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PubMed1992

The efficacy of chemotherapy with mebendazole in human cystic echinococcosis: long-term follow-up of 52 patients.

Sixty patients with Echinococcus granulosus infection of the liver, lungs, bone and/or soft tissues were treated for several months with oral mebendazole (50-60 mg kg-1 day-1), in divided doses after fat-rich meals, either without surgery (WS), post-surgery (PS) or pre- and post-surgery (PPS). Long-term follow-up, possible for 52 of the patients, showed that WS, PS and PPS patients have so far remained disease-free following treatment for (means +/- standard deviations) 65.5 +/- 37.7, 82.5 +/- 37.0 and 84.1 +/- 28.3 months, respectively. Ultrasound and computed tomography scans were similar in WS and PPS patients post-treatment. Blood eosinophil levels, which were sometimes elevated initially, returned to normal in all patients and this decrease indicated cyst degeneration before this was evident on the scans. Treatment of patients with cystic echinococcosis may no longer require surgery.

Adolescent↗

PubMed1994

Echinococcus multilocularis: parasite-specific humoral and cellular immune response subsets in mouse strains susceptible (AKR, C57B1/6J) or 'resistant' (C57B1/10) to secondary alveolar echinococcosis.

Parasite-specific humoral and cell-mediated immune responses were investigated in highly susceptible (AKR and C57B1/6J) and relatively resistant (C57B1/10) mice undergoing secondary alveolar echinococcosis (infection with Echinococcus multilocularis metacestode). The parasite-specific proliferative immune response of lymph node cells upon in vitro antigen stimulation remained weak in all three mouse strains. By day 30 p.i., CD4+ lymphoblast cells dominated the total population of blast cells in all three mouse strains. There was, however, an unexpectedly high proportion of CD8+ blast cells; by day 90 p.i., a marked proportional increase in CD8+ cells was seen in susceptible (AKR and C57B1/6J), but not in resistant (C57B1/10) mice. Susceptible, but not resistant mice exhibited a significantly decreased responsiveness of lymph node cells to concanavalin A (Con A) stimulation on day 90 p.i. Analysis of the humoral immune response by ELISA showed that resistance in C57B1/10 mice was associated with the ability of the host to synthesize antibodies to Em2 of the IgG3 and IgG1 isotype. Em2 is a lectin-binding carbohydrate antigen of the laminated layer. In susceptible AKR and C57B1/6J mice, low levels of anti-Em2 antibodies of the IgG2a isotype were detected. Anti-Em2 antibodies of the IgG3/IgG1 isotype, however, were absent. Differences in subclass-specific IgG responses were confirmed by immunoblot analyses. Our findings suggest that differences in antigen recognition (with respect to subsets of humoral and cellular immune components), probably controlled by non-H-2 gene(s), coupled to immune suppression modulated by CD8+ cells and/or respective cytokines, may determine susceptibility or resistance in experimental infection with E. multilocularis.

Animals↗

PubMed1987

Spinal involvement in alveolar echinococcosis: assessment of two cases.

Two cases of spinal involvement in alveolar echinococcosis are reported. Conventional radiographs showed bone lysis and spondylitis; computed tomographic scans showed detail of local spread to the ribs, other vertebrae, and soft tissues. Differential diagnosis, which includes other infections and hydatidosis, is difficult, and the diagnosis may be suggested by evidence of a primary hepatic focus, geographic propensity to the infection, and laboratory findings.

Aged↗

PubMed2004

Cystic echinococcosis of livestock and humans in central Sudan.

