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PubMed1976

Antibody persistence after surgical treatment of echinococcosis.

Studies on the persistence and levels of antibodies in 280 patients at different intervals following surgery for echinococcosis are described. Post-operative antibody levels were investigated by means of four immunodiagnostic methods, namely, the complement fixation, latex agglutination, indirect haemagglutination, and intradermal tests. After surgical removal of the cysts the tests became negative in some patients, whereas in others they remained positive for many years. As the post-operative period increased, the percentage of positive results fell and this fall was faster in lung echinococcosis than in liver echinococcosis. The titres obtained with the serological tests decreased at the same rate as the percentage of positive results, but the intradermal test remained positive, with an unchanged titre, for many years. In the case of secondary echinococcosis, medium and high titres predominated in all the tests. These immunological investigations during the post-operative period make it possible to evaluate the results of surgery and, to some extent, to clarify the prognosis.

Antibodies↗

PubMedDate not supplied

[An improvement in a new method for the surgical treatment of echinococcosis].

Parasitic cysts were intraoperatively treated with glycerol in 179 patients with echinococcosis at various sites and 3% hydrogen peroxide in 165 patients with hepatic echinococcosis. Experiments on 60 cotton rats experimentally infected with Echinococcus alveolaris and 156 albino mice with E. granulosus provided evidence for the surgical use of 80-100% glycerol or 3% hydrogen peroxide to treat the cysts. Intraoperative glycerol treatment of cysts in patients with complicated hepatic echinococcosis fails to normalize amino acid metabolism, as well as immunity even a year postoperatively. The glycerol method has no contraindications for pulmonary and hepatic echinococcosis. Hydrogen peroxide has a damaging effect on all germinal elements of both E. alveolaris and E. granulosus. The authors recommend that 3% hydrogen peroxide should be intraoperatively used for treatment of cysts. After surgery, there is a tendency for amino acid metabolism to become normal in such patients.

Amino Acids↗

PubMed2002

[How can we prevent alveolar echinococcosis? Ecosystem and risk management viewpoints].

PURPOSE: This article focuses on understanding epidemiological features of alveolar echinococcosis and discussing its prevention and control, especially from a viewpoint of the ecosystem and risk management. METHOD: Publications on alveolar echinococcosis throughout the world were systematically reviewed with special reference to ecology, epidemiology and countermeasures. RESULTS: Alveolar echinococcosis, caused by accidental infection with larva of the parasite Echinococcus multilocularis is fatal to humans unless diagnosed at an early stage. No effective control measures have been identified so far because it is difficult to fully understand the ecology of the parasite and its intermediate and definitive hosts. It is also not easy to determine the precise infection route to humans mainly because of the long latent period. In Hokkaido, infection rates among red foxes have recently risen even in low endemic districts. Not only stray and domestic dogs but also some pigs in Hokkaido have been found to be infected. While the number of reported human cases is still small, around 10 cases per year, local residents seem to be threatened with the risk of infection. DISCUSSION AND CONCLUSIONS: We predict that the incidence of alveolar echinococcosis among humans in Japan will increase in the near future if no effective preventive measures are conducted. In addition, Echinococcus multilocularis infection has the potential to affect the economy of Hokkaido because of its impact on the agricultural and tourist industries. Well-designed epidemiological surveys are therefore urgently required, in the context of ecosystem and risk management prior to large outbreaks. International collaboration is also desired.

Animals↗

PubMed2002

[Mediastinal echinococcosis].

Among 29,875 autopsies 59 cases of mediastinal echinococcosis were revealed. Among 4178 patients with thoracic echinococcosis 55 patients had mediastinal echinococcosis. All the patients were operated, most of them underwent ideal ecinococcectomy. Intraoperative prophylaxis of echinococcosis was performed: plearal cavity was treated by low-frequency ultrasound and glycerin. 7 examined patients demonstrated reduction of immune and phagocytosis indices in blood (DC3+, CD4+, CD8+, CD16+, CD21+). Increase of immunoglobulines A, M, G and circulating immune complexes was revealed. Reactions of scolexprecipitation and lymphocytes antigen-fixing were positive.

Antigens, CD↗

PubMed2002

[Imaging diagnosis and classification of hepatic cystic echinococcosis].

