Biliary fascioliasis: Magnitude of the problem and role of immunodiagnosis

ABSTRACT

This study was carried out to evaluate the prevalence of fascioliasis, which is a relatively common, but usually underestimated problem in many rural areas in Egypt and to assess its role in causing biliary disorders using the recent technique of cystatin capture ELISA for immunodiagnosis of such cases.Between July 1999 and July 2001, 3218 individuals [2409 males and 809 females] with ages ranged from 6-70 years were selected by stratified random sampling from EI-Husseinya, Sharkeya Governorate, all these individuals were subjected to thorough history taking, clinical examination, stool examination using modified kato-thick smear method, serodiagnosis using cystatin capture ELISA technique. Patients with history suggestive of hepatobiliary disease were subjected to further radiological examination e.g abdominal ultrasonography, C, T abdomen and sometimes ERCP, also routine laboratory investigations were done for this group of patients e.g complete liver function tests and complete blood picture. The overall prevalence of fascioliasis among the present group of patients was 3.7%, the incidence was higher among adolescent [> 12 - 18 years] and adult [> 18 - 40 years] and much less in younger [6-12 years] and older [more than 40 years] age groups. Out of these fasciola positive patients only 10 patients [8.5%] suffered form biliary disorders as proved by abdominal ultrasonography and occasionally ERCP, these constituted about 3.4% of total number of patients who gave history suspecting biliary disorders [N=298]. The cystatin capture ELISA was used to detect anti-fasciola cystatin proteinase antibodies in sera of all fasciola copro positive group [118 patients] and also in a randomly selected group of copro negative patients [358 patients] with relevant or irrelevant signs and symptoms suggesting biliary affection. The ELISA capture test was positive in 110 out of 118 copro positive patients [93.2%] and it was negative in 352 out of 358 copro negative patients. This proved the highly specificity and sensitivity of this test in diagnosis of fascioliasis. The present community based study clarified the magnitude of fascioliasis as a health problem in rural area in Egypt and the significance of it as an aetiological agent of biliary disorders and the value of cystatin capture ELISA in picking up such cases