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PubMed1990

[MRT and CT in alveolar echinococcosis of the liver].

To compare the value of MRI and CT in evaluating hepatic alveolar echinococcosis a study was conducted on 30 patients. The liver was initially affected in all patients. At the time of examination, 15 patients had undergone partial liver resection. MRI showed no advantage over CT in demonstrating an echinococcal mass lesion. MRI was superior in identifying concomitant pathological changes of the intrahepatic and extrahepatic venous system due to the intrinsic contrast of vascular structures. However, CT was superior in identifying calcifications, an important attribute of the disease. MRI should only be used in imaging alveolar echinococcosis of the liver if diagnostic questions remain open after CT, in particular questions concerning venous pathology. MRI may also be used to replace CT in patients with a contraindication to urographic contrast material.

Adult↗
PubMed1985

[Budd-Chiari syndrome in liver echinococcosis].

In two female patients a diagnosis of Budd-Chiari syndrome secondary to hepatic echinococcosis was established by CT. One patient developed acute Budd-Chiari syndrome secondary to E. granulosus lesions of the liver. The second patient presented with a picture of chronic Budd-Chiari syndrome secondary to alveolar echinococcosis. CT findings of Budd-Chiari syndrome included ascites, low density areas in the liver parenchyma, hypertrophy of the caudate lobe, non visualisation of the hepatic veins, occlusion of the retrohepatic inferior vena cava and enlarged retroperitoneal veins.

Adult↗
PubMed1984

[Mebendazole therapy in echinococcosis. Long-term study and course parameters in 8 patients].

Eight patients with inoperable echinococcosis, four each with the cystic or alveolar form, had received mebendazole (Vermox) at a daily dose of 1.5 g for an average of 27 months. In six patients with clinical symptoms the number of fever attacks fell by 60% and of hospital admissions by 54%, cholangitic and/or icteric attacks disappearing completely. Two patients had no recognizable symptoms, either before or after treatment. One woman with multilocular disease died of bleeding from esophageal varices. The immunological and morphological findings did not reveal any relationship to the clinical course. Apart from reversible leukopenia in one patient there were no serious side effects. These observations indicate a satisfactory effect of long-term treatment of inoperable echinococcosis with mebendazole.

Adult↗
PubMed1982

[Sonography vs. computer tomography in liver manifestations of echinococcosis].

Hepatic echinococcosis generally gives rise to typical signs by ultrasound and computed tomography, even though a relatively large number of conditions has to be considered in the differential diagnosis. Comparing the two methods in 29 patients with manifestations of hepatic involvement by echinococcosis it was demonstrated that ultrasound is only slightly inferior, in cases of small-size involvement, which fails to be diagnosed as focal disease of the liver parenchyma. But ultrasound is the primary method of investigation, especially when the differential diagnosis is still open, and it is preferred for serial studies during and after treatment. Computed tomography is the method of choice particularly when it is necessary pre-operatively to document involvement beyond the liver itself.

Diagnosis, Differential↗
PubMed2000

A cross-sectional survey to analyse the risk factors associated with human cystic echinococcosis in an endemic area of mid-Wales.

In mid-Wales, the prevalence of cystic echinococcosis (hydatid disease) in humans and other animals has been well documented. A cross-sectional study was therefore undertaken to examine the associated demographic and environmental risk factors for the disease in humans, in Powys, mid-Wales. Overall, 223 fully completed questionnaires were returned from a postal survey. Eighteen of the respondents had been treated for cystic echinococcosis (CE). No significant association was found between many of the well-established risk factors, such as dog or farm ownership, and treatment for CE, although women were more likely to have been treated for the disease than men.

Agricultural Workers' Diseases↗
PubMed2000

Risk factors associated with human cystic echinococcosis in Jordan: results of a case-control study.

The parasites causing cystic echinococcosis (CE) are transmitted to man and domestic animals either directly or indirectly from dogs. High levels of human infection have been frequently described in sheep-rearing areas of the world, where the infection cycles between dogs and sheep through the use of working dogs and the feeding of sheep offal to dogs. A case-control study was undertaken in northern Jordan to examine the epidemiological characteristics of echinococcosis in a Muslim community. Forty-four indigenous Jordanians who had been treated for CE between 1990 and 1996 were contacted and three controls for each case, matched for sex and age, were selected from the Jordanian population. The most important single factor associated with treatment for CE was the main source of domestic water; 42 (95%) of the cases but only 81 (61%) of the controls reported that they used a public, piped, water supply as their principal source of household water [odds ratio (OR) = 13.22; 95% confidence interval (CI) = 2.91-83.7]. The keeping of dogs or close association with dogs or farm animals was not associated with any increased risk of CE. However, individuals who grew their own vegetables had a significantly decreased risk of acquiring CE (OR = 0.30; CI = 0.08-0.98). There was evidence of widespread ignorance of the disease and how it is transmitted.

