Co esponding au ho : DURAN Yasin
Copy igh © 2025 Au ho (s) e ain he copy igh o his a icle. This a icle is published unde he e ms o he C ea i e Commons A ibu ion License 4.0.
The impo ance o indi ec hemagglu ina ion assay es and eosinophilia in ollow-up
o calci ied li e hyda id cys : A Re ospec i e S udy
DURAN Yasin 1, *, POLAT Fa in Rüş ü 2, POLAT İb ahim Fa ih 3, BENEK Sua 2, ÇAĞLAYAN Kasım 2, SAĞIROĞLU
Tame 2, ÖZKAN GÜRDAL Sibel 2 and BALİ İlhan 2
1 Beyken Uni e si y Medical Facul y, Di ision o Gene al Su ge y İSTANBUL/TURKEY.
2 (Senio Au o )Teki dag Namık Kemal Uni e si y Medical Facul y, Di ision o Gene al Su ge y, Teki dag- TURKEY.
2 Teki dag Namık Kemal Uni e si y Medical Facul y, Di ision o Gene al Su ge y, Teki dag- TURKEY.
3 Teki dag Namık Kemal Uni e si y, Ins i u e o Science (Mas e s d.), Teki dag- TURKEY.
Wo ld Jou nal o Ad anced Resea ch and Re iews, 2025, 26(02), 1478-1482
[A pa o his a icle was p esen ed o ally a he 33 d In e na ional Socie y o Su geons, Gas oen e ologis s and
Oncologis s Wo ld Cong ess held on 28.09-01.10.2022-ISTANBUL]
A icle DOI: h ps://doi.o g/10.30574/wja .2025.26.2.1757
Abs ac
In oduc ion: Calci ied li e cys ic echinococcosis(C-LCE) does no equi e in e en ional ea men bu necessi a es
egula moni o ing. The assessmen o C-LCE commonly in ol es adiological, se ological and hema ological
examina ions. This s udy in es iga es he co ela ion be ween eosinophilia and se ological es esul s in pa ien s wi h
adiologically con i med C-LCE.
Ma e ials and Me hods: This e ospec i e s udy included 25 pa ien s diagnosed wi h C-LCE h ough adiological
imaging who we e ea ed in su ge y depa men s be ween 2010 and 2017. The le els o indi ec hemagglu ina ion
assay (IHA) and pe iphe al eosinophilia coun s we e analyzed. Pa ien s wi h an IHA i e o ≤1/320 and nega i e
pe iphe al eosinophilia we e no adminis e ed chemo he apy, while hose wi h highe i e s ecei ed ea men and
ollow-up ca e.
Resul s: The majo i y o pa ien s we e emale. All cys s we e soli a y and localized in he igh hepa ic lobe. Imaging
esul s we e consis en wi h C-LCE. IHA posi i i y was obse ed in 22 pa ien s, wi h se en o hem exhibi ing
eosinophilia. A di ec associa ion was no ed be ween high IHA i e s and he p esence o eosinophilia.
Conclusion: In e en ional ea men o C-LCE ca ies signi ican isks, including in ec ion and is ula o ma ion.
The e o e, non-in asi e ollow-up s a egies using adiological, hema ological and se ological es s a e ecommended.
E alua ing pe iphe al eosinophil le els alongside se ological ma ke s can enhance ea men decision-making
Keywo ds: Cys ic echinococcosis; Calci ied cys ; Eosinophilia; Se ology; Li e
1. In oduc ion
Li e cys ic echinococcosis(LCE) is a pa asi ic in ec ion caused by Echinococcus g anulosus, wi h endemic p e alence
in Sou h Cen al Eu ope, Sou h Ame ica, Aus alia, and Alaska [1,2]. Typically, LCE emains asymp oma ic unless cys s
g ow la ge enough o exe p essu e on adjacen s uc u es, become in ec ed o up u e [3,4-6]. The p ima y ea men
objec i e is scolocidal inac i a ion. Depending on he classi ica ion by Gha bi, managemen op ions include an i-
helmin hic chemo he apy, pe cu aneous aspi a ion unde adiological guidance, su ge y, o obse a ional ollow-up
[1,3]. Cys s classi ied as calci ied (Type V in he Gha bi sys em) should be ollowed-up wi h o wi hou chemo he apy
Publica ion his o y: Recei ed on 29 Ma ch 2025; e ised on 08 May 2025; accep ed on 10 May 2025
Wo ld Jou nal o Ad anced Resea ch and Re iews, 2025, 26(02), 1478-1482
1479
p ima ily managed h ough pe iodic moni o ing [2]. Biannual assessmen s in ol ing adiological imaging,
hema ological, and se ological es s a e essen ial o ea ly de ec ion o cys eac i a ion [2-3].
