Infectious and Tropical Diseases Unit, Careggi University Hospital, University of Florence, Florence, Italy
| | - Lorenzo Zammarchi
- Infectious and Tropical Diseases Unit, Careggi University Hospital, University of Florence, Florence, Italy
| | - Filippo Bartalesi
- Infectious and Tropical Diseases Unit, Careggi University Hospital, University of Florence, Florence, Italy
| | - Joachim Richter
- Institute of Tropical Medicine and International Health, Charité - Universitätsmedizin, Berlin, Germany
| | - Peter Chiodini
- Department of Clinical Parasitology, Hospital for Tropical Diseases, London, United Kingdom
| | - Gauri Godbole
- Department of Clinical Parasitology, Hospital for Tropical Diseases, London, United Kingdom
| | - Thomas Junghanss
- Section of Clinical Tropical Medicine, University Hospital, Heidelberg, Germany
| | - Marija Stojkovic
- Section of Clinical Tropical Medicine, University Hospital, Heidelberg, Germany
| | - Luigi Sammarchi
- Division of Radiology, IRCCS San Matteo Hospital Foundation, Pavia, Italy
| | - Roberto Dore
- Department of Radiology, Istituti Clinici di Pavia e Vigevano, University Hospital, Pavia, Italy
| | - Alessandro Vercelli
- Department of Radiology, Istituti Clinici di Pavia e Vigevano, University Hospital, Pavia, Italy
| | - Francesco Benazzo
- Division of Orthopedics and Traumatology, IRCCS San Matteo Hospital Foundation, Pavia, Italy.,Department of Clinical, Surgical, Diagnostic and Pediatric Science, University of Pavia, Pavia, Italy
| | - Fabrizio Cuzzocrea
- Division of Orthopedics and Traumatology, IRCCS San Matteo Hospital Foundation, Pavia, Italy
| | - Francesca Tamarozzi
- Centre for Tropical Diseases, Istituto di Ricovero e Cura a Carattere Scientifico (IRCCS) Sacro Cuore-Don Calabria Hospital, Verona, Italy
| | - Enrico Brunetti
- Unit of Infectious and Tropical Diseases, IRCCS San Matteo Hospital Foundation, Pavia, Italy.,Department of Clinical, Surgical, Diagnostic and Pediatric Science, University of Pavia, Pavia, Italy
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Role of microRNAs in host defense against Echinococcus granulosus infection: a preliminary assessment. Immunol Res 2019; 67:93-97. [PMID: 30498955 DOI: 10.1007/s12026-018-9041-4] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/06/2023]
Abstract
Cystic echinococcosis (CE) is a neglected helminthic zoonosis caused by the larval stage of the tapeworm Echinococcus granulosus s.l. MicroRNAs (miRNAs) are regulators of gene expression that have been linked with the pathogenesis of several human diseases, but little exists in the available literature about miRNAs in CE. Here, we investigate the expression profiles of 84 microRNAs relevant to the function of lymphocytes and other immune cells during CE infection in the peripheral blood of patients with cysts in active and inactive stages. We applied the microRNA PCR array technology to blood samples from 20 patients with a single hepatic CE cyst in either the active (CE3b) or inactive (CE4-CE5) stage. Our results show a significant upregulation of eight miRNAs (let-7g-5p, let-7a-5p, miR- 26a-5p, miR- 26b-5p, miR- 195-5p, miR- 16-5p, miR- 30c-5p, and miR- 223-3p) in patients with active cysts compared to those with inactive cysts. The high expression of these miRNAs in patients with active cysts suggests their role in a specific host immune response against the infection. Further work in this direction may help shed light on the pathogenesis of human CE.
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Zait H, Hamrioui B. Human cystic echinococcosis: Serological diagnosis by indirect hemagglutination test, enzyme-linked immunosorbent assay, immunoelectrophoresis, and immunoblotting in surgically confirmed patients versus cases diagnosed by imaging techniques. Med Mal Infect 2019; 50:676-683. [PMID: 31727467 DOI: 10.1016/j.medmal.2019.10.001] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/27/2018] [Revised: 11/01/2018] [Accepted: 10/01/2019] [Indexed: 10/25/2022]
Abstract
INTRODUCTION Human cystic echinococcosis (CE) diagnosis is based on imaging findings and serology. Serology is the first-line test followed by imaging tests. MATERIALS AND METHODS A total of 268 serum samples from CE patients were included in this study. The serodiagnosis was made simultaneously by indirect hemagglutination assay (IHA), enzyme-linked immunosorbent assay (ELISA), immunoblotting test (IB), and immunoelectrophoresis (IEP). RESULTS In serum samples belonging to surgically confirmed CE patients, we observed a percentage of positivity of 83.7% [77.2%-89.0%] and 80.7% [73.9%-86.4%] for IHA and IgG-ELISA, respectively. IgG-IB was associated with a higher positivity rate than IEP with 81.3% [74.6%-86.9%] and 62.0% [54.2%-69.5%], respectively. IHA and ELISA results were analyzed using cut-off generated by receiver operating curves. The best diagnostic performances were achieved by IHA (cut-off ≥1/128) and ELISA (>1.16 index). Sensitivities reported in patients with suggestive imaging findings and positive Echinococcus IB were 86.2% [78.0%-92.2%], 72.5% [62.8%-80.9%], 49.0% [39.0%-59.1%] for IHA, IgG-ELISA, and IEP, respectively. All tests gave false negative results in the confirmed CE group. Overall, 18.6% of negative results were obtained by IgG-IB test. Cross-reactivities with non-hydatid serum samples were observed in all tests. Only one patient carrying Taenia saginata serum cross-reacted with 8/12 kDa band by IB. We observed specificity at 73% [63.2%-81.4%], 87% [78.8%-92.9%], 99% [94.6%-100.0%], and 99% [94.6%-100.0%] with IHA, IgG-ELISA, IEP, and IgG-IB, respectively. Serology was less sensitive (74%) in lung cysts. Sensitivity was better in liver cysts, especially by IgG-IB (96%).
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Affiliation(s)
- H Zait
- Laboratory of parasitology and mycology, Mustapha tertiary care hospital, Algiers, Algeria.
| | - B Hamrioui
- Laboratory of parasitology and mycology, Mustapha tertiary care hospital, Algiers, Algeria
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Kaminstein D, Heller T, Tamarozzi F. Sound Around the World: Ultrasound for Tropical Diseases. Infect Dis Clin North Am 2019; 33:169-195. [PMID: 30712760 DOI: 10.1016/j.idc.2018.10.008] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/01/2023]
Abstract
Ultrasound for diagnosis and staging of schistosomiasis and echinococcosis have paved the way over the past several decades for the application of ultrasound in tropical diseases. Until recently, the size and cost of ultrasound systems limited the application in low-resource settings. The increase in portable ultrasound systems has given more clinicians access to ultrasound, and clinically based protocols for the care of patients have emerged, such as focused assessment with sonography for HIV/TB and tropical cardiac ultrasound. This article explores the history and current use of ultrasound in these diseases and highlights their application in the care of patients.
