Retrospective Analysis of Cystic Echinococcosis Results in Aydin Adnan Menderes University Training and Research Hospital Parasitology Laboratory Between 2005 and 2017

Objective: Echinococcus granulosus is the causative helminth of cystic echinococcosis (CE). The parasite is known to form fluid-filled cysts that grow slowly in the internal organs, particularly the liver and/or lungs. This disease is still important in terms of public health and economically in Turkey and other countries where animal husbandry is widespread. The aim of our study was to retrospectively evaluate the cases that were admitted to the Adnan Menderes University, Training and Research Hospital Parasitology laboratory on suspicion of CE between January 2005 and January 2017. Methods: Totally, 3446 sera (from 2019 female and 1427 male) were tested with an in-house ELISA for the presence of E. granulosus specific IgG antibodies at the timeswhen they were sent. Socio-demographic characteristics (age, gender, residence, and dog ownership), positivity titers, and cyst locations of pathologically confirmed CE patients were analyzed retrospectively. Results: The ages of patients varied between 4-87 years. It was found that 1104 (32%) of the 3446 sera were positive, and of them, 642 (58.1%) were female and 462 (41.9%) were male. Patients who had pathologically confirmed CE diagnosis constituted 247 (22.3%) of the total seropositive sera. Liver was the most commonly affected organ (81.8%), followed by lungs (6.1%). Conclusion: CE remains an important public health problem in our city; therefore, it is once again emphasized that preventive studies should be planned.

Structural and Immunodiagnostic Characterization of Synthetic Antigen B Subunits From Echinococcus granulosus and Their Evaluation as Target Antigens for Cyst Viability Assessment.

Background: Several tools have been proposed for serodiagnosis of cystic echinococcosis (CE), but none seems promising for cyst viability assessment. Antigens with stage-specific diagnostic value have been described, but few studies with well-characterized antigens and human serum samples have been performed. Antigen B (AgB) proteoforms hold promise as markers of viability, due to their differential stage-related expression and immunoreactivity. Methods: Four AgB subunits (AgB1, AgB2, AgB3, AgB4) were synthesized and structurally characterized. Based on the preliminary evaluation of the subunits by western immunoblotting and enzyme-linked immunosorbent assay (ELISA), AgB1 and AgB2 were further tested in two ELISA setups and extensively validated on 422 human serum samples. Results: All subunits showed a high degree of spontaneous oligomerization. Interacting residues within oligomers were identified, showing that both the N-terminal and C-terminal of each subunit are involved in homo-oligomer contact interfaces. No hetero-oligomer was identified. AgB1 and AgB2 ELISAs revealed different sensitivities relative to cyst stage. Of note, besides high specificity (97.2%), AgB1 revealed a higher sensitivity for active-transitional cysts (100% for CE1, 77.8% for CE2, 81.5% for CE3a, and 86.3% for CE3b) than for inactive cysts (41.7% for CE4 and 11.1% for CE5) and postsurgical patients (44%). Interestingly, 19 of 20 patients with spontaneously inactive cysts and 6 of 9 treated with albendazole >5 years earlier were negative on the AgB1 assay. Conclusions: The structural characterization of subunits provides insights into the synthetic antigen conformation. The stage-related sensitivity of synthetic AgB1 holds promise as part of a multiantigen setting and deserves further longitudinal evaluation as marker of cyst viability.

Knowledge, attitudes, and practices regarding cystic echinococcosis and sheep herding in Peru: a mixed-methods approach.

