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Kuehn R, Uchiumi LJ, Tamarozzi F. Treatment of uncomplicated hepatic cystic echinococcosis (hydatid disease). Cochrane Database Syst Rev 2024; 7:CD015573. [PMID: 38994714 PMCID: PMC11240857 DOI: 10.1002/14651858.cd015573] [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] [Indexed: 07/13/2024]
Abstract
BACKGROUND Cystic echinococcosis is a parasitic infection mainly impacting people living in low- and middle-income countries. Infection may lead to cyst development within organs, pain, non-specific symptoms or complications including abscesses and cyst rupture. Treatment can be difficult and varies by country. Treatments include oral medication, percutaneous techniques and surgery. One Cochrane review previously assessed the benefits and harms of percutaneous treatment compared with other treatments. However, evidence for oral medication, percutaneous techniques and surgery in specific cyst stages has not been systematically investigated and the optimal choice remains uncertain. OBJECTIVES To assess the benefits and harms of medication, percutaneous and surgical interventions for treating uncomplicated hepatic cystic echinococcosis. SEARCH METHODS We searched CENTRAL, MEDLINE, two other databases and two trial registries to 4 May 2023. We searched the reference lists of included studies, and contacted experts and researchers in the field for relevant studies. SELECTION CRITERIA We included randomized controlled trials (RCTs) in people with a diagnosis of uncomplicated hepatic cystic echinococcosis of World Health Organization (WHO) cyst stage CE1, CE2, CE3a or CE3b comparing either oral medication (albendazole) to albendazole plus percutaneous interventions, or to surgery plus albendazole. Studies comparing praziquantel plus albendazole to albendazole alone prior to or following an invasive intervention (surgery or percutaneous treatment) were eligible for inclusion. DATA COLLECTION AND ANALYSIS We used standard Cochrane methods. Our primary outcomes were symptom improvement, recurrence, inactive cyst at 12 months and all-cause mortality at 30 days. Our secondary outcomes were development of secondary echinococcosis, complications of treatment and duration of hospital stay. We used GRADE to assess the certainty of evidence. MAIN RESULTS We included three RCTs with 180 adults and children with hepatic cystic echinococcosis. Two studies enrolled people aged 5 to 72 years, and one study enrolled children aged 6 to 14 years. One study compared standard catheterization plus albendazole with puncture, aspiration, injection and re-aspiration (PAIR) plus albendazole, and two studies compared laparoscopic surgery plus albendazole with open surgery plus albendazole. The three RCTs were published between 2020 and 2022 and conducted in India, Pakistan and Turkey. There were no other comparisons. Standard catheterization plus albendazole versus PAIR plus albendazole The cyst stages were CE1 and CE3a. The evidence is very uncertain about the effect of standard catheterization plus albendazole compared with PAIR plus albendazole on cyst recurrence (risk ratio (RR) 3.67, 95% confidence interval (CI) 0.16 to 84.66; 1 study, 38 participants; very low-certainty evidence). The evidence is very uncertain about the effects of standard catheterization plus albendazole on 30-day all-cause mortality and development of secondary echinococcosis compared to open surgery plus albendazole. There were no cases of mortality at 30 days or secondary echinococcosis (1 study, 38 participants; very low-certainty evidence). Major complications were reported by cyst and not by participant. Standard catheterization plus albendazole may increase major cyst complications compared with PAIR plus albendazole, but the evidence is very uncertain (RR 10.74, 95% CI 1.39 to 82.67; 1 study, 53 cysts; very low-certainty evidence). Standard catheterization plus albendazole may make little to no difference on minor complications compared with PAIR plus albendazole, but the evidence is very uncertain (RR 1.03, 95% CI 0.60 to 1.77; 1 study, 38 participants; very low-certainty evidence). Standard catheterization plus albendazole may increase the median duration of hospital stay compared with PAIR plus albendazole, but the evidence is very uncertain (4 (range 1 to 52) days versus 1 (range 1 to 15) days; 1 study, 38 participants; very low-certainty evidence). Symptom improvement and inactive cysts at 12 months were not reported. Laparoscopic surgery plus albendazole versus open surgery plus albendazole The cyst stages were CE1, CE2, CE3a and CE3b. The evidence is very uncertain about the effect of laparoscopic surgery plus albendazole on cyst recurrence in participants with CE2 and CE3b cysts compared to open surgery plus albendazole (RR 3.00, 95% CI 0.13 to 71.56; 1 study, 82 participants; very low-certainty evidence). The second study involving 60 participants with CE1, CE2 or CE3a cysts reported no recurrence in either group. The evidence is very uncertain about the effect of laparoscopic surgery plus albendazole on 30-day all-cause mortality in participants with CE1, CE2, CE3a or CE3b cysts compared to open surgery plus albendazole. There was no mortality in either group (2 studies, 142 participants; very low-certainty evidence). The evidence is very uncertain about the effect of laparoscopic surgery plus albendazole on major complications in participants with CE1, CE2, CE3a or CE3b cysts compared to open surgery plus albendazole (RR 0.50, 95% CI 0.13 to 1.92; 2 studies, 142 participants; very low-certainty evidence). Laparoscopic surgery plus albendazole may lead to slightly fewer minor complications in participants with CE1, CE2, CE3a or CE3b cysts compared to open surgery plus albendazole (RR 0.13, 95% CI 0.02 to 0.98; 2 studies, 142 participants; low-certainty evidence). Laparoscopic surgery plus albendazole may reduce the duration of hospital stay compared with open surgery plus albendazole (mean difference (MD) -1.90 days, 95% CI -2.99 to -0.82; 2 studies, 142 participants; low-certainty evidence). Symptom improvement, inactive cyst at 12 months and development of secondary echinococcosis were not reported. AUTHORS' CONCLUSIONS Percutaneous and surgical interventions combined with albendazole can be used to treat uncomplicated hepatic cystic echinococcosis; however, there is a scarcity of randomised evidence directly comparing these interventions. There is very low-certainty evidence to indicate that standard catheterization plus albendazole may lead to fewer cases of recurrence, more major complications and similar complication rates compared to PAIR plus albendazole in adults and children with CE1 and CE3a cysts. There is very low-certainty evidence to indicate that laparoscopic surgery plus albendazole may result in fewer cases of recurrence or fewer major complications compared to open surgery plus albendazole in adults and children with CE1, CE2, CE3a and CE3b cysts. Laparoscopic surgery plus albendazole may lead to slightly fewer minor complications. Firm conclusions cannot be drawn due to the limited number of studies, small sample size and lack of events for some outcomes.
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Affiliation(s)
- Rebecca Kuehn
- Department of Clinical Sciences, Liverpool School of Tropical Medicine, Liverpool, UK
| | - Leonardo J Uchiumi
- Control Program of Cystic Echinococcosis, Ministry of Health, Río Negro Province, Viedma, Argentina
| | - Francesca Tamarozzi
- Department of Infectious Tropical Diseases and Microbiology, IRCCS Sacro Cuore Don Calabria Hospital, Negrar di Valpolicella, Verona, Italy
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Nenni M, Çelebier M, Maçin S, Örsten S, Yabanoğlu-Çiftçi S, Baysal İ. Untargeted metabolomics to discriminate liver and lung hydatid cysts: Importance of metabolites involved in the immune response. Vet Parasitol 2024; 328:110180. [PMID: 38626652 DOI: 10.1016/j.vetpar.2024.110180] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/12/2024] [Revised: 02/28/2024] [Accepted: 04/01/2024] [Indexed: 04/18/2024]
Abstract
The Echinococcus granulosus sensu lato species complex is responsible for the neglected zoonotic disease known as cystic echinococcosis (CE). Humans and livestock are infected via fecal-oral transmission. CE remains prevalent in Western China, Central Asia, South America, Eastern Africa, and the Mediterranean. Approximately one million individuals worldwide are affected, influencing veterinary and public health, as well as social and economic matters. The infection causes slow-growing cysts, predominantly in the liver and lungs, but can also develop in other organs. The exact progression of these cysts is uncertain. This study aimed to understand the survival mechanisms of liver and lung CE cysts from cattle by determining their metabolite profiles through metabolomics and multivariate statistical analyses. Non-targeted metabolomic approaches were conducted using quadrupole-time-of-flight liquid chromatography/mass spectrometry (LC-QTOF-MS) to distinguish between liver and lung CE cysts. Data processing to extract the peaks on complex chromatograms was performed using XCMS. PCA and OPLS-DA plots obtained through multiple statistical analyses showed interactions of metabolites within and between groups. Metabolites such as glutathione, prostaglandin, folic acid, and cortisol that cause different immunological reactions have been identified both in liver and lung hydatid cysts, but in different ratios. Considering the differences in the metabolomic profiles of the liver and lung cysts determined in the present study will contribute research to enlighten the nature of the cyst and develop specific therapeutic strategies.
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Affiliation(s)
- Merve Nenni
- Cukurova University, Faculty of Pharmacy, Department of Analytical Chemistry, Adana, Turkey; Hacettepe University, Graduate School of Health Sciences, Department of One Health, Ankara, Turkey
| | - Mustafa Çelebier
- Hacettepe University, Faculty of Pharmacy, Department of Analytical Chemistry, Ankara, Turkey
| | - Salih Maçin
- Selçuk University, Faculty of Medicine, Department of Medical Microbiology, Konya, Turkey
| | - Serra Örsten
- Hacettepe University, Graduate School of Health Sciences, Department of One Health, Ankara, Turkey; Hacettepe University, Vocational School of Health Services, Ankara, Turkey
| | | | - İpek Baysal
- Hacettepe University, Graduate School of Health Sciences, Department of One Health, Ankara, Turkey; Hacettepe University, Vocational School of Health Services, Ankara, Turkey.
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Tamarozzi F. Ultrasound diagnosis of cystic echinococcosis: updates and implications for clinical management. J Helminthol 2024; 98:e34. [PMID: 38628145 DOI: 10.1017/s0022149x2400021x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/19/2024]
Abstract
The diagnosis of cystic echinococcosis (CE) is based on imaging. Detection of a focal lesion with morphological characteristics of Echinococcus granulosus sensu lato metacestode is the starting point for the diagnostic workup. In organs explorable with ultrasound (US), this is the method of choice for both aetiological diagnosis of CE and staging of the CE cyst. Staging in terms of lesion morphology is also needed when serology is added to the diagnostic workflow when imaging alone is inconclusive. Finally, staging guides the clinical management of uncomplicated CE, especially in the liver. This commentary provides an overview of the most up-to-date evidence backing the above-mentioned role of US in the diagnosis and clinical management of CE. Finally, we outline future perspectives for the improvement of CE diagnosis.
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Affiliation(s)
- F Tamarozzi
- Department 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
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Haddad MHF, Sepahvand Z, Fadaei T, Belali R. Epidemiological characteristics of human cystic echinococcosis in Khuzestan province (Iran), 2011-2021: a retrospective analytical study. J Parasit Dis 2023; 47:718-726. [PMID: 38009155 PMCID: PMC10667199 DOI: 10.1007/s12639-023-01619-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/07/2023] [Accepted: 07/17/2023] [Indexed: 11/28/2023] Open
Abstract
Hydatid cyst (HC) disease is endemic in many Mediterranean countries. The most polluted areas of Iran include the Alborz and Zagros Mountain ranges, where animal husbandry is common. This study investigated the epidemiological dimensions of HC in patients admitted to hospitals in Khuzestan province from 2011 to 2021. Of all 183 patients identified, 113 (61.7%) were female with the mean age of 37.7 ± 17, men with the mean age of 36.7 ± 19. Also, we found that housewives made up 49.2% of our HC patients. 65% of the patients in this study lived in urban areas, and 42% had a history of contact with dogs. The liver was reported to be the most HC-affected organ. The most clinical symptoms were abdominal pain and hepatomegaly. 59% of the patients had only one cyst. This study found that surgery and radiology were the most common treatment and diagnostic methods. There were significant relationships between: gender and occupation (p < 0.001); location with dog contact, duration of dog contact (p < 0.001); ways of washing raw vegetables (p < 0.01), and type of treatment (p < 0.05); occupation and dog contact (p < 0.001); with the involvement of the liver being greater in patients who used only water to wash vegetables (p < 0.01). The key to successful disease management is early diagnosis. How to intervene and treat HC necessitates the identification of the stages of the cyst, which is dependent on imaging techniques. The prevalence of human hydatidosis has been overlooked as the most important disease that health policymakers should consider. Furthermore, training programs are required to better understand the disease's symptoms and identify sources of infection.
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Affiliation(s)
| | - Zahra Sepahvand
- Student Research Committee, Ahvaz Jundishapur University of Medical Sciences, Ahvaz, Iran
| | - Tahereh Fadaei
- Student Research Committee, Ahvaz Jundishapur University of Medical Sciences, Ahvaz, Iran
| | - Rafie Belali
- Department of Physiology, School of Medicine, Ahvaz Jundishapur University of Medical Sciences, Ahvaz, Iran
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Brunetti E, Tamarozzi F. Watch-and-wait approach for inactive echinococcal cysts: scoping review update since the issue of the WHO-IWGE Expert Consensus and current perspectives. Curr Opin Infect Dis 2023; 36:326-332. [PMID: 37466115 PMCID: PMC10487372 DOI: 10.1097/qco.0000000000000943] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 07/20/2023]
Abstract
PURPOSE OF REVIEW This work aims to provide an update of knowledge on the evolution of inactive cystic echinococcosis (CE) cysts (CE4-CE5) managed by 'watch-and-wait', by means of a scoping review of the literature published after the publication of the WHO-IWGE (Informal Working Group on Echinococcosis) Expert Consensus document in 2010. RECENT FINDINGS A total of 31 articles were included. Population ultrasound-based studies showed that spontaneously inactivated CE cysts represent 50.2% (95% confidence interval 38.7-61.8) of all detected untreated CE cysts, and that the prevalence of CE4-CE5 cysts tends to increase with age. Four longitudinal population-based studies showed that CE cysts naturally tend to evolve towards inactivation and that spontaneously inactivated cysts reactivate in a minority of cases. This was confirmed by four hospital-based studies, showing that spontaneously inactivated cysts reactivate rarely, while rate of reactivation is higher if inactivity was obtained posttreatment. It was not possible to drive conclusions on any difference in the clinical course of infection in immunocompromised or pregnant patients. SUMMARY CE cysts tend to evolve spontaneously to inactivation over time. The published literature supports the safety of the watch-and-wait approach for inactive cysts, sparing treatment to a substantial proportion of asymptomatic patients. A regular follow-up with ultrasound of all inactive cysts is required to detect reactivations.
