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| Year : 1985 | Volume
: 31
| Issue : 3 | Page : 158-60 |
A comparative evaluation of Casoni's intradermal test and counter-immuno-electrophoresis test in the diagnosis of hydatid disease.
Mathur MM, Bhave GG
How to cite this article:
Mathur M M, Bhave G G. A comparative evaluation of Casoni's intradermal test and counter-immuno-electrophoresis test in the diagnosis of hydatid disease. J Postgrad Med 1985;31:158 |
How to cite this URL:
Mathur M M, Bhave G G. A comparative evaluation of Casoni's intradermal test and counter-immuno-electrophoresis test in the diagnosis of hydatid disease. J Postgrad Med [serial online] 1985 [cited 2023 May 31];31:158. Available from: https://www.jpgmonline.com/text.asp?1985/31/3/158/5394 |
Hydatid disease is a cyclozoonotic disease caused by cestode of the genus Echinococcus which has four species. Out of these four species, E. granulosus is the most common species which produces infection in humans. In India, various reports are available suggesting high endemicity of this disease.[9],[11],[13] In most of the places, laboratory diagnosis is based mainly on Casoni's test. The main drawback of Casoni's test is lack of standardization of the antigen and high percentage of false positivity. Therefore, to find out a better method for diagnosis, a simple rapid method like counterimmunoelectrophoresis (CIE) is compared with the commonly used Casoni's test.
The present study includes 44 clinically suspected cases of hydatid disease. Detailed clinical history, site of the hydatid cyst and findings of other investigations including X-rays were recorded. In each case, 5 ml of plain blood was collected and serum was separated and stored at 4°C until use.
Counterimmunoelectrophoresis (CIE) was carried out by modified Kelkar and Kotwal method.[4] Agarose-gel slides were prepared by using 1% agarose and wells of 4 mm diameter, with their edges 3 mm apart, were punched. Antigen-hydatid fluid from hydatid cyst was obtained with aseptic precautions at the time of operation of the patient. The fluid was centrifuged and the deposit was examined for the presence of scolices. The supernatant was used for the test after estimating protein content which was 2.1 mg/ml. Anodal wells were charged with patient's sera and cathodal wells with the above hydatid antigen. Electrophoresis was run for 45 minutes and a line of precipitation between antigen and antibody well was considered as positive [Fig. 1].
Casoni's I/d test was done as follows: The antigen for Casoni's test was obtained from Span Diagnostics (India). 0.2 ml of the antigen was injected I /d on the forearm and the same amount of normal saline was injected in the other forearm which served as a control. A reaction consisting of a wheal with erythema at the site of injection after 30 minutes was taken as immediate positive reaction. The test was again observed after 24 hours and a wheal with erythema at the injection site was taken as a delayed positive reaction. Both immediate and delayed positive reactions were taken as positive in the present study.
After subjecting all 44 cases to either surgery or investigations, 12 cases were surgically proved to be suffering from hydatid disease and 32 were confirmed as non-hydatid cases.
In the present series of 12 confirmed cases of hydatid disease, Casoni's I/d test was positive in 7 and CIE test was positive in 9 cases as shown in. In addition to 7 cases detected by Casoni's I /d test, 2 more were found positive by CIE. In 32 non-hydatid cases, Casoni's I/d test was positive in 4, cases. No false positive test was observed by CIE test. Majority of the patients (75%) had hydatid cyst located in the liver. In three false negative cases by CIE, hydatid cysts were located in the liver (calcified), lung and the peritoneal cavity. Out of 9 cases of hydatid cyst of liver, 8 were detected by CIE and 7 were detected by Casoni's I/d tests.
Echinococcosis is one of the major public health problems in most of the tropical countries. The laboratory diagnosis is based mainly on Casoni's test. The sensitivity of Casoni's test varies from 50-65%.[2],[12] In the present series, the sensitivity of Casoni's I/d test was 58.33%. In contrast, CIE has given higher sensitivity (75%) as compared to Casoni's test and no false positive results, though this test gave 25% false negativity. The sensitivity of CIE test has been reported to vary from 66 to 82%.[4],[5],[7],[8]
In the CIE test, there is no interference with other helmenthic infestation as shown by Kelkar and Kotwal[4] who reported that CIE test was negative in known cases of Taenia and H. nana infestations. In most of the reports as well as in our finding, there are no false positive results in the control group.
Localisation of the cyst in different organs like the liver, lungs does not affect the sensitivity of the CIE test,[1] while in other immunodiagnostic tests like indirect haemagglutination or indirect fluorescent antibody test, the sensitivity is more in hepatic than pulmonary cases.[3] CIE is a rapid, sensitive test and definitely better than Casoni's test for the diagnosis of hydatidosis.
The only drawback of CIE observed in our study was false negative results in three cases. The possible reasons for these negative results are as follows: all available antibody is complexed to the antigen forming immune complexes.[10] Healthy intact hydatid cyst gives a low level of antigenic stimulation and senescent or dead cysts apparently cease to stimulate the host who may be seronegative. A sterile cyst may not stimulate humoral immune response hence CIE may come negative. Purification of the whole hydatid fluid antigen may further increase the specificity of the test. Thus it seems that CIE is a better diagnostic test for hydatid disease as compared to the Casoni's I/d test. It does not give false positive reactions, but some false negatives may be encountered. Moreover, being a sophisticated test, it cannot be carried out as a routine laboratory test in peripheral or rural health practice.
We are thankful to Dr. G. B. Parulkar, Dean, Seth G.S. Medical College and K.E.M. Hospital, Parel, Bombay-400 012, for his kind permission to publish this paper.
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| 2. | Chordi, R.: Navarra, Spain (Thesis) 1962, Quoted by Kagan (1968).[3] |
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| 4. | Kelkar, S. S. and Kotwal, S. E.: Counterimmunoelectrophoresis in diagnosis of hydatid disease. Lancet, 1: 755-756, 1975. |
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| 7. | Mahajan, R. C., Ganguly, N. K., Sharma, Saroj, Chandarani, R. E. and Chitkara, N. L.: Counterimmunoelectrophoresis for rapid serodiagnosis of human hydatid disease. Ind. J. Med. Res., 64: 1173-1176, 1976. |
| 8. | Nagaty, H. F. and Tabarestani, M.: Evaluation of the counterimmunoelectrophoresis (CIEP) and agar gel diffusion (AGD) techniques in the diagnosis of hydatidosis in Iran. Trans. Roy. Soc. Trop. Med. and Hyg., 73: 720-721, 1979. |
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| 10. | Richard-Lenoble, D., Smith, M. D. and Loisy, M.: Human hydatidosis: evaluation of three serodiagnostic methods, the principal subclass of specific immunoglobin and the detection of circulating immune-complexes. Ann. Trop. Med. and Parasitol., 72: 553-560, 1978. |
| 11. | Sharma, T. D. and Chitkara, N. L.: Hydatid disease in Amritsar: A study of potential human risk. Ind. J. Med. Res., 51: 1015-1018, 1963. |
| 12. | Sorive, F., Castagaari, L. and TOIU, A.: La diagnoni biologics dell idstidasi u mann Brill. 1st Sieroter Mailan, 48: 44, 1966. |
| 13. | Upadhyaya, G. H., Rai, P. and Shah, P. K.: Clinical study of hydatid disease in Jamnagar. J. Ind. Med. Assoc., 63: 213-216, 1974. |
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