Membranous glomerulonephritis secondary to hydatid disease

A rare case of hydatid cyst-associated AA amyloidosis and literature review of hydatid cyst-associated nephropathy

Hydatid disease is an infective picture caused by echinococcus, which progresses with cysts in various organs, especially in the liver. Renal involvement is an unusual location in the course of the disease. Although mostly asymptomatic renal cysts are seen, rarely glomerular or tubular associated nephropathy develops. In addition, the development of amyloidosis has been shown previously in patients with untreated chronic hydatid cysts. We wanted to bring a 27-year-old female patient with a 10-year history of hydatid cyst and AA amyloidosis to the literature. In addition, in our literature review for hydatid disease-associated nephropathies, we brought together data from 12 studies involving a total of 21 cases. Of these cases, 3 were membranous glomerulonephritis (MGN), 5 were, membranoproliferative glomerulonephritis (MPGN), 1 was minimally change disease (MCD), 5 were AA amyloidosis (including our case), 3 were immunoglobulin A nephropathy (IgAN), 1 was tubulointerstitial nephritis (TIN), 1 was chronic kidney disease (CKD), 1 was TIN with mesangioproliferative glomerulonephritis (MesPGN), 1 was TIN with IgAN, 1 was MPGN with immunoglobulin M nephropathy (IgMN). In this way, we wanted to shed light on the relationship between Echinococcus and nephropathy. In this way, we wanted to emphasise the necessity of doing renal examinations in the follow-up of hydatid cyst patients.

The role of helminths in the development of non-communicable diseases

Non-communicable diseases (NCDs) like cardiovascular disease, chronic respiratory diseases, cancers, diabetes, and neuropsychiatric diseases cause significant global morbidity and mortality which disproportionately affect those living in low resource regions including low- and middle-income countries (LMICs). In order to reduce NCD morbidity and mortality in LMIC it is imperative to understand risk factors associated with the development of NCDs. Certain infections are known risk factors for many NCDs. Several parasitic helminth infections, which occur most commonly in LMICs, have been identified as potential drivers of NCDs in parasite-endemic regions. Though understudied, the impact of helminth infections on the development of NCDs is likely related to helminth-specific factors, including species, developmental stage and disease burden. Mechanical and chemical damage induced by the helminth in combination with pathologic host immune responses contribute to the long-term inflammation that increases risk for NCD development. Robust studies from animal models and human clinical trials are needed to understand the immunologic mechanisms of helminth-induced NCDs. Understanding the complex connection between helminths and NCDs will aid in targeted public health programs to reduce helminth-induced NCDs and reduce the high rates of morbidity that affects millions of people living in parasite-endemic, LMICs globally.

Hodgkin's lymphoma, nephrotic syndrome, and echinococcosis cysts: an unusual association and literature review

We present a 5-year-old female with minimal change nephrotic syndrome (MCNS). Within several months, she became steroid-dependent with progression of edema and ascites. Imaging studies revealed abnormal solid mass and liver cysts and she was diagnosed with both abdominal Hodgkin's lymphoma (cHD) and large hepatic cystic echinococcosis (CE). Association between MCNS and cHL or with CE has been described in the literature in adults and rarely in the pediatric population. We report, for the first time, a simultaneous occurrence of all three: MCNS, cHL, and CE. Literature review and suggested pathophysiologic mechanisms underlying this phenomenon are presented.

Primary extradural hydatid cyst associated with nephrotic syndrome in a pediatric patient

BACKGROUND

Primary intracranial extradural hydatid cyst is a very rare entity. Overlying bony erosion and extension of an extradural hydatid cyst into the scalp has never been described in literature. Association of nephrotic syndrome is described in pulmonary and hepatic hydatid cysts, but never reported in intracranial hydatidosis.

CASE REPORT

We report a 6-year-old girl with primary extradural hydatid cyst having unusual radiological features. The child initially presented with features of nephrotic syndrome. Steroid therapy failed to achieve complete remission of the nephrotic syndrome, which was later abolished by cyst removal and albendazole therapy.

CONCLUSION

Because of the very slow increase in the volume of the extradural hydatid cyst, intensification of symptoms may also be very slow. Sometimes, the cyst may already be very large at the time of the diagnosis. The hydatid disease should be considered in the etiology of nephrotic syndrome especially in the endemic zones.

Renal injury due to hepatic hydatid disease

BACKGROUND

Many studies on renal hydatid disease have been reported in the literature, and the disease process appears to be well defined. However, renal injury without direct renal invasion remains poorly understood. The present study aims to define the frequency and the property of the renal involvement in hydatid disease.

