Evaluation of immunochromatography method in the diagnosis of cystic echinococcosis

Year 2023, , 389 - 394, 27.10.2023

Özlem Koca Özgül Çetinkaya Aylin Erman Daloğlu Yeşim Çekin Hatice Özen

https://doi.org/10.38053/acmj.1345403

Abstract

Aims: Echinococcus granulosus is the causative agent of hydatid cyst, or cystic echinococcosis (CE), with its current name. Echinococcus granulosus is a zoonotic cestode; commonly found in humans and farm animals. In cystic echinococcosis infection, transmission occurs by oral ingestion of parasite eggs excreted in infected dog feces. The larval form is responsible for the formation of slowly growing cysts in the organs and tissues of mammals such as humans, sheep, goats and cattle. In this study, it was aimed to compare indirect hemagglutination (IHA) and immunochromatographic (ICT) methods from the sera of patients with suspected CE and to evaluate serological tests based on imaging and clinical diagnosis.
Methods: Between 31 October 2022 and 31 January 2023, blood samples of 95 patients with suspected CE from different units of our hospital and for whom IHA was routinely requested were included in the study prospectively. VIRAPID® Hydatidosis (Vircell, Granada, Spain) test using the immunochromatographic method and ELI.H.A. Echinococcus (ELITech Microbio, France) test was studied in accordance with the manufacturer’s instructions.
Results: Based on clinical and imaging methods of 95 patients included in our study, 64 (63.1%) were diagnosed with hydatid cyst. Based on imaging and clinical diagnosis; sensitivity, specificity, positive predictive value and negative predictive values were calculated as 81.3%, 96.8%, 98.1%, 71.4% for the IHA test, and were calculated as 75.0%, 93.5%, 96.6%, 64.4% for the ICT test, respectively. Good agreement was found between the two tests (percent agreement=68.0%; kappa value=0.682; p<0.001). Sensitivity (IHA: 87.2%; ICT: 94.9%) and specificity (IHA: 96.8%; ICT: 93.5%) of IHA (positive titer of 1/160 and above) and ICT methods in active cysts with cyst stage (CE) 1-2-3) values were found to be compatible, The sensitivity of the ICT method in inactive cysts with CE 4-5 (IHA: 72%, ICA: 44%) was found to be statistically significantly lower than the IHA method (p<0.001).
Conclusion: Rapid diagnostic tests generally stand out as they do not require personnel training in health institutions and are easy to apply. Especially in the active period of the cysts, the tests show a very good and harmonious performance, and it significantly supports the clinical and radiological findings in the early diagnosis of the disease and in the treatment follow-up, however, they need to be developed in order to be used in the differential diagnosis of inactive cyst stages, especially in cases in between, and performance studies in larger patient groups are required.

Keywords

Cystic echinococcosis, Echinococcus granulosus, immunochromatography, indirect hemagglutination

Supporting Institution

None

Thanks

Many thanks for all of your efforts

References

• Esenkaya Taşbent F, Yağcı B, Kadıyoran C, İyisoy MS. Comparative evaluation of the efficacy of indirect hemagglutination test and radiological methods in the pre-diagnosis of cystic echinococcosis. Turkiye parazitol Derg. 2021;45(1):22-27.
• Agudelo Higuita NI, Brunetti E, McCloskey C. Cystic echinococcosis. J Clin Microbiol. 2016;54(3):518-523.
• Alver O, Payaslıoğlu AM, Özakın C, Esen S. Laboratory results of cystic echinococcosis in 2017 and 2018. Turkish J Parasitol. 2021;45(3):207-210.
• 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. Rev Esp enferm Dig. 2022;114(1):35-41.
• Tamer GS, Dündar D, Uzuner H, Baydemir C. Evaluation of immunochromatographic test for the detection of antibodies against Echinococcosis granulosus. Med Sci Monit. 2015;21:1219-1222.
• Ulusan Bağcı Ö, Pektaş B, Aksoy Gökmen A, Kaya S. Use of indirect hemagglutination test in the diagnosis of cystic echinococcosis: Two years of retrospective laboratory experience. Türk Mikrobiyoloji Cemiy Derg. 2022;52(3):223-231.
• Ok ÜZ, Kilimcioğlu AA, Özkol M. Türkiye’de İnsanlarda kistik ekinokokkoz. Mikrobiyol Bul. 2020;54(3):510-522.
• Ertug S, Caliskan SO, Malatyali E, Ertabaklar H. Investigation of the applicability of a rapid diagnosis test in the diagnosis of cystic echinococcosis. Turkish J Parasitol. 2018;42(2).
• WHO. Puncture, Aspiration, Injection, Re-aspiration : an option for the treatment of cystic echinococcosis / WHO Informal Working Group on Echinocossosis. 2023. Available at: https://iris.who.int/handle/10665/67207?&locale-attribute=en
• Akgün S, Sayiner HS, Karslıgil T. Kistik ekinokokoz’un serolojik tanısında indirekt hemaglütinasyon, indirekt floresan antikor ve enzim immuno assay testlerinin etkinliğinin değerlendirilmesi. J Contemp Med. 2018; 8(1): 14-19.
• 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. 2020;50(8):676-683.
• Peruzzu A, Mastrandrea S, Fancellu A, 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.
• Tamarozzi F, Covini I, Mariconti M, et al. Comparison of the diagnostic accuracy of three rapid tests for the serodiagnosis of hepatic cystic echinococcosis in humans. PLoS Negl Trop Dis. 2016;10(2):e0004444.
• Gottstein B. Molecular and immunological diagnosis of echinococcosis. Clin Microbiol Rev. 1992;5(3):248-261.
• Miman O, Atambay M, Aydin NE, Daldal N. The clinical, serological and morphological analysis of 91 patients with cystic echinococcosis following surgery. Turkiye Parazitolojii Derg. 2010;34(3):179-183.
• Behçet M, Avcıoğlu F. Kistik ekinokokkozis şüpheli hastaların İndirekt Hemaglutinasyon yöntemiyle değerlendirilmesi. J Biotechnol Strateg Heal Res. 2020;4(1):26-31.
• Tamarozzi F, Longoni SS, Vola A, 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. 2021;11(2):167.