Post-treatment follow-up study of abdominal cystic echinococcosis in tibetan communities of northwest Sichuan Province, China

Background

Human cystic echinococcosis (CE), caused by the larval stage of Echinococcus granulosus, with the liver as the most frequently affected organ, is known to be highly endemic in Tibetan communities of northwest Sichuan Province. Antiparasitic treatment with albendazole remains the primary choice for the great majority of patients in this resource-poor remote area, though surgery is the most common approach for CE therapy that has the potential to remove cysts and lead to complete cure. The current prospective study aimed to assess the effectiveness of community based use of cyclic albendazole treatment in Tibetan CE cases, and concurrently monitor the changes of serum specific antibody levels during treatment.

Methodology/Principal Findings

Ultrasonography was applied for diagnosis and follow-up of CE cases after cyclic albendazole treatment in Tibetan communities of Sichuan Province during 2006 to 2008, and serum specific IgG antibody levels against Echinococcus granulosus recombinant antigen B in ELISA was concurrently monitored in these cases. A total of 196 CE cases were identified by ultrasound, of which 37 (18.9%) showed evidence of spontaneous healing/involution of hepatic cyst(s) with CE4 or CE5 presentations. Of 49 enrolled CE cases for treatment follow-up, 32.7% (16) were considered to be cured based on B-ultrasound after 6 months to 30 months regular albendazole treatment, 49.0% (24) were improved, 14.3% (7) remained unchanged, and 4.1% (2) became aggravated. In general, patients with CE2 type cysts (daughter cysts present) needed a longer treatment course for cure (26.4 months), compared to cases with CE1 (univesicular cysts) (20.4 months) or CE3 type (detached cyst membrane or partial degeneration of daughter cysts) (9 months). In addition, the curative duration was longer in patients with large (>10 cm) cysts (22.3 months), compared to cases with medium (5–10 cm) cysts (17.3 months) or patients with small (<5 cm) cysts (6 months). At diagnosis, seven (53.8%) of 13 cases with CE1 type cysts without any previous intervention showed negative specific IgG antibody response to E. granulosus recombinant antigen B (rAgB). However, following 3 months to 18 months albendazole therapy, six of these 7 initially seronegative CE1 cases sero-converted to be specific IgG antibody positive, and concurrently ultrasound scan showed that cysts changed to CE3a from CE1 type in all the six CE cases. Two major profiles of serum specific IgG antibody dynamics during albendazole treatment were apparent in CE cases: (i) presenting as initial elevation followed by subsequent decline, or (ii) a persistent decline. Despite a decline, however, specific antibody levels remained positive in most improved or cured CE cases.

Conclusions

This was the first attempt to follow up community-screened cystic echinococcosis patients after albendazole therapy using ultrasonography and serology in an endemic Tibetan region. Cyclic albendazole treatment proved to be effective in the great majority of CE cases in this resource-poor area, but periodic abdominal ultrasound examination was necessary to guide appropriate treatment. Oral albendazole for over 18 months was more likely to result in CE cure. Poor drug compliance resulted in less good outcomes. Serology with recombinant antigen B could provide additional limited information about the effectiveness of albendazole in CE cases. Post-treatment positive specific IgG antibody seroconversion, in initially seronegative, CE1 patients was considered a good indication for positive therapeutic efficacy of albendazole.     

基于粪便DNA 的藏狐微卫星位点筛选及个体识别

藏狐是我国青藏高原东部多房棘球绦虫和石渠棘球绦虫最主要的野生动物终末宿主。棘球绦虫会导致一类称为棘球绦虫病的致死性人兽共患疾病,青藏高原东部牧区是该病重要的流行区。因此作为终末宿主,评估藏狐种群的棘球绦虫感染率对于该病的流行病学研究意义明显。而要获取这方面信息,首先必须了解藏狐的种群数量。为此,我们基于非损伤取样的原则,使用藏狐新鲜粪便作为研究材料,从已发布的藏狐及近缘种的48个微卫星位点中筛选了11 个用于藏狐粪便DNA 多态性分析。对2011 -2012 年7 -8 月间收集的128 份有效藏狐粪便样品(2011 年68 份,2012 年60 份)进行特异性PCR 扩增,并用琼脂糖凝胶电泳和荧光引物标记法进行基因分型,根据各位点的等位基因频率计算出各位点的基因型数(N),期望杂合度(He )、观测杂合度(Ho)、多态信息含量(PIC)以及不同个体基因型相同概率值(PI)。结果发现,各位点N 介于4 - 7,H e为0.66 - 0. 80,H o为0.17 -0.68,PIC 为0.5496 - 0.7623。11 个位点的累积PI 值满足个体识别的需要(PIbiased = 1. 283 × 10 ^{- 11} ;PIsi bs =7.572 × 10 ^{- 5} )。但是,由于粪便DNA 质量差异较大,不同位点的扩增成功率差异较大(0.176 - 0. 926)。我们发现,按照扩增成功率由高到低排列,前6 个微卫星位点(P03,CXX172,CPH6,CPH8,P01i,P08)的扩增成功率均超过0.6,且累积PI 值小于0.004 (PIbiased =2.775 × 10 ^{- 7} ;PIsibs = 3. 606 ×10 ^{- 3} ),表明这6 个位点可以对藏狐进行个体识别。因此,针对本研究的数据,制定了如下的个体识别原则: (1)只有粪便DNA 至少成功扩增出前6 个微卫星位点的样品可以进入下一步分析; (2)所有位点的信息均相同的两个样品被认为是来自同一个体;(3)保险起见,如果仅有一对位点信息不相等,此两个样品依然被判定来自同一个体。在此基础上,我们从2011 年样品中识别出30 个藏狐个体,从2012 年样品中识别出21 个个体。