Echinococcosis: a review

Stage-Oriented CT Classification and Intermodal Evolution Model in Hepatic Alveolar Echinococcosis

Background

Alveolar echinococcosis (AE) is one of the most dangerous human parasitoses. The main site of disease manifestation is the liver (about 98 %). The Echinococcus Multilocularis Ulm Classification for Computed Tomography (EMUC-CT), presented in 2016, was the first compilation of CT morphological criteria of hepatic AE. Studies based on EMUC-CT made it possible to draw conclusions about the development of the lesions in the course of disease beyond purely diagnostic typing. Among the most important findings of these precursor studies was that EMUC-CT type IV presented as an initial lesion, whereas EMUC-CT type III lesions were mostly associated with an advanced disease constellation. An intermodal view of image morphological criteria provides further multi-layered indications for lesion evolution.

Method

With the “Alveolar Echinococcosis Ulm Classification” (AEUC), a revision of the previous EMUC-CT was carried out with stage-oriented reorganization of the primary morphologies. Furthermore, an intermodal classification scheme for the evolution of hepatic AE lesions based on AEUC, MRI Kodama classification, and aspects of ultrasound could be outlined.

Results

The first stage-oriented CT classification of hepatic AE “AEUC” is based with respect to its lesion characterization on the separate consideration of two classification pillars, the five “primary morphologies”, AEUC I–V (AEUC II–IV with subcriteria) and the five “patterns of calcification”. In addition, an intermodal classification scheme presents five stages of lesion evolution: “initial stage”, “progressive stage”, “advanced stage”, “transitional stage” and “regressive stage”.

Conclusion

The imaging modalities differ with respect to their visualization of lesion criteria. This underlines the need for unimodal classification systems. Staging of an AE lesion can be done more accurately by evaluating different modalities.

Key Points:

Citation Format

Antiparasitic effects of Elettaria cardamomum L. essential oil and its main compounds, 1-8 Cineole alone and in combination with albendazole against Echinococcus granulosus protoscoleces

Background

The present investigation aims to determine the chemical structure and protoscolicidal effects of Elettaria cardamomum L. essential oil (ECEO) and its main compounds 1–8 cineole alone and along with albendazole (ALZ) against Echinococcus granulosus protoscoleces in vitro and ex vivo. We also decided to evaluate some cellular mechanisms such as the apoptotic activity and the permeability of plasma membrane of protoscoleces treated with ECEO and 1–8 cineole.

Methods

Hydatid cyst protoscoleces were divided into seven groups including protoscoleces treated with ECEO 50 µl/mL (T1), protoscoleces treated with ECEO 100 µl/mL (T2), protoscoleces treated with ECEO 200 µl/mL (T3), protoscoleces treated with 1–8 cineole 100 µg/mL (T4), protoscoleces treated with 1–8 cineole 200 µg/mL (T5), protoscoleces treated with 1–8 cineole 100 µg/mL + albendazole 50 µg/mL (T6), and protoscoleces treated with 1–8 cineole 200 µg/mL + albendazole ALZ-50 µg/mL (T7). The viability of protoscoleces were recorded by eosin staining examination. Moreover, the induction of apoptosis and the plasma membrane permeability of the protoscoleces treated with ECEO and 1–8 cineole were evaluated.

Results

The highest protoscolicidal effect of ECEO was observed at the dose of 200 µl/ml (T3). 1,8-Cineole alone and combined with ALZ, particularly at the dose of 200 µg/ml (T5 and T7), destroyed the 100% protoscolices after 10 min incubation. The ECEO (T1-T3) and 1–8 cineole alone (T4 and T5) and in combination with ALZ (T6 and T7) took longer to display their protoscolicidal effect ex vivo. The obtained results of relative fuorescent items exhibited that the protoscoleces incubated with ECEO and 1,8-Cineole, alter the permeability of plasma membrane by Sytox Green with increasing the concentration. The findings revealed exhibited that ECEO and 1,8-Cineole increasingly and dose-dependently induced activation of caspase-3 enzyme ranging from 6.8 to 23.3%.

Conclusion

Our obtained results revealed that ECEO and its main compound, 1,8-Cineole exhibited the potent protoscolicidal in vitro and ex vivo; and if more research is done on their efficacy and toxicity in animal models and even clinical setting, it can be suggested as a protoscolicidal agent to use during hydatid cyst surgery.

Detection of Anti-Echinococcus granulosus Antibodies in Humans: An Update from Pakistan

Human cystic echinococcosis (CE) is a zoonotic disease caused by the larval stage of Echinococcus granulosus sensu lato that causes economic losses by affecting livestock and also poses a public health threat worldwide. The present study is the first retrospective report on the seroprevalence of anti-E. granulosus antibodies in humans in Pakistan. The study used data from 93 blood analysis reports of patients suspected of having CE from different medical centers in Lahore, Pakistan. Out of 93 sera samples, 20 (21.5%) were seropositive, and higher seropositivity (17.2%) was recorded with the indirect hemagglutination test (IHA) than with enzyme-linked immunosorbent assay (ELISA). The findings indicated that age, gender, and year had no significant relationship with the seropositivity of CE. The current study provides directions towards the management of the disease in the near future in Pakistan.

Fatal infection with Versteria sp. in a muskrat, with implications for human health

The Taeniidae tapeworms are a family of helminths that have a similar life cycle, with intermediate hosts developing characteristic cysts in visceral organs. We describe here a case in Pennsylvania, USA, of fatal Versteria infection in a muskrat (Ondatra zibethicus), which, to our knowledge, has not been reported to develop disease associated with infection. Postmortem examination revealed widespread tissue loss and replacement by solid-bodied cestode larvae with minimal adjacent inflammation in many visceral organs, most severe in the lungs, liver, and brain. Key morphologic features via histology included cephalic structures and short rostellar hooklets, which are characteristic for the genus. Genetic characterization confirmed the cestode as being an undescribed lineage of Versteria that has been implicated as the cause of severe morbidity and mortality in humans and nonhuman primates in North America. Considering the zoonotic significance of this pathogen, our report expands on the limited literature regarding disease caused by Versteria and emphasizes the need to identify the causative tapeworm more accurately, especially in rodent intermediate hosts given that previous reports do not have molecular confirmation of species.

Structural changes and expression of hepatic fibrosis-related proteins in coculture of Echinococcus multilocularis protoscoleces and human hepatic stellate cells

Background

Echinococcus multilocularis is the causative agent of human hepatic alveolar echinococcosis (AE). AE can cause damage to several organs, primarily the liver, and have severe outcomes, such as hepatic failure and encephalopathy. The main purpose of this study was to explore the interactions between hepatic stellate cells (HSCs) and E. multilocularis protoscoleces (PSCs). The results of this study provide an experimental basis for further examination of the pathogenesis of hepatic fibrosis due to AE infection.

Methods

We investigated the role of Echinococcus multilocularis (Echinococcus genus) PSCs in hepatic fibrosis by examining structural changes and measuring hepatic fibrosis-related protein levels in cocultures of PSCs and human HSCs. Structural changes were detected by transmission electron microscopy (TEM), and levels of the hepatic fibrosis-related proteins collagen I (Col-I), alpha-smooth muscle actin (α-SMA) and osteopontin (OPN) were measured by western blotting and enzyme-linked immunosorbent assay (ELISA).

Results

Under coculture (1) both PSCs and HSCs exhibited morphological changes, as observed by TEM; (2) Col-I, α-SMA, and OPN expression levels, which were determined by western blotting and ELISA, significantly increased after 3 days of incubation.