Animals↗
PubMed1995

Evaluating the activity of liver cystic echinococcosis using the delayed-hypersensitivity skin reaction to common antigens.

When 11 patients with active liver cystic echinococcosis were tested with a commercial, delayed-hypersensitivity, skin test (DHST) to seven common antigens (Multitest; Merieux Institute, Lyon) they all reacted less than 30 patients with non-parasitic liver cysts, who had normal reactions. This immunosuppression in cystic echinococcosis was transient, as DHST performed within a few months of treatment were normal. DHST may help in evaluating the activity of Echinococcus granulosus cysts.

Echinococcosis, Hepatic↗
PubMed1995

Immunoblot evaluation of IgG and IgG-subclass antibody responses for immunodiagnosis of human alveolar echinococcosis.

Antigen binding of total-IgG and IgG-subclass antibodies from patients with alveolar or cystic echinococcosis (AE and CE) was assessed by immunoblotting. Antigen extracts were prepared from Echinococcus multilocularis protoscoleces (EmP) or from homogenized E. multilocularis metacestode tissue (EmCH). Antigens of approximately 44, 35, 21, 17.5 and 16.5 were recognized by total-IgG and IgG1- and IgG4-subclass antibodies in some of 50 human AE sera from China, Japan or France. The 44- and 35-kDa polypeptides, present in both EmP and EmCH extracts, were recognized by total-IgG antibodies in sera from 82% and 66% of the AE patients, respectively. However, over 30% cross-reactivity occurred between these two antigens and sera from CE and Taenia solium cysticercosis patients. The immunoblot specificities of the 27-, 21- and 17.5-kDa antigens in EmP for E. multilocularis infection were 73%, 88% and 93%, respectively. Recognition of the 17.5-kDa antigen in the EmP immunoblot was much higher for the Japanese AE cases (11/13; 85%) than for the French (9/19; 47%) or Chinese (9/18; 50%) AE cases. None of the CE cases from Uruguay or Libya, where human AE has not been reported, was seropositive for the 17.5-kDa antigen. Antibodies from three (7.3%) of the 41 Chinese CE cases recognized the 17.5-kDa antigen. Within the 13 Japanese AE sera, the combined detection by IgG1, IgG4 and total-IgG antibodies of the 27-, 21- and 17.5-kDa antigens in either EmP or EmCH immunoblots was greater than that by each class/subclass alone, increasing the overall sensitivity for AE patients. A combined ELISA/immunoblot approach, including IgG-subclass detection using E. multilocularis protocolex or cyst extracts, could be useful for the differential diagnosis of human alveolar echinococcosis. An algorithm for such an approach is given.

Algorithms↗
PubMed2000

Epidemiology of alveolar echinococcosis in Xinjiang Uygur autonomous region, China: a preliminary analysis.

The Xinjiang Uygur autonomous region (XUAR) in north-western China is known to be endemic for Echinococcosis multilocularis, the causative agent of human alveolar echinococcosis (HAE). Despite regular reports of HAE cases in their region, very little is known about the local epidemiology of the disease or the transmission of E. multilocularis. The epidemiology of HAE in Xinjiang has now been investigated by the analysis of data collected from the medical records of 157 clinical cases who had attended the four main hospitals in the region. These data indicate that the disease is relatively common in the Altai, western Junggar, and Tianshan mountain ranges, whereas the Tarim and Junggar basins are likely to be of low endemicity. The prevalence of the disease in the Kunlun mountains is not clear. Semi-nomadic groups, especially those of Kazakh or Mongol origin, have a higher risk of infection than other ethnic groups. Prevalence of the disease in humans appears to be correlated with aspects of the local climate, such as annual precipitation and temperature. Red foxes, Microtinae, Ochotona spp. and Marmota spp. may be important hosts of E. multilocularis in the XUAR, sustaining the transmission cycles of the parasite.

Adolescent↗
PubMed2004

Alveolar echinococcosis of the liver: correlative color Doppler US, CT, and MRI study.