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Affiliation(s)
- Enrico Brunetti
- Division of Infectious and Tropical Diseases, University of Pavia, IRCCS S. Matteo Hospital Foundation, WHO Collaborating Centre on Clinical Management of Cystic Echinococcosis, Pavia
| | - 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
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Nicolao MC, Rodrigues CR, Coccimiglio MB, Ledo C, Docena GH, Cumino AC. Characterization of protein cargo of Echinococcus granulosus extracellular vesicles in drug response and its influence on immune response. Parasit Vectors 2023; 16:255. [PMID: 37516852 PMCID: PMC10387209 DOI: 10.1186/s13071-023-05854-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/14/2023] [Accepted: 06/28/2023] [Indexed: 07/31/2023] Open
Abstract
BACKGROUND The Echinococcus granulosus sensu lato species complex causes cystic echinococcosis, a zoonotic disease of medical importance. Parasite-derived small extracellular vesicles (sEVs) are involved in the interaction with hosts intervening in signal transduction related to parasite proliferation and disease pathogenesis. Although the characteristics of sEVs from E. granulosus protoscoleces and their interaction with host dendritic cells (DCs) have been described, the effect of sEVs recovered during parasite pharmacological treatment on the immune response remains unexplored. METHODS Here, we isolated and characterized sEVs from control and drug-treated protoscoleces by ultracentrifugation, transmission electron microscopy, dynamic light scattering, and proteomic analysis. In addition, we evaluated the cytokine response profile induced in murine bone marrow-derived dendritic cells (BMDCs) by qPCR. RESULTS The isolated sEVs, with conventional size between 50 and 200 nm, regardless of drug treatment, showed more than 500 cargo proteins and, importantly, 20 known antigens and 70 potential antigenic proteins, and several integral-transmembrane and soluble proteins mainly associated with signal transduction, immunomodulation, scaffolding factors, extracellular matrix-anchoring, and lipid transport. The identity and abundance of proteins in the sEV-cargo from metformin- and albendazole sulfoxide (ABZSO)-treated parasites were determined by proteomic analysis, detecting 107 and eight exclusive proteins, respectively, which include proteins related to the mechanisms of drug action. We also determined that the interaction of murine BMDCs with sEVs derived from control parasites and those treated with ABZSO and metformin increased the expression of pro-inflammatory cytokines such as IL-12 compared to control cells. Additionally, protoscolex-derived vesicles from metformin treatments induced the production of IL-6, TNF-α, and IL-10. However, the expression of IL-23 and TGF-β was downregulated. CONCLUSIONS We demonstrated that sEV-cargo derived from drug-treated E. granulosus protoscoleces have immunomodulatory functions, as they enhance DC activation towards a type 1 pro-inflammatory profile against the parasite, and therefore support the proposal of a new approach for the prevention and treatment of secondary echinococcosis.
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Affiliation(s)
- María Celeste Nicolao
- Laboratorio de Zoonosis Parasitarias, IIPROSAM, Universidad Nacional de Mar del Plata (UNMdP), Funes 3350, Nivel Cero, 7600, Mar del Plata, Argentina
- Consejo Nacional de Investigaciones Científicas y Técnicas (CONICET), Buenos Aires, Argentina
| | - Christian Rodriguez Rodrigues
- Consejo Nacional de Investigaciones Científicas y Técnicas (CONICET), Buenos Aires, Argentina
- Departamento de Química, Facultad de Ciencias Exactas y Naturales, Universidad Nacional de Mar del Plata (UNMdP), Funes 3350, Nivel 2, 7600, Mar del Plata, Argentina
| | - Magalí B Coccimiglio
- Laboratorio de Zoonosis Parasitarias, IIPROSAM, Universidad Nacional de Mar del Plata (UNMdP), Funes 3350, Nivel Cero, 7600, Mar del Plata, Argentina
| | - Camila Ledo
- Laboratorio de Zoonosis Parasitarias, IIPROSAM, Universidad Nacional de Mar del Plata (UNMdP), Funes 3350, Nivel Cero, 7600, Mar del Plata, Argentina
| | - Guillermo H Docena
- Consejo Nacional de Investigaciones Científicas y Técnicas (CONICET), Buenos Aires, Argentina
- Instituto de Estudios Inmunológicos y Fisiopatológicos (IIFP), La Plata, Argentina
| | - Andrea C Cumino
- Laboratorio de Zoonosis Parasitarias, IIPROSAM, Universidad Nacional de Mar del Plata (UNMdP), Funes 3350, Nivel Cero, 7600, Mar del Plata, Argentina.
- Consejo Nacional de Investigaciones Científicas y Técnicas (CONICET), Buenos Aires, Argentina.
- Departamento de Química, Facultad de Ciencias Exactas y Naturales, Universidad Nacional de Mar del Plata (UNMdP), Funes 3350, Nivel 2, 7600, Mar del Plata, Argentina.
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Yoo JS, Kang MK, Park JG, Kim HJ, Choi JH. Clinical Implications for the Comprehensive Interpretation of Radiologic and Immunodiagnostic Tests in Patients Suspected of Parasitic Hepatic Cyst, a Rare Case in Korea. Trop Med Infect Dis 2023; 8:tropicalmed8030155. [PMID: 36977156 PMCID: PMC10052134 DOI: 10.3390/tropicalmed8030155] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/25/2023] [Revised: 03/01/2023] [Accepted: 03/02/2023] [Indexed: 03/06/2023] Open
Abstract
Cystic echinococcosis (CE) is a representative neglected tropical disease (NTD) with increased morbidity and mortality but is ignored and overlooked in developed countries. Serological and radiographic findings are helpful in distinguishing these parasites; however, conflicting results of these can make it difficult to diagnose if medical knowledge of hepatic parasitic disease, including the etiology, features of imaging, and immunodiagnostic test, is not acquired. We report the case of a male patient with dyspepsia and right epigastric pain who had positive results for cysticercosis antibodies on immunodiagnostic examination. Abdominal ultrasonography revealed two huge communicating cystic lesions measuring 8–11 cm. Further evaluations for cysticercosis of the brain (neurocysticercosis) and eyes (intraocular cysticercosis) were unremarkable throughout the brain imaging test and fundus examination. A laparoscopic right hemi-hepatectomy was performed for diagnosis and treatment. On histopathological examination, diverse stages of Echinococcus granulosus were identified. Albendazole was administered postoperatively, and the patient was also followed up. We should be aware of the etiologies that have been prevalent in parasite infection thought to be the cause of hepatic cysts. Moreover, we make an effort to ascertain the patient’s nationality, past travel experiences, and immediate environment, including any animals and pets. We present the case of a patient who was worried about the possibility of liver invasion of cysticercus due to the positivity of the cysticercosis antibody and was ultimately diagnosed with CE.
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Affiliation(s)
- Jae-Sung Yoo
- Department of Internal Medicine, Yeungnam University Medical Center, Daegu 42415, Republic of Korea
| | - Min-Kyu Kang
- Department of Internal Medicine, College of Medicine, Yeungnam University, Daegu 42415, Republic of Korea
- Correspondence: ; Tel.: +82-53-620-3316; Fax: +82-53-654-8386
| | - Jung-Gil Park
- Department of Internal Medicine, College of Medicine, Yeungnam University, Daegu 42415, Republic of Korea
| | - Hyung-Joo Kim
- Departments of Surgery, Yeungnam University Medical Center, Daegu 42415, Republic of Korea
| | - Joon-Hyuk Choi
- Department of Pathology, College of Medicine, Yeungnam University, Daegu 42415, Republic of Korea
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Tamarozzi F, Kibona T, de Glanville WA, Mappi T, Adonikamu E, Salewi A, Misso K, Maro V, Casulli A, Santoro A, Santolamazza F, Mmbaga BT, Cleaveland S. Cystic echinococcosis in northern Tanzania: a pilot study in Maasai livestock-keeping communities. Parasit Vectors 2022; 15:396. [PMID: 36307877 PMCID: PMC9616617 DOI: 10.1186/s13071-022-05518-x] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/12/2022] [Accepted: 09/29/2022] [Indexed: 12/03/2022] Open
Abstract
Background There are close similarities between the life-cycles of Echinococcus granulosus sensu lato (E. granulosus s.l.) that causes cystic echinococcosis (CE) in humans and Taenia multiceps/Coenurus cerebralis that causes cerebral coenurosis in small ruminants. Recent evidence highlights that livestock in Maasai communities of northern Tanzania are suffering from increases in the prevalence of cerebral coenurosis, leading to concerns about a possible concurrent increased risk of human CE. The aim of this study was to estimate the prevalence of human abdominal CE and the prevalence and species/genotypes of E. granulosus s.l. in livestock in Maasai communities. Methods Human CE was diagnosed by abdominal ultrasound on volunteers aged ≥ 7 years in five villages in the Longido and Ngorongoro Districts in northern Tanzania. Infection in ruminants was evaluated through inspection in local abattoirs, followed by molecular identification of one cyst per animal, with a priority for hepatic cysts, using PCR targeting of the cytochrome c oxidase I gene (COX1), followed by restriction fragment length polymorphism and multiplex PCR, and sequencing of non-E. granulosus s.l. samples. Results Ultrasound was performed on 823 volunteers (n = 352 in two villages in Longido District, and n = 471 in three villages of Ngorongoro). Hepatic CE cases were diagnosed only in Ngorongoro (n = 6; 1.3%), of which three had active cysts. Village-level prevalence of CE ranged between 0 and 2.4%. Of the 697 ruminants inspected, 34.4% had parasitic cysts. Molecular identification was achieved for 140 of the 219 (63.9%) cysts sampled. E. granulosus s.l. and T. hydatigena/Cysticercus tenuicollis were identified in 51.4% and 48.6%, respectively, of livestock cysts. E. granulosus s.l. was identified in livestock from both Longido (35.3% of 116 genotyped cysts) and Ngorongoro (91.2% of 34 genotyped cysts). Of the total of 72 E. granuslosus s.l. cysts identified in livestock, 87.5% were E. granulosus sensu stricto (G1–G3 genotypes), 9.7% were E. ortleppi (G5) and one cyst was E. canadensis (G6–10). The three active human cysts, which were removed surgically, were G1–G3 genotypes. Conclusions Multiple species/genotypes of E. granulosus s.l. are circulating in Maasai communities of northern Tanzania. Human CE was detected in villages of Ngorongoro District and a high prevalence of echinococcal cysts was observed in livestock in both districts. More precise estimation of the prevalence in this area and a better understanding of the specific risk factors for CE among Maasai communities in northern Tanzania is needed. Interventions targeting transmission routes common to both E. granulosus s.l. and T. multiceps would have dual benefits for preventing both human and livestock disease. Graphical Abstract ![]()
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Affiliation(s)
- Francesca Tamarozzi
- IRCCS Sacro Cuore Don Calabria Hospital, Negrar di Valpolicella, Verona, Italy.
| | - Tito Kibona
- Kilimanjaro Clinical Research Institute, Moshi, Tanzania
| | | | - Tauta Mappi
- Kilimanjaro Clinical Research Institute, Moshi, Tanzania
| | | | - Anande Salewi
- Kilimanjaro Christian Medical Centre, Moshi, Tanzania
| | - Kennedy Misso
- Kilimanjaro Christian Medical Centre, Moshi, Tanzania
| | - Venance Maro
- Kilimanjaro Christian Medical Centre, Moshi, Tanzania.,Kilimanjaro Christian Medical University College, Moshi, Tanzania
| | | | | | | | - Blandina T Mmbaga
- Kilimanjaro Christian Medical Centre, Moshi, Tanzania.,Kilimanjaro Christian Medical University College, Moshi, Tanzania
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Zandi S, Mariconti M, Zandi H, Jafari A, Hajimohammadi B, Eslami G, Vakili M, Sheykhzadegan M, Askari V, Hosseini SS. Bacterial and Fungal Occurrence in Hydatid Cysts from Livestock in Central Iran. Vet Res Commun 2022; 47:421-430. [PMID: 35732851 DOI: 10.1007/s11259-022-09959-8] [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: 03/02/2022] [Accepted: 06/13/2022] [Indexed: 11/26/2022]
Abstract
Echinococcus granulosus sensu lato causes Cystic echinococcosis. This study investigated the bacterial and fungal species in the liver and lung hydatid cysts obtained from sheep, goats, cattle, and camels slaughtered in Yazd abattoir, Central Iran. In this study, 84 hydatid cysts were obtained from 20 sheep, 13 goats, 25 cattle, and 26 camels. The fertility and viability rates were assessed using light microscopy and eosin staining, respectively. The aspirated hydatid cysts were cultured to detect the presence of any bacteria and fungi. Bacterial isolates were identified by biochemical tests. DNA was also extracted from germinal layers, and then genotyping was carried out targeting the cox 1 gene. The statistical analysis was performed by SPSS version 16.0. This study showed that 22.62% (19/84) of hydatid cysts had bacterial occurrence, and none of the samples had fungal species. Among the fertile cysts, 52.6% had bacterial occurrence, of which 40% were viable. Most bacteria detected in hydatid cysts included Staphylococcus saprophyticus, Escherichia coli, and S. epidermidis. Hydatid cysts with bacterial occurrence were identified as G1-G3, G5, and G6/G7. The bacterial species occurrence in hydatid cysts had no significant relationship with fertility and viability (P > 0.05), without any significant relation with viability (P > 0.05), animal species (P > 0.05), involved organ in animals (P > 0.05), and hydatid cyst genotypes (P > 0.05). It should also be mentioned that this is the first study to assess the relationship between hydatid cyst genotyping and the occurrence of fungal and bacterial species.