Conclusions

The results of this study provide insights into the molecular mechanisms of AE-induced hepatic fibrosis.

Graphical abstract

A Challenging Diagnosis of Two Ruptured and Intact Pulmonary Echinococcal Cysts in a 54-Year-Old Woman: A Case Report

PURPOSE

Echinococcosis is one of the most important parasitic zoonotic diseases around the world. Echinococcus granulosus is the most widespread species of the genus Echinococcus that can develop cysts in different parts of the body. We tried to present a case of pulmonary cystic echinococcosis.

METHODS

Here, we report a rare case of two ruptured and intact cysts in a 54-year-old woman with weakness, lethargy, body pain, stomachache, dizziness, and vision problems.

RESULTS

According to the patient's manifestations and imaging findings, besides the COVID-19 pandemic, she was suspected of having COVID-19 and tuberculosis. However, when the aspirated sample was stained, hooklets of E. granulosus were observed. Surgical removal and chemotherapy were used for treatment.

CONCLUSION

Treatment of pulmonary cystic echinococcosis is based on surgery, but, along with it, the chemotherapy makes a better prognosis.

New geographic records for Echinococcus canadensis in coyotes and moose from Nova Scotia, Canada

Echinococcus spp. tapeworms can cause serious diseases in mammals, including humans. Within the E. granulosus species complex, metacestodes produce unilocular cysts that are responsible for cystic echinococcosis in animal intermediate hosts. Canids are definitive hosts, harbouring adult cestodes in their intestines. Adult E. canadensis were recovered from the small intestine of 1 of 262 coyotes (Canis latrans) from Nova Scotia, Canada. Subsequently, we found unilocular cysts in lungs and livers of 4 of 8 sympatric moose (Alces alces) from Cape Breton Island. DNA was extracted from three cysts using the Qiagen DNeasy Blood and Tissue kit and assayed by polymerase chain reaction (PCR) with primers (cest4 and cest5) for a 117-bp region of the small subunit of ribosomal RNA of E. granulosus sensu lato, and further validated as E. canadensis G8 using primers targeting nicotinamide adenosine dinucleotide dehydrogenase subunit 1 (ND1) and cytochrome c oxidase subunit 1 (CO1) mitochondrial genes. These are the first records of E. canadensis in any of the three Maritime provinces, which include Nova Scotia, New Brunswick, and Prince Edward Island. The parasite was thought to be absent in this region due to extirpation of wolves (Canis spp.) in the 1800s. These findings suggest that further wildlife surveillance and risk assessment is warranted.

Isolated renal hydatid disease: varied presentations, treatments, dilemmas, and the way ahead: case report series

Background

Hydatid disease is an infectious disease that affects several organs. Isolated renal involvement is very rare. The treatment for renal hydatid cyst ranges from minimally invasive percutaneous aspiration techniques to laparoscopic and open techniques. We describe five cases of isolated renal hydatidosis with varied presentations who were treated successfully by various methods.

Case presentation

The presenting symptoms included flank pain (n = 5), mass abdomen (n = 2), and hydaturia (n = 1). In 4 patients, the diagnosis of a hydatid cyst was known preoperatively, but one patient with a preoperative diagnosis of a simple cyst was found to harbor hydatidosis intra-operatively. Eosinophilia as a marker for the active disease was present in 60% (3/5), while echinococcal serology was positive in only 25% (1/4). Two cases were approached laparoscopically, while three required an open approach. Two patients were treated with nephrectomy due to the high bulk of the disease, while the other three underwent renal preserving cyst excision.

Conclusions

The presence of eosinophilia in the preoperative workup may indicate an infective/active hydatid disease. Echinococcal serology is representative of past hydatid infection but cannot reveal about current disease status. Cysts with varied attenuations and residence in an endemic region may support a renal hydatid cyst diagnosis. A holistic approach including clinical history, laboratory parameters, and imaging is needed for diagnosis. Surgical treatment requires cyst excision, along with precautions to prevent spilling. Nephrectomy may be preferred in cases with minimal residual function.

Point-of-care Ultrasound Diagnosis of Pulmonary Hydatid Cyst Disease Causing Shock: A Case Report

Introduction

Point-of-care ultrasound (POCUS) is accepted as an important tool for evaluating patients presenting to the emergency department (ED) with dyspnea1 and undifferentiated shock.2 Identifying the etiology and type of shock is time-critical since treatments vary based on this information. Clinicians typically rely on the history, exam, and diagnostics tests to identify the etiology of shock. In resource-limited settings where there is reduced access to timely laboratory and diagnostic studies. The use of POCUS enables rapid classification and directed treatment of shock. Additionally, POCUS can aid in the diagnosis of rarer tropical diseases that can be important causes of shock in resource-limited settings.

Case Report

We discuss a case of a pediatric patient who presented to an ED in Cusco, Peru, with acute dyspnea and shock. Point-of-care ultrasound was used to expedite the diagnosis of a ruptured pulmonary hydatid cyst, guide proper management of septic and anaphylactic shock, and expedite definitive surgical intervention.

Conclusion

In resource-limited settings where there is reduced access to timely laboratory and diagnostic studies, the use of POCUS enables rapid classification and directed treatment of shock.

Evaluation of the scolicidal activities of eugenol essential oil and its nanoemulsion against protoscoleces of hydatid cysts

BACKGROUND

Cystic echinococcosis caused by the cestode Echinococcus granulosus remains a serious helminthic zoonosis affecting humans and animals in many endemic developing countries. Surgical intervention is the best management choice, although it is associated with high recurrence rates and serious complications. Also, the commonly used chemotherapeutics exhibited serious side effects. This study aimed to evaluate the protoscolicidal effects of eugenol (Eug) essential oil and its nanoemulsion (Eug-NE) against protoscoleces (PCs) of hydatid cysts in vitro.

METHODS

Eug-NE was prepared and characterized. Their cytotoxicity on macrophages was assessed by the 3-(4,5-dimethylthiazol-2-yl)-2,5-diphenyltetrazolium bromide assay. E. granulosus PCs were treated with various concentrations of Eug and Eug-NE at different exposure times. The viability of protoscoleces was evaluated by the eosin exclusion test, and the changes in the morphology of protoscoleces were assessed. Albendazole (ABZ) was used as a positive control.

RESULTS

The cellular cytotoxicity of Eug and Eug-NE on macrophage cells, in minimum and maximum concentrations (0.2 and 1 μl/mL), were nearly negligible ranging from 4.7% to 8.3% and 3.7% to 7.2%, respectively. The results showed highly significant activity of Eug-NE and Eug against hydatid PCs compared to ABZ (P < 0.05). Eug and Eug-NE have similar protoscolicidal effects at all used concentrations. Their highest scolicidal activity (100% mortality rate) was recorded at 1 μl/ml after 30 min incubation (LC50 = 0.298-LC90 = 0.521 and LC50 = 0.309-LC90 = 0.646, respectively). Both formulations showed time- and dose-dependent effects.

CONCLUSIONS

This study suggested the potent scolicidal activities of Eug and Eug-NE as promising alternative scolicidal agents. Future studies are recommended to explore the mechanism of action and treatment response in vivo and clinical settings.

