HISTOCHEMICAL CHANGES OF THE PULMONARY HYDATID CYSTS IN SHEEP INFECTED WITH CYSTIC ECHINOCOCCOSIS.

Hydatid cyst (Hydatidosis) is considered one of the parasitic diseases that pose a threat to both animals and humans alike. Objectives: the present study was aimed to investigate cystic echinococcosis in sheep. By employing a variety of specific stains, we sought to uncover the mesmerizing histochemical changes associated with this condition. Twenty lung samples infected with hydatid disease were obtained. The samples were fixed in 10% formalin and processed and then stained with haematoxylin and eosin and some special stains such as Periodic Acid Schiff (PAS), Gomri's aldehyde fuschin, Best Carmine, Van Gieson, Toluidine blue and Alcian blue to investigate the histochemical changes that occurred in the lung tissue. Chemical changes were observed in the lung tissue affected by hydatid cysts, revealing insights into the underlying pathological processes. The presence of hydatid cysts was characterized by encapsulation within the lung tissue, consisting of a laminated layer surrounded by a fibrous membrane. Severe pneumonia was evident, accompanied by the infiltration of inflammatory cells and the presence of necrotic cells containing lytic nucleic acids. These changes resulted in atelectasis (partial or complete lung collapse) and emphysema (destruction of alveolar walls). Despite these pathological changes, intact elastic fibers were observed surrounding the bronchiole, indicating preserved structural integrity. Necrosis of epithelial cells in the bronchiole was also observed, disrupting normal respiratory system functioning. The hydatid cyst has a clear effect on the lung tissue, represented by the histochemical changes that certainly cause damage to the lung and this is reflected in its vital function inside the body.

Basic Operative Tactics for Pulmonary Echinococcosis in the Era of Endostaplers and Energy Devices.

Human echinococcosis is a zoonotic infection caused by the larvae of the tapeworm species Echinococcus. The liver is the most common location for a primary echinococcosis. However, the parasite may bypass or spread from the liver to the lungs, causing primary or secondary pulmonary echinococcosis, respectively. Pulmonary echinococcosis is a clinically challenging condition in which anthelminthic regiments are important, but surgery has the central role in removing the cysts and preventing recurrences. Surgical treatment may involve cystotomy, enucleation, capitonnage, or atypical resections, which occasionally are in combination with hepatic procedures. The utilization of modern devices is greatly underdescribed in surgery for thoracic infections, even though these facilitate much of the work. Therefore, this article aims to describe pulmonary echinococcosis and the role of modern surgical devices in the treatment process. Furthermore, we report surgical treatment of three different cases of pulmonary echinococcosis. Surgeries of uncomplicated and ruptured hepatic or pulmonary cysts are described. Simple small pulmonary echinococcal lesions can be excised by endostaplers both for diagnostic and curative reasons. Larger cysts can be removed by energy devices unless large bronchial air leaks occur. Complicated cysts require treatment by more extensive techniques. Inexperienced surgeons should not abstain but should carefully decide preoperatively how to proceed.

Pulmonary hydatidosis genotypes isolates from human clinical surgery based on sequencing of mitochondrial genes in Fars, Iran.

BACKGROUND: Cystic echinococcosis (CE)/hydatidosis is an important neglected parasitic zoonotic disease caused by the metacestode of Echinococcus granulosus s.l. The present study was designed to identify the pulmonary CE species/genotypes in isolated human underwent to surgery in our center in Southern Iran. METHODS: The study population of this study were all patients in Fars province who were admitted to Namazi Hospitals for pulmonary hydatid cyst surgery. Thoracic surgery was performed in the thoracic ward and the cyst/s was removed by open surgery via posterolateral or lateral thoracotomy. DNA was extracted from the germinal layer or the protoscoleces. PCR technique was performed using the cytochrome C oxidase subunit1 (cox1) gene, and the products were sequenced. RESULTS: A total of 32 pulmonary hydatid cyst samples were collected from 9 (28%) female and 23 (72%) male aged from 4 to 74 years old. A total of 18(56%) cyst/s were in the left lobe and 14 (44%) cysts in the right lobe. Sequence analysis of the cysts showed that 24 samples (75%) were E. granulosus s.s (G1-G3) genotype and 8 (25%) were E. canadensis (G6/G7) genotype. CONCLUSION: E.granulosus s.s genotype was the most prevalent genotype followed by E. canadensis (G6/G7) genotype. There was no significant statistical correlation between cysts' size, location, genotype strain, and patients' age and gender.

