Echinococcosis: a review

Application of Multi-Slice Computed Tomography for the Preoperative Diagnosis and Classification of Pulmonary Cystic Echinococcosis

Pulmonary cystic echinococcosis remains a serious threat to public health. A standardized, imaging-based classification method for pulmonary echinococcosis has not yet been developed despite the existence of a standardized ultrasound classification method and treatment plan for hepatic cystic echinococcosis. Chest computed tomography (CT) images from 34 cases of pulmonary cystic echinococcosis with 46 lesions were used for classification based on the World Health Organization (WHO) standardized ultrasound classification of hepatic cystic echinococcosis. CT findings were compared with intraoperative observations and postoperative pathological results to assess accuracy. Pulmonary cystic echinococcosis was common in women (14/34, 41.2%) and children (14/34, 41.2%) with a single cyst (28/46, 60.9%). Most lesions were classified as cystic echinococcosis 1(CE1, 19/46) or cystic echinococcosis 3(CE3, 21/46). Blood leukocytosis was mostly observed in CE3 lesions (100%, 9/9) (p < 0.05). The preoperative CT diagnosis of pulmonary cystic echinococcosis had an accuracy rate of 100%. The preoperative CT typing, and postoperative pathological typing had a coincidence rate of 97.8% (45/46). Our study provided a classification method based on CT imaging for pulmonary cystic echinococcosis that can be used during pre-surgical planning to reduce patient’s postoperative complications and mortality.

Echocardiographic Features of Cardiac Echinococcal Infection

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Cardiac masses are a rare but important finding requiring detailed investigation.

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Echocardiography is a first-line imaging modality.

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CT and MRI together allow precise structural and tissue characterization.

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Surgical removal is a potentially curative treatment for cardiac hydatid cysts.

Rapid Growth of Hydatid Cyst: A Pediatric Case Report

Hydatid disease is a parasitic infection caused by Echinococcus granulosus with worldwide distribution. The most affected organs are liver and lungs, but it can be detected in any other organs as well. We reported a 5-yr-old boy from Shiraz, southern Iran in 2017 who presented with abdominal discomfort. Imaging revealed multiple liver hydatid cyst and a huge kidney hydatid cyst. This case showed the possible implication of rapid growth of multiple hydatid cyst as well as unusual organ presentation in the pediatric population.

Combining derivative Raman with autofluorescence to improve the diagnosis performance of echinococcosis

Echinococcosis is a zoonotic parasitic disease transmitted by animals and distributed all over the world. There is no standardized and widely accepted treatment method, and early and accurate diagnosis is crucial for the prevention and cure of echinococcosis. Here, we explored the feasibility of using derivative Raman in combination with autofluorescence (AF) to improve the diagnosis performance of echinococcosis. The spectra of serum samples from patients with echinococcosis, as well as healthy volunteers, were recorded at 633 nm excitation. The normalized mean Raman spectra showed that there is a decrease in the relative amounts of β carotene and phenylalanine and an increase in the percentage of tryptophan, tyrosine, and glutamic acid contents in the serum of echinococcosis patients as compared to that of healthy subjects. Then, principal components analysis (PCA), combined with linear discriminant analysis (LDA), were adopted to distinguish echinococcosis patients from healthy volunteers. Based on the area under the ROC curve (AUC) value, the derivative Raman + AF spectral data set achieved the optimal results. The AUC value was improved by 0.08 for derivative Raman + AF (AUC = 0.98), compared to Raman alone. The results demonstrated that the fusion of derivative Raman and AF could effectively improve the performance of the diagnostic model, and this technique has great application potential in the clinical screening of echinococcosis.

Closed Cyst Resection for Liver Hydatid Disease: a New Standard

BACKGROUND

Although radical resections are recommended for the surgical management of liver hydatid disease (LHD), whether closed (CCR) or opened (OCR) cyst resections should be performed remains unclear. The aim of this study was to compare the postoperative and long-term outcomes of CCR and OCR for primary and recurrent LHD.

MATERIALS AND METHODS

Medical charts of patients who underwent surgery at a single centre were retrospectively reviewed and compared with respect to major postoperative complications and recurrence rates.

RESULTS

Seventy-nine CCRs and 37 OCRs were included. The major morbidity rates were 19% and 5% in the OCR and CCR groups, respectively (P = 0.036). In multivariate analysis, OCR (P = 0.030, OR = 5.37) and the operative time (P < 0.001, OR = 18.88) were the only independent predictors of major complications. The 5-year and 10-year recurrence rates were both 0% in the CCR group compared to 18% and 27%, respectively, in the OCR group (P < 0.001). The mean time to recurrence was 10.5 (± 8) years.

DISCUSSION

Closed cyst resection for LHD is a safe and effective approach with a low risk of recurrence. Considering that recurrence could appear more than 10 years after surgery, follow-up of patients should be adapted.

Factors influencing the spatial distribution of cystic echinococcosis in Tibet, China

Cystic echinococcosis (CE), which is caused by Echinococcus granulosus, is a worldwide helminthozoonosis that is highly endemic in the Tibet Autonomous Region of China and has important public health and economic impacts. However, the spatial epidemiological characteristics of CE in Tibet are still unclear. Based on recorded human CE cases and the use of a geographic information system, the spatial distribution patterns of CE prevalence at three different scales were analyzed. In addition, a spatial agglomeration map of CE prevalence was generated based on cold/hot spot analysis. By combining maps of environmental and biological covariates with information about known human CE cases, the links between CE prevalence and relevant covariates were explored, revealing that the annual average precipitation, elevation, water accessibility and animal population (dog and yak) were associated with the prevalence of CE at the significance level of P < 0.05. Our results provide a novel insight and better understanding of the current situation of and the factors influencing CE in Tibet, which can help public health authorities develop disease prevention and control strategies.

Survey of coyotes, red foxes and wolves from Wyoming, USA, for Echinococcus granulosus s. l

The paraphyletic group Echinococcus granulosus sensu lato is comprised of parasitic tapeworms of wild and domestic canids such as wolves (Canis lupus) and coyotes (Canis latrans), which serve as definitive hosts, and ungulates, which are the intermediate hosts. Members of this tapeworm group are characterized by both cosmopolitan distribution and zoonotic disease potential. This survey (conducted from 2012 through 2017) was designed to provide insight into the prevalence and distribution of this parasite in wild canids in Wyoming. Echinococcus sp. infections were documented in 14 of 22 gray wolves (63.6%), 1 of 182 coyotes (0.55%) and 0 of 5 red foxes (Vulpes fulva). Echinococcus granulosus s. l. was confirmed in 4 of these 14 specimens obtained from wolves with two parasite specimens corresponding morphologically with E. canadensis (G8/G10). These results suggest that wolves serve as the major definitive host of E. granulosus s. l. in Wyoming, while coyotes do not play an equivalent role. Limited sample size precludes evaluation of the importance of the red fox as a favorable definitive host. Whereas this study documents the occurrence of E. granulosus s. l. in Wyoming, the zoonotic disease risk does not appear to be high. Education remains the key to disease prevention, coupled with good hygienic practices by humans and anthelmintic treatment of domestic dogs exhibiting elevated risk of exposure.

