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Abudouaini H, Zhang X, Dai Y, Meng Y, Lu Q, Ren Q, Sun H, Ma Y, He B, Wang S. Activating the iNOS regulatory pathway by arginine deprivation targets energy metabolism to induce autophagy-dependent apoptosis against spinal echinococcosis. Biochem Pharmacol 2024; 227:116453. [PMID: 39059773 DOI: 10.1016/j.bcp.2024.116453] [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: 03/20/2024] [Revised: 07/23/2024] [Accepted: 07/23/2024] [Indexed: 07/28/2024]
Abstract
Spinal echinococcosis is one of the most overlooked zoonotic parasitic diseases worldwide. There is currently no safe and effective treatment to eradicate it, and research based on the physiological-metabolic signature of the disease is lacking. Herein, we repurposed agrimol B as a potent anti-hydatid compound and validated its pharmacological mechanism based on arginine uptake as a target through multi-omics sequencing. This herbal component suppressed energy metabolism and activated ROS aggregation by inducing mitochondrial membrane potential depolarization, which subsequently triggered autophagy-dependent apoptosis leading to parasite death. Moreover, we discovered that arginine deprivation induced metabolic changes led to a shift from ornithine to nitrogen oxide synthesis, thus boosting the iNOS enzyme-regulated dominant metabolic pathway. The excess NO targeted the mitochondrial respiratory chain complex IV to disrupt energy metabolic homeostasis and induced a downstream pathological waterfall effect to kill the hydatid. A novel metabolic regulatory mechanism targeting mitochondrial damage for arginine starvation therapy was discovered. Finally, arginine depletion was found to be superior to the anti-spinal echinococcosis effect of albendazole and accompanied by the potential for disc protection. This study unveils the role of arginine in the physiological metabolism of Echinococcus granulosus and reveals the value of targeting arginine metabolism as a potential therapy. In addition, agrimol B is proposed as a promising therapeutic strategy for spinal echinococcosis to block arginine uptake and break this parasite's metabolic balance.
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Affiliation(s)
- Haimiti Abudouaini
- Department of Spine Surgery, Xi'an Jiaotong University Affiliated HongHui Hospital, Beilin District, Xi'an, Shanxi Province, 710000, China
| | - Xuefang Zhang
- Department of Spine Surgery, Xi'an Jiaotong University Affiliated HongHui Hospital, Beilin District, Xi'an, Shanxi Province, 710000, China
| | - Yi Dai
- The First Affiliated Hospital of Shihezi University, Xinjiang Uygur Autonomous Region, Shihezi City, 832000, China
| | - Yibin Meng
- Department of Spine Surgery, Xi'an Jiaotong University Affiliated HongHui Hospital, Beilin District, Xi'an, Shanxi Province, 710000, China
| | - Qing Lu
- Department of Spine Surgery, Xi'an Jiaotong University Affiliated HongHui Hospital, Beilin District, Xi'an, Shanxi Province, 710000, China
| | - Qian Ren
- The First Affiliated Hospital of Shihezi University, Xinjiang Uygur Autonomous Region, Shihezi City, 832000, China
| | - Haohao Sun
- The First Affiliated Hospital of Shihezi University, Xinjiang Uygur Autonomous Region, Shihezi City, 832000, China
| | - Yibo Ma
- The First Affiliated Hospital of Shihezi University, Xinjiang Uygur Autonomous Region, Shihezi City, 832000, China
| | - Baorong He
- Department of Spine Surgery, Xi'an Jiaotong University Affiliated HongHui Hospital, Beilin District, Xi'an, Shanxi Province, 710000, China.
| | - Sibo Wang
- Department of Spine Surgery, Xi'an Jiaotong University Affiliated HongHui Hospital, Beilin District, Xi'an, Shanxi Province, 710000, China.
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Ma W, Ma Z, Shi Y, Pang X, Yimingjiang M, Dang Z, Cui W, Lin R, Zhang W. Comparison of clinicopathological features between cerebral cystic and alveolar echinococcosis: analysis of 27 cerebral echinococcosis cases in Xinjiang, China. Diagn Pathol 2024; 19:90. [PMID: 38956596 PMCID: PMC11218392 DOI: 10.1186/s13000-024-01500-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/16/2024] [Accepted: 05/27/2024] [Indexed: 07/04/2024] Open
Abstract
BACKGROUND Cerebral echinococcosis is relatively rare, and it is important to distinguish cerebral cystic echinococcosis (CCE) from cerebral alveolar echinococcosis (CAE) in terms of pathological diagnosis. We aim to describe the different clinicopathological features among patients with CCE and CAE. METHODS We collected 27 cases of cerebral echinococcosis which were diagnosed in the Department of Pathology of the First Affiliated Hospital of Xinjiang Medical University from January 1, 2012, to June 30, 2023. We compared the patients' clinical characteristics, MRI features, and pathologic manifestations of CCE and CAE. RESULTS Among 27 cases of cerebral echinococcosis, 23 cases were CAE and 4 cases were CCE. The clinical manifestations of both CCE and CAE patients mainly included headache (21 patients, 77.78%), limb movement disorders (6 patients, 22.22%), epileptic seizures (4 patients, 14.81%) and visual disturbances (2 patients, 7.41%). The average onset age of CAE cases was 34.96 ± 11.11 years, which was 9.00 ± 7.26 years in CCE cases. All CAE patients presented with multiple involvements in the brain and extracranial organs while all CCE patients observed a solitary lesion in the brain and 3 CCE cases had no extracranial involvement. Lesions of CCE in MRI showed a single isolated circular, which was well demarcated from the surrounding tissues and with no obvious edema around the lesions, whereas CAE lesions presented as multiple intracranial lesions, with blurred edges and edema around the lesions, and multiple small vesicles could be observed in the lesions. The edge of CAE lesions could be enhanced, while CCE lesions have no obvious enhancement. CCE foci were clear cysts with a wall of about 0.1 cm. Microscopically, the walls of the cysts were characterized by an eosinophilic keratin layer, which was flanked on one side by basophilic germinal lamina cells, which were sometimes visible as protocephalic nodes. While the CAE lesion was a nodular structure with a rough and uneven nodule surface, and the cut section was cystic and solid; microscopically, the CAE lesion had areas of coagulative necrosis, and the proto-cephalic nodes were barely visible. Inflammatory cell areas consisting of macrophages, lymphocytes, epithelioid cells, plasma cells, eosinophils, and fibroblasts can be seen around the lesion. Brain tissues in the vicinity of the inflammatory cell areas may show apoptosis, degeneration, necrosis, and cellular edema, while brain tissues a little farther away from the lesion show a normal morphology. CONCLUSIONS With the low incidence of brain echinococcosis, the diagnosis of echinococcosis and the differential diagnosis of CAE and CCE are challenging for pathologists. Grasping the different clinical pathology characteristics of CAE and CCE is helpful for pathologists to make accurate diagnoses.
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Affiliation(s)
- Wenmei Ma
- Department of Pathology, The First Affiliated Hospital of Xinjiang Medical University, Xinjiang, China
- State Key Laboratory of Pathogenesis, Prevention and Treatment of High Incidence Diseases in Central Asia, Urumqi, 830054, Xinjiang, China
| | - Zhiping Ma
- Department of Pathology, The First Affiliated Hospital of Xinjiang Medical University, Xinjiang, China
| | - Yi Shi
- Department of Pathology, The First Affiliated Hospital of Xinjiang Medical University, Xinjiang, China
| | - Xuelian Pang
- Department of Pathology, The First Affiliated Hospital of Xinjiang Medical University, Xinjiang, China
| | - Maiweilidan Yimingjiang
- Department of Pathology, The First Affiliated Hospital of Xinjiang Medical University, Xinjiang, China
| | - Zhe Dang
- Department of Nuclear Medicine, The First Affiliated Hospital of Xinjiang Medical University, Xinjiang, China
| | - Wenli Cui
- Department of Pathology, The First Affiliated Hospital of Xinjiang Medical University, Xinjiang, China
| | - Renyong Lin
- Department of Pathology, The First Affiliated Hospital of Xinjiang Medical University, Xinjiang, China
- State Key Laboratory of Pathogenesis, Prevention and Treatment of High Incidence Diseases in Central Asia, Urumqi, 830054, Xinjiang, China
| | - Wei Zhang
- Department of Pathology, The First Affiliated Hospital of Xinjiang Medical University, Xinjiang, China.
