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Covalent cross-linking of liver collagen by pyridinoline increases in the course of experimental alveolar echinococcosis.

We report that covalent cross-linking of collagen molecules by pyridinoline increases significantly in liver in a murine model of alveolar echinococcosis. The highest amount of pyridinoline per collagen molecule (up to 3.5 fold the control values) is found in liver parasitic lesions. It is also increased, but to a far lesser extent, at distance from the fibrotic areas, in macroscopically normal zones of the liver, suggesting that the increase in mature collagen cross-linking occurring in the fibrogenesis due to Echinococcus multilocularis infection involves the whole liver. The comparison of these data with those we have obtained in another parasitic disease, murine schistosomiasis leading to a milder liver fibrosis, largely reversible following chemotherapy, supports a relationship between the liver pyridinoline level and the severity of liver fibrosis. Pyridinoline could be a tissular marker of chronic liver fibrosis in parasitic diseases.

Amino Acids↗

[Alveolar echinococcosis in the French province of Ardennes: isolated case or new focus?].

The first three autochthonous cases of alveolar echinococcosis were diagnosed in the Ardennes area (France). This is the most occidental localization of this disease in Northern Europe. The authors discuss these cases with an epidemiological regard. They are looking for relationships with natural parasitic cycle in the neighbouring country Belgium and their consequences on local public health in the future.

Animals↗

Postoperative changes in serum cytokines profile and nitric oxide levels in patients with cystic echinococcosis.

The aim of the present study was to examine serum cytokines and nitric oxide (NO) levels in patients with cystic echinococcosis (CE). 28 patients with CE were studied and all underwent surgery. Serum levels of tumour necrosis factor-alpha (TNF-alpha), interleukin IL-1beta, receptor of soluble IL-2R (sIL-2R), IL-6, IL-8, nitrate/nitrite, and C-reactive protein (CRP) were determined before and after induction of treatment. Data were compared with those obtained from 28 healthy volunteers. IL-6 was elevated in all CE patients (100%). IL-8 was increased in 11/28 (39.3%). Increased levels of IL-2R and TNF-alpha were found in a limited number of them particularly those showing cysts in the central area of the liver (5/28, 6/28). IL-1beta level was not elevated in any patient except in secondary severe CE. CRP and nitrate/nitrite levels were also increased. A positive correlation between CRP and IL-6 (r = 0.74; p < 0.001) was found confirming the link between inflammation due to CE and activation of monocytes. All patients completely recovered and the levels of the studied parameters reverted to normal levels except one patient in whom severe recurrent disease occurred two years after the first operation. These results suggest that there are different immunoregulatory events and cytokines response during CE and may be in part related to slight monocytosis and in part to Th2 activation. IL-6, NO and CRP were unambiguously involved in the host parasite interaction and therefore may be useful markers in monitoring CE management and evaluating surgical stress.

C-Reactive Protein↗

[Surgery and long-term follow-up of hepatic echinococcosis outside endemic regions].

UNLABELLED: The aim of the study was to characterize the therapeutic pathways in patients with echinococcal hydatids in an institution outside the endemic areas but with a high frequency of oncological hepatic surgery. PATIENTS AND METHODS: 44 patients with echinococcosis from 1987-1997 were reviewed. To evaluate the long-term results, clinical examination, chest x-ray, serology and liver ultrasound were performed. According to the study protocol 39 patients were evaluable. 89.7 % of the patients suffered from a primary disease, whereas 7.7 had a local recurrence and another 2.5 of patients showed a second site of manifestation after former operation. E. cysticus occurred in 82.5 %, E. alveolaris in 17.5 %. RESULTS: In 66.7 % of all cases a resecting procedure (pericystectomy, atypic resection, regular and extended hemihepatectomy) was performed. One patient underwent an orthotopic liver transplantation and in 10 % the surgical procedure included only an open drainage of the cysts. A simple cystectomy was performed in 23 %. One patient died from multiple organ failure as a consequence of local bleeding complications. The overall complication rate was 38.5 %, including the postoperative death and 7.7 % reoperations. The complication rate following pericystectomy was much higher than after simple cystectomy. At the time of follow-up (median 66 months) no patient showed a recurrent disease. CONCLUSION: Compared to reports from endemic regions the rate of resective procedures was much higher. The therapeutic strategy lead to excellent long-term results. Simple cystectomy should be preferred as pericystectomy showed a higher morbidity.

Adult↗

[Echinococcosis - a rare differential diagnosis of a tumorous hepatic lesion].

