Cholangiohydatidosis. Clinical features, postoperative complications and hospital mortality. A systematic review.

BACKGROUND: Cholangiohydatidosis (CH) is an evolutionary complication of hepatic cystic echinococcosis, associated with increased morbidity and mortality. The aim of this study was to describe the available evidence regarding clinical characteristics of CH, postoperative complications and hospital mortality. METHODOLOGY/PRINCIPAL FINDINGS: Systematic review. Studies related to CH with no language or publication restriction were included. Sensitive searches were performed in Trip Database, SciELO, BIREME-BVS, WoS, PubMed, EMBASE and SCOPUS. MeSH and free terms were used, including articles up to April 2023. The main outcome variables were postoperative complications and hospital mortality; the secondary ones were publication year, origin and design of primary studies, main clinical manifestation, anatomical location and type of cysts, hospital stay, surgical procedure performed, reinterventions; and methodological quality of primary studies, which was assessed using MInCir-T and MInCir-P scales. Descriptive statistics, calculation of weighted averages and their comparison by least squares logistic regression were applied. 446 studies were retrieved from the searches performed, 102 of which met the inclusion and exclusion criteria. The studies analyzed represent 1241 patients. The highest proportion of articles was published in the last decade (39.2%). Reports are mainly from Turkey (28.4%), Greece (9.8%), Morocco and Spain (8.8% each). With a weighted mean of 14.3 days of hospital stance; it was verified that 26.2% of patients developed postoperative complications (74,3% Clavien y Dindo III y IV), 6.7% needed re-interventions, and 3.7% died. When comparing the variables age, postoperative complications, hospital mortality, and reinterventions in two periods of time (1982-2006 vs. 2007-2023), no statistically significant differences were found. When applying the MInCir-T and MInCir-P scales, the methodological quality of the primary studies was 9.6±1.1 and 14.5±4.3 points, respectively. CONCLUSION/SIGNIFICANCE: CH is associated with severe postoperative complications and significant hospital mortality, independent of the development of therapeutic support associated with the passage of time.

Scientific literature on neglected tropical diseases: a bibliometric analysis.

Neglected tropical diseases (NTDs) are a group of diseases mainly affecting people in low- and middle-income Countries. The aim of this study was to perform a bibliometric analysis of the scientific literature on NTDs. Using the MeSH database, we quantified the number of publications on MEDLINE targeting each NTD, which were published from 1 January 1999 to 31 January 2019. In order to weight the number of publications targeting a given NTD according to the total number of publications/year, we calculated a Yearly Publication Index (YPI) for each NTD/year. Linear regression was used to determine if there was a significant increase or decrease of YPI over time. In order to weight the number of publications according to disease burden (expressed in Disability-adjusted life years - DALYs) we calculated a DALYs-weighted Publication Index (DWPI) for each NTD. The highest absolute number of publications focused on leishmaniasis, dengue and Chagas disease; the lowest on tungiasis, dracunculiasis, chromoblastomycosis and yaws. The number of publications significantly increased for chikungunya, chromoblastomycosis, dengue, leishmaniasis, snakebite envenoming, and yaws. It significantly decreased for ascariasis, cysticercosis, echinococcosis, leprosy, lymphatic filariasis, mycetoma, onchocerciasis. Leprosy had the highest DWPI (i.e. the highest number of publication considering the burden of disease), followed by Chagas disease; lymphatic filariasis had the lowest, followed by onchocerciasis. Overall, lymphatic filariasis, onchocerciasis and ascariasis presented the worst scenario, with both very few publications compared with their disease burden and a decreasing number of publications.

Recurrencia en echinococcosis quística hepática

El tratamiento quirúrgico de la equinococosis quística hepática se asocia (entre otras), con una tasa de recurrencia actual de hasta 27%, aunque es infrecuente la recurrencia después de la exéresis total de un quiste intacto. Por lo general, la recurrencia ocurre producto del derrame de estructuras parasitarias vivas a alguna cavidad, o de dejar residuos de germinal, vesículas hijas o protoescólices durante la cirugía. La recurrencia suele ser asintomática, por lo que el diagnóstico depende, casi exclusivamente, de un seguimiento riguroso y prolongado en el tiempo, con controles clínicos, determinaciones serológicas, e imágenes. El tratamiento puede incluir el uso de albendazol, asociado a técnicas de radiología intervencionista o cirugía. El objetivo de este manuscrito fue generar un documento de lectura referente a la recurrencia de la equinococosis quística hepática.

