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PubMed1977

The anti-echinococcosis campaign in Cyprus.

A national anti-echinococcosis campaign was started in 1971, in which education of the public, the control of dogs and the control of slaughter were emphasised. The campaign has already achieved almost total elimination of infection in food animals born subsequent to its initiation. Stray dogs are rare and all others are registered and examined three or four times a year. Infection in dogs has decreased by over 80 per cent (from 6-8 in 1972 to 1-1 in 1976). Legislation governing abattoir functioning and dog control is in force. Violation of legislation is penalised, although the level of awareness of the problem by the public, who co-operate willingly, does not often warrant this.

Abattoirs↗

PubMed2005

Infected primary intramuscular echinococcosis of thigh.

An unusual case of infected primary echinococcosis involving quadriceps muscles of the thigh and presenting as a cystic mass in a child is being reported. The diagnosis was made preoperatively with ultrasound examination and serology. After a cover of medical treatment the cyst was excised. Various clinical possibilities and management strategies are discussed.

Child↗

PubMed2000

[Surgical treatment of hepatic alveolar echinococcosis].

INTRODUCTION: Alveolar hydatid disease is an uncommon parasitosis found in the northern hemisphere, caused by the larval stage of a tapeworm growing in the liver: Echinococcus multilocularis. It behaves like a malignant tumor, producing liver necrosis and invading the biliary tract, main vessels and surrounding structures. METHODS: Review of the different therapeutic approaches in hepatic alveolar echinococcosis over 21 years in an epidemic area. RESULTS: The various surgical approaches (all types of hepatectomy, palliative surgical procedures and liver transplantation) were combined with medical, endoscopic and radiological interventional treatment. Recently, asymptomatic forms were more frequently encountered. CONCLUSIONS: The wide use of ultrasonography and specific serological tests have led to early diagnosis, allowing more curative hepatectomies.

Echinococcosis, Hepatic↗

PubMed2001

[Surgical therapy of alveolar echinococcosis and long-term outcome].

INTRODUCTION: The incidence of alveolar echinococcosis (AE) is low, and studies and progress reports with regard to surgical procedures are rare. METHODS: Retrospective analysis of surgical therapy of AE and its long-term results between 1983 and 2000 by evaluating medical records and questionnaires. SETTING: German university hospital within the endemic area. RESULTS: Twenty-five surgical procedures were performed in 19 patients with AE (12x partial resection of the liver, 3 of them with additional extrahepatic resection; 3x just extrahepatic resection, 4x bilidigestive anastomosis, 5x exploratory laparotomy, 1x bypass procedure). Fifteen patients were operated on the first time with that diagnosis, four due to a relapse. Seven surgical procedures were estimated to be curative, whereas 18 were palliative, because the parasitic mass could not be resected in toto. One patient died from persistent systemic sepsis as a consequence of microbial superinvasion of a splenic parasitic mass. Morbidity was 28%. All patients had additional medical treatment and periodic follow-up. Three of seven patients estimated for curative surgery developed a relapse. One of the patients discharged following palliative surgery died 13 years after diagnosis with liver insufficiency. Advances in conservative and interventional treatments have greatly improved the prognosis of the disease. CONCLUSION: Curative surgery for AE is feasible only in a minority of patients, because frequently the disease has already spread widely when diagnosed. The minimum distance between the lesion and the cut surface should be 2 cm. Taking the advances in conservative treatment into consideration, the benefit of palliative surgery is uncertain and today there is no evidence for prolonged survival by palliative surgical procedures. Palliative surgery should therefore be reserved for cases with complications that could not be managed by conservative and interventional treatment.

Adult↗

PubMed1997

Bone and soft tissue manifestations of alveolar echinococcosis.

OBJECTIVE: The present study demonstrates the osseous and soft tissue manifestations of alveolar echinococcosis (AE). PATIENTS: We report on eight patients with AE with bone or soft tissue involvement confirmed at biopsy or needle cytology. RESULTS: All eight patients showed hepatic involvement. Four exhibited infiltration of the spine as a result of direct spread of the hepatic primary lesion; distant metastases were observed in only three of these patients. Calcifications, which are typical for hepatic manifestations of the disease, were observed in soft tissue in only two of eight cases (25%); we observed no instances of endovesicular daughter cysts. CONCLUSIONS: AE manifests itself in the vertebral column as a form of spondylitis and in soft tissue presents similar to an abscess. Since in most of these cases spread of the disease per continuitatem from the liver is present, the diagnosis is easily made from the characteristic hepatic findings.

Adult↗

PubMedDate not supplied

Comparison of contrast-enhanced power Doppler ultrasound (Levovist) and computed tomography in alveolar echinococcosis.

