Echinococcosis is a cosmopolitan zoonosis caused by adult or larval stages of cestodes belonging to the genus Echinococcus (family Taeniidae). The two major species of medical and public health importance are Echinococcus granulosus and E. multilocularis, which cause cystic echinococcosis (CE) and alveolar echinococcosis (AE), respectively. Both CE and AE are both serious diseases, the latter especially so, with a high fatality rate and poor prognosis if managed inappropriately. This review discusses new concepts and approaches in the immunology and diagnosis of CE, but comparative reference has also been made to AE infection and to earlier pivotal studies of both diseases. The review considers immunity to infection in the intermediate and definitive hosts, innate resistance, evasion of the immune system, and vaccination of intermediate and definitive hosts, and it particularly emphasizes procedures for diagnosis of CE and AE, including the value of immunodiagnostic approaches. There is also discussion of the new advances in recombinant and related DNA technologies, especially application of PCR, that are providing powerful tools in the fields of vaccinology and molecular diagnosis of echinococcosis.

Concepts in Immunology and Diagnosis of Hydatid Disease

An epidemiological and ecological study of human alveolar echinococcosis transmission in south Gansu, China

Control of echinococcosis and cysticercosis: a public health challenge to international cooperation in China.

Echinococcus granulosus cyst fluid and E. multilocularis protoscolex extract were fractionated by a single step of preparative isoelectric focusing, resulting in an antigen B-rich fraction (8-kD) and an Em18-rich fraction, respectively. The usefulness of both fractions for differential serodiagnosis of cystic (CE) and alveolar (AE) echinococcosis was evaluated by a large-scale immunoblot analysis on a battery of 354 serum samples. These included 66 from AE patients originating from four different endemic areas, 173 from CE patients originating from seven different endemic areas, 71 from patients with other parasitic diseases, 15 from patients with hepatomas, and 29 from healthy individuals. In an immunoblot with the antigen B-rich fraction, 92% (158 of 173) of the CE sera as well as 79% (52 of 66) of the AE sera reacted with the 8-kD subunit. No cross-reactivity occurred with any sera from patients with cysticercosis, other parasitic diseases, or with hepatomas, or from healthy controls. In an immunoblot with the Em18-rich fraction, all but two sera from AE patients (64 of 66, 97%) recognized Em18, and only nine of 34 CE sera from China reacted with it. All other (139) CE sera from six other countries were negative as were all (115) other non-echinococcosis sera. These findings indicate that antigen B (8-kD) is not species-specific for E. granulosus but is genus-specific for Echinococcus, and that the Em18 antigen is a reliable serologic marker for species-specific differentiation of AE from CE.

Differential serodiagnosis for cystic and alveolar echinococcosis using fractions of Echinococcus granulosus cyst fluid (antigen B) and E. multilocularis protoscolex (EM18).

https://onlinelibrary.wiley.com/doi/pdf/10.1111/j.1469-0691.2007.01665.x

The immunodiagnosis of Echinococcus multilocularis infection.

Western blot analysis was carried out using crude antigens of Echinococcus multilocularis and 33 serum samples from the People's Republic of China to differentiate patients with alveolar hydatid disease (AHD) with active lesions from those with inactive lesions, those with other parasitoses including cystic hydatid disease (CHD), and healthy persons. This analysis was based on the detection of antibody responses against two polypeptides, Em18 and Em16, which appeared to be species specific and good indices for the differentiation of AHD with active lesions from AHD with inactive lesions. Twenty-one of the 33 samples showed antibody responses against Em18 and/or Em16. Fifteen were antibody-positive for both Em18 and Em16, five were antibody-positive for Em18 only, and one was antibody-positive for Em16 only. Of the subjects from which the 33 samples were obtained, 12 patients had AHD with active lesions, two had AHD, but their lesions were resolved by surgical resections, 14 had CHD with active lesions, and five were apparently healthy people. Western blot analysis confirmed all 14 cases of AHD, three of the 14 cases of CHD, and showed that one of the five apparently healthy individuals had a positive serologic response for AHD. This apparently healthy person with a positive serologic response for AHD by Western blot analysis was found to be positive for the disease on re-examination. Thus, Western blot analysis based on the antibody responses against Em18 and Em16, especially against Em18, was extremely reliable for the detection of AHD with active lesions, although it failed to differentiate two of the 14 patients with CHD.(ABSTRACT TRUNCATED AT 250 WORDS)

Xian-Gen Wang

Papers

Differential serodiagnosis of alveolar and cystic hydatid disease in the People's Republic of China.