Intrabiliary Rupture of a Hepatic Hydatid Cyst: A Case Report.

BACKGROUND Hydatid disease is a common parasitic infection in many areas of Asia, South America, and Africa. It can affect any organ, most commonly the liver. The hydatid is often asymptomatic and the diagnosis is made when complications arise. The most common complication of this disease is opening in the bile ducts, which is a life-threatening condition causing serious acute cholangitis. We report a case of acute cholangitis caused by hydatid cyst rupture into the right bile duct. CASE REPORT A 33-year-old woman, with no medical or surgical history, presented to our Emergency Department with abdominal pain, jaundice, and fever for 3 days prior to admission. The patient was hemodynamically stable. In the examination, we noticed right upper-quadrant tenderness with guarding, icterus sclera, and negative Murphy sign. A CT scan showed a liver hydatid cyst of the 4th and 8th of segments, with intrahepatic and extrahepatic biliary duct dilation. The cyst communicated with the right hepatic bile duct via a large fistula. A diagnosis of acute cholangitis was made and she underwent conservative treatment with external drainage of the pericystic cavity through the biliary duct. The postoperative course was uncomplicated and she was discharged 15 days later. CONCLUSIONS The surgical approach to hepatic hydatid must be customized based on the specific characteristics of the cyst and associated complications. Acute hydatid cholangitis is a rare but serious complication of a hydatid cyst, which requires early diagnosis and adequate surgical management.

A Rare Autochthonous Case of Hepatic Hydatid Cyst in the Non-Endemic Region of Taiwan.

BACKGROUND Hepatic hydatid cyst disease, caused by the parasite Echinococcus granulosus, is endemic in certain rural areas of the world, but not in most of East Asia outside Mainland China. In Taiwan, only one autochthonous case has been reported over the past 40 years. We present the case of an urban 91-year-old female patient without international travel history for more than 40 years. CASE REPORT The 91-year-old woman who used a wheelchair came to the Emergency Department reporting melena for 2 days and 1 episode of coffee-grounds vomitus. Epigastric tenderness was present. An incidental finding of elevated liver enzymes along with the clinical picture prompted further survey. Computed tomography revealed a 14×10×12 cm homogeneous cystic lesion in the right hepatic lobe with a partially calcified wall. On sonograms, a similar lesion was found, and the pathognomic "water-lily" sign was visualized along with the isoechoic-to-hypoechoic internal septa, fulfilling the diagnosis despite the patient's refusal to undergo magnetic resonance imaging studies and invasive definite diagnostic procedures. Although anthelmintic chemotherapy and invasive therapeutic measures were also refused, her symptoms improved and was not recurrent under supportive measures. However, the cyst was still present 12 months after discharge. CONCLUSIONS The case highlights that in areas with few cases of hepatic hydatid disease, the accurate diagnosis could be missed in patients without a significant epidemiological history. However, once imaging findings, especially those that are pathognomic, are appropriately interpreted on at least 2 imaging modalities, such cases could be diagnosed without further definitive studies.

Gossypiboma mimicking hepatic hydatid cyst after 22 years: a case report.

Gossypiboma is a non-absorbable material that is forgotten during surgery. These are medicolegal pathology that leads to diagnostic confusion from abscess to tumor. We present the case of gossypiboma detected in laparotomy in a 57-year-old male patient who had a history of operation due to a hydatid cyst 22 years ago and was referred to our center due to hydatid recurrence. The case should suggest a history of surgical gossypiboma, especially in asymptomatic patients. In this preventable pathology, the strategy during sur-gery and the careful and proper attitude of the surgical team are the main determinants.

Percutaneous drainage and combined praziquantel-albendazole therapy: a novel approach for the treatment of simple echinococcal liver cysts.

