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WS/T 381-2021 English PDF

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WS/T 381-2021: Diagnosis standard of cysticercosis
Status: Valid

WS/T 381: Evolution and historical versions

Standard ID	Contents [version]	USD	STEP2	[PDF] delivered in	Standard Title (Description)	Status	PDF
WS/T 381-2021	English	529	Add to Cart	5 days [Need to translate]	Diagnosis standard of cysticercosis	Valid	WS/T 381-2021
WS 381-2012	English	799	Add to Cart	4 days [Need to translate]	Diagnosis of cysticercosis	Obsolete	WS 381-2012

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Basic data

Standard ID	WS/T 381-2021 (WS/T381-2021)
Description (Translated English)	Diagnosis standard of cysticercosis
Sector / Industry	Health Industry Standard (Recommended)
Classification of Chinese Standard	C61
Word Count Estimation	23,236
Issuing agency(ies)	National Health Commission

WS 381-2012: Diagnosis of cysticercosis

---This is a DRAFT version for illustration, not a final translation. Full copy of true-PDF in English version (including equations, symbols, images, flow-chart, tables, and figures etc.) will be manually/carefully translated upon your order.
Diagnosis of cysticercosis ICS 11.020 C61 People's Republic of China health industry standards Diagnosis of cysticercosis Posted on.2012-06-04 2012-10-15 Implementation Ministry of Health of People's Republic of China released Directory Preface Ⅰ 1 Scope 1 2 Terms and definitions 1 3 diagnostic basis 1 4 diagnostic principles 2 5 diagnosis 2 6 differential diagnosis 3 Appendix A (informative) etiology 4 Appendix B (informative) Epidemiology 5 Appendix C (informative) Clinical manifestations 6 Appendix D (Normative) Laboratory tests 7 Appendix E (Informative) Imaging Performance 11 Appendix F (informative) differential diagnosis 13

Foreword

This standard was drafted in accordance with the rules given in GB/T 1.1-2009. This standard except Chapter 6 is the recommended terms, the rest is mandatory. This standard proposed by the Ministry of Health parasitic disease standard professional committee. This standard was drafted. Shandong Institute of Parasitic Diseases, Chinese Center for Disease Control and Prevention parasitic diseases prevention and control. The main drafters of this standard. Yan Tianmin, Yang Yanjun, Lee Teng-jun, Ge Lingyun, Liu Xin, Dai Wei, Deng Xueli, officials Yayi, Chen Ying Dan, Xu Longqi. Diagnosis of cysticercosis

1 Scope

This standard specifies the diagnosis of cysticercosis diagnosis, diagnosis, diagnosis and differential diagnosis. This standard applies to all levels of medical institutions and disease prevention and control agencies on the diagnosis of cysticercosis.

2 Terms and definitions

The following terms and definitions apply to this document. 2.1 Cysticercus cysticercus Cysticercosis bladderworm Larvae of Taenia. 2.2 Cysticercosis Cysticercosis Cysticercosis Taeniasolium Cysticercus parasites in human-caused diseases. According to cysticercosis parasitic sites, cysticercosis main points For the brain cysticercosis, subcutaneous and muscle cysticercosis, Ocular cysticercosis, other parts of cysticercosis and mixed cysticercosis (see Appendix A).

