Diagnostic Performances of Commercial ELISA, Indirect Hemagglutination, and Western Blot in Differentiation of Hepatic Echinococcal and Non-Echinococcal Lesions: A Retrospective Analysis of Data from a Single Referral Centre

Ambra Vola Unit of Infectious and Tropical Diseases, San Matteo Hospital Foundation, Pavia, Italy;

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Tommaso Manciulli Department of Clinical, Surgical, Diagnostic and Pediatric Sciences, University of Pavia, Pavia, Italy;

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Annalisa De Silvestri Clinical Epidemiology and Biometric Unit, San Matteo Hospital Foundation, Pavia, Italy;

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Raffaella Lissandrin Unit of Infectious and Tropical Diseases, San Matteo Hospital Foundation, Pavia, Italy;
Department of Clinical, Surgical, Diagnostic and Pediatric Sciences, University of Pavia, Pavia, Italy;

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Mara Mariconti Unit of Infectious and Tropical Diseases, San Matteo Hospital Foundation, Pavia, Italy;
Department of Clinical, Surgical, Diagnostic and Pediatric Sciences, University of Pavia, Pavia, Italy;

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Mar Siles-Lucas Instituto de Recursos Naturales y Agrobiología de Salamanca, Consejo Superior de Investigaciones Científicas, Salamanca, Spain;

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Enrico Brunetti Unit of Infectious and Tropical Diseases, San Matteo Hospital Foundation, Pavia, Italy;
Department of Clinical, Surgical, Diagnostic and Pediatric Sciences, University of Pavia, Pavia, Italy;

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Francesca Tamarozzi Department of Infectious Diseases, WHO Collaborating Centre for the Epidemiology, Detection and Control of Cystic and Alveolar Echinococcosis, Istituto Superiore di Sanità, Rome, Italy

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The diagnosis of cystic echinococcosis (CE) is based on imaging. Serology supports imaging in suspected cases, but no consensus exists on the algorithm to apply when imaging is inconclusive. We performed a retrospective analysis of serology results of patients with untreated hepatic CE and non-CE lesions, seen from 2005 to 2017, to evaluate their accuracy in the differential diagnosis of hepatic CE. Serology results of three seroassays for echinococcosis (ELISA RIDASCREEN, indirect hemagglutination (IHA) Cellognost, and Western blot LDBIO) and clinical characteristics of eligible patients were retrieved. Patients were grouped as having active or inactive CE and liquid or solid non-CE lesions. Sensitivity, specificity, and diagnostic accuracy were compared between scenarios encompassing different test combinations. Eligible patients included 104 patients with CE and 257 with non-CE lesions. Sensitivity and diagnostic accuracy of Western blot (WB) were significantly higher than those of the following: 1) IHA or ELISA alone, 2) IHA+ELISA interpreted as positive if both or either tests positive, and 3) IHA+ELISA confirmed by WB if discordant. The best performances were obtained when WB was applied on discordant or concordant negative IHA+ELISA. Analyses performed within “active CE (n = 52) versus liquid non-CE (n = 245)” and “inactive CE (n = 52) versus solid non-CE (n = 12)” groups showed similar results. Specificity was high for all tests (0.99–1.00) and did not differ between test combination scenarios. WB may be the best test to apply in a one-test approach. Two first-level tests confirmed by WB seem to provide the best diagnostic accuracy. Further studies should be performed in different settings, especially where lower test specificity is likely.

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Author Notes

Address correspondence to Francesca Tamarozzi, Istituto Superiore di Sanità, Viale Regina Elena 299, Rome 00161, Italy. E-mail: francesca.tamarozzi@iss.it

Financial support: This work was funded by the European Union Seventh Framework Program (FP7/2007–2013) under the project HERACLES, grant agreement no. 602051–to E. B.

Authors’ addresses: Ambra Vola, Unit of Infectious and Tropical Diseases, San Matteo Hospital Foundation, Pavia, Italy, E-mail: ambra.vola@gmail.com. Tommaso Manciulli, Department of Clinical, Surgical, Diagnostic and Pediatric Sciences, University of Pavia, Pavia, Italy, E-mail: tommaso.manciulli01@universitadipavia.it. Annalisa De Silvestri, Clinical Epidemiology and Biometric Unit, San Matteo Hospital Foundation, Pavia, Italy, E-mail: a.desilvestri@smatteo.pv.it. Raffaella Lissandrin, Mara Mariconti, and Enrico Brunetti, Unit of Infectious and Tropical Diseases, San Matteo Hospital Foundation, Pavia, Italy, and Department of Clinical, Surgical, Diagnostic and Pediatric Sciences, University of Pavia, Pavia, Italy, E-mails: raffaella.lissandrin@unipv.it, maramariconti@libero.it, and enrico.brunetti@unipv.it. Mar Siles-Lucas, Instituto de Recursos Naturales y Agrobiología de Salamanca, CSIC, Salamanca, Spain, E-mail: mmar.siles@irnasa.csic.es. Francesca Tamarozzi, Department of Infectious Diseases, WHO Collaborating Centre for the Epidemiology, Detection and Control of Cystic and Alveolar Echinococcosis, Istituto Superiore di Sanità, Rome, Italy, E-mail: francesca.tamarozzi@iss.it.

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