Cystic echinococcosis (CE) is a worldwide helminthic zoonosis causing serious disease in humans. The WHO Informal Working Group on Echinococcosis recommends a stage-specific treatment approach of hepatic CE that facilitates the decision on what therapy option is most appropriate. Percutaneous aspiration, instillation of a scolicide, e.g., ethanol or hypertonic saline, and subsequent re-aspiration (PAIR) have been advocated for treating medium-size unilocular WHO-stage CE1 cysts. PAIR can pose a risk of toxic cholangitis because of spillage of ethanol in the case of a cysto-biliary fistula or of life-threatening hypernatriaemia when hypertonic saline is used. The purpose of our study is to develop an alternative, safe, minimally invasive method to treat CE1 cysts, avoiding the use of toxic topic scolicides.We opt for percutaneous drainage (PD) in four patients: the intrahepatic drainage catheter is placed under CT-fluoroscopy, intracystic fluid is aspirated, and the viability of intracystic echinococcal protoscolices is assessed microscopically. Oral praziquantel (PZQ) is added to albendazole (ABZ) instead of using topical scolicidals.Protoscolices degenerate within 5 to 10 days after PZQ co-medication at a cumulative dosage of 250 to 335 mg/kg, and the cysts collapse. The cysts degenerate, and no sign of spillage nor relapse is observed in the follow-up time of up to 24 months post-intervention.In conclusion, PD combined with oral PZQ under ABZ coverage is preferable to PAIR in patients with unilocular echinococcal cysts.

Kidney invasion occurred 2 years following liver transplantation for hepatic alveolar echinococcosis: a case report.

BACKGROUND: The organ most commonly invaded in echinococcosis is the liver; the lungs, brain, kidneys, heart, and spleen are rarely invaded, and multi-organ involvement in echinococcosis is even rarer. No studies have reported renal invasion after liver transplantation for hepatic alveolar echinococcosis. CASE PRESENTATION: We report here a case of renal invasion 2 years after allogeneic liver transplantation in a 53-year-old female patient with hepatic alveolar echinococcosis combined with lung metastases. At the time of the first consultation, the lesion had been found to involve the second hepatic hilum combined with lung metastases, but the patient requested conservative treatment, and the lesion was not controlled by taking albendazole for 3 years. After discussion in the treatment group, it was decided to use allogeneic liver transplantation and lung segmental resection for surgical treatment, after which the patient was put on long-term oral immunosuppression. She was hospitalized 2 years later for low back pain and diagnosed with renal alveolar echinococcosis. Due to significant compression and left-sided renal insufficiency, the final option was to remove the diseased kidney. It is worth mentioning that signs of unexplained urinary tract infection were present throughout the course of treatment. CONCLUSION: This study suggests that extra attention should be paid to the presence of cryptogenic lesions in patients with hepatic alveolar echinococcosis who already have definite metastatic lesions. Immunosuppressive drugs after liver transplantation in patients with hepatic echinococcosis may cause occult lesions to develop into active ones. In clinical practice, particular attention should be paid to patients with hepatic alveolar echinococcosis with long-term concomitant signs of unexplained urinary tract infections, which may be a precursor clinical feature of cryptogenic renal alveolar echinococcosis.

Risk factors and management of biliary leakage after Endocystectomy for hepatic cystic echinococcosis.

BACKGROUND: Endocystectomy is a conservative surgical approach to managing cystic echinococcosis. Bile leakage is the main complication of this technique. The aim of this study was to evaluate the factors associated with bile leakage and to assess the outcomes and cost efficiency of strategies used to treat bile leakage. METHODOLOGY/PRINCIPAL FINDINGS: Patients who underwent endocystectomy between 2005 and 2020 were included. The preoperative characteristics, intra- and postoperative outcomes, hospital costs, and cost efficiency (the Diagnosis-Related Group reimbursement minus the overall cost) were evaluated prospectively. A total of eighty patients with 142 cysts were included. Postoperative complications occurred in 17 patients (21%), including 11 patients with bile leakage (type A: 1, type B: 6 and type C: 4 patients, total 13%). Bile leakage was more frequent in patients with preoperative MRI signs of cysto-biliary fistulas or intraoperative visible cysto-biliary fistulas (p = 0.03 and p = 0.04, respectively) and in patients with cysts larger than 8 cm (p = 0.03). Patients with bile leakage who underwent reoperation (type C) had significantly shorter hospital stays (9 vs. 16 days, p<0.01) and better cost efficiency than those who received radiologic or endocscopic interventions (€2,072 vs. -€2,097 p = 0.01). No mortality was observed, and recurrence was seen in two patients. CONCLUSIONS/SIGNIFICANCE: Endocystectomy is a safe and efficient technique. Preoperative and intraoperative cysto-biliary fistulas and a cyst diameter larger than 8 cm are correlated to postoperative bile leakage. Early operative management of bile leakage reduces hospital stay and improves cost efficiency compared with radiologic or endoscopic treatments.

