Original Article

Evaluation of Echinococcosis Pre-Diagnosis Patients Admitted to the National Parasitology Reference Laboratory of Turkey from 2014-2019


Background: Echinococcosis is a common parasite with zoonotic character created by a small cestode, Echinococcus spp., and is an important public health problem in Turkey as well as all over the world. We aimed to investigate antibodies in serum samples of suspected Echinococcosis patients sent to the National Parasitology Reference Laboratories of the General Directorate of Public Health.

Methods: Serum samples of 2390 patients sent to our laboratory between January 1, 2014 and May 01, 2019, evaluated by ELISA, Indirect Hemagglutination Test (IHA) and Western Blot (WB) methods are presented. Our laboratory is the national reference laboratory. All kinds of tests requested from suspected patients can be performed

Results: Overall, 1199 (50.2%) of 2390 serum samples were female and 1191 (49.8%) were male. It was observed that 178 (14.9%) of men and 210 (17.5%) of women were seropositive. There was no statistical difference between the sexes in terms of seropositivity. Of all samples, 1941 (81.2%) were negative, 388 (16.2%) were positive, and 61 (2.6%) were borderline. Results determined as borderline are considered suspicious and a recommendation is made to repeat the test after 15 days. A statistical difference was found in the distribution of seropositivity by years. While seropositivity was lowest in 2014, it was found to be highest in 2018 and 2019.

Conclusion: Despite all the precautions taken, it is seen that echinococcosis still continues to exist in Turkey as a zoonotic disease. Hence, CE has been involved in Turkey Zoonotic Diseases Action Plan (2019-2023) and decided to carry out studies for the protection and prevention of the disease.

