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PubMed1997

[Survey of echinococcosis in Hokkaido and measure against it].

The first patient with echinococcosis who had lived in Rebun island was discovered in 1937 at Otaru and 134 patients had been identified as Rebun cases till 1989. In the meantime, the eradication of echinococcosis succeeded with extermination of dogs and foxes from the island. On the other hand, the first patient of Kon-sen cases was found in 1965 and 208 patients have been treated so far. The patients had been restricted within the Kon-sen region until 1979, but thereafter the patients have been found sporadically all over Hokkaido. This distributional tendency of the patients coincides with the explosion of the infection with Echinococcus multilocularis in foxes in Hokkaido after 1980. Prevention measure against echinococcosis has been carried out by the Committee for the Disorder of Hokkaido, by which we have been successful. We succeed in the early diagnosis and treatment of the patients, but still have no decisive methods to eradicate E. multilocularis in Hokkaido. This is one of the important problems of zoonosis to solve for the next century of Hokkaido.

Animals↗

PubMed1997

Serodiagnosis of alveolar echinococcosis: detection of antibody against EM18 in patients and rodents.

An international collaborative study on echinococcosis has been carried out for the establishment of a simple means for differential serodiagnosis of alveolar echinococcosis (AE) from other parasitic diseases including cystic echinococcosis (CE). The main candidate epitope is Em18 (previously undescribed epitope of a low molecular weight protein of 18.5 kDa). Evaluation of the usefulness of Em18 is introduced in this review paper. Serum samples showing antibody response against Em18 are exclusively from AE. The predominant IgG subclass recognizing Em18 is IgG4 or IgG1 or IgG4 + IgG1 but never IgG2. There are good correlations between (1) the antibody response against Em18 and the presence of active lesions and (2) the antibody response against Em18 and the Em2-ELISA values. Em18 is, therefore, expected to be reasonably reliable and useful for differentiation of active AE from inactive AE. A new ELISA system using a partially purified Em18 enriched fraction (PP-Em 18/16-ELISA) has been evaluated for serodiagnosis of AE compared with Em2plus-ELISA. A total of 194 serum samples were examined: 127 sera from AE (79) and CE (48) in China where both AE and CE are endemic, 21 sera from CE in Australia where CE only exists, 28 sera from cysticercosis (21), paragonimiasis (5) or sparganasis (2) in Korea where no indigenous AE nor CE exists and 11 normal sera. Antibody levels by PP-Em18/16-ELISA were much higher in AE than in CE and it was also true for commercially available Em2plus-ELISA. Some of CE from China showed exceptionally higher levels of antibody in comparison with those of CE from Australia. It is suggested that these strongly positive cases of CE from China may have been exposed to both species of Echinococcus. Although most of sera from paragonimiasis showed high antibody levels by Emplus-ELISA, they were negative by PP-Em18/16-ELISA. Therefore, PP-Em18/16-ELISA is expected to be more reliable for differentiation of AE from CE and others especially in Asian countries where paragonimiasis is still not rare. Antibody responses in rodents naturally infected with E. multilocularis: Serum samples from the wild vole, Clethrionomys rufocanus bedfordiae, infected with E. multilocularis showed similar antibody responses as in AE patients, whereas those from Norway rats, Rattus norvegicus, showed almost none. The latter rodents were simultaneously infected with Taenia taeniaeformis but showed no antibody response against T. taeniaeformis either. Therefore, we speculate that Norway rats may only be infected with E. multilocularis under some immunosuppressed conditions or genetic unresponsiveness. It is stressed that Em18 is highly specific to E. multilocularis, and antibody response against Em18 is reasonably reliable for differentiation of AE from other helminthic infections by Western blot and ELISA in humans and may be useful for detection of domestic animals contaminated with E. multilocularis in the endemic area.

Animals↗

PubMed1998

[Diagnosis and treatment of cystic echinococcosis].

