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Popa GL, Popa AC, Mastalier B, Crețu CM, Popa MI. Complicated Clinical Course of a Patient with Multivisceral Cystic Echinococcosis Requiring Extensive Surgical and Medical Treatment. J Clin Med 2023; 12:5596. [PMID: 37685663 PMCID: PMC10488279 DOI: 10.3390/jcm12175596] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/30/2023] [Revised: 08/22/2023] [Accepted: 08/25/2023] [Indexed: 09/10/2023] Open
Abstract
Cystic echinococcosis is an often-overlooked condition that otherwise negatively impacts both the individual and the community, prompting major public health concerns. Early diagnosis and treatment, as well as collaboration between specialties including surgery and parasitology, are essential for avoiding complications and disease relapse. To better illustrate this, we present the case of an elderly person with a rare localization of the disease at the muscular level. The patient underwent numerous surgical interventions, and received multiple courses of antiparasitic treatment over the course of 40 years as a result of the multivisceral dissemination of the parasite.
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Affiliation(s)
- Gabriela Loredana Popa
- Department of Microbiology, Faculty of Dentistry, Carol Davila University of Medicine and Pharmacy, 020021 Bucharest, Romania
- Parasitic Disease Department, Colentina Clinical Hospital, 020125 Bucharest, Romania;
| | - Alexandru Cosmin Popa
- Departament of Surgery, Faculty of Medicine, Carol Davila University of Medicine and Pharmacy, 020021 Bucharest, Romania; (A.C.P.); (B.M.)
- Surgery Department, Colentina Clinical Hospital, 020125 Bucharest, Romania
| | - Bogdan Mastalier
- Departament of Surgery, Faculty of Medicine, Carol Davila University of Medicine and Pharmacy, 020021 Bucharest, Romania; (A.C.P.); (B.M.)
- Surgery Department, Colentina Clinical Hospital, 020125 Bucharest, Romania
| | - Carmen Michaela Crețu
- Parasitic Disease Department, Colentina Clinical Hospital, 020125 Bucharest, Romania;
- Department of Parasitology, Faculty of Medicine, Carol Davila University of Medicine and Pharmacy, 020021 Bucharest, Romania
| | - Mircea Ioan Popa
- Department of Microbiology II, Faculty of Medicine, Carol Davila University of Medicine and Pharmacy, 020021 Bucharest, Romania;
- Cantacuzino National Military Medical Institute for Research and Development, 050096 Bucharest, Romania
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Tao J, Du X, Liu K, Wang C, Lv Y, Wang M, Yang Z, Yang J, Li S, Wu C, Li M, Zhao W. Clinical characteristics and antibodies against Echinococcus granulosus recombinant antigen P29 in patients with cystic echinococcosis in China. BMC Infect Dis 2022; 22:609. [PMID: 35820830 PMCID: PMC9275268 DOI: 10.1186/s12879-022-07597-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/03/2022] [Accepted: 07/04/2022] [Indexed: 11/17/2022] Open
Abstract
Objectives Cystic echinococcosis (CE) is a neglected parasitic zoonotic disease caused by the larval stage of the tapeworm Echinococcus granulosus (E. granulosus). This study aimed to understand the clinical characteristics of human CE in Ningxia Hui Autonomous Region (NHAR) located in northwest China and to investigate the antibody profiles against the recombinant E. granulosus antigen P29 (rEg.P29) in plasma of CE patients. Methods A total of 37 human CE patients, along with 37 healthy donors enrolled in this study and demographic and clinical data were analyzed, including age, gender, laboratory data, symptoms, and cysts description. Plasma levels of cytokines, total IgG, and total IgE were determined by sandwich ELISA kits. Specific antibodies against rEg.P29 and hydatid cyst fluid (HCF) were assessed by indirect ELISA. Results The results revealed that females have a higher percentage of CE patients than males. The incidence of CE reached a peak in the 41–50 years-old group. The liver was the most frequent location, accounting for 91.9%. Based on the CT images, cysts of 34 patients who had liver involvement, were classified as 1 (2.9%) CE1, 12 (35.3%) CE2, 5 (14.7%) CE3a, 1 (2.9%) CE3b, and 15 (44.2%) CE5. Twenty-nine (78.4%) patients had a single cyst and 8 (21.6%) had at least two cysts. The most frequently reported symptom was upper abdominal pain. The plasma level of IL-6 and total IgE were significantly increased in CE patients compared with healthy donors. Additionally, IgG response to rEg.P29 in CE patients was significantly higher than in healthy donors, and the dominant IgG subclass was IgG4. Further analysis of different patient groups revealed that rEg.P29-specific IgG and IgG4 were only elevated in CE patients with CE2 type cysts. Conclusions This study systematically investigated the clinical characteristics of patients with CE and may provide a reference basis for the diagnosis and treatment of CE in NHAR. Furthermore, tests of specific IgG and IgG4 against rEg.P29 can be used as an assisted method for imaging techniques to identify cystic activity and determine the best therapeutic approach for CE.