New information was collected on cystic echinococcosis in livestock (camels, cattle and sheep) and humans in the central region of Sudan. The livestock data were collected in abattoir-based surveys in the towns of Omdurman, Tamboul and Wad Madani, between 1998 and 2001, and covered a total of 8205 animals. The highest prevalence of infection was found in the camels (44.6% of 242 infected), followed by the sheep (6.9% of 5595) and cattle (3.0% of 2368). Records were made of the sizes of the 1320 hydatid cysts detected in the livestock (907 in sheep, 71 in cattle, and 342 in camels), whether or not each cyst was fertile, and where it occurred in the body of the host. Cysts collected from cattle and camels where much more likely to be fertile (22% and 24%, respectively) than those from sheep (1%). Camels and cattle therefore appear to be the principal intermediate hosts for Echinococcus granulosus in central Sudan, whereas sheep apparently play a marginal role in transmission. In 2002, as a preliminary assessment of the public-health impact of the disease, 300 residents of a rural village 60 km west of Wad Madani were surveyed using a portable ultrasound scanner. Only one (0.33%) of the villagers investigated was found infected. The implications of these finding are discussed in terms of the various strains of E. granulosus and the role of each in human disease.

Adolescent↗

PubMed2005

The types and timing of the degenerative changes seen in the cysts during and after benzimidazole treatment of cystic echinococcosis.

In a large-scale Bulgarian study, 122 patients with abdominal and/or lung echinococcosis were randomly selected for treatment with albendazole or mebendazole. The main aims were to evaluate the effect of each drug on the hydatid cysts, to follow the changes in cyst morphology during and after treatment, and to determine how quickly each drug produced the first, detectable, degenerative changes in the cysts. Follow-up was based on periodic ultrasonography, chest radiography and computed tomography. The abdominal cysts were categorised as small (<5 cm in diameter) or large. As albendazole treatment had effects that were almost identical to those of mebendazole treatment, the results for the two drugs were combined. In the lungs and, particularly, in the abdomen, the size of the cysts being treated influenced the character and timing of the degenerative changes seen in them. The initial change seen in each abdominal cyst was detachment of the endocyst, which occurred 1-3 months (small cysts) or 2-5 months (large cysts) after the initiation of treatment (P<0.05). The abdominal cysts then developed a hyper-echoic/hyper-dense appearance, became smaller, and finally disappeared 3.3-9.3 months (small cysts) or 5.6-13.9 months (large cysts) after treatment began (P<0.05). The first degenerative change noted in the lung cysts was cyst rupture, which occurred as early as day 10 of therapy but was generally observed 1 or 2 months after treatment began. After their complete evacuation, the ruptured lung cysts shrank and became deformed, some disappearing within 5-9 months of the initiation of treatment. The degenerative changes recorded, which began significantly earlier in the lung cysts than in abdominal cysts, indicate serious damage to the cysts and the parasiticidal, curative effect of each of the two benzimidazoles employed.

Adolescent↗

PubMed1990

Evaluation of response to chemotherapy of human cystic echinococcosis.

Fifty-five patients with echinococcosis were treated with mebendazole (30) and albendazole (25). To determine changes in cyst morphology and to evaluate the varying degree of response, progress during follow-up was shown by radiography, computerized tomography and ultrasonography. Persistence of cysts without any change in the morphology and cyst enlargement were taken as criteria for unsuccessful treatment. Development of echogenic foci and increase in density of cyst fluid were considered as a therapeutic effect. Changes in cyst wall such as thickening and deposition of calcium and detachment of the cyst membrane may also indicate response. An essential criterion, for a positive drug effect, was cyst size reduction as well as shape deformation. However, the most convincing and reliable criterion was the complete disappearance of hydatid cysts. Comparative assessment of the therapeutic effect of the two drugs favoured albendazole.

Adolescent↗

PubMed1978

Echinococcosis complicated by purulent pericarditis.

Three patients are described in whom purulent pericarditis arose as a complication of hydatid disease. In one patient a myocardial cyst ruptured into the pericardial cavity and subsequently became superinfected, probably from a coexisting bronchopneumonia. This patient also had widespread intravascular dissemination of germinal membrane. Two patients had echinococcal cysts of the liver, which became infected following surgery. This led to formation of a fistula between the hepatic hydatid and the pericardium, resulting in purulent pericarditis. The cases illustrate the protean nature of echinococcosis, especially the cardiac form, and emphasize the difficulty of recognizing purulent pericarditis as a complication of other conditions.

