RESUMEN
INTRODUCTION: Alveolar echinococcosis (AE), caused by the larval forms of Echinococcus multilocularis, is a zoonotic disease affecting the liver, lungs, lymph nodes, kidneys, brain, bones, thyroid, and other organs. Diagnosing AE in a non-endemic area is usually challenging. With the rapid development and increasing application of sequencing techniques in recent years, metagenomic next-generation sequencing (mNGS) has become a powerful tool for diagnosing rare infectious diseases. CASE PRESENTATION: A 45-year-old woman was admitted to the hospital for the presence of pulmonary shadows for more than 3 months. The lung computed tomography (CT) at a local hospital revealed scattered solid and quasi-circular nodules in the left upper lobe, left lower lobe, right middle lobe, and right lower lobe. The largest nodule was located in the dorsal part of the right lung, measuring 2.0 × 1.7 × 1.5 cm. Moreover, abdominal CT revealed one space-occupying lesion each in the left and right lobes. The pathological analysis of the lung biopsy specimen revealed infiltration of lymphocytes, plasma cells, and eosinophils in the alveolar wall and interstitial area. No pathogenic bacteria were observed in the sputum smear and culture tests. There were no parasite eggs in the stool. The mNGS of the lung puncture tissue revealed 6156 sequence reads matching E. multilocularis; thus, the condition was diagnosed as AE. Albendazole 400 mg was administered twice daily, and the patient was stable during follow-up. CONCLUSION: This case emphasizes the role of mNGS in diagnosing AE. As a novel, sensitive, and accurate diagnostic method, mNGS could be an attractive approach for facilitating early diagnosis and prompt treatment of infectious diseases, especially when the infection was caused by rare pathogens.
Asunto(s)
Equinococosis , Echinococcus multilocularis , Secuenciación de Nucleótidos de Alto Rendimiento , Pulmón , Metagenómica , Humanos , Femenino , Persona de Mediana Edad , Animales , Pulmón/parasitología , Pulmón/patología , Pulmón/diagnóstico por imagen , Metagenómica/métodos , Echinococcus multilocularis/genética , Echinococcus multilocularis/aislamiento & purificación , Equinococosis/diagnóstico , Equinococosis/parasitología , Tomografía Computarizada por Rayos X , Albendazol/uso terapéutico , Equinococosis Pulmonar/diagnóstico , Equinococosis Pulmonar/parasitología , Equinococosis Pulmonar/diagnóstico por imagenRESUMEN
This report describes a male in his late 20s who presented with a 2-month history of recurrent haemoptysis and chest pain. A chronic infection, such as tuberculosis, was suspected. He had undergone surgical resection of an intrapericardial hydatid cyst in the past. His blood investigations showed peripheral eosinophilia, and his chest X-ray showed a cystic oval lesion in the left upper zone. A CT pulmonary angiogram revealed filling defects in the bilateral segmental and subsegmental arteries with a cystic lesion in the left upper lobe. Further workup, including bronchoalveolar lavage culture and MRI of the thorax, confirmed the diagnosis of a hydatid cyst of pulmonary echinococcosis. This case illustrates the presentation of multisystemic echinococcosis in a young male with no other risk factors, initially treated with surgical resection and antihelminthic therapy. The disease later recurred, which required prolonged medications, which brought the patient into remission.
Asunto(s)
Equinococosis Pulmonar , Humanos , Masculino , Equinococosis Pulmonar/complicaciones , Equinococosis Pulmonar/diagnóstico , Equinococosis Pulmonar/diagnóstico por imagen , Equinococosis Pulmonar/cirugía , Adulto , Albendazol/uso terapéutico , Hemoptisis/etiología , Hemoptisis/diagnóstico , Antihelmínticos/uso terapéutico , Recurrencia , Dolor en el Pecho/etiología , Cardiopatías/parasitología , Cardiopatías/diagnóstico , Cardiopatías/cirugía , Cardiopatías/diagnóstico por imagen , Cardiopatías/complicaciones , Tomografía Computarizada por Rayos X , Imagen por Resonancia Magnética , Estudios de SeguimientoRESUMEN
Parasitic infections by Echinococcus granulosus are rare in Germany, and predominantly affect individuals with a migration background. Liver and lungs are the most commonly affected organs. Pulmonary cysts often remain asymptomatic until rupture, at which point symptoms may manifest. The diagnostic approach typically involves a combination of imaging modalities and serological tests, occasionally supplemented by molecular genetic methods. Given the global movements of migration, considerations of the epidemiology of common diseases in the country of origin should also be taken into account in the differential diagnosis. We present the unusual case of a pneumogenic sepsis in a young man from Syria, where the combination of medical history alongside radiological, serological, and molecular genetic investigations ultimately led to the diagnosis of a severe pulmonary echinococcosis with rupture.