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Affiliation(s)
- Jia Tao
- School of Basic Medical Sciences, Ningxia Medical University, Xingqing, Yinchuan, 750003, Ningxia Hui Autonomous Region, China.,Ningxia Key Laboratory of Prevention and Control of Common Infectious Diseases, Xingqing, Yinchuan, 750003, Ningxia Hui Autonomous Region, China
| | - Xiancai Du
- School of Basic Medical Sciences, Ningxia Medical University, Xingqing, Yinchuan, 750003, Ningxia Hui Autonomous Region, China.,Ningxia Key Laboratory of Prevention and Control of Common Infectious Diseases, Xingqing, Yinchuan, 750003, Ningxia Hui Autonomous Region, China
| | - Kejun Liu
- Department of Hepatobiliary Surgery, General Hospital of Ningxia Medical University, Xingqing, Yinchuan, 750003, Ningxia Hui Autonomous Region, China
| | - Chan Wang
- School of Basic Medical Sciences, Ningxia Medical University, Xingqing, Yinchuan, 750003, Ningxia Hui Autonomous Region, China.,Ningxia Key Laboratory of Prevention and Control of Common Infectious Diseases, Xingqing, Yinchuan, 750003, Ningxia Hui Autonomous Region, China
| | - Yongxue Lv
- School of Basic Medical Sciences, Ningxia Medical University, Xingqing, Yinchuan, 750003, Ningxia Hui Autonomous Region, China.,Ningxia Key Laboratory of Prevention and Control of Common Infectious Diseases, Xingqing, Yinchuan, 750003, Ningxia Hui Autonomous Region, China
| | - Minglei Wang
- Department of Radiology, General Hospital of Ningxia Medical University, Xingqing, Yinchuan, 750003, Ningxia Hui Autonomous Region, China
| | - Zhiqi Yang
- Department of Hepatobiliary Surgery, People's Hospital of Ningxia Hui Autonomous Region, Jinfeng, Yinchuan, 750021, Ningxia Hui Autonomous Region, China
| | - Jihui Yang
- School of Basic Medical Sciences, Ningxia Medical University, Xingqing, Yinchuan, 750003, Ningxia Hui Autonomous Region, China.,Ningxia Key Laboratory of Prevention and Control of Common Infectious Diseases, Xingqing, Yinchuan, 750003, Ningxia Hui Autonomous Region, China
| | - Shasha Li
- School of Basic Medical Sciences, Ningxia Medical University, Xingqing, Yinchuan, 750003, Ningxia Hui Autonomous Region, China.,Ningxia Key Laboratory of Prevention and Control of Common Infectious Diseases, Xingqing, Yinchuan, 750003, Ningxia Hui Autonomous Region, China
| | - Changyou Wu
- Institute of Immunology, Zhongshan School of Medicine, Sun Yat-Sen University, Guangzhou, 5102275, Guangdong, China
| | - Minghao Li
- The Third School of Clinical Medicine, Ningxia Medical University, Jinfeng, Yinchuan, Ningxia Hui Autonomous Region, 750021, China. .,Ningxia Key Laboratory of Prevention and Control of Common Infectious Diseases, Xingqing, Yinchuan, 750003, Ningxia Hui Autonomous Region, China. .,Department of Hepatobiliary Surgery, People's Hospital of Ningxia Hui Autonomous Region, Jinfeng, Yinchuan, 750021, Ningxia Hui Autonomous Region, China.
