The pathology, phylogeny, and epidemiology of Echinococcus ortleppi (G5 genotype): a new case report of echinococcosis in China.

BACKGROUND: Cystic echinococcosis (CE), caused by the larval stage of the complex Echinococcus granulosus sensu lato (s.l.), is a zoonotic parasitic disease with a high social burden in China. E. ortleppi is a species (formerly genotype 5 of E. granulosus s.l.) with unique epidemic areas (tropical areas), transmission patterns (mainly cattle origin), and pathological characteristics (large and small hook lengths) compared to other species that cause CE. A 19-year-old female patient in an area with no history of echinococcosis in Guizhou Province, China, was diagnosed with E. ortleppi infection in 2019. This study is to understand the source of this human E. ortleppi infection. METHODS: We performed computer tomography (CT) scans, surgical operation, morphological sectioning, molecular diagnosis, phylogenetic analyses, and epidemiological investigation in Anshun City, Guizhou Province, China in 2019. RESULTS: The patient presented with intermittent distension and pain in the upper abdomen without other abnormal symptoms. Routine blood examination results were normal. However, abdominal CT revealed a fertile cyst with a diameter of approximately 8 cm, uniform density, and a clear boundary, but without an evident cyst wall in the right lobe of the liver. The cyst was fertile, and phylogenetic analyses revealed that the isolates represented a new E. ortleppi genus haplotype. A result of 10‒14 years incubation period with indigenous infection was considered available for the case through the epidemiological survey. CONCLUSIONS: CE due to E. ortleppi infection can be confused with other diseases causing liver cysts, resulting in misdiagnosis. A transmission chain of E. ortleppi may exist or existed in the past in the previously considered non-endemic areas of echinococcosis in southwestern China.

Interactions between hydatid cyst and regulated cell death may provide new therapeutic opportunities.

Cystic echinococcosis and alveolar echinococcosis are chronic zoonotic infections, transmitted throughout the world. Development of the cestode larval stages in the liver and lungs causes damage to intermediate hosts, including humans. Several pathways leading to the suppression of host immune response and the survival of the cysts in various hosts are known. Immune response modulation and regulated cell death (RCD) play a fundamental role in cyst formation, development and pathogenesis. RCD, referring to apoptosis, necrosis and autophagy, can be triggered either via intrinsic or extrinsic cell stimuli. In this review, we provide a general overview of current knowledge on the process of RCD during echinococcosis. The study of interactions between RCD and Echinococcus spp. metacestodes may provide in-depth understanding of echinococcosis pathogenesis and open new horizons for human intervention and treatment of the disease.

TITLE: Les interactions entre kyste hydatique et mort cellulaire régulée peuvent ouvrir de nouvelles perspectives thérapeutiques. ABSTRACT: L'échinococcose kystique et l'échinococcose alvéolaire sont des infections zoonotiques chroniques, transmises dans le monde entier. Le développement des stades larvaires des cestodes dans le foie et les poumons provoque des lésions chez les hôtes intermédiaires, y compris les humains. Plusieurs voies menant à la suppression de la réponse immunitaire de l'hôte et à la survie des kystes chez divers hôtes sont connues. La modulation de la réponse immunitaire et la mort cellulaire régulée (MCR) jouent un rôle fondamental dans la formation, le développement et la pathogenèse du kyste. La MCR, faisant référence à l'apoptose, à la nécrose et à l'autophagie, peut être déclenchée par des stimuli intrinsèques ou extrinsèques. Dans cette revue, nous fournissons un aperçu général des connaissances actuelles sur le processus de la MCR au cours de l'échinococcose. L'étude des interactions entre les métacestodes d'Echinococcus spp. et la MCR pourrait permettre d'approfondir la compréhension de la pathogénie et d'ouvrir de nouveaux horizons pour l'intervention humaine et le traitement de l'échinococcose.