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Affiliation(s)
- Daniel Kaminstein
- Department of Emergency Medicine, Medical College of Georgia, Augusta University, Augusta, GA 30912, USA.
| | - Tom Heller
- Lighthouse Clinic, Kamuzu Central Hospital, Area 33, P.O. Box 106, Lilongwe, Malawi
| | - Francesca Tamarozzi
- Center for Tropical Diseases, IRCSS, Sacro Cuore Don Calabria Hospital, Via Don A Sempreboni 5, Negrar, Verona 37024, Italy
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Pagnozzi D, Tamarozzi F, Roggio AM, Tedde V, Addis MF, Pisanu S, Masu G, Santucciu C, Vola A, Casulli A, Masala G, Brunetti E, Uzzau S. Structural and Immunodiagnostic Characterization of Synthetic Antigen B Subunits From Echinococcus granulosus and Their Evaluation as Target Antigens for Cyst Viability Assessment. Clin Infect Dis 2019; 66:1342-1351. [PMID: 29149256 PMCID: PMC5905600 DOI: 10.1093/cid/cix1006] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/27/2017] [Accepted: 11/13/2017] [Indexed: 12/28/2022] Open
Abstract
Background Several tools have been proposed for serodiagnosis of cystic echinococcosis (CE), but none seems promising for cyst viability assessment. Antigens with stage-specific diagnostic value have been described, but few studies with well-characterized antigens and human serum samples have been performed. Antigen B (AgB) proteoforms hold promise as markers of viability, due to their differential stage-related expression and immunoreactivity. Methods Four AgB subunits (AgB1, AgB2, AgB3, AgB4) were synthesized and structurally characterized. Based on the preliminary evaluation of the subunits by western immunoblotting and enzyme-linked immunosorbent assay (ELISA), AgB1 and AgB2 were further tested in two ELISA setups and extensively validated on 422 human serum samples. Results All subunits showed a high degree of spontaneous oligomerization. Interacting residues within oligomers were identified, showing that both the N-terminal and C-terminal of each subunit are involved in homo-oligomer contact interfaces. No hetero-oligomer was identified. AgB1 and AgB2 ELISAs revealed different sensitivities relative to cyst stage. Of note, besides high specificity (97.2%), AgB1 revealed a higher sensitivity for active-transitional cysts (100% for CE1, 77.8% for CE2, 81.5% for CE3a, and 86.3% for CE3b) than for inactive cysts (41.7% for CE4 and 11.1% for CE5) and postsurgical patients (44%). Interestingly, 19 of 20 patients with spontaneously inactive cysts and 6 of 9 treated with albendazole >5 years earlier were negative on the AgB1 assay. Conclusions The structural characterization of subunits provides insights into the synthetic antigen conformation. The stage-related sensitivity of synthetic AgB1 holds promise as part of a multiantigen setting and deserves further longitudinal evaluation as marker of cyst viability.
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Affiliation(s)
- Daniela Pagnozzi
- Porto Conte Ricerche, Science and Technology Park of Sardinia, Tramariglio, Alghero (Sassari), Italy
| | - Francesca Tamarozzi
- Department of Clinical, Surgical, Diagnostic and Pediatric Sciences, University of Pavia, Italy.,WHO Collaborating Centre for the Clinical Management of Cystic Echinococcosis, Pavia, Italy
| | - Anna Maria Roggio
- Porto Conte Ricerche, Science and Technology Park of Sardinia, Tramariglio, Alghero (Sassari), Italy
| | - Vittorio Tedde
- Porto Conte Ricerche, Science and Technology Park of Sardinia, Tramariglio, Alghero (Sassari), Italy
| | - Maria Filippa Addis
- Porto Conte Ricerche, Science and Technology Park of Sardinia, Tramariglio, Alghero (Sassari), Italy
| | - Salvatore Pisanu
- Porto Conte Ricerche, Science and Technology Park of Sardinia, Tramariglio, Alghero (Sassari), Italy
| | - Gabriella Masu
- National Reference Laboratory of Cystic Echinococcosis, Istituto zooprofilattico sperimentale della Sardegna "G. Pegreffi", Sassari, Italy
| | - Cinzia Santucciu
- National Reference Laboratory of Cystic Echinococcosis, Istituto zooprofilattico sperimentale della Sardegna "G. Pegreffi", Sassari, Italy
| | - Ambra Vola
- WHO Collaborating Centre for the Clinical Management of Cystic Echinococcosis, Pavia, Italy.,Division of Infectious and Tropical Diseases, IRCCS San Matteo Hospital Foundation, Pavia, Italy
| | - Adriano Casulli
- WHO Collaborating Centre for the Epidemiology, Detection and Control of Cystic and Alveolar Echinococcosis, Department of Infectious Diseases, Istituto Superiore di Sanità, Rome, Italy.,European Union Reference Laboratory for Parasites (EURLP), Department of Infectious Diseases, Istituto Superiore di Sanità, Rome, Italy
| | - Giovanna Masala
- National Reference Laboratory of Cystic Echinococcosis, Istituto zooprofilattico sperimentale della Sardegna "G. Pegreffi", Sassari, Italy
| | - Enrico Brunetti
- Department of Clinical, Surgical, Diagnostic and Pediatric Sciences, University of Pavia, Italy.,WHO Collaborating Centre for the Clinical Management of Cystic Echinococcosis, Pavia, Italy.,Division of Infectious and Tropical Diseases, IRCCS San Matteo Hospital Foundation, Pavia, Italy
| | - Sergio Uzzau
- Porto Conte Ricerche, Science and Technology Park of Sardinia, Tramariglio, Alghero (Sassari), Italy.,Department of Biomedical Sciences, University of Sassari, Italy
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Validation of a one-step PCR assay for the molecular identification of Echinococcus granulosus sensu stricto G1-G3 genotype. Mol Biol Rep 2019; 46:1747-1755. [PMID: 30734170 DOI: 10.1007/s11033-019-04625-w] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/17/2018] [Accepted: 01/18/2019] [Indexed: 12/22/2022]
Abstract
The Italian National Reference Center for Echinococcosis (CeNRE, Sassari, Italy) set up a diagnostic protocol of "one-step-PCR" useful for the detection of E. granulosus sensu stricto (E.g.s.s.) and the identification of its genotype (G1-G3). The purpose of this work was to perform the validation of the "PCR E.g.s.s." method. The procedures were performed employing the criteria of the World Organization for Animal Health as well as of the Italian Accreditation Body (ACCREDIA) based on the Regulation UNI CEI EN ISO/IEC 17025. Positive DNA samples belonging to E. granulosus, E. ortleppi, E. multilocularis, E. canadensis species were used for the experiments. Analytical specificity evidenced primer pairs Cal (Calreticulin l gene of 1001 bp) with an specificity higher respect to Ef1 (Elongation-Factor 1 Alpha gene of 706 bp) and NAD (Dehydrogenase-subunit 1 gene of 219 bp). The analytical sensitivity presented the capability to detect a very low amount of parasite DNA corresponding to a concentration of 12.5 pg/µl; accuracy and precision related to the operator performance, along with repeatability and reproducibility, evidenced high concordance among results and demonstrated an excellent κ values of Cohen. According to the good performance related to the evaluated parameters, the method "PCR E.g.s.s." was suitable for the validation procedure, and consequently, to be undergone to the accreditation process. In conclusion, the results demonstrated an elevated robustness and reliable features of the "PCR E.g.s.s." able to perform a rapid diagnosis of E. granulosus in only "one step", hence, it is likely to avoid the sequencing step.