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Affiliation(s)
- Sajad Zandi
- Research Center for Food Hygiene and Safety, School of Public Health, Shahid Sadoughi University of Medical Sciences, Yazd, Iran
- Department of Parasitology and Mycology, School of Medicine, Shahid Sadoughi University of Medical Sciences, Yazd, Iran
| | - Mara Mariconti
- Infectious Diseases and Immunology, IRCCS San Matteo Hospital Foundation, Pavia, Italy
| | - Hengameh Zandi
- Research Center for Food Hygiene and Safety, School of Public Health, Shahid Sadoughi University of Medical Sciences, Yazd, Iran
- Department of Microbiology, School of Medicine, Shahid Sadoughi University of Medical Sciences, Yazd, Iran
| | - AbbasAli Jafari
- Department of Parasitology and Mycology, School of Medicine, Shahid Sadoughi University of Medical Sciences, Yazd, Iran
| | - Bahador Hajimohammadi
- Research Center for Food Hygiene and Safety, School of Public Health, Shahid Sadoughi University of Medical Sciences, Yazd, Iran
- Department of Food Hygiene and Safety, School of Public Health, Shahid Sadoughi University of Medical Sciences, Yazd, Iran
| | - Gilda Eslami
- Research Center for Food Hygiene and Safety, School of Public Health, Shahid Sadoughi University of Medical Sciences, Yazd, Iran.
- Department of Parasitology and Mycology, School of Medicine, Shahid Sadoughi University of Medical Sciences, Yazd, Iran.
| | - Mahmood Vakili
- Health Monitoring Research Center, School of Medicine, Shahid Sadoughi University of Medical Sciences, Yazd, Iran
| | - Maryam Sheykhzadegan
- Research Center for Food Hygiene and Safety, School of Public Health, Shahid Sadoughi University of Medical Sciences, Yazd, Iran
| | - Vahideh Askari
- Research Center for Food Hygiene and Safety, School of Public Health, Shahid Sadoughi University of Medical Sciences, Yazd, Iran
| | - Saeedeh Sadat Hosseini
- Research Center for Food Hygiene and Safety, School of Public Health, Shahid Sadoughi University of Medical Sciences, Yazd, Iran
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10
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Autoimmunity in human CE: Correlative with the fertility status of the CE cyst. Helminthologia 2022; 59:1-17. [PMID: 35601761 PMCID: PMC9075880 DOI: 10.2478/helm-2022-0011] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/11/2020] [Accepted: 01/27/2022] [Indexed: 11/20/2022] Open
Abstract
Cystic echinococcosis is speculated to exert several immune-evasion strategies involving autoimmune-phenomena. We evaluated the hypothesizes that the prevalence of autoantibodies increases in the sera of CE patients that may evidence the association between the parasite and autoimmune diseases. Sera from 63 subjects at distinct types of CE cyst fertility were investigated for antinuclear antibodies (ANA), and anti-CCP antibodies. Plasma levels and cellular production of IL-17A cytokine were specifically defined as being assumed to prime for autoimmunity. Healthy-controls were age and gender-matched to test sera. ANA expressions inside the surgically removed metacestode and adventitial layer were also assayed. Out of 63 patients, 35 % had fertile highly viable cysts (group-1), 41 % had fertile low viable cysts (group-2) and 24 % had non-fertile cysts (group-3). A four-fold increase in ANA sera-levels was detected in group-1 compared with their controls (p-value 0.001) while anti-CCP levels were of insignificant differences. In group-2 and group-3, no significant differences were detected between ANA and anti-CCP sera-levels in CE patients and their controls. IL-17A sera-levels in group-1 and group- 2 were significantly higher than their healthy-controls while being of insignificant differences in group-3, p-value= 0.300. No association was detected between sera-levels of IL-17A and ANA as well as anti-CCP antibodies. Interestingly, relative IL-17A cellular expression associated positive ANA deposition in the parasite cells and adventitial layer. Collectively, based on the parasite fertility, IL-17A and ANA seemed to be involved in the host immune defenses against CE. There is no association between CE and anti-CCP antibodies.
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11
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Prevalence rate and risk factors of human cystic echinococcosis: A cross-sectional, community-based, abdominal ultrasound study in rural and urban north-central Chile. PLoS Negl Trop Dis 2022; 16:e0010280. [PMID: 35263331 PMCID: PMC8936472 DOI: 10.1371/journal.pntd.0010280] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/17/2021] [Revised: 03/21/2022] [Accepted: 02/24/2022] [Indexed: 11/23/2022] Open
Abstract
Background Cystic echinococcosis (CE) caused by Echinococcus granulosus sensu lato (s.l.) is a neglected and underdiagnosed parasitic zoonosis that has a significant socioeconomic impact on rural communities relying on livestock farming. CE is endemic across Latin America, including Chile, where the Coquimbo region exhibits a relatively high record of hospital-based human cases and infected animals. However, the incidence of hospitalized CE cases may underestimate the real burden of infection in a population, since the majority of cases never reach medical attention or official disease records. Methodology/Principal findings In 2019, a cross-sectional, community-based study was conducted with the objectives of estimating for the first time the prevalence of human abdominal CE using abdominal ultrasound (US) screening in volunteers residing in urban and rural localities of the Monte Patria municipality located in Limarí province, Coquimbo region, Chile, and identifying the risk factors associated with human infection. Pre-screening activities included a 16-h lecture/hands-on training aimed at rural physicians that focused on the diagnosis of CE by US, based on current WHO recommendations. A total of 2,439 (~8% of municipality inhabitants) people from thirteen target localities were screened by abdominal US in June-July 2019. We found an overall CE prevalence of 1.6% (95% CI 1.1–2.2) with a significantly higher likelihood of infection in rural localities, older age classes and people drinking non-potable water; 84.6% of infected volunteers were newly diagnosed with CE. Cysts were either in active or inactive stages in equal proportions; active cysts were detected in all age classes, while 95.7% of inactive cysts occurred in >40 years-old subjects. Conclusions/Significance This is the first US survey aimed at detecting human infection caused by Echinococcus granulosus s.l. in Chile. Our findings indicate a high CE prevalence in the area, and contribute to define the demographic and behavioral risk factors promoting the transmission of the parasitic infection within target communities. Our results support the implementation of cost-effective strategies for the diagnosis, treatment and control of CE, and the need to improve the epidemiological surveillance system in Chile. Human cystic echinococcosis (CE) is a parasitic disease caused by Echinococcus granulosus s.l. complex; its cycle involves canids and livestock, mainly sheep. It is endemic in areas with extensive livestock breeding activities, where close contact occurs between humans and the domestic dog-livestock parasite cycle. After ingestion of parasite eggs, people may develop fluid-filled cysts, mainly in the liver. CE is a neglected disease, which causes significant socioeconomic impact mainly on poor communities worldwide. Prevalence data in many affected areas is lacking or largely underestimated, partly because human cases typically do not reach medical attention or official disease records. We determined the prevalence of abdominal CE by ultrasound population-based screening in volunteers residing in urban and rural localities of the Monte Patria Municipality, Limarí province, Coquimbo region, which is an E. granulosus s.l. endemic area of northern Chile, and assessed the risk factors associated with human infection. We performed an ultrasound survey on 2,439 people residing in thirteen localities and found an overall prevalence of 1.6% (95% CI 1.1–2.2). A higher risk of infection was associated with residing in rural localities, older age and drinking non-potable water. CE cysts were either in active or inactive stages in equal proportions and 84.6% of infected volunteers were newly diagnosed with CE. Our findings will serve to support the implementation of cost-effective diagnostic, treatment and control strategies and to improve the epidemiological surveillance system for CE in Chile.
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12
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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: 20] [Impact Index Per Article: 6.7] [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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13
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Zhu Y, Zhang T, Zhao Y, Wang Y, Lv Y, Li S, Yang S, Zhu M, Zhao W, Wang Q. Screening, construction, and serological identification of the diagnostic antigen molecule EG-06283 for the diagnosis of Echinococcus granulosus. Parasitol Res 2021; 120:2557-2567. [PMID: 34043054 DOI: 10.1007/s00436-021-07183-y] [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: 01/25/2021] [Accepted: 05/03/2021] [Indexed: 11/30/2022]
Abstract
Several strategies exist to prevent and control echinococcosis, a global parasitic disease. However, most treatments are ineffective and adverse effects are common. Therefore, we aimed to screen protoscolex antigen molecules of Echinococcus granulosus to identify a diagnostic biomarker for hydatid disease. Published E. granulosus transcriptome sequencing data were analyzed to screen for antigen molecules that are highly expressed in protoscoleces but not in oncospheres. The membrane protein EG-06283 (annotated as Frizzled-4) was selected from 16 antigens, and its gene fragment was subjected to codon optimization and synthesis. rEG-06283 expression was induced in the pET-24a/EG-06283/BL21 strain; subsequently, the protein was purified and subcutaneously injected into ICR mice at weeks 0, 2, 4, and 6. Blood sampling occurred periodically to quantify serum immunoglobulin G (IgG) levels via enzyme-linked immunosorbent assays (ELISA). Immunogenicity was determined by western blot assays using sera from normal mice and mice with secondary hydatid infections. The antigen's immune reactivity and diagnostic value were validated using sera of patients with hydatid disease. ELISA results confirmed that the antigen molecule induced specific IgG production in mice, resulting in significantly higher levels than those in the adjuvant and control groups (P < 0.05). The western blot results indicated that the protein was recognized by antibodies in the sera of mice with hydatid infection and the antisera of immunized mice. Quantification of protein levels in the sera of patients with hydatid disease significantly differed from levels in healthy participants (P < 0.05). These results indicate that rEG-06283 is a potential diagnostic antigen for E. granulosus infections.
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Affiliation(s)
- Yazhou Zhu
- Department of Cell Biology and Genetics, School of Basic Medicine, Ningxia Medical University, Yinchuan, 750004, Ningxia, China.,Ningxia Key Laboratory of Prevention and Control of Common Infectious Diseases, Ningxia Medical University, Yinchuan, 750004, Ningxia, China.,Scientific Technology Center of Ningxia Medical University, Yinchuan, 750004, Ningxia, China
| | - Tingrui Zhang
- Department of Cell Biology and Genetics, School of Basic Medicine, Ningxia Medical University, Yinchuan, 750004, Ningxia, China.,Ningxia Key Laboratory of Prevention and Control of Common Infectious Diseases, Ningxia Medical University, Yinchuan, 750004, Ningxia, China.,Scientific Technology Center of Ningxia Medical University, Yinchuan, 750004, Ningxia, China
| | - Yinqi Zhao
- Ningxia Key Laboratory of Prevention and Control of Common Infectious Diseases, Ningxia Medical University, Yinchuan, 750004, Ningxia, China.,Scientific Technology Center of Ningxia Medical University, Yinchuan, 750004, Ningxia, China
| | - Yin Wang
- Department of Neurobiology, School of Basic Medicine, Ningxia Medical University, Yinchuan, 750004, Ningxia, China
| | - Yongxue Lv
- Department of Cell Biology and Genetics, School of Basic Medicine, Ningxia Medical University, Yinchuan, 750004, Ningxia, China.,Ningxia Key Laboratory of Prevention and Control of Common Infectious Diseases, Ningxia Medical University, Yinchuan, 750004, Ningxia, China.,Scientific Technology Center of Ningxia Medical University, Yinchuan, 750004, Ningxia, China
| | - Shasha Li
- Department of Cell Biology and Genetics, School of Basic Medicine, Ningxia Medical University, Yinchuan, 750004, Ningxia, China.,Ningxia Key Laboratory of Prevention and Control of Common Infectious Diseases, Ningxia Medical University, Yinchuan, 750004, Ningxia, China.,Scientific Technology Center of Ningxia Medical University, Yinchuan, 750004, Ningxia, China
| | - Songhao Yang
- Ningxia Key Laboratory of Prevention and Control of Common Infectious Diseases, Ningxia Medical University, Yinchuan, 750004, Ningxia, China.,Scientific Technology Center of Ningxia Medical University, Yinchuan, 750004, Ningxia, China
| | - Mingxing Zhu
- Ningxia Key Laboratory of Prevention and Control of Common Infectious Diseases, Ningxia Medical University, Yinchuan, 750004, Ningxia, China.,Scientific Technology Center of Ningxia Medical University, Yinchuan, 750004, Ningxia, China
| | - Wei Zhao
- Department of Cell Biology and Genetics, School of Basic Medicine, Ningxia Medical University, Yinchuan, 750004, Ningxia, China. .,Ningxia Key Laboratory of Prevention and Control of Common Infectious Diseases, Ningxia Medical University, Yinchuan, 750004, Ningxia, China. .,Scientific Technology Center of Ningxia Medical University, Yinchuan, 750004, Ningxia, China.
| | - Qiang Wang
- Scientific Technology Center of Ningxia Medical University, Yinchuan, 750004, Ningxia, China.
