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Early Serodiagnosis of Trichinellosis by ELISA Using Excretory–Secretory

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Early Serodiagnosis of Trichinellosis by ELISA Using Excretory–Secretory Sun et al. Parasites & Vectors (2015) 8:484 DOI 10.1186/s13071-015-1094-9 RESEARCH Open Access Early serodiagnosis of trichinellosis by ELISA using excretory–secretory antigens of Trichinella spiralis adult worms Ge-Ge Sun, Zhong-Quan Wang*, Chun-Ying Liu, Peng Jiang, Ruo-Dan Liu, Hui Wen, Xin Qi, Li Wang and Jing Cui* Abstract Background: The excretory–secretory (ES) antigens of Trichinella spiralis muscle larvae (ML) are the most commonly used diagnostic antigens for trichinellosis. Their main disadvantage for the detection of anti-Trichinella IgG is false-negative results during the early stage of infection. Additionally, there is an obvious window between clinical symptoms and positive serology. Methods: ELISA with adult worm (AW) ES antigens was used to detect anti-Trichinella IgG in the sera of experimentally infected mice and patients with trichinellosis. The sensitivity and specificity were compared with ELISAs with AW crude antigens and ML ES antigens. Results: In mice infected with 100 ML, anti-Trichinella IgG were first detected by ELISA with the AW ES antigens, crude antigens and ML ES antigens 8, 12 and 12 days post-infection (dpi), respectively. In mice infected with 500 ML, specific antibodies were first detected by ELISA with the three antigen preparations at 10, 8 and 10 dpi, respectively. The sensitivity of the ELISA with the three antigen preparations for the detection of sera from patients with trichinellosis at 35 dpi was 100 %. However, when the patients’ sera were collected at 19 dpi, the sensitivities of the ELISAs with the three antigen preparations were 100 % (20/20), 100 % (20/20) and 75 % (15/20), respectively (P < 0.05). The specificities of the ELISAs with the three antigen preparations were 98.11, 95.60 and 89.31 %, respectively (P <0.05). Conclusions: The sensitivity and specificity of the T. spiralis AW ES antigens were superior to those of the AW crude antigens and ML ES antigens. Thus, the AW ES antigens might serve as potential antigens for the early and specific serodiagnosis of trichinellosis. Keywords: Trichinella spiralis, Trichinellosis, Adult worm, Excretory–secretory (ES) antigens, Serodiagnosis Background Following the ingestion of infested meat, Trichinella Trichinellosis is a serious zoonotic disease caused by the larvae are released from their capsules to invade the upper nematode genus Trichinella. Humans acquire the disease small intestine and mature into adult worms (AW). The by ingesting raw or insufficiently cooked meat of pigs or hallmark of the intestinal phase, which usually lasts 1 week, other animals containing the Trichinella larvae [1]. Human is a non-specific gastroenteritis, with diarrhoea, abdominal trichinellosis has been documented in 55 countries around pain, nausea, and/or vomiting. In 2–3 weeks, the fertilized the world and is considered to be a neglected tropical females produce ~1500 newborn larvae that migrate via the disease, especially in developing countries [2, 3]. From 2004 blood and lymphatic systems to invade and encapsulate in to 2009, 15 outbreaks of human trichinellosis consisting of the skeletal muscles (muscular or acute phase). The acute 1387 cases and 4 deaths were reported in China [4]. Trichi- phase is associated with an inflammatory and allergic nellosis is a major food-borne zoonosis with health, social, response to muscle invasion by the migrating larvae. Fever, and economic impacts in endemic countries [5]. eyelid or facial oedema, myalgia, and eosinophilia are the most prominent manifestations [6, 7]. * Correspondence: [email protected]; [email protected] However, the clinical diagnosis of human trichinellosis is Department of Parasitology, Medical College, Zhengzhou University, difficult because its clinical manifestations are nonspecific Zhengzhou, China © 2015 Sun et al. Open Access This article is distributed under the terms of the Creative Commons Attribution 4.0 International License (http://creativecommons.org/licenses/by/4.0/), which permits unrestricted use, distribution, and reproduction in any medium, provided you give appropriate credit to the original author(s) and the source, provide a link to the Creative Commons license, and indicate if changes were made. The Creative Commons Public Domain Dedication waiver (http://creativecommons.org/publicdomain/zero/1.0/) applies to the data made available in this article, unless otherwise stated. Sun et al. Parasites & Vectors (2015) 8:484 Page 2 of 8 [6, 7]. At present, a definitive diagnosis of human trichinel- (no. 2011–016). Before the investigation, oral informed losis can be made by detecting larvae in a muscle biopsy consent was obtained from all individuals. sample or specific anti-Trichinella IgG antibodies [8], but the parasitological examination of biopsy samples is not Parasites and experimental animals sufficiently sensitive to detect Trichinella larvae in light The isolate (ISS534) of T. spiralis used in this study was infections and during the early stage of