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Hirano K, Maruki Y, Yamashige D, Kobayashi O, Shiotsuka M, Morizane C, Imamura T, Hiraoka N, Okusaka T. Two Cases of Disseminated Alveolar Echinococcosis: The Diagnosis, Management, and Differential Considerations for Liver Lesions. Intern Med 2024; 63:1247-1252. [PMID: 37779063 PMCID: PMC11116014 DOI: 10.2169/internalmedicine.2444-23] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/18/2023] [Accepted: 08/17/2023] [Indexed: 10/03/2023] Open
Abstract
Alveolar echinococcosis (AE), caused by Echinococcus multilocularis, is an aggressive and potentially critical infestation that primarily affects the liver and can metastasize to any part of the body. We herein report two cases of echinococcosis, which could be differentiated from malignancy on imaging studies, with infections of the liver and mediastinal lymph nodes, and also associated with systemic disseminated lesions. AE is a very invasive infectious disease, and in order to detect such lesions at an early stage when they are still resectable, it is necessary to understand the characteristic imaging findings and determine the patient's current medical history.
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Affiliation(s)
- Kazuki Hirano
- Department of Hepatobiliary and Pancreatic Oncology, National Cancer Center Japan, Japan
- Department of Gastroenterology, Toranomon Hospital, Japan
| | - Yuta Maruki
- Department of Hepatobiliary and Pancreatic Oncology, National Cancer Center Japan, Japan
| | - Daiki Yamashige
- Department of Hepatobiliary and Pancreatic Oncology, National Cancer Center Japan, Japan
| | - Osamu Kobayashi
- Department of Infection, National Cancer Center Japan, Japan
| | - Mika Shiotsuka
- Department of Infection, National Cancer Center Japan, Japan
| | - Chigusa Morizane
- Department of Hepatobiliary and Pancreatic Oncology, National Cancer Center Japan, Japan
| | - Tsunao Imamura
- Department of Diagnostic Pathology, National Cancer Center Japan, Japan
| | - Nobuyoshi Hiraoka
- Department of Diagnostic Pathology, National Cancer Center Japan, Japan
| | - Takuji Okusaka
- Department of Hepatobiliary and Pancreatic Oncology, National Cancer Center Japan, Japan
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Yang Y, Cairang Y, Jiang T, Zhou J, Zhang L, Qi B, Ma S, Tang L, Xu D, Bu L, Bu R, Jing X, Wang H, Zhou Z, Zhao C, Luo B, Liu L, Guo J, Nima Y, Hua G, Wa Z, Zhang Y, Zhou G, Jiang W, Wang C, De Y, Yu X, Cheng Z, Han Z, Liu F, Dou J, Feng H, Wu C, Wang R, Hu J, Yang Q, Luo Y, Wu J, Fan H, Liang P, Yu J. Ultrasound identification of hepatic echinococcosis using a deep convolutional neural network model in China: a retrospective, large-scale, multicentre, diagnostic accuracy study. Lancet Digit Health 2023; 5:e503-e514. [PMID: 37507196 DOI: 10.1016/s2589-7500(23)00091-2] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/03/2022] [Revised: 03/08/2023] [Accepted: 04/29/2023] [Indexed: 07/30/2023]
Abstract
BACKGROUND Ultrasonography is the most widely used technique to diagnose echinococcosis; however, challenges in using this technique and the demand on medical resources, especially in low-income or remote areas, can delay diagnosis. We aimed to develop a deep convolutional neural network (DCNN) model based on ultrasonography to identify echinococcosis and its types, especially alveolar echinococcosis. METHODS This retrospective, large-scale, multicentre study used ultrasound images from patients assessed at 84 hospitals in China, obtained between Jan 1, 2002, and Dec 31, 2021. Patients with a diagnosis of cystic echinococcosis, alveolar echinococcosis, or seven other types of focal liver lesions were included. We tested ResNet-50, ResNext-50, and VGG-16 as the backbone network architecture for a classification DCNN model and input the perinodular information from the ultrasound images. We trained and validated the DCNN model to diagnose and classify echinococcosis using still greyscale ultrasound images of focal liver lesions in four stages: differentiating between echinococcosis and other focal liver lesions (stage one); differentiating cystic echinococcosis, alveolar echinococcosis, and other focal liver lesions (stage two); differentiating cystic echinococcosis, alveolar echinococcosis, benign other focal liver lesions, and malignant focal liver lesions (stage three); and differentiating between active and transitional cystic echinococcosis and inactive cystic echinococcosis (stage four). We then tested the algorithm on internal, external, and prospective test datasets. The performance of DCNN was also compared with that of 12 radiologists recruited between Jan 15, 2022, and Jan 28, 2022, from Qinghai, Xinjiang, Anhui, Henan, Xizang, and Beijing, China, with different levels of diagnostic experience for echinococcosis and other focal liver lesions in a subset of ultrasound data that were randomly chosen from the prospective test dataset. The study is registered at ClinicalTrials.gov (NCT03871140). FINDINGS The study took place between Jan 1, 2002, and Dec 31, 2021. In total, to train and test the DCNN model, we used 9631 liver ultrasound images from 6784 patients (2819 [41·7%] female patients and 3943 [58·3%] male patients) from 87 Chinese hospitals. The DCNN model was trained with 6328 images, internally validated with 984 images, and tested with 2319 images. The ResNet-50 network architecture outperformed VGG-16 and ResNext-50 and was generalisable, with areas under the receiver operating characteristic curve (AUCs) of 0·982 (95% CI 0·960-0·994), 0·984 (0·972-0·992), and 0·913 (0·886-0·935) in distinguishing echinococcosis from other focal liver lesions; 0·986 (0·966-0·996), 0·962 (0·946-0·975), and 0·900 (0·872-0·924) in distinguishing alveolar echinococcosis from cystic echinococcosis and other focal liver lesions; and 0·974 (0·818-1·000), 0·956 (0·875-0·991), and 0·944 (0·844-0·988) in distinguishing active and transitional cystic echinococcosis from inactive echinococcosis in the three test datasets. Specifically, in patients with the hepatitis B or hepatitis C virus, the model could distinguish alveolar echinococcosis from hepatocellular carcinoma with an AUC of 0·892 (0·812-0·946). In identifying echinococcosis, the model showed significantly better performance compared with senior radiologists from a high-endemicity area (AUC 0·942 [0·904-0·967] vs 0·844 [0·820-0·866]; p=0·027) and improved the diagnostic ability of junior, attending, and senior radiologists before and after assistance with AI with comparison of AUCs of 0·743 (0·714-0·770) versus 0·850 (0·826-0·871); p<0·0001, 0·808 (0·782-0·832) versus 0·886 (0·864-0·905); p<0·0001, and 0·844 (0·820-0·866) versus 0·870 (0·847-0·890); p=0·092, respectively. INTERPRETATION The DCNN model was shown to be accurate and robust, and could improve the ultrasound diagnostic ability of radiologists for echinococcosis and its types for highly endemic and remote regions. FUNDING National Natural Science Foundation of China and National Key Research & Development Program of China. TRANSLATION For the Chinese translation of the abstract see Supplementary Materials section.
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Affiliation(s)
- Yongfeng Yang
- Department of Interventional Ultrasound, The Fifth Medical Centre of Chinese People's Liberation Army General Hospital, Beijing, China; Graduate School of Chinese People's Liberation Army, General Hospital, Beijing, China
| | - Yangdan Cairang
- Department of Hepatopancreatobiliary Surgery, Affiliated Hospital of Qinghai University, The Research Key Laboratory for Echinococcosis of Qinghai Province, Xining, China
| | - Tian'an Jiang
- Department of Ultrasound Medicine, The First Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou, China
| | - Jianhua Zhou
- Department of Ultrasound, Sun Yat-sen University Cancer Centre, Guangzhou, China
| | - Li Zhang
- Department of Ultrasound, People's Hospital of Xinjiang Uygur Autonomous Region, Urumchi, China
| | - Baowen Qi
- Department of Ultrasound, People's Hospital of Xinjiang Uygur Autonomous Region, Urumchi, China
| | - Shumei Ma
- Department of Ultrasound Medicine, Affiliated Hospital of Qinghai University, Xining, China
| | - Lina Tang
- Department of Diagnostic Ultrasound, Fujian Medical University Cancer Hospital, Fuzhou, China
| | - Dong Xu
- Colorectal Surgery and Oncology, The Second Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou, China; Key Laboratory of Cancer Prevention and Intervention, Ministry of Education, Hangzhou, China
| | - Lingdai Bu
- Department of Ultrasound, People's Hospital of Bortala Mongol Autonomous Prefecture, Bortala Mongol Autonomous Prefecture, China
| | - Rui Bu
- Department of Ultrasound, The Second Affiliated Hospital of Kunming Medical University, Kunming, China
| | - Xiang Jing
- Department of Ultrasound, Tianjin Third Central Hospital, Tianjin, China
| | - Hui Wang
- Department of Ultrasound, China-Japan Union Hospital of Jilin University, Changchun, China
| | - Zubang Zhou
- Department of Ultrasound, Gansu Provincial Hospital, Lanzhou, China
| | - Cheng Zhao
- Department of Ultrasound, The Affiliated Hospital of Qingdao University, Qingdao, China
| | - Baoming Luo
- Department of Ultrasound, Sun Yat-Sen Memorial Hospital, Sun Yat-Sen University, Guangzhou, China
| | - Liwen Liu
- Department of Ultrasound, The Xijing Hospital of Air Force Medical University, Xi'an, China
| | - Jianqin Guo
- Department of Intervention Ultrasound, Qinghai Provincial People's Hospital, Xining, China; Department of Interventional Ultrasound, The First Affiliated Hospital of Hainan Medical College, Hainan, China
| | - Yuzhen Nima
- Department of Intervention Ultrasound, Qinghai Provincial People's Hospital, Xining, China; Department of Ultrasound, The People's Hospital of the Tibet Autonomous Region, Lasa, China
| | - Guoyong Hua
- Department of Ultrasound, Gansu Provincial Hospital, Lanzhou, China
| | - Zengcheng Wa
- Department of Ultrasound, Qinghai Red Cross Hospital, Xining, China
| | - Yuying Zhang
- Department of Ultrasound, Qinghai Provincial People's Hospital, Xining, China
| | - Guoyi Zhou
- Innovation Research Center, SonoScape, Shenzhen, China
| | - Wen Jiang
- Innovation Research Center, SonoScape, Shenzhen, China
| | | | - Yang De
- Department of Ultrasound, The People's Hospital of the Tibet Autonomous Region, Lasa, China
| | - Xiaoling Yu
- Department of Interventional Ultrasound, The First Medical Centre of Chinese People's Liberation Army General Hospital, Beijing, China
| | - Zhigang Cheng
- Department of Interventional Ultrasound, The Fifth Medical Centre of Chinese People's Liberation Army General Hospital, Beijing, China
| | - Zhiyu Han
- Department of Interventional Ultrasound, The Fifth Medical Centre of Chinese People's Liberation Army General Hospital, Beijing, China
| | - Fangyi Liu
- Department of Interventional Ultrasound, The Fifth Medical Centre of Chinese People's Liberation Army General Hospital, Beijing, China
| | - Jianping Dou
- Department of Interventional Ultrasound, The Fifth Medical Centre of Chinese People's Liberation Army General Hospital, Beijing, China
| | - Hui Feng
- Department of Ultrasound, The Fifth Medical Centre of Chinese People's Liberation Army General Hospital, Beijing, China
| | - Chong Wu
- Department of Interventional Ultrasound, The Fifth Medical Centre of Chinese People's Liberation Army General Hospital, Beijing, China
| | - Ruifang Wang
- Department of Interventional Ultrasound, The Fifth Medical Centre of Chinese People's Liberation Army General Hospital, Beijing, China
| | - Jie Hu
- Department of Interventional Ultrasound, The First Medical Centre of Chinese People's Liberation Army General Hospital, Beijing, China
| | - Qi Yang
- Department of Ultrasound, Peking University Shenzhen Hospital, Shenzhen, China
| | - Yanchun Luo
- Department of Interventional Ultrasound, The Fifth Medical Centre of Chinese People's Liberation Army General Hospital, Beijing, China
| | - Jiapeng Wu
- Department of Interventional Ultrasound, The Fifth Medical Centre of Chinese People's Liberation Army General Hospital, Beijing, China
| | - Haining Fan
- Department of Interventional Ultrasound, The Fifth Medical Centre of Chinese People's Liberation Army General Hospital, Beijing, China.
| | - Ping Liang
- Department of Interventional Ultrasound, The Fifth Medical Centre of Chinese People's Liberation Army General Hospital, Beijing, China.
| | - Jie Yu
- Department of Interventional Ultrasound, The Fifth Medical Centre of Chinese People's Liberation Army General Hospital, Beijing, China.
