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An unusual case of Echinococcus cysticus infection of the neck, face and skull is reported. The disease was misdiagnosed for several years as tuberculosis of the lymph nodes and consequently incorrectly treated. Definitive therapy required radical surgery.
Echinococcus granulosus has been an uncommon disease in the United States. Cases may appear unexpectedly because of increased immigration from endemic areas. Over the past 3 years, 10 cases of hydatid liver disease were diagnosed by sonography in our institution. Sonography is a simple noninvasive method of early diagnosis even when clinical signs are nonspecific. The sonographic patterns of this condition are described.
A case report is presented of a patient in whom daughter cysts of Echinococcus granulosus were removed endoscopically from the common bile duct. We would like to suggest in this paper that in cases of operated hydatid disease of the liver with retained cysts in the common bile duct, endoscopic removal instead of surgery is possible; and in particular that anaphylactic reaction need not be expected as the cysts content is drained into the gut.
Arecoline hydrobromide has been used for almost half a century for the treatment of Echinococcus granulosus in dogs. Trials in New Zealand showed that it had real limitations for this purpose. Its main value lies in its use as a diagnostic agent for detecting infections in dogs on a group basis. The data so obtained can be used in educating dog owners as well as for providing base-line data and an index of progress in a continuing control programme. The drug's limitations for treatment and value as a diagnostic agent in a field trial are assessed.
Efficacy of an injectable formulation of praziquantel (given intramuscularly or subcutaneously at a dosage level of 5 mg/kg of body weight) or a tablet formulation (5 mg/kg) against immature Echinococcus granulosus was studied in experimentally infected dogs. The compound was efficacious (100% clearance) if injected via either route or if administered orally.
Trials with oxfendazole carried out on 120 dogs infected with either Echinococcus granulosus or Taenia hydatigena indicated that a single treatment significantly reduced the proportion of dogs infected with tapeworms. Diarrhoea occurred occasionally when the dose rate exceeded 20 mg/kg.
Tablets of micronised nitroscanate (nominal particle size 2--3 microns) were given to a total of 190 dogs that had been experimentally infected with either Echinococcus granulosus or Taenia hydatigena. The efficiency of the drug in tablet form in freeing dogs from tapeworms, was investigated. The dose rate at which 50 per cent of normally fed dogs can be expected to be freed from E granulosus was found to be 89 mg/kg (95 per cent confidence limits 55 mg/kg to 140 mg/kg). The 90 per cent effective dose rate was not determined within the range 32 mg/kg to 250 mg/kg. The dose rate at which 90 per cent of normally fed dogs can be expected to be freed from T hydatigena was 37 mg/kg (95 per cent confidence limits 23 mg/kg to 60 mg/kg).
In a previous survey, carried out in 100 dogs in Rome by Tassi and Widenhorn (1977), two animals, which always lived in the urban area, were found infected by Echinococcus granulosus. An urban infection was therefore hypothized. During a following experiment 6 three-month old Beagle dogs were fed for nine months with raw meat sold in the butcheries of Rome as "food for pets". Two dogs of the same breed and origin were fed for the same period with canned food and were kept as control animals. At the end of the experiment three of the six dogs were found infected by E. granulosus, while the renmant three and the two controls resulted negative. An additional similar trial was carried out in Bologna. Three dogs were fed for seven months with the same kind of raw meat sold in three butcheries of Bologna, and a fourth dog was kept as control. At the end of the seven months also one of the three dogs was found infected by E. granulosus. These results seem to confirm the hypothesis of an urban infection by E. granulosus in dogs. Various possibilities of contamination of raw meat sold in butcheries as food for animals are discussed.
During 1971 to 1976, a survey was conducted to determine the prevalence of Echinococcus granulosus infection among dogs and sheep in central Utah. For each year, the number of dogs positive for adult tapeworms of the total number examined and the percentage infected were: in 1971, 14 of 51 infected (27.4%); in 1972, 13 of 46 infected (28.3%); in 1973, 7 of 36 infected (19.4%); in 1974, 34 of 244 infected (13.9%); in 1975, 13 of 267 infected (4.9%); and in 1976, 14 of 195 infected (7.2%), or a 6-year total of 95 of 839 infected (av = 11.3%). For each year, the number of sheep positive with hydatid cysts of the total number examined and the percentage infected were: in 1971, 103 of 1,007 infected (10.2%); in 1972, 235 of 1,808 infected (13.0%); in 1973, 242 of 2,003 infected (12.1%); in 1974, 105 of 1,406 infected (7.5%); in 1975, 96 of 1,599 infected (6.0%); and in 1976, 96 of 1,171 infected (8.2%), or a 6-year total of 877 of 8,994 infected (av = 9.8%). These results represent a definite decline in numbers of infected animals and suggest that preventive and control measures advocated in central Utah are being implemented.
