Portable Ultrasound Scanner Versus Serology in Screening for Hydatid Cysts in a Nomadic Population

Macpherson, C. N. L.; Zeyhle, E.; Römig, Thomas; Rees, Philip; Were, John

doi:10.1016/s0140-6736(87)90839-7

Cited by 119 publications

(69 citation statements)

References 9 publications

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“…Human CE prevalence rates varied between 0.4% and 3.6% in Tunisia, 3,34 up to 5.6% in Kenya, 24,35 0.3-2.9% in China, 36,37 1.3-5.6% in Uruguay, 33,38 and up to 8.6% in Argentina. 39 However, the current study is probably one of the largest human CE mass screening programs undertaken.…”

Section: Discussionmentioning

confidence: 98%

“…27 In Tunisia, 7.7% of persons Ͼ 39 years of age had CE 26 , while in east Africa, the prevalence of CE in Turkana, Kenya increased with age from 0.17% in the 0-4-yearold group to 11.1% in the Ͼ 50-year-old group. 24 Since hydatid cysts usually grow very slowly, patients may remain asymptomatic for many years. If one assumes that small univesicular hydatid cysts (Ͻ 5 cm in diameter, i.e., Type I) represent relatively early infection, compared with large, more complex hydatid cysts (i.e., Types II, III, and IV by ultrasound 28 ), then the specific prevalence of Type I cysts should decrease with age if the hydatid cysts in older people are simply older cysts resulting from early asymptomatic infection.…”

Section: Discussionmentioning

confidence: 99%

“…This difference is similar to those in studies in other regions of Africa endemic for CE such as Tunisia where females (4.3%) were also at greater risk of infection than males (2.5%)Ͼ 26 In northwestern Kenya, females exhibited approximately twice the CE prevalence rate compared with males (5.6% versus 2.9%). 24 Differences in prevalence rates between the sexes in Kenya were attributed to different behavioral attitudes toward dogs. 40 This may also be the case in Libya, although no specific observations on human-dog contact have as yet been made.…”

Section: Discussionmentioning

confidence: 99%

“…23 Currently, however, the most effective community based screening technique for CE is the use of a portable ultrasound scanner. 24,25 Confirmation of between 60% and 90% of ultrasound-detected CE cases can be made serologically. 26,27 A pilot ultrasound-serologic CE survey in five areas in northwest Libya showed a prevalence rate of 1.4% (57 of 4,103).…”

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confidence: 99%

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An extensive ultrasound and serologic study to investigate the prevalence of human cystic echinococcosis in northern Libya.

Shambesh¹,

Craig²,

Macpherson³

et al. 1999

The American Journal of Tropical Medicine and Hygiene

115

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Abstract. A prevalence study of abdominal cystic echinococcosis (CE) was undertaken in the northwest, northcentral, and northeast regions of Libya. A total of 36 villages along the coast were included, in which 20,220 people were screened by portable ultrasound. Three hundred thirty-nine (1.7%) were diagnosed with CE. There was no significant difference between CE prevalence rates in the three regions of Libya (mean ϭ 1.6%); however, intervillage rates were variable, ranging from 0% to 4.5%. The prevalence of CE increased significantly with age (P Ͻ 0.0001) and females were significantly more affected (2%) than males (1.3%) (P Ͻ 0.0001). Cases of CE were distributed among 3.2% of housewives, 2.6% of farmers, 2.3% of male civil servants, 1.3% of female students, and 1.1% of male students. Housewives (P Ͻ 0.0001) and students (P Ͻ 0.0001) were significantly more at risk for CE. A statistically significant proportion (62% [210 of 339]) of CE cases kept dogs (P Ͻ 0.0001). Of the ultrasound-positive CE cases 69% (233 of 339) were antibody seropositive by ELISA using Echinococcus granulosus hydatid cyst fluid antigen B. Blood samples (n ϭ 10,096) collected onto filter papers were taken randomly from ultrasound-negative people who entered the study, of which 11.2% were found to be seropositive. Seropositivity increased with age (P Ͻ 0.0001), with females exhibiting higher seroprevalence than males for all age groups (P Ͻ 0.0001). Seroprevalence was distributed occupationally among 17.3% of female students, 11.2% of male students, 8.3% of housewives, 7.3% of farmers, and 6.4% of male civil servants. Housewives and students were more likely to be seropositive (P Ͻ 0.0001). Forty-seven percent (526) of the seroreactors kept dogs. All liver hydatid cysts detected by ultrasound during community screening were classified according to morphology and size into six types. Type I (17.5% of all cases) were small univesicular cysts less than 50 mm in diameter with no laminations or daughter cysts. Type II (34%) were univesicular cysts with only laminations. Type IIIa (8.5%) were univesicular cysts with the appearance of laminations and daughter cysts. Type IIIb (13%) were univesicular with laminations and less prominent daughter cysts. Type IV (5.6%) presented as a solid mass. Type V were degenerated calcified or partially calcified cysts (13.2%). Type VI presented as multiple cysts (8% of all cases). The CE cases that exhibited Types II, IIIa, IIIb, IV or VI cysts showed the highest seropositivity (86%, 96%, 95%, 100%, and 96%, respectively), while Types I and V were the least seroreactive (38% and 22%, respectively). Cases of CE occurred in 311 families, with 93% having only one member as a CE case while 7% of the families had two or more cases. However, 25% of the ultrasound-negative persons belonging to families with an index CE case were seropositive for antibodies to Echinococcus. These results confirm the importance of human CE in Libya. They also confirm the usefulness of ultrasound combined with serology as a mass screeni...

