四川江油市包虫病流行病学调查

目的  了解绵阳市江油市包虫病的流行现状,为制定防控策略提供依据。 方法  对江油市2005~2015 年报告的包虫病病例进行调查;对当地感染病例所在乡及毗邻乡镇的人群进行B超筛查,阳性者做血清学检测。对终宿主和中间宿主动物进行调查,检测犬粪包虫抗原,捕获野鼠进行解剖。 结果  共调查包虫病病例8 例,其中3例为当地感染病例;共对3 028人进行B超筛查,发现肝囊肿、包块、钙化点等异常人群91人。采集B超异常人群的血液标本87份,进行包虫病IgG 抗体酶标检查,阳性率9.20%。检测犬粪503份、猫粪49份,无阳性发现。捕获鼠类91只,无阳性发现。 结论  江油市出现了本地感染包虫病病人,本次调查未发现新病人,也未找到病原体,但包虫病传播链存在, 下一步要继续做好流行病学研究,同时加强防控工作。     

2011-2018年宜兴市棘球蚴病监测

目的　分析2011-2018年江苏省宜兴市棘球蚴病监测结果,为该市棘球蚴病防治提供参考依据。方法　在中国疾病预防控制中心传染病报告信息管理系统中,对宜兴市2007年以来报告的棘球蚴病病例进行个案调查。2011-2018年,对宜兴市芳东村和芳庄村常住人口以及羊肉交易市场从业人员进行血清学抗棘球绦虫抗体检测和腹部B超筛查,同时检查羊肉交易市场屠宰羊只肝、肺脏是否存在囊状物、包块或结节,并收集芳东村和芳庄村家犬粪便进行棘球绦虫抗原检测。此外,2011-2018年每年均采用调查表对上述监测人群开展棘球蚴病防治知识知晓情况调查。结果　自2007年以来,宜兴市共报告7例棘球蚴病病例,患病率为0.56/10万人;7例均为细粒棘球蚴病患者,其中2例有流行区旅行史,5例有本地羊肉市场从业史或养犬史。2011-2018年共对1 861人开展人群血清学调查,血清抗棘球绦虫抗体阳性率为0.54%,2016年后未检出阳性;对1 807人开展腹部B超筛查,发现可疑囊肿143人（7.91%）,可疑者血清学检测阳性率为1.40%（2/143）。2011-2018年共检测家犬粪便446份,棘球绦虫抗原检出率为0.67%（3/446）;共触诊或肉眼观察羊肉交易市场屠宰羊肝、肺脏4 010份,检出囊状物、结节7份,平均检出率为0.17%。2011-2018年共对538人进行棘球蚴病防治知识知晓情况调查,平均知晓率为76.95%（414/538）,各年知晓率总体呈逐年上升趋势。结论　宜兴市棘球蚴病患病率和人群血清抗棘球绦虫抗体阳性率较低,但存在棘球蚴病流行风险,应持续加强监测并采取相应防控措施。     

2011-2018年宜兴市棘球蚴病监测

目的　分析2011-2018年江苏省宜兴市棘球蚴病监测结果，为该市棘球蚴病防治提供参考依据。方法　在中国疾病预防控制中心传染病报告信息管理系统中，对宜兴市2007年以来报告的棘球蚴病病例进行个案调查。2011-2018年，对宜兴市芳东村和芳庄村常住人口以及羊肉交易市场从业人员进行血清学抗棘球绦虫抗体检测和腹部B超筛查，同时检查羊肉交易市场屠宰羊只肝、肺脏是否存在囊状物、包块或结节，并收集芳东村和芳庄村家犬粪便进行棘球绦虫抗原检测。此外，2011-2018年每年均采用调查表对上述监测人群开展棘球蚴病防治知识知晓情况调查。结果　自2007年以来，宜兴市共报告7例棘球蚴病病例，患病率为0.56/10万人；7例均为细粒棘球蚴病患者，其中2例有流行区旅行史，5例有本地羊肉市场从业史或养犬史。2011-2018年共对1 861人开展人群血清学调查，血清抗棘球绦虫抗体阳性率为0.54%，2016年后未检出阳性；对1 807人开展腹部B超筛查，发现可疑囊肿143人（7.91%），可疑者血清学检测阳性率为1.40%（2/143）。2011-2018年共检测家犬粪便446份，棘球绦虫抗原检出率为0.67%（3/446）；共触诊或肉眼观察羊肉交易市场屠宰羊肝、肺脏4 010份，检出囊状物、结节7份，平均检出率为0.17%。2011-2018年共对538人进行棘球蚴病防治知识知晓情况调查，平均知晓率为76.95%（414/538），各年知晓率总体呈逐年上升趋势。结论　宜兴市棘球蚴病患病率和人群血清抗棘球绦虫抗体阳性率较低，但存在棘球蚴病流行风险，应持续加强监测并采取相应防控措施。     

