Even a worm will turn: An atypical presentation of hydatid disease.

Hydatid disease (cystic echinococcosis) is a neglected zoonosis, often incidentally detected in its late stages. The clinical manifestations depend on the location and dimensions of the cysts, with the liver and lungs frequently affected. This case report describes thrombocytopenia, an unusual haematological complication of hydatid disease. We use this case to highlight the role that platelets play in various parasitic infections and to advocate for further research into the role of platelets in hydatid disease. Contribution: We draw attention to a less well-known complication of hydatid disease.

Intramuscular Hydatid Cyst of the Thigh: A Rare Presentation in an Elderly Patient.

Intramuscular hydatid cysts are an uncommon presentation of echinococcosis, with most cases occurring in the liver and lungs. This case report describes an 81-year-old male who presented with a painless, progressively enlarging swelling in the right thigh noticed over the past year. The patient's history included trauma to the area from an animal-related incident five years earlier. Physical examination revealed a firm, irregular, and non-tender mass. Ultrasonography suggested a multiloculated cystic lesion with calcification, raising suspicions of a hematoma or hydatid cyst. Fine-needle aspiration cytology indicated an organized hematoma with secondary calcification. Given the diagnostic uncertainty, surgical excision revealed a 3x3 cm hydatid cyst in the intramuscular plane. A histopathological examination confirmed the diagnosis. The patient's postoperative course was uneventful, with no signs of recurrence at the three-month follow-up. This case underscores the importance of considering hydatid disease in the differential diagnosis of intramuscular swellings, particularly in patients with relevant exposure histories.

Giant cerebral hydatid cyst with intraventricular extension: A rare case report with imaging findings.

Hydatid cyst is the condition caused by larvae of the parasite Echinococcus granulosus, usually involving the liver, lung, and spleen. Involvement of the cerebrum with a hydatid cyst is a rare entity, comprising 2%-3% of all cases of hydatidosis. Intraventricular extension of cerebral hydatid cysts occurs in only a limited percentage of cases. Cerebral hydatid cysts can present with nonspecific symptoms, usually with features of raised intracranial pressure. Therefore, it is crucial to consider cerebral hydatid cysts as a potential diagnosis, especially in pediatric patients with nonspecific neurological symptoms, particularly those from areas endemic to the parasite. We report a case of a 9-year-old girl who presented with progressive headache and vomiting, with imaging findings suggestive of a giant hydatid cyst in the brain. She was managed surgically with a good outcome.

Recurrent Hydatid Disease of Temporal Bone and Skull Base: A Case Report and Literature Review.

Hydatid disease is a parasitic infestation caused by Echinococcus granulosus. The disease is rare in the head and neck region with varying presentations. We present a rare case of recurrent hydatid disease of the temporal bone with intracranial involvement; and the treatment thereof. Hydatid disease is endemic in few parts of the world, its occurrence in head and neck region is very rare. The commonest causative organism is E. granulosus giving rise to cystic hydatid disease. Most of the former are asymptomatic, but can give rise to symptoms because of their mass effects or rupture. Our case is a 38 year male presenting to ENT department with recurrent left ear discharge, giddiness, headache and facial palsy having operated elsewhere twice in the past. The patient was investigated by Computed Tomography (CT) scanning and Magnetic Resonance Imaging (MRI) of temporal bones, head and neck regions. Which showed soft tissue attenuation of middle ear cleft and multiple cystic lesions in the middle and posterior cranial fossae indicating intracranial extension of disease. We operated for left subtotal petrosectomy with vestibular labyrinthectomy. During the perioperative period he was treated with Albendazole. Patient remains clinically and radiologically asymptomatic (post surgery 1 year) till date of this manuscript submission. Hence, we report the recurrent hydatid cyst in the temporal bone and skull base, which was managed by combination of surgical and medical treatment.

Ecoepidemic modeling and dynamics of alveolar echinococcosis transmission.