3 diagnostic basis

3.1 Epidemiology history Taeniasis, cysticercosis prevalence area living history, or have taeniasis (feces in the row of white section) history, or with tapeworm patients Close contact history (see Appendix B). 3.2 Clinical manifestations 3.2.1 Subcutaneous or muscular nodules (see Appendix C). 3.2.2 headache, dizziness, seizures and other nervous system and mental symptoms (see Appendix C). 3.2.3 visual impairment, severe blindness, monocular damage more see (see Appendix C). 3.2.4 exclude other causes of organ damage caused by clinical manifestations (see Appendix C). 3.3 etiological examination Surgical removal of nodules by compression method, cysticerci incubation test and pathological examination of cysticercosis (see Appendix D). 3.4 Immunological testing Serum or cerebrospinal fluid cysticerci immunological detection of specific antibodies (see Appendix D). 3.5 imaging performance 3.5.1 Subcutaneous or muscular B-ultrasound shows typical cysticercosis (see Appendix E). 3.5.2 brain CT, MRI showed atypical cysticercosis in the brain image (see Appendix E). 3.5.2.1 brain CT, MRI showed atypical abnormalities. 3.5.2.2 brain CT, MRI showed typical cysticercosis images. 3.5.3 Eye B ultrasound examination shows a typical cysticercosis image (see Appendix E). 3.6 Diagnostic or pathogenic treatment response Diagnostic therapy is effective or pathogenic response.

4 diagnostic principles

Comprehensive epidemiological history, clinical manifestations, laboratory tests, imaging studies and diagnostic treatment results to be diagnosed.

5 diagnostic

5.1 suspected cases 5.1.1 Subcutaneous or muscle cysticercosis Conforms to both 3.1 and 3.2.1. 5.1.2 Neurocysticercosis 5.1.2.1 Meet both 3.1 and 3.2.2. 5.1.2.2 Conforms to both 3.1 and 3.5.2.1. 5.1.3 Occipital cysticercosis In line with 3.1 and 3.2.3. 5.1.4 other parts of cysticercosis Meet both 3.1 and 3.2.4. 5.1.5 mixed cysticercosis In line with 5.1.1, 5.1.2, 5.1.3, 5.1.4 any two or more. 5.2 Clinical diagnosis of cases 5.2.1 Subcutaneous or muscle cysticercosis In line with 5.1.1 and 3.4. 5.2.2 Neurocysticercosis 5.2.2.1 Meets 3.4 and 5.1.2.1 at the same time. 5.2.2.2 Meets 3.5.2.2 and 5.1.2.1 at the same time. 5.2.2.3 Meets 3.6 and 5.1.2.1 simultaneously. 5.2.2.4 Meets 3.4 and 5.1.2.2 at the same time. 5.2.2.5 Meets 3.6 and 5.1.2.2 at the same time. 5.2.3 Occipital cysticercosis 5.2.3.1 In line with 3.4 and 5.1.3 at the same time. 5.2.3.2 Meets 3.5.3 and 5.1.3 at the same time. 5.2.4 other parts of cysticercosis Simultaneous with 3.4 and 5.1.4. 5.2.5 mixed cysticercosis Meets 3.4 and 5.1.5 at the same time. 5.3 confirmed cases 5.3.1 subcutaneous or muscle cysticercosis Meets 3.3 and 5.2.1 at the same time. 5.3.2 Neurocysticercosis 5.3.2.1 Meets 3.3 and 5.2.2.1 at the same time. 5.3.2.2 Meet both 3.3 and 5.2.2.2. 5.3.2.3 Meet both 3.3 and 5.2.2.3. 5.3.2.4 Meets 3.3 and 5.2.2.4 at the same time. 5.3.2.5 Meets 3.3 and 5.2.2.5 at the same time. 5.3.3 cysticercosis 5.3.3.1 Meets 3.3 and 5.2.3.1 at the same time. 5.3.3.2 Meet both 3.3 and 5.2.3.2. 5.3.4 other parts of cysticercosis In line with 3.3 and 5.2.4. 5.3.5 Mixed cysticercosis Meets 3.3 and 5.2.5 at the same time.

