ABSTRACT
We present the case of a patient who consulted for cough, showing a mass in the lower lobe of the right lung on imaging studies. Bronchoscopy revealed an irregular, whitish endobronchial formation, from which whitish membranes were aspirated. Biopsies were taken from the aspirated material and sent for analysis Based on the cyto and histopathological study, pulmonary hydatid disease coexisting with a sarcoma was diagnosed. In our area, hydatid disease continues to be frequent and its pulmonary location is, together with the hepatic, the two most common forms of presentation. The usual complication is the rupture of the cyst with the eventual seeding and its infection. In this case, the coexistence of hydatid disease with a pulmonary sarcoma was revealed, a fact of which we only know of one report, more than fifty years ago. The publication is motivated by the extremely infrequent nature of this association, highlighting the importance of carrying out histopathological studies even when clinical and imaging suspicion points to hydatid disease.
Se presenta el caso de un paciente que consultó por tos, evidenciándose en los estudios de imagen una masa en el lóbulo inferior del pulmón derecho. En la broncoscopía se observó una formación endobronquial, blanquecina, irregular, de la que se aspiraron membranas blanquecinas; del material aspirado se tomaron biopsias que se enviaron para su análisis. Con el estudio cito e histopatológico se diagnosticó hidatidosis pulmonar coexistente con un sarcoma. En nuestra zona la hidatidosis continúa siendo frecuente y su localización pulmonar es, junto a la hepática, las dos formas de presentación más comunes. La complicación habitual es la rotura del quiste con la eventual siembra y la infección del mismo. En este caso se pone de manifiesto la coexistencia de hidatidosis con un sarcoma pulmonar, hecho del que solo conocemos un informe, reportado hace más de cincuenta años. Motiva la publicación lo extremadamente infrecuente de esta asociación, resaltando la importancia de efectuar estudios histopatológicos aun cuando la sospecha clínica y de las imágenes orienten a la hidatidosis.
Subject(s)
Echinococcosis, Pulmonary , Lung Neoplasms , Humans , Echinococcosis, Pulmonary/complications , Echinococcosis, Pulmonary/diagnostic imaging , Lung , Bronchoscopy , Lung Neoplasms/complications , Lung Neoplasms/diagnostic imagingABSTRACT
El Paraguay integra la Iniciativa Sudamericana para el Control y Vigilancia de Equinococosis Quística. Con el fin de optimizar los informes epidemiológicos sobre hidatidosis, presentamostres casos clínicos vistos en centros nacionales y realizamos una revisión de la literatura local sobre el tópico. Desde 1969 hasta la fecha se describen 70casos de equinococosis quística. Se requieren estudios epidemiológicos sistemáticos para evaluar el grado de penetración, la distribución geográfica y las características de transmisión de esta enfermedad en nuestro país.Palabras clave: equinococosis;equinococosispulmonar; equinococosis hepática; equinococcus granulosus; zoonosis.
Paraguay is a member of the South American Initiative for the Control and Surveillance of Cystic Echinococcosis. In order to optimize the epidemiological reports on hydatidosis, we present three clinical cases seen in national centers and we carry out a review of the local literature on the topic. From 1969 to date, 70cases of cystic echinococcosis have been described. Systematic epidemiological studies are required to assess the degree of penetration, geographic distribution, and transmission characteristics of this disease in our country.Key words:echinococcosis;echinococcosispulmonar;echinococcosishepatic;echinococcus granulosus; zoonoses.
Subject(s)
Humans , Male , Female , Adult , Middle Aged , Echinococcosis, Hepatic , Echinococcosis, Pulmonary , Zoonoses , EchinococcosisABSTRACT
Cystic echinococcosis (CE) in children is a public health problem. To describe the clinical and epidemiological profile of CE, we reviewed the records of 55 children admitted to our institution with a confirmed diagnosis of CE between 2017-2019, analyzing demographic data, clinical manifestations, and treatment. Of the population, 61.8% (34/55) were male. The mean age was 9.25 years (SD: 2.79); 16.4% had previous CE diagnosis, and 50.9% had contact with dogs. The median time of illness was 2 months. Of the patients, 65.5% had hepatic involvement, 56.4% had pulmonary involvement, and 21.8% had both hepatic and pulmonary involvement. The most frequent symptoms were abdominal pain (80.6%) and cough (80.6%). Surgical treatment was performed in 87.5% of patients with hepatic CE, in 100% of those with pulmonary CE and in 100% of those with hepatic and pulmonary CE. Albendazole was prescribed in 100% of hepatic cases, in 73.7% of pulmonary cases, and in 75% of those with both conditions. Mortality was not reported.
