Abstract
BackgroundExamination of feces by light microscopy is widely used for specific parasitological diagnosis of clonorchiasis. However, the true incidence of infection is underestimated owing to the high missing diagnosis rate of this method. The enzyme-linked immunosorbent assay (ELISA) is widely used for the detection and control of clonorchiasis but the practicality of this method is unclear. The purpose of this study was to evaluate the effect of ELISA as a supplementary method for the diagnosis of clonorchiasis.Methodology/Principal FindingsThe present study recruited 2,359 clinically suspected patients from Heilongjiang Province, China. In all, 954 cases were identified as antibody-positive by immunoglobulin (IgG)-ELISA and 495 individuals were diagnosed as egg-positive by the Kato-Katz (KK) method. The seropositive and egg-negative individuals were re-examined by repeated egg counts and/or the number of KK slides and 18 (18.18%) cases were confirmed as clonorchiasis. The 40.44%, antibody-positive rate determined by IgG-ELISA was significantly higher (P<0.05) than the 21.75% egg-positive rate found by examination of feces. A Bayesian approach indicated that the prevalence of clonorchiasis in this region was 22.27% and that the sensitivity, specificity, positive predictive value and negative predictive value of IgG-ELISA were 98.7%, 76.53%, 54.66% and 99.52%, respectively. The agreement between the two methods was moderate (kappa value = 0.564). The clonorchiasis patients lived mainly along the Songhua River. The risk factors, except for ethnic factors, were estimated effectively by both methods.Conclusions/SignificanceThe present study suggested that clonorchiasis was widely distributed in Heilongjiang Province, China. The missing diagnosis rate was high using the KK technique alone. The combination of immunological methods and parasitological techniques could improve diagnostic accuracy and reduce the missing diagnosis rate. ELISA used as an auxiliary diagnostic method was realistic and practical for a large-scale screening test, monitoring the prevalence and assessing the risk factors of clonorchiasis.
Highlights
The oriental or Chinese liver fluke, Clonorchis sinensis (C. sinensis), is an important food-borne zoonotic parasite
Parasitological and Immunological Examinations IgG-enzyme-linked immunosorbent assay (ELISA) was used as a first screening step, followed by the KK technique to confirm infection based on the presence of C. sinensis eggs in stools
We found 954 seropositive and 1405 seronegative participants using IgGELISA
Summary
The oriental or Chinese liver fluke, Clonorchis sinensis (C. sinensis), is an important food-borne zoonotic parasite. Persistent and chronic infection often lead to hepatobiliary diseases, including cholangitis, cholelithiasis, cholecystitis, pancreatitis, hepatic fibrosis, cholangiocarcinoma and liver cancer [3,4,5]. According to national sampling surveys, the prevalence of clonorchiasis as a representative of food-borne parasitical disease increased from 1990–2003 [9,10]. Clonorchiasis is the subject of national parasitic disease control programs in China with a projected timescale of 2006–2015. The true incidence of infection is underestimated owing to the high missing diagnosis rate of this method. The enzyme-linked immunosorbent assay (ELISA) is widely used for the detection and control of clonorchiasis but the practicality of this method is unclear. The purpose of this study was to evaluate the effect of ELISA as a supplementary method for the diagnosis of clonorchiasis
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