New data are given on the life cycle of tapeworms of the genus Echinococcus, agents of a serious helmintozoonotic disease. The tapeworm Echinococcus granulosus, the agent of cystic echinococcosis, circulates also in Slovakia. Cystic echinococcosis most frequently affects the liver and a radical surgical treatment supplemented with the application of antiparasitics are the commonly used methods. The authors present the WHO proposal for classification of echinococcal cysts into 6 types, according to ultrasound imaging. They also report on a new technique known as PAIR (puncture--aspiration--injection--reaspiration), successfully used in many patients in endemic countries. They warn of a rapid distribution of the tapeworm E. multilocularis, the agent of alveolar echinococcosis, in central Europe. (Ref. 13.)

Echinococcosis↗

PubMed2005

Pulmonary complications of cystic echinococcosis in children in Uruguay.

Cystic echinococcal lesions surgically removed from 99 patients aged 1-15 years in Uruguay were histopathologically studied. The lesions were collected from the lungs, liver, peritoneum, omentum, pleura, ovary, appendix and perinephrium. All intact cysts were well-developed and unilocular. Pulmonary and hepatic fertile cysts in which protoscoleces were produced were in 75% and 47%, respectively, of all patients. Fertile cysts having many protoscoleces were in the lungs of a 1-year-old infant. Sixteen ruptured pulmonary cysts were found in the lungs of 13 patients and four ruptured hepatic cysts were found in the liver of three patients. Pulmonary complications were seen in patients having pulmonary echinococcal cysts. In lung tissue surrounding echinococcal cysts, pulmonary complications included chronic congestion, hemorrhage, bronchopneumonia, as well as interstitial pneumonia that included histological changes caused by bronchiolitis, organizing pneumonia and obstructive pneumonia. Liver tissue adjacent to echinococcal cysts showed atrophy of hepatic cells, proliferation of interstices, small focal hemorrhages, and infiltration of mononuclear cells. The present study shows that a close relationship exists between pulmonary echinococcosis and pneumonia. The term 'echinococcal pneumonia' is proposed for pneumonia accompanying pulmonary echinococcosis.

Adolescent↗

PubMed1985

Effect of plasma mebendazole concentrations in the treatment of human echinococcosis.

High oral doses of mebendazole were given for a mean period of 23 months to 22 patients with inoperable alveolar or cystic echinococcosis (Echinococcus multilocularis n = 18, E. granulosus n = 4). Clinical, morphological, biochemical and serological findings and plasma mebendazole levels were monitored. Clinical and biochemical improvement or stabilization was observed in 17 patients but the parasitic lesions did not decrease in size in most instances. One patient died shortly after onset of therapy with hemorrhage of esophageal varices. Three patients with alveolar and one with cystic echinococcosis had evidence of progressive disease such as increase of cholestasis, destruction of lumbar vertebrae and growth of an intraperitoneal cyst. The plasma mebendazole levels (4 hr after the morning dose) of the latter 4 patients were 0.09 +/- SD 0.02 mumol/l, while in those with clinical stabilization or improvement it was 0.30 +/- SD 0.14 mumol/l (P less than 0.001). These preliminary data indicate 1) a good clinical response to chemotherapy in most patients despite unchanged size of the parasitic lesions, and 2) a direct correlation of clinical response with plasma mebendazole levels.

Adult↗

PubMed2001

Cystic echinococcosis of the tongue leading to diagnosis of multiple localizations.

The tongue is a rare site of localization of cystic echinococcosis. We report a 3-year-old patient with cystic echinococcosis of the tongue demonstrated by histopathology. The cyst of the tongue was surgically removed. The tongue lesion led us to find additional liver and lung cystic lesions that were successfully treated with albendazole therapy.

Albendazole↗

PubMed1979

Chemotherapy of echinococcosis with mebendazole: clinical observations of 7 patients.

