Abstract
BackgroundThe diagnosis of cystic echinococcosis (CE) is primarily based on imaging, while serology should be applied when imaging is inconclusive. CE cyst stage has been reported among the most important factors influencing the outcome of serodiagnosis. We performed a systematic review and meta-analysis of the relation between cyst stage of hepatic CE and diagnostic sensitivity of serological tests, to evaluate whether their relation is a consistent finding and provide guidance for the interpretation of results of serological tests.Methodology/Principal findingsMEDLINE, EMBASE, CENTRAL, and Lilacs databases were searched on December 1st 2019. Original studies published after 2003 (year of publication of the CE cyst classification), reporting sensitivity of serological tests applied to the diagnosis of human hepatic CE, as diagnosed and staged by imaging, were included. The quality of studies was assessed using the Newcastle-Ottawa Scale. Data from 14 studies were included in the meta-analysis. Summary estimates of sensitivities and 95% confidence intervals were obtained using random effects meta-analysis. Overall, test sensitivity was highest in the presence of CE2 and CE3 (CE3a and/or CE3b), and lowest in the presence of CE5 and CE4 cysts. ELISA, ICT and WB showed the highest sensitivities, while IHA performed worst.Conclusions/SignificanceThe results of our study confirm the presence of a clear and consistent relation between cyst stage and serological tests results. Limitations of evidence included the heterogeneity of the antigenic preparations used, which prevented to determine whether the relation between cyst stage and sensitivity was influenced by the type of antigenic preparation, the paucity of studies testing the same panel of sera with different assays, and the lack of studies assessing the performance of the same assay in both field and hospital-based settings. Our results indicate the absolute need to consider cyst staging when evaluating serological results of patients with hepatic CE.
Highlights
Cystic echinococcosis (CE) is a neglected zoonosis caused by infection with the larval stage of the cestode Echinococcus granulosus sensu lato [1]
Cystic echinococcosis is a neglected zoonosis induced by the development of parasitic cysts in intermediate hosts, including humans, mostly in the liver
The diagnosis of CE is based on imaging
Summary
Cystic echinococcosis (CE) is a neglected zoonosis caused by infection with the larval stage of the cestode Echinococcus granulosus sensu lato [1]. Humans are dead-end intermediate hosts, in whom the larval stage develops as fluid-filled cysts mainly in liver and lungs [3]. This, is one of the critical actions indicated by the WHO for echinococcosis in the recently issued “2021–2030 road map for neglected tropical diseases” [7]. To “define target product profile and develop optimal diagnostic for humans” is indicated as a critical action required, in order to reach disease-specific targets. The diagnosis of cystic echinococcosis (CE) is primarily based on imaging, while serology should be applied when imaging is inconclusive. We performed a systematic review and meta-analysis of the relation between cyst stage of hepatic CE and diagnostic sensitivity of serological tests, to evaluate whether their relation is a consistent finding and provide guidance for the interpretation of results of serological tests
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