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In the 500 cattles examined, 90 (18%) had hydatid cysts in one or more organs whereas only 12(2.4%) goats, out of 500 had the disease. This is considered to be due to shorter period of longevity and age of slaughter of goats compared to catte. Since dog is an important definitive host responsible for the spread of echinococcosis, a survey on the incidence of hydatid cyst in dogs is necessary from public health point of view.
An enzyme-linked immunosorbent assay (ELISA) for the serological differentiation of cystic (Echinococcus granulosus) and alveolar (E. multilocularis) echinococcosis in man has been evaluated. A discrimination rate of 95.1% was found for 82 sera from patients of geographically disparate endemic areas. This rate was essentially the same as that found for 57 Swiss patients, indicating that inter- and intraspecific strain differences do not influence the test results. The assay method is suitable for immunodiagnostic purposes as well as for seroepidemiological studies.
Forty patients with echinococcosis were treated with mebendazole (approximately 50 mg/kg body weight) and under observation for up to 8 years. In 8 patients, E. multilocularis-infection was diagnosed whereas 32 patients had liver (n = 19 lung, n = 7) or other infestations of E. granulosus. 23 patients had been treated with mebendazole alone. 20 further patients received the treatment pre- and post-operatively and in the remaining cases mebendazole was given pre- or post-operatively according to the patients' requirements. Besides the clinical and laboratory findings, morphological parameters of organ infestation due to the parasites were examined repeatedly by x-ray, ultra sound, Ct-scan or scintigram. In the course of treatment we noticed that mebendazole had a certain effect in the case of E. multilocularis-infection and in the case of lung infestation due to E. granulosus. Furthermore, patients who were treated with mebendazole and who were under observation for several years, showed improvement of the liver cyst. The analysis of all morphological data available from patients with liver cysts indicated that marked changes had already been observed in the period of one to thirty months after the beginning of therapy.
Complex experimental and morpho-laboratory examinations of 164 patients and 30 animals have shown the daughter bullas implanted into the liver tissue of animals to perish, the cavity being substituted by the connective tissue. In patients with Echinococcosis with the live parasite, suppuration or calcification scolexes were not found or died. In cases with the dead parasite and the destroyed cuticular membrane scolexes could be found in the fibrous capsule cavity and outside its limits. This fact should be taken into consideration when choosing the operative method.
Thirty-three patients with alveolar echinococcosis treated by surgery or with mebendazole were observed up to six years. Of three immunoassays (IgG ELISA, complement fixation, indirect haemagglutination) correlation with the clinical course was achieved by IgG ELISA only. Serum antibody levels tended to increase during the first year and decreased during the second year after therapy had been started, Long persisting antibody was most sensitively indicated by indirect haemagglutination.
A counter immunoelectrophoresis was used for the demonstration of antibodies to echinococci. The antigen was prepared from hydatid fluid obtained from liver cysts of sheep. After concentration the antigenic material contained 1800 to 2900 micrograms of nitrogen per milliliter fluid. One or more precipitating lines were regarded as positive. Serum samples of 184 patients with surgically proven echinococcosis gave positive results in 80,4% of the cases. Among them, patients with hydatid disease of the liver were positive in 83,2% of the cases, and patients with hydatid disease of the lung were positive in 78,6 of the cases. The arithmetric mean of the number of lines was 2,4. Sera of 1182 patients with other diseases (among others diseases of the gastro-intestinal and respiratory tract, allergies, neuro-psychiatric, gynecologic and parasitic diseases) reached in 4,6% of the cases with the formation of precipitating lines. The described test is simple to perform, it can be read after a short period of time and it can be used as a screening test for mass case finding.
The article describes imaging of cerebral alveolar echinococcosis via nuclear magnetic resonance. The results are correlated with surgical and CT findings.
Preliminary results of a long-term, prospective therapeutic trial with mebendazole in 28 patients mainly with inoperable echinococcosis are reported. The course of disease was monitored closely and plasma mebendazole levels were checked regularly. A major problem is the lack of reliable methods for defining and measuring early success or failure of therapy. Most of the patients improved clinically. No marked change of parasitic lesions was observed except in one patient with constantly low plasma mebendazole levels who deteriorated. No serious side effects occurred. The preliminary results are encouraging and suggest that mebendazole has a "parasitostatic" effect on larval growth.
Cardiac hydatid disease represents 0.02-2% of the possible locations of the parasite. The case of an asymptomatic 60-year-old male patient, hospitalised for mnesic and cognitive disease, and with history of hepatic and pulmonary echinococcosis is reported. The patient showed a cardiac cyst localised in the mediobasal portion of the ventricular septum, with partial obstruction of the left ventricular outflow tract and with alteration of the left ventricular compliance. This case is of particular interest either for the rarity of cardiac localization or disagreement between the severity of anatomic involvement and absence of correlated symptoms. Therefore all patients affected by hydatid disease could be routinely investigated by 2D echo because this imaging technique is non invasive, feasible and has a high sensitivity for detecting intracardiac echinococcal cysts.
