Prevention and control of cystic echinococcosis

Prevalence and geographic distribution of Echinococcus genus in wild canids in southern Québec, Canada

Echinococcus spp. is an emerging zoonotic parasite of high concern. In Canada, an increase in the number of human and animal cases diagnosed has been reported, but information regarding the parasite's distribution in wildlife reservoir remains limited. A cross-sectional study was conducted to estimate the prevalence of wild canids infected with Echinococcus spp. and Echinococcus multilocularis in areas surrounding populated zones in Québec (Canada); to investigate the presence of areas at higher risk of infection; to evaluate potential risk factors of the infection; and as a secondary objective, to compare coproscopy and RT-PCR diagnostic tests for Taenia spp. and Echinococcus identification. From October 2020 to March 2021, fecal samples were collected from 423 coyotes (Canis latrans) and 284 red foxes (Vulpes vulpes) trapped in 12 administrative regions. Real-time PCR for molecular detection of genus Echinococcus spp. and species-specific Echinococcus multilocularis were performed. A total of 38 positive cases of Echinococcus spp., of which 25 were identified as E. multilocularis, were detected. Two high-risk areas of infection were identified. The prevalence of Echinococcus spp. was 22.7% (95% CI 11.5-37.8%) in the Montérégie centered high-risk area, 26.5% (95% CI 12.9-44.4%) in the Bas-St-Laurent high-risk area, and 3.0% (95%CI 1.8-4.7%) outside those areas. For E. multilocularis, a prevalence of 20.5% (95% CI 9.8-35.3%) was estimated in the high-risk area centered in Montérégie compared to 2.4% (95% CI 1.4-3.9%) outside. Logistic regression did not show any association of infection status with species, sex, or geolocation of capture (p > 0.05). This study shows the circulation of Echinococcus in a wildlife cycle in 9/12 administrative regions of Québec.

Orbital intramuscular hydatid cyst causing compressive optic neuropathy: a case report and literature review

BACKGROUND

Echinococcosis, commonly known as hydatid disease, is a zoonotic infection resulting from the tapeworm Echinococcus granulosus. The occurrence of hydatid cysts in the orbital region is uncommon, representing less than 1% of all reported hydatid cases. This report details a unique case of an intramuscular hydatid cyst in the orbital region that led to compressive optic neuropathy.

CASE PRESENTATION

A 22-year-old male from Kabul, Afghanistan presented with a five-month history of progressive proptosis in his left eye, associated with a gradual decrease in vision over the past three weeks. The left eye exhibited upward globe dystopia, ocular motility limitation, mild conjunctival injection, and chemosis. Diagnosis was achieved through imaging and histopathological examination. Treatment involves surgical removal of the cyst and prolonged albendazole therapy. The postoperative course showed significant improvement in the patient's condition and restoration of his vision.

CONCLUSIONS

Despite its rarity, this case underscores the importance of awareness and knowledge of hydatid disease among physicians, especially those working in endemic areas. It emphasizes the importance of including hydatid disease in the differential diagnosis of orbital masses, particularly in endemic regions.

Current status and future prospects of Echinococcus multilocularis vaccine candidates: A systematic review

The larval stages of Echinococcus multilocularis (E. multilocularis) are what cause the zoonotic disease known as alveolar echinococcosis (AE). Identifying the antigens that trigger immune responses during infection is extremely important for the development of vaccines against Echinococcus infections. Several studies conducted in recent decades have described the specific traits of the protective antigens found in E. multilocularis and their role in immunizing different animal hosts. The objective of the current systematic review was to summarize the findings of relevant literature on this topic and unravel the most effective vaccine candidate antigens for future research. A comprehensive search was conducted across five databases, including ProQuest, PubMed, Scopus, ScienceDirect, and Web of Science, until March 1, 2023. Two reviewers autonomously conducted the screening and evaluation of data extraction and quality assessment. In the present study, a total of 41 papers matched the criteria for inclusion. The study findings indicate that the combination of Em14-3-3 and BCG is widely considered the most often employed antigens for E. multilocularis immunization. In addition, the study describes antigen delivery, measurement of immune responses, adjuvants, animal models, as well as routes and doses of vaccination. The research indicated that recombinant vaccines containing EMY162, EM95, and EmII/3-Em14-3-3 antigens and crude or purified antigens containing ribotan-formulated excretory/secretory antigens exhibited the most favorable outcomes and elicited protective immune responses.

Characterization of research trends and prospects on hepatic echinococcosis over the past forty years: a bibliometric analysis

BACKGROUND

The distribution of hepatic echinococcosis (HE) is extensive, significantly impacting public health and economic development. Therefore, analyzing global collaboration networks and tracking developmental trends over the past four decades are crucial. This study aimed to demonstrate collaboration in the field of HE and explore key topics and future directions.

MATERIALS AND METHODS

Bibliometric analyses were conducted using CiteSpace, Bibliometrix package of R, and VOSviewer software on HE-related studies from the Web of Science Core Collection published before 1 August 2023.

RESULTS

This study identified 2605 records published in 196 journals by 9860 authors from 2607 institutes in 90 countries. Publications significantly notably increased in 2021. Developing countries like Turkey and China made notable contributions, while developed countries like the USA had higher average citation rates. The largest nodes in every cluster of the collaboration network were Hacettepe University, Tehran University, Xinjiang Medical University, Salford University, and the University of Pavia, and the top-producing authors were Wen H, Vuitton DA, Gottstein B, and Craig PS. Keyword co-occurrence analysis suggested that surgical techniques and novel drugs targeting combined immune checkpoints are the main therapeutic approaches in the future.

CONCLUSION

Although developing countries had significantly contributed to publications on HE, the citation rate for individual articles from developed countries was significantly higher. Additionally, advancements in surgical techniques and novel drugs targeting combined immune checkpoints may emerge as the next research focus and developmental direction.

Immunohistochemistry as a Reliable Tool for the Diagnosis of Cystic Echinococcosis in Patients from Sardinia, Italy-A Confirmatory Study

Cystic Echinococcosis (CE) is a zoonotic disease caused by the larval stage of the tapeworm Echinococcus granulosus sensu lato (s.l.). This study aims to investigate the use of two monoclonal antibodies (mAbEmG3 and mAbEm2G11) by immunohistochemistry (IHC) to confirm the diagnosis of CE in human patients, in particular in those cases in which other techniques fail to provide a correct or conclusive diagnosis. For this purpose, a survey on 13 patients was performed. These subjects were referred to Sardinian hospitals (Italy) from 2017 to 2022 and were suspected to be affected by CE. Our findings from these 13 patients showed the detection of E. granulosus sensu stricto by IHC in 12 of 13 echinococcal cysts, as one sample was of a non-parasitological origin. The results confirmed that IHC, by means of the mAbEmG3 and mAbEm2G11, is a reliable diagnostic tool that showed a very high performances when tested on strain of E. granulosus s.l. from Sardinia.

Developing a geographical-meteorological indicator system and evaluating prediction models for alveolar echinococcosis in China

BACKGROUND

Geographical and meteorological factors have been reported to influence the prevalence of echinococcosis, but there's a lack of indicator system and model.

OBJECTIVE

To provide further insight into the impact of geographical and meteorological factors on AE prevalence and establish a theoretical basis for prevention and control.

METHODS

Principal component and regression analysis were used to screen and establish a three-level indicator system. Relative weights were examined to determine the impact of each indicator, and five mathematical models were compared to identify the best predictive model for AE epidemic levels.

RESULTS

By analyzing the data downloaded from the China Meteorological Data Service Center and Geospatial Data Cloud, we established the KCBIS, including 50 basic indicators which could be directly obtained online, 15 characteristic indicators which were linear combination of the basic indicators and showed a linear relationship with AE epidemic, and 8 key indicators which were characteristic indicators with a clearer relationships and fewer mixed effects. The relative weight analysis revealed that monthly precipitation, monthly cold days, the difference between negative and positive temperature anomalies, basic air temperature conditions, altitude, the difference between positive and negative atmospheric pressure anomalies, monthy extremely hot days, and monthly fresh breeze days were correlated with the natural logarithm of AE prevalence, with sequential decreases in their relative weights. The multinomial logistic regression model was the best predictor at epidemic levels 1, 3, 5, and 6, whereas the CART model was the best predictor at epidemic levels 2, 4, and 5.

