Annals of Laboratory Medicine

Korean Society for Laboratory Medicine (대한진단검사의학회)
권호 표지
DOI QR코드

DOI QR Code

Head-to-Head Comparison of Nine Assays for the Detection of Anti-Echinococcus Antibodies: A Retrospective Evaluation

  • Carolina Mattwich (Max von Pettenkofer-Institut fur Hygiene und Medizinische Mikrobiologie, Medizinische Fakultat, LMU Munchen) ;
  • Kristina Huber (Division of Infectious Diseases and Tropical Medicine, University Hospital Ludwig-Maximilian University Munich) ;
  • Gisela Bretzel (Division of Infectious Diseases and Tropical Medicine, University Hospital Ludwig-Maximilian University Munich) ;
  • Sebastian Suerbaum (Max von Pettenkofer-Institut fur Hygiene und Medizinische Mikrobiologie, Medizinische Fakultat, LMU Munchen) ;
  • Andreas Wieser (Max von Pettenkofer-Institut fur Hygiene und Medizinische Mikrobiologie, Medizinische Fakultat, LMU Munchen) ;
  • Karl Dichtl (Max von Pettenkofer-Institut fur Hygiene und Medizinische Mikrobiologie, Medizinische Fakultat, LMU Munchen)
  • Received : 2023.05.19
  • Accepted : 2023.09.12
  • Published : 2024.03.01
Download PDF
⟨ Previous Next ⟩

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.

Keywords

Acknowledgement

We thank Thomas Grube and Karin Tybus for technical support.

References

  1. Woolsey ID and Miller AL. Echinococcus granulosus sensu lato and Echinococcus multilocularis: a review. Res Vet Sci 2021;135:517-22. https://doi.org/10.1016/j.rvsc.2020.11.010
  2. Baumann S, Shi R, Liu W, Bao H, Schmidberger J, Kratzer W, et al. Worldwide literature on epidemiology of human alveolar echinococcosis: a systematic review of research published in the twenty-first century. Infection 2019;47:703-27. https://doi.org/10.1007/s15010-019-01325-2
  3. Casulli A, Abela-Ridder B, Petrone D, Fabiani M, Bobić B, Carmena D, et al. Unveiling the incidences and trends of the neglected zoonosis cystic echinococcosis in Europe: a systematic review from the MEmE project. Lancet Infect Dis 2023;23:e95-107. https://doi.org/10.1016/S1473-3099(22)00638-7
  4. Casulli A. Recognising the substantial burden of neglected pandemics cystic and alveolar echinococcosis. Lancet Glob Health 2020;8:e470-1. https://doi.org/10.1016/S2214-109X(20)30066-8
  5. Wen H, Vuitton L, Tuxun T, Li J, Vuitton DA, Zhang W, et al. Echinococcosis: advances in the 21st century. Clin Microbiol Rev 2019;32:e00075-18. https://doi.org/10.1128/CMR.00075-18
  6. Karshima SN, Ahmed MI, Adamu NB, Magaji AA, Zakariah M, Mohammed K. Africa-wide meta-analysis on the prevalence and distribution of human cystic echinococcosis and canine Echinococcus granulosus infections. Parasit Vectors 2022;15:357. https://doi.org/10.1186/s13071-022-05474-6
  7. Brunetti E, Kern P, Vuitton DA, Writing Panel for the WHO-IWGE. Expert consensus for the diagnosis and treatment of cystic and alveolar echinococcosis in humans. Acta Trop 2010;114:1-16. https://doi.org/10.1016/j.actatropica.2009.11.001
  8. Eckert J and Deplazes P. Biological, epidemiological, and clinical aspects of echinococcosis, a zoonosis of increasing concern. Clin Microbiol Rev 2004;17:107-35. https://doi.org/10.1128/CMR.17.1.107-135.2004
  9. Budke CM, Deplazes P, Torgerson PR. Global socioeconomic impact of cystic echinococcosis. Emerg Infect Dis 2006;12:296-303. https://doi.org/10.3201/eid1202.050499
  10. Torgerson PR, Keller K, Magnotta M, Ragland N. The global burden of alveolar echinococcosis. PLoS Negl Trop Dis 2010;4:e722. https://doi.org/10.1371/journal.pntd.0000722
  11. Vuitton DA. Echinococcosis and allergy. Clin Rev Allergy Immunol 2004; 26:93-104. https://doi.org/10.1007/s12016-004-0004-2
  12. Calame P, Weck M, Busse-Cote A, Brumpt E, Richou C, Turco C, et al. Role of the radiologist in the diagnosis and management of the two forms of hepatic echinococcosis. Insights Imaging 2022;13:68. https://doi.org/10.1186/s13244-022-01190-y
  13. Stojković M, Weber TF, Junghanss T. Clinical management of cystic echinococcosis: state of the art and perspectives. Curr Opin Infect Dis 2018;31:383-92. https://doi.org/10.1097/QCO.0000000000000485
  14. 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. https://doi.org/10.1371/journal.pntd.0009370
  15. Tamer GS, Dündar D, Uzuner H, Baydemir C. Evaluation of immunochromatographic test for the detection of antibodies against Echinococcosis granulosus. Med Sci Monit 2015;21:1219-22. https://doi.org/10.12659/MSM.893155
  16. 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;89:20-5. https://doi.org/10.1016/j.diagmicrobio.2017.06.002
  17. Peruzzu A, Mastrandrea S, Fancellu A, Bonelli P, Muehlethaler K, Masala G, et al. 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. https://doi.org/10.1016/j.cimid.2022.101816
  18. Vola A, Manciulli T, De Silvestri A, Lissandrin R, Mariconti M, Siles-Lucas M, et al. 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 2019;101:1345-9. https://doi.org/10.4269/ajtmh.19-0556
  19. Mahajan S, Thapar S, Khillan V, Gupta P, Rastogi A, Gupta E. Comparative evaluation of echinococcus serology with cytology for the diagnosis of hepatic hydatid disease. J Lab Physicians 2020;12:98-102. https://doi.org/10.1055/s-0040-1716460
  20. Tamarozzi F, Longoni SS, Vola A, Degani M, Tais S, Rizzi E, et al. 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;11:167. https://doi.org/10.3390/diagnostics11020167
  21. Deininger S and Wellinghausen N. Evaluation of a new combined western and line blot assay (EUROLINE-WB) for diagnosis and species identification of Echinococcus infection in humans. GMS Infect Dis 2019;7: Doc01.
  22. Hernández-González A, Sánchez-Ovejero C, Manzano-Román R, González Sánchez M, Delgado JM, Pardo-García T, et al. 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. https://doi.org/10.1371/journal.pntd.0006741
  23. Lissandrin R, Tamarozzi F, Piccoli L, Tinelli C, De Silvestri A, Mariconti M, et al. Factors influencing the serological response in hepatic Echinococcus granulosus infection. Am J Trop Med Hyg 2016;94:166-71. https://doi.org/10.4269/ajtmh.15-0219