La equinococosis quística (EQ) en niños es un problema de salud pública. Para describir las características clínicas y epidemiológicas de la EQ se revisaron los registros de 55 niños con diagnóstico confirmado de EQ admitidos entre 2017 y 2019 en un centro quirúrgico referencial del Perú. Se analizaron los datos demográficos, las manifestaciones clínicas y el tratamiento. El 61,8% (34/55) de los niños fue de sexo masculino. La edad promedio fue de 9,25 años (DE: 2,79); un 16,4% tuvo diagnóstico previo de EQ, y un 50,9% tuvo contacto con perros. La mediana de tiempo de enfermedad fue de dos meses. El 65,5% tuvo afectación hepática, el 56,4% pulmonar y el 21,8% hepática y pulmonar. Los síntomas más frecuentes fueron dolor abdominal (80,6%) y tos (80,6%). El tratamiento quirúrgico se realizó en el 87,5% de los casos con EQ hepática y en el 100% de los casos con EQ pulmonar y EQ hepática y pulmonar. Se prescribió albendazol en el 100% de casos hepáticos, en el 73,7% de casos pulmonares y en el 75% de ambas afectaciones. No se reporta mortalidad.
Subject(s)
Echinococcosis, Hepatic , Echinococcosis, Pulmonary , Animals , Child , Dogs , Echinococcosis, Hepatic/diagnosis , Echinococcosis, Hepatic/drug therapy , Echinococcosis, Hepatic/surgery , Echinococcosis, Pulmonary/diagnosis , Echinococcosis, Pulmonary/surgery , Echinococcosis, Pulmonary/therapy , Female , Humans , Male , Peru/epidemiologyABSTRACT
Resumen Introducción: El tratamiento de elección del Quiste Hidatídico Pulmonar (QHP) es la resección quirúrgica. Actualmente, existe controversia sobre la superioridad de la cirugía con capitonaje (CC) versus la cirugía sin capitonaje (SC). Objetivo: Comparar los resultados de la cirugía conservadora CC y SC mediante Propensity Score Matching (PSM). Materiales y Método: Se realizó un estudio analítico retrospectivo de los pacientes con QHP tratados quirúrgicamente en el Hospital Guillermo Grant Benavente, Concepción, Chile; entre enero-1995 y diciembre-2018. Se realizó un PSM con una relación 1:1 entre los pacientes operados con la técnica CC y SC. Posterior al PSM se balancearon las características basales. Resultados: Total 205 episodios de QHP en el período. Se realizó cirugía conservadora en 165 casos, 101 CC y 64 SC. Posterior al emparejamiento se obtuvieron 53 pacientes operados CC y 53 SC. No se observaron diferencias significativas en la presencia de fuga aérea persistente (CC = 9,4%; SC = 11,3%, p 0,75), empiema (CC = 3,8%; SC = 0%, p 0,49), días con pleurotomía (CC = 9,1 ± 8,9; SC 10,1 ± 10,7, p 0,39, mediana 6 versus 6 días, respectivamente), ni días de estadía posoperatoria (CC = 10,4 ± 9,0; SC = 11,7 ± 11,9, p 0,22, mediana 7 versus 7 días, respectivamente). Conclusiones: La cirugía SC demostró resultados comparables a la técnica CC en el tratamiento quirúrgico conservador del QHP.
Background: The treatment of choice for Pulmonary Hydatid Cys (PHC) is surgical resection. There is currently controversy about the superiority of surgery with capitonage (SC) versus surgery without it (SWC). Aim: To compare the results of conservative surgery with capitonnage and versus surgery without capitonnage using Propensity Score Matching (PSM). Materials and Method: A retrospective analytical study was carried out with patients with PHC treated surgically at the Guillermo Grant Benavente Hospital, Concepción, Chile, between January-1995 and December-2018. A PSM was performed with a 1:1 ratio. Results: Conservative surgery was done in 165 cases, 101 SC and 64 SWC. After matching, 53 SC and 53 SWC operated patients were obtained. No significant differences were observed in the presence of persistent air leak (9.4% vs11.3%, SC vs SWC respectively, p 0.75), empyema (3.8% vs 0%, p 0.49), days with pleurotomy (9.1 ± 8.9 vs 10.1 ± 10.7, p 0.39), nor days of postoperative stay (10.4 ± 9.0 vs 11.7 ± 11.9, p 0.22). Conclusión: The SWC demonstrated comparable results to the SC technique in the conservative surgical treatment of PHC.
