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PubMed2003

Alveolar echinococcosis: MR findings in the liver.

PURPOSE: To clarify the magnetic resonance (MR) imaging findings of alveolar echinococcosis in the liver. MATERIALS AND METHODS: Thirty-five patients with 50 lesions histologically proven to be alveolar echinococcosis were evaluated with MR imaging. Lesions were assessed with regard to the distribution pattern of solid and cystic components and pattern of contrast material enhancement. RESULTS: Cystic components exhibited two patterns at T2-weighted MR imaging: small round cysts and large and/or irregular cysts. Forty-eight lesions (96%) contained small round cysts. Twenty-six lesions (52%) had large and/or irregular cysts. Forty-five lesions (90%) were associated with a solid component. MR imaging characteristics were categorized into five types: multiple small round cysts without a solid component (two lesions [4%], type 1), multiple small round cysts with a solid component (20 lesions [40%], type 2), a solid component surrounding large and/or irregular cysts with multiple small rounds cysts (23 lesions [46%], type 3), a solid component without cysts (two lesions [4%], type 4), and a large cyst without a solid component (three lesions [6%], type 5). In most cases (97%), contrast enhancement was weak. CONCLUSION: The MR findings of alveolar echinococcosis in the liver are multiple small round cysts with a weakly enhanced solid component. The cystic component can be a large and/or irregular lesion, and such lesions are depicted clearly at T2-weighted MR imaging.

Adolescent↗

PubMed2003

Splenectomy versus spleen-preserving surgery for splenic echinococcosis.

BACKGROUND/AIMS: The spleen is the third most common location of hydatid disease after liver and lung. The aim of this study was to analyse the long-term outcome of surgical treatment of patients with splenic echinococcosis comparing splenectomy with spleen-preserving surgery. METHODS: During a period of 25 years (1976-2001), 19 (5.4%) patients with splenic echinococcosis were treated in our department out of 349 patients with abdominal hydatid disease. In 16 patients the spleen was the only organ involved, while in 3 patients the liver was also affected. RESULTS: Eleven patients had splenectomy and in the other 8 the spleen was preserved: enucleation (n = 4), partial cystectomy and omentoplasty (n = 2) and cystojejunal Roux-en-Y anastomosis (n = 2). One (6%) patient died in the early postoperative period and 5 (29%) patients had postoperative complications. There was no significant difference between the splenectomy and spleen-preserving groups concerning median hospital stay and postoperative complication rate. The median follow-up in 15 patients was 52 (range 6-300) months. Two patients (13%) developed recurrence of the disease requiring re-operation at 2 and 3 years, respectively. Recurrence occurred in 1 (12%) patient in the splenectomy group and in 1 (14%) out of 7 patients in the spleen-preserving group. CONCLUSION: In the present series it was possible to preserve the spleen in 8 (42%) of 19 patients, without significant increase of recurrent echinococcosis.

Adult↗

PubMed1988

Two-dimensional echocardiographic features of echinococcosis of the heart and great blood vessels. Clinical and surgical implications.

Echocardiographic findings in cardiac echinococcosis have been previously described in isolated cases, but no detailed account of the various echocardiographic aspects and their clinical and surgical implications have ever been reported. We present a retrospective analysis of the two-dimensional echocardiograms of 15 patients with hydatid cysts affecting the heart or great blood vessels. Two-dimensional echocardiogram features were compared with the main clinical syndromes. Surgical confirmation of the echocardiogram findings was available in 12 patients. The cyst sizes ranged from 0.5 to 12 cm in diameter. Eleven patients had single cysts, three patients had two cysts, and one patient had multiple cysts. Cysts were located in the intramyocardial region in nine patients, the pericardial in three, and the paracardial in another three. All intramyocardial cysts protruded into the adjacent cardiac chamber, but in only two patients was there significant tricuspid valvular dysfunction. Pericardial and mediastinal cysts showed compression of cardiac chambers or great blood vessels, and two cysts had ruptured into the descendent thoracic aorta or inferior vena cava. In most patients, two-dimensional echocardiographic images of hydatid cysts were those of a cystic mass having well-defined edges and internal trabeculations corresponding to daughter membranes. However, in four patients, two-dimensional echocardiographic images showed a "solid" mass instead of a cystic mass, and in one patient with the multivesicular variety of echinococcosis, the images showed a large mass with poorly defined edges having a honeycombed appearance causing lysis of the anterior arch of the second and third left ribs. The two-dimensional echocardiographic finding showed good correlation with main clinical syndromes, but anaphylactic reactions occurred in every cyst location. In one patient, postoperative two-dimensional echocardiography showed two small intramyocardial cysts that had not been noticed during preoperative two-dimensional echocardiography or during surgical examination. Pathological examination in the four patients with a solid mass showed replacement of the hydatid liquid by necrotic matter containing membrane residues with a foreign-body inflammatory reaction of a granulomatous type. In conclusion, two-dimensional echocardiography is a very useful tool for diagnosis and management of patients with cardiac echinococcosis, but the great diversity of findings regarding number, size, location, and appearance of cysts must be borne in mind to interpret correctly the two-dimensional echocardiograms.