A correlative study of ultrasound with serology in an area in China co-endemic for human alveolar and cystic echinococcosis

We correlated ultrasound (US) imaging classifications for human alveolar echinococcosis (AE) and cystic echinococcosis (CE) with serology (ELISA and immunoblotting (IB) incorporating native and recombinant/purified echinococcal antigens) in community surveys (2001-2003) and follow-up (2002 and 2003) of US-confirmed cases in Ningxia, China. One hundred and seventy-one cases (96 with AE, 75 with CE) were identified; of these, US classification and serological data were obtained for 142 and 112 cases, respectively. Seropositive-rates increased in CE patients with highly viable unilocular cyst lesions (Types CL, CE 1 or CE 2) to degenerating primary lesions (CE 3), but then decreased in subjects with inactive (CE 4) or dead (CE 5) cysts. In contrast, there was a constant increase in seropositivity from the early (P1, P2) to the advanced stages (P3, P4) with AE cases. For US-confirmed cases, follow-up by US combined with serology is invaluable for studying the clinical progression of echinococcosis and for detecting recurrent cysts or reinfection post-treatment.     

Unexpected discovery of massive liver echinococcosis. A clinical,morphological, and functional diagnosis

We report a case of symptomatic massive liver echinococcosis due to Echinococcus granulosus, unexpectedly found in a 34 year old woman living in Apulia, Italy. Based on size (max diameter 18 cm), clinical presentation, geographical area, and natural history of echinococcosis, we estimate that the initial infection should have occurred 9-20 yrs before. Presenting symptoms were those of typical mass effect with RUQ pain, pruritus, malaise, and recent weight loss. Abdominal ultrasound diagnosis of probable echinococcal cyst was subsequentely confirmed by positive serology and further detailed by radiological imaging. The cyst was massively occupying subdiaphragmatic liver segments and extending to the omentum and the stomach. The characteristics of the lesion were compatible with the WHO 2003 classification type CE2l, indicating a large active fertile cyst with daughter cysts. The cyst was successfully treated with medical therapy followed by surgery. The prevalence, diagnostic workup, management, and costs of echinococcosis are discussed in this case presentation.     

Comparison of serology, antigenemia assay and the polymerase chain reaction for monitoring active cytomegalovirus infections in hematopoietic stem cell transplantation patients

Forty-six allogeneic hematopoietic stem cell transplantation (HSCT) patients were monitored for the presence of CMV antibodies, CMV-DNA and CMV antigens after transplantation. Immunoenzymatic serological tests were used to detect IgM and the increase in CMV IgG antibodies (increase IgG), a nested polymerase chain reaction (N-PCR) was used to detect CMV-DNA, and an antigenemia assay (AGM) was used to detect CMV antigens. The presence of CMV-IgM and/or CMV-increase IgG antibodies was detected in 12/46 (26.1%) patients, with a median time between HSCT and the detection of positive serology of 81.5 days. A positive AGM was detected in 24/46 (52.2%) patients, with a median time between HSCT and antigen detection of 62 days. Two or more consecutive positive N-PCR results were detected in 32/46 (69.5%) patients, with a median time between HSCT and the first positive PCR of 50.5 days. These results confirmed that AGM and mainly PCR are superior to serology for the early diagnosis of CMV infection. Six patients had CMV-IgM and/or CMV-increase IgG with a negative AGM (five cases) or N-PCR assay (one case). In five of these cases the serological markers were detected during the first 100 days after HSCT, the period of highest risk. These findings support the idea that serology may be useful for monitoring CMV infections in HSCT patients, especially when PCR is unavailable.     