Adult↗

PubMed1999

[A rare case of generalized echinococcosis and pregnancy].

The authors describe a rare case of combination of generalized echinococcosis and gravidity. It concerns about a 23-years-old patient in 10 lunar month in whom 10 days before the term, accidentally through ultrasound is found an Echinococcus cyst in the liver. The delivery performed with planned caesarean section without disturbance of the cyst, ended successfully. Two days after the surgery the patient complained of troubled respiration and oppression. The X-ray photograph showed 3 Echinococcus cysts more--one in the right end two in the left lungs. The problem was solved with three more operations after 2, 6 and 10 months, with which the Echinococcus cysts were eliminated.

Adult↗

PubMedDate not supplied

[Echinococcosis of intra- and extrahepatic bile ducts. Report of a case at the Central Military Hospital].

We present a woman 34 years old with echinococcosis of intra and extra hepatic biliary ducts including gallbladder. We found alive cysts, dead cysts and fragments of germinative membranes of a complicated cyst in left lobe (I - II) with clinical findings of obstructive jaundice; pain; cholecystitis and great dilation of biliary ducts. We performed left lobectomy, exploration of biliary ducts, transduodenal sphincteroplasty, cholecystectomy. We haven't had complications. We present ultrasound images of the pathologic pieces.

Adult↗

PubMedDate not supplied

[Agranulocytosis--a complication of the chemotherapy of echinococcosis with mebendazole].

Only two of the 75 patients with echinococcosis, treated with mebendazole in a dose of 50 mg/kg b. m. for 30 days (single course) and administered from 1 to 13 courses with intervals of 1 to 3 months, developed agranulocytosis eventuating in death in one female patient. Analysis of blood levels of mebendazole and its metabolites permits a hypothesis that high concentrations thereof may have a toxic effect on the bone marrow, inducing its hypoplasia, in subjects sensitive to these substances.

Acute Disease↗

PubMed2004

Twenty years of percutaneous treatments for cystic echinococcosis: a preliminary assessment of their use and safety.

Image-guided percutaneous treatments for echinococcal cysts were introduced in the mid-eighties. Today they represent a third therapeutic option, after surgery and benzimidazole derivatives. Two types of percutaneous treatments are available, based on the destruction of the germinal layer or the evacuation of the endocyst. To assess the extent of their use and their safety, a Medline search of the literature on this subject was performed. The number of cysts treated, their anatomical sites, the complications and, length of follow-up (when available), were all examined. The results show that percutaneous treatments for cystic echinococcosis are safe and efficacious in selected anatomical sites, provided basic safety issues are correctly addressed. However, before drawing final conclusions, a more detailed analysis of the literature is needed. Percutaneous treatments could be simplified and made more effective if a scolecidal agent could be found that melts the entire endocyst without causing harm to the biliary epithelium.

Anaphylaxis↗

PubMed2004

An up-to-date on clinical management of human cystic echinococcosis.

More than one thousand of patients with more than two thousand of Echinococcus granulosus hydatid cysts were observed during the last 20 years. The therapeutic approach ranged from chemotherapy with benzimidazole carbamates (mebendazole and albendazole) to surgery, percutaneous non conventional treatment, and a "wait and see" approach, on the basis of the clinical picture, of the compliance and of the socio-economic background of each patient. The observed results, mainly those regarding chemotherapy, were briefly summarized and discussed. Most important point to underline is the need of data about a more prolonged follow-up on wider casuistries of patients both treated (with chemotherapy, with surgery, with percutaneous non conventional treatment) and not treated, to obtain a more suitable evaluation of the long-term outcome of the performed clinical approach. Moreover, a multidisciplinary approach is advisable to assure a better clinical management to patients with cystic echinococcosis.

Adolescent↗

PubMed1991

[Diagnosis and therapy of renal echinococcosis].

About 60% of clinically diagnosed cases of echinococcosis are found in the liver. Echinococcal involvement of the kidney is extremely rare. Imaging techniques such as sonography and CAT scan disclose typical findings are obtained in most of the cases. In this paper the necessary diagnostic procedure and a organ-preserving surgical technique are described.