[Hepatic Hydatid Cyst: A Case Report]

Hydatid cysts are caused by an infestation with larval tapeworms of the genus Echinococcus. The disease is endemic in developing countries but has rarely been reported from immigrant workers in Korea. This paper reports a case of hepatic hydatid cyst in a 27-year-old female. She was referred with abdominal pain that had persisted for the past 2 months. The patient was a foreign worker from Mongolia. The physical examination was unremarkable, and blood tests showed peripheral blood eosinophilia and elevated liver enzymes. Abdominal ultrasonography showed a well-circumscribed cystic mass with septation in the liver. A surgical resection was performed for complete removal. After uncomplicated postoperative recovery, the patient was discharged with albendazole 400 mg twice daily. The hydatid cyst is an important disease that should be considered in the differential diagnosis of cystic lesions in the liver, particularly in those who have lived in endemic areas. A correct early diagnosis based on the typical image findings is important for early treatment before the rupture of the cyst, which is associated with low morbidity and mortality. A current surgical resection combined albendazole are effective treatments for hepatic hydatid cysts, associated with low recurrence rates.

A global assessment of Echinococcus multilocularis infections in domestic dogs: proposing a framework to overcome past methodological heterogeneity

Echinococcus multilocularis, the aetiological agent of human Alveolar Echinococcosis, is transmitted between small mammals and wild or domestic canids. Dogs infected with E. multilocularis as dead-end hosts. Whereas E. multilocularis infections in wild hosts and humans have been well-studied in recent decades, infections in domestic dogs are sparsely reported. This literature review and meta-analysis highlighted gaps in the available data and provided a re-assessment of the global distribution of domestic dog E. multilocularis infections. We found 46 published articles documenting the prevalence of E. multilocularis in domestic dogs from 21 countries across Europe, Asia and North America. Apparent prevalence estimates ranged from 0.00% (0.00-0.33%) in Germany to 55.50% (26.67-81.12%) in China. Most studies were conducted in areas of high human Alveolar Echinococcosis. By accounting for reassessed diagnostic sensitivity and specificity, we estimated true prevalence in a subset of studies, which varied between 0.00% (0.00-12.42%) and 41.09% (21.12-65.81%), as these true prevalence estimates were seldom reported in the articles themselves. Articles also showed a heavy emphasis on rural dogs, dismissing urban ones, which is concerning due to the role urbanisation plays in the transmission of zoonotic diseases, especially those utilising pets as definitive hosts. Lastly, population studies on canine Alveolar Echinococcosis were absent, highlighting the relative focus on human rather than animal health. We thus developed a framework for investigating domestic dog E. multilocularis infections and performing risk assessment of dog-associated transmission to fill the gaps found in the literature.

Rupture of pulmonary hydatid cyst in pediatrics: A cross-sectional study

Introduction

Pulmonary hydatid cyst is a parasitic disease causing an endemic and a health burden in many regions. Lung cysts are more common than liver cysts in children and patients may remain asymptomatic. Cyst rupturing is not uncommon, and it is considered the most feared complication. In this cohort study, we aimed to identify the risk factors related to cyst rupture in a Jordanian pediatric population.

Methods

We retrospectively evaluated all pediatric patients who underwent cystostomy and capitonnage for pulmonary hydatid cyst between 2003 and 2020 at King Abdullah University Hospital.

Results

We found 43 patients with a mean age of 13 ± 4 years who suffered from 61 pulmonary cysts. 55.6% of them were males. The most prevalent symptom was shortness of breath. The rupture rate for patients was 39.5%, and 29.5% for cysts. None of the patients with cyst rupture had an anaphylactic reaction. The left lower lobe was the most common location for both intact and ruptured cysts. 25.6% of the patients had giant cysts (>10 cm) with a mean of 7.4 cm for all cysts. Patients with intact cysts had higher-rates of cough (42.3% vs. 29.4%) and lower-rates of shortness of breath (34.6% vs. 52.9%) than patients with ruptured cysts, which were not statistically significant. Although statistically insignificant, patients with ruptured cysts tended to have multiple cysts in one lung (29.4% vs. 7.7%, p = 0.180), and more complication rates (29.4% vs 7.7%, p = 0.09). Both groups had almost identical IgG-ELISA positive results. We found no significant association between cyst rupture and age, gender, presenting symptoms, cyst size, cyst location, and rate of postoperative complications.

Conclusion

The rupture of pulmonary hydatid cyst has clinical consequences in pediatric patients, further studies on larger populations are needed to identify factors that make patients more prone to rupture and prioritize them for clinical monitoring and management.

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Hydatid cyst rupture is a common serious complication in pediatrics with 39.5% of the diagnosed cases.

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About 25% of pediatric patients tend to develop giant cysts but the cyst size was not significantly associated with rupture.

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Pediatric patients with rupture pulmonary hydatid cyst have a low tendency to develop an anaphylactic reaction.

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Larger sample size is needed to define the risk factors and predictors of pulmonary hydatid cyst rupture.

Immunological detection of human and camel cystic echinococcosis using different antigens of hydatid cyst fluid, protoscoleces, and germinal layers

BACKGROUND AND AIM

Cystic echinococcosis (CE)/hydatidosis is one of the most prevalent neglected zoonotic diseases. It is initially asymptomatic and does not produce any clinical signs until the cyst becomes enlarged, causing localized pressure on internal organs and tissues. Therefore, the detection of Echinococcus granulosus antibodies is highly essential. This study evaluated the antigens of hydatid cyst fluid, protoscoleces, and germinal layers for efficient immunological diagnosis of CE in humans and camels.

MATERIALS AND METHODS

Hydatid cyst fluid (FLc), protoscoleces (Psc), and the germinal layer (GLc) antigens were prepared from camel-lung hydatid cysts. In the same way, hydatid cyst fluid (FLh) and protoscoleces (Psh) antigens from human-liver cyst aspirate were produced. The comparative immunodiagnostic efficacy of the prepared antigens was verified using indirect enzyme-linked immunosorbent assay (ELISA), SDS-PAGE, and immunoblotting.

RESULTS

ELISA proves that FLc and GLc antigens were higher than FLh and Psh antigens. This shows that binding reactivity in naturally infected human sera, camel sera, and Psc is the most potent, exhibiting 100% sensitivity with 78.26% and 76.47% specificity in camel and human sera, respectively. The CE prevalence using diagnostic Psc was 54.79% and 61.32% in tested human and camel sera, respectively. The electrophoretic profiles of all shared antigens showed similarities at 52, 41, and 22 kDa. Immunoblotting demonstrated common immune-reactive bands in all antigen types at 52 and 41 kDa against positive human and camel sera.