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Abstract
Among parasitic hepatic cystic lesions, the most common disease is represented by cystic echinococcosis (CE), especially in high endemic countries. European epidemiology of CE in children is difficult to assess because of under-reporting but is increasing, because of high immigration flows from endemic countries and an increased awareness. Hydatidosis can be localized in every part of the body. The liver and lungs are the most common localizations in both children and adults. Multiorgan involvement is rarely reported in children. Different tests are available. Usually the sensitivity of serological screening tests is variable, ranging between 60% and 90%. The immunoblot assay is used as a confirmatory test because of its higher sensitivity and specificity. Radiological tests are the criterion standard for diagnosis of CE, with an ultrasound accuracy of approximately 90%. In case of inactive and uncomplicated cysts the watch-and-wait approach is recommended. Albendazole, currently used for 3 to 6 months consecutively represents the most commonly used drug in children even if there is limited experience in treating children younger than 6 years of age. Percutaneous treatment with the puncture, aspiration, injection, and reaspiration technique is a minimally invasive procedure. Surgery is indicated based on cyst characteristics in case of big cysts with multiple daughter cysts, single superficial cysts at risk of spontaneous or traumatic rupture, cysts related with the biliary tract in which the percutaneous treatment is contraindicated, and cysts compressing related structures.
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Bhutani N, Kajal P. Hepatic echinococcosis: A review. Ann Med Surg (Lond) 2018; 36:99-105. [PMID: 30450204 PMCID: PMC6226561 DOI: 10.1016/j.amsu.2018.10.032] [Citation(s) in RCA: 55] [Impact Index Per Article: 9.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/17/2018] [Revised: 10/24/2018] [Accepted: 10/26/2018] [Indexed: 12/28/2022] Open
Abstract
Cystic echinococcosis (CE) is a widely endemic helminthic disease caused by infection with metacestodes (larval stage) of the Echinococcus granulosus tapeworm and transmitted by dogs. E. granulosus are common parasites in certain parts of the world, and are present on every continent with the exception of Antarctica. As a result, a large number of people are affected by CE. In humans, the disease is characterized by slowly growing cyst commonly occurring in liver and lungs. Clinical features are mainly right upper quadrant pain, feeling of lump and enlarged tender liver. The cyst may be complicated by infection or rupture and may lead to anaphylactic reaction. The diagnosis depends on clinical suspicion. They appear in two ways as general (systemic) symptoms, and local symptoms based on the site and organ on which the larva settles. While cysts sometimes recover spontaneously, more severe clinical presentations are observed in immunosuppressed individuals. Ultrasonography supported by serology is the main diagnostic modality. The treatment varies from surgical intervention to minimally invasive treatments (percutaneous drainage) or medical therapies. Surgery is still the best treatment modality. Percutaneous drainage of the cyst is a good option in selected cases. New sensitive and specific diagnostic methods and effective therapeutic approaches against echinococcosis have been developed in the last 10 years. Echinococcal cysts, although fairly uncommon, should be considered in the differential diagnosis of hepatic cysts. Serum antibody assays generally have low sensitivities, but antigen assays may be of value. Imaging is crucial in determining cyst stage, size, location and complications. Uncomplicated active cysts can be managed with chemotherapy alone or in combination with a PAIR approach. Inactive cysts can be managed with the “watch-and-wait” strategy. Surgery is the first choice when there is cystobiliary fistula and significant extra-hepatic extension with high risk of perforation.
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Affiliation(s)
| | - Pradeep Kajal
- Dept. of Paediatric Surgery, PGIMS Rohtak, Haryana, India
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35
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Hernández-González A, Sánchez-Ovejero C, Manzano-Román R, González Sánchez M, Delgado JM, Pardo-García T, Soriano-Gálvez F, Akhan O, Cretu CM, Vutova K, Tamarozzi F, Mariconti M, Brunetti E, Vola A, Fabiani M, Casulli A, Siles-Lucas M. 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. PLoS Negl Trop Dis 2018; 12:e0006741. [PMID: 30188936 PMCID: PMC6143278 DOI: 10.1371/journal.pntd.0006741] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/16/2018] [Revised: 09/18/2018] [Accepted: 08/08/2018] [Indexed: 12/28/2022] Open
Abstract
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.