We report the case of a 44-year-old woman who was admitted to our hospital because of a newly developed painless jaundice. Though she felt quite well sonographic and radiographic evaluation showed a tumor of the liver. An extensive diagnostic workup was performed but it was not until laparotomy that a malignant tumor could definitely be ruled out and the presumptive diagnosis of an echinococcosis was proven. A partial resection of the liver was performed.

Adult↗

Epidemiology of alveolar echinococcosis in southern Cantal, Auvergne region, France.

Alveolar echinococcosis (AE) is a helminth zoonosis which is encountered only in the northern hemisphere. In central France, the Auvergne region represents the most western and southern extension of this helminthiasis. In 1999, a human case of AE was diagnosed in the southern part of the Cantal department, where AE was supposed absent, and an epidemiological survey was subsequently carried out. The transmission of the zoonosis in the sylvatic and peridomestic definitive hosts was studied, as well as that in the rodent and human intermediate hosts. Eleven red foxes (Vulpes vulpes) were shot, and 50 fox faecal deposits were collected. Twelve farm dogs had their faeces taken by rectal touch, and four were checked after arecoline purgation. Optical detection of Echinococcus multilocularis worms was achieved on fox intestines after scraping, and also on dog stools after arecoline therapy. Coproantigen ELISA assay was performed for the 11 scraping products, for the 50 fox faeces, and for the 12 dog faecal samples. No adult AE agent was observed by microscopy, and the ELISA assay yielded positive results in one of 11 fox intestines, one of 50 fox faeces, and 2 of 12 dog faecal samples. Twenty-five small mammals were trapped, of which 19 were Arvicola terrestris water voles. One rodent liver exhibited a hepatic lesion consistent with AE. An epidemiological questionnaire was completed in 85 human volunteers, who were also serologically tested for AE. Only one (the case's husband) exhibited a Western-blotting pattern indicative of a low-grade AE infection. The results of this preliminary study suggested a slow AE extension to the south of Cantal department from the northern focus.

Aged↗

Estimating the economic effects of cystic echinococcosis. Part 2: an endemic region in the United Kingdom, a wealthy, industrialized economy.

The economic costs of cystic echinococcosis (CE) in Wales, which is part of one of the most highly developed, industrialized countries in the World, were evaluated. In this region, the disease in both sheep and humans causes financial losses. The sheep-related costs in the most highly endemic area, of southern and mid Wales, were estimated from recently published prevalences of the disease in local sheep. No relevant and recent data were available on the sheep in the rest of Wales but these animals were assumed to have lower prevalences, in line with historical data, and were ignored in the economic analysis. The costs of the disease in humans were based on published incidences of human cases treated surgically and the costs of surgery as estimated from hospital records and by costing out the procedures each patient received whilst undergoing treatment. The quality of life of patients treated for CE was also determined and compared with that of healthy, case-matched controls, using a standard health-survey questionnaire (SF-36). The results indicated that the treated patients suffered some long-term morbidity, caused by the disease itself, its treatment or both. Although accurate monetary values were not calculated for this decreased quality of life, the results indicate that the economic effects of human CE are greater than simply the cost of treatment. Assuming that the long-term morbidity demonstrated does have an economic effect, each year CE in Wales is probably costing the U.K. economy more than U.S.$1 million, and perhaps as much as U.S.$7.9 million.

Animals↗

The occurrence of polycystic echinococcosis in Suriname.

The occurrence of polycystic echinococcosis (PE) caused by Echinococcus vogeli in Suriname is reviewed. Six of the eight known cases, including the first (which was incorrectly diagnosed as cystic hydatid disease caused by E. granulosus) in 1982, are described. The distribution in Suriname of the natural hosts of E. vogeli--the bush dog (Speothus venaticus) and the paca (Agouti paca)--is discussed. Characteristics of the four species recognized in the genus Echinococcus are compared, and all known cases of PE in 11 countries in the Neotropics are summarized. Finally, it is stressed, that, in Suriname, PE should be considered during the differential diagnosis of all subjects from rural areas who present with abdominal pain and palpable, intraperitoneal masses.

Adult↗

Estimating the economic effects of cystic echinococcosis. Part 3: Jordan, a developing country with lower-middle income.