Equinococosis atípica: quiste hidatídico mamario / Atypical echinococcosis: Breast hydatid cyst

Presentamos un caso de una mujer de 33 años que consultó por una tumoración palpable y dolorosa en mama izquierda de 3 años de evolución. El diagnóstico se realizó de forma casual por el hallazgo quirúrgico macroscópicamente compatible con un quiste hidatídico de mama. La equinococosis quística aislada de mama es una entidad muy rara. Es un reto lograr un diagnóstico preoperatorio y diferenciarla de otras lesiones mamarias. Hay muy pocos casos publicados y en la mayoría, el diagnóstico de certeza se consigue tras la cirugía, dado que resulta muy complicado sospechar esta patología, únicamente, en base a la exploración clínica y la radiología

We report the case of a 33-year old patient who presented a palpable lump in her left breast for three years. The diagnosis was made by chance by the surgical finding macroscopically compatible with a breast hydatid cyst. Cystic echinococcosis of the breast is a very uncommon disease. It is a challenge to achieve a preoperative diagnosis and to differentiate it from other breast lesions. There are limited reported cases in the literature, and in majority of them the certain diagnosis is obtained postoperatively, since it is complicated to suspect this pathology based solely on clinical examination and radiological investigations

Analysis of factors affecting outcomes of pregnancy complicated by Echinococcus: an algorithm for approach and management.

PURPOSE: The management of hydatid disease (HD) co-occurring with pregnancy remains a challenge for physicians. We aimed to determine factors that were related to fetal and maternal outcomes in HD complicated pregnancies and then develop an approach/treatment algorithm. METHOD: All patients at the participating hospitals were first analyzed to determine whether they had HD. Only patients diagnosed with HD during the course of their pregnancy were included. Certain cyst-related factors (diameter, localization, increase in size, and viability) and certain pregnancy-related factors (treatments, gestational week, maternal co-morbidities, and delivery type) were investigated. Nonlinear principal component analysis (NPCA) was performed to determine the relationships between the categories of variables. RESULTS: Out of 12,926 pregnancies, 27 cases were diagnosed with HD. In 13 cases, each developed at least one fetal problem. Using Albendazol in first trimester, presence of an active cyst, increased diameter by more than 1 cm during pregnancy and a cyst diagnosed in the second trimester were associated with at least one fetal problem. According to the NPCA results, cyst diameter when first diagnosed was related to fetal outcomes; a cyst greater than 10 cm was associated with "at least one fetal problem". Cysts 5-10 cm in diameter were in a neutral position, while 2-5 cm in diameter were in the "no problems" group. CONCLUSIONS: HD mostly affects fetus. If cyst-related and pregnancy-related variables are optimal, close follow-up on a monthly is the best course of action. However, in high-risk conditions, percutaneous interventions or surgery should be considered.

Experimental Nanopulse Ablation of Multiple Membrane Parasite on Ex Vivo Hydatid Cyst.

The impact of ultrashort nanopulse on cellular membrane is of biological significance and thus has been studied intensively. Different from cell study, this ex vivo study aims to investigate the biological effects of nanosecond pulsed electric field (nsPEF) on an independent multimembrane parasite, human hydatid cyst, to observe the unique influence of nanopulse on macromembrane structure, permeabilization, and biochemistry. The 300 ns nsPEF was delivered on an experimental model of single human hydatid cyst ex vivo with eight different parameters. Then pathological changes during 7 days of 48 parasite cysts were followed up after nsPEF. The laminated layer, the germinal layer, the protoscolex, and cyst fluid were evaluated by the morphological, pathological, and biochemical measurements. The parameter screening found that nsPEF can damage hydatid cyst effectively when the field strength is higher than 14 kV/cm. When nsPEF is higher than 29 kV/cm, nsPEF destroy hydatid cyst completely by collapsing the germinal layer, destructing protoscolices, and exhausting the nutrition.

[Physiological characteristics of Echinococcus and their association with interventions against echinococcosis].

