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PubMed1977

[Embolization of the lung in echinococcosis (author's transl)].

Four months before her death of right heart failure, a 38-year-old woman with a known inoperable echinococcosis of the liver developed fever, increasing eosinophilia and pleuropneumonia. After improvement of the clinical, radiological and laboratory parameters under steroid medication, two months before her death hemoptysis and multifocal perfusion defects in the lung scintigram as a sign of pulmonary embolism occurred, for which heparin therapy was introduced. At autopsy a recurrent embolization due to echinococcus cysts with extensive displacement of the arterial pulmonary blood circulation were found.

Adult↗

PubMedDate not supplied

[Comparative values of homologous and heterologous antigens in the diagnosis of hydatidosis and alveolar echinococcosis using immunofluorescence].

Scoleces of E. multilocularis obtained from experimentally infested animals are compared with scoleces of E. granulosus from naturally infested animals towards homologous and heterologous sera (fluorescent antibody test). The antigens of larvae of both species are differently located, but larvae show a very close degree of antigenic reactivity. The use of scoleces of E. multilocularis does not improve the sensibility of the test applied to the diagnosis of echinococcosis. But the production of large amounts of antigen might allow regular investigations among high risk people.

Antigens↗

PubMed1984

[Chemotherapy of human echinococcosis].

In human echinococcosis, today as in the past, surgical removal of the parasite remains the treatment of choice. Beside certain conditions, adjuvant chemotherapy with Vermox is indicated for echinococcus multilocularis as well as echinococcus granulosus. A substantial decrease of the echinococcal parasite mass under Mebendazole is not yet known. Nevertheless jaundiced patients with diffuse liver infestation with echinococcus multilocularis became jaundice-free and able to work. Mebendazole toleration is very good. A closely interrelated medical control of patients under Mebendazole therapy ought to be interdisciplinarily carried through between internists and surgeons.

Administration, Oral↗

PubMed1978

Cerebral echinococcosis, a pediatric disease: report of two cases with one successful five-year follow-up.

Two cases of cerebral echinococcosis in children emphasize the need to consider the Echinococcus in the differential diagnosis of children with CNS signs and symptoms. One patient died because of delay in seeking medical attention. The other is now a 22-year-old college student with no evidence of recurrence more than five years after removal of Echinococcus cysts from both brain and liver. The newer modalities available for diagnosis are discussed. Therapy with mebendazole is reviewed; this relatively new, highly effective anthelmintic is well tolerated and has been apparently highly effective in a small number of cases.

Adolescent↗

PubMed1982

[Metastatic pulmonary echinococcosis secondary to a primary cardiac lesion situated in the interventricular septum. One case successfully treated surgically (author's transl)].

The authors report a case of metastatic pulmonary echinococcosis secondary to a primary cardiac lesion. The diagnosis was made on the basis of round pulmonary lesions developing during an episode of cardiac diseases which had been labelled as idiopathic acute pericarditis. The septal site then suspected on the basis of minor conduction disturbances was confirmed by angiography and could be excised under extracorporeal circulation.

Adult↗

PubMedDate not supplied

[The mebendazole treatment of patients with alveolar echinococcosis].

Chemotherapy was administered to 17 alveolar echinococcosis patients. Two of these patients developed an uncomplicated disease (a subtotal involvement of both liver lobes), fifteen a complicated condition. In 13 patients with the complicated condition metastases to the lungs, peritoneum, as well as diaphragmatic and abdominal organs' growth were detected, in 4 ones jaundice developed. Mebendazole was administered in a daily dose of 50 mg/kg together with the drugs improving its absorption. 30-day courses with 1-3 month intervals were administered. The efficacy of this therapy and its tolerance were assessed from clinical, laboratory and instrumental findings, including serologic tests. Intolerance presenting as alopecia was observed in 4 women, in one of them twice. Mebendazole efficacy in these patients was compared to that in patients administered the drug in a daily dose of 100 mg in 1978-1980. A positive time course was observed in 53% of patients.

Adolescent↗

PubMed1993

[Prevention of recurrent parasitic infections after surgical treatment of echinococcosis].