The economic costs of cystic echinococcosis (CE) in Jordan, a developing country of lower-middle income, were investigated. Initial cost-estimates for livestock were based on the published prevalences of Echinococcus granulosus infection in sheep and goats and the values of livestock-related products together with likely production losses. Likewise, the annual numbers of human cases of CE were estimated using published surgical incidences in man. The costs of surgery were estimated from hospital records and by costing out the procedures each patient received whilst undergoing treatment. After comparing the quality of life of patients treated for CE with that of case-matched controls, it appeared that the treated patients had some long-term morbidity caused either by the disease or the resulting treatment. A simple spreadsheet model was built up, to sum the individual cost items. Each cost item and each of the data related to prevalence and incidence was assigned a mathematical distribution and varied randomly, using Monte-Carlo techniques, throughout its range, over 10 000 simulations. The results of the study indicate that the most likely range of annual economic losses attributable to CE in Jordan (encompassing 95% confidence limits) is from U.S.$2 602 215-6533 661, with a median of U.S.$3 874 070.

Animal Husbandry↗

Risk factors for human alveolar echinococcosis: a case-control study in Hokkaido, Japan.

A case-control study to determine the risk factors for human alveolar echinococcosis (AE) was conducted in Hokkaido, Japan. The 134 cases were either patients clinically diagnosed as having AE (N =61) or other individuals found to be seropositive for Echinococcus multilocularis although showing no abnormalities in ultrasound scans (N = 73). Two groups of case-matched controls were employed: one of 670 individuals selected from a list of residents of Hokkaido (group A) and the other of 650 subjects selected from a list of individuals who had been found seronegative in earlier investigations (group B). Because of the long latency of AE, potential risk factors were studied over two different periods: for the 0-10 and 11-20 years before the year of diagnosis/recorded seropositivity. The results of multivariate analyses, in which the cases were compared with each control group, indicated that the rearing of cattle and pigs and the use of well water were significant risk factors and that the use of tap water significantly decreased the risk of an individual having AE. Extension of the piped water supply and health education on improving the disposal of household rubbish (to keep foxes away from houses) should help reduce the risk of AE infection in the study area.

Animal Husbandry↗

Studies on the sero-epidemiology of endemic diseases in Libya. I. Echinococcosis in Libya.

In Libya traditional animal husbandry and the practice of domestic slaughter of food animals contribute to the maintenance of the Echinococcus cycle. The cost of echinococcosis is high and may significantly affect the national economy. This study, employing the ELISA test, has indicated an approximately 10% infection rate in children and young adults from the environs of Benghazi, no difference being apparent between rural and urban dwellers. The prevalence of the infection should be determined in both animals and man and possible disease inter-relationships investigated. Surveys are required in all alleged endemic areas and in sheep and camel breeding areas. It is also necessary to determine the importance of foxes, hyaenas and jackals in transmission among other animals. A clinical trial is recommended to assess the value of mebendazole against Echinococcus cysts.

Adolescent↗

Primary cardiac echinococcosis: report of two cases with review of the literature.

Two case reports of Saudi patients with primary cardiac hydatid cysts are presented. In the first case, a multilocular cyst was located in the wall of the left ventricle, whereas in the second case a cyst was located in the pericardial sac and another cyst in the left ventricular wall. The diagnosis was based on a history of animal contact, full clinical examination, serological tests and the use of plain radiography, including conventional tomogram, two-dimensional echocardiography, computed tomography and thallium perfusion isotope scan. This study has indicated that non-invasive radiological methods are sufficient to diagnose cardiac echinococcosis and could provide the same information as, or even more than if invasive techniques were used. Further screening of the two patients showed no involvement of other organs by hydatid cysts.

Adult↗

Initial observation on albendazole in combination with cimetidine for the treatment of human cystic echinococcosis.

Concentrations of albendazole were measured, by high-pressure liquid chromatography, in 19 patients being treated for cystic echinococcosis. All of the patients were given three 4-week courses of albendazole (20 mg/kg/day), separated by 10-day-long drug-free intervals. Seven patients also received three courses of cimetidine (10 mg/kg/day). Concentrations of albendazole sulphoxide (ABZSX) were significantly higher in samples of bile and hydatid cyst fluid from the patients receiving albendazole and cimetidine than in those from patients receiving albendazole alone (P < 0.05). The therapeutic benefit of the combined drug treatment, which was well-tolerated, was more than that with albendazole alone.

Albendazole↗

A retrospective study of human cystic echinococcosis in Jordan.

