Prevention and control of cystic echinococcosis

ERCP treatment of obstructive jaundice caused by hydatid cyst in extrahepatic ducts 13 years after liver hydatid endocystectomy. A case report

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Hydatid disease is a parasitic infestation by a tapeworm of the genus Echinococcosis of which 50%–75% of hydatid cysts occur in the liver.

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In approximately one-fourth of the cases, hepatic hydatid cyst ruptures into the biliary tree producing obstructive jaundice.

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Moreover, primary hydatid cysts of the biliary tract have been reported in English literature.

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This is an interesting and intriguing case of obstructive jaundice caused by hydatid cyst in extrahepatic ducts 13 years after liver hydatid endocystectomy.

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ERCP represent an important management strategy for patients with hydatid cysts in extra-hepatic ducts even primary or complications of liver hydatid cyst.

Introduction

Hydatid disease affects most commonly the liver, and complications with the rupture into the biliary tree develop in approximately one-fourth of the cases. Moreover, primary hydatid cysts of the biliary tract have been reported.

Presentation of case

We report an extremely rare case of obstructive jaundice caused by hydatid cyst in extrahepatic ducts 13 years after liver hydatid endocystectomy treated by Endoscopic retrograde cholangiopancreatography (ERCP). A 28-year-old male patient who had undergone surgical treatment – removal of liver hydatid cyst 13 years earlier, presented with signs of obstructed jaundice, confirmed with blood tests results and magnetic resonance cholangiopancreatography (MRCP). Actually, there were no pathological changes detected in the hepatic parenchyma, but the intrahepatic and extrahepatic bile ducts were dilated. ERCP was performed and the entire hydatid material was evacuated and washed out into the gastrointestinal tract. In addition, after laparoscopic cholecystectomy, hydatid cysts were also confirmed in the gallbladder.

Discussion

Generally, the obstructive jaundice caused by hydatid cyst in the extrahepatic ducts can also be caused by the rupture of the liver hydatid cyst in the biliary tract, or by primary hydatid cyst in the biliary tract. The ERCP plays a key role in the diagnosis and the treatment of this pathology.

Conclusion

The ERCP, has now become an important diagnostic and therapeutic procedure in management of primary extrahepatic hydatid cysts and of complicated liver hydatid cysts.

Comparison of the Level of Awareness about the Transmission of Echinococcosis and Toxocariasis between Pet Owners and Non-Pet Owners in Greece

Ζoonotic parasitic diseases that can occur through animal contact pose risks to pets, their owners and to their bond. This study aims to assess the level of knowledge about zoonoses, specifically echinococcosis and toxocariasis, among cat/dog owners and non-pet owners in Greece. Multiple-choice questionnaires were designed to obtain data regarding the knowledge of pet and non-pet owners on echinococcosis and toxocariasis, including signs and symptoms of these zoonoses, ways of transmission and precautions that need to be taken into account in order to avoid it. A total of 185 questionnaires were retrieved and data was expressed as absolute (Ν) and relative frequencies (%). Associations between pet ownership, residence and outcome variables were evaluated using the Fisher exact test and Chi-squared test, respectively. Multifactorial linear regression analysis was used to investigate the cross-sectional association between demographic characteristics and the awareness of helminthic zoonoses. All tests were two-sided and statistical significance was set at p < 0.05. Our study revealed a disturbing lack of awareness of echinococcosis and toxocariasis (mean zoonotic knowledge score 8.11 ± 3.18) independently of pet ownership. Surprisingly, in some cases the ignorance of pet owners exceeded that of non-pet owners. Given the progressive impact of toxocariasis in public health and the high prevalence of echinococcosis in the Mediterranean region, measures should be taken to inform people about zoonoses and eliminate their putative transmission.

Investigating the effect of gold nanoparticles on hydatid cyst protoscolices under low-power green laser irradiation

Objectives

Various scolicidal agents are applied for the destruction of protoscolices in cysts media. Undesirable complications of the scolicidal agents limit the techniques to treat the cyst disease. Therefore, new non-toxic scolicidal agents are needed. Upon laser light irradiation, the photothermal gold nanoparticles (AuNPs) convert the absorbed laser light into heat through photothermal effect which kills the surrounding protoscolices by rising the temperature of the cysts media. In this study, we introduced biocompatible AuNPs as a non-toxic scolicidal agent to cure liver hydatid cysts.

Material and Methods

The protoscoleces were collected from the livers of naturally infected sheeps. In each experimental group, 1.5 mL suspensions of hydatid liquid containing protoscolices were added to test tubes. The test tubes were divided into five groups. Control, AuNPs only, Green laser only, High-dose AuNPs + laser and Low-dose AuNPs + laser groups. Two concentrations (0.4 and 0.8 mL) of AuNPs and three laser powers (30, 50, 150 mW) were applied for 30, 60 and 120 minutes to the groups. Then the ciysts liquid assessed under a light microscope and determined the viability of protoscoleces.

Results

Protoscolices in high-dose AuNPs group were destructed up to 89.30% deaths under 150 mW laser power for 120 minutes. However, negligible cell deaths were observed in cases where only AuNPs added or only laser irradiated groups. Increasing the dose of AuNPs or laser power or duration of aplication increased the protoscolosidal death rate.

Conclusion

In the study, we have successfully demonstrated that the AuNPs are an effective therapeutic and scolicidal agent to cure hydatid cyst disease under laser irradiation.

Sero-epidemiology of Hydatidosis Among General Population of Jolfa County, Northwestern Iran Using IHA, ELISA and Western Blot (2017-2018)

BACKGROUND

Human hydatidosis is mostly a latent and neglected disease with known endemicity in Iran.

AIMS

Due to the importance of this infection in the country and its latent nature, we aimed to evaluate the serological status of hydatid cyst in northwestern Iran.

OBJECTIVES

Herein, we evaluated the serological status of hydatid cyst in urban and rural inhabitants of Jolfa county, northwestern Iran during 2017-2018.

METHODS

In total, 1296 blood samples were obtained from human individuals and the presence of anti-E. granulosus antibodies was investigated using IHA, ELISA and WB.

RESULTS

Based on results, 25 IHA positive person were detected in the examined population, however ELISA test showed 14 of 25 IHA positive patients as negative. Also, 269 IHA negative fellows were shown as negative by ELISA. WB analysis of sera from 25 IHA positive subjects revealed consistent results with the ELISA test, and the most reactive SHCF Ag was a 37 KDa protein. The age-standardized seroprevalence of hydatidosis among Jolfa's general population was 1.12% with 95%CI: 1.02-1.20. Moreover, there existed a significant association between keeping/- contact with dogs (P = 0.022) as well as vegetable consumption (P < 0.001) with ELISA positive test results.

CONCLUSION

Along with such serological evidence in this region, we highly suggest physical examination and applying imaging techniques for suspected cases in the area for a better understanding of CE.