Alveolar and cystic echinococcosis are important zoonotic diseases caused by the dog/fox tapeworms of Echinococcus granulosus and E. multilocularis, which are distributed in almost whole the world. The diseases remarkably impact on the people's health and economic development of communities. Echinococcus tapeworms need two mammalian animals to complete their lifecycle. The worms undergo different developmental stages (adult, egg/oncosphere, cyst, and protoscolex). Each stage has its own distinct physiological characteristics. We summarize the characteristics and emphasize that some features that strongly impact on design of control program. Based on the lifecycle of these worms, two stages are infectious, one is egg the only stage for primarily infecting humans and intermediate host, and another stage is protoscolex, the only stage for infecting the definite hosts of the worms. Eggs are produced by the adult worms parasitized in the intestine of definite hosts. It takes 45 days for eggs becoming mature in dogs. With this feature of the tapeworm, New Zealand and Tasmania in Australia designed control program for deworming 8 times annually with an interval between deworms at 45 days. E. multilocularis takes 28-30 days in dog/fox producing mature eggs. Given that co-existence of E. granulosus and E. multilocularis in western China, a control measure so called "prepatent deworming control measure" has been used in these endemic areas with dosing worms in dogs every month. It normally takes 12-15 months for producing protosocleces in E. granulosus cysts in sheep. If meat markets attract most lambs, that is an effective measure for controlling cystic echinococcosis given that there are no protoscoleces produced from those lambs. In addition, Echinococcus has its own unique biological characteristics, such as sexual reproduction and asexual reproduction, single-cell layer structure of cyst, bidirectional development of protoscoleces induced by bile salts, and long term of infection causing host asymptomatic reaction make the parasites a models for addressing some biological and biomedical issues. And more, hydatid cyst fluid is the antigen resource for identifying diagnostic reagents; the specific gene expressed in oncospheres has been developed as an effective vaccine used for control program. With the development and application of high-throughput omics, including genomics, transcriptomics and proteomics, we can use the physiological characteristics of Echinococcus for searching diagnostic reagents, developing preventive vaccines and identify new drug targets.

Cirugía de la hidatidosis hepática. Factores de riesgo y variables asociadas al desarrollo de morbilidad postoperatoria. Revisión global de la evidencia existente / Surgery for hepatic hidatidosis. Risk factors and variables associated with postoperative morbidity. Overview of the existing evidence

Las publicaciones relacionadas con morbilidad postoperatoria en hidatidosis hepática son escasas y de resultados disímiles. El objetivo de este estudio fue determinar factores de riesgo y protectores de morbilidad postoperatoria en pacientes intervenidos por hidatidosis hepática. Se realizó una revisión global de la evidencia, basada en revisiones sistemáticas, ensayos clínicos y estudios observacionales, obtenidos de Trip Database, BVS, SciELO, Cochrane Central Register of Controlled Trials, WoS, MEDLINE, EMBASE, SCOPUS, EBSCOhost, IBECS, ePORTUGUESe, LILACS y WHOLIS. Se identificaron 1.087 artículos relacionados y 69 cumplían criterios de selección (2 revisiones sistemáticas, 3 ensayos clínicos y 64 estudios observacionales). Se identificaron como factores de riesgo la edad, el antecedente de cirugía previa por hidatidosis hepática, la localización centro hepática, la existencia de comunicaciones biliares y complicaciones evolutivas del quiste y como protectores las técnicas quirúrgicas radicales. Se identificaron factores de riesgo y protectores; sin embargo, los estudios son escasos y de calidad moderada a baja (AU)

There are few publications related to postoperative morbidity in hepatic hydatidosis and these have mixed results. The aim of this study was to determine risk and protective factors of postoperative morbidity in patients operated on for hepatic hydatidosis. A comprehensive review was made of the evidence, based on systematic reviews, clinical analyses and observational studies, obtained from the Trip Database, BVS, SciELO, Cochrane Central Register of Controlled Trials, WoS, MEDLINE, EMBASE, SCOPUS, EBSCOhost, IBECS, ePORTUGUESe, LILACS and WHOLIS. 1,087 related articles were identified; 69 fulfilled the selection criteria (2 systematic reviews, 3 clinical trials and 64 observational studies). Age, history of previous surgery for hepatic hydatidosis, location in the hepatic center, existence of biliary communications and evolutionary complications of the cyst were identified as risk factors, and radical surgical techniques as protective factors. Risk and protective factors were identified; however, the studies are few and the quality moderate to low (AU)