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Section: Discussionmentioning

confidence: 98%

Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

mentioning

confidence: 99%

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An extensive ultrasound and serologic study to investigate the prevalence of human cystic echinococcosis in northern Libya.

Shambesh¹,

Craig²,

Macpherson³

et al. 1999

The American Journal of Tropical Medicine and Hygiene

115

View full text Add to dashboard Cite

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“…11 US is easy to use in field settings, noninvasive, and sensitive and specific for CE. [12][13][14] Cyst stages as described by the classification are defined by their observable physical characteristics and account for changes in parasite activity/viability as cyst morphology of the different cyst stages. The WHO classification consists of six stages.…”

Section: Introductionmentioning

confidence: 99%

Expert Reliability for the World Health Organization Standardized Ultrasound Classification of Cystic Echinococcosis

Solomon¹,

Fields²,

Tamarozzi³

et al. 2017

The American Society of Tropical Medicine and Hygiene

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Abstract. Cystic echinococcosis (CE), a parasitic zoonosis, results in cyst formation in the viscera. Cyst morphology depends on developmental stage. In 2003, the World Health Organization (WHO) published a standardized ultrasound (US) classification for CE, for use among experts as a standard of comparison. This study examined the reliability of this classification. Eleven international CE and US experts completed an assessment of eight WHO classification images and 88 test images representing cyst stages. Inter-and intraobserver reliability and observer performance were assessed using Fleiss' and Cohen's kappa. Interobserver reliability was moderate for WHO images (κ = 0.600, P < 0.0001) and substantial for test images (κ = 0.644, P < 0.0001), with substantial to almost perfect interobserver reliability for stages with pathognomonic signs (CE1, CE2, and CE3) for WHO (0.618 < κ < 0.904) and test images (0.642 < κ < 0.768). Comparisons of expert performances against the majority classification for each image were significant for WHO (0.413 < κ < 1.000, P < 0.005) and test images (0.718 < κ < 0.905, P < 0.0001); and intraobserver reliability was significant for WHO (0.520 < κ < 1.000, P < 0.005) and test images (0.690 < κ < 0.896, P < 0.0001). Findings demonstrate moderate to substantial interobserver and substantial to almost perfect intraobserver reliability for the WHO classification, with substantial to almost perfect interobserver reliability for pathognomonic stages. This confirms experts' abilities to reliably identify WHO-defined pathognomonic signs of CE, demonstrating that the WHO classification provides a reproducible way of staging CE.

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The Role of the WHO in the Global Management of Hydatid Disease. Lessons Learned in the Field

Brunetti

Macpherson

2020

The Surgical Management of Parasitic Diseases

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Portable Ultrasound Scanner Versus Serology in Screening for Hydatid Cysts in a Nomadic Population

Cited by 119 publications

References 9 publications

An extensive ultrasound and serologic study to investigate the prevalence of human cystic echinococcosis in northern Libya.

An extensive ultrasound and serologic study to investigate the prevalence of human cystic echinococcosis in northern Libya.

Expert Reliability for the World Health Organization Standardized Ultrasound Classification of Cystic Echinococcosis

The Role of the WHO in the Global Management of Hydatid Disease. Lessons Learned in the Field

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