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14
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Tamarozzi F, Silva R, Fittipaldo VA, Buonfrate D, Gottstein B, Siles-Lucas M. Serology for the diagnosis of human hepatic cystic echinococcosis and its relation with cyst staging: A systematic review of the literature with meta-analysis. PLoS Negl Trop Dis 2021; 15:e0009370. [PMID: 33909640 PMCID: PMC8081258 DOI: 10.1371/journal.pntd.0009370] [Citation(s) in RCA: 32] [Impact Index Per Article: 10.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/13/2020] [Accepted: 04/07/2021] [Indexed: 01/13/2023] Open
Abstract
Background The diagnosis of cystic echinococcosis (CE) is primarily based on imaging, while serology should be applied when imaging is inconclusive. CE cyst stage has been reported among the most important factors influencing the outcome of serodiagnosis. We performed a systematic review and meta-analysis of the relation between cyst stage of hepatic CE and diagnostic sensitivity of serological tests, to evaluate whether their relation is a consistent finding and provide guidance for the interpretation of results of serological tests. Methodology/Principal findings MEDLINE, EMBASE, CENTRAL, and Lilacs databases were searched on December 1st 2019. Original studies published after 2003 (year of publication of the CE cyst classification), reporting sensitivity of serological tests applied to the diagnosis of human hepatic CE, as diagnosed and staged by imaging, were included. The quality of studies was assessed using the Newcastle-Ottawa Scale. Data from 14 studies were included in the meta-analysis. Summary estimates of sensitivities and 95% confidence intervals were obtained using random effects meta-analysis. Overall, test sensitivity was highest in the presence of CE2 and CE3 (CE3a and/or CE3b), and lowest in the presence of CE5 and CE4 cysts. ELISA, ICT and WB showed the highest sensitivities, while IHA performed worst. Conclusions/Significance The results of our study confirm the presence of a clear and consistent relation between cyst stage and serological tests results. Limitations of evidence included the heterogeneity of the antigenic preparations used, which prevented to determine whether the relation between cyst stage and sensitivity was influenced by the type of antigenic preparation, the paucity of studies testing the same panel of sera with different assays, and the lack of studies assessing the performance of the same assay in both field and hospital-based settings. Our results indicate the absolute need to consider cyst staging when evaluating serological results of patients with hepatic CE. Cystic echinococcosis is a neglected zoonosis induced by the development of parasitic cysts in intermediate hosts, including humans, mostly in the liver. The diagnosis of CE is based on imaging. As CE cysts may assume different aspects (stages), the range of differential diagnoses is broad, from harmless simple cysts to neoplasms. Serological assays for the detection of serum antibodies are applied when imaging is inconclusive, but their performance depend on a number of factors, among which cyst stage has been reported as important. If this was a robust finding, it would be absolutely required to interpret serological findings in the light of CE cyst staging. The results of our systematic review and meta-analysis of the relation between cyst stage of hepatic CE and diagnostic sensitivity of serological tests confirmed that such relation is clear and consistent, and indicate the absolute need to consider cyst staging when evaluating serology results of patients with hepatic CE.
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Affiliation(s)
- Francesca Tamarozzi
- Department of Infectious-Tropical Diseases and Microbiology, IRCCS Sacro Cuore Don Calabria Hospital, Negrar, Verona, Italy
- * E-mail:
| | - Ronaldo Silva
- Department of Infectious-Tropical Diseases and Microbiology, IRCCS Sacro Cuore Don Calabria Hospital, Negrar, Verona, Italy
| | - Veronica Andrea Fittipaldo
- Department of Infectious-Tropical Diseases and Microbiology, IRCCS Sacro Cuore Don Calabria Hospital, Negrar, Verona, Italy
| | - Dora Buonfrate
- Department of Infectious-Tropical Diseases and Microbiology, IRCCS Sacro Cuore Don Calabria Hospital, Negrar, Verona, Italy
| | - Bruno Gottstein
- Institute of Infectious Diseases, Faculty of Medicine, University of Bern, Bern, Switzerland
| | - Mar Siles-Lucas
- Instituto de Recursos Naturales y Agrobiología de Salamanca (IRNASA-CSIC), Salamanca, Spain
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15
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Vuitton DA, McManus DP, Rogan MT, Romig T, Gottstein B, Naidich A, Tuxun T, Wen H, Menezes da Silva A. International consensus on terminology to be used in the field of echinococcoses. ACTA ACUST UNITED AC 2020; 27:41. [PMID: 32500855 PMCID: PMC7273836 DOI: 10.1051/parasite/2020024] [Citation(s) in RCA: 146] [Impact Index Per Article: 36.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/18/2020] [Accepted: 04/07/2020] [Indexed: 12/13/2022]
Abstract
Echinococcoses require the involvement of specialists from nearly all disciplines; standardization of the terminology used in the field is thus crucial. To harmonize echinococcosis terminology on sound scientific and linguistic grounds, the World Association of Echinococcosis launched a Formal Consensus process. Under the coordination of a Steering and Writing Group (SWG), a Consultation and Rating Group (CRG) had the main missions of (1) providing input on the list of terms drafted by the SWG, taking into account the available literature and the participants’ experience; and (2) providing independent rating on all debated terms submitted to vote. The mission of the Reading and Review Group (RRG) was to give an opinion about the recommendation paper in terms of readability, acceptability and applicability. The main achievements of this process were: (1) an update of the current nomenclature of Echinococcus spp.; (2) an agreement on three names of diseases due to Echinococcus spp.: Cystic Echinococcosis (CE), Alveolar Echinococcosis (AE) and Neotropical Echinococcosis (NE), and the exclusion of all other names; (3) an agreement on the restricted use of the adjective “hydatid” to refer to the cyst and fluid due to E. granulosus sensu lato; and (4) an agreement on a standardized description of the surgical operations for CE, according to the “Approach, cyst Opening, Resection, and Completeness” (AORC) framework. In addition, 95 “approved” and 60 “rejected” terms were listed. The recommendations provided in this paper will be applicable to scientific publications in English and communication with professionals. They will be used for translation into other languages spoken in endemic countries.
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Affiliation(s)
- Dominique A Vuitton
- National French Reference Centre for Echinococcosis, University Bourgogne Franche-Comté and University Hospital, FR-25030 Besançon, France
| | - Donald P McManus
- Molecular Parasitology Laboratory, Infectious Diseases Division, QIMR Berghofer Medical Research Institute, AU-4006 Brisbane, Queensland, Australia
| | - Michael T Rogan
- Department of Biology and School of Environment & Life Sciences, University of Salford, GB-M5 4WT Manchester, United Kingdom
| | - Thomas Romig
- Department of Parasitology, Hohenheim University, DE-70599 Stuttgart, Germany
| | - Bruno Gottstein
- Institute of Parasitology, School of Medicine and Veterinary Medicine, University of Bern, CH-3012 Bern, Switzerland
| | - Ariel Naidich
- Department of Parasitology, National Institute of Infectious Diseases, ANLIS "Dr. Carlos G. Malbrán", AR-1281 Buenos Aires, Argentina
| | - Tuerhongjiang Tuxun
- WHO Collaborating Centre for Prevention and Care Management of Echinococcosis and State Key Laboratory of Pathogenesis, Prevention and Treatment of High Incidence Diseases in Central Asia, CN-830011 Urumqi, PR China
| | - Hao Wen
- WHO Collaborating Centre for Prevention and Care Management of Echinococcosis and State Key Laboratory of Pathogenesis, Prevention and Treatment of High Incidence Diseases in Central Asia, CN-830011 Urumqi, PR China
| | - Antonio Menezes da Silva
- Past-President of the World Association of Echinococcosis, President of the College of General Surgery of the Portuguese Medical Association, PT-1649-028 Lisbon, Portugal
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16
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An M, Zhu Y, Xu C, Li Y, Pang N, Zhao X, Li Z, Wang H, Zhang F, Ding J. Soluble ST2 (sST2) as potential marker for hepatic cystic echinococcosis activity. J Infect 2020; 80:462-468. [DOI: 10.1016/j.jinf.2020.01.018] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/29/2019] [Revised: 01/17/2020] [Accepted: 01/25/2020] [Indexed: 12/18/2022]
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17
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Reinventing the Wheel of Echinococcus granulosus sensu lato Transmission to Humans. Trends Parasitol 2020; 36:427-434. [PMID: 32298630 DOI: 10.1016/j.pt.2020.02.004] [Citation(s) in RCA: 47] [Impact Index Per Article: 11.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/05/2020] [Revised: 02/03/2020] [Accepted: 02/24/2020] [Indexed: 12/31/2022]
Abstract
Control of cystic echinococcosis (CE) relies on interrupting Echinococcus granulosus sensu lato transmission through interventions in dogs and livestock. However, primary prevention measures aimed at avoiding ingestion of Echinococcus eggs may help reduce the burden of human CE. CE is generally considered, to variable extents, to be foodborne, but there is little evidence on the actual contamination of matrices and sociocultural factors involved in parasite transmission. An overall appraisal of published literature suggests that environmental contamination, possibly through hand-to-mouth transmission, may be of primary importance. While in most endemic areas sufficient epidemiological information is available to start CE control programs, identifying the main sources of infection to humans would allow optimization of site-specific interventions while avoiding irrelevant health education messages.
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18
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Role of microRNAs in host defense against Echinococcus granulosus infection: a preliminary assessment. Immunol Res 2019; 67:93-97. [PMID: 30498955 DOI: 10.1007/s12026-018-9041-4] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/06/2023]
Abstract
Cystic echinococcosis (CE) is a neglected helminthic zoonosis caused by the larval stage of the tapeworm Echinococcus granulosus s.l. MicroRNAs (miRNAs) are regulators of gene expression that have been linked with the pathogenesis of several human diseases, but little exists in the available literature about miRNAs in CE. Here, we investigate the expression profiles of 84 microRNAs relevant to the function of lymphocytes and other immune cells during CE infection in the peripheral blood of patients with cysts in active and inactive stages. We applied the microRNA PCR array technology to blood samples from 20 patients with a single hepatic CE cyst in either the active (CE3b) or inactive (CE4-CE5) stage. Our results show a significant upregulation of eight miRNAs (let-7g-5p, let-7a-5p, miR- 26a-5p, miR- 26b-5p, miR- 195-5p, miR- 16-5p, miR- 30c-5p, and miR- 223-3p) in patients with active cysts compared to those with inactive cysts. The high expression of these miRNAs in patients with active cysts suggests their role in a specific host immune response against the infection. Further work in this direction may help shed light on the pathogenesis of human CE.
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19
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Kaminstein D, Heller T, Tamarozzi F. Sound Around the World: Ultrasound for Tropical Diseases. Infect Dis Clin North Am 2019; 33:169-195. [PMID: 30712760 DOI: 10.1016/j.idc.2018.10.008] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/01/2023]
Abstract
Ultrasound for diagnosis and staging of schistosomiasis and echinococcosis have paved the way over the past several decades for the application of ultrasound in tropical diseases. Until recently, the size and cost of ultrasound systems limited the application in low-resource settings. The increase in portable ultrasound systems has given more clinicians access to ultrasound, and clinically based protocols for the care of patients have emerged, such as focused assessment with sonography for HIV/TB and tropical cardiac ultrasound. This article explores the history and current use of ultrasound in these diseases and highlights their application in the care of patients.
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Affiliation(s)
- Daniel Kaminstein
- Department of Emergency Medicine, Medical College of Georgia, Augusta University, Augusta, GA 30912, USA.
| | - Tom Heller
- Lighthouse Clinic, Kamuzu Central Hospital, Area 33, P.O. Box 106, Lilongwe, Malawi
| | - Francesca Tamarozzi
- Center for Tropical Diseases, IRCSS, Sacro Cuore Don Calabria Hospital, Via Don A Sempreboni 5, Negrar, Verona 37024, Italy
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20
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Mohammed AA, Allen JT, Rogan MT. Echinococcus granulosus cyst fluid enhances epithelial-mesenchymal transition. Parasite Immunol 2019; 40:e12533. [PMID: 29719047 DOI: 10.1111/pim.12533] [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: 08/18/2017] [Accepted: 04/18/2018] [Indexed: 12/17/2022]
Abstract
Cystic echinococcosis is characterized by fluid-filled hydatid cysts in the liver and lungs. The cysts are surrounded by a host fibrous layer (the pericyst) which acts to isolate the parasite from surrounding tissues. Previous studies in liver cysts have indicated that the parasite may be a stimulating fibrosis. The aim of this study was to investigate whether hydatid cyst fluid (HCF) could influence the potential for fibrosis to occur in lung tissue by stimulating epithelial to mesenchymal transition (EMT) in a human lung epithelial cell line. An adenocarcinoma-derived alveolar basal epithelial cell line (A549) was used as a model for human alveolar epithelial cells (AEC II). These were cultured in vitro with HCF (UK sheep origin). Assays to investigate cell proliferation, cell migration and expression of cytoskeletal markers showed that HCF could stimulate changes indicative of EMT, including enhanced cell proliferation and migration; increased expression of mesenchymal cytoskeletal markers (fibronectin and vimentin) accompanied by a down-regulation of an epithelial marker (E-cadherin). Molecules within hydatid cyst fluid are capable of inducing phenotypic changes in A549 cells indicating that the parasite has the potential to modify lung epithelial cells which could contribute to fibrotic reactions.