CONCLUSION

This immunological study introduces camel hydatid cyst Psc as a potent diagnostic antigen and new immune-reactive fractions of 52 and 41 kDa for diagnosing hydatidosis in humans and camels.

Prevalence of Hepatic Alveolar hydatid in a Nonendemic Region of North India in Hospital-based Population

Objective:

The objective of this study was to calculate the prevalence of hepatic alveolar hydatid disease in hospital-based population in North India, a nonendemic region for alveolar hydatid disease.

Materials and Methods:

This study was conducted at a tertiary care center in North India between April 2017 and March 2019. Patients with suspected hepatic alveolar hydatid on ultrasonography were evaluated with further imaging studies based on classical radiological findings and then confirmed by histopathology.

Results:

Twenty-five cases of hepatic alveolar hydatid were diagnosed primarily based on the classical imaging/radiological findings with histopathology confirmation, with a 2-year period prevalence of 0.207 cases/1000 population. Majority of the cases were in the age group of 41–60 years, with a mean age of 53.04 years. Fifty-two percent of the cases were female. Majority of them were from hilly areas and working with livestock animals. Abdominal pain was the most common presenting symptom.

Conclusion:

Hepatic alveolar hydatid is considered as a rare disease in India; however, the increased number of cases been diagnosed in our study could be either due to increased diagnostic modalities or due to actual increase in the number of cases. Therefore, hepatic alveolar hydatid should be considered in the differentials of suspicious liver mass in nonendemic regions.

Effect of Taxus baccata L. Extract on Hydatid Cyst Protoscolices In vitro

Hydatidosis is the most important global parasitic infectious disease both in humans and animals, which can lodge at different organs of the host, such as liver, lung (even heart), and brain which may lead to death. Surgery is the main method for the treatment of hydatidosis. In surgical therapy of hydatidosis, the use of sporicidal agents is very important since these agents inactivate live protoscolices and prevent recurrence of infection. Presently, numerous scolicidal chemical agents have been administrated to inactivate the hydatid cyst contents. Recently, there has been a high tendency among researchers to evaluate and present herbal plants as alternative option due to inexpensiveness, availability, low side effects, and toxicity. This study aimed to evaluate the scolicidal effect of hydro alcoholic Taxus baccata L. extract in vitro for the first time. The scolicidal activities of the extract were tested in concentrations of 50, 100, and 150 mg/ml following 10, 30, and 60 min of incubation, and the experiments were performed in triplicate. Viability of protoscolices was confirmed by 0.1% eosin vital staining. The data were analyzed in SAS software (version 9.4). The results showed that the hydroalcoholic extract of Taxus baccata L. at the concentration of 150 mg/ml led to killing 66.6% of protoscolices at 60 min. according to the results of this investigation, it is recommended to use this plant as a scolicidal plant. The findings of the present study showed that Taxus baccata L. had potent scolicidal effects. However, further studies are required to evaluate the efficacy of Taxus baccata L. in vivo.

Annual assessment of Echinococcus multilocularis surveillance reports submitted in 2020 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, the UK 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 E. multilocularis infection in dogs, and repealing Delegated Regulation (EU) No 1152/2011. Due to the UK exiting the European Union and under the Withdrawal Act, the data submitted by the UK after the 31 January 2020 are excluded from this assessment. 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. All the countries participating in this surveillance (Finland, the UK, Ireland and Norway) succeeded in the fulfilment of the technical legal requirements foreseen in Commission Delegated Regulation (EU) 2018/772 concerning these four different categories. Within the UK, Northern Ireland fulfils those requirements only when assuming a diagnostic test sensitivity value of 0.99, provided by the national reference laboratory, which is higher than the sensitivity value suggested by EFSA (conservative value of 0.78) and not supported by adequate scientific evidence. None of the four countries recorded positive samples in the 12-month reporting period.

Label-free detection of echinococcosis and liver cirrhosis based on serum Raman spectroscopy combined with multivariate analysis

In this paper, we investigated the feasibility of using serum Raman spectroscopy and multivariate analysis method to discriminate echinococcosis and liver cirrhosis from healthy volunteers. Raman spectra of serum samples from echinococcosis, liver cirrhosis, and healthy volunteers were recorded under 532 nm excitation. The normalized mean Raman spectra revealed specific biomolecular differences associated with the disease, mainly manifested as the contents of β carotene in the serum of patients with echinococcosis and liver cirrhosis were lower than those of healthy people. Furthermore, principal components analysis (PCA), combined with linear discriminant analysis (LDA), was adopted to distinguish patients with echinococcosis, liver cirrhosis, and healthy volunteers. The overall diagnostic accuracy based on the PCA-LDA algorithm was 87.7 %. The diagnostic sensitivities to healthy volunteers, patients with echinococcosis, and liver cirrhosis were 92.5 %, 81.5 %, and 89.1 %, and the specificities were 93.2 %, 96.1 %, and 92.4 %, respectively. This exploratory work demonstrated that serum Raman spectroscopy technology combined with PCA-LDA diagnostic algorithm has great potential for the non-invasive identification of echinococcosis and liver cirrhosis.

Hydatid disease of the interventricular septum: Echocardiographic and computed tomography findings

Hydatid disease (HD) is prevalent in South Africa, with cardiac HD being a rare but important manifestation to recognise and diagnose. An incidental finding on computed tomography (CT) of the chest in a patient with pulmonary HD prompted further multimodality imaging, which confirmed the presence of cardiac HD involving the interventricular septum. This case report focuses on imaging findings related to cardiac HD, as demonstrated by the CT of the chest and two- and three-dimensional transoesophageal echocardiography. Multimodality imaging is essential to assist in making a diagnosis and providing a detailed assessment of patients with cardiac HD.

Multimodality Imaging for Diagnosis and Characterization of a Cardiac Hydatid Cyst

Here, we report the case of a young patient admitted to the emergency department because of abdominal pain. Computed tomography revealed a mass within her right heart. Through serial multimodality imaging testing, including computed tomography, three-dimensional (2D)- and three-dimensional echocardiography, as well as cardiac magnetic resonance, the diagnosis of cardiac involvement in the course of Echinococcus granulosus infection was hypothesized.

Distribution of alveolar echinococcosis according to environmental and geographical factors in Germany, 1992-2018

Alveolar echinococcosis (AE) is a rare zoonotic disease caused by the larval stage of Echinococcus multilocularis. Despite its low world-wide prevalence, this disease shows differences in the regional distribution of cases. In the present cohort study, we analyse the distribution of AE according to environmental and geographical factors in Germany. We identified the place of residence of 591 cases of AE from the national database for AE, and georeferenced these localities in the Universal Transverse Mercator coordinate system. Data on elevation, air temperature, precipitation height and land cover were mapped out and correlated with the distribution of cases of disease during the period 1992-2018. Moran's I statistic was used for spatial autocorrelation. Differences in frequency distribution between elevation, air temperature, precipitation height and landscape feature classes were analysed with the Kruskal-Wallis test. With the multiple linear regression analysis, we determined the influences and interactions of geographical and climatic factors on the number of AE cases. The results showed a heterogeneous distribution of AE cases with a higher concentration in southern Germany than in the rest of Germany (I = 0.225517, Z = 35.8182 and p < 0.001). There was a statistically significant difference in frequency distribution between precipitation height, air temperature, elevation and landscape feature classes and AE cases in Germany (p < 0.0001). In regions with higher elevations (505-672 m), moderate average air temperatures (6.0-7.9°C) and higher precipitation rates (701-1000 mm) most AE cases were recorded. It seems, that regions with higher precipitation rates, higher elevations and moderate average air temperatures have a higher infection burden and infection conditions. It is therefore extremely important to generate greater awareness of the disease in these regions, with the aim of recognising potential cases of AE as early as possible and introducing the appropriate therapeutic measures.