A Review of the Antimicrobial Activity of Selenium Nanoparticles

Antimicrobial resistance has become a severe problem for health systems worldwide, and counteractions are challenging because of the lack of interest of pharmaceutical companies in generating new and effective antimicrobial drugs. Selenium nanoparticles have attracted considerable interest in treating bacteria, fungi, parasites, and viruses of clinical importance due to their high therapeutic efficacy and almost zero generation of adverse effects. Some studies have revealed that the antimicrobial activity of these nanoparticles is due to the generation of reactive oxygen species, but more studies are needed to clarify their antimicrobial mechanisms. Other studies show that their antimicrobial activity is increased when the surface of the nanoparticles is functionalized with some biomolecules or when their surface carries a specific drug. This review addresses the existing background on the antimicrobial potential offered by selenium nanoparticles against viruses, bacteria, fungi, and parasites of clinical importance.

Annual assessment of Echinococcus multilocularis surveillance reports submitted in 2021 in the context of Commission Delegated Regulation (EU) 2018/772

This report is part of the Echinococcus multilocularis surveillance scientific reports which are presented annually by EFSA to the European Commission and are intended to assess the sampling strategy, data collection and detection methods used by Finland, Ireland, United Kingdom (Northern Ireland) and Norway in their respective surveillance programmes. The surveillance programmes of these four countries were evaluated by checking the information submitted by each of them and verifying that the technical requirements were fulfilled as laid down in Commission Delegated Regulation (EU) 2018/772 of 21 November 2017 supplementing Regulation (EU) No 576/2013 of the European Parliament and of the Council with regard to preventive health measures for the control of Echinococcus multilocularis infection in dogs, and repealing Delegated Regulation (EU) No 1152/2011. The information was divided in four different categories for assessment: the type and sensitivity of the detection method, the selection of the target population, the sampling strategy and the methodology. For each category, the main aspects that need to be considered in order to accomplish the technical requirements of the legislation were checked against compliance of several criteria. Three of the countries participating in this surveillance (Finland, Ireland and Norway (mainland)) succeeded in the fulfilment of the technical legal requirements foreseen in Commission Delegated Regulation (EU) 2018/772 concerning these four different categories. Northern Ireland did not fulfil those requirements, not even assuming a diagnostic test sensitivity value of 0.99 (value provided by the national reference laboratory, higher than the conservative sensitivity value suggested by EFSA, i.e. 0.78). None of the four countries recorded positive samples in the 12-month reporting period.

Epidemiological, Morphometric, and Molecular Investigation of Cystic Echinococcosis in Camel and Cattle From Upper Egypt: Current Status and Zoonotic Implications

Cystic echinococcosis has been considered one of the major parasitic zoonoses which is associated with severe economic losses. The present study was undertaken to investigate the occurrence, organ distribution, cyst fertility, and viability of cystic echinococcosis in slaughtered camels and cattle from various abattoirs in Assiut Governorate, Egypt. The work also involved morphological, morphometric, and molecular identification of the parasite. The occurrence of hydatid cysts was investigated in total number of 100 lungs of camels and 574 liver and lungs of cattle admitted to three slaughterhouses at Assiut Governorate, Egypt. Moreover, several individual variable factors, including organ involvement, age, sex, and hydatid cyst characteristics, were studied to identify their possible association with the occurrence of the disease. Genomic DNA was extracted from the hydatid cysts, followed by molecular identification of the parasite through amplification of ribosomal DNA internal transcribed spacer (ITS) regions. Hydatid cysts were found in 6 camels (6%) out of 100 inspected camels, while 5 hydatid cysts (0.87%) were detected in a total number of 574 cattle examined. The parasite was detected exclusively in lungs of camels, while lungs were the main organ infected by the parasite in cattle and one hydatid cyst was found in the liver (0.17%). In camel, 66.7, 16.65, and 16.65%of detected cysts were fertile, sterile, and calcified, respectively, while in cattle, these percentages were 60, 20, and 20%, respectively. None of the studied variable factors were significantly associated with the occurrence of the disease in camels, with the exception that all cysts were found in the lung. Conversely, we found a significant association (P < 0.05) between the age and sex of the slaughtered cattle and the occurrence of hydatid cysts. In this respect, the rate of infection was higher in female cattle and those cattle more than 5 years (P < 0.05). The morphological, morphometric, and molecular studies confirmed the presence of the parasite. Taken together, our results concluded that camels and cattle play a potential role in maintaining the transmission cycle of this zoonotic parasite.

In vitro evaluation of albendazole-loaded nanostructured lipid carriers on Echinococcus granulosus microcysts and their prophylactic efficacy on experimental secondary hydatidosis

To enhance the therapeutic effects of albendazole (ABZ) on Echinococcus granulosus protoscoleces and metacestodes, ABZ-loaded nanostructured lipid carriers (ABZ-NLCs) are prepared by the hot high-speed homogenization method. Protoscoleces and microcysts were treated in vitro with free ABZ and ABZ-NLCs (concentrations of 1, 5, and 10 μg/ml), and the corresponding effects were monitored by methylene blue exclusion test and scanning and transmission electron microscopy. Chemoprophylactic treatment was performed on Balb/C mice 1 day before intraperitoneal injection of viable protoscoleces. The drugs were administered daily by intragastric inoculation for a period of 30 days. The prophylactic efficacy was assessed based on the number and weight of cysts developed in treated mice. The ultrastructural alterations in cysts were examined by transmission electron microscopy. After 18 days, all the protoscoleces incubated with 10 μg/ml ABZ-NLCs were killed, while 51.25 ± 4.03% of the protoscoleces incubated with 10 μg/ml free ABZ were still viable. Microcysts treated with ABZ-NLCs underwent degenerative alterations in a shorter time than when free ABZ was applied. The mean weight of the cysts recovered from mice of ABZ-NLCs group was significantly lower than that of the free ABZ group (P < 0.05), yielding prophylactic efficacy of 92.45% and 38.53%, respectively. The cysts treated with ABZ-NLCs showed marked ultrastructural changes in the germinal layer. This study demonstrated that both in vitro and in vivo treatments with ABZ-NLCs are significantly more efficient than treatment with free ABZ against E. granulosus protoscoleces, metacestodes, and prevention of cyst development in mice.

Laparoscopic transdiaphragmatic approach to a thoracic paravertebral hydatid cyst presenting with compression myelopathy

An elderly gentleman presented with heaviness over the right side of the chest, lower back pain and difficulty in walking for the last 6 months. He also reported of progressive weakness of the left leg associated with tingling and numbness for 2 months. Imaging studies revealed a large hydatid cyst in the right thoracic cavity compressing the spinal cord. The patient was prescribed a 14-day course of albendazole therapy. He underwent laparoscopic transdiaphragmatic deroofing and evacuation of the cyst. Postoperative recovery was uneventful. The patient started showing symptom relief from day 1 of surgery and by day 3, his right leg strength and sensation recovered remarkably. Echinococcal cyst is a zoonotic disease that can affect any part of the body. Vertebral involvement and spinal cord compression is a rare manifestation of echinococcal disease. Such cases pose diagnostic and therapeutic challenges and require a multidisciplinary approach to treat them successfully.

Genetic diversity and haplotypes of paediatric hydatid cyst isolates and first occurrence of E. canadensis (G6/G7) in paediatric cases in Turkey

Cystic echinococcosis (CE) is a neglected zoonotic tropical disease caused by Echinococcus granulosus sensu lato. The aim of this study was to investigate the genetic variation of hydatid cyst isolates obtained from surgically confirmed paediatric cases originating from two different regions in eastern Turkey. Seventeen paediatric cases aged between 6 and 16 were operated by open surgery, and the germinal layers of their cysts were obtained for further molecular analyses. After genomic DNA isolation, 875 bp mt-CO1 gene fragments were amplified in all samples by PCR. Then, the unidirectional sequence analyses of the PCR products were carried out. According to the BLAST analyses of 17 sequences, 16 of these sequences were matched with E. granulosus sensu stricto, while one sequence was identified as E. canadensis (G6/G7) for the first time in paediatric cases in Turkey. High haplotype diversity and low nucleotide diversity were observed in the E. granulosus s.s. sequences.