Alveolar echinococcosis, transmitted between definitive hosts and intermediate hosts via predation, threatens the health of humans and causes great economic losses in western China. In order to explore the transmission mechanism of this disease, an eco-epidemiological lifecycle model is formulated to illustrate interactions between two hosts. The basic and demographic reproduction numbers are developed to characterize the stability of the disease-free and endemic equilibria as well as bifurcation dynamics. The existence of forward bifurcation and Hopf bifurcation are confirmed and are used to explain the threshold transmission dynamics. Numerical simulations and bifurcation diagrams are also presented to depict rich dynamics of the model. Numerical analysis suggests that improving the control rate of voles will reduce the risk of transmission, while the high predation rate of foxes may also lead to a lower transmission risk, which is different from the predictions of previous studies. The evaluation of three control measures on voles implies that, when the fox's predation rate is low (high), the chemical (integrated) control will be more effective.

Pulmonary hydatid cyst emergence post laparoscopic ovarian drilling in a clear preoperative chest: A novel case report.

Echinococcus granulosus is the parasite that causes hydatid disease. The liver is the most often affected organ, followed by the lungs and other organs. We present the case of a 24-year-old woman who had no notable medical history prior to the presentation of a persistent cough and mild chest discomfort 3 weeks after laparoscopic ovarian drilling surgery. There were upper lobe opacities on the right side of the chest X-ray. Serology was used to confirm the diagnosis of a hydatid cyst, with computed tomography (CT) providing additional supporting evidence. This case demonstrated that, especially in endemic areas, patients presenting with atypical respiratory symptoms should have rare infectious etiologies taken into consideration during the postoperative period. After the cyst was successfully surgically removed, the patient received albendazole for antiparasitic treatment. She experienced an uneventful recovery and exhibited no clinical symptoms at follow-up.

Hydatid cyst of the pancreas revealed by acute pancreatitis: A case report.

INTRODUCTION AND IMPORTANCE: A hydatid cyst is a parasitic disease caused by the development of the larval form of Echinococcus granulosus (1). The liver and lungs are the most frequent locations, while pancreatic involvement is unusual (<1 %), even in countries where hydatid disease is endemic (2). We report a rare case of a hydatid cyst of the pancreas, revealed by acute pancreatitis. Through this observation and a review of the literature, we discuss the diagnostic and therapeutic challenges of this rare localization of a hydatid cyst. CASE PRESENTATION: A 60-year-old man from rural southwestern Tunisia, with a medical history of cardiac conduction disorder such as atrioventricular block treated with a pacemaker and type II diabetes for 10 years, presented with epigastric pain and periodic episodes of vomiting for the past 2 years. The patient noticed a recent exacerbation of the pain over the last 3 months. On physical examination, there was no jaundice or fever. Mild tenderness of the entire supramesocolic region of the abdomen was revealed, and no palpable mass was evident. Biological tests showed an elevation of lipase to 5 times the normal level and an increased leukocyte count of 12,000/dL. Liver function tests were normal. The CT scan indicated pancreatitis, Balthazar grade E, with cystic formation in the tail of the pancreas extending into the dilated Wirsung duct. The echinococcal immunological test (ELISA) was positive, and tumor markers (CEA, CA 19-9) were negative. The diagnosis of a pancreatic hydatid cyst with pancreatitis was considered. The patient underwent surgery 2 months after the onset of pancreatitis. A left splenopancreatectomy was performed. Histopathological examination confirmed the presence of a hydatid cyst. Following an uneventful postoperative period, the patient was discharged on the 7th postoperative day. The patient was treated with Penicillin V (Oracillin®) 2 million IU per day for 2 years and Albendazole 800 mg per day for 2 months after surgery. At 1 year post-surgery, no hydatid recurrence was detected, and hydatid serology was negative. CLINICAL DISCUSSION: Finally, We reported the case of a rare observation of hydatid cyst of the pancreas revealed by acute pancreatitis. CONCLUSION: We highlighted the necessity to consider the hydatid origin when evaluating complicated cystic pancreatic tumors, especially in endemic regions.

Characteristics of the imaging diagnosis of alveolar echinococcosis.