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Alvi MA, Ali RMA, Khan S, Saqib M, Qamar W, Li L, Fu BQ, Yan HB, Jia WZ. Past and Present of Diagnosis of Echinococcosis: A Review (1999-2021). Acta Trop 2023; 243:106925. [PMID: 37080264 DOI: 10.1016/j.actatropica.2023.106925] [Citation(s) in RCA: 6] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/18/2023] [Revised: 03/17/2023] [Accepted: 04/08/2023] [Indexed: 04/22/2023]
Abstract
The larval forms of taeniid cestodes belonging to the genus Echinococcus are the source of the zoonotic infection known as echinococcosis. Alveolar and cystic echinococcosis are caused by Echinococcus multilocularis and Echinococcus granulosus (s. s) respectively. It is endemic in several regions of the world. In this systematic review, we describe diagnosis, and the species (human, canids, livestock, and small rodents) affected by cystic (CE) and alveolar echinococcosis (AE). From 1999 to 2021, we searched the online directory through PubMed, SCOPUS, Web of Science, and google scholar. Among the 37,700 records found in the online databases, 187 publications met our eligibility requirements. The majority of investigations employed a range of diagnostic methods, such as ELISA, imaging, copro-PCR, necropsy or arecoline hydrobromide purgation, morphological cestode confirmation, and fecal sieving/flotation to detect and confirm Echinococcus infection. ELISA was the most commonly used method followed by PCR, and imaging. The research team retrieved data describing the incidence or assessment of the diagnostic test for E. multilocularis in humans (N = 99), canids (N = 63), small ruminants (N = 13), large ruminants (N= 3), camel (N= 2), pigs (N=2) and small mammals (N= 5). This study was conducted to explore the diagnostic tools applied to detect echinococcosis in humans as well as animals in prevalent countries, and to report the characteristic of new diagnostic tests for disease surveillance. This systematic review revealed that ELISA (alone or in combination) was the most common method used for disease diagnosis and diagnostic efficacy and prevalence rate increased when recombinant antigens were used. It is highly recommended to use combination protcols such as serological with molecular and imaging technique to diagnose disease. Our study identified scarcity of data of reporting echinococcosis in humans/ animals in low-income or developing countries particularly central Asian countries. Study reports in small rodents indicate their role in disease dissemination but real situation in these host is not refected due to limited number of studies. Even though echinococcosis affects both public health and the domestic animal sector, therefore, it is important to devise new and strengthe implementation of the existing monitoring, judging, and control measures in this estimate.
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Affiliation(s)
- Mughees Aizaz Alvi
- State Key Laboratory of Veterinary Etiological Biology, College of Veterinary Medicine, Lanzhou University, National Para-reference Laboratory for Animal Echinococcosis, Lanzhou Veterinary Research Institute, Chinese Academy of Agricultural Sciences, Lanzhou, China; Department of Clinical Medicine and Surgery, University of Agriculture, Faisalabad, Pakistan
| | - Rana Muhammad Athar Ali
- Department of Clinical Medicine and Surgery, University of Agriculture, Faisalabad, Pakistan
| | - Sadiq Khan
- Department of Clinical Medicine and Surgery, University of Agriculture, Faisalabad, Pakistan
| | - Muhammad Saqib
- Department of Clinical Medicine and Surgery, University of Agriculture, Faisalabad, Pakistan
| | - Warda Qamar
- Department of Parasitology, University of Agriculture, Faisalabad, Pakistan
| | - Li Li
- State Key Laboratory of Veterinary Etiological Biology, College of Veterinary Medicine, Lanzhou University, National Para-reference Laboratory for Animal Echinococcosis, Lanzhou Veterinary Research Institute, Chinese Academy of Agricultural Sciences, Lanzhou, China
| | - Bao-Quan Fu
- State Key Laboratory of Veterinary Etiological Biology, College of Veterinary Medicine, Lanzhou University, National Para-reference Laboratory for Animal Echinococcosis, Lanzhou Veterinary Research Institute, Chinese Academy of Agricultural Sciences, Lanzhou, China
| | - Hong-Bin Yan
- State Key Laboratory of Veterinary Etiological Biology, College of Veterinary Medicine, Lanzhou University, National Para-reference Laboratory for Animal Echinococcosis, Lanzhou Veterinary Research Institute, Chinese Academy of Agricultural Sciences, Lanzhou, China.
| | - Wan-Zhong Jia
- State Key Laboratory of Veterinary Etiological Biology, College of Veterinary Medicine, Lanzhou University, National Para-reference Laboratory for Animal Echinococcosis, Lanzhou Veterinary Research Institute, Chinese Academy of Agricultural Sciences, Lanzhou, China; Jiangsu Co-innovation Center for Prevention and Control of Important Animal Infectious Diseases and Zoonoses, Yangzhou, China.
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18F-FDG-PET/MR in Alveolar Echinococcosis: Multiparametric Imaging in a Real-World Setting. Pathogens 2022; 11:pathogens11030348. [PMID: 35335672 PMCID: PMC8951377 DOI: 10.3390/pathogens11030348] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/01/2022] [Accepted: 03/09/2022] [Indexed: 02/04/2023] Open
Abstract
Recent improvements in alveolar echinococcosis (AE) therapy can provide long-term disease control, and even allow structured treatment interruption in selected cases. Imaging has a pivotal role in monitoring disease activity, with 18-fluoro-deoxyglucose positron emission and computed tomography (18F-FDG-PET/CT) in particular having proven beneficial for assessing disease activity. Repetitive regular examinations to monitor therapy response, however, can lead to substantial radiation burden. Therefore, by combining metabolic information and excellent tissue contrast in magnetic resonance imaging (MRI), PET/MR appears ideally suited for this task. Here, we retrospectively analyzed 51 AE patients that underwent 18F-FDG-PET/MR. Patients had a ‘confirmed/probable’ diagnosis in 22/29 cases according to the WHO classification. FDG uptake, diffusion restriction, and MRI morphology were evaluated. We found significant differences in FDG uptake between responders to benzimidazole therapy and progressive manifestations (SUVavg 2.7 ± 1.3 vs. 5.4 ± 2.2, p < 0.001) as well as between Kodama Types 1 and 3 (F = 9.9, p < 0.003). No significant differences were detected for ADC values or MRI morphology concerning response and no correlations were present between FDG uptake and ADC values. The mean radiation dose was 5.9−6.5 mSv. We conclude that the combination of metabolic information and MRI morphology at a low radiation dose proposes PET/MR as a suitable imaging modality for AE assessment. Longitudinal studies are needed to define the role of this imaging modality.
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Lightowlers MW, Gasser RB, Hemphill A, Romig T, Tamarozzi F, Deplazes P, Torgerson PR, Garcia HH, Kern P. Advances in the treatment, diagnosis, control and scientific understanding of taeniid cestode parasite infections over the past 50 years. Int J Parasitol 2021; 51:1167-1192. [PMID: 34757089 DOI: 10.1016/j.ijpara.2021.10.003] [Citation(s) in RCA: 13] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/23/2021] [Revised: 10/06/2021] [Accepted: 10/07/2021] [Indexed: 02/07/2023]
Abstract
In the past 50 years, enormous progress has been made in the diagnosis, treatment and control of taeniid cestode infections/diseases and in the scientific understanding thereof. Most interest in this group of parasites stems from the serious diseases that they cause in humans. It is through this lens that we summarize here the most important breakthroughs that have made a difference to the treatment of human diseases caused by these parasites, reduction in transmission of the taeniid species associated with human disease, or understanding of the parasites' biology likely to impact diagnosis or treatment in the foreseeable future. Key topics discussed are the introduction of anti-cestode drugs, including benzimidazoles and praziquantel, and the development of new imaging modalities that have transformed the diagnosis and post-treatment monitoring of human echinococcoses and neurocysticercosis. The availability of new anti-cestode drugs for use in dogs and a detailed understanding of the transmission dynamics of Echinococcus granulosus sensu lato have underpinned successful programs that have eliminated cystic echinococcosis in some areas of the world and greatly reduced the incidence of infection in others. Despite these successes, cystic and alveolar echinococcosis and neurocysticercosis continue to be prevalent in many parts of the world, requiring new or renewed efforts to prevent the associated taeniid infections. Major advances made in the development of practical vaccines against E. granulosus and Taenia solium will hopefully assist in this endeavour, as might the understanding of the parasites' biology that have come from an elucidation of the nuclear genomes of each of the most important taeniid species causing human diseases.
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Affiliation(s)
- Marshall W Lightowlers
- Department of Biosciences, Melbourne Veterinary School, Faculty of Veterinary and Agricultural Sciences, The University of Melbourne, 250 Princes Highway, Werribee, Victoria 3030, Australia.
| | - Robin B Gasser
- Department of Biosciences, Melbourne Veterinary School, Faculty of Veterinary and Agricultural Sciences, The University of Melbourne, Parkville, Victoria 3010, Australia
| | - Andrew Hemphill
- Institute of Parasitology, Department of Infectious Diseases and Pathobiology, Vetsuisse Faculty, University of Bern, Länggassstrasse 122, 3012 Bern, Switzerland
| | - Thomas Romig
- University of Hohenheim, Parasitology Unit, Emil-Wolff-Strasse 34, 70599 Stuttgart, Germany
| | - Francesca Tamarozzi
- Department of Infectious Tropical Diseases and Microbiology, IRCCS Sacro Cuore Don Calabria Hospital, 37024 Negrar di Valpolicella, Verona, Italy
| | - Peter Deplazes
- Institute of Parasitology, Vetsuisse, and Medical Faculty, University of Zürich, Zürich, Switzerland
| | - Paul R Torgerson
- Section of Epidemiology, Vetsuisse Faculty, University of Zürich, Zürich, Switzerland
| | - Hector H Garcia
- Infectious Diseases Laboratory Research-LID, Faculty of Science and Philosophy, Alberto Cazorla Talleri, Universidad Peruana Cayetano Heredia, Lima, Perú; Cysticercosis Unit, Instituto Nacional de Ciencias Neurológicas, Lima, Perú
| | - Peter Kern
- Ulm University Hospital, Division of Infectious Diseases, Albert-Einstein-Allee 23, 89081 Ulm, Germany
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Abstract
Hepatic alveolar echinococcosis (HAE) is a rare but severe zoonosis caused by the pseudotumoral intrahepatic development of the larval stage of the tapeworm Echinococcus multilocularis. HAE is present only in the Northern Hemisphere, predominantly in China. Currently, there is a significant resurgence of cases in historically endemic areas associated with emergence of HAE in countries not previously concerned. Today, in European countries, HAE is often discovered by chance; however, clinicians should be made aware of opportunistic infections that progressively emerged recently as a result of therapeutic or pathological immunosuppression. Ultrasonography is the key first-line diagnostic procedure, with specific serology providing confirmation in 95% of the cases. Albendazole, only parasitostatic, is the mainstay for treatment. Surgical resection, if feasible, is the gold standard for treatment, and more patients are currently eligible for this option because of an earlier diagnosis. The prognosis has considerably improved but remains poor in countries where access to care is less favorable.
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Affiliation(s)
- Solange Bresson-Hadni
- Gastroenterology and Hepatology, Faculty of Medicine, University Hospitals of Geneva, Switzerland.,Division of Tropical and Humanitarian Medicine, Faculty of Medicine, University Hospitals of Geneva, Faculty of Medicine, Switzerland.,Laboratory of Parasitology-Mycology, National Reference Center for Echinococcosis, University Hospital of Besançon, Besançon, France
| | - Laurent Spahr
- Gastroenterology and Hepatology, Faculty of Medicine, University Hospitals of Geneva, Switzerland
| | - François Chappuis
- Division of Tropical and Humanitarian Medicine, Faculty of Medicine, University Hospitals of Geneva, Faculty of Medicine, Switzerland
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Graeter T, Shi R, Bao H, Liu W, Li W, Jiang Y, Schmidberger J, Brumpt E, Delabrousse E, Kratzer W. Intrahepatic manifestation and distant extrahepatic disease in alveolar echinococcosis: a multicenter cohort study. Acta Radiol 2021; 62:997-1005. [PMID: 32847367 DOI: 10.1177/0284185120951958] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/28/2022]
Abstract
BACKGROUND The main endemic areas of alveolar echinococcosis (AE) are in central Europe and western China. The infiltration of intrahepatic vascular and bile ducts as well as extrahepatic disease can lead to complications and may increase morbidity in AE. PURPOSE To evaluate the vascular/biliary involvement of hepatic alveolar echinococcosis (HAE) and distant extrahepatic disease at each of four locations in Germany, France, and China. MATERIAL AND METHODS Contrast-enhanced abdominal magnetic resonance imaging (MRI) scans of patients with HAE, 200 in total, were evaluated by five examiners. AE liver lesions were classified according to Kodama's classification. Furthermore, distant extrahepatic manifestations were documented with additionally performed imaging modalities. Vascular/biliary involvement of hepatic manifestations as well as the presence of extrahepatic manifestations were correlated with the respective Kodama type of the liver lesion. RESULTS Distant extrahepatic AE manifestations were significantly more frequent in China than in Europe (12/100 vs. 3/100; Fisher's exact test: P=0.0286). A significant relationship exists between presence of distant extrahepatic disease manifestation and size of the AE liver lesion (132.53 ± 48.65 vs. 92.49 ± 50.06; P = 0.0030). Vascular/biliary involvement is significantly more frequent in China than in Europe (86/100 vs. 65/100; χ2 = 11.92; P = 0.0006). Vascular/biliary involvement depends on lesion size (111.10 ± 47.44 vs. 47.36 ± 24.36; P<0.0001). Different types of AE liver lesions are associated with differences in vascular/biliary involvement and extrahepatic manifestations. CONCLUSION Vascular/biliary involvement and presence of distant extrahepatic manifestations depend on size of the HAE lesions and are more frequently detected in China. Different MRI morphological patterns influence vascular/biliary involvement and the occurrence of distant extrahepatic manifestations.