The results of surgical treatment of 741 patients with hydatid disease of the lungs, liver, and other abdominal organs were studied. Recurrences were found in different periods after the operation in 147 (19.8%) patients: solitary cysts in 34, multiple cysts in 90, and a combined affection in 23 patients. The recurrent cysts were revealed in a previously operated on hepatic lobe in 69, in the other lobe in 42, and in the other abdominal organs in 37 patients in 29 of which the cysts were located on the serosa of the abdominal organs. The recurrences were caused by a nonradical character of the first operation and dissemination of the embryonic elements with their subsequent implantation growth. On the basis of this, the author draws a parallel between the recurrence of malignant new growths and echinococcosis (alveococcosis) and formulates the general principles of aparasitism and antiparasitism of surgical interventions and similar principles of ablastemics and antiblastemics in oncology.

Echinococcosis, Hepatic↗

PubMed1977

[Single ruptured pelvic hydatid cyst as an unusual manifestation of secondary peritoneal echinococcosis].

The authors report the case of a large pelvic tumour compressing the bladder, the ureters and the recto-sigmoid junction. Its sudden rupture into the peritoneum led to an emergency operation and the discovery of a hydatid cyst ruptured into the pouch of Douglas and a hepatic cyst. The most frequent presentation of peritoneal echinococcosis, peritoneal cysts are metastases from a hepatic or splenic cyst which has ruptured into the peritoneum. They are usually multiple. Single pelvic lesions are rare, their hydatid nature is in the absence of a past history of hydatid disease difficult to suspect before operation. The object of the latter is to treat in one stage the primary cyst and its peritoneal metastases. The narrow vascular connections of the pelvic cysts render cystectomy dangerous and make one prefer removal of the germinal membrane followed by marsupialisation or drainage of the remaining cavity. In the long term, the frequency of peritoneal recurrences makes prolonged supervision necessary.

Douglas' Pouch↗

PubMed1991

Echinococcosis (hydatid disease) in Missouri: diagnosis by fine-needle aspiration of a lung cyst.

Echinococcus granulosus was diagnosed by fine-needle aspiration cytology of a lung cyst in a 6-yr-old white female in central Missouri. No adverse reaction occurred following the aspiration. The cytologic sample yielded clear fluid containing numerous clearly identifiable protoscoleces diagnostic for echinococcosis using routine PAP staining. Since hydatid disease is extremely uncommon in the Midwest, it had not initially been considered in the differential diagnosis. The infection was probably not indigenous to Missouri, since the patient lived the first 3 1/2 yr of life in Alaska, where the organism is endemic. This can only be speculative, however, since echinococcal organisms are found in wildlife in the Midwest.

Biopsy, Needle↗

PubMed2004

Structured treatment interruption in patients with alveolar echinococcosis.

In human alveolar echinococcosis (AE), benzimidazoles are given throughout life because they are only parasitostatic. It has been a longstanding goal to limit treatment, and recent reports suggest that, in selected cases, benzimidazoles may be parasitocidal. Previously, we showed that positron -emission tomography (PET) using [(18)F]fluoro-deoxyglucose discriminates active from inactive lesions in AE. We have now performed a 3-year prospective study in 23 patients and conducted a structured treatment interruption in those without signs of PET activity. Disease progression was further assessed by ultrasound, computerized tomography, laboratory parameters, and clinical examination. We found PET-negative lesions in 15 of 23 patients and benzimidazoles were discontinued in these patients. After 18 months, patients were reevaluated, and, of the 15 initially PET-negative patients, 8 showed either new activity on PET (n = 6) or signs of clinical progression (n = 2). Reinitiation of benzimidazoles halted parasite growth again. No further progression was detected after 36 months. PET had a sensitivity of 91% for the detection of active lesions. In conclusion, despite successful suppression of metabolic activity, in most cases benzimidazoles do not kill the parasite. PET is a reliable tool for assessing metabolic activity and for timely detection of relapses. Neither duration of treatment, kind of treatment, lesion size, calcifications, or regressive changes reliably indicate parasite death. We discourage the discontinuation of benzimidazoles in inoperable AE even after many years of treatment. However, patients with a poor compliance of benzimidazole intake or patients suffering from side effects to benzimidazoles might be assessed for PET negativity. If permanent discontinuation of benzimidazoles is attempted, the course of disease should be followed by PET.