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Affiliation(s)
- A A Mohammed
- Biomedical Research Centre, School of Environment & Life Sciences, University of Salford, Salford, UK
| | - J T Allen
- Biomedical Research Centre, School of Environment & Life Sciences, University of Salford, Salford, UK
| | - M T Rogan
- Biomedical Research Centre, School of Environment & Life Sciences, University of Salford, Salford, UK
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21
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Tamarozzi F, Akhan O, Cretu CM, Vutova K, Akinci D, Chipeva R, Ciftci T, Constantin CM, Fabiani M, Golemanov B, Janta D, Mihailescu P, Muhtarov M, Orsten S, Petrutescu M, Pezzotti P, Popa AC, Popa LG, Popa MI, Velev V, Siles-Lucas M, Brunetti E, Casulli A. Prevalence of abdominal cystic echinococcosis in rural Bulgaria, Romania, and Turkey: a cross-sectional, ultrasound-based, population study from the HERACLES project. THE LANCET. INFECTIOUS DISEASES 2018; 18:769-778. [PMID: 29793823 DOI: 10.1016/s1473-3099(18)30221-4] [Citation(s) in RCA: 87] [Impact Index Per Article: 14.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/14/2017] [Revised: 02/26/2018] [Accepted: 03/19/2018] [Indexed: 12/13/2022]
Abstract
BACKGROUND Cystic echinococcosis is a neglected zoonotic infection that is distributed worldwide and prioritised by WHO for control efforts. The burden of human cystic echinococcosis is poorly understood in most endemic regions, including eastern Europe. We aimed to estimate the prevalence of abdominal cystic echinococcosis in rural areas of Bulgaria, Romania, and Turkey. METHODS We did a cross-sectional ultrasound-based survey that recruited volunteers from 50 villages in rural areas of Bulgaria, Romania, and Turkey. These villages were in provinces with annual hospital incidence of cystic echinococcosis within the mid-range for the respective countries. All people who attended a session were allowed to participate if they agreed to be screened. Abdominal ultrasound screening sessions were hosted in public community structures such as community halls, primary health-care centres, schools, and mosques. Lesions were classified using an adapted WHO classification. We reported the prevalence of abdominal cystic echinococcosis adjusted by sex and age through direct standardisation, using the country's rural population as a reference. FINDINGS From July 1, 2014, to Aug 3, 2015, 24 693 individuals presented to screening sessions and 24 687 underwent ultrasound screening. We excluded a further six indivduals due to missing data, leaving 24 681 people in our analysis. Abdominal cystic echinococcosis was detected in 31 of 8602 people screened in Bulgaria, 35 of 7461 screened in Romania, and 53 of 8618 screened in Turkey. The age and sex adjusted prevalence of abdominal cystic echinococcosis was 0·41% (95% CI 0·29-0·58) in Bulgaria, 0·41% (0·26-0·65) in Romania, and 0·59% (0·19-1·85) in Turkey. Active cysts were found in people of all ages, including children, and in all investigated provinces. INTERPRETATION Our results provide population-based estimates of the prevalence of abdominal cystic echinococcosis. These findings should be useful to support the planning of cost-effective interventions, supporting the WHO roadmap for cystic echinococcosis control. FUNDING European Union Seventh Framework Programme.
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Affiliation(s)
- Francesca Tamarozzi
- WHO Collaborating Centre for Clinical Management of Cystic Echinococcosis, University of Pavia, Pavia, Italy; Department of Clinical Surgical Diagnostic and Pediatric Sciences, University of Pavia, Pavia, Italy; Center for Tropical Diseases, Sacro Cuore-Don Calabria Hospital, Negrar, Verona, Italy; WHO Collaborating Centre for the Epidemiology, Detection and Control of Cystic and Alveolar Echinococcosis, Department of Infectious Diseases, Istituto Superiore di Sanità, Rome, Italy
| | - Okan Akhan
- Department of Radiology, Faculty of Medicine, Hacettepe University, Ankara, Turkey
| | - Carmen Michaela Cretu
- Parasitology, Carol Davila University of Medicine and Pharmacy, Colentina Clinical Hospital, Bucharest, Romania
| | - Kamenna Vutova
- Specialized Hospital for Active Treatment of Infectious and Parasitic Diseases Prof Ivan Kirov, Department of Infectious, Parasitic and Tropical Diseases, Sofia, Bulgaria
| | - Devrim Akinci
- Department of Radiology, Faculty of Medicine, Hacettepe University, Ankara, Turkey
| | - Rossitza Chipeva
- Specialized Hospital for Active Treatment of Infectious and Parasitic Diseases Prof Ivan Kirov, Department of Infectious, Parasitic and Tropical Diseases, Sofia, Bulgaria
| | - Turkmen Ciftci
- Department of Radiology, Faculty of Medicine, Hacettepe University, Ankara, Turkey
| | | | - Massimo Fabiani
- Unit of Epidemiology, Biostatistics and Mathematical Modelling, Department of Infectious Diseases, Istituto Superiore di Sanità, Rome, Italy
| | - Branimir Golemanov
- Clinical Centre of Gastroenterology, University Hospital Queen Joanna- Institute for Specialization and Improvement of Medical Doctors, Medical Faculty, Medical University, Sofia, Bulgaria
| | - Denisa Janta
- National Institute of Public Health, Bucharest, Romania
| | - Patricia Mihailescu
- Eco-Para-Diagnostic, Colentina Clinical Hospital, Bucharest, Romania; Colentina Clinical Hospital, Eco-Para-Diagnostic, Bucharest, Romania
| | - Marin Muhtarov
- Multi-Profile Hospital for Active Treatment Kardzhali, Gastroenterology Ward, Kardzhali, Bulgaria
| | - Serra Orsten
- School of Health Services, Hacettepe University, Ankara, Turkey
| | | | - Patrizio Pezzotti
- Unit of Epidemiology, Biostatistics and Mathematical Modelling, Department of Infectious Diseases, Istituto Superiore di Sanità, Rome, Italy
| | - Alexandru Cosmin Popa
- Surgery, Carol Davila University of Medicine and Pharmacy, Colentina Clinical Hospital, Bucharest, Romania
| | - Loredana Gabriela Popa
- Microbiology, Carol Davila University of Medicine and Pharmacy, Colentina Clinical Hospital, Bucharest, Romania
| | - Mircea Ioan Popa
- Microbiology, Carol Davila University of Medicine and Pharmacy, Cantacuzino National Institute for Research, Bucharest, Romania
| | - Valeri Velev
- Specialized Hospital for Active Treatment of Infectious and Parasitic Diseases Prof Ivan Kirov, Department of Infectious, Parasitic and Tropical Diseases, Sofia, Bulgaria
| | - Mar Siles-Lucas
- Parasitology Unit, Instituto de Recursos Naturales y Agrobiología de Salamanca, IRNASA-CSIC, Salamanca, Spain
| | - Enrico Brunetti
- WHO Collaborating Centre for Clinical Management of Cystic Echinococcosis, University of Pavia, Pavia, Italy; Department of Clinical Surgical Diagnostic and Pediatric Sciences, University of Pavia, Pavia, Italy; Division of Tropical and Infectious Diseases, San Matteo Hospital Foundation, Pavia, Italy
| | - 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 Reference Laboratory for Parasites and Unit of Foodborne and Neglected Parasitic Diseases, Department of Infectious Diseases, Istituto Superiore di Sanità, Rome, Italy.
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22
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Díaz Á, Sagasti C, Casaravilla C. Granulomatous responses in larval taeniid infections. Parasite Immunol 2018. [DOI: 10.1111/pim.12523] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/29/2022]
Affiliation(s)
- Á. Díaz
- Área/Cátedra de Inmunología; Departamento de Biociencias (Facultad de Química) e Instituto de Química Biológica (Facultad de Ciencias); Universidad de la República; Montevideo Uruguay
| | - C. Sagasti
- Área/Cátedra de Inmunología; Departamento de Biociencias (Facultad de Química) e Instituto de Química Biológica (Facultad de Ciencias); Universidad de la República; Montevideo Uruguay
| | - C. Casaravilla
- Área/Cátedra de Inmunología; Departamento de Biociencias (Facultad de Química) e Instituto de Química Biológica (Facultad de Ciencias); Universidad de la República; Montevideo Uruguay
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23
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Pang N, Zhang F, Li S, Zhu Y, Zhang C, An M, Wang H, Mamuti W, Ding J, Fan H. TGF-β/Smad signaling pathway positively up-regulates the differentiation of Interleukin-9-producing CD4 + T cells in human Echinococcus granulosus infection. J Infect 2018; 76:406-416. [DOI: 10.1016/j.jinf.2018.01.005] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/30/2017] [Revised: 12/15/2017] [Accepted: 01/07/2018] [Indexed: 12/17/2022]
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24
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Saidi F, Habibzadeh F. The Non-operative Management of Asymptomatic Liver Hydatids: Ending Echinococcophobia. J Gastrointest Surg 2018; 22:486-495. [PMID: 29119531 DOI: 10.1007/s11605-017-3630-8] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/17/2017] [Accepted: 11/01/2017] [Indexed: 01/31/2023]
Abstract
BACKGROUND Cystic echinococcosis is common in many countries and involves the liver in 75% of cases. The current belief is that all incidentally discovered asymptomatic liver hydatids must be subjected to some types of interventional treatments pre-emptively for fear of some presumably impending complications. We conducted this study to assess the prognosis of patients with liver hydatids without any surgical interventions. Furthermore, we tried to predict the outcome of the cyst using two radiological signs. METHODS Of 434 asymptomatic patients with liver cysts who referred to our center, 297 were found eligible to be monitored at 1-3-year intervals by unenhanced computed tomography (CT) over a 20-year period. The patients were given the option of either having their cysts removed by open operation (the surgical group) or entering an open-ended "watch-and-wait" program (the surveillance group). Using unenhanced CT, cyst size, laminated membrane detachment (LMD), and pericyst degenerative changes (PDCs) were evaluated every 1-3 years. If a complication happened or the cyst size increased during the follow-up period, the cyst outcome was considered "unfavorable"; otherwise, it was considered "favorable." RESULTS Forty-three patients with 56 liver cysts were operated upon without morbidity or mortality. One hundred and twenty-seven patients with 137 cysts were followed. After a median follow-up of 6 (IQR 3 to 10) years, 111 (81.0%) had favorable outcome and 26 (19.0%) cysts had an unfavorable outcome. The size of 69 (50.4%) cysts with favorable outcome was not changed. It was decreased by a mean of 35.7% (SD 17.5%) in 34 (24.8%) cysts; 8 (5.8%) cysts disappeared. Of 26 cysts with unfavorable outcome, 8 (5.8%) developed complications (6 fistulas and 2 secondary infections) after a median follow-up of 6.5 (IQR 2.3 to 12.8) years. The size of the remaining 18 cysts increased by a mean of 42.2% (SD 29.5%). Albendazole administered at a dose of 400 mg, po, bid for 3 years, had a significant effect on hydatids. After adjustment for cyst size at diagnosis and patient's age and sex, logistic regression analysis showed that being univesicular (OR 6.00, 95% CI 1.32 to 27.29), having LMD (OR 5.51, 95% CI 1.03 to 29.43), and the presence of PDCs (OR 4.25, 95% CI 1.36 to 13.30) were independent predictors of a favorable outcome for a cyst. CONCLUSIONS More than 80% of asymptomatic liver hydatids have a favorable outcome without pre-emptive surgical interventions. The presence of LMD at any stage and/or PDCs of any grade justifiably exempts asymptomatic univesicular liver hydatids from any treatments. Those without LMD or PDCs can be effectively managed with long-term albendazole, artificially inducing larval involution.
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Affiliation(s)
- Farrokh Saidi
- Shaheed Beheshti University of Medical Sciences, Tehran, Iran
| | - Farrokh Habibzadeh
- Shiraz University of Medical Sciences, Shiraz, Iran. .,R&D Headquarters, Petroleum Industry Health Organization, PO Box 71955-575, Shiraz, Iran.
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25
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Díaz Á. Immunology of cystic echinococcosis (hydatid disease). Br Med Bull 2017; 124:121-133. [PMID: 29253150 DOI: 10.1093/bmb/ldx033] [Citation(s) in RCA: 26] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/18/2017] [Accepted: 09/15/2017] [Indexed: 12/18/2022]
Abstract
BACKGROUND The neglected disease cystic echinococcosis is caused by larval Echinococcus granulosus flatworms, which form bladder-like hydatid cysts in liver, lungs, and other organs. SOURCES OF DATA Published literature. AREAS OF AGREEMENT Establishing larvae are susceptible to antibody-dependent killing, as attested by successful animal vaccination, whereas once established they are partially protected by the so-called laminated layer. Host responses are Th2 dominated, with a Th1 component. Diagnostic antigens from cyst fluid are known, but responses appear absent in one-fifth of patients. AREAS OF CONTROVERSY Is evasion mainly based on induction of Th2 or regulatory responses by the parasite? GROWING POINTS The parasite induces regulatory responses. The laminated layer has immune-regulatory properties. AREAS TIMELY FOR DEVELOPING RESEARCH Develop tools for functional genomics; characterize immunologically interesting proteins suggested by genomic information; analyse infection in broader context of granulomatous responses; identify molecules secreted/excreted by intact larvae/cysts towards their outside, including diffusible immune-regulators.
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Affiliation(s)
- Álvaro Díaz
- Cátedra de Inmunología, Departamento de Biociencias (Facultad de Química) e Instituto de Química Biológica (Facultad de Ciencias), Universidad de la República, Montevideo, Uruguay
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26
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Solomon N, Fields PJ, Tamarozzi F, Brunetti E, Macpherson CNL. Expert Reliability for the World Health Organization Standardized Ultrasound Classification of Cystic Echinococcosis. Am J Trop Med Hyg 2017; 96:686-691. [PMID: 28070008 DOI: 10.4269/ajtmh.16-0659] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/28/2022] Open
Abstract
Cystic echinococcosis (CE), a parasitic zoonosis, results in cyst formation in the viscera. Cyst morphology depends on developmental stage. In 2003, the World Health Organization (WHO) published a standardized ultrasound (US) classification for CE, for use among experts as a standard of comparison. This study examined the reliability of this classification. Eleven international CE and US experts completed an assessment of eight WHO classification images and 88 test images representing cyst stages. Inter- and intraobserver reliability and observer performance were assessed using Fleiss' and Cohen's kappa. Interobserver reliability was moderate for WHO images (κ = 0.600, P < 0.0001) and substantial for test images (κ = 0.644, P < 0.0001), with substantial to almost perfect interobserver reliability for stages with pathognomonic signs (CE1, CE2, and CE3) for WHO (0.618 < κ < 0.904) and test images (0.642 < κ < 0.768). Comparisons of expert performances against the majority classification for each image were significant for WHO (0.413 < κ < 1.000, P < 0.005) and test images (0.718 < κ < 0.905, P < 0.0001); and intraobserver reliability was significant for WHO (0.520 < κ < 1.000, P < 0.005) and test images (0.690 < κ < 0.896, P < 0.0001). Findings demonstrate moderate to substantial interobserver and substantial to almost perfect intraobserver reliability for the WHO classification, with substantial to almost perfect interobserver reliability for pathognomonic stages. This confirms experts' abilities to reliably identify WHO-defined pathognomonic signs of CE, demonstrating that the WHO classification provides a reproducible way of staging CE.