人棘球蚴病血清学诊断试剂检测效果评价

【摘要】目的 了解我国现有的人群棘球蚴病血清学诊断试剂的检测水平,为全国中央转移支付地方棘球蚴病防治项目进行人群棘球蚴病血清流行病学调查与监测,筛选适宜的检测试剂提供参考。方法 选择我国目前已用于防治实践或研制比较成熟的血清学诊断试剂共9种（A、B、C、D、E、F、G、H、I）,对收集的400份标本血清,采用双盲法进行检测,计算并比较各试剂的反映真实性的相关指标。 结果 参评的9种血清学诊断试剂灵敏度在42.4%～94.3%,特异度在48.6%～100%,正确指数在0.285～0.802之间,阳性预测值在55.6%～94.0%之间,阴性预测值在35.2%～85.5%之间,一致性在41.3%~85.5%之间,与囊虫病的交叉反应最低为25%,最高达82.5%。结论 我国目前人群棘球蚴病血清学诊断试剂的检测水平较低,试剂的灵敏度和特异度有待进一步提高,且与囊虫病普遍存在较强的交叉反应性,需进一步加强研制灵敏、特异、便于现场应用的血清学诊断试剂,以用于棘球蚴病病人的早期诊断。     

Differential serodiagnosis of cystic and alveolar echinococcosis using native and recombinant antigens in Japan

Our group at Asahikawa Medical College has established differential serodiagnosis for zoonotic larval cestodiases such as alveolar echinococcosis (AE), cystic echinococcosis (CE) and neurocysticercosis (NCC) using purified specific antigens. In this brief review, we introduce (a) four imported CE cases in Japan, easily identified serologically, (b) most recent advances in serology for differentiation of AE and monitoring of prognosis of AE in Japan. It includes application of affinity purified Em18 and prototype of a recombinant Em18 antigen. Serology using affinity purified Em18 antigens is showing much higher sensitivity for detection of AE cases which are usually undetectable by the ongoing serology for AE authorized in Hokkaido, Japan. As serology for AE, CE or NCC is still not popular in the majority of Asian countries, we expect that this review paper stimulates researchers who are interested in serology or serodiagnosis for these larval cestodiases including AE, CE and NCC.     

Echinococcosis prevalence in elderly population from Haiyan County of Qinghai Province

Echinococcus infection in elderly population (60-87 years old) was investigated by serological assay, medical imaging and epidemiology history in August, 2008. A total of 234 subjects from different nationalities were examined. Seven cases were serologically positive for echinococcosis and confirmed by medical imaging. Out of 30 suspected sera-positive cases, 3 were positive by medical imaging. There were 10 confirmed echinococcosis cases with a positive rate of 4.3%. There was significant difference on the prevalence among different towns (P < 0.05), but no significant statistical difference on the prevalence among nationalities, careers and sex. The prevalence in females (4.8%) was higher than that of males (3.6%).     

Cardiac Hydatidosis

We report a case of an adult who developed superior vena cava syndrome because of cardiac hydatidosis. A 37-year-old man from Morocco developed progressive dyspnoea and cough. Cardiac hydatidosis was diagnosed because of both the typical radiological findings and the positive serology for echinococcosis. The patient was treated by surgery and albendazole without complications.     