Response patterns in adventitial layer of Echinococcus granulosus sensu stricto cysts from naturally infected cattle and sheep.

Cystic echinococcosis is a zoonotic disease caused by the metacestode of Echinococcus granulosus sensu lato. The disease is characterized by the development of cystic structures inside viscera of the intermediate host, mainly liver and lungs. These cysts are formed by three layers: germinal, laminated, and adventitial layer, the latter being the local host immune response. Metacestodes that develop protoscoleces, the infective stage to the definitive host, are termed fertile, whereas cysts that do not produce protoscoleces are termed non-fertile. Sheep usually harbor fertile cysts while cattle usually harbor non-fertile cysts. Adventitial layers with fibrotic resolution are associated to fertile cysts, whereas a granulomatous reaction is associated with non-fertile cysts. The aim of this study was to analyze cellular distribution in the adventitial layer of fertile and non-fertile E. granulosus sensu stricto cysts found in liver and lungs of cattle and sheep. A total of 418 cysts were analyzed, 203 from cattle (8 fertile and 195 non-fertile) and 215 from sheep (64 fertile and 151 non-fertile). Fertile cysts from cattle showed mixed patterns of response, with fibrotic resolution and presence of granulomatous response in direct contact with the laminated layer, while sheep fertile cysts always displayed fibrotic resolution next to the laminated layer. Cattle non-fertile cysts display a granulomatous reaction in direct contact with the laminated layer, whereas sheep non-fertile cysts display a granulomatous reaction, but in direct contact with the fibrotic resolution. This shows that cattle and sheep cystic echinococcosis cysts have distinct local immune response patterns, which are associated to metacestode fertility.

Chronic pulmonary thromboembolism due to intracardiac and pulmonary hydatidosis.

Hydatid disease remains a problem in endemic areas. The combination of both intracardiac and pulmonary hydatid disease in association with chronic pulmonary thromboembolism is a rare presentation. We report a case of a 14-year-old girl with hydatid disease of the lungs, right ventricle, and pulmonary arteries, presenting as chronic pulmonary thromboembolism. She underwent surgery for wedge resection of the pulmonary hydatid in the right lower lobe, removal of the right ventricular hydatid (under cardiopulmonary bypass), and pulmonary endarterectomy (under total circulatory arrest). Her postoperative recovery was uneventful.

Fasciola hepatica coinfection modifies the morphological and immunological features of Echinococcus granulosus cysts in cattle.

Polyparasitism occurs when animals harbour multiple parasites concomitantly. It is a common occurrence but is generally understudied in wild and domestic animals. Fasciola hepatica and Echinococcus granulosus, which are helminths of ungulates, frequently coinfect cattle. The effects of this particular type of polyparasitism are not well documented. The metacestode of Echinococcus granulosus is surrounded by the adventitial layer, which constitutes the host immune response to the parasite. This layer in cattle is produced by a granulomatous reaction and is involved in echinococcal cyst (EC) fertility. Due to the systemic immune-modulating abilities of Fasciola hepatica, coinfection possibly generates a favourable environment for EC growth. A total of 203 Echinococcus granulosus sensu stricto cysts were found in 82 cattle, of which 42 ECs were found in 31 animals coinfected with Fasciola hepatica. The overall infection intensity was 3 cysts per animal. Coinfection with Fasciola hepatica decreased the mean infection intensity to 1.4 cysts per animal. Regarding EC size, coinfection resulted in smaller ECs (15.91 vs 22.09 mm), especially for infertile lung cysts. The adventitial layer of ECs in coinfected animals lacked lymphoid follicles and palisading macrophages, which are generally hallmarks of the granulomatous immune response. The ECs in coinfected animals had organized laminated layers, whereas those in animals without coinfection did not. Although coinfection was not statistically associated with EC fertility, we did not find fertile cysts in the livers of coinfected animals. We concluded that coinfection with Fasciola hepatica and Echinococcus granulosus has a detrimental effect on ECs, particularly infertile cysts.