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Li X, Dang Z, Tang W, Zhang H, Shao J, Jiang R, Zhang X, Huang F. Detection of Parasites in the Field: The Ever-Innovating CRISPR/Cas12a. BIOSENSORS 2024; 14:145. [PMID: 38534252 DOI: 10.3390/bios14030145] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/19/2023] [Revised: 03/11/2024] [Accepted: 03/12/2024] [Indexed: 03/28/2024]
Abstract
The rapid and accurate identification of parasites is crucial for prompt therapeutic intervention in parasitosis and effective epidemiological surveillance. For accurate and effective clinical diagnosis, it is imperative to develop a nucleic-acid-based diagnostic tool that combines the sensitivity and specificity of nucleic acid amplification tests (NAATs) with the speed, cost-effectiveness, and convenience of isothermal amplification methods. A new nucleic acid detection method, utilizing the clustered regularly interspaced short palindromic repeats (CRISPR)-associated (Cas) nuclease, holds promise in point-of-care testing (POCT). CRISPR/Cas12a is presently employed for the detection of Plasmodium falciparum, Toxoplasma gondii, Schistosoma haematobium, and other parasites in blood, urine, or feces. Compared to traditional assays, the CRISPR assay has demonstrated notable advantages, including comparable sensitivity and specificity, simple observation of reaction results, easy and stable transportation conditions, and low equipment dependence. However, a common issue arises as both amplification and cis-cleavage compete in one-pot assays, leading to an extended reaction time. The use of suboptimal crRNA, light-activated crRNA, and spatial separation can potentially weaken or entirely eliminate the competition between amplification and cis-cleavage. This could lead to enhanced sensitivity and reduced reaction times in one-pot assays. Nevertheless, higher costs and complex pre-test genome extraction have hindered the popularization of CRISPR/Cas12a in POCT.
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Affiliation(s)
- Xin Li
- School of Life Science and Engineering, Foshan University, Foshan 528225, China
| | - Zhisheng Dang
- National Institute of Parasitic Diseases, Chinese Center for Diseases Control and Prevention (Chinese Center for Tropical Diseases Research), Key Laboratory of Parasite and Vector Biology, National Health Commission of the People's Republic of China (NHC), World Health Organization (WHO) Collaborating Center for Tropical Diseases, National Center for International Research on Tropical Diseases, Shanghai 200025, China
| | - Wenqiang Tang
- State Key Laboratory of Hulless Barley and Yak Germplasm Resources and Genetic Improvement, Lhasa 850002, China
- Tibet Academy of Agriculture and Animal Husbandry Sciences, Lhasa 850002, China
| | - Haoji Zhang
- School of Life Science and Engineering, Foshan University, Foshan 528225, China
| | - Jianwei Shao
- School of Life Science and Engineering, Foshan University, Foshan 528225, China
| | - Rui Jiang
- College of Animal Science and Veterinary Medicine, Huazhong Agricultural University, Wuhan 430070, China
| | - Xu Zhang
- School of Life Science and Engineering, Foshan University, Foshan 528225, China
| | - Fuqiang Huang
- School of Life Science and Engineering, Foshan University, Foshan 528225, China
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Yimit Y, Yasin P, Tuersun A, Abulizi A, Jia W, Wang Y, Nijiati M. Differentiation between cerebral alveolar echinococcosis and brain metastases with radiomics combined machine learning approach. Eur J Med Res 2023; 28:577. [PMID: 38071384 PMCID: PMC10709961 DOI: 10.1186/s40001-023-01550-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/28/2023] [Accepted: 11/23/2023] [Indexed: 12/18/2023] Open
Abstract
BACKGROUND Cerebral alveolar echinococcosis (CAE) and brain metastases (BM) share similar in locations and imaging appearance. However, they require distinct treatment approaches, with CAE typically treated with chemotherapy and surgery, while BM is managed with radiotherapy and targeted therapy for the primary malignancy. Accurate diagnosis is crucial due to the divergent treatment strategies. PURPOSE This study aims to evaluate the effectiveness of radiomics and machine learning techniques based on magnetic resonance imaging (MRI) to differentiate between CAE and BM. METHODS We retrospectively analyzed MRI images of 130 patients (30 CAE and 100 BM) from Xinjiang Medical University First Affiliated Hospital and The First People's Hospital of Kashi Prefecture, between January 2014 and December 2022. The dataset was divided into training (91 cases) and testing (39 cases) sets. Three dimensional tumors were segmented by radiologists from contrast-enhanced T1WI images on open resources software 3D Slicer. Features were extracted on Pyradiomics, further feature reduction was carried out using univariate analysis, correlation analysis, and least absolute shrinkage and selection operator (LASSO). Finally, we built five machine learning models, support vector machine, logistic regression, linear discrimination analysis, k-nearest neighbors classifier, and Gaussian naïve bias and evaluated their performance via several metrics including sensitivity (recall), specificity, positive predictive value (precision), negative predictive value, accuracy and the area under the curve (AUC). RESULTS The area under curve (AUC) of support vector classifier (SVC), linear discrimination analysis (LDA), k-nearest neighbors (KNN), and gaussian naïve bias (NB) algorithms in training (testing) sets are 0.99 (0.94), 1.00 (0.87), 0.98 (0.92), 0.97 (0.97), and 0.98 (0.93), respectively. Nested cross-validation demonstrated the robustness and generalizability of the models. Additionally, the calibration plot and decision curve analysis demonstrated the practical usefulness of these models in clinical practice, with lower bias toward different subgroups during decision-making. CONCLUSION The combination of radiomics and machine learning approach based on contrast enhanced T1WI images could well distinguish CAE and BM. This approach holds promise in assisting doctors with accurate diagnosis and clinical decision-making.
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Affiliation(s)
- Yasen Yimit
- Medical Imaging Center, The First People's Hospital of Kashi (Kashgar) Prefecture, Kashi, 844000, People's Republic of China
| | - Parhat Yasin
- Department of Spine Surgery, The First Affiliated Hospital of Xinjiang Medical University, Urumqi, 830054, Xinjiang, China
| | - Abuduresuli Tuersun
- Medical Imaging Center, The First People's Hospital of Kashi (Kashgar) Prefecture, Kashi, 844000, People's Republic of China
| | - Abudoukeyoumujiang Abulizi
- Medical Imaging Center, The First People's Hospital of Kashi (Kashgar) Prefecture, Kashi, 844000, People's Republic of China
| | - Wenxiao Jia
- Medical Imaging Center, Xinjiang Medical University Affiliated First Hospital, Urumqi, 830054, People's Republic of China
| | - Yunling Wang
- Medical Imaging Center, Xinjiang Medical University Affiliated First Hospital, Urumqi, 830054, People's Republic of China
| | - Mayidili Nijiati
- Medical Imaging Center, The First People's Hospital of Kashi (Kashgar) Prefecture, Kashi, 844000, People's Republic of China.
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文 家, 王 奇, 费 帆, 廖 晓, 陈 勇, 袁 莉, 陈 增, 陈 隆, 徐 如, 刘 进. [Clinical Features and Surgical Outcomes of 15 Cases of Intracranial Alveolar Echinococcosis]. SICHUAN DA XUE XUE BAO. YI XUE BAN = JOURNAL OF SICHUAN UNIVERSITY. MEDICAL SCIENCE EDITION 2023; 54:1250-1255. [PMID: 38162060 PMCID: PMC10752774 DOI: 10.12182/20231160603] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 12/18/2022] [Indexed: 01/03/2024]
Abstract
Objective To investigate the surgical treatment strategy of intracranial alveolar echinococcosis (AE) and the clinical outcomes. Methods The clinical and follow-up data of 15 intracranial AE patients who underwent surgical treatment in the Departments of Neurosurgery of Sichuan Provincial People's Hospital (SPPH) and People's Hospital of Aba Tibetan and Qiang Autonomous Prefecture (a branch hospital of SPPH) between March 2017 and January 2021 were retrospectively analyzed. Full follow-up data were available for each of the 15 cases. The clinical and imaging characteristics, general surgical information, and surgical outcomes were analyzed. Results In the 15 patients, there were a total of 50 intracranial lesions, with an average of (3.3±3.1)/case. Four cases had solitary intracranial lesions, while 11 cases had multiple lesions, with the number of intracranial lesions per case ranging from 2 to 13. All patients with solitary intracranial lesions received total resection. In 6 patients with multiple intracranial lesions, only the largest lesion was surgically removed, and in 5 patients, 2 to 3 adjacent lesions were surgically removed. All but one patient had extracranial lesions in their liver, lungs, kidneys, adrenal glands, and thoracic vertebrae. The patients were followed up for 12 to 58 months after surgery, with the mean follow-up time being (28.1±13.4) months. Among the 15 cases, 13 showed stable intracranial condition during postoperative follow-up. Intracranial lesions recurred in 2 patients who had deep lesions accompanied by dissemination to the subarachnoid space. Two patients died during follow-up. Conclusion Microsurgical treatment of intracranial AE is effective, but total surgical resection is difficult to accomplish when patients have echinococcosis lesions located at a depth, especially when the lesions are spreading to the subarachnoid space. The prognosis of patients is closely associated with the extent of lesion invasion and the control of systemic hydatid lesions, especially those in the liver.