Applying molecular immunohaematology to regularly transfused thalassaemic patients in Thailand

Background

Red blood cell transfusion is the principal therapy in patients with severe thalassaemias and haemoglobinopathies, which are prevalent in Thailand. Serological red blood cell typing is confounded by chronic transfusion, because of circulating donor red blood cells. We evaluated the concordance of serological phenotypes between a routine and a reference laboratory and with red cell genotyping.

Materials and methods

Ten consecutive Thai patients with β-thalassemia major who received regular transfusions were enrolled in Thailand. Phenotypes were tested serologically at Songklanagarind Hospital and at the National Institutes of Health. Red blood cell genotyping was performed with commercially available kits and a platform.

Results

In only three patients was the red cell genotyping concordant with the serological phenotypes for five antithetical antigen pairs in four blood group systems at the two institutions. At the National Institutes of Health, 32 of the 100 serological tests yielded invalid or discrepant results. The positive predictive value of serology did not reach 1 for any blood group system at either of the two institutions in this set of ten patients.

Discussion

Within this small study, numerous discrepancies were observed between serological phenotypes at the two institutes; red cell genotyping enabled determination of the blood group when serology failed due to transfused red blood cells. We question the utility of serological tests in regularly transfused paediatric patients and propose relying solely on red cell genotyping, which requires training for laboratory personnel and physicians. Red cell genotyping outperformed red cell serology by an order of magnitude in regularly transfused patients.     

Luetic lymphadenopathy despite negative serology

Laboratory tests can be misleading for the diagnosis of syphilis and false-negative results are possible, but it is rare for both treponemal and non-treponemal tests to prove negative in different stages of the disease. We report on a case of luetic lymphadenopathy, diagnosed by histological examination and supported by immunohistochemical staining for Treponema pallidum, in the absence of skin lesions and positive serology. This case reminds us of how syphilis may present in many different clinical forms and that it should not be excluded only on the basis of negative serological tests. This patient's negative serology was probably due to inadequate initial antibiotic therapy. Given the current widespread use of antibiotics, greater consideration is warranted of the extent to which serological test results are modified by non-specific antibiotic therapies.     

Anti HCV seroprevalence among the voluntary blood donors in Thailand

Hepatitis C virus (HCV) infection is an increasing problem, affecting large numbers of the population in both the developed and the developing parts of the world. It is generally accepted as a significant public health problem with major associated morbidities and mortalities, in particular hepatocellular carcinoma. One of several strategies for prevention of HCV transmission is screening for anti HCV serology among donated blood in the blood bank. However, screening for HCV infection varies considerably throughout the world; differences between resource-poor and resource-rich countries are particularly pronounced. This is a particular problem in the developing countries in Asia where HCV infection has high prevalence, this is especially the case among the underprivileged populations and those countries are usually less able to afford routine HCV serological screening in blood bank. In Thailand, HCV infection is an important infectious disease. However, screening for anti HCV serology is performed in only a few large blood banks. The purpose of this study is to summarize the prevalence of Anti HCV seropositivity among the voluntary blood donors in the previous reports in Thailand. This review identified 5 reports in the literature reporting data in 39,633 documented voluntary donors. In all there were 541 cases with Anti HCV seropositivity. The summative percentage for Anti HCV seropositive was 1.37%. This rate is similar to the high levels reported previously from many other Asian countries, implying the importance of HCV infection in Asia. Thorough donor screening to eliminate high-risk donors is recommended to improve blood transfusion services in Thailand and other developing countries and screening for Anti HCV serology should be set as the national strategies covering all blood banks.     

