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PubMed1996

[Continuous therapy with albendazole for hepatic alveolar echinococcosis associated with obstructive jaundice].

To observe clinical results of continuous therapy with albendazole for hepatic alveolar echinococcosis associated with obstructive jaundice, we treated 6 patients continuously with albendazole at a dosage of 20 mg.kg-1.d-1. Jaundice disappeared and serum bilirubin level returned to normal within 1-2.5 months in the patients. Ultrasound and/or CT scanning of liver before treatment displayed irregular heterogenous lesions, obscure hilar region with marked intrahepatic biliary dilatation. In one severe jaundiced patient, the common bile duct and the pancreatic duct were dilated and the portal and splenic veins were also distended with marked splenomegaly. Two patients were followed up for 3-9 year after cessation of treatment, their hepatic lesions were almost completely calcified and considered cured. The other four patients were still subjected to treatment one year later. CT and ultrasound scanning showed marked improvement of intrahepatic lesions and disappearance of intrahepatic biliary dilatation. Liver function tests returned to normal except that serum globulin remained elevated in 2 cases. Clinical observation and CT scanning of liver indicated that continuous therapy with albendazole is effective in the treatment of hepatic alveolar echinococcosis associated with obstructive jaundice. No adverse side reactions were seen.

Adult↗

PubMed1998

[Splenic echinococcosis--a rare differential diagnosis in a cystic lesion of the spleen].

Cystic tumours of the spleen are generally rare and a parasitic origin is relatively improbable. Our case report, however, shows that in case of a splenic cyst, differential diagnosis must always consider the possibility of echinococcosis. We report on a patient suffering from a cystic lesion of the spleen where radiology yielded the final pointer to diagnosing an echinococcosis of the spleen.

Adult↗

PubMed1976

[Extraorganic forms of abdominal localization of echinococcosis].

The author has analysed 66 pateints (5.4% of all cases of the disease) with extraorganic abdominal echinococcosis. The forms of retroperitoneal (lumbar, pelvic, mesenteric and omental) and intraperitoneal echinococcosis (primary cystic and adhesive-disseminated) are differentiated. The problems of diagnosis, the differential diagnosis and selection of an appropriate therapy are discussed. The mortality in multiple and associated affections was within the range of 10 per cent.

Abdomen↗

PubMedDate not supplied

[Experimental echinococcosis and alveococcosis and a trial of the preparation SK-1].

In autobred albino mice, the maximum nonlethal dose of the agent CK-1 was established, which was 19.0 g/kg, the agent was nontoxic. Cotton rats aged 30-45 days were infected by alveococcosis from a donor rat. The methods and formulas developed by Mikhaĭlitsin et al. were used during experiments and investigations. At the beginning of treatment, 5 rats were found to have a great deal of parasitic larvocysts (PL) 10 days after infection. Eight rats formed a control group, 8 were treated with CK-1 in a constantly increasing doses of 0.1, 0.26, and 0.34 g/kg for 3 weeks. Following 40 days of infection, the animals were anesthesized and CK-1 was ascertained to have a high antialveococcal activity: the index of suppressed PL growth was 90.23 to 92.74%. In 14 piglets aged 1 month, infected by echinococcosis strains and treated CK-1 in high doses, was established to cause echinococcal death. In 14 puppies, the agent was highly effective in strobular echinococcosis.

Animals↗

PubMed2001

Alveolar echinococcosis of the spine.

Alveolar echinococcosis (AE) is a rare parasitic disease caused by the larval stage of Echinococcus multilocularis. It differs from cystic echinococcosis caused by Echinococcus granulosus. The main endemic areas of AE are Alaska, Canada, Japan, and parts of Europe. Hepatic involvement invariably occurs, but it is unusual for bone to be affected. We report the case of a woman presenting with a long history of pain, cachexia, morning stiffness, and biological signs of inflammation. Radiographs and principally magnetic resonance images were nonspecific, showing inhomogeneous osteolysis of vertebral bodies without loss of intervertebral disc height but with a paravertebral mass. The diagnosis ultimately relied on pathological examination, which showed an anhistic laminated membrane colored in red with Periodic-Acid-Schiff surrounding a central cavity, and by the serologic testing, principally ELISA Em2(+) method, which allowed a 97% specificity and 99% specificity in the diagnosis of AE. AE involving bone is an uncommon condition. Although magnetic resonance imaging can be used to search for local complications, the features it detects are, like those revealed by radiographs, nonspecific and can lead to AE being misdiagnosed as neoplasm or tuberculous osteitis. When a patient presents with suspected AE in an endemic area, the diagnosis can be achieved by serological testing alone (Western blot and Em2(+) ELISA), thereby avoiding the need for biopsy.