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Affiliation(s)
- Ana Hernández-González
- Instituto de Salud Carlos III, Centro Nacional de Microbiología, Majadahonda, Madrid, Spain
| | - Carlos Sánchez-Ovejero
- Instituto de Recursos Naturales y Agrobiología de Salamanca (IRNASA-CSIC), Salamanca, Spain
| | - Raúl Manzano-Román
- Instituto de Recursos Naturales y Agrobiología de Salamanca (IRNASA-CSIC), Salamanca, Spain
| | - María González Sánchez
- Instituto de Recursos Naturales y Agrobiología de Salamanca (IRNASA-CSIC), Salamanca, Spain
| | | | | | | | - Okan Akhan
- Faculty of Medicine, Hacettepe University, Ankara, Turkey
| | - Carmen M. Cretu
- University of Medicine and Pharmacy, Colentina Clinical Hospital - Parasitology, Bucharest, Romania
| | - Kamenna Vutova
- Specialised Hospital of Infectious and Parasitic Diseases "Prof. Ivan Kirov", Department of Infectious, Parasitic and Tropical Diseases, Medical University, Sofia, Bulgaria
| | - Francesca Tamarozzi
- Centre for Tropical Diseases, Sacro Cuore-Don Calabria Hospital, Negrar, Verona, Italy
| | - Mara Mariconti
- Department of Clinical Surgical Diagnostic and Paediatric Sciences, University of Pavia, Pavia, Italy
| | - Enrico Brunetti
- Department of Clinical Surgical Diagnostic and Paediatric Sciences, University of Pavia, and Division of Infectious and Tropical Diseases, San Matteo Hospital Foundation, Pavia, Italy
| | - Ambra Vola
- San Matteo Hospital Foundation, Pavia, Italy
| | - Massimo Fabiani
- Infectious Diseases Department, Istituto Superiore di Sanità, Rome, Italy
| | - Adriano Casulli
- WHO Collaborating Centre for the epidemiology, detection and control of cystic and alveolar echinococcosis, Istituto Superiore di Sanità, Rome, Italy
- European Reference Laboratory for Parasites (EURLP), Istituto Superiore di Sanità, Rome, Italy
| | - Mar Siles-Lucas
- Instituto de Recursos Naturales y Agrobiología de Salamanca (IRNASA-CSIC), Salamanca, Spain
- * E-mail:
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Performance of the commercially available SERION ELISA classic Echinococcus IgG test for the detection of cystic echinococcosis in clinical practice. J Helminthol 2018; 93:636-639. [PMID: 29950187 DOI: 10.1017/s0022149x18000536] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
Diagnosis of cystic echinococcosis (CE) is at present mainly based on imaging techniques. Serology has a complementary role, partly due to the small number of standardized and commercially available assays. Therefore we examined the clinical performance of the SERION ELISA classic Echinococcus IgG test. Using 10 U/ml as a cut-off point, and serum samples from 50 CE patients and 105 healthy controls, the sensitivity and specificity were 98.0% and 96.2%, respectively. If patients with other infectious diseases were used as negative controls, the specificity decreased to 76.9%, which causes poor positive predictive values. However, if results between 10 and 15 U/ml are classified as indecisive, the specificity of positive results (≥15 U/ml) increased to 92.5% without greatly affecting the sensitivity (92.0%). Using this approach in combination with imaging studies, the SERION ELISA classic Echinococcosis IgG test can be a useful aid in the diagnosis of CE.
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Fathi S, Jalousian F, Hosseini SH, Najafi A, Darabi E, Koohsar F. Design and construction of a new recombinant fusion protein (2b2t+EPC1) and its assessment for serodiagnosis of cystic echinococcosis. APMIS 2018; 126:428-439. [PMID: 29696723 DOI: 10.1111/apm.12838] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/18/2017] [Accepted: 03/14/2018] [Indexed: 12/31/2022]
Abstract
The immunodiagnostic tests for cystic echinococcosis (CE) are mostly serological tests based on ELISA that use hydatid cyst antigens for primary screening because of its simple preparation and availability. The challenge to develop new serological methods (as compared to those based on the hydatid cyst fluid antigens) to meet the gold standard remains. Appropriate sources of antigenic material are necessary for application to improve the efficacy of immunodiagnostic tests at a population level. In the current study, a fusion protein containing the coding sequence of antigen B2t and two sequences of EPC1 antigen with some modifications was reconstructed. Using bioinformatics tools, these sequences were joined together by applying the sequence of a rigid α-helix-forming linker to obtain an appropriate structure of a fusion protein. Synthetic recombinant fusion protein was expressed using pET28a as a vector and evaluated by indirect ELISA test for sera from patients with hepatic CE and other parasitic infections. The sensitivity of the fusion protein was lower (88.46%) than the available ELISA kit (96.15%). However, the differences in sensitivity were not statistically significant as compared to the recombinant fusion peptide with the commercial kit (p = 0.269). The specificity of the recombinant fusion protein (95.45%) was not significantly lower than the commercial kit (96.59%; p = 1.000). Moreover, surprisingly there was no difference in the cross-reactivity values of performance between the recombinant-ELISA and commercial kit. The positive and negative predictive values of the recombinant antigen were achieved as 92% and 93.33%, respectively, while for the commercial kit, they were obtained as 94.33% and 97.70%, respectively. In conclusion, as an early evaluation of these antigens the performance of our recombinant fusion protein in ELISA is relatively promising. Although, it seemed that this peptide with specific antigenic epitopes might be more appropriate for the serological evaluation of CE by use of bioinformatics tools, our findings showed that cross-reactions and a negative reaction could occur in clinical performance. This fusion protein may have utility for diagnosis in humans, but further evaluation is needed using the WHO ultrasound classification for CE.
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Affiliation(s)
- Saeid Fathi
- Department of Parasitology, Faculty of Veterinary Medicine, University of Tehran, Tehran, Iran
| | - Fatemeh Jalousian
- Department of Parasitology, Faculty of Veterinary Medicine, University of Tehran, Tehran, Iran
| | - Seyed Hossein Hosseini
- Department of Parasitology, Faculty of Veterinary Medicine, University of Tehran, Tehran, Iran
| | - Ali Najafi
- Molecular Biology Research Center, Systems Biology and Poisoning Institute, Baqiyatallah University of Medical Sciences, Tehran, Iran
| | - Enayat Darabi
- Department of Parasitology and Mycology, School of Public Health, Tehran University of Medical Sciences, Tehran, Iran
| | - Faramarz Koohsar
- Paramedical Faculty, Golestan University of Medical Sciences, Gorgan, Iran
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Baraquin A, Zait H, Grenouillet FE, Moreau E, Hamrioui B, Grenouillet F. Large-scale evaluation of a rapid diagnostic test for human cystic echinococcosis. Diagn Microbiol Infect Dis 2017. [PMID: 28647066 DOI: 10.1016/j.diagmicrobio.2017.06.002] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/27/2022]
Abstract
Cystic echinococcosis (CE) is a neglected zoonotic disease, diagnosed through clinical findings, imaging techniques, and serology, for which many serological tests are available. Here we report a rapid unit assay, the immunochromatographic VIRapid® HYDATIDOSIS test (Vircell, Granada, Spain), potentially suitable for laboratories in low-prevalence or poorly equipped areas. This test was evaluated with a large retrospective cohort (224 sera), including patients suffering from CE or from other parasitic or liver diseases. The test was also assessed in routine conditions with a prospective cohort (115 sera) in areas where both cystic and alveolar echinococcoses have been diagnosed. Its performance (in terms of sensitivity, specificity, and both positive and negative likelihood ratios) was similar to an ELISA based on a crude antigen. Our study shows that this test performs adequately in the diagnostic process, when used with caution, especially regarding cross-reactivity with other parasitic diseases.
