Analysis of factors affecting outcomes of pregnancy complicated by Echinococcus: an algorithm for approach and management.

PURPOSE: The management of hydatid disease (HD) co-occurring with pregnancy remains a challenge for physicians. We aimed to determine factors that were related to fetal and maternal outcomes in HD complicated pregnancies and then develop an approach/treatment algorithm. METHOD: All patients at the participating hospitals were first analyzed to determine whether they had HD. Only patients diagnosed with HD during the course of their pregnancy were included. Certain cyst-related factors (diameter, localization, increase in size, and viability) and certain pregnancy-related factors (treatments, gestational week, maternal co-morbidities, and delivery type) were investigated. Nonlinear principal component analysis (NPCA) was performed to determine the relationships between the categories of variables. RESULTS: Out of 12,926 pregnancies, 27 cases were diagnosed with HD. In 13 cases, each developed at least one fetal problem. Using Albendazol in first trimester, presence of an active cyst, increased diameter by more than 1 cm during pregnancy and a cyst diagnosed in the second trimester were associated with at least one fetal problem. According to the NPCA results, cyst diameter when first diagnosed was related to fetal outcomes; a cyst greater than 10 cm was associated with "at least one fetal problem". Cysts 5-10 cm in diameter were in a neutral position, while 2-5 cm in diameter were in the "no problems" group. CONCLUSIONS: HD mostly affects fetus. If cyst-related and pregnancy-related variables are optimal, close follow-up on a monthly is the best course of action. However, in high-risk conditions, percutaneous interventions or surgery should be considered.

[Physiological characteristics of Echinococcus and their association with interventions against echinococcosis].

Alveolar and cystic echinococcosis are important zoonotic diseases caused by the dog/fox tapeworms of Echinococcus granulosus and E. multilocularis, which are distributed in almost whole the world. The diseases remarkably impact on the people's health and economic development of communities. Echinococcus tapeworms need two mammalian animals to complete their lifecycle. The worms undergo different developmental stages (adult, egg/oncosphere, cyst, and protoscolex). Each stage has its own distinct physiological characteristics. We summarize the characteristics and emphasize that some features that strongly impact on design of control program. Based on the lifecycle of these worms, two stages are infectious, one is egg the only stage for primarily infecting humans and intermediate host, and another stage is protoscolex, the only stage for infecting the definite hosts of the worms. Eggs are produced by the adult worms parasitized in the intestine of definite hosts. It takes 45 days for eggs becoming mature in dogs. With this feature of the tapeworm, New Zealand and Tasmania in Australia designed control program for deworming 8 times annually with an interval between deworms at 45 days. E. multilocularis takes 28-30 days in dog/fox producing mature eggs. Given that co-existence of E. granulosus and E. multilocularis in western China, a control measure so called "prepatent deworming control measure" has been used in these endemic areas with dosing worms in dogs every month. It normally takes 12-15 months for producing protosocleces in E. granulosus cysts in sheep. If meat markets attract most lambs, that is an effective measure for controlling cystic echinococcosis given that there are no protoscoleces produced from those lambs. In addition, Echinococcus has its own unique biological characteristics, such as sexual reproduction and asexual reproduction, single-cell layer structure of cyst, bidirectional development of protoscoleces induced by bile salts, and long term of infection causing host asymptomatic reaction make the parasites a models for addressing some biological and biomedical issues. And more, hydatid cyst fluid is the antigen resource for identifying diagnostic reagents; the specific gene expressed in oncospheres has been developed as an effective vaccine used for control program. With the development and application of high-throughput omics, including genomics, transcriptomics and proteomics, we can use the physiological characteristics of Echinococcus for searching diagnostic reagents, developing preventive vaccines and identify new drug targets.

[(MODERN EPIDEMIOLOGICAL SITUATION ON ECHINOCOCCOSIS IN THE TYUMEN REGION)].