Asunto(s)
Equinococosis Pulmonar , Humanos , Equinococosis Pulmonar/complicaciones , Equinococosis Pulmonar/diagnóstico por imagen , Equinococosis Pulmonar/diagnóstico , Masculino , Diagnóstico Diferencial , Echinococcus granulosus/aislamiento & purificación , Sepsis/diagnóstico , Sepsis/parasitología , Animales , Rotura Espontánea , Adulto , Resultado del Tratamiento , Enfermedades RarasRESUMEN
Echinococcosis is a parasitic infection that is distributed worldwide. Its clinical presentation depends on the size and location of the cyst. A 7-year-old was found with a superimposed infected pulmonary hydatid cyst that was initially misdiagnosed as complicated pneumonia. Our case underscores the challenges of diagnosing and managing echinococcosis, emphasizes the need for a high index of suspicion, and describes the disease's ability to mimic other clinical entities.
Asunto(s)
Equinococosis Pulmonar , Humanos , Equinococosis Pulmonar/diagnóstico , Equinococosis Pulmonar/diagnóstico por imagen , Niño , Masculino , Diagnóstico Diferencial , Tomografía Computarizada por Rayos XRESUMEN
The Echinococcus granulosus sensu lato species complex is responsible for the neglected zoonotic disease known as cystic echinococcosis (CE). Humans and livestock are infected via fecal-oral transmission. CE remains prevalent in Western China, Central Asia, South America, Eastern Africa, and the Mediterranean. Approximately one million individuals worldwide are affected, influencing veterinary and public health, as well as social and economic matters. The infection causes slow-growing cysts, predominantly in the liver and lungs, but can also develop in other organs. The exact progression of these cysts is uncertain. This study aimed to understand the survival mechanisms of liver and lung CE cysts from cattle by determining their metabolite profiles through metabolomics and multivariate statistical analyses. Non-targeted metabolomic approaches were conducted using quadrupole-time-of-flight liquid chromatography/mass spectrometry (LC-QTOF-MS) to distinguish between liver and lung CE cysts. Data processing to extract the peaks on complex chromatograms was performed using XCMS. PCA and OPLS-DA plots obtained through multiple statistical analyses showed interactions of metabolites within and between groups. Metabolites such as glutathione, prostaglandin, folic acid, and cortisol that cause different immunological reactions have been identified both in liver and lung hydatid cysts, but in different ratios. Considering the differences in the metabolomic profiles of the liver and lung cysts determined in the present study will contribute research to enlighten the nature of the cyst and develop specific therapeutic strategies.
Asunto(s)
Enfermedades de los Bovinos , Hígado , Pulmón , Metabolómica , Animales , Bovinos , Enfermedades de los Bovinos/parasitología , Hígado/parasitología , Pulmón/parasitología , Echinococcus granulosus/fisiología , Echinococcus granulosus/inmunología , Equinococosis Pulmonar/veterinaria , Equinococosis/veterinaria , Equinococosis/parasitología , Equinococosis Hepática/veterinaria , Equinococosis Hepática/parasitología , Cromatografía Liquida , Espectrometría de Masas/veterinariaRESUMEN
BACKGROUND: Co-infection with other microorganisms such as parasites in patients with COVID-19 can affect the clinical outcome and require prompt diagnosis and appropriate therapy. CASE PRESENTATION: We present a case of an adult male with chest pain, dyspnea, cough, diplopia, and anorexia who was confirmed to have acute COVID-19 pneumonia. 2 weeks prior to admission, a hydatid lung cyst was identified on examination, but the patient refused surgery. Thoracoabdominal computed tomography (CT) revealed a rupture of the lung hydatid cyst and co-infection with COVID-19. The patient has prescribed a treatment protocol for COVID-19 and albendazole. Despite measures taken to manage severe inflammation and decreasing blood oxygen levels, the patient required admission to the intensive care unit (ICU) and intubation. After approximately 3 weeks of hospitalization, the patient was successfully extubated and discharged uneventfully from the hospital. Oral albendazole was prescribed for follow-up treatment. CONCLUSION: Our case highlights the importance of considering hydatid cysts in the differential diagnosis of patients with COVID-19, especially those living in endemic areas.