BACKGROUND: To date, no study has compared unenhanced and contrast-enhanced (Levovist) power Doppler ultrasound with three-phase helical computed tomography (CT) for the analysis of the vascularization of hepatic lesions in patients who have alveolar echinococcosis. METHODS: Fifteen patients (11 female and four male; average age, 45.8 years) with confirmed Echinococcus multilocularis infection underwent unenhanced and contrast-enhanced (Levovist) power Doppler ultrasound (2- to 5-MHz transducer head) and three-phase helical CT. The largest identified lesion in each patient was studied. RESULTS: CT visualized vascularization peripheral or central to the largest echinococcal lesions in 11 of 15 patients. Vascularization in the area of the echinococcal lesions was not visualized by unenhanced or contrast-enhanced power Doppler ultrasound in any of the 15 patients studied. CONCLUSION: Three-phase helical CT visualizes the vascularization associated with Echinococcus multilocularis lesions in the liver. Neither unenhanced nor contrast-enhanced ultrasound in power mode is suitable for this application.

Adult↗

PubMed1999

[Acute pericardial tamponade in cardiac echinococcosis].

An echinococcal cyst of the heart is a rare cause of acute cardiac tamponade. We report on a 24 year old male from the Kosovo who was brought in an emergency state from a provincial hospital complaining of severe dyspnea, thoracic pain, dizziness, and a short period of unconsciousness. Surgical decompression had to be performed urgently, because the pericardium could not be punctuated due to the position of the hydatid cyst. The differential diagnosis was cardiac tumor or echinococcal cyst. Because of a negative result of a test for anti-echinococcal antibodies (indirect haemagglutination) and no eosinophilia (5%), the diagnosis of hydatid cyst was at first discarded. Later on, the test for anti-echinococcal antibodies became positive and a marked eosinophilia (59%) was manifest. In combination with a typical appearance in the echocardiograph and NMR, the diagnosis of a cardiac hydatid cyst was made. After preoperative treatment with albendazole, the cyst was sterilized with a 20% NaCl solution and the contents evacuated. The therapy with albendazole was continued. When last seen eight months after the first incidence, the patient was well except some degree of dyspnea on exertion. As a differential diagnosis of a cardiac tumor, a hydatid cyst should be taken into account in patients from an area where Echinococcus granulosus is endemic. A negative test on antiechinococcal antibodies and the absence of eosinophilia do not rule out echinococcosis.

Adult↗

PubMed2003

Primary ovarian echinococcosis.

INTRODUCTION: The incidence of genital system hydatid disease in abdominal operation is 0.1%. During a period of 20 years (1957-1977), 12 cases were reported. This disease has no specific symptoms and findings. It is diagnosed intraoperatively. CASE REPORT: We report a 50-year-old patient admitted to our hospital with the complaint of abdominal pain and swelling, operated because of her adnexal mass and diagnosed as primary ovarian hydatid disease (echinococcosis).

Abdominal Pain↗

PubMed2003

Long-term benzimidazole treatment of alveolar echinococcosis with hematogenic subcutaneous and bone dissemination.

We report a case of advanced alveolar echinococcosis (AE) that presented like a malignant tumor. It was diagnosed histologically from a subcutaneous nodule with skin inflammation on the right leg. Additionally, the patient showed bone metastases in the lower thoracic spine and the left third toe. This is the first case with proven hematogenic spread of AE to a subcutaneous site. The patient was treated with albendazole and remained stable for 6 years. When progression of AE occurred the therapy was changed to mebendazole, resulting in a stable condition for further 4 years.

Albendazole↗

PubMed2003

Cystic echinococcosis in Jordan: socioeconomic evaluation and risk factors.

The costs of illness and surgical intervention for human cystic echinococcosis (CE) cases in Jordan was economically evaluated by 77 surgeons and 77 CE patients. The cost of diagnosis for each CE case was 111.30 US Dollars and 146.20 US Dollars as estimated by surgeons and patients, respectively. The cost of surgical extraction of hydatid cysts for each case was 590.20 US Dollars and 638.50 US Dollars as estimated by both groups, respectively. Knowledge, attitudes and practices (KAP) of 77 CE patients as well as several Jordanian groups with different occupations including 144 shepherds, 119 settled livestock owners, 25 slaughter house workers, 400 university students and 80 inhabitants of a CE focus in southern Jordan were analyzed through a set of questionnaires. All of these groups had poor knowledge of CE, especially the source and causes of infection. All practices and attitudes of each group favored continuous transmission of the parasite and indicate the need for the implementation of a proper control program in the country.

Adolescent↗

PubMed2005

Screening for cystic echinococcosis in an endemic region of Peru using portable ultrasonography and the enzyme-linked immunoelectrotransfer blot (EITB) assay.