6 differential diagnosis

Should be associated with subcutaneous lipoma, other brain parasites infection and brain abscess, brain metastases, glioblastoma, brain tuberculosis, encephalitis, primary Or other secondary epilepsy disease phase identification (see Appendix F). Appendix A. (Informative) Etiology Taeniasolium Linnaeus (1785) is also called Taenia solium. People are their only ultimate hosts, adult parasites in humans The upper intestine, mature pregnancy section contains a large number of eggs with the excretion of feces. When its eggs or pregnancy section pigs, boars and other intermediate host after swallowing pigs Cysticercosis. When people eat raw or uncooked cysticerci pork, the cysticerci in the human small intestine by the role of digestive juice, Egg escaped and bored into the intestinal wall, the blood circulation or lymphatic system to the host body parasites everywhere, causing human cysticercosis. Cysticercus cellulosae on the human body Is far greater than adult worms, the number of human parasitic cysticerci can range from one to tens of thousands of parasitic parts of a very wide, common parts Subcutaneous, muscle, brain and eye, followed by the heart, tongue muscle, oral submucosal, liver, lung, breast, spinal cord and so on. Cysticercus metabolites and toxins can cause significant local tissue response and induce immune response. Cysticercus around the organization often With cell infiltration, followed by fibrosis and cysticercosis wrapped cysticercosis, the gradual calcification of cysticercosis. In the pathogen treatment of drug-killed worms After the death, the surrounding tissue inflammatory response is obvious. Cysticercus the shape and size of the parasitic sites and the number of different, usually subcutaneous, muscle Cysticercus cellulosae about the size of soybeans, milky white Translucent capsule; capsule filled with liquid, divided into two layers of the outer wall, the outer cortex, within the interstitial layer, there is a volume of contractions rolled head.

Appendix B

(Informative) Epidemiology It is endemic in many countries around the world, in Europe, Asia, Africa and South America. In our country, where there is pig taeniasis Popular areas have cysticercosis occurred, to the northeast, northwest, north China, especially in Henan and Shandong more. Taeniasis patients is the only source of cysticercosis. Human infection cysticercosis in three ways. a) self-infection, that is, the patient's body already has adult infection, when encountered nausea, vomiting, intestinal peristalsis can reverse the thrust of pregnancy Cause of infection in the stomach; b) self-infection, the patient eats the egg that emanates itself causes the re-infection; c) allogenic infection, eating eggs caused by other people. Pig improper feeding methods, pigs infected with tapeworm eggs excrement pollute the environment, so that pigs infected with Cysticercus and human meat improper ways, poor health Health habits can lead to transmission and infection.

Appendix C

(Informative) Clinical manifestations C.1 Subcutaneous and muscle cysticercosis Located in the subcutaneous, submucosal, muscle 0.5cm ~ 1.5cm nodules, the number can be from one to hundreds. Subcutaneous or submucosal nodules are more Oval or round (such as oral submucosal), no adhesions with the surrounding tissue, no tenderness, hardness approximate cartilage. Nodules to the trunk, head, neck, upper limbs And upper limbs more often appear in batches, can gradually disappear. A large number of intramuscular parasites, muscle weakness may occur, swollen, numbness Or pseudo-muscle hypertrophy and so on. C.2 Neurocysticercosis Complex and diverse clinical symptoms, most of the slow course of the disease, a few cases of acute onset, and even cause sudden death. The degree of nerve damage is usually up to now The number of cysticerci and parasitic sites caused by mechanical damage, inflammation and poisoning response. Clinical manifestations may have increased intracranial pressure, nervous system set Body signs, epilepsy, mental disorders and memory loss and so on. Epileptic seizures account for about 80% of cerebral cysticercosis, can be a major episode, a small attack, fine God sports seizures. Increased intracranial pressure accounted for 40% to 50%, manifested as headache, dizziness, nausea, vomiting, visual impairment and papilledema or With bleeding. Cysticercus parasites in the fourth ventricle who often stiff neck, forced head position, said Bruns sign. Such as cysticercosis block cerebrospinal fluid circulation Access, can cause increased acute intracranial pressure, leading to hernia, life-threatening. C.3 Ocular cysticercosis Multiple monocular involvement. Cysticercosis parasitic on the retina can cause visual impairment and even blindness, often the cause of retinal detachment. Cysticercus Parasitic vitreous or anterior chamber, there may be floaters mosquito or shadow floating sense. Parasites in the conjunctiva, eyelid and extraocular muscle may appear partial charge Blood, blink response increased, tearing, itching, etc., and can be found cysts. When the parasites are dead, the stimulation of insect body decomposition products can lead to pigment film, retinal Membrane and choroidal inflammation, vitreous opacity, or cataracts, glaucoma and blindness. C.4 other parts of cysticercosis Cysticercosis parasitic in the spinal canal paraplegia due to spinal cord compression, sensory disturbances, incontinence or urinary retention and so on. Parasitic in the heart Dirty, tongue, oral submucous, vocal cord and diaphragm, liver, lung and other organs, causing the corresponding dysfunction. C.5 Mixed cysticercosis With any of the above two types of cysticercosis symptoms, signs.