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Affiliation(s)
- Tilmann Graeter
- Department of Diagnostic and Interventional Radiology, University Hospital Ulm, Ulm, Germany
| | - Rong Shi
- Department of Diagnostic and Interventional Radiology, University Hospital Ulm, Ulm, Germany
| | - Haihua Bao
- Qinghai University, Qinghai University First Affiliated Hospital, Qinghai Province, Xining, PR China
| | - Wenya Liu
- Xinjiang Medical University, First Affiliated Hospital, WHO Collaborating Centre on Prevention and Care Management of Echinococcosis, Urumqi, Xinjiang Uyghur Autonomous Region, PR China
| | - Weixia Li
- Qinghai University, Qinghai University First Affiliated Hospital, Qinghai Province, Xining, PR China
| | - Yi Jiang
- Xinjiang Medical University, First Affiliated Hospital, WHO Collaborating Centre on Prevention and Care Management of Echinococcosis, Urumqi, Xinjiang Uyghur Autonomous Region, PR China
| | | | - Eleonore Brumpt
- University of Franche-Comté, WHO Collaborating Centre/National French Reference Centre for Echinococcosis, Besançon, France
- Department of Radiology, Besançon University Hospital, Besançon, France
| | - Eric Delabrousse
- University of Franche-Comté, WHO Collaborating Centre/National French Reference Centre for Echinococcosis, Besançon, France
- Department of Radiology, Besançon University Hospital, Besançon, France
| | - Wolfgang Kratzer
- Department of Internal Medicine I, University Hospital Ulm, Ulm, Germany
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Peters L, Burkert S, Grüner B. Parasites of the liver - epidemiology, diagnosis and clinical management in the European context. J Hepatol 2021; 75:202-218. [PMID: 33636243 DOI: 10.1016/j.jhep.2021.02.015] [Citation(s) in RCA: 19] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/17/2020] [Revised: 01/22/2021] [Accepted: 02/03/2021] [Indexed: 12/13/2022]
Abstract
Parasites in the liver cause significant global morbidity and mortality, as they can lead to recurrent cholangitis, cirrhosis, liver failure and cancer. Due to climate change and globalisation, their incidence is increasing, especially in Europe. The correct diagnosis of a hepatic parasite is often delayed because clinicians are unfamiliar with respective entities. Therefore, in this review, we aim to provide clinicians with a comprehensive clinical picture of hepatic parasites and to bring these neglected parasitic liver diseases to the wider attention of hepatology stakeholders in Europe and around the world.
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Affiliation(s)
- Lynn Peters
- University Hospital of Ulm, Department of Internal Medicine III, Division of Infectious Diseases, Albert-Einstein-Allee 23, 89081 Ulm, Germany
| | - Sanne Burkert
- University Hospital of Ulm, Department of Internal Medicine III, Division of Infectious Diseases, Albert-Einstein-Allee 23, 89081 Ulm, Germany
| | - Beate Grüner
- University Hospital of Ulm, Department of Internal Medicine III, Division of Infectious Diseases, Albert-Einstein-Allee 23, 89081 Ulm, Germany.
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Alveolar Echinococcosis of the Liver with a Rare Infiltration of the Adrenal Gland. Helminthologia 2021; 58:100-105. [PMID: 33664623 PMCID: PMC7912238 DOI: 10.2478/helm-2021-0002] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/08/2019] [Accepted: 12/01/2020] [Indexed: 12/28/2022] Open
Abstract
Human alveolar echinococcosis (AE) is a silently-progressing disorder that has become a threat in many countries. Since 2000, when the first case was recorded, the number of human AE patients in Slovakia is on continuous raise. The article presents a rare case of alveolar echinococcosis with infiltration in the adrenal gland and discusses the problems associated with differential diagnosis of the disease. In 2016, abdominal ultrasound performed due abdominal pain complaint showed the presence of cystic lesions in the right liver lobe of 54-year old female patient. During surgery, another lesion in the right adrenal gland was found, and neoplastic processes or echinococcosis were considered in the differential diagnosis. Due to unclear correlation between radiology, serology and histopathology results and endemic situation in Slovakia, molecular examination was recommended. Subsequently E. multilocularis was confirmed as etiological agent of infection. Alveolar echinococcosis is considered as a rare disease, with very few patients referred to clinicians or hospitals that sometimes have almost none existing experience with the diagnosis and treatment of the disease. Therefore, the establishment of networks or reference centres specialized on management of the disease would be suitable way to provide the patients with the best care and improve the disease diagnosis, treatment and prognosis.
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Emerging human alveolar echinococcosis in Hungary (2003-2018): a retrospective case series analysis from a multi-centre study. BMC Infect Dis 2021; 21:168. [PMID: 33568075 PMCID: PMC7877032 DOI: 10.1186/s12879-021-05859-5] [Citation(s) in RCA: 11] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/01/2020] [Accepted: 01/31/2021] [Indexed: 02/06/2023] Open
Abstract
Background Human alveolar echinococcosis (AE) caused by Echinococcus multilocularis is an underreported, often misdiagnosed and mistreated parasitic disease mainly due to its low incidence. The aim of this study was to describe the epidemiological and clinical characteristics of human AE patients in Hungary for the first time. Method Between 2003 and 2018, epidemiological and clinical data of suspected AE patients were collected retrospectively from health database management systems. Results This case series included a total of 16 AE patients. The mean age of patients was 53 years (range: 24–78 years). The sex ratio was 1:1. Four patients (25%) revealed no recurrence after radical surgery and adjuvant albendazole (ABZ) therapy. For five patients (31.3%) with unresectable lesions, a stabilization of lesions with ABZ treatment was achieved. In seven patients (43.8%), progression of AE was documented. The mean diagnostic delay was 33 months (range: 1–122 months). Three AE related deaths (fatality rate 18.8%) were recorded. Conclusions AE is an emerging infectious disease in Hungary with a high fatality rate since based on our results, almost every fifth AE patient died in the study period. Differential diagnosis and appropriate surgical and medical therapy for AE is an urging challenge for clinicians in Hungary, as well as in some other European countries where E. multilocularis is prevalent.
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Hashemzadeh S, Rezabakhsh A, Rahbarghazi R, Amini H. A giant splenic hydatid cyst: Why calcified cysts should not be considered as a dead cyst. Clin Case Rep 2021; 9:269-273. [PMID: 33489171 PMCID: PMC7813004 DOI: 10.1002/ccr3.3512] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/14/2020] [Revised: 08/31/2020] [Accepted: 09/24/2020] [Indexed: 12/28/2022] Open
Abstract
Our case report showed that peripheral wall calcification of the hydatid cyst does not mean inactivation of the cyst and calcification of cyst wall may occur in all stages of disease.
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Affiliation(s)
- Shahriar Hashemzadeh
- Tuberculosis and Lung Disease Research CenterTabriz University of Medical SciencesTabrizIran
- Department of General and Thoracic SurgeryTabriz University of Medical SciencesTabrizIran
| | - Aysa Rezabakhsh
- Cardiovascular Research CenterTabriz University of Medical SciencesTabrizIran
| | - Reza Rahbarghazi
- Department of Applied Cell SciencesFaculty of Advanced Medical SciencesTabriz University of Medical SciencesTabrizIran
- Stem Cell Research CenterTabriz University of Medical SciencesTabrizIran
| | - Hassan Amini
- Department of General and Thoracic SurgeryTabriz University of Medical SciencesTabrizIran
- Stem Cell Research CenterTabriz University of Medical SciencesTabrizIran
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12
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The spectrum of multimodality imaging findings in hepatic alveolar echinococcosis and the potential role of diffusion-weighted imaging in its characterisation. Pol J Radiol 2020; 85:e613-e623. [PMID: 33376563 PMCID: PMC7757515 DOI: 10.5114/pjr.2020.101015] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/06/2020] [Accepted: 05/25/2020] [Indexed: 12/28/2022] Open
Abstract
Purpose To study the spectrum of imaging findings in hepatic alveolar echinococcosis (HAE) and to evaluate the potential role of diffusion-weighted imaging (DWI) in its characterisation. Material and methods Two radiologists with more than seven years of experience retrospectively studied ultrasonography, computed tomography (CT), and magnetic resonance imaging (MRI) findings in 23 histopathologically proven cases of HAE with emphasis on the appearance and extent of disease. DWI characteristics of lesions were noted, and their apparent diffusion values (ADC) were calculated. Results Ultrasonography features of HAE included heterogeneous, hyperechoic hepatic mass with or without calcification (n = 20), or heterogeneous mass with solid-cystic appearance (n = 2). CT revealed heterogeneous density infiltrative hepatic mass with no contrast enhancement in 19 patients or thick-walled cystic mass (n = 4). Following Kodama classification one type 1, six type 2, two type 3, eight type 4, and two type 5 lesions were identified on T2-weighted MRI. No enhancement was seen on post-contrast T1-weighted images. Mean ADC values were 1.74 ± 0.48 × 10-3 mm2/s (range: 1.39 × 10-3 mm2/s to 2.3 × 10-3 mm2/s). Conclusions HAE by virtue of its infiltrative growth pattern with a tendency to involve biliary, vascular, and extra hepatic structures can be easily misdiagnosed as malignant hepatic neoplasm. Knowledge of varied imaging appearances of HAE is essential to suspect the condition and to make an appropriate diagnosis. Diffusion-weighted imaging is a useful adjunct with relatively high diffusivity (high ADC values) suggesting diagnosis of alveolar hydatid.
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Graeter T, Bao HH, Shi R, Liu WY, Li WX, Jiang Y, Schmidberger J, Brumpt E, Delabrousse E, Kratzer W. Evaluation of intrahepatic manifestation and distant extrahepatic disease in alveolar echinococcosis. World J Gastroenterol 2020; 26:4302-4315. [PMID: 32848335 PMCID: PMC7422544 DOI: 10.3748/wjg.v26.i29.4302] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/03/2020] [Revised: 06/09/2020] [Accepted: 07/23/2020] [Indexed: 02/06/2023] Open
Abstract
BACKGROUND The main endemic areas of alveolar echinococcosis (AE) are in Central Europe and Western China. Both the infiltration of intrahepatic vascular and bile duct structures as well as extrahepatic disease can lead to further complications and may increase morbidity in patients with AE.
AIM To evaluate vascular/biliary involvement in hepatic AE and its distant extrahepatic disease manifestations in an international collective was the aim.
METHODS Consecutively, five experienced examiners evaluated contrast-enhanced abdominal computed tomography (CT) scans for 200 patients with hepatic AE of each of four locations (n = 50) in Germany, France and China. Therefore, we retrospectively included the 50 most recent abdominal contrast-enhanced CT examinations at each center, performed because of hepatic AE from September 21, 2007 to March 21, 2018. AE liver lesions were classified according to the echinococcosis multilocularis Ulm classification for CT (EMUC-CT). Distant extrahepatic manifestations were documented either by whole body positron emission tomography–CT or with the addition of thoracic CT and cranial magnetic resonance imaging. Vascular/biliary involvement of the hepatic disease as well as the presence of distant extrahepatic manifestations were correlated with the EMUC-CT types of liver lesion. Statistical analysis was performed using SAS Version 9.4 (SAS Institute Inc., Cary, NC, United States).
RESULTS Distant extrahepatic AE manifestations were significantly more frequent in China than in Europe (P = 0.0091). A significant relationship was found between the presence of distant extrahepatic disease and AE liver lesion size (P = 0.0075). Vascular/biliary structures were involved by the liver lesions significantly more frequently in China than in Europe (P < 0.0001), and vascular/biliary involvement depended on lesion size. Different morphological types of AE liver lesions led to varying frequencies of vascular/biliary involvement and were associated with different frequencies of distant extrahepatic manifestations: Vascular/biliary involvement as a function of lesions primary morphology ranged from 5.88% of type IV liver lesions to 100% among type III lesions. Type IV differed significantly in these associations from types I, II, and III (P < 0.0001). With respect to extrahepatic disease, the primary morphology types IV and V of liver lesions were not associated with any case of distant extrahepatic disease. In contrast, distant extrahepatic manifestations in types I–III were found to varying degrees, with a maximum of 22% for type III.
CONCLUSION Different CT morphological patterns of hepatic AE lesions influence vascular/biliary involvement and the occurrence of distant extrahepatic manifestations. There are intercontinental differences regarding the characteristics of AE manifestation.