Another Piece of the Puzzle: Echinococcus oligarthrus Recorded in Jaguarundis (Herpailurus yagouaroundi) in Southern Brazil

Echinococcus oligarthrus is a tapeworm endemic to South America and widely distributed in the Amazon region. Its lifecycle is maintained by relationships between felids and their prey, mainly small sylvatic rodents, but humans can be infected occasionally. We report two female jaguarundis (Herpailurus yagouaroundi) harboring E. oligarthrus in southern Brazil. The felines were found road killed in periurban areas, and, during necropsy, the small intestine was examined. Visual inspection revealed helminths, which were submitted to microscopy and molecular examination. Morphologically, they were around 2.5 mm long, with four suckers and an armed scolex with two rows of hooks. Phylogenetic reconstruction using cytochrome c oxidase subunit I gene sequences placed samples from south Brazil in the same clade as all other E. oligarthrus samples, but as a sister group. Genetic distance gave similar results, resulting in a divergence of 0.087% between the samples described in this study and other samples. The geographic pattern of genetic diversity, as assessed by analysis of molecular variance, suggests that the divergency results from isolation by distance. This finding expands the geographic range of E. oligarthrus and brings new insights to help understand and prevent the zoonosis it causes.

Challenges in treatment of renal echinococcosis with gross hydatiduria and unsalvageable kidney: a case report

Introduction

Renal echinococcosis is of rare occurrence, and although often asymptomatic, it can present with various mild to drastic presentations, of which hydatiduria is pathognomonic. Diagnosis can be preliminarily established by imaging, and treatment is primarily surgical. We present a patient with renal echinococcosis treated successfully with exclusive antiparasitic pharmacotherapy after refusing surgery despite extensive renal involvement. We hope through this report to help establish future solid guidelines regarding this uncommon therapeutic approach.

Case presentation

This is a case of a 49-year-old Syrian shepherd presenting with flank pain and passage of grape-skin-like structures in urine. A diagnosis of renal echinococcosis with hydatiduria and significant parenchymal destruction was established based on exposure history, positive serology, imaging findings, and renal scintigraphy. After proper counseling, the patient refused nephrectomy and was therefore started on dual pharmacotherapy (albendazole and praziquantel) and is having an uneventful follow-up and a satisfactory response to treatment.

Conclusion

This case embodies the daily challenges physicians navigate as they uphold the ethical principles of their practice and support their patients’ autonomy while delivering the best standards of care and consulting the scientific evidence. Although surgery is the cornerstone of renal echinococcosis treatment, treating physicians should be prepared to tackle situations where surgery cannot be done and offer the best next available option for patients who refuse surgery. As data on exclusive pharmacotherapy are limited, future research should thoroughly investigate the efficacy of this uncommon approach and outline reliable recommendations, facilitating future clinical decision-making in this avenue.

Molecular characterization and immune protection of the 3-hydroxyacyl-CoA dehydrogenase gene in Echinococcus granulosus

BACKGROUND

Cystic echinococcosis (CE) is a serious parasitic zoonosis caused by the larvae of the tapeworm Echinococcus granulosus. The development of an effective vaccine is one of the most promising strategies for controlling CE.

METHODS

The E. granulosus 3-hydroxyacyl-CoA dehydrogenase (EgHCDH) gene was cloned and expressed in Escherichia coli. The distribution of EgHCDH in protoscoleces (PSCs) and adult worms was analyzed using immunofluorescence. The transcript levels of EgHCDH in PSCs and adult worms were analyzed using quantitative real-time reverse transcription PCR (RT-qPCR). The immune protective effects of the rEgHCDH were evaluated.

RESULTS

The 924-bp open reading frame sequence of EgHCDH, which encodes a protein of approximately 34 kDa, was obtained. RT-qPCR analysis revealed that EgHCDH was expressed in both the PSCs and adult worms of E. granulosus. Immunofluorescence analysis showed that EgHCDH was mainly localized in the tegument of PSCs and adult worms. Western blot analysis showed that the recombinant protein was recognized by E. granulosus-infected dog sera. Animal challenge experiments demonstrated that dogs immunized with recombinant (r)EgHCDH had significantly higher serum IgG, interferon gamma and interleukin-4 concentrations than the phosphate-buffered saline (PBS) control group. The rEgHCDH vaccine was able to significantly reduce the number of E. granulosus and inhibit the segmental development of E. granulosus compared to the PBS control group.

CONCLUSIONS

The results suggest that rEgHCDH can induce partial immune protection against infection with E. granulosus and could be an effective candidate for the development of new vaccines.

Hydatid Cyst of the Oromaxillofacial Region - A Rare Location: A Case Report and Review of the Literature

Oromaxillofacial hydatid cysts are rare, even in countries where echinococcosis is endemic. This study aimed to describe an isolated oromaxillofacial hydatid cyst and to discuss the epidemiology, clinical features, and treatment thereof. The authors report the case of a 12 year-old boy who presented with a 2-week history of an enlarging hydatid cyst in the parapharyngeal space extending to the neck, with no pulmonary or hepatic involvement. We present our clinical findings, diagnostic techniques, and treatment and review the relevant literature. Forty-one cases, with a male:female ratio of 1.21:1, have been reported, mostly in patients aged 20 to 40 years (both sexes). Oromaxillofacial hydatid cysts are most commonly located in the parotid gland (19.51%, n = 8), submandibular region including the submandibular gland (17.07%, n = 7), and infratemporal fossa (14.63%, n = 6). Only 2 (4.88%) cases of hydatid cysts in the parapharyngeal space have been reported before. Although isolated parapharyngeal space hydatid cysts are rare, oromaxillofacial surgeons should consider relevant diagnostic and therapeutic procedures to ensure complete resection.

Metabolomic profiling of active and inactive liver cystic echinococcosis

Cystic Echinococcosis (CE) is one of the life-threatening diseases worldwide. It is a parasitic zoonosis caused by tapeworms of the species Echinococcus granulosus sensu lato (s.l). The treatment options of CE vary from simple "watch and wait" approach to invasive treatment, based on the type and especially the nature of the cyst (active/inactive). Serological tests are inadequate to distinguish between active and inactive CE. A diagnostic reference that can determine whether the cyst is active or inactive can easily guide the treatment strategy. We aimed to test whether gas chromatography-mass spectrometry (GC-MS) and liquid chromatography-quadropole time of flight mass spectrometry (LC-qTOF-MS) based metabolomics can establish a plasma metabolic fingerprint of CE patients and identify a diagnostic reference to discriminate active and inactive CE cysts. Metabolite concentrations were measured in plasma samples of 36 active CE patients, 17 inactive CE patients and 31 healthy controls. Multivariate statistical analysis on 232 identified metabolites obtained from two analytical platforms was performed by using principle component analysis (PCA) and partial least square-discriminant analysis (PLS-DA) methods. The PLS-DA scores plot of the combined data set demonstrated a good separation between the groups. Compared to the healthy control group, decreased levels of squalene and increased levels of glyceric acid, 3-phosphoglycerate, glutamic acid, palmitoleic acid and oleic acid were determined in the CE patients. However, decreased levels of 3-phosphoglycerate and increased levels of 4-hydroxyphenylacetylglutamine, docosahexanoic acid were determined in active CE patients compared to the inactive CE patients. Determination of differences in metabolites may provide detailed understandings of potential metabolic process associated with active and inactive CE patients, and altered specific metabolic changes may provide some clues to obtain diagnostic reference for CE. This study has certain limitations: a. various factors affecting results of metabolomic studies such as lifestyle and dietary habits of the patients could not be fully controlled b. other infectious or malignant diseases of the liver should also be included as a positive control to evaluate the specificity of the diagnostic references.