Alveolar echinococcosis (AE) primarily manifests in the liver and exhibits characteristics resembling those of slow-growing malignant tumours. Untreated Echinococcus multilocularis infection can be lethal. By infiltrating the vascular systems, biliary tracts, and the hilum of the liver, it might lead to various problems. Due to its ability to infiltrate neighbouring tissues or metastasize to distant organs, AE can often be mistaken for malignancies. We present a concise overview of the epidemiological and pathophysiological characteristics of AE, as well as the clinical manifestations of the disease. This article primarily examines the imaging characteristics of AE using various imaging techniques such as ultrasonography, computed tomography (CT), magnetic resonance imaging, diffusion-weighted imaging, and virtual non-enhanced dual-energy CT. We additionally examined the contribution of radiography in the diagnosis, treatment, and monitoring of the condition.

Cerebral Echinococcosis Mimicking a Brain Tumour in Rural Southwest Nigeria.

Echinococcosis is a zoonosis caused by tapeworms of the genus Echinococcus. Cerebral echinococcosis (CE) poses a significant public health challenge due to its neglected status. It is endemic in Central Asia, Africa and parts of South America, with prevalence estimated to be 1.18-3 per 100,000 population in Iran. We report the case of a 45-year-old male who presented with seizure disorders and was evaluated and treated for a neoplasm, with complete excision of the lesion. Pathologic examination revealed the characteristic echinococcal (hydatid) cyst. The patient recovered fully. As CE is a great imitator of several other conditions in endemic areas, a high index of suspicion must be maintained in endemic countries.

L'échinococcose est une zoonose provoquée par des ténias du genre Echinococcocus. L'échinococcose cérébrale (EC) pose un défi de santé publique important en raison de son statut négligé. Elle est endémique en Asie centrale, en Afrique et dans certaines parties de l'Amérique du Sud, avec une prévalence estimée entre 1,18 et 3 pour 100 000 habitants en Iran. Nous rapportons le cas d'un homme de 45 ans qui a présenté des troubles épileptiques et a été évalué et traité pour une tumeur, avec excision complète de la lésion. L'examen pathologique a révélé le kyste échinococcique (hydatique) caractéristique. Le patient s'est complètement rétabli. Comme l'EC est un grand imitateur de plusieurs autres conditions dans les zones d'endémie, un indice de suspicion élevé doit être maintenu dans les pays d'endémie. MOTS CLÉS: Tumeur cérébrale, rapport de cas, échinococcose cérébrale, sud-ouest du Nigeria.

Percutaneous Aspiration Injection and Re-aspiration as A Minimally Invasive Treatment for Spinal Cystic Echinococcosis: A Case Report.

Cystic echinococcosis is a parasitic disease with significant importance for public health in endemic regions. Spinal cystic echinococcosis, however, is a rare form that may lead to severe complications due to its localization. In this manuscript, we presented a 16-year-old male patient who admitted with abdominal and back edema for 2 months, evaluated with preliminary diagnoses of Pott's abscess and malignant mass, subsequently diagnosed with spinal cystic echinococcosis. It was concluded that cystic echinococcosis should be considered in differential diagnosis of large cystic masses and percutaneous aspiration, injection, reaspiration method might be a safe and effective treatment option particularly for cases of complicated spinal cystic echinococcosis.

Complete removal of a ruptured pulmonary hydatid cyst during conscious sedation bronchoscopy: A case report and literature review.

The complete removal of a pulmonary hydatid cyst by bronchoscopy occurs rarely in clinical practice. We describe a 22-year-old male originally from Lebanon, with suspected hydatid cyst rupture on computed tomography chest after experiencing sudden onset fevers and cough whilst taking empiric anthelmintic therapy. Bronchoscopy revealed white gelatinous material in the posterior segment of the left lower lobe. The complete membranes of a hydatid cyst were removed with grasping forceps. Histologic examination confirmed the diagnosis of echinococcosis.

Use of the EmsB microsatellite-based next generation sequencing for genotyping of Echinococcus granulosus sensu lato in hydatid cyst tissue samples from animals and humans.

