Echinococcosis is one of the 17 neglected tropical diseases (NTDs) recognized by the World Health Organization. The two major species of medical importance are Echinococcus granulosus and Echinococcus multilocularis (1).There are many studies about diagnostic method of hydatidosis, but there is still the question that which test to perform and when

Arab-Mazar, Zahra

Rahmati Roodsari, Sara

English

Journals Portal, Shahid Beheshti University of Medical Sciences

                                                                                                                           Novelty in Biomedicine NBM 101   Novelty in Biomedicine 2020, 2, 101-2 Letter to Editor   Which Test to Perform for Cystic hydatic Diagnosis and When?    Zahra Arab-Mazar1, Sara Rahmati Roodsari2*  1 Department of Medical Parasitology and Mycology, School of Public Health, Tehran University of Medical Sciences, Tehran, Iran 2 Shahid Beheshti University of Medial Sciences, Tehran, Iran  Received: 05 March, 2020; Accepted: 15 April, 2020   *Corresponding Author: Sara Rahmati Roodsari, Shahid Beheshti University of Medial Sciences, Tehran, Iran. Tel: (+98) 21-22439788. Fax: . Email: s_r_r85@yahoo.com  Please cite this article as: Arab-Mazar Z, Rahmati Roodsari S. Which Test to Perform for Hydatic Diagnosis and When? Novel Biomed. 2020;8(2):101-2.    Dear Editor-in-chief Echinococcosis is one of the 17 neglected tropical diseases (NTDs) recognized by the World Health Organization. The two major species of medical importance are Echinococcus granulosus and Echinococcus multilocularis1. Cystic hydatic disease is a widespread human infection caused by the larval stage of the taeniid tapeworm Echinococcus granulosus which is affects over 1 million people and is responsible for over $3 billion in expenses every year1.  E. multilocularis is the cause of one of the most pathogenic of all human parasitic infections, appears to be spreading in parts of western Europe, USA, and Japan2. Cystic hydatid disease continues to be a major public health problem in many countries despite being, in principle, preventable, treatable and eradicable.  The incubation period and the clinical presentation of CE are highly variable. The latter is dependent upon several features such as the involved organ, the location of the cyst within the organ, and its relation with surrounding structures, its size, and the integrity of the wall. Cystic echinococcosis is usually asymptomatic unless complications occur3.  There are many studies about diagnostic method of hydatidosis, but there is still the question that which test to perform and when. The remarkable development in the past 20 years or so of high resolution imaging technologies, such as computerized tomography (CT) scan and ultrasound have enabled precision detection of taeniid larval cystic infection in humans. Cysts that are not accessible to ultrasound can be studied using other imaging modalities such as computed tomography (CT) or magnetic resonance imaging (MRI). MRI is better than CT at the structural, atage-defining features of cysts seen on ultrasound4.   Clinical laboratory analysis, including chemistry and hematology testing, is nonspecific in patients with cystic echinococcosis. For those with biliary obstruction, elevated levels of bilirubin, transaminases, and gamma-glutamyl transferase perhaps observed. In the setting of cyst leakage into the biliary tree or cyst rupture, significant elevation in gamma-glutamyl transferase and alkaline phosphatase may also be observed, together with eosinophilia, which is usually absent in intact cysts.  Immunodiagnostics play an ancillary role in diagnosis due to limitations in sensitivity and specificity. However, serology perhaps useful to support or confirm a diagnosis of cystic echinococcosis. World health organization/world organization for animal health recommendations include sequential testing based on a screening and confirmatory test model.  In cellular immunity tests, the interdermal Casoni test is well known which has low sensitivity and high result of false positive5. Also in humeral immunity, there are many serological techniques, which their sensitivities and specificities are depending on the antigens’ quality. Arab-Mazar and Rahmati Roodsari                                              Which Test to Perform for Hydatic Diagnosis and When? NBM                                                                            102                                   Novelty in Biomedicine 2020, 2, 101-2 Currently there are two common antigens are used for the serological diagnosis, whole parasite or organelles and soluble antigens6, 7.  