A Rare Case of Cardiac Echinococcosis: The Role of Multimodality Imaging

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Multimodality imaging plays a crucial role in confirming cardiac echinococcosis.

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Speckle-tracking echocardiography gives information about regional myocardial function.

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Cyst rupture often causes life-threatening anaphylactic shock.

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We present an unusual case of cyst rupture, with chest pain as the only symptom.

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Complete surgical removal is the treatment of choice for cardiac echinococcosis.

Wandering parasite: endoscopic management of hydatid cysts of abdomen encroaching thorax

BACKGROUND

Minimal access surgery has opened avenues of hybrid approach for abdominal hydatid cysts extending into thorax. This approach of combined laparoscopy and thoracoscopy should be evaluated for its feasibility and efficacy.

AIM

Present prospective study was designed to highlight the feasibility and utility of endoscopic approach in the management of complex hydatid cyst of the liver and spleen extending into the thorax.

MATERIAL AND METHODS

Patients undergoing combined Laparoscopy and thoracoscopy for abdominal hydatid cysts extending into thorax over a period of 4 years were included in the study. Their clinical features, investigations, imaging, treatment and duration of hospital stay were studied. Clinical outcomes were assessed with respect to morbidity and mortality using Calvien Dindo scale.

RESULTS

A total of 15 patients were studied. All patients had thoracic hydatid cysts with liver involvement in 12, splenic involvement in 2, and both liver and spleen in 1 patient. The most common symptom was pain in the abdomen in 11 patients (73.3%) followed by lump in the abdomen in 2 patients (13.33%), and dyspnoea in 2 patients (13.33%). Computed Tomography was diagnostic in all patients. Most common type was Gomez type 1 (7 patients) followed by Gomez type II (3 Patient) and Gomez type III (2 patient). The mean operative time was 120 min. Mean hospital stay was 10 days. Pleural effusion being the commonest postoperative sequelae.

CONCLUSION

This endoscopic approach for liver and splenic hydatid cyst extending into thorax is feasible and averts morbidities of thoracotomy.

Albendazole Nanocrystal-Based Dissolving Microneedles with Improved Pharmacokinetic Performance for Enhanced Treatment of Cystic Echinococcosis

Cystic echinococcosis (CE) is a zoonosis caused by Echinococcus spp., affecting both humans and animals' lives. Current treatment of CE by oral administration of albendazole (ABZ) is hampered by several limitations. The poor aqueous solubility and the rapid metabolism of ABZ in the liver are the main issues, leading to lack of efficacy of the treatment. In the present study, we developed a nanocrystalline (NC) formulation of ABZ to be delivered intradermally using dissolving microneedles (DMNs). The NC formulation was developed using milling in an ultrasmall-scale device. Following several screenings, Pluronic F127 was selected as a suitable stabilizer, producing NCs with around 400 nm in size with narrow particle distribution. The crystallinity of ABZ was maintained as observed by DSC and XRD analysis. The NC approach was able to improve the dissolution percentage of ABZ by approximately three-fold. Furthermore, the incorporation of NCs into DMNs using the combination of poly(vinylpyrrolidone) and poly(vinyl alcohol) formed sharp needles with sufficient mechanical strength and insertion properties. Dermatokinetic studies revealed that >25% of ABZ was localized in the dermis of excised neonatal porcine skin up to 48 h after DMN administration. In in vivo pharmacokinetic studies, the AUC and relative bioavailability values of ABZ delivered by NC-loaded DMNs were found to be significantly higher than those obtained after oral administration of coarse suspension of ABZ or ABZ-NCs, as well as DMNs delivering coarse ABZ as indicated by the relative bioavailability values of >100%. Therefore, the combination approach developed in this study could maintain the systemic circulation of ABZ, which could be possibly caused by avoiding the first-pass metabolism in the liver. This could be beneficial to improve the efficacy of ABZ in CE treatment.

Anaphylactic shock due to ruptured pulmonary hydatid cyst in a young patient from Iran

Introduction

and importance: Hydatidosis is a zoonotic condition caused by contact with the tapeworm Echinococcus granulosus metacestode. The liver and lungs are the most prominent locations for cysts. This is a rare case of pulmonary hydatid cyst (PHC) rupture in a young woman following a severe cough.

Case presentation

On July 9, 2018, a 20-year-old woman presented to our hospital in northern Iran with a complaint of cough with excessive sputum, dyspnea, drooling, symptoms of nausea and vomiting, itching and urticarial. Imaging findings showed evidence of a large, space-occupying mass in the right lung. She underwent a thoracoscopic wedge resection (TWR) as a minimally invasive technique, to remove the wall and contents of the cyst. Also, anaphylactic shock occurred in the patient. Due to hemodynamic disorders and heart and respiratory failure, unfortunately, the patient expired.

Clinical discussion

The rupture of a hydatid cyst may result in irreversible damage. PHC rupture is a serious complication that causes excessive coughing and chest pain. A rupture into the pleural or pericardial cavity is a serious and potentially fatal disease.

Conclusion

Anaphylactic shock should be considered as one of the serious complications of PHC, particularly in young ones. Therefore, early diagnosis and appropriate treatment are essential to prevent severe complications such as anaphylactic shock.

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Anaphylactic shock due to ruptured pulmonary hydatid cyst in a young patient from Iran.

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Radiography and CT scan showed evidence of a large, space-occupying mass in the right lung.

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Early diagnosis and appropriate treatment are essential to prevent severe complications such as anaphylactic shock.

The situation of echinococcosis in stray dogs in Turkey: the first finding of Echinococcus multilocularis and Echinococcus ortleppi

Echinococcosis, caused by larval stage of the genus Echinococcus, is one of the most important zoonotic diseases worldwide. The purpose of this study was to determine the presence and prevalence of Echinococcus species in stray dogs of Erzurum, a highly endemic region for cystic echinococcosis (CE) and alveolar echinococcosis (AE) in Turkey. The study samples consisted of 446 stray dog faecal specimens collected from an animal shelter in Erzurum, Turkey, between October 2015 and February 2016. The faecal samples were collected from individual dogs for the isolation of taeniid eggs using the sequential sieving and flotation method (SSFM). Molecular analyses and sequencing revealed the prevalence of Echinococcus spp. as 14.13% (63/446) in faecal samples. The stray dogs harboured five different Echinococcus spp.: E. granulosus s.s. (G1/G3) (n = 41), E. equinus (G4) (n = 3), E. ortleppi (G5) (n = 1), E. canadensis (G6/G7) (n = 3) and E. multilocularis (n = 16). E. granulosus s.s. was the most abundant species. Surprisingly, the occurrence of E. multilocularis in dogs was revealed for the first time in Turkey. E. ortleppi was also reported for the first time in Turkey. These findings highlight a significant public health risk for human AE and CE, presenting useful baseline data on Echinococcus spp. infection in dogs for designing control strategies.