Complicación infrecuente de un quiste hidatídico de pulmón: neumomediastino, hidroneumotórax y enfisema masivo de tejidos blandos / Unusual complication of a lung hydatid cyst: Pneumomediastinum, hydropneumothorax, and massive soft tissue emphysema

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Hidatidosis intravascular pulmonar / Intravascular pulmonary echinococcosis

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[(EXPERIENCE WITH ALBENDAZOLE TREATMENT IN CHILDREN WITH CYSTIC ECHINOCOCCOSIS)].

The tolerability and efficiency of specific chemotherapy with albendazole were analyzed in 18 patients with cystic echinococcosis at various sites. The most common complication of albendazole treatment was its hepatotoxic effect. Al- bendazole chemotherapy during at least its 3 cycles was observed to be highly effective in preventing recurrent echinococ- cosis in children. If there were small-sized hydatid cysts in the liver and lung, there was a reduction in their number and sizes after 4-5 albendazole treatment cycles.

[(MODERN EPIDEMIOLOGICAL SITUATION ON ECHINOCOCCOSIS IN THE TYUMEN REGION)].

The conducted research allow to conclude that the most developed agricultural area of the Tyumen region with a population comprising of 14,1% of the rural population, is endemic for echinococcosis. The incidence has a pronounced tendencyto increase (Tgrowth=+5.7 percent). Installed a statistically significant difference in the incidence ofechinococ- cosis in two selected areas in endemic zones (7 rural and 3 urban) living in it 60,7% of the population of the Tyumen region; - risk groups in the incidence of echinococcosis are local villagers, containing farm animals and dogs; urban residents who regularly attend the nearby forest to gather berries and wild plants, persons working age, hunters with years of experi- ence; the risk of infection is June - September. The first place among agricultural animals as an intermediate the hosts of Echinococcus is a sheep, the second place - the cattle, the third place - pigs, the prevalence in endemic incidence of echinococcosis people area respectively in 5.6 times, 2.7 times and 3.8 times higher than in non-endemic areas with no registration morbidity people. The obtained results allow to recommend the measures to optimise epidemiological surveil- lance and parasitological monitoring of echinococcosis: a clearer and more coherent relationship and interaction between agencies, medical organizations, Rospotrebnadzor, Rosselkhoznadzor and Management ofhunting economy; the expan- sion of research on contamination ofthe environment by the hexacanth cyst on the territories of settlements and priusadeb- nyh plots (soil, bottom sediments, especially not having drains, water storage tanks); mass serological screening of the population, primarily in rural endemic areas, to determine the immune segment, risk groups among sex, age and profes- sional groups to assess the level of endemic diseases; clarify the ways and factors of transmission in specific conditions, it is important for the organization of effective prevention measures.

Fine-needle aspiration diagnosis of primary hydatid disease of the thyroid; first reported case in the USA.

Echinococcosis or hydatid disease (HD) is a parasitic disease caused by species of the Echinococcus genus. Since the incidence of HD in the USA is very low and the primary HD of the thyroid is extremely rare even in endemic regions, the occurrence of primary thyroid HD is exceptional in the USA. Thyroid HD is rarely diagnosed by fine-needle aspiration (FNA). Our literature review revealed less than ten cases of primary HD of thyroid diagnosed by FNA worldwide. Hereby, we report the first case of a primary thyroid HD diagnosed by fine-needle aspiration in the USA.

Punción, aspiración, instilación y re-aspiración en casos complejos de hidatidosis hepática / PAIR for complex hepatic hydatid disease

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Living donor liver transplantation for Echinococcus Alveolaris: single-center experience.

