Response patterns in adventitial layer of Echinococcus granulosus sensu stricto cysts from naturally infected cattle and sheep.

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.

Tibetan patients with hepatic hydatidosis can tolerate hypoxic environment without incident increase of pulmonary hypertension: an echocardiography study.

Use of echocardiography to evaluate the characteristics of right heart and pulmonary artery of Tibetans with hepatic hydatidosis living in a high plateau area. We recruited 222 Tibetan adults diagnosed with hydatidosis from June 2016 to June 2017 in Shiqu and Seda areas of Tibet; 40 healthy control from the same area, denoted as the high plateau group. We also include 755 Healthy adults of Han nationality living in the plain from the EMINCA study as the low altitude group. Compared to high plateau group, hydatidosis individuals showed decreased RVADed, RVTDed, increased E(T)/A(T) and reduced RVFAC and TAPSE (p < 0.05). The 2 groups did not differ in the incidence rate of tricuspid regurgitation (TR) and pulmonary regurgitation (PR) (63.9% vs. 55.0%, p = 0.281 and 15.3% vs. 5.0%, p = 0.135, respectively) or incidence of pulmonary hypertension (PH) (13.9% vs. 20.5%, p = 0.167). PH risk did not differ between hydatidosis individuals and high plateau controls (OR 0.559, 95% CI 0.243-1.287). The RVADed and TAPSE were higher and E(T)/A(T) was lower for high plateau group than low altitude group (p < 0.05). The decreased right ventricular size and reduced diastolic and systolic function were found in Tibetans with hydatidosis. Hepatic hydatidosis had no significant effect on the incidence of pulmonary hypertension in Tibetans. Healthy Tibetans showed increased right ventricular size, decreased diastolic function, and increased systolic function compared to the Han counterparts.

Simple liver cysts and cystoid lesions in hepatic alveolar echinococcosis: a retrospective cohort study with Hounsfield analysis.

BACKGROUND: Alveolar echinococcosis (AE) is a rare zoonosis caused by the larval stage of the tapeworm Echinococcus multilocularis. AE lesions affect the liver in more than 98% of cases. AE lesions have various morphological characteristics that are described in the Echinococcus multilocularis Ulm classification for computed tomography (EMUC-CT). One of these characteristics is a cystoid portion. The aim of the study was to compare the density of simple hepatic cysts with cystoid portions of AE lesions classified on the basis of the EMUC-CT. RESULTS: Hounsfield Unit (HU) measurements of the cystoid portions of all EMUC-CT type I-IV AE lesions (n = 155) gave a mean of 21.8 ± 17.6, which was significantly different from that of 2.9 ± 4.5 for the simple hepatic cysts (p < 0.0001). The difference between each of the individual AE types and simple hepatic cysts was also significant. In addition, the HU values of the cystoid portions in types I, II and IIIa/b and simple cysts were each significantly different from type IV (p < 0.0001). The HU measurements in type IV presented by far the highest mean. CONCLUSIONS: The significantly higher density measured in the cystoid portions of hepatic AE lesions offers a good means of differentiation from simple hepatic cysts.

[A CASE OF FAMILIAL PULMONARY AND HEPATIC ECHINOCOCCOSIS)].

Echinococcus granulosus still remains a widespread disease. Moreover, there is a large number of patients in whom it is diagnosed rather late because its clinical presentation can be unspecific and symptoms vary. We report a familial case of the disease. Its specific feature was the onset with the bilateral pulmonary process and late involvement of the liver. This excluded other pulmonary diseases, such as pneumonia, tuberculosis or cancer.

Ultrasonographic findings of small lesion of hepatic alveolar echinococcosis.