Adult↗

PubMed1997

Effect of albendazole on recurrent and residual alveolar echinococcosis of the liver after surgery.

Patients with alveolar echinococcosis of the liver (AEL) can be cured by complete excision of the lesions; however, it is not always completely resectable in advanced cases. Recently, benzimidazole-type drugs have been reported to be effective in nonresectable AEL. One hundred fifty-two patients with AEL have been surgically treated in our institution since 1937. Our clinical trial with albendazole, one of the benzimidazole carbamates, has included 26 cases of AE since September 1988, each of whom had undergone an operation. Complete resection was performed in only six cases. Evaluation of response to the treatment was possible in 20 cases. A favorable response to albendazole, such as decreases in the size of the lesions, changes in cyst morphology, and amelioration in clinical symptoms or signs, was achieved in 11 (55%) cases. These favorable responses were also seen in cases of noncurative resection and palliative operation. The cumulative survival rate of the patients was 87%, 15 years after the operation. A complete response was achieved in one case; the residual lesion in the liver completely disappeared on the computed tomography image 3.5 years after noncurative surgery. Palliative or mass reduction surgery combined with albendazole therapy may be a strategy for advanced disease, especially when complete resection might result in significant morbidity or mortality.

Adult↗

PubMed1984

The value of computed tomography in osseous hydatid disease (echinococcosis).

The authors report three cases of osseous hydatid disease (echinococcosis) in which examination by computed tomography (CT) was found to be helpful in establishing the diagnosis. Recognition of this rare bone infection in orthodox radiographs is notoriously difficult, but is aided by knowledge of the patient having lived in an area in which the disease is endemic. In two instances, one involving the shoulder and the other the thoracic spine, radiological abnormalities had been attributed at first to tuberculosis. In the third case, in which a destructive lesion in the sacrum had been interpreted correctly, CT studies provided confirmation of a recurrence. CT has proved to be an effective and sensitive method of demonstrating these destructive lesions in bone, of determining their spread, and of establishing the presence of other hydatid cysts in adjacent soft tissues. This technique has been found to be of value in preoperative planning of the surgical approach to hydatid lesions of the skeleton.

Adult↗

PubMed1981

Chemotherapy of alveolar echinococcosis. Comparison of plasma mebendazole concentrations in animals and man.

High oral doses of mebendazole have been only partly effective in the treatment of patients with alveolar or cystic echinococcosis. In order to improve therapeutic results the pharmacology of mebendazole has been investigated. Jirds experimentally infected with larval Echinococcus multilocularis were given food containing mebendazole 100 to 1000 ppm. Drug plasma concentrations above 0.25 mumol/l were associated with a reduction in parasite weight to 1 to 10% of that in untreated controls. In treated animals parasite weight was negatively correlated with the plasma mebendazole concentration and with the duration of therapy. In patients on long term therapy with similar doses of mebendazole (16 to 48 mg/kg per day), plasma concentrations were much lower than in jirds. Only 19% of fasting plasma concentrations exceeded 0.25 mumol/l. Plasma concentrations 4 h after the morning dose did not exceed this value in 48% of cases. The results can be explained by the irregular drug absorption and short plasma half life observed in 7 hospitalized patients. It is likely that better results would be obtained if doses of mebendazole were adjusted to produce peak plasma levels exceeding 0.25 mumol/l.

Adult↗

PubMed1983

Preliminary observations on the biliary elimination of mebendazole and its metabolites in patients with echinococcosis.

The biliary excretion of mebendazole has been investigated in two patients to whom it was given for the treatment of echinococcosis, although it was found to be only partly effective. Oral mebendazole was extensively metabolized and the conjugated parent substance and its metabolites were excreted in the bile. One patient without cholestasis and with normal liver function had an apparent total biliary clearance (776 ml/min) which approached the hepatic plasma flow. The other patient with cholestasis and impairment of the hepatic drug metabolizing capacity showed a drastically reduced apparent total biliary clearance of 3.8 ml/min. The average plasma level of mebendazole was significantly lower in the former and higher in the latter patient (0.06 and 0.91 nmol/ml, respectively). The data suggest that impaired metabolism and/or biliary elimination can account for the higher plasma mebendazole level in patients with liver damage.