Analysis of Factors Influencing Cystic Echinococcosis in Northwest Non-Qinghai Tibetan Plateau Regions of China

Cystic echinococcosis (CE) is an important health problem in northwest non-Qinghai Tibetan Plateau regions of China. Understanding CE risk factors may help in formulating effective prevention and control measures. In the current study, negative binomial regression was used to analyze CE-related factors using prevalence data from 147 counties (cities, districts, and banners) in northwest non-Qinghai Tibetan Plateau regions of China gathered from a national survey conducted in 2012, county economic data, and livestock production data for 2012. The negative binomial regression models indicated Echinococcus granulosus infection rate in livestock (odds ratio [OR]: 1.0471, 95% CI: 1.0128-1.0825, P = 0.0067), the mean number of dogs per family (OR: 3.0589, 95% CI: 1.5116-6.1900, P = 0.0019), the mean number of sheep per family (OR: 1.0431, 95% CI: 1.0027-1.0852, P = 0.0365), and the source of drinking water (OR: 0.9808, 95% CI: 0.9627-0.9992, P = 0.0413) were correlated with human CE prevalence, whereas altitude, surface temperature, economy, and mean number of cattle per family had a negative association. We found that the positive rate of dog stool coproantigen of Echinococcus was associated with human CE prevalence using the univariate analysis but not after controlling for covariates including the number of dogs per family. This might be partially due to the deworming campaigns that were carried out in most of the researched areas. Therefore, the positive rate of dog stool coproantigen of Echinococcus could not reflect the dog infection rate under natural conditions. These findings indicate that dogs and livestock play the most important role in CE transmission. Further studies should be carried out at the township or village level.

Economic Effect of Confiscation of Cattle Viscera Infected with Cystic Echinococcosis, Huancayo Province, Peru

We report cystic echinococcosis (CE) prevalence in Huancayo Province, Peru, and the associated economic effect of bovine organ condemnation. CE prevalence during the 16-month study period was 42.8% and caused $14,595 in economic losses. CE threatens food security in the region by reducing farmers’ income and viscera supply in markets.

Biological and morphological consequences of dsRNA-induced suppression of tetraspanin mRNA in developmental stages of Echinococcus granulosus

BACKGROUND

Cystic echinococcosis, caused by the cestode Echinococcus granulosus, is a neglected tropical disease with remarkable morbidity in humans and a problem of worldwide economic importance in livestock industry. Understanding the molecular basis of the parasite growth and development is essential for the disease diagnosis, management and control. The tetraspanin (TSP) family of proteins are transmembrane proteins with a role in many physiological processes of eukaryotic organisms. TSPs present in the tegumental surface of platyhelminths play pivotal roles in host-parasite interaction. However, little is known about the role of TSPs in growth and development in the Platyhelminthes. To understand the role of TSP1 in the growth and development of E. granulosus we investigated the effect of EgTSP1-specific long dsRNA in different in vitro stages of the parasite.

METHODS

Different stages of E. granulosus, protoscoleces and strobilated worms, were cultivated In vitro in di-phasic media. Using long dsRNA and two delivery methods, i.e. electroporation and electro-soaking, EgTSP1 silencing was performed with an EgTSP1-specific dsRNA. The TSP1 expression profile was assessed as well as the biological and ultrastructural properties of the parasites.

RESULTS

After three days of dsRNA treatment, EgTSP1 expression was significantly reduced in both stages of E. granulosus as compared to irrelevant/unrelated dsRNA and untreated controls. Silencing expression of EgTSP1 in different stages of E. granulosus resulted in reduced viability and body contractions, inhibition of protoscoleces evagination and distinctive tegumental changes. Ultrastructural morphology of the strobilated worms treated with EgTSP1-specific dsRNA was indicative of the microtriches impairments and vacuolated tegument compared to the control helminths.

CONCLUSIONS

Results of the present study suggest that EgTSP1 plays important structural roles in tegument configuration in E. granulosus. EgTSP1 is proved to be a potential target for the development of vaccines and RNAi-based drugs.

Cerebral Cystic Echinococcosis

Cystic echinococcosis (CE) is a neglected helminthic disease and major public health problem in several regions of the world. The zoonosis is caused by the larval stage of different cestode species belonging to the genus Echinococcus. CE can affect any organ with the liver and lungs being most commonly involved. The brain is involved in less than 2% of the cases. We report a case of a CE1 echinococcal cyst of the brain in an Iranian patient.

Targeted Sequencing of Genomic Repeat Regions Detects Circulating Cell-free Echinococcus DNA

Background

Echinococcosis is a chronic zoonosis caused by tapeworms of the genus Echinococcus. Treatment of the disease is often expensive and complicated, sometimes requiring extensive surgery. Ultrasonographic imaging is currently the main technique for diagnosis, while immunological analysis provides additional information. Confirmation still needs pathological analysis. However, these diagnostic techniques generally detect infection in late stages of the disease. An accurate, early and non-invasive molecular diagnostic method is still unavailable.

Methodology/Principal findings

We sequenced the cell-free DNA (cfDNA) from plasma of echinococcosis patients and confirmed the presence of Echinococcus DNA. To improve detection sensitivity, we developed a method based on targeted next-generation sequencing of repeat regions. Simulation experiments demonstrate that the targeted sequencing is sensitive enough to detect as little as 0.1% of an Echinococcus genome in 1 mL of plasma. Results obtained using patient plasma shows that the Area Under the Curve (AUC) of the method is 0.862, with a detection sensitivity of 62.50% and specificity of 100%, corresponding to a Youden-index of 0.625.

Conclusions/Significance

This study provides evidence that hydatid cysts release cfDNA fragments into patient plasma. Using the repeat region targeted sequencing method, highly specific detection of Echinococcus infection was achieved. This study paves a new avenue for potential non-invasive screening and diagnosis of echinococcosis.

Echinococcosis is a severe chronic parasitic disease caused by tapeworms of the genus Echinococcus. According to the World Health Organization, there are more than 1 million people living with echinococcosis worldwide. For decades, little progress has been made to develop a molecular diagnosis and specific treatment for the disease. Although imaging and immunological detection are used for diagnosis, these technologies are either only effective for late stages of the disease or hardly conclusive. The detection of cell-free DNA has been a powerful tool for precise diagnosis. In this study, we showed the presence of Echinococcus-derived cell-free DNA in plasma of echinococcosis patients. We further established an assay to detect parasite DNA in blood samples based on amplification of Echinococcus specific repeat regions followed by targeted next-generation sequencing. This technique provides a new method for potential extensive screening and precision diagnosis of echinococcosis with high specificity.

National survey and molecular diagnosis of Echinococcus granulosus sensu lato in livestock in France, 2012

The parasitic species of the Echinococcus granulosus sensu lato (sl) complex are the causative agents of cystic echinococcosis in humans. The lifecycle of E. granulosus sl is essentially domestic, and is based on the consumption by dogs of hydatid cysts in viscera of livestock species. The aim of this study was to survey E. granulosus sensu lato in livestock in France. A 1-year national survey of E. granulosus sl in livestock at the slaughterhouse was organized in 2012 in France, with systematic molecular confirmation. The prevalence of E. granulosus ss nationally was 0.002% in sheep, mainly focused in the Alpine area, and 0.001% in cattle, with the distribution of cases throughout the country. Echinococcus canadensis G6/7 was observed only in Corsica in pigs, with a prevalence of nearly 1% in the island. A national prevalence of 0.0002% was estimated for E. ortleppi in cattle, due to seven cases distributed in two foci. The results of this survey are of particular interest because of the zoonotic risk associated with the presence of these parasite species, for which systematic control at the slaughterhouse should enable their elimination.

Co-existence of hepatocellular carcinoma and cystic echinococcosis

PURPOSE

Co-existence of hepatocellular carcinoma (HCC) and cystic echinococcus (CE) is extremely rare. Echinococcus granulosus may exhibit a protective effect against cancer. Herein, this study aimed to evaluate the possible effects of echinococcal infection on HCC patients.

