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.

Pancreatic Hydatid Cyst Misdiagnosed as Mucinous Cystadenoma: CT and MRI Findings.

Isolated hydatid cysts of the pancreas are rare lesions, even in endemic regions. In this report, we present the case of a 76-year-old patient who was admitted to our clinic with a diagnosis of a cystic lesion in the tail of the pancreas. On preoperative computed tomography (CT) and magnetic resonance (MR) examination, the cyst was characterized as a mucinous cystadenoma. A laparoscopic distal pancreatectomy followed. A histopathological examination revealed a large hydatid cyst in the tail of the pancreas.

Cardiac Echinococcosis: A Single-Centre Study with 25 Patients.

BACKGROUND: In this study, we aimed to analyse patients who underwent surgery for cardiac echinococcosis in our department. METHODS: Between June 2005 and June 2013, 25 patients (15 male, 10 female) underwent cardiac hydatid cyst operation. The mean patient age was 33.4±12.6 (15-75) years. RESULTS: The most common presenting symptom was dyspnoea. Cysts were located only in the heart in 16 patients, lung in 4 patients, liver in 4 patients, and brain with lung involvement in 1 patient. Concomitant cardiac and pulmonary surgery was performed in 2 patients. The cardiac hydatid cysts were intracavitary in 11 patients and extracavitary in 14 patients. We used cardiopulmonary bypass in all but 1 patient, who presented with an extracavitary cyst. In 3 patients, surgery was performed with cardiopulmonary bypass without cross-clamping of the aorta. There were no mortalities in the early follow-up period. CONCLUSION: Cardiac echinococcosis is a rare but fatal disease and should be surgically treated when diagnosed. There is some controversy about how echinococcosis spreads to the heart (via haematogenous spread or direct extension from adjacent structures). According to our study, we think that haematogenous spread is the main method of the distribution of cardiac echinococcosis, and the direct extension method from adjacent structures must be questioned.

[(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.

Scolicidal and apoptotic activities of albendazole sulfoxide and albendazole sulfoxide-loaded PLGA-PEG as a novel nanopolymeric particle against Echinococcus granulosus protoscoleces.

Treatment failures of human cystic echinococcosis (CE) with albendazole (ABZ) have attributed to its low solubility and poor drug absorption rate, resulting in low drug level in plasma. The scolicidal effects of ABZ-loaded liposome nanoparticles have recently evaluated; however, these particles have several challenges due to their low encapsulated load. This investigation was designed to evaluate and compare in vitro apoptotic activities of ABZ sulfoxide (ABZs) and ABZs-loaded poly(lactic-co-glycolic acid) (PLGA)-PEG against protoscoleces (PSCs). ABZs-loaded PLGA-PEG was prepared by a double-emulsion method (W1/O/W2). Various concentrations of ABZs and ABZs-loaded PLGA-PEG (50, 100, 150, and 200 µg/ml) were experimentally tested against PSC of CE at different exposure times (5, 10, 20, 30, and 60 min). ABZs-loaded PLGA-PEG at concentrations of 150 and 200 µg/ml was able to act at a 100 % scolicidal rate in all exposure times (5 to 60 min), while ABZs at a concentration of 200 µg/ml demonstrated 94, 100, and 100 % mortality rates following 20, 30, and 60 min of exposure times, respectively. The messenger RNA (mRNA) expression of caspase-3 was assessed by semi-quantitative RT-PCR after 15 h of exposure. Caspase-3 mRNA expression was higher in both PSC treated with ABZs and PSC treated with ABZs-loaded PLGA-PEG than that in control groups (P < 0.05). No significant difference was observed between the apoptotic intensity of PSC treated with ABZs and that of PSC treated with ABZs-loaded PLGA-PEG (P > 0.05). DNA fragmentation assay and ultrastructural changes revealed that ABZs and ABZs-loaded PLGA-PEG induced the apoptosis of PSC by activation of caspase-3. The higher permeability and scolicidal rate of ABZs-loaded PLGA-PEG can be addressed as an effectual alternative strategy to improve the treatment of human CE.

A RARE CASE OF HYDATID CYST DISEASE OF THE BREAST: A CASE REPORT AND REVIEW OF LITERATURE.