Surgical treatment of hepatic cystic echinococcosis is associated (among others), with a current recurrence rate of up to 27%; although recurrence after total resection of an intact cyst is rare. In general, recurrence occurs as a result of the spillage of living parasitic structures into a cavity, or of leaving germinal residues, daughter vesicles, or protoscolices during surgery. Recurrence is usually asymptomatic, so the diagnosis depends almost exclusively on a rigorous and prolonged follow-up, with clinical controls, serological determinations, and images. Treatment may include the use of albendazole, followed by interventional radiology techniques or surgery. The aim of this manuscript was to generate a reading document regarding the recurrence of hepatic cystic echinococcosis.

Morphology of Echinococcus granulosus protoscolex / Morfología de los Protoescolex de echinococcus granulosus

SUMMARY: Echinococcus granulosus (E. granulosus), is a tapeworm that spreads between intermediate and definitive hosts through the ingestion of fecal matter contaminated with the parasite's eggs. The life cycle consists of differentiation from eggs to oncospheres to embryos, which eventually form cysts in organs like the liver, lungs and others. Within these cysts are protoscolices, an intermediate stage of the parasite which develop into adult tapeworms once they infect their definitive hosts. When these hydatid cysts form in humans, it is known as Cystic Echinococcosis (CE). This disease is treated through surgical excision of the cysts and or chemotherapy with benzimidazole compounds. Understanding the morphology of the intermediate developmental stage of E. granulosus, protoscolex stage, can allow researchers to identify defining structural changes and protein functions that could be used to develop treatment modalities for CE. Unique characteristics in the tegumental surface during the protoescolex stage and proteins associated with cyst fertility have all been identified in previous research studies and bring researchers closer to understanding the underlying mechanisms of E. granulosus development, and consequently, means to disrupt it to achieve better control of the disease.

El Echinococcus granulosus (E. granulosus), es un cestodo que se propaga entre huéspedes intermedios y definitivos a través de la ingestión de materia fecal contaminada con los huevos del parásito. El ciclo de vida consiste en la diferenciación de huevos a oncosferas y embriones, que finalmente forman quistes en órganos como el hígado, los pulmones y otros. Dentro de estos quistes hay protoescólices, una etapa intermedia del parásito que se convierte en su forma adulta (tenia), una vez que infectan a sus huéspedes definitivos. Cuando estos quistes hidatídicos se desarrollan en seres humanos, se les conoce como equinococosis quística (EC). Esta enfermedad se trata mediante la extirpación quirúrgica de los quistes o la quimioterapia con compuestos benzimidazólicos. La comprensión de la morfología de la etapa de desarrollo intermedia del E. granulosus y la etapa de protosclex, puede permitir a los investigadores identificar cambios estructurales definidos y funciones de proteínas que podrían usarse para desarrollar modalidades de tratamiento para la CE. Las características únicas en la superficie tegumentaria durante la etapa de protoescolex y las proteínas asociadas con la fertilidad del quiste se han identificado en estudios de investigación anteriores y acercan a los investigadores a la comprensión de los mecanismos subyacentes del desarrollo del E. granulosus y, en consecuencia, los medios para interrumpirlo para lograr un mejor control de la enfermedad.

