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PubMed2005

Rare localizations of echinococcosis: personal experience.

BACKGROUND: The rare localizations of hydatidosis represent an interesting topic, especially with reference to epidemiological and diagnostic problems. Hydatid disease, common in Mediterranean countries, still remains endemic in some regions of Italy. METHODS: In the period April 1983-October 2003 73 patients with hydatid disease were observed. RESULTS: Seven patients (9.5%) presented a primary rare localization (thyroid, kidney, sacrospinal muscle, peritoneum and spleen). The main peculiarity of primary rare hydatidosis localizations concerns diffusion of the infecting embryo; the most reliable hypothesis is that liver and lung can be bypassed through precapillary anastomosis between pre- and post-parenchymal circulation. The new imaging techniques allow a correct topographic evaluation and so a radical surgical treatment. The chemotherapy, complementary to surgery, produced degenerative modifications of parasite in 75.8% of the present cases and reduction of recurrence from 23.3% to 6.7%. At follow up of 1-5 years no patients had recurrence. CONCLUSION: It is important to be aware, especially in countries where echinococcosis is endemic, that it is possible to find an echinococcosis cyst in a rare localization.

Adult↗
PubMedDate not supplied

Ultrasonographic diagnosis of ovine cystic echinococcosis.

The sanitary and economic impact of cystic echinococcosis is serious in those countries where it becomes endemic. Ultrasonography is one technique that may be used to diagnose this disease in endemic areas. In parasitized sheep, hydatid cysts appear sonographically as a round hypoechoic structure. Twenty two sheep destined for slaughter were studied sonographically and imaging findings compared to post-mortem findings. Three sheep with hydatid cysts were identified. Eighty additional sheep not destined for slaughter were also studied. Echinococcus granulosus cysts were detected in three animals. Forty sheep from a non-endemic area had no hepatic cysts. The in vivo sonographic study of sheep provides a useful screening tool for echinococcosis.

Animals↗
PubMed1997

Immunodiagnosis of alveolar echinococcosis by enzyme-linked immunosorbent assay using a partially purified Em18/16 enriched fraction.

An improved enzyme-linked immunosorbent assay (ELISA) system using partially purified Eml8/16 enriched fraction (PP-Em18/16) prepared by isoelectric focusing was evaluated for serodiagnosis of alveolar echinococcosis (AE). The PP-Em18/16-ELISA was compared with Em2plus-ELISA by using sera from AE and cystic echinococcosis (CE) patients in China, where both AE and CE are endemic; sera from CE patients in Australia, where only CE exists; and sera from patients with cysticercosis, paragonimiasis, or sparganosis in Korea, where no indigenous AE or CE exists. We used Em2plus-ELISA as a standard ELISA and found 24.6% (17 of 69 specimens) cross-reactivity with sera from CE. Furthermore, some of the sera from paragonimiasis, sparganosis, and cysticercosis patients were also cross-reactive in the Em2plus-ELISA. When we tested for similar cross-reactivity in the same sera from CE patients by PP-Em18/16-ELISA (23.2%, 16 of 69), it became evident that the specificity of the PP-Em18/16-ELISA was better than that of the Em2plus-ELISA, since no sera from patients with the examined parasitic diseases except CE showed cross-reactivity. Some CE patients from China showed exceptionally high levels of antibody in comparison with those of CE patients from Australia, where no AE occurs. It is speculated that these patients with strongly positive cases of CE from China may have been exposed to both species of Echinococcus.

Animals↗
PubMed1998

Analysis of specific immunoglobulin G subclass antibodies for serological diagnosis of Echinococcosis by a standard enzyme-linked immunosorbent assay.

The potential roles of specific antibodies of the different immunoglobulin G (IgG) subclasses in the serological diagnosis of cystic echinococcosis (CE) and alveolar echinococcosis (AE) were investigated by an enzyme-linked immunosorbent assay based on hydatid fluid as antigen. Specific antibodies of subclass 1 were found to be of major importance. In sera collected at the time of diagnosis (i.e., before any therapeutic intervention was initiated) they could be demonstrated in 14 of 15 sera from patients with CE and in all 12 sera from patients with AE. The most discriminatory and the most specific antibodies found in this study belonged to IgG subclass 4. Only one false-positive reaction was observed with 253 sera from healthy volunteers, and no cross-reactions occurred in 80 sera from patients with different parasitic infections. Specific IgG4 antibodies could be demonstrated in 61.0 to 66.7% (CE) or 47.6 to 66.7% (AE) of the cases. Antibody levels of IgG subclass 2 were elevated only moderately, and subclass 3 antibodies were detected in a few cases only. In addition, nonspecific reactions in sera of healthy volunteers or patients with other parasitic infections could partially be attributed to antibodies of subclasses 2 and 3.

Animals↗
PubMed1996

Hepatic tissue culture model for study of host-parasite interactions in alveolar echinococcosis.