Journal Article↗

PubMed1982

Surgical treatment of cardiac echinococcosis: report of nine cases.

We reviewed the results in eight patients followed from 10 months to 22 years after one-stage surgery for removal of primary and secondary myocardial and pericardial hydatid cysts. The results were satisfactory in eight patients who survived the operation. One patient, however, with recurrent myocardial echinococcosis, pulmonary embolization, and sepsis died at reoperation. The series was analyzed with reference to the surgical treatment and world-wide experience of complicated cardiac echinococcosis.

Journal Article↗

PubMed2002

Diagnosis and surgical treatment of complicated liver echinococcosis.

BACKGROUND/AIMS: Complicated liver echinococcosis considerably worsens the prognosis of the disease. In this study the treatment of patients with complicated disease was analyzed. METHODS: The records of 136 patients who had undergone surgery in our clinic during the last decade were evaluated. RESULTS: Among all complications, the most common were lesions of the bile ducts (88 patients) and suppuration of the cysts (77 patients). Twenty-nine cases had a combination of two complications. Surgery was based on the nature of complications, number and sizes of hydatid cysts and patients general condition. The surgical treatment of choice was echinococcectomy, with possible liquidation of the fibrous capsule cavity. In cases with complications such as suppuration, remaining bile fistulas, large cyst cavities or extrahepatic location, external drainage is obligatory. Post-operative complications occurred in 43 patients (31.6 %), 22.4 % of them being specific in nature. Postoperative mortality was 2.2 % (three patients). CONCLUSION: Timely diagnosis, appropriate investigation and well planned surgical techniques may improve the outcome of complicated liver echinococcosis.

Journal Article↗

PubMed2005

[Evaluation of cystic and alveolar echinococcosis cases in people in Erzurum and surrounding cities.].

The aim of this study was to evaluate retrospectively cases of cystic echinococcosis (CE) and alveolar echinococcosis (AE) cases admitted to the Department of Pathology, Faculty of Medicine, Atatürk University These cases had come from Erzurum and surrounding cities. A total of 133 tissue samples from the cases submitted to the Department of Pathology from the Department of Surgery between 1 January 1999 and 15 July 2004 had been diagnosed as CE/AE. Of these cases, 111 (83.5%) were CE and 22 (16.5%), AE. The annual distribution of cases was as follows: 16, 13, 15, 46, 25 and 18 cases in 1999, 2000, 2001, 2002, 2003 and 2004, respectively. Fifty seven (51.4%) cases of CE were male and 54 (48.6%), female while 9 (40.9%) AE cases were male and 13 (59.1%), female, making a total of 66 (49.6%) male cases and 67 (50.4%), female. The mean age of female cases with CE was 33 (5-76) and that of male patients was 32.3 (2-66) while the mean age of female cases with AE was 43.4 (18-59) and that of male cases with AE, 37.3 (18-52). The mean age of cases with both AE and CE was 35 (5-76) for females and 33 (2-66) for males. CE was located mainly in the liver (72.1%) and the lung (9.0%). AE was located in liver in 19 (86.4%) cases. Lesions were located in both the liver and kidney in one case, in the spleen, omentum, uterus, ovary and abdomen in one case and in the lung, pleura and brain in another case. The regional distribution of cases in cities was as follows: 58% from Erzurum, 13.4% from Ağri, 7.6% from Kars, 5.9% from Iğdir and 3.4% from Erzincan.