Distribución espacial de los Genotipos de Echinococcus granulosus sensu lato por hospedero en el continente americano. Revisión sistemática / Spatial distribution of Echinococcus granulosus sensu lato genotypes in the american continent

BACKGROUND: Knowledge of the distribution cystic is required for its territorial control. Aim: To describe the spatial distribution of Echinococcus granulosus sensu lato genotypes by host in the American continent. MATERRIAL AND METHODS: A systematic review of studies from the American continent, related to genotypes of the E. granulosus s.l complex were included, including any host species, without restriction of language or year of publication. Sensitive searches were performed based on sensitive searches from PubMed, EMBASE, ScienceDirect, SCOPUS and WoS; SciELO and BIREME-BVS and Trip Database. MeSH and free terms were used, including articles up to December 2020. Cartography was carried out with the Arc Map 10® program, using a world geodetic system. Result variables sought were genotype, host, geographic location, year of publication, number of samples, genes used for genotyping. RESULTS: From 1123 retrieved studies retrieved, 53 met the inclusion and exclusion criteria. The studies analyzed represent 3,397 samples from humans and animals. Thirty six percent of articles were published in the five-year period 2016-2020. Reports were mainly from Argentina (27.9%), Brazil (20.6%) and Chile (13.2%). The most reported genotypes globally were G1-G3 (47.3%), G7 (15.3%), G5 (14.6%) and G6 (13.3%). A predominance of G1-G3 and G6 genotypes was verified in South America, G8 and G10 in North America, and "epidemiological silence" in Central America and the Caribbean. Conclusions: Spatial analysis allows defining the relationship of territories and cases with their own characteristics, which can help to plan control interventions.

PROTEOMIC PROFILE OF ECHINOCOCCUS GRANULOSUS: A SYSTEMATIC REVIEW.

Cystic echinococcosis is a zoonotic disease caused by the larval stage of Echinococcus granulosus. This affliction is an endemic worldwide condition that represents a neglected parasitic disease with important socioeconomic repercussions. Proteomic characterization of larval and adult stages of E. granulosus, as well as the association between expression profiles and host interactions, is relevant for a better understanding of parasite biology, and eventually for drug design and vaccine development. This study aimed to develop a synthesis of the evidence available related to proteomics of E. granulosus. A systematic review was carried out to collect data concerning the proteomics of E. granulosus, without language or host restriction, published between 1980 and 2019. A systematic search was carried out in the Trip Database, BIREME-BVS, SciELO, Web of Science, PubMed, EMBASE, SCOPUS, EBSCO host, and LILACS, using MeSH terms, free words, and Boolean connectors, and adapting strategies to each source of information. Additionally, a manual cross-reference search was performed. Variables studied were the year of publication, geographic origin of the study, number of samples, hosts, parasitic organs, proteomic techniques, and parasite proteins verified. Nine-hundred and thirty-six related articles were identified: 17 fulfilled selection criteria, including slightly more than 188 samples. Most articles were published between 2014 and 2019 (64.7%) and were from Brazil and China (35.3% each). In reference to confirmed hosts in the primary articles, cattle (41.2%) and humans (23.5%) were the most frequently reported. Concerning proteomic techniques applied in the primary articles, LC-MS/MS was the most used (41.1%), and 890 proteins were reported by the primary articles. As the results of our search suggest, the information related to E. granulosus proteomics is scarce, heterogeneous, and scattered throughout several articles that include a diversity of tissues, samples, intermediate hosts, and proteomic techniques. Consequently, the level of evidence generated by our search is type 4.

[Spatial distribution of Echinococcus granulosus sensu lato genotypes in the american continent]. / Distribución espacial de los Genotipos de Echinococcus granulosus sensu lato por hospedero en el continente americano. Revisión sistemática.

