Parasites and Biliary stones

Echinococcosis ٤٦
metacestodes involve the lungs, spleen, or brain in addition to the liver.
One-third of cases present with cholestatic jaundice, one-third present
with epigastric pain, and the remainder present with vague symptoms like
weight loss or fatigue, or are noted to have incidental hepatomegaly
(Ammann and Eckert, 1996).
Diagnosis:
Early diagnosis of cystic and alveolar echinococcosis can provide
substantial improvements in the quality of the management and treatment
of both diseases. The definitive diagnosis for most cases of cystic and
alveolar echinococcosis in man is by physical imaging methods, such as
radiology (figure 14), ultrasonography, computed axial tomography (CT
scanning) (figure 15) and magnetic resonance imaging (Pawlowski et al.,
2001). Immunodiagnosis is useful not only in primary diagnosis but also
for follow-up of patients after surgical or pharmacological treatment
(Gottstein, 1992).
Detection of circulating E. granulosus antigens in serum is less
sensitive than antibody detection, which remains the method of choice.
ELISA, indirect haemagglutination antibody assay, latex agglutination
test, and immunoblot test are the most commonly used immunological
methods. The immunofluorescence antibody test and arc-5
immunoelectrophoresis are also used. Additionally, the lipoproteins
antigen B and antigen 5, the major components of hydatid cyst fluid, are
widely used in assays for immunodiagnosis of cystic echinococcosis.
(Poretti et al., 1999). Hydatid cyst fluid antigens are the usual source of
antigenic material for immunodiagnosis (Zhang and McManus, 2003).
Some of the serologic tests (Casony intradermal test, Weinberg test,
complement fixation and indirect hemagglutination tests) are not reliable
(Morris and Richards, 1992). Cross-reactivity with antigens from other