Some 676 human cases of cystic echinococcosis (CE) were recorded from 18 major hospitals in Jordan from January 1985 to October 1993. The number and origins of the cases indicate that CE is an endemic and widespread disease in Jordan. Operations for the extraction of hydatid cysts represented 0.1% of all surgical operations carried out in the surveyed hospitals during the study period (excluding Caesarean sections). The mean annual surgical incidence of CE was estimated to be 0.5-8.2 per 100,000 population, depending on the governorate studied, with an overall mean of 2.9 per 100,000. Incidence was higher in the more rural eastern and south-western governorates than elsewhere, and more cases fell in the 21-30-year age group than in any other. Many more of the cases were female than male (443 v. 233; P < 0.001). The liver was the most common organ infected (54.5% of cases), followed by the lungs (12.1%), and multiple hydatidosis usually involved the liver.

Adolescent↗

A pilot, serological survey for cystic echinococcosis in north-western Mongolia.

The seroprevalence of cystic echinococcosis in north-western Mongolia was determined in a cross-sectional study of 334 semi-nomadic pastoralists in their summer grazing areas. Overall, 5.2% of the subjects were found to be strongly seropositive for antibodies to Echinococcus granulosus antigen B by ELISA. Only 10% of the adult subjects (aged > or = 15 years) had heard of the disease and only 5% recognized hydatid cysts in their livestock (in contrast to the neighbouring province in China, where 76% had seen and recognized cysts in the organs of slaughtered animals). The close association between Mongolian pastoralists, their dogs and livestock is likely to encourage ready transmission of the parasite in a region where home slaughter is practised and offal for various scavengers, including domestic dogs. Further information is needed to determine the prevalence of infection in other intermediate hosts and in dogs and the clinical importance of the disease in this remote region.

Adolescent↗

IgG-subclass antibody responses and the natural history of hepatic cystic echinococcosis in asymptomatic patients.

Given that cystic echinococcosis (CE) is a serious clinical problem in endemic countries, there is still relatively little information available on the natural history of the human disease. The aim of the present study was to correlate serological status with pathology, in ultrasound-characterised, asymptomatic cases of human CE. Serum concentrations of IgG reacting with antigen B from cyst fluid and of similarly specific IgG1, IgG2, IgG3 and IgG4 were determined by ELISA and further investigated by immunoblotting. CE cases with simple cysts (Type I), or cysts with clear laminations and daughter cysts (Types II and III) exhibited elevated IgG4 seropositivity, whereas concentrations of specific IgG1 and IgG4 declined in CE cases characterised by cyst infiltration or calcifications (Types IV and V). The responses of each specific IgG subclass were used, in association with an ultrasound classification, to try to develop an immunoserological natural-history profile of CE in asymptomatic patients. Specific IgG4 antibody responses were particularly associated with the evolutive phase of CE (Types I, II and III), whereas the IgG1, IgG2 and IgG3 responses tended to be associated with the involutive phase (Types IV and V). These results indicated that an IgG4 antibody response was associated with (or was a marker for) cystic development, growth and disease progression, whereas the IgG1, IgG2 and IgG3 responses occurred predominantly when cysts became infiltrated or were destroyed by the host. The findings support the view that evolutive and subsequent involutive phases occur in untreated CE.

Analysis of Variance↗

Echinococcosis in the stray dogs of Tehran, Iran.

Echinococcus granulosus infections were detected in 29 (48%) of 60 stray dogs from Tehran. The adult worms, in a random sample, measured 3.0-7.7 mm in length. The mean, estimated age of the dogs investigated was 5 years, with no significant differences in the prevalences observed in the young, mature and old animals. Bad abattoirs and the frequent slaughter of animals in places other than abattoirs appear to be the main reasons for the high prevalence of canine echinococcosis in Tehran and elsewhere in Iran.

Animals↗

Estimating the economic effects of cystic echinococcosis: Uruguay, a developing country with upper-middle income.

Cost-benefit analyses, run before the commencement of a programme to control a parasitic disease, should include estimates of the economic losses attributable to the disease. Uruguay, a middle-income, developing country, has a recent history of persistent problems with cystic echinococcosis, in both its human population and livestock. The economic effects in Uruguay of this disease, caused by the larval stage of the canine tapeworm Echinococcus granulosus, have now been evaluated. Data on the incidence of the disease, in humans and livestock, were used to construct cost estimates. The estimated minimum cost (U.S.$2.9 million/year) was based on the condemnation costs of infected offal together with the actual costs of the hospital treatment of the human cases. The estimate of the maximum cost (U.S.$22.1 million/year) also included the production losses resulting from lower livestock efficiency and the reduced income of individuals with morbidity attributable to the disease.

Animals↗