BACKGROUND: Knowledge of the distribution cystic is required for its territorial control. AIM: To describe the spatial distribution of Echinococcus granulosus sensu lato genotypes by host in the American continent. MATERIAL AND METHODS: A systematic review of studies from the American continent, related to genotypes of the E. granulosus s.l complex were included, including any host species, without restriction of language or year of publication. Sensitive searches were performed based on sensitive searches from PubMed, EMBASE, ScienceDirect, SCOPUS and WoS; SciELO and BIREME-BVS and Trip Database. MeSH and free terms were used, including articles up to December 2020. Cartography was carried out with the Arc Map 10® program, using a world geodetic system. Result variables sought were genotype, host, geographic location, year of publication, number of samples, genes used for genotyping. RESULTS: From 1123 retrieved studies retrieved, 53 met the inclusion and exclusion criteria. The studies analyzed represent 3,397 samples from humans and animals. Thirty six percent of articles were published in the five-year period 2016-2020. Reports were mainly from Argentina (27.9%), Brazil (20.6%) and Chile (13.2%). The most reported genotypes globally were G1-G3 (47.3%), G7 (15.3%), G5 (14.6%) and G6 (13.3%). A predominance of G1-G3 and G6 genotypes was verified in South America, G8 and G10 in North America, and "epidemiological silence" in Central America and the Caribbean. CONCLUSIONS: Spatial analysis allows defining the relationship of territories and cases with their own characteristics, which can help to plan control interventions.

Incurable and refractory spinal cystic echinococcosis: A case report.

BACKGROUND: Although the incidence and cure rate of spinal hydatidosis are low, the recurrence rate of spinal hydatidosis is high, and the prognosis of spinal hydatidosis is poor. Therefore, we report a typical case of refractory spinal hydatidosis to increase spine surgeons' awareness of the disease and reduce misdiagnosis and recurrence. CASE SUMMARY: A 48-year-old man presented with back pain, significant weight loss, and paralysis of both lower limbs. The patient was misdiagnosed with spinal tuberculosis in an outside hospital. However, spinal magnetic resonance imaging (MRI) showed hyperintense cystic components on T2-weighted images and hypointensity on T1-weighted images. A lobulated, multiocular, honeycomb-appearance, septated cystic mass protruding intraspinally and compressing the spinal cord at segments T8-T9 was present. Paravertebral polycystic lobular lesions presented as a "bunch of grapes". The ELISA test result for Echinococcus granulosus was positive. Then, a diagnosis of spinal hydatidosis and lung hydatid disease was made, and the patient underwent left transthoracic approach lobectomy, paravertebral lesion debridement, and subtotal vertebrectomy with vertebral body replacement of segments T8 and T9 by a mesh cage. The patient also underwent albendazole chemotherapy before and after surgery. One year after stopping the drug therapy, the patient developed recurrent T5 vertebral lesions and underwent a second subtotal vertebrectomy surgery. The patient is currently in good condition and is receiving long-term medication and follow-up. CONCLUSION: The MRI feature of a "bunch of grapes" is a typical imaging indication of spinal hydatidosis. Subtotal vertebrectomy is a risk factor for postoperative recurrence. Total spondylectomy makes it possible to cure spinal hydatidosis, but antiparasitic drug therapy is also an important supplementary therapy to multimodal therapy. It is preferable for patients with spinal hydatidosis to receive life-long antiparasitic medication therapy and follow-up.

Extra-visceral retroperitoneal echinococcosis: case series with follow-up / Echinococosis retroperitoneal extra-visceral: serie de casos con seguimiento

SUMMARY: Extra-visceral retroperitoneal echinococcosis (EVRE), represents an infrequent condition, even in endemic areas. Its best treatment option is surgery. The aim of this study was to determine postoperative morbidity (POM) and recurrence in patients with EVRE, surgically treated. Case series with follow-up of patients with EVRE undergoing surgery consecutively at RedSalud Mayor Temuco Clinic, between 2008 and 2019. The outcome variables were POM and recurrence. Other variables of interest were cyst diameter, surgical time, and hospital stay. Descriptive statistics was used. In this study, 12 patients (75.0 % male), with a median age of 46 years, were treated. The 58.3 % of cases were primary retroperitoneal cysts. The median of cyst diameter, surgical time, and hospital stay were 15 cm, 95 min, and 4 days respectively. The most frequent type of resection was total cystectomy (58.3 %). MPO was 8.3 % (there was urinary infection in one patient). No reoperations were necessary. There was no operative mortality. With a median follow-up of 90 months, a recurrence of 8.3 % was verified (one case). The results achieved, in terms of POM and recurrence were similar to other series.