OBJECTIVE: To investigate the features of small lesions of hepatic alveolar echinococcsis paragonimiasis (AE) on conventional ultrasound (US) and contrast-enhanced ultrasound (CEUS) imaging. METHODS: This retrospective study was approved by the Institutional Review Board, and the requirement for informed consent was waived. US and CEUS features of seventeen lesions histopathologically proven hepatic AE were retrospectively reviewed. Nine patients with seventeen hepatic AE lesions who were admitted to our hospital between January 2008 and June 2015 were enrolled. All hepatic AE lesions were small (≤3cm). The US and CEUS examinations were performed with a Philips IU22 scanner with a 1-5-MHz convex transducer. After US was completed, the CEUS study was performed. Pulse-inversion harmonic imaging was used for CEUS. A bolus injection of 2.4mL of a sulfur-hexafluoride-filled microbubble contrast agent (SonoVue) was administered. The features of the lesions by US and CEUS were retrospectively reviewed. RESULTS: In total, all lesions were detected by US and CEUS. The mean size of the lesions was 1.8±0.7cm (range: 1.0-3.0cm). Five patients (55.6%, 5/9) had a lesion in the right hepatic lobe; two (22.2%, 2/9) had two lesions in the left hepatic lobe; and two patients (22.2%, 2/9) had four lesions in the right lobe. Seven lesions (41.2%, 7/17) were hypoechoic nodules and ten (58.8%, 10/17) were hyperechoic nodules. Nine lesions (52.3%, 9/17) were of mixed echogenicity type. Ten lesions (58.8%, 10/17) had a regular shape. Nine lesions (52.3%, 9/27) had a sharp margin and six (35.3%, 6/17) had indistinct margins. Four lesions (57.1%, 4/7) with hypoechoic nodule had small dotted calcifications, none was found in hyperechoic nodule. Seven nodules (41.2%, 7/17) showed short striated blood-flow signals surrounding the margin, on color Doppler flow imaging. By CEUS, All the lesions were hypoechoic with mixed content (). 12 lesions (70.1%, 12/17) were rim enhanced with irregular piece-like nonenhanced internal areas and showed nonhomogeneous hypo-enhancement during the arterial phase, with mixed echogenicity. The main pathological findings included: (1) (1) coagulative or liquefactive necrosis within the lesion with sporadic distribution of wizened alveolar hydatid cysts; and (2) hyperplasia of granulomatous and fibrous tissue around the lesion. CONCLUSION: Hyperechogenicity, mixed echogenicity type, dotted calcification with hypoechogenicity, sharp margin, rim enhancement and piece-like nonenhanced areas could be seen as the main ultrasonographic features of small lesion of hepatic alveolar echinococcosis.

Role of Different Treatment Modalities in Cavity Volume during the Treatment of Cystic Ecchinococcosis.

OBJECTIVE: Surgery and percutaneous aspiration-injection-re-aspiration (PAIR) are widely accepted treatment modalities for hepatic hydatid cysts. Endoscopic retrograde cholangiopancreaticography (ERCP) acts as a minimally invasive rescue method for the biliary complications of both the hydatid cysts and treatment modalities. The aim of this study was to identify the role of different treatment modalities in the obliteration of hydatid cysts. METHODS: Patients treated for hydatid cysts between January 2009 and December 2013 were evaluated in the study. Data were collected from hospital records. All cyst cavities were evaluated by ultrasonography or computed tomography. RESULTS: Ninety-five (40.4%) males and 140 (59.5%) females were included in the study. Before the procedures, the mean cyst diameter was 89.7±33.5 mm. At follow-up, the mean cyst diameter decreased to 53.2±30.1 mm. In the ERCP group, the mean diameter of the residual hydatid cyst cavity was significantly lower than that of the other groups (p=0.003). CONCLUSION: ERCP provides faster cyst shrinkage and even disappearance of the residual cavity in 50% of cases. Moreover, in hydatid cysts with biliary communication, ERCP+ES can be safely used for primary treatment.

Hidatidosis hepática: todavía un problema / Liver hydatid disease: still a problem

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[Up-to-date approaches in treatment of hydatid disease of the liver in childhood].

Sixty children (age 3-15 years) with hydatid disease of the liver were treated. The patients were divided into 2 equal groups (control and main groups).The hydatid disease of the liver was revealed in 22 (33.6%) patients, combined hydatid disease of the liver and lung were noted in 38 (66.4%) patients. The "capitonnage" of the residual cavity was applied in the control group and omentoplasty--in the main group. Chemotherapy with Nemazol (dose 10-15 mg/kg/day) was carried out. In order to reduce the negative influence of Nemazol on patients and to accelerate reparation processes of liver parenchyma Vobenzyme (2-3 pills/3 times/day) was applied. The number of complications was 23.2 % in the control group. The adhesive bowel obstruction was noted in 6.6% of patients, bleeding and jaundice in 3.3%, the residual cavity suppuration in 10%. Complications were registered in the main group in 6.6% of children (the adhesive bowel obstruction in 3.3%, preservation of the residual cavity after a year in 3.3%). The number of relapses in the control group was 6 (12%), there were no relapses in the main group. Thus the procedure of preoperative and postoperative chemotherapy allowed avoidance of the development of relapses of hydatid disease of the liver. Omentoplasty is the most rational method of treatment of residual cavity in surgery of hydatid disease of the liver in children.

Atypical intraoperative anaphylactic shock with ECG changes secondary to non-ruptured hepatic hydatid cyst.