Fibrin Glue and Partial Capitonnage in Giant Hydatid Cyst in a Pediatric Patient

Surgery is still used as the first choice in the treatment of pulmonary hydatid cysts. Video-assisted thoracoscopic surgery (VATS) has started to be performed as a minimally invasive surgical option in recent years for lung hydatid cyst, few cases have been reported in the literature, especially in children. Thoracoscopic surgery experience is limited in pulmonary hydatid cyst for both adult and child patients. We present a pediatric case of giant lung hydatid cyst, in that we had partial capitonnage with VATS and fibrin glue.

Advances in research on echinococcoses epidemiology in China

Echinococcoses are serious zoonotic diseases in China's vast, western and north-western pastoral areas that has one of the highest prevalence in the world. The two most common forms, cystic echinococcosis (CE) and alveolar echinococcosis (AE), are co-epidemic in some areas causing a grave threat to people's health and economic development. Echinococcus spp. are transmitted through domestic, sylvatic and mixed cycles involving many kinds of host. Successful transmission requires a favourable environment for the growth of the parasites and survival of their eggs, while the unique customs and religious beliefs in the endemic areas pose a challenge to the prevention and control of these parasites. Based on previous epidemiological studies, this paper reviews the particular factors affecting the transmission of Echinococcus parasites in China, with a focus on biological (parasite genotype and the species, age, sex and density of hosts), environmental (landscape and climate) and social (age, gender, ethnicity, education, occupation, life style, cultural customs, living conditions and hygiene practices of humans in the endemic areas). These three factors interact with each other and jointly determine the parasites' transmission intensity, the study of which supports the formulation of the strategies and measures that are significant for control of these infections.

Epidemiological and Molecular Characterization of Echinococcus granulosus Isolated from Small Ruminants in Kashmir Valley, India

BACKGROUND

Cystic Echinococcosis (CE) is an emergent or re-emergent zoonosis and remains a public health and economic problem all over the world.

METHODS

The present study was carried on the prevalence and genotypes of Echinococcus present in small ruminants in Kashmir valley. A total of 2100, sheep (2052) and goats (48), slaughtered or spontaneously dead, from various areas of Kashmir valley were screened for the presence of hydatidosis. In case of goat none of the cases were found positive for hydatidosis, whereas, all the positive cases (85) were recorded in sheep only. The overall prevalence of hydatidosis was 4.04%. The prevalence was higher in female sheep (5.46%) compared to males (2.83%). Season-wise highest prevalence was in summer (4.55%), followed by autumn (4.1%), spring (3.89%) and winter (2.5%).The liver was observed to be the most frequently infected organ with relative prevalence of 61.17% followed by lungs (38.82%).The rDNA-ITS1 fragment of positive samples was amplified with BD1 / 4S primers.

RESULTS

The length of amplified fragment for all isolated samples was 1000bps. The products obtained on PCR were digested with four restriction enzymes (Rsa 1, Alu 1, Msp 1 and Taq1). Rsa 1, Alu 1, Msp 1 yielded identical fragments, 300 and 700 bp in sheep. TaqI restriction enzyme had no effect on PCR product and after digestion; intact 1000bps fragment was seen.

CONCLUSION

Phylogenetic analysis of ITS1 gene revealed that the common sheep strain (G1) is the predominant genotype in sheep in Kashmir valley.

Geographical Detector-based influence factors analysis for Echinococcosis prevalence in Tibet, China

Echinococcosis, caused by genus Echinococcus, is the most pathogenic zoonotic parasitic disease in the world. In Tibet of the People's Republic of China, echinococcosis refers principally to two types of severe zoonosis, cystic echinococcosis (CE) and alveolar echinococcosis (AE), which place a serious burden on public health and economy in the local community. However, research on the spatial epidemiology of echinococcosis remains inadequate in Tibet, China. Based on the recorded human echinococcosis data, maps of the spatial distribution of human CE and AE prevalence in Tibet were produced at city level and county level respectively, which show that the prevalence of echinococcosis in northern and western Tibet was much higher than that in other regions. We employ a geographical detector to explore the influencing factors for causing CE and AE while sorting information on the maps of disease prevalence and environment factors (e.g. terrain, population, and yak population). The results of our analysis showed that biological factors have the most impact on the prevalence of echinococcosis, of which the yak population contributes the most for CE, while the dog population contributes the most for AE. In addition, the interaction between various factors, as we found out, might further explain the disease prevalence, which indicated that the echinococcosis prevalence is not simply affected by one single factor, but by multiple factors that are correlated with each other complicatedly. Our results will provide an important reference for the evaluation of the echinococcosis risk, control projects, and prevention programs in Tibet.

Robotic resection for hydatid disease of the liver

Robotic-assisted surgery for the management of hepatic echinococcosis was introduced in 2016. The advantage it offers over laparoscopy is less rigidity with the use of the 360° rotation of the Endo-Wrist technology, thus allowing the preservation of the integrity of the liver tissue. Herein, we report the first successful robotic resection of the left lobe of the liver for hydatid disease in the Middle East. Our patient is a 71-year-old man found to have a large left hepatic lobe hydatid disease on CT scan. The hydatid liver disease was resected completely with an operation time of 130 min and minimal intraoperative blood loss. Patient did well postoperatively and was discharged home on day 2. Our experience shows that robotic surgery for hydatid disease of the liver can be safely performed, with an excellent outcome to the patient. It also provides unique technical advantages in the field of minimal-invasive surgery.

Long-term Follow-up of a Patient with Portal Hypertension and Hepatic Failure Due to Hepatic Hydatid Disease

We observed liver failure with a presumed etiology of echinococcosis in an 89-year-old woman. Our patient had been born and then resided on Rebun Island until she was 12 years old. At 46 years old, she had been referred to our hospital due to right abdominal pain. Ultrasound had revealed multilocular cysts in the right lobe of the liver. At 84 years old, the hepatic cyst occupied nearly the entire liver with ring-shaped calcification along the cyst wall. The patient was diagnosed with decompensated cirrhosis and hepatic hydatid disease based on typical imaging and the long-term natural clinical course.

First Report of Echinococcus ortleppi in Free-Living Wild Boar (Sus scrofa) from Portugal

Cystic echinococcosis (CE) is a zoonosis that is prevalent worldwide. It is considered endemic in Portugal but few studies have been performed on Echinococcus granulosus sensu lato and their hosts. In this study, CE cysts are reported for the first time in a free-living wild boar (Sus scrofa) in Portugal. The presence of the metacestodes in the liver of the wild boar was identified by morphological features, microscopic examination and molecular analysis. The sequencing of part of the DNA nuclear ribosomal internal transcribed spacer-1 (ITS-1) region revealed a G5 genotype that presently corresponds to Echinococcus ortleppi. This is the first report of E. ortleppi in Portugal and to the best of the authors’ knowledge, in Europe. These results suggest that wild boar may be a host of CE, namely, crossing the livestock–wildlife interface, which has important public health implications. Wildlife reservoirs must be taken into account as CE hosts and surveillance of game as well as health education for hunters should be implemented using a One Health approach, with implementation of feasible and tailor-made control strategies, namely, proper elimination of byproducts in the field.

lncRNA028466 regulates Th1/Th2 cytokine expression and associates with Echinococcus granulosus antigen P29 immunity

Background

Cystic echinococcosis (CE) is a parasitic disease that is caused by Echinococcus granulosus (Eg). The recombinant Echinococcus granulosus antigen P29 (rEg.P29) was shown to confer effective immunity to sheep and mice during E. granulosus secondary infection in our previous study. In this study, we sought to investigate the ability of long noncoding RNA 028466 (lncRNA028466) as a regulator for the protective immunity mediated by rEg.P29 vaccination and to study the effects of lncRNA028466 on CD4⁺T cell differentiation in mice spleen.