METHODS

Eighty patients older than 18 years and diagnosed with liver echinococcosis were included in the study. The echinococcosis was diagnosed by the haemagglutination test and abdominal ultrasonography. Twenty-four-hour protein excretion was measured for patients who had elevated serum creatinine levels or whose urinalyses were positive for haematuria or proteinuria. Subsequently, renal biopsy was performed, and the specimens were examined by light microscopy and immunofluorescence staining.

RESULTS

Haematuria was detected in 11 patients (13.75%), and proteinuria was detected in nine patients (11.25%). Percutaneous renal biopsy was applied to nine patients who gave signed consents to undergo the test. We detected four immunoglobulin A nephritis (together with tubulointerstitial nephritis in one patient), one membranoproliferative glomerulonephritis, one immunoglobulin M nephritis together with mesangiocapillary glomerulonephritis, one membranous glomerulonephritis, one amyloidosis and one tubulointerstitial nephritis. Renal hydatid cyst was detected only in four patients (5%).

CONCLUSIONS

Hydatid disease, which affects the kidney, is not rare, and we suggest that urinalysis and, if indicated, renal biopsy should be performed for hepatic hydatid disease diagnosis.

Cestodes. Echinococcus

This article deals with cystic echinococcosis (CE) and alveolar echinococcosis in humans caused by the cestode parasites Echinococcus granulosus and Echinococcus multilocularis. The life cycles of these parasites and their epidemiologic aspects are briefly discussed, and a detailed review is presented on clinical aspects of the diseases, including diagnosis and therapy. Considerable progress has been made in chemotherapy but the results are not yet satisfactory. A new alternative for treatment of CE is puncture of cysts, aspiration of fluid, injection of ethanol, and reaspiration of fluid (PAIR).

Hydatid disease: analysis of parasite antigens in circulating immune complexes and in preformed hydatid antigen-antibody complexes

Fifty-three sera from 29 patients with hydatid disease, all but one positive for specific anti-parasite antibodies and all negative for specific circulating antigens, were studied for the presence of circulating immune complexes (CIC) by conglutinin binding-assay (KgBA). Fourteen serum samples (26%) from eight patients (27%) were positive. These positive sera were pooled for each patient and the eight samples were PEG-precipitated and analysed for the presence of specific Echinococcus granulosus antigens in the CIC using a human anti-human-hydatid cyst fluid antiserum capable of recognizing the major antigenic systems of the parasite namely, antigens 4 and 5. The assays utilized for detecting antigen in CIC were: (a) blotting on nitrocellulose paper after sodium dodecil sulphate polyacrylamide gel electrophoresis (SDS-PAGE) and specific immunological detection; (b) ultracentrifugation in acid buffer and subsequent detection of antigens by a sandwich-radioimmuno assay (RIA); (c) protein separation by isoelectric focusing (IEF) and specific immunological recognition. In addition, all positive sera were analysed for the presence of antigen in the CIC by a modified KgBA and by polyethylenglicol (PEG)-precipitation in acid buffer followed by immunological recognition of antigen. All tests gave negative results with the patients' samples, but were positive with preformed in vitro complexes between parasite antigens and corresponding antibodies. Failure to detect antigen in the CIC could be due to: 1) insufficient sensitivity of the assays used to detect hydatid antigens in CIC; 2) rapid clearance of antigen or CIC from the circulation; 3) presence of parasite antigen not recognized by the antiserum employed; 4) production of CIC as a result of polyclonal B-cell activation. This last hypothesis is supported by the demonstration of IgM-rheumatoid factor (RF) and anti-F(ab')2 antibodies respectively in 11 (44%) and 13 (52%) out of 25 patients.

Combined application of enzyme-linked immunosorbent assay (ELISA) and indirect haemagglutination test (IHA) as a useful tool for the diagnosis and post-operative surveillance of human alveolar and cystic echinococcosis

A combined application of enzyme-linked immunosorbent assay (ELISA) and indirect haemagglutination test (IHA) for the diagnosis and post-operative surveillance of human alveolar and cystic echinococcosis is described. Since January 1985 each serum sample submitted for the detection of specific antibodies was examined with both an ELISA using Echinococcus multilocularis antigen (EmELISA) and an IHA using E. granulosus antigen (EgIHA). In the course of our study altogether 72 human cases of Echinococcus infections were diagnosed. All 16 cases of alveolar echinococcosis (= 100%) and 48 out of 56 cases of cystic echinococcosis (= 86%) were revealed as Echinococcus infection at least in one of the two tests. Although crude antigens were used in both, EmELISA and EgIHA, species-specific diagnosis was achieved in 57 (= 89%) of 64 cases of the infections with E. multilocularis or E. granulosus. The diagnostic value of EmELISA and EgIHA for the post-operative surveillance is demonstrated by the follow-up of the immune response of one case of alveolar and three cases of cystic echinococcosis.