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Affiliation(s)
- Tilmann Graeter
- Department of Diagnostic and Interventional Radiology, University Hospital Ulm, Ulm 89081, Germany
| | - Hai-Hua Bao
- Qinghai University, Qinghai University First Affiliated Hospital, Xining 810001, Qinghai Province, China
| | - Rong Shi
- Department of Diagnostic and Interventional Radiology, University Hospital Ulm, Ulm 89081, Germany
| | - Wen-Ya Liu
- Xinjiang Medical University, First Affiliated Hospital, WHO Collaborating Centre on Prevention and Care Management of Echinococcosis, Urumqi 830054, Xinjiang Uyghur Autonomous Region, China
| | - Wei-Xia Li
- Qinghai University, Qinghai University First Affiliated Hospital, Xining 810001, Qinghai Province, China
| | - Yi Jiang
- Xinjiang Medical University, First Affiliated Hospital, WHO Collaborating Centre on Prevention and Care Management of Echinococcosis, Urumqi 830054, Xinjiang Uyghur Autonomous Region, China
| | - Julian Schmidberger
- Department of Internal Medicine I, University Hospital Ulm, Ulm 89081, Germany
| | - Eleonore Brumpt
- WHO Collaborating Centre on Prevention and Treatment of Human Echinococcosis/National French Reference Centre for Echinococcosis, University Bourgogne Franche-Comté and Besançon University Hospital, Besançon 25030, France
| | - Eric Delabrousse
- WHO Collaborating Centre on Prevention and Treatment of Human Echinococcosis/National French Reference Centre for Echinococcosis, University Bourgogne Franche-Comté and Besançon University Hospital, Besançon 25030, France
| | - Wolfgang Kratzer
- Department of Internal Medicine I, University Hospital Ulm, Ulm 89081, Germany
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Graeter T, Eberhardt N, Shi R, Schmidberger J, Beer AJ, Beer M, Henne-Bruns D, Hillenbrand A, Barth TFE, Grimm J, Kratzer W, Gruener B. Hepatic alveolar echinococcosis: correlation between computed tomography morphology and inflammatory activity in positron emission tomography. Sci Rep 2020; 10:11808. [PMID: 32678174 PMCID: PMC7366930 DOI: 10.1038/s41598-020-68624-9] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/05/2019] [Accepted: 06/18/2020] [Indexed: 12/15/2022] Open
Abstract
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.
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Affiliation(s)
- Tilmann Graeter
- Department of Diagnostic and Interventional Radiology, Ulm University Hospital, Albert-Einstein-Allee 23, 89081, Ulm, Germany
| | - Nina Eberhardt
- Department of Nuclear Medicine, Ulm University Hospital, Albert-Einstein-Allee 23, 89081, Ulm, Germany
| | - Rong Shi
- Department of Diagnostic and Interventional Radiology, Ulm University Hospital, Albert-Einstein-Allee 23, 89081, Ulm, Germany
| | - Julian Schmidberger
- Department of Internal Medicine I, Ulm University Hospital, Albert-Einstein-Allee 23, 89081, Ulm, Germany
| | - Ambros J Beer
- Department of Nuclear Medicine, Ulm University Hospital, Albert-Einstein-Allee 23, 89081, Ulm, Germany
| | - Meinrad Beer
- Department of Diagnostic and Interventional Radiology, Ulm University Hospital, Albert-Einstein-Allee 23, 89081, Ulm, Germany
| | - Doris Henne-Bruns
- Department of General and Visceral Surgery, Ulm University Hospital, Albert-Einstein-Allee 23, 89081, Ulm, Germany
| | - Andreas Hillenbrand
- Department of General and Visceral Surgery, Ulm University Hospital, Albert-Einstein-Allee 23, 89081, Ulm, Germany
| | - Thomas F E Barth
- Institute of Pathology, Ulm University, Albert-Einstein-Allee 23, 89081, Ulm, Germany
| | - Johannes Grimm
- Institute of Pathology, Ulm University, Albert-Einstein-Allee 23, 89081, Ulm, Germany
| | - Wolfgang Kratzer
- Department of Internal Medicine I, Ulm University Hospital, Albert-Einstein-Allee 23, 89081, Ulm, Germany.
| | - Beate Gruener
- Department of Internal Medicine III, Ulm University Hospital, Albert-Einstein-Allee 23, 89081, Ulm, Germany
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15
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Sulima M, Sikorska K, Nahorski W, Borys S. Clinical aspects and treatment of alveolar echinococcosis: the current state of knowledge and difficulties in the diagnosis and management of cases in Poland. POSTEP HIG MED DOSW 2020. [DOI: 10.5604/01.3001.0013.9008] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/17/2022] Open
Abstract
The aim of the study is to summarize the current state of knowlege in the diagnosis and monitoring of patients with alveolar echinococcosis (AE), using serological tests and imaging techniques, and to present the most recent therapeutic guidelines based on a literature review. The paper discusses the challenges in diagnosing and treating AE encountered in clinical practice in Poland, based on the analysis of medical records of 86 patients with AE, who were hospitalized in the University Centre for Maritime and Tropical Medicine (UCMTM) between 2000 and 2018. In Poland, AE is usually diagnosed at the advanced stage, when optimal, radical surgery is not an option. Diagnosis of AE is often preceded by invasive diagnostic methods, such as biopsy or exploratory laparotomy, which may result in the infection spreading. Pharmacological treatment is associated with potential adverse effects and is a significant financial burden for the patient due to the lack of reimbursement. There is a need to raise the awareness of AE among physicians performing imaging studies and to facilitate access to modern techniques enabling the assessment of the parasitic process.
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Affiliation(s)
- Małgorzata Sulima
- Department of Tropical and Parasitic Diseases, University Centre of Maritime and Tropical Medicine, Medical University of Gdansk, Gdynia, Poland
| | - Katarzyna Sikorska
- Department of Tropical and Parasitic Diseases, University Centre of Maritime and Tropical Medicine, Medical University of Gdansk, Gdynia, Poland
| | - Wacław Nahorski
- Department of Tropical and Parasitic Diseases, University Centre of Maritime and Tropical Medicine, Medical University of Gdansk, Gdynia, Poland
| | - Sebastian Borys
- Department of Tropical and Parasitic Diseases, University Centre of Maritime and Tropical Medicine, Medical University of Gdansk, Gdynia, Poland
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A mathematical modelling approach for treatment and control of Echinococcus multilocularis. Parasitology 2020; 147:376-381. [PMID: 31789140 DOI: 10.1017/s0031182019001720] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/22/2022]
Abstract
Alveolar echinococcosis (AE) is a zoonotic parasitic diseases caused by a cestode parasite known as Echinococcus multilocularis. The parasite has a wildlife cycle with definitive hosts (foxes) and small mammals as intermediate hosts (rodents) while humans are the accidental hosts. Parasite infection pressure relation to time of the year and age dependent infection pressure for parasite abundance also depend on the urbanization. The aim of current work is forecasting the thresholds via the computational analysis of the disease spread which is a useful approach since it can help to design the experimental settings with better planning and efficiency. Network analysis when interlinked with the computational techniques provides better insight into the spatial and temporal heterogeneities. In the present study, a mathematical framework that describes the transmission dynamics and control measures of E. multilocularis in foxes is documented. We used treatment of foxes with baits for the prevention of the E. multilocularis infection. A novel approach of networking, called Petri net (PN), based on density dependent differential equations, is utilized during this research. The accurate description of the transmission of the parasite and the effect of drug on it is provided to the readers in this article. The transitions, which are difficult to analyse theoretically, are presented with the aid of the discrete approach of networking. A discrete mathematical framework can prove to be an accurate and robust tool to analyse and control the parasite dynamics.
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17
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Sulima M, Nahorski W, Gorycki T, Wołyniec W, Wąż P, Felczak-Korzybska I, Szostakowska B, Sikorska K. Ultrasound images in hepatic alveolar echinococcosis and clinical stage of the disease. Adv Med Sci 2019; 64:324-330. [PMID: 31003201 DOI: 10.1016/j.advms.2019.04.002] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/08/2018] [Revised: 12/30/2018] [Accepted: 04/05/2019] [Indexed: 02/07/2023]
Abstract
PURPOSE Hepatic alveolar echinococcosis (AE) is a parasitic disease caused by the larval stage of the tapeworm Echinococcus multilocularis. Ultrasonography is the method of choice in the initial diagnosis of AE. The aim of the study is to present the most frequent sonomorphological patterns of lesions in hepatic AE based on the analysis of ultrasound findings in patients treated for AE at the University Centre of Maritime and Tropical Medicine (UCMMiT; Gdynia, Poland), and to establish whether there is a relationship between the clinical stage of AE and the occurrence of a specific sonomorphological pattern of hepatic lesions. PATIENTS AND METHODS We analysed the results of ultrasound examinations of 58 patients hospitalized in the UCMMiT with probable or certain diagnosis of AE. Liver lesions were assessed according to the classification developed by researchers from the University Hospital in Ulm (Germany). Statistical analysis was based on the relationship between the occurrence of a specific sonomorphological pattern of hepatic lesions and the clinical stage of AE. RESULTS The most frequently observed patterns of AE lesions in the liver were the hailstorm and the pseudocystic patterns. There was no correlation between the clinical stage of the disease and the ultrasonographic appearance of lesions. There was no statistically significant relationship between the more frequent occurrences of specific ultrasonographic patterns of lesions in the liver and radical or non-radical surgery. CONCLUSIONS The ultrasonographic appearance of the lesion in liver AE cannot determine the therapeutic management. Treatment plan should be established based on the PMN classification.
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18
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Engler A, Shi R, Beer M, Schmidberger J, Kratzer W, Barth TFE, Grimm J, Hillenbrand A, Henne-Bruns D, Gruener B, Beer AJ, Graeter T. Simple liver cysts and cystoid lesions in hepatic alveolar echinococcosis: a retrospective cohort study with Hounsfield analysis. ACTA ACUST UNITED AC 2019; 26:54. [PMID: 31469072 PMCID: PMC6716343 DOI: 10.1051/parasite/2019057] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/14/2019] [Accepted: 08/15/2019] [Indexed: 12/13/2022]
Abstract
BACKGROUND Alveolar echinococcosis (AE) is a rare zoonosis caused by the larval stage of the tapeworm Echinococcus multilocularis. AE lesions affect the liver in more than 98% of cases. AE lesions have various morphological characteristics that are described in the Echinococcus multilocularis Ulm classification for computed tomography (EMUC-CT). One of these characteristics is a cystoid portion. The aim of the study was to compare the density of simple hepatic cysts with cystoid portions of AE lesions classified on the basis of the EMUC-CT. RESULTS Hounsfield Unit (HU) measurements of the cystoid portions of all EMUC-CT type I-IV AE lesions (n = 155) gave a mean of 21.8 ± 17.6, which was significantly different from that of 2.9 ± 4.5 for the simple hepatic cysts (p < 0.0001). The difference between each of the individual AE types and simple hepatic cysts was also significant. In addition, the HU values of the cystoid portions in types I, II and IIIa/b and simple cysts were each significantly different from type IV (p < 0.0001). The HU measurements in type IV presented by far the highest mean. CONCLUSIONS The significantly higher density measured in the cystoid portions of hepatic AE lesions offers a good means of differentiation from simple hepatic cysts.
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Affiliation(s)
- Agata Engler
- Department of Diagnostic and Interventional Radiology, University Hospital Ulm, Albert-Einstein-Allee 23, 89081 Ulm, Germany
| | - Rong Shi
- Department of Diagnostic and Interventional Radiology, University Hospital Ulm, Albert-Einstein-Allee 23, 89081 Ulm, Germany
| | - Meinrad Beer
- Department of Diagnostic and Interventional Radiology, University Hospital Ulm, Albert-Einstein-Allee 23, 89081 Ulm, Germany
| | - Julian Schmidberger
- Department of Internal Medicine I, University Hospital Ulm, Albert-Einstein-Allee 23, 89081 Ulm, Germany
| | - Wolfgang Kratzer
- Department of Internal Medicine I, University Hospital Ulm, Albert-Einstein-Allee 23, 89081 Ulm, Germany
| | - Thomas F E Barth
- Department of Pathology, University Hospital Ulm, Albert-Einstein-Allee 23, 89081 Ulm, Germany
| | - Johannes Grimm
- Department of Pathology, University Hospital Ulm, Albert-Einstein-Allee 23, 89081 Ulm, Germany
| | - Andreas Hillenbrand
- Department of General and Visceral Surgery, University Hospital Ulm, Albert-Einstein-Allee 23, 89081 Ulm, Germany
| | - Doris Henne-Bruns
- Department of General and Visceral Surgery, University Hospital Ulm, Albert-Einstein-Allee 23, 89081 Ulm, Germany
| | - Beate Gruener
- Department of Internal Medicine III, University Hospital Ulm, Albert-Einstein-Allee 23, 89081 Ulm, Germany
| | - Ambros J Beer
- Department of Nuclear Medicine, Ulm University Hospital, Albert-Einstein-Allee 23, 89081 Ulm, Germany
| | - Tilmann Graeter
- Department of Diagnostic and Interventional Radiology, University Hospital Ulm, Albert-Einstein-Allee 23, 89081 Ulm, Germany
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19
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Alveolar Hydatid. INFECTIOUS DISEASES IN CLINICAL PRACTICE 2019. [DOI: 10.1097/ipc.0000000000000746] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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20
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Ailixire SA, Sai Charan Goud K, Hari Krishna K, Wenya L. A new classification of hepatic alveolar echinococcosis (HAE) calcification and biological activity using CT and PET-CT. ACTA ACUST UNITED AC 2019. [DOI: 10.1016/j.jrid.2019.06.002] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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21
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Wetscher M, Hackländer K, Faber V, Taylor N, Auer H, Duscher GG. Hunting Poses Only a Low Risk for Alveolar Echinococcosis. Front Public Health 2019; 7:7. [PMID: 30761283 PMCID: PMC6361863 DOI: 10.3389/fpubh.2019.00007] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/17/2018] [Accepted: 01/09/2019] [Indexed: 12/28/2022] Open
Abstract
The Austrian province of Tyrol belongs to the areas where the alveolar echinococcosis (AE) caused by the fox tapeworm Echinococcus multilocularis (E. multilocularis) is highly endemic. In Central Europe and since 2011 in Austria, a growing incidence of human cases of AE has been observed, presumably linked with increasing fox populations infected by the fox tapeworm E. multilocularis. Hunting and the related activities put hunters in a high-risk group, and they are considered particularly vulnerable for the contraction of an AE. In light of this risk and the increased number of AE cases made public in Austria, the objective of the study was to investigate the prevalence of AE in hunters and to provide a possible connection to the incidence increase. In 2015 and 2016, we examined 813 serums of active hunters from all nine districts of Tyrol and serologically tested them for E. multilocularis antibodies. Twenty-one (2.58%) positive results in ELISA were detected via Western blot (WB), and only one (0.12%) serum showed a low positive reaction. No lesion in the liver parenchyma could be detected by abdominal ultrasonography in this patient so far, but the risk of developing alveolar echinococcosis remains for this WB-positive hunter. Risk factor analysis of these 813 hunters revealed that 697 (85.7%) hunted red foxes regularly and 332 (40.8%) of those skinned them as well. Three hundred and eighteen (39.1%) out of the 813 hunters were owners of hunting dogs; 89 (10.9%) and 243 (29.9%) were owners of non-hunting dogs and cats, respectively. Our results indicate that hunters do not have a greater risk of infection with E. multilocularis compared to non-hunters in Austria. The cause of the unexpected increase in AE cases in Austria remains unclear.