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Affiliation(s)
- 家智 文
- 阿坝藏族羌族自治州人民医院 神经外科 (马尔康 624000)Department of Neurosurgery, People's Hospital of Aba Tibetan and Qiang Autonomous Prefecture, Maerkang 624000, China
| | - 奇 王
- 阿坝藏族羌族自治州人民医院 神经外科 (马尔康 624000)Department of Neurosurgery, People's Hospital of Aba Tibetan and Qiang Autonomous Prefecture, Maerkang 624000, China
| | - 帆 费
- 阿坝藏族羌族自治州人民医院 神经外科 (马尔康 624000)Department of Neurosurgery, People's Hospital of Aba Tibetan and Qiang Autonomous Prefecture, Maerkang 624000, China
| | - 晓灵 廖
- 阿坝藏族羌族自治州人民医院 神经外科 (马尔康 624000)Department of Neurosurgery, People's Hospital of Aba Tibetan and Qiang Autonomous Prefecture, Maerkang 624000, China
| | - 勇 陈
- 阿坝藏族羌族自治州人民医院 神经外科 (马尔康 624000)Department of Neurosurgery, People's Hospital of Aba Tibetan and Qiang Autonomous Prefecture, Maerkang 624000, China
| | - 莉 袁
- 阿坝藏族羌族自治州人民医院 神经外科 (马尔康 624000)Department of Neurosurgery, People's Hospital of Aba Tibetan and Qiang Autonomous Prefecture, Maerkang 624000, China
| | - 增雄 陈
- 阿坝藏族羌族自治州人民医院 神经外科 (马尔康 624000)Department of Neurosurgery, People's Hospital of Aba Tibetan and Qiang Autonomous Prefecture, Maerkang 624000, China
| | - 隆益 陈
- 阿坝藏族羌族自治州人民医院 神经外科 (马尔康 624000)Department of Neurosurgery, People's Hospital of Aba Tibetan and Qiang Autonomous Prefecture, Maerkang 624000, China
| | - 如祥 徐
- 阿坝藏族羌族自治州人民医院 神经外科 (马尔康 624000)Department of Neurosurgery, People's Hospital of Aba Tibetan and Qiang Autonomous Prefecture, Maerkang 624000, China
| | - 进平 刘
- 阿坝藏族羌族自治州人民医院 神经外科 (马尔康 624000)Department of Neurosurgery, People's Hospital of Aba Tibetan and Qiang Autonomous Prefecture, Maerkang 624000, China
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Wang S, Sun H, Wang S, Ren Q, Dai Y, Zhu M, Zhang Y, Kang H, Li J, Xiao J, Dong Y, Wang W. α-Mangostin Exhibits a Therapeutic Effect on Spinal Cystic Echinococcosis by Affecting Glutamine Metabolism. Antimicrob Agents Chemother 2023; 67:e0009823. [PMID: 37140388 PMCID: PMC10269084 DOI: 10.1128/aac.00098-23] [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: 01/25/2023] [Accepted: 04/03/2023] [Indexed: 05/05/2023] Open
Abstract
Spinal cystic echinococcosis, a severely neglected, rare disease, is characterized by high morbidity, disability, and mortality in prevalent regions. Due to the high-risk nature of surgical treatment and the ineffectiveness of conventional drugs, there is an unmet need for novel safe and effective drugs for the treatment of this disease. In this study, we examined the therapeutic effects of α-mangostin for spinal cystic echinococcosis, and explored its potential pharmacological mechanism. The repurposed drug exhibited a potent in vitro protoscolicidal effect and significantly inhibited the evolution of larval encystation. Moreover, it demonstrated a remarkable anti-spinal cystic echinococcosis effect in gerbil models. Mechanistically, we found that α-mangostin intervention led to intracellular depolarization of mitochondrial membrane potential and reactive oxygen species generation. In addition, we observed elevated expression of autophagic proteins, aggregation of autophagic lysosomes, activated autophagic flux, and disrupted larval microstructure in protoscoleces. Further metabolite profiling showed that glutamine was imperative for autophagic activation and anti-echinococcal effects mediated by α-mangostin. These results suggest that α-mangostin is a potentially valuable therapeutic option against spinal cystic echinococcosis through its effect on glutamine metabolism.
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Affiliation(s)
- Sibo Wang
- Department of Orthopedics, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
- The First Affiliated Hospital of Shihezi University, Shihezi City, Xinjiang Uygur Autonomous Region, China
| | - Haohao Sun
- The First Affiliated Hospital of Shihezi University, Shihezi City, Xinjiang Uygur Autonomous Region, China
| | - Shan Wang
- The First Affiliated Hospital of Shihezi University, Shihezi City, Xinjiang Uygur Autonomous Region, China
| | - Qian Ren
- The First Affiliated Hospital of Shihezi University, Shihezi City, Xinjiang Uygur Autonomous Region, China
| | - Yi Dai
- The First Affiliated Hospital of Shihezi University, Shihezi City, Xinjiang Uygur Autonomous Region, China
| | - Meipeng Zhu
- Department of Orthopedics, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
| | - Yayun Zhang
- Department of Orthopedics, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
| | - Honglei Kang
- Department of Orthopedics, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
| | - Jing Li
- The First Affiliated Hospital of Shihezi University, Shihezi City, Xinjiang Uygur Autonomous Region, China
| | - Jun Xiao
- The First Affiliated Hospital of Shihezi University, Shihezi City, Xinjiang Uygur Autonomous Region, China
| | - Yimin Dong
- Department of Orthopedics, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
| | - Weishan Wang
- The First Affiliated Hospital of Shihezi University, Shihezi City, Xinjiang Uygur Autonomous Region, China
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Belloumi N, Habouria C, Fidha S, Bachouch I, Ben Abdallah FC, Fenniche S. Non-resectable pulmonary alveolar echinococcosis with multi-stage vertebral location. Respir Med Case Rep 2023; 44:101886. [PMID: 37388238 PMCID: PMC10302124 DOI: 10.1016/j.rmcr.2023.101886] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/11/2023] [Revised: 04/19/2023] [Accepted: 06/04/2023] [Indexed: 07/01/2023] Open
Abstract
Alveolar echinococcosis (also known as Hydatid cyst or Hydatydosis) is a zoonosis with a high degree of disability and morbidity. Bone echinococcosis is a rare presentation. Authors are always defending a personalized approach taking account of the particularities of the cyst location. Recognition of this syndrome is crucial because advances in medical and surgical management strategies have controlled and relieved symptoms in numerous cases. We report, hereby, a case of a patient with a thoracic spine alveolar echinococcosis of an unusual extension. We discussed the outcome of the treatment after fifteen years of follow-up.
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Affiliation(s)
- N. Belloumi
- Pulmonology department Pavilion 4, Abderrahmen Mami hospital, Ariana, Tunisia
- Faculty of medicine of Tunis, University of Tunis el manar, Tunisia
| | - C. Habouria
- Pulmonology department Pavilion 4, Abderrahmen Mami hospital, Ariana, Tunisia
- Faculty of medicine of Tunis, University of Tunis el manar, Tunisia
| | - S. Fidha
- Pulmonology department Pavilion 4, Abderrahmen Mami hospital, Ariana, Tunisia
- Faculty of medicine of Tunis, University of Tunis el manar, Tunisia
| | - I. Bachouch
- Pulmonology department Pavilion 4, Abderrahmen Mami hospital, Ariana, Tunisia
- Faculty of medicine of Tunis, University of Tunis el manar, Tunisia
| | - F. Chermiti Ben Abdallah
- Pulmonology department Pavilion 4, Abderrahmen Mami hospital, Ariana, Tunisia
- Faculty of medicine of Tunis, University of Tunis el manar, Tunisia
| | - S. Fenniche
- Pulmonology department Pavilion 4, Abderrahmen Mami hospital, Ariana, Tunisia
- Faculty of medicine of Tunis, University of Tunis el manar, Tunisia
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Zali A, Shahmohammadi M, Biazar BH, Masoumi N, Samieefar N, Akhlaghdoust M. Spinal hydatid cyst initially diagnosed as spinal tumor: A case report and review of the literature. Clin Case Rep 2023; 11:e7244. [PMID: 37143458 PMCID: PMC10151595 DOI: 10.1002/ccr3.7244] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/17/2022] [Revised: 03/26/2023] [Accepted: 04/10/2023] [Indexed: 05/06/2023] Open
Abstract
The spinal hydatid cyst is a benign pathology but has considerable morbidity. It should be considered as a differential diagnosis in patients having signs and symptoms of spinal compression, particularly in endemic areas.