PURPOSE: To determine and compare the imaging features of hepatic alveolar Echinococcosis using color Doppler US, CT, and MRI. MATERIAL AND METHODS: Abdominal CT and MRI with and without contrast agents and color Doppler US were performed on seven patients with hepatic alveolar Echinococcosis. The lesions were evaluated for location, features of echogenicity, intensity and density, calcification, and vascular, hilar, and perihepatic involvement. The diagnosis was confirmed histopathologically in all patients. RESULTS: Six patients had solitary lesions, and one displayed multiple lesions. The lesions were generally seen as heterogeneous and hyper- or hypoechoic when imaged with color Doppler US, hypodense with CT, and hypointense with MRI, in comparison with the liver parenchyma. Calcification, central necrosis, and small peripheral cysts were observed in six, seven, and four patients, respectively. Vascular flow or contrast enhancement was not observed in any of the cases. A look at the respective advantages of each method reveals that calcification was best rendered visible via CT, small peripheral cysts with T2-weighted MRI, central necrosis with CT and MRI, and perihepatic invasion with multiplanar MRI. Vascular involvement was revealed by all methods. CONCLUSION: Color Doppler US, CT, and MR imaging function extremely well as complementary methods in the diagnosis of HAE. Color Doppler US should be performed in these patients owing to its ability to efficiently detect the disease. Knowledge of imaging characteristics makes it possible to radiologically ascertain an early diagnosis.

Adult↗
PubMed2003

Molecular confirmation of human alveolar echinococcosis in Poland.

Infections of humans with Echinococcus multilocularis, the causative agent of alveolar echinococcosis (AE), a zoonosis, have been described with increasing frequency in Poland since 1994. In the attempt to verify these reports, we analyzed specimens obtained from a representative group of Polish patients. Liver lesions in patients with AE that was diagnosed on the basis of results of histological and serological tests contained E. multilocularis DNA, as shown by the presence of specific microsatellite sequences and mitochondrial 12S rDNA. The same tests clearly distinguished between AE and cystic echinococcosis, which is caused by Echinococcus granulosus. These data are unequivocal proof that human infections with E. multilocularis occur in Poland.

Animals↗
PubMed2003

A novel recombinant antigen for immunodiagnosis of human cystic echinococcosis.

A pool of serum samples from mice infected with oncospheres (eggs) of Echinococcus granulosus was used to screen a cDNA library constructed with RNA extracted from protoscolex larvae from sheep hydatid cysts. One immunoreactive clone, designated EpC1, was shown to encode a protein of 76 residues. The complementary DNA (cDNA) fragment was subcloned into an expression vector, pET-41b(+), and the resulting recombinant EpC1 glutathione S-transferase (GST) fusion protein (rEpC1-GST) was expressed in Escherichia coli and was affinity purified against the GST tag. Immunoglobulin G was the dominant antibody isotypes generated against rEpC1-GST. A total of 896 human serum samples were used to evaluate the diagnostic sensitivity and specificity of the fusion protein by immunoglobulin G immunoblotting; 324 serum samples from patients with cystic echinococcosis (CE), 172 from patients with neurocysticercosis, 89 from patients with alveolar echinococcosis, and 241 from patients with other infections or clinical presentations, as well as 70 from confirmed-negative control subjects, yielded an overall sensitivity of 92.2% and an overall specificity of 95.6%. The combined levels of sensitivity and specificity achieved with the rEpC1-GST fusion protein for diagnosis of CE are unprecedented, taking into account the large panel of serum samples that were tested.

Amino Acid Sequence↗
PubMed2003

Cystic echinococcosis of the thyroid gland in children and adults.

In humans, cystic echinococcosis is one of the most serious helminthic diseases worldwide. The larval stages (cysts) of Echinococcus granulosus are mainly located in the liver and the lung. Other locations of infection are rare, which may occasionally hinder its diagnosis. A 14-year-old girl from Kosovo presented with a cystic lesion in the left thyroid lobe of 4 years duration. Although two percutaneous punctures had been performed, she developed a recurrence and therefore had to undergo thyroid surgery. The results of the histopathologic examination revealed a hydatid cyst, and consequently, the patient received a long-term course of medication, namely, albendazole. Imaging of the cranium and chest were normal. A computed tomography of the abdomen detected a further cyst in the liver which did not show the typical signs of cystic echinococcosis. An echinococcus cyst in the thyroid gland is rare, especially in children. In a review of the literature published since 1965, only 12 children have been reported. Although by definition percutaneous drainage is contraindicated to avoid the spread of protoscolices, it is documented in eleven patients without complications. Surgical extirpation is mandatory. Chemotherapy with benzomidazole derivatives is necessary to avoid recurrence.

Adolescent↗
PubMed1992

Evaluation of eight serological tests in the diagnosis of human echinococcosis and follow-up.