Adult↗

PubMed1990

[Treatment of multiple and associated bilateral echinococcosis of the lungs and liver].

The peculiarities of one-stage echinococcotomy in 7 patients with multiple and combined bilateral echinococcosis of the lungs and liver are discussed. The operation is carried out by two surgical teams who work simultaneously except for the interval of time from the moment that the pleural cavity is opened to the removal of the pneumothorax, in which period the surgeons work in turns.

Adolescent↗

PubMed1990

[Clinico-morphological basis of selection of the methods of treatment of echinococcosis of the abdominal organs and retro- peritoneal space].

The work is based on the analysis of surgical treatment of 2,985 patients with hydatid diseases of the organs of the abdominal cavity and retroperitoneal space. The character of the operative intervention is determined by the period of hydatid vital activity, its size, and the features of its localization within the organ. The authors identified the following periods of hydatid vital activity: living parasite, dead parasite; complicated echinococcosis. Organ preserving operations are indicated in subcortical localization of the hydatid in the liver, in one of the poles of the spleen and in the kidney when the fibrous capsule is well preserved. Splenectomy or nephrectomy must be carried out in large and giant hydatids of the spleen and kidney localized in the organ or in its hilus and in irreversible changes in the organ. Open echinococcectomy is indicated in suppuration of large hydatids in the subdiaphragmatic space in occasional cases.

Animals↗

PubMed1988

[Neurological manifestations of alveolar echinococcosis].

Among 78 cases of alveolar echinococcosis reported in Lorraine, France, 5 had neurologic complications which in 3 cases revealed the disease. Results of parasitic tests are discussed and emphasis is placed on differences between this disease and hydatidosis. Encephalic localizations (3 cases) were multiple making neurosurgery impossible. The outcome was fatal in 2 cases: 1 month after the initial neurologic signs in the absence of treatment (case 1) and 4 months after treatment with flubendazole (case 2). This drug was however effective in the 3rd case (hepatic, pulmonary and cerebral form) with follow-up now at 4 years. Epidemiologic, histopathologic, clinical, diagnostic characteristics and course of these encephalic localizations are reviewed. Spinal localizations (2 cases) presented with a picture of spinal cord compression. After laminectomy and flubendazole, the course was marked by relapse with death in one case and a satisfactory neurologic course with a 4 year follow-up in the other one.

Aged↗

PubMed1987

[Bone echinococcosis].

Hydatidosis of the bone is a rare form of human echinococcosis. Due to the clinical, diagnostic, therapeutic and prognostic problems involved, the costal and occipital locations are of particular interest. Both are rare and differ from visceral locations in that they are always "primary" and have the capacity to destroy the bone matrix and infiltrate the adjacent tissues. The course of the disease is particularly slow and without specific signs and symptoms so that it can look like any bone condition. Laboratory tests are frequently negative and not wholly specific. While some authors claim that the radiological picture is of no diagnostic significance, others state that it offers pathognomonic signs. Diagnosis will be obtained through the combined assessment of clinical, radiological, laboratory and anamnestic data. Provenance from a rural area should reinforce the suspicion. Surgery, whether radical or conservative, is the key factor in treatment though local recurrences are common. Better results are obtained by combining surgery with Mebendazole for pre and postoperative prophylaxis. Large doses over a long period will give a better clinical course and reduce the incidence of recurrences. The prognosis is good for both sites as long as surgical treatment is given in good time.

Adult↗

PubMed1985

[False negative reactions in the serodiagnosis of cystic echinococcosis in humans].

Clinically supposed cases of echinococcosis can be strongly confirmed by application of serodiagnostic techniques. In certain cases false-negative reactions have to be taken into account. This has been observed in 4 out of 51 parasitologically confirmed cases. One patient had a hyalin cyst, a case in which supposingly no antigen diffused into the host's system. In two cases the cysts were calcified, in one patient only no explanation could be given.

Adult↗