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Affiliation(s)
- Alireza Zali
- Functional Neurosurgery Research Center, Shohada Tajrish Neurosurgical Comprehensive Center of ExcellenceShahid Beheshti University of Medical SciencesTehranIran
- USERN Office, Functional Neurosurgery Research CenterShahid Beheshti University of Medical SciencesTehranIran
| | - Mohammadreza Shahmohammadi
- Functional Neurosurgery Research Center, Shohada Tajrish Neurosurgical Comprehensive Center of ExcellenceShahid Beheshti University of Medical SciencesTehranIran
| | - Bijan Herfedoust Biazar
- Functional Neurosurgery Research Center, Shohada Tajrish Neurosurgical Comprehensive Center of ExcellenceShahid Beheshti University of Medical SciencesTehranIran
| | - Niloofar Masoumi
- Student Research Committee, School of PharmacyShahid Beheshti University of Medical SciencesTehranIran
- USERN OfficeShahid Beheshti University of Medical SciencesTehranIran
- Network of Interdisciplinarity in Neonates and Infants (NINI)Universal Scientific Education and Research Network (USERN)TehranIran
| | - Noosha Samieefar
- USERN OfficeShahid Beheshti University of Medical SciencesTehranIran
- Network of Interdisciplinarity in Neonates and Infants (NINI)Universal Scientific Education and Research Network (USERN)TehranIran
- School of MedicineShahid Beheshti University of Medical SciencesTehranIran
| | - Meisam Akhlaghdoust
- Functional Neurosurgery Research Center, Shohada Tajrish Neurosurgical Comprehensive Center of ExcellenceShahid Beheshti University of Medical SciencesTehranIran
- USERN Office, Functional Neurosurgery Research CenterShahid Beheshti University of Medical SciencesTehranIran
- Network of Interdisciplinarity in Neonates and Infants (NINI)Universal Scientific Education and Research Network (USERN)TehranIran
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Alvi MA, Ali RMA, Khan S, Saqib M, Qamar W, Li L, Fu BQ, Yan HB, Jia WZ. Past and Present of Diagnosis of Echinococcosis: A Review (1999-2021). Acta Trop 2023; 243:106925. [PMID: 37080264 DOI: 10.1016/j.actatropica.2023.106925] [Citation(s) in RCA: 6] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/18/2023] [Revised: 03/17/2023] [Accepted: 04/08/2023] [Indexed: 04/22/2023]
Abstract
The larval forms of taeniid cestodes belonging to the genus Echinococcus are the source of the zoonotic infection known as echinococcosis. Alveolar and cystic echinococcosis are caused by Echinococcus multilocularis and Echinococcus granulosus (s. s) respectively. It is endemic in several regions of the world. In this systematic review, we describe diagnosis, and the species (human, canids, livestock, and small rodents) affected by cystic (CE) and alveolar echinococcosis (AE). From 1999 to 2021, we searched the online directory through PubMed, SCOPUS, Web of Science, and google scholar. Among the 37,700 records found in the online databases, 187 publications met our eligibility requirements. The majority of investigations employed a range of diagnostic methods, such as ELISA, imaging, copro-PCR, necropsy or arecoline hydrobromide purgation, morphological cestode confirmation, and fecal sieving/flotation to detect and confirm Echinococcus infection. ELISA was the most commonly used method followed by PCR, and imaging. The research team retrieved data describing the incidence or assessment of the diagnostic test for E. multilocularis in humans (N = 99), canids (N = 63), small ruminants (N = 13), large ruminants (N= 3), camel (N= 2), pigs (N=2) and small mammals (N= 5). This study was conducted to explore the diagnostic tools applied to detect echinococcosis in humans as well as animals in prevalent countries, and to report the characteristic of new diagnostic tests for disease surveillance. This systematic review revealed that ELISA (alone or in combination) was the most common method used for disease diagnosis and diagnostic efficacy and prevalence rate increased when recombinant antigens were used. It is highly recommended to use combination protcols such as serological with molecular and imaging technique to diagnose disease. Our study identified scarcity of data of reporting echinococcosis in humans/ animals in low-income or developing countries particularly central Asian countries. Study reports in small rodents indicate their role in disease dissemination but real situation in these host is not refected due to limited number of studies. Even though echinococcosis affects both public health and the domestic animal sector, therefore, it is important to devise new and strengthe implementation of the existing monitoring, judging, and control measures in this estimate.
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Affiliation(s)
- Mughees Aizaz Alvi
- State Key Laboratory of Veterinary Etiological Biology, College of Veterinary Medicine, Lanzhou University, National Para-reference Laboratory for Animal Echinococcosis, Lanzhou Veterinary Research Institute, Chinese Academy of Agricultural Sciences, Lanzhou, China; Department of Clinical Medicine and Surgery, University of Agriculture, Faisalabad, Pakistan
| | - Rana Muhammad Athar Ali
- Department of Clinical Medicine and Surgery, University of Agriculture, Faisalabad, Pakistan
| | - Sadiq Khan
- Department of Clinical Medicine and Surgery, University of Agriculture, Faisalabad, Pakistan
| | - Muhammad Saqib
- Department of Clinical Medicine and Surgery, University of Agriculture, Faisalabad, Pakistan
| | - Warda Qamar
- Department of Parasitology, University of Agriculture, Faisalabad, Pakistan
| | - Li Li
- State Key Laboratory of Veterinary Etiological Biology, College of Veterinary Medicine, Lanzhou University, National Para-reference Laboratory for Animal Echinococcosis, Lanzhou Veterinary Research Institute, Chinese Academy of Agricultural Sciences, Lanzhou, China
| | - Bao-Quan Fu
- State Key Laboratory of Veterinary Etiological Biology, College of Veterinary Medicine, Lanzhou University, National Para-reference Laboratory for Animal Echinococcosis, Lanzhou Veterinary Research Institute, Chinese Academy of Agricultural Sciences, Lanzhou, China
| | - Hong-Bin Yan
- State Key Laboratory of Veterinary Etiological Biology, College of Veterinary Medicine, Lanzhou University, National Para-reference Laboratory for Animal Echinococcosis, Lanzhou Veterinary Research Institute, Chinese Academy of Agricultural Sciences, Lanzhou, China.
| | - Wan-Zhong Jia
- State Key Laboratory of Veterinary Etiological Biology, College of Veterinary Medicine, Lanzhou University, National Para-reference Laboratory for Animal Echinococcosis, Lanzhou Veterinary Research Institute, Chinese Academy of Agricultural Sciences, Lanzhou, China; Jiangsu Co-innovation Center for Prevention and Control of Important Animal Infectious Diseases and Zoonoses, Yangzhou, China.
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10
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Yang L, Tuxunjiang P, Liu W, Guo H. Vertebral and pelvic echinococcosis in northwestern China. INTERNATIONAL ORTHOPAEDICS 2023; 47:1153-1162. [PMID: 36826481 PMCID: PMC10079730 DOI: 10.1007/s00264-023-05731-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/19/2023] [Accepted: 02/07/2023] [Indexed: 02/25/2023]
Abstract
PURPOSE Echinococcosis remains a major economic and severe public health problem in endemic areas. Bone echinococcosis is rare, and the vertebra and pelvis are the most common sites of echinococcosis involving the skeletal. Because of the clinical severe symptoms and high recurrence rate, it brings excellent trouble to patients. METHODS This study retrospectively analyzed the clinical manifestations, laboratory tests, radiological findings, and treatment of 44 patients with vertebral and pelvic echinococcosis during a period of 16 years (2005-2020). RESULTS The mean age was 43 years (25 males, 19 females; 19-68 years). The most common symptom was pain, followed by numbness, weakness, activity limitation, and progressive paraparesis. Enzyme-linked immunosorbent assay test (ELISA) results were positive in 18 cases (75%). There are 24 cases of hydatid infection of the spine, 14 hydatid infection of the pelvis, and six hydatid infection of both vertebra and pelvis. The site of infection was 13 (29.5%) thoracic, five (11.4%) lumbar, four (9.1%) lumbosacral, seven (15.9%) sacral, 19 (43.2%) ilium, seven (15.9%) hip, six (13.6%) ischium, five (11.4%) pubis, and two (4.5%) femur, respectively. The imaging findings were cystic dilatancy, septal, and irregular bone destruction. MRI has a special value in showing the relationship between the surrounding tissues and organs of cystic bone echinococcosis. All patients were followed up for at least one year. The mean follow-up time was 3.6 years. CONCLUSIONS Even in epidemic areas, the incidence of bone echinococcosis is relatively rare. However, when encountering the vertebral and pelvic destruction, consider bone echinococcosis's possibility, especially for the herdsmen in endemic regions.
