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Factors Influencing the Serological Response in Hepatic Echinococcus granulosus Infection

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  • Department of Infectious Diseases, Istituto Di Ricovero e Cura a Carattere Scientifico San Matteo Hospital Foundation, Pavia, Italy; World Health Organization Collaborating Centre for Clinical Management of Cystic Echinococcosis, Pavia, Italy; Department of Clinical, Surgical, Diagnostic and Pediatric Sciences, University of Pavia, Italy; Clinical Epidemiology and Biometry Unit, Istituto Di Ricovero e Cura a Carattere Scientifico San Matteo Hospital Foundation, Pavia, Italy; Department of Microbiology and Virology, Istituto Di Ricovero e Cura a Carattere Scientifico San Matteo Hospital Foundation, Pavia, Italy; Department of Internal Medicine and Clinical Therapy, University of Pavia, Italy
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Knowledge of variables influencing serology is crucial to evaluate serology results for the diagnosis and clinical management of cystic echinococcosis (CE). We analyzed retrospectively a cohort of patients with hepatic CE followed in our clinic in 2000–2012 to evaluate the influence of several variables on the results of commercial enzyme-linked immunosorbent assay (ELISA) and indirect hemagglutination (IHA) tests. Sera from 171 patients with ≥ 1 hepatic CE cyst, and 90 patients with nonparasitic cysts were analyzed. CE cysts were staged according to the WHO-IWGE classification and grouped by activity. A significant difference in ELISA optical density (OD) values and percentage of positivity was found among CE activity groups and with controls (P < 0.001). The serological response was also influenced by age (P < 0.001) and cyst number (P = 0.003). OD values and cyst size were positively correlated in active cysts (P = 0.001). IHA test showed comparable results. When we analyzed the results of 151 patients followed over time, we found that serology results were significantly influenced by cyst activity, size, number, and treatment ≤ 12 months before serum collection. In conclusion, serological responses as assessed by commercial tests depend on CE cyst activity, size and number, and time from treatment. Clinical studies and clinicians in their practice should take this into account.

Author Notes

* Address correspondence to Francesca Tamarozzi, Department of Clinical, Surgical, Diagnostic and Pediatric Sciences, University of Pavia, Via Brambilla 74, Pavia 27100, Italy. E-mail: f_tamarozzi@yahoo.com
† These authors contributed equally to this work.

Financial support: The research leading to these results has been partly funded from the European Union Seventh Framework Programme (FP7/2007-2013) under the project HERACLES (grant agreement no. 602051) to Enrico Brunetti.

Authors' addresses: Raffaella Lissandrin and Enrico Brunetti, Department of Infectious Diseases, IRCCS San Matteo Hospital Foundation, Pavia, Italy, WHO Collaborating Centre for Clinical Management of Cystic Echinococcosis, Pavia, Italy, and Department of Clinical, Surgical, Diagnostic and Pediatric Sciences, University of Pavia, Pavia, Italy, E-mails: raffaella.lissandrin@unipv.it and enrico.brunetti@unipv.it. Francesca Tamarozzi, WHO Collaborating Centre for Clinical Management of Cystic Echinococcosis, Pavia, Italy, and Department of Clinical, Surgical, Diagnostic and Pediatric Sciences, University of Pavia, Pavia, Italy, E-mail: f_tamarozzi@yahoo.com. Luca Piccoli, Department of Infectious Diseases, IRCCS san Matteo Hospital Foundation, Pavia, Italy, Current address: Institute for Research in Biomedicine, Bellinzona, Switzerland, E-mail: luca.piccoli@irb.usi.ch. Carmine Tinelli and Annalisa De Silvestri, Clinical Epidemiology and Biometry Unit, IRCCS San Matteo Hospital Foundation, Pavia, Italy, E-mails: ctinelli@smatteo.pv.it and a.desilvestri@smatteo.pv.it. Mara Mariconti, Department of Infectious Diseases, IRCCS San Matteo Hospital Foundation, Pavia, Italy, and WHO Collaborating Centre for Clinical Management of Cystic Echinococcosis, Pavia, Italy, E-mail: mara.mariconti@guest.unimi.it. Francesca Genco, Department of Microbiology and Virology, IRCCS San Matteo Hospital Foundation, Pavia, Italy, E-mail: francesca.genco@unipv.it. Valeria Meroni, Department of Microbiology and Virology, IRCCS San matteo Hospital Foundation, Department of Internal Medicine and Clinical Therapy, University of Pavia, Italy, E-mail: v.meroni@smatteo.pv.it.

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