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Affiliation(s)
- Nadia Solomon
- School of Medicine, St. George's University, St. George's, Grenada.,Windward Islands Research and Education Foundation (WINDREF), St. George's, Grenada
| | - Paul J Fields
- Windward Islands Research and Education Foundation (WINDREF), St. George's, Grenada
| | - Francesca Tamarozzi
- WHO Collaborating Centre for Clinical Management of Cystic Echinococcosis, University of Pavia, Pavia, Italy
| | - Enrico Brunetti
- Department of Infectious Diseases, San Matteo Hospital Foundation, Pavia, Italy.,WHO Collaborating Centre for Clinical Management of Cystic Echinococcosis, University of Pavia, Pavia, Italy
| | - Calum N L Macpherson
- School of Veterinary Medicine, St. George's University, St. George's, Grenada.,School of Medicine, St. George's University, St. George's, Grenada.,Windward Islands Research and Education Foundation (WINDREF), St. George's, Grenada
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27
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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: 273] [Impact Index Per Article: 39.0] [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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28
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Tamarozzi F, Mariconti M, Neumayr A, Brunetti E. The intermediate host immune response in cystic echinococcosis. Parasite Immunol 2016; 38:170-81. [DOI: 10.1111/pim.12301] [Citation(s) in RCA: 32] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/29/2015] [Accepted: 12/09/2015] [Indexed: 12/18/2022]
Affiliation(s)
- F. Tamarozzi
- Department of Clinical, Surgical, Diagnostic and Paediatric Sciences; University of Pavia; Pavia Italy
- WHO Collaborating Centre for Clinical Management of Cystic Echinococcosis; Pavia Italy
| | - M. Mariconti
- WHO Collaborating Centre for Clinical Management of Cystic Echinococcosis; Pavia Italy
- Division of Infectious and Tropical Diseases; San Matteo Hospital Foundation; Pavia Italy
| | - A. Neumayr
- Medical Services and Diagnostic; Swiss Tropical and Public Health Institute; Basel Switzerland
- University of Basel; Basel Switzerland
| | - E. Brunetti
- Department of Clinical, Surgical, Diagnostic and Paediatric Sciences; University of Pavia; Pavia Italy
- WHO Collaborating Centre for Clinical Management of Cystic Echinococcosis; Pavia Italy
- Division of Infectious and Tropical Diseases; San Matteo Hospital Foundation; Pavia Italy
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29
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Zhang F, Pang N, Zhu Y, Zhou D, Zhao H, Hu J, Ma X, Li J, Wen H, Samten B, Fan H, Ding J. CCR7(lo)PD-1(hi) CXCR5(+) CD4(+) T cells are positively correlated with levels of IL-21 in active and transitional cystic echinococcosis patients. BMC Infect Dis 2015; 15:457. [PMID: 26503442 PMCID: PMC4624577 DOI: 10.1186/s12879-015-1156-9] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/23/2014] [Accepted: 09/29/2015] [Indexed: 12/28/2022] Open
Abstract
Background In our study, we investigated whether circulating T follicular helper (Tfh) and the related cytokines are involved in human cystic echinococcosis (CE). Methods A total of 64 patients with CE and 30 healthy controls were enrolled in this study. Percentages of CCR7loPD-1hi cells within CXCR5+ CD4+ T cells (circulating Tfh cells) were detected by flow cytometry. Levels of IL-21 and IL-4 in peripheral blood were detected by cytometric bead array. The mRNA expression of IL-21, IL-4, Bcl-6, and Blimp-1 in peripheral blood mononuclear cells (PBMCs) were measured by real-time PCR. Levels of IgG1, IgG2, IgG3, and IgG4 in the patients’ sera were measured using enzyme-linked immunosorbent assay. Results Percentages of circulating Tfh cells were significantly increased in the CE1, CE2, and CE3 groups (p < 0.05). The concentrations of IL-21 and IL-4 in the serum were significantly increased in CE1, CE2, and CE3 groups (p < 0.05). IL-21 was positively correlated with circulating Tfh cells in CE3 group (r = 0.779, p < 0.05). The mRNA levels of IL-21, IL-4, and Bcl-6 were increased in CE1, CE2, and CE3 groups. Levels of IgG1 and IgG4 in patients’ sera were increased in CE1, CE2, and CE3 groups. Levels of IgG2 and IgG3 were increased in CE4-5 group. Additionally, after stimulation with hydatid fluid in vitro, the levels of circulating Tfh cells, IL-21 and IL-4 in PBMCs isolated from CE patients were significantly increased (p < 0.05). Conclusions The levels of circulating Tfh and related cytokines were significantly increased in CE patients, suggesting that they are involved in human CE. Electronic supplementary material The online version of this article (doi:10.1186/s12879-015-1156-9) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- Fengbo Zhang
- Department of Clinical Laboratory, First Affiliated Hospital of Xinjiang Medical University, 393 Xinyi Road, 830011, Urumqi, Xinjiang, China.
| | - Nannan Pang
- Department of Clinical Laboratory, First Affiliated Hospital of Xinjiang Medical University, 393 Xinyi Road, 830011, Urumqi, Xinjiang, China.
| | - Yuejie Zhu
- Department of Clinical Laboratory, First Affiliated Hospital of Xinjiang Medical University, 393 Xinyi Road, 830011, Urumqi, Xinjiang, China.
| | - Dexian Zhou
- Department of Hepatopancreatobiliary Surgery, Affiliated Hospital of Qinghai University, 251 Xining Road, 810000, Xining, Qinghai, China.
| | - Hui Zhao
- Department of Clinical Laboratory, First Affiliated Hospital of Xinjiang Medical University, 393 Xinyi Road, 830011, Urumqi, Xinjiang, China.
| | - Jinwei Hu
- Department of Clinical Laboratory, First Affiliated Hospital of Xinjiang Medical University, 393 Xinyi Road, 830011, Urumqi, Xinjiang, China.
| | - Xiumin Ma
- Department of Clinical Laboratory, First Affiliated Hospital of Xinjiang Medical University, 393 Xinyi Road, 830011, Urumqi, Xinjiang, China.
| | - Jun Li
- Department of Clinical Laboratory, First Affiliated Hospital of Xinjiang Medical University, 393 Xinyi Road, 830011, Urumqi, Xinjiang, China.
| | - Hao Wen
- Department of Clinical Laboratory, First Affiliated Hospital of Xinjiang Medical University, 393 Xinyi Road, 830011, Urumqi, Xinjiang, China.
| | - Buka Samten
- Department of Pulmonary Immunology, University of Texas Health Science Center at Tyler, Texas, 75708, USA.
| | - Haining Fan
- Department of Hepatopancreatobiliary Surgery, Affiliated Hospital of Qinghai University, 251 Xining Road, 810000, Xining, Qinghai, China.
| | - Jianbing Ding
- Department of Clinical Laboratory, First Affiliated Hospital of Xinjiang Medical University, 393 Xinyi Road, 830011, Urumqi, Xinjiang, China. .,Department of Immunology, School of Preclinical Medicine of Xinjiang Medical University, 393 Xinyi Road, 830011, Urumqi, Xinjiang, China.
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30
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Rogan MT, Bodell AJ, Craig PS. Post-encystment/established immunity in cystic echinococcosis: is it really that simple? Parasite Immunol 2014; 37:1-9. [DOI: 10.1111/pim.12149] [Citation(s) in RCA: 28] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/18/2014] [Accepted: 09/29/2014] [Indexed: 11/30/2022]
Affiliation(s)
- M. T. Rogan
- Cestode Zoonoses Research Group; School of Environment and Life Sciences; University of Salford; Salford M54WT UK
| | - A. J. Bodell
- Cestode Zoonoses Research Group; School of Environment and Life Sciences; University of Salford; Salford M54WT UK
| | - P. S. Craig
- Cestode Zoonoses Research Group; School of Environment and Life Sciences; University of Salford; Salford M54WT UK
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31
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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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Mohamed RM, Abdel-Hafeez EH, Belal US, Norose K, Aosai F. Human Cystic Echinococcosis in the Nalut District of Western Libya: A Clinico-epidemiological Study. Trop Med Health 2014; 42:177-84. [PMID: 25589882 PMCID: PMC4287493 DOI: 10.2149/tmh.2014-16] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/19/2014] [Accepted: 09/07/2014] [Indexed: 12/28/2022] Open
Abstract
Human cystic echinococcosis (CE) is an endemic disease in the Mediterranean area that has not yet been fully documented in western Libya. The present study describes the clinico-epidemiologic profile of CE in western Libya’s Nalut district. From April 2008 to July 2011, 36 cases of CE were confirmed following surgical removal of cysts. The cysts were most frequently found in the liver (61.1%), followed by the lungs (19.4%), kidneys (11.1%), peritoneal cavity (11.1%), and spleen (5.6%). Among the 36 patients, 6 possessed plural cysts and 3 had cysts in 2 organs. Blood samples from this group were examined for the presence of serum anti-hydatid IgG antibodies, which revealed positivity in 25 patients (69.4%). An additional 300 blood samples were collected randomly from the inpatient and outpatient clinics at Nalut Hospital. Twenty-seven samples (9%) were found to be positive for the anti-hydatid IgG antibody among which the prevalence of infection tended to be higher in men (12%) than in women (6%). This study demonstrates that CE is a major parasitic infectious disease of public health significance in Libya, notably in the western part of the country, and that disease awareness needs to be raised nationwide.
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Affiliation(s)
- Rabie M Mohamed
- Department of Parasitology, Faculty of Medicine, Minia University , Minia, 61519, Egypt
| | - Ekhlas H Abdel-Hafeez
- Department of Parasitology, Faculty of Medicine, Minia University , Minia, 61519, Egypt
| | - Usama S Belal
- Department of Parasitology, Faculty of Medicine, Minia University , Minia, 61519, Egypt
| | - Kazumi Norose
- Department of Infection and Host Defense, Graduate School of Medicine, Chiba University , 1-8-1 Inohana Chuo-ku, Chiba 260-8670, Japan
| | - Fumie Aosai
- Department of Infection and Host Defense, Graduate School of Medicine, Shinshu University , 3-1-1 Asahi, Matsumoto 390-8621, Japan
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Piccoli L, Tamarozzi F, Cattaneo F, Mariconti M, Filice C, Bruno A, Brunetti E. Long-term sonographic and serological follow-up of inactive echinococcal cysts of the liver: hints for a "watch-and-wait" approach. PLoS Negl Trop Dis 2014; 8:e3057. [PMID: 25122222 PMCID: PMC4133254 DOI: 10.1371/journal.pntd.0003057] [Citation(s) in RCA: 54] [Impact Index Per Article: 5.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/11/2013] [Accepted: 06/18/2014] [Indexed: 12/28/2022] Open
Abstract
Human cystic echinococcosis is a chronic, complex and neglected infection. Its clinical management has evolved over decades without adequate evaluation of efficacy. Recent expert opinion recommends that uncomplicated inactive cysts of the liver should be left untreated and solely monitored over time ("watch-and-wait" approach). However, clinical data supporting this approach are still scant and published mostly as conference proceedings. In this study, we report our experience with long-term sonographic and serological follow-up of inactive cysts of the liver. From March 1994 to October 2013, 38 patients with 47 liver cysts, diagnosed as inactive without any previous treatment history, were followed with ultrasound and serology at 6-12 months intervals for a period of at least 24 months (median follow-up 51.95 months) in our outpatient clinic. In 97.4% of patients, the cysts remained inactive over time and in only one case was reactivation of the cyst detected. No complications occurred during the time of monitoring. During follow-up, serology tests for CE were negative at diagnosis or became negative in 74.1% and were positive or became positive in 25.9% of cases. Patients with inactive cysts on ultrasound but positive serological tests were also investigated by CT scan (chest and abdomen) to rule out extra-hepatic cyst localization. This study confirms the importance of a stage-specific approach to the management of cystic echinococcosis and supports the use of a monitoring-only approach to inactive, uncomplicated cysts of the liver. It also confirms that serology plays only an ancillary role in the clinical management of these patients, compared to ultrasound and other imaging techniques. The implications of these findings for clinical management and natural history of cystic echinococcosis are discussed.