The effect of high dosage therapy with Mebendazole was studied in 5 patients with cystic echinococcosis and 2 patients with alveolar echinococcosis involving several organs. Follow-up studies at regular intervals from 7 to 20 months indicated an improvement of the pathological findings initially observed. This could clearly be demonstrated by the radiographic findings in cases with pulmonary involvement. The desintegration or dissolution of pulmonary cysts was observed within a few months after treatment with Mebendazole had begun. However, consolidation of previously emptied cysts occurred during the follow-up later. Allergic reactions were observed after commencement of drug therapy in two cases. These were probably due to spillage of antigenic material. The following treatment periods were tolerated well. No serious toxic side effects were observed in the other cases described here.

Adult↗

PubMed1985

[Intrathoracic complications of hepatic echinococcosis].

Five clinical forms of intrathoracic complications of hepatic Echinococcosis were distinguished on the basis of examination of 115 patients with hepatic Echinococcosis. They were: bilio-bronchial, hepato-pleural, hepato-pleuro-bronchial, hepato-pulmonary and hepato-mediastinal form found in 15 patients (13%). The intrathoracic complications must be treated surgically, cases with bilio-bronchial complications requiring emergent operative interventions. Thoracodiaphragmatomy is thought to be the optimal access.

Adult↗

PubMedDate not supplied

[Multiple echinococcosis. Therapeutic trials of fluoromebendazole].

The authors describe 3 cases of hydatic cysts (two diffuse echinococcosis and one surgical dissemination) which have been treated by fluoromebendazole for several months. The drugs has been well tolerated. Results seem encouraging, although the little amount of cases does not allow any definite conclusions. More works should help knowing more about the effects of this broad-spectrum anti-helminthic drug, which has, else where, proved itself very efficient against experimental echinococcosis of mice.

Adult↗

PubMed1993

[Echinococcosis--the current surgical aspects].

Over the period 1985 through 1992, forty-four patients presenting echinococcosis (echinococcus of the liver--33 cases, lung--nine, and spleen--two), aged 12 to 79 years, are operated in the emergency surgery clinic of the State Faculty Hospital "Queen Giovanna". The up-to-date methods of diagnosing are comprehensively described, followed by illustration and discussion of the operative procedures used in the treatment of echinococcosis. The early and long-term results are estimated as satisfactory.

Adolescent↗

PubMed1993

[Rare localizations of echinococcosis].

The author describes 28 observations of rare localizations of the echinococcosis in patients with proved "omission" of the hexacantic embryo of the liver and the lung barrier. It has been established that the spleen is most often affected. The necessity of diagnostication with modern visual technics--echography and KT--has been proved, as well as confirmation of the specificity of the process with the immunological reactions for echinococcosis. The approach for an organ-preserving operation at the spleen localization has been emphasized, stating as well the indications for splenectomy. General theoretical and practical conclusions for the diagnostics and the treatment of these localizations have been made.

Adult↗

PubMed2005

Risk factors for canine echinococcosis in an endemic area of Peru.

An epidemiological study was conducted in a highland rural community in Peru to determine risk factors for canine echinococcosis caused by Echinococcus granulosus. Dogs were diagnosed using a coproantigen enzyme-linked immunosorbent assay (ELISA). Dog owners were interviewed prior to stool collection and asked for attitudes, practices and beliefs likely to be associated with local patterns of E. granulosus transmission. Univariate and multivariate analysis were used to determine odds ratios (OR) and their 95% confidence intervals (CI). The main risk factors found to be significantly associated with canine echinococcosis by univariate analysis were dog age (3-25 months) (OR, 5.14; CI, 1.7-15.7), female sex (OR, 4.3; CI, 1.4-13.3) and having been fed hydatid infected offal (OR, 2.9; 95% CI, 1.0-8.6). There was complete lack of knowledge about echinococcosis transmission. In addition to periodic dog treatment, control programs need to emphasize education of the human population to increase knowledge of parasite transmission and to change human practices associated with high rates of infection.

Animals↗

PubMed2004

The evaluation of HLA-DRB1 antigens as susceptibility markers for unilocular cystic echinococcosis in Egyptian patients.