The conducted research allow to conclude that the most developed agricultural area of the Tyumen region with a population comprising of 14,1% of the rural population, is endemic for echinococcosis. The incidence has a pronounced tendencyto increase (Tgrowth=+5.7 percent). Installed a statistically significant difference in the incidence ofechinococ- cosis in two selected areas in endemic zones (7 rural and 3 urban) living in it 60,7% of the population of the Tyumen region; - risk groups in the incidence of echinococcosis are local villagers, containing farm animals and dogs; urban residents who regularly attend the nearby forest to gather berries and wild plants, persons working age, hunters with years of experi- ence; the risk of infection is June - September. The first place among agricultural animals as an intermediate the hosts of Echinococcus is a sheep, the second place - the cattle, the third place - pigs, the prevalence in endemic incidence of echinococcosis people area respectively in 5.6 times, 2.7 times and 3.8 times higher than in non-endemic areas with no registration morbidity people. The obtained results allow to recommend the measures to optimise epidemiological surveil- lance and parasitological monitoring of echinococcosis: a clearer and more coherent relationship and interaction between agencies, medical organizations, Rospotrebnadzor, Rosselkhoznadzor and Management ofhunting economy; the expan- sion of research on contamination ofthe environment by the hexacanth cyst on the territories of settlements and priusadeb- nyh plots (soil, bottom sediments, especially not having drains, water storage tanks); mass serological screening of the population, primarily in rural endemic areas, to determine the immune segment, risk groups among sex, age and profes- sional groups to assess the level of endemic diseases; clarify the ways and factors of transmission in specific conditions, it is important for the organization of effective prevention measures.

[(EXPERIENCE WITH ALBENDAZOLE TREATMENT IN CHILDREN WITH CYSTIC ECHINOCOCCOSIS)].

The tolerability and efficiency of specific chemotherapy with albendazole were analyzed in 18 patients with cystic echinococcosis at various sites. The most common complication of albendazole treatment was its hepatotoxic effect. Al- bendazole chemotherapy during at least its 3 cycles was observed to be highly effective in preventing recurrent echinococ- cosis in children. If there were small-sized hydatid cysts in the liver and lung, there was a reduction in their number and sizes after 4-5 albendazole treatment cycles.

Living donor liver transplantation for Echinococcus Alveolaris: single-center experience.

Echinococcus alveolaris (EA) causes a hepatic zoonotic infection and behaves like a malignant tumor during invasion. Liver transplantation (LT) is the only curative treatment option for this unresectable disease. Here, we share our experience with living donor liver transplantation (LDLT) due to EA from the time between March 2002 and November 2014 at the Liver Transplantation Institute of Inönü University. Ten patients (mean age, 38.6 years) undergoing LDLT because of unresectable EA were evaluated preoperatively, and the operative and follow-up data were analyzed retrospectively. The mean time interval between diagnosis and LT was 27 months. The mean operation time and mean intraoperative blood requirement were 613 minutes and 4 units of packed red blood cells, respectively. Diaphragmatic resections were performed in 3 patients, and vena cava replacement was performed in 2 patients because of difficulties in removing the extended disease. The local recurrence and distant metastasis rates were 10% and 20%, respectively. The mean survival time was 19.5 months (range, 0-54 months), and the mortality rate was 30%. Unresectable hepatic alveolar echinococcosis is a rare indication for LT and presents some technical difficulties during surgery because diaphragmatic resection, vascular reconstruction, or multiple blood transfusions may be needed. LDLT can be performed successfully in patients with this rare infectious disease, with careful follow-up for potential recurrence and metastasis and administration of low-dose immunosuppressive agents.

[Improvement of surgical treatment of echinococcosis].

A hydatid disease is a serious public health problem in Kazakhstan. Surgical treatment is the main treatment of hepatic echinococcosis. Considering high rate of recurrence of the disease the search for new methods of surgical treatment remains relevant. The aim of the study was to improve the efficiency and safety of surgical treatment of hepatic echinococcosis; to develop a new physical method for cleaning residual cyst cavity. Experimental and clinical investigation of IED effects on hydadtid cyst embryonic element was studied. In order to monitor the effectiveness of developed method the morphological study of histological material was done. В It is experimentally proved that the optimal mode of impact of IED on germinal elements of hydatid cysts at which their complete destruction, is the exposure 120 seconds by 200 ml of liquid or 0,6 seconds per 1 ml volume. The method of cleaning of residual cavity with IED was developed. By this method for the years 2007-2013, 25 patients were operated on, of which there were 13 (52,0%) men, 12 (48,0%) women. The mean age was 37,8В±0,8. Single cysts observed in 16 (64.0 %) cases, multiple in 9 (36.0%). Primary cysts were observed in 20 (80.0%) cases, recurrent 5 (20.0%). Size up to 10 cm cyst verified in 8 (32.0%) cases, from 10cm to 20 cm in 15 (60.0 %) cases, 20 cm or more - 2 ( 8.0%). To localize the left lobe of the liver was struck in 24.0% of cases, the right to 76.0%. The cysts were located in the right lobe of the liver in 76,0%, left lobe in 24,0%. Echinococcectomy was performed in 22 (53.0%) patients, resection-2 (12.0%), pericystectomy-1 (6.0%). Average estimated blood loss was 320.6 ml. Blood transfusion was performed in only 1 (4.0%) patients. Postoperative complications in the form of left-hand reactive pleuritis were marked in 3 (12.0%) cases. Average period of hospitalization amounted to 12,8В±2,2 bed-days. Echinococcectomy supplemented by cleaning of the residual cavity impulse electric discharge may be an alternative to radical methods of surgical treatment of hepatic echinococcosis, due to the fact that IED has a destructive effect against Echinococcus germinal elements, simple to use, safe.

