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Casulli A, Pane S, Randi F, Scaramozzino P, Carvelli A, Marras CE, Carai A, Santoro A, Santolamazza F, Tamarozzi F, Putignani L. Primary cerebral cystic echinococcosis in a child from Roman countryside: Source attribution and scoping review of cases from the literature. PLoS Negl Trop Dis 2023; 17:e0011612. [PMID: 37669300 PMCID: PMC10503711 DOI: 10.1371/journal.pntd.0011612] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/06/2023] [Revised: 09/15/2023] [Accepted: 08/21/2023] [Indexed: 09/07/2023] Open
Abstract
BACKGROUND Human cystic echinococcosis (CE) is a zoonotic parasitic infection caused by the larval stage of the species belonging to the Echinococcus granulosus sensu lato (s.l.) complex. Parasitic cysts causing human CE are mainly localized in the liver and in the lungs. In a smaller number of cases, larvae may establish in any organ or tissue, including the central nervous system (CNS). Cerebral CE (CCE) is rare but poses serious clinical challenges. METHODS This study presents a case of CCE in a child living in the countryside near Rome (Italy), along with a comparative molecular analysis of the isolated cyst specimens from the patient and sheep of local farms. We also systematically searched the literature to summarize the most relevant epidemiological and clinical aspects of this uncommon localization. FINDINGS The comparative molecular analysis confirmed that the infection was caused by E. granulosus sensu stricto (s.s.) (G3 genotype), and most likely acquired in the family farm. The literature search identified 2,238 cases of CCE. In 80.51% of cases, brain was the only localization and single CCE cysts were present in 84.07% of cases. Mean patients' age was 20 years and 70.46% were children. Cyst rupture was reported in 12.96% and recurrence of CCE after treatment in 9.61% of cases. Permanent disability was reported in 7.86% of cases, while death occurred in 6.21%. In case series reporting all CE localization, CCE represented 1.5% of all CE cases. In the few reports that identified at molecular level the CCE cyst, E. granulosus s.s. was found in 40% and E. canadensis in 60% of cases. CONCLUSIONS We report a rare case of CCE and evidenced the probable local origin of infection. The proportions of CE cases with uncommon localizations and with high impact on patients' lives have been globally neglected and should be included in the computation of the global burden of CE.
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Affiliation(s)
- Adriano Casulli
- WHO Collaborating Centre for the Epidemiology, Detection and Control of Cystic and Alveolar Echinococcosis, Department of Infectious Diseases, Istituto Superiore di Sanità, Rome, Italy
- European Union Reference Laboratory for Parasites, Department of Infectious Diseases, Istituto Superiore di Sanità, Rome, Italy
| | - Stefania Pane
- Unit of Microbiomics, Bambino Gesù Children’s Hospital, IRCCS, Rome, Italy
| | - Franco Randi
- Neurosurgery Unit, IRCCS Bambino Gesù Children’s Hospital, Rome, Italy
| | - Paola Scaramozzino
- Istituto Zooprofilattico Sperimentale del Lazio e della Toscana “M. Aleandri”, Epidemiology Unit, Rome, Italy
| | - Andrea Carvelli
- Istituto Zooprofilattico Sperimentale del Lazio e della Toscana “M. Aleandri”, Epidemiology Unit, Rome, Italy
| | | | - Andrea Carai
- Neurosurgery Unit, IRCCS Bambino Gesù Children’s Hospital, Rome, Italy
| | - Azzurra Santoro
- WHO Collaborating Centre for the Epidemiology, Detection and Control of Cystic and Alveolar Echinococcosis, Department of Infectious Diseases, Istituto Superiore di Sanità, Rome, Italy