Asunto(s)
Albendazol , COVID-19 , Equinococosis Pulmonar , COVID-19/complicaciones , COVID-19/diagnóstico , Humanos , Masculino , Equinococosis Pulmonar/complicaciones , Equinococosis Pulmonar/diagnóstico , Equinococosis Pulmonar/diagnóstico por imagen , Albendazol/uso terapéutico , Albendazol/administración & dosificación , Tomografía Computarizada por Rayos X , SARS-CoV-2 , Coinfección/parasitología , Coinfección/diagnóstico , Persona de Mediana Edad , Pulmón/parasitología , Pulmón/diagnóstico por imagen , Pulmón/patología , Índice de Severidad de la EnfermedadRESUMEN
PURPOSE: Radiotherapy showed the potential to effectively kill the cysts of pulmonary cystic echinococcosis (CE). However, little is known about its safety. This study was designed to investigate the safety of three-dimensional conformal radiotherapy (3D-CRT) on the normal lung tissue adjacent to the cyst and blood of sheep naturally infected with pulmonary CE. METHODS: Twenty pulmonary CE sheep were randomly divided into control group (n = 5) and radiation groups with a dose of 30 Gray (Gy) (n = 5), 45 Gy (n = 5), and 60 Gy (n = 5), respectively. Animals in control group received no radiation. Heat shock protein 70 (Hsp70), tumor growth factor-ß (TGF-ß), matrix metalloproteinase-2 (MMP-2) and MMP-9 in the lung tissues adjacent to the cysts, which were considered to be closely related to the pathogenesis of CE, were evaluated after 3D-CRT. A routine blood test was conducted. RESULTS: The results showed that there were multiple cysts of various sizes with protoscoleces in the lung tissues of sheep, and necrotic cysts were found after 3D-CRT. 3D-CRT significantly increased the mRNA level of Hsp70, enhanced the protein level of TGF-ß and slightly increased the expression of MMP-2 and MMP-9 in lung tissues adjacent to the cysts. 3D-CRT did not significantly alter the amount of WBC, HB and PLT in sheep blood. CONCLUSIONS: The results suggested that 3D-CRT may suppress the inflammation and induce less damage of the normal lung tissues and blood. We preliminarily showed that 3D-CRT under a safe dose may be used to treat pulmonary CE.