infection. Because obtained from domestic pigs in Nanyang, Henan Province, T. spiralis muscle larvae (ML) are easily collected from China. The reference Trichinella isolates used in this study experimentally infected animals, their excretory–secretory were T. nativa (T2, ISS10), T. britovi (T3, ISS100), T. (ES) antigens can be prepared by the in vitro cultivation of pseudospiralis (T4, ISS13) and T. nelsoni (T7, ISS29); isolated muscle larvae, resulting in a preparation with high these isolates were obtained from the International specificity [9]. Thus, an ELISA with the ML ES antigens is Trichinella Reference Centre (ITRC; Rome, Italy). The the most commonly used serological method for the diag- Trichinella isolates were maintained by serial passage nosis of trichinellosis and is recommended by the Inter- in BALB/c mice every 6–8 months in our laboratory. national Commission on Trichinellosis (ICT) [10, 11]. The Specific pathogen-free (SPF) female BALB/c mice aged main disadvantage of the detection of anti-Trichinella IgG 6 weeks were purchased from the Experimental Animal against ML ES antigens is the occurrence of a high rate of Centre of Henan Province. false negative results during the early stage of infection [12]. These false negatives may occur because the majority of T. Serum samples spiralis ML ES antigens are stage-specific; thus, the ML ES T. spiralis was used to infect the BALB/c mice. Twenty antigens are not recognized by antibodies induced by the mice were randomly divided into two groups (ten mice per parasites during the intestinal phase [13, 14]. Several studies group): mice infected with 500 ML and mice infected with demonstrated that the maximum detection rate of 100 % 100 ML. Approximately 100 μl of tail blood was collected of anti-Trichinella IgG was not reached until at least 1–3 from the infected mice on alternate days from 2–28 dpi to months after human infection with the parasite [10]. There isolate sera [12]. Serum samples from normal mice were is an obvious time lag (window period) between the used as the negative control. time when patients develop clinical symptoms and Sera were obtained from BALB/c mice infected with 300 positive serology during the acute stage of trichinello- ML of T. spiralis, T. nativa, T. britovi, T. pseudospiralis and sis [6, 15]. Additionally, the ML ES antigens also have T. nelsoni 42 dpi. Serum samples of mice infected with cross-reactivity with the sera of patients with other three spargana of Spirometra mansoni were collected helminthiases (e.g., paragonimiasis, schistosomiasis, 30 dpi in our department. Serum samples of mice in- clornorchiasis, cysticercosis, and anisakiasis) [15–17]. fected with Toxoplasma gondii, Schistosoma japanicum Hence, there is an urgent need to develop new specific and Angiostrongylus cantonensis were gifted by Prof. early diagnostic antigens for acute trichinellosis. GR Yin (Shanxi Medical University), Dr. JH Lei (Tongji Trichinella spiralis ML develop to AW in the small Medical College of Huazhong University of Science and intestine 31 h after infection, live in the intestinal mucosa Technology), and Prof. ZY Lv (Department of Parasitology, and persist for 10–20 days in mice and rats or 4–6 weeks Zhongshan School of Medicine, Sun Yat-Sen University), in humans [18]. During the intestinal stage of trichinello- respectively. All of the serum samples were stored at −80 °C sis, the ES antigens produced by the AW result in early prior to use. exposure to the immune system and elicit the production Forty-two serum samples from patients with trichinellosis of specific anti-Trichinella antibodies by the host. Previous were used to identify the sensitivity of the T. spiralis AW studies showed that AW crude antigens were recognized ES antigens. These serum samples were collected from by infected sera from mice or swine 7 days post-infection the patients during two outbreaks with trichinellosis (dpi) [19]. However, to the best of our knowledge there that occurred in the Yunnan province of southwestern has been no report on the serodiagnosis of trichinellosis China in 2003 and 2013 [20, 21]. These patients with using T. spiralis AW ES antigens. The aim of this study trichinellosis presented with a clinical suspicion of trichi- was to evaluate the potential of T. spiralis AW ES antigens nellosis. The diagnosis of trichinellosis was confirmed for for the early serodiagnosis of acute trichinellosis. all of these patients by the presence of a high fever associ- ated with periorbital or facial oedema, myalgia, a high level of eosinophilia, and a history of ingestion of raw or under- Methods cooked meat. All of these patients had positive ELISA Ethics statement or IIF results for trichinellosis, and two patients had a All procedures of animal experiments and the use of the Trichinella-positivemusclebiopsy.Outof42patients patients’ serum samples in this study were approved by the with trichinellosis, 22 serum samples were collected 35 Life Science Ethics Committee of Zhengzhou University dpi and 20 were collected 19 dpi. Sun et al. Parasites & Vectors (2015) 8:484 Page 3 of 8 Sera used to assess cross-reactivity were selected from (99 3-s cycles, 100 W, 0 °C).
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