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Affiliation(s)
- Alice Baraquin
- Chrono-environnement, UMR UBFC/CNRS 6249 aff. INRA, University of Bourgogne/Franche-Comté, Besançon, France
| | - Houria Zait
- Parasitology & Mycology Department, Mustapha University Hospital, Algiers, Algeria
| | - Florence-Elisabeth Grenouillet
- Parasitology & Mycology Department, French National Reference Center for Alveolar Echinococcosis and WHO Collaborating Center for Prevention and Treatment of Human Echinococcosis, University Hospital, Besançon, France
| | - Elise Moreau
- Parasitology & Mycology Department, French National Reference Center for Alveolar Echinococcosis and WHO Collaborating Center for Prevention and Treatment of Human Echinococcosis, University Hospital, Besançon, France
| | - Boussad Hamrioui
- Parasitology & Mycology Department, Mustapha University Hospital, Algiers, Algeria
| | - Frédéric Grenouillet
- Chrono-environnement, UMR UBFC/CNRS 6249 aff. INRA, University of Bourgogne/Franche-Comté, Besançon, France; Parasitology & Mycology Department, French National Reference Center for Alveolar Echinococcosis and WHO Collaborating Center for Prevention and Treatment of Human Echinococcosis, University Hospital, Besançon, France.
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Stojkovic M, Adt HM, Rosenberger K, Boubaker G, Hernandez-Gonzalez A, Junghanss T, Zwahlen M, Siles-Lucas M. Follow-up of surgically treated patients with cystic echinococcosis: can novel recombinant antigens compete with imaging? Analysis of a patient cohort. Trop Med Int Health 2017; 22:614-621. [PMID: 28218991 DOI: 10.1111/tmi.12859] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/07/2023]
Abstract
OBJECTIVE To compare the performance of two novel recombinant antigens (EgP29, 2B2t) with imaging in a well-defined cohort of surgically treated cystic echinococcosis (CE) patients to determine whether serology reflects surgical cure as defined by imaging. METHODS From a cohort of 223 CE-confirmed patients of a national clinical center for echinococcosis, 36 surgically treated patients were eligible for analysis. Sera were tested by enzyme-linked immunosorbent assay (ELISA) for specific IgG and IgG4 antibodies against the EgP29 and 2B2t antigens. We used a hierarchical linear regression model to examine the course of antibody levels over time for each patient. A meta-analysis of the patient-specific estimates of the time to negativity was performed using the metan command in Stata. RESULTS The range of positive serological results at the beginning of post-surgical monitoring was 34-60%: 2B2t 51%, 2B2t-IgG4 34%, EgP29 60% and EgP29-IgG4 40%. The pooled estimates of time to seronegativity were as follows: 2B2t-ELISA 3.92 (3.24, 4.61) years; 2B2t-IgG4-ELISA 4.60 (3.91, 5.29) years; EgP29-ELISA 3.94 (3.50, 4.39) years; EgP29-IgG4-ELISA 2.55 (1.93, 3.18) years. CONCLUSION After surgical treatment, antibodies to the recombinant antigens 2B2t and EgP29 become negative in the majority of CE-confirmed, surgically cured patients. The major drawback is the fact that only around half of the CE-confirmed, surgically treated patients were at all responsive to the test antigens, so they are of limited benefit for documenting primary cure. Equally, these antigens do not appear to be sensitive to recurrences.
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Affiliation(s)
- Marija Stojkovic
- Section Clinical Tropical Medicine, Heidelberg University Hospital, Heidelberg, Germany
| | - Hans-Micha Adt
- Section Clinical Tropical Medicine, Heidelberg University Hospital, Heidelberg, Germany
| | - Kerstin Rosenberger
- Section Clinical Tropical Medicine, Heidelberg University Hospital, Heidelberg, Germany
| | - Ghalia Boubaker
- Institute of Parasitology, University of Bern, Bern, Switzerland.,Graduate School for Cellular and Biomedical Sciences, University of Bern, Bern, Switzerland.,Department of Clinical Biology B, Laboratory of Parasitology and Mycology, University of Monastir, Monastir, Tunisia
| | - Ana Hernandez-Gonzalez
- Instituto de Recursos Naturales y Agrobiología de Salamanca, Consejo Superior de Investigaciones Científicas, Salamanca, Spain
| | - Thomas Junghanss
- Section Clinical Tropical Medicine, Heidelberg University Hospital, Heidelberg, Germany
| | - Marcel Zwahlen
- Institute of Social and Preventive Medicine, University of Bern, Bern, Switzerland
| | - Mar Siles-Lucas
- Instituto de Recursos Naturales y Agrobiología de Salamanca, Consejo Superior de Investigaciones Científicas, Salamanca, Spain
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[Rapid diagnostic tests for the serodiagnosis of human cystic echinococcosis]. ACTA ACUST UNITED AC 2017; 110:20-30. [PMID: 28275967 DOI: 10.1007/s13149-017-0548-z] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/29/2016] [Accepted: 11/29/2016] [Indexed: 12/15/2022]
Abstract
Cystic echinococcosis (CE) is a parasitic zoonosis especially affecting resource-poor populations in livestock raising areas. Imaging, in particular ultrasound (US), is crucial for the diagnosis, staging, and clinical management of abdominal CE in humans. Serology is a valuable complement to imaging, especially when ultrasound features of CE are absent or unclear. In rural endemic areas, where expertise in US is scant, and conventional serology techniques are unavailable due to lack of laboratory equipment, rapid diagnostic tests (RDTs) may be very useful. Several reports have described the performance of commercial and experimental RDTs in the diagnosis of CE, including a recent study by our group that compared the diagnostic performances of three commercial RDTs for the diagnosis of hepatic CE. To put RDTs for CE in context, we reviewed the available literature in English on this topic. Overall, RDTs appear to be useful in resourcepoor settings where they may replace conventional serodiagnostic tests. However, like other serodiagnostic tests, RDTs lack standardization and show unsatisfactory sensitivity and specificity. An important issue that needs to be addressed is that studies on the diagnostic performance of RDTs fail to take into account the variables known to influence results such as anatomical location and cyst stage.