METHODS

Three thousand three hundred hepatic CE patients and 815 HCC patients were retrospectively reviewed between January 2010 and December 2018 in Xinjiang, China, and these patients were 1:5 matched according to their sex, age and tumor TMN stage, and only 13 patients coexisted both CE and HCC. Preoperative ultrasonography (US), computed tomography (CT), liver magnetic resonance imaging (MRI) and dot immune-gold filtration assay (DIGFA) were used for preoperative identification and intraoperative specimens from liver resections were pathologically examined for further confirmation. Survival time was analyzed through Cox proportional hazard model analysis.

RESULTS

The co-existing incidence rate of two diseases was 0.39%. For these concurrent cases, HCC was all at the advanced stage and CE lesions were inactive. Median survival time for HCC patients was 6 month (1-17). However, it was 8 month (3-90) for the co-existing cases and was much longer than the median survival time of HCC patients (P<0.05), which was closely associated with tumor size, location, TMN stage and hydatid size, location, classification. Four of the patients underwent surgical intervention and their median survival time was 17 month (3-68).

CONCLUSIONS

Echinococcus granulosus may elicit a protective effect against the development and progression of HCC, while more basic and clinical researches are needed.

Spread of Cystic Echinococcosis in Pakistan Due to Stray Dogs and Livestock Slaughtering Habits: Research Priorities and Public Health Importance

Background: Cystic echinococcosis (CE) is a global zoonotic parasitic disease caused by the larval stage of Echinococcus granulosus and it has been reported from both livestock and humans in Pakistan. The definitive host of E. granulosus is the dog, and the large number of stray dogs in Pakistan contributes to the spread of CE. However, there is little information between stray dogs and CE relation in the country. Methods: During the study, total 123 butcher's shops and abattoirs were included for collection of data relating to the hydatid cyst prevalence in slaughtered animals (sheep, goat, cattle, and buffaloes). The number of animals slaughtered in each butcher's shop during sampling period was also recorded, and the association of the shop environment with dogs was inspected. Results: Data was collected for CE from 123 butcher's shops in Rawalpindi and Islamabad, Pakistan. The slaughtering rate the in the butcher's shops was 2-10 animals/day including sheep/goat/cattle and buffaloes. The overall prevalence of CE in all examined animals was 2.77%. In buffaloes the higher prevalence was recorded as compared to other hosts. The findings showed that lung and liver were most affected organs and majority (59%) of the cysts were fertile in infected animals. The presence of a large number of stray dogs were an important factor in the spread of CE. They were rarely vaccinated, have easy access to infected offal at slaughtering site and had insufficient or inappropriate anthelmintic treatment. Conclusions: The most pressing need is to raise public awareness of this huge problem by considering CE a major ailment and promoting the collection and mapping of epidemiological data. Efficient CE control is required, especially treating dogs with antiparasitic drugs, for which government support and affiliation with the veterinary sector is essential.

Role of microRNAs in host defense against Echinococcus granulosus infection: a preliminary assessment

Cystic echinococcosis (CE) is a neglected helminthic zoonosis caused by the larval stage of the tapeworm Echinococcus granulosus s.l. MicroRNAs (miRNAs) are regulators of gene expression that have been linked with the pathogenesis of several human diseases, but little exists in the available literature about miRNAs in CE. Here, we investigate the expression profiles of 84 microRNAs relevant to the function of lymphocytes and other immune cells during CE infection in the peripheral blood of patients with cysts in active and inactive stages. We applied the microRNA PCR array technology to blood samples from 20 patients with a single hepatic CE cyst in either the active (CE3b) or inactive (CE4-CE5) stage. Our results show a significant upregulation of eight miRNAs (let-7g-5p, let-7a-5p, miR- 26a-5p, miR- 26b-5p, miR- 195-5p, miR- 16-5p, miR- 30c-5p, and miR- 223-3p) in patients with active cysts compared to those with inactive cysts. The high expression of these miRNAs in patients with active cysts suggests their role in a specific host immune response against the infection. Further work in this direction may help shed light on the pathogenesis of human CE.

The local immune response during Echinococcus granulosus growth in a quantitative hepatic experimental model

The local immune mechanisms responsible for the establishment and development of Echinococcus granulosus sensu stricto infection in the liver, have been little explored. We developed a suitable experimental model that mimics naturally infected livers using portal injection of protoscoleces. Opposite to Echinococcus multilocularis infection which is dose-dependent, fully mature hydatid cysts can be established in the liver whatever the injection dose; although most of the infection sites were seen at the establishment phase as inflammatory granulomas associated with fibrosis, they never matured into cysts. At the establishment phase, a strong immune response was composed of T and B cells, with T1-type, T2-type cells and cytokines and IL-10-secreting CD8⁺ T cells in the liver. At the established phase, results suggested a local production of antibodies by B cells, and an involvement of NK and NKT cells. Infection outcome and local immune response in the liver, were different in the mouse models of Echinococcus granulosus sensu stricto and Echinococcus multilocularis respectively; however, only early specificities at the microenvironment level might explain the major differences found between the lesions induced by the two species. Our quantitative experimental model appears fully appropriate to further study this microenvironment and its relationship with each cestode species.

Surgical Infections in Low- and Middle-Income Countries: A Global Assessment of the Burden and Management Needs

Background: The burden of surgical infections in low- and middle-income countries (LMICs) remains poorly defined compared with high-income countries. Although there are common infections necessitating surgery prevalent across the world, such as appendicitis and peptic ulcer disease, other conditions are more localized geographically. To date, comprehensive assessment of the burden of surgically treatable infections or sequelae of surgical infections in LMICs is lacking. Methods: We reviewed the literature to define the burden of surgical infections in LMICs and characterize the needs and challenges of addressing this issue. Results: Surgical infections comprise a broad range of diseases including intra-abdominal, skin and soft tissue, and healthcare-associated infections and other infectious processes. Treatment of surgical infections requires a functional surgical ecosystem, microbiology services, and appropriate and effective antimicrobial therapy. Systems must be developed and maintained to evaluate screening, prevention, and treatment strategies. Solutions and interventions are proposed focusing on reducing the burden of disease, improving surveillance, strengthening antibiotic stewardship, and enhancing the management of surgical infections. Conclusions: Surgical infections constitute a large burden of disease globally. Challenges to management in LMICs include a shortage of trained personnel and material resources. The increasing rate of antimicrobial drug resistance, likely related to antibiotic misuse, adds to the challenges. Development of surveillance, infection prevention, and antimicrobial stewardship programs are initial steps forward. Education is critical and should begin early in training, be an active process, and be sustained through regular programs.

Infectious Lung Disease

Infectious diseases are one of the main causes of morbidity and mortality worldwide. With new pathogens continuously emerging, known infectious diseases reemerging, increasing microbial resistance to antimicrobial agents, global environmental change, ease of world travel, and an increasing immunosuppressed population, recognition of infectious diseases plays an ever-important role in surgical pathology. This becomes particularly significant in cases where infectious disease is not suspected clinically and the initial diagnostic workup fails to include samples for culture. As such, it is not uncommon that a lung biopsy becomes the only material available in the diagnostic process of an infectious disease. Once the infectious nature of the pathological process is established, careful search for the causative agent is advised. This can often be achieved by examination of the hematoxylin and eosin-stained sections alone as many organisms or their cytopathic effects are visible on routine staining. However, ancillary studies such as histochemical stains, immunohistochemistry, in situ hybridization, or molecular techniques may be needed to identify the organism in tissue sections or for further characterization, such as speciation.