Vascular pathology in patients with alveolar echinococcosis: framework for assessment and clinical management - a retrospective case series.

OBJECTIVE: Alveolar echinococcosis (AE) is a parasitic liver disease with infiltrative growth similar to solid organ malignancies. Major vascular damage is frequent and often remains untreated until catastrophic events precipitate. Detailed clinical and radiological assessment is required to guide individualised treatment decisions. Standardised radiological reporting templates of malignancies with profiles resembling AE are candidates for adaptation. Our objectives are to describe vascular pathology in AE and establish a framework for structured evaluation as the basis for treatment decisions and monitoring. DESIGN: Retrospective case series. RESULTS: 69 patients (37.1%) had vascular involvement: portal vein (PV) 24.7%, hepatic vein (HV) 22.6% inferior vena cava (IVC) 13.4%. Significant stenosis/occlusion of vessels was present in 15.1% of PV, in 13.4% of HV and in 7.5% of IVC involvement. Vascular pathology needing specific treatment or monitoring was present in 8.6% of patients. The most frequent clinical presentation was high grade IVC stenosis or occlusion which was seen in 11 patients of the cohort. CONCLUSION: Advanced AE requires early multidisciplinary assessment to prevent progressive impairment of liver function due to vascular damage. The focus at first presentation is on complete evaluation of vascular (and biliary) involvement. The focus in non-resectable AE is on prevention of vascular (and biliary) complications while suppressing growth of AE lesions by benzimidazole treatment to improve the quality of life of patients. We developed a framework for standardised vascular assessment and follow-up of patients with AE to recognise and treat complications early.

Pulmonary cystic echinococcosis.

PURPOSE OF REVIEW: The aim of our review is to summarize specific clinical, diagnostic and treatment aspects of pulmonary cystic echinococcosis. The lung is the organ second most affected by cystic echinococcosis with approximately a quarter of cystic echinococcosis cysts. Most cysts are in the liver. Apart from the watch and wait approach for selected inactive cysts [cystic echinococcosis CE4, CE5], the well established WHO cystic echinococcosis cyst classification-based treatment of hepatic cystic echinococcosis cannot be applied to pulmonary cystic echinococcosis cysts. Some standard interventions can even be harmful when applied to pulmonary cystic echinococcosis cysts. RECENT FINDINGS: Cystic echinococcosis is one of the neglected tropical diseases (NTDs). Development of new diagnostics and treatment modalities is hampered by low investment into research and is accordingly slow. SUMMARY: Surgery is the mainstay of treatment for pulmonary cystic echinococcosis cysts. Parenchyma-sparing surgical techniques should be used whenever possible. Albendazole induces decay of the parasitic cyst membrane, opening of cystobronchial fistulas and cyst complications, which can be life threatening. It is strongly recommended to seek advice from expert centres, including differential diagnoses, treatment and a long-term management plan.

Predictive Factors of Liver Hydatid Cyst Recurrence in Children.

BACKGROUND: Liver hydatid cyst affects approximately 95% of the world's echinococcosis cases. Despite advances in treatment, the recurrence rate remains high and is influenced by several factors that are yet to be determined. The objective of this study was to identify the predictive factors of liver hydatid cyst recurrence following surgery in children and to establish a treatment regimen aimed at preventing this postoperative morbidity. METHODS: A bi-centric retrospective descriptive and analytic study was conducted involving 122 children who underwent surgery for liver hydatid cysts between January 1st, 2009, and December 31st, 2017. All factors that could potentially contribute to recurrence were thoroughly investigated. The data was processed using SPSS.v21, and a significant level of p-value 0.05 was applied. RESULTS: Out of the 122 children, 20 patients experienced cyst recurrence (16.39%). Among them, there were nine girls and eleven boys. The median time of recurrence was 16.5 months. Abdominal ultrasonography demonstrated efficacy in detecting recurrence. Several factors were identified as predictors of postoperative recurrence, including intimate contact of the hydatid cyst with the large vessels (p = 0.031), intraperitoneal effusion (p = 0.042), bile duct dilation (p = 0.032), and postoperative spontaneous discontinuation of medical treatment (p = 0.010). Among these factors, two independent risk factors for recurrence were identified: intimate contact of the hydatid cyst with the large vessels (p = 0.011) and the presence of an intraperitoneal effusion (p = 0.018). CONCLUSION: Our study has identified several predictors of postoperative recurrence, including two previously undocumented risk factors in the literature. Awareness of these risk factors can assist surgeons in implementing preventive measures to avoid the recurrence of hydatid cysts. LEVEL OF EVIDENCE: Prognosis study Level II.