Cystic echinococcosis (CE) caused by the larval form of Echinococcus granulosus is a major public health problem in sheep-raising regions of the World. This study compared portable ultrasound with the enzyme-linked immunoelectrotransfer blot (EITB) assay as screening methods to estimate the prevalence of human CE in a remote village in the Peruvian Andes. Three hundred eighty-nine villagers were examined by portable ultrasound and blood samples were drawn by venipuncture. Sera were collected and tested for antibodies against CE using an EITB assay. Cystic lesions were classified based on their ultrasound morphologic characteristics. The prevalence of human CE using portable ultrasound and the EITB assay were 4.9% and 2.6%, respectively. Fifty-three percent of subjects with CE were EITB positive. Portable ultrasound was well received by the community, augmented CE detection and allowed a faster estimate of human infection than the EITB assay.

Adolescent↗

PubMed2002

Human cystic echinococcosis in the West Bank of Palestine: surgical incidence and seroepidemiological study.

The surgical incidence of cystic echinococcosis (CE) due to Echinococcus granulosus was investigated in hospitals of the West Bank, Palestinian Authority between January 1990 and December 1997. Serum samples from school-children in Yata town, which showed the highest surgical incidence, were tested for anti-hydatid antibodies. A total of 390 surgically confirmed cases were recorded throughout the 8-year period, with an overall mean annual surgical incidence (MASI) of 3.1 per 100,000. A high MASI of 4.9, 5.0 and 5.1 per 100,000 was found in Hebron, Jericho and Bethlehem Governorates, respectively. Yata town, Hebron governorate, showed the highest MASI, at 16.8 per 100,000. The highest incidence was found in age groups 11-20 and 21-30 years, at 27.4% and 21.5% of the total number of cases. While there was no significant gender difference in the number of cases in the age groups of 20 years or less, the male to female case ratio was 1:3.2-4.1 in the older age groups. The liver was the most common site of hydatid cysts in 69.9% of cases. Lung cysts were predominant in younger age groups (20 years or less). The seropositivity for CE in the school-children of Yata was 2.4% and 2.1% using enzyme-linked immunosorbent assay and the indirect haemagglutination test, respectively. CE is a significant endemic disease throughout the West Bank. The disease is acquired early in life and is more prevalent among females than males. Behaviour and life-style favour the spread of the disease.

Adolescent↗

PubMed2005

Usefulness of recombinant Em18-ELISA to evaluate efficacy of treatment in patients with alveolar echinococcosis.

Alveolar echinococcosis (AE) is a rare parasitic disease caused by Echinococcus multicularis and most commonly involves the liver. Early diagnosis is essential to improve the prognosis of patients with AE of the liver. Em18, an 18-kD diagnostic antigen from Echinococcus multilocularis, is highly specific and sensitive to detect AE. We previously reported that an enzyme-linked immunosorbent assay (ELISA) system using a recombinant Em18 antigen (RecEm18) was highly useful in the differential serodiagnosis of AE. In this report, we present seven AE patients who showed dynamic changes in RecEm18-ELISA values in the course of long-term follow up of albendazole (ABZ) chemotherapy, and/or resections of the liver or bone metastasis. All seven AE patients revealed positive values, over the cutoff level, of the RecEm18-ELISA before the treatments. The values in six patients fell below the cutoff level after the treatments, but the value in a patient with recurrence never fell below the cutoff level, and increased again. From these results, it seems that the RecEm18-ELISA is useful to evaluate the efficacy of treatment and predict recurrence in patients with AE. RecEm18-ELISA may be an important examination for: (a) the mass screening of AE in Japan, (b) the confirmative diagnosis of AE prior to surgical and/or chemotherapeutic treatments, (c) the follow up of AE patients after treatments, and (d) for deciding on the discontinuation of chemotherapy in patients with an appropriate response.

Administration, Oral↗

PubMed2006

Alveolar echinococcosis of the liver in a Tokyo resident with an unknown route of infection: report of a case.

We report the case of a 45-year-old Tokyo man who developed alveolar echinococcosis of the liver, which is an extremely rare disorder in Japan, except for Hokkaido, Japan's northernmost island. The findings of multiple clustered cysts on computed tomography were unlike those of any hepatic tumors we had previously encountered. T2-weighted magnetic resonance imaging revealed the characteristic findings of small cysts with a very high signal intensity. The tumors were successfully removed by a hepatic resection. The patient lives in Tokyo, but has visited Hokkaido many times. The exact route of infection in this patient remains unclear. Sliced raw venison, which he reported eating on every visit to Sapporo in Hokkaido, represented the only potential route of infection we could identify. This meat may have somehow become contaminated with embryonated eggs. Nowadays, even city inhabitants are at risk of developing rare diseases due to the rapid development of transportation systems.

Diet↗

PubMed2004

Alveolar echinococcosis of the liver in an adult with human immunodeficiency virus type-1 infection.