Asunto(s)
Equinococosis Pulmonar , Proteínas HSP70 de Choque Térmico , Pulmón , Radioterapia Conformacional , Enfermedades de las Ovejas , Animales , Ovinos , Radioterapia Conformacional/efectos adversos , Radioterapia Conformacional/métodos , Pulmón/parasitología , Pulmón/efectos de la radiación , Pulmón/patología , Proteínas HSP70 de Choque Térmico/genética , Proteínas HSP70 de Choque Térmico/metabolismo , Equinococosis Pulmonar/veterinaria , Enfermedades de las Ovejas/parasitología , Factor de Crecimiento Transformador beta/sangre , Factor de Crecimiento Transformador beta/metabolismo , Factor de Crecimiento Transformador beta/genética , Metaloproteinasa 9 de la Matriz/metabolismo , Metaloproteinasa 9 de la Matriz/sangre , Metaloproteinasa 2 de la Matriz/metabolismo , Metaloproteinasa 2 de la Matriz/genéticaRESUMEN
BACKGROUND: Lophomonas blattarum is a rare protozoan that causes opportunistic infections, and the co-infection of lophomonas with tuberculosis and human hydatidosis is a serious public problem in the co-endemic areas of developing countries. CASE REPORT: We presented a 58-year-old female with fever, losing weight, and cough with whitish-yellow sputum that started one month ago. Increasing inflammatory markers and hypereosinophilia in laboratory tests, and a cavity with thick, regular walls and undulating air-fluid levels measuring 43 × 30, evident in the upper segment of the right lower lobe (RLL), along with consolidation and the ground glass opacity of the upper segment and posterior basal of the RLL is apparent in CT scan were reported. Then, a bronchoscopy was requested, and the BAL specimen reported a negative fungal and bacterial infection in the samples. Several live and oval flagellated lophomonas protozoa, hydatid cyst protoscoleces (the larval forms of the parasites), and M. tuberculosis were observed in microscopic evaluation. The patient was treated with metronidazole, oral albendazole, and a combination of TB regimen. CONCLUSION: Physicians should always consider the possibility of co-infections of lophomonas with tuberculosis and human hydatidosis and investigate patients with risk factors such as immunodeficiency conditions or treated with immunosuppressive medications.
Asunto(s)
Coinfección , Equinococosis Pulmonar , Mycobacterium tuberculosis , Tuberculosis , Femenino , Humanos , Persona de Mediana Edad , Equinococosis Pulmonar/complicaciones , Equinococosis Pulmonar/diagnóstico , Equinococosis Pulmonar/tratamiento farmacológico , Coinfección/diagnóstico , Coinfección/tratamiento farmacológico , Metronidazol/uso terapéutico , Pulmón , Tuberculosis/tratamiento farmacológicoRESUMEN
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.
Asunto(s)
Equinococosis Pulmonar , Echinococcus , Humanos , Animales , Ovinos , Equinococosis Pulmonar/parasitología , Equinococosis Pulmonar/patología , Pulmón/patología , Células Epiteliales/patología , Necrosis/patologíaRESUMEN
Echinococcosis is primarily a disease of developing nations with poor medical infrastructure, where cohabitation with domesticated animals is common. These conditions, in conjunction with the inherent chronicity of the disease, lead to low rates of diagnosis and high morbidity. Robust surveillance is not readily available in communities with the highest disease burden.WHO classifications assist in diagnostic and treatment endeavours especially in countries where this disease is not commonly encountered. However, the understanding of the pathophysiology of echinococcosis and optimal treatment are still lacking in certain patient populations.We present the case of a female from Central Asia with an isolated pulmonary hydatid cyst. She was diagnosed several months after she had an uncomplicated pregnancy and gave birth to a healthy baby girl. Due to a delay in surgical intervention, our patient received a prolonged course of treatment which resulted in a significant reduction in the size of the cyst. Given her improvement, we questioned the current guidelines set by the WHO regarding surgical resection of pulmonary hydatid cysts, compared with an extended course with albendazole in patients with an unusual and protracted course of the disease. Furthermore, we discuss the possible role of pregnancy in exacerbating symptoms of underlying pulmonary hydatid disease.
Asunto(s)
Equinococosis Pulmonar , Animales , Femenino , Humanos , Equinococosis Pulmonar/diagnóstico por imagen , Equinococosis Pulmonar/tratamiento farmacológico , Albendazol/uso terapéutico , Animales DomésticosRESUMEN
BACKGROUND: The lungs are considered the second-most frequent location for hydatid cyst in human. The current retrospective hospital-based study aimed to assess the epidemiological data, clinical presentation, and treatment outcomes of lung hydatid cyst in patients who underwent surgery for this disease in Fars province, southern Iran. METHODS: In this retrospective study, hospital records of 224 pulmonary hydatid cyst patients were assessed in two main university-affiliated hospitals in Fars Province, southern Iran. Clinical features of patients, epidemiological data, cyst features, surgical interventions, and treatment outcomes were reviewed and analyzed. RESULTS: A total of 224 hydatid cyst cases of the lung were reviewed. Male patients accounted for the majority of cases (60.4%). The average age of the patients was 31.13 (± 19.6), ranging from 2 to 94 years old. Of the 224 patients, 145 (75.9%) cases had only one single cyst and mostly 110 (53.9%) located in the right lung. Also, 6 (2.9%) cases had cysts in both lungs. The lower lobe of the lungs was the most common location of the hydatid cyst. The average size of lung hydatid cyst was 7.37 cm (SD = 3.86; rang: 2-24) while for the cyst areas was 42.87cm2 (SD = 52.76; range: 2-488). Regarding the surgical method, 86 (38.6%) cases were operated by lung resection surgery while 137 (61.4%) cases had lung preserving one. The chief complaints of the patients were cough (55.4%) and dyspnea (32.6%). Relapse was documented in 25 (11.16%) of cases. CONCLUSIONS: Lung hydatid cyst is a common infection in southern Iran. Lung preserving surgery is the method of choice for the management of hydatid cyst. Relapse, which was not uncommon in our study, is a challenging feature of hydatid cyst management.