Plasma Circulating Cell-Free DNA Facilitated the Detection of an Alveolar Echinococcosis Patient Initially Misdiagnosed as Cystic Echinococcosis: A Case Report

Echinococcosis, especially alveolar echinococcosis (AE), is becoming an emerging/re-emerging disease with a growing number of cases reported globally. The diagnosis of echinococcosis is based mainly on imaging, which may be challenging when the image presentation is atypical. We reported one patient with suspected cystic echinococcosis (CE) by imaging. The cell-free DNA (cfDNA) obtained from sequencing the patient's plasma before the operation showed that this patient probably had AE with 45 reads mapped to the Echinococcus multilocularis reference genome (Read-Pairs Per Million = 0.24). The patients underwent surgery, and the pathological result showed that the patient had AE. The conventional polymerase chain reaction (PCR) of her lesion sample extraction also indicated that the infection was caused by Echinococcus multilocularis. The follow-up ultrasound after three months indicated no recurrence. We demonstrated that the differentiation of CE and AE by imaging may not be that easy, with further elaboration on the differentiation between AE and CE in different aspects. We demonstrated that it is possible to use patients' plasma cfDNA mapped to Echinococcus references before the operation to obtain the objective clue of the lesion to facilitate diagnosis.

Baiting not-owned dogs against Echinococcus granulosus: innovative tools for integrated control

Cystic echinococcosis (CE), caused by the larval stage of the cestode Echinococcus granulosus, is one of the most widespread zoonoses in Mediterranean countries. Baiting not-owned dogs with praziquantel (PZQ), due to their key role in the maintaining the transmission of CE, currently appears to be the most effective way to limit the transmission of CE, as well as an important aspect to introduce for the control of this parasitic disease. Therefore, this study aims to test 3 types of PZQ-based baits by evaluating different parameters (integrity over time, attractiveness and palatability for dogs, and mechanical resistance after release to different altitudes) and the bait acceptance in field by target animals, i.e. not-owned dogs, by using camera traps. The double PZQ-laced baits (with a double layer of highly palatable chews) showed the greatest resistance in the environment while also preserving the attractiveness and palatability up to 10 days, also withstood heights of 25 m, thus resulting as the most suitable also for drone delivery. The results on the field showed that most of the baits were consumed by not-owned dogs (82.2%), while the remaining were consumed by wild boars (8.9%), foxes (6.7%), badgers (1.1%) and hedgehogs (1.1%), confirming the specific and high attractiveness of the double PZQ-laced baits for the target population and highlights how an anthelmintic baiting programme may be a viable tool for the management of E. granulosus among free-ranging dog populations in endemic rural areas.

A 16-year-old adolescent with a history of minor abdominal trauma diagnosed with a giant isolated primary splenic hydatid cyst: a case report

Introduction

Hydatosis is a zoonotic parasitic disease caused by echinococcosis larval infection. South America, Africa, the Middle East, South Europe, India, and Australia are endemic to this disease. Splenic involvement is a rare and complicated hydatid disease presentation. A splenic hydatid cyst is an infrequent clinical occurrence, even in regions where the disease is endemic.

Case presentation

A 16-year-old male, having a background of mild abdominal trauma and non-resolving dull abdominal pain attended a paediatric surgical outpatient office and following a thorough examination, was diagnosed with a giant solitary isolated splenic hydatid cyst. Subsequently, the patient received albendazole and underwent total splenectomy, necessitated by the considerable size of the cyst, classified as a giant.

Clinical discussion

Splenic involvement of hydatid disease is a rare presentation (0.5-8%.). With the initial clinical finding often involving the accidental discovery of a palpable mass, the most frequently reported symptoms and signs include the presence of a palpable mass, fever, dull pain, or splenomegaly. Ultrasound and computed tomography are the most helpful tools for evaluating focal splenic diseases. The preferred treatment involves the use of antihelminthic drugs such as albendazole or mebendazole in conjunction with splenectomy. Total splenectomy is the preferred approach and is associated with decreased hospital stay, reduced healthcare costs, and a lower likelihood of recurrence.

Conclusion

in endemic areas, in patients with splenic cysts, hydatidosis should be contemplated.

Changes in the global epidemiological characteristics of cystic echinococcosis over the past 30 years and projections for the next decade: Findings from the Global Burden of Disease Study 2019

Background

Despite ongoing changes in the global epidemiology of cystic echinococcosis (CE), there is a lack of research conducted to date.

Methods

We extracted data on incidence and disability-adjusted life years for 204 countries and territories from 1990 to 2019 to evaluate the epidemiological characteristics and burden of CE through the Global Burden of Diseases, Injuries, and Risk Factors Study 2019. We used locally weighted linear regression to analyse the primary driving factors of the prevalence of CE at the national and regional levels and utilised a Bayesian Age-Period-Cohort model to forecast the global incidence of CE in the next decade.

Results

Globally, the incidence of CE remained constantly high from 1990 (2.65 per 100 000 population) to 2019 (2.60 per 100 000 population), resulting in an estimated 207 368 new cases in 2019. We observed substantial variations in the disease burden regarding its spatiotemporal distribution, population demographics, and Socio-Demographic Index levels. According to established models, factors such as health care capacity, livestock husbandry, agricultural activities, rural populations, and education levels are likely to play significant roles in determining the prevalence of CE across different countries. By 2030, the worldwide number of CE cases could reach as high as 235 628, representing an increase of 13.63% compared to 2019.

Conclusions

Over the past three decades, the global burden of CE has persistently remained high, especially in Central Asia, as well as North Africa and the Middle East. Efforts should focus on more effective prevention and control measures in these key regions and should specifically target vulnerable populations to prevent the escalation of epidemics.

Mouse model of secondary cystic echinococcosis

Cystic echinococcosis (CE) is a parasitic zoonosis caused by the larval stage of the cestode Echinococcus granulosus sensu lato (s. l.), a genetic complex composed of five species: E. granulosus sensu stricto (s. s.), E. equinus, E. ortleppi, E. canadensis, and E. felidis. The parasite requires two mammalian hosts to complete its life cycle: a definitive host (mainly dogs) harboring the adult parasite in its intestines, and an intermediate host (mostly farm and wild ungulates) where hydatid cysts develop mainly in the liver and lungs. Humans are accidental intermediate hosts, being susceptible to either primary or secondary forms of CE; the first one due to the ingestion of oncospheres, and the second one because of the spillage of protoscoleces (PSC) contained within a primary cyst. Secondary CE is a serious medical problem, and can be modeled in immunocompetent mice (a non-natural intermediate host) through the intraperitoneal inoculation of viable PSC from E. granulosus s. l. This model is useful to study not only the immunobiology of CE, but also to test new chemotherapeutics or therapeutical protocols, to explore novel vaccine candidates, and to evaluate alternative diagnostic and/or follow-up tools. The mouse model of secondary CE involves two sequential stages: an early stage of parasite pre-encystment (PSC develop into hydatid cysts in the peritoneal cavity of mice), and a late or chronic stage of parasite post-encystment (already differentiated cysts slowly grow during the whole host lifespan). This model is a time-consuming infection, whose outcome depends on several factors like the parasite infective dose, the mouse strain, and the parasite species/genotype. Thus, such variables should always be adjusted according to the research objectives. Herein, the general materials and procedures needed to establish secondary CE in mice are described, as well as several useful tips and recommendations.

Reinfection of farm dogs following praziquantel treatment in an endemic region of cystic echinococcosis in southeastern Iran

Cystic Echinococcosis (CE) as a prevalent tapeworm infection of human and herbivorous animals worldwide, is caused by accidental ingestion of Echinococcus granulosus eggs excreted from infected dogs. CE is endemic in the Middle East and North Africa, and is considered as an important parasitic zoonosis in Iran. It is transmitted between dogs as the primary definitive host and different livestock species as the intermediate hosts. One of the most important measures for CE control is dog deworming with praziquantel. Due to the frequent reinfection of dogs, intensive deworming campaigns are critical for breaking CE transmission. Dog reinfection rate could be used as an indicator of the intensity of local CE transmission in endemic areas. However, our knowledge on the extent of reinfection in the endemic regions is poor. The purpose of the present study was to determine E. granulosus reinfection rate after praziquantel administration in a population of owned dogs in Kerman, Iran. A cohort of 150 owned dogs was recruited, with stool samples collected before praziquantel administration as a single oral dose of 5 mg/kg. The re-samplings of the owned dogs were performed at 2, 5 and 12 months following initial praziquantel administration. Stool samples were examined microscopically using Willis flotation method. Genomic DNA was extracted, and E. granulosus sensu lato-specific primers were used to PCR-amplify a 133-bp fragment of a repeat unit of the parasite genome. Survival analysis was performed using Kaplan-Meier method to calculate cumulative survival rates, which is used here to capture reinfection dynamics, and monthly incidence of infection, capturing also the spatial distribution of disease risk. Results of survival analysis showed 8, 12 and 17% total reinfection rates in 2, 5 and 12 months following initial praziquantel administration, respectively, indicating that 92, 88 and 83% of the dogs had no detectable infection in that same time periods. The monthly incidence of reinfection in total owned dog population was estimated at 1.5% (95% CI 1.0-2.1). The results showed that the prevalence of echinococcosis in owned dogs, using copro-PCR assay was 42.6%. However, using conventional microscopy, 8% of fecal samples were positive for taeniid eggs. Our results suggest that regular treatment of the dog population with praziquantel every 60 days is ideal, however the frequency of dog dosing faces major logistics and cost challenges, threatening the sustainability of control programs. Understanding the nature and extent of dog reinfection in the endemic areas is essential for successful implementation of control programs and understanding patterns of CE transmission.