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Affiliation(s)
- Monika Wetscher
- Department of Integrative Biology and Biodiversity Research, Institute of Wildlife Biology and Game Management, University of Natural Resources and Life Sciences, Vienna, Austria
| | - Klaus Hackländer
- Department of Integrative Biology and Biodiversity Research, Institute of Wildlife Biology and Game Management, University of Natural Resources and Life Sciences, Vienna, Austria
| | - Viktoria Faber
- Third Medical Department with Haematology, Medical Oncology, Haemostaseology, Infectious Diseases and Rheumathology, Oncologic Center, Paracelsus Medical University, Salzburg, Austria
| | - Ninon Taylor
- Third Medical Department with Haematology, Medical Oncology, Haemostaseology, Infectious Diseases and Rheumathology, Oncologic Center, Paracelsus Medical University, Salzburg, Austria
| | - Herbert Auer
- Department of Medical Parasitology, Center of Pathophysiology, Infectiology and Immunology, Institute of Specific Prophylaxis and Tropical Medicine, Medical University Vienna, Vienna, Austria
| | - Georg G Duscher
- Department of Pathobiology, Institute of Parasitology, University of Veterinary Medicine, Vienna, Austria
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Alveolar echinococcosis in Germany, 1992-2016. An update based on the newly established national AE database. Infection 2017; 46:197-206. [PMID: 29090421 DOI: 10.1007/s15010-017-1094-0] [Citation(s) in RCA: 21] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/09/2017] [Accepted: 10/26/2017] [Indexed: 12/28/2022]
Abstract
PURPOSE Alveolar echinococcosis is a rare disease caused by the parasite Echinococcus multilocularis. The newly established national database should enable us to determine high-risk areas and evaluate the endemic levels. METHODS The national database was implemented using SQL Workbench. We used EpiInfo™ software to display the prevalence of disease. Moran's I geodata analysis according to cluster and high risk areas was performed with GeoDa™. SAS Version 9.2 was used for the statistical analysis of the cases (n = 523). RESULTS The analysis showed a concentration of cases in Baden-Württemberg and Bavaria. Moran's I showed a heterogeneous case distribution throughout Germany (I = 0.208815, Z = 32.6175, p < 0.001). In the period from 1992 to 2016, the prevalence was 0.64/100,000 inhabitants in the whole of Germany, 2.18/100,000 inhabitants in Baden-Württemberg and 1.48/100,000 inhabitants in Bavaria. The analysis also revealed a difference between men and women, with a prevalence of 0.58/100,000 and 0.69/100,000, respectively. The analysis of spatial autocorrelation and possible risk areas showed that the southeast regions of Baden-Württemberg (I = 0.188514, Z = 11.3197, p < 0.001) and the southwest part of Bavaria (I = 0.176953, Z = 13.5144, p < 0.001) constitute the high risk areas. CONCLUSIONS The prevalence of disease is noticeably high in the Swabian Jura, the Bavarian Alps and the Alpine foothills. Raising awareness and educating doctors in high risk areas may prevent new cases and assist in earlier diagnosis.
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Sade R, Kantarci M, Ogul H, Gundogdu B, Aydınlı B. Differentiation between hepatic alveolar echinococcosis and primary hepatic malignancy with diffusion-weighted magnetic resonance imaging. Diagn Interv Imaging 2017; 99:169-177. [PMID: 29110943 DOI: 10.1016/j.diii.2017.09.007] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/06/2017] [Revised: 08/03/2017] [Accepted: 09/20/2017] [Indexed: 12/28/2022]
Abstract
PURPOSE To determine the value of diffusion-weighted magnetic resonance imaging (DW-MRI) in discriminating between hepatic alveolar echinococcosis (AE) and hepatocellular carcinoma and intrahepatic cholangiocarcinoma. METHODS We included 49 patients (27 men, 22 women; mean age: 52.02±9.76 [SD] years; range: 25-72years) with 57 histopathologically confirmed hepatic AE lesions. Fifty patients (18 men, 32 women; mean age: 58.93±8.42 [SD] years; range: 42-71years) with 61 histopathologically confirmed hepatocellular carcinoma and 50 patients (24 men, 26 women; mean age: 50.11±7.70 [SD] years; range: 38-69years) with 54 histopathologically confirmed intrahepatic cholangiocarcinoma lesions were used as control groups. All patients had MRI examination of the liver that included conventional MRI sequences and DW-MRI using b values of 50, 400 and 800s/mm2. Two radiologists evaluated conventional MRI and DW-MRI images and calculated ADC values of hepatic lesions. RESULTS The mean ADC value of solid components of hepatic AE lesions was 1.34±0.41×10-3 mm2/s (range: 0.9-1.59×10-3 mm2/s) and was significantly higher than that of the solid components of hepatocellular carcinoma lesions (mean ADC value, 0.99±0.29×10-3 mm2/s; range: 0.7-1.15×10-3 mm2/s) and of intrahepatic cholangiocarcinoma lesions (mean ADC value, 1.05±0.22×10-3 mm2/s; range: 0.86-1.18×10-3 mm2/s) (P<0.001). CONCLUSION In general ADC values can help discriminate between AE and hepatocellular carcinoma and intrahepatic cholangiocarcinoma. However, the use of ADC values cannot help differentiating Type 4 AE from hepatocellular carcinoma or intrahepatic cholangiocarcinoma.
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Affiliation(s)
- R Sade
- Ataturk University, School of Medicine, Department of Radiology, 200 Evler Mah. 14. Sok No 5, Dadaskent, Erzurum, Turkey
| | - M Kantarci
- Ataturk University, School of Medicine, Department of Radiology, 200 Evler Mah. 14. Sok No 5, Dadaskent, Erzurum, Turkey.
| | - H Ogul
- Ataturk University, School of Medicine, Department of Radiology, 200 Evler Mah. 14. Sok No 5, Dadaskent, Erzurum, Turkey
| | - B Gundogdu
- Ataturk University, School of Medicine, Department of Pathology, Erzurum, Turkey
| | - B Aydınlı
- Akdeniz University, School of Medicine, Department of General Surgery, Antalya, Turkey
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Grüner B, Schmidberger J, Drews O, Kratzer W, Gräter T. Imaging in alveolar echinococcosis (AE): Comparison of Echinococcus multilocularis classification for computed-tomography (EMUC-CT) and ultrasonography (EMUC-US). ACTA ACUST UNITED AC 2017. [DOI: 10.1016/j.jrid.2017.05.001] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
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To see or not to see: non-invasive imaging for improved readout of drug treatment trials in the murine model of secondary alveolar echinococcosis. Parasitology 2017; 144:937-944. [PMID: 28270242 DOI: 10.1017/s0031182017000051] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/28/2022]
Abstract
Alveolar echinococcosis (AE) is an emerging zoonotic disease caused by the cestode Echinococcus multilocularis. The secondary infection model of AE is based on intraperitoneal injection of disease-causing metacestodes into the peritoneal cavity of mice, which allows investigations on novel drugs or immunotherapeutical treatment options in vivo. So far, such in vivo studies assessed exclusively the parasite weight at the endpoint of a given treatment period. We here developed an ultrasound (US)-based scoring system that allows to follow-up parasite development in the living animal, and provides insights into parasite growth during the treatment phase. By this method a statistically significant difference between untreated and medicated mice with E. multilocularis infection was observed at 2 months post-infection, and the growth curve of the parasite load was described by a linear mixed model. High correlation and similar levels of variation were observed for the standard method based on parasite weight measurement, the novel US-based scoring system, as well volume segmentation by post-mortem magnetic resonance imaging. Thus, US-based scoring in the live animal has the potential to assist the 3R concept by contributing to the refinement and reduction of animal use in experimental echinococcosis.
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Kern P, Menezes da Silva A, Akhan O, Müllhaupt B, Vizcaychipi KA, Budke C, Vuitton DA. The Echinococcoses: Diagnosis, Clinical Management and Burden of Disease. ADVANCES IN PARASITOLOGY 2017; 96:259-369. [PMID: 28212790 DOI: 10.1016/bs.apar.2016.09.006] [Citation(s) in RCA: 258] [Impact Index Per Article: 36.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Abstract
The echinococcoses are chronic, parasitic diseases that are acquired after ingestion of infective taeniid tapeworm eggs from certain species of the genus Echinococcus. Cystic echinococcosis (CE) occurs worldwide, whereas, alveolar echinococcosis (AE) is restricted to the northern hemisphere, and neotropical echinococcosis (NE) has only been identified in Central and South America. Clinical manifestations and disease courses vary profoundly for the different species of Echinococcus. CE presents as small to large cysts, and has commonly been referred to as 'hydatid disease', or 'hydatidosis'. A structured stage-specific approach to CE management, based on the World Health Organization (WHO) ultrasound classification of liver cysts, is now recommended. Management options include percutaneous sterilization techniques, surgery, drug treatment, a 'watch-and-wait' approach or combinations thereof. In contrast, clinical manifestations associated with AE resemble those of a 'malignant', silently-progressing liver disease, with local tissue infiltration and metastases. Structured care is important for AE management and includes WHO staging, drug therapy and long-term follow-up for at least a decade. NE presents as polycystic or unicystic disease. Clinical characteristics resemble those of AE, and management needs to be structured accordingly. However, to date, only a few hundreds of cases have been reported in the literature. The echinococcoses are often expensive and complicated to treat, and prospective clinical studies are needed to better inform case management decisions.
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Affiliation(s)
- P Kern
- University Hospital of Ulm, Ulm, Germany
| | | | - O Akhan
- Hacettepe University, Ankara, Turkey
| | - B Müllhaupt
- University Hospital of Zurich, Zürich, Switzerland
| | - K A Vizcaychipi
- National Institute of Infectious Diseases, Buenos Aires, Argentina
| | - C Budke
- Texas A&M University, College Station, TX, United States
| | - D A Vuitton
- Université de Franche-Comté, Besançon, France
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Echinococcosis. Infect Dis (Lond) 2017. [DOI: 10.1016/b978-0-7020-6285-8.00120-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/18/2022] Open
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Mihmanli M, Idiz UO, Kaya C, Demir U, Bostanci O, Omeroglu S, Bozkurt E. Current status of diagnosis and treatment of hepatic echinococcosis. World J Hepatol 2016; 8:1169-1181. [PMID: 27729953 PMCID: PMC5055586 DOI: 10.4254/wjh.v8.i28.1169] [Citation(s) in RCA: 103] [Impact Index Per Article: 12.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/27/2016] [Revised: 06/21/2016] [Accepted: 07/13/2016] [Indexed: 02/06/2023] Open
Abstract
Echinococcus granulosus (E. granulosus) and Echinococcus multilocularis (E. multilocularis) infections are the most common parasitic diseases that affect the liver. The disease course is typically slow and the patients tend to remain asymptomatic for many years. Often the diagnosis is incidental. Right upper quadrant abdominal pain, hepatitis, cholangitis, and anaphylaxis due to dissemination of the cyst are the main presenting symptoms. Ultrasonography is important in diagnosis. The World Health Organization classification, based on ultrasonographic findings, is used for staging of the disease and treatment selection. In addition to the imaging methods, immunological investigations are used to support the diagnosis. The available treatment options for E. granulosus infection include open surgery, percutaneous interventions, and pharmacotherapy. Aggressive surgery is the first-choice treatment for E. multilocularis infection, while pharmacotherapy is used as an adjunct to surgery. Due to a paucity of clinical studies, empirical evidence on the treatment of E. granulosus and E. multilocularis infections is largely lacking; there are no prominent and widely accepted clinical algorithms yet. In this article, we review the diagnosis and treatment of E. granulosus and E. multilocularis infections in the light of recent evidence.