Adult↗

PubMed2002

CT findings in skeletal cystic echinococcosis.

PURPOSE: To evaluate the CT findings of skeletal cystic echinococcosis. MATERIAL AND METHODS: CT findings of 7 patients with pathologically confirmed skeletal cystic echinococcosis were evaluated. RESULTS: There were 4 men and 3 women, aged 36-75 years. Hydatid cysts were located in the spine (n=2), a rib (n=3), the pelvis and a vertebra (n=1), the pelvis and the left femur (n=1). The size of the lesions varied from 1 cm to 15 cm. CT showed well defined, single or multiple cystic lesions with no contrast enhancement, no calcification, no daughter cysts, and no germinal membrane detachment. The cystic lesion had a honeycomb appearance in 2 cases; there was pathologic fracture in 2 cases, bone expansion in 5 cases, cortical thinning in 6 cases, cortical destruction in 6 cases, bone sclerosis in 1 case, and soft tissue extension in 6 cases. CONCLUSION: Preoperative differential diagnosis of skeletal cystic lesions should include cystic echinococcosis, especially in endemic areas, since this diagnosis may easily be missed unless kept in mind.

Adult↗

PubMed1979

Disseminated echinococcosis with repeated anaphylactic shock. Treated with mebendazole.

A 46-year-old man, who was twice operated on for echinococcosis and who suffered from recurrent angioneurotic edema, was hospitalized with anaphylactic shock. Chest x-ray examination showed round lesions in the lungs; Casoni, immunofluorescence and hemagglutination tests for echinococcosis were strongly positive. With a diagnosis of disseminated echinococcosis, drug treatment with mebenzadole was given for 29 weeks (the last 22 weeks a dose of 1,200 mg daily). No side effects were observed, allergic manifestations disappeared, and the round lesions were noticeably reduced. The titer of hemagglutination fell gradually, and IgE concentration initially increased and later fell. Mebendazole is proposed as a drug of choice in the cure of disseminated hydatidosis; it may both alter the indication for operation and considerably improve the prognosis.

Anaphylaxis↗

PubMed1997

Musculoskeletal involvement in cystic echinococcosis: report of eight cases and review of the literature.

OBJECTIVE: Our purpose was to describe the morphologic appearance of musculoskeletal lesions in patients with cystic echinococcosis shown by CT and MR imaging. CONCLUSION: Patients with musculoskeletal lesions of cystic echinococcosis typically have cystic structures in adjacent soft tissues. These cysts morphologically resemble abscesses, with peripheral uptake of contrast medium and variable signal intensities on T1-weighted MR images. The absence of calcifications or endovesicular daughter cysts does not exclude the diagnosis of cystic echinococcosis.

Adult↗

PubMed1997

Secondary multiple intracranial hydatid cysts caused by intracerebral embolism of cardiac echinococcosis: an exceptional case of hydatidosis. Case report.

The authors present an extremely rare case of secondary multiple cerebral echinococcosis caused by presumed intracerebral and arterial embolism of cardiac hydatidosis in a 7-year-old girl. The first manifestations were symptoms of raised intracranial pressure. Unfortunately, before the primary ruptured echinococcosis cyst was detected in the myocardium of the left ventricle, the patient underwent nine operations over an 8-year period for hydatid embolism affecting the brain and the femoral artery and was treated with concurrent mebendazole therapy. The combined therapy would not have been successful without removal of the intracardiac hydatid cyst. This case is unusual because of the multiplicity of intracranial hydatid cysts and its embolic origin from cardiac echinococcosis. The present case is believed to be the first one in which the development of an embolism in the brain was studied by magnetic resonance imaging.

Brain Diseases↗

PubMed2005

Echinococcosis in Tibetan populations, western Sichuan Province, China.