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Quistes , Equinococosis Pulmonar , Humanos , Masculino , Preescolar , Niño , Adolescente , Adulto Joven , Adulto , Persona de Mediana Edad , Anciano , Anciano de 80 o más Años , Equinococosis Pulmonar/cirugía , Estudios Retrospectivos , Irán/epidemiología , Recurrencia Local de Neoplasia , Pulmón , Hospitales UniversitariosRESUMEN
This case report describes the presentation, diagnosis, and treatment of a 13-year-old boy with pulmonary cystic echinococcosis. The patient presented with low-volume hemoptysis, and lung imaging revealed a large cystic mass, as well as smaller pseudo-nodular lesions, suggesting a large intrathoracic hydatid cyst and ruptured cysts. The diagnosis was confirmed by a positive echinococcosis Western Blot assay, despite equivocal serology. The treatment consisted of surgical removal of the large cyst using thoracoscopy, along with a two-week course of albendazole and praziquantel, followed by albendazole alone for two years. Analysis of the cyst membrane revealed an Echinococcus granulosus protoscolex. The patient had a successful recovery.
Asunto(s)
Quistes , Equinococosis Pulmonar , Equinococosis , Echinococcus granulosus , Masculino , Animales , Humanos , Niño , Adolescente , Albendazol/uso terapéutico , Equinococosis/diagnóstico por imagen , Equinococosis/tratamiento farmacológico , Pulmón/diagnóstico por imagen , Equinococosis Pulmonar/diagnóstico por imagen , Equinococosis Pulmonar/tratamiento farmacológicoRESUMEN
Echinococcosis is caused by tapeworms belonging to the Echinococcus genus. The most common site of infection is the liver although it may involve almost any organ. Symptoms of pulmonary echinococcosis vary depending on the location and structure of the cyst. While uncomplicated cysts usually appear at imaging as well-defined homogeneous lesions with fluid content and smooth walls of variable thickness, complicated lesions may have a more heterogeneous content with higher density making more difficult the distinction from malignancies or other infections. Hereby we describe the case of a 61-year-old Northern African male admitted to our tertiary center for left upper chest pain who then underwent a chest computed tomography (CT) scan which demonstrated a large hypodense lesion, with smooth and thick walls, in the upper left lobe. The following magnetic resonance confirmed the homogeneous fluid content, and the 18 F- fluorodeoxyglucose-positron emission tomography/CT demonstrated a mild uptake of the walls. According to these findings, the main differential diagnoses at imaging included bronchogenic cyst, synovial sarcoma, and pulmonary hematoma although the patient denied any recent trauma. Given the large size and clinical symptoms he underwent surgery. Intra-operative frozen section, supported by imprint cytology, excluded the presence of malignancy while suggested an echinococcal laminar exocyst. The final pathological examination confirmed the diagnosis of echinococcosis (i.e., Echinococcus Granulosus protoscolex). After surgery he was treated with albendazole and at the six-month follow-up he was in good clinical conditions. Our case highlights the importance of considering rare infections, particularly in individuals from endemic areas. Frozen tissue analyses can be a diagnostic challenge and often require ancillary tools such as imprint cytology and serial sections for more sensitive and accurate diagnosis.