Echinococcus granulosus (Batsch, 1786), a cestode of the Teniidae family, causes human cystic echinococcosis (CE) also known as hydatid disease. Echinococcus granulosus sensu lato includes the G1, G3, G4, G5, G6/7 and G8/10 genotypes which are known to cause human CE. This study aimed to differentiate genotypes of E. granulosus s.l. complex by employing EmsB, a tandemly repeated multilocus microsatellite, using next-generation sequencing (MIC-NGS). Human and animal histopathology-confirmed hydatid cyst tissue samples and reference DNA samples of E. granulosus G1, G3, G4, G5, G6/7 and G10 underwent MIC-NGS assay with custom primers amplifying a 151 bp EmsB DNA fragment. NGS data were analysed using online Galaxy analysis pipeline, a phylogenetic tree was constructed by MEGA software, and haplotype networking was performed with PopArt 1.7. All sixty samples (49 from animals and 11 from humans) included were successfully identified and genotyped with a 100 % success rate. The study showed improved discrimination power to distinguish all study samples including closely related E. granulosus s.s. genotypes G1-G3. The maximum likelihood tree reaffirmed the monophyly of E. granulosus s.l. The median-joining haplotype networking revealed 12 distinct haplotypes. In conclusion, MIC-NGS assay was shown to be sensitive, specific and simple to apply to clinical samples offering a powerful discriminatory tool for the genotyping of E. granulosus s.l.

Hydatid cysts in the mesocolon mimicking peritoneal pseudomyxoma in a post-appendectomy patient: A case report.

We aimed to present a case of two mesocolonic hydatid cysts that mimicked the presentation of peritoneal pseudomyxoma. Hydatidosis is a zoonotic parasitic infection caused by the cestode Echinococcus spp., whose larval stage affects various organs. The present case describes a 40-year-old male patient who presented with severe lower abdominal pain and was diagnosed with acute appendicitis. The patient underwent an appendectomy and was later referred to an oncology surgery clinic because of imaging findings suggestive of peritoneal pseudomyxoma or carcinomatosis. A video-assisted laparoscopic procedure revealed two cysts and microscopic findings confirmed hydatid cysts. The patient was from a hydatidosis-endemic region of southern Brazil. This case highlights the diagnostic challenges and the need for a multidisciplinary approach and careful histopathological analysis in patients with complex abdominal conditions. This also demonstrates the importance of disseminating knowledge about this condition and its management.

Osteoarticular hydatid disease: Epidemiological features, diagnosis and treatment.

Osteoarticular hydatid disease is a very rare disease. Its diagnosis is challenging and often late because of the nonspecific clinical and radiological features. Through this study, we aim to describe the epidemiological, clinical and radiological features of a series of patients diagnosed with osteoarticular hydatid disease. Ten patients were included. The average age was 40,5 years [25-75]. The onset of symptoms was progressive in all cases with a mean diagnosis delay of 11 months [1-48]. Most frequent locations were spinal (n=7), pelvic (n=3) and costal (n=3). Hydatid serology was positive in seven screened patients. Seven patients underwent surgery and all of them received albendazole postoperatively with an average of 8 monthly courses. Total remission was reported in only one patient. There was no significant difference in the clinical outcome based on the number of albendazole courses. The diagnosis of osteoarticular hydatid disease is often challenging because of its progressive onset and nonspecific clinical signs. Epidemiological setting, immunological screening and imaging features contribute to an earlier diagnosis. Its management requires both surgery and long-term antiparasitic treatment.

Chemotherapy for the treatment of alveolar echinococcosis: Where are we?

Alveolar echinococcosis (AE) is a severe liver disease due to infection with the Echinococcus multilocularis larval stage, called the metacestode. Management of AE is based on benzimidazole chemotherapy (albendazole or mebendazole), associated with surgery when possible. Benzimidazoles are the only compounds recommended for the treatment of AE; however, these are parasitostatic, which means that the parasite can resume growth when treatment is interrupted. Also, benzimidazoles can cause liver dysfunction which may prevent their use. Numerous drugs have been reported to have in vitro activity against E. multilocularis, but few had satisfactory in vivo activity, and none were clearly more effective than benzimidazoles. These drugs belong to various therapeutic categories including anti-infective agents (e.g. amphotericin B, mefloquine, pentamidine derivatives), anti-neoplastic compounds (e.g. imatinib, nilotinib, bortezomib), plant-extracted compounds (e.g. thymol, crocin, carvacrol) and others (e.g. metformin, verapamil, thiaclopride). These treatments are generally of limited interest due to their toxicity, their unfavorable pharmacokinetics, or the scarcity of studies involving humans. Apart from benzimidazoles, only amphotericin B, mefloquine and nitazoxanide have been reported to be used for human AE treatment, with unsatisfactory results. Few studies have aimed at developing innovative strategies for AE drug therapy, such as vectorization of drugs using nanoparticles. Altogether, this review emphasizes the urgent need for new therapeutic strategies in AE management, for which there is currently no curative chemotherapy.