[Comparative efficacy of albendazole and mebendazole oily suspensions in albino mice with experimental larval alveococcosis].

The comparative efficacy of albendazole and mebendazole oily suspensions (AOS and MOS) was studied in an experimental model of experimental larval alveococcosis in albino mice. The animals were intragastrically injected with the agents once daily for 40 days on day 35 after intraperitoneal inoculation with E. multilocularis acephalocysts. They were dissected 29 days after treatment termination (103 days following inoculation) and the rate of infestation and viability and the degree of maturity of developed alveococcosis larvocysts (AL) were determined. The AOS and MOS efficiency estimated by the mean mass of AL per animal was 83.3 and 98.1%, respectively; whereas the similar indicator calculated by one largest AL weight per animal found among all the animals in the compared groups was equal to 57.7 and 96.9%, respectively. Under the equal conditions of solubilization in vegetable oil, the biological activity and bioavailability of mebendazole were shown to increase to a much greater extent than those of albendazole. The findings suggest that the use of mebendazole is promising for designing new vegetable oil-based formulations of the agent.

[Study of the therapeutic activity of nocodazole on experimental models of larval alveococcosis].

The therapeutic activity of parenteral nocodazole was studied on four larval alveococcosis models: golden hamsters (Mesocricetus auratus), Djungarian hamsters (Phodopus sungorus campbelli Thomas), albino rats (Rattus rattus albus), and cotton rats (Sigmodon hispidus) at the late stage of E. multilocularis invasion. The agent (aqueous suspension) was intraperitoneally, intramuscularly, and subcutaneously injected in daily doses of 0.125-0.5 g/kg as 1-8 injections. Mebendazole was the drug of comparison. In the golden hamsters, one intraperitoneal nocodazole injection in daily doses of 0.25 and 0.5 g/kg caused death of all alveococcosis larvocysts whereas mebendazole 0.5 g/kg proved to be ineffective. In the Djungarian hamsters, one intraperitoneal nocodazole injection in a dose of 0.25 g/kg was fatal to alveococcosis larvocysts in 3 (75%) of the 4 animals. In the albino rats, nocodazole once administered intraperitoneally in a dose of 0.125 g/kg caused no death of all parasitic larvocysts, but inhibited their growth by 94.4%. The found alveococcus larvocysts were dead in all the cotton rats receiving nocodazole intramuscularly and subcutaneously 8 times in daily doses of 0.125 and 0.2 g/kg, respectively. Larvocystic death induced by nocodazole in animals with intensive invasion was accompanied by the high rate of collapse in larvocysts.

[A case of alopecia in a patient with hydatid disease treated with Nemozole (albendazole)].

The paper describes the development of alopecia with a patient with echinocccosis alveolaris during treatment with Nemozole (albandazole). To decide to continue or to discontinue Nemozole treatment in the development of alopecia, the patient should be given full information on the risk of alopecia to his life and quality of life as compared to the sequels of recurrent hydatid disease when Nemozole is discontinued.

[Potential risk factors for alveolar echinococcosis in humans in Poland]. / Potencjalne czynniki ryzyka zachorowania na alweolarna echinokokoze dla ludzi w Polsce.

The high prevalence of Echinococcus multilocularis recorded in foxes in Poland creates the risk of alveolar echinococcosis in humans. Sensational press releases on threats which had appeared during last few years do not favour the rational opinion on the risk of this dangerous disease. Based on accessible epidemiological data the potential risk factors of alveococcosis are addressed in this article.

Atypical radiological findings in cerebral hydatid disease.