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Affiliation(s)
- Laihong Yang
- Medical Imaging Center, Xinjiang Medical University Affiliated First Hospital, Urumqi, 830054, People's Republic of China
| | - Pahati Tuxunjiang
- Medical Imaging Center, Xinjiang Medical University Affiliated First Hospital, Urumqi, 830054, People's Republic of China
| | - Wenya Liu
- Medical Imaging Center, Xinjiang Medical University Affiliated First Hospital, Urumqi, 830054, People's Republic of China
| | - Hui Guo
- Medical Imaging Center, Xinjiang Medical University Affiliated First Hospital, Urumqi, 830054, People's Republic of China. .,State Key Laboratory of Pathogenesis, Prevention and Treatment of High Incidence Diseases in Central Asia, Xinjiang Medical University, Urumqi, People's Republic of China.
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11
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Stefaniak M, Derda M, Zmora P, Nowak SP. Risk Factors and the Character of Clinical Course of the Echinococcus multilocularis Infection in Patients in Poland. Pathogens 2023; 12:pathogens12020199. [PMID: 36839470 PMCID: PMC9962699 DOI: 10.3390/pathogens12020199] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/30/2022] [Revised: 01/26/2023] [Accepted: 01/27/2023] [Indexed: 01/31/2023] Open
Abstract
Alveolar echinococcosis (AE) is a chronic zoonotic disease caused by the larval form of Echinococcus multilocularis. In humans, it may become a serious chronic infection of the liver which resembles a slow malignant process leading to death when untreated. The aim of the study was an assessment of the risk factors of the E. multilocularis infections and the description of AE clinical course in the group of 36 patients with confirmed AE, hospitalized at the Department and Clinic of Tropical and Parasitic Diseases, Poznan University of Medical Sciences between 2013 and 2022. Among the study participants, most patients cultivated land, bred livestock, worked in the forest, or were employed in animal shelters. The E. multilocularis infection was diagnosed based on imaging and immunoassay techniques within 6 months in the majority of patients hospitalized in the Department. All patients hospitalized in the Department initiated anti-parasitic therapy at the moment of the diagnosis. Pharmacological treatment combined with surgery was applied in most of the study participants, who were presented with more advanced stages of infection. We conclude the following: 1. For humans in the risk group, regular abdominal imaging examinations and the detection of specific antibodies against E. multilocularis are recommended. 2. Regular screening tests in the hyperendemic areas of AE would increase the early detection of the disease and to improve the clinical prognosis in this extremely life-threatening parasitic disease.
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Affiliation(s)
- Magdalena Stefaniak
- Department of Biology and Medical Parasitology, Institute of Biostructural Basics of Medical Sciences, Poznan University of Medical Sciences, 60-781 Poznan, Poland
| | - Monika Derda
- Department of Biology and Medical Parasitology, Institute of Biostructural Basics of Medical Sciences, Poznan University of Medical Sciences, 60-781 Poznan, Poland
| | - Pawel Zmora
- Department of Molecular Virology, Institute of Bioorganic Chemistry Polish Academy of Sciences, 61-704 Poznan, Poland
| | - Szymon Pawel Nowak
- Department and Clinic of Tropical and Parasitic Diseases, Poznan University of Medical Sciences, 60-355 Poznan, Poland
- Correspondence: ; Tel.: +48-61-869-13-63
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12
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Sun Y, Yan C, Tian D, Zhang C, Zhang Q. Imaging Manifestations and Misdiagnosis Analysis of Six Cases of Bone Hydatid Disease. THE KOREAN JOURNAL OF PARASITOLOGY 2022; 60:413-417. [PMID: 36588418 PMCID: PMC9806501 DOI: 10.3347/kjp.2022.60.6.413] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 08/25/2022] [Accepted: 11/14/2022] [Indexed: 12/29/2022]
Abstract
We retrospectively evaluated the clinical and imaging features of 6 patients with bone hydatid disease confirmed by surgery and pathological examination. Among the 6 patients, 2 were infected with Echinococcosis granulosus metacestode and 4 were infected with E. multilocularis metacestode. The 2 cases with cystic echinococcosis were diagnosed by computed tomographic (CT) examination, and other 4 cases were diagnosed by magnetic resonance (MR) imaging. On the initial evaluation, 1 case each was misdiagnosed as a giant cell tumor or neurogenic tumor, and 2 were misdiagnosed as tuberculosis. The imaging manifestations of bone hydatid disease are complex, but most common findings include expansive osteolytic bone destruction, which may be associated with sclerosing edges or dead bone formation, localized soft tissue masses, and vertebral lesions with wedge-shaped changes and spinal stenosis. Combining imaging findings with the patient's epidemiological history and immunological examinations is of great help in improving the diagnosis and differential diagnosis of bone hydatid disease.
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Affiliation(s)
- Yanqiu Sun
- Department of Radiology, Qinghai Provincial People’s Hospital, Xining, Qinghai,
China
| | - Chunlong Yan
- Department of Radiology, Jining No.1 People’s Hospital, Jining, Shandong,
China,Graduate school of Soochow University, Suzhou, Jiangsu,
China
| | - Dengfeng Tian
- Department of Radiology, Qinghai Provincial People’s Hospital, Xining, Qinghai,
China
| | - Chenhong Zhang
- Department of Radiology, Qinghai Provincial People’s Hospital, Xining, Qinghai,
China
| | - Qiang Zhang
- Department of Radiology, Qinghai Provincial People’s Hospital, Xining, Qinghai,
China,Corresponding author ()
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Song T, Peng S, Zhou X, Jiang L, Zhang J. Case Report: Diagnosis of vertebral alveolar echinococcosis upon next-generation sequencing in a suspected tuberculosis. Front Surg 2022; 9:984640. [PMID: 36248358 PMCID: PMC9556986 DOI: 10.3389/fsurg.2022.984640] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/18/2022] [Accepted: 09/13/2022] [Indexed: 11/17/2022] Open
Abstract
Introduction Alveolar echinococcosis (AE), caused by larval stages of Echinococcus multilocularis, is a rare zoonotic disease that mainly involves the liver. The diagnosis of extrahepatic AE is usually difficult. Here, we describe a rare case of vertebral alveolar echinococcosis with a suspected history of spinal tuberculosis, diagnosed by metagenomic next-generation sequencing (mNGS). Case Presentation A 44-year-old woman presented with repetitive neck and back pain, with a surgical history of suspected spinal tuberculosis. Magnetic resonance imaging (MRI) showed cystic masses in the craniocervical junction region and effusion around lumbar vertebrae. Multiple culture tests were performed to detect tuberculosis and other pathogens through puncture of the effusion and of cerebrospinal fluid, but the results were all negative. Finally, mNGS of the effusion fluid was performed and Echinococcus multilocularis were detected. The results were further confirmed by Sanger sequencing. Conclusion This case emphasizes a role of mNGS in the diagnosis of infectious diseases with unknown pathogen. As a newly emerged sensitive and accurate diagnostic strategy, mNGS provides clinicians an opportunity to clarify pathogens in complicated infectious cases, especially in patients with a history of multiple infections.