Hydatid cyst of the breast is extremely rare even in endemic areas and it only accounts for 0.27% of all hydatid cyst disease cases. It can either be a primary site or part of a disseminated hydatidosis. Surgery remains to be a treatment of choice. Only few reports are published in the literatures and most of the reported cases have been diagnosed postoperatively as it is not easy to reach at a definitive diagnosis with clinical examination and radiological investigations only. This is a case of an isolated hydatid cyst of breast in an 18-year old woman from the Amhara region, Ethiopia. She presented with left breast painless lump of 5 years duration and a correct pre-operative diagnosed was made by fine needle aspiration cytology, then confirmed after surgery. We believe this disease should be included in the differential diagnosis of benign breast lumps especially in endemic areas.

Lesson of the month 2: Cough and right hypochondrial discomfort.

Cystic echinococcosis, commonly known as hydatid disease, is caused by the larval stage of the tapeworm Echinococcus granulosus. Humans are an accidental host to this rare disease in the UK, with around 10-20 new cases reported each year. Once suspected, the diagnosis is confirmed through a combination of relevant history, imaging studies and serological testing. This lesson presents a case of hydatid disease and outlines the significant management issues when cysts rupture and the disease becomes disseminated.

Isolated hydatid cyst of uterine cervix: A case report.

Hydatid disease is an endemic infection which can affect any organ, mainly the liver and lungs. Peritoneal echinococcosis is usually known to occur secondary to hepatic hydatid cyst rupture into the peritoneal cavity. An isolated cyst in the pelvic cavity is considered as primary only when there are no other hydatid cysts. Herein, we report an isolated pelvic-cervical hydatid cyst which presented without any involvement of the other abdominal organs or lungs. Our patient, a 27-year-old woman with the primary complaints of dyspareunia and chronic pelvic pain, had thin-walled large cystic mass originating from the cervix, diagnosed by ultrasonography. She underwent surgery with the most likely initial diagnosis of exophytic fibroid with cystic degeneration. Gynecologists should be aware of the possibility of isolated primary hydatid cyst of the pelvic cavity and should consider this condition in the differential diagnosis of cystic pelvic masses, especially in areas where the disease is endemic.

Primary pelvic hydatid cyst an unusual cause of cystic adnexal image (mass).

Hydatid cyst is a parasitic human infection which is endemic in North Africa. It is more frequently localized in the liver and the lung. Involvement of others sites is usually secondary to these primary localizations. We report 2 exceptional cases of primary pelvic hydatid cyst diagnosed respectively in a 37-year-old and in a 48-year-old women. These cases will focus on the different characteristics of the infection, and the benefit of including epidemiologic arguments in using the diagnostical approach of adnexal masses.

[Immunorehabilitation in patients with paecilomycosis-complicated echinococcosis and asthma].

Paecilomycosis is a new type of systemic mycosis caused by different species of fungi of the genus Paecilomyces. Paecilomycosis-complicated echinococcosis and asthma run a severe course. A complication of mycosis is accompanied by secondary immunodeficiency. A good result was obtained in the treatment of ill children by using the fungicide diflucan and the immunomodulator polyoxidonium. In the examinees with paecilomycosis-complicated echinococcosis, secondary immunodeficiency was characterized by a statistical significant reduction in the blood levels of the lymphoid cells CD3+, CD4+, CD8+, CD16+, CD21+, by phagocytosis, a decrease in its quantitative parameters, and an increase in the counts of immunoglobulins and circulating immunocomplexes. To normalize the immune status in patients with paecilomycosis-complicated echinococcosis, it is expedient to postsurgicallyuse fungicides, such as nizoral, diflucan, orungal, mycosyst, and the immunomodulators polyoxidonium and irillen.

Giant Brain Hydatid Cyst in an Adult: A New Case Report

Cystic echinococcosis is an important zoonotic disease that occurs in humans and mammals in general, which causes considerable economic loss and poses health concerns in different parts of the world. The patient involved in this case report was a 28-year old man living in Birjand city who had been suffering from intermittent headache, nausea and vomiting for the past two weeks. The other symptoms presented by the patient were dizziness, blurred vision, seizures and imbalance. The patient only complained of headache in the last two weeks and had no symptoms of visual or speech impairment. He had a history of consuming raw vegetables, but did not have canine contact. In brain computed tomography and magnetic resonance imaging, a large cyst was evident in his brain. The patient was admitted to Razi Hospital in Birjand and followed-up by surgical treatment of the hydatid cyst, with no complications observed.

Epidemiological and Clinical Characteristics of Alveolar Echinococcosis: An Emerging Infectious Disease in Alberta, Canada.