Appendix D

(Normative) Laboratory examination D.1 etiological examination D.1.1 tabletting method Surgical removal of subcutaneous or intramuscular nodules, remove the internal capsule, after the liquid was drawn out between the two slides, gently flatten, low magnification Check the head and neck section, the structure of the first section of cysticercus and adult head section of the same, approximately spherical, with two rings around the head and the outer ring of the top and four Sucker. D.1.2 Cysticercus incubation test Surgical removal of nodules, light lifting away from the outer end of the head capsule, cut a small mouth, peel the inner capsule, placed in 50% bile saline at 37 ℃ Incubation in the incubator, if the live cysticerci, 10min ~ 60min visible head outstretched. This method can check the survival of cysticercosis. hatch If the 12h extension without head, can be observed under the microscope structure. D.1.3 histopathological examination The surgically removed nodules were fixed with 10% formalin and then washed, dehydrated with increasing concentrations of alcohol, embedded in paraffin, sliced Serial sections, the thickness of 7μm ~ 10μm. The sections were deparaffinized with xylene, stained with hematoxylin-eosin, and the structure of the head section was observed under a microscope. D.2 Immunological test D.2.1 Sample collection Venous blood samples collected 2mL, serum or under sterile conditions lumbar puncture to take cerebrospinal fluid 1mL ~ 2mL for testing. Test standard This and its handling Follow the kit instructions and determine the results. D.2.2 indirect hemagglutination test (indirecthaemagglutinationtest, IHA) D.2.2.1 Principle The soluble antigen adsorbed on the surface of red blood cells, which is sensitized, adsorbed antigen of red blood cells called red blood cells. In the right Conditions, the sensitized erythrocyte interaction with the corresponding antibodies, the occurrence of specific antigen - antibody reaction, the emergence of visible red blood cell agglutination Like, known as indirect hemagglutination test. D.2.2.2 reagent preparation Experimental reagent preparation method is as follows. a) 0.01 mol/L pH 6.4 phosphate buffer (PBS); b) chromium trichloride solution CrCl3 · 6H2O532mg dissolved in 100mL distilled water, set at 4 ℃ refrigerator, temporary use for 1. 500 dilution; c) tannic acid solution Weigh tannic acid 100mg, dissolved in 20mL of distilled water, set at 4 ℃ refrigerator, Pro use 1..20000 dilution; d) 10% glutaraldehyde treatment of human "O" red blood cells, when used to wash with pH6.4PBS 2 times, spare; e) Healthy Rabbit Serum Rabbit heart blood was aseptically sampled from healthy rabbits and the serum was separated and inactivated at 56 ° C for 30 minutes. The human "O" red blood cells Absorption treatment, refrigerator preservation; f) 0.5% rabbit serum (pH 6.4, 0.5% saline PBS). D.2.2.3 cysticercus antigen preparation Fresh Cysticercus cellulosae was collected, the cyst fluid was collected under aseptic conditions with a 2 mL syringe, then centrifuged at 2500 g for 30 min, Supernatant, home refrigerator set aside. D.2.2.4 Erythrocyte sensitization Take pH6.4PBS1mL and 1.10 antigen 1mL, added to the test tube, then add 1mL of chromium trichloride dilution, mix and set 37 ℃ water bath 5min, after removal of 3mL added by 2 washed 10% of the washed red blood cells (0.3mL), fully mixed, and immediately add Into 1..20000 tannic acid solution 1mL, mix, set 37 ℃ water bath sensitized 15min, during shaking 1 to 2 times, after removal to 1200g away Heart 5min, the supernatant