1. Romig T, Deplazes P, Jenkins D, Giraudoux P, Massolo A, Craig PS, et al. Ecology and Life Cycle Patterns of Echinococcus Species. Adv Parasitol. 2017;95:213-314.
2. Thompson RC. Biology and Systematics of Echinococcus. Adv Parasitol. 2017;95:65-109.
3. Agudelo Higuita NI, Brunetti E, McClos-key C.J. Cystic Echinococcosis. J Clin Mi-crobiol. 2016 Mar;54(3):518-23.
4. Hüttner M, Romig T. Echinococcus species in African wildlife. Parasitology. 2009; 136(10):1089-95.
5. Vuitton DA, McManus DP, Rogan MT, et al. International consensus on terminology to be used in the field of echinococcoses. Parasite. 2020;27:41.
6. WHO (World Health Organization). 2021a. Echinococcosis. Access address: https://www.who.int/health-topics/echinococcosis#tab=tab_2. Date of access:24.04.2021
7. Wen H, Vuitton L, Tuxun T, et al. Echino-coccosis: Advances in the 21st Century. Clin Microbiol Rev. 2019 Feb 13;32(2):e00075-18.
8. WHO (World Health Organization). 2021b. Access addres: https://www.who.int/publications/i/item/WHO-HTM-NTD-NZD-2017.01 Date of access: 24.04.2021
9. CDC (Centre for Disease Control and Prevention). 2021. Parasites – Echinococcosis. Access addres: https://www.cdc.gov/parasites/echinococcosis/diagnosis.html. Date of access: 24.04.2021
10. Moro P, Schantz PM. Echinococcosis: a review. Int J Infect Dis. 2009;13(2):125-33.
11. Siles-Lucas M, Casulli A, Conraths FJ, Müller N. Laboratory Diagnosis of Echinococcus spp. in Human Patients and Infected Animals. Adv Parasitol. 2017;96:159-257.
12. Woolsey ID, Miller AL. Echinococcus granulosus sensu lato and Echinococcus multilocularis: A review. Res Vet Sci. 2021;135:517-22.
13. Deplazes P, Rinaldi L, Alvarez Rojas CA, et al. Global Distribution of Alveolar and Cystic Echinococcosis. Adv Parasitol. 2017;95:315-493.
14. Tamarozzi F, Deplazes P, Casulli A. Reinventing the wheel of Echinococcus granulosus sensu lato transmission to humans. Trends Parasitol. 2020;36(5):427-34.
15. Altintaş N, Topluoğlu S, Yildirim A, et al. Current Situation Report Of Cystic Echinococcosis In Turkey. Turk Hij Den Biyol Derg.. 2020;77(3):1-52.
16. Karaman Ü, Miman Ö, Kara M, Gıcık Y, Aycan ÖM, Atambay M. Hydatid Cyst Prevalence in the Region of Kars. Turkiye Parazitol Derg. 2005;29(4):238-40.
17. Yazar S, Yaman O, Cetinkaya F, Sahin I. Cystic echinococcosis in central Anatolia, Turkey. Saudi Med J. 2006;27(2):205.
18. Eşgin M, Aktaş M, Coşkun Ş. The Investigation of Antibody Presence in the Sera of Patients with A Suspicion of Cystic Echinococcosis by Using Indirect Hemaglutination Test. Turkiye Parazitol Derg. 2007;31(4):283-7.
19. Delibaş SB, Ozkoç S, Sahin S, Aksoy U, Akisü C. Evaluation of patients presenting with a suspicion of cystic echinococcosis to the serology laboratory of the Parasitology Department of Dokuz Eylül University Medical Faculty. Turkiye Parazitol Derg.. 2006;30(4):279-81.
20. Tamer GS. Determination of The Incidence of Toxoplasmosis and Cystic Echinococcosis in Kocaeli. Turkiye Parazitol Derg. 2009; 33 (2): 125. 2009;130.
21. Yaman M. Control of Cystic Echinococcosis. Yüzüncü Yıl Veteriner Fakültesi Dergisi. 2011;22(2):121-5.
22. Ertabaklar H, Dayanır Y, Ertuğ S. Research to Investigate the Human Cystic Echinococcosis with Ultrasound and Serologic Methods and Educational Studies in Different Provinces in Aydın/Turkey. Turkiye Parazitol Derg. 2012;36(3):142-6.
23. Aydin Terzioğlu M, Adiyaman G, Doğruman Al F, Kuştimur S, Özkan S. Determination of Anti-Echinococcus IgG Antibodies by ELISA in Patients with Suspected Hydatid Cyst. Turkiye Parazitol Derg. 2012;36(2):61-4.
24. Çetinkaya Ü, Hamamcı B, Kaya M, et al. Investigation of Anti-Echinococcus granulosus Antibodies in Patients with Suspected Cystic Echinococcosis. Turkiye Parazitol Derg. 2012;36(2):57-60.
25. Daldal Ü, Atambay M, Aycan T, Yıldız N, Kaya Ö. evaluation of patients presenting with a suspicion of cystic echinococcosis to the serology laboratory of the Parasitology Department Of Inonu University Medical Faculty. Mustafa Kemal Üniversitesi Tıp Derg. 2012;3(11):19-25.
26. Yazıcı V, Oruç T, Ören E, Ertabaklar H. Retrospective Evaluation of Patients with Probable Cystic Echinococcosis to the Central Laboratory of the Kocaeli Derince Education and Research Hospital Between 2009 and 2011. Turkiye Parazitol Derg. 2012;36:219-21.
27. Yılmaz H, Cengiz ZT, Çiçek M. Unilocular Cyst Hydatid Cases Diagnosed between 1998-2005 in the Parasitology Laboratory of Yüzüncü Yıl University Research and Training Hospital. Turkiye Parazitol Derg. 2013;37:249-51.
28. Güreser AS, Özcan O, Özünel L, Boyacıoğlu Zİ, Taylan HA. Evaluation of the Radiological, Biochemical and Serological Parameters of Patients Prediagnosed as Cystic Echinococcosis in Çorum, Turkey. Mirobiyol Bul. 2015;49(2):231-9.
29. Beyhan YE, Babür C, Mungan M, Taylan HA. Evaluation of Cystic Echinococcosis Suspected Patients Applied to National Parasitology Reference Laboratory of Public Health Institution of Turkey Between 2009-2013. Turkiye Parazitol Derg. 2015;39:17-21.