We screened 3,199 people from Shiqu County, Sichuan Province, China, for abdominal echinococcosis (hydatid disease) by portable ultrasound combined with specific serodiagnostic tests. Both cystic echinococcosis (CE) (Echinococcus granulosus infection) and alveolar echinococcosis (AE) (E. multilocularis) were co-endemic in this area at the highest village prevalence values recorded anywhere in the world: 12.9% were infected with one or the other form (6.8% CE and 6.2% AE). Prevalences of both CE and AE were significantly higher in female than male patients and increased with the age of the person screened. Pastoral herdsmen were at highest risk for infection (prevalence 19.0%). Prevalence of CE varied in 5 townships from 0% to 12.1%, whereas AE prevalence ranged from 0% to 14.3%. Risk factors associated with both infections included the number of owned dogs, frequency of contact with dogs, and sources of drinking water.

Adolescent↗

PubMed1984

An immunoassay for the detection of circulating antigens in human echinococcosis.

An immunoassay (double-antibody-sandwich-ELISA) was developed to detect circulating antigens (CAg) in patients with cystic (Echinococcus granulosus) echinococcosis. Echinococcus antigens derived from heterologous intermediate hosts were used to immunize rabbits and to purify the rabbit-IgG-fraction obtained by affinity-chromatography, thus avoiding major interference with host components. The purified rabbit anti-hydatid IgG was immunosorbed with bovine and human sera. One part of the resulting IgG served as coating agent in a double antibody sandwich-ELISA; the other part, coupled to alkaline phosphatase, as detecting conjugate. The specificity of the antibody reaction was demonstrated by immunoelectrophoresis. Sera of 21 patients with cystic echinococcosis were examined with this test system. In seven of the patients' sera CAg were detected in concentrations ranging between 310 ng and 680 ng protein per ml serum. Comparing pre- and postoperative serum samples obtained from nine patients operated on for cystic echinococcosis, four sera were found to be CAg-positive before and three after operation.

Animals↗

PubMed1990

Recurrence rate after discontinuation of long-term mebendazole therapy in alveolar echinococcosis (preliminary results).

The recurrence rate was investigated in 19 patients with non-resectable alveolar echinococcosis after discontinuation of a long-term therapy with mebendazole (average treatment 4.3 years). A control group consisted of 14 patients who underwent radical surgery and finished a course of prophylactic postoperative mebendazole treatment of 2 years. In the controls, no recurrence was observed after a post-therapy period averaging 3.5 years. In contrast, recurrence occurred in 7/19 patients (37%) with non-resectable alveolar echinococcosis an average of 1.6 years after discontinuation of the long-term mebendazole therapy. The absence of clinically detectable recurrence in the remaining 12 patients seems to be due either to spontaneous inactivation of alveolar echinococcosis preceding chemotherapy or too short post-therapy surveillance. The patients with recurrence responded favorably to reintroduction of chemotherapy. The data indicate that mebendazole therapy is parasitostatic rather than parasiticidal.

Adult↗

PubMed1994

Immunoglobulin G subclass responses in human cystic and alveolar echinococcosis.

Immunoglobulin G (IgG) subclass-specific antibody responses were investigated in both human cystic echinococcosis (CE) and alveolar echinococcosis (AE) by enzyme-linked immunosorbent assay (ELISA) and Western blotting. Sera were tested from 81 CE and 50 AE surgically confirmed cases using partially purified hydatid cyst fluid antigen B (EgB), and crude hydatid cyst fluid (EgCF) from Echinococcus granulosus and a protoscolex extract (EmP) prepared from E. multilocularis metacestodes. Eighty-nine percent of CE patients and 94% of AE patients were seropositive for total IgG antibodies. The dominant IgG antibody isotype in both CE and AE was IgG4, for which 73% of CE and 84% of AE cases were seropositive in the ELISA. Anti-Echinococcus IgG1 antibodies were detected in 58% of CE and 84% of AE patients. Sensitivity for IgG2 and IgG3 was significantly lower for both CE and AE patients. The IgG4 antibodies in CE patients predominantly recognized the E. granulosus antigen B subunits, i.e., at 20, 16 and 12 kD, while IgG1 antibodies primarily bound to the 38-kD subunit of antigen 5 from E. granulosus hydatid fluid. The possible functional significance of an IgG4 response and the potential use of combined assessment of total IgG, IgG1, and IgG4 antibodies in serologic diagnosis and follow-up for human echinococcosis are discussed.