BACKGROUND: The parasitic disease, cystic echinococcosis (CE), is prevalent in low-income, livestock-raising communities and 2000 new people will be diagnosed this year in South America alone. The disease usually passes from livestock to dogs to humans, making it a zoonotic disease and part of the One Health Initiative. Control of CE has been infamously difficult; no endemic areas of South America have succeeded in maintaining sustainable eradication of the parasite. For the current study, we aimed to gain a better understanding of the knowledge, attitudes, and practices of rural sheep farmers and other community leaders regarding their sheep herding practices and perspectives about a control program for CE. We also hope to identify potential barriers and opportunities that could occur in a control program. The authors conducted Knowledge, Attitude and Practices (KAP) surveys and semi-structured interviews in rural communities in the highlands of Peru. The KAP surveys were administered to 51 local shepherds, and the semi-structured interviews were administered to 40 individuals, including shepherds, community leaders, and health care providers. RESULTS: We found that the shepherds already deworm their sheep at a median of 2 times per year (N = 49, range 2-4) and have a mean willingness-to-pay of U.S. $ 0.60 for dog dewormer medication (N = 20, range = 0.00- $2.00 USD). We were not able to learn the deworming agent or agents that were being used, for neither sheep nor dogs. Additionally, 90% of shepherds slaughter their own sheep (N = 49). We also learned that the main barriers to an effective control program include: lack of education about the cause and control options for CE, accessibility to the distant communities and sparse grazing pastures, and a lack of economic incentive. CONCLUSIONS: Findings suggest it may be feasible to develop an effective CE control program which can be used to create an improved protocol to control CE in the region.

[Cystic Echinococcosis Seropositivity in the Blood Samples Sent to Parasitology Laboratory of Yüzüncü Yil University Medical Faculty between 2005 and 2013: Retrospective Assessment]. / Yüzüncü Yil Üniversitesi Tip Fakültesi Parazitoloji Laboratuvarina 2005-2013 Yillari Arasinda Gönderilen Kan Örneklerinde Kistik Ekinokokkozis Seropozitifligi: Retrospektif Degerlendirme.

OBJECTIVE: This study was performed in order to contribute the data on the prevalence of cystic echinococcosis (CE) in Turkey and to reveal this parasitosis problem in Van province. METHODS: Blood samples of 2642 patients (1214 men, 1428 women; 506 of them 0-13 age, 2136 of them 14 and over age group), which were sent with suspected CE to Parasitology Laboratory from various policlinics of Yüzüncü Yil University Medical Faculty, between the dates of 01.09.2005 and 01.09.2013, were evaluated for CE by using Enzyme-Linked Immunosorbent Assay (ELISA) (R-Biopharm, Germany; IgG) method. RESULTS: 801 (30.3%) of examined blood samples of these patients were found positive for this parasitosis. Seropositivity was found 31.9% of men, 29% of women; 33.4% of 0-13 age group, 29.6% of 14 and over age group in the study. Cysts, which were obtained from operated seropositive patients, were confirmed that unilocular cysts as pathological. CONCLUSION: As a result, it was seen that CE is continued to be a major public health problem in Van province and it was appear that comprehensive protection and control programs should be carry out to struggle this disease.

The serological study of cystic echinococcosis and assessment of surgical cases during 5 years (2007-2011) in Khorram Abad, Iran.

BACKGROUND: Echinococcus granulosus is a cestode whose larval stage causes cystic echinococcosis in wild animals, livestock, and human. OBJECTIVE: The aim of this study is to highlight the seroepidemiology of E. granulosus infection and surgical cases in the general population of Khorram Abad district, southwest of Iran. MATERIALS AND METHODS: Anti-E. granulosus antibodies were tested in 617 inhabitants in Khorram Abad by enzyme-linked immunoassay and antigen B. The surgical cases of cystic echinococcosis were investigated in Shohaday-e-Ashayer Hospital of Khorram Abad (as a referral center) from 2007 to 2011. RESULTS: In total, 95 (15.4%) of the 617 participants (mean age 39.6 ± 17.6 years) had anti-E. granulosus antibodies. Prevalence of infection was more in males (60%) than females (40%), and showed statistical significance (P < 0.001). High-titer antibodies were most prevalent among the subjects aged 20-29 years. There was significant association between the presence of Echinococcus antibodies and the sector of residence, education of volunteers, and occupation (P < 0.05). According to hospital records, 58 cystic echinococcosis cases were referred to the hospital during the 5 years. Among the cases, 28 (48.3%) were men and 30 (51.7%) were women. They were between 4 and 74 years of age (36.6 ± 18.9 years). The liver was the organ where most of the hydatid cysts (51.7%) were located, followed by lungs (20.7%). CONCLUSION: This is the first report of the seroprevalence and contributing factors for E. granulosus infection in the general population in Khorram Abad. The findings confirm the importance of diagnosing human cystic echinococcosis in these regions, given the prevalence rates of surgical cases during the last 5 years, and need further evaluation of the risk factors present.