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Chebli H, Laamrani El Idrissi A, Benazzouz M, Lmimouni BE, Nhammi H, Elabandouni M, Youbi M, Afifi R, Tahiri S, Essayd El Feydi A, Settaf A, Tinelli C, De Silvestri A, Bouhout S, Abela-Ridder B, Magnino S, Brunetti E, Filice C, Tamarozzi F. Human cystic echinococcosis in Morocco: Ultrasound screening in the Mid Atlas through an Italian-Moroccan partnership. PLoS Negl Trop Dis 2017; 11:e0005384. [PMID: 28248960 PMCID: PMC5348040 DOI: 10.1371/journal.pntd.0005384] [Citation(s) in RCA: 38] [Impact Index Per Article: 5.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/25/2016] [Revised: 03/13/2017] [Accepted: 02/04/2017] [Indexed: 12/28/2022] Open
Abstract
Background Cystic echinococcosis (CE) is a neglected parasitic zoonosis with considerable socioeconomic impact on affected pastoral communities. CE is endemic throughout the Mediterranean, including Morocco, where the Mid Atlas is the most prevalent area for both human and animal infection. The highest hospital annual incidence of human CE is recorded in the provinces of Ifrane and El Hajeb. However, hospital-based statistics likely underestimate the real prevalence of infection, as a proportion of cases never reach medical attention or official records. Methodology/Principal findings In 2012, a project on clinical management of CE in Morocco was launched with the aims of estimating the prevalence of human abdominal CE in selected rural communes of the above mentioned provinces using ultrasound (US) screening and training local physicians to implement US-based focused assessment and rational clinical management of CE according to the WHO-IWGE Expert Consensus. A total of 5367 people received abdominal US during four campaigns in April-May 2014. During the campaigns, 24 local general practitioners received >24 hours of hands-on training and 143 health education sessions were organized for local communities. We found an overall CE prevalence of 1.9%, with significantly higher values in the rural communes of Ifrane than El Hajeb (2.6% vs 1.3%; p<0.001). CE cysts were predominantly in inactive stage, especially in older age groups. However, active cysts were present also in adults, indicating acquisition of infection at all ages. Province of residence was the only risk factor consistently associated with CE infection. Conclusions/Significance Our results show a high prevalence and on-going, likely environmental transmission of CE in the investigated provinces of Morocco, supporting the implementation of control activities in the area by national health authorities and encouraging the acceptance and divulgation of diagnosis and treatment algorithms based on imaging for CE at both national and local level. Cystic Echinococcosis (CE) is a parasitic infection whose natural domestic cycle develops between dogs and sheep (and other livestock). Human infection is endemic in pastoral communities, where close contact with the dog-sheep cycle occurs. In humans, as well as in livestock, the parasite develops as fluid-filled cyst mainly in the liver. CE is a neglected disease, as it is a disabler without high mortality, it affects mainly poor communities, and requires complex and expensive clinical management and long-term integrated public health control strategies. The prevalence of infection in an area is often unknown or largely underestimated, therefore the problem is perceived as not important. In Morocco, the Mid Atlas is the most prevalent area for human and animal infection. We performed an ultrasound survey on 5,367 people in Ifrane and El Hajeb provinces, and found an overall prevalence of 1.9%. CE cysts were predominantly inactive, however, active cysts were present also in adults. Our results show a high prevalence and on-going transmission of CE, encouraging the prompt strengthening and complete implementation of control activities envisaged by Moroccan health authorities in the area and the adoption of diagnosis and treatment algorithms based on imaging at both national and local level, to avoid a risk-associated and expensive treatment of inactive cysts.
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Affiliation(s)
- Houda Chebli
- Directorate of Epidemiology, Division of Infectious Diseases, Service of Parasitic Diseases, Ministry of Health of Morocco, Rabat, Morocco
| | - Abderrhamane Laamrani El Idrissi
- Directorate of Epidemiology, Division of Infectious Diseases, Service of Parasitic Diseases, Ministry of Health of Morocco, Rabat, Morocco
| | - Mustapha Benazzouz
- Department of Hepatogastroenterology (Medicine C), Ibn Sina Hospital, University “Mohammed V”, Rabat, Morocco
| | - Badre Eddine Lmimouni
- Parasitology laboratory, Military Teaching Hospital “Mohammed V”, Rabat, Morocco; Team Research in parasitology, tropical and fungal infectious diseases, School of Medicine and Pharmacy, University “Mohammed V”, Rabat, Morocco
| | - Haddou Nhammi
- Directorate of Epidemiology, Division of Infectious Diseases, Service of Parasitic Diseases, Ministry of Health of Morocco, Rabat, Morocco
| | - Mourad Elabandouni
- Directorate of Epidemiology, Division of Infectious Diseases, Service of Parasitic Diseases, Ministry of Health of Morocco, Rabat, Morocco
| | - Mohammed Youbi
- Directorate of Epidemiology, Division of Infectious Diseases, Service of Parasitic Diseases, Ministry of Health of Morocco, Rabat, Morocco
| | - Rajaa Afifi
- Department of Hepatogastroenterology (Medicine C), Ibn Sina Hospital, University “Mohammed V”, Rabat, Morocco
| | - Sara Tahiri
- Parasitology laboratory, Military Teaching Hospital “Mohammed V”, Rabat, Morocco; Team Research in parasitology, tropical and fungal infectious diseases, School of Medicine and Pharmacy, University “Mohammed V”, Rabat, Morocco
| | - Abdellah Essayd El Feydi
- Department of Hepatogastroenterology (Medicine C), Ibn Sina Hospital, University “Mohammed V”, Rabat, Morocco
| | - Adbellatif Settaf
- Department of Hepatobiliary Surgery (Surgery B), Ibn Sina Hospital, University “Mohammed V”, Rabat, Morocco
| | - Carmine Tinelli
- Clinical Epidemiology and Biometry Unit, San Matteo Hospital Foundation, Pavia, Italy
| | - Annalisa De Silvestri
- Clinical Epidemiology and Biometry Unit, San Matteo Hospital Foundation, Pavia, Italy
| | - Souad Bouhout
- Directorate of Epidemiology, Division of Infectious Diseases, Service of Parasitic Diseases, Ministry of Health of Morocco, Rabat, Morocco
| | | | - Simone Magnino
- Department of Control of Neglected Tropical Diseases, WHO Headquarters, Geneva, Switzerland
| | - Enrico Brunetti
- Department of Clinical, Surgical, Diagnostic and Pediatric Sciences, University of Pavia, Pavia, Italy; WHO-Collaborating Centre for Clinical management of Cystic Echinococcosis, Pavia, Italy
- Division of Infectious and Tropical Diseases, San Matteo Hospital Foundation, Pavia, Italy
| | - Carlo Filice
- Department of Clinical, Surgical, Diagnostic and Pediatric Sciences, University of Pavia, Pavia, Italy; WHO-Collaborating Centre for Clinical management of Cystic Echinococcosis, Pavia, Italy
- Division of Infectious and Tropical Diseases, San Matteo Hospital Foundation, Pavia, Italy
| | - Francesca Tamarozzi
- Department of Clinical, Surgical, Diagnostic and Pediatric Sciences, University of Pavia, Pavia, Italy; WHO-Collaborating Centre for Clinical management of Cystic Echinococcosis, Pavia, Italy
- * E-mail:
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Laboratory Diagnosis of Echinococcus spp. in Human Patients and Infected Animals. ADVANCES IN PARASITOLOGY 2017; 96:159-257. [PMID: 28212789 DOI: 10.1016/bs.apar.2016.09.003] [Citation(s) in RCA: 108] [Impact Index Per Article: 15.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
Abstract
Among the species composing the genus Echinococcus, four species are of human clinical interest. The most prevalent species are Echinococcus granulosus and Echinococcus multilocularis, followed by Echinococcus vogeli and Echinococcus oligarthrus. The first two species cause cystic echinococcosis (CE) and alveolar echinococcosis (AE) respectively. Both diseases have a complex clinical management, in which laboratory diagnosis could be an adjunctive to the imaging techniques. To date, several approaches have been described for the laboratory diagnosis and followup of CE and AE, including antibody, antigen and cytokine detection. All of these approaches are far from being optimal as adjunctive diagnosis particularly for CE, since they do not reach enough sensitivity and/or specificity. A combination of several methods (e.g., antibody and antigen detection) or of several (recombinant) antigens could improve the performance of the adjunctive laboratory methods, although the complexity of echinococcosis and heterogeneity of clinical cases make necessary a deep understanding of the host-parasite relationships and the parasite phenotype at different developmental stages to reach the best diagnostic tool and to make it accepted in clinical practice. Standardization approaches and a deep understanding of the performance of each of the available antigens in the diagnosis of echinococcosis for the different clinical pictures are also needed. The detection of the parasite in definitive hosts is also reviewed in this chapter. Finally, the different methods for the detection of parasite DNA in different analytes and matrices are also reviewed.
