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Alveolar echinococcosis is a rare parasitic disease caused by Echinococcus multilocularis and most commonly involves the liver. Early diagnosis and precise evaluation of the localisation and the extent of the lesions are essential for treatment. In this report, we present US and CT findings in a patient with hepatic alveolar echinococcosis.
A case of alveolar echinococcosis with involvement of the femur is described. Bone involvement is extremely rare in alveolar echinococcosis. Attention is drawn to the difficulty of diagnosis, and the therapeutic possibilities are discussed.
We conducted a case-control study to investigate risk factors for acquiring autochthonous alveolar echinococcosis in Germany. Forty cases and 120 controls matched by age and residence were interviewed. Patients were more likely than controls to have owned dogs that killed game (odds ratio [OR] = 18.0), lived in a farmhouse (OR = 6.4), owned dogs that roamed outdoors unattended (OR = 6.1), collected wood (OR = 4.7), been farmers (OR = 4.7), chewed grass (OR = 4.4), lived in a dwelling close to fields (OR = 3.0), gone into forests for vocational reasons (OR = 2.8), grown leaf or root vegetables (OR = 2.5), owned cats that roamed outdoors unattended (OR = 2.3), and eaten unwashed strawberries (OR = 2.2). Sixty-five percent of cases were attributable to farming. Measures that prevent accidental swallowing of possibly contaminated material during farming or adequate deworming of pet animals might reduce the risk for alveolar echinococcosis.
The status of intestinal parasitic infections and seroprevalence of cystic echinococcosis in the inhabitants in Dornod and Selenge, Mongolia, was observed with stool and serum samples from 165 and 683 residents from August 9 to August 15, 2003. A total of 10 inhabitants (6.1%) were found to be infected with protozoan cysts or oocysts by stool examinations; 7, 1 and 2 cases with Entamoeba coli, Giardia lamblia and Cryptosporidium parvum, respectively. A total of 62 people (9.1%) revealed significantly high levels of specific antibodies against Echinococcus granulosus by enzyme-linked immunosorbent assay (ELISA). The surveyed areas are rural areas and the sanitized tab water is not available. There is a possibility of endemic transmission of water-borne protozoan diseases in these areas. The clinical echinococcosis is needed to be searched from the seropositive inhabitants.
Ten cases of echinococcosis diagnosed in American Indians in Arizona and New Mexico between 1972 and 1975 were investigated as part of a regional epidemiologic study. Patients were visited at home to discover factors associated with local parasite transmission, to detect possible additional cases among family members, and to perform diagnostic tests on dogs. Six patients were Navajo, 2 Zuni, and 2 Santo Domingo Indians. An additional case in a Navajo man was detected by serologic testing of patients' family members; this was the 20th case diagnosed in the region since 1965. Dogs owned by three of the Navajo patients were infected with Echinococcus granulosus. Arecoline-purge testing of 110 dogs in the Zuni pueblo demonstrated echinococcosis in a single stray dog. The findings at slaughter of Navajo-owned sheep indicate that the infection is enzootic in this intermediate host. The epidemiologic findings suggest that humans were infected from dogs which contracted their infections from two sources. The first was sheep raised locally in rural areas of the Navajo Reservation where the infection is enzootic in the dog-sheep cycle; transmission was apparently facilitated by the widespread practice of home butchering. A second source of human infection was dogs which became infected by eating viscera of sheep of off-reservation origin; these sheep were purchased and butchered by individual families in urban areas of the Navajo Reservation and in the Zuni and Santo Domingo pueblos.