This s udy aims o e ospec i ely analyze he ela ionship be ween pe iphe al eosinophil coun s and se ological es
esul s in pa ien s wi h adiologically con i med C-LCE.
2. Ma e ial and me hods
A e ospec i e e iew was conduc ed on 25 pa ien s diagnosed wi h C-LCE be ween 2010 and 2017 a wo medical
ins i u ions(Saka ya Toyo a Hospi al and Teki dag Uni e si y Resea ch Hospi al). Pa ien eco ds we e assessed o
demog aphic da a, hema ological and se ological es esul s, cys localiza ion, and cys dimensions. Desc ip i e
s a is ics we e used o e alua e indings, wi h esul s p esen ed as nume ical alues and pe cen ages.
IHA was u ilized as he p ima y se ological es , employing Hyda idose Fumouze So ibel ki s (Le allois Pe e , F ance).
Pe iphe al eosinophil coun s we e de e mined using ABX Pen a DX 120 (Ho iba, Mon pellie , F ance). An IHA i e
exceeding 1/320 was conside ed posi i e, while eosinophilia was de ined as a se um eosinophil coun abo e 0.7 ×
10³/µL.
Pa ien s we e managed wi h o wi hou chemo he apy based on IHA and eosinophil indings. Albendazole (15 mg/kg
pe day) was adminis e ed in di ided doses o h ee weeks, ollowed by a one-week d ug- ee in e al. This cycle was
epea ed o e 6–12 mon hs, wi h li e unc ion moni o ed mon hly.
2.1. S a is ical Analysis
Da a we e analysed using he PASW (PASW S a is ics 18.0.0, SPSS Inc., Chicago, IL) s a is ics p og am. Values o p≤0.05
we e conside ed s a is ically signi ican .
3. Resul s
Among he 25 pa ien s, 72% we e emale. The mean age was 38.8 ± 22 yea s, wi h an age ange o 24–55 yea s. A
s a is ically signi ican gende di e ence was obse ed (p<0.05). Howe e , no signi ican di e ence in IHA i e s was
ound be ween male and emale pa ien s (p>0.05). All cys s we e soli a y and loca ed in he igh lobe o he li e ,
classi ied as Type V based on adiological imaging.
IHA posi i i y (>1/160 i e ) was de ec ed in 88% o pa ien s. Se e e posi i i y (>1/1280 i e ) was iden i ied in 20%
o cases, all o whom exhibi ed eosinophilia. A s a is ically signi ican co ela ion was no ed be ween high IHA i e s and
eosinophilia (p<0.05). Howe e , cys size did no demons a e a signi ican ela ionship wi h ei he IHA i e s o
eosinophilia (p>0.05). Th oughou he ollow-up pe iod, no scolocidal ac i a ion o new cys o ma ion was obse ed,
and no cases o mo bidi y o mo ali y we e epo ed.
Table 1 The dis ibu ion o Indi ec Hemagglu ina ion Assay(IHA) i e s and eosinophilia
Ti e o IHA
Numbe o Cases
Eosinophillia
+
-
Nega i e (unde 1/160)
3 (12%)
0
3 (12%)
Suspec Posi i e (1/160-1/320)
3 (12%)
0
3 (12%)
Mild posi i e (1/320)
6 (24%)
0
6 (24%)
Medium posi i e (1/640)
8 (32%)
2 (8%)
6 (24%)
Se e e posi i e (1/1280 and up)
5 (20%)
5 (20%)
0
To al
25 (100%)
25 (100%)
Wo ld Jou nal o Ad anced Resea ch and Re iews, 2025, 26(02), 1478-1482
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Table 2 The dis ibu ion o cys s by IHA, eosinophilia and size
Size o Cys
Calcified Cys
Numbe o Case
IHA
Eosinophillia
+
-
+
-
> 4 cm
+
15 (60%)
13
P=0,654
2
3
P=0,700
12
≤ 4 cm
+
10 (40%)
9
1
4
6
To al
25
25 (100%)
25
25
4. Discussion
LCE is a pa asi ic disease wi h widesp ead hepa ic in ol emen [1,2,7]. In many cases, cys s a e iden i ied inciden ally
du ing imaging o un ela ed symp oms. LCE a e usually don' gi e signs unless he p essu e eaches a size ha causes
symp oms, in ec ion o up u e [2]. Li e a u e indica es ha 80% o hyda id cys s a e soli a y and localized in he igh
hepa ic lobe, consis en wi h ou indings [1,8,9]. I is seen ha ou s udy is compa ible wi h he li e a u e.