OBJECTIVE: To investigate the imaging characteristics of hepatic cystic echinococcosis in different imaging examinations and to formulate an imaging classification. METHODS: The data of pre-operative imaging examination of 2 039 cases with hepatic cystic echinococcosis, who underwent operation during the period January 1984 to December 2000, by B mode ultrasonograohy (all cases), X-ray computed tomography (909 cases), and magnetic resonance imaging (24 cases) were analyzed, being compared with the pathological findings of the resected specimens. RESULTS: Imaging examinations succeeded to identify not only the location, size, and form of hydatid cyst in liver, but also the typical pathomorphology of complications. The hepatic echinococcosis can be divided into seven imaging-diagnostic patterns: solitary cyst (1 625 cases, 79.70%), multiple cysts (414 cases, 20.30%), primary hydatid cyst with daughter cysts (1 114 cases, 54.63%), calcified cyst (186 cases, 9.12%), consolidated cyst (28 cases, 1.37%), cyst with infection (391 cases, 19.18%), and ruptured cyst (298 cases, 14.62%). CONCLUSION: A new diagnostic system of hepatic echinococcosis has been formulated based on imaging examination and by reference to clinical manifestation. It helps select appropriate operation program.

Adolescent↗

PubMedDate not supplied

A case of hepatic alveolar echinococcosis contracted in Belgium.

We report herein the case of a Belgian 76-year-old woman who developed a hepatic tumour suspected to be a breast cancer metastasis. Radiological imaging and guided biopsies were not contributive. The patient underwent an explorative laparoscopy with frozen sections that did not provide further diagnosis, and an open left bisegmentectomy was performed during the same anaesthesia. Histopathological examination of the hepatic mass showed Echinococcus multilocularis metacestodes, demonstrating alveolar echinococcosis. As our patient denied any travel in foreign countries and has undergone regular abdominal ultrasonographies since her mastectomy, it is highly likely that this alveolar echinococcosis had been contracted in Belgium. If some imported cases may be seldom managed in Belgium, to our knowledge, this case is the first occurrence of alveolar echinococcosis contracted in Belgium. This report, added to the demonstration of E. multilocaris infection of 50% of red foxes in Southern Belgium, and the potential infection of domestic cats and dogs, should attract attention of the medical community on the possible outbreak of endemic alveolar echinococcosis in Belgium, and on the related public health concerns.

Aged↗

PubMed2002

[Echinococcosis in North-Easter Poland--epidemiological and clinical aspects].

The incidence was assessed of antibodies against E. granulosus and chosen biochemical parameters among the inhabitants of north-eastern Poland. Among 532 studied subjects, 110 were seropositive. Group I (n = 73) was pharmacologically treated. Group II was surgically treated. Control group consisted of 15 healthy persons. 20.6% seropositive inhabitants of north-east Poland indicate that echinococcosis is not rare. Mainly it was echinococcosis of the liver, only in 2.7% it was connected with other organs. Echinococcosis was diagnosed among women aged 47-70, living in town, in majority owners of a dog. The course of echinococcos in majority cases was without clinical signs. In the diagnosis USG and serological test were helpful. Laboratory findings were not characteristic of echinococcosis. If it is possible surgical treatment is recommended for removal of parasite, verification of preoperative tests. In majority of chirurgically removed cyst, antibodies against E. granulosus were found after 3.5 years on the average, what evidenced strong immunogenicity of the parasite.

Adult↗

PubMed1992

[Environmental hygienic aspects of echinococcosis].

A literature review on the current situation of echinococcosis in Central Europe is given. The only final host for Echinococcus granulosus in this region ist the dog. The infection rate of dogs with E. granulosus in Central Europe is less than 1%. According to meat inspection statistics in Germany less than 0.008% of sheep, pigs and horses carry larval stages of E. granulosus. Parasitologically confirmed is the occurrence of a cattle-dog strain, the cysts of which were found in 0.26% of slaughter cattle. It is not known whether this strain infects also man as does the sheep-dog strain. Cases of cystic echinococcosis (E. granulosus) diagnosed in Central Europe are often imported from mediterranean countries. In Baden-Wurtemberg, the only state where human cases of echinococcosis are recorded, 50-100 cases are diagnosed per year. In areas with endemic E. multilocularis infection also dogs and cats may be infected with the adult worm besides the red fox. Recent investigations have revealed that not only in classical endemic areas (Switzerland, Austria, Baden-Wurtemberg, Rhineland-Palatinate) foxes have infection rates of up to 67% but that E. multilocularis-infection is also wide-spread in Thuringia, Hesse, Northrhine-Westphalia and in the southern parts of Lower Saxony. The most northern infested area seems to be the region of Detmold (infection rate of foxes 9%). The infection rates with alveolar echinococcosis (E. multilocularis) in humans even in endemic areas are low. In Baden-Wurtemberg 140 new cases became known during the past ten years.(ABSTRACT TRUNCATED AT 250 WORDS)

Animals↗

PubMed2004

[Overview of therapeutic options for cystic echinococcosis].