Watch-and-wait approach for inactive echinococcal cysts: scoping review update since the issue of the WHO-IWGE Expert Consensus and current perspectives.

PURPOSE OF REVIEW: This work aims to provide an update of knowledge on the evolution of inactive cystic echinococcosis (CE) cysts (CE4-CE5) managed by 'watch-and-wait', by means of a scoping review of the literature published after the publication of the WHO-IWGE (Informal Working Group on Echinococcosis) Expert Consensus document in 2010. RECENT FINDINGS: A total of 31 articles were included. Population ultrasound-based studies showed that spontaneously inactivated CE cysts represent 50.2% (95% confidence interval 38.7-61.8) of all detected untreated CE cysts, and that the prevalence of CE4-CE5 cysts tends to increase with age. Four longitudinal population-based studies showed that CE cysts naturally tend to evolve towards inactivation and that spontaneously inactivated cysts reactivate in a minority of cases. This was confirmed by four hospital-based studies, showing that spontaneously inactivated cysts reactivate rarely, while rate of reactivation is higher if inactivity was obtained posttreatment. It was not possible to drive conclusions on any difference in the clinical course of infection in immunocompromised or pregnant patients. SUMMARY: CE cysts tend to evolve spontaneously to inactivation over time. The published literature supports the safety of the watch-and-wait approach for inactive cysts, sparing treatment to a substantial proportion of asymptomatic patients. A regular follow-up with ultrasound of all inactive cysts is required to detect reactivations.

Diagnosis and surgical treatment of cysto-gastric fistula out of an hepatic hydatid cyst. Unusual case.

BACKGROUND: Hydatid cyst is an endemic zoonotic infection that annual incidence ranges from <1 to 200 per 100,000 individuals. The most common complication of hepatic hydatid cyst reported is rupture of the cysts, most commonly intrabiliary rupture. Direct rupture to hollow visceral organs is rarely seen. We describe here an unusual cystogastric fistula in a patient with liver hydatid cyst. CASE PRESENTATION: The 55-year-old male patient presented with right upper quadrant abdominal pain. After radiological imaging studies, the diagnose was of hydatid cyst involving the left lateral segment of the liver ruptured into the gastric lumen and resulted in a cystogastric fistula. Gastroscopy revealed that the cyst and its contents protruding from anterior wall to the gastric lumen. Partial pericystectomy and omentopexy were performed and the gastric wall was primarily repaired. There were no complications in the postoperative period and 3-month follow up. CONCLUSION: This case, to our knowledge, is the first reported case of cystogastric fistula surgically treated in a patient with liver hydatid cyst in the literature. Our clinical experience shows that, although it is a benign disease, complicated hydatid cysts should be evaluated in detail preoperatively, and after the detailed diagnostic work-up, surgical therapy might be planned individually for each case. KEY WORDS: Cysto-gastric fistula, Hydatid Cyst, Liver hydatidosis.

Alveolar echinococcosis in solid organ transplant recipients: a case series from two national cohorts.

Alveolar echinococcosis (AE) is a severe parasitic infection caused by the ingestion of Echinococcus multilocularis eggs. While higher incidence and faster evolution have been reported in immunosuppressed patients, no studies have been performed specifically on AE in transplant patients. We searched for all de novo AE cases diagnosed between January 2008 and August 2018 in solid organ transplant (SOT) recipients included in the Swiss Transplant Cohort Study and the FrancEchino Registry. Eight cases were identified (kidney = 5, lung = 2, heart = 1, liver = 0), half of which were asymptomatic at diagnosis. AE diagnosis was difficult due to the low sensitivity (60%) of the standard screening serology (Em2+) and the frequently atypical radiological presentations. Conversely, Echinococcus Western blot retained good diagnostic performances and was positive in all eight cases. Five patients underwent surgery, but complete resection could only be achieved in one case. Moreover, two patients died of peri-operative complications. Albendazole was initiated in seven patients and was well tolerated. Overall, AE regressed in one, stabilized in three, and progressed in one case, and had an overall mortality of 37.5% (3/8 patients). Our data suggest that AE has a higher mortality and a faster clinical course in SOT recipients; they also suggest that the parasitic disease might be due to the reactivation of latent microscopic liver lesions through immune suppression. Western blot serology should be preferred in this population. Finally, surgery should be considered with caution, because of its low success rate and high mortality, and conservative treatment with albendazole is well tolerated.