Human alveolar echinococcosis (AE) is a zoonotic cestode infection which is usually fatal in the absence of treatment. Treatment involves major surgery or indefinite antiparasitic therapy. The incidence is rising in Europe and Asia, with an increased risk observed in immunocompromised individuals. Previously, AE acquisition in North America was extremely rare, except for one remote Alaskan Island. Recent studies have demonstrated a new European-like strain of Echinococcus multilocularis (Em) in wildlife and in human AE in western Canada. We report the experience of all AE patients diagnosed in Alberta. Each was diagnosed by histopathology, serology, and PCR-confirmed by a reference laboratory. Seventeen cases of human AE, aged 19-78 years, nine females, were diagnosed between 2013 and 2020: all definitely or probably acquired in Alberta. Six lived in urban areas, and 14 had kept dogs. In eight, the lesions were found incidentally on abdominal imaging performed for other indications. Six were immunocompromised to varying degrees. Six were first diagnosed at surgery. All have been recommended benzimidazole therapy. One died of surgical complications. Clinicians should be aware of this diagnostic possibility in patients presenting with focal nonmalignant hepatic mass lesions. Greater urbanization of coyotes, the predominant definitive host of Em in Alberta, and growing numbers of immune suppressed individuals in the human population may lead to increasing recognition of AE in North America.

New aspects of neotropical polycystic (Echinococcus vogeli) and unicystic (Echinococcus oligarthrus) echinococcosis.

Of the four species of the genus Echinococcus (Cestoda) distinguished by biological and morphological characteristics, two species, E. vogeli and E. oligarthrus, occur widely in the Neotropics. Approximately 200 cases of polycystic echinococcosis (PE) have been recorded from 12 countries in South America. Following early proliferation of E. vogeli in the human host, typically in the liver, the metacestode usually spreads in the peritoneal and pleural cavities, and numerous organs may be invaded. The clinical characteristics of PE in 81 patients with sufficient information are reviewed. Type I disease consists of polycysts in the liver and abdominal cavity (37% of the patients had this characteristic); type II is similar to type I but also includes hepatic insufficiency (26%); type III consists of cysts in liver and chest (14%); type IV consists of cysts only in the mesenteries (16%); and type V consists of cysts calcified in liver and lung (4%). The percentage of patients with polycysts in the liver was 81%, and the percentage of patients with polycysts in the chest was 14%. PE is most ready diagnosed by geographic origin of the patient and by means of ultrasound or computerized tomography scanning showing cysts and calcifications. The highest mortality was for patients with type II disease, due to hepatic failure and its complications. There were five patients who died due to surgical accidents, whereas 35 cases had uncomplicated surgery. Twenty-three patients died of PE, making the total mortality 29% (23 of 78 cases). None of the 13 patients treated only with albendazole, the most efficacious treatment, was completely cured. PE represents a severe medical problem in South America. A reevaluation of the characteristics of the metacestode of E. oligarthrus indicated that it is unicystic. Only three human cases are known (two with infection in the orbit and one with infection in the heart). The metacestode of E. oligarthrus, in contrast with that of E. vogeli, consists of a spherical, fluid-filled vesicle that enlarges concentrically and is not known to undergo exogenous proliferation.

[Pathophysiology and immune response in sheep experimentally infected with Echinococcus granulosus]. / Fisiopatología y respuesta inmune de ovinos experimentalmente infectados con Echinococcus granulosus.

The immune response to Echinococcus granulosus in sheep has not been extensively investigated. The objective of this study was to increase the information on the physiopathology of E. granulosus and the immune response elicited in sheep. Animals were experimentally inoculated with three different doses of E. granulosus eggs and the immune response was evaluated over 500 days using enzyme immunoassay with three antigenic preparations: total hydatid fluid, purified fraction of hydatid fluid and purified lipoprotein fraction. Sheep were slaughtered at different intervals to observe the macroscopic and microscopic development of the parasite. Immune response was detected at 10 days and was maintained throughout the observation period, being initially proportional to the load of inoculated eggs and then decreasing over time. Fertile cysts were identified 10 months after inoculation and live onchosphere 500 days after inoculation. Antibody response to E. granulosus in sheep preceded hydatid fluid formation and was generated by the mobility of the onchosphere. Early histological identification of fertile cysts indicates that feeding dogs with viscera of young sheep can produce cycles of infection. Furthermore, the presence of live onchosphere in the liver here found contributes to a better knowledge of the pathogenesis of this disease it could be hypothetically considered as a cause for the repeated surgeries necessary in man after the extirpation of a hydatid cyst.