This is the first study dealing with the correlation between HLA antigens and cystic echinococcosis (CE) in Egyptian patients. The potential immunogenetic predisposition for susceptibility and resistance to unilocular echinococcosis was investigated by HLA-DRB1 typing; first by HLA-DRB1 amplification using PCR then using the allele-specific probing technique based on the reverse hybridization principle. The study was carried out on 35 patients with confirmed CE, and 100 apparently healthy individuals. A statistically significant positive association was found between HLA-DR3 and HLA-DR11 and the occurrence of CE. HLA-DR3 antigen was positively associated with the occurrence of isolated pulmonary cysts, multiple cysts, cysts >5 cm in size, non-cured disease and with a common radiological picture of hydatid cyst. A significant positive association of HLA-DR11 with the occurrence of cysts <5 cm in size was detected. This study demonstrates that carriers of DR-3 and DR-11 are at high risk for CE, and that those with DR-3 are more liable to complications.

Adolescent↗

PubMed1986

Autoantibodies in humans with cystic or alveolar echinococcosis.

Sera from 16 echinococcosis patients were analyzed with respect to polyclonal B cell activation and autoantibody formation. At least 8 of the sera were from patients who were never in tropical countries and therefore their cases were not complicated by other parasitic diseases. In comparison with a group of 52 healthy controls, these patients had significant levels of antibodies to DNP and haemocyanin, indicators of polyclonal B cell activation. There were also significant differences between control and patient groups with respect to antibodies to dsDNA, histones, actin, vimentin, and desmin. This is the first report of autoantibodies in echinococcosis.

Adolescent↗

PubMed1988

Our experiences in surgical treatment of thoracic echinococcosis during the period 1977-1986.

Our experience is based on 147 patients with thoracic echinococcosis (TE) who underwent surgery. Of these, 131 (89.1%) patients had pulmonary TE, 3 (2.1%) had extra-pulmonary TE, and 13 (8.8%) had pulmohepatic TE Ninety-nine (67.3%) patients had uncomplicated TE, and 48 (32.7%) had complicated TE. All patients underwent surgery. In 129 (87.8%) patients, we performed cystectomy with capitonage and in 18 (12.2%) cases we performed a lung resection (lobectomy or segmentectomy). Postoperative complications occurred in 2 (1.4%) patients, and recurrence in 2 (1.4%) patients who previously had complicated TE. On admission, there was no evidence of allergic reactions in patients with complicated TE. The average time of postoperative treatment was 13 days. The results of surgical treatment were excellent. The conclusion reached is that a cystectomy with capitonage is the treatment of choice for pulmonary echinococcosis, while lung resection may be necessary if lung tissue has been destroyed by prolonged compression or infection.

Adolescent↗

PubMedDate not supplied

Immunodiagnostic differentiation of alveolar and cystic echinococcosis using ELISA test with 18-kDa antigen extracted from Echinococcus protoscoleces.

Immunoblotting analysis was carried out using crude extracts of Echinococccus multilocularis and E. granulosus. A total of 214 serum samples were examined for the detection of antibody responses against 18-kDa polypeptides (Eg18 and Em18). Of 44 sera from patients with alveolar echinococcosis (AE) 91% were positive against both Eg18 and Em18, compared with 10% and 13%, respectively, of 70 cystic echinococcosis (CE) samples and 13% and 17% of 29 cysticercosis samples. A relatively purified 18-kDa antigen was extracted from E. granulosus protoscoleces and an 18-kDa-ELISA test which is simple, fast and highly sensitive and specific has been established. A comparative ELISA analysis, using the purified 18-kDa antigen and pooled AE and CE serum, indicated that there are significant differences in antibody levels between AE and CE sera. The maximum ratio for the evaluation of AE to CE was 2.26. The 18-kDa-ELISA was positive for 91% (40/44) and 11% (8/70) of AE and CE sera, respectively, and there was no cross-reactivity with cysticercosis sera or healthy controls. The overall diagnostic values of 18-kDa-ELISA for AE sera were sensitivity 91%, specificity 94%, positive predictive value 83% and negative predictive value 97%. We conclude that (i) the 18-kDa antigenic component may not be species specific but (ii) levels of antibody to the 18-kDa antigen are significantly different between AE and CE sera. Therefore, the 18-kDa antigen can be a reliable serological marker for differentiation of AE from CE.