Quantifying the load of Echinococcus granulosus eggs in experimental dog infection using probe-based copro-qPCR analysis

Designing and implementing Cystic Echinococcosis control programs require quantitative information about the worm load and the intensity of infection in dog populations in endemic areas. So far no "probe-based" molecular quantification tool has been available for E. granulosus. This study was conducted in order to develop and evaluate a qPCR technique for measuring worm load of E. granulosus in the final host. A species-specific TaqMan probe was designed based on the available sequences in GenBank. The study was conducted in two stages. First, stool samples from an experimentally infected dog were collected in days 7, 14, 21, 28, 35 and 49, and were analyzed by real-time qPCR assay. In the second stage, 600 mg negative stool specimens were manually spiked with 1, 5, 10, 20 and 40 eggs and the specimens were analyzed using real-time qPCR. According to the standard curve analysis, 93% efficiency and coefficients of correlation (Rsq) > 0.991 were documented. Quantitative PCR assays showed an increasing signal of infection during the 7-week course of infection. As revealed by the qPCR results from week 5 onward, signals indicative of egg excretion began and reached maximum on week 7. No qPCR signal from the samples containing 1, 10 and 20 eggs was recorded, however the samples containing 5 and 40 eggs produced signals proportional to the primary DNA. The study presents a molecular tool to quantify the burden of E. granulosus infection in dogs. This tool could be applied for measuring the burden of infection in the definitive hosts in surveillance and control programs.

The occurrence of Echinococcus spp. in golden jackal (Canis aureus) in southwestern Hungary: Should we need to rethink its expansion?

Alveolar echinococcosis and cystic echinococcosis are severe zoonotic diseases caused by Echinococcus multilocularis and Echinococcus granulosus s.l. in Europe. To present knowledge, in the European continent, the most important definitive hosts of these parasites belong to the Canidae family. The golden jackal as an opportunistic mesopredator frequently preys on rodents including arvicolids and other easily available food resources, such as viscera and other carrion. By these reasons, the golden jackal can promote the maintenance of both Echinococcus multilocularis and Echinococcus granulosus s.l. Our investigation was conducted in the southwestern part of Hungary where one of the densest golden jackal populations exists. We examined altogether 173 golden jackal small intestines to determine the presence of Echinococcus multilocularis and Echinococcus granulosus s.l. After the molecular diagnostic procedure, we found 27 Echinococcus multilocularis-positive (prevalence: 15.6%; mean intensity: 664 worms) and three Echinococcus granulosus s.l. infected hosts (prevalence: 1.7%; mean intensity: 554.3 worms). We suggest the invasion of the golden jackal in Europe can enhance the spread of both Echinococcus multilocularis and Echinococcus granulosus s.l. This novel epidemiological situation can influence the geographical distribution of these helminths and the characteristics of their endemic in different host species, as well as in humans.

Intestinal echinococcosis in a dog from Missouri

CASE DESCRIPTION

A 17-week-old 14.4-kg (31.7-lb) female German Shepherd Dog from Missouri with a history of multiple intermittent episodes of vomiting and diarrhea underwent exploratory celiotomy.

CLINICAL FINDINGS

At the time of surgery, the dog was bright, alert, and responsive, with a tender abdomen and palpable mesenteric lymph nodes. Hematologic data revealed mild leukocytosis, mild hypoproteinemia, and mild hypoalbuminemia. Moderate petechiation of the jejunal serosa and prominent mesenteric lymph nodes, but no palpable obstructions, were found during surgery. Jejunal and lymph node biopsies were performed; histologic examination revealed multiple segments of adult cestodes up to 700 μm long in the jejunum. Segments had a scolex and contained approximately 30- to 35-μm-diameter ova, morphologically compatible with Echinococcus spp. Fecal flotation revealed numerous proglottids and ova similar to those recognized histologically. Results of PCR assays confirmed Echinococcus multilocularis of E4 haplotype (a European strain).

TREATMENT AND OUTCOME

Praziquantel (5 mg/kg [2.3 mg/lb], SC, once) was administered after surgery; treatments after hospital discharge included praziquantel (10 mg/kg [4.5 mg/lb], PO, once). No proglottids or ova were observed by fecal flotation after the treatments. The dog remained healthy without gastrointestinal signs 1 year later.

CLINICAL RELEVANCE

The dog of this report had no travel history outside the state of Missouri. To the authors' knowledge, this is the first report of intestinal E multilocularis infection in a pet dog in the contiguous United States and first detection of a European strain of E multilocularis in this country. Findings suggested possible establishment of a European strain of this zoonotic pathogen in the contiguous United States.

Environmental, climatic and host population risk factors of human cystic echinococcosis in southwest of Iran

BACKGROUND

Cystic echinococcosis (CE), a worldwide zoonotic disease, is affected by various biological and environmental factors. We investigated dog/livestock populations, climatic and environmental factors influencing the distribution of human CE cases in Fars province, southwest Iran.

METHODS

We mapped the addresses of 266 hospitalised CE patients (2004-2014) and studied the effects of different temperature models, mean annual rainfall and humidity, number of frosty days, slope, latitude, land covers, close proximity to nomads travel routes, livestock and dog densities on the occurrence of CE using geographical information systems approach. Data were analyzed by logistic regression.

RESULTS

In the multivariate model predicting CE, living in an urban setting and densities of cattle and dogs were the most important CE predictors, sequentially. Dry (rained) farm, density of camel and sheep, close proximity to nomads travel routes, humidity, and slope also were considered as the determinants of CE distribution, when analyzed independently. Slope had a negative correlation with CE while temperature, frost days and latitude were not associated with CE.

CONCLUSIONS

In our study, an urban setting was the most important risk factor and likely due to a combination of the high density of key life cycle hosts, dogs and livestock, a large human susceptible population and the high number of abattoirs. Farmland and humidity were highly suggestive risk factors and these conditions support the increased survival of Echinococcus granulosus eggs in the soil. These findings support the development of strategies for control of disease. More research is needed test optimal interventions.