Two patients receiving oral high-dose mebendazole therapy for echinococcosis were found to have severe, reversible neutropenia, apparently due to marrow suppression; platelets and RBCs were also reversibly suppressed in one. High blood levels of mebendazole (239 ng/mL) in one patient may have resulted in the neutropenia and several toxic side effects, as well as a striking shrinkage of the patient's pulmonary and liver cysts. Neutropenia with high-dose mebendazole therapy may occur in up to 5% of patients and may be much more common than previously recognized. The WBC count should be monitored frequently during the first several weeks of therapy. Further experience will be needed to determine whether neutropenia is related to mebendazole levels.
We report five cases of echinococcosis diagnosed on material obtained by fine-needle aspiration. The sites were the liver in three cases, the thigh in one case, and the retroperitoneum in one case. No complications were observed.
High oral doses of mebendazole are used experimentally for the treatment of human alveolar and cystic echinococcosis. In order to assess bioavailability of this drug 1.5 g doses were given to 3 volunteers. Measurable plasma concentrations of 17 to 134 nmol/l were found only if mebendazole was given together with a fatty meal. In a patient with cholestasis plasma concentrations were higher than in the 3 normal subjects. In patients on long term treatment the increase in plasma concentration after administration of a 1 g dose varied between 0 and 500 nmol/l. It is concluded that systemic availability of mebendazole is enhanced by concomitant food intake. In view of the large intra- and interindividual variation in plasma concentration, monitoring plasma levels during long term therapy appears advisable.
Parasite-specific immunoglobulin classes were determined by the ELISA in sera of 19 patients with cystic or alveolar echinococcosis before and after 2 years (+/- 4 months) of continuous treatment with mebendazole at daily doses of 35-50 mg/kg body weight. In the majority of cases IgG decreased and IgA and IgE decreased or disappeared. In contrast, four patients with progressive disease showed reverse tendencies with increasing IgG, IgA and IgE concentrations during the same period.
Mebendazole, its fluorine analogue flubendazole, and other benzimidazole derivatives are active against many gastrointestinal and tissue-stage helminths. This article reviews the published literature and proceedings of a workshop on the use of benzimidazoles against larval echinococcosis (hydatid disease). Orally administered high doses (30-50 mg/kg body weight) of mebendazole given daily for 20-90 days to rodents or sheep infected with larval Echinococcus granulosus cause damage of destruction of the cyst wall, loss of cyst fluid, and death of protoscolices. Similar treatment of rodents infected with E. multilocularis with mebendazole, flubendazole, fenbendazole, and albendazole for 60-300 days leads to reduction of weight, inhibition of growth and the metastases formation of E. multilocularis tissue, and to prolonged host survival time although the metacestodes are not killed. Mebendazole or flubendazole treatment of human patients infected with E. granulosus is followed by subjective improvement in most, and evidence of regression of cysts in some; in other patients, cysts continue to grow or have been proven viable even after several months of high-dose mebendazole therapy. In patients infected with E. Multilocularis, the progressive course of the disease appeared to be arrested, but treatment apparently did not kill the parasite. Side effects of some patients have included allergic reactions, alopecia, and reversible neutropenia. Some possible reasons for different responses to treatment include inadequate plasma drug absorption from the gut and age, condition, and location of cysts. Many remaining questions concerning the risk versus benefits of mebendazole therapy can be answered only through controlled clinical trials.
Eighty children suffering from pulmonary and/or hepatic echinococcosis are reported. The epidemiological and parasitological aspects are reviewed, and the importance of the radiological signs and differential diagnosis are emphasized.
Since 1976 60 patients with inoperable alveolar echinococcosis caused by Echinococcus multilocularis were treated with high doses of mebendazole and examined at regular intervals prospectively according to our protocol regarding clinical course, liver function, morphology, immunologically and plasma mebendazole levels. The average duration of disease was 8(1-19) years, the average duration of chemotherapy was 4.25 (0.75-9) years. The long term results showed a correlation of the clinical course with the mean plasma mebendazole levels and the duration of chemotherapy, respectively. Death (n = 5) or transient progression of the disease process (n = 14) was observed primarily in patients with low plasma mebendazole levels in the early course and within the first two years of chemotherapy. Only 9 patients showed a decrease of the parasite mass. Immundiagnosis (total serum IgE and serum antibodies against Echinococcus antigen) gave some information with regard to therapy results, but only in the long-term course. The cumulative survival of the patients under study was 96% at 5 years and 84% at 10 years, respectively which is markedly higher compared to historical control series with a letality of greater than 90% within 10 years.
An experimental model of human alveolar echinococcosis was developed, using intrahepatic injection of E. multilocularis larvae in mice differing by their sensitivity to this parasite; it seems to be suitable for studying the relationship between cell-mediated immunity and a) growth of the parasite, b) development of fibrosis.
Crude soluble antigens were evaluated with indirect haemagglutination and ELISA for their specificity in the immunodiagnosis of alveolar and cystic echinococcosis. Using a combination of heterologous crude antigens, the ELISA method made a correct species-specific diagnosis in 96.3% of the patients. These results are similar to those obtained by immunodiagnosis with purified antigens.