Anti HCV seroprevalence among the voluntary blood donors in Thailand

Hepatitis C virus (HCV) infection is an increasing problem, affecting large numbers of the population in both the developed and the developing parts of the world. It is generally accepted as a significant public health problem with major associated morbidities and mortalities, in particular hepatocellular carcinoma. One of several strategies for prevention of HCV transmission is screening for anti HCV serology among donated blood in the blood bank. However, screening for HCV infection varies considerably throughout the world; differences between resource-poor and resource-rich countries are particularly pronounced. This is a particular problem in the developing countries in Asia where HCV infection has high prevalence, this is especially the case among the underprivileged populations and those countries are usually less able to afford routine HCV serological screening in blood bank. In Thailand, HCV infection is an important infectious disease. However, screening for anti HCV serology is performed in only a few large blood banks. The purpose of this study is to summarize the prevalence of Anti HCV seropositivity among the voluntary blood donors in the previous reports in Thailand. This review identified 5 reports in the literature reporting data in 39,633 documented voluntary donors. In all there were 541 cases with Anti HCV seropositivity. The summative percentage for Anti HCV seropositive was 1.37%. This rate is similar to the high levels reported previously from many other Asian countries, implying the importance of HCV infection in Asia. Thorough donor screening to eliminate high-risk donors is recommended to improve blood transfusion services in Thailand and other developing countries and screening for Anti HCV serology should be set as the national strategies covering all blood banks.     

Echinokokkose der Lunge

Echinococcosis is caused by larvae of the tapeworm Echinococcus. Lung involvement occurs almost exclusively in cystic echinococcosis caused by E. granulosus. Humans can accidentally become intermediate hosts, often by handling infected dogs in endemic areas. The liver is most commonly affected, followed by the lung. The course is usually benign; however, cyst expansion or rupture can lead to symptomatic disease. The diagnosis is based on a previous stay in an endemic area, cyst morphology on imaging, and – if positive – serology. Excision of the cyst with sparing of lung tissue is the treatment of choice. Benzimidazoles, preferably albendazole, are available for perioperative or in the case of inoperability for sole medical therapy. With lung cysts, the indication for drainage procedures is limited to particular cases.     

Inconclusive results in conventional serological screening for Chagas' disease in blood banks: evaluation of cellular and humoral response

Objective To find the most reliable screening method for Trypanosoma cruzi infection in blood banks. Material and methods Epidemiological data, lymphoproliferation assay, parasitological, conventional serological tests: immunofluorescence, haemagglutination, ELISA with epimastigote and trypomastigote antigens and reference serological tests: trypomastigote excreted‐secreted antigens (TESA) blot and chemiluminescent ELISA assay with mucine from trypomastigote forms were applied to individuals with inconclusive serology, non‐chagasic individuals and chronic chagasic patients. Results TESA blot had the best performance when used as a single test in all the groups. In the inconclusive group 20.5% of individuals were positive for TESA blot, 23.3% for either lymphoproliferation or TESA blot, and 17.8% for lymphoproliferation only. Positive lymphoproliferation without detectable antibodies was observed in 5.47% of all inconclusive serology cases. Analysis of six parameters (three serological assays, at least one parasitological test, one lymphoproliferation assay and epidemiological data) in the inconclusive group showed that diagnosis of Chagas’ disease was probable in 15 patients who were positive by two or more serological tests or for whom three of those six parameters were positive. Conclusion TESA blot is a good confirmatory test for Chagas’ disease in the inconclusive group. Although lymphoproliferation suggests the diagnosis of Chagas’ disease in the absence of antibodies when associated with a high epidemiological risk of acquiring Chagas’ disease, the data from this study and the characteristics of the lymphoproliferation assay (which is both laborious and time‐consuming) do not support its use as a confirmatory test in blood‐bank screening. However, our findings underscore the need to develop alternative methods that are not based on antibody detection to improve the diagnosis when serological tests are inconclusive.     

Autoimmune hepatitis type-2 and Epstein-Barr virus infection in a toddler: art of facts or an artifact?