The ELISA with use of IgG, IgA, and IgE, latex agglutination, indirect hemagglutination (IHA), total IgE, the radioallergosorbent test (RAST), and immunoelectrophoresis (IEP) were carried out to determine the preoperative diagnosis of infection due to Echinococcus granulosus in 131 patients. Eighty-nine patients received follow-up care for 42 +/- 22 months (mean +/- SD); 72 were treated surgically and 17 with mebendazole only. We analyzed 5 +/- 2 serum samples per patient and analyzed each serum sample using the eight tests. IgG ELISA was the most sensitive (up to 94%) and specific (up to 99%) test for the majority of cyst locations in the patient. IEP was positive in only 73% of cases. The combination of IgG ELISA, IHA, and IgA ELISA allowed us to achieve a sensitivity of 81% in cases of pulmonary echinococcosis. IgE and IgA were both responsible for most nonspecific reactions, the former in patients with parasitic diseases other than echinococcosis and the latter in patients with cirrhosis of the liver and malignancies. IgG ELISA and IHA were the most adequate tests for postsurgical follow-up. In patients with favorable clinical outcome, the specific IgG level decreased early toward the end of the first year, although serological positivity could persist beyond 6 years. A rise of IgG level 2 or 3 years after treatment suggested persistent active infection. In patients with mebendazole-associated cure, only tests with total or specific IgE detection seemed to exhibit a strong association with decreasing levels or with negative results.

Adolescent↗
PubMedDate not supplied

MR imaging in spinal echinococcosis.

A case of spinal echinococcosis with dorsal spinal cord compression is presented and the findings on plain radiography, polytomography, myelography, CT, and magnetic resonance (MR) imaging are discussed. Although CT and MR are complementary studies for the diagnosis of spinal echinococcosis, MR is the study of choice for prolonged follow-up of complicated cases.

Adult↗
PubMed2006

Radio frequency ablation (RFA)-assisted pericystectomy for hepatic echinococcosis: an alternative technique.

The aim of this study is to describe an alternative technique, using radio frequency energy to perform pericystectomy for hepatic echinococcosis. We present 3 patients with hepatic echinococcosis who were treated with radio frequency ablation (RFA)-assisted pericystectomy. A Radionics Cooltip Radio Frequency System (Tyco, Greece, Radionics) with a single shaft 15 cm long needle electrode and a 2 cm exposure tip, was used. The needle electrode was inserted in consecutive sites into the "healthy" hepatic parenchyma close to the cyst wall, so that a tissue zone around the cystic cavity was gradually ablated. The complete ablation of a site was followed by sharp division of the parenchyma. The operation completed successfully in all patients. Minor bleeding and/or bile leakage were successfully controlled with RFA coagulation. No other hemostatic method was used. The postoperative course was uneventful. No evidence of recurrent disease, or any other cause of morbidity, has been demonstrated at follow up (2 y). RFA-assisted pericystectomy for hepatic hydatid disease in experienced hands, might be useful to perform a "sterile" resection, eradicating single or multiple cysts and preventing local recurrence, with minimal morbidity.

Adult↗
PubMed1986

Sensitized chick cells in the indirect haemagglutination test for echinococcosis.

An indirect haemagglutination (IHA) test was performed with chick red blood cells (RBC) on sera from 26 confirmed cases of echinococcosis and 45 control sera. The results were compared with those obtained in an IHA test with sheep RBC on the same batches of sera; both tests were equally sensitive. The chick cells settled quickly and the results could be determined within 30-45 min. Heterophilic antigen was not a problem. This study also showed that chick cells stabilised by the double-aldehyde method, could be sensitised with the antigen and then stored at 4 degrees C for up to 31 days before use in the IHA test without loss of sensitivity. The use of sensitised double-aldehyde stabilised (DAS) chick cells in IHA tests provides a rapid diagnostic test in echinococcosis.

Animals↗
PubMed1986

Enhancement of sensitivity of the haemagglutination test for echinococcosis by use of Staphylococcus aureus protein A.

A modification of the indirect haemagglutination test is described for the serodiagnosis of echinococcosis. In the modified test the Cowan I strain of Staphylococcus aureus, which contains protein A, was used to enhance haemagglutination of sensitised red cells. The test was performed in parallel with the indirect haemagglutination test on 31 sera from surgically-confirmed cases of hydatid disease and on 45 sera from healthy blood donors. Use of S. aureus protein A enhanced the sensitivity of the test and greatly increased the titres obtained with most of the sera. None of the sera from healthy blood donors exhibited a titre greater than 64, whereas all but two of the sera from cases of hydatid disease exhibited titres greater than 128. The immunoassay is simple, inexpensive and requires little technical skill. It has the potential for wide application in the serodiagnosis of echinococcosis.

Antibodies↗