Methods

Female BALB/c mice were divided into two groups and were vaccinated subcutaneously with rEg.P29 antigen and PBS as a control (12 mice each group). Following prime-boost vaccination, CD4⁺T, CD8⁺T, and B cells from the spleen were isolated by flow cytometry. Quantitative real-time PCR (qRT-PCR) was performed to measure the expression of lncRNA028466 in these three kinds of cells. Then, lncRNA028466 was overexpressed and knocked down in naive CD4⁺T cells, and Th1 and Th2 cytokine expression was detected. qRT-PCR, western blot, and ELISA were performed to evaluate the production of IFN-γ, IL-2, IL-4, and IL-10, and flow cytometry was performed to detect the differentiation of Th1 and Th2 subgroups.

Results

lncRNA028466 was significantly decreased after the second week of immunization with rEg.P29 antigen. The proportion of CD4⁺ T cells was increased after rEg.P29 immunization. Overexpression of lncRNA028466 facilitated the production of IL-4, IL-10 and suppressed the production of IFN-γ, IL-2. Furthermore, after transfection with siRNA028466, IL-2 production was facilitated and IL-10 production was suppressed in naive CD4⁺ T cells.

Conclusions

Immunization with rEg.P29 downregulated the expression of lncRNA028466, which was related to a higher Th1 immune response and a lower Th2 immune response. Our results suggest that lncRNA028466 may be involved in rEg.P29-mediated immune response by regulating cytokine expression of Th1 and Th2.

Supplementary Information

The online version contains supplementary material available at 10.1186/s13071-021-04795-2.

Exploring Risk for Echinococcosis Spillover in Northern Minnesota Tribal Communities

Echinococcus spp. are zoonotic cestode parasites with a worldwide distribution and a complex, two-host life cycle involving carnivore definitive hosts and small mammal or ungulate intermediate hosts. Surveillance for Echinococcus spp. in the Midwestern United States (USA) is rare. Using a mixed-methods approach, we examined Echinococcus infection risks in wildlife and domestic dogs in four Minnesota Tribal Nations. We hypothesized that the spillover of Echinococcus spp. into domestic dogs would vary with the presence or absence of suspected wildlife host species and certain behaviors associated with domestic dog ownership, like feeding wildlife host carcasses or frequency of veterinary care. Among 83 dogs tested, three (3.6%) were positive for Echinococcus spp. Despite low prevalence, pet owner survey and focus group findings indicated that dogs encounter peri-domestic wildlife most often when they roam freely or consume wildlife carcasses. This study demonstrates a need for further research into spillover potential of endemic zoonotic Echinococcus spp. in the Midwest USA.

Genetic Characterization of Echinococcus granulosus Sensu Lato in Livestock and Human Isolates from North of Iran Indicates the Presence of E. ortleppi in Cattle

PURPOSE

Identification of different genotypes of echinococcal cyst in various domestic herbivores and humans within the target area was the principal aim of the present study, performed using sequence data of cox1 and nad1 mitochondrial genes.

METHODS

A total of 57 cystic echinococcosis (CE) cysts were isolated from indigenous livestock including 45 cattle, 9 sheep and 3 goats from several slaughterhouses in Guilan Province. Moreover, 12 formalin-fixed paraffin-embedded (FFPE) CE cyst tissues from humans were also included, obtained from the archives of several hospitals in Rasht, the capital of Guilan. Genetic sequencing was conducted using mitochondrial cytochrome c oxidase subunit 1 (cox1) and NADH dehydrogenase subunit 1 (nad1) genes.

RESULTS

Our results found that E. granulosus sensu stricto (s.s.) and E. ortleppi were present in 92.7% and 7.2% isolates, respectively. E. granulosus s.s. (genotypes G1 and G3) and E. ortleppi were isolated from various livestock whereas all CE cysts isolated from humans were E. granulosus s.s. G1 genotype.

CONCLUSION

We found that E. granulosus s.s. G1 was the predominant genotype within the study region. This is the first study to report E. ortleppi in cattle in Iran.

A 28-Year-Old Pregnant Woman With a Lung Abscess and Complicated Pleural Effusion

CASE PRESENTATION

A 28-year-old woman G1P0 at 22 weeks of gestation and with no significant medical history presented to the ED complaining of worsening dyspnea and right-sided pleuritic chest pain. Symptoms started 2 weeks before presentation, with minimal productive cough and dyspnea on exertion. One week after the initial symptoms, the patient started noticing right-sided chest and shoulder pain along with subjective fevers and night sweats. She denied hemoptysis, weight loss, abdominal pain, diarrhea, nausea, vomiting, arthralgia, or rash. Her pregnancy had so far been uncomplicated. The patient did not use tobacco, alcohol, or recreational drugs. She worked at a daycare center but denied any particular sick contacts. She moved to the United States 7 years ago from Sudan and denied any recent travel.

A 9-Year-Old Boy With Recurrent Chest Pain and Nonresolving Pneumonia

CASE PRESENTATION

A previously healthy, 9-year-old boy presented with five recurrent episodes of left-sided chest pain with low-grade fever over the last 18 months. The pain usually lasted for few hours, was severe and consistent, and resolved spontaneously. It worsened during inspiration, physical activity, and swallowing. He did not experience any cough, dyspnea, chills, cold sweats, or weight loss. His medical and family history was unremarkable.

Computed tomography and magnetic resonance imaging of hydatid disease: A pictorial review of uncommon imaging presentations

Hydatid disease (HD), also known as echinococcal disease or echinococcosis, is a worldwide zoonosis with a wide geographic distribution. It can be found in almost all parts of the body and usually remains silent for a long period of time. Clinical history can be varied based on the location, size, host immune response, and complications.

The most common imaging modalities used for diagnosis and further evaluations of HD are ultrasound, computed tomography (CT), and magnetic resonance imaging (MRI). Although conventional radiography may be the first used tool, rarely can lead to a definite judgment. Clinical indications and cyst location may alter the choice of imaging. MRI and CT would be useful when the involved area is inaccessible for ultrasound or surgical treatment is required. CT is particularly valuable for osseous organ involvements and the presence of calcifications in the cyst and also demonstrates the size, number, and local complications. MRI can differentiate HD from neoplasms in cases with an unusual appearance on imaging. Moreover, it is preferable in biliary or neural involvements. Besides, more detailed images of MRI and CT could help to resolve the diagnostic uncertainty.

Imaging is the main stem for HD diagnosis. Brain, orbit, muscle, bone, and vascular structures are less commonly involved areas. Familiarity with typical clinical presentation, CT scan and MR imaging findings of HD in this sites facilitate the radiologic diagnosis and guiding appropriate treatment.

Angioembolization in massive hemoptysis for a patient with acute coronary syndrome and history of hydatid cyst

Cystic echinococcosis (CE) or hydatid disease is a zoonosis caused by ingestion of the eggs of the tapeworm Echinococcus granulosus. Larger cysts can cause symptoms by compressing surrounding tissues. Large cysts can also rupture and cause sudden onset of cough, fever, hypersensitivity reactions, and massive hemoptysis. We report a case of hydatid cyst, which caused massive hemoptysis after an urgent percutaneous coronary intervention and was successfully controlled with bronchial artery embolization. <Learning objective: In patients with hydatid cyst, even old lesions, there is a possibility of bleeding and massive hemoptysis after anticoagulation treatment. Bronchial artery embolization is a safe and effective therapy in these situations, when the patient is not a good surgical candidate and the bleeding is life-threatening.>.