Demonstration of amyloid and immune complex deposits in renal and hepatic parenchyma of Alaskan alveolar hydatid disease patients

Histopathological changes and the incidence of amyloid and immune complex (IC) deposits were examined in six liver (autopsy or biopsy) and two kidney (autopsy) samples from seven Alaskan alveolar hydatid disease (AHD) patients. Both the kidney samples showed evidence of severe nephropathy and glomerular IC deposits. Two of the six liver samples had typical amyloid deposits. All the liver samples examined showed variable amounts of parenchymal atrophy adjacent to the locus of larval Echinococcus multilocularis, periportal and portal fibrosis. Thus secondary amyloidosis and IC-mediated pathological changes should be included as possible complications of AHD.

Detection of specific circulating antigen, immune complexes and antibodies in human hydatidosis from Turkana (Kenya) and Great Britain, by enzyme-immunoassay

Circulating antigen, specific immune complexes (IgG and IgM) and specific antibodies (IgG, IgM, IgE and IgA) were detected by enzyme-linked immunosorbent assay (ELISA) in the sera of hydatid (Echinococcus granulosus) patients from Turkana (Kenya) and the UK. Specific IgG and IgM antibodies predominated in current UK hydatid infections, while all classes of specific antibodies were lower in the Turkana patients. Circulating antigen, detected in 3% polyethylene glycol (PEG) precipitated complexes, using peroxidase conjugated hyperimmune human hydatid IgG (Fab) was more specific in ELISA than either antibody or immune complex assays where peroxidase conjugated anti-human IgG was used. Anti-human immunoglobulin ('rheumatoid' factor) was not detected in hydatid sera. Serum antigen, specific IgM immune complexes and specific IgM antibodies were associated with UK cases of current hydatid infection in contrast to patients with previous histories of hydatidosis. In 3 hydatid patients (from UK) levels of circulating antigen and specific IgM immune complexes rapidly declined within 1-4 months after surgical cyst removal. The detection of specific IgG and antigen in PEG precipitated immune complexes from false-negative/low responder Turkana hydatid sera, suggests that antibody 'mopping' by specific antigen may be occurring. After SDS-PAGE/immunoblotting analysis, antigen of mol. wt 67 000, present in hydatid cyst fluid and protoscoleces, was identified as putative circulating antigen in 3% PEG precipitates of sera from albendazole treated hydatid patients.

Hydatid disease: research and control in Turkana. II. The role of immunological techniques for the diagnosis of hydatid disease

Immunological studies have been applied to the immunodiagnosis of human hydatidosis in Turkana and for the specific identification of Echinococcus eggs, particularly in regard to their potential for the assessment of a hydatid control programme in the north-west of the District. A high rate of false negatives has been obtained with sensitive antibody tests for proven hydatid patients in Turkana and presents problems for prevalence estimation in the population. A seroepidemiological study using specific antibody detection indicated a 2.17% seropositive rate, and by using a portable ultrasound 67% of antibody positives were confirmed as having liver/abdominal cysts. An enzyme immunoassay test for specific circulating antigen, often associated with circulating immune complexes, was positive in sera in 75% of hydatid patients who were antibody-negative. The formation of specific circulating immune complexes may contribute directly to the production of a state of false negativity. These studies indicate that by combining tests for antibodies and antigens together with ultrasound, the true prevalence of human hydatidosis in Turkana is at least 5%. Characterization of Echinococcus antigens recognized by human antisera from Turkana and British hydatid patients indicates that both groups recognize the same major protein antigens in cyst fluid and protoscoleces. The results of assaying anti-oncospheral antibodies in people living in the high prevalence area of north-west Turkana compared to people in areas of low prevalence indicates that most of the people in the high prevalence area are probably infected (challenged) with Echinococcus eggs. This observation suggests that there may be a high level of acquired resistance. A species-specific immunofluorescence test using an anti-Echinococcus monoclonal antibody has been developed which can specifically identify oncospheres artificially hatched from Echinococcus eggs. This test will be applied to the problem of identification of Echinococcus eggs in the environment and in dog faeces, with a view to studying the epidemiology of the disease and for use in assessment of the hydatid control programme.

Amyloidosis in experimental murine alveolar hydatidosis

Male mice (eight to ten weeks old, C57BL/6J, H-2b strain) were inoculated intraperitoneally with 50 Echinococcus multilocularis cysts each and killed 12 and 17 weeks later. The alveolar cyst masses were weighed and the spleens and kidneys fixed for light and electron microscopy of sections. Amorphous eosinophilic deposits in both were extensive and there were apple-green birefringent deposits visible under polarized light in all the glomeruli. The presence of amyloid was confirmed by electron microscopy.