was discarded, and then washed with 0.5% rabbit serum sensitized erythrocytes twice, and finally the red blood cells were added 40mL0.5% rabbit serum, Red blood cell concentration of 0.75%. D.2.2.5 Serum test Serum test process is as follows. a) Specimens were diluted with 96-well V-type plexiglass microplate, each row of 8 holes, each hole by adding 0.5% rabbit serum 1 drop (50μL), and then 0.025mL metal dilution stick stained sera were seized in the first well, as a multiple dilution to the seventh hole, the first 8 Holes were 0.5% rabbit serum control. Each hole was added antigen-sensitized erythrocyte 1 drop (50μL), set micro-shaker shaking 2min, room Placed in warm 1h, observe the results; b) Results Judgment The erythrocytes diluted to 1. 8 in the serum were agglutinated to (3), and the erythrocytes were (3) agglutinated The maximum dilution factor is positive titer. D.2.3 ELISA (enzyme-linked immunosorbentassay, ELISA) D.2.3.1 Principle Enzyme-linked immunosorbent assay is the combination of antigen or antibody with enzyme to maintain its immunoreactivity and enzyme activity. Enzyme-linked antigen or Antibody and enzyme substrate treatment, due to the catalytic effect of the enzyme, the colorless substrate or compound hydrolysis, oxidation or reduction reaction and color. Colorimetric determination of the color depth of the reaction solution. D.2.3.2 reagent preparation Experimental reagent preparation method is as follows. a) 10-fold phosphate buffered saline (PBS) stock solution, when used for 1.10 dilution; b) washing solution (PBS-T) PBS1000mL Tween-200.5mL Serve; c) Serum dilution (pH7.2) 0.05mol/LNa2HPO472mL, 0.05mol/LKH2PO428mL, after mixing Add 0.85gNaCl and 1.10 Tween-200.5mL (also can not add Tween-20); d) substrate 0.2mol/LNa2HPO42.4mL, 0.1mol/L citric acid 2.6mL, distilled water 5mL, after mixing 4mg o-phenylenediamine, and finally adding H2O215μL (when used with the existing); e) Antigen preparation Cysticercus indirect hemagglutination test. D.2.3.3 Test methods Polystyrene reaction plate as a carrier, the cysticerci antigen diluted 1..2000 were added to the hole, each hole by adding 0.2mL, set Wet box at 37 ℃ incubator 2h, and then transferred to 4 ℃ refrigerator overnight, remove the next day, washed three times (each 3min ~ 5min) before adding 1.50 dilution of patient serum 0.2mL, set 37 ℃ incubator 2h, the same method as above, washed three times, and then added 1..2000 dilution of enzyme binding 0.2mL, set 37 ℃ 3h, rinsed 3 times, plus substrate solution 0.2mL, 30min after the addition of stop solution, with the enzyme-linked determination of absorbance A value. D.2.3.4 Judgment of the result A value of serum hole to be detected ≥ healthy control serum average 1.5 times the value of A positive. D.2.4 circulating antigen (circulatingantigen, CAg) test D.2.4.1 Principle Monoclonal antibodies were used as coating and enzyme-labeled antibody, respectively, using double antibody sandwich method for the detection of cysticercosis patients with serum or cerebrospinal fluid Circulating antigen. D.2.4.2 kit composition Cysticercosis CAg detection plate (antibody pre-coated ELISA plate), ELISA anti-CAg antibody, CAg positive control serum, CAg negative Control serum, developer A solution, developer B solution, color-killing solution, PBS-T concentrated (20mL/bottle, diluted with distilled water before use 20 times) Polyethylene glycol (PEG) 6000 (7.0 g/pack, 1 bag, dissolved in 100 mL of PBS-T solution before use). D.2.4.3 Sample pretreatment CAg in serum and cerebrospinal fluid has been combined with antibodies