Background Echinococcosis is a neglected tropical disease that is severely underdiagnosed in resource-limited settings. In developed countries, diagnosing echinococcosis is challenging, and reliable serological assays are urgently needed. In the Central European Alps, EM is more common than EG; however, data on the diagnostic performance of assays for EM cases are scarce. We evaluated the suitability of nine antibody assays for routine diagnostics. Methods Nine commercially available serological assays for detecting anti-Echinococcus antibodies were compared head-to-head using samples collected from 50 patients with echinococcosis and 50 age- and sex-matched control subjects. The assays are Anti-Echinococcus ELISA (IgG) (Euroimmun), Echinococcus IgG ELISA (DRG), Echinococcus IgG ELISA (IBL International), Echinococcus Western Blot IgG (LDBIO Diagnostics), EUROLINE WB (Euroimmun), Hydatidosis ELISA IgG (VirCell), Hydatidosis VIRCLIA IgG Monotest (VirCell), Ridascreen Echinococcus IgG (R-Biopharm), and Virapid Hydatidosis (VirCell). The cases were ranked according to the WHO-Informal Working Group on Echinococcosis (WHO-IWGE) criteria as confirmed, probable, or possible. Results The performance of the assays varied greatly, with overall sensitivities ranging between 50% and 88% and specificities between 62% and 100%. We observed a trend toward better performance with cases classified as "confirmed" using the WHO-IWGE criteria. Combined analysis with sequential screening and confirmatory testing resulted in a maximum sensitivity of 84% and specificity of 100%. Differentiation between EG and EM infections is clinically relevant but was found to be unreliable. Conclusions Echinococcus serological assays are highly variable in terms of sensitivity and specificity. Knowledge of the pre-test probability in the patient cohort is required to choose a suitable assay. A combined approach with screening and confirmatory assays may be the best diagnostic strategy in many situations.

中文翻译：

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抗棘球绦虫抗体检测的九种检测方法的头对头比较：回顾性评估。

背景 棘球蚴病是一种被忽视的热带疾病，在资源有限的环境中严重漏诊。在发达国家，诊断包虫病具有挑战性，迫切需要可靠的血清学检测。在中欧阿尔卑斯山，EM 比 EG 更常见；然而，有关 EM 病例检测诊断性能的数据很少。我们评估了九种抗体检测对于常规诊断的适用性。方法 使用从 50 名包虫病患者和 50 名年龄和性别匹配的对照受试者收集的样本，对 9 种市售的抗棘球蚴抗体血清学检测方法进行了头对头比较。这些检测包括抗棘球绦虫 ELISA (IgG) (Euroimmun)、棘球绦虫 IgG ELISA (DRG)、棘球绦虫 IgG ELISA (IBL International)、棘球绦虫蛋白质印迹 IgG (LDBIO Diagnostics)、EUROLINE WB (Euroimmun)、包虫病 ELISA IgG (VirCell) 、包虫病 VIRCLIA IgG Monotest (VirCell)、Ridascreen 棘球蚴 IgG (R-Biopharm) 和 Virapid 包虫病 (VirCell)。根据世界卫生组织棘球蚴病非正式工作组 (WHO-IWGE) 标准对病例进行分级，分为确诊、可能或可能。结果 检测的性能差异很大，总体灵敏度在 50% 到 88% 之间，特异性在 62% 到 100% 之间。我们观察到，使用 WHO-IWGE 标准将病例分类为“确诊”的情况呈现出更好的表现趋势。与序贯筛选和验证性测试相结合的分析得出的最大敏感性为 84%，特异性为 100%。EG 和 EM 感染之间的区分具有临床意义，但被发现不可靠。结论 棘球绦虫血清学检测在敏感性和特异性方面存在很大差异。选择合适的检测方法需要了解患者队列中的预测试概率。在许多情况下，筛查和验证性检测相结​​合的方法可能是最好的诊断策略。