Molecular survey on cattle and sheep hydatidosis and first detection of Echinococcus canadensis (G6/G7) in sheep in Turkey.

Larval stage of genus Echinococcus is the causing agent for the zoonotic infection which is life threatening known as Echinococcosis. The purpose of this study was the identification, molecular analysis and characterization of Echinococcus spp. in sheep and cattle. The sampling was done from slaughterhouse of Elazig, Turkey. A total of 85 isolates (sheep, n = 19 and cattle, n = 66) have been collected after slaughtering. Following the gDNA isolation and PCR products of mt-CO1 gene (446 bp) of all the samples were sequenced. Out of 85 isolates, 84 were recognized as Echinococcus granulosus sensu stricto and one sheep isolate was found as Echinococcus canadensis (G6/G7 ) which is identified for the first time in Turkey. However, single nucleotide polymorphism has been observed not only in samples of different animals but also in samples collected from the same cattle. Six liver and three lung hydatid cysts have been detected in cattle. Although no nucleotide differences have been observed in the liver samples, there was single nucleotide polymorphism (C→T) in 40th nucleotide of two lung cysts. As a result of haplotype analysis, 16 haplotypes of E. granulosus s.s. were detected in 66 cattle isolates whereas 7 haplotypes of E. granulosus s.s. were identified in 19 sheep samples.

Molecular characterization of human lung and liver cystic echinococcosis isolates in Van Province, Turkey.

Cystic echinococcosis (CE) is a zoonotic infection and could lead to significant public health problems. The genetic diversity of CE includes five species: E. granulosus sensu stricto (s.s.) (G1-G3), Echinococcus equinus (G4), Echinococcus ortleppi (G5), Echinococcus canadensis genotypic cluster (G6, G7, G8 and G10, with the doubtful G9) and the Echinococcus felidis (lion strain). The species are important in epidemiology, pathology, control, prevention measures and vaccine/drug designs. The aim of the present study was to determine the E. granulosus genotypes in humans in the Van province in east of Turkey. In total, 102 echinococcal cysts were collected from operated patients. Genomic analyses were conducted with PCR-RFLP of the rDNA internal transcribed spacer 1 (ITS1) fragment and partial PCR sequencing of the cytochrome c oxidase subunit 1 (cox1) mitochondrial DNA gene region. In total, DNAs of 96 isolates could be extracted, unfortunately six extractions failed. The PCR-RFLP analysis findings were identical in all isolates. Two bands were observed at approximately 300 bp and 600 bp. All profiles corresponded to the G1-G3 strain. Also, 446 bp amplified gene regions were observed for cox1. Out of 20 samples, alignment of 16 sequences exhibited a total identification (100%) of granulosus sensu stricto (G1/G3). Of 16 samples, 8 were obtained in the lung and 12 were obtained in the liver; 8 belonged to male and 12 belonged to female patients. Other four samples exhibited one nucleotide substitution at different positions. Four samples had one nucleotide substitution at different positions. We detected single nucleotide variations in TRH1, TRH67, TRH85 and TRH89 isolates at the positions C240T; G330T; G211A and T157C, respectively. In conclusion, the present study was the first comprehensive molecular investigation on genetic characterization of human CE isolates in Van region. The findings demonstrated that E. granulosus s.s. was the dominant species, which indicated that the sheep-dog cycle was the source in human infections. And, probably, it would be possible to describe these mutations as "Turkey" or "lung" variants. In addition to contributing molecular epidemiological data, the present results should be considered when designing and implementing E. granulosus control programs.

Scolicidal Effects of Nanoparticles Against Hydatid Cyst Protoscolices in vitro.