Subject(s)
Humans , Male , Female , Adult , Echinococcosis, Pulmonary/surgery , Echinococcosis, Pulmonary/complications , Echinococcosis, Pulmonary/diagnosis , Parasitic Diseases , Pulmonary Surgical Procedures , Thoracic Surgery , Retrospective Studies , Models, Statistical , Propensity Score , Lung Abscess/diagnosis , Lung Abscess/therapy , Lung DiseasesABSTRACT
BACKGROUND: Most cystic echinococcosis cases in Southern Brazil are caused by Echinococcus granulosus and Echinococcus ortleppi. Proteomic studies of helminths have increased our knowledge about the molecular survival strategies that are used by parasites. Here, we surveyed the protein content of the hydatid fluid compartment in E. granulosus and E. ortleppi pulmonary bovine cysts to better describe and compare their molecular arsenal at the host-parasite interface. METHODS: Hydatid fluid samples from three isolates of each species were analyzed using mass spectrometry-based proteomics (LC-MS/MS). In silico functional analyses of the identified proteins were performed to examine parasite survival strategies. RESULTS: The identified hydatid fluid protein profiles showed a predominance of parasite proteins compared to host proteins that infiltrate the cysts. We identified 280 parasitic proteins from E. granulosus and 251 from E. ortleppi, including 52 parasitic proteins that were common to all hydatid fluid samples. The in silico functional analysis revealed important molecular functions and processes that are active in pulmonary cystic echinococcosis, such as adhesion, extracellular structures organization, development regulation, signaling transduction, and enzyme activity. CONCLUSIONS: The protein profiles described here provide evidence of important mechanisms related to basic cellular processes and functions that act at the host-parasite interface in cystic echinococcosis. The molecular tools used by E. granulosus and E. ortleppi for survival within the host are potential targets for new therapeutic approaches to treat cystic echinococcosis and other larval cestodiases.
Subject(s)
Echinococcosis, Pulmonary , Echinococcus granulosus , Animals , Cattle , Chromatography, Liquid , Proteomics , Tandem Mass SpectrometryABSTRACT
RESUMEN La equinococosis quística (EQ) en niños es un problema de salud pública. Para describir las características clínicas y epidemiológicas de la EQ se revisaron los registros de 55 niños con diagnóstico confirmado de EQ admitidos entre 2017 y 2019 en un centro quirúrgico referencial del Perú. Se analizaron los datos demográficos, las manifestaciones clínicas y el tratamiento. El 61,8% (34/55) de los niños fue de sexo masculino. La edad promedio fue de 9,25 años (DE: 2,79); un 16,4% tuvo diagnóstico previo de EQ, y un 50,9% tuvo contacto con perros. La mediana de tiempo de enfermedad fue de dos meses. El 65,5% tuvo afectación hepática, el 56,4% pulmonar y el 21,8% hepática y pulmonar. Los síntomas más frecuentes fueron dolor abdominal (80,6%) y tos (80,6%). El tratamiento quirúrgico se realizó en el 87,5% de los casos con EQ hepática y en el 100% de los casos con EQ pulmonar y EQ hepática y pulmonar. Se prescribió albendazol en el 100% de casos hepáticos, en el 73,7% de casos pulmonares y en el 75% de ambas afectaciones. No se reporta mortalidad.
ABSTRACT Cystic echinococcosis (CE) in children is a public health problem. To describe the clinical and epidemiological profile of CE, we reviewed the records of 55 children admitted to our institution with a confirmed diagnosis of CE between 2017-2019, analyzing demographic data, clinical manifestations, and treatment. Of the population, 61.8% (34/55) were male. The mean age was 9.25 years (SD: 2.79); 16.4% had previous CE diagnosis, and 50.9% had contact with dogs. The median time of illness was 2 months. Of the patients, 65.5% had hepatic involvement, 56.4% had pulmonary involvement, and 21.8% had both hepatic and pulmonary involvement. The most frequent symptoms were abdominal pain (80.6%) and cough (80.6%). Surgical treatment was performed in 87.5% of patients with hepatic CE, in 100% of those with pulmonary CE and in 100% of those with hepatic and pulmonary CE. Albendazole was prescribed in 100% of hepatic cases, in 73.7% of pulmonary cases, and in 75% of those with both conditions. Mortality was not reported.
Subject(s)
Humans , Male , Female , Infant , Child, Preschool , Child , Adolescent , Child , Public Health , Echinococcosis , Echinococcus granulosus , Echinococcosis, Hepatic , Echinococcosis, PulmonaryABSTRACT
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.