Retrospective Study of Cystic Echinococcosis (CE) Based on Hospital Record from Five Major Metropolitan Cities of Pakistan

BACKGROUND

Human cystic echinococcosis (CE) is an important zoonotic parasitic disease. It is one of the NTDs having strong roots in Pakistan. There are limited studies on the prevalence of CE in Pakistan.

METHOD

A retrospective study was conducted to determine the geographical distribution of human CE in Punjab (Lahore, Multan, and Faisalabad) and Sindh (Karachi and Hyderabad) provinces of Pakistan. Clinical records of infected patients from nine major hospitals were retrieved from 2008 to 2018.

RESULTS

A total of 188 surgically confirmed cases were included from selected hospitals during the study period, which showed the annual frequency of 18.8 cases/year. The number of reported cases was higher in Sindh province (67.55%) compared to Punjab (32.45%). Total number of CE cases/city was higher in Karachi (47.34%) compared to Hyderabad city (20.21%), while in Punjab province, this frequency was higher in Lahore (25%) followed by Multan (5.32%) and Faisalabad (2.13%). Out of total 188 patients, 73 (38.83%) were males and 115 (61.7%) were females. In surveyed hospitals, high burden of infection was reported in young adults (21-30 years; 29.79%) followed by 21.81% and 17.02% in 31-40 and 41-50 age groups, respectively. Data retrieved from the hospital record of diagnosed cases of CE showed liver (36.17%, n = 68) as the most affected organ followed by lungs (26.06%, n = 49). In this survey, some unusual sites of cyst formation were also observed.

CONCLUSION

Current study is a step forward towards filling the gap of knowledge for prevalence and regional distribution of hydatidosis in Pakistan reporting the CE cases in humans for the first time in Multan and Faisalabad.

Prevalence of Intestinal Helminth Infections in Dogs and Two Species of Wild Animals from Samarkand Region of Uzbekistan

This study aimed to determine the prevalence of intestinal helminth parasitic infections and associated risk factors for the human infection among the people of Samarkand, Uzbekistan. Infection status of helminths including Echinococcus granulosus was surveyed in domestic and wild animals from 4 sites in the Samarkand region, Uzbekistan during 2015-2018. Fecal samples of each animal were examined with the formalin-ether sedimentation technique and the recovery of intestinal helminths was performed with naked eyes and a stereomicroscope in total 1,761 animals (1,755 dogs, 1 golden jackal, and 5 Corsac foxes). Total 658 adult worms of E. granulosus were detected in 28 (1.6%) dogs and 1 (100%) golden jackal. More than 6 species of helminths, i.e., Taenia hydatigena, Dipylidium caninum, Diplopylidium nolleri, Mesocestoides lineatus, Toxocara canis, and Trichuris vulpis, were found from 18 (1.0%) dogs. Six (T. hydatigena, Toxascaris leonina, Alaria alata, Uncinaria stenocephala, D. caninum, and M. lineatus) and 2 (D. nolleri and M. lineatus) species of helminths were also detected from 5 Corsac foxes and 1 golden jackal, respectively. Taeniid eggs were found in 2 (20%) out of 10 soil samples. In the present study, it was confirmed that the prevalences of helminths including E. granulosus are not so high in domestic and wild animals. Nevertheless, the awareness on the zoonotic helminth infections should be continuously maintained in Uzbekistan for the prevention of human infection.

Knowledge, Attitudes, and Practices of 50 Patients with Surgically Treated Cystic Echinococcosis from Basrah Province, Iraq

Cystic echinococcosis (CE) is recognised worldwide as a neglected disease of public health concern, particularly in low- and middle-income countries. The objectives of this study were to describe, using a questionnaire survey, the characteristics, attitudes, knowledge, and practices of patients with CE from Basrah Province, Iraq. We interviewed 50 patients, 31 female and 19 male, of whom, 74% originated from rural areas. Approximately half (48%) of the participants reported slaughtering livestock at home for their families’ consumption; 78% indicated the presence of a large number of stray dogs roaming freely about their village; 86% reported that they never boiled water prior to drinking it; and 26% reported not washing vegetables prior to eating them. Although a large proportion of the participants (72%) had heard of hydatid disease prior to becoming ill, over half (57%) were not aware how the disease was transmitted from animals to humans. This study highlighted a gap in health education efforts regarding CE in Southern Iraq, with a lack of counselling of patients on how to prevent reinfection. An intensive control programme should be implemented and founded on health education to reduce CE disease in Basrah.

Simultaneous Hydatid Cyst of the Liver and Left Iliac Fossa: An Unusual Case Report

Hydatid disease is a significant health problem in many livestock-rearing areas especially in the developing world, mainly caused by Echinococcus granulosus. The liver and lung are the most common affected sites. However, hydatid disease can occur anywhere in the body. Simultaneous involvement of two organs or sites is very unusual, mainly for organs other than the lung and liver. We thus report a very unusual combination of hepatic and left iliac fossa with hydatid disease in an adult patient. A 37-year-old farmer from a village presented with intermittent right upper quadrant and left iliac fossa pain associated with distention of abdomen for one month. Abdominal radiological investigations reported hydatid cyst disease; one cyst was found in the right lobe of the liver and another in the left iliac fossa. Positive IgG antibody by the ELISA test also confirmed the diagnosis. Pericystectomy and excision of hydatid cyst without spillage of content for the liver and left iliac fossa were done, respectively. Patient was discharged on the 10th postoperative day with an uneventful postoperative course. There was no recurrence of the lesion during one-year follow-up period. A combination of hydatid disease in the liver and iliac fossa is very unusual, so clinician should have thoughts regarding this rare entity as an important differential diagnosis.

Control of cystic echinococcosis: Background and prospects

Cystic echinococcosis (CE), caused by Echinococcus granulosus, is a chronic and debilitating zoonotic larval cestode infection in humans, which is principally transmitted between dogs and domestic livestock, particularly sheep. Human CE occurs in almost all pastoral communities and rangeland areas of the underdeveloped and developed world. Control programmes against CE have been implemented in several endemic countries to reduce or eliminate the disease. New Zealand and Tasmania are examples of some of the first programmes to be undertaken (in insular territories) and which were very successful in the elimination of CE. The advent and proven effectiveness of praziquantel, plus the experience of insular models, produced high expectations for rapid advances in a second generation of control programmes undertaken in continental areas (Argentina, Uruguay and Chile). Nevertheless, only moderate gains in CE control have been made and the impact on prevalence among humans has been slight. A major impediment to the adoption of procedures that were successful in New Zealand and Tasmania has been the requirement to administer praziquantel to dogs in rural areas eight times per year over numerous years. In addition, there have been clear technological improvements made in the diagnosis of canine echinococcosis for surveillance, the genetic characterization of parasite strains and in vaccination against CE infection in livestock. In order to establish new paradigms and appropriate combinations of control strategies, we have carried out a review and discussion of the available control tools and control models. Control strategies must be suitable and sustainable to benefit the Echinococcosis-endemic areas primarily, which at the same time are the poorest regions of the world.

Pulmonary hydatid cyst: Review of literature

Echinococcosis is a rare infectious disease in human being that occurs by the larval stages of taeniid cestodes of the genus Echinococcus. Human cystic echinococcosis is the most common presentation. The liver is the most common site of echinococcal cyst, followed by the lungs. The symptoms of lung infestation lead to sudden onset of chest pain, cough, fever, and hemoptysis after a cyst rupture. The diagnosis is confirmed by radiology supplemented with serology. Chest X-ray and computer tomography of chest is the principal investigation for pulmonary hydatid cyst (PHC). The treatment of PHCs is either pharmacotherapy and/or surgery. Surgical intervention is the most preferred treatment of choice; pharmacotherapy is useful in selected patients. Pharmacotherapy includes oral administration of benzimidazoles group of drugs like mebendazole or albendazole.