English Abstract↗

PubMed1999

Primary disease recurrence after liver transplantation for alveolar echinococcosis: long-term evaluation in 15 patients.

Between 1986 and 1991, 21 patients received liver grafts in our center for incurable alveolar echinococcosis (AE). The aim of this study was to analyze the long-term results in 15 of these 21 patients who survived more than 1 year after undergoing a liver transplantation (LT). The follow-up, mainly aimed at the diagnosis of recurrence, consisted of repeated radiological and specific immunological investigations. The role of pre- and post-LT benzimidazole (BZM) therapy was also evaluated. Among the 15 patients, 8 patients had a palliative LT related to previously known pulmonary AE metastases and/or inextirpable abdominal parasitic foci. In the 7 remaining patients, LT was considered curative. In June 1998, the mean follow-up duration was 96 months (range: 28-138 months). Five late deaths occurred, 2 of them were directly related to residual AE. A reinfection of the graft was observed in 4 patients. Preoperative BZM therapy seemed useful in preventing or delaying the parasitic recurrence. Post-LT BZM was able to stabilize and even to reduce residual AE. The anti-Em2 enzyme-linked immunosorbent assay (ELISA), which is the standard test used in patient follow-up after partial liver resection for AE, did not appear useful in detecting recurrence here; however, an ELISA, using a crude heterologous antigen (Echinococcus granulosus) allowed early diagnosis of residual AE. In conclusion, primary disease recurrence is not rare after LT for AE. Immunosuppressive therapy may favor larval growth in extrahepatic sites; therefore, an extensive extrahepatic radiological check-up has to be performed before LT. BZM therapy seems to stabilize residual foci. Anti-Eg immunoglobulin G (IgG) follow-up is the most useful test for early diagnosis of parasite recurrence.

Adult↗

PubMed1994

Intracranial alveolar echinococcosis: CT and MRI.

Intracranial alveolar echinococcosis is uncommon. We report a patient with right frontal lobe and palpebral lesions secondary to a primary hepatic focus with secondary lesion in the lung. The intracranial and palpebral cystic masses were totally removed and both proved to be alveolar hydatid cysts. An unusual feature in this case is CT and MRI demonstration of dural and bony extension.

Brain Diseases↗

PubMedDate not supplied

Experience in the chemotherapy of severe, inoperable echinococcosis in man.

The effect of albendazole and mebendazole was studied in 25 patients with severe, multiple, inoperable echinococcosis. Eleven patients were treated with albendazole 10 mg/kg/day for four courses of 30 days with 15-day drug-free intervals and 14 with mebendazole 50-70 mg/kg/day continuously for between 6 and 24 months. The determination of cyst response was based on the changes in cyst appearance as seen by radiography, ultrasound and computed tomography. Albendazole and mebendazole were found to have favourable effects in patients with severe, inoperable hydatid disease, although the degree of response varied. Treatment with albendazole was successful in seven cases, partially successful in two, and failure was noted in the other two patients. In patients treated with mebendazole, success was established in three, partial success in five and failure in six cases. The differences in response were mainly associated with cyst condition and the drug used. In some cases long-term therapy and retreatment should be recommended.

Adult↗

PubMed2006

Epidemiological study of the cystic echinococcosis in Morocco.

The objectives of this epidemiological study on cystic echinococcosis (CE) in Morocco (2001-2004) were to update the prevalence of CE in different animal species living in the most important areas of the country and to collect protoscoleces and germinal layers for genetic research purposes. The post mortem inspection concerned 2948 sheep, 2337 goats, 618 cattle, 482 camels and 455 equines (325 horses, 60 mules and 70 donkeys) in five different regions: the Rif (Mediterranean coast and high mountains of the Rif), the Loukkos (Atlantic northwest plain), the center (Rabat and Casablanca regions), the Middle Atlas mountains and the south (arid and semi desert areas). The global CE infection prevalence rates obtained were 22.98% in cattle, 10.58% in sheep, 12.03% in camels, 17.80% in equines and 1.88% in goats. The infection rates were especially high in the Middle Atlas in cattle (48.72%) and in the Loukkos in cattle and sheep (37.61 and 31.65%, respectively). The majority of infected cattle (49.6%) and sheep (52.1%) had hydatid cysts in both liver and lungs. Except for cattle, the liver was more infected than lungs in all the other animal species. Animals more than 5 years old were the most infected in all species. The mean CE infection rates of these animals were about 56% in cattle, 40% in sheep, 20% in camels, 17.80% in equines and 7% in goats. These rates were much higher in the Loukkos (85% of cattle and 59% of sheep) and in the Middle Atlas (68% of cattle and 45% of sheep) than in the other regions. Results showed that Echinococcus granulosus is in an endemic steady state with no evidence of protective immunity in the intermediate hosts. The mean numbers of infections per year are 0.099 for cattle, 0.063 for sheep, 0.03 for camels and 0.010 for goats.