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Antolová D, Hudáčková D, Fecková M, Feketeová A, Szilágyová M. Pyogenic liver abscess in a child with concomitant infections – Staphylococcus aureus, Echinococcus multilocularis and Mycobacterium tuberculosis. Helminthologia 2016. [DOI: 10.1515/helmin-2016-0026] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/28/2022] Open
Abstract
Summary
Pyogenic liver abscess is an uncommon but important and potentially life-threatening disease that occurs whenever there is failure of clearance of an infection in the liver. Work presents a rare case of pyogenic liver abscess with confirmed bacterial aetiology of Staphylococcus aureus, subsequently confirmed Echinococcus multilocularis and suspected Mycobacterium tuberculosis liver infection in 6 years old child. Moreover, several other parasitic diseases were recorded. According to clinical presentation of diseases, it could be supposed that liver impairment caused by alveolar echinococcosis and potentially also by M. tuberculosis could be the predisposition site for the capture of Staphylococcus aureus in altered liver tissues during its haematogenous spreading, and thus contributed to the development and subsequent clinical presentation of pyogenic liver abscess. The presence of three different aetiological agents complicated the diagnostic process as well as the therapy of the patient and made her prognosis uncertain. Proper diagnosis of multiloculated liver abscesses, with echinococcosis and hepatic tuberculosis considered in the differential diagnosis, is therefore crucial to administration of early and appropriate treatment.
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Affiliation(s)
- D. Antolová
- Institute of Parasitology SAS, Hlinkova 3, 040 01 Košice, Slovakia
| | - D. Hudáčková
- Department of Infectious Diseases, Children’s Faculty Hospital Košice, Trieda SNP 1, 040 01 Košice, Slovakia
| | - M. Fecková
- Institute of Parasitology SAS, Hlinkova 3, 040 01 Košice, Slovakia
| | - A. Feketeová
- Pediatric Clinic, Children’s Faculty Hospital Košice, Trieda SNP 1, 040 01 Košice, Slovakia
| | - M. Szilágyová
- Clinic of Infectology and Travel Medicine, Comenius University Bratislava, Jessenius Faculty of Medicine and University Hospital, Martin
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Graeter T, Kratzer W, Oeztuerk S, Haenle MM, Mason RA, Hillenbrand A, Kull T, Barth TF, Kern P, Gruener B. Proposal of a computed tomography classification for hepatic alveolar echinococcosis. World J Gastroenterol 2016; 22:3621-3631. [PMID: 27053854 PMCID: PMC4814648 DOI: 10.3748/wjg.v22.i13.3621] [Citation(s) in RCA: 50] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/21/2015] [Revised: 10/30/2015] [Accepted: 12/30/2015] [Indexed: 02/06/2023] Open
Abstract
AIM: To establish a computed tomography (CT)-morphological classification for hepatic alveolar echinococcosis was the aim of the study.
METHODS: The CT morphology of hepatic lesions in 228 patients with confirmed alveolar echinococcosis (AE) drawn from the Echinococcus Databank of the University Hospital of Ulm was reviewed retrospectively. For this reason, CT datasets of combined positron emission tomography (PET)-CT examinations were evaluated. The diagnosis of AE was made in patients with unequivocal seropositivity; positive histological findings following diagnostic puncture or partial resection of the liver; and/or findings typical for AE at either ultrasonography, CT, magnetic resonance imaging or PET-CT. The CT-morphological findings were grouped into the new classification scheme.
RESULTS: Within the classification a lesion was dedicated to one out of five “primary morphologies” as well as to one out of six “patterns of calcification”. “primary morphology” and “pattern of calcification” are primarily focussed on separately from each other and combined, whereas the “primary morphology” V is not further characterized by a “pattern of calcification”. Based on the five primary morphologies, further descriptive sub-criteria were appended to types I-III. An analysis of the calcification pattern in relation to the primary morphology revealed the exclusive association of the central calcification with type IV primary morphology. Similarly, certain calcification patterns exhibited a clear predominance for other primary morphologies, which underscores the delimitation of the individual primary morphological types from each other. These relationships in terms of calcification patterns extend into the primary morphological sub-criteria, demonstrating the clear subordination of those criteria.
CONCLUSION: The proposed CT-morphological classification (EMUC-CT) is intended to facilitate the recognition and interpretation of lesions in hepatic alveolar echinococcosis. This could help to interpret different clinical courses better and shall assist in the context of scientific studies to improve the comparability of CT findings.
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Jiang Y, Li J, Wang J, Xiao H, Li T, Liu H, Liu W. Assessment of Vascularity in Hepatic Alveolar Echinococcosis: Comparison of Quantified Dual-Energy CT with Histopathologic Parameters. PLoS One 2016; 11:e0149440. [PMID: 26901164 PMCID: PMC4762698 DOI: 10.1371/journal.pone.0149440] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/01/2015] [Accepted: 01/31/2016] [Indexed: 02/07/2023] Open
Abstract
Purpose To investigate whether dual-energy computer tomography(DECT) could determine the angiographic vascularity of alveolar echinococcosis lesions by comparing the quantitative iodine concentration (IC) with the microvascular density (MVD). Material and Methods Twenty-five patients (16 men, 9 women; mean age, 40.9 ± 13.8 years) with confirmed hepatic alveolar echinococcosis (HAE) underwent DECT of the abdomen, consisting of arterial phase (AP), portal venous phase (PVP), and delayed phase (DP) scanning, in dual-source mode (100 kV/140 kV). Image data were processed with a DECT software algorithm that was designed for the evaluation of iodine distribution in the different layers (marginal zone, solid and cystic) of the lesions. The CT patterns of HAE lesions were classified into three types: solid type, pseudocystic type and ‘geographic map’ (mixed) type. The IC measurements in different layers and different types of lesions were statistically compared. MVD was examined using CD34 immunohistochemical staining of the resected HAE tissue and scored based on the percentage of positively stained cells and their intensity. Pearson’s correlation analysis was used to evaluate the potential correlation between DECT parameters and MVD. Results A total of 27 HAE lesions were evaluated, of which 9 were solid type, 3 were pseudocystic type and 15 were mixed type. The mean lesion size was 100.7 ± 47.3 mm. There was a significant difference in the IC measurements between different layers of HAE lesions during each scan phase (p < 0.001). The IC in the marginal zone was significantly higher than in the solid and cystic components in AP (2.15 mg/mL vs. 0.17 or 0.01 mg/mL), PVP (3.08 mg/mL vs. 0.1 or 0.02 mg/mL), and DP (2.93 mg/mL vs. 0.04 or 0.02 mg/mL). No significant difference was found among the different CT patterns of HAE lesions. Positive expression of CD34 in the marginal zones surrounding HAE lesions was found in 92.5% (25/27) of lesions, of which 18.5% (5/27) were strongly positive, 62.7% (17/27) were moderately positive, and 11.1% (3/27) were weakly positive. In contrast, 7.4% (2/27) of the lesions were negative for CD34. There was a positive correlation between IC measurements and MVD in the marginal zone of HAE lesions (r = 0.73, p < 0.05). Conclusions The DECT quantitative iodine concentration was significantly correlated with MVD in the marginal zones surrounding HAE lesions. Dual-energy CT using a quantitative analytic methodology can be used to evaluate the vascularity of AE.
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Affiliation(s)
- Yi Jiang
- Imaging Center, The First Affiliated Hospital of Xinjiang Medical University, Urumqi, Xinjiang, China
| | - Jiaqi Li
- Imaging Center, The First Affiliated Hospital of Xinjiang Medical University, Urumqi, Xinjiang, China
| | - Jing Wang
- Imaging Center, The First Affiliated Hospital of Xinjiang Medical University, Urumqi, Xinjiang, China
| | - Hu Xiao
- Imaging Center, The First Affiliated Hospital of Xinjiang Medical University, Urumqi, Xinjiang, China
| | - Tingting Li
- Imaging Center, The First Affiliated Hospital of Xinjiang Medical University, Urumqi, Xinjiang, China
| | - Hui Liu
- Imaging Center, The First Affiliated Hospital of Xinjiang Medical University, Urumqi, Xinjiang, China
| | - Wenya Liu
- Imaging Center, The First Affiliated Hospital of Xinjiang Medical University, Urumqi, Xinjiang, China
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Alveolar echinococcosis: correlation between hepatic MRI findings and FDG-PET/CT metabolic activity. ACTA ACUST UNITED AC 2015; 40:56-63. [PMID: 24970734 DOI: 10.1007/s00261-014-0183-0] [Citation(s) in RCA: 44] [Impact Index Per Article: 4.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/06/2023]
Abstract
OBJECTIVE To correlate the appearance of alveolar echinococcosis (AE) hepatic lesions in magnetic resonance imaging (MRI) as defined by Kodama, to the metabolic activity visualized in 18-fluoro-deoxyglucose positron emission tomography combined with computed tomography (PET/CT). MATERIALS AND METHODS Forty-two patients diagnosed with AE and who underwent both MRI and PET/CT were included. The forty-two hepatic lesions were divided into five types according to Kodama's classification by three independent readers blinded with regard to the PET/CT information. Concerning PET/CT, two independent readers, unaware of the MRI information, considered the results as positive when an increased FDG-uptake was observed at 1 or 3 h after FDG-injection, and as negative when no increased uptake was noted. Inter-observer agreement was assessed by using κ statistics. RESULTS Forty-two lesions were counted and the mean diameter of overall evaluated lesions was 6.3 cm. One lesion (2.4%) was categorized as type 1, 11 (26.2%) as type 2, 24 (57.1%) as type 3, 3 (7.1%) as type 4, and 3 (7.1%) as type 5. The inter-observer analysis found a κ coefficient of 0.96. All type-1, 90.9% of type-2 and 87.5% of type-3 lesions showed an increased FDG-uptake on PET/CT images. All non-microcystic AE liver lesions (types 4 and 5) showed no abnormal increased FDG-uptake on PET/CT images. The inter-observer analysis at 1 and 3 h found a κ coefficient of 0.95 and 0.92, respectively. CONCLUSIONS In patients with AE liver lesions, the absence of microcysts on MRI is strongly correlated to a metabolically inactive disease.
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Li H, Song T, Qin Y, Liu W, Li X, Shao Y, Wen H. Efficiency of liposomal albendazole for the treatment of the patients with complex alveolar echinococcosis: a comparative analysis of CEUS, CT, and PET/CT. Parasitol Res 2015; 114:4175-80. [DOI: 10.1007/s00436-015-4649-y] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/12/2015] [Accepted: 07/23/2015] [Indexed: 12/28/2022]
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Richter PJ, Holtfreter M, Orhun A, Müller-Stöver I, Kubitz R, Hillenbrand A, Kratzer W, Gräter T, Grüner B. Echinokokkose-Erkrankungen. MMW Fortschr Med 2015; 157:56-63. [PMID: 26099410 DOI: 10.1007/s15006-015-2727-9] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/22/2022]
Affiliation(s)
- Pisa Joachim Richter
- Klinik für Gastroenterologie, Hepatologie und Infektiologie, Universitätsklinikum Düsseldorf, Heinrich-Heine-Unversität, Moorenstr. 5, D-40225, Düsseldorf, Deutschland,
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Gottstein B, Wang J, Blagosklonov O, Grenouillet F, Millon L, Vuitton DA, Müller N. Echinococcus metacestode: in search of viability markers. ACTA ACUST UNITED AC 2014; 21:63. [PMID: 25429386 PMCID: PMC4245873 DOI: 10.1051/parasite/2014063] [Citation(s) in RCA: 39] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/02/2014] [Accepted: 11/11/2014] [Indexed: 12/27/2022]
Abstract
Epidemiological studies have demonstrated that most humans infected with Echinococcus spp. exhibit resistance to disease. When infection leads to disease, the parasite is partially controlled by host immunity: in case of immunocompetence, the normal alveolar echinococcosis (AE) or cystic echinococcosis (CE) situation, the metacestode grows slowly, and first clinical signs appear years after infection; in case of impaired immunity (AIDS; other immunodeficiencies), uncontrolled proliferation of the metacestode leads to rapidly progressing disease. Assessing Echinococcus multilocularis viability in vivo following therapeutic interventions in AE patients may be of tremendous benefit when compared with the invasive procedures used to perform biopsies. Current options are F18-fluorodeoxyglucose-positron emission tomography (FDG-PET), which visualizes periparasitic inflammation due to the metabolic activity of the metacestode, and measurement of antibodies against recEm18, a viability-associated protein, that rapidly regresses upon metacestode inactivation. For Echinococcus granulosus, similar prognosis-associated follow-up parameters are still lacking but a few candidates may be listed. Other possible markers include functional and diffusion-weighted Magnetic Resonance Imaging (MRI), and measurement of products from the parasite (circulating antigens or DNA), and from the host (inflammation markers, cytokines, or chemokines). Even though some of them have been promising in pilot studies, none has been properly validated in an appropriate number of patients until now to be recommended for further use in clinical settings. There is therefore still a need to develop reliable tools for improved viability assessment to provide the sufficient information needed to reliably withdraw anti-parasite benzimidazole chemotherapy, and a basis for the development of new alternative therapeutic tools.