Evaluation of clinical, diagnostic and treatment aspects in hydatid disease: analysis of an 8-year experience

Background & Objective

Echinococcosis is still a common health problem. The aim of this study was to discuss our 8-year data in terms of diagnosis, treatment and follow-up of cystic Echinococcosis.

Methods

A total of 178 patients who had hydatid cyst were analyzed retrospectively from the hospital records. The diagnosis of hydatid cyst was based on clinical-serological and radiological findings. Treatment response was evaluated with clinical, radiological and serological findings.

Results

A total of 178 medical records were evaluated; the male:female ratio was 0.73 and mean age 44.6±16.9 years. The most common symptom was abdominal pain (94, 52.8%). The mean cyst size was 9.5±3.9 cm. Eosinophilia was significantly higher in patients with complicated cyst (35.3%) (p=0.002). The average duration of hospitalization in surgical patients was shorter than non-surgical patients (p=0.026). There was no significant correlation between the preference of scolicidal agent (hypertonic saline, H₂O₂, povidone iodine) and recurrence in patients who underwent surgery (p>0.05). There was no significant difference between the patients who underwent radical and conservative surgery in terms of complication and recurrence (p=0.077, p=0.557). No significant difference was found between percutaneous and surgical treatment in terms of complication and recurrence (p=0.264, p=0.276).

Conclusion

Even though considerable progress has been made, uncertainties remain in the diagnosis and treatment of Echinococcosis. Hence, standardized diagnostic and treatment procedures should be established with well-designed studies.

Determination of Echinococcus Granulosus Genotypes in Livestock Slaughtered in Shush County, Southwest Iran Using PCR-RFLP

Echinococosis is a zoonotic disease caused by the larval stages of Echinococcus spp. that occurs in most parts of the world. Herein, we aimed to evaluate the genotypes of isolated hydatid cysts from slaughtered animals in Shush county, southwestern Iran. Totally, 96 hydatid cysts were collected, including 11 buffaloes, 13 cattle, 12 goat and 60 sheep. The PCR was done by a primer pair (BDI and 4s) to amplify ITS1 fragment. Four restriction endonucleases including AluI, HpaII, RsaI, and TaqI were used for RFLP products and enzymatic reactions were electrophoresed. Finally, twenty PCR products were sent for sequencing and phylogenetic tree was drawn with MEGA6. Molecular identification of 96 hydatid cysts demonstrated a distinctive 1000 bp fragment in all samples from four animal hosts. RFLP analysis showed similar digestion patterns in all samples. AluI digestion yielded 800 bp and 200 bp fragments, HpaII digestion made 700 bp and 300 bp fragments and RsaI digestion entailed 655 and 345segments. Moreover, TaqI rendered no digestion pattern on rDNA-ITS1 region. Additionally, E. granulosus sensu stricto (G1-3 complex) was the prevailing genotype in all livestock samples, according to PCR-RFLP and sequencing analyses.

The current prevalence and diversity of cystic echinococcosis in slaughtered animals in Egypt

Cystic echinococcosis is a potential zoonotic helminthic disease affect a broad spectrum of mammals including humans worldwide. The economic impact of the disease interestingly requires updated gathering information on the prevalence in slaughtered animals. Accordingly, in the current study, 573 camels, 4300 sheep, and 1235 pigs were surveyed in four Egyptian municipal abattoirs. Among those, 62 (10.82%) camels, 33 (0.77%) sheep and 3 (0.24%) pigs had cystic echinococcosis in lungs, livers and spleen. The diversity of cysts revealed that positive-cystic echinococcosis animals from all species were detected in El-Basatin abattoir. In El-Monieb abattoir, sheep only were infected. In El-Waraa and Beni-Suef abattoirs, cysts were seen in camels only. Infected animals included both sexes. In camels, lungs were the most affected organs, while in sheep, livers were the most abundant. In pigs, hydatid cysts were detected only in lungs. Moreover, camel cysts were mostly large-sized (diameter > 10 cm) with smaller cysts are also recorded. In sheep, small-, moderately- and large-sized cysts were equally present. Cysts in pigs were large-sized. Camels showed a higher percentage of fertile cysts (46.77%; 29/62) followed by sheep (21.21%; 7/33). Calcified/degenerated cysts were less in camels (38.71%; 24/62) than in sheep (75.76%). Non-viable cysts were the less frequent in both species (14.52% in camels and 3.03% in sheep). All cysts recovered from pigs were fertile. In Egypt, governmental agencies and veterinary authorities are asked to potentially eradicate stray dogs (the main definitive host) and towards the proper hygienic disposal of infected offal in abattoirs to minimize the prevalence of cystic echinococcosis.

Molecular identification of cystic echinococcosis in humans and pigs reveals the presence of both Echinococcus granulosus sensu stricto and Echinococcus canadensis G6/G7 in the hyperendemic focus of the Republic of Moldova

Cystic echinococcosis is caused by the parasitic species of the complex Echinococcus granulosus sensu lato. This disease is hyperendemic in the Republic of Moldova. Recent molecular analyses have revealed the exclusive presence of E. granulosus sensu stricto in sheep and cattle. Previous reports of prevalence in pigs suggest the potential presence of Echinococcus canadensis G6/G7, as this species is also reported in neighboring countries. The presence of cystic echinococcosis in pigs was specifically monitored at the slaughterhouse. In the meantime, human cases were genotyped for the first time. E. canadensis G6/G7 was identified in all ten pigs infected by E. granulosus s.l. One human case of infection by E. canadensis G6/G7 was also identified, while E. granulosus sensu stricto was found to be the cause for the 13 others. The description of one human case of E. canadensis G6/G7 has confirmed its zoonotic impact in the country. Future studies will be needed to estimate the relative proportion and distribution of both parasitic species in Moldova.

Mechanism of Fibrosis Induced by Echinococcus spp

Infection with Echinococcus spp. causes fibrosis in various vital organs, including the liver and lungs. Hepatic fibrosis is a pathological feature of Echinococcus infection that destroys normal liver tissue, leading to jaundice, cholecystitis, portal hypertension, etc. Severe Echinococcus multilocularis infections lead to liver failure and hepatic encephalopathy. The formation of peripheral fiberboards around the metacestode is a major reason as to why antiparasitic drugs fail to be effectively transported to the lesion site. Studies on the mechanism of hepatic fibrosis caused by Echinococcus are important for treatment in patients. Recent studies have focused on miRNA and TGF-β. More recent findings have focused on the generation of collagen fibers around the metacestode. In this review paper we focus on the mechanism by which the Echinococcus parasite induces fibrosis in liver and some other organs in intermediate hosts—animals as well as human beings.