Comparison of Laparoscopic and Conventional Cystotomy/Partial Cystectomy in Treatment of Liver Hydatidosis.

INTRODUCTION: Hydatidosis is a zoonotic infection and treatment is mandatory to avoid complications. Surgery remains the first choice in the treatment especially for CE2-CE3b cysts. Open or laparoscopic approaches are available. However, comparative studies are limited. MATERIALS AND METHODS: Data of patients who underwent cystotomy/partial cystectomy for liver hydatidosis between January 2012 and September 2016 (n=77) were evaluated retrospectively. Recurrent cases and the patients with previous hepatobiliary surgery were excluded. 23 patients were operated upon laparoscopically and named as Group 1. 48 patients operated conventionally named as Group 2. Demographics, cyst characteristics, operative time, length of hospital stay, recurrences, and surgery related complications were evaluated. RESULTS: Groups were similar in terms of demographics, cyst characteristics, and operative time. The length of hospital stay was 3.4 days in Group 1 and 4.7 days in Group 2 (p=0,007). The mean follow-up period was 17.8 months and 21.7 months, respectively (p=0.170). Overall complication rates were similar in two groups (p=0.764). Three conversion cases occurred (13%). One mortality was seen in Group 2. Four recurrences occurred in each group (17% versus 8.3%, respectively) (p=0.258). CONCLUSIONS: Laparoscopy is a safe and feasible approach for surgical treatment of liver hydatidosis. Recurrence may be prevented by selection of appropriate cases in which exposure of cysts does not pose an intraoperative difficulty.

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.

Evaluation of clinical, diagnostic and treatment aspects in hydatid disease: analysis of an 8-year experience.

BACKGROUND & OBJECTIVE: Echinococcosis is still a common health problem. The aim of this study was to discuss our 8-year data in terms of diagnosis, treatment and follow-up of cystic Echinococcosis. METHODS: A total of 178 patients who had hydatid cyst were analyzed retrospectively from the hospital records. The diagnosis of hydatid cyst was based on clinical-serological and radiological findings. Treatment response was evaluated with clinical, radiological and serological findings. RESULTS: A total of 178 medical records were evaluated; the male:female ratio was 0.73 and mean age 44.6±16.9 years. The most common symptom was abdominal pain (94, 52.8%). The mean cyst size was 9.5±3.9 cm. Eosinophilia was significantly higher in patients with complicated cyst (35.3%) (p=0.002). The average duration of hospitalization in surgical patients was shorter than non-surgical patients (p=0.026). There was no significant correlation between the preference of scolicidal agent (hypertonic saline, H2O2, povidone iodine) and recurrence in patients who underwent surgery (p>0.05). There was no significant difference between the patients who underwent radical and conservative surgery in terms of complication and recurrence (p=0.077, p=0.557). No significant difference was found between percutaneous and surgical treatment in terms of complication and recurrence (p=0.264, p=0.276). CONCLUSION: Even though considerable progress has been made, uncertainties remain in the diagnosis and treatment of Echinococcosis. Hence, standardized diagnostic and treatment procedures should be established with well-designed studies.

Morbidity pattern of hydatid disease (cystic echinococcosis) and lack of its knowledge in patients attending Mamata General Hospital, Khammam, Andhra Pradesh.

There is hearsay that prevalence of hydatid disease in Khammam and Nalgonda districts of Andhra Pradesh is high. We report here a preliminary study conducted to determine the magnitude of the problem of hydatid disease and the morbidity associated with it in patients attending MGH, KMM, A.P. (rural hospital). Eleven cases were identified during the period from November 2005 to May 2006 (seven months). Pain in abdomen, mass per abdomen, loss of appetite, pregnancy complicated by cystic echinococcosis (CE), and jaundice were the main clinical symptoms and signs. Ultrasonography, detection and removal of the cysts on the operation table, microscopic examination of the aspirated hydatid fluid were confirmatory. Ziehl-Neelsen stain of the aspirated fluid revealed acid-fast scolices. Interrogation of the patients and their family members (50) revealed that there was a total lack of knowledge of dog-tapeworm-caused infection in humans. They knew 'rabies' as the only disease man gets from dogs, and tapeworms are from pork and beef.