Recombinant antigen P29 of Echinococcus granulosus induces Th1, Tc1, and Th17 cell immune responses in sheep

Echinococcosis is a common human and animal parasitic disease that seriously endangers human health and animal husbandry. Although studies have been conducted on vaccines for echinococcosis, to date, there is no human vaccine available for use. One of the main reasons for this is the lack of in-depth research on basic immunization with vaccines. Our previous results confirmed that recombinant antigen P29 (rEg.P29) induced more than 90% immune protection in both mice and sheep, but data on its induction of sheep-associated cellular immune responses are lacking. In this study, we investigated the changes in CD4+ T cells, CD8+ T cells, and antigen-specific cytokines IFN-γ, IL-4, and IL-17A after rEg.P29 immunization using enzyme-linked immunospot assay (ELISPOT), enzyme-linked immunosorbent assay (ELISA), and flow cytometry to investigate the cellular immune response induced by rEg.P29 in sheep. It was found that rEg.P29 immunization did not affect the percentage of CD4+ and CD8+ T cells in peripheral blood mononuclear cells (PBMCs), and was able to stimulate the proliferation of CD4+ and CD8+ T cells after immunization in vitro. Importantly, the results of both ELISPOT and ELISA showed that rEg.P29 can induce the production of the specific cytokines IFN-γ and IL-17A, and flow cytometry verified that rEg.P29 can induce the expression of IFN-γ in CD4+ and CD8+ T cells and IL-17A in CD4+ T cells; however, no IL-4 expression was observed. These results indicate that rEg.P29 can induce Th1, Th17, and Tc1 cellular immune responses in sheep against echinococcosis infection, providing theoretical support for the translation of rEg.P29 vaccine applications.

[Alveolar echinococcosis in fattening pigs in a conventional housing system]

In a conventional fattening farm in southern Germany, up to 100 % of the livers of individual slaughter groups were condemned due to parasitic lesions during 2022. Intensification of antiparasitic metaphylaxis with fenbendazole to control Ascaris suum in the herd was unsuccessful. A pathomorphologic examination of 6 livers from two slaughter groups revealed oligofocal fibrotic inflammation. Histologically, chronic granulomatous hepatitis with massive involvement of eosinophilic granulocytes and central parasitic structures of a helminth were detected. Examination of the liver lesions by PCR revealed evidence of Echinococcus (E.) multilocularis. To determine the source of introduction into the herd, fecal samples were collected from semi-feral domestic cats near the feed mixer and in the corridor of the barn. Parasitologically, cestode eggs were detected in the fecal samples. Genome fragments of E. multilocularis could not be amplified by PCR. In the present case, domestic cats were suspected as the most likely source of entry into the herd. Control measures were aimed at preventing parasite entry by therapy of the domestic cats with antiparasitics. Differentially, no other possible pathogens could be detected by PCR and bacteriological examination.

A rare case of gallbladder cystic echinococcosis disease in western China

Hydatid disease, also known as echinococcosis, is an endemic zoonotic parasitic disease caused by larvae of the Echinococcus tapeworm.Humans as accidental intermediate hosts in the parasite life cycle, echinococcus usually parasitizes the liver, solitary cystic echinococcosis in the gallbladder is very rare. Here we report a rare case of cystic echinococcosis in the gallbladder without liver involvement. A female patient was admitted to the hospital primarily for "right upper abdominal pain with radiating pain in the back of the shoulder for 20 days", initially suspected to be gallbladder stones, and underwent laparoscopic cholecystectomy after completing the relevant investigations, and was diagnosed with primary cystic echinococcosis of the gallbladder based on the pathologic findings in the postoperative period. The patient recovered well after surgery and remained well without complications during the 6-month follow-up period. This case illustrates that echinococcus granulosus can also parasitize in the gallbladder only, although it is quite uncommon. In addition, it is difficult to distinguish it from gallbladder stones by conventional imaging. The diagnosis of some cases of gallbladder cystic echinococcosis is completed during surgery and confirmed by postoperative pathological results.

miRNA based biomarkers for the early diagnosis of Echinococcus granulosus in experimentally infected dogs

Cystic echinococcosis, which is caused by the Echinococcus granulosus. Carnivores, as final hosts, contain adult tapeworms in the small intestine, and a variety of mammals, including humans, harbor the metacestod. This study was designed to investigate the miRNA-based biomarkers for early and accurate diagnosis of E. granulosus in experimentally infected dogs. A liver with an obvious hydatid cyst was obtained from a slaughterhouse and then protoscoleces were collected. Following, viable protoscoleces were administred to three experimental dogs (ED1, ED2 and ED3) and another uninfected control dog (UCD) was kept as control without infection. Stool samples of all groups were collected during 50 days from the beginning of the experimental infection and stored at - 80 °C till work. Total miRNA was isolated from all individual stool samples. The qRT-PCR method was used to determine the differences in the expression levels of E. granulosus specific miRNAs which were egr-let-7-5p, egr-miR-2b-5p, egr-miR-71-5p and egr-miR-125-5p. All miRNAs were found to be expressed from the first day in all infected dogs. In the stool samples of the UCD, the egr-miR-71-5p was detected, while the other miRNAs (egr-let-7-5p, egr-miR-2b-5p, egr-miR-125-5p) were not expressed. The expression of egr-let-7-5p and egr-miR-125-5p was significantly increased in ED1 compared to UCD on all days. In particular, for the first time, the expression levels of egr-let-7-5p and egr-miR-125-5p increased significantly between days 15 and 19. Similarly, the increase in let-7-5p and miR-125-5p expression was statistically significant in ED2. In ED3, egr-let-7-5p, egr-miR2b-5p and egr-miR-125-5p expressions were significantly increased on all days. In particular, egr-let-7-5p expression levels increased significantly for the first time between days 15 and 19. In addition, egr-mir-125-5p expression levels were found to increase at a high level for the first time on day 16. In conclusion, especially egr-let-7-5p and egr-miR-125-5p can be used as early diagnostic biomarkers in dogs infected with E. granulosus.

Echinococcus granulosus cyst fluid inhibits KDM6B-mediated demethylation of trimethylated histone H3 lysine 27 and interleukin-1β production in macrophages

BACKGROUND

Echinococcus granulosus can manipulate its host's immune response to ensure its own survival. However, the effect of histone modifications on the regulation of the NOD-like receptor protein 3 (NLRP3) inflammasome and downstream interleukin-1β (IL-1β) production in response to the parasite is not fully understood.

METHODS

We evaluated IL-1β secretion through enzyme-linked immunosorbent assay and assessed reactive oxygen species levels using the dichlorodihydrofluorescein diacetate probe. Western blotting and quantitative real-time polymerase chain reaction were performed to examine the expression of NLRP3 and IL-1β in mouse peritoneal macrophages and Tohoku Hospital Pediatrics-1 cells, a human macrophage cell line. The presence of trimethylated histone H3 lysine 27 (H3K27me3) modification on NLRP3 and IL-1β promoters was studied by chromatin immunoprecipitation.

RESULTS

Treatment with E. granulosus cyst fluid (EgCF) considerably reduced IL-1β secretion in mouse and human macrophages, although reactive oxygen species production increased. EgCF also suppressed the expression of NLRP3 and IL-1β. Mechanistically, EgCF prompted the enrichment of repressive H3K27me3 modification on the promoters of both NLRP3 and IL-1β in macrophages. Notably, the presence of EgCF led to a significant reduction in the expression of the H3K27me3 demethylase KDM6B.

CONCLUSIONS

Our study revealed that EgCF inhibits KDM6B expression and H3K27me3 demethylation, resulting in the transcriptional inhibition of NLRP3 and IL-1β. These results provide new insights into the immune evasion mechanisms of E. granulosus.