30. Çitil BE, Tunçoğlu E, Erbil ÖF, Değirmenci M, Özenoğlu A, Sert H. Evaluation of Patients who were Prediagnosed As Cystic Echinococcosis by Using Indirect Haemagglutination Test (IHA) Technique in Adıyaman. Van Tıp Derg.. 2015;22(4):220-4.
31. Yilmaz A, Hakan U, Aktaş F. Evaluation of Patients Suspected with Cystic Echinococcosis by Indirect Hemagglutination (IHA) Methods at Regional Hospital of Erzurum Between 2009-2013. Gümüşhane Üniversitesi Sağlık Bilimleri Derg.. 2016;5(1):23-32.
32. Kiliç S, Babür C, Taylan HA. Comparison of The Results of Indirect Hemagglutination and ELİSA Methods for the Cases Prediagnosed as Hydatid Cyst Disease. Mikrobiyol Bul. 2007;41(4):571-7.
33. Brundu D, Piseddu T, Stegel G, Masu G, Ledda S, Masala G. Retrospective study of human cystic echinococcosis in Italy based on the analysis of hospital discharge records between 2001 and 2012. Acta Trop, 2014; 140:91–96.
34. Bingham G, Budge CM, Larrieu E, et al. A community- based study to examine the epidemiology of human cystic echinococ-cosis in Rio Negro Province, Argentina. Acta Trop. 2014;136:81-8.
35. Lopez-Bernus A, Belhassen-García M, Alonso- Sardón M, Carpio-Perez A, Velasco-Tirado V, Romero-Alegria Á et al. Surveillance of Human Echinococcosis in Castilla-Leon (Spain) between 2000-2012. PLoS Negl Trop Dis, 2015; 9(10): e0004154.
36. Akpolat N, Çiçek M, Çakir F, Şükran C, Kadri G. Patients with cystic Echinococcosis suspected applicant laboratory between 2005-2012 Anti-Echinococcus IgG IFA seropositivity designated assessment method. International Archives of Medical Research. 2013;5(2):9-14.
37. Akgün S, Sayiner HS, Karsligil T. The evaluation of effectiveness of Indirect Hemagglutination, Indirect Fluorescent Antibody test and enzyme immunoassay in serological diagnosis of cystic Echinococcosis. Cagdas Tıp Dergisi. 2018;8(1):14-9.
38. Şafak B. Serology Results of Cystic Echinococcosis Between 2011-2013 in Balıkesir Atatürk State Hospital. Kocatepe Tıp Dergisi. 2015;16(4):265-8.
39. Moradi M, Rampisheh Z, Roozbehani M, Razmjou E. A retrospective study of hydatid cysts in patients undergoing liver and lung surgery in Tehran, Iran. Heliyon. 2019; 5(6): e01897.
40. Ertuğ S, Sari C, Gürel M, Boylu Ş, Çanakkalelioğlu L, Şahin B. Evaluation of Patients who were Prediagnosed As Cystic Echinococcosis by Using Indirect Haemagglutination Test (IHA) Technique in Adıyaman. Türkiye Parazitol Derg. 2002;26(3):254-6.
41. Yazar S, Altıntaş N. Serodiagnosis of cystic echinococcosis in Turkey. Helminthologia 2003;40: 9-13.
42. Zhang W, Li J, McManus DP. Concepts in immunology and diagnosis of hydatid disease. Clin Microbiol Rev. 2003;16:18-36.
43. Kaur M, Mahajan RC, Malla N. Diagnostic accuracy of rapid enzyme linked immuno-sorbent assay for the diagnosis of human hydatidosis. Indian J Med Res. 1999;110:18-21.
44. Zarzosa MP, Domingo AO, Gutierrez P, et al. Evaluation of six serological tests in diagnosis and postoperative control of pulmonary hydatid disease patients. Diagn Microbiol Infect Dis. 1999;35:255-62.
45. Sarı C, Ertuğ S, Karadam SY, Ozgün H, Karaoğlu AO, Ertabaklar H. The compara-tive evaluation of enzym lynked immuno-sorbent assay (ELISA), indirect hemagglu-tination test (IHA) ve indirect fluorescent antibody test (IFAT) in the diagnosis of cystic echinococcosis. Türkiye Parazitol Derg. 2009;33:73-6
46. Auer H, St€ockl C, Suhendra S, Schneider R. Sensitivity and specificity of new com-mercial tests for the detection of specific Echinococcus antibodies. Wien Klin Wochenschr. 2009;121: 37-41.
47. Bilge UE, Özdemir M, Baykan M. Comparison of Commercial IFA, IHA and In-House IFA Tests in the Diagnosis of Cystic Echinococosis. Türkiye Parazitol Derg. 2009;33:195-8.
48. Liance M, Janin V, Bresson-Hadni S, Vuit-ton DA, Houin R, Piarroux R. Immunodi-agnosis of Echinococcus infections: con-firmatory testing and species differentia-tion by a new commercial Western Blot. J Clin Microbiol. 2000;38: 3718-21.
49. van Doorn HR, Hofwegen H, Koelewijn R, et al. Reliable serodiagnosis of imported cystic echinococcosis with a commercial indirect hemagglutination assay. Diagn Mi-crobiol Infect Dis. 2007;57: 409-12.
50. Hernandez-Gonzalez A, Santivanez S, García HH, et al. Improved serodiagnosis of cystic echinococcosis using the new re-combinant 2B2t antigen. PLoS Negl Trop Dis. 2012;6(7); e1714.
51. Akisu C, Delibaş B, Yuncu G, et al. Evaluation of IHA, ELISA and Western Blot tests in diagnosis of pulmonary cystic hidatidosis. Tuberk Toraks. 2005;53(2):156-60.
52. TR Ministry of Health, General Directorate of Public Health Access address: https://hsgm.saglik.gov.tr/tr/zoonotikvektorel-haberler/t%C3%BCrkiye-zoonotik-hastal%C4%B1klar-eylem-plan%C4%B1-2019-2023.html. Date of access: 06.11.2021
IssueVol 17 No 2 (2022) QRcode
SectionOriginal Article(s)
DOI https://doi.org/10.18502/ijpa.v17i2.9543
Diagnosis Echinococcosis Western blot Serology

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How to Cite
Yücesan B, Babür C, Kılıç S, Dikmen A. Evaluation of Echinococcosis Pre-Diagnosis Patients Admitted to the National Parasitology Reference Laboratory of Turkey from 2014-2019. Iran J Parasitol. 2022;17(2):250-258.