Title: Chimiothérapie de l'échinococcose alvéolaire : où en sommes-nous ? Abstract: L'échinococcose alvéolaire (EA) est une maladie sévère du foie due à l'infection par la forme larvaire d'Echinococcus multilocularis, appelée métacestode. La prise en charge de l'EA repose sur la chimiothérapie par benzimidazolés (albendazole ou mébendazole), si possible associée à la chirurgie. Les benzimidazolés sont les seules molécules recommandées dans le traitement de l'EA, toutefois, ceux-ci sont parasitostatiques, ce qui signifie que le parasite peut reprendre sa croissance lors d'une interruption du traitement. Également, les benzimidazolés peuvent causer une dysfonction hépatique qui peut empêcher leur utilisation. De nombreux médicaments ont été rapportés comme ayant une activité in vitro contre E. multilocularis, mais peu d'entre eux avaient une activité in vivo satisfaisante et aucun n'était clairement plus efficace que les benzimidazolés. Ces médicaments appartiennent à diverses catégories, notamment les agents anti-infectieux (par exemple l'amphotéricine B, la méfloquine, des dérivés de la pentamidine), les composés antinéoplasiques (par exemple l'imatinib, le nilotinib, le bortézomib), les composés extraits de plantes (par exemple le thymol, la crocine, le carvacrol) et d'autres (par exemple metformine, vérapamil, thiaclopride). Ces traitements présentent généralement un intérêt limité en raison de leur toxicité, de leur pharmacocinétique défavorable ou de la rareté des études menées chez l'homme. Outre les benzimidazolés, seules l'amphotéricine B, la méfloquine et la nitazoxanide ont été utilisées dans le traitement de l'EA humaine, avec des résultats insatisfaisants. Peu d'études se sont intéressées à développer des stratégies médicamenteuses innovantes contre l'EA, comme la vectorisation de médicaments à l'aide de nanoparticules. Cette revue souligne le besoin urgent de nouvelles stratégies thérapeutiques dans la prise en charge de l'EA, pour lesquelles il n'existe pas de chimiothérapie curative.

[Hepatotoxicity due to albendazole: safe alternatives for echinococcosis therapy]. / Hepatotoxizität durch Albendazol: sichere Alternativen bei Echinokokkosetherapie.

Infection with Echinococcus multilocularis leads to the clinical manifestation of alveolar echinococcosis. This is characterized by the formation of alveolar liver tumours, which usually disintegrate necrotically in the course of the disease. Pseudocysts are formed. Especially in the early stages, curative resection followed by long-term treatment with albendazole is recommended. However, the majority of patients are not amenable to curative surgery. In these cases, albendazole therapy is the first-choice treatment. We present a rare case of albendazole-associated hepatitis in a patient with inoperable Echinococcus multilocularis infection, with a favourable outcome following a change in treatment to mebendazole.

Studies on absorption mechanism and pharmacokinetic properties of albendazole-bile acid conjugate: In vivo and in vitro.