Abattoirs↗

PubMed2006

Cystic echinococcosis in water buffaloes: epidemiological survey and molecular evidence of ovine (G1) and buffalo (G3) strains.

A survey of cystic echinococcosis (CE) in the water buffalo (Bubalus bubalis) of the Italian Mediterranean breed was carried out in Campania, a region of southern Italy. In addition, a molecular study was performed on 48 hydatid cysts coming from 48 water buffaloes in order to determine the Echinococcus granulosus strain(s) present in this host. Out of a total of 722 water buffaloes examined for CE, 76 (10.5%) were found infected. The average number of cysts per buffalo was 4.3 (minimum 1, maximum 45). Seventeen buffaloes had hydatid cysts only in the liver (with an average of 5 cysts/liver), 34 only in the lungs (with an average of 1.8 cysts/lungs), and 25 buffaloes had cysts both in the liver and in the lungs. Fertile cysts were found in 10 (13.2%) out of the 76 positive buffaloes. The sequencing of the mitochondrial cytochrome C oxidase subunit 1 (CO1) gene of the 48 hydatid cysts produced sequences of 419 bp for each sample analysed. For 33 samples, alignment of the obtained sequences with those present in GenBank showed a total homology with the common domestic sheep strain G1; for 15 samples, sequences obtained showed 100% homology with buffalo strain G3. The findings of the present survey represent the first epidemiological and molecular comprehensive studies on CE in water buffalo from an endemic area for E. granulosus.

Abattoirs↗

PubMedDate not supplied

Combined eco-epidemiological and molecular biology approaches to assess Echinococcus granulosus transmission to humans in Mauritania: occurrence of the 'camel' strain and human cystic echinococcosis.

Mauritania lies between West-Central Africa where human cystic echinococcosis (CE) is considered extremely rare and West Maghreb where CE accounts for a real public health problem. Until 1992, Mauritania was considered as human CE-free even through CE seemed well known in livestock. In 1992, the introduction of ultrasonography led to the diagnosis of the first human CE cases. In 1997, a veterinary study revealed that dogs living around Nouakchott were commonly infected by Echinococcus granulosus. To assess E. granulosus transmission and to identify the most relevant animal reservoir responsible for human CE emerging in Mauritania, a simultaneous eco-epidemiological and molecular biology approach was performed. The fieldwork included sample collection and investigation of relationship between intermediate hosts, definitive hosts and humans. Typing of E. granulosus strains was performed using comparison of polymerase chain reaction (PCR)-amplified DNA sequences with one nuclear (BG 1/3) and 2 mitochondrial (COI, NDI) targets. Results show that the 'camel' strain is actually infectious to humans and circulates between intermediate hosts including camels and cattle. It is suggested that preventive measures at slaughtering places could reduce human contamination.

Animals↗

PubMed1998

Experimental infection of larval Echinococcus multilocularis in the rodent brain as a model for cerebral alveolar echinococcosis.