Subject(s)
Cattle Diseases/physiopathology , Cysts/veterinary , Echinococcosis, Hepatic/veterinary , Echinococcosis, Pulmonary/veterinary , Echinococcosis/veterinary , Echinococcus granulosus/physiology , Sheep Diseases/physiopathology , Animals , Cattle , Cattle Diseases/parasitology , Cysts/parasitology , Cysts/physiopathology , Echinococcosis/parasitology , Echinococcosis/physiopathology , Echinococcosis, Hepatic/parasitology , Echinococcosis, Hepatic/physiopathology , Echinococcosis, Pulmonary/parasitology , Echinococcosis, Pulmonary/physiopathology , Sheep , Sheep Diseases/parasitology , Sheep, DomesticABSTRACT
Resumen Introducción: La hidatidosis humana es una zoonosis prevalente en nuestro medio, causada principalmente por el parásito Echinococcus granulosus. Las complicaciones más frecuentes en el pulmón son la rotura y la infección del quiste. Objetivos: Describir y comparar características clínicas, tratamiento, morbilidad y mortalidad de los pacientes hospitalizados por quiste hidatídico pulmonar (QHP) complicado versus no complicado. Materiales y Método: Estudio analítico longitudinal. Período enero de 1973 - diciembre de 2017 en Hospital Clínico Regional de Concepción "Dr. Guillermo Grant Benavente", Chile. Revisión de base de datos, protocolos de QHP y fichas clínicas. Se utilizó planilla Microsoft Excel® y programa SPSS24®, con función chi cuadrado y t de Student. Se consideró significativo p < 0,05. Resultados: Total 364 episodios de QHP, complicados 179 (49,2%) versus no complicados 185 (50,8%). Edad promedio 36,4 ± 18,9 versus 32,4 ± 19,1 años, hombres 114 (63,7%) versus 107 (57,8%), respectivamente. Se encontró diferencia estadísticamente significativa en: sintomatología tos 147 (82,1%) versus 120 (64,9%), hemoptisis 93 (52,0%) versus 45 (24,3%), respectivamente; QHP derecho 115 (64,2%) versus 99 (53,5%), respectivamente; cirugía conservadora 139 (77,7%) versus 167 (90,3%), reoperaciones 22 (12,3%) versus 8 (4,3%), respectivamente; morbilidad 47 (26,3%) versus 30 (16,2%), mortalidad 6 (3,4%) versus 0 (0%), estadía hospitalaria postoperatoria promedio 16,1 ± 14,3 versus 10,7 ± 7,7 días, recidivas 15 (8,4%) versus 13 (7,0%), respectivamente. Discusión: Aproximadamente la mitad de los QHP son complicados. Los QHP complicados presentan diferencias estadísticamente significativas en su clínica, tratamiento, morbilidad, mortalidad y estadía hospitalaria postoperatoria.
Background: Human hydatidosis is a prevalent zoonosis in our environment, caused mainly by the Echinococcus granulosus parasite. The most common complications in the lung are cyst rupture and infection. Aim: To describe and compare clinical characteristics, treatment, morbidity and mortality of patients hospitalized for complicated versus uncomplicated hydatid pulmonary cyst (HPC). Materials and Method: Longitudinal analytical study. Period January 1973 - December 2017 at the Regional Clinical Hospital of Concepción "Dr. Guillermo Grant Benavente", Chile. Database, prospective protocols and medical records were reviewed. Microsoft Excel® spreadsheet and SPSS24® program with chi square and Student's t-test were used. It was considered significant p < 0.05. Results: Total 364 episodes of HPC, complicated 179 (49.2%) versus uncomplicated 185 (50.8%). Average age 36.4 ± 18.9 versus 32.4 ± 19.1 years, male 114 (63.7%) versus 107 (57.8%), respectively. A statistically significant difference was found in: symptomatology cough 147 (82.1%) versus 120 (64.9%), hemoptysis 93 (52.0%) versus 45 (24.3%), respectively; HPC right 115 (64.2%) versus 99 (53.5%), respectively; resective cyst surgery 139 (77.7%) versus 167 (90.3%), reoperation 22 (12.3%) versus 8 (4.3%), respectively; morbidity 47 (26.3%) versus 30 (16.2%), mortality 6 (3.4%) versus 0 (0%), average postoperative hospital stay 16.1 ± 14.3 versus 10.7 ± 7.7 days, recurrence 15 (8.4%) versus 13 (7.0%), respectively. Conclusions: Approximately half of the HPCs are complicated. Complicated HPCs present statistically significant differences in their clinical, treatment, morbidity, mortality and postoperative hospital stay.
Subject(s)
Humans , Male , Female , Echinococcosis, Pulmonary/mortality , Echinococcosis, Pulmonary/therapy , Echinococcosis, Pulmonary/epidemiology , Chi-Square Distribution , Chile , Longitudinal Studies , Morbidity , Sex Distribution , Age Distribution , AftercareABSTRACT
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.