BACKGROUND: Echinococcus granulosus is causative agent of cystic echinococcosis (CE), which has a cosmopolitan distribution. The current methods for the treatment of human CE include surgery. Therefore, the development of new scolicidal agents with low side effects and more efficacies is an urgent need. PURPOSE: The present study aimed to compare the scolicidal efficacies of silver, iron, copper, silica and zinc oxide nanoparticles (NPs) against hydatid cyst protoscolices in vitro. METHODS: Hydatid cysts of sheep liver and lung were collected. The cyst fluid containing protoscolices was aspirated aseptically. The scolicidal activities of the silver, iron, copper, silica and zinc nanoparticles (Ag-NP, Fe-NP, Cu-NP, Si-NP and Zn-NP) were tested at different concentrations of 0.25, 0.5 and 1 mg/mL following 10, 30 and 60 min of incubation in triplicate. Viability of protoscolices was confirmed by 0.1% eosin staining. RESULTS: Results showed that Ag-NPs at all concentrations tested had the highest scolicidal effect. Ag-NPs at 1 mg/mL concentration after 60 min of exposure time showed 80% mortality rate. Si-NPs had the high scolicidal activity at 1 mg/mL concentration (52.33%), Cu-NPs at 0.5 mg/mL concentration (41%), Fe-NPs at 1mg/mL concentration (28%) and Zn-NPs at concentration of 1mg/mL after 60 mins (15.67%). CONCLUSION: The findings of the present study showed that Ag-NPs, Fe-NPs, Cu-NPs, Si-NPs and Zn-NPs had potent scolicidal effects and that Ag-NPs are recommended as effective scolicidal agents. However, further in vivo studies are required to evaluate the efficacy of these nanoparticles.

Frequency and clinical presentation of alveolar and cystic echinococcosis in a tertiary medical center in Germany 2004-2018: lessons from a low-prevalence area.

INTRODUCTION: The prevalence of alveolar echinococcosis (AE) and cystic echinococcosis (CE) in Germany is increasing. The number of cases in northern and eastern regions is low, so there is little experience with regard to diagnosis and therapy. OBJECTIVES: The objective of this paper was to evaluate the management of suspected and/or diagnosed echinococcosis at a university center in a low-prevalence region. METHODS: All the patients at the Leipzig University Hospital between 2004 and 2018 who had been serologically examined for echinococci were included in a retrospective cohort study. Clinical course, imaging, histology, therapeutic characteristics, relevant comorbidities and risk factors for AE and CE were evaluated. A time-staggered prevalence estimation, as well as sensitivity and specificity calculations for the serological tests, were performed. RESULTS: A total of 382 patients were enrolled, with 11 AE and 7 CE cases identified. The mean prevalence rate of AE in this cohort was 2.9 % and that of CE was 1.8 %. Among the patients, 56 % had known risk factors for AE and CE. The serological tests showed a sensitivity of 86 % and a specificity of 91 %. Two patients with false-negative serology were diagnosed by biopsy. All CE and 5 AE patients (45 %) were operated on. Six AE patients received long-term treatment with albendazole. CONCLUSIONS: AE and CE are rare diseases in the greater Leipzig region; however, case numbers are on the rise. Due to favorable factors such as the escalation of migration, a further increase is expected. Diagnosis and therapy are challenging and should be supported by specialists (experienced infectiologists, imaging experts and skilled hepatobiliary surgeons) who should be integrated in a German network.

Echinococcus Granulosus in Childhood: A Retrospective Study of 187 Cases and Newer Data.

Echinococcus granulosus, first reported by Goeze in 1782, is the causative parasite of cystic echinococcosis (hydatidosis) especially for countries that are endemic areas. Since the 1970s, the incidence of echinococcosis in Greece has been very high. Nevertheless, with the implementation of special prevention measures in the 1980s, a large reduction in the incidence of hydatidosis meant that it reached European levels. Therefore, we analyzed the demographics, multiple organ localizations of the parasite, diagnosis, and conservative and optimal surgical treatment over a total period of 39 years, especially for pulmonary and hepatic echinococcosis in children. The higher incidence of pulmonary echinococcosis compared with other localizations, male predominance, wide range of age, and various cystic sizes were some of the main demographics. Because cystic echinococcosis remains a main public health problem, we advocate a meticulous clinical investigation and treatment methodology to bridge the gap between knowledge and awareness of this important disease.