- European Union Reference Laboratory for Parasites, Department of Infectious Diseases, Istituto Superiore di Sanità, Rome, Italy
| | - Federica Santolamazza
- WHO Collaborating Centre for the Epidemiology, Detection and Control of Cystic and Alveolar Echinococcosis, Department of Infectious Diseases, Istituto Superiore di Sanità, Rome, Italy
- European Union Reference Laboratory for Parasites, Department of Infectious Diseases, Istituto Superiore di Sanità, Rome, Italy
| | - Francesca Tamarozzi
- Department of Infectious-Tropical Diseases and Microbiology, WHO Collaborating centre on Strongyloidiasis and other Neglected Tropical Diseases, IRCCS Sacro Cuore Don Calabria Hospital, Negrar di Valpolicella, Verona, Italy
| | - Lorenza Putignani
- Unit of Microbiomics; Research Unit of Human Microbiome, Bambino Gesù Children’s Hospital, IRCCS, Rome, Italy
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Dorjsuren T, Ganzorig S, Dagvasumberel M, Tsend-Ayush A, Ganbold C, Ganbat M, Tsogzolbaatar EO, Tsevelvaanchig U, Narantsogt G, Boldbaatar C, Mundur B, Khand-Ish M, Agvaandaram G. Prevalence and risk factors associated with human cystic echinococcosis in rural areas, Mongolia. PLoS One 2020; 15:e0235399. [PMID: 32614862 PMCID: PMC7331993 DOI: 10.1371/journal.pone.0235399] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/31/2020] [Accepted: 06/15/2020] [Indexed: 12/11/2022] Open
Abstract
Cystic echinococcosis is a chronic, complex and neglected zoonotic disease with considerable socio-economic impact on the affected population. Even though Mongolia is included in the list of high cystic echinococcosis risk countries, there has been very limited research and evidence on the prevalence or prevention of cystic echinococcosis. This field-based cross-sectional study to investigate the prevalence of cystic echinococcosis and its potential risk factors in Mongolia was conducted from April 2016 to March 2018. A total of 1,993 people were examined by ultrasound in five provinces of Mongolia. All cystic echinococcosis positive cases were classified according to the WHO-IWGE expert recommendations. The logistic regression model was used to detect the association between the presence of echinococcus infection and each potential risk factor. This was the first community survey based on ultrasound screening in Mongolia. We found 98 cystic echinococcosis cases (prevalence = 4.9%), including 85 abdominal ultrasound cystic echinococcosis positive cases and 13 abdominal ultrasound cystic echinococcosis negative cases (surgically treated cystic echinococcosis cases 11, and 2 confirmed cases of lung cystic echinococcosis by chestcomputed tomography in hospital of Ulaanbaatar). The prevalence of cystic echinococcosis varied greatly among different provinces, ranging from 2.0% to 13.1%. Children, elderly people and those with lower education had higher chances of getting cystic echinococcosis. Rather than dog ownership itself, daily practice for cleaning dog feces was associated with increased odds of cystic echinococcosis. The results of the present study show very high endemicity of cystic echinococcosis in Umnugovi province. Evaluation of potential risk factors associated with cystic echinococcosisshow high significance for following factors: demographics (age), social condition (education level) and hygiene practices (cleaning dog feces and use of gloves). Children under 18 and elderly people are considered as the most risk age groups in Mongolia.