Alveolar echinococcosis is a serious and often fatal disease of humans that in most cases can be efficiently cured only by complete surgical resection of the Echinococcus multilocularis lesion. In a few patients, however, a spontaneous cure of the disease has been observed by demonstrating the presence of lesions with dead metacestodes. The present study shows a comparative analysis of the cellular (lymphoproliferative assay) and humoral (antibody activity in an Em2 enzyme-linked immunosorbent assay [ELISA] and immunoblotting) immune response in 1) patients who were cured by a radical surgical resection of the E. multilocularis parasite lesion, 2) patients who had a partial surgical resection of the parasite lesion, 3) patients who had a non-resectable alveolar echinococcosis, and 4) patients who were shown to be spontaneously cured and had lesions with dead parasites. The in vitro lymphoproliferative response to E. multilocularis antigen stimulation was very high in cured patients who had radical surgery or in patients with lesions containing dead parasites, but it was significantly lower in patients who had partial surgical or no resection. Antibody concentrations in the Em2-ELISA were high in patients who had incomplete or no surgery, and low or negative in cured patients who had radical surgery or in patients with lesions containing dead parasites. Immunoblot analysis of patient sera revealed a consistent antibody banding pattern among cured patients with radical surgery and patients with incomplete or no surgery, whereas cured patients with lesions containing dead parasites showed a very faint antibody pattern.(ABSTRACT TRUNCATED AT 250 WORDS)
This paper reports two cases of neotropical echinococcosis caused by Echinococcus oligarthrus and E. vogeli, neither of which has been reported from Suriname. Case 1, a six-year-old boy, presented a 15 x 25 mm retro-ocular cystic tumor (observed by ultrasound, computed tomography scan, and magnetic resonance imaging) causing exophthalmia, chemosis, palpebral ptosis, and blindness of the left eye. Of two tentative diagnoses, Echinococcus cyst or dermoid tumor, the former was shown to be correct at surgery when a clear liquid and detached protoscoleces were aspirated. Rostellar hooks of the protoscolex were characteristic of E. oligarthrus. Case 2, a 41-year-old man, had polycystic masses excised from the liver and abdomen. A presurgery diagnosis of E. vogeli infection was made due to calcifications seen in the lesions, positive serology, residence of the patient in the tropical forest, and later by the size and shape of rostellar hooks. The presence of these two parasites in one of the former Guianas is not surprising; both species are endemic in tropical forest in Central and South America wherever people have not exterminated wild canids, especially the bush dog, (Speothos venaticus), and felids (wild cats of several species), along with pacas, agoutis, and other rodents that serve as intermediate host of these two cestodes. Eighty-six cases of polycystic echinococcosis are known in people from 11 countries from Nicaragua to Argentina: 32 due to E. vogeli, three to E. oligarthrus, and 51 for which determination of the species was not possible because the hooks of the protoscolex were not found or described. Research to elucidate aspects of transmission of E. vogeli and E. oligarthrus is of practical importance for defining measures for preventing the severe and frequently fatal illnesses caused by these two cestodes.
Echinococcus granulosus cyst fluid and E. multilocularis protoscolex extract were fractionated by a single step of preparative isoelectric focusing, resulting in an antigen B-rich fraction (8-kD) and an Em18-rich fraction, respectively. The usefulness of both fractions for differential serodiagnosis of cystic (CE) and alveolar (AE) echinococcosis was evaluated by a large-scale immunoblot analysis on a battery of 354 serum samples. These included 66 from AE patients originating from four different endemic areas, 173 from CE patients originating from seven different endemic areas, 71 from patients with other parasitic diseases, 15 from patients with hepatomas, and 29 from healthy individuals. In an immunoblot with the antigen B-rich fraction, 92% (158 of 173) of the CE sera as well as 79% (52 of 66) of the AE sera reacted with the 8-kD subunit. No cross-reactivity occurred with any sera from patients with cysticercosis, other parasitic diseases, or with hepatomas, or from healthy controls. In an immunoblot with the Em18-rich fraction, all but two sera from AE patients (64 of 66, 97%) recognized Em18, and only nine of 34 CE sera from China reacted with it. All other (139) CE sera from six other countries were negative as were all (115) other non-echinococcosis sera. These findings indicate that antigen B (8-kD) is not species-specific for E. granulosus but is genus-specific for Echinococcus, and that the Em18 antigen is a reliable serologic marker for species-specific differentiation of AE from CE.
The Western blotting (WB) method was used to evaluate the prevalence of human alveolar echinococcosis in Hokkaido, Japan. One hundred and sixteen WB-positive serum specimens were found in 1987 and 1988, and were grouped into two serologically different types from their WB-immunostaining patterns: "complete type", that showed multiple bands with various molecular weights ranging from 29 to 205 kilodaltons (kDa), and "incomplete type", that revealed a few bands with low molecular weights of 30-35 kDa and/or with molecular weights higher than 90 kDa. Therefore, we found that the WB method is applicable for the sero-epidemiological studies of human alveolar echinococcosis in Hokkaido.
Western blot analysis was carried out in order to evaluate new serodiagnostic markers, Em18 and Em16, for differentiation of alveolar echinococcosis (AE) from cystic echinococcosis (CE) using 36 serum samples from hydatid patients from Xinjiang, China, where AE and CE are both endemic and one double infection case has been reported. All AE cases except one (5/6) who exhibited a calcified lesion and a single case of double infection showed antibody responses against Em18 and Em16. Some of CE patient sera (6/22) showed antibody response against Em16 except one who showed that against Em18. Analyses of IgG subclass responses against Em18 and Em16 were carried out using all serum samples showing antibody responses against Em18 and/or Em16 (seven CE, five AE, and one AE + CE) and additional samples of three CE and 22 AE from Sichuan, China. IgG4 was the most predominant antibody subclass. Em18 and Em16 were recognized by both IgG4 and IgG1 (in most cases) or by either IgG4 or IgG1 (in minor cases) or by IgG3 (in very rare cases). Neither Em18 nor Em16 was recognized by IgG2 antibodies. The usefulness of Em18 and Em16 as potential new markers for serological differentiation of human AE and CE, respectively, is discussed.