Proteomic Insights into the Biology of the Most Important Foodborne Parasites in Europe

Foodborne parasitoses compared with bacterial and viral-caused diseases seem to be neglected, and their unrecognition is a serious issue. Parasitic diseases transmitted by food are currently becoming more common. Constantly changing eating habits, new culinary trends, and easier access to food make foodborne parasites' transmission effortless, and the increase in the diagnosis of foodborne parasitic diseases in noted worldwide. This work presents the applications of numerous proteomic methods into the studies on foodborne parasites and their possible use in targeted diagnostics. Potential directions for the future are also provided.

Evaluation of the efficacy of albendazole sulfoxide (ABZ-SO)-loaded chitosan-PLGA nanoparticles in the treatment of cystic echinococcosis in laboratory mice

Albendazole is known as the drug of choice for medical treatment of cystic echinococcosis (CE). Albendazole sulfoxide (ABZ-SO), as the main active metabolite of albendazole, has low efficacy in the disease due to low water solubility and poor absorptivity. PLGA nanoparticles (NPs) enhance the dissolution of poorly soluble drugs, and chitosan (CS) coating enhances oral drug delivery of NPs. In this study, the efficacy of ABZ-SO-loaded CS-PGLA NPs in the treatment of CE was evaluated in laboratory mice. ABZ-SO-loaded CS-PGLA NPs were prepared by nanoprecipitation and characterized by dynamic light scattering method and scanning electron microscopy. Thirty mice were intraperitoneally infected by 1000 protoscoleces of Echinococcus granulosus. Ten months later, the mice were allocated into 3 groups: groups 1 and 2 were treated with ABZ-SO and ABZ-SO-loaded CS-PGLA NPs, respectively, and the mice in group 3 remained untreated as the control group. The drugs were administered by gavage for 45 days at a daily dose of 10 mg/kg. Finally, all mice were opened and the cysts were collected, counted, weighed, and measured separately. The therapeutic effect of ABZ-SO in the number, weight, and volume of the cysts were not statistically significant compared with those in ABZ-SO-loaded CS-PGLA NPs and the control group. However, the therapeutic effect of ABZ-SO-loaded CS-PGLA NPs in the weight and volume of cysts were statistically significant when compared with that in the control group (p ˂ 0.05). In conclusions, this study revealed that ABZ-SO-loaded CS-PGLA NPs could enhance the therapeutic efficacy of ABZ-SO in the treatment of CE in laboratory mice.

Clinical Characteristics and Management of the Hydatid Cyst of the Liver: A Study from a Tertiary Care Center in Nepal

A hydatid cyst of the liver is a significant yet neglected public health problem in Nepal. The present study was carried out to evaluate the demographic characteristics, clinical presentations, and management of the patients of the hydatid cyst of the liver in the setting of a developing country. It was a retrospective, descriptive analysis of 53 patients admitted in the department of surgery with the diagnosis of hydatid cyst of the liver based on clinical manifestations, imaging studies, or serology between 2016 and 2019. The median age of the patients was 36 years, with the age group of 25-45 years being the most commonly affected (23, 43.4%). 58.5% of the patients were female. Abdominal pain (49, 92.5%) and a palpable liver (17, 32.1%) were the most common complaint and physical finding in our study population, respectively. Abdominal ultrasonography and computed tomography scan were the major imaging studies used to establish a diagnosis. A unilocular and anechoic cystic lesion was the most frequent imaging finding. The right lobe of the liver harbored the cysts in the maximum number of patients. Surgery was the preferred modality of treatment (23, 43.4%), with pericystectomy being the most common form of surgical intervention. The hydatid cyst of the liver is a common cause of morbidity in Nepal. Clinical evaluation supplemented by imaging studies is required for diagnosis, and surgery remains the treatment of choice in most cases. To explain the epidemiological pattern of the disease, multicentric studies involving a larger sample of patients should be conducted.

Evaluation of the Diagnostic Performance of Recombinant Antigen B1 for Detection of Cystic Echinococcosis Using Lateral Flow Dipstick Test

Background

Human echinococcosis is a neglected zoonotic disease distributed worldwide. It comprises cystic and alveolar forms, the former being the more prevalent disease. Imaging techniques are the first choice for diagnosis of cystic echinococcosis and serology is used as an additional diagnostic technique in doubtful cases or as the sole test in low-resource settings. Rapid diagnostic tests are useful and convenient for immunodiagnosis of cystic echinococcosis in endemic areas, where medical facilities often struggle with limited resources.

Methods

Recently, we have developed Hyd Rapid™, an IgG4 lateral flow dipstick test using recombinant antigen B1 for detection of cystic echinococcosis. This study was performed between 2016 until 2018 at the Institute for Research in Molecular Medicine, Universiti Sains Malaysia. The diagnostic performance of Hyd Rapid™ was tested in-house and at two international laboratories in Switzerland and Iran.

Results

The overall diagnostic sensitivity for detection of cystic and alveolar echinococcosis was 95% (56/59). Meanwhile, the diagnostic specificity, with and without exclusion of cysticercosis and fascioliasis, was 100% (n=48) and 88% (63/72), respectively.

Conclusion

Hyd Rapid™ detected cystic echinococcosis as well as probable cases of alveolar echinococcosis. Therefore, Hyd Rapid™ showed good potential as a serological tool for echinococcosis, and merits further evaluation.

Comparative Evaluation of Echinococcus Serology with Cytology for the Diagnosis of Hepatic Hydatid Disease

Objectives  The purpose of this study is to determine the diagnostic efficacy of enzyme-linked immunosorbent assay (ELISA) in radiologically confirmed liver mass lesions for the diagnosis of hepatic hydatid disease (HHD) and to compare the diagnostic performance of ELISA with fine needle aspiration cytology (FNAC) (taken as standard) for HHD diagnosis. Materials and Methods  This retrospective study included blood samples of 223 patients with radiologically confirmed liver mass lesions in which immunoglobulin G (IgG) anti- Echinococcus antibodies were tested using a commercial IgG ELISA (RIDASCREEN, R-Biopharm AG, Darmstadt, Germany). Results of ELISA, ultrasonography, FNAC, and liver function tests were obtained from the hospital information system. ELISA results were compared with those of FNAC to analyze the diagnostic efficacy of ELISA for HHD diagnosis. Statistical Analysis  Comparison of the results obtained from ELISA was performed with respect to FNAC results (taken as standard) to analyze the diagnostic efficacy of ELISA for HHD detection. Data has been represented as median (range) or in frequencies. Wilson score was used to assess 95% confidence interval of diagnostic parameters. The analysis was performed using SPSS Version 22.0 (IBM Corp.) and Open Epi (version 3.01). Results  Out of 223 cases with liver mass lesions, Echinococcus IgG was reactive in 62 (28%) cases and FNAC was positive in 16 (7.2%) cases. Since two cases were FNAC-positive but IgG-nonreactive, total HHD cases were 64 (28.7%). Echinococcus IgG reactive cases were seen more in the extremes of age group, that is, 1 to 10 years and 81 to 90 years. Taking FNAC as the standard, the sensitivity, specificity, positive predictive value, and negative predictive value of ELISA were 87.5, 76.8, 22.6, and 98.7%, respectively. Cytology-positive cases demonstrated a mean ELISA optical density/cut-off (OD/CO) of 4.2 ± 3 standard deviation. Conclusion  ELISA in radiologically confirmed liver mass cases is highly sensitive in detecting HHD and hence should be used along with ultrasonography for the screening of HHD followed by confirmation with cytology even in cases with a higher OD/CO of ELISA.