Animals↗

PubMed1999

Polyvisceral echinococcosis with involvement of the heart and chest wall: follow-up and review of literature.

Echinococcosis remains an endemic surgical problem in countries where sheep and cattle raising is carried out, particularly in many Mediterranean countries. The life cycle of echinococcosis is usually marked by the filtration of larvae through the liver and lungs which are the organs most commonly affected by a hydatid cyst. Hydatid cysts in other sites are not common. Cardiac echinococcosis has been reported infrequently even in countries in which hydatid disease is endemic, only isolated sporadic cases have been reported in the literature. Here we report a case of polyvisceral hydatid cyst with involvement of heart and chest wall and reviewed the literature and discussed clinical procedures and management.

Adult↗

PubMedDate not supplied

Development in diagnosis and treatment of hepatic echinococcosis in a surgical department of a Mediterranean centre over a 20-years period.

Liver echinococcosis is an endemic disease in some areas of the world like Middle East and is a serious problem both from social-economic and clinical-therapeutical stand-points in other areas like Mediterranean regions. We report our experience on hepatic echinococcosis diagnosis and treatment over a 20-year period. In this retrospective study we have reviewed 89 patients affected by hepatic hydatidosis who underwent surgery in our Unit (between November 1975 and October 1995). Patients were divided into two groups: group A including 65 patients (30 males and 35 females) operated on between 1975 and 1988 and group B including 24 patients (11 males and 13 females) operated on between 1989 and 1995. Main outcome measures reported were recurrence of echinococcosis, association with surgical procedure, complications, diagnostic trial. In group A we performed 41 marsupializations, 20 subtotal pericystectomies and 4 total pericystectomies; while 14 total pericystectomies and 10 liver resections were performed in group B. Postoperative hospital stay was of 30 days for group A patients and of 18 days for group B. A single death occurred in group A. Recurrences occurred in group A only (11 cases equal to 17%) and were treated with total pericystectomies (8 cases) and liver resections (3 cases). Our study shows the development of diagnostic procedures trial during the 20-year period and the different surgical approaches between the two groups. Nevertheless we believe that surgical procedures should be tailored to each patient avoid H high surgical risk due to the benign nature of the disease.

Adolescent↗

PubMed2001

Soft tissue echinococcosis: a report of two cases and review of the literature.

Echinococcosis (hydatid cyst disease) is a zoonotic infection caused by the parasitic tapeworm Echinococcus. The larval stage of this parasite can implant in many organs of the body, most commonly the liver, and create internal budding cystic masses. Echinococcal cysts also can implant in soft tissues; however, a review of the literature revealed no published case with the patient initially presenting with a soft tissue mass. Two such cases are reported in the current study. Physicians who evaluate soft tissue masses, particularly in patients from Echinococcus-endemic areas, need to include echinococcosis in their differential diagnoses. The current treatment of choice for soft tissue echinococcosis is wide resection combined with perioperative medical therapy.

Adult↗

PubMed2000

Neurocysticercosis and echinococcosis in Asia: recent advances in the establishment of highly reliable differential serodiagnosis for international collaboration.

Neurocysticercosis (NCC) and echinococcosis, caused by the larval stage of taeniid cestodes, are recognized as major parasitic zoonoses threatening human life worldwide. Cystic echinococcosis (CE), caused by Echinococcus granulosus, has well been known to be more widely distributing in Europe and Asia (Eurasia) than alveolar echinococcosis (AE) caused by E. multilocularis. However, it has recently been found that AE is more widely distributing or spreading in Eurasia. Furthermore, NCC caused by Taenia solium is also spreading in Eurasia. Due to the lack of reliable methodology for diagnosing these zoonotic cestodiases worldwide, prevalence rates of these diseases are extremely underestimated. Our group has been working for the establishment of differential serodiagnosis and molecular diagnosis of AE. CE and NCC as international collaboration projects sponsored by the Ministry of Education, Japan from 1994 until 2000 at least. In this paper, we introduce (1) the most recent original work on the establishment of differential serodiagnoses of NCC, AE and CE, (2) international collaboration work on epidemiology of these diseases in several countries, and discuss (3) what we can and should do for the control of such global parasitic diseases. It is stressed that international collaboration or cooperation work on the control of parasitic diseases is only successful based on the original scientific contribution of high standard.

Animals↗

PubMedDate not supplied

[Orthopedic aspects of osseous echinococcosis--radiologic diagnosis, current surgery and drug therapy aspects].

