Hydatid disease: analysis of parasite antigens in circulating immune complexes and in preformed hydatid antigen-antibody complexes.

Fifty-three sera from 29 patients with hydatid disease, all but one positive for specific anti-parasite antibodies and all negative for specific circulating antigens, were studied for the presence of circulating immune complexes (CIC) by conglutinin binding-assay (KgBA). Fourteen serum samples (26%) from eight patients (27%) were positive. These positive sera were pooled for each patient and the eight samples were PEG-precipitated and analysed for the presence of specific Echinococcus granulosus antigens in the CIC using a human anti-human-hydatid cyst fluid antiserum capable of recognizing the major antigenic systems of the parasite namely, antigens 4 and 5. The assays utilized for detecting antigen in CIC were: (a) blotting on nitrocellulose paper after sodium dodecil sulphate polyacrylamide gel electrophoresis (SDS-PAGE) and specific immunological detection; (b) ultracentrifugation in acid buffer and subsequent detection of antigens by a sandwich-radioimmuno assay (RIA); (c) protein separation by isoelectric focusing (IEF) and specific immunological recognition. In addition, all positive sera were analysed for the presence of antigen in the CIC by a modified KgBA and by polyethylenglicol (PEG)-precipitation in acid buffer followed by immunological recognition of antigen. All tests gave negative results with the patients' samples, but were positive with preformed in vitro complexes between parasite antigens and corresponding antibodies. Failure to detect antigen in the CIC could be due to: 1) insufficient sensitivity of the assays used to detect hydatid antigens in CIC; 2) rapid clearance of antigen or CIC from the circulation; 3) presence of parasite antigen not recognized by the antiserum employed; 4) production of CIC as a result of polyclonal B-cell activation. This last hypothesis is supported by the demonstration of IgM-rheumatoid factor (RF) and anti-F(ab')2 antibodies respectively in 11 (44%) and 13 (52%) out of 25 patients.