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Affiliation(s)
- Bruno Gottstein
- Institute of Parasitology, Vetsuisse Faculty and Faculty of Medicine, University of Bern, Switzerland
| | - Junhua Wang
- Institute of Parasitology, Vetsuisse Faculty and Faculty of Medicine, University of Bern, Switzerland - WHO-Collaborating Centre for the Prevention and Treatment of Human Echinococcosis, University of Franche-Comté and University Hospital, Besançon, Franche-Comté, France
| | - Oleg Blagosklonov
- Department of Nuclear Medicine, University of Franche-Comté and Jean Minjoz University Hospital, Besançon, Franche-Comté, France - WHO-Collaborating Centre for the Prevention and Treatment of Human Echinococcosis, University of Franche-Comté and University Hospital, Besançon, Franche-Comté, France
| | - Frédéric Grenouillet
- Laboratory of Parasitology-Mycology, Centre Hospitalier Universitaire, Université de Franche Comté, Besançon, France - WHO-Collaborating Centre for the Prevention and Treatment of Human Echinococcosis, University of Franche-Comté and University Hospital, Besançon, Franche-Comté, France
| | - Laurence Millon
- Laboratory of Parasitology-Mycology, Centre Hospitalier Universitaire, Université de Franche Comté, Besançon, France - WHO-Collaborating Centre for the Prevention and Treatment of Human Echinococcosis, University of Franche-Comté and University Hospital, Besançon, Franche-Comté, France
| | - Dominique A Vuitton
- WHO-Collaborating Centre for the Prevention and Treatment of Human Echinococcosis, University of Franche-Comté and University Hospital, Besançon, Franche-Comté, France
| | - Norbert Müller
- Institute of Parasitology, Vetsuisse Faculty and Faculty of Medicine, University of Bern, Switzerland
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Disseminated alveolar hydatid disease resembling a metastatic malignancy: a diagnostic challenge-a report of two cases. Case Rep Radiol 2014; 2014:638375. [PMID: 25374743 PMCID: PMC4206930 DOI: 10.1155/2014/638375] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/08/2014] [Accepted: 09/07/2014] [Indexed: 12/28/2022] Open
Abstract
Alveolar hydatid disease or alveolar echinococcosis is a disease of the parasite Echinococcus multilocularis that is potentially fatal if left untreated. It primarily involves the liver but can be disseminated to other organs like the lungs and the brain by hematogenous route. Multiorgan involvement and the aggressive appearance of lesions make alveolar hydatid disease easy to confuse with a metastatic malignancy. For this reason, histopathological confirmation is essential for definite diagnosis. We present the imaging features of this disease in two patients in order to emphasize that these lesions can be easily misdiagnosed as malignancies.
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Kaltenbach TEM, Gruener B, Akinli AS, Kratzer W, Oeztuerk S, Mason RA, Haenle MM, Graeter T. Acoustic structure quantification (ASQ): a new tool in sonographic examination of liver lesions in hepatic alveolar echinococcosis. J Med Ultrason (2001) 2014; 41:445-53. [PMID: 27278025 DOI: 10.1007/s10396-014-0540-1] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/21/2014] [Accepted: 03/24/2014] [Indexed: 01/30/2023]
Abstract
PURPOSE Qualitative and quantitative acoustic structure quantification (ASQ) is a new, noninvasive sonographic imaging method based on B-mode. This prospective clinical pilot study aims to answer the question whether delineation and measurement of liver lesions in hepatic alveolar echinococcosis (HAE) can be improved by ASQ. Furthermore, this is the first pilot study to explore how ASQ parameters in HAE lesions develop. METHODS A total of 24 patients (male = 13/female = 11, mean age = 52 years (16-85), mean disease duration = 68 months (1-334)) with HAE were examined with ASQ using a Toshiba Aplio 500 unit. ASQ parameters were measured in HAE liver lesions and in adjacent non-tumor parenchyma. Quantitative analysis was performed offline using ASQ quantification software. RESULTS Subjectively parasitic tumors in HAE appear more prominent in color-coded ASQ imaging, but the size of lesions measured in ASQ mode does not differ from size measurements in B-mode. Median focal disturbance ratio (FD ratio) in lesions was 3 (0.1-3), compared with 0.5 (0.1-1.8) in surrounding liver parenchyma (p < 0.0001). Statistical comparison of other ASQ parameters (mode, average, standard deviation) shows results that are similarly significant with p values between p < 0.0001 and p < 0.0018. CONCLUSION ASQ is a promising sonographic method for examination and quantification of structural changes of liver parenchyma in HAE lesions.
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Affiliation(s)
- Tanja Eva-Maria Kaltenbach
- Department of Internal Medicine I, University Hospital Ulm, Albert-Einstein-Allee 23, 89081, Ulm, Germany
| | - Beate Gruener
- Section of Infectious Diseases and Clinical Immunology, Comprehensive Infectious Diseases Center (CIDC) Ulm, Albert-Einstein-Allee 23, 89081, Ulm, Germany
| | - Atilla Serif Akinli
- Department of Internal Medicine I, University Hospital Ulm, Albert-Einstein-Allee 23, 89081, Ulm, Germany
| | - Wolfgang Kratzer
- Department of Internal Medicine I, University Hospital Ulm, Albert-Einstein-Allee 23, 89081, Ulm, Germany.
| | - Suemeyra Oeztuerk
- Department of Internal Medicine I, University Hospital Ulm, Albert-Einstein-Allee 23, 89081, Ulm, Germany
| | - Richard Andrew Mason
- Louis Stokes Cleveland Department of Veterans Affairs Medical Center, 10701 East Boulevard, Cleveland, OH, 44106, USA
| | - Mark Martin Haenle
- Department of Internal Medicine I, University Hospital Ulm, Albert-Einstein-Allee 23, 89081, Ulm, Germany
| | - Tilmann Graeter
- Department of Interventional and Diagnostic Radiology, University Hospital Ulm, Albert-Einstein-Allee 23, 89081, Ulm, Germany
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Kantarci M, Pirimoglu B, Kizrak Y. Diagnostic imaging and interventional procedures in a growing problem: Hepatic alveolar echinococcosis. World J Surg Proced 2014; 4:13-20. [DOI: 10.5412/wjsp.v4.i1.13] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/28/2013] [Revised: 12/19/2013] [Accepted: 02/18/2014] [Indexed: 02/06/2023] Open
Abstract
Alveolar echinococcosis (AE) of the liver is caused by the metacestode of the fox tapeworm Echinococcus multilocularis (E. multilocularis), which is endemic in many parts of the world. AE is a very aggressive and potentially fatal infestation which always affects the liver primarily and metastasizes to any part of the body. Without timely diagnosis and therapy, the prognosis is dismal, with death the eventual outcome in most cases. Diagnosis is usually based on findings at radiological imaging and in serological analyses. The alveolar cysts grow by exogenous proliferation and behave like a malignant neoplasm. Since AE lesions can occur almost anywhere in the body, familiarity with the spectrum of cross-sectional imaging appearances is advantageous. Therefore, AE lesions can cause physicians to generate a long list of differential diagnoses, including malignant tumors. Disseminated parasitic lesions in unusual locations with atypical imaging appearances may make it difficult to narrow the differential diagnosis. For diagnosis, ultrasonography (US) remains the first line examination. For a more accurate disease evaluation, aiming to guide the surgical strategy, computed tomography (CT), magnetic resonance imaging (MRI), including magnetic resonance cholangiography (MRC) imaging, are of importance, providing useful complementary information. However, making the correct diagnosis is possible if imaging findings are correlated with appropriate clinical findings. We present an overview of the radiological patterns produced by E. multilocularis lesions as seen on US, CT and MRI and discuss the interventional procedures in hepatic AE lesions.
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Becce F, Pomoni A, Uldry E, Halkic N, Yan P, Meuli R, Schmidt S. Alveolar echinococcosis of the liver: diffusion-weighted MRI findings and potential role in lesion characterisation. Eur J Radiol 2014; 83:625-31. [PMID: 24457140 DOI: 10.1016/j.ejrad.2013.12.025] [Citation(s) in RCA: 30] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/31/2013] [Revised: 12/23/2013] [Accepted: 12/27/2013] [Indexed: 02/07/2023]
Abstract
PURPOSE To report the diffusion-weighted MRI findings in alveolar echinococcosis (AE) of the liver and evaluate the potential role of apparent diffusion coefficients (ADCs) in the characterisation of lesions. MATERIALS AND METHODS We retrospectively included 22 patients with 63 AE liver lesions (≥1 cm), examined with 3-T liver MRI, including a free-breathing diffusion-weighted single-shot echo-planar imaging sequence (b-values=50, 300 and 600 s/mm(2)). Two radiologists jointly assessed the following lesion features: size, location, presence of cystic and/or solid components (according to Kodama's classification system), relative contrast enhancement, and calcifications (on CT). The ADC(total), ADC(min) and ADC(max) were measured in each lesion and the surrounding liver parenchyma. RESULTS Three type 1, 19 type 2, 17 type 3, three type 4 and 21 type 5 lesions were identified. The mean (±SD) ADC(total), ADC(min) and ADC(max) for all lesions were 1.73 ± 0.50, 0.76 ± 0.38 and 2.63 ± 0.76 × 10(-3)mm(2)/s, respectively. The mean ADC(total) for type 1, type 2, type 3, type 4 and type 5 lesions were 1.97 ± 1.01, 1.76 ± 0.53, 1.73 ± 0.41, 1.15 ± 0.42 and 1.76 ± 0.44 × 10(-3)mm(2)/s, respectively. No significant differences were found between the five lesion types, except for type 4 (p=0.0363). There was a significant correlation between the presence of a solid component and low ADCmin (r=0.39, p=0.0016), whereas an inverse correlation was found between the relative contrast enhancement and ADCtotal (r=-0.34, p=0.0072). CONCLUSION The ADCs of AE lesions are relatively low compared to other cystic liver lesions, which may help in the differential diagnosis. Although ADCs are of little use to distinguish between the five lesion types, their low value reflects the underlying solid component.
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Affiliation(s)
- Fabio Becce
- Department of Diagnostic and Interventional Radiology, Lausanne University Hospital, Rue du Bugnon 46, 1011 Lausanne, Switzerland
| | - Anastasia Pomoni
- Department of Diagnostic and Interventional Radiology, Lausanne University Hospital, Rue du Bugnon 46, 1011 Lausanne, Switzerland
| | - Emilie Uldry
- Department of Visceral Surgery, Lausanne University Hospital, Rue du Bugnon 46, 1011 Lausanne, Switzerland
| | - Nermin Halkic
- Department of Visceral Surgery, Lausanne University Hospital, Rue du Bugnon 46, 1011 Lausanne, Switzerland
| | - Pu Yan
- University Institute of Pathology, Lausanne University Hospital, Rue du Bugnon 25, 1011 Lausanne, Switzerland
| | - Reto Meuli
- Department of Diagnostic and Interventional Radiology, Lausanne University Hospital, Rue du Bugnon 46, 1011 Lausanne, Switzerland
| | - Sabine Schmidt
- Department of Diagnostic and Interventional Radiology, Lausanne University Hospital, Rue du Bugnon 46, 1011 Lausanne, Switzerland.
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Geigy CA, Kühn K, Rütten M, Howard J, Grimm F, Rohrer Bley C. Unusual presentation of alveolar echinococcosis as prostatic and paraprostatic cysts in a dog. BMC Vet Res 2013; 9:159. [PMID: 23938212 PMCID: PMC3765175 DOI: 10.1186/1746-6148-9-159] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/25/2013] [Accepted: 08/08/2013] [Indexed: 12/28/2022] Open
Abstract
Background Alveolar echinococcosis (AE) is caused by the larval stage (metacestode) of Echinococcus multilocularis. The domestic dog can act as a definitive host and harbor adult cestodes in its small intestine or become an aberrant intermediate host carrying larval stages that may cause severe lesions in the liver, lungs and other organs with clinical signs similar to AE in humans. Case presentation A case of canine AE, affecting the liver and prostate with development of multilocular hydatid paraprostatic cysts and possible lung involvement is described in an 8–year-old neutered male Labrador retriever dog. The dog presented with progressive weight loss, acute constipation, stranguria and a suspected soft tissue mass in the sublumbar region. Further evaluation included computed tomography of the thorax and abdomen, which revealed cystic changes in the prostate, a paraprostatic cyst, as well as lesions in the liver and lungs. Cytological examination of fine-needle aspirates of the liver, prostate and paraprostatic cyst revealed parasitic hyaline membranes typical of an Echinococcus infection and the presence of E. multilocularis-DNA was confirmed by PCR. The dog was treated with albendazole and debulking surgery was considered in case there was a good response to antiparasitic treatment. Constipation and stranguria resolved completely. Six months after the definitive diagnosis, the dog was euthanized due to treatment-resistant ascites and acute anorexia and lethargy. Conclusions To the authors’ knowledge, this is the first publication of an E. multilocularis infection in a dog causing prostatic and paraprostatic cysts. Although rare, E. multilocularis infection should be considered as an extended differential diagnosis in dogs presenting with prostatic and paraprostatic disease, especially in areas where E. multilocularis is endemic.
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Affiliation(s)
- Caroline A Geigy
- Division of Radiation Oncology, Vetsuisse Faculty, University of Zurich, Zurich, Switzerland.