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Affiliation(s)
- Tiange Song
- Department of Laboratory Medicine, Sichuan Provincial People's Hospital, University of Electronic Science and Technology of China, Chengdu, China
- Sichuan Provincial Key Laboratory for Human Disease Gene Study, Sichuan Provincial People's Hospital, University of Electronic Science and Technology of China, Chengdu, China
- Research Unit for Blindness Prevention of Chinese Academy of Medical Sciences (2019RU026), Sichuan Academy of Medical Sciences, Chengdu, China
| | - Shengkun Peng
- Department of Radiology, Sichuan Provincial People's Hospital, University of Electronic Science and Technology of China, Chengdu, China
| | - Xiaoli Zhou
- Department of Laboratory Medicine, Sichuan Provincial People's Hospital, University of Electronic Science and Technology of China, Chengdu, China
- Sichuan Provincial Key Laboratory for Human Disease Gene Study, Sichuan Provincial People's Hospital, University of Electronic Science and Technology of China, Chengdu, China
- Research Unit for Blindness Prevention of Chinese Academy of Medical Sciences (2019RU026), Sichuan Academy of Medical Sciences, Chengdu, China
| | - Li Jiang
- Department of Laboratory Medicine, Sichuan Provincial People's Hospital, University of Electronic Science and Technology of China, Chengdu, China
- Sichuan Provincial Key Laboratory for Human Disease Gene Study, Sichuan Provincial People's Hospital, University of Electronic Science and Technology of China, Chengdu, China
- Research Unit for Blindness Prevention of Chinese Academy of Medical Sciences (2019RU026), Sichuan Academy of Medical Sciences, Chengdu, China
- Correspondence: Li Jiang Jie Zhang
| | - Jie Zhang
- Department of Laboratory Medicine, Sichuan Provincial People's Hospital, University of Electronic Science and Technology of China, Chengdu, China
- Sichuan Provincial Key Laboratory for Human Disease Gene Study, Sichuan Provincial People's Hospital, University of Electronic Science and Technology of China, Chengdu, China
- Research Unit for Blindness Prevention of Chinese Academy of Medical Sciences (2019RU026), Sichuan Academy of Medical Sciences, Chengdu, China
- Correspondence: Li Jiang Jie Zhang
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Qu J, Xu H, Lv X. Disseminated alveolar echinococcosis in a patient diagnosed by metagenomic next-generation sequencing: A case report. Front Public Health 2022; 10:972619. [PMID: 36091563 PMCID: PMC9454002 DOI: 10.3389/fpubh.2022.972619] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/18/2022] [Accepted: 07/29/2022] [Indexed: 01/25/2023] Open
Abstract
Background Alveolar echinococcosis (AE) is a parasitic zoonosis with high mortality and disability rates. Diverse clinical manifestations and mimicking of differential diagnoses such as tuberculosis and malignancy pose a diagnostic dilemma. With the rapid development of molecular diagnostic techniques in recent years, metagenomic next-generation sequencing (mNGS) has become an attractive approach for the etiological diagnosis of infectious diseases. Case presentation we report a case of 51-year-old Chinese Tibetan male presented with 3-year low-back pain and 4-month discomfort in the right upper quadrant of the abdomen. He had been in good health. He was diagnosed with tuberculosis and was given anti-tuberculosis treatment a month prior to the visit, but the symptoms were not relieved. Abdominal computerized tomography (CT) revealed a hypodense lesion with uneven enhancement in the liver, and two ring-enhancing cystic lesions in the right abdominal wall. Lumbar spine enhanced MRI showed lesions of mixed density with uneven enhancement in the L1 vertebra and paraspinal tissue. The pathological results of the liver biopsy revealed parasitic infection and possibly echinococcosis. The metagenomic next-generation sequencing (mNGS) of the puncture fluid of abdominal cysts using Illumina X10 sequencer revealed 585 sequence reads matching Echinococcus multilocularis. Disseminated AE was diagnosed. Albendazole (400 mg, twice daily) was used, and the patient was in stable condition during follow-up. Conclusions mNGS may be a useful tool for the diagnosis of AE. The case would help clinicians to improve their diagnostic skills.
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Affiliation(s)
- Junyan Qu
- Center of Infectious Disease, West China Hospital of Sichuan University, Chengdu, China
| | - Huan Xu
- Pathology Department, West China Hospital, Sichuan University, Chengdu, China
| | - Xiaoju Lv
- Center of Infectious Disease, West China Hospital of Sichuan University, Chengdu, China,*Correspondence: Xiaoju Lv
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15
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Comparative genomic analysis of Echinococcus multilocularis with other tapeworms. Biologia (Bratisl) 2022. [DOI: 10.1007/s11756-022-01120-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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16
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Production and Evaluation of a Novel Multi-Epitope Bivalent Vaccine Against Echinococcus multilocaularis Metacestode. Int J Pept Res Ther 2022. [DOI: 10.1007/s10989-022-10421-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
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17
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Calame P, Weck M, Busse-Cote A, Brumpt E, Richou C, Turco C, Doussot A, Bresson-Hadni S, Delabrousse E. Role of the radiologist in the diagnosis and management of the two forms of hepatic echinococcosis. Insights Imaging 2022; 13:68. [PMID: 35394226 PMCID: PMC8994011 DOI: 10.1186/s13244-022-01190-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/18/2021] [Accepted: 02/15/2022] [Indexed: 11/10/2022] Open
Abstract
Echinococcosis is a parasitic disease caused by two zoonotic tapeworms (cestodes) of the Echinocococcus genus. It can be classified as either alveolar or cystic echinococcosis. Although the two forms differ significantly in terms of imaging findings, they share similarities in terms of management and treatment. In parallel to medical treatment with albendazole (ABZ), and surgery, historically used in these diseases, various imaging-guided interventional procedures have recently emerged (drainage, stenting, or Puncture, aspiration, injection, and reaspiration (PAIR)). These options open up a new range of therapeutic options. As in oncology, multidisciplinary consultation meetings now play a major role in adapted management and patient care in hepatic echinococcosis. Consequently, diagnostic imaging and interventional expertise have brought radiologists to the fore as important members of these multidisciplinary team. The radiologist will need to evaluate parasite activity in both forms of the disease, to guide the choice of the appropriate therapy from among medical treatment, interventional radiology procedures and/or surgical treatment. Knowledge of the specific complications of the two forms of echinococcosis will also help radiologists to discuss the appropriate treatment and management. The aim of this review is to describe the core knowledge that what a radiologist should possess to actively participate in multidisciplinary meetings about hepatic echinococcosis. We discuss the role of imaging, from diagnosis to treatment, in alveolar (AE) and cystic echinococcosis (CE), respectively.
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Affiliation(s)
- Paul Calame
- Department of Radiology, University of Bourgogne Franche-Comté, University Hospital Besançon, 3 Boulevard Fleming, 25030, Besançon, France. .,EA 4662 Nanomedicine Lab, Imagery and Therapeutics, University of Bourgogne Franche-Comté, Besançon, France.
| | - Mathieu Weck
- Department of Radiology, University of Bourgogne Franche-Comté, University Hospital Besançon, 3 Boulevard Fleming, 25030, Besançon, France
| | - Andreas Busse-Cote
- Department of Radiology, University of Bourgogne Franche-Comté, University Hospital Besançon, 3 Boulevard Fleming, 25030, Besançon, France
| | - Eleonore Brumpt
- Department of Radiology, University of Bourgogne Franche-Comté, University Hospital Besançon, 3 Boulevard Fleming, 25030, Besançon, France
| | - Carine Richou
- Department of Hepatology, University of Bourgogne Franche-Comté, University Hospital Besançon, 25030, Besançon, France
| | - Celia Turco
- Department of Digestive Surgery, University of Bourgogne Franche-Comté, University Hospital Besançon, 25030, Besançon, France
| | - Alexandre Doussot
- Department of Digestive Surgery, University of Bourgogne Franche-Comté, University Hospital Besançon, 25030, Besançon, France
| | - Solange Bresson-Hadni
- Laboratoire de Parasitologie-Mycologie, University Hospital Besançon, 25030, Besançon, France.,Centre National de Référence Echinococcoses, University Hospital Besançon, 25030, Besançon, France
| | - Eric Delabrousse
- Department of Radiology, University of Bourgogne Franche-Comté, University Hospital Besançon, 3 Boulevard Fleming, 25030, Besançon, France.,EA 4662 Nanomedicine Lab, Imagery and Therapeutics, University of Bourgogne Franche-Comté, Besançon, France
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Xu X, Gao C, Qian X, Liu H, Wang Z, Zhou H, Zhou Y, Wang H, Hou L, He S, Feng X, Fan H. Treatment of Complicated Hepatic Alveolar Echinococcosis Disease With Suspicious Lymph Node Remote Metastasis Near the Inferior Vena Cava-Abdominal Aorta: A Case Report and Literature Review. Front Oncol 2022; 12:849047. [PMID: 35402272 PMCID: PMC8987535 DOI: 10.3389/fonc.2022.849047] [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: 01/05/2022] [Accepted: 02/28/2022] [Indexed: 11/21/2022] Open
Abstract
Echinococcosis is a human-animal parasitic disease caused by Echinococcosis tapeworm larvae in humans. From a global perspective, it is mainly prevalent in the mid-high latitudes of the Northern Hemisphere, and it is a widespread infectious disease. Its form, host and release areas are slightly different. In clinical practice, Echinococcus granulosus (hepatic cystic echinococcosis) is the most common. Its growth mode is swelling growth and its metastasis is more common in implanted metastasis; However, hepatic alveolar echinococcosis (HAE) is rare. It has been reported that HAE can metastasize through the blood or lymph nodes, and its invasive growth pattern is known as “carcinoma”. At this time, it may be accompanied by invasion of the portal vein and inferior vena cava(IVC)or metastasis to distant organs outside the liver (such as lung, brain, lymph nodes). Most patients are in the middle or late stages, making treatment complicated. World Health Organization guidelines recommend radical resection of HAE; However, there is no consensus on lymph node dissection. To date, there have been no reports of cases of HAE accompanied by inferior vena cava-para-abdominal aortic suspected lymph node metastasis and infection. This article reports a clinical case of a complex HAE treated by the surgical method of “middle liver resection + abdominal enlarged lymph node resection + inferior vena cava repair”, and histological examination was performed to illustrate the differences in microscopic pathology of alveolar echinococcosis invading the liver and lymph nodes at different magnifications. This article reviews the relevant literature on HAE and derives the latest treatment methods for HAE to provide a reference for future clinical cases of similar alveolar echinococcosis and maximize the benefits of patients.