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Affiliation(s)
- Luca Piccoli
- Department of Infectious Diseases, IRCCS San Matteo Hospital Foundation, Pavia, Italy
- WHO Collaborating Centre for Clinical Management of Cystic Echinococcosis, Pavia, Italy
| | - Francesca Tamarozzi
- WHO Collaborating Centre for Clinical Management of Cystic Echinococcosis, Pavia, Italy
- Department of Clinical, Surgical, Diagnostic and Pediatric Sciences, University of Pavia, Pavia, Italy
- * E-mail:
| | - Federico Cattaneo
- Department of Infectious Diseases, IRCCS San Matteo Hospital Foundation, Pavia, Italy
| | - Mara Mariconti
- Department of Infectious Diseases, IRCCS San Matteo Hospital Foundation, Pavia, Italy
- WHO Collaborating Centre for Clinical Management of Cystic Echinococcosis, Pavia, Italy
| | - Carlo Filice
- Department of Infectious Diseases, IRCCS San Matteo Hospital Foundation, Pavia, Italy
- WHO Collaborating Centre for Clinical Management of Cystic Echinococcosis, Pavia, Italy
- Department of Clinical, Surgical, Diagnostic and Pediatric Sciences, University of Pavia, Pavia, Italy
| | - Antonella Bruno
- Laboratory of Parasitology, IRCCS San Matteo Hospital Foundation, Pavia, Italy
| | - Enrico Brunetti
- Department of Infectious Diseases, IRCCS San Matteo Hospital Foundation, Pavia, Italy
- WHO Collaborating Centre for Clinical Management of Cystic Echinococcosis, Pavia, Italy
- Department of Clinical, Surgical, Diagnostic and Pediatric Sciences, University of Pavia, Pavia, Italy
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Fallah M, Kavand A, Yousefi Mashouf R. Infected hydatid cysts bacteria in slaughtered livestock and their effects on protoscoleces degeneration. Jundishapur J Microbiol 2014; 7:e10135. [PMID: 25371792 PMCID: PMC4217659 DOI: 10.5812/jjm.10135] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/20/2013] [Revised: 02/20/2013] [Accepted: 04/25/2013] [Indexed: 11/16/2022] Open
Abstract
Background: The protoscoleces of fertile hydatid cysts are considered as major risks in surgery and producing secondary cysts if rupture the cyst during operation and, cause infecting the dogs with adult worm if eaten by this animal. Bacterial infection of the hydatid fluid can lead to sterilization of the cyst. Objectives: The aim of this study was to determine the bacterial infection rate of livestock hydatid cysts in Hamedan, Iran, and test the isolated bacteria effects on viable protoscoleces, in vitro. Materials and Methods: A total of 5709 slaughtered livestock were inspected to detect the presence of hydatid cysts. The hydatid fluid of all cysts was cultured separately to isolate and identify the bacteria. The effect of isolated bacteria was tested on viable protoscoleces in culture tubes, in vitro. The culture tubes were observed and examined under a light microscope every two hours for 24 hours, and then, after 36 and 48 hours. Results: Infected cysts were found in 74% of animals in Hamedan (46% were calcified and the bacteria was isolated from 52%) and 62% in Borujerd. The isolated bacteria in the infected cysts were as follows: Escherichia coli, E. blattae, Klebsiella pnoumoniae, Proteus mirabilis, Enterobacter aerogenes, coagulase-positive and coagulase-negative Staphylococci, Pseudomonas aeruginosa and Edwardsiella tarda. The protoscoleces incubated with the isolated bacteria totally degenerated, but 55% of the protoscoleces in the control groups were intact and viable even after one week. Conclusions: This study indicated a high percentage of cysts bacterial infections in two provinces of Iran. The common isolated bacteria were E. coli and Klebsiella. The isolated bacteria degenerated the protoscoleces during short-time incubation, in vitro.
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Affiliation(s)
- Mohammad Fallah
- Department of Parasitology and Mycology, Hamedan University of Medical Sciences, Hamedan, IR Iran
- Corresponding author: Mohammad Fallah, Department of Parasitology and Mycology, Hamedan University of Medical Sciences, Hamedan, IR Iran. Tel: +98-8112528058; +98-9181113650, Fax: +98-8112520203, E-mail:
| | - Abdollah Kavand
- Kowsar Hospital, Social Security Organization, Borujerd, IR Iran
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Rinaldi F, Brunetti E, Neumayr A, Maestri M, Goblirsch S, Tamarozzi F. Cystic echinococcosis of the liver: A primer for hepatologists. World J Hepatol 2014; 6:293-305. [PMID: 24868323 PMCID: PMC4033287 DOI: 10.4254/wjh.v6.i5.293] [Citation(s) in RCA: 57] [Impact Index Per Article: 5.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/12/2013] [Revised: 01/22/2014] [Accepted: 03/18/2014] [Indexed: 02/06/2023] Open
Abstract
Cystic echinococcosis (CE) is a complex, chronic and neglected disease with a worldwide distribution. The liver is the most frequent location of parasitic cysts. In humans, its clinical spectrum ranges from asymptomatic infection to severe, potentially fatal disease. Four approaches exist in the clinical management of CE: surgery, percutaneous techniques and drug treatment for active cysts, and the ”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. This paper reviews recent advances in classification and diagnosis and the currently available evidence for clinical decision-making in cystic echinococcosis of the liver.
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Th9/IL-9 profile in human echinococcosis: their involvement in immune response during infection by Echinococcus granulosus. Mediators Inflamm 2014; 2014:781649. [PMID: 24799769 PMCID: PMC3985320 DOI: 10.1155/2014/781649] [Citation(s) in RCA: 31] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/17/2013] [Revised: 02/21/2014] [Accepted: 02/21/2014] [Indexed: 12/28/2022] Open
Abstract
Th9 cells have been reported to contribute to immune responses; however, the role of Th9 cells in Echinococcus granulosus infection is unknown. This study is to determine whether Th9 cells and IL-9 are involved in human Echinococcus granulosus infection. Compared with healthy controls (HC group), the mRNA levels of PU.1, IL-9, and GATA-3 were significantly increased in patients before therapy (CE group), as revealed by qRT-PCR. Flow cytometry analysis showed that the percentages of Th9 and Th2 cells in CE group were significantly higher. The levels of IL-9, IL-4, IL-10, and TGF-β in CE group were also significantly increased, as detected by CBA assay. The percentages of Th9 and Th2 cells in CE group were positively correlated. After treatments of surgery in combination with albendazole, the PU.1 and GATA-3 mRNA levels were significantly decreased in patients after therapy (PCE group) compared with CE group. The numbers of Th9 and Th2 cells and levels of IL-9, IL-4, IL-10, and TGF-β were also significantly decreased in PCE group. In conclusion, the ratios of Th9 cells and IL-9 levels were significantly decreased after treatment, suggesting that Th9/IL-9 may be involved in immune response induced by Echinococcus granulosus infection.
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Mandal S, Mandal MD. Human cystic echinococcosis: epidemiologic, zoonotic, clinical, diagnostic and therapeutic aspects. ASIAN PAC J TROP MED 2012; 5:253-60. [PMID: 22449514 DOI: 10.1016/s1995-7645(12)60035-2] [Citation(s) in RCA: 104] [Impact Index Per Article: 8.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/20/2011] [Revised: 01/15/2012] [Accepted: 03/15/2012] [Indexed: 12/13/2022] Open
Abstract
This review represents an updated scenario on the transmission cycle, epidemiology, clinical features and pathogenicity, diagnosis and treatment, and prevention and control measures of a cestode parasite Echincoccus granulosus (E. granulosus) infection causing cystic echinococcosis (CE) in humans. Human CE is a serious life-threatening neglected zoonotic disease that occurs in both developing and developed countries, and is recognized as a major public health problem. The life cycle of E. granulosus involves a definitive host (dogs and other canids) for the adult E. granulosus that resides in the intestine, and an intermediate host (sheep and other herbivores) for the tissue-invading metacestode (larval) stage. Humans are only incidentally infected; since the completion of the life cycle of E. granulosus depends on carnivores feeding on herbivores bearing hydatid cysts with viable protoscoleces, humans represent usually the dead end for the parasite. On ingestion of E. granulosus eggs, hydatid cysts are formed mostly in liver and lungs, and occasionally in other organs of human body, which are considered as uncommon sites of localization of hydatid cysts. The diagnosis of extrahepatic echinococcal disease is more accurate today because of the availability of new imaging techniques, and the current treatments include surgery and percutaneous drainage, and chemotherapy (albendazole and mebendazole). But, the wild animals that involve in sylvatic cycle may overlap and interact with the domestic sheep-dog cycle, and thus complicating the control efforts. The updated facts and phenomena regarding human and animal CE presented herein are due to the web search of SCI and non-SCI journals.
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Affiliation(s)
- Shyamapada Mandal
- Department of Zoology, Gurudas College, Narkeldanga, Kolkata-700 054, India.
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Comparative performances of flubendazole and albendazole in cystic echinococcosis: ex vivo activity, plasma/cyst disposition, and efficacy in infected mice. Antimicrob Agents Chemother 2011; 55:5861-7. [PMID: 21930885 DOI: 10.1128/aac.05105-11] [Citation(s) in RCA: 43] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
The need to identify improved therapy against cystic echinococcosis (CE) has motivated pharmacology-based research. The comparative pharmacological performances of the benzimidazole compounds flubendazole (FLBZ) and albendazole (ABZ) were addressed here. The goals of the work were as follows: (i) to evaluate the ex vivo activities of FLBZ, ABZ, and their respective metabolites against Echinococcus granulosus protoscoleces, (ii) to compare the plasma and cyst disposition kinetics for the two drugs in infected mice, and (iii) to compare the clinical efficacies of FLBZ and ABZ against CE in mice. For the ex vivo study, E. granulosus protoscoleces were incubated with FLBZ, reduced FLBZ (R-FLBZ), ABZ, and ABZ-sulfoxide (ABZSO) (10 nmol/ml). Protoscolex viability was monitored by the methylene blue exclusion test and scanning electron microscopy (SEM). For the pharmacokinetic study, BALB/c mice with CE were allocated to two different groups and orally treated with either FLBZ or ABZ (5 mg/kg of body weight), both formulated as a cyclodextrin-based solution. Blood and cyst samples were taken up to 12 h posttreatment and analyzed by high-performance liquid chromatography (HPLC). For the efficacy study, CE-infected BALB/c mice were divided into three groups: the unmedicated control group and the FLBZ- and ABZ-treated groups. Oral treatments were performed twice a day during 25 days. After treatment, all animals were killed and the weight of the cysts was recorded. Loss of protoscolex viability was observed after drug incubation. FLBZ was detected in plasma (area under the concentration-versus-time curve [AUC] = 1.8 μg · h/ml) and cysts (AUC = 0.3 μg · h/g) collected from treated infected animals. Conversely, ABZSO was the only active molecule measured in plasma (AUC = 4.4 μg·h/ml) and cysts (AUC = 1.5 μg·h/g) after ABZ treatment. FLBZ induced a 90% reduction in cyst weight in comparison to those collected from untreated control mice (P < 0.05). However, no differences in cyst weight were observed between the ABZ-treated (8.2 g) and unmedicated control (10.5 g) groups. Due to these results, we consider flubendazole to have great potential to become a drug of choice in the treatment of cystic echinococcosis.
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Vacirca D, Perdicchio M, Campisi E, Delunardo F, Ortona E, Margutti P, Teggi A, Gottstein B, Siracusano A. Favourable prognostic value of antibodies anti-HSP20 in patients with cystic echinococcosis: a differential immunoproteomic approach. Parasite Immunol 2011; 33:193-8. [PMID: 21306401 DOI: 10.1111/j.1365-3024.2010.01264.x] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
Abstract
Seeking biomarkers reflecting disease development in cystic echinococcosis (CE), we used a proteomic approach linked to immunological characterisation for the identification of respective antigens. Two-dimensional gel electrophoresis (2-DE) of sheep hydatid fluid, followed by immunoblot analysis (IB) with sera from patients with distinct phases of disease, enabled us to identify by mass spectrometry heat shock protein 20 (HSP20) as a potential marker of active CE. Using IB, antibodies specific to the 34 kDa band of HSP20 were detected in sera from 61/95 (64%) patients with CE, but not in sera from healthy subjects. IB revealed anti-HSP20 antibodies in a higher percentage of sera from patients with active disease than in sera from patients with inactive disease (81 vs. 24%; P = 10(-4)). These primary results were confirmed in a long-term follow-up study after pharmacological and surgical treatment. Herewith anti-HSP20 antibody levels significantly decreased over the course of treatment in sera from patients with cured disease, relative to sera from patients with progressive disease (P = 0·017). Thus, during CE, a comprehensive strategy of proteomic identification combined with immunological validation represents a promising approach for the identification of biomarkers useful for the prognostic assessment of treatment of CE patients.
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Affiliation(s)
- D Vacirca
- Department of Cell Biology and Neurosciences, Istituto Superiore di Sanità, Rome, Italy
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Barnes T, Hinds L, Jenkins D, Bielefeldt-Ohmann H, Lightowlers M, Coleman G. Comparative Pathology of Pulmonary Hydatid Cysts in Macropods and Sheep. J Comp Pathol 2011; 144:113-22. [DOI: 10.1016/j.jcpa.2010.07.003] [Citation(s) in RCA: 26] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/14/2010] [Revised: 05/17/2010] [Accepted: 07/22/2010] [Indexed: 01/01/2023]
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Abstract
Liver hydatidosis is the most common clinical presentation of cystic echinococcosis (CE). Ultrasonographic mass surveys have demonstrated the true prevalence, including the asymptomatic characteristic of the majority of cases, providing new insight into the natural history of the disease. This raises the question of whether to treat or not to treat these patients, due to the high and unsuspected prevalence of CE. The high rate of liver/lung frequencies of cyst localization, the autopsy findings, and the involution of cysts demonstrated in long time follow-up of asymptomatic carriers contribute to this discussion. The decision to treat an asymptomatic patient by surgery, albendazole, or puncture aspiration injection and reaspiration or to wait and watch, is based on conflicting reports in the literature, the lack of complications in untreated patients over time, and the spontaneous disappearance and involution of cysts. All these points contribute to difficulties of individual clinical decisions. The patients should be informed of the reasons and the risks of watchful/waiting without treatment, the possibility of complications, and the risks of the other options. As more information on the natural history of liver hydatidosis is acquired, selection of the best treatment will be come easier. Without this knowledge it would be very difficult to establish definitive rules of treatment. At present, it is possible to manage these patients over time and to wait for the best moment for treatment. Follow-up studies must be conducted to achieve this objective.