Echinococcal cys s a e usually seen asymp oma ic, bu he de elopmen o some impo an complica ions, such as lung
in ec ion, cholangi is, up u e, and anaphylaxis, p o ides a good eason o pa ien s o conside ea men [2].
The managemen o LCE a ies om conse a i e chemo he apy o pe cu aneous d ainage o su gical in e en ion [1].
Fo adiologically con i med C-LCE, in asi e ea men is gene ally unnecessa y due o associa ed isks such as in ec ion
and/o is ula o ma ion [10,11,12,13]. Ins ead, pa ien s should unde go long- e m ollow-up in ol ing adiological,
se ological, and hema ological assessmen s e e y six mon hs [2]. Deep-sea ed small cys s (≤ ou cm) may be managed
conse a i ely unless complica ions a ise [12].
Se ological es ing emains a aluable diagnos ic and moni o ing ool [1,2]. A ailable es s include IHA, enzyme-linked
immunoso ben assay (ELISA), Weinbe g es , and Casoni skin es [10]. Due o hei low sensi i i y, Weinbe g and
Casoni es s a e no longe widely used. ELISA has high sensi i i y (>90%) bu may yield alse-posi i e esul s o up o
a yea pos - ea men [2,11]. IHA, while eliable, has a sensi i i y o 85% and may pe sis o yea s, educing i s e icacy
in endemic egions [1,2].
Pe iphe al eosinophilia is usually de ec ed in abou hal o pa ien s [7]. Eosinophilia (> 3%) occu s in 25% o 40% o
pa ien s wi h hyda id cys in wes e n coun ies, bu i appea s as a non-speci ic inding in endemic locals [2]. In his
s udy, eosinophilia was obse ed in acco dance wi h he li e a u e. Eosinophilia was obse ed in se en (28%) pa ien s
wi h a high IHA i e (> 1/640). These indings align wi h exis ing li e a u e, sugges ing a co ela ion be ween ele a ed
eosinophil coun s and se ological ma ke s.
Di e en deg ees o calci ica ion may be p esen in all cys o ms, om ac i e classic unilocula o mul i esicula cys s
o he mo e complica ed s ages, such as ad anced and highly degene a e phases whe e he pa asi e wall appea s
massi ely calci ied [14]. Cys calci ica ion is ega ded as he e minal phase o pa asi e degene a ion, es ic ed o i e
Type and belie ed o be an index o cys inac i i y. All cys ypes wi h signs o calci ica ion inc easing as he degene a i e
p ocess p og esses. Ne e heless, he de ec ion o calci ica ion is no in i sel su icien o e alua e pa asi e ac i i y and
can be misleading, since his p ocess may coexis wi h s ill ac i e cys s, and pa ial calci ica ion is no always indica i e
o pa asi e dea h [15]. In his case, o he suppo ing me hods such as se ological es s and pe iphe al eosinophils a e
needed.
5. Conclusion
The long- e m ollow-up o C-LCE should inco po a e hyda id se ologies, pe iodic imaging, and eosinophil assessmen s.
Conduc ing pe iphe al eosinophil coun s alongside se ological es ing enhances he accu acy o scolocidal ac i i y
moni o ing. Ou indings sugges ha chemo he apy may no be equi ed o pa ien s wi h IHA i e s ≤1/320 and
nega i e eosinophilia. Howe e , u he la ge-scale andomized s udies a e necessa y o es ablish de ini i e ea men
guidelines.
Wo ld Jou nal o Ad anced Resea ch and Re iews, 2025, 26(02), 1478-1482
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Compliance wi h e hical s anda ds
Disclosu e o con lic o in e es
No con lic o in e es was decla ed by he au ho s.
Financial Disclosu e
The au ho s decla ed ha his s udy has ecei ed no inancial suppo .
S a emen o in o med consen
In o med Consen was no ecei ed due o he e ospec i e na u e o he s udy.
Au ho con ibu ions
Su gical&medical p ac ices: Du an Y, Pola FR Concep -, Design-, Supe ision-, Resou ce-, Ma e ials- Du an Y , Pola FR,
Da a Collec ion &/o P ocessing-, Analysis- Du an Y , Pola FR, , Pola IF; Analysis o In e p e a ion-, Li e a u e Sea ch-
, W i ing-, C i ical Re iews- Du an Y , Pola FR, , Bali İ, Benek S, Çaglayan K, Sagi oglu T, Gu dal SÖ D a ing &/o
Re ising: Du an Y , Pola FR W i ing: Du an Y , Pola FR Final App o al:Du an Y, Pola FR, Pola IF, Benek S, Çağlayan K,
Sağı oğlu T, Özkan Gü dal S, Bali İ.
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