Global profiling of the proteome, phosphoproteome, and N-glycoproteome of protoscoleces and adult worms of Echinococcus granulosus

Introduction

Cystic echinococcosis (CE) is a chronic zoonosis caused by infection with the metacestode of the Echinococcus granulosus. A unique characteristic of E. granulosus protoscolex (PSC) is their ability to develop bidirectionally into an adult worm in the definitive host or a secondary hydatid cyst in the intermediate host. Furthermore, cestodes have a complex life cycle involving different developmental stages; however, the mechanisms underlying this development remain unknown. Several studies have demonstrated that certain matrix proteins undergo posttranslational modifications (PTMs), including phosphorylation and glycosylation, which have important regulatory effects on their functional properties.

Methods

Systematic analyses of the proteome, phosphorylated modified proteome, and glycosylated modified proteome of protoscoleces (PSCs) and adult worms were performed using a proteomic strategy. Data are available via ProteomeXchange with identifier PXD043166.

Results

In total, 6,407 phosphorylation sites and 1757 proteins were quantified. Of these, 2032 phosphorylation sites and 770 proteins were upregulated, and 2,993 phosphorylation sites and 1,217 proteins were downregulated in adult worms compared to PSCs. A total of 612 N-glycosylation sites were identified in the 392 N-glycoproteins. Of these, 355 N-glycosylation sites and 212 N-glycoproteins were quantified. Of these, 90 N-glycosylation sites and 64 N-glycoproteins were upregulated, and 171 N-glycosylation sites and 126 N-glycoproteins were downregulated in adult worms compared to PSCs. GO enrichment analysis indicated that the differentially expressed phosphoproteins were mainly enriched in the regulation of oxidoreduction coenzyme metabolic processes, myelin sheath, and RNA helicase activity, whereas the differentially expressed N-glycoproteins were enriched in the cellular response to unfolded proteins, endoplasmic reticulum lumen, and nucleic acid binding. KEGG enrichment analysis indicated that the differently expressed phosphoproteins were mainly enriched in RNA transport, hypertrophic cardiomyopathy (HCM), glycolysis/gluconeogenesis, HIF-1 signaling pathway and pyruvate metabolism. Differentially expressed N-glycoproteins were enriched in the PI3K-Akt signaling pathway, ECM-receptor interactions, and protein processing in the endoplasmic reticulum.

Discussion

To our knowledge, this study is the first global phosphoproteomic and N-glycoproteomic analysis of E. granulosus, which provides valuable information on the expression characteristics of E. granulosus and provides a new perspective to elucidate the role of protein phosphorylation and N-glycosylation in the development of E. granulosus.

Changes in intestinal flora of mice induced by rEg.P29 epitope peptide vaccines

OBJECTIVE

Cystic echinococcosis (CE), a zoonotic parasitic disease caused by Echinococcus granulosus, remains a public health and socioeconomic issue worldwide, making its prevention and treatment of vital importance. The aim of this study was to investigate changes in the intestinal microbiota of mice immunized with three peptide vaccines based on the recombinant antigen of E. granulosus, P29 (rEg.P29), with the hope of providing more valuable information for the development of vaccines against CE.

METHODS

Three peptide vaccines, rEg.P29T , rEg.P29B , and rEg.P29T + B , were prepared based on rEg.P29, and a subcutaneous immunization model was established. The intestinal floras of mice in the different immunization groups were analyzed by 16 S rRNA gene sequencing.

RESULTS

The intestinal microbiota analysis at both immunization time points revealed that Firmicutes, Bacteroidota, and Verrucomicrobiota were the predominant flora at the phylum level, while at the genus level, Akkermansia, unclassified_Muribaculaceae, Lachnospiraceae_NK4A136_group, and uncultured_rumen bacterium were the dominant genera. Some probiotics in the intestines of mice were significantly increased after immunization with the peptide vaccines, such as Lactobacillus_taiwanensis, Lactobacillus_reuteri, Lachnospiraceae_NK4A136_group, Bacteroides_acidifaciens, and so forth. Meanwhile, some harmful or conditionally pathogenic bacteria were decreased, such as Turicibacter sanguinis, Desulfovibrio_fairfieldensis, Clostridium_sp, and so forth, most of which are associated with inflammatory or infectious diseases. Kyoto Encyclopaedia of Genes and Genomes enrichment analysis revealed that the differential flora were enriched in multiple metabolic pathways, primarily biological systems, human diseases, metabolism, cellular processes, and environmental information processing.

CONCLUSION

In this study, we comprehensively analyzed and compared changes in the intestinal microbiota of mice immunized with three peptide vaccines as well as their related metabolic pathways, providing a theoretical background for the development of novel vaccines against E. granulosus.

A life-threatening encounter: an uncommon case of ruptured hydatid cyst presenting as anaphylactic shock and respiratory distress in a 12-year-old boy

Introduction and importance

Although rare, the spontaneous rupture of a lung hydatid cyst or its perforation into the pleural cavity can give rise to an abrupt onset of symptoms, including cough, fever, hemoptysis (coughing up blood), and hypersensitivity reactions, and can ultimately lead to respiratory failure.

Case presentation

A 12-year-old boy was brought to the emergency room with a loss of consciousness. Symptoms included tachypnea, fever, low blood pressure, and overall respiratory distress. After resuscitation, a chest X-ray revealed a distinct, well-defined round opacity located in the lower region of the right lung, leading to mediastinal displacement. After confirmation of the disease, the child was hospitalized in the ICU care and consequently underwent surgery. Treatment was successful and there was no recurrence on the follow-up.

Clinical discussion

Studies have demonstrated that the right lower lobe of the lung is the most frequently affected area of the lung by hydatid cysts. Symptomatic and complicated hydatid cysts are a rare concept in children, and only a small percentage, are diagnosed in patients younger than 16 years. Surgery remains the preferred treatment for the majority of patients with pulmonary hydatid disease. It is important to note that combined surgery and chemotherapy represents the current gold standard in managing pulmonary hydatid cyst.

Conclusion

Although anaphylactic shock caused by a ruptured lung hydatid cyst is rare, it should be taken into consideration by physicians as a differential diagnosis in patients who also have respiratory symptoms, particularly in endemic areas.

Cystic echinococcosis microRNAs as potential noninvasive biomarkers: current insights and upcoming perspective

INTRODUCTION

Echinococcosis, also known as hydatidosis, is a zoonotic foodborne disease occurred by infection with the larvae of Echinococcus spp. which can lead to the development of hydatid cysts in various organs of the host. The diagnosis of echinococcosis remains challenging due to limited diagnostic tools.

AREAS COVERED

In recent years, microRNAs (miRNAs) have emerged as a promising biomarker for various infectious diseases, including those caused by helminths. Recent studies have identified several novel miRNAs in Echinococcus spp. shedding light on their essential roles in hydatid cyst host-parasite interactions. In this regard, several studies have shown that Echinococcus-derived miRNAs are present in biofluids such as serum and plasma of infected hosts. The detection of these miRNAs in the early stages of infection can serve as an early prognostic and diagnostic biomarker for echinococcosis.

EXPERT OPINION

The miRNAs specific to Echinococcus spp. show great potential as early diagnostic biomarkers for echinococcosis and can also provide insights into the pathogenesis of this disease. This review attempts to provide a comprehensive overview of Echinococcus-specific miRNAs, their use as early diagnostic biomarkers, and their function in host-parasite interactions.

Incidentally diagnosed multiple intradural extramedullary spinal hydatidosis in a young adult: A case report and review of the literature

Key Clinical Message

Although quite rare, vertebral hydatidosis should always be considered as a differential diagnosis for spinal presentations, particularly in endemic areas for echinococcosis.

Abstract

In this paper, we report a rare case of asymptomatic multiple intradural, extramedullary spinal hydatidosis, incidentally diagnosed in a patient with signs and symptoms of a true protruded disc. Although quite rare, vertebral hydatidosis should always be considered as a differential diagnosis for spinal presentations, particularly in endemic areas for echinococcosis.

