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Performance of Echinococcosis Serology is Associated with Disease Endemicity, Hydatid Cyst Location, Eosinophilia, Imaging Finding, and Treatment

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Abstract

Background

We aimed to assess echinococcosis serology performance for diagnosing cystic echinococcosis (CE) in children living in CE-endemic vs. non-endemic populations, and in different clinical settings.

Methods

A retrospective cohort study, assessing children with ELISA test for echinococcosis, 2005–2021. Sensitivity, specificity, positive and negative predictive values (PPV and NPV) were calculated comparing CE-endemic vs. non-endemic populations, cases with/without eosinophilia, and cases with/without CE-suggestive imaging findings. Additionally, we examined the association between serology titers/levels (values) and clinical characteristics.

Results

Of 273 cases, 66 (24%) were confirmed as CE. Overall, 97% of CE were in Bedouin children, and the pre-test probability was 28% vs. 9% (p < 0.001) in CE-endemic vs. non-endemic population, respectively. Sensitivity was higher in hepatic than extra-hepatic CE (74% vs. 47%). Overall specificity was 86%. PPVs were higher in CE-endemic population compared to non-endemic (66% vs. 22%), while NPVs were higher in non-endemic population (100% vs. 87%). Eosinophilia was associated with lower specificity (73% vs. 94%) and PPV (47% vs. 78%). Typical imaging was associated with higher specificity (94% vs. 82%) and PPV (91% vs. 11%), while NPVs were lower in typical imaging cases (77% vs. 98%). Higher titer levels (above median) were associated with typical imaging (76% vs. 49%), higher PPV (79% vs. 43%), albendazole treatment (100% vs. 56%), surgery (60% vs. 19%), and new imaging finding (75% vs. 0%).

Conclusions

Echinococcosis serology performance was impacted by disease endemicity, and by various clinical characteristics. These findings may assist physicians in the interpretation of echinococcosis serology results.

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Data availability

Upon justified request to the corresponding author data will be made available.

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Funding

No funding has been received for this study.

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Authors and Affiliations

  1. Faculty of Health Sciences, Ben-Gurion University of the Negev, Beer Sheva, Israel

    Moshe Shmueli, Orli Sagi, Daniel Grupel, Asaf Sheves, Zaki Assi & Shalom Ben-Shimol

  2. Medical School for International Health, Faculty of Health Sciences, Ben-Gurion University of the Negev, Beer Sheva, Israel

    Jacob Van Buren

  3. The Parasitology Laboratory, Soroka University Medical Center, Beer-Sheva, Israel

    Orli Sagi

  4. Internal Medicine B, Soroka University Medical Center, Beer Sheva, Israel

    Daniel Grupel & Zaki Assi

  5. Department of Pediatric Surgery, Soroka University Medical Center, Beer-Sheva, Israel

    Asaf Sheves

  6. Pediatric Infectious Disease Unit, Soroka University Medical Center, Beer-Sheva, Israel

    Shalom Ben-Shimol

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  1. Moshe Shmueli
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  2. Jacob Van Buren
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Correspondence to Shalom Ben-Shimol.

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Shmueli, M., Van Buren, J., Sagi, O. et al. Performance of Echinococcosis Serology is Associated with Disease Endemicity, Hydatid Cyst Location, Eosinophilia, Imaging Finding, and Treatment. Acta Parasit. 69, 233–241 (2024). https://doi.org/10.1007/s11686-023-00736-4

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