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Affiliation(s)
- Temuulen Dorjsuren
- Department of Biology, Mongolian National University of Medical Sciences, Ulaanbaatar, Mongolia
- * E-mail:
| | - Sumiya Ganzorig
- Laboratory of space and biological resources, National University of Mongolia, Ulaanbaatar, Mongolia
| | | | - Altansukh Tsend-Ayush
- Department of Molecular Biology and Genetics, Mongolian National University of Medical Sciences, Ulaanbaatar, Mongolia
| | - Chimedlkhamsuren Ganbold
- Department of Molecular Biology and Genetics, Mongolian National University of Medical Sciences, Ulaanbaatar, Mongolia
| | - Mandukhai Ganbat
- Department of Epidemiology and Biostatistics, Mongolian National University of Medical Sciences, Ulaanbaatar, Mongolia
| | - Enkh-Oyun Tsogzolbaatar
- Department of Epidemiology and Biostatistics, Mongolian National University of Medical Sciences, Ulaanbaatar, Mongolia
| | | | - Giimaa Narantsogt
- Department of Biology, Mongolian National University of Medical Sciences, Ulaanbaatar, Mongolia
| | | | - Burnee Mundur
- Department of Biology, Mongolian National University of Medical Sciences, Ulaanbaatar, Mongolia
| | - Munkhgerel Khand-Ish
- Department of Biology, Mongolian National University of Medical Sciences, Ulaanbaatar, Mongolia
| | - Gurbadam Agvaandaram
- Department of Biology, Mongolian National University of Medical Sciences, Ulaanbaatar, Mongolia
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A multiplex PCR for the identification of Echinococcus multilocularis, E. granulosus sensu stricto and E. canadensis that infect human. Parasitology 2019; 146:1595-1601. [DOI: 10.1017/s0031182019000921] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/12/2023]
Abstract
AbstractEchinococcus granulosus sensu stricto (s.s.), Echinococcus multilocularis and Echinococcus canadensis are the common causes of human echinococcosis in China. An accurate species identification tool for human echinococcosis is needed as the treatments and prognosis are different among species. The present work demonstrates a method for the simultaneous detection of these three Echinococcus species based on multiplex polymerase chain reaction (mPCR). Specific primers of this mPCR were designed based on the mitochondrial genes and determined by extensive tests. The method can successfully detect either separated or mixed target species, and generate expected amplicons of distinct size for each species. Sensitivity of the method was tested by serially diluted DNA, showing a detection threshold as less as 0.32 pg for both E. granulosus s.s. and E. canadensis, and 1.6 pg for E. multilocularis. Specificity assessed against 18 other parasites was found to be 100% except weakly cross-react with E. shiquicus. The assay was additionally applied to 69 echinococcosis patients and 38 healthy persons, confirming the high reliability of the method. Thus, the mPCR described here has high application potential for clinical identification purposes, and can further provide a useful tool for evaluation of serology and imaging method.
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Genotyping and phylogenetic analysis of unusually located hydatid cysts isolated from humans in north-east Iran. J Helminthol 2019; 94:e64. [PMID: 31331413 DOI: 10.1017/s0022149x19000579] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/18/2022]
Abstract
Despite several studies conducted to determine the genotypes of cystic echinococcosis (CE) agents in humans and other intermediate hosts, the relationship between parasite genotype and clinical presentation of hydatidosis is yet to be well defined. The aim of this study was to compare the genotypes/haplotypes of CE agents of human extra-hepatopulmonary hydatid cysts and common hydatid cysts of the liver. A comparative analysis was carried out between partial cox1 sequences of ten extra-hepatopulmonary hydatid cysts, two liver cysts and reliable sequences from the GenBank database. All the studied hydatid cysts had the Echinococcus granulosus sensu stricto (G1-G2-G3) genotypes. The liver CE cysts were caused by common G1 genotype, while six of the extra-hepatopulmonary cysts had genotypes different from common G1 cysts. The sequences of these six isolates were identical to the G2 and G3 genotypes of E. granulosus sensu stricto; the kidney and peritoneum cysts and most of the brain cysts were identified as G2 genotype, while G3 genotype was only reported in a cyst belonging to the pelvic region. Given the observed differences between the sequences of hydatid cysts, it seems that the replacement of hydatid cysts in organs other than the liver and lungs can be related to their genotypes and probably intra-genotypic characteristics. It was hypothesized that in each geographic area, less frequent genotypes were likely to be more consistent with placement in the host's unusual organs.