Giant Echinococcosis of the Liver with Suppuration: A Case Report and Review of the Literature

Purpose: Cystic echinococcosis (CE) is a common, complex parasitic disease that constitutes a major public health concern. CE demonstrates high endemicity in areas where dogs are used for herding or where animal husbandry practices involve close contact with livestock. It can clinically manifest with a variety of signs and symptoms, such as cholangitis, jaundice, pancreatitis, external biliary fistula, inferior vena cava obstruction, portal hypertension, and superinfection. The latter can notably be related to suppuration, either by rupture or bacteremia. The aim of this study is to report our 76-year-old patient who presented with a primarily infected giant-suppurated hydatid cyst of the liver and its surgical management. Methods: In this case, the diagnosis was based primarily on clinical presentation, computed tomography (CT) scan, and magnetic resonance imaging (MRI) of the patient's abdomen. The surgical procedure of choice was the partial retaining of the pericystic membrane and drainage of the cystic contents (partial pericystectomy). Results: The surgical management and meticulous long-term follow-up of our patient produced a positive outcome without any post-operative complications.

Molecular characterization and immunological properties of Echinococcus granulosus sensu stricto (G1) ADK1 and ADK8

Adenylate kinases (ADKs) are one of the important enzymes regulating adenosine triphosphate (ATP) metabolism in Echinococcus granulosus sensu lato. The objective of the present study was to explore the molecular characteristics and immunological properties of E. granulosus sensu stricto (G1) adenylate kinase 1 (EgADK1) and adenylate kinase 8 (EgADK8). EgADK1 and EgADK8 were cloned and expressed, and the molecular characteristics of EgADK1 and EgADK8 were analyzed through different bioinformatics tools. Western blotting was used to examine the reactogenicity of recombinant adenylate kinase 1 (rEgADK1) and recombinant adenylate kinase 8 (rEgADK8) and to evaluate their diagnostic value. The expression profiles of EgADK1 and EgADK8 in 18-day-old strobilated worms and protoscoleces were analyzed by quantitative real-time PCR, and their distribution in 18-day-old strobilated worms, the germinal layer, and protoscoleces was determined by immunofluorescence localization. EgADK1 and EgADK8 were successfully cloned and expressed. Bioinformatics analysis predicted that EgADK1 and EgADK8 have multiple phosphorylation sites and B-cell epitopes. Compared with EgADK8, EgADK1 and other parasite ADKs have higher sequence similarity. In addition, both cystic echinococcosis (CE)-positive sheep sera and Cysticercus tenuicollis-infected goat sera could recognize rEgADK1 and rEgADK8. EgADK1 and EgADK8 were localized in protoscoleces, the germinal layer, and 18-day-old strobilated worms. EgADK1 and EgADK8 showed no significant difference in their transcription level in 18-day-old strobilated worms and protoscoleces, suggesting that EgADK1 and EgADK8 may play an important role in the growth and development of E. granulosus sensu lato. Since EgADK1 and EgADK8 can be recognized by other parasite-positive sera, they are not suitable as candidate antigens for the diagnosis of CE.

Molecular Screening of Echinococcus spp. and Other Cestodes in Wild Carnivores from Central Italy

Tapeworm infections are among the most relevant parasitic diseases in humans and animals. Tapeworms from the Genus Echinococcus are particularly important as they can cause cystic or alveolar echinococcosis. A molecular screening was performed on 279 fecal samples collected from carcasses of wild carnivores from Central Italy using PCR targeting diagnostic fragments of nad1, rrnS, and nad5 genes. Samples positive for either Taenia spp. or Echinococcus granulosus were sequenced to taxonomically identify the parasitic DNA. Of the 279 samples, 134 (48.0%) gave positive results in the multiplex PCR. Only one (0.4%) sample from an Apennine wolf tested positive for Echinococcus granulosus sensu stricto (genotype G3), whereas no sample tested positive for E. multilocularis. The most frequently detected tapeworms were: Mesocestoides corti (syn M. vogae) (12.9%), M. litteratus (10.8%), Taenia serialis (9.3%), and T. hydatigena (6.5%), other tapeworms were rarely detected. The results suggest that Echinococcus infections in Central Italy do not seem to be sustained by sylvatic cycles, confirming the absence of E. multilocularis in Central Italy. The survey corroborates, yet again, the importance of passive surveillance of wild animals that can serve as reservoirs for zoonotic pathogens, especially on wild canids that in other areas are strongly implicated in the transmission of E. granulosus and E. multilocularis.

Occurrence and Economic Impact of Cystic Echinococcosis in Cattle Slaughtered in the Matabeleland Region, Zimbabwe

BACKGROUND

Cystic echinococcosis is a neglected disease responsible for millions of infections in both animals and humans. The toll on the global economy is estimated to be in the billions of United States dollars. Although much effort has been made by public health authorities to curb the rise in new infections, the occurrence of cystic echinococcosis is still being noted, especially in low-income countries. This study was conducted in the Matabeleland region of Zimbabwe to determine the incidence of cystic echinococcosis in bovines.

METHODS

Meat inspection records from 2011 through 2021 kept at licensed abattoirs in the Matabeleland region were used to generate annual total figures of bovines slaughtered in the region, together with the corresponding number of organs condemned due to cystic echinococcosis. Descriptive statistics showing the overall incidence in each year, incidence per district, and cysts in infected organs were expressed as a percentage of the total number of cattle slaughtered per category.

RESULTS

Bulawayo had the highest occurrence of cystic echinococcosis (1.359%, 95% CI, 1.254-1.412), followed by Matabeleland South (0.914%, 95% CI, 0.886-0.929) and then Matabeleland North (0.848%, 95% CI 0.818-0.863) provinces. The Bulilima, Bulawayo, and Bubi districts had the highest occurrences of cystic echinococcosis at 1.749%, 1.358%, and 1.286%, respectively. The lung was the most frequently affected organ (n=7155; at 0.854 %; and 95% CI, 0.8334-0.874%, followed by the liver (0.053%; 95% CI, 0.048-0.058%). The total direct economic loss due to organ condemnation during the study period was US$ 24,812.43.

Clinical Implications for the Comprehensive Interpretation of Radiologic and Immunodiagnostic Tests in Patients Suspected of Parasitic Hepatic Cyst, a Rare Case in Korea

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.

Seropositivity Pattern of Human Cystic Echinococcosis at a Tertiary Care Hospital of India

Cystic echinococcosis (CE), even after several control measures, causes significant morbidity throughout the world. Besides imaging investigation technology, the serological tests are essential for both diagnosis and management of this slowly progressive disease. The present study was a hospital-based retrospective study that examined the seropositivity rate for Echinococcus granulosus sensu lato antibody in patients suspected of CE at our tertiary health care center over 8 years from 2013 to 2020. Records of new visits to hospital/clinics and associated hospital discharge constituted the denominator of calculation. All samples were tested using commercially available indirect immunoglobulin G enzyme-linked immunosorbent assay kit. A total of 925 suspected patients with a clinical diagnosis of CE were screened. The age group that commonly tested positive for CE was 20 to 39 years, and liver was the predominant organ found to be affected. The seropositive rate was 41.2%. On further year-wise analysis, it was observed that the seropositivity rate had significantly declined from 61.4% in 2013 to 33.8% in 2020. This study clearly showed that there is a by 27.6% decline of CE seropositivity rate in 8 years. This declining rate may be attributed to improved socioeconomic status and better implementation of health programs.

Phylogeny and population structure of Echinococcus granulosus (sensu stricto) based on full-length cytb-nad2-atp6 mitochondrial genes - First report from Sialkot District of Pakistan

Cystic echinococcosis is a zoonotic disease of livestock having serious economic setbacks. The etiological agents of the disease belong to Echinococcus granulosus sensu lato. Despite of worldwide distribution of the disease, the molecular studies mainly employ amplification of cox1, nad1 and nad5 genes. To further strengthen the knowledge about significance of other molecular markers and to investigate the genetic diversity and population structure of Echinococcus species in Pakistan, the current study was designed in which full length mitochondrial cytb, atp6 and nad2 genes were amplified. Based on BLAST searches of the generated cytb, atp6 and nad2 gene sequences from a total of 18 hydatid cysts collected from cattle, 12 isolates were identified as E. granulousus G3 and 6 as E. granulosus (G1). The phylogeny inferred by the Bayesian method using nucleotide sequences of cytb-atp6-nad2 further confirmed their identity. The diversity indices indicated a high haplotype and a low nucleotide diversity. The negative values of Tajima's D and Fu's Fs test demonstrated deviation from neutrality suggesting a recent population expansion. To the best of our knowledge, the present study described the genetic variation of E. granulosus population for the first time in Pakistan using full-length cytb, atp6 and nad2 mitochondrial genes. The findings on the genetic variation of E. granulosus in Pakistan will constitute useful baseline information for future studies on the prevalence and population structure of E. granulosus based on full-length cytb, atp6 and nad2.