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Zhang T, Ma LH, Liu H, Li SK. Incurable and refractory spinal cystic echinococcosis: A case report. World J Clin Cases 2021; 9:10337-10344. [PMID: 34904108 PMCID: PMC8638056 DOI: 10.12998/wjcc.v9.i33.10337] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/08/2021] [Revised: 08/27/2021] [Accepted: 09/23/2021] [Indexed: 02/06/2023] Open
Abstract
BACKGROUND Although the incidence and cure rate of spinal hydatidosis are low, the recurrence rate of spinal hydatidosis is high, and the prognosis of spinal hydatidosis is poor. Therefore, we report a typical case of refractory spinal hydatidosis to increase spine surgeons’ awareness of the disease and reduce misdiagnosis and recurrence.
CASE SUMMARY A 48-year-old man presented with back pain, significant weight loss, and paralysis of both lower limbs. The patient was misdiagnosed with spinal tuberculosis in an outside hospital. However, spinal magnetic resonance imaging (MRI) showed hyperintense cystic components on T2-weighted images and hypointensity on T1-weighted images. A lobulated, multiocular, honeycomb-appearance, septated cystic mass protruding intraspinally and compressing the spinal cord at segments T8–T9 was present. Paravertebral polycystic lobular lesions presented as a “bunch of grapes”. The ELISA test result for Echinococcus granulosus was positive. Then, a diagnosis of spinal hydatidosis and lung hydatid disease was made, and the patient underwent left transthoracic approach lobectomy, paravertebral lesion debridement, and subtotal vertebrectomy with vertebral body replacement of segments T8 and T9 by a mesh cage. The patient also underwent albendazole chemotherapy before and after surgery. One year after stopping the drug therapy, the patient developed recurrent T5 vertebral lesions and underwent a second subtotal vertebrectomy surgery. The patient is currently in good condition and is receiving long-term medication and follow-up.
CONCLUSION The MRI feature of a “bunch of grapes” is a typical imaging indication of spinal hydatidosis. Subtotal vertebrectomy is a risk factor for postoperative recurrence. Total spondylectomy makes it possible to cure spinal hydatidosis, but antiparasitic drug therapy is also an important supplementary therapy to multimodal therapy. It is preferable for patients with spinal hydatidosis to receive life-long antiparasitic medication therapy and follow-up.
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Affiliation(s)
- Tao Zhang
- Department of Spine Surgery, the 940th Hospital of Joint Logistics Support Force of Chinese PLA, Lanzhou 730050, Gansu Province, China
| | - Li-Hua Ma
- the First Hospital of Lanzhou University, Lanzhou 730050, Gansu Province, China
| | - Hua Liu
- Department of Spine Surgery, the 940th Hospital of Joint Logistics Support Force of Chinese PLA, Lanzhou 730050, Gansu Province, China
| | - Song-Kai Li
- Department of Spine Surgery, the 940th Hospital of Joint Logistics Support Force of Chinese PLA, Lanzhou 730050, Gansu Province, China
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The Significance of Perfusion-Weighted Magnetic Resonance Imaging in Evaluating the Pathological Biological Activity of Cerebral Alveolar Echinococcosis. J Comput Assist Tomogr 2021; 46:131-139. [DOI: 10.1097/rct.0000000000001253] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
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21
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Schmidt-Hellerau K, Reiners K, Yagdiran A, Friedrichs N, Fischer J, Fätkenheuer G, Lehmann C, Jung N. Alveolar echinococcosis as a cause of vertebral osteomyelitis and soft tissue infection with recurrent cutaneous fistula formation. Int J Infect Dis 2021; 114:31-33. [PMID: 34715358 DOI: 10.1016/j.ijid.2021.10.041] [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: 07/20/2021] [Revised: 10/15/2021] [Accepted: 10/18/2021] [Indexed: 10/20/2022] Open
Abstract
Echinococcus multilocularis is endemic in Germany. However, alveolar echinococcosis is a rare disease. Most commonly the parasite affects the liver, behaving like a malignant tumour. Bones are affected in less than 2% of cases. We report a case of vertebral osteomyelitis accompanied by recurrent cutaneous fistula formation.
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Affiliation(s)
- Kirsten Schmidt-Hellerau
- University of Cologne, Faculty of Medicine, University Hospital Cologne, Department I of Internal Medicine, Cologne, Germany.
| | - Kerstin Reiners
- University of Cologne, Faculty of Medicine, University Hospital Cologne, Department I of Internal Medicine, Cologne, Germany; Institute for Infection Control Oldenburg, Oldenburg, Germany
| | - Ayla Yagdiran
- University of Cologne, Faculty of Medicine, University Hospital Cologne, Department of Orthopaedics and Trauma Surgery, Cologne, Germany
| | - Nicolaus Friedrichs
- University of Cologne, Faculty of Medicine, University Hospital Cologne, Institute of Pathology, Cologne, Germany
| | - Julia Fischer
- University of Cologne, Faculty of Medicine, University Hospital Cologne, Department I of Internal Medicine, Cologne, Germany; German Centre for Infection Research (DZIF), partner site Bonn-Cologne, Cologne, Germany; University of Cologne, Centre for Molecular Medicine Cologne, Cologne, Germany
| | - Gerd Fätkenheuer
- University of Cologne, Faculty of Medicine, University Hospital Cologne, Department I of Internal Medicine, Cologne, Germany; German Centre for Infection Research (DZIF), partner site Bonn-Cologne, Cologne, Germany
| | - Clara Lehmann
- University of Cologne, Faculty of Medicine, University Hospital Cologne, Department I of Internal Medicine, Cologne, Germany; German Centre for Infection Research (DZIF), partner site Bonn-Cologne, Cologne, Germany; University of Cologne, Centre for Molecular Medicine Cologne, Cologne, Germany
| | - Norma Jung
- University of Cologne, Faculty of Medicine, University Hospital Cologne, Department I of Internal Medicine, Cologne, Germany
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22
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Reuss AM, Wulf MA, Oertel MF, Bozinov O, Henzi A, Kaelin MB, Reinehr M, Grimm F, Rushing EJ. An immunocompetent farmer with isolated cerebral alveolar echinococcosis: illustrative case. JOURNAL OF NEUROSURGERY: CASE LESSONS 2021; 1:CASE2187. [PMID: 35855465 PMCID: PMC9245736 DOI: 10.3171/case2187] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 02/09/2021] [Accepted: 03/25/2021] [Indexed: 11/09/2022]
Abstract
BACKGROUND Alveolar echinococcosis is a rare condition, but living or working in a rural environment is a substantial risk factor. The liver is the organ primarily affected, with additional extrahepatic manifestations in approximately 25% of cases. Primary extrahepatic disease is rare, and isolated cerebral involvement is extremely unusual. OBSERVATIONS The authors described an illustrative case of isolated cerebral alveolar echinococcosis in an immunocompetent farmer. Magnetic resonance imaging of the brain showed a predominantly cystic lesion with perifocal edema and a “bunch of grapes” appearance in the left frontal lobe. Histology revealed sharply demarcated fragments of a fibrous cyst wall accompanied by marked inflammation and necrosis. Higher magnification showed remnants of protoscolices with hooklets and calcified corpuscles. Immunohistochemistry and polymerase chain reaction (PCR) analysis confirmed the diagnosis of cerebral alveolar echinococcosis. Interestingly, serology and thoracic and abdominal computed tomography results were negative, indicative of an isolated primary extrahepatic manifestation. LESSONS Isolated, primary central nervous system echinococcosis is extremely rare, with only isolated case reports. As in the authors’ case, it can occur in immunocompetent patients, especially persons with a rural vocational history. Negative serology results do not exclude cerebral echinococcosis, which requires histological confirmation. Immunohistochemical staining and PCR analysis are especially useful in cases without classic morphological findings.
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Affiliation(s)
| | | | | | | | | | | | - Michael Reinehr
- Division of Infectious Diseases and Hospital Epidemiology; and
| | - Felix Grimm
- Institute of Parasitology, University Hospital Zurich, University of Zurich, Switzerland
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23
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Extrahepatic alveolar echinococcus on multi-slice computed tomography and magnetic resonance imaging. Sci Rep 2021; 11:9409. [PMID: 33931712 PMCID: PMC8087791 DOI: 10.1038/s41598-021-89101-x] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/25/2020] [Accepted: 04/13/2021] [Indexed: 02/02/2023] Open
Abstract
Alveolar echinococcus (AE) is a severe health problem in endemic areas. In recent years, the incidence of this disease in China has been increasing. The study was designed to illustrate the multi-slice computed tomography (MSCT) and magnetic resonance imaging (MRI) features of extrahepatic AE. A cohort of 33 patients who suffered from extrahepatic AE was enrolled consecutively from January 2012 to December 2017. The MSCT and MRI features of extrahepatic AE were recorded and analyzed by experienced radiologists. All cases secondary to hepatic AE, except two primary extrahepatic AE, were found in this study. Locations of extrahepatic AE included 19 (57.6%) lung, 10 (30.3%) adrenal gland, 9 (27.3%) brain, 5 (15.2%) peritoneal cavity, 5 (15.2%) spleen, 4 (12.1%) diaphragm, 3 (9.1%) kidney, 3 (9.1%) retroperitoneal, and 2 (6.1%) vertebra; Involvement of 1 (3.0%) heart, 1 (3.0%) mediastinum, 1 (3.0%) muscle, and 1 (3.0%) pancreas was rare. AE of the lung usually appeared as irregular and scattered nodules with small vacuoles or cavities inside and peripheral distribution. Multiple cerebral nodules with calcification and surrounding edema were the most common features seen in brain AE. Adrenal gland AE presented as plaques containing different sizes of hypodense areas and different amounts of calcification. Injection of contrast medium showed no enhancement of lesions except in the brain. MSCT and MRI are reliable imaging methods for the diagnosis of extrahepatic AE. When one AE patient is clinically confirmed, MSCT scan from the chest to the abdomen should be performed to exclude other organs AE.