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Bold B, Boué F, Schindler C, Badmaa B, Batbekh B, Argamjav B, Bayasgalan C, Ito A, Narankhuu U, Shagj A, Zinsstag J, Umhang G. Evidence for camels (Camelus bactrianus) as the main intermediate host of Echinococcus granulosus sensu lato G6/G7 in Mongolia. Parasitol Res 2019; 118:2583-2590. [PMID: 31278516 DOI: 10.1007/s00436-019-06391-x] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/07/2019] [Accepted: 06/27/2019] [Indexed: 12/14/2022]
Abstract
Cystic echinococcosis (CE), the parasitic disease caused by the larval stage of Echinococcus granulosus sensu lato (s.l.), is a global public health problem. In Mongolia, despite wide distribution of human CE, not enough information is available on the prevalence and molecular characterization of CE in livestock and its zoonotic linkage with human cases. We investigated the distribution of human CE cases and livestock population using statistical models to get insight into the zoonotic linkage. The incidence of human CE cases increased by a factor of 1.71 for one interquartile range increment in the density of the camel population. No significant association was observed with other livestock species. The samples collected from 96 camels and 15 goats in an endemic region showed a CE prevalence of 19.7% and 6.7%, respectively. All livestock CE were E. granulosus s.l. G6/G7 species of the E. granulosus s.l. complex. The genetic diversity was investigated using the haplotype network based on full cox1 gene analysis of the samples collected from livestock CE and nucleotide sequences previously reported from human CE and wild canids infection in Mongolia. Four haplotypes were identified within the livestock samples, two of which had not been previously reported. A common haplotype was identified among humans, camels, goats, and a wolf, all of which were within the same geographical area. A mixed infection of E. granulosus s.l. G6/G7 with different haplotypes in the intermediate host was identified. To the best of our knowledge, this is the most comprehensive description of the current epidemiological situation of CE in Mongolia with substantial evidence that camels might be the main intermediate host of E. granulosus s.l. G6/G7 in Mongolia. Moreover, our result presents the first report in the country to provide insight into the prevalence of E. granulosus s.l. G6/G7 in livestock.
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Affiliation(s)
- Bolor Bold
- Department of Epidemiology, National Center for Zoonotic Disease, Ulaanbaatar, Mongolia.,Epidemiology and Public Health Department, Swiss Tropical and Public Health Institute, Basel, Switzerland.,University of Basel, Basel, Switzerland
| | - Franck Boué
- Anses LRFSN, Wildlife Surveillance and Eco-epidemiology Unit, National Reference Laboratory for Echinococcus spp., Technopôle agricole et vétérinaire, 54220, Malzéville, France
| | - Christian Schindler
- Epidemiology and Public Health Department, Swiss Tropical and Public Health Institute, Basel, Switzerland.,University of Basel, Basel, Switzerland
| | - Battsetseg Badmaa
- School of Veterinary Medicine, Mongolian University of Life Sciences, Ulaanbaatar, Mongolia
| | - Belgutei Batbekh
- School of Veterinary Medicine, Mongolian University of Life Sciences, Ulaanbaatar, Mongolia
| | - Bayanzul Argamjav
- School of Veterinary Medicine, Mongolian University of Life Sciences, Ulaanbaatar, Mongolia
| | | | - Akira Ito
- Department of Parasitology, Asahikawa Medical University, Asahikawa, Japan
| | - Uranshagai Narankhuu
- Department of Epidemiology, National Center for Zoonotic Disease, Ulaanbaatar, Mongolia
| | - Agiimaa Shagj
- Department of Epidemiology, National Center for Zoonotic Disease, Ulaanbaatar, Mongolia
| | - Jakob Zinsstag
- Epidemiology and Public Health Department, Swiss Tropical and Public Health Institute, Basel, Switzerland.,University of Basel, Basel, Switzerland
| | - Gérald Umhang
- Anses LRFSN, Wildlife Surveillance and Eco-epidemiology Unit, National Reference Laboratory for Echinococcus spp., Technopôle agricole et vétérinaire, 54220, Malzéville, France.
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