Experimental infection of larval Echinococcus multilocularis in the rodent brain was attempted to establish a murine model for cerebral alveolar echinococcosis. Balb/c mice and jirds were injected intracranially with 10% of a homogenated hydatid cyst mass. Small cystic larvae were observed macroscopically in the cranial cavity 1, 2 and 5 months post-infection in both mice and jirds. Some larval cysts from both rodents contained mature or immature protoscoleces. In mice, the laminated layer was found in the lateral ventricle 2 months post-infection but without protoscoleces. At five months post-infection, larger larval cysts were found in the cranial cavity of a mouse, which also demonstrated partial palsy of the legs. A laminated layer with mature protoscoleces was observed in the third ventricle and the mouse also harboured, in the left lung, a larval cyst containing protoscoleces surrounded by lymphocytes. Jirds were also found to be infected with metacestodes in the cranial cavity, but neither unusual behaviour nor establishment of cysts inside the brain was observed in jirds during the course of infection.

Animals↗

PubMed1983

[Echinococcosis in children--a case contribution].

Hydatid disease, or echinococcosis, is the most dangerous type of parasitosis in man in Europe. Two types are of clinical importance, namely, alveolar hydatid disease caused by Echinococcus multilocularis and cystic hydatid disease caused by Echinococcus granulosus. Cystic hydatid disease is characterised by an expansive growth via the formation of single or multiple cysts expanding in such a manner that they cause symptoms of space-occupying lesions, whereas the cysts of Echinococcus multilocularis undergo endogenous budding forming aggregates of innumerable small cysts honeycombing and even infiltrating the affected organ like a malignant tumour unlimited by the natural boundaries of the organ. Usually it takes about 10-15 years before the disease becomes manifest after the infection, because it is only then that compression of the surrounding organ tissue gives rise to symptoms. Hence, echinococcus disease is rare in children. The article reports on 7 children treated for Echinococcus granulosus. Complete exstirpation of the hydatid tissue is the treatment of choice. This is mostly achieved because of the benign nature of the growth. Chemotherapy remains an exception to the rule.

Adolescent↗

PubMed1994

Three- to 7-year follow-up after albendazole treatment of 68 patients with cystic echinococcosis (hydatid disease).

Sixty-eight cystic echinococcosis patients were each treated with 800 mg albendazole/day in four 28-day courses separated by 14-day drug-free intervals. Follow-up for 3-7 years showed that this treatment alone eradicated the cysts in many patients; in most of the remainder, disease progression stopped. Of the 59 patients with liver cyst(s), 41% were cured (all cysts disappeared), 17% showed marked improvement (> 25% contraction, complete consolidation), 24% limited improvement and 15% no change. Of the 12 patients with lung cyst(s), 72% were cured, 9% showed limited improvement and 18% showed no change (18%). No patient worsened but a recurrence occurred in two patients at about 56 months. The times taken to detect an initial cyst change and to detect cure were longer than is generally expected; initial cyst changes and cure could only be detected after 1 year in 12% and 69% of patients with liver cysts and 22% and 37% of those with lung cysts, respectively.

Adolescent↗

PubMed1975

Clinical echinococcosis.

In 221 patients (0.48% of hospital admissions) with hydatid disease (122 female and 99 males), 81% had single and 19% multiple organs involved. Lungs, liver and spleen as single sites of echinococcosis together represented 83.24% of cases and the liver alone represented 95.24% of instances with multiple organ involvement. One hundred seventy-nine single and 74 multiple cysts (ratio of 2.42/1) represented a total of 363 cysts (1.64 cysts/patient). The incidence of intact cysts was 51.52% and 48.48% had ruptured. Ruptures numbered highest in the lungs (73.44%) and greater in multiple (79.66%) than in single cysts (68.12%). In the liver, 27.14% of single and 54.55% of multiple cysts (40.44% of all liver cysts) had ruptured. Cysts varied in size from 0.8 to 35 cm diameter. Single cysts averaged significantly higher (14.16 cm) and multiple ones lower (5.71 cm) as did intact (6.75 cm) versus reptured cysts (4.33 cm). Except for 10 silent and 15 symptomatic cysts treated medically, all the rest were treated surgically by removal of the endocyst or resection of both endo and exocysts including 205 first, 31 second and 5 third procedures (1.75% of all major operations). Complications occurred in 28.57%. Surgical mortality (3.57%) was markedly lower than with conservative treatment (60%) and significantly less than that of the whole group (14.48%).

Adolescent↗