Cerebral hydatid disease is very rare, representing only 2% of all cerebral space occupying lesions. The diagnosis is usually based on a pathognomonic CT pattern. Exceptionally, the image is atypical raising suspicion of many differential diagnoses such as intracerebral infectious, vascular lesions, or tumors. We report 2 atypical cases of cerebral hydatid cysts diagnosed in a 21, and a 24-year-old woman. The CT scan results suggest oligodendroglioma in the first case and brain abscess in the second. An MRI was helpful in the diagnosis of the 2 cases. Both patients underwent successful surgery with a good outcome. The hydatid nature of the cyst was confirmed by histology in both cases.

The pathology, phylogeny, and epidemiology of Echinococcus ortleppi (G5 genotype): a new case report of echinococcosis in China.

BACKGROUND: Cystic echinococcosis (CE), caused by the larval stage of the complex Echinococcus granulosus sensu lato (s.l.), is a zoonotic parasitic disease with a high social burden in China. E. ortleppi is a species (formerly genotype 5 of E. granulosus s.l.) with unique epidemic areas (tropical areas), transmission patterns (mainly cattle origin), and pathological characteristics (large and small hook lengths) compared to other species that cause CE. A 19-year-old female patient in an area with no history of echinococcosis in Guizhou Province, China, was diagnosed with E. ortleppi infection in 2019. This study is to understand the source of this human E. ortleppi infection. METHODS: We performed computer tomography (CT) scans, surgical operation, morphological sectioning, molecular diagnosis, phylogenetic analyses, and epidemiological investigation in Anshun City, Guizhou Province, China in 2019. RESULTS: The patient presented with intermittent distension and pain in the upper abdomen without other abnormal symptoms. Routine blood examination results were normal. However, abdominal CT revealed a fertile cyst with a diameter of approximately 8 cm, uniform density, and a clear boundary, but without an evident cyst wall in the right lobe of the liver. The cyst was fertile, and phylogenetic analyses revealed that the isolates represented a new E. ortleppi genus haplotype. A result of 10‒14 years incubation period with indigenous infection was considered available for the case through the epidemiological survey. CONCLUSIONS: CE due to E. ortleppi infection can be confused with other diseases causing liver cysts, resulting in misdiagnosis. A transmission chain of E. ortleppi may exist or existed in the past in the previously considered non-endemic areas of echinococcosis in southwestern China.

New aspects of neotropical polycystic (Echinococcus vogeli) and unicystic (Echinococcus oligarthrus) echinococcosis.

Of the four species of the genus Echinococcus (Cestoda) distinguished by biological and morphological characteristics, two species, E. vogeli and E. oligarthrus, occur widely in the Neotropics. Approximately 200 cases of polycystic echinococcosis (PE) have been recorded from 12 countries in South America. Following early proliferation of E. vogeli in the human host, typically in the liver, the metacestode usually spreads in the peritoneal and pleural cavities, and numerous organs may be invaded. The clinical characteristics of PE in 81 patients with sufficient information are reviewed. Type I disease consists of polycysts in the liver and abdominal cavity (37% of the patients had this characteristic); type II is similar to type I but also includes hepatic insufficiency (26%); type III consists of cysts in liver and chest (14%); type IV consists of cysts only in the mesenteries (16%); and type V consists of cysts calcified in liver and lung (4%). The percentage of patients with polycysts in the liver was 81%, and the percentage of patients with polycysts in the chest was 14%. PE is most ready diagnosed by geographic origin of the patient and by means of ultrasound or computerized tomography scanning showing cysts and calcifications. The highest mortality was for patients with type II disease, due to hepatic failure and its complications. There were five patients who died due to surgical accidents, whereas 35 cases had uncomplicated surgery. Twenty-three patients died of PE, making the total mortality 29% (23 of 78 cases). None of the 13 patients treated only with albendazole, the most efficacious treatment, was completely cured. PE represents a severe medical problem in South America. A reevaluation of the characteristics of the metacestode of E. oligarthrus indicated that it is unicystic. Only three human cases are known (two with infection in the orbit and one with infection in the heart). The metacestode of E. oligarthrus, in contrast with that of E. vogeli, consists of a spherical, fluid-filled vesicle that enlarges concentrically and is not known to undergo exogenous proliferation.

Interactions between hydatid cyst and regulated cell death may provide new therapeutic opportunities.