to form immune complexes, to be destroyed after the antibody can be detected for the following pre-treatment. a) cerebrospinal fluid to take cerebrospinal fluid 0.2mL boiling bath 5min, cooled to room temperature and then take 0.1mL test; b) serum serum 1.0mL added 7% PEG solution, mix evenly, at room temperature for 20min,.2000g centrifugation 30min, the supernatant was discarded, the centrifuge tube upside down 3min ~ 5min, except for the use of absorbent paper mouth liquid; sediment with 0.1mL PBS-T and 0.1mL distilled water resuspended, boiling 5min, until cooled to room temperature after the test. D.2.4.4 Test procedures Cyclic antigen test procedures are as follows. a) plus samples will be pretreated cerebrospinal fluid or serum added to the reaction wells, 0.1mL/well, each plate was set positive and negative serum pairs According to the blank control, each well was incubated at 37 ℃ for 1h or 43 ℃ for 30min and then placed at 2 ℃ ~ 8 ℃ overnight, washed 3 times and patted dry; b) Add enzyme-labeled antibody 0.1mL/well (blank wells do not add), 43 ℃ 30min or 37 ℃ 2h wash 3 times, pat dry; c) Add 1 drop (50μL) of reagent A and solution B to each well of substrate solution, avoid dark reaction for 15min ~ 20min at room temperature; d) add color stop solution 0.05mL/well. D.2.4.5 Determination of the result Zero blank hole, with a microplate reader determination of each hole A450, sample hole A value greater than 2.1 times the negative control hole A value was positive, negative pair According to hole A value less than 0.03 by 0.03 calculation. D.2.4.6 Clinical significance CAg positive that the body of patients with live parasites, but some patients with echinococcosis can also be positive, should pay attention to clinical identification; In addition to detecting cases of CAg, but also for antibody testing, so as to avoid missing. D.2.4.7 Precautions For patients with brain-type, serum and cerebrospinal fluid CAg can be detected simultaneously to improve the detection rate. D.2.5 Short-range antibody (immunoglobulinG4, IgG4) detection D.2.5.1 kit composition Antigen coated plate, sample dilution, anti-human IgG4 enzyme conjugate, stop solution, PBS-T solid detergent, negative control, substrate dilution Liquid, positive control, substrate dry powder. D.2.5.2 Sample dilution Sample dilution is as follows. a) Preparation of Detergent and Sample Diluent Each bag of PBS-T solid detergent was thoroughly dissolved with 500 mL of distilled water as anti Should plate washing solution and sample diluent; b) if the sample is diluted directly for serum sample reaction; if the filter paper blood, according to the diameter of 1.1cm wafer plus.200μL sample Dilution, 37 ℃ soak 2h (or 4 ℃ environment overnight) spare. D.2.5.3 operating procedures Operating procedures are as follows. a) Add sample reaction required amount of the reaction strip, if the serum sample, add 2 diluted samples per well (about 0.1mL), subdivision Do not join the serum to be tested 10μL, mix; if the filter paper blood samples, then directly add 100μL of diluted filter paper blood that is can. At the same time set negative, positive and blank control 1 hole, negative, positive control and serum sample processing methods the same, blank control Add only two drops of sample dilution (approximately 0.1 mL) into the well. 37 ℃ dark reaction after 90min rejection liquid hole, each hole filled with wash Distilled liquid, left to stand after 30s, washed a total of 5 times, each time need to rest for 30s, the last pat beat; ...

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