Natural history of Echinococcus granulosus microcyst development in long term in vitro culture and molecular and morphological changes induced by insulin and BMP-4

Introduction

Cystic echinococcosis (CE) caused by the cestode Echinococcus granulosus is a disease of worldwide public health and economic importance. The determinants and underlying cellular mechanisms of CE development and fate in intermediate hosts are largely unknown. Hormones and cytokines such as insulin and BMP-4 are the key players in the development, differentiation, and apoptosis. In this study, we evaluated the long term natural history of E. granulosus microcysts in an vitro setting and the molecular and morphological changes induced by the growth factors, insulin and BMP4 during the development of metacestode stage of E. granulosus.

Methods

E. granulosus protoscoleces were cultivated and the parasite development was followed in the long term mono-phasic culture for 105 days and the morphometric, molecular and immunohistochemical changes were evaluated, including the microcysts number and size, microcysts development and deformation rates as well as the markers of calcification (Alizarin Red staining) and apoptosis (BAX, BCL2, Caspase-3, Caspase-8 and TNF-α expression) in the microcysts. Also the biological, histological and molecular consequences of insulin and BMP-4 treatment on the parasite development were evaluated.

Results

Insulin and BMP-4 treatment of microcysts resulted in significant increase in microcyst formation, increased size, reduced apoptosis and deformation of the microcysts. Alizarin red staining of the microcysts treated with the insulin and BMP-4 confirmed that calcium deposition is significantly lower than the untreated microcysts. Also Alizarin Red staining and Immunohistochemistry of the microcysts indicates that calcium accumulation in deformed microcysts is higher than the normal ones on day 105. The microcysts began to wrinkle and the germinal layer was partially detached from the laminated layer on day 84.

Conclusion

Results of the present study suggest that the degenerative changes in hydatid cysts can be slowed down by insulin and BMP-4, indicating that cellular factors and host hormones could contribute to the longevity of hydatid cysts. Significant evidences are provided suggesting that the microcysts cultivated in vitro can undergo calcification and apoptotic processes similar to what have been observed in the natural hydatid infection in the intermediate hosts.

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

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

Mathematical modelling of echinococcosis in human, dogs and sheep with intervention

In this study, a model for the spread of cyst echinococcosis with interventions is formulated. The disease-free and endemic equilibrium points of the model are calculated. The control reproduction number Rc for the model is derived, and the global dynamics are established by the values of Rc. The disease-free equilibrium is globally asymptotically stable if and only if Rc<1. For Rc>1, using Volterra-Lyapunov stable matrices, it is proven that the endemic equilibrium is globally asymptotically stable. Sensitivity analysis to identify the most influential parameters in the dynamics of CE is carried out. To establish the long-term behaviour of the disease, numerical simulations are performed. The impact of control strategies is investigated. It is shown that, whenever vaccination of sheep is carried out solely or in combination with cleaning or disinfecting of the environment, cyst echinococcosis can be wiped out.

Expansion of Opportunistic Enteric Fungal Pathogens and Occurrence of Gut Inflammation in Human Liver Echinococcosis

Increasing evidence shows that the gut fungal mycobiota is implicated in human disease. However, its relationship with chronic helminth infections, which cause immunosuppression and affect over 1 billion people worldwide, remains unexplored. In this study, we investigated the gut mycobiome and its associations with gut homeostasis in a severe helminth disease worldwide: liver echinococcosis. Fecal samples from 63 patients and 42 healthy controls were collected to characterize the fungal signatures using ITS1 sequencing, QIIME pipeline, and machine learning analysis. The levels of fecal calprotectin and serological anti-Saccharomyces cerevisiae antibodies (ASCA) in these subjects were experimentally measured. We found that fungal microbiota was significantly skewed in disease, with an overrepresentation of Aspergillus, Candida, Geotrichum, Kazachstania, and Penicillium and a decrease of Fusarium. Machine learning analysis revealed that the altered fungal features could efficiently predict infection with high sensitivity and specificity (area under the curve [AUC] = 0.93). The dysbiosis was characterized by expansions of multiple opportunistic pathogens (Aspergillus spp. and Candida spp.). Clinical association analysis revealed that host immunity might link to the expansions of the invasive fungi. Accompanying the opportunistic pathogen expansion, the levels of fungi-associated fecal calprotectin and serological ASCA in the patients were elevated, suggesting that gut inflammation and microbiota translocation occurred in this generally assumed extraintestinal disease. This study highlights enteric fungal pathogen expansions and increased levels of markers for fungi-associated mucosal inflammation and intestinal permeability as hallmarks of liver echinococcosis. IMPORTANCE Helminth infection affects over 1 billion people worldwide. However, its relationship with the gut mycobiome remains unknown. Among the most prevalent helminth diseases, human hydatid disease (echinococcosis) is highlighted as one of the most important (second/third for alveolar/cystic echinococcosis) foodborne parasitic diseases at the global level. Herein, we investigated the mycobiome and gut homeostasis (i.e., inflammation and permeability) in human echinococcosis. Our results revealed that fungal dysbiosis with an expansion of opportunistic pathogens and increased levels of fecal calprotectin and serum ASCA are hallmarks of human liver echinococcosis. Host immunity is associated with enteric fungal expansions. These findings suggest that an extraintestinal helminth infection is able to alter gut fungal microbiota and impair gut homeostasis, which resembles concomitant gut symptoms in inflammatory gut-related diseases (e.g., AIDS). In clinical practice, physicians need to take cautious medical consideration of gut health for nonintestinal helminth diseases.

Paediatric pulmonary echinococcosis: A neglected disease

Echinococcosis is a worldwide public health problem causing considerable paediatric morbidity and mortality in endemic areas. The presentation of cystic echinococcosis (CE) varies by age. Unlike adults, where hepatic involvement is common, pulmonary CE is the dominant site in the paediatric population. Pulmonary cysts are typically first seen on chest X-ray, either as an incidental finding or following respiratory symptoms after cyst rupture or secondary infection of the cyst. In children, pulmonary cysts have a broad differential diagnosis, and a definitive diagnosis relies on the combination of imaging, serology, and histology. In countries with high infectious burdens from diseases such as acquired immunodeficiency syndrome (AIDS) and tuberculosis (TB), the diagnosis is additionally challenging, as atypical infections are more common than in developed countries. Pulmonary CE is treated with a combination of surgery and chemotherapy.

Cystic echinococcosis in cattle slaughtered at a slaughterhouse in Gessa, southern Ethiopia

Cystic echinococcosis is caused by the metacestode of the zoonotic flatworm Echinococcus granulosus. A cross-sectional study was conducted from October 2020 to August 2021 at the Gessa municipality abattoir in southern Ethiopia, through regular meat examinations and cyst characterization to determine the prevalence, organ distribution, and fertility of Cystic echinococcosis. The overall prevalence of Echinococcus granulosus sensu lato was 17.9% (69/384) and has shown a statistically significant association (p < 0.05) with the body condition of cattle but not with other putative risk factors (p > 0.05). The odds of poor body condition cattle infected with CE was 1.29 times higher than medium body condition (OR = 0.506; CI = 0.566–2.96). Based on organ distribution of cysts, the lungs and liver were the most affected organs having a statistically significant difference (p < 0.05) with the prevalence of CE. Based on the size of cysts, small (47.9%) size cysts revealed the highest prevalence as compared with large (33.3%) and medium (18.8%) sized cysts. On cyst characterization, the majority of Cystic echinococcosis were sterile cysts (55.4%) followed by fertile (38.8%) and calcified (8.7%) cysts and revealed a statistically significant difference (p < 0.05). Cyst number, organ localization, fertility of cyst, and cyst size have shown a strong positive correlation (r = 0.8686, r = 0.8393, r = 0.9506, and r = 0.9189) with the prevalence of CE, respectively. The presence of an overall high prevalence of Echinococcus granulosus sensu lato in the present study required urgent action to interrupt the life cycle of Cystic echinococcosis and further studies using molecular techniques to characterize the circulating genotypes to prevent the risk of zoonosis in humans in the study area.