Echinococcosis in humans and animals in Southern Africa Development Community countries: A systematic review

The taeniid Echinococcus is the causative agent of the zoonotic disease echinococcosis/hydatidosis and is associated with economic losses in livestock production. This review summarizes available scientific literature on circulating species of Echinococcus in humans, wild and domestic animals in countries of Southern Africa Development Community, and identifies knowledge gaps and recommend research priorities. Data were systematically accessed from Google Scholar, MEDLINE/PubMed and from library resources from December 2017 to June 2019. Meta-analysis was conducted in STATA program and heterogeneity and prevalence values were pooled by host species with 95% confidence interval. In intermediate hosts, the overall prevalence of Echinococcus by meat inspection was 10% (CI: 9-11%) in small ruminants, 7% (CI: 5-8%) in cattle, 1% (CI: 0-1%) in pigs and 9% (CI: 0-29%) in wild herbivores. In canids by CoproAg-ELISA and necropsy the prevalence was of 10% (CI: 8-10%) and 6% (CI: 3-10%) respectively. A high level of heterogeneity (I2 > 65%) was observed for all study groups. Echinococcus equinus, E. canadensis, E ortleppi and E. felidis were reported from wildlife and E. ortleppi, E. granulosus s. s. and E. canadensis from humans. There is paucity of research in echinococcosis and gaps in prevalence reports over time in both humans and animals in the SADC region and we recommend an increase in future studies on the epidemiology of disease, risk factors for transmission in animals and humans and its relation with human health specially in the advent of HIV pandemic following a "One Health" approach.

Current situation and future prospects of Echinococcus granulosus vaccine candidates: A systematic review

Cystic echinococcosis is a worldwide zoonotic disease, represents a threat for livestock and humans, manifests as a quiescent, subclinical and chronic hydatid cyst infection. The disease imposes high expenditures and economic losses in medical and veterinary. Prophylactic vaccination would be one of the effective preventive health care against echinococcosis. During the last decades, many studies have characterized the protective antigens of Echinococcus granulosus and their role in immunization of various animal host species. Herein, we aimed to systematically evaluate and represent the best antigens as possible vaccine candidates for cystic echinococcosis. Data were systematically searched from five databases including ProQuest, PubMed, Scopus, ScienceDirect and Web of Science, up to 1 February 2020. Two reviewers independently screened and assessed data extraction and quality assessment. A total of 47 articles were eligible for inclusion criteria in the current study. The most common antigens used for vaccination against E. granulosus were EG95 and antigen B. Freund's adjuvant and Quil A have been predominantly utilized. In addition, regarding the antigen delivery, animal models, measurement of immune responses and reduction in hydatid cyst have been discussed in the text. The data demonstrated that DNA vaccines with antigen B and recombinant protein vaccines based on EG95 antigen have the best results and elicited protective immune responses.

Case 275: Multiple Hepatic Hydatid Cysts

HistoryA 61-year-old woman presented to the cardiology service with sinus tachycardia. As part of her work-up, she underwent routine echocardiography that showed a normal heart but incidentally revealed multiple lesions in the liver. An outpatient CT scan was performed to characterize the liver lesions. The patient had emigrated to Canada from the Middle East several years earlier and had no medical history of note; in particular, there was no history of cancer or predisposing factors for chronic liver disease. The patient's clinical examination findings; laboratory test results, including complete blood count; and liver function test results were normal.

Zoonotic implications of camel diseases in Iran

Approximately 60% of all human pathogens and 75% of emerging infectious diseases are zoonotic (of animal origin). Camel zoonotic diseases can be encountered in all camel-rearing countries. In this article, all studies carried out on camel zoonotic diseases in Iran are reviewed to show the importance of camels for public health in this country. More than 900 published documents were systematically searched to find relevant studies from 1,890 until late 2018. The collected articles were classified according to the aetiological agents. In this study, 19 important zoonotic diseases were reported among Iranian camels including listeriosis, leptospirosis, plague, Q fever, brucellosis, campylobacteriosis, tuberculosis, pasteurellosis, clostridiosis, salmonellosis, Escherichia coli infections, rabies, camelpox, Middle East respiratory syndrome coronavirus, Crimean-Congo haemorrhagic fever, echinococcosis, cryptosporidiosis, toxoplasmosis and dermatophytosis, most of which belong to bacterial, viral, parasitic and fungal pathogens, respectively. Results show that camels are one of the most important sources of infections and diseases in human; therefore, continuous monitoring and inspection programs are necessary to prevent the outbreak of zoonotic diseases caused by this animal in humans.

Hepatic alveolar echinococcosis: correlation between computed tomography morphology and inflammatory activity in positron emission tomography

Positron emission tomography-computed tomography (PET-CT) with 18F-fluorodesoxyglucose (FDG) is the imaging modality of choice for assessing inflammation surrounding hepatic alveolar echinococcosis (AE) lesions. This study is the first to evaluate FDG uptake in hepatic AE (n = 51) based on the standardized uptake value (SUV) and to correlate the SUVs with primary morphology and calcification patterns, based on the Echinococcus multilocularis Ulm Classification for Computed-Tomography (EMUC-CT). Our results show that the SUVs were increased for lesions with EMUC-CT types I-IV primary morphology, compared to the surrounding healthy liver tissue (SUV = 2.5 ± 0.4; p < 0.05). Type IV lesions included, by far, the highest number of PET-negative lesions. A comparison of lesions with different primary morphologies showed clear differences. The highest SUVs were found for types I and III, and the lowest was found for type IV. Type IV lesions (SUV, 3.8 ± 1.5) showed significantly lower uptake compared to type I (SUV, 6.9 ± 3.5; p = 0.030) and type III (SUV, 7.4 ± 3.9; p = 0.031) lesions. For type II lesions, the results showed only a statistical trend (SUV, 6.1 ± 3.1; p = 0.073). Due to the small number of cases, an evaluation of type V (n = 1) lesions was not possible. The different SUVs of lesions with different primary morphologies, particularly the lower FDG uptake observed in type IV lesions, suggested that these SUVs might reflect different stages of the disease.

Evaluation of radiologic diagnostic criteria and treatment options in skeletal muscle hydatid cysts

AIM

To investigate the diagnosis and treatment methods of soft tissue involvement of hydatid cysts (HCs).