RESUMEN: La equinococosis retroperitoneal extravisceral (EREV), representa una condición poco frecuente, incluso en áreas endémicas. Su mejor opción de tratamiento es la cirugía. El objetivo de este estudio fue determinar morbilidad postoperatoria (MOP) y recurrencia de pacientes con EREV tratados quirúrgicamente. Serie de casos con seguimiento de pacientes con EREV intervenidos de forma consecutiva en Clínica RedSalud Mayor Temuco, entre 2008 y 2019. Las variables resultado fueron POM y recurrencia. Otras variables de interés fueron diámetro del quiste, tiempo quirúrgico y estancia hospitalaria. Se utilizó estadística descriptiva. Se trató a 12 pacientes (75,0 % hombres), con una mediana de edad de 46 años. El 58,3 % de los casos fueron quistes retroperitoneales primarios. La mediana del diámetro del quiste, tiempo quirúrgico y estancia hospitalaria fueron 15 cm, 95 min y 4 días, respectivamente. El tipo de resección más frecuente fue la quistectomía total (58,3 %). La MPO fue 8,3 % (infección urinaria en un paciente). No hubo reintervenciones ni mortalidad operatoria. Con una mediana de seguimiento de 90 meses, se verificó una recurrencia de 8,3 % (un caso). Los resultados obtenidos, en cuanto a MPO y recurrencia, son similares a otras series.

[Simultaneous combined radical surgery for hepatic and renal alveolar echinococcosis: an analysis of 10 clinical cases].

Objective: To examine the feasibility, safety and efficacy of simultaneous combined radical surgery for hepatic and renal alveolar echinococcosis (AE). Methods: Clinical dates of consecutive 10 hepatic and renal AE patients who accepted surgical treatment in the First Affiliated Hospital of Xinjiang Medical University during April 2013 to September 2019 were analyzed retrospectively. There were 8 males and 2 females, aged (42.5±10.3) years (range: 27 to 52 years). Seven of them had previously palliative surgical treatment with poor compliance to post-operative medication. All of the patients had hepatic-renal combined AE lesions, and two of them had left lateral and left renal lesions for each, which sized for (726.4±576.1)cm3 (range: 117.0 to 1 998.0 cm3). Extra-hepatic or renal lesions infiltrated to right diaphragm, inferior vena cava, right adrenal gland, abdominal wall, right psoas muscle, duodenum wall and right pulmonary lobe (respectively were 7, 7, 6, 2, 1, 1, 2 cases). Surgery were performed mainly with simultaneous combined surgery and vascular reconstruction techniques for this series. Hemi-hepatectomy or extended right lobectomy was applied in 8 patients, while 2 other patients received ex vivo liver resection and autotransplantation, additionally, one patient had partial hepatectomy for left lateral lobular lesion. Total right nephrectomy, partial right nephrectomy and partial left nephrectomy were respectively performed on 7, 3 and 1 patient(s). Additionally, extra-hepatic or renal lesions were eradicated followed by relevant repairments or reconstructions. Results: Surgeries went well and there was no intra-or post-operative liver or renal dysfunction occurred. During recovery period, 3 cases experienced with hydrothorax and managed well after drainage and supportive treatment, and one patient developed peri-renal urinary leakage and cured by "J" catheter. The subjects were followed-up for 6 to 81 months (median: 21 months), no death, organ dysfunction, chronic or acute kidney diseases occurred. One case encountered with abdominal hernia at post-operative 7th month and was successfully managed with laparoscopic repair with artificial mesh. No disease recurrence in all patients, which reached clinical cure at last. Conclusion: When complied strictly to indications, simultaneous combined radical surgery could be a feasible, safe and efficient approach for patients with hepatic and renal AE, which is primary or relapsed from previous hepatic AE surgery or interventional therapies as well as neighboring organ AE invasions.

Pulmonary Echinococcosis or Lung Hydatidosis: A Narrative Review.