An in vitro model for growth and differentiation of the metacestode tissue of the tapeworm Echinococcus multilocularis is described. This model simulates the organotropism of the parasite toward the liver of the intermediate host. In the presence of collagen-embedded primary hepatocytes from rats and humans, which can be kept in culture for 2 to 3 months, the parasitic vesicles grew by exogenous budding and multiplied about 12-fold within 3 weeks. In contrast, without the hepatocytes, the metacestodes rapidly degenerated. Development of protoscolices was seen only in the presence of rat hepatocytes but not in coculture of the metacestodes with hepatocytes of human origin, thus reflecting the in vivo situation during infection of rodents and in alveolar echinococcosis in humans. The experiments indicated that growth of the metacestodes and development of protoscolices depended on soluble low-molecular-weight factors released by the hepatocytes. The in vitro-grown metacestodes did not differ morphologically from the larvae found in infected intermediate hosts, and their infectivity was completely maintained. This report describes the first in vitro model of alveolar echinococcosis and will be the basis for future studies on host-parasite interactions of this important zoonosis.

Animals↗
PubMed2000

Acute echinococcosis: a case report.

We report the case of a 69-year-old man with acute pulmonary echinococcosis. A computed tomographic scan of the thorax revealed the presence of multiple nodules in both lungs, and laboratory tests showed eosinophilia and the presence of antibodies against Echinococcus granulosus. Therapy with albendazole led to resolution of the pulmonary nodules and a normalization of the white cell count. To our knowledge this is the first described case of acute echinococcosis, as the diagnosis of this disease is usually delayed to chronic phases. Therefore, finding unexplained eosinophilia, especially in association with pulmonary nodules, should lead one to suspect acute hydatid disease.

Acute Disease↗
PubMed2004

Use of two sensitive and specific immunoblot markers, em70 and em90, for diagnosis of alveolar echinococcosis.

Antibodies against Echinococcus multilocularis metacestodes were screened by immunoblotting sera from patients with alveolar echinococcosis (n = 39), cystic echinococcosis (n = 109), or other parasitic infections (n = 66) and healthy individuals (n = 32). Two antigens, approximately 70 and 90 kDa, are found to be valuable for confirmatory diagnosis, with a sensitivity and specificity of 100 and 99.51%, respectively.

Antibodies, Helminth↗
PubMed1996

Alveolar echinococcosis of the liver: percutaneous stent therapy in Budd-Chiari syndrome.

BACKGROUND AND AIMS: Infiltration of the hepatic veins in the alveolar echinococcosis can lead to the development of the Budd-Chiari syndrome. The medical and surgical treatment of this condition is generally unsatisfactory. The results of successful interventional treatment with percutaneous stent implantation in the hepatic veins are reported. METHODS: Using a transjugular approach, metal mesh stents (Boston Scientific, Medi-Tech Accuflex 8/60 mm) were placed in the median and left hepatic veins of a 53 year old woman. After the intervention, oral chemotherapy with albendazole (2 x 400 mg/day) was continued, but no anticoagulants were given. RESULTS: Stent placement was performed without complications. The clinical picture improved rapidly: normalisation of portal blood flow was confirmed by Doppler ultrasound and there was improvement of liver function, reduction of oesophageal varices, and disappearance of ascites. A follow-up examination at 15 months showed no evidence of stent occlusion. CONCLUSIONS: Treatment of portal hypertension in alveolar echinococcosis of the liver is problematic. In selected patients with portal hypertension secondary to hepatic vein stenoses but no cirrhosis, percutaneous stent placement in the hepatic veins represents a promising treatment alternative.

Albendazole↗
PubMed2006

Echinococcosis: a possible etiology in psoriatic disease.

We aimed to investigate seroprevalence of Echinococcus granulosus in patients with psoriasis to determine a possible etiologic role, since both echinococcosis and psoriasis are defined as T cell-mediated diseases. Forty psoriatic patients and 50 age- and sex-matched control subjects were included in the study. IgG-specific ELISA was used to determine seropositivity. E. granulosus-specific IgG antibodies were found to be positive in 17/40 (42.5%) of the patients with psoriasis and in 11/50 (22%) of the control subjects (p = 0.008). Our results suggest that echinococcosis might be one of the causative pathogens in the etiopathogenesis of psoriasis in highly endemic regions.

Adult↗
PubMed2002

The immunodiagnostic potential of protoscolex antigens in human cystic echinococcosis and the possible influence of parasite strain.

The results of ELISA, SDS-PAGE and western blotting indicated that the protoscolex antigens of Echinococcus granulosus (of 10-125 kDa) included antigens recognized by sera from human cases of cystic echinococcosis (CE). Some of the latter antigens (of approximately 79, 59, 45, 38, 31 and 29 kDa) exhibited cross-reactivity with sera from humans with other parasitic infections, including alveolar echinococcosis, cysticercosis and African trypanosomiasis. The 31-kDa antigen recognized by IgG antibodies in human CE sera only appeared to be present in the extracts of protoscoleces from sheep, and not in the corresponding extracts from horse or camel cysts. In contrast, the human CE sera recognized a 45-kDa protoscolex antigen only present in the horse cysts and a 125-kDa antigen present in the camel and horse (but not sheep) cysts. Extracts of protoscoleces from different species of hosts might therefore provide a source of strain-specific diagnostic antigens for human CE.