Coupled with improvements in immunodiagnostic test sensitivity and antigen specificity, diagnosis of cestode zoonosis is now more accurate than ever before. Although further developments in immunodiagnostic are required, laboratory tests have provided improved capability for screening populations in both epidemiological and community studies.  In addition, there is significant cross reactivity is seen with other parasitic infection such as alveolar echinococcosis, cysticercoids, fascioliasis, as well as with other non-parasitic conditions like malignancy. Therefore in patients with reactive primary screening serology, should have another confirmatory test8.    In most of endemic countries, the diagnosis of cystic echinococcosis rests mainly on imaging. The world health organization informal working group on echinococcosis (WHO-IWGE) published in 20039.   Based on the above data, diagnosis of hydatid disease relies on epidemiologic and clinical finding. In addition based on our knowledge, there are many helpful diagnostic methods for hydatid disease but false positive reactions or false negative reactions occurs in many cases. For example false positive results have been also described in some patients with tumors, but there is no explanation for that10. It should be mentioned that serology perhaps useful to support or confirm a diagnostic of cystic echinococcosis.  Cystic echinococcosis is a complex infection, as a result comparison of epidemiological, biological and clinical data must be the rule in diagnostic of this infection11. At the end, there are many unanswered questions and unresolved problems. There is also a clear need for research into developing of diagnosis test, control and prevention programs which help social, political and economic situation of the affected communities12.  Keywords: Echinococcosis, Cystic hydatic, Diagnosis   References 1. Agudelo NH, Brunetti E, McCloskey C. Cystic Echinococcosis. Journal of Clinical Microbiology. 2016;54(3):518-23. 2. Eckert J, Deplazes P. Biological, epidemiological, and clinical aspects of echinococcosis, a zoonosis of increasing concern. Clinical Microbiology Reviews. 2004;17(1):107-35. 3. Brunetti E, Junghanss T. Update on cystic hydatid disease. Current Opinion in Infectious Diseases. 2009;22(5):497-502. 4. Stojkovic M, Rosenberger K, Kauczor H-U, Junghanss T, Hosch W. Diagnosing and staging of cystic echinococcosis: how do CT and MRI perform in comparison to ultrasound? PLoS Neglected Tropical Diseases. 2012;6(10). 5. Yarzabal L, Schantz P, Lopez-Lemes M. Comparative sensitivity and specificity of the Casoni intradermal and the immunoelectrophoresis tests for the diagnosis of hydatid disease. The American Journal of Tropical Medicine and Hygiene. 1975;24(5):843-8. 6. Garabedian G. Evaluation of the reactivity of hydatid whole-scolex antigen in hydatid disease serology. Annals of Tropical Medicine & Parasitology. 1971;65(3):385-91. 7. Ambroise-Thomas P, Truong TK. Le diagnostic sérologique de l'amibiase humaine par la technique des anticorps fluorescents. Bulletin of the World Health Organization. 1969;40(1):103. 8. Eckert J, Gemmell M, Meslin Fo-X, Pawlowski Z, Organization WH. WHO/OIE manual on echinococcosis in humans and animals: a public health problem of global concern. 2001. 9. Group WIW. International classification of ultrasound images in cystic echinococcosis for application in clinical and field epidemiological settings. Acta Tropica. 2003;85(2):253-61. 10. Biava M-F, Dao A, Md A, Fortier B, Md P-p. Laboratory diagnosis of cystic hydatic disease. World Journal of Surgery. 2001;25(1):10. 11. Nabarro LE, Amin Z, Chiodini PL. Current management of cystic echinococcosis: a survey of specialist practice. Clinical Infectious Diseases. 2015;60(5):721-8. 12. Brunetti E, Garcia HH, Junghanss T. Cystic echinococcosis: chronic, complex, and still neglected. PLoS Neglected Tropical Diseases. 2011;5(7).  

Which Test to Perform for Cystic hydatic Diagnosis and When?

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Which Test to Perform for Cystic hydatic Diagnosis and When?

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