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Kantarci M, Bayraktutan U, Karabulut N, Aydinli B, Ogul H, Yuce I, Calik M, Eren S, Atamanalp SS, Oto A. Alveolar echinococcosis: spectrum of findings at cross-sectional imaging. Radiographics 2013; 32:2053-70. [PMID: 23150858 DOI: 10.1148/rg.327125708] [Citation(s) in RCA: 89] [Impact Index Per Article: 8.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/15/2022]
Abstract
Alveolar echinococcosis is a rare parasitic disease caused by the fox tapeworm Echinococcus multilocularis, which is endemic in many parts of the world. Without timely diagnosis and therapy, the prognosis is dismal, with death the eventual outcome in most cases. Diagnosis is usually based on findings at radiologic imaging and in serologic analyses. Because echinococcal lesions can occur almost anywhere in the body, familiarity with the spectrum of cross-sectional imaging appearances is advantageous. Echinococcal lesions may produce widely varied imaging appearances depending on the parasite's growth stage, the tissues or organs affected, and the presence of associated complications. Although the liver is the initial site of mass infestation by E multilocularis, the parasite may disseminate from there to other organs and tissues, such as the lung, heart, brain, bones, and ligaments. In severe infestations, the walls of the bile ducts and blood vessels may be invaded. Disseminated parasitic lesions in unusual locations with atypical imaging appearances may make it difficult to narrow the differential diagnosis. Ultrasonography, computed tomography (CT), magnetic resonance (MR) imaging with standard and diffusion-weighted sequences, and MR cholangiopancreatography all provide useful information and play complementary roles in detecting and characterizing echinococcal lesions. Cross-sectional imaging is crucial for differentiating echinococcosis from malignant processes: CT is most useful for depicting the peripheral calcifications surrounding established echinococcal cysts, and MR imaging is most helpful for identifying echinococcosis of the central nervous system.
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Affiliation(s)
- Mecit Kantarci
- Department of Radiology, Atatürk University, School of Medicine, 200 Evler Mah. 14. Sok No 5, Dadaskent, Erzurum 25090, Turkey.
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Caoduro C, Porot C, Vuitton DA, Bresson-Hadni S, Grenouillet F, Richou C, Boulahdour H, Blagosklonov O. The Role of Delayed 18F-FDG PET Imaging in the Follow-up of Patients with Alveolar Echinococcosis. J Nucl Med 2013; 54:358-63. [DOI: 10.2967/jnumed.112.109942] [Citation(s) in RCA: 66] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022] Open
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Geramizadeh B, Nikeghbalian S, Malekhosseini SA. Alveolar echinococcosis of the liver: report of three cases from different geographic areas of iran. HEPATITIS MONTHLY 2012; 12:e6143. [PMID: 23087758 PMCID: PMC3475026 DOI: 10.5812/hepatmon.6143] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 05/07/2012] [Revised: 05/19/2012] [Accepted: 05/22/2012] [Indexed: 12/11/2022]
Abstract
INTRODUCTION Alveolar echinococcosis (AE) is a chronic, serious and sometimes lethal parasitic infection, which is caused by Echinococcus multilocularis (EM). AE has been reported to occur in people from the north of Iran; however, until now there have been no cases of AE reportedfrom the southern provinces, such as Khuzestan. CASE PRESENTATION Herein, we report our experiences with three cases of hepatic AE, who presented with large masses in the liver, from both the northern and southern provinces of Iran. Three patients are described who were presented with hepatic masses from different provinces of the country. CONCLUSIONS There were three female patients, 21, 47 and 53 year-old. They were presented with liver masses from different centers of the country i.e. Khorasan, Ardabil and Khuzestan. According to our experience, AE is not an uncommon disease in Iran. Moreover, it has a widespread epidemiology, i.e., this disease should be suspected in all provinces of Iran, not only in the northern, but also in the southern regions of the country.
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Affiliation(s)
- Bita Geramizadeh
- Transplant Research Center, Department of Pathology, Shiraz University of Medical Science, Shiraz, IR Iran
- Department of Pathology, Department of Pathology, Shiraz University of Medical Science, Shiraz, IR Iran
- Corresponding author: Bita Geramizadeh, Transplant Research Center, Department of Pathology, Shiraz University of Medical Science, P.O. Box: 71345-1864, Shiraz, IR Iran. Tel.: +98-7116474331, Fax: +98-7116474331, E-mail:
| | - Saman Nikeghbalian
- Transplant Ward, Department of Surgery, Shiraz University of Medical Science, Shiraz, IR Iran
| | - Seyed Ali Malekhosseini
- Transplant Ward, Department of Surgery, Shiraz University of Medical Science, Shiraz, IR Iran
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Nunnari G, Pinzone MR, Gruttadauria S, Celesia BM, Madeddu G, Malaguarnera G, Pavone P, Cappellani A, Cacopardo B. Hepatic echinococcosis: Clinical and therapeutic aspects. World J Gastroenterol 2012; 18:1448-58. [PMID: 22509076 PMCID: PMC3319940 DOI: 10.3748/wjg.v18.i13.1448] [Citation(s) in RCA: 173] [Impact Index Per Article: 14.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/02/2011] [Revised: 09/20/2011] [Accepted: 01/22/2012] [Indexed: 02/06/2023] Open
Abstract
Echinococcosis or hydatid disease (HD) is a zoonosis caused by the larval stages of taeniid cestodes belonging to the genus Echinococcus. Hepatic echinococcosis is a life-threatening disease, mainly differentiated into alveolar and cystic forms, associated with Echinoccus multilocularis (E. multilocularis) and Echinococcus granulosus (E. granulosus) infection, respectively. Cystic echinococcosis (CE) has a worldwide distribution, while hepatic alveolar echinococcosis (AE) is endemic in the Northern hemisphere, including North America and several Asian and European countries, like France, Germany and Austria. E. granulosus young cysts are spherical, unilocular vesicles, consisting of an internal germinal layer and an outer acellular layer. Cyst expansion is associated with a host immune reaction and the subsequent development of a fibrous layer, called the pericyst; old cysts typically present internal septations and daughter cysts. E. multilocularis has a tumor-like, infiltrative behavior, which is responsible for tissue destruction and finally for liver failure. The liver is the main site of HD involvement, for both alveolar and cystic hydatidosis. HD is usually asymptomatic for a long period of time, because cyst growth is commonly slow; the most frequent symptoms are fatigue and abdominal pain. Patients may also present jaundice, hepatomegaly or anaphylaxis, due to cyst leakage or rupture. HD diagnosis is usually accomplished with the combined use of ultrasonography and immunodiagnosis; furthermore, the improvement of surgical techniques, the introduction of minimally invasive treatments [such as puncture, aspiration, injection, re-aspiration (PAIR)] and more effective drugs (such as benzoimidazoles) have deeply changed life expectancy and quality of life of patients with HD. The aim of this article is to provide an up-to-date review of biological, diagnostic, clinical and therapeutic aspects of hepatic echinococcosis.
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Schweiger A, Grimm F, Tanner I, Müllhaupt B, Bertogg K, Müller N, Deplazes P. Serological diagnosis of echinococcosis: the diagnostic potential of native antigens. Infection 2011; 40:139-52. [PMID: 22076692 DOI: 10.1007/s15010-011-0205-6] [Citation(s) in RCA: 35] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/20/2011] [Accepted: 09/27/2011] [Indexed: 12/13/2022]
Abstract
PURPOSE Human alveolar (AE) and cystic echinococcosis (CE) caused by the metacestode stages of Echinococcus multilocularis and E. granulosus, respectively, lack pathognomonic clinical signs. Diagnosis therefore relies on the results of imaging and serological studies. The primary goal of this study was to evaluate the efficacy of several easy-to-produce crude or partially purified E. granulosus and E. multilocularis metacestode-derived antigens as tools for the serological diagnosis and differential diagnosis of patients suspicious for AE or CE. METHODS The sera of 51 treatment-naïve AE and 32 CE patients, 98 Swiss blood donors and 38 patients who were initially suspicious for echinococcosis but suffering from various other liver diseases (e.g., liver neoplasia, etc.) were analysed. RESULTS According to the results of enzyme-linked immunosorbent assays (ELISA), metacestode-derived antigens of E. granulosus had sensitivities varying from 81 to 97% and >99.9% for the diagnosis of CE and AE, respectively. Antigens derived from E. multilocularis metacestodes had sensitivities ranging from 84 to 91% and >99.9% for the diagnosis of CE and AE, respectively. Specificities ranged from 92 to >99.9%. Post-test probabilities for the differential diagnosis of AE from liver neoplasias, CE from cystic liver lesions, and screening for AE in Switzerland were around 95, 86 and 2.2%, respectively. Cross-reactions with antibodies in sera of patients with other parasitic affections (fasciolosis, schistosomosis, amebosis, cysticercosis, and filarioses) did occur at variable frequencies, but could be eliminated through the use of confirmatory testing. CONCLUSIONS Different metacestode-derived antigens of E. granulosus and E. multilocularis are valuable, widely accessible, and cost-efficient tools for the serological diagnosis of echinococcosis. However, confirmatory testing is necessary, due to the lack of species specificity and the occurrence of cross-reactions to other helminthic diseases.
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Affiliation(s)
- A Schweiger
- Institute of Parasitology, University of Zurich, Zurich, Switzerland
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Tao S, Qin Z, Hao W, Yongquan L, Lanhui Y, Lei Y. Usefulness of gray-scale contrast-enhanced ultrasonography (SonoVue®) in diagnosing hepatic alveolar echinococcosis. ULTRASOUND IN MEDICINE & BIOLOGY 2011; 37:1024-1028. [PMID: 21640477 DOI: 10.1016/j.ultrasmedbio.2011.04.014] [Citation(s) in RCA: 23] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/18/2010] [Revised: 04/12/2011] [Accepted: 04/26/2011] [Indexed: 05/30/2023]
Abstract
Hepatic alveolar echinococcosis (HAE) is a parasitic infection with an infiltrative growth pattern that has the appearance of a hepatic malignant tumor. Ultrasound (US) has been used for screening of HAE in epidemic areas. However, it has been very difficult to evaluate the clear boundary and microvessel perfusion of the lesions. The aim of this study was to demonstrate the characteristic imaging and clinical significance of HAE lesions by contrast-enhanced ultrasonography (CEUS). Seventeen patients with 19 HAE lesions were examined in sequence with US, color Doppler flow imaging (CDFI) and then CEUS before any treatment. All the data were compared before surgery. Examined by fundamental US, 47.4% of HAE lesions showed irregular hyperechoic substantive areas and 52.6% appeared as having a mixed echotype with irregular anechoic areas in the central portion of the lesions. The CDFI method indicated no blood flow signals inside any of the 19 lesions. By CEUS, all 19 lesions displayed circular rim enhancement in the peripheral segments and absent enhancement within the central areas of the lesions (a "black hole" effect). As a result, the lesions' margins were clear, irregular and distinct. In general, the sizes of all the HAE lesions observed by CEUS were larger than those obtained by fundamental US. Therefore, CEUS is a simple imaging method and can be a helpful tool for more accurate sizing of HAE lesions and their surrounding invasion range and the proper cut-off margin when radical hepatectomy is needed.
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Affiliation(s)
- Song Tao
- Department of Ultrasonography, First Affiliated Hospital, Xinjiang Medical University, Urumqi, PR China
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Abstract
PURPOSE OF REVIEW Human alveolar echinococcosis is caused by the larval stage of Echinococcus multilocularis, occurring in at least 42 countries of the northern hemisphere. Recent studies in Europe and Asia have shown that the endemic area of E. multilocularis is larger than previously known and the parasite has regionally expanded from rural to urban areas. Diagnosis of alveolar echinococcosis is supported by results from imaging studies, histopathology and/or nucleic acid detection, and serology. The present review summarizes current understanding of clinical features, knowledge on appropriate treatment, and discusses ways to improve standards of care. RECENT FINDINGS High prevalences of this deadly disease have been discovered in surveys in parts of China. Clinical manifestations, diagnostic tools and the burden of disease were described, and are based on high case numbers. In Europe, excellent tools have been introduced, which improve disease management. Long-term observations in Switzerland provide an optimistic view, as the infection can be well controlled, if patients are cared for in specialized centres. An expert consensus summarizes the current recommendation for diagnosis and treatment of alveolar echinococcosis by the Informal Working Group on Echinococcosis of the WHO. SUMMARY Diagnosis and treatment of alveolar echinococcosis remains a challenge for clinicians. The updated WHO-recommendations aim to support decisions on diagnosis and treatment of alveolar echinococcosis. Anti-infective therapy is the backbone of treatment; surgery should be restricted to patients at an early stage of the disease. For the majority of cases continuous chemoprophylaxis with benzimidazoles is cost-effective and leads to a good quality of life for patients with this chronic disease.
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Effects of in vitro exposure of Echinococcus multilocularis metacestodes to cytostatic drugs on in vivo growth and proliferation of the parasite. Parasitol Res 2010; 107:459-63. [DOI: 10.1007/s00436-010-1892-0] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/22/2010] [Accepted: 04/20/2010] [Indexed: 12/28/2022]
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Gottstein B. Hydatid disease. Infect Dis (Lond) 2010. [DOI: 10.1016/b978-0-323-04579-7.00114-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/26/2022] Open
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