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Pakala T, Molina M, Wu GY. Hepatic Echinococcal Cysts: A Review. J Clin Transl Hepatol 2016; 4:39-46. [PMID: 27047771 PMCID: PMC4807142 DOI: 10.14218/jcth.2015.00036] [Citation(s) in RCA: 91] [Impact Index Per Article: 11.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/21/2015] [Revised: 12/15/2015] [Accepted: 12/16/2015] [Indexed: 12/16/2022] Open
Abstract
Cystic echinococcosis (CE) is a widely endemic helminthic disease caused by infection with metacestodes (larval stage) of the Echinococcus granulosus tapeworm. E. granulosus are common parasites in certain parts of the world, and are present on every continent with the exception of Antarctica. As a result, a large number of people are affected by CE. The increased emigration of populations from endemic areas where prevalence rates are as high as 5-10% and the relatively quiescent clinical course of CE pose challenges for accurate and timely diagnoses. Upon infection with CE, cyst formation mainly occurs in the liver (70%). Diagnosis involves serum serologic testing for antibodies against hydatid antigens, but preferably with imaging by ultrasound or CT/MRI. Treatment methods include chemotherapy with benzimidazole carbamates and/or surgical approaches, including percutaneous aspiration injection and reaspiration. The success of these methods is influenced by the stage and location of hepatic cysts. However, CE can be clinically silent, and has a high risk for recurrence. It is important to consider the echinococcal parasite in the differential diagnosis of liver cystic lesions, especially in patients of foreign origin, and to perform appropriate long-term follow-ups. The aim of this review is to highlight the epidemiology, natural history, diagnostic methods, and treatment of liver disease caused by E. granulosus.
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Affiliation(s)
- Tina Pakala
- Department of Medicine, Division of Gastroenterology-Hepatology, University of Connecticut Health Center, Farmington, CT, USA
| | - Marco Molina
- Department of Radiology, University of Connecticut Health Center, Farmington, CT, USA
| | - George Y. Wu
- Department of Medicine, Division of Gastroenterology-Hepatology, University of Connecticut Health Center, Farmington, CT, USA
- Correspondence to: George Y. Wu, Department of Medicine, Division of Gastroenterology-Hepatology, University of Connecticut Health Center, 263 Farmington Ave, Farmington, CT 06030, USA. Tel: +1-860-679-2509, Fax: +1-860-679-8582, E-mail:
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Tamarozzi F, Mariconti M, Neumayr A, Brunetti E. The intermediate host immune response in cystic echinococcosis. Parasite Immunol 2016; 38:170-81. [DOI: 10.1111/pim.12301] [Citation(s) in RCA: 32] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/29/2015] [Accepted: 12/09/2015] [Indexed: 12/18/2022]
Affiliation(s)
- F. Tamarozzi
- Department of Clinical, Surgical, Diagnostic and Paediatric Sciences; University of Pavia; Pavia Italy
- WHO Collaborating Centre for Clinical Management of Cystic Echinococcosis; Pavia Italy
| | - M. Mariconti
- WHO Collaborating Centre for Clinical Management of Cystic Echinococcosis; Pavia Italy
- Division of Infectious and Tropical Diseases; San Matteo Hospital Foundation; Pavia Italy
| | - A. Neumayr
- Medical Services and Diagnostic; Swiss Tropical and Public Health Institute; Basel Switzerland
- University of Basel; Basel Switzerland
| | - E. Brunetti
- Department of Clinical, Surgical, Diagnostic and Paediatric Sciences; University of Pavia; Pavia Italy
- WHO Collaborating Centre for Clinical Management of Cystic Echinococcosis; Pavia Italy
- Division of Infectious and Tropical Diseases; San Matteo Hospital Foundation; Pavia Italy
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Pagnozzi D, Addis MF, Biosa G, Roggio AM, Tedde V, Mariconti M, Tamarozzi F, Meroni V, Masu G, Masala G, Brunetti E, Uzzau S. Diagnostic Accuracy of Antigen 5-Based ELISAs for Human Cystic Echinococcosis. PLoS Negl Trop Dis 2016; 10:e0004585. [PMID: 27023205 PMCID: PMC4811537 DOI: 10.1371/journal.pntd.0004585] [Citation(s) in RCA: 25] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/24/2015] [Accepted: 03/08/2016] [Indexed: 12/13/2022] Open
Abstract
BACKGROUND Clinical diagnosis and follow up of cystic echinococcosis (CE) are based on imaging complemented by serology. Several immunodiagnostic tests are commercially available, but the development of new tools is still needed to overcome the lack of standardization of the target antigen, generally consisting of a crude extract of Echinococcus granulosus hydatid cyst fluid. In a previous work, we described a chromatographic method for the preparation of a highly enriched Antigen 5 fraction from hydatid cyst fluid. The high reactivity of patient sera against this preparation prompted us to evaluate further this antigen for the serodiagnosis of CE on a larger cohort of samples. METHODOLOGY/PRINCIPAL FINDINGS A total of 327 sera from CE patients with heterogeneous conditions for cyst stage, cyst number, organ localization, drug therapy, and surgical intervention, together with 253 sera from healthy controls, were first analyzed by an ELISA based on the Ag5 preparation in two different experimental setups and, in parallel, by a commercial ELISA routinely used in clinical laboratories for CE serodiagnosis. The Ag5 ELISAs revealed different sensitivity (88.3% vs 95.3%) without significant differences in specificity (94.1% vs 92.5%), for the two setups, respectively. Moreover, possible relationships between the Ag5 ELISA absorbance results and clinical variables were investigated. Chi squared test, bivariate logistic regression and multiple regression analyses highlighted differences in the serology reactivity according to pharmacological treatment, cyst activity, and cyst number. CONCLUSIONS/SIGNIFICANCE The two Ag5 ELISAs revealed different performances depending on the setup. The good diagnostic sensitivity and the high reliability of the Ag5 preparation method make this antigen a promising candidate for the serodiagnosis of CE. Further studies will be needed to evaluate the ability of our test to provide useful information on specific CE clinical traits.