Isolation and molecular characterization of recombinant Echinococcus granulosus P29 protein (recP29) and its assessment for the post-surgical serological follow-up of human cystic echinococcosis in young patients.

We synthesized recombinant Echinococcus granulosus protoscolex recP29 antigen to be preliminarily assessed by ELISA and immunoblotting. RecP29-serology was carried out on 54 young patients with cystic echinococcosis (CE). Patients were classified into either cured (CCE) (n=40) or non-cured (NCCE) (n=14) CE patients. RecP29 ELISA showed a gradual decrease of antibody concentrations in all CCE cases that were initially (before treatment) seropositive to this antigen (25 out of 40) or that seroconverted following treatment. A complete seronegativity was reached within 3 years post-surgery in all of these cases. Conventional HCF ELISA yielded seronegativity in only 10% of initially recP29-seropositive CCE patients (P=0.086). Likewise, recP29 immunoblotting yielded seronegativity in 93% of 29 out of 40 initially recP29-immunoblot-positive CCE patients after 3 years follow-up, compared with 72% in the HCF immunoblotting (P=0.060). Eleven out of 14 NCCE patients were initially positive by recP29 ELISA, and 10 out of these maintained a marked anti-recP29 antibody reactivity until the endpoint of the follow-up period. All 14 NCCE cases were initially seropositive by recP29 immunoblotting, and 13 cases remained seropositive until the end of the study. Thus, recombinant P29 protein appears prognostically useful for monitoring those post-surgical CE cases with an initial seropositivity to this marker.

Canine echinococcosis in northwest Libya: assessment of coproantigen ELISA, and a survey of infection with analysis of risk-factors.

In order to determine the prevalence and risk factors for canine echinococcosis in different endemic localities in the Tripoli area of northwest Libya, stray dogs were examined post-mortem, and owned dogs screened for Echinococcus granulosus infection using a standardised genus specific coproantigen ELISA. The prevalence of E. granulosus infection at necropsy in stray-dogs was 25.8% (15/58, 95% CI 15.3-39.0%), and 21.6% (72/334, 95% CI 17.3-26.4%) of owned dogs tested were positive by coproantigen ELISA. Sheepdogs appeared to have a significantly higher copro-positive prevalence (19/19 positive, p=0.003), compared to 23.6% of other dog classes (e.g. 52/220 guard dogs and household pets). Worm burdens in necropsied dogs ranged from 29 to 2900 (mean 1064) and were positively correlated to coproantigen ELISA OD values (r(s)=0.87, p<0.001), but negatively correlated with dog age (r(s)=-0.69, p=0.001). Dog age was a significant factor in copro-prevalence as there was an increasing coproantigen-positive tendency in younger dogs (< or =5 years, p=0.04). A total of 45/132 (34%, 95% CI 25.9-42.1%) of farms/homestead had at least one dog that was coproantigen positive. Overall copro-prevalence in dogs by locality varied, with Alkhums (Leptis-Magna) district having the highest copro-prevalence at 38.7% (24/62, 95% CI 26.6-50.8%) (p=0.001). Coproantigen testing of a cohort of owned dogs before and approximately 15 months after praziquantel treatment showed a significant decrease in the coproantigen positive rate from 21.6% (72/334) to 9% (21/233) post-treatment. The overall E. granulosus coproantigen positive rate ('re-infection rate') within the same cohort of dogs was 22 % (10/45) by 15 months post-treatment. Significant risk factors for a copro-positive owned dog were associated with non-restraint of dogs, and owners that did not de-worm their dogs. Home slaughtering of livestock and lack of knowledge about E. granulosus transmission were also significant risk factors for a canine coproantigen positive result.