Effects of Zataria multiflora essential oil on the germinative cells of Echinococcus granulosus

Background

Novel and more efficient compounds are urgently required for medical treatment of cystic echinococcosis (CE). Germinative cell culture of Echinococcus granulosus could be used for anti-echinococcosis agent tests and other biological studies on CE. This study was performed to establish an in vitro cell culture model for E. granulosus germinative cells and to evaluate the lethal effect of Zataria multiflora essential oil (ZMEO) on the cultured cells.

Methods

The inner surface of germinal layers of CE cysts was scraped, and the obtained materials were trypsinized to obtain a suspension of single germinative cells. Medium 199 was used as the basic culture medium and was supplemented with fetal bovine serum, 2-mercaptoethanol, l-cysteine, l-glutamine, glucose, sodium pyruvate, hydatid fluid, amphotericin B and antibiotics. The cells were cultured at a concentration of 10⁴ cells/ml of culture medium and incubated at 37 °C. The culture medium was replaced every 7 days. Chemical composition of ZMEO was identified by GC-MS analysis. ZMEO was tested at concentrations of 0.5–8 mg/ml. Viability of the cells was assessed by trypan blue exclusion assay.

Results

A significant increase in the cell number was evident at 20, 30 and 45 days after cultivation. At 45 days of cultivation, the number of cells was approximately five-fold higher than on the first day. In GC-MC analysis, carvacrol, p-cymene, g-terpinene and thymol were found to be the main compounds of ZMEO. The lethal effect of ZMEO on the germinative cells at concentrations of 6, 7 and 8 mg/ml was 100% after 60, 25 and 7 min of exposure, respectively.

Conclusions

At 45 days of cultivation, the cell concentration was suitable for the desired in vitro experiments. A high lethal effect of ZMEO on the germinative cells of E. granulosus may be considered an opportunity for the introduction of a novel, more effective and safer therapeutic agent for treatment of CE using an herbal product.

Graphic abstract

Development of Optical Biosensor Using Protein A-Conjugated Chitosan-Gold Nanoparticles for Diagnosis of Cystic Echinococcosis

Human echinococcosis is a serious parasitic diseasethat still affects millions of people in many parts of the world. Since it can offer a critical threat to people's health, it is important to discover a rapid, convenient, and economical method for detection. Herein, we propose a novel point of care assay, namely, an enhanced immuno-dot-blot assay for diagnosis of cystic echinococcosis (hydatidosis). This method is based on the formation of a sandwich complex between a goldnanoprobe (chitosan-gold nanoparticleprotein A) and hydatid cyst antigen (Ag B), which holds anti-Ag B antibodies. Briefly, protein A was conjugated to chitosan-gold nanoparticles via glutaraldehyde chemistry. Then, Ag B was immobilized on the surface of a nitrocellulose membrane, which was followed by the addition of the sera sample and gold nanoprobes. The positive signals were easily detectable by naked eye. The signal intensity of this biosensor was proportional to the concentration of active anti-Echinococcus granulosus antibodies on the surface of the nanoparticles, titer of antibodies in the sera samples, and concentration of Ag B coated on the nitrocellulose membrane. The minimum concentration to use the protein A for conjugation to detect titer of anti-Echinococcus IgGand the concentration of Ag B coated in nitrocellulose membrane were 0.5 and 0.3 mg/mL, respectively. This enhanced immuno-dot-blot assay offers a simple diagnostic technique withoutthe need for expensive equipment for diagnosis of echinococcosis.

Laparoscopic or open treatment for hepatic alveolar echinococcosis: A single-institution experience

OBJECTIVE

The aim of this study was to evaluate the safety and efficacy of laparoscopy in the treatment of hepatic alveolar echinococcosis (AE).

METHODS

Between January 2018 and December 2019, 213 hepatic AE patients were admitted to the authors' institution. Among them, 165 patients (77.46%, 165/213) underwent surgery. Of 13 patients who underwent laparoscopic treatment, two required conversion to open surgery. The remaining 11 patients (group 1) were analyzed. During the same period, 154 patients underwent open surgery, but only 14 records were compatible with the criteria for the laparoscopic approach and were reviewed retrospectively (group 2).

RESULTS

Conversion to open surgery occurred in two cases. Both groups were basically consistent in terms of detailed demographic data, characteristics of the lesions, and surgical strategy (P > 0.05). The laparoscopic group not only achieved the same R0 resection as the open group, but the results were also significantly superior to those of the open group in terms of postoperative complications, postoperative catheterization time, and postoperative hospital stay (P = 0.042, P = 0.046, and P = 0.045, respectively). No recurrences were observed in either group during this period.

CONCLUSIONS

Laparoscopic surgery provides a safe and efficacious approach for hepatic AE in selected patients. Large, prospective, randomized trials are needed to confirm its superiority.

Meta-analysis of the prevalence of Echinococcus in dogs in China from 2010 to 2019

BACKGROUND

Echinococcosis (canine Echinococcus disease) is a neglected tropical disease that causes serious public harm. Dogs, as a terminal host of Echinococcus spp., are a key part of the Echinococcus epidemic. Echinococcosis spreads easily in humans and animals in some areas of China and it is therefore necessary to fully understand the prevalence of Echinococcus spp. in dogs.

METHODOLOGY/PRINCIPAL FINDINGS

PubMed, ScienceDirect, Chongqing VIP, China National Knowledge Infrastructure (CNKI), and WanFang databases were searched for relevant articles published in the past 10 years. A final total of 108 studies were included. The overall prevalence of Echinococcus spp. in dogs in China was 7.3%, with the highest point estimate found in sampling year 2015 (8.2%) and publication year 2015 (16.5%). Northwestern China (7.9%) had the highest infection rate in China. Qinghai Province (13.5%) showed the highest prevalence among the 11 provinces we included. We also found that geographical and climatic factors are related to the incidence of canine echinococcosis. We further investigated the source of heterogeneity by analysis of subgroups (sampling district, detection method, dog type, season, parasite species, medication, and study quality level).

CONCLUSIONS/SIGNIFICANCE

Our research indicated that Echinococcus spp. were still prevalent in some areas in China. More localized prevention and control policies should be formulated, including improving drinking water hygiene and strengthening hygiene promotion. We recommend the rational use of anti-Echinococcus drugs. In addition, treatment of livestock offal and feces and improving the welfare of stray dogs may play an important role in reducing canine Echinococcus infections.

Epidemiological survey of human echinococcosis in east Gansu, China

Echinococcosis is endemic in pastoral regions of south, west and mid-Gansu province, China. The present study aimed to determine the prevalence of echinococcosis in east Gansu, and analyze its associated risk factors. A cross-sectional survey was conducted in 2011 in 12 villages of Xiaonangou township, Huan County in east Gansu province by ultrasound abdominal scan and auxiliary serotest, and a prevalence surveillance study from 2008 to 2014 was performed in one villages by ultrasonography screening. Questionnaire information analysis indicates that the risk factors are in association with the gender, age, and education level. The cross-sectional survey found a cystic echinococcosis prevalence of 2.21% (107/4837). Higher prevalence was seen in females (χ² = 4.198, P < 0.05), older ages (> 60 years) (χ²_trend = 96.30, P < 0.05), and illiterates (χ² = 90.101, P < 0.05). Prevalence surveillance showed changing profile of 3.35% in 2011 to 0.88% (1/113) in 2014.