Title: Échinococcose alvéolaire chez les receveurs d'une greffe d'organe solide : une série de cas de deux cohortes nationales. Abstract: L'échinococcose alvéolaire (EA) est une maladie parasitaire grave causée par l'ingestion d'œufs d'Echinococcus multilocularis. Bien qu'une plus haute incidence et une évolution plus rapide aient été rapportées chez les patients immunodéprimés, aucune étude n'a été conduite spécifiquement sur cette maladie chez les patients transplantés. Nous avons donc listé tous les cas d'échinococcose alvéolaire apparus de novo entre janvier 2008 et août 2018 chez les patients transplantés d'organe solide inclus dans la cohorte Swiss Transplant Cohort Study et le registre FrancEchino. Huit patients ont été identifiés (rein = 5, poumon = 2, cœur = 1, foie = 0), dont la moitié était asymptomatique au moment du diagnostic. Le diagnostic était compliqué par la basse sensibilité (60 %) de la sérologie standard de dépistage (Em2+) et par les présentations radiologiques atypiques des lésions. Les performances diagnostiques du Western Blot n'étaient toutefois pas affectées et ce test était positif chez tous les patients. Sur les cinq patients opérés, une résection complète n'a été possible que dans un cas, tandis que deux patients sont décédés dans les suites de l'opération. L'albendazole a été introduit chez 7 patients et a été bien toléré. Dans l'ensemble, l'EA s'est stabilisée dans 3 cas, a régressé dans un cas et a progressé dans un autre cas, avec une mortalité de 37,5 % (3/8 patients). Nos résultats suggèrent une mortalité plus élevée et une évolution plus rapide de l'EA chez les patients transplantés. Ils suggèrent aussi que la maladie parasitaire pourrait être due à la réactivation de lésions hépatiques microscopiques latentes à la faveur de l'immunosuppression. Le Western Blot devrait être préféré dans cette population. Finalement, la chirurgie devrait être envisagée avec prudence, étant donnés son faible taux de réussite, le nombre élevé de décès peri-opératoires et la bonne tolérance au traitement conservateur par albendazole.

Chylothorax due to hepatic alveolar echinococcosis with infiltration of diaphragm and left pleura: a case report.

BACKGROUND: Alveolar echinococcosis (AE) is an endemic parasitic zoonosis in Germany. In most cases, the liver is the primary organ affected. CASE PRESENTATION: A 59-year old female patient presented with increasing exertional dyspnea and unintentional weight loss. A computed tomography (CT) scan showed a left-sided chylous pleural effusion and multiple intrahepatic masses with infiltration of the diaphragm and the pleura. The findings were initially misinterpreted as hepatocellular carcinoma (HCC) with infiltrating growth. Liver biopsy of one of the masses showed no evidence of malignancy, but an amorphous necrosis of unclear origin. HCC was further ruled out by magnetic resonance imaging (MRI). However, MRI findings were highly suspicious for hepatothoracic dissemination and complications due to AE. Typical histologic findings in a repeated and more specific examination of the liver tissue and a positive serology for echinococcosis confirmed the diagnosis of AE. As the hepatic and pulmonary manifestations were considered inoperable in a curative matter, an anti-parasitic treatment with albendazole was initiated. A video-assisted thoracoscopic surgery (VATS) with removal of the chylous effusion as well as a talc pleurodesis was performed to relieve the patient from dyspnea. Two months later, the patient was asymptomatic and a positron emission tomography (PET)-CT-scan with [18 F] fluoro-2-deoxy-d-glucose (FDG) showed a remarkable diminution of the hepatic manifestation. CONCLUSIONS: This case demonstrates a rare presentation of alveolar echinococcosis with a focus on pulmonary symptoms, emphasizing the importance of evaluation for pulmonary involvement in patients with AE and respiratory symptoms.

[2023 update on alveolar echinococcosis]. / Échinococcose alvéolaire : prise en charge en 2023.