The results of operative treatment of 65 patients with multiple echinococcosis of the liver are analysed. For the purpose of treatment of the cyst's residual cavity in 19 cases the authors used furacillin solution warmed up to 70 degrees C. As a result of the study it was established, that at a distance of 2 cm around the fibrous capsule rather high temperature is mounted, which is fatal for oncosphera. This method advantageously differs from others (4% formalin solution, iodine tincture). In 29 cases the residual cavity was treated with 4% formalin solution, in 11 cases 4% formalin solution was combined with iodine tincture, in the rest 6 cases--4% formalin solution was used and 1% chlorhexidinum solution followed by 70% alcohol. For elimination of residual cavities, which appeared after echinococcectomy, combinations of various methods were used, among which the proposed by the authors method of "hood", which is formed from the omentum with vascular pedicle. Complications (purulent fistulas formation) occurred in 5 patients. The authors come to a conclusion that for elimination of residual cavities after echinococcectomy in multiple echinococcosis of the liver the combination of various methods is obligatory.
Echinococcosis of the heart is a rare but dangerous for life disease, very difficult for diagnosis. 5 patients with echinococcosis of the heart were examined, 2 were operated. Introduction into clinical practice of complex echocardiography contributed to precise diagnosis. The viability of the parasite was determined after application of the latex-test. Defection of the living echinococcus parasites in the heart was indication for surgery. Removal of the echinococcus from the myocardium of the left ventricle in 1 patient was carried out without artificial circulation and was accompanied by a significant risk, the complete excision of fibrous capsula being impossible. Intraventricular location of the echinococcus cyst in the other patient has required artificial circulation and cardioplegia. Intraventricular cyst was successfully and radically removed after preliminary sterilization by glycerine solution.
Hydatid cyst is not mentioned among the chest wall tumours in areas not known to harbour echinococcosis. One of the uncommon sites for echinococcosis even in endemic countries is the chest wall. The striking resemblance between neoplasm and hydatid cysts forms a diagnostic dilemma and makes the correct diagnosis essential before surgery.
Diagnosis and treatment of combined damage to the liver by echinococcosis and amebiasis were analyzed in 36 patients. The clinical picture in this combination depends on the phase, localization and sizes of a focal lesion. The authors consider ultrasound to be a basic diagnostic method that clarifies the nature of the contents of cavities, which will aid in making a correct diagnosis. The examination of liver function and its correction are required in the preoperative period. The authors consider omentoplasty to be the operation of choice for uncomplicated echinococcosis. It is necessary to drain an abscess residual cavity it the umbilical vein is catheterized.
Echinococcosis is an infectious disease caused by the larval form of the genus Echinococcus. Two of the parasite species may cause severe disease in humans: Echinococcus granulosus and Echinococcus multilocularis. The liver is the most frequently involved organ in patients with echinococcosis. Diagnosis is achieved by variety of clinical methods, such as computerized tomography, ultrasound examination, magnetic resonance imaging and immunodiagnosis based on the detection of patient's serum antibodies.
This study was experimental and clinical. The experiments were made on 80 cotton rats. The clinical study covered 289 patients operated on for echinococcosis. Earlier studies indicated that echinococcosis is accompanied by secondary immunodeficiency and amino acid metabolic disorders. The homeopathic drug Cheblin-CK-1 used normalized amino acid metabolism 40 days after treatment in these patients. The same properties were displayed by homeopathic drugs.
Over 11 years 280 patients underwent surgery for hepatic echinococcosis. A complicated form of the disease was revealed in 151 (54%) patients. Suppuration of cyst was in 88 (31.4%) patients, perforation of cyst into biliary tract--in 87 (31.1%), compression of bile ducts by cyst with mechanical jaundice--in 5 (1.8%), perforation into abdominal cavity--in 2 (0.7%) and cyst's calcification--in 9 (3.2%). The diagnosis was based on clinical, objective and instrumental examinations. The most informative methods in diagnosis of hepatic echinococcosis were US (96.7%) and CT (100%). Radical operations were performed in 26 patients: pericystectomy--6, "ideal" echinococcectomy--11, resection of the liver--9. In true bursting of parasite's elements into biliary tract with mechanical jaundice and cholangitis, the correction of biliary tract's passability was carried out. Postoperative complications were revealed in 33.2% patients, in the most cases they were non-specific. Lethality was 1.7% (3 patients).
Laparoscopic intervention was performed in 39 patients with hepatic echinococcosis. The operation was conducted with the use of 3 trochars. Fibrous capsule was cleansed with the betadine solution or by non-focused laser radiation of YAG-laser. The operation lasted from 40 to 120 minutes with an average +/- SD (65.3 +/- 3.4) min. The transition to the laparotomy was not necessary. Mean duration of hospitalization was (3.6 +/- 1.2) days. All patients remained alive. 8 of them (20.5%) developed complications: in 5 the bile flowed out from the residual cavity following the drain, 2 developed the suppuration of post-operative wound. Patients were observed during 4-36 month after operation (an average 18 months). The recurrence of echinococcosis was diagnosed in 1 patient (5.9%).