PURPOSE: To improve the oral bioavailability of albendazole (ABZ), a series of albendazole-bile acid conjugates (ABCs) were synthesized. ABC's transmembrane transport mechanism and in vivo pharmacokinetic properties were preliminarily studied. METHODS: The transmembrane transport mechanism of ABCs was studied using the Caco-2 monolayer cell model and intestinal perfusion model. The concentration of ABCs and ABZ were evaluated using High-Performance Liquid Chromatography (HPLC) and HPLC-Mass Spectrometry (HPLC-MS/MS). RESULTS: Compared to ABZ, better permeability was observed for different types and concentrations of ABCs using the Caco-2 monolayer cell model, with ABC-C8 showing the highest permeability. The transmembrane transport of ABCs was affected by ASBT inhibitors, indicating an ASBT-mediated active transport mechanism. Additionally, introducing cholic acid resulted in ABZ no longer being a substrate for P-gp, MRP2, and BCRP, effectively reversing ABZ efflux. In vivo unidirectional intestinal perfusion results in rats showed that ABCs altered the absorption site of ABZ from the jejunum to the ileum. The absorption efficiency of ABCs in each intestinal segment was higher than that of ABZ, and the transmembrane transport efficiency decreased with increasing concentrations of ASBT inhibitors. This further confirmed the presence of both passive diffusion and ASBT-mediated active transport mechanisms in the transport of ABCs. The solubility of ABCs in gastric juice and pharmacokinetics in rats showed that ABZ-C4 exhibited enhanced solubility. Moreover, ABCs significantly increased oral bioavailability compared to ABZ, with ABC-C4 showing an approximately 31-fold increase in bioavailability. CONCLUSION: The transmembrane transport mechanism of ABCs involves a combination of ASBT-mediated active transport and passive diffusion. Moreover, the incorporation of BAs successfully reverses the efflux of ABZ by efflux proteins. Among the synthesized conjugates, ABC-C4 demonstrated superior dissolution behavior both in vitro and in vivo.

Repurposing of a library for high-content screening of inhibitors against Echinococcus granulosus.

BACKGROUND: Cystic echinococcosis (CE) is a zoonotic disease caused by the larval stage of the dog tapeworm Echinococcus granulosus sensu lato (E. granulosus), with a worldwide distribution. The current treatment strategy for CE is insufficient. Limited drug screening models severely hamper the discovery of effective anti-echinococcosis drugs. METHODS: In the present study, using high-content screening technology, we developed a novel high-throughput screening (HTS) assay by counting the ratio of propidium iodide-stained dead protoscoleces (PSCs) to the total number of PSCs. In vitro and ex vivo cyst viability assays were utilized to determine the effect of drugs on cyst viability. RESULTS: Using the newly established HTS assay, we screened approximately 12,000 clinical-stage or The Food and Drug Administration (FDA)-approved small molecules from the Repurposing, Focused Rescue, and Accelerated Medchem (ReFRAME) library, as well as the LOPAC1280 and SelleckChem libraries, as a strategic approach to facilitate the drug discovery process. Initial screening yielded 173 compounds with anti-echinococcal properties, 52 of which demonstrated dose-response efficacy against E. granulosus PSCs in vitro. Notably, two agents, omaveloxolone and niclosamide, showed complete inhibition upon further validation in cyst and microcyst viability assays in vitro after incubation for 3 days, and in an ex vivo cyst viability assay using cysts isolated from the livers of mice infected with E. granulosus, as determined by morphological assessment. CONCLUSIONS: Through the development of a novel HTS assay and by repurposing libraries, we identified omaveloxolone and niclosamide as potent inhibitors against E. granulosus. These compounds show promise as potential anti-echinococcal drugs, and our strategic approach has the potential to promote drug discovery for parasitic infections.

Case report: a rare case of intradural and pleural wall cystic echinococcosis.

BACKGROUND: Cystic echinococcosis (CE) is prevalent in livestock farming regions around the world. However, it remains relatively rare compared to other infectious diseases. CE typically affects the liver, lungs, brain, and kidneys. Spinal and pleural wall involvement is exceedingly rare. We report a unique case of intradural and pleural wall CE in a young male, successfully treated with surgery and postoperative medication. CASE PRESENTATION: A 19-year-old Tibetan male from the Qinghai-Tibet Plateau was diagnosed with intradural and pleural wall CE through imaging, serology, and surgical pathology. According to the Dew/Braithwaite & Lees (BL) classification, his condition was an exceptionally rare form of spinal echinococcosis, compounded by an even rarer pleural wall involvement. Prompt surgical intervention and postoperative medication resulted in significant improvement in spinal cord compression symptoms. CONCLUSIONS: This case highlights the diagnostic and therapeutic challenges of rare CE locations. MRI proved superior to CT in diagnosing bony cystic echinococcosis. Early surgical intervention combined with medication facilitates spinal cord function recovery, providing valuable insights for managing similar cases.