Alveolar echinococcosis is a rare but severe parasitic disease and is now in Europe the parasitic infection associated with the most morbidity and mortality. Its prevalence is increasing in Switzerland in both urban and rural areas. Echinococcosis is a differential diagnosis that should be considered when facing a cystic hepatic lesion. Moreover, this parasitic infection is increasing amongst immunocompromised patients, making the diagnosis more complex, because of atypic lesions and a more rapid evolution. At the current time, several treatment options, both surgical and medical, can offer patients a good prognosis and maintain a good quality of life.

L'échinococcose alvéolaire est une parasitose rare mais sévère. En Europe, il s'agit de l'infection parasitaire causant le plus de morbimortalité. Son incidence est en augmentation en Suisse dans les zones urbaines et rurales. L'échinococcose est donc un diagnostic différentiel à évoquer face à une lésion kystique hépatique. En outre, cette infection parasitaire est en augmentation chez les patients immunosupprimés, chez qui le diagnostic est plus complexe en raison de lésions atypiques et d'une évolution plus rapide. À l'heure actuelle, plusieurs modalités de traitements chirurgicaux et médicamenteux permettent d'offrir un bon pronostic aux patients tout en maintenant une bonne qualité de vie.

Management of Hydatid cysts of parotid glands.

Hydatidosis (Echinococcosis) is a disease caused by infestation of hydatid cysts in any organ of body but mainly liver (70% of cases). Hydatidosis of salivary glands is rare and necessitate computerized tomography for diagnosis while fine needle aspiration remains controversial procedure. MATERIALS AND METHODS: 6 patients diagnosed with hydatid cysts of parotid glands. These cases were admitted and treated at the maxillofacial surgery Clinic of the "AL-Ramadi" Hospital in Iraq. 5 patients were female and 1 male with age group was between 30 -50 years. The patients complained of painless unilateral swelling in parotid region and who were diagnosed hydatid cysts using CT. All cases were treated by superficial parotidectomy with cystectomy and preservation of facial nerve. RESULTS: All hydatid cysts are CE1- type with no recurrences were reported in any of these cases. The postoperative edema was the most common complication. Other complications were not seen. CONCLUSION: parotid hydatid cyst should be included in differential diagnosis of persistent parotid swelling especially those with history of hepatic hydatid cysts. Computerized tomography is the gold imaging that aid in diagnosis and classification of hydatid cysts. Most cases are CE1 type and Eosinophilia is a sign of concern in some patients. Surgical treatment remains the "gold standard" in therapy.

Metabolomic profiling of early inactive hepatic alveolar and cystic echinococcosis.

Hepatic alveolar echinococcosis (AE) and cystic echinococcosis (CE) are severe helminthic zoonoses and leading causes of parasitic liver damage. They pose a high mortality risk due to invisible clinical signs, especially at the early inactive stage. However, the specific metabolic profiles induced by inactive AE and CE lesions remain largely unclear. Therefore, we used gas chromatography-mass spectrometry-based metabolomic profiling to identify the global metabolic variations in AE and CE patient sera to differentiate between the two diseases and reveal the mechanisms underlying their pathogenesis. In addition, specific serum biomarkers of inactive hepatic AE and CE were screened using receiver operating curves, which can contribute to the clinical diagnosis of both diseases, especially in the earlier phase. These differential metabolites are involved in glycine, serine, tyrosine, and phenylalanine metabolism. Further analysis of key metabolic pathways showed that inactive AE lesions strongly alter amino acid metabolism in the host. CE lesions have an altered metabolism of oxidative stress response. These changes suggest these metabolite-associated pathways can serve as biomarkers to distinguish individuals with inactive AE and CE from healthy populations. This study also investigated the differences in serum metabolic profiles in patients with CE and AE. The biomarkers identified belonged to different metabolic pathways, including lipid, carnitine, androgen, and bile acid metabolism. Taken together, by investigating the different phenotypes of CE and AE with metabolomic profiling, serum biomarkers facilitating early diagnosis were identified.

Diagnosis, treatment, and outcome of four dogs with alveolar echinococcosis in the northwestern United States.