Global distribution of Echinococcus granulosus genotypes in domestic and wild canids: a systematic review and meta-analysis

The current systematic review and meta-analysis demonstrate the genotypic distribution of canine echinococcosis worldwide. Studies published from the inception until 21 May 2021 were screened, relevant articles were selected and the random-effect model was used to draw forest plots with 95% confidence intervals (CIs). Totally, 44 articles were included, mostly examined dogs (37 records), followed by wolf (8 records), jackal (7 records), fox (3 records), pump fox (3 records) and coyote (1 record). Echinococcus granulosus sensu stricto (G1–G3) and G6/7 cluster of Echinococcus canadensis were the most common genotypes among canids. Most studies were conducted in Asia and Europe with 17 and 15 datasets, respectively. Exclusively, Iran possessed the highest number of studies (10 records). Meta-analysis showed that the pooled molecular prevalence of echinococcosis was 33.82% (95% CI 24.50–43.83%). Also, the highest and lowest prevalence of canine echinococcosis was calculated for South America (66.03%; 95% CI 25.67–95.85%) and Europe (19.01%; 95% CI 9.95–30.16%). Additionally, there were statistically significant differences between the global prevalence of echinococcosis in canines and publication year, continent, country, sample type, host and molecular test. These findings will elevate our knowledge on the poorly known canine echinococcosis worldwide.

Echinococcosis in a non-endemic country - 20-years' surgical experience from a Norwegian tertiary referral Centre

BACKGROUND

In Scandinavia, the incidence of cystic echinococcosis (CE) and alveolar echinococcosis (AE) is low and almost exclusively an imported disease following the trends of immigration. The aim of the study was to review available data on clinical management and outcome for patients treated at Oslo University Hospital, a referral centre for echinococcosis in Norway, with special emphasis on surgical treatment.

METHODS

All patients admitted with echinococcosis between January 2000 and December 2020 were identified. Medical records were reviewed retrospectively concerning patient demographics, treatment strategy, surgical procedures, complications and outcomes.

RESULTS

A total of 92 patients with median age 37 years (range 4-85) were identified. Sixty-eight patients (74%) were symptomatic. All patients, except for two, were immigrants to Norway and born in endemic areas. Ninety patients were diagnosed with CE and two with AE. Location of the cysts was most commonly in the liver (86%) followed by peritoneum, lungs, and spleen. All patients with active cysts were treated with albendazole. Surgical treatment was performed in 51 (56%) patients. The most common reason for abstaining from surgical treatment was that the diagnostic work-up revealed inactive cysts or interventional radiology was performed. Of the 51 patients who underwent surgery, a radical procedure was performed in 32 (64%) cases, a conservative procedure in 12 (24%), and a combination in six (12%). Clavien Dindo grade ≥3 complications occurred in 30%, and 90-day mortality was 2%. Bile leakage occurred in seven patients and was treated successfully with endoscopic retrograde cholangiopancreatography with biliary stent placement in all patients.

CONCLUSION

In a low-endemic area like Norway, management of echinococcus includes medical therapy, surgery, and/or interventional radiology. Surgical intervention seems to be effective, and is associated with acceptable morbidity rates.

Hydatid cysts of the liver with concomitant massive peritoneal hydatidosis: a case report

The worldwide distribution of Echinococcus granulosus and its capability to persist in the human organism by causing serious medical and economical damage makes this parasite popular in terms of diagnosis and treatment implementation. Besides the liver as the primary target organ for this parasite, cases of secondary peritoneal hydatidosis are reported. Although rarely, they present with unusual abdominal symptoms with a bizarre presentation on abdominal ultrasound and Computerized Tomography scans. We present a case of a 44 years old male patient with concomitant presence of liver hydatid cysts and massive peritoneal hydatidosis treated with a combination of surgery and postoperative medications. The treatment of peritoneal hydatidosis consists of surgical removal of all the present cysts. In addition, anti-parasitic drugs are recommended to prevent a recurrence. The concomitant presence of liver hydatid cysts and peritoneal echinococcosis can appear as a result of abdominal trauma or iatrogenic spillage during abdominal surgery.

Laparoscopic Treatment Strategies for Liver Echinococcosis

Liver echinococcosis is clinically mainly composed of hepatic cystic echinococcosis (CE) and hepatic alveolar echinococcosis (AE). At present, laparoscopy has been comprehensively applied in the treatment of two types of liver echinococcosis. For hepatic CE treatment, both laparoscopic total pericystectomy and laparoscopic hepatectomy can achieve radical results, but the former is considered the first choice owing to its being more minimally invasive; laparoscopic subtotal pericystectomy and laparoscopic partial pericystectomy can be accepted as complementary options, considering the presence of complicated cysts and the level of laparoscopic technique in remote hospitals; laparoscopic cystectomy is simple, but it is not currently recommended for treatment of hepatic CE owing to poor efficacy and high risk of postoperative complications. For hepatic AE treatment, laparoscopy not only achieves the same radical effect as open surgery in selected patients, but also is more minimally invasive, so it has a better prospect.

Unraveling post-translational modifications in Echinococcus granulosus sensu lato

Echinococcus granulosus sensu lato (s.l.) is the helminth parasite responsible for cystic echinococcosis, a neglected tropical disease currently affecting millions of people worldwide. Incomplete knowledge on the parasite biochemistry contributes, at least partially, to the limited development of useful biotechnological advances for the infection control. In this sense, little information is available regarding post-translational modifications (PTMs) occurring in E. granulosus s.l. proteins, which ultimately may affect the performance of biotechnological products to be developed. Therefore, we report here a proteomic analysis of the parasite PTMs identified through FindMod software applied to a set of tegumental proteins previously characterized by mass spectrometry (MALDI-TOF/TOF) analysis of protein spots from a 2D electrophoresis gel. Manual searches for already annotated proteins exhibiting such PTMs were also performed within proteome databases of E. granulosus s.l. and other platyhelminthes. In addition, key enzymes involved in PTMs modifications were searched for within E. granulosus s.l. proteome. Finally, the presence of selected PTMs was further confirmed by a high-resolution proteomic approach (nanoLC-MS/MS). A set of 22 different PTMs most likely to be present in the parasite was suggested, 9 of them with high confidence as they were identified in the same m/z fragment by both proteomic techniques (acetylation, deamidation, deamidation followed by methylation, mono- and di-hydroxylation, mono- and di-methylation, S-nitrosylation and phosphorylation). Interestingly, 5 PTMs were herein identified for the first time in E. granulosus s.l. proteins. Our results expand the scarcely studied topic of PTMs in platyhelminthes.

Pulmonary hydatid cyst mimicking lung tumor in a heavy smoker patient— Uniportal VATS management

Introduction and importance

Human infection with E. granulosus leads to the development of one or more hydatid cysts located most often in the liver and lungs. However, radiologically and clinically, analysis of atypical or complicated pulmonary hydatid cysts may resemble other types of malignancies.

Case presentation

Here, we present a 65-year-old man presented with chest pain, loss of appetite, and weight loss for 6 months' duration. The patient was surgically treated for a pulmonary hydatid cyst that mimicked a lung tumor clinically and radiologically. The patient underwent surgery using a uniportal video-assisted thoracoscopic surgery (UVATS) approach. The patient was put on an anti-helminthic drug (Albendazole table 400 mg twice daily for 21 days and 14 days off). He will continue for 3 cycles on this schedule.

Discussion

The diagnosis of pulmonary hydatid cyst depends mainly on the imaging procedures supported by appropriate serology and often histopathology. The treatment of choice for the pulmonary hydatid cyst is surgical resection. The uniportal video-assisted thoracoscopic surgery (UVATS) method has been proven to be safe and effective around globally. This includes a shorter surgery time, less pain, less chest tube drainage, and less need for painkillers after the surgery.

Conclusion

In this report, we present a case of a radiologically and clinically pulmonary hydatid cyst mimicking a lung tumor. In the differential diagnosis of a lung tumor, a pulmonary hydatid cyst should be considered particularly in endemic regions.

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Atypical or complicated pulmonary hydatid cysts may resemble other types of malignancies radiologically and clinically.

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In the differential diagnosis of a lung tumor, a pulmonary hydatid cyst should be considered.

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Uniportal VATS approach is simple, safe and feasible for removal of pulmonary hydatid cyst.

Ruptured pulmonary hydatid cyst presenting as hemoptysis in TB endemic country: A case report

Introduction

Hydatid disease is a major zoonotic disease. After the liver, the lungs are the common site of involvement. Clinical manifestations of the disease depend on the site and size of the cysts as well as the presence of complications. The majority of the cases remain asymptomatic. Complicated pulmonary cysts can present as chest pain, cough, shortness of breath, and hemoptysis. Sometimes, imaging is not sufficient for diagnosis and histopathological evaluation can provide the confirmatory diagnosis.

Case presentation

A 32-year-old female presented with the complaints of episodic hemoptysis for the duration of two years. Radiological imaging could not provide a confirmatory diagnosis. Bronchoscopy was planned further. An endobronchial biopsy was taken for histopathological evaluation after seeing the whitish membranous structure within the right middle lobe bronchus. Hence, the diagnosis of ruptured cystic pulmonary hydatidosis was made.