MATERIALS AND METHODS

Eleven patients who were diagnosed as having HC with muscular tissue (soft tissue) involvement between 2010 and 2016 were evaluated retrospectively. Seven patients had typical HC magnetic resonance imaging (MRI) and four patients had cysts with an unusual appearance. We evaluated how to diagnose the cysts using imaging methods, their characteristic radiologic images, and treatment alternatives against the disease. The patients were treated with antihelminthic chemotherapy preoperatively and postoperatively.

RESULTS

Of the 11 patients who underwent treatment, 7 were diagnosed using MRI and 4 were diagnosed with histopathologic examinations. The mean follow-up period was 16 (range, 6-24) months, and the mean age was 39.4 (range, 24-56) years. In seven patients, multivesicular appearance with specific MRI findings, T2-hypointense rim appearance, double-rim sign, membrane dissociation, and appearance of daughter cysts were identified as diagnostic criteria. Two patients underwent ultrasound assisted percutaneous aspiration-injection-reaspiration (PAIR) treatment. Seven patients underwent total pericystectomy, and two patients underwent subtotal pericystectomy with serum saline injection into the cyst. Two patients showed signs of mild anaphylaxis, one during the diagnosis and one during treatment.

CONCLUSION

There may be difficulties in the diagnosis and treatment of HCs of the musculoskeletal system. It should be known that there are alternative methods in the treatment (cyst excision and PAIR treatment). Clinical, serologic, and radiologic findings should be used in the diagnosis. To avoid complications during the histopathologic diagnosis, MRI should be examined in detail. It is thought that atypical cysts can be diagnosed (double-layer appearance and peripheral rim sign) in addition to typical cysts (detached membrane and multivesicular appearance), and diagnosis and treatment can be planned without anaphylactic complications.

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.

Hepatic alveolar echinococcosis: Comparative computed tomography study between two Chinese and two European centres

The main endemic areas for alveolar echinococcosis (AE) are in Central Europe and Western China, and in >98% of cases, AE manifests in the liver. The aim of this work was to compare European and Chinese patient groups for number, size, and computed tomography (CT) appearance of hepatic AE lesions. A total of 200 CT scans of patients with hepatic AE were evaluated by four blinded, experienced radiologists from two European (Besancon, Ulm) and two Chinese centres (Xining, Urumqi). In addition to noting the number, size, and localisation of the lesions, the radiologists evaluated morphological appearance using the Echinococcus multilocularis Ulm Classification - CT scheme. Chinese patients were younger than European patients (36.8 ± 13.2 vs. 63.5 ± 17.7; p < 0.0001) and had significantly larger lesions (120.4 ± 50.8 vs. 70.9 ± 39.8; p < 0.0001). The morphological appearance of the lesions on CT differed significantly between the two groups (p < 0.05), as did the number of lesions (2.6 ± 3.9 in European centres versus 3.8 ± 5.0 in Chinese centres; p = 0.0062). Patient age and AE-related morphological manifestations differ between Europe and China, but the reasons for the differences are unknown.

Improvement of Antialveolar Echinococcosis Efficacy of Albendazole by a Novel Nanocrystalline Formulation with Enhanced Oral Bioavailability

Alveolar echinococcosis (AE) is a chronic infectious parasitic disease that is fatal and still being neglected. Currently, the AE treatment recommended by the WHO is complete excision of the lesions, followed by the oral administration of albendazole (ABZ), the only effective first-line anti-AE drug, for two years. Unfortunately, complete excision of AE lesions is impossible in most cases, leaving the long-term use of ABZ as the only alternative. However, only about one-third of patients experience complete remission or cure with such treatments, largely because of the low oral bioavailability of ABZ caused by its very low solubility. To improve the oral bioavailability of ABZ, a novel nanocrystalline (NC) formulation of ABZ was obtained by spray-drying ABZ with a triblock copolymer poly(ethylene oxide)-poly(propylene oxide)-poly(ethylene oxide) (Poloxamer 188), and its physical structure was confirmed by scanning electron microscopy (SEM), small-angle X-ray scattering (SAXS), wide-angle X-ray diffraction (WAXRD), and polarized optical microscopy (POM). The significantly reduced ABZ crystallite size coupled with prolonged ABZ supersaturation significantly improved the drug dissolution performance compared with that of the commercial ABZ oral product (Albenda), and the NC formulation showed an approximately 4.2-fold higher AUC than Albenda in a pharmacokinetic comparison in Beagle dogs as measured by the plasma concentration of albendazole sulfoxide, the active antiparasitic metabolite. Even more encouragingly, after 30 days of once-daily oral administration of the NC and Albenda formulations to SD rats with hepatic alveolar echinococcosis, the NC formulation demonstrated a cyst inhibition effect 3.7-fold greater than that of Albenda. We therefore conclude that the NC formulation could potentially be developed into an improved anti-AE drug therapy.

Recent advances on innate immune pathways related to host-parasite cross-talk in cystic and alveolar echinococcosis

Cystic echinococcosis (CE) and alveolar echinococcosis (AE) are life-threatening parasitic infections worldwide caused by Echinococcus granulosus (sensu lato) and E. multilocularis, respectively. Very little is known about the factors affecting innate susceptibility and resistance to infection with Echinococcus spp. Although benzimidazolic drugs against CE and AE have definitively improved the treatment of these cestodes; however, the lack of successful control campaigns, including the EG95 vaccine, at a continental level indicates the importance of generating novel therapies. This review represents an update on the latest developments in the regulatory functions of innate immune pathways such as apoptosis, toll-like receptors (TLRs), and inflammasomes against CE and AE. We suggest that apoptosis can reciprocally play a bi-functional role among the host-Echinococcus metabolite relationships in suppressive and survival mechanisms of CE. Based on the available information, further studies are needed to determine whether the orchestrated in silico strategy for designing inhibitors and interfering RNA against anti-apoptotic proteins and TLRs would be effective to improve new treatments as well as therapeutic vaccines against the E. granulosus and E. multilocularis.

In vitro efficacy study of Cinnamomum zeylanicum essential oil and cinnamaldehyde against the larval stage of Echinococcus granulosus

Hydatidosis or cystic echinococcosis is a disease caused by the larval stage of Echinococcus granulosus sensu lato. Chemotherapy can be used alone or in combination with surgery or percutaneous treatment. Benzimidazoles are the only agents used and approved for treatment, but their efficacy is extremely variable. Therefore, it is necessary to find new drugs to improve the treatment of this disease. In the last decades, the biological properties of essential oils and their components began to be investigated as alternatives in the treatment of different ailments. The aim of the present work was to evaluate the in vitro efficacy of the essential oil of Cinnamomum zeylanicum (cinnamon) and cinnamaldehyde against protoscoleces and metacestodes of E. granulosus. The essential oil and cinnamaldehyde, its major component, showed a dose and time dependent effect against protoscoleces. However, cinnamaldehyde showed a greater protoscolicidal effect than the essential oil. The maximum protoscolicidal effect was found with 50 μg/mL of cinnamaldehyde. Viability decreased by 1.7 ± 0.8% after 4 days of incubation and reached 0% at 8 days. Interestingly, there were no significant differences between the activity of cinnamaldehyde at the concentrations of 25 and 10 μg/mL and the efficacy observed with the essential oil at 200 and 50 μg/mL, respectively. Cinnamaldehyde also had a strong in vitro effect against murine cysts, while only the higher concentration of the essential oil caused ultrastructural alterations. Working with components instead of with essential oils has some advantages, particularly in relation to the reproducibility of the formulations and their effectiveness. For this reason, the results obtained in this work are promising in the search for pharmaceutical alternatives for the treatment of cystic echinococcosis.