PURPOSE: Skeletal manifestation of alveolar (E. multilocularis) or cystic (E. granulosus) echinococcosis is seldom, with an incidence of less than 2% of all cases. By reporting on a rare case of bony manifestation of E. granulosus, we intend to emphasize current standards in surgical and drug management of the disease. Typical radiographic and blood-chemistry findings are highlighted on a 62-year-old Arabiqu female suffering from a cystic echinococcosis with skeletal manifestation in the left ileum and lower lumbar spine. RESULTS: Radiographically typical are fine zones of osteolysis which, at a later stage, show confluence. Due to the rigid structure of cortical bone, cysts tend to grow slowly, and seldom exceed 2 cm in diameter. Only after having broken through the cortical bone, may a massive increase in size be observed. By means of serological tests, it is postoperatively possible to evaluate how successful radical surgery with removal of larvae was. Furthermore, serological tests can be used as a screening method, offering a diagnostic tool that can also utilized in detecting a recurrence. CONCLUSION: The surgical aim in the treatment of osseous echinococcosis should be in accordance to curative tumor surgery. Even after radical removal of the parasites, the WHO suggests an adjuvant chemotherapy with mebendazole or albendazole for at least two years after surgery. In cases where only a palliative treatment is possible, the antihelminthic drug administration can be continuous.

Acetabulum↗

PubMed2001

[Clinico-epidemiologic aspects of pulmonary echinococcosis in western Herzegovina from 1969 to 1998].

This research has included 111 pulmonary echinococcosis patients in the billy-mountainous, more cattle raising region of Western Herzegovina. Since 1969, the prevalence of pulmonary echinococcosis, which was 27 (0.15%) at the time, has had a slow declining tendency after the application of various epidemiological-preventive measures synchronized by the veterinarian and the medical services. It was not until 1998 the prevalence result fell down to 1 (0.01%). This study describes the therapy approach of surgery results with 82 patients who were operated on, as well as the prognosis of 29 other echinococcosis patients who rejected surgery but were regularly checked up. Apart form the progress in healing this disease, which is still found and presents a problem in the Mediterranean part of Herzegovina, because of its frequency and the difficulty in diagnostics; and particularly because of possible complications of this zoonosis. The possibility and the way of the albendazolom drug treatment have also been described here.

Adolescent↗

PubMed2002

Experimental study on a novel compound extracted from Traditional Chinese Medicine for treatment of alveolar echinococcosis.

OBJECTIVE: To evaluate the efficacy of a novel compound derived from Traditional Chinese Medicine (TCM) for treatment of alveolar echinococcosis in the Kuming mouse. METHODS: The compound was extracted from TCM by serial procedures including amalgamation of TCM drugs, boiling in a beaker, cold condensation using a reflux instrument, evaporation by mild heating and finally, formation of a deep brown powder. An animal model of alveolar echinococcosis was established concurrently. A bit of alveococcus tissue derived from alveolar echinococcosis in the mouse was transplanted into the peritoneal cavity of the musculus of a Kuming mouse. The duration of infection after inoculation was classified as either 1 week or 10 weeks; the animals were again divided into treated groups and control groups. Estimation of the alveococcus inhibitory rate and electron microscopic observation served as the main methods for assessment of efficacy. The infected mice in the treated groups were intra-gastrically administered once per day with the TCM extractive powder at doses of 20 mg.kg(-1) for three months continuously. All the animals were sacrificed and examined half a month after the end of TCM treatment. RESULTS: Total wet weight of alveococcus collected from the 9 mice in the treated group after one week of infection was 37.8 g (x +/- s, 4.196 +/- 2.090 g), which was markedly lower than the amount collected from 10 mice of the control group (121.3 g, x +/- s, 12.1 +/- 4.3 g). Therefore, the inhibitory rate of the alveococcus was 65.7% (P < 0.01). Similarly, the total wet weight of alveococcus from 7 mice of the treated group after 10 weeks of infection was 4.3 g (x +/- s, 0.62 +/- 1.21 g), which was much lower than the amount collected from 6 mice of the control group (17.85 g, x +/- s, 2.93 +/- 3.28 g). The inhibitory rate of alveococcus was 80.6% (P < 0.01). Furthermore, the ultrastructural appearances of alveococcus showed obvious differences between the two groups. CONCLUSION: TCM extractive powder for treatment of murine alveococcosis is considered to be a hopeful anti-echinococcus compound; it is a topic for further study.

Animals↗