A 62-year-old woman was admitted to the hospital for removal of hydatid cyst from the liver. Intraoperatively, the patient suddenly became hypotensive with tachycardia and ST segment elevation. There was no erythema, bronchospasm or desaturation. Anaesthetic agents were stopped and oxygen fraction was increased. In view of the recurrence of hypotension, she was admitted to the intensive care unit (ICU) without completion of surgery. She was successfully resuscitated and acute myocardial infarction was ruled out. She was managed for the possibility of anaphylaxis with hydration, dopamine, antihistamin and hydrocortisone. After stabilisation, she was taken back to the theatre and the cyst was then removed. Histopathology confirmed hydatid disease of the liver. The patient was discharged from the ICU and then from the hospital in 6 days. Anaphylaxis secondary to hydatid disease is uncommon; however, the possibility of such a diagnosis in all patients with non-ruptured hydatid disease in the endemic areas that develop intraoperative shock should be considered.

[Alveococcosis of liver: retrospective analysis of treatment of 51 patients].

51 patients with liver alveococcosis were operated on: radical operations with the whole hydatid tumor removal, cytoreductive operations with 50-80% of the tumor removal and alveococcal nodes' preserving on vital organs; and palliative manipulations, aimed the relief of complications were performed. According to the treatment results, the radical liver resection proved to be the most effective. When the complete tumor removal is impossible, cytoreductive operations are possible. Combination with antiparasitic therapy is required.

[The surgical treatment of hydatid disease of liver and lungs: the state of art].

Results of surgical treatment of 65 patients with the combined hydatid disease were analyzed. Lung invasion was combind with liver cysts in 57 patients, spleen -- in 2 patients, soft tissues of the thorax - in 2 patients and retroperitoneal cysts were found in 3 patients. Lung echinococcectomy with the use of minithoracotomy proved to be a method of choice. The access permits early recovery and shorter rehabilitation period, allowing to perform the second liver surgery on the 3--7th day after the first operation.

Hepatic echinococcosis: clinical and therapeutic aspects.

Echinococcosis or hydatid disease (HD) is a zoonosis caused by the larval stages of taeniid cestodes belonging to the genus Echinococcus. Hepatic echinococcosis is a life-threatening disease, mainly differentiated into alveolar and cystic forms, associated with Echinoccus multilocularis (E. multilocularis) and Echinococcus granulosus (E. granulosus) infection, respectively. Cystic echinococcosis (CE) has a worldwide distribution, while hepatic alveolar echinococcosis (AE) is endemic in the Northern hemisphere, including North America and several Asian and European countries, like France, Germany and Austria. E. granulosus young cysts are spherical, unilocular vesicles, consisting of an internal germinal layer and an outer acellular layer. Cyst expansion is associated with a host immune reaction and the subsequent development of a fibrous layer, called the pericyst; old cysts typically present internal septations and daughter cysts. E. multilocularis has a tumor-like, infiltrative behavior, which is responsible for tissue destruction and finally for liver failure. The liver is the main site of HD involvement, for both alveolar and cystic hydatidosis. HD is usually asymptomatic for a long period of time, because cyst growth is commonly slow; the most frequent symptoms are fatigue and abdominal pain. Patients may also present jaundice, hepatomegaly or anaphylaxis, due to cyst leakage or rupture. HD diagnosis is usually accomplished with the combined use of ultrasonography and immunodiagnosis; furthermore, the improvement of surgical techniques, the introduction of minimally invasive treatments [such as puncture, aspiration, injection, re-aspiration (PAIR)] and more effective drugs (such as benzoimidazoles) have deeply changed life expectancy and quality of life of patients with HD. The aim of this article is to provide an up-to-date review of biological, diagnostic, clinical and therapeutic aspects of hepatic echinococcosis.

Cysto-biliary communication in liver hydatidosis.

BACKGROUND: Liver hydatidosis is a severe health problem in endemic areas. Due to migration from these countries to other zones, now it is a worldwide problem. Liver hydatidosis can provoke many complications (abscess, fistula to adjacent organs, migration, etc.), but the most frequent and one of the most severe complication is the communication between the cyst and the biliary tree. AIM: The aim of this study is to perform a review on the epidemiology, clinical features, diagnostic methods, and therapeutic options to treat the communication between the cyst and the biliary tree. RESULTS: Due to the lack of randomized clinical trial or meta-analysis on this topic, we performed a classical review and included our personal algorithm. CONCLUSIONS: The communication between the cyst and the biliary tree varies from a small communication to a frank intrabiliary rupture. The percentage of patients with the communication between the cyst and the biliary tree is not well known because there is no accepted definition. The therapeutic options are multiple and related to the size of the communication, the location of the cyst, and the experience of the hepatobiliary surgeon. ERCP is now an important tool for the treatment of the communication between the cyst and the biliary tree.