Surgical excision of echinococcal cyst has long been considered the only effective treatment for echinococcosis. However, the remarkable advances in imaging techniques, particularly ultrasound, made during the past 25 years have greatly facilitated diagnosis, treatment and follow-up. Today, chemotherapy and percutaneous treatments have become widely available. A major step forward in management of the disease came in 2001, when the WHO International Working Group on Echinococcosis (WHO-IWGE) came to a consensus by developing a standardized classification of ultrasound images in cystic echinococcosis. Thus, the most appropriate treatment for patients affected by this serious and sometimes life-threatening disease may now be chosen. An overview of the three main therapeutic options for abdominal- and particularly hepatic-cystic echinococcosis is presented, with focus on the indications and contraindications of each one. Data from long-term follow-up studies are also discussed, with emphasis on the resulting stage-specific criteria for treatment.

Albendazole↗

PubMed1999

[Up-dated progress in diagnosis and treatment of echinococcosis].

Diagnostic proces and choice of optimal management of cystic echinococcosis have to be related to the natural history of the parasite. The early and the late stages of invasion require a careful differential diagnosis with non-parasitic diseases. These are also the stages that many not require surgery. Chemotherapy, PAIR and "wait and observe approach" are alternative ways of cystic echinococcosis management. Em-18 WB test has a good diagnostic value in alveolar echinococcosis. Management of alveolar echinococcosis is based on radical surgery, prolonged chemotherapy and long-term observation.

Animals↗

PubMed1991

Serodiagnosis of echinococcosis: evaluation of two reference laboratories.

Two reference laboratories (CDC, Atlanta, and Institute of Hygiene, Vienna) were evaluated for their ability to diagnose echinococcosis from single serum-specimens by serological assays. Out of 18 specimens, both laboratories correctly identified the 12 sera from patients with echinococcosis. Each laboratory was able to give the species diagnosis for 11 of 12 cases. The CDC abstained from giving a final species-diagnosis for a serum from a patient with alveolar echinococcosis, the Institute of Hygiene similarly, for a case of cystic echinococcosis. Our findings reveal the considerable potential of today's serological methods for primary diagnosis of infections with Echinococcus granulosus and Echinococcus multilocularis.

Adult↗

PubMed1990

Echinococcosis in Austria.

In 1982, a research project on the prevalence of human echinococcosis in Austria was started. Within the period from 1982 to 1988, data on 188 patients with cystic (CE) and of 16 patients with alveolar (AE) echinococcosis were obtained. 15 out of 16 AE patients and 79 (= 42%) out of 188 CE patients were Austrian nationals, 1 AE patient was of Swiss nationality, and 94% of the 109 non-Austrian patients came from Mediterranean countries. Cases of (presumably autochthonous) cystic echinococcosis were found in Lower Austria, Vienna, Burgenland, Styria, Upper Austria, Carinthia, Salzburg and Vorarlberg, the eastern part of Austria being the main distribution area. Cases of (certainly autochthonous) alveolar echinococcosis were recorded in the Tyrol, in Carinthia and in Lower Austria. At the time of diagnosis, the average ages of Austrian patients with E. multilocularis (49 years) and with E. granulosus (55 years), respectively were significantly higher than those of foreign CE patients (34 years). The finding concerning the localisation of the infection (78% of E. granulosus cysts and 100% of E. multilocularis lesions were located in the liver) are consistent with previously published reports.

Adult↗

PubMedDate not supplied

[Comprehensive examination of the population to detect echinococcosis and recurrences of the disease].

The paper presents results of examination of 1017 persons with a view to detecting primary echinococcosis and recurrences of the disease in 357 previously operated patients by using the combined diagnostic programme (fluorography, ultrasonic examination and immunodiagnosis) elaborated by the author. Prophylactic examination revealed 28 primary echinococcosis patients and 69 patients with recurrent echinococcosis with later recovery from the disease. The data suggest that a prophylactic screening should be performed by using the combined diagnostic program that enables the final diagnosis to be made. All the operated echinococcosis patients should be registered and prophylactically examined at least once a year for disease recurrences by means of the complex diagnostic program.

Echinococcosis↗

PubMedDate not supplied

[Echinococcosis in the Ukrainian SSR].

Various types of echinococcosis foci were detected in the Ukrainian Soviet Socialist Republic: steppe zone foci with sheep pattern circulation dominating, where invasion is transmitted according to scheme: sheep--dogs attached to flocks; forest lowland and forest-steppe zones with pig pattern of echinococcosis circulating, where invasion is transmitted according to scheme: pigs--dogs. In steppe zone foci cases of echinococcosis in humans are regularly recorded and a large stratum of seropositive subjects was revealed by the indirect hemagglutination and latex agglutination tests. In second type foci only single cases of human echinococcosis were observed and low seropositive stratum was detected. Complex of antiechinococcosis measures conforming to different foci types was developed.