We describe a patient with human immunodeficiency virus type-1 (HIV) infection and alveolar echinococcosis (AE) with a focus on two messages. Despite being severely immunocompromised over years the patient exhibited a long-term asymptomatic course of AE. This is in clear contrast to reports describing accelerated courses of AE in immunocompromised patients. The patient had therapeutic mebendazole drug levels with only 1/10 of the normal drug dose. He was co-treated with protease inhibitors for his HIV infection. These drugs are known as strong inhibitors of cytochrome P450 3A4 (CYP3A4)-dependent metabolism. We speculate that benzimidazoles and protease inhibitors interfere at the CYP3A4-level. The first report of co-infection of HIV and accelerated AE was in a young girl with an extremely low CD4 cell count and an abrogated lymphoproliferative responsiveness to parasite antigen stimulation. Since the CD4 cell count in our patient remained in the range of 27-150 cells/microl, we speculate that there was a critical threshold of immunosupression for constraining AE. Initial treatment with albendazole for AE added to the current highly active antiretroviral treatment (HAART), and suppressive toxoplasmosis therapy became complicated by pancytopenia. After full recovery of the bone marrow, mebendazole was introduced with a new HAART and the previously prescribed toxoplasmosis maintenance therapy. Surprisingly, efficient mebendazole levels were achieved with an uncommonly low dose. These observations suggest that the benzimidazoles, albendazole and mebendazole, may interact with protease inhibitors, which are known for their strong inhibition of the CYP3A4.

AIDS-Related Opportunistic Infections↗

PubMedDate not supplied

Extrahepatic alveolar echinococcosis without liver involvement: a rare manifestation.

BACKGROUND: Alveolar echinococcosis (AE) primarily affects the liver and extrahepatic disease is considered the consequence of a secondary infection via metastatic spread from the hepatic focus. PATIENTS: Two patients with extrahepatic AE without liver involvement are presented. The first case is a patient with AE of the spleen and a small pulmonary calcification. In the second case exclusive affection of the spine was observed. DISCUSSION: Various pathogenetic explanations for hepatic omission appear plausible: a passage of oncospheres through hepatic sinuses without causing disease, a passage via lymphatic vessels or via portocaval anastomoses and the vascular passage in a retrograde fashion. Extrahepatic manifestation of AE without apparent liver involvement is rare. However, AE should be taken into account among other differential diagnoses even in cases of extrahepatic lesions without liver involvement.

Adult↗

PubMed1992

Effects of cyclosporin A on the course of murine alveolar echinococcosis and on specific cellular and humoral immune responses against Echinococcus multilocularis.

The effects of cyclosporin A (CsA) on Echinococcus multilocularis (E. multilocularis) metacestode growth, and on the specific immune responses of the hosts, were examined in AKR mice. Mice were intra-peritoneally infected with a metacestode homogenate. CsA (40 mg kg(-1) day(-1)) was injected subcutaneously from the 45th day after infection (Group 1), and from the day before infection (Group 2) until the day of autopsy (days 125 and 80, respectively). Results showed that unlike ths situation with some other helminthiases, CsA had no antiparasitic effect, although it lengthened the maturation time of protoscoleces in Group 1. The parasitic burden, unmodified in Group 1, was significantly enhanced in Group 2. This enhancement was associated with a decrease in antibody levels, whereas the delayed-type hypersensitivity was decreased in the two groups. These results confirm the role of cellular immunity in controlling the first stages of the larval development of E. multilocularis and indicate the necessity for a careful follow-up of any recurrence of alveolar echinococcosis in patients treated with CsA after liver transplantation.

Animals↗

PubMed1993

Serum antibodies in canine echinococcosis.

Specific IgG, IgA and IgE antibodies against E. granulosus protoscolex antigen were detected by enzyme-linked immunosorbent assay (ELISA) in sera from dogs experimentally or naturally infected with E. granulosus. The specificities of the IgG, IgA and IgE ELISAs were 100, 100 and 97.3%, respectively. Sera from 626 dogs of different categories and geographic regions in Australia, Uruguay and Kenya were tested. There were distinct differences in antibody responses in experimentally infected canids and in the number of naturally infected dogs found seropositive, depending on geographic region. The overall sensitivities of the ELISA (IgG, IgA and IgE) ranged between 73 and 84%, except for one geographic region where it was 54%. Genetic differences of the dogs and/or antigenic variations of the parasite appear to be responsible for the variations in specific antibody levels in infected dogs. In average, approximately one third of dogs from hyperendemic hydatid regions, without E. granulosus worms at autopsy or negative for E. granulosus infection by arecoline testing, were seropositive for anti-E. granulosus antibodies, suggesting previous infection with or exposure to the parasite. The results of this study demonstrate that, although the diagnosis of current intestinal E. granulosus infection on an individual dog basis is not always reliable by serology, serum antibody ELISA is useful as an epidemiological/educational tool for seroprevalence studies on canine echinococcosis.

Animals↗