Background: Lung hydatidosis is a zoonosis related to infection by the Echinococcus tapeworm species. Lung involvement in this condition is second only to the liver echinococcosis. Diagnosis ordinarily results from an accidental finding in a direct chest radiograph evaluation because of the delayed growth of the cysts. Moreover, a consistent treatment regimen or approach may not be feasible because of the variability of pulmonary echinococcosis. In this review, we expect to sum up the main features of lung hydatidosis with a perspective on medical and surgical treatment. Methods: Cochrane Library and PubMed were the databases used to perform a narrative literature review. Search terms included "pulmonary echinococcosis" and "lung hydatidosis." The MeSH terms were "lung" [All Fields] AND {"echinococcosis" [MeSH Terms] OR ("hydatidosis" [All Fields] OR "pulmonary" [All Fields] AND "echinococcosis" [All Fields] OR "hydatidosis." A search period from September 1980 to May 2020 was chosen to compare studies from different decades, given the changes in pulmonary echinococcosis management. Results: A uniform treatment regimen or approach may not be feasible because of the variability of pulmonary echinococcosis. No clinical trials have analyzed and compared all the diverse treatment approaches. Cyst size, characteristics, position in the lung and clinical presentation, and the availability of medical/surgical expertise and equipment are the mainstays of echinococcosis management. When feasible, surgery is as yet the principal therapeutic choice to eliminate the cysts; anti-parasitic drugs may minimize complications during high-risk surgery or be used as definitive therapy in some instances with contraindications to surgery. Conclusions: Lung hydatidosis management must become less heterogeneous. We support treatment directed to the subject established on the clinical scenario, host factors, and surgical risk. Strict cooperation in this process between infectious disease specialists and surgeons may optimize best practices to help create shared practical guidelines to simplify clinicians' decision-making. Furthermore, we need a consensus for lung hydatidosis treatment and inserting this disease to global surgery agenda will have a positive impact on acquiring high-quality data that enables us to create an evidence-based guideline for this disease.

Morphological characteristics of liver abscesses according its etiology / Características morfológicas de los abscesos hepáticos según su etiología

Although infrequent in the diagnostics areas, liver abscesses are of significant relevance, which is related to the high morbidity and mortality figures they can cause if they are not detected and treated in time. Although multiple operational classifications are described, the one most recognized for its usefulness is that related to its causative agent (pyogenic or bacterial infection, hydatid origin or secondary to infected hydatidosis, and amoebic or by invasive amebiasis). The objective of this article was to generate a study report regarding the morphological characteristics of liver abscesses, characterizing them according to their etiology, as well as describing their study and the latest recommended treatments.

Los abscesos hepáticos son entidades nosológicas de baja frecuencia, pero de significativa relevancia, la que se relacionada con las elevadas cifras de morbilidad y mortalidad que pueden causar si no son detectados y tratados a tiempo. Si bien se describen múltiples clasificaciones operacionales, aquella más reconocida por su utilidad es la relacionada a su agente causal (piógenos o bacterianos, hidatídicos o secundarios a hidatidosis infectada, y amebianos o por amebiasis invasora). El objetivo de este artículo fue generar un documento de estudio respecto de las características morfológicas de los abscesos hepáticos, caracterizándolos de acuerdo con su etiología, así como describir su estudio y tratamiento recomendado de acuerdo con el estado del arte.

Percutaneous stenting of left hepatic vein followed by Ex vivo Liver Resection and Autotransplantation in a patient with hepatic alveolar echinococcosis with Budd-Chiari syndrome.

BACKGROUND AND AIMS: Infiltration of hepatic venous outflow in hepatic alveolar echinococcosis can lead to development of Budd-Chiari syndrome. Medical treatment of this condition is generally unsatisfactory. Radical hepatic resection is impossible for extensive parasitic involvement of liver. This is a case report on a patient who was successfully treated with percutaneous stenting of left hepatic vein followed by Ex vivo Liver Resection and Autotransplantation (ELRA). METHODS: Using the transjugular approach, a metal mesh stent was placed in the left hepatic vein of a 45-year-old man who presented with Budd-Chiari syndrome. After disappearance of ascites and improvement in liver function, Ex vivo Liver Resection and Autotransplantation were performed. RESULTS: The patient underwent left hepatic vein stenting for Budd-Chiari syndrome without complication. Three months later, liver biopsy showed fibrous proliferation of interlobular portal areas and normal hepatic lobules. After successful Ex vivo Liver Resection and Autotransplantation, follow-up examination at 6 months showed normal liver function and no evidence of recurrence. CONCLUSIONS: Allotransplantation is an accepted treatment for advanced hepatic alveolar echinococcosis with Budd-Chiari syndrome. However, shortage of organ donors and need for immunosuppression are challenging problems. In selected patients with hepatic vein stenoses presenting as Budd-Chiari syndreme, percutaneous stenting of hepatic veins followed by ex vivo liver resection and autotransplantation represent an alternative curative treatment option.

