Abstract
Human alveolar echinococcosis (AE), which is caused by the cestode Echinococcus (E.) multilocularis, is an epidemiologically relevant issue in modern medicine and still poses a diagnostic and therapeutic challenge. Since diagnosis mainly relies on imaging procedures and serological testing, we retrospectively and comparatively analyzed the performance of an Echinococcus IgG screening ELISA, whole serum IgE, and two specific confirmatory ELISA platforms using the defined E. multilocularis antigens Em2-Em18 (Em2+) and recombinant Em18 (recEm18). With special emphasis on the clinical usefulness of recEm18, we correlated the laboratory results with clinical characteristics and imaging findings in a large and well-characterized cohort of N = 124 AE patients, who were followed over several years after either surgical plus subsequent pharmacological treatment or pharmacotherapy alone. All patients had routinely received PET-CTI every two years. Our data reveal strong correlations for both Echinococcus IgG and recEm18 with tracer uptake in PET-CTI and parasitic lesion size and number, suggesting additional clinical usefulness of recEm18 for certain constellations only, while IgG and Em2+ still appear reasonable and sensitive screening methods for initial diagnosis of AE. With this study, we aim to contribute to further optimizing medical care of AE patients. For instance, it might be reasonable to consider the replacement of some PET-CTI follow-ups by imaging procedures with less radiation exposure or serological means alone. Further studies that clarify the correlation of serological markers with ultrasound criteria might be particularly useful, and further retrospective as well as prospective investigations are justified in this context.
Highlights
Human echinococcosis is a parasitic zoonosis caused by tapeworms of the genus Echinococcus (E.)
Since several serological tools are currently available for this purpose in clinical use, and as both primary diagnosis and follow-up strongly rely on serological findings, we aimed to comparatively evaluate routine test procedures for their diagnostic significance in different courses of alveolar echinococcosis
We provide data on the correlations and the clinical usefulness of the serological routine parameters mentioned with clinical aspects of the disease, and aim to further optimize the diagnostic algorithms concerning both initial diagnosis and individual follow-ups in defined alveolar echinococcosis (AE) patients
Summary
Human echinococcosis is a parasitic zoonosis caused by tapeworms of the genus Echinococcus (E.). Primary diagnosis of the disease is mainly based on imaging procedures and immunological testing for the confirmation of suspect imaging results, i.e., in particular, serological antibody detection in patient sera or immunohistochemistry from tissue samples. Since several serological tools are currently available for this purpose in clinical use, and as both primary diagnosis and follow-up strongly rely on serological findings, we aimed to comparatively evaluate routine test procedures for their diagnostic significance in different courses of alveolar echinococcosis. We used the Serion ELISA classic Echinococcus IgG in primary screening for antibodies to hydatid antigens and the Bordier Em2+ as well as recEm18 ELISA for the detection of E. multilocularis-specific antibody responses in N = 124 clinically and radiologically well-defined AE patients who underwent different treatment regimens and follow-ups over a long-time period. Our data further substantiate pre-existing evidence and provide new aspects concerning the clinical usefulness and possible strengths of selected serological routine markers
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