Recurrent Inactive Hydatid Cyst of the Liver Causing Restrictive Pulmonary Physiology

Hydatid and alveolar cysts are formed by the helminths Echinococcus granulosus and Echinococcus multilocularis, respectively, which are endemic to pastoral areas, and are more commonly found in South America, the Mediterranean, Russia, and China. Hydatid cysts can cause bacteremia, form abscesses, or cause mass effect by compressing surrounding organs. Strategies to prevent such complications include benzimidazoles, surgical resection, and Puncture, Aspiration, Injection and Re-aspiration (PAIR) procedure. A 71-year-old Egyptian man with remote history of Echinococcus infection one year status post PAIR procedure, presented with dyspnea on exertion. On exam, the patient had a palpable right upper quadrant mass. The patient had a known small hydatid liver cyst on prior ultrasound, however repeat imaging showed growth to 15×19×14cm, with right hemidiaphragm elevation, compressive atelectasis, and compression of the right atrium. He had no peripheral eosinophilia and negative echinococcal serology, consistent with remote infection. The patient underwent repeat PAIR procedure and 3L of serous fluid was drained from the cyst. Fluid analysis was negative for scolices, cysts or hooklets. His symptoms improved; however the cyst re-accumulated 1 month later. Total cystectomy was performed surgically by hepatic wedge resection, with permanent improvement in symptoms. This case is a rare example of Echinococcus infection causing significant respiratory morbidity requiring repeated invasive procedures and surgery, in the setting of inactive disease.

Echinococcus Granulosus in Childhood: A Retrospective Study of 187 Cases and Newer Data

Echinococcus granulosus, first reported by Goeze in 1782, is the causative parasite of cystic echinococcosis (hydatidosis) especially for countries that are endemic areas. Since the 1970s, the incidence of echinococcosis in Greece has been very high. Nevertheless, with the implementation of special prevention measures in the 1980s, a large reduction in the incidence of hydatidosis meant that it reached European levels. Therefore, we analyzed the demographics, multiple organ localizations of the parasite, diagnosis, and conservative and optimal surgical treatment over a total period of 39 years, especially for pulmonary and hepatic echinococcosis in children. The higher incidence of pulmonary echinococcosis compared with other localizations, male predominance, wide range of age, and various cystic sizes were some of the main demographics. Because cystic echinococcosis remains a main public health problem, we advocate a meticulous clinical investigation and treatment methodology to bridge the gap between knowledge and awareness of this important disease.

Survey of echinococcoses in southeastern Qinghai Province, China, and serodiagnostic insights of recombinant Echinococcus granulosus antigen B isoforms

Background

Echinococcoses, caused by metacestodes of Echinococcus granulosus (cystic echinococcosis; CE) and E. multilocularis (alveolar echinococcosis; AE), represent major emerging parasitic diseases. These enzootic helminthiases invoke significant public health concerns and social burdens in endemic areas. The diseases are prevalent in the Qinghai-Tibetan Plateau, China, while community-based epidemiological studies have been scarcely reported. We surveyed echinococcosis patients in the southeastern Qinghai Province, China, to better understand the concurrent epidemiological situation in this area.

Methods

During July and August of 2013 and 2014, we screened echinococcosis patients at Yushu and Golog Prefectures, Qinghai Province, China, in a diagnostic campaign. A total of 2856 people (male:female ratio, 1:1.12; mean age, 34.6 years; age range, 6–88 years) were ultrasonographically examined for the presence of hepatic echinococcal cysts. We also collected serum samples from patients and analyzed antibody reactivity against recombinant forms of diverse E. granulosus antigen Bs (rEgAgB1-5) by enzyme-linked immunosorbent assay.

Results

We detected 134 patients whose imaging scans were compatible with CE (115 cases) and AE (20 patients). One patient might have been infected with both CE and AE. The overall incidence was 4.7% (CE, 4.0%; AE, 0.7%). A large proportion (67.5%) of CE patients was diagnosed at active and transitional CE1-CE3 stages in their late 30s. The AE cases were generally detected at advanced stage in patients at early 20s (60%). Analysis of the receiver operating characteristic curve and Youden’s index indicated that rEgAgB2 was the most promising biomarker, followed by rEgAgB3 and rEgAgB1. Overall, sensitivity and specificity of rEgAgB1-3 were 84.5–92.7% and 91.9–94.6%, respectively. rEgAgB4 and 5 showed low sensitivity with high cross-reactivity.

Conclusions

Our results strongly suggest that disability-adjusted life years related to echinococcoses in Qinghai-Tibetan areas might be more serious than previously considered. Control and prevention strategy against CE and AE are highly required in these areas. In addition to ultrasonography, serological tests might provide supportive data. However, serological data should be carefully interpreted for differential diagnosis, especially in areas where both CE and AE are co-endemic.

Electronic supplementary material

The online version of this article (10.1186/s13071-019-3569-6) contains supplementary material, which is available to authorized users.

A systematic review and meta-analysis of the genetic characterization of human echinococcosis in Iran, an endemic country

Human echinococcosis is an infectious disease caused by tapeworms belonging to the species Echinococcus. This parasite has a worldwide distribution and is considered a neglected tropical disease by the World Health Organization. Due to the diversity of Echinococcus spp. hosts, as well as variation in geographical, climatic, and socio-ethnic conditions, the question of the strains or genotypes of Echinococcus spp. that are involved in human infections is important. The aim of this study was to provide a summary of the available data on genotypes of Echinococcus obtained from the Iranian population. Four international databases (PubMed, Scopus, Science Direct, and Web of Science) and 4 Persian databases (Magiran, Scientific Information Database, Iran Medex, and IranDoc) were searched for cross-sectional studies that reported the genotypes of Echinococcus spp. in human echinococcosis cases using molecular methods in Iran through July 2018. The Newcastle-Ottawa Scale was used to assess the quality of the selected studies. A total of 559 cases of human cystic echinococcosis were reported in the 21 included articles. The majority of cases belonged to genotype G1 (89.2%; 95% confidence interval [CI], 80.1 to 95.8), genotype G6 (8.2%; 95% CI, 2.8 to 15.9), and genotype G3 (2.3%; 95% CI, 1.1 to 3.9). Since genotype G1 of Echinococcus appears to be the most prevalent genotype affecting humans in Iran, disease control initiatives aimed at sheep intermediate hosts may be the most beneficial. In addition, educational programs and serological screening in individuals may help reduce the national impact of the disease.

Diagnosis and treatment of a case of hepatic mixed echinococcosis infection combined with distant organ metastasis

Hydatidosis is a zoonotic parasitic disease caused by Echinococcus, which is highly prevalent in pastoral areas. In China, this disease is mainly caused by Echinococcus granulosus and Echinococcus multilocularis. Cystic echinococcosis, which is one of the most common types of echinococcosis, is described as swelling and growth of cystic lesions. Alveolar echinococcosis, which is less common, is invasive. Cases of mixed echinococcosis infection accompanied by extrahepatic organ metastasis are extremely rare. Treatment of these cases is complicated and the prognosis is extremely poor. We report a case of hepatic echinococcosis in a 40-year-old Tibetan man who was treated with the hepatic right tricuspidectomy + left hepatic duct jejunostomy (Roux-en-Y) surgical procedure. This procedure provides a reference for treatment of similar cases of echinococcosis. For patients with multiorgan metastasis, chemotherapy is the first choice. This should be followed by possible surgical treatment for life-threatening lesions of alveolar echinococcosis and subsequent chemotherapy. Individualized treatment accompanied by multidisciplinary treatment and damage control surgery could optimally benefit patients with advanced hepatic echinococcosis.

Epidemiological survey of echinococcosis in Tibet Autonomous Region of China

BACKGROUND

The echinococcosis is prevalent in 10 provinces /autonomous region in western and northern China. Epidemiological survey of echinococcosis in China in 2012 showed the average prevalence of four counties in Tibet Autonomous Region (TAR) is 4.23%, much higher than the average prevalence in China (0.24%). It is important to understand the transmission risks and the prevalence of echinococcosis in human and animals in TAR.