A serious complicatıon of liver hydatid cysts in children: cystobiliary fistulas

AIM

We aimed to determine predictive factors for predicting cystobiliary fistulas (CBF) in children after treatment of liver hydatid cyst (LHD).

METHODS

The records of patients who were treated for LHD between 01.06.2009 and 1.06.2019 were retrospectively reviewed. Age, sex, laboratory test results, size and number of cysts, method of first intervention (percutaneous or surgery), whether or not CBF developed and how it was treated were investigated. Among findings, those could be predictive were investigated. Data were evaluated with SPSS 21.0 program, p < 0.05 was considered significant.

RESULTS

Of the 97 patients, 48 (49.5%) were male, 49 (50.5%) female, the mean age was 11.2 years, Eighty patients had right (82.5%), 13 had left, and 4 had bilobar involvement. As first intervention, surgery was performed in 39 (40.2%); percutaneous treatment was performed in 58 (59.8%) patients. In 8 patients (20.5%) in surgery group and in 6 patients (10.3%) in percutaneous group, totally in 14 patients (14.4%), CBF developed. The mean cyst diameter of CBF-developed group was 114.36 mm, and of CBF-undeveloped group was 74.30 mm. There was no statistically significant differences between groups in terms of age, sex, involved lobe, other organ involvement, and preoperative results (p > 0.5). There was a significant relationship between the cyst diameter and the rate of CBF development in both surgical and percutaneous groups (p < 0.05). ROC analysis was performed, and the cut-off value for the development of CBF detected as 69 mm for children. Since obstructive jaundice seen in adults is not common in children, an increase in liver function tests and bilirubin levels were not seen in our patients.

CONCLUSION

A significant correlation was found only between the size of the cyst and developing CBF. Cysts greater than 69 mm have a higher risk of developing CBF after both percutaneous and surgical treatment and should be closely monitored.

Phylogenetic Characteristics of Echinococcus granulosus Sensu Lato in Uzbekistan

Echinococcosis occurs mainly in areas with heavy livestock farming, such as Central Asia, America, and Australia. Echinococcus granulosus sensu lato (s.l.) infection causes echinococcosis in intermediate hosts, such as sheep, cattle, goats, camels, and horses. Numerous cases of echinococcosis occur in Uzbekistan as stock farming is a primary industry. Epidemiological and genetic studies of E. granulosus s.l. are very important for mitigating its impact on public health and the economy; however, there are no such studies on E. granulosus s.l. in Uzbekistan. In the present study, to determine which genotypes exist and are transmitted, we isolated Echinococcus sp. from definitive hosts (one isolate each from jackal and dog) and intermediate hosts (52 isolates from humans and 6 isolates from sheep) in Uzbekistan and analyzed the isolates by sequencing 2 mitochondrial DNA components (cox1 and nad1). The results showed that all of isolates except one belonged to the E. granulosus sensu stricto (s.s.) G1 and G3 genotypes. Phylogenetic analysis based on cox1 sequences showed that 42 isolates from humans, 6 isolates from sheep, and one isolate from jackal were the G1 genotype, whereas the remaining 8 isolates from human and the one isolate from dog were the G3 genotype. These results suggest that the G1 and G3 genotypes of E. granulosus s.s. are predominant in Uzbekistan, and both wild animals and domestic animals are important for maintaining their life cycle. Only one isolate from human sample was confirmed to be E. eqiinus (G4 genotype), which is known to be for the first time.

Preliminary Evaluation of Recombinant EPC1 and TPx for Serological Diagnosis of Animal Cystic Echinococcosis

Animal cystic echinococcosis (CE) is one of the most important helminthic diseases and affects many mammalian intermediate hosts. Practical and effective diagnosis is crucial for animal CE control. Two different recombinant antigens derived from Echinococcus granulosus, Echinococcus protoscolex calcium binding protein 1 (rEg-EPC1) and thioredoxin peroxidase (rEg-TPx), were evaluated in this study to detect the specific immunoglobulin G (IgG) in sheep and goat with CE by the indirect enzyme-linked immunosorbent assays. The diagnostic effect of the above-listed proteins was determined to their sensitivity and specificity and compared with hydatid cyst fluid, two previously reported immunogenic recombinant proteins (dihydrofolate reductase and P29), and two commercial kits available in China. Of these, the best diagnostic results were obtained in the anti-TPx IgG ELISA, with 92.6% sensitivity, 98.8% specificity, and no cross-reactivity with anti-Eg95 IgG. Recombinant E. granulosus thioredoxin peroxidase shows good potential for serological diagnosis of animal cystic echinococcosis.

Epidemiological and molecular studies on Echinococcus granulosus from free-roaming dogs in Southeast Iran

Background and Aim:

Cystic echinococcosis (CE), as a major zoonotic helminth infection, imposes remarkable socioeconomic burden on many endemic countries across the world, including Iran. Due to the high importance of free-roaming dogs in the transmission of CE, epidemiological and molecular studies in this type of hosts are required in the endemic regions. This study aimed to investigate the epidemiology and genotyping of Echinococcusgranulosus isolated from stray dogs in Kerman, Southeast Iran.

Materials and Methods:

Eighty-four samples were isolated from stray dogs in the city and suburbs of Kerman in coordination with the health authorities and the municipality office for rabies control and dog population management. Dog demographic data, including age and sex were collected. The worm was isolated by necropsy and genomic DNA was extracted and partial cytochrome c oxidase subunit 1 gene was amplified using specific primers. Phylogenetic and Templeton-Crandall-Sing (TCS) network analyses were carried out on the sequence data.

Results:

The overall prevalence of CE in the surveyed dogs was 10.7% (9/84 cases). Out of 84 stray dogs, 33 (39.3%) and 51 (60.7%) cases were male and female, respectively. There was not a statistically significant difference between the infection and gender of dogs. However, infection is shown more in dogs under one year of age with a statistically significant difference (p<0.05). The results of molecular studies indicated E. granulosus G1 genotype for all isolates. The high presence of free-roaming dogs in urban and peri-urban areas and high frequency of parasite in this animal is a risk factor for humans in the region. Haplotype sequence analysis on the dog isolates revealed a close relationship with other E. granulosus isolates in Kerman.

Conclusion:

The findings of this study provide evidence-based data about the epidemiological and molecular characteristics of CE in dog definitive hosts of Southeast Iran. Further studies are required to understand the prevalence and parasite genotypes in dogs in Iran.