A 30-year-old Italian male was admitted to the hospital showing all clinical signs of acute pancreatitis. With the help of computerized tomography, ultrasonic and angiographic methods multiple cysts in pancreatic body and tail as well as close to the hilus of the spleen could be shown. Positive serological tests made the diagnosis "echinococcus granulosus" likely. Resection of the left part of the pancreas as well as resection of the spleen eliminated the parasite. Histologically hydatid cyst was traceable in the pancreatic duct.
Circulating immune complexes (CIC) were investigated by the C1q binding assay in sera of 23 patients infected with Echinococcus granulosus. For the 23 sera studied, nine were found to be positive in the test. When the samples were grouped according to the cyst localization, the highest rate of CIC positively was found in the group of sera from patients with pulmonary cyst; in this group, double diffusion (DD) and indirect haemagglutination (IHA) tests gave a low rate of positivity for antibodies directed against parasitic antigens. Rheumatoid factor, anti-nuclear and anti-mitochondrial autoantibodies were not detectable in patients' sera by indirect immunofluorescence technique (IIF). Anti-smooth muscle autoantibodies, detectable by IIF, were present in 56% of the sera and this positivity was higher in the hepatic (83%) than in the pulmonary form (40%).
The pathology of the spleen, lymph nodes and thymus of C57L/J mice, infected intraperitoneally with 20 and 100 cysts of Echinococcus multilocularis is described at 2, 4, 8 and 12 weeks postinfection (p.i.). For the first 8 weeks, growth of the larval cyst mass (LCM) was slow and blastogenesis in T-dependent areas of both spleen and lymph nodes was moderate whereas in B-cell compartments it was intense. A rapid growth of the LCM between 8 and 12 weeks p.i., 15-20 times greater than for the first 8 weeks, was associated with depletion of lymphocytes in thymus dependent area (TDA) of both spleen and lymph nodes, gross expansion of the red pulp with extramedullary haemopoiesis, partial atrophy of spleen follicles, but not those of the lymph node, and involution of the thymus. At 12 weeks p.i. the TDA had mainly plasma cells and histiocytes among occasional lymphocytes and blast cells; germinal centre activity and plasmacytosis persisted in B-cell areas. Morphological aspects of these changes are discussed in relation to the invasiveness and proliferation of the LCM during the course of infection.
Seven cases of unusual location of echinococcus cysts are described. Three of them were located in the muscles, three in the subcutaneous tissue and one in a retroperitoneal position.
From 1964-1976 34 patients were treated for Echinococcus of the liver at the Mainz University department of surgery. There were 25 cases of E. cysticus and 9 cases of E. alveolaris. Decisive for the diagnosis are Casoni's intracutaneous test, scout film of the abdomen, liver scan and arteriography. In all cases a surgical therapy is indicated. A central localization of the parasite cysts makes problems to the surgical management. In these cases we prefere the cystectomy. All other echinococcal cysts were removed totally, either by pericystectomy or hepatic lobectomy. Such a radicality is the exception in E. alveolaris. Twice we performed right hepatic lobectomy. In the other cases operative treatment was carried out to confirm diagnosis and ensure bile passage by a hepato-enterostomy. However, palliative bile draining procedures may prolong survival time to more than 10 years.
CT was performed in seventeen cases of E. alveolaris of the liver, and two cases of E. alveolaris of the lung. The scans provided considerable detailed information which, when taken together, enabled a specific diagnosis of echinococcus infestation to be made in most cases. The extent of intra- and extrahepatic infiltration by E. alveolaris can be well defined by CT.
Experimental infection of mother mice by intraperitoneal injection of Echinococcus multilocularis cyst material does not result in the transfer of protective immunity to the offspring. In the contrary, if infected via the same route, filial mice show a lower antibody titer, when examined 36, 78 and 120 days p.i. and a higher worm burden (average: 1455 mg) in comparison with control mice born of non-infected mothers (average parasite weight: 844 mg). The question is discussed, whether these observations are due to the suppressive action of transferred antibodies or whether the offspring become immunologically tolerant by the transfer of parasite antigen.
A limited, but controlled trial with mebendazole incorporated in a prepared food and with tablets given with this food showed that with the former there was an overall reduction in the expected dog population harbouring Echinococcus granulosus and Taenia hydatigena. Neither treatment was fully effective.
The effect of an antibiotic of the streptothricin class on Echinococcus granulosus and Taenia hydatigena infections has been investigated in a trial involving 160 dogs. The drug showed significant activity in freeing dogs from Thydatigena, but the evidence for similar activity against E granulosus was less well marked. Vomiting and diarrhoea were common sequelae of dosing. The preparation tested consisted of four chemical components and the cestocidal value of each was not determined.