[Treatment of patient with echinococcosis of lungs and mediastinum]. / Lechenie patsienta s ékhinokokkozom legkikh i sredosteniia.

It is presented diagnosis and treatment of 53-year-old man with multiple echinococcosis of the lungs and mediastinum. The diagnosis was confirmed by chest CT. Patient previously underwent surgery for liver echinococcosis. Excision of echinococcosis lesions in the lungs and mediastinum was performed. Chest wall repair was made by using of pedicled flap from the right lateral surface of the thorax followed by donor site plasty by polypropylene mesh. There were no intraoperative complications. In the postoperative period, intermediate bronchus occlusion mas made by occluder due to persistent air output through the pleural drains. The device was removed after 4 days. The patient was discharged. Multidisciplinary approach is useful to achieve good results in these patients.

Hepatic Echinococcosis with Thoracic Involvement. Clinical Characteristics of a Prospective Series of Cases.

INTRODUCTION: Thoracic involvement (TIHE) is one of the evolutionary complications of hepatic echinococcosis (HE). AIM: The aim of this study was to describe the clinical characteristics and postoperative morbidity (POM) of a series of patients with TIHE treated surgically. MATERIAL AND METHODS: Series of cases of patients treated for TIHE between 2000 and 2014 in the Hospital Regional and Clínica Mayor in Temuco, Chile, with a minimum 12-month follow-up. The outcome variable was "development of POM". Descriptive statistics were used. RESULTS: The series was composed of 37 patients with a mean age of 53.2 ± 47.4 years (51.4% female). Mean cyst diameter was 19.4 ± 15.5 cm, and 75.7% of the lesions were located in the right hepatic lobe. The most frequent surgical technique used for the cyst was subtotal pericystectomy (56.8%); the residual cavity was treated by capitonnage (27.0%) or omentoplasty (21.6%), and a phrenoplasty with or without prosthetic material was performed for the TIHE. Mean hospital stay was 6.0 ± 5.7 days and follow-up was 61.4 ± 79.9 months; a mortality rate of 2.7% (one patient) and a POM of 24.3% (9 patients) were verified. CONCLUSION: TIHE is an uncommon evolutionary complication of HE associated with significant POM rate.

Cholangiohydatidosis: an Infrequent Cause of Obstructive Jaundice and Acute Cholangitis

ABSTRACT Background. One of the evolutionary complications of hepatic echinococcosis (HE) is cholangiohydatidosis, a rare cause of obstructive jaundice and cholangitis. The aim of this study was to describe the results of surgical treatment on a group of patients with cholangiohydatidosis and secondary cholangitis in terms of post-operative morbidity (POM). Material and method. Case series of patients operated on for cholangiohydatidosis and cholangitis in the Department at Surgery of the Universidad de La Frontera and the Clínica Mayor in Temuco, Chile between 2004 and 2014. The minimum follow-up time was six months. The principal outcome variable was the development of POM. Other variables of interest were age, sex, cyst diameter, hematocrit, leukocytes, total bilirubin, alkaline phosphatase and transaminases, type of surgery, existence of concomitant evolutionary complications in the cyst, length of hospital stay, need for surgical re-intervention and mortality. Descriptive statistics were calculated. Results. A total of 20 patients were studied characterized by a median age of 53 years, 50.0% female and 20.0% having two or more cysts with a mean diameter of 13.3 ± 6.3 cm. A median hospital stay of six days and follow-up of 34 months was recorded. POM was 30.0%, re-intervention rate was 10.0% and mortality rate was 5.0%. Conclusion. Cholangiohydatidosis is a rare cause of obstructive jaundice and cholangitis associated with significant rates of POM and mortality.(AU)

Detection of taeniid (Taenia spp., Echinococcus spp.) eggs contaminating vegetables and fruits sold in European markets and the risk for metacestode infections in captive primates.