| | - Wei Zhao
- School of Basic Medical Sciences, Ningxia Medical University, Xingqing, Yinchuan, 750003, Ningxia Hui Autonomous Region, China. .,Ningxia Key Laboratory of Prevention and Control of Common Infectious Diseases, Xingqing, Yinchuan, 750003, Ningxia Hui Autonomous Region, China.
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Öztürk G, Uzun MA, Özkan ÖF, Kayaalp C, Tatlı F, Eren S, Aksungur N, Çoker A, Bostancı EB, Öter V, Kaya E, Taşar P. Turkish HPB Surgery Association consensus report on hepatic cystic Echinococcosis (HCE). Turk J Surg 2022; 38:101-120. [PMID: 36483170 PMCID: PMC9714645 DOI: 10.47717/turkjsurg.2022.5757] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/30/2022] [Accepted: 05/30/2022] [Indexed: 12/24/2022]
Abstract
OBJECTIVES Cystic Echinococcosis (CE) is one of the important problems of the Eurasian region. We aimed to prepare a consensus report in order to update the treatment approaches of this disease. This study was conducted by Turkish HPB Surgery Association. MATERIAL AND METHODS This study was conducted with the modified Delphi model. For this purpose, we conducted a three-stage consensus-building approach. RESULTS Six topics, including diagnosis, medical treatment, percutaneous treatment, surgical treatment, management of complications and posttreatment follow-up and recurrences in HCE were discussed. CONCLUSION The expert panel made recommendations for every topic.
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Affiliation(s)
- Gürkan Öztürk
- Department of General Surgery, Atatürk University Faculty of Medicine, Erzurum, Türkiye
| | - Mehmet Ali Uzun
- Clinic of General Surgery, Şişli Hamidiye Etfal Education and Research Hospital, İstanbul, Türkiye
| | - Ömer Faruk Özkan
- Clinic of General Surgery, Ümraniye Education and Research Hospital, İstanbul, Türkiye
| | - Cüneyt Kayaalp
- Department of General Surgery, Yeditepe University Faculty of Medicine, İstanbul, Türkiye
| | - Faik Tatlı
- Department of General Surgery, Harran University Faculty of Medicine, Şanlıurfa, Türkiye
| | - Suat Eren
- Department of General Surgery, Atatürk University Faculty of Medicine, Erzurum, Türkiye
| | - Nurhak Aksungur
- Department of General Surgery, Atatürk University Faculty of Medicine, Erzurum, Türkiye
| | - Ahmet Çoker
- Clinic of General Surgery, Medicana International İzmir Hospital, İzmir, Türkiye
| | | | - Volkan Öter
- Clinic of Gastroenterological Surgery, Ankara State Hospital, Ankara, Türkiye
| | - Ekrem Kaya
- Department of General Surgery, Uludağ University Faculty of Medicine, Bursa, Türkiye
| | - Pınar Taşar
- Department of General Surgery, Uludağ University Faculty of Medicine, Bursa, Türkiye
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Treatment of Hepatic Hydatid Disease: Role of Surgery, ERCP, and Percutaneous Drainage: A Retrospective Study. Surg Laparosc Endosc Percutan Tech 2020; 31:313-320. [PMID: 32956333 DOI: 10.1097/sle.0000000000000861] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/07/2020] [Accepted: 08/14/2020] [Indexed: 11/26/2022]
Abstract
INTRODUCTION Failure to follow the World Health Organization's Informal Working Group on Echinococcosis guidance or having limited experience in the management of cystic echinococcosis (CE) in endemic or nonendemic areas of the world may lead to risky unnecessary procedures. MATERIALS AND METHODS Medical records of all patients undergoing surgery for hepatic hydatid disease at the gastroenterologic surgery and general surgery departments of our hospital between December 2014 and October 2019 were collected and reviewed retrospectively. Demographic characteristics, the size and number of the cysts preoperative liver function tests, surgical treatment, endoscopic retrograde cholangiopancreatography (ERCP), percutaneous drainage (PD), morbidity, and treatment outcomes were reviewed. RESULTS Of 122 patients included in the study, 77 (63, 1%) were female and 45 (36, 9%) were male individuals and their mean age was 44.95 years. CE1 was identified in 13 patients (10.6%) CE2 in 66 patients (54.1%), CE3a in 7 patients (5.8%), CE3b in 28 patients (22.9%), and CE4 in 8 patients (6.6%). Twenty patients (16.4%) with a cystobiliary fistula in the liver, obstructive jaundice, and postoperative bile leak underwent ERCP. PD was performed in patients with fluid in the hepatic hydatid cyst pouch, increased pouch size because of bile collection, and clinical symptoms postoperatively. Patients presenting with persistent bile leak despite PD underwent ERCP and were treated with endoscopic sphincterotomy and stent placement. Patients with PD were followed by keeping the percutaneous drain open and closed for a while to create pressure difference in the cyst pouch after ERCP. The percutaneous drain was removed in the next 14 to 21 days after checking the pouch size, whereas the common bile duct stents were removed 2 months later after performing a follow-up cholangiography. CONCLUSIONS ERCP should be the primary method for the diagnosis and treatment for hepatic hydatid cysts ruptured into the ducts. İn some cases, high-flow hydatid cysts with rupture into the bile ducts or persistent biliary fistulas can be treated with ERCP and endoscopic sphincterotomy, biliary stent, PD, and nasobiliary drainage without the need for surgical intervention.
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Hamza A, Krasniqi A, Sada F, Zejnullahu V, Bicaj B. ERCP treatment of obstructive jaundice caused by hydatid cyst in extrahepatic ducts 13 years after liver hydatid endocystectomy. A case report. Int J Surg Case Rep 2020; 74:38-41. [PMID: 32777766 PMCID: PMC7417887 DOI: 10.1016/j.ijscr.2020.07.056] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/03/2020] [Revised: 07/16/2020] [Accepted: 07/17/2020] [Indexed: 02/07/2023] Open
Abstract
Hydatid disease is a parasitic infestation by a tapeworm of the genus Echinococcosis of which 50%–75% of hydatid cysts occur in the liver. In approximately one-fourth of the cases, hepatic hydatid cyst ruptures into the biliary tree producing obstructive jaundice. Moreover, primary hydatid cysts of the biliary tract have been reported in English literature. This is an interesting and intriguing case of obstructive jaundice caused by hydatid cyst in extrahepatic ducts 13 years after liver hydatid endocystectomy. ERCP represent an important management strategy for patients with hydatid cysts in extra-hepatic ducts even primary or complications of liver hydatid cyst.
Introduction Hydatid disease affects most commonly the liver, and complications with the rupture into the biliary tree develop in approximately one-fourth of the cases. Moreover, primary hydatid cysts of the biliary tract have been reported. Presentation of case We report an extremely rare case of obstructive jaundice caused by hydatid cyst in extrahepatic ducts 13 years after liver hydatid endocystectomy treated by Endoscopic retrograde cholangiopancreatography (ERCP). A 28-year-old male patient who had undergone surgical treatment – removal of liver hydatid cyst 13 years earlier, presented with signs of obstructed jaundice, confirmed with blood tests results and magnetic resonance cholangiopancreatography (MRCP). Actually, there were no pathological changes detected in the hepatic parenchyma, but the intrahepatic and extrahepatic bile ducts were dilated. ERCP was performed and the entire hydatid material was evacuated and washed out into the gastrointestinal tract. In addition, after laparoscopic cholecystectomy, hydatid cysts were also confirmed in the gallbladder. Discussion Generally, the obstructive jaundice caused by hydatid cyst in the extrahepatic ducts can also be caused by the rupture of the liver hydatid cyst in the biliary tract, or by primary hydatid cyst in the biliary tract. The ERCP plays a key role in the diagnosis and the treatment of this pathology. Conclusion The ERCP, has now become an important diagnostic and therapeutic procedure in management of primary extrahepatic hydatid cysts and of complicated liver hydatid cysts.
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Affiliation(s)
- Astrit Hamza
- Department of Abdominal Surgery, Clinic of Surgery, University Clinical Centre of Kosova (UCCK), 10000, Prishtina, Kosovo; Faculty of Medicine, University of Prishtina, 10000, Prishtina, Kosovo; Kavaja Hospital, Prishtina-Ferizaj highway 5(th) km, 10000, Prishtina, Kosovo
| | - Avdyl Krasniqi
- Kavaja Hospital, Prishtina-Ferizaj highway 5(th) km, 10000, Prishtina, Kosovo
| | - Fatos Sada
- Faculty of Medicine, University of Prishtina, 10000, Prishtina, Kosovo; Department of Anesthesiology and Reanimation, University Clinical Centre of Kosova (UCCK), 10000, Prishtina, Kosovo; Kavaja Hospital, Prishtina-Ferizaj highway 5(th) km, 10000, Prishtina, Kosovo
| | - Valon Zejnullahu
- Department of Abdominal Surgery, Clinic of Surgery, University Clinical Centre of Kosova (UCCK), 10000, Prishtina, Kosovo
| | - Besnik Bicaj
- Faculty of Medicine, University of Prishtina, 10000, Prishtina, Kosovo; Kavaja Hospital, Prishtina-Ferizaj highway 5(th) km, 10000, Prishtina, Kosovo.
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Alizadeh Z, Mahami-Oskouei M, Spotin A, Kazemi T, Ahmadpour E, Cai P, Shanehbandi D, Shekari N. Parasite-derived microRNAs in plasma as novel promising biomarkers for the early detection of hydatid cyst infection and post-surgery follow-up. Acta Trop 2020; 202:105255. [PMID: 31682814 DOI: 10.1016/j.actatropica.2019.105255] [Citation(s) in RCA: 29] [Impact Index Per Article: 7.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/03/2019] [Revised: 10/31/2019] [Accepted: 10/31/2019] [Indexed: 02/08/2023]
Abstract
Currently, cystic echinococcosis (CE) follow-up is a serious concern among surgeons. MicroRNAs (miRNAs) are small, endogenous, non-coding RNAs which are present in human body fluids in a highly stable form. Recently, it is observed that Echinococcus granulosus expresses a large number of miRNAs in its developmental stages. The current study aimed at evaluating the capacity of parasitic miRNAs to serve as plasma biomarkers for hydatid cysts before and after CE surgery. Hydatidosis patients were identified using radiological and histopathological examinations. Following RNA extraction and cDNA synthesis, the expression levels of parasite-derived miRNAs including egr-miR-71 and egr-let-7 were quantitatively evaluated using real-time polymerase chain reaction (RT-PCR) in 30 hydatid cyst-infected individuals before surgery and an equal number of healthy controls. Then, three- and six-month follow-ups were performed after cystectomy. To analyze parasite-derived miRNAs, the relative fold change between uninfected and infected samples was determined and normalized to hsa-miR-16-5p as the housekeeping internal control. RT-PCR demonstrated that egr-miR-71 and egr-let-7 were specifically amplified in all the plasma samples from the infected individuals with hydatid cyst; yet they were significantly down-regulated at three and six months' post-surgery (P < 0.05). The egr-miR-71 had a higher level of expression in larval stage compared with egr-let-7. The results of the current study indicated that hydatid cyst-derived miRNAs including egr-miR-71 and egr-let-7 can be detected in human plasma. Considering the changes in the expression levels of these miRNAs after three and six months, it seems that these miRNAs, especially egr-miR-71, could serve as novel promising biomarkers for the early diagnosis and monitoring of hydatidosis.
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Velasco-Tirado V, Romero-Alegría Á, Belhassen-García M, Alonso-Sardón M, Esteban-Velasco C, López-Bernús A, Carpio-Perez A, Jimenez López MF, Muñoz Bellido JL, Muro A, Cordero-Sanchez M, Pardo-Lledias J, Muñoz-Bellvis L. Recurrence of cystic echinococcosis in an endemic area: a retrospective study. BMC Infect Dis 2017; 17:455. [PMID: 28655301 PMCID: PMC5488421 DOI: 10.1186/s12879-017-2556-9] [Citation(s) in RCA: 22] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/14/2017] [Accepted: 06/16/2017] [Indexed: 01/20/2023] Open
Abstract
Background Cystic echinococcosis (CE) is a chronic, complex and neglected zoonotic disease. CE occurs worldwide. In humans, it may result in a wide spectrum of clinical manifestations, ranging from asymptomatic infection to fatal disease. Clinical management procedures have evolved over decades without adequate evaluation. Despite advances in surgical techniques and the use of chemotherapy, recurrence remains one of the major problems in the management of hydatid disease. The aim of this study was to determine the frequency of CE recurrence and the risk factors involved in recurrence. Methods A descriptive longitudinal-retrospective study was designed. We reviewed all patients diagnosed with CE according to ICD-9 (code 122–0 to 122–9) criteria admitted at Complejo Asistencial Universitario de Salamanca, Spain, between January 1998 and December 2015. Results Among the 217 patients studied, 25 (11.5%) had a hydatid recurrence after curative intention treatment. Median duration of recurrence’s diagnosis was 12.35 years (SD: ±9.31). The likelihood of recurrence was higher [OR = 2.7; 95% CI, 1.1–7.1; p < 0.05] when the cyst was located in organs other than liver and lung, 22.6% (7/31) vs 14.2% (31/217) in the cohort. We detected a chance of recurrence [OR = 2.3; 95% CI, 1.4–6.5; p > 0.05] that was two times higher in those patients treated with a combination of antihelminthic treatments and surgical intervention (20/141, 14.2%) than in patients treated with surgical intervention alone (5/76, 6.6%). Conclusions Despite advances in diagnosis and therapeutic techniques in hydatid disease, recurrence remains one of the major problems in the management of hydatid disease. The current management and treatment of recurrences is still largely based on expert opinion and moderate-to-poor quality of evidence. Consequently, large prospective and multicenter studies will be needed to provide definitive recommendations for its clinical management.
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Affiliation(s)
- Virginia Velasco-Tirado
- Servicio de Dermatologia Complejo Asistencial Universitario de Salamanca (CAUSA), Instituto de investigación Biomédica de Salamanca (IBSAL), Centro de Investigación de Enfermedades Tropicales de la Universidad de Salamanca (CIETUS), Universidad de Salamanca, Paseo San Vicente, Salamanca, Spain
| | - Ángela Romero-Alegría
- Servicio de Medicina Interna, CAUSA, IBSAL, CIETUS, Universidad de Salamanca, Paseo San Vicente, 58-182, 37007, Salamanca, Spain
| | - Moncef Belhassen-García
- Servicio de Medicina Interna, Sección de Enfermedades Infecciosas, CAUSA, IBSAL, CIETUS, Universidad de Salamanca, Paseo San Vicente, 58-182, 37007, Salamanca, Spain.
| | | | | | | | | | | | | | - Antonio Muro
- Laboratorio de Inmunología Parasitaria y Molecular, CIETUS, IBSAL, Facultad de Farmacia, Universidad de Salamanca, Salamanca, Spain
| | - Miguel Cordero-Sanchez
- Servicio de Medicina Interna, Seccion de Enfermedades Infecciosas, CAUSA, CIETUS, IBSAL, Universidad de Salamanca, Salamanca, Spain
| | - Javier Pardo-Lledias
- Servicio de Medicina Interna, Hospital General de Palencia "Río Carrión", C/ Donantes de Sangre, Palencia, Spain
| | - Luis Muñoz-Bellvis
- Servicio de Cirugia, CAUSA, IBSAL, Universidad de Salamanca, Salamanca, Spain
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Patkowski W, Kotulski M, Remiszewski P, Grąt M, Zieniewicz K, Kobryń K, Najnigier B, Ziarkiewicz-Wróblewska B, Krawczyk M. Alveococcosis of the liver - strategy of surgical treatment with special focus on liver transplantation. Transpl Infect Dis 2016; 18:661-666. [PMID: 27416884 DOI: 10.1111/tid.12574] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/21/2015] [Revised: 11/10/2015] [Accepted: 04/29/2016] [Indexed: 01/28/2023]
Abstract
BACKGROUND Echinococcosis is a zoonosis caused by infestation with any of 4 (of the 16) members of the Echinococcus genus, namely Echinococcus granulosus, Echinococcus multilocularis, Echinococcus oligarthus, and Echinococcus vogelii. The aim of this retrospective analysis was to present the outcomes of patients undergoing liver resection and liver transplantation (LT) for E. multilocularis infection. METHODS A total of 44 patients who underwent surgical treatment of E. multilocularis infection in the period between 1989 and 2014 were included in the study cohort and retrospectively analyzed. RESULTS LT was performed in 22 patients (50.0%), including 4 of 26 patients undergoing initial non-transplant management. Non-transplant procedures comprised liver resection in 23 patients (88.5%), diagnostic laparoscopy in 2 (7.7%), and left adrenalectomy in 1 patient (3.8%). Post-transplantation survival rates were 90%, 85%, and 75% at 1, 5, and 10 years, respectively. CONCLUSION In conclusion, LT for E. multilocularis infection is a safe and effective treatment method.
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Affiliation(s)
- W Patkowski
- Department of General, Transplant and Liver Surgery, Medical University of Warsaw, Warsaw, Poland.
| | - M Kotulski
- Department of General, Transplant and Liver Surgery, Medical University of Warsaw, Warsaw, Poland
| | - P Remiszewski
- Department of General, Transplant and Liver Surgery, Medical University of Warsaw, Warsaw, Poland
| | - M Grąt
- Department of General, Transplant and Liver Surgery, Medical University of Warsaw, Warsaw, Poland
| | - K Zieniewicz
- Department of General, Transplant and Liver Surgery, Medical University of Warsaw, Warsaw, Poland
| | - K Kobryń
- Department of General, Transplant and Liver Surgery, Medical University of Warsaw, Warsaw, Poland
| | - B Najnigier
- Department of General, Transplant and Liver Surgery, Medical University of Warsaw, Warsaw, Poland
| | | | - M Krawczyk
- Department of General, Transplant and Liver Surgery, Medical University of Warsaw, Warsaw, Poland
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Abstract
Hydatid disease is a zoonosis caused by the larvae of Echinococcus granulosus . Humans are an intermediate host and are usually infected by direct contact with dogs or indirectly by contaminated foods. Hydatid disease mainly involves the liver and lungs. The disease can be asymptomatic. Imaging techniques such as ultrasonography and computed tomography are used for diagnosis. The growth of hydatid cysts can lead to complications. Communication between bile duct and cysts is a common complication. The goal of treatment for hydatid disease is to eliminate the parasite with minimum morbidity and mortality. There are 3 treatment options: surgery, chemotherapy, and interventional procedures. Medical treatment has low cure and high recurrence rates. Percutaneous treatment can be performed in select cases. There are many surgical approaches for managing hydatid cysts, although there is no best surgical technique, and conservative and radical procedures are used. Conservative procedures are usually preferred in endemic areas and are easy to perform but are associated with high morbidity and recurrence rates. In these procedures, the parasite is sterilized using a scolicidal agent, and the cyst is evacuated. Radical procedures include hepatic resections and pericystectomy, which have high intraoperative risk and low recurrence rates. Radical procedures should be performed in hepatobiliary centers. The most common postoperative complications are biliary fistulas and cavity-related complications. Endoscopic retrograde cholangiopancreatography can be used to diagnose and treat biliary system complications. Endoscopic sphincterotomy, biliary stenting, and nasobiliary tube drainage are effective for treating postoperative biliary fistulas.
