Comparative Evaluation of Echinococcus Serology with Cytology for the Diagnosis of Hepatic Hydatid DiseaseFunding This research did not receive any specific grant from funding agencies in the public, commercial, or profit sectors.
Objectives The purpose of this study is to determine the diagnostic efficacy of enzyme-linked immunosorbent assay (ELISA) in radiologically confirmed liver mass lesions for the diagnosis of hepatic hydatid disease (HHD) and to compare the diagnostic performance of ELISA with fine needle aspiration cytology (FNAC) (taken as standard) for HHD diagnosis.
Materials and Methods This retrospective study included blood samples of 223 patients with radiologically confirmed liver mass lesions in which immunoglobulin G (IgG) anti-Echinococcus antibodies were tested using a commercial IgG ELISA (RIDASCREEN, R-Biopharm AG, Darmstadt, Germany). Results of ELISA, ultrasonography, FNAC, and liver function tests were obtained from the hospital information system. ELISA results were compared with those of FNAC to analyze the diagnostic efficacy of ELISA for HHD diagnosis.
Statistical Analysis Comparison of the results obtained from ELISA was performed with respect to FNAC results (taken as standard) to analyze the diagnostic efficacy of ELISA for HHD detection. Data has been represented as median (range) or in frequencies. Wilson score was used to assess 95% confidence interval of diagnostic parameters. The analysis was performed using SPSS Version 22.0 (IBM Corp.) and Open Epi (version 3.01).
Results Out of 223 cases with liver mass lesions, Echinococcus IgG was reactive in 62 (28%) cases and FNAC was positive in 16 (7.2%) cases. Since two cases were FNAC-positive but IgG-nonreactive, total HHD cases were 64 (28.7%). Echinococcus IgG reactive cases were seen more in the extremes of age group, that is, 1 to 10 years and 81 to 90 years. Taking FNAC as the standard, the sensitivity, specificity, positive predictive value, and negative predictive value of ELISA were 87.5, 76.8, 22.6, and 98.7%, respectively. Cytology-positive cases demonstrated a mean ELISA optical density/cut-off (OD/CO) of 4.2 ± 3 standard deviation.
Conclusion ELISA in radiologically confirmed liver mass cases is highly sensitive in detecting HHD and hence should be used along with ultrasonography for the screening of HHD followed by confirmation with cytology even in cases with a higher OD/CO of ELISA.
02 September 2020 (online)
Thieme Medical and Scientific Publishers Private Ltd.
A-12, Second Floor, Sector -2, NOIDA -201301, India
- 1 Li H, Song T, Shao Y, Aili T, Ahan A, Wen H. Comparative evaluation of liposomal Albendazole and tablet-Albendazole against hepatic cystic echinococcosis: a non-randomized clinical trial. Medicine (Baltimore) 2016; 95 (04) e2237
- 2 Manzano-Román R, Sánchez-Ovejero C, Hernández-González A, Casulli A, Siles-Lucas M. Serological diagnosis and follow-up of human cystic echinococcosis: a new hope for the future?. BioMed Res Int 2015; 2015: 428205
- 3 Belhassen-García M, Romero-Alegria A, Velasco-Tirado V. et al. Study of hydatidosis-attributed mortality in endemic area. PLoS One 2014; 9 (03) e91342
- 4 Malla N, Mewara A. Human cystic echinococcosis with special reference to India - an overview. Ann Clin Cytol Pathol 2016; 2 (05) 1038
- 5 Fomda BA, Khan A, Thokar MA. et al. Sero-epidemiological survey of human cystic echinococcosis in Kashmir, North India. PLoS One 2015; 10 (04) e0124813
- 6 Wuestenberg J, Gruener B, Oeztuerk S. et al. Diagnostics in cystic echinococcosis: serology versus ultrasonography. Turk J Gastroenterol 2014; 25 (04) 398-404