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Zhang B, Zhang L, Zhou H, Tian J, Wang J. Progressive compressive myelopathy induced by a rare primary isolated thoracic vertebral hydatid cyst: A case report. Medicine (Baltimore) 2021; 100:e25177. [PMID: 33726007 PMCID: PMC7982161 DOI: 10.1097/md.0000000000025177] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/28/2020] [Accepted: 02/25/2021] [Indexed: 01/05/2023] Open
Abstract
RATIONALE Hydatid cyst is a disease caused by the larvae of Echinococcus spp. The larvae often reside in the liver, lungs, and brain. Occasionally, a primary isolated thoracic vertebral hydatid cyst is reported to cause severe complications. Various diseases may lead to the development of progressive compressive myelopathy. Herein, we report a rare case of a primary isolated thoracic vertebral hydatid cyst with compressive myelopathy. PATIENT CONCERNS A 57-year-old female had numbness and weakness in the lower limbs for a span of 3-months. DIAGNOSIS Thoracic magnetic resonance imaging (MRI) showed that an isolated mass was observed in the T5 vertebral body, which compressed the spinal cord. The diagnosis was confirmed after surgical excision, and Echinococcus granulosus was found to be the etiologic factor. INTERVENTIONS The patient underwent laminectomy with no complications. OUTCOMES After surgical decompression, the patient made slow and measurable progress. While relatively rare in the non-pastoral area, the primary isolated thoracic vertebral column hydatid cyst may be considered as a possible etiology of atypical extradural spinal compression. LESSONS This case illustrates the complexity of spinal echinococcosis manifestations and the necessity of an interdisciplinary approach.
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Affiliation(s)
- Bei Zhang
- Department of Radiology, First Hospital of Jilin University
| | - Li Zhang
- Department of Radiology, First Hospital of Jilin University
| | - Hongli Zhou
- Pain Department, China-Japan Union Hospital of Jilin University, No. 126
| | - Junwei Tian
- Department of Bone and Joint Surgery, First Hospital of Jilin University Changchun, Changchun, China
| | - Jiping Wang
- Department of Radiology, First Hospital of Jilin University
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Li S, Chen J, He Y, Deng Y, Chen J, Fang W, Zeren Z, Liu Y, Abdulaziz ATA, Yan B, Zhou D. Clinical Features, Radiological Characteristics, and Outcomes of Patients With Intracranial Alveolar Echinococcosis: A Case Series From Tibetan Areas of Sichuan Province, China. Front Neurol 2021; 11:537565. [PMID: 33519658 PMCID: PMC7843382 DOI: 10.3389/fneur.2020.537565] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/24/2020] [Accepted: 12/21/2020] [Indexed: 02/05/2023] Open
Abstract
Objectives: Intracranial alveolar echinococcosis (IAE), a zoonotic disease, is a critical health problem in the Tibetan region. We aimed to describe the clinical and radiological characteristics and outcomes among patients with IAE. Methods: We screened patients diagnosed with IAE between March 2015 and May 2019 at the Ganzi Tibetan Autonomous Prefecture People's Hospital. Detailed demographics, clinical characteristics, neuroimaging features, and outcomes were recorded. Results: A total of 21 patients with an average age of 44.1 ± 12.7 years were included. Thirteen (61.9%) patients were male. The most common chief neurological complaint was headache (n = 17, 81.0%), followed by dizziness, seizure, visual disturbances, hemiparesis, disturbed consciousness, and dysphasia. All the patients had coexisting liver localizations. The typical neuroimaging features of IAE on cerebral magnetic resonance imaging scans showed obvious low-signal shadow with multiple small vesicles inside the lesions on T2-weighted images and FLAIR images. The pathological HE staining demonstrates vesicular lesions with several internal sacs. For hepatic alveolar echinococcosis (AE), the hepatic portal was invaded in six (28.6%) patients, and the portal vein (n = 5, 23.8%) was the mostly commonly involved vessel. As for treatment, 11 patients (52.4%) had poor compliance with albendazole. The duration of patients taken albendazole ranged from 2 months to 3 years. Cerebral AE surgery was performed in 11 patients, five of them underwent partial resection of AE lesions, and six patients received total resection. One patient with primary IAE underwent radical surgery. Ten patients (47.6%) died during the follow-up for a mean of 21.7 ± 11.9 (3–46) months. In total, 28.9% of the patients died within 5 years, and 71.6% died within 10 years. The median interval between the date of diagnosis as AE and death was 84 (19–144) months. Conclusion: Despite substantial advances in diagnostic and therapeutic methods, the treatment of IAE remains difficult and results in unsatisfactory outcomes. The major critical issue is surgical treatment of IAE although the disease is disseminated. Besides, lifelong albendazole would be indicated, but most patients had poor medication compliance. It is important to educate patients about the necessity of medical treatment.
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Affiliation(s)
- Sisi Li
- Department of Neurology, West China Hospital, Sichuan University, Chengdu, China
| | - Jiani Chen
- Department of Neurology, West China Hospital, Sichuan University, Chengdu, China
| | - Yongqiao He
- Department of Neurology, Ganzi Tibetan Autonomous Prefecture People's Hospital, Kangding, China
| | - Yongyi Deng
- Department of Neurology, Ganzi Tibetan Autonomous Prefecture People's Hospital, Kangding, China
| | - Jie Chen
- Department of Neurology, Ganzi Tibetan Autonomous Prefecture People's Hospital, Kangding, China
| | - Wenyu Fang
- Department of Neurology, Ganzi Tibetan Autonomous Prefecture People's Hospital, Kangding, China
| | - Zhamu Zeren
- Department of Neurology, Ganzi Tibetan Autonomous Prefecture People's Hospital, Kangding, China
| | - Yadong Liu
- Department of Neurology, West China Hospital, Sichuan University, Chengdu, China
| | | | - Bo Yan
- Department of Neurology, West China Hospital, Sichuan University, Chengdu, China
| | - Dong Zhou
- Department of Neurology, West China Hospital, Sichuan University, Chengdu, China
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Llenas-García J, Hurtado R, Lenghel FO, Reyes-Casado Y, Sevilla-Monllor A, Saura-Sánchez E. An Unusual Cause of Chronic Back Pain in a Migrant From Western Sahara. Clin Infect Dis 2020; 68:2131-2134. [PMID: 31143946 DOI: 10.1093/cid/ciy704] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Affiliation(s)
- Jara Llenas-García
- Internal Medicine Department, Hospital Vega Baja, Alicante, Spain.,Infectious Diseases Division, Hospital Vega Baja, Alicante, Spain
| | - Roberto Hurtado
- Internal Medicine Department, Hospital Vega Baja, Alicante, Spain
| | | | | | - Alexandra Sevilla-Monllor
- Traumatology and Orthopedic Surgery Department, Hospital General Universitario de Elche, Alicante, Spain
| | - Eladio Saura-Sánchez
- Traumatology and Orthopedic Surgery Department, Hospital General Universitario de Elche, Alicante, Spain
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Hu C, Liu Z, Liu C, Zhang Y, Fan H, Qian F. Improvement of Antialveolar Echinococcosis Efficacy of Albendazole by a Novel Nanocrystalline Formulation with Enhanced Oral Bioavailability. ACS Infect Dis 2020; 6:802-810. [PMID: 31576751 DOI: 10.1021/acsinfecdis.9b00231] [Citation(s) in RCA: 12] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Abstract
Alveolar echinococcosis (AE) is a chronic infectious parasitic disease that is fatal and still being neglected. Currently, the AE treatment recommended by the WHO is complete excision of the lesions, followed by the oral administration of albendazole (ABZ), the only effective first-line anti-AE drug, for two years. Unfortunately, complete excision of AE lesions is impossible in most cases, leaving the long-term use of ABZ as the only alternative. However, