Cystic echinococcosis in humans and animals in Egypt: An epidemiological overview

Human and camel cystic echinococcosis - a polyclonal antibody-based sandwich ELISA for its serodiagnosis with molecular identification

Cystic echinococcosis (CE) is an emergent neglected disease affecting human and animals in Egypt with a wide distribution and incidence. This study aimed to evaluate the use of a polyclonal antibody-based sandwich ELISA in the detection of Echinococcus granulosus antigen in human and camel sera. Hydatid cyst protoscoleces antigen (PsAg) was isolated from hydatid cysts collected from naturally infected camel livers and lungs. PsAg was used for immunization of rabbits to raise IgG polyclonal antibodies (IgG PsAb). IgG PsAb were then precipitated, purified using Protein-A Sepharose gel and labeled with horseradish peroxidase enzyme. We assayed the purity of the IgG PsAb, and the two prepared E. granulosus antigens CPsAg from camel cysts and HPsAg from human cysts by Sodium dodecyl-sulfate polyacrylamide gel electrophoresis (SDS-PAGE). The resulted protein bands of the prepared CPsAg appeared at different molecular weights: 180, 90, 68, 54, 42 and 22 kDa while, HPsAg shared with it in 4 common bands at 68, 54, 42, and 22 kDa. The purified IgG PsAb had been resolved at two bands at 52 kDa and at 32 kDa. Sandwich ELISA were performed for the detection of circulating E. granulosus antigens in sera of human (n = 183) and camels (n = 190). The purified IgG PsAb showed strong reactivity against E. granulosus infected human and camel samples and no cross reactivity neither with free-healthy negative sera nor with others parasitic diseases (Schistosomiasis, Fascioliasis, Toxoplasmosis, Ancylostomiasis for human samples and Fascioliasis, ticks' infestation, Eimeriosis, Cryptosporidiosis, Nasal myiasis, Toxoplasmosis for camel samples). The sensitivity of the assay was 98.25% (56/57) and 96.9% (31/32) against human and camel samples, respectively. Specificity was 100% in both human and camel samples. Sandwich ELISA detected CE in 33.3% (24/72) and 55.6% (50/90) random human and camel samples, respectively. Indirect ELISA, using CPsAg, was used for detection of antibodies in positive human and camels' sera and detected 96.5% (55/57) and 93.8% (30/32) of human and camel samples, respectively. In our study, Genomic DNA was extracted from protoscoleces fluid of human liver hydatid cysts to identify the Echinococcus sp. isolate based on NADH dehydrogenase subunit 1 (NAD1) gene by Polymerase Chain Reaction (PCR) and the isolate (GenBank: OP785689.1) were identified as E. granulosus sensu lato genotype. In conclusion, Sandwich ELISA technique was found to be a potent and sensitive assay for detection of hydatid antigen in both human and camel samples.

Advances in Detecting Cystic Echinococcosis in Intermediate Hosts and New Diagnostic Tools: A Literature Review

Cystic echinococcosis (CE) is a zoonotic disease affecting humans and animals. Despite a lack of clarity about many details of parasite-intermediate host interactions, the nature of the immune responses triggered by hydatid infection has revealed new perspectives. This study discusses the latest advances in elucidating the immunologic mechanism of echinococcosis and its detection and potential approaches to enhance serodiagnosis accuracy. Moreover, nanobiosensors have been evaluated according to their potential to improve treatment efficiency and aid in an early diagnosis of cystic echinococcosis. The serum of an intermediate host can diagnose CE by analyzing antibodies induced by Echinococcus granulosus. Among the most notable features of this method are its noninvasive ability and high sensitivity, both of which make it an excellent tool for clinical diagnosis. Several serological tests, including ELISAs and immunoblotting, can detect these antibodies to assess the disease's state and determine the treatment outcome. A thorough understanding of what cross-reactivity means and the stage of the disease are crucial to interpreting serological results. Nanobiosensors have also proven better than conventional biosensors in detecting hydatid cysts. Additionally, they are highly sensitive and versatile when detecting specific biomarkers, improving diagnostic accuracy. These immunomodulatory molecules, induced by E. granulosus, are a good candidate for diagnosing cystic echinococcosis because they alter intermediate host immune responses. Hydatid cyst detection is also enhanced through nanobiosensors, which provide better accuracy.

An in vivo appraisal of Punica granatum peel extract's ultrastructural effect on cystic echinococcosis in mice

In the past decade, interest has significantly increased regarding the medicinal and nutritional benefits of pomegranate (Punica granatum) peel. This study examined the effects of using pomegranate peel extract (PGE) alone and in combination with albendazole (ABZ) on ultrastructural and immunological changes in cystic echinococcosis in laboratory-infected mice. Results revealed that the smallest hydatid cyst size and weight (0.48 ± 0.47mm, 0.17 ± 0.18 gm) with the highest drug efficacy (56.2%) was detected in the PGE + ABZ group, which also exhibited marked histopathological improvement. Ultrastructural changes recorded by transmission electron microscopy including fragmentation of the nucleus, glycogen depletion, and multiple lysosomes in vacuolated cytoplasm were more often observed in PGE + ABZ group. IFN-γ levels were significantly increased in the group treated with ABZ, with a notable reduction following PGE treatment, whether administered alone or in combination with ABZ. Thus, PGE enhanced the therapeutic efficiency of ABZ, with improvement in histopathological and ultrastructural changes.

Global, Regional and National Burden of Human Cystic Echinococcosis from 1990 to 2019: A Systematic Analysis for the Global Burden of Disease Study 2019

BACKGROUND

Cystic echinococcosis (CE) is a neglected tropical parasitic disease that poses huge disease, social and economic burdens worldwide; however, there has been little knowledge on the global morbidity, mortality and disability-adjusted life years (DALYs) of CE until now. This study aimed to collect the most up-to-date data about the global, regional and national disease burden due to CE from 1990 to 2019 and to project trends in the next 10 years.

METHODS

We measured the global, regional and national morbidity, mortality and DALYs of CE from 1990 to 2019 based on the Global Burden of Disease Study 2019 (GBD 2019) data, and we examined the correlation between socioeconomic development levels and the disease burden of CE. In addition, the disease burden due to CE was projected from 2020 to 2030.

RESULTS

The age-standardized incidence rate (ASIR) of CE reduced from 2.65/105 [95% UI: (1.87/105 to 3.7/105)] in 1990 to 2.6/105 [95% UI: (1.72/105 to 3.79/105)] in 2019 (EAPC = -0.18%). The number of deaths, DALYs, age-standardized mortality rate (ASMR) and age-standardized DALY rate due to CE all showed a tendency to decline from 1990 to 2019. A higher disease burden of CE was measured in women than in men in 2019. There was a significant difference in the ASMR of CE by region according to the socio-demographic index (SDI), and lower burdens of CE were estimated in high-SDI regions. The global ASIR of CE is projected to decline from 2020 to 2030; however, the ASMR and age-standardized DALY rate are projected to rise.

CONCLUSIONS

The global burden of CE remains high, and it is recommended that more health resources are allocated to low-SDI regions, women and the elderly aged 55 to 65 years to reduce the disease burden of CE.

Does the expression of granzyme B participate in inflammation, fibrosis, and fertility of hydatid cysts?

Echinococcus granulosus (sensu lato), a cestode that is endemic in Egypt, causes cystic echinococcosis (CE), a significant but neglected zoonotic disease that is prevalent throughout the world. Infected hydatid cysts are classified as fertile or non-fertile based on the presence of protoscoleces; nevertheless, the mechanism of non-fertile CE cysts remains unknown. The study aimed to assess whether granzyme B (GrB) expression and CD4 + /CD8 + could be related to the induction of non-fertile CE cysts. A total of fifty-eight individuals diagnosed with visceral hydatid cysts were selected, and they were further divided according to cyst fertility into fertile and non-fertile. Immunohistochemistry for CD4, CD8, and GrB was done. According to the results, hydatid cysts are common in adults and have no gender preference. The same clinical and laboratory data were shared by patients with fertile and non-fertile cysts (p = 0.186). GrB expression was not impacted by the fibrous deposition inside the hydatid cyst wall (p = 0.85); however, GrB was significantly correlated with the inflammatory density (p = 0.005). GrB expression was also found to be significantly higher in non-fertile cysts (p = 0.04). GrB expression is positively correlated with CD4 and CD8 expression. In conclusion, the expression of GrB in hydatid cysts may exacerbate the inflammatory response and impede cyst fertility while not affecting the fibrous deposition in the cyst wall.

Gastrointestinal Parasites of Dogs in Egypt: An Update on the Prevalence in Dakahlia Governorate and a Meta-Analysis for the Published Data from the Country

Since the last survey on gastrointestinal (GIT) parasites infecting dogs in Dakahlia governorate, Egypt, was published 40 years ago, the present study detected various GIT parasites in feces of 78 stray dogs in this governorate. Twenty-one dogs (35.9%) had eggs/oocysts of eight different parasites including Toxocara canis (19.2%), Toxascaris leonina (2.6%), hookworms (1.3%), Taenia species (5.1%), Dipylidium caninum (2.6%), Cystoisospora canis (5.1%), Cystoisospora ohioensis (2.6%), and Neospora caninum-like oocysts (1.3%). These results were combined in various meta-analyses with findings of all published surveys on GIT parasites of dogs in Egypt to underline the potential parasitic zoonoses from dogs in the country. Feces and/or gastrointestinal tracts of 19,807 dogs from various Egyptian governorates, but particularly Cairo, have been microscopically tested in 182 datasets published between 1938 and 2022, revealed during our systematic database search. Toxocara canis, interestingly, displayed a twofold higher pooled prevalence (24.7%) when compared to the published global pooled prevalence for T. canis, indicating that dogs represent a major risk for toxocariasis in humans from Egypt. Dipylidium caninum (25.4%) as well as various Taenia species (17.1%) also displayed high pooled prevalences. On the contrary, lower pooled prevalence was estimated for the most important zoonotic taeniid "Echinococcus granulosus" (2.4%) as well as for hookworms (1.8%) in comparison to what has been published from other countries in the region. Relatively high prevalences were estimated for three protozoa detected in dogs and are common to infect children in Egypt; Cryptosporidium (5.5%), Giardia (7.4%), and Entamoeba histolytica (9.8%). In general, the pooled prevalence estimated for various parasites detected in dogs from Egypt has decreased in the recent years, sometimes by as much as one-fifth, but this great decline is statistically insignificant, which should alert the veterinary and public health authorities to continue their efforts for controlling these parasites in a "One Health" approach.

Pathological Findings and Oxidative Stress Status Associated with Hydatidosis in Dromedary Camels

(1) Background: Cystic echinococcosis is a zoonotic helminth disease that causes severe economic losses. The study aimed to assess the prevalence and viability of cystic echinococcosis in examined camels. In addition, assessing the histological, morphological, oxidative, and antioxidant state related to the cystic echinococcosis infection; (2) Methods: The study was performed on 152 slaughtered dromedary camels between March and September 2022 at El-Basatin abattoir in Cairo Governorate, Egypt; (3) Results: The results revealed that the prevalence of hydatidosis was 21.7% in slaughtered camel and the highest infection rate observed in lungs was 87.87%, while it was 9% in livers. Camels' liver infections were rare, whereas their lung infections were more common. By comparing to non-infected camels, the level of MAD was significantly increased with hydatid cysts infection, while the level of GSH, SOD and CAT was significantly decreased. Histopathological section of camel cyst revealed layered membranes surrounded by a zone of cellular infiltration and an outermost fibrous tissue reaction. In addition, there was evidence of atelectasis, emphysema, hemorrhage, congestion, and fibrosis in the surrounding tissues. Nonetheless, the degeneration and necrosis of hepatocytes and other pathological alterations in liver cyst sections were remarkably comparable to those seen in the lungs. Furthermore, calcification was detected.

Occurrence and Phylogenetic Description of Cystic Echinococcosis Isolate from Egyptian Camel (Camelus Dromedarius)

Cystic echinococcosis is one of the most significant cyclo-zoonotic diseases of major economic and public health significance worldwide. The current study was carried out to determine the epidemiological profile of cystic echinococcosis as well as to investigate its molecular and phylogenic status from one-humped camel (Camelus dromedarius) in the southern region of Egypt. In the present work, 110 camels freshly slaughtered at Daraw abattoirs, Aswan governorate were inspected for the presence of Hydatid cysts (HCs) visually and manually by palpation and incision, over a period of one year (June, 2018 - May, 2019). Furthermore, fourteen fertile hydatid cyst samples were collected from lungs of slaughtered camels. DNA extraction from two fertile samples was successfully achieved followed by phylogenetic analysis on two mitochondrial genes (cox1and nad1). Out of 110 camels slaughtered 11 (10 %) were found harboring hydatid cysts. The infection was found to prevail throughout the year, with the highest peak encountered in winter (45.5 %). The lungs were the most frequently infected organs (72.7 %) with liver cysts occurring at a significantly lower rate (27.3 %). The mean value of total protein, glucose, urea, cholesterol, magnesium, potassium, copper and creatinine was higher in cystic fluid from camels as compared to cattle. Blast and phylogenetic analysis on sequenced genes showed the presence of Echinococcus intermedius, originally the pig genotype (G7) in camels for the first time in Egypt. To the best of our knowledge, the current research provides a description of the current epidemiological and molecular situation of camel hydatidosis in the southern region of Egypt. Furthermore, the current results may have significant implications for hydatid disease control in the studied region.