- 7 Derfoufi O, Ngoh Akwa E, Elmaataoui A. et al. Epidemiological profile of echinococcosis in Morocco from 1980 to 2008 [in French]. Ann Biol Clin (Paris) 2012; 70 (04) 457-461
- 8 Mandal S, Mandal MD. Human cystic echinococcosis: epidemiologic, zoonotic, clinical, diagnostic and therapeutic aspects. Asian Pac J Trop Med 2012; 5 (04) 253-260
- 9 Piccoli L, Tamarozzi F, Cattaneo F. et al. Long-term sonographic and serological follow-up of inactive echinococcal cysts of the liver: hints for a “watch-and-wait” approach. PLoS Negl Trop Dis 2014; 8 (08) e3057
- 10 Ernest E, Nonga HE, Kynsieri N, Cleaveland S. A retrospective survey of human hydatidosis based on hospital records during the period 1990-2003 in Ngorongoro, Tanzania. Zoonoses Public Health 2010; 57 (7-8) e124-e129
- 11 Mihmanli M, Idiz UO, Kaya C. et al. Current status of diagnosis and treatment of hepatic echinococcosis. World J Hepatol 2016; 8 (28) 1169-1181
- 12 Pakala T, Molina M, Wu GY. Hepatic echinococcal cysts: a review. J Clin Transl Hepatol 2016; 4 (01) 39-46
- 13 Symeonidis N, Pavlidis T, Baltatzis M. et al. Complicated liver echinococcosis: 30 years of experience from an endemic area. Scand J Surg 2013; 102 (03) 171-177
- 14 Siracusano A, Delunardo F, Teggi A. Ortona E. Host-parasite relationship in cystic echinococcosis: an evolving story. Clin Dev Immunol 2012; 2012: 639362
- 15 McManus DP, Gray DJ, Zhang W, Yang Y. Diagnosis, treatment, and management of echinococcosis. BMJ 2012; 344: e3866
- 16 Brunetti E, Garcia HH, Junghanss T. International CE Workshop in Lima, Peru, 2009. Cystic echinococcosis: chronic, complex, and still neglected. PLoS Negl Trop Dis 2011; 5 (07) e1146
- 17 Khurana S, Das A, Malla N. Increasing trends in seroprevalence of human hydatidosis in North India: a hospital-based study. Trop Doct 2007; 37 (02) 100-102
- 18 Yang YR, Craig PS, Ito A. et al. A correlative study of ultrasound with serology in an area in China co-endemic for human alveolar and cystic echinococcosis. Trop Med Int Health 2007; 12 (05) 637-646
- 19 Abdelraouf A, El-Aal AA, Shoeib EY. et al. Clinical and serological outcomes with different surgical approaches for human hepatic hydatidosis. Rev Soc Bras Med Trop 2015; 48 (05) 587-593
- 20 Gochhait D, Dey P, Rajwanshi A, Nijhawan R, Radhika S, Gupta N. Spectrum of fungal and parasitic infections on fine needle aspiration cytology. Diagn Cytopathol 2015; 43 (06) 450-455
- 21 Bakshi P, Srinivasan R, Rao KL. et al. Fine needle aspiration biopsy in pediatric space-occupying lesions of liver: a retrospective study evaluating its role and diagnostic efficacy. J Pediatr Surg 2006; 41 (11) 1903-1908
- 22 Moro P, Schantz PM. Echinococcosis: a review. Int J Infect Dis 2009; 13 (02) 125-133
- 23 Wattal C, Malla N, Khan IA, Agarwal SC. Comparative evaluation of enzyme-linked immunosorbent assay for the diagnosis of pulmonary echinococcosis. J Clin Microbiol 1986; 24 (01) 41-46
- 24 Brunetti E, Junghanss T. Update on cystic hydatid disease. Curr Opin Infect Dis 2009; 22 (05) 497-502
- 25 Zhang W, McManus DP. Recent advances in the immunology and diagnosis of echinococcosis. FEMS Immunol Med Microbiol 2006; 47 (01) 24-41
- 26 Pawlowski ZS, Eckert DA, Vuitton DA. et al. Echinococcosis in humans: clinical aspects, diagnosis and treatment. In: Eckert J, Gemmell MA, Meslin F-X, Pawlowski ZS. eds. WHO/OIE Manual on Echinococcosis in Humans and Animals: A Public Health Problem of Global Concern. Paris: World Organisation for Animal Health; 2001: 20-72
- 27 Nunnari G, Pinzone MR, Gruttadauria S. et al. Hepatic echinococcosis: clinical and therapeutic aspects. World J Gastroenterol 2012; 18 (13) 1448-1458