Could SUVmax be an auxiliary parameter in the clinical management of pulmonary hydatid disease?

OBJECTIVE: The aim of this study was to investigate the role of 18F-fluorodeoxyglucose positron emission tomography/computerized tomography (FDG-PET/CT) in the diagnosis and treatment of pulmonary hydatid disease and also compare the morphological characteristics of the lesions with SUVmax values and identify complicated disease. METHODS: Thirty-six patients with a diagnosis of pulmonary hydatid disease who underwent 18F-FDG PET/CT imaging were included in this retrospective study. The size of the lesions, morphological characteristics, accompanying parenchymal and pleural findings, SUVmax and HUmean values and FDG uptake in mediastinal lymph nodes were noted. The relationship between morphologic properties, SUVmax of the lesions and lymphatic FDG uptake was analysed. RESULTS: A total of 99 lesions of 36 patients were classified as solid (7.1%), cystic (53.5%), semisolid (20.2%) and cavitary (19.2%). Thirty-two of the lesions were encapsulated, 38 of the lesions had border irregularity. Accompanying consolidation was present in 10 cases, bronchial obstruction in 9, pleural thickening in 28 and effusion in 3. There was positive correlation between lesions HUmean and SUVmax values (r = 0.285). SUVmax values were significantly higher in lesions with irregular borders, solid or semisolid type and presence of consolidation, bronchial obstruction and pleural thickening. Also more lymphatic FDG uptake was detected in this group. CONCLUSION: Higher SUVmax values may be a useful parameter in the diagnosis of complicated pulmonary hydatid disease. FDG-PET may provide guidance for determining the priority of lesion for surgery in cases with multiple lesions and may be helpful to evaluate the response to medical treatment.

A Retrospective Analysis on the Cystic Echinococcosis Cases Occured in Northeastern Punjab Province, Pakistan.

A retrospective study was performed to report the case occurrence of cystic echinococcosis (CE) in three hospitals of north-eastern region in Punjab Province, Pakistan. We reviewed retrospectively the clinical records of patients in 4 hospitals which were diagnosed with CE during 2012-2017. A total of 198 cases, 82 (41.4%) male and 116 (58.6%) females were detected as CE. The most Highest incidence was revealed in.... 21-30 years-old group (24.2%) followed by 41-50 (22.7%), 31-40 (16.2%), 11-20 (13.6%), 51-60 (8.1%), below 10 (5.5%), over 71 (5.1%) and 61-70 year-old group (4.5%). CE was detected in various organs of infected individuals. However, most of CE cases were detected in the liver (47.4%) and lung (18.6%). The present study indicated that CE is more or less prevalent in surveyed areas and one of the most important public health problems in Punjab Province, Pakistan.

Intact endobronchial hydatid cyst: an unexpected bronchoscopic challenge.

We describe a rare case of intact endobronchial hydatid cyst that posed a diagnostic challenge because of an unusual imaging manifestation (atelectasis) and unexpected bronchoscopic findings. Although the role of bronchoscopy in the management of pulmonary hydatid cyst is still controversial, 6 cases of complicated pulmonary hydatid cyst removed completely by suction through a fiberoptic bronchoscope have been reported so far. To the best of our knowledge, this is the first nonsurgically treated case of intact endobronchial hydatid cyst with an uneventful long-term follow-up.

A novel bronchoscope method (saline injection method) for complete extraction of ruptured pulmonary hydatid cyst.

