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Close Relationship between Clinical Regression and Specific Serology in the Follow-up of Patients with Alveolar Echinococcosis in Different Clinical Stages

We compared four enzyme-linked immunosorbent assays (ELISAs) with 172 serum samples from 28 patients with alveolar echinococcosis in different clinical stages according to the World Health Organization–PNM (P = parasitic mass in the liver, N = involvement of neighboring organs, M = metastasis) staging system. The sequential antibody responses against Em ^2plus, Em10, and Em18 antigens, and a crude antigen extract were measured in cohorts with resected and unresected lesions. Antibody levels in all assays correlated with the PNM stage before treatment, and the highest correlation was shown for the Em18 assay. The PNM stage did not influence the antibody kinetics, but changes in antibody levels depended on the treatment. In patients after curative surgery, seroreversion in the Em ^2plus ELISA indicated successful resection of lesions in more patients than any other assay, irrespective of the clinical stage. There were no significant differences in the time before assays that use recombinant or purified antigens became unreactive. Antibodies directed against crude antigens were detectable longer than other antibodies in all patient cohorts and stages.

Received October 2, 2008. Accepted for publication January 5, 2009.

Acknowledgments: We thank Mechthild Schulze, Susanne Meisel, and Marion Merkle for excellent technical assistance, and Christoph Schoen for assistance with the statistical analysis.

Financial support: Serologic analysis in Japan was supported in part by the Infection Matrix Fund from the Ministry of Education, Japan, to Akira Ito.

^* Address correspondence to Dennis Tappe, Institute of Hygiene and Microbiology, University of Würzburg, Josef-Schneider-Strasse 2, 97080 Würzburg, Germany. E-mail: dtappe{at}hygiene.uni-wuerzburg.de

Authors’ addresses: Dennis Tappe and Matthias Frosch, Institute of Hygiene and Microbiology, University of Würzburg, Josef-Schneider-Strasse. 2, 97080 Würzburg, Germany, E-mail: dtappe{at}hygiene.uni-wuerzburg.de. Yasuhito Sako, Sonoyo Itoh, Minoru Nakao, and Akira Ito, Department of Parasitology, Asahikawa Medical College, Midorigaoka Higashi 2-1-1-1, Asahikawa 078-8510, Japan. Beate Grüner, Stefan Reuter, and Peter Kern, Comprehensive Infectious Diseases Center, Division of Infectious Diseases and Clinical Immunology, University Hospital and Medical Center Ulm, Albert-Einstein-Allee 23, 89081 Ulm, Germany.

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