Animals↗

PubMed1997

Subclass-specific serological reactivity and IgG4-specific antigen recognition in human echinococcosis.

Immunoglobulin (Ig) subclass-specific antibody responses and isotype-specific recognition of E. multilocularis (Em) and E. granulosus (Eg) antigens (Ag) were evaluated in both alveolar echinococcosis (AE) and cystic echinococcosis (CE). AE patients were divided into 3 groups by clinical and therapeutic criteria according to their actual state of infection, i.e. elimination of parasite, and regression or progression of disease, CE patients were either before or after surgery, of in continuous chemotherapy due to parasite persistence. Total IgE was highly elevated in progressive AE cases (7/11), but not in the cases with eliminated infection or regression. In AE patients with active disease, EmAg-specific IgE, total IgG, IgG1, IgG2 and IgG4 were particularly high. Similarly, in 9 of 30 CE patients, total IgE was raised above reference values, indicating progressive disease. CE patients" sera antibody cross-reacted with crude EmAg, and detectable Ig levels of the same isotype were also measured by ELISA. In both AE and CE, parasite-specific antigen recognition was dominated by IgG1 and IgG4. In AE patients with progressive disease, IgG4 distinctively recognized low molecular weight EmAg of Ar 26 kD, 18 kD, 16 kD and 12 kD. As prominent IgG4 and IgE responses develop with chronic helminth infections only, these serological parameters may indicate successful parasite infestation and severe outcome of disease. In summary, analyses of immunoglobulin isotype responses in AE patients by ELISA in combination with immunoblotting are a useful approach for post-treatment follow-up of patients at risk of developing recrudescent disease.

Adult↗

PubMed2002

Usefulness of hydatid cyst fluid of Echinococcus granulosus developed in mice with secondary infection for serodiagnosis of cystic Echinococcosis in humans.

The aim of this work was to assess the usefulness of hydatid cyst fluid (HCF) of Echinococcus granulosus, obtained from mice experimentally infected with hydatid cyst tissue homogenates, for the serodiagnosis of cystic echinococcosis (CE) in humans. The sensitivity and specificity of HCF obtained from mice for the detection of immunoglobulin G (IgG) antibodies in the sera of CE patients were compared with those of HCF from sheep and/or from a human CE patient by using immunoblotting (IB) and an enzyme-linked immunosorbent assay (ELISA). HCFs obtained from three different host species all were highly useful for immunoblotting, and sera from 19 (95%) of 20 CE patients equally recognized the antigen B subunit (approximately 8 kDa). HCF from mice showed a cross-reaction with 9 of 20 alveolar echinococcosis (AE) sera (45%), whereas HCFs from two other host species cross-reacted with 14 of the AE sera (70%). Although 2 (10%) of 20 sera from neurocysticercosis (NCC) patients were false positive with HCF from both sheep and humans, none of these sera showed a positive reaction with HCF from mouse origin. ELISAs with HCFs from both mouse and sheep origins detected all 20 CE and AE sera; however, these ELISAs showed 45% (9 of 20) and 60% (12 of 20) false-positive reactions with 20 NCC sera, respectively. The presence of nonspecific human IgG in HCF obtained from a CE patient prevented us from applying it to the ELISA. HCF of E. granulosus, obtained from laboratory mice with a secondary infection with hydatid cyst tissue homogenates, appears to be highly useful for the serodiagnosis of CE in humans and may be useful in domestic animals.

Animals↗