Cystic echinococcosis and alveolar echinococcosis are chronic zoonotic infections, transmitted throughout the world. Development of the cestode larval stages in the liver and lungs causes damage to intermediate hosts, including humans. Several pathways leading to the suppression of host immune response and the survival of the cysts in various hosts are known. Immune response modulation and regulated cell death (RCD) play a fundamental role in cyst formation, development and pathogenesis. RCD, referring to apoptosis, necrosis and autophagy, can be triggered either via intrinsic or extrinsic cell stimuli. In this review, we provide a general overview of current knowledge on the process of RCD during echinococcosis. The study of interactions between RCD and Echinococcus spp. metacestodes may provide in-depth understanding of echinococcosis pathogenesis and open new horizons for human intervention and treatment of the disease.

TITLE: Les interactions entre kyste hydatique et mort cellulaire régulée peuvent ouvrir de nouvelles perspectives thérapeutiques. ABSTRACT: L'échinococcose kystique et l'échinococcose alvéolaire sont des infections zoonotiques chroniques, transmises dans le monde entier. Le développement des stades larvaires des cestodes dans le foie et les poumons provoque des lésions chez les hôtes intermédiaires, y compris les humains. Plusieurs voies menant à la suppression de la réponse immunitaire de l'hôte et à la survie des kystes chez divers hôtes sont connues. La modulation de la réponse immunitaire et la mort cellulaire régulée (MCR) jouent un rôle fondamental dans la formation, le développement et la pathogenèse du kyste. La MCR, faisant référence à l'apoptose, à la nécrose et à l'autophagie, peut être déclenchée par des stimuli intrinsèques ou extrinsèques. Dans cette revue, nous fournissons un aperçu général des connaissances actuelles sur le processus de la MCR au cours de l'échinococcose. L'étude des interactions entre les métacestodes d'Echinococcus spp. et la MCR pourrait permettre d'approfondir la compréhension de la pathogénie et d'ouvrir de nouveaux horizons pour l'intervention humaine et le traitement de l'échinococcose.

Complications of extrahepatic echinococcosis: fistulization of an adrenal hydatid cyst into the intestine.

Echinococcal cysts are usually found in liver and lungs, but any other organ can potentially be involved. Extrahepatic disease due to hydatid cyst may develop in the abdominal and pelvic cavity, aside from in other less common locations, which may make both diagnosis and treatment more complex. We present a rare case of extrahepatic echinococcosis in a 70-year old patient with a 4-d history of dull abdominal pain, anemia within the transfusion range and fever. She underwent surgery for left renal hydatid cysts 30 years ago. After non operative treatment, imaging studies showed a calcified hydatid cyst in a retrogastric location communicating with a proximal jejunal loop. En-block resection of the mass together with the adrenal gland was performed including closure of the enteric fistula. Anatomic pathology confirmed the diagnosis of a calcified hydatid cyst of left adrenal origin. Surgery is the treatment of choice and most authors recommend removal of cyst and adrenal gland.

Primary cerebral intraventricular hydatid cyst: a case report and review of the literature.

Intracranial hydatid cysts, which are common in certain areas worldwide, almost always develop at an intraparenchymal site. However, the literature on intraventricular hydatid cysts consists of only 6 independent case reports and about 30 cases that are described in large series. We report on a 10-year-old girl who was admitted with an intracranial cyst. She complained of headache of 10 months' duration that had intensified significantly over the 3 weeks immediately before her admission. The results of a neurologic examination showed bilateral papilledema and slight left hemiparesis. Magnetic resonance imaging revealed a right temporo-parieto-occipital cystic lesion that was causing the shifting of the midline structures to the contralateral side. The giant cyst was successfully removed without rupture. The possibility of infection with Echinococcus granulosus should be included in the differential diagnosis of unspecific neurologic symptoms such as a progressively worsening headache, especially in pediatric patients from the geographic areas in which that parasite is endemic.

Giant hydatid liver cyst. Management of residual cavity.

The management of the residual cavity during surgical intervention for giant hydatid liver cysts is often a challenging problem. Herein, is described the case of a 55-year-old female patient who was diagnosed with a giant hydatid cyst occupying almost the entire left lobe of the liver. After partial cystectomy, the residual cavity was managed by combination of suture obliteration with omentoplasty. The patient had an uneventful postoperative course and was discharged eight days later. The clinical presentation, diagnostic work-up and surgical management of the patient are discussed, along with a review of the literature.