INTRODUCTION: Echinococcus granulosus is an important public health problem in the Mediterranean area. Today's surgery is the principal therapeutic approach for chronic ruptured hydatid cyst removal. OBJECTIVES: In this paper, a new bronchoscopic method using saline injection is explained as a safe method to remove ruptured pulmonary hydatid cysts. This non-invasive method has no complications and no need to anesthesia and admission. We hope that this novel bronchoscopic method can be a starting point for future advances in the field of pulmonary hydatid cyst treatment methods. METHODS: Saline injection method by bronchoscopy (M. E. Hejazi Method) RESULTS: We extracted the entire hydatid cysts of both patients by fiber optic bronchoscopy using saline injection method (M. E. Hejazi Method) for the detachment of underlying membrane from cavity wall. CONCLUSIONS: This bronchoscopic method is minimally invasive, without surgery, anesthesia and hospital admission, the least complication and morbidity as well as is cost benefit in comparison with surgery.

Intracardiac and pulmonary artery hydatidosis causing thromboembolic pulmonary hypertension.

Hydatidosis is a serious parasitic infection in endemic areas. A rare presentation is pulmonary arterial cysts causing thromboembolic pulmonary hypertension. We report the case of a young man who presented with clinical and radiological findings of thromboembolic pulmonary hypertension. The patient was found to have hydatid cysts in both pulmonary arteries and in the right ventricular outflow tract. To remove all cysts without causing rupture, anaphylactic shock or systemic emboli, placing the patient under cardiopulmonary arrest was necessary, and in the case of pulmonary arterial involvement, total circulatory arrest was necessary. The cysts were removed successfully, and the patient survived the operation. The patient is being followed up on albendazole treatment. Myocardial preservation and management of total circulatory arrest are the cornerstones of a successful surgical outcome.

Recurrent multiple-organ involvement of disseminated alveolar echinococcosis in 3 patients: Case report.

RATIONALE: Alveolar echinococcosis (AE) is a rare but highly malignant form of echinococcosis caused by Echinococcus multilocularis. There have been very few reports on multiple-organ AE, especially AE in bones. Here we report 3 rare cases of disseminated multiple-organ AE from western China and its neighboring areas. PATIENT CONCERNS: Patient 1 had back and left hip pain, headache, and weakness in left lower limb, often with minor epilepsy and fluctuation of blood pressure. Lower limbs Babinski sign was positive and muscular tension was above normal range. The second patient had pain in lower limbs and chest discomfort without fever, cough, sputum, chest tightness, or hemoptysis. Patient 3 had masses and pain in the back side of his right shoulder. DIAGNOSES: The patients had been treated for AE multiple times and were positive for serum hydatid antigens. They were diagnosed as multiorgan AE involving liver, spinal cord, and many other organs. INTERVENTIONS: The patients had undergone surgeries to decompress the spinal cord, remove lesions from tissues as required, and were put on albendazole for at least 2 years. OUTCOMES: The patients responded well and AE recurrence has not occurred. LESSONS: All 3 cases experienced multiple recurrences of AE due to missed diagnosis, misdiagnosis, or inappropriate treatment, which resulted in metastatic multiorgan AE. These cases demonstrated the need for more policy attention to battle AE endemic in western China.

Subretinal echinococcosis: a case report.

BACKGROUND: Echinococcosis is a dangerous zoonotic parasitic disease. Ocular echinococcosis is very rare, especially the hydatid cysts in subretinal space. We present a case of subretinal echinococcosis and management. CASE PRESENTATION: A 37-year-old man with subretinal echinococcosis who developed panuveitis and visual impairment. The patient lives on agriculture and animal husbandry, which made him susceptible to parasitic infection. He had severe panuveitis and blurred vision on arrival at hospital. According to his ocular examination and systemic review, the subretinal echinococcosis diagnosis was made. The patient received pars plana lensectomy and pars plana vitrectomy. The lesion underneath his retina was removed, and histopathology examination confirmed the subretinal echinococcosis diagnosis. CONCLUSIONS: Echinococcosis is a dangerous zoonotic parasitic disease in pastoral areas. Ocular echinococcosis is usually secondary to systemic infection. Although the incidence is rare, the disease could lead to destructive visual function impairment.