Adult↗

PubMed1983

Chemotherapy of larval echinococcosis with mebendazole: microsomal liver function and cholestasis as determinants of plasma drug level.

High oral doses of mebendazole have been only partly effective in the treatment of patients with alveolar or cystic echinococcosis, possibly due to an inadequate plasma concentration of the drug in some patients. In order to improve therapeutic results the influence of liver function on the plasma levels of mebendazole was investigated during long term therapy. Plasma mebendazole concentrations measured before the morning dose (trough values) showed a highly significant, negative correlation both with the aminopyrine breath test (ABT; rs = -0.78, n = 14, p less than 0.001) and the second exponential component of bromsulphthalein elimination (BSP- k2; rs = -0.74, n = 12, p less than 0.01). These relationships also applied over longer than a single day, since trough and peak mebendazole levels observed over an interval of 6 months before and after testing liver function were equally well correlated with ABT and BSP-k2. The daily dosage and other liver function tests seemed to be of minor importance in determining the plasma levels. It was concluded that the microsomal function of the liver and/or cholestasis might be important determinants of plasma mebendazole levels. The results of the study imply that higher and more effective mebendazole concentrations might be achieved by inhibition of the drug metabolizing capacity of the liver rather than by increasing the dose of mebendazole.

Adult↗

PubMed1986

Collagen immunotyping of the hepatic fibrosis in human alveolar echinococcosis.

An extremely dense fibrosis is responsible for the main complications of alveolar echinococcosis (AE), a severe parasitic disease due to the development in the liver of a larval form of the cestode Echinococcus multilocularis. Immunotyping of collagens present in fibrous, granulomatous, and normal areas of the liver was performed in nine patients with AE. Immunofluorescent labelling of collagen types showed that dense fibrosis was entirely composed of thick bundles of type I and type III collagens, surrounding old parasitic vesicles with an autofluorescent laminated layer. In granulomatous areas, collagens were labelled as clusters consisting mainly of type III procollagen and collagen. Concentric bundles of type III collagen surrounded active parasitic vesicles. An enhancement of the normal labelling in portal spaces of the intact liver was present in all the patients. These results suggest that irreversible acellular keloid scar-like fibrosis observed in AE is the ultimate result of cytotoxic and fibrogenetic events related to the immune response of the host which are taking place initially in the granulomatous area surrounding the young parasite larvae.

Collagen↗

PubMed1986

Intracranial alveolar echinococcosis in China: discussion of surgical treatment.

Intracranial alveolar echinococcosis is an uncommon disease and difficult to treat. Three patients with central nervous system (CNS) involvement are reported, and the surgical treatment of the monomassive type is emphasized. The largest mass lesion reported, so far, in the literature (9.0 X 6.5 X 4.5 cm) was extirpated in one of our cases. Related problems are discussed in combination with the literature.

Adult↗

PubMedDate not supplied

Radical and nonradical hepatic resection for alveolar echinococcosis: report of 18 cases.

The authors report their experience with 18 patients who underwent liver resection for alveolar echinococcosis of the liver from June, 1982 to January, 1989. Preparation for surgery included transhepatic biliary external-internal drainage in order to alleviate jaundice in 8 cases and catheterization of infected necrotic cavities in 7 cases. Resection was radical in 9 patients who underwent either right lobectomy (5 cases) or right trisegmentectomy (4 cases) with "en bloc" extension to the bifurcation of the hepatic ducts in 3 cases. Resection was nonradical in another group of 9 patients who had either atypical right hepatectomy (6 cases) or atypical left hepatectomy (3 cases). All patients were submitted to a periodic follow-up. The 9 patients treated by radical resection are alive and symptom-free and appear to be disease-free at radiologic imaging, except for 1 patient who had a small area of parasitic recurrence on computed tomography scan 4 years after operation. Among the 9 patients treated by palliative resection, 3 patients died during the follow-up period, the cause of the death having been related to the disease in 2 cases and nonrelated in 1 case. The 6 surviving patients had no noticeable growth of the parasitic mass during the period of follow-up. When feasible, radical liver resection is the best form of therapy. When massive parasitic invasion of both lobes of the liver and the porta hepatis and vena cava precludes radical hepatectomy, palliative resection associated with percutaneous procedures has to be considered before embarking on orthotopic liver transplantation.

Adult↗