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      Humoural immune response and pathological analysis in patients with false immune diagnosis of cystic echinococcosis

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          Abstract

          The patients with false immune diagnosis of hydatid disease were investigated for the humoural immune response to analyse the possible reasons and mechanism leading to false immune diagnosis. Two hundred and thirty-nine patients with nature-unknown cysts and 30 healthy controls were detected by immunological assays (four hydatid antigen-based immunogold filtration assay and enzyme-linked immune absorbent assay) and ultrasound. Sensitivity of and specificity of immunological assay and ultrasound were calculated, respectively. The serological diagnosis was compared with surgical pathology to screen the patients with false immune diagnosis for the immunoglobulin measurement and pathological analysis. The history and cyst characteristics were also reviewed. The results indicate the immunoglobulin has little influence on false immunodiagnosis. The false-negative immunodiagnosis was caused by the cysts' inactive status while the false positive caused by previous rupture, antigen cross-reaction. The clinical diagnosis of cystic echinococcosis requires a combination of immunodiagnosis and ultrasonography, which is the necessary complementary confirmation.

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          Most cited references29

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          Concepts in immunology and diagnosis of hydatid disease.

          Echinococcosis is a cosmopolitan zoonosis caused by adult or larval stages of cestodes belonging to the genus Echinococcus (family Taeniidae). The two major species of medical and public health importance are Echinococcus granulosus and E. multilocularis, which cause cystic echinococcosis (CE) and alveolar echinococcosis (AE), respectively. Both CE and AE are both serious diseases, the latter especially so, with a high fatality rate and poor prognosis if managed inappropriately. This review discusses new concepts and approaches in the immunology and diagnosis of CE, but comparative reference has also been made to AE infection and to earlier pivotal studies of both diseases. The review considers immunity to infection in the intermediate and definitive hosts, innate resistance, evasion of the immune system, and vaccination of intermediate and definitive hosts, and it particularly emphasizes procedures for diagnosis of CE and AE, including the value of immunodiagnostic approaches. There is also discussion of the new advances in recombinant and related DNA technologies, especially application of PCR, that are providing powerful tools in the fields of vaccinology and molecular diagnosis of echinococcosis.
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            Echinococcosis: diagnosis and diagnostic interpretation in population studies.

            Diagnosis is a basic component of population studies on echinococcosis. Other than careful necropsy in animals, there is no perfect gold standard. In the definitive host, techniques for direct parasite identification include copro-antigen and copro-DNA detection. In intermediate hosts, necropsy is typically used. In humans, diagnostic imaging and serology are both widely employed. The use of multiple parallel testing or an additional confirmatory test (or tests) in a diagnostic strategy can overcome the lack of a perfect gold standard. This will yield valuable information at population and individual levels, providing the study is well designed and any shortcomings of the tests are incorporated into the analysis. Here, we discuss analytical approaches to population studies of echinococcosis.
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              Modulation of dendritic cell differentiation and cytokine secretion by the hydatid cyst fluid of Echinococcus granulosus.

              Chronic infection by Echinococcus granulosus results in establishment of fluid-filled cysts (hydatid cysts) in liver or lungs of infected hosts, which can escape destruction by the host immune system for long periods. This study explores the modulation by hydatid cyst fluid of the in vitro human monocyte to dendritic cell (DC) transition induced by granulocyte-macrophage colony-stimulating factor (GM-CSF) and interleukin-4 (IL-4). Addition of the fluid to adherent peripheral blood monocytes cultured in GM-CSF/IL-4 stimulates release of prostaglandin E2 (PGE2) and IL-6. Exposure of differentiating DC to the fluid during the 7-day culture in GM-CSF/IL-4 impairs their subsequent ability to secrete IL-12, IL-6 or PGE2 in response to lipopolysaccharide (LPS) stimulation. This inhibition is not dependent on the initial release of PGE2. The presence of hydatid cyst fluid also modulates the phenotype of the cells generated during culture, resulting in increased CD14 expression and decreased expression of CD1a. Finally, hydatid fluid can stimulate predifferentiated DC to mature, as evidenced by release of IL-12 and IL-6, and by up-regulation of class II major histocompatibility complex and CD86. The possible role of dendritic cell modulation in regulating the host immune response to hydatid cysts is discussed.
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                Author and article information

                Journal
                Parasite Immunol
                Parasite Immunol
                pim
                Parasite Immunology
                BlackWell Publishing Ltd (Oxford, UK )
                0141-9838
                1365-3024
                April 2014
                07 March 2014
                : 36
                : 4
                : 170-176
                Affiliations
                [1 ]The Department of Hepatobiliary Surgery, The First Affiliated Hospital Zhejiang University School of Medicine Hangzhou, Zhejiang, China
                [2 ]The First Affiliated Hospital, Xinjiang Medical University Urumqi, Xinjiang, China
                [3 ]Department of Pharmacy, Shandong University of Traditional Chinese Medicine Jinan, Shandong, China
                Author notes
                Correspondence: Shusen Zheng, Department of Hepatobiliary Surgery, The First Affiliated Hospital Zhejiang University School of Medicine, 79 Qingchun Road, Hangzhou, Zhejiang 310003, China (e-mail: zhengshusen@ 123456zju.edu.cn ), Hao Wen,  State Key Laboratory Incubation Base of Xinjiang Major Diseases Research (2010DS890298) and Xinjiang Key Laboratory of Echinococcosis, The First Affiliated Hospital of Xinjiang Medical University, Urumqi, Xinjiang 830054,China (e-mail: Dr.wenhao@ 123456163.com ).

                Disclosures: All the authors declare there is no competing interest.

                Article
                10.1111/pim.12096
                4312899
                24372157
                856ff161-c9b1-4e1e-96b6-27936fda0b0b
                © 2013 The Authors Parasite Immunology Published by John Wiley & Sons Ltd

                This is an open access article under the terms of the Creative Commons Attribution-NonCommercial-NoDerivs License, which permits use and distribution in any medium, provided the original work is properly cited, the use is non-commercial and no modifications or adaptations are made.

                History
                : 17 June 2013
                : 18 December 2013
                Categories
                Original Articles

                Immunology
                false negative,false positive,humoural immune response,hydatid disease,immunological assay

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