METHODS

A stratified and proportionate sampling method was used to select samples in TAR. The selected residents were examined by B-ultrasonography diagnostic, and the faeces of dogs were tested for the canine coproantigen against Echinococcus spp. using enzyme-linked immunosorbent assay. The internal organs of slaughtered domestic animals were examined by visual examination and palpation. The awareness of the prevention and control of echinococcosis among of residents and students was investigated using questionnaire. All data were inputted using double entry in the Epi Info database, with error correction by double-entry comparison, the statistical analysis of all data was processed using SPSS 21.0, and the map was mapped using ArcGIS 10.1, the data was tested by Chi-square test and Cochran-Armitage trend test.

RESULTS

A total of 80 384 people, 7564 faeces of dogs, and 2103 internal organs of slaughtered domestic animals were examined. The prevalence of echinococcosis in humans in TAR was 1.66%, the positive rate in females (1.92%) was significantly higher than that in males (1.41%), (χ² = 30.31, P < 0.01), the positive rate of echinococcosis was positively associated with age (χ²_trend = 423.95, P < 0.01), and the occupational populations with high positive rates of echinococcosis were herdsmen (3.66%) and monks (3.48%). The average positive rate of Echinococcus coproantigen in TAR was 7.30%. The positive rate of echinococcosis in livestock for the whole region was 11.84%. The average awareness rate of echinococcosis across the region was 33.39%.

CONCLUSIONS

A high prevalence of echinococcosis is found across the TAR, representing a very serious concern to human health. Efforts should be made to develop an action plan for echinococcosis prevention and control as soon as possible, so as to control the endemic of echinococcosis and reduce the medical burden on the population.

Echinococcosis transmission on the Tibetan Plateau

Since the mid-1990s detailed studies and field investigations on the Tibetan Plateau have revealed human echinococcosis to be an under-reported major public health problem, particularly in the dominant pastoral communities in the eastern and central regions. Human prevalence surveys showed that cystic echinococcosis (CE, caused by Echinococcus granulosus) and alveolar echinococcosis (AE, caused by Echinococcus multilocularis) are co-endemic with higher burdens of each disease than other endemic world regions. Epidemiological investigations identified some major risk factors for human CE and AE including dog ownership, husbandry practices and landscape features. Dogs appear to be the major zoonotic reservoir for both E. granulosus and E. multilocularis, but the latter is also transmitted in complex wildlife cycles. Small mammal assemblages especially of vole and pika species thrive on the Plateau and contribute to patterns of E. multilocularis transmission which are influenced by landscape characteristics and anthropogenic factors. Tibetan foxes are a principal definitive host for both E. multilocularis and E. shiquicus. In 2006 a national echinococcosis control programme was initiated in Tibetan communities in northwest Sichuan Province and rolled out to all of western China by 2010, and included improved surveillance (and treatment access) of human disease and regular deworming of dogs with annual copro-testing. Control of echinococcosis in Tibetan pastoral communities poses a difficult challenge for delivery and sustainability.

Surgery for Pulmonary Hydatidosis in Turkey in 2014: A Nationwide Study

OBJECTIVES

Turkey remains among the countries where hydatid disease is endemic. In this study, it was aimed to determine the number of operations performed for the treatment of pulmonary hydatid disease in Turkey during 2014 and to present the distribution of these operations according to the different regions of the country.

MATERIALS AND METHODS

The Turkish Thoracic Society Thoracic Surgery Study Group connected with the thoracic surgeons in each city through telephone. A data set was sent by email. The age, sex, contact with animals that might be a risk of gaining the hydatid disease, the side of the disease, the type of surgical method, other organ involvement were recorded and collected from each data set to form the final data, and the results were evaluated. Turkey comprises of 81 cities that are grouped in seven different regions. The number of operations was calculated for each city and region to present the distribution.

RESULTS

Overall, 101 centers from 81 cities were considered in the study. A total of 715 pulmonary hydatid cyst operations were performed in 690 patients during the study period. The most common operation technique was cystotomy and capitonnage through thoracotomy (76%). The highest incidence rate of operated patients was in the Eastern Anatolian Region (2.15 patients per 100 000 person-years).

CONCLUSION

Pulmonary hydatid disease still has a high incidence rate particularly in the southeast and east of Turkey, which are mainly rural areas and where stockbreeding is very common. Cystotomy and capitonnage is still the most common surgical method used to treat pulmonary hydatid cysts. Preventive methods should be performed strictly in these cities and regions to decrease the risk of infection.

Hydatid cyst involving Right Pectoralis Major Muscle: A case report

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Hydatid cyst is fairly common in endemic areas & can involve any part of the body.

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Involvement of Pectoralis major muscle is rare.

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Ultrasound and CT scan help in diagnosing them.

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Most of the times, surgery is the usual treatment modality, followed by irrigation with a scolicidal agent.

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A course of albendazole should be prescribed after surgery.

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Hydatid cyst is fairly common in endemic areas & can involve any part of the body.

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Involvement of Pectoralis major muscle is rare.

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Ultrasound and CT scan help in diagnosing them.

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Most of the times, surgery is the usual treatment modality, followed by irrigation with a scolicidal agent.

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A course of albendazole should be prescribed after surgery.

Background and aim

Hydatid disease is caused by Echinococcus granulosus; a tapeworm. They rarely affect the musculoskeletal system of the body (<5% of cases). The objective of this case report is to discuss about hydatid cyst disease involving the right pectoralis major muscle.

Case presentation

Herein, we report a case of a 35 years old lady who came to the outpatient department with a gradually increasing soft swelling at the right upper chest below the clavicle. The final diagnosis was made with the help of a CT scan. The cyst was excised and the area was washed with a scolicidal agent. There was no recurrence after six months of follow up and the patient was doing well.

Conclusion

Hydatid cyst of the Pectoralis Major is rare and must be considered in the differential of any muscular swelling in the body in endemic areas. These cysts should be treated with enucleation/excicion followed by irrigation of the area with a scolicidal agent.

Echinococcosis: Advances in the 21st Century

Echinococcosis is a zoonosis caused by cestodes of the genus Echinococcus (family Taeniidae). This serious and near-cosmopolitan disease continues to be a significant public health issue, with western China being the area of highest endemicity for both the cystic (CE) and alveolar (AE) forms of echinococcosis. Considerable advances have been made in the 21st century on the genetics, genomics, and molecular epidemiology of the causative parasites, on diagnostic tools, and on treatment techniques and control strategies, including the development and deployment of vaccines. In terms of surgery, new procedures have superseded traditional techniques, and total cystectomy in CE, ex vivo resection with autotransplantation in AE, and percutaneous and perendoscopic procedures in both diseases have improved treatment efficacy and the quality of life of patients. In this review, we summarize recent progress on the biology, epidemiology, diagnosis, management, control, and prevention of CE and AE. Currently there is no alternative drug to albendazole to treat echinococcosis, and new compounds are required urgently. Recently acquired genomic and proteomic information can provide a platform for improving diagnosis and for finding new drug and vaccine targets, with direct impact in the future on the control of echinococcosis, which continues to be a global challenge.

Knowledge Domain and Emerging Trends on Echinococcosis Research: A Scientometric Analysis

The echinococcosis of humans and animals is a chronic helminthic disease caused by the larva of genus Echinococcus tapeworms. It is a globally distributed disease which is an important socioeconomic and public health problem in many low and middle-income countries. This research aimed to firstly quantitatively analyze the publications with bibliometrics software and evaluated the hot topics and emerging trends of echinococcosis research from 1980 to 2017. A total of 7688 references on echinococcosis research were retrieved from the Web of Science Core Collection database. Then the reference was analyzed with CiteSpace software to make the knowledge network maps. The largest cluster (#0) with 83 members was cystic echinococcosis, and cystic echinococcosis, mebendazole, antibody and transmission were the four keywords with the strongest citation bursts in the echinococcosis research field. Furthermore, cystic echinococcosis, chemotherapy and immunodiagnosis, management of definitive and intermediate host are the top four research hot topics and emerging trends in the echinococcosis field. This research presents an insight into the echinococcosis field and valuable visualizing information for echinococcosis researchers to detect new viewpoints on cooperative countries/institutions, potential co-workers and research frontiers.