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Affiliation(s)
- Erdogan Sozuer
- Department of Surgery, Erciyes University Faculty of Medicine, Kayseri, Turkey
| | - Muhammet Akyuz
- Department of Surgery, Erciyes University Faculty of Medicine, Kayseri, Turkey
| | - Sami Akbulut
- Department of Surgery and Liver Transplant Institute, Inonu University Faculty of Medicine, Malatya, Turkey
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Bedioui H, Ayari H, Bouslama K, Maghrebi H, Hsairi H, Jouini M, Kacem JM, Safta ZB. Les facteurs prédictifs de récidive du kyste hydatique du foie : l’expérience tunisienne. ACTA ACUST UNITED AC 2012; 105:265-9. [DOI: 10.1007/s13149-012-0243-z] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/12/2011] [Accepted: 03/27/2012] [Indexed: 01/20/2023]
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Ramia JM, Ruiz-Gomez F, Plaza RDL, Veguillas P, Quiñones J, García-Parreño J. Ambispective comparative study of two surgical strategies for liver hydatidosis. World J Gastroenterol 2012; 18:546-50. [PMID: 22363121 PMCID: PMC3280400 DOI: 10.3748/wjg.v18.i6.546] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/23/2011] [Revised: 11/12/2011] [Accepted: 11/19/2011] [Indexed: 02/06/2023] Open
Abstract
AIM To investigate the morbidity, mortality, recurrence and technical aspects of two distinct surgical strategies that were implemented in successive periods. METHODS Ninty-two patients with 113 cysts underwent surgical procedures. The study was divided into 2 periods. Data from first period (P1) were compiled retrospectively. The surgical strategy was conservative surgery. The second period (P2) included a prospective study conducted according to a protocol following the criterion that radical procedures should be performed whenever it is technically feasible. RESULTS Patients of both periods showed no statistically significant differences in age, gender, cyst location or mortality. Among the P2 group, patients exhibited more preoperative jaundice, and cyst size was smaller (P < 0.05). Changes in surgical strategy increased the rate of radical surgery, decreases morbidity and in-hospital stay (P < 0.001). A negative result in P2 was the death of two old patients (4.8%) who had undergone conservative treatments. The rate of radical surgery in P2 was around 75%. CONCLUSION Radical surgery should be the technique of choice whenever it is feasible, because it diminishes morbidity and in-hospital stay. Conservative surgery must be employed only in selected cases.
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Ozden E, Bostanci Y, Mercimek MN, Yakupoglu YK, Yilmaz AF, Sarıkaya S. Renal hydatid cyst treatment: Retroperitoneoscopic “closed cyst” pericystectomy. Int J Urol 2011; 18:237-9. [DOI: 10.1111/j.1442-2042.2010.02703.x] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
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Abstract
PURPOSE OF REVIEW Cystic echinococcosis, or cystic hydatidosis, is a complex, chronic disease with a cosmopolitan distribution. In humans, its clinical spectrum ranges from asymptomatic infection to severe, rarely even fatal disease. Four approaches in clinical management exist: surgery, percutaneous techniques and drug treatment for active cysts, and the so-called watch and wait approach for inactive cysts. Allocation of patients to these treatments should be based on cyst stage, size and location, available clinical expertise and comorbidities. However, clinical decision algorithms, efficacy, relapse rates, and costs have never been properly evaluated.We review the currently available evidence for clinical decision-making and discuss ways to improve standards of care of one of the most neglected infectious diseases. RECENT FINDINGS Data are mostly derived from case series and small clinical trials, and treatment guidelines remain at the level of expert opinion. No single high-quality comparative clinical trial of the four treatment options is available to resolve important questions such as stage-specific allocation of treatments, adverse events and long-term relapse rates. Recent work is beginning to acknowledge this problem. SUMMARY Currently, four treatment modalities are available for cystic echinococcosis. The level of evidence on which clinicians have to rely is low. For the time being patients should thus be treated in referral centres. Proper comparative clinical trials are urgently needed.
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