Východisko: Cieľom tejto práce je zistiť diagnostickú hodnotu dôkazu sérových IgG protilátok v diagnostike askariózy. 
Súbor a metódy: Vyšetrili sme séra 80 pacientov vo veku 8 - 35 r., 35 bolo infikovaných Ascaris lumbricoides (A.l.), 2 pacienti s infekciou Trichuris trichiura, jeden pacient s Ancylostoma/Necator a jeden pacient so zmiešanou infekciou A.l., Trichuris trichiura, Ancylostoma/Necator, Clonorchis sinensis. Do štúdie sme zaradili ialšie 3 séra pacientov s IgG protilátkami proti Trichinella spp., anti Toxocara sp., anti Echinococcus granulosus a 7 sér pacientov bez parazitárnej infekcie. Kontrolnú skupinu tvoril súbor 19 sér tehotných žien a 12 náhodne vybraných sér pacientov, ktorí neboli infikovaní škrkavkami.
IgG protilátky proti A.l. sme vyšetrovali testom ELISA komerčnou súpravou: Ascaris lumbricoides IgG (Novagnost). Vzorky stolice sme vyšetrovali: hrubým náterom podľa Kato a koncentračnou metódou s merthiolát-jód-formaldehydom (MIF). 
Výsledky: V kontrolnej skupine sme zistili protilátky proti A.l. u 8 osôb (25,8 %), z toho u 3 tehotných žien. Z 35 pacientov s infekciou A.l. sme séropozitivitu zistili u 28 (80 %), 7 pacienti (20 %) boli sérologicky negatívni. IgG pozitívni boli aj dvaja pacienti s infekciou Trichuris trichiura, resp. Ancylostoma/Necator a aj pacient so zmiešanou infekciou A.l., Trichuris trichiura, Ancylostoma/Necator, Clonorchis sinensis. Reaktivitu IgG protilátok proti A.l. sme zistili aj u pacientov s pozitívnymi protilátkami proti Trichinella spp., Echinococcus granulosus, Toxocara sp. Naopak, zo 7 pacientov neinfikovaných škrkavkami šesť vykázalo séropozitivitu, iba jeden bol negatívny. Protilátkovú perzistenciu sme zaznamenali u 5 pacientov po úspešnej liečbe mebendazolom (stolica bola negatívna). Citlivosť a špecifickosť použitého testu ELISA bola nižšia ako uvádza výrobca (u oboch parametrov 95 %); v citlivosti testu sme dosiahli hodnoty 80 % a špecifickosti 65 %. 
Záver: Z výsledkov našej štúdie vyplýva, že dôkaz sérových protilátok nie je metódou voľby v diagnostike askariózy. 
Môže byť vhodnou doplnkovou metódoudiagnostiky askariózy, najmä v ranných štádiách ochorenia spôsobených migráciou lariev škrkaviek. 
Kľúčové slová: Ascaris lumbricoides - askarióza - ELISA - IgG protilátky - sérologická diagnostika.

Diagnosis of ascariasis with proof of serum antibodies

Background: The aim of this study was to evaluate the diagnostic value of the proof of serum antibodies in the diagnostics of ascariasis. 
Patients and methods: We investigated sera of 80 patients in the age between 8 - 35 years. Out of them, 35 where infected with Ascaris lumbricoides (A.l.), two patients were infected by Trichuris trichiura, one patient with Ancylostoma/Necator and one patient was infected with a combination of helmints: A.l., Trichuris trichiura, Ancylostoma/Necator and Clonorchis sinensis. Into our study were also included 3 sera positive for IgG antibodies against Trichinella spp., Toxocara sp., Echinococcus granulosus and serum samples of 7 patients without parasite infection.. As a control group we used the serum samples of 19 pregnant woman and sera from 12 patients without infection of Ascaris lumbricoides.
The specific antibodies IgG against A.l. were examined using commercial ELISA set: Ascaris lumbricoides IgG (Novagnost). The faecal smears were examined microscopically according to Kato and following the faecal concentration by formalin-ether sedimentation. 
Results: In the control group we detected the specific IgG antibodies against A.l. in 8 samples (25,8 %), out of them three were pregnant woman. Out of 35 patients which were infected with A.l. we detected seropositivity in 28 ones (80 %), 7 patients (20 %) were seronegative. The IgG positivity we detected in two patients with Trichuris trichiura, resp. Ancylostoma/Necator infections and one patient with infections of A.l., Trichuris trichiura, Ancylostoma/Necator, Clonorchis sinensis too. The reactivity of specific IgG antibodies against A.l. was also detected in sera samples of patients with positive antibodies Trichinella sp., Echinococcus granulosus, Toxocara sp. In comparison, we detected the specific antibodies against Ascaris lumbricoides in 6 patients from 7 ones, who had no Ascaris infection; one from them was seronegative only. 5 patients were positive after the threatment with mebendazol (the faecal specimens were negative). We found 80 % sensitivity and 65 % specificity of the test that was lower as presented by producer of set (95 % sensitivity and specificity).
Conclusion:
According to results of our study, the diagnostic of ascariasis using serological detection of antibodies give controversy results, therefore we don't consider this method as a method of choice of diagnostics of ascariasis. It may serve as an appropriated supplementary method especially in the early stadiums of infection caused by larval migration. 
Key words: Ascaris lumbricoides - ascariasis - ELISA - IgG antibodies - serological diagnostics.

František ONDRISKA, Gabriela VOZÁROVÁ, Silvia PENCÁKOVÁ, Anna ŠOLTÉSOVÁ, Ľudmila ŠIŠKOVÁ

 


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