Calmodulin-specific small interfering RNA induces consistent expression suppression and morphological changes in Echinococcus granulosus

Among parasitic helminths, biological features of Echinococcus granulosus have been a focus of particular interest in biology and medicine. The determinants and underlying molecular mechanisms of Echinococcus development in different host settings is largely unknown. The phenomenal bi-directional development of E. granulosus protoscoleces into multi-proglottid and/or microcysts, is a fascinating feature of the parasite cultivation. Calmodulin (CaM) is the major intracellular Ca2+ binding protein in plant and animal organisms. Many Ca2+-related processes in the physiology of eukaryotic organisms are CaM-dependent, however little is known on the role of CaM in platyhelminths growth and development. Small interfering (si) RNA-induced manipulations of the genes involving in the parasite development is an opportunity to explore novel approaches for cystic echinococcosis (CE) prevention and management. Regarding the fundamental role of CaM in cellular function of the parasites, in this study, we investigated the molecular and morphological changes induced by siRNA on CaM in different in vitro stages of E. granulosus. Three developmental stages of the tapeworm, protoscoleces, microcysts and strobilated worms, were cultivated in vitro in mono- and di-phasic media and three delivery methods, i.e. electroporation, soaking and electro-soaking, were used for RNA interference. The level of mRNA suppression as well as the phenotypic changes of the parasites were measured. Following RNA interference, EgCaM mRNA suppressions of 65-99% were recorded in different stages of the tapeworm as compared to untreated/unrelated siRNA controls. Lower viability, growth retardation, morphological abnormalities as well as EgCaM expression suppression were documented in the parasite implying potential of siRNA technology for the prevention and management of CE.

Neglected Zoonoses and the Missing Opportunities for One Health Education: The Case of Cystic Echinococcosis among Surgically Operated Patients in Basrah, Southern Iraq

Cystic echinococcosis (CE) is recognized as a neglected disease of public health significance throughout the world, particularly in low and middle-income countries. The objectives of this study were to describe the characteristics, attitudes, knowledge, and practices of some Basrah province residents diagnosed with CE. Using a questionnaire survey, we interviewed 50 surgically operated cases of CE from Basrah, south Iraq. The cases comprised of 31 females and 19 males, of which 74% originated from rural areas. The questionnaire contained 30 questions and focused on gathering the demographic characteristics of the patients and capturing their overall knowledge, attitudes, and practices toward CE. Approximately half of the participants reported slaughtering livestock at home for their families’ consumption, 78% indicated the presence of a large number of stray dogs roaming freely about their village, 86% reported that they never boiled water before drinking it, and 26% reported not washing vegetables before eating them. Although a large proportion of the participants (72%) had heard of hydatid disease before becoming sick, over half (57%) were not aware of how the disease can be transmitted from animals to humans. This study highlights a gap in One Health education efforts regarding CE in southern Iraq, with a lack of counselling of patients on how to prevent reinfection. An intensive One Health education program should be implemented in Basrah to reduce CE at the human–animal interface. Lack of awareness on zoonoses among medical professionals, who are supposed to disseminate advice on preventative measures to their patients, is a challenge to the public health system.

Echinococcus granulosus sensu stricto: silencing of thioredoxin peroxidase impairs the differentiation of protoscoleces into metacestodes

Cystic echinococcosis (CE) is a cosmopolitan parasitic disease caused by infection with the larval stage of Echinococcus granulosus sensu lato. Thioredoxin peroxidase (TPx) may play an essential role in the antioxidant defence system of E. granulosus s.l. as neither catalase nor glutathione peroxidase activities have been detected in the parasite. However, it is not known whether TPx affects the survival and growth of E. granulosus s.l. during development. In this study, three fragments of siRNA specific for EgTPx (siRNA-1/2/3) were designed and transfected into protoscoleces of E. granulosus sensu stricto by electroporation. Quantitative real-time PCR and Western blotting analysis showed that siRNA-3 significantly reduced the expression of EgTPx. Coincidentally, knockdown of EgTPx expression in protoscoleces with siRNA-3 significantly reduced the viability of the parasite under oxidative stress induced by 0.6 mM H₂O₂. In vitro culture studies showed that protoscoleces treated with siRNA-3 reduced pre-microcyst formation. In vivo experiments showed that injecting mice intraperitoneally with protoscoleces treated with siRNA-3 resulted in a significant reduction in the number, size and weight of CE cysts compared with those of control animals. Silencing of EgTPx led to the impairment of growth of E. granulosus s.s. both in vitro and in vivo, indicating that EgTPx is an important factor for protoscoleces survival and plays an important role in the antioxidant defence against the host during development.

First Case of Human Primary Vertebral Cystic Echinococcosis Due to Echinococcus Ortleppi

Cystic echinococcosis (CE) is a cosmopolitan parasitic zoonosis affecting more than one million people worldwide. In humans, primary bone CE is rare and involvement of E. ortleppi is very uncommon. We report here the first case of primary vertebral cystic echinococcosis due to E. ortleppi in Burgundy, France.

Efficiency of flubendazole-loaded mPEG-PCL nanoparticles: A promising formulation against the protoscoleces and cysts of Echinococcus granulosus

None of the existing drugs can effectively treat the human cystic echinococcosis. This study aimed to improve the efficacy of flubendazole (FLBZ) against the protoscoleces and cysts of Echinococcus granulosus by preparing polymeric FLBZ-loaded methoxy polyethylene glycol-polycaprolactone (mPEG-PCL) nanoparticles. The protoscoleces and microcysts were treated with FLBZ-loaded mPEG-PCL nanoparticles (FLBZ-loaded nanoparticles) and free FLBZ at the final concentrations of 1, 5, and 10 μg/mL for 27 and 14 days, respectively. The chemoprophylactic efficacy of the drugs was evaluated in experimentally infected mice. The nanoparticles were stable for 1 month, with an average size of 101.41 ± 5.14 nm and a zeta potential of -19.13 ± 2.56 mV. The drug-loading and entrapment efficiency of the FLBZ-loaded nanoparticles were calculated to be 3.08 ± 0.15% and 89.16 ± 2.93%, respectively. The incubation of the protoscoleces with the 10 μg/mL nano-formulation for 15 days resulted in 100% mortality, while after incubation with the 10 μg/mL free FLBZ, the viability rate of the protoscoleces was only 44.0% ± 5.22%. Destruction of the microcysts was observed after 7 days' exposure to the FLBZ-loaded nanoparticles at a concentration of 10 μg/mL. The in vivo challenge showed a significant reduction in the weight and number of the cysts (P <  0.05) in the mice treated with the FLBZ-loaded nanoparticles, yielding efficacy rates of 94.64% and 70.21%, correspondingly. Transmission electron microscopy revealed extensive ultrastructural damage to the cysts treated with the FLBZ-loaded nanoparticles. The results indicated that the FLBZ-loaded nanoparticles were more effective than the free FLBZ against the protoscoleces and cysts of E. granulosus both in vitro and in vivo.