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Arandes AS, Bertomeu FG, Artero JM. Microscopic Image of the Protoscolex of Echinococcus granulosus on the “Hydatid Sand”. Am J Trop Med Hyg 2010; 82:980. [PMID: 20519587 PMCID: PMC2877436 DOI: 10.4269/ajtmh.2010.09-0743] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Affiliation(s)
- Antonio Soriano Arandes
- *Address correspondence to Antonio Soriano Arandes, Department of Pediatrics, University Hospital Joan XXIII, Tarragona, Spain. E-mail:
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Brunetti E, Kern P, Vuitton DA. Expert consensus for the diagnosis and treatment of cystic and alveolar echinococcosis in humans. Acta Trop 2010; 114:1-16. [PMID: 19931502 DOI: 10.1016/j.actatropica.2009.11.001] [Citation(s) in RCA: 1197] [Impact Index Per Article: 85.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/23/2009] [Revised: 11/02/2009] [Accepted: 11/04/2009] [Indexed: 12/13/2022]
Abstract
The earlier recommendations of the WHO-Informal Working Group on Echinococcosis (WHO-IWGE) for the treatment of human echinococcosis have had considerable impact in different settings worldwide, but the last major revision was published more than 10 years ago. Advances in classification and treatment of echinococcosis prompted experts from different continents to review the current literature, discuss recent achievements and provide a consensus on diagnosis, treatment and follow-up. Among the recognized species, two are of medical importance -Echinococcus granulosus and Echinococcus multilocularis - causing cystic echinococcosis (CE) and alveolar echinococcosis (AE), respectively. For CE, consensus has been obtained on an image-based, stage-specific approach, which is helpful for choosing one of the following options: (1) percutaneous treatment, (2) surgery, (3) anti-infective drug treatment or (4) watch and wait. Clinical decision-making depends also on setting-specific aspects. The usage of an imaging-based classification system is highly recommended. For AE, early diagnosis and radical (tumour-like) surgery followed by anti-infective prophylaxis with albendazole remains one of the key elements. However, most patients with AE are diagnosed at a later stage, when radical surgery (distance of larval to liver tissue of >2cm) cannot be achieved. The backbone of AE treatment remains the continuous medical treatment with albendazole, and if necessary, individualized interventional measures. With this approach, the prognosis can be improved for the majority of patients with AE. The consensus of experts under the aegis of the WHO-IWGE will help promote studies that provide missing evidence to be included in the next update.
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Affiliation(s)
- Enrico Brunetti
- Division of Infectious and Tropical Diseases, University of Pavia, IRCCS S.Matteo Hospital Foundation, WHO Collaborating Center for Clinical Management of Cystic Echinococcosis, 27100 Pavia, Italy.
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Identification of a novel 19 kDa Echinococcus granulosus antigen. Acta Trop 2010; 113:42-7. [PMID: 19769934 DOI: 10.1016/j.actatropica.2009.09.003] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/19/2008] [Revised: 09/07/2009] [Accepted: 09/10/2009] [Indexed: 11/20/2022]
Abstract
By screening an Echinococcus granulosus cDNA library with IgG4 from patients with active cystic echinococcosis (CE), we identified a cDNA encoding a protein of 19.0 kDa (Eg19). Eg19, in 12% SDS-PAGE in reducing and non-reducing conditions, showed several bands between 19 and 100 kDa. Immunoblotting (IB) analysis detected total IgG, IgG1 and IgG4 specific to the 38/40 kDa band of Eg19 in the 10% of patients' sera. The percentage of total IgG, IgG1 and IgG4-positive sera were significantly higher in sera from patients with active disease and cyst in multiple sites than from patients with inactive disease and cyst in the liver (P<10(-4)). ELISA analysis disclosed that during the follow-up anti-Eg19 antibody concentration decreased over the course of treatment in sera from patients with cured disease. Even if Eg19 appear to have no benefit in the diagnosis of the disease, our data, confirming the presence of antigens inducing both IgG1 and IgG4 during active development of CE, suggest that Eg19 might be a marker of disease status.
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Treatment response of cystic echinococcosis to benzimidazoles: a systematic review. PLoS Negl Trop Dis 2009; 3:e524. [PMID: 19787039 PMCID: PMC2745697 DOI: 10.1371/journal.pntd.0000524] [Citation(s) in RCA: 142] [Impact Index Per Article: 9.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/24/2009] [Accepted: 09/01/2009] [Indexed: 12/14/2022] Open
Abstract
Over the past 30 years, benzimidazoles have increasingly been used to treat cystic echinococcosis (CE). The efficacy of benzimidazoles, however, remains unclear. We systematically searched MEDLINE, EMBASE, SIGLE, and CCTR to identify studies on benzimidazole treatment outcome. A large heterogeneity of methods in 23 reports precluded a meta-analysis of published results. Specialist centres were contacted to provide individual patient data. We conducted survival analyses for cyst response defined as inactive (CE4 or CE5 by the ultrasound-based World Health Organisation [WHO] classification scheme) or as disappeared. We collected data from 711 treated patients with 1,308 cysts from six centres (five countries). Analysis was restricted to 1,159 liver and peritoneal cysts. Overall, 1–2 y after initiation of benzimidazole treatment 50%–75% of active C1 cysts were classified as inactive/disappeared compared to 30%–55% of CE2 and CE3 cysts. Further in analyzing the rate of inactivation/disappearance with regard to cyst size, 50%–60% of cysts <6 cm responded to treatment after 1–2 y compared to 25%–50% of cysts >6 cm. However, 25% of cysts reverted to active status within 1.5 to 2 y after having initially responded and multiple relapses were observed; after the second and third treatment 60% of cysts relapsed within 2 y. We estimated that 2 y after treatment initiation 40% of cysts are still active or become active again. The overall efficacy of benzimidazoles has been overstated in the past. There is an urgent need for a pragmatic randomised controlled trial that compares standardized benzimidazole therapy on responsive cyst stages with the other treatment modalities. Cystic echinococcosis (CE) is a parasitic infection of worldwide occurrence transmitted to humans by dogs. After infection cysts develop, mainly in the liver and lung. Ultrasound-based staging of cysts into active, transitional, and inactive has opened new venues for treatment and follow-up. Currently four treatment modalities are in use: (1) surgery, (2) percutaneous sterilization techniques, (3) chemotherapy with benzimidazoles, and (4) watch and wait for inactive cysts. However, evidence is insufficient for these four modalities, and determining individual treatment options for patients remains controversial. Medical treatment with benzimidazoles started in the 1970s. Important questions remain unanswered, however, such as efficacy stratified by cyst type and the duration of treatment. We therefore initiated EchinoMEDREV, a collaborative effort to collect individual patient data from patients treated with benzimidazoles and to analyze cyst outcome after initiation of benzimidazole therapy using a common analytical strategy across treatment centres. We found that the efficacy of benzimidazoles has been overstated in the past. Additionally, natural cyst decay has not been taken into account. Evidence from randomized controlled trials is urgently needed to determine the true efficacy of benzimidazoles. Our analysis will help to design benzimidazole trial arms on the basis of the currently available best evidence.
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Akyildiz HY, Akcan A, Karahan I, Kucuk C, Sözüer E, Esin H. Recurrent liver hydatid disease: when does it become symptomatic and how does one diagnose it? Clin Imaging 2009; 33:55-8. [PMID: 19135931 DOI: 10.1016/j.clinimag.2008.05.003] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/01/2008] [Accepted: 05/10/2008] [Indexed: 10/21/2022]
Abstract
BACKGROUND Echinococcosis is a zoonotic disease that mainly occurs in sheep-grazing areas. Recurrence of the disease and its diagnosis are relatively new areas of investigation due to the limited number of cases. The aim of this study was to evaluate the diagnosis of the symptomatic recurrent liver hydatid disease and the efficacy of abdominal ultrasonography (US). MATERIALS AND METHODS Between 1988 and 2006, 412 patients with hydatid cyst of the liver were operated at Erciyes University Medical Faculty. We have considered a growing cyst at the original operative site or at the neighboring hepatic tissue as recurrence and investigated 38 of them for the recurrence of the disease (9.2%). RESULTS The recurrence usually occurred after 2 years. The majority of the cases were Types 2 and 3 (24 cases; 8 were Type 4 and 6 were Type 1) according to Gharbi classification. In 35 patients with recurrent disease approved after surgical exploration, US was successful in preoperative diagnosis (100%). Overall, the recurrence was demonstrated correctly by means of US in 35 patients (92.1%), and 23 of 26 patients (88.4%) were correctly diagnosed with the use of computed tomography. In our study, in the first 2 years after the operation, the success rate of US examination was 72.7%. The success rate of US rose up to 100% when the frequency of recurrence is highest. CONCLUSION Beyond 2 years after surgery, US examination alone might be enough for the diagnosis of symptomatic recurrent liver hydatid disease in patients with the suspicion of recurrence. Postoperative early US profile and annual US examination must be performed for at least 5 years to prevent misinterpretation in doubtful cases.
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Affiliation(s)
- Hiizir Yakup Akyildiz
- Department of General Surgery, Erciyes University School of Medicine, Kayseri, Turkey.
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Logar J, Soba B, Kotar T. Serological evidence for human cystic echinococcosis in Slovenia. BMC Infect Dis 2008; 8:63. [PMID: 18471283 PMCID: PMC2412869 DOI: 10.1186/1471-2334-8-63] [Citation(s) in RCA: 14] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/04/2007] [Accepted: 05/09/2008] [Indexed: 11/16/2022] Open
Abstract
Background Cystic echinococcosis (CE) is caused by the larva of tapeworm Echinococcus granulosus. Dogs and other canids are the primary definitive hosts for this parasite. CE may develop after accidental ingestion of tapeworm eggs, excreted with the feces of these animals. In the intestine, the larvae released from the eggs are nested in the liver, lungs or other organs of livestock as intermediate hosts and humans as aberrant hosts. The aim of this study was to examine serologically whether some of the patients in Slovenia, suspected of CE by imaging findings in the liver or lungs had been infected with the larva of Echinococcus granulosus. Methods Between January 1, 2002 and the end of December 2006, 1323 patients suspected of having echinococcosis were screened serologically by indirect haemagglutination assay (IHA). For confirmation and differentiation of Echinococcus spp. infection, the sera of IHA-positive patients were then retested by western blot (WB). Results Out of 127 IHA-positive sera, 34 sera were confirmed by WB and considered specific for CE. Of 34 sera of CE-positive patients sera, 32 corresponded to the characteristic imaging findings of a liver cysts and 2 to those of lung cysts. The mean age of CE-positive patients was 58.3 years. No significant differences were found between the CE-positive patients in regard to their sex. Conclusion In the study, it was found out that CE was mostly spread in the same area of Slovenia as in the past, but its prevalence decreased from 4.8 per 105 inhabitants in the period 1956–1968 to 1.7 per 105 inhabitants in the period 2002–2006. In spite of the decreased prevalence of CE in the last years, it is suggested that clinicians and public health authorities, especially in the eastern parts of Slovenia where the most CE patients come from, should pay greater attention to this disease in the future.
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Affiliation(s)
- Jernej Logar
- Department of Parasitology, Institute of Microbiology and Immunology, Medical Faculty, University of Ljubljana, Ljubljana, Slovenia.
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Yang YR, Craig PS, Sun T, Vuitton DA, Giraudoux P, Jones MK, Williams GM, McManus DP. Echinococcosis in Ningxia Hui Autonomous Region, northwest China. Trans R Soc Trop Med Hyg 2008; 102:319-28. [DOI: 10.1016/j.trstmh.2008.01.007] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/05/2007] [Revised: 01/17/2008] [Accepted: 01/17/2008] [Indexed: 11/25/2022] Open
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Siracusano A, Riganò R, Ortona E, Profumo E, Margutti P, Buttari B, Delunardo F, Teggi A. Immunomodulatory mechanisms during Echinococcus granulosus infection. Exp Parasitol 2008; 119:483-489. [PMID: 18329023 DOI: 10.1016/j.exppara.2008.01.016] [Citation(s) in RCA: 57] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/14/2007] [Revised: 01/22/2008] [Accepted: 01/28/2008] [Indexed: 12/15/2022]
Abstract
The pathologic events that ensue after humans ingest the eggs of Echinococcus granulosus and continue while cystic echinococcosis develops, provide an excellent example illustrating the evasive strategies helminth parasites use to develop, progress and cause chronic disease. The hydatid cyst secretes and exposes numerous immunomodulatory molecules to the host's immune system. By characterizing these molecules we can understand the mechanisms that E. granulosus uses for increasing the efficiency and persistency of infection in the host. These molecules modulate both the innate and adaptive arms of the immune response and appear to target cellular and humoral responses. In this review, we discuss recent advances in the immunobiology of host-E. granulosus interactions that provide intriguing insights into the complex interplay between host and parasite that ultimately facilitates parasite survival.
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Affiliation(s)
- Alessandra Siracusano
- Dipartimento di Malattie Infettive, Parassitarie ed Immunomediate, Istituto Superiore di Sanità, Viale Regina Elena 299, 00161 Roma, Italy.
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Margutti P, Ortona E, Delunardo F, Tagliani A, Profumo E, Riganò R, Buttari B, Teggi A, Siracusano A. Thioredoxin peroxidase from Echinococcus granulosus: a candidate to extend the antigenic panel for the immunodiagnosis of human cystic echinococcosis. Diagn Microbiol Infect Dis 2007; 60:279-85. [PMID: 18060722 DOI: 10.1016/j.diagmicrobio.2007.10.004] [Citation(s) in RCA: 22] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/25/2007] [Revised: 10/01/2007] [Accepted: 10/10/2007] [Indexed: 11/28/2022]
Abstract
The currently available tests for the diagnosis of cystic echinococcosis (CE), enzyme-linked immunosorbent assay (ELISA), and immunoblotting (IB) lack sensitivity and specificity, and antigen panels need standardizing. By screening an Echinococcus granulosus cDNA library with IgG1 from patients with CE, we identified E. granulosus thioredoxin peroxidase (EgTPx). Although IB and ELISA achieved the same specificity (92%), ELISA showed higher sensitivity than IB (83% versus 42%) in determining total immunoglobulin G (IgG) specific to EgTPx in CE sera. The percentage of total IgG- and IgG1-positive sera in ELISA was equally distributed in patients with active, transitional, and inactive disease. Conversely, the percentages of IgG4-positive sera were significantly higher in sera from patients with active than inactive disease (P = 0.03). Our data suggest that adding this highly specific recombinant antigen to the standard diagnostic panel of antigens used in ELISA would increase diagnostic sensitivity. Antibodies specific to EgTPx are of potential interest in the host-parasite relationship.
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Affiliation(s)
- Paola Margutti
- Department of Infectious, Parasitic and Immune-mediated Diseases, Istituto Superiore di Sanità, 00161 Rome, Italy
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