Animals↗
PubMed1990

Phrenomediastinal echinococcosis.

A patient with the rare presentation of posterior mediastinal echinococcosis is reported. Magnetic resonance imaging (MR) demonstrated the extension of a primary retroperitoneal cyst into the posterior mediastinum which was subsequently confirmed surgically to be of echinococcal origin. Such a case of phrenomediastinal echinococcosis has been described only once before in literature.

Adult↗
PubMed2004

[Polycystic echinococcosis in the Eastern Brazilian Amazon: an update].

By means of epidemiological and clinical-laboratorial approaches was consolidated an update of polycystic echinococcosis in the Eastern Brazilian Amazon, period from 1962 to 2003, including unpublished cases and those already published. In that way, they were identified 40 cases of the disease in referred period, understanding cases coming from the States of Pará and Amapá, Brazil. The width of the ages went from 10 to 72 years and 47.5% belonged to the masculine sex. The liver was the attacked organ (82.5% of the cases). The Echinococcus vogeli (Rausch and Bernstein, 1972), comes as the main agent involved. Starting from the recognition of the importance and of the implications of the handling of the echinococcosis for the tropical area, it is believed that should happen an improvement of the diagnosis, appropriate treatment and of a better registration of the disease.

Adolescent↗
PubMed2002

An autochthonous case of Echinococcus vogeli Rausch & Bernstein, 1972 polycystic echinococcosis in the state of Rondônia, Brazil.

The present case report refers to a patient from the State of Rondônia, North region of Brazil, attended with clinical suspicion of hepatic echinococcosis. Examination by imaging (ultrasonography and computerized tomography) revealed a conglomerate of cystic lesions, with mobile contents within the cyst. The serology (immunoblot) for Echinococcus sp. was positive (21 and 31 kDa bands). This case is the first reported in Rondônia, suggesting the need to investigate the polycystic echinococcosis in individuals with hepatic cysts from areas of tropical forest and hunting habits where wild life was present as wild dogs, cats and rodents, particularly Agouti paca (paca) and Dasyprocta aguti (agouti).

Animals↗
PubMed2004

Erroneous reports of the neotropical Echinococcus oligarthrus as a cause of echinococcosis in India.

Two cases of submandibular echinococcosis have been reported in adult residents of India (Kini et al., 1997; Sahni et al., 2000). It was stated in both publications that the cestode was E. oligarthrus, "a rare variety of E. granulosus", based on morphogical characteristics. It was also mentioned that 3 cases of E. granulosus with similar submandibular metacestode had been previously diagnosed in India. The metacestode is readily distinguishable from that of E. oligarthrus. The final hosts of E. oligarthrus are several neotropical species of wild cats and metacestode occurs in hystricognath, all of them absent in India. The larval stage of all 4 species of Echinococcus can be differentiated on the basis of the form and dimensions of rostellar hooks of protoescoleces. With the information provided in the two papers we concluded that the 2 cases of echinococcosis described in India were due to E. granulosus.

Animals↗
PubMed2006

Molecular confirmation of a case of multiorgan cystic echinococcosis.

We report on the results of radical surgery performed on a 10-yr-old Chinese female with multiple echinococcosis lesions and the diagnosis of the infection by imaging, histology, serology, and DNA analysis. Molecular genotyping provided unequivocal proof that the patient was infected with Echinococcus granulosus, the cause of cystic echinococcosis.

Animals↗
PubMed2002

Molecular and cellular tools in human cystic echinococcosis.

The latest developments in the molecular and cellular mechanisms that underlie Echinococcus infection have renewed interest in the immunodiagnosis of this disease and have helped in understanding the host-parasite relationship. This review discusses current concepts on the immune response to Echinococcus granulosus in humans, and relates these findings to diagnosis and clinical management. The two most promising molecular tools developed for the immunodiagnosis of cystic echinococcosis involve isolating native or recombinant parasite antigens to detect specific serum antibodies in patients with suspected echinococcosis and producing monoclonal antibodies to detect parasite antigens in clinical samples. Novel drugs should be designed to strengthen host immune responses thus combating parasitic survival. Currently, attention has been focused on understanding T-helper lymphocyte activity; in particular the role of Th1 and Th2 subsets in orchestrating immune responses. The Th1/Th2 model explaining how selective immune responses--including cell-mediated or humoral immunity--develop, seems promising as the rationale for molecular tools that could lead to new therapeutic strategies.

Animals↗
PubMedDate not supplied

Cystic echinococcosis of the liver associated with repeated international travels to endemic areas.

Cystic echinococcosis (CE) is increasingly seen in immigrants from endemic areas to Western countries; however, it is rarely reported in short-term travels to endemic areas. This is partly because the echinococcal cyst typically grows slowly and may long remain clinically silent. We describe a case of cystic echinococcosis in a man born and living in a nonendemic urban area in North Italy that was acquired during a period of frequent travels in highly endemic countries.

Developing Countries↗