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Affiliation(s)
| | | | - Grazia Biosa
- Porto Conte Ricerche Srl, Tramariglio, Alghero (Sassari), Italy
| | | | - Vittorio Tedde
- Porto Conte Ricerche Srl, Tramariglio, Alghero (Sassari), Italy
| | - Mara Mariconti
- Department of Clinical, Surgical, Diagnostic and Pediatric Sciences, University of Pavia, Pavia, Italy
- WHO Collaborating Centre for the Clinical Management of Cystic Echinococcosis, Pavia, Italy
| | - Francesca Tamarozzi
- Department of Clinical, Surgical, Diagnostic and Pediatric Sciences, University of Pavia, Pavia, Italy
- WHO Collaborating Centre for the Clinical Management of Cystic Echinococcosis, Pavia, Italy
| | - Valeria Meroni
- Department of Microbiology and Virology, IRCCS San Matteo Hospital Foundation and Department of Internal Medicine and Clinical Therapy, University of Pavia, Pavia, Italy
| | - Gabriella Masu
- Centro Nazionale di Riferimento per l’Echinococcosi, IZS “G. Pegreffi”, Sassari, Italy
| | - Giovanna Masala
- Centro Nazionale di Riferimento per l’Echinococcosi, IZS “G. Pegreffi”, Sassari, Italy
| | - Enrico Brunetti
- Department of Clinical, Surgical, Diagnostic and Pediatric Sciences, University of Pavia, Pavia, Italy
- WHO Collaborating Centre for the Clinical Management of Cystic Echinococcosis, Pavia, Italy
- Division of Infectious and Tropical Diseases, IRCCS San Matteo Hospital Foundation, Pavia, Italy
| | - Sergio Uzzau
- Porto Conte Ricerche Srl, Tramariglio, Alghero (Sassari), Italy
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Tamarozzi F, Covini I, Mariconti M, Narra R, Tinelli C, De Silvestri A, Manzoni F, Casulli A, Ito A, Neumayr A, Brunetti E. Comparison of the Diagnostic Accuracy of Three Rapid Tests for the Serodiagnosis of Hepatic Cystic Echinococcosis in Humans. PLoS Negl Trop Dis 2016; 10:e0004444. [PMID: 26871432 PMCID: PMC4752287 DOI: 10.1371/journal.pntd.0004444] [Citation(s) in RCA: 40] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/27/2015] [Accepted: 01/19/2016] [Indexed: 12/28/2022] Open
Abstract
BACKGROUND The diagnosis of cystic echinococcosis (CE) is based primarily on imaging, in particular with ultrasound for abdominal CE, complemented by serology when imaging results are unclear. In rural endemic areas, where expertise in ultrasound may be scant and conventional serology techniques are unavailable due to lack of laboratory equipment, Rapid Diagnostic Tests (RDTs) are appealing. METHODOLOGY/PRINCIPAL FINDINGS We evaluated the diagnostic accuracy of 3 commercial RDTs for the diagnosis of hepatic CE. Sera from 59 patients with single hepatic CE cysts in well-defined ultrasound stages (gold standard) and 25 patients with non-parasitic cysts were analyzed by RDTs VIRapid HYDATIDOSIS (Vircell, Spain), Echinococcus DIGFA (Unibiotest, China), ADAMU-CE (ICST, Japan), and by RIDASCREEN Echinococcus IgG ELISA (R-Biopharm, Germany). Sensitivity, specificity and ROC curves were compared with McNemar and t-test. For VIRapid and DIGFA, correlation between semiquantitative results and ELISA OD values were evaluated by Spearman's coefficient. Reproducibility was assessed on 16 randomly selected sera with Cohen's Kappa coefficient. Sensitivity and Specificity of VIRapid (74%, 96%) and ADAMU-CE (57%, 100%) did not differ from ELISA (69%, 96%) while DIGFA (72%, 72%) did (p = 0.045). ADAMU-CE was significantly less sensitive in the diagnosis of active cysts (p = 0.019) while DIGFA was significantly less specific (p = 0.014) compared to ELISA. All tests were poorly sensitive in diagnosing inactive cysts (33.3% ELISA and ADAMU-CE, 42.8% DIGFA, 47.6% VIRapid). The reproducibility of all RDTs was good-very good. Band intensity of VIRapid and DIGFA correlated with ELISA OD values (r = 0.76 and r = 0.79 respectively, p<0.001). CONCLUSIONS/SIGNIFICANCE RDTs may be useful in resource-poor settings to complement ultrasound diagnosis of CE in uncertain cases. VIRapid test appears to perform best among the examined kits, but all tests are poorly sensitive in the presence of inactive cysts, which may pose problems with accurate diagnosis.
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Affiliation(s)
- Francesca Tamarozzi
- Department of Clinical Surgical Diagnostic and Paediatric Sciences, University of Pavia, Pavia, Italy.,WHO Collaborating Centre for the Clinical Management of Cystic Echinococcosis, Pavia, Italy
| | - Ilaria Covini
- Department of Clinical Surgical Diagnostic and Paediatric Sciences, University of Pavia, Pavia, Italy
| | - Mara Mariconti
- Department of Clinical Surgical Diagnostic and Paediatric Sciences, University of Pavia, Pavia, Italy.,WHO Collaborating Centre for the Clinical Management of Cystic Echinococcosis, Pavia, Italy
| | - Roberta Narra
- Department of Clinical Surgical Diagnostic and Paediatric Sciences, University of Pavia, Pavia, Italy.,WHO Collaborating Centre for the Clinical Management of Cystic Echinococcosis, Pavia, Italy
| | - Carmine Tinelli
- Clinical Epidemiology and Biometry Unit, San Matteo Hospital Foundation, Pavia, Italy
| | - Annalisa De Silvestri
- Clinical Epidemiology and Biometry Unit, San Matteo Hospital Foundation, Pavia, Italy
| | - Federica Manzoni
- Clinical Epidemiology and Biometry Unit, San Matteo Hospital Foundation, Pavia, Italy
| | - Adriano Casulli
- Department of Infectious, Parasitic and Immunomediated Diseases, Istituto Superiore di Sanitá, Roma, Italy
| | - Akira Ito
- Department of Parasitology, Asahikawa Medical University, Asahikawa, Japan
| | - Andreas Neumayr
- Medical Services and Diagnostic, Swiss Tropical and Public Health Institute, and University of Basel, Basel, Switzerland
| | - Enrico Brunetti
- Department of Clinical Surgical Diagnostic and Paediatric Sciences, University of Pavia, Pavia, Italy.,WHO Collaborating Centre for the Clinical Management of Cystic Echinococcosis, Pavia, Italy.,Division of Tropical and Infectious Diseases, San Matteo Hospital Foundation, Pavia, Italy
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