Echinococcus alveolaris (EA) causes a hepatic zoonotic infection and behaves like a malignant tumor during invasion. Liver transplantation (LT) is the only curative treatment option for this unresectable disease. Here, we share our experience with living donor liver transplantation (LDLT) due to EA from the time between March 2002 and November 2014 at the Liver Transplantation Institute of Inönü University. Ten patients (mean age, 38.6 years) undergoing LDLT because of unresectable EA were evaluated preoperatively, and the operative and follow-up data were analyzed retrospectively. The mean time interval between diagnosis and LT was 27 months. The mean operation time and mean intraoperative blood requirement were 613 minutes and 4 units of packed red blood cells, respectively. Diaphragmatic resections were performed in 3 patients, and vena cava replacement was performed in 2 patients because of difficulties in removing the extended disease. The local recurrence and distant metastasis rates were 10% and 20%, respectively. The mean survival time was 19.5 months (range, 0-54 months), and the mortality rate was 30%. Unresectable hepatic alveolar echinococcosis is a rare indication for LT and presents some technical difficulties during surgery because diaphragmatic resection, vascular reconstruction, or multiple blood transfusions may be needed. LDLT can be performed successfully in patients with this rare infectious disease, with careful follow-up for potential recurrence and metastasis and administration of low-dose immunosuppressive agents.

Giant hydatid cyst of the pelvis, femur and retroperitoneal space: surgical treatment with extended hemipelvectomy.

Hydatid disease of the bone is a very rare manifestation of the disease, and is often associated with debilitating symptoms. We present a rare case of skeletal hydatidosis in a 56-year-old man who had been misdiagnosed for many years. Massive involvement of the pelvic bones and soft tissues was evident. An extended hemipelvectomy was performed in order to achieve resection of the affected segments with a clear surgical margin. The patient recovered uneventfully and there are no signs of recurrence of the disease.

Hidatidosis muscular como causa de una masa paravertebral / Muscular hydatidosis as a cause of a paravertebral mass

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[Improvement of surgical treatment of echinococcosis].

A hydatid disease is a serious public health problem in Kazakhstan. Surgical treatment is the main treatment of hepatic echinococcosis. Considering high rate of recurrence of the disease the search for new methods of surgical treatment remains relevant. The aim of the study was to improve the efficiency and safety of surgical treatment of hepatic echinococcosis; to develop a new physical method for cleaning residual cyst cavity. Experimental and clinical investigation of IED effects on hydadtid cyst embryonic element was studied. In order to monitor the effectiveness of developed method the morphological study of histological material was done. В It is experimentally proved that the optimal mode of impact of IED on germinal elements of hydatid cysts at which their complete destruction, is the exposure 120 seconds by 200 ml of liquid or 0,6 seconds per 1 ml volume. The method of cleaning of residual cavity with IED was developed. By this method for the years 2007-2013, 25 patients were operated on, of which there were 13 (52,0%) men, 12 (48,0%) women. The mean age was 37,8В±0,8. Single cysts observed in 16 (64.0 %) cases, multiple in 9 (36.0%). Primary cysts were observed in 20 (80.0%) cases, recurrent 5 (20.0%). Size up to 10 cm cyst verified in 8 (32.0%) cases, from 10cm to 20 cm in 15 (60.0 %) cases, 20 cm or more - 2 ( 8.0%). To localize the left lobe of the liver was struck in 24.0% of cases, the right to 76.0%. The cysts were located in the right lobe of the liver in 76,0%, left lobe in 24,0%. Echinococcectomy was performed in 22 (53.0%) patients, resection-2 (12.0%), pericystectomy-1 (6.0%). Average estimated blood loss was 320.6 ml. Blood transfusion was performed in only 1 (4.0%) patients. Postoperative complications in the form of left-hand reactive pleuritis were marked in 3 (12.0%) cases. Average period of hospitalization amounted to 12,8В±2,2 bed-days. Echinococcectomy supplemented by cleaning of the residual cavity impulse electric discharge may be an alternative to radical methods of surgical treatment of hepatic echinococcosis, due to the fact that IED has a destructive effect against Echinococcus germinal elements, simple to use, safe.