OBJECTIVE: To describe the clinical disease, diagnostic findings, medical management, and outcome in dogs with alveolar echinococcosis (AE). ANIMALS: 4 dogs with naturally occurring AE. PROCEDURES: Medical records were retrospectively reviewed from 2020 to 2022 to identify dogs diagnosed with AE. Signalment, case history, clinical signs, imaging and pathological laboratory findings, treatment, and clinical outcome were reported. RESULTS: All dogs developed systemic clinical illness and weight loss. Abdominal ultrasonography revealed multifocal to coalescent cystic masses of variable size distributed throughout the liver in all cases. Evaluation of aspirated hepatic cyst contents included membranous parasite structures and calcareous corpuscles. Echinococcus multilocularis was confirmed via PCR from hepatic cyst fluid in 3 of 4 cases. Treatment included systemic benzimidazole and praziquantel administration, 1 or more instances of ultrasound-guided cyst drainage in all cases, with ethanol ablation (percutaneous aspiration-injection-reaspiration) in 2 cases, and surgical resection in 1 case. Two of 4 dogs were euthanized within 5 months of diagnosis. One of these dogs was necropsied and had nearly complete obliteration of the hepatic parenchyma by multilocular cystic masses. One dog is still alive, and 1 dog has been lost to follow-up. CLINICAL RELEVANCE: This series of cases highlighted the diagnostic findings and therapeutic intervention in 4 dogs with AE. This was the first report of medical management incorporating the percutaneous aspiration-injection-reaspiration method used in humans. Reports of canine AE are rare in the US, so this series serves to help raise awareness of hepatic AE in the northwestern US.

[Preoperative radiation navigation in determining surgical strategy for liver echinococcosis]. / Predoperatsionnaya luchevaya navigatsiya v opredelenii khirurgicheskoi taktiki pri ekhinokokkoze pecheni.

OBJECTIVE: To analyze the technology for diagnostic modeling of liver echinococcosis. MATERIAL AND METHODS: In the Botkin Clinical Hospital, we developed a theory of diagnostic modeling of liver echinococcosis. Treatment outcomes were analyzed in 264 patients who underwent various surgical interventions. RESULTS: A retrospective group enrolled 147 patients. When comparing the results of diagnostic and surgical stages, we identified 4 models of liver echinococcosis. The choice of surgical intervention in the prospective group was based on previous models. Diagnostic modeling reduced the number of general surgical and specific complications, as well as mortality in the prospective study group. CONCLUSION: The technology for diagnostic modeling of liver echinococcosis made it possible not only to identify 4 models of liver echinococcosis, but also determine the most optimal surgical intervention for each of model.

Alveolar echinococcosis in immunocompromised hosts.

BACKGROUND: Alveolar echinococcosis (AE) results of an infection with the larval stage of Echinococcus multilocularis. It has been increasingly described in individuals with impaired immune responsiveness. OBJECTIVES: This narrative review aims at describing the presentation of AE according to the type of immune impairment, based on retrospective cohorts and case reports. Implications for patient management and future research are proposed accordingly. SOURCES: Targeted search was conducted in PubMed using ((alveolar echinococcosis) OR (multilocularis)) AND ((immunosuppressive) OR (immunodeficiency) OR (AIDS) OR (solid organ transplant) OR (autoimmunity) OR (immune deficiency)). Only publications in English were considered. CONTENT: Seventeen publications were found, including 13 reports of 55 AE in immunocompromised patients (AE/IS) and 4 retrospective studies of 755 AE immunocompetent patients and 115 AE/IS (13%). The cohorts included 9 (1%) solid organ transplantation (SOT) recipients, 2 (0.2%) HIV patients, 41 (4.7%) with chronic inflammatory/autoimmune diseases (I/AID) and 72 (8.3%) with malignancies. SOT, I/AID and malignancies, but not HIV infection, were significantly associated with AE (odds ratios of 10.8, 1.6, 5.9, and 1.3, respectively). Compared to AE immunocompetent patients, AE/IS was associated with earlier diagnosis (PNM stages I-II: 49/85 (58%) vs. 137/348 (39%), p < 0.001), high rate of atypical imaging (24/50 (48%) vs. 106/375 (28%), p < 0.01), and low sensitivity of serology (19/77 (25%) vs. 265/329 (81%), p < 0.001). Unusually extensive or disseminated infections were described in SOT and I/AID patients. IMPLICATIONS: Patients who live in endemic areas should benefit from serology before onset of a long-term immunosuppressive therapy, even if the cost-benefit ratio has to be evaluated. Physicians should explain AE to immunocompromised patients and think about AE when finding a liver lesion. Further research should address gaps in knowledge of AE/IS. Especially, extensive and accurate records of AE cases have to be collected by multinational registries.