Epstein-Barr virus (EBV) can cause frequently asymptomatic (or anicteric) and self-limited hepatitis, while occasionally may result in considerable cholestatic hepatitis. Herein, we describe the case of a previously healthy toddler (26 month old girl) with prolonged cholestasis, elevated serum transaminases, EBV serology compatible with recent EBV infection and positive anti liver kidney microsomal antibody type 1 which is characteristic of new-onset autoimmune hepatitis type 2. Liver biopsy was also typical of autoimmune hepatitis as attested by the presence of portal inflammation with predominant T-lymphocytes and plasma cells and interface hepatitis. Persistent EBV-related hepatitis was excluded by the absence of viral inclusions and steatosis on liver specimens and negative liver EBV-PCR. In conclusion, our case strongly suggests that in children with prolonged cholestatic hepatitis, positive EBV serology cannot exclude the presence of other causes of liver disease. In this context, autoimmune hepatitis should be considered as an alternate diagnosis, particularly when there is specific liver-related autoantibody detection. In such conditions, liver biopsy seems mandatory in an attempt to achieve a correct and timely diagnosis of a potentially catastrophic disease as autoimmune hepatitis. Although some cases of autoimmune hepatitis type 1 following EBV infection have been reported in adults, to the best of our knowledge, the present case of autoimmune hepatitis type 2 after EBV infection represents the first case in children ever reported in the English literature.     

Autochthonous human alveolar echinococcosis in a Hungarian patient

Background

Alveolar echinococcosis is a zoonotic parasitic disease causing a severe clinical condition and is known as the most deadly of all helminth infections. Moreover, this disease is also an increasing concern in Northern and Eastern Europe due to its spread in the wildlife animal host.

Case presentation

An asymptomatic 70-year-old woman from south-western Hungary was diagnosed with multiple liver lesions. Imaging techniques (ultrasound, computed tomography and magnetic resonance imaging), serology (ELISA, indirect hemagglutination and Western blot), and conventional staining methods (hematoxylin–eosin and periodic acid–Schiff) were used for the detection of the disease. A histopathological re-evaluation of formalin-fixed paraffin block by immunohistochemical staining with the monoclonal antibody Em2G11 definitively confirmed the diagnosis of alveolar echinococcosis.

Conclusions

To our knowledge, this is the first confirmed autochthonous case of human alveolar echinococcosis in Hungary. To what extent diagnostic difficulties may contribute to underestimate this zoonosis in Eastern Europe is unknown. Differential diagnosis with alveolar echinococcosis should be considered for patients with multiple, tumor-like cystic lesions of the liver, in countries where this parasite is emerging.

     

Latex agglutination test for amoebiasis in Pakistani patients with chronic 'obscure' liver enlargements.

The latex agglutination test for amoebiasis was done in 50 Pakistani patients in whom a clinical diagnosis of chronic non-supparative amoebic hepatitis was made on the basis of liver enlargement associated with chronic recurrent abdominal disturbance. The serological test was negative in 32 (64%) and positive in 18 (36%). Examination of stool specimens showed a higher frequency of E. histolytica in serology positive patients. The liver biopsy findings were variable and included normal histology in 40 percent and non-specific changes in another 34 per cent of the patients. There was evidence of early abscess formation in one patient with a strongly positive serological reaction. Chronic liver enlargements in this region form a heterogenous group and the existence of chronic non-suppurative amoebic hepatitis as a clinico-pathological entity remains doubtful.     

Human toxocariasis and pyogenic liver abscess: a possible association

OBJECTIVES: To study the role of human toxocariasis in the pathogenesis of pyogenic liver abscess. METHODS: We compared the serology for toxocariasis and serum levels of IgE in 16 patients with pyogenic liver abscess to those in 32 matched (age and gender) controls to define the possible association between these two entities. RESULTS: The serology for toxocariasis was positive in 10 of 16 patients compared with 4 of 32 controls. The relative odds and 95% confidence interval (conditional logistic regression), comparing cases and matched controls, was significant (1.4; 95% confidence interval, 1.1-1.7) for Toxocara serology. Regarding IgE serum levels, there was no difference between cases and controls. CONCLUSIONS: Human toxocariasis can be one of the predisposing causes of pyogenic liver abscess, especially in tropical countries in which this parasitic disease is common. Treatment of human toxocariasis may prevent morbid complications like hepatic abscess and should be considered in patients with clinical and/or serological evidence of Toxocara infection.