Agricultural Workers' Diseases↗

PubMed1979

Immunoreactivity in pulmonary echinococcosis. A comparative study of immunodiagnostic tests.

A comparison was made of the diagnostic value of five immunological tests-complement fixation (CF), latex agglutination (LA), bentonite flocculation (BF), passive haemagglutination (PHA), and intradermal (ID)-in patients operated on for pulmonary echinococcosis. The sensitivity of all five tests was significantly lower in the patients with pulmonary echinococcosis than in a comparable group with liver echinococcosis. Some 252 patients with miscellaneous nonhydatid diseases and parasitic infections were also tested; nonspecific reactions were highest in the ID and CF tests and lowest in the LA and BF tests. None of the serological tests was significantly more sensitive than the others, although the CF test was somewhat less sensitive and therefore probably has the least diagnostic value in pulmonary echinococcosis. The ID test showed a significantly higher sensitivity than any of the serological tests. The difficulties encountered in the immunodiagnosis of pulmonary hydatid disease are discussed and it is recommended that at least two serological methods (PHA and either LA or BF) and the ID test should be used in each case.

Echinococcosis, Pulmonary↗

PubMed1985

Epidemiological basis for chemotherapy of human echinococcosis.

Cystic (E. granulosus) echinococcosis is an important medical problem in Mediterranean countries where the dog-sheep-dog strain predominates. This mainly man-made infection is susceptible to control programmes directed against the infections in dogs. In man, surgery still remains a major curative intervention. Some benzimidazole compounds (mebendazole, albendazole) are effective in some cases of cystic echinococcosis, however, further studies on more effective drugs are recommended. At present chemotherapy should be used only in inoperable cases of cystic echinococcosis in man. Alveolar (E. multilocularis) echinococcosis is diagnosed more and more frequently in some regions of Central Europe. Man cannot interfere much with the reservoir of E. multilocularis in wild life, but should be able to protect himself and his dogs against infection from natural foci. High doses of mebendazole taken continuously have shown to increase substantially the survival rate of infected patients. However, further studies are needed to improve the efficacy of chemotherapy and to make it available to all those patients who have not been cured by surgery.

Animals↗

PubMed1996

[Echinococcosis of the heart].

Human disease caused by echinococcus granulosus is rare in Northern Europe, but is seen increasingly due to migration of labour and of tourism to endemic areas e. g. Southern Europe and the Middle East. Echinococcosis of the heart occurs in only 0.5 to 2% of cases of echinococcosis. Diagnosis is difficult because of the long latency between infection and manifestation of disease, and also because symptoms are unspecific. It is a diagnosis "to think of". Apart from a thorough history serological tests and medical imaging (ultrasound, X-rays, computed tomography) are used in the diagnosis of echinococcosis. Surgery is the preferred therapy, if not feasible medical treatment with benzimidazoles (Albendazole and Mebendazole) is effective. We describe a case of echinococcosis of the heart as the only manifestation of the disease: a 34-year-old male Turkish patient came in severe cardiac shock due to cardiac tamponade to the emergency department. Immediate heart surgery revealed a pericardium filled with cysts of echinococcus granulosus, infiltrating the left ventricle of the heart (Figure 1). The cysts were removed and the patient was put on a 2-year course of Mebendazole. The patient is free of relapse for more than 6 years now and he is considered to be cured.

Adult↗

PubMed1998

[Epidemiologic aspects of echinococcosis].

The performed studies showed, that morbidity of the population with echinococcosis substantially varies even within the boundaries of any administrative region and depends on a number of factors. According to climato-geographic conditions it is possible to single out three zones: arid zone (deserts, semi-deserts, salt-marshes) with minimal level of invasion of the population with echinococcosis; zone of semi-deserts and alpines with medium level of invasion; and zone of oases, valleys, middle-mountains and tugays--with high level of invasion. Among the risk group--cattle-breeders--2 subgroups could be singled out: steppe and mountains cattle-breeders, the risk of invasion in the laffer subgroup is substantially higher. It is necessary to include into the risk group also country housewives who are in constant contact with domestic animals, and schoolchildren who an in constant contact with dogs. The significance of aerogenic route of invasion is especially pronounced in children, and frequency of pulmonary form of echinococcosis has reached 50% and more. Besides studying the structure of morbidity and echinococcosis disease in relation to age, sex, occupational activities, for evaluation of epidemiologic conditions on territories it is advisable also to perform mapping of regions according to mass prophylactic examinations data with the use of serological reactions and US examinations, as well as to analyse epidemiologic conditions with the use of such criteria as indices of invasion, morbidity and detectability.

Adolescent↗