Assessment of the immunological surveillance value of humoral and lymphocyte assays in severe human cystic echinococcosis

Abstract

Thirty cystic echinococcosis (CE) patients in Uruguay with severe bone or secondary disseminated echinococcosis were immunologically assessed using cellular (lymphocyte transformation assay, LTA) and humoral (specific antibody and subclass responses, circulating antigen and circulating immune-complexes) immunological assays during the course of chemotherapy (albendazole and/or praziquantel). CE patients were divided into 4 groups, according to clinical treatment and outcome: (I) surgery and chemotherapy, (II) chemotherapy with outcome unchanged, (III) chemotherapy with outcome improved, and (IV) chemotherapy considered cured. Increased circulating antigen was of prognostic value in some severe CE cases where levels remained high and/or increased. The lymphoproliferative response in vitro to Echinococcus granulosus antigen was statistically greater in all patient groups compared to normal individuals but at lower levels in improved or cured CE patients. Levels of non-specific LTA response were significantly lower than controls for all groups during albendazole treatment (P < 0.001) but returned to normal levels in cured patients, a result consistent with parasite-induced suppression of cellular responses. This study suggests that, at least in severe osseous and secondary CE, immunosurveillance by specific antibodies, especially total specific immunoglobulin, was overall of more practical use than antigen-specific in-vitro lymphocyte transformation assays.

Long-term serological evaluation of patients with cystic echinococcosis treated with benzimidazole carbamates

“…They also support the role of HFF in eliciting a preferentially Th1 activation [29]. Our data on IgG4 again support the reported closer association of the specific IgG4 isotype with nonresponding patients than with those who respond well [5,33,34].…”

Musculoskeletal hydatid disease: A report of 13 cases

“…However, seronegativity may develop because unknown host and/or parasite factors cause inadequate T-helper-2 cell activation, thus reducing production of T-helper-2 cytokines implicated in immunoglobulin expression in cystic echinococcosis (Rigano et al 1998). Bonifacino et al (2000) found increased circulating antigen and speci c antibodies, especially total speci c immunoglobulin, of prognostic value in some patients with severe bone or secondary disseminated echinococcosis where the levels remained high and/or increased. However, while the level of total IgE decreased in our patient no.…”

“…This response in our series may have been due to albendazole/ mebendazole treatment. Indeed, Bonifacino et al (2000) found that antigen-speci c in vitro lymphocyte transformation assays show a signi cantly lower response than controls during albendazole treatment, but return to normal levels in healed patients due to parasite-induced suppress ion of cellular responses.…”

Lytic parasitic: a case of bone destructing echinococcosis

“… 20 Bonifacino et al looked at patients with secondary disseminated hydatid disease or with severe bone involvement and concluded that the role of praziquantel use in these severe cases required further appraise. 20 , 21 Although it has been suggested that praziquantel used in combination with albendazole may have synergistic effects resulting in increased levels of albendazole, 19 , 22 there is limited evidence on whether this dual therapy is superior compared with albendazole alone. 20 Gdoura et al 3 described a protocol with albendazole administered at a dose of 400 mg, orally, twice daily 2 weeks before surgery and approximately 6 months postsurgery.…”