Clinical discussion

Echinococcus granulosus is the cause of cystic pulmonary hydatid disease which is transmitted through contamination by the infected definitive host, mostly dogs. Most cases remain asymptomatic for a long period. Hydatid disease has many clinical and radiological forms which should be recognized and included in the differential diagnosis of many pulmonary problems. Sometimes, imaging and serological studies may not confirm the diagnosis, histopathological evaluation may be required.

Conclusion

Uncomplicated hydatid cysts are most commonly diagnosed incidentally in the adult population. Complicated hydatid cyst can present with various clinical manifestations. Episodic hemoptysis is one of the manifestations in our case. Clinicians should be aware of the typical as well as atypical manifestations of pulmonary hydatid disease.

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Ruptured pulmonary hydatid cyst usually presents with anaphylactic reaction but hemoptysis alone can be a presentation.

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Imaging and histologic findings help in confirming the diagnosis.

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Preventive educational program and early identification with atypical features are vital to prevent potential complications.

Effects of green synthesized zinc nanoparticles alone and along with albendazole against hydatid cyst protoscoleces

Background

The current investigation aims to green synthesized the zinc nanoparticles (ZnNPs) using Lavandula angustifolia extract by microwave technique and its protoscolicidal effects alone and combined with albendazole against hydatid cyst protoscoleces.

Methods

Different concentrations of the ZnNPs (50, 100, and 200 μg/ml) alone and combined with albendazole (ALZ, 100 μg/ml) were treated with hydatid cyst protoscoleces obtained from liver of infected sheep for 5–60 min in vitro and ex vivo. Eosin exclusion examination was used to assess the viability of protoscoleces. The induction of apoptosis in hydatid cyst protoscoleces was assessed by measurement of the Caspase-3 activity of protoscoleces treated with various concentrations of ZnNPs.

Results

The size of green synthesized ZnNPs was ranged from 30 to 80 nm, most of these nanoparticles were between 50 and 60 nm in size. In vitro, the highest scolicidal effect of ZnNPs was observed at the concentration of 200 μg/ml, where it killed 81.6% of protoscolices. While the combination of these nanoparticles with ALZ, especially at the concentration of 200 μg/ml, completely killed the protoscolices after 10 min’ exposure. However, compared to in vitro assay, the drugs tested took longer to show their protoscolicidal effect.

Conclusion

Based on the obtained results, ZnNPs particularly in combination with albendazole displayed the potent protoscolicidal in vitro and ex vivo as an intraperitoneal model of administration of agents to hydatid cyst treatment; nevertheless, additional investigations are mandatory to evaluate the efficacy and safety Zn NPs as a favorable protoscolicidal agent in clinical setting.

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ZnNPs particularly in combination with albendazole displayed the relevant protoscolicidal in vitro effects.

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ZnNPs particularly in combination with albendazole displayed the potent protoscolicidal ex vivo effects.

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ZnNPs induced the apoptosis through the activation of caspase-3 enzyme.

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Additional investigations are mandatory to evaluate the its efficacy and safety in clinical setting.

Assessment of echinococcosis control in Tibet Autonomous Region, China

BACKGROUND

In China the highest prevalence of echinococcosis is in Tibet Autonomous Region (TAR). The government has issued documents and implemented comprehensive prevention and control measures focusing on controlling the source of infection of echinococcosis. It was very important to understand the implementation and effect of infectious source control measures. The purpose of this study was to examine the implementation of measures to control infectious source (domestic and stray dogs) in TAR and to assess their effectiveness.

METHODS

We collected data on domestic dog registration and deworming and stray dog sheltering in 74 counties/districts in the TAR from 2017 to 2019. Fecal samples from domestic dogs were collected from randomly selected towns to determine Echinococcus infection in dogs using coproantigen ELISA. We analyzed the data to compare the canine rate of infection between 2016 and 2019. The data analysis was performed by SPSS statistical to compare dog infection rate in 2016 and 2019 by chi-square test, and ArcGIS was used for mapping.

RESULTS

From 2017 to 2019, 84 stray dog shelters were built in TAR, and accumulatively 446,660 stray or infected dogs were arrested, sheltered, or disposed of. The number of domestic dogs went downward, with an increased registration management rate of 78.4% (2017), 88.8% (2018), and 99.0% (2019). Dogs were dewormed 5 times in 2017, 12 times in 2018, and 12 times in 2019. The dog infection rate was 1.7% (252/14,584) in 2019, significantly lower than 7.3% (552/7564) from the survey of echinococcosis prevalence in Tibet in 2016 (P < 0.05).

CONCLUSION

Between 2017 and 2019, the number of stray dogs and infection rate of Echinococcus spp. in domestic dogs decreased significantly, indicating that dogs were effectively controlled as a source of infection in TAR and reflecting a significant decrease in the risk of echinococcosis transmission.

Cell-Membrane Biomimetic Indocyanine Green Liposomes for Phototheranostics of Echinococcosis

Echinococcosis is an important zoonotic infectious disease that seriously affects human health. Conventional diagnosis of echinococcosis relies on the application of large-scale imaging equipment, which is difficult to promote in remote areas. Meanwhile, surgery and chemotherapy for echinococcosis can cause serious trauma and side effects. Thus, the development of simple and effective treatment strategies is of great significance for the diagnosis and treatment of echinococcosis. Herein, we designed a phototheranostic system utilizing neutrophil-membrane-camouflaged indocyanine green liposomes (Lipo-ICG) for active targeting the near-infrared fluorescence diagnosis and photothermal therapy of echinococcosis. The biomimetic Lipo-ICG exhibits a remarkable photo-to-heat converting performance and desirable active-targeting features by the inflammatory chemotaxis of the neutrophil membrane. In-vitro and in-vivo studies reveal that biomimetic Lipo-ICG with high biocompatibility can achieve in-vivo near-infrared fluorescence imaging and phototherapy of echinococcosis in mouse models. Our research is the first to apply bionanomaterials to the phototherapy of echinococcosis, which provides a new standard for the convenient and noninvasive detection and treatment of zoonotic diseases.

Autoimmunity in human CE: Correlative with the fertility status of the CE cyst

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.

Integrative Analysis of RNA Expression and Regulatory Networks in Mice Liver Infected by Echinococcus multilocularis

The larvae of Echinococcus multilocularis causes alveolar echinococcosis, which poses a great threat to the public health. However, the molecular mechanisms underlying the host and parasite interactions are still unclear. Exploring the transcriptomic maps of mRNA, miRNA and lncRNA expressed in the liver in response to E. multilocularis infection will help us to understand its pathogenesis. Using liver perfusion, different cell populations including the hepatic cells, hepatic stellate cells and Kupffer cells were isolated from mice interperitoneally inoculated with protoscoleces. Their transcriptional profiles including lncRNAs, miRNAs and mRNAs were done by RNA-seq. Among these cell populations, the most differentially-expressed (DE) mRNA, lncRNAs and miRNAs were annotated and may involve in the pathological processes, mainly including metabolic disorders, immune responses and liver fibrosis. Following the integrative analysis of 38 differentially-expressed DEmiRNAs and 8 DElncRNAs, the lncRNA-mRNA-miRNA networks were constructed, including F63-miR-223-3p-Fbxw7/ZFP36/map1b, F63-miR-27-5p-Tdrd6/Dip2c/Wdfy4 and IFNgAS1-IFN-γ. These results unveil the presence of several potential lncRNA-mRNA-miRNA axes during E. multilocularis infection, and further exploring of these axes may contribute to better understanding of the pathogenic mechanisms.

Cystic Echinococcosis of Liver and Spleen Communicating to the Lung: A Rare Case

The annual cystic echinococcosis (CE) incidence in endemic countries is between 1 and 200 per 100,000 population. The clinical manifestations of CE are associated with damage or dysfunction of target organs and affect primarily the liver in around 70% of cases and lungs in around 20% of cases. The involvement of the spleen is rarely seen, representing 2 to 6% of all CE cases. We describe a 60-year-old female patient who presented with 15 days' history of intermittent fever and abdominal distension, having significant hepatosplenomegaly. CE was diagnosed involving the liver, spleen, and lungs and was confirmed radiologically and microbiologically. CE is caused by the larval or cystic stage of the zoonotic dog-tapeworm. Humans can be infected by ingestion of contaminated food or water. At present, there are nine species under the genus Echinococcus with E. granulosus sensu stricto having worldwide distribution, while the rest are focally distributed. CE involving multiple organs is rare. CE should be taken into consideration in patients with these symptoms in endemic areas.