Due to frequent cases of alveolar echinococcosis (AE) in captive primates in Europe, 141 samples of food, which consisting of vegetables and fruits, were investigated for contamination with egg-DNA of taeniids. Each sample consisted of at least 40 heads of lettuce as well as various vegetables and fruits. The samples were purchased at different times of the year: either from September to November (autumn), originating from greenhouses or fields in the Basel region in the North of Switzerland, or in April and May (spring) when fruit and vegetables are sourced from throughout Europe from various wholesalers. Each sample was washed, and the washing water sieved through mesh apertures of 50 µm and 21 µm, respectively. The debris, including taeniid eggs, collected on the 21 µm sieve were investigated by a multiplex PCR-analysis followed by direct sequencing. In 17 (18%) of the 95 samples collected in autumn, taeniid-DNA was detected (Taenia hydatigena in four, Taenia ovis in three, Taenia polyacantha in two and Hydatigera (Taenia) taeniaeformis in five cases). Similarly, in 13 (28%) of the 46 samples collected during spring taeniid-DNA was detected (Echinococcus granulosus s.l. in two, Taenia crassiceps in one, T. hydatigena in two, Taenia multiceps/Taenia serialis in two, Taenia saginata in one and H. taeniaeformis in five cases). Although DNA of Echinococcus multilocularis was not found specifically in this study, the detection of other fox taeniids reveals that vegetables and fruit fed to the primates at the Zoo Basel at different times of the year and from different origin are contaminated with carnivore's faeces and therefore act as a potential source of AE infections.

Secondary inguinal hydatidosis mimicking irreducible inguinal hernia: report of a rare case.

Peritoneal hydatidosis secondary to liver hydatid disease is not uncommon but peritoneal hydatidosis herniating to the inguinal canal is rare, with fewer than five cases reported in the literature. We describe a 54-year-old man who presented with a progressively enlarging soft, cystic swelling in the right inguinal region. Clinical examination suggestive of irreducible right inguinal hernia and ultrasonography revealed it to be a cystic swelling within the hernial sac. The swelling was excised en bloc and open mesh hernioplasty was performed. Cyst biopsy revealed hydatid disease; hence, the patient was put on adjunctive albendazole chemotherapy for 3 months.

Quiste hidatídico hepático complicado con invasión a vena cava inferior y embolización de membranas hidatídicas a aurícula derecha: caso clínico / Hepatic hydatid cyst invading inferior vena cava with embolic membranes to right atrium: report of one case

We report a 30 year old female admitted with a story of right upper quadrant pain and previous hepatic surgery for hydatid disease. A thoracoabdominal angio CAT sean and transesophageal echocardiogram revealed a mass located in the right atrium. The patient was operated and the right atrial mass was excised. Pathological study of the surgical piece confirmed a hydatid cyst. Post operative recovery was uneventful.

La hidatidosis es una zoonosis parasitaria, de mayor incidencia en el sur de Chile. Su localización más frecuente es hepática y pulmonar. Sus complicaciones derivan de su crecimiento y afección de estructuras adyacentes o de su ruptura a cavidades. Presentamos un caso de quiste hidatídico hepático complicado, en una paciente que debutó con cuadro de dolor abdominal localizado en hipocondrio derecho producto de una lesión quística hepática con comunicación a vena cava inferior, siendo intervenida en su hospital de origen. Posteriormente AngioTAC y ecocardiografía transesofágica confirmaron masa intra auricular. Se realizó extracción de la masa bajo paro circulatorio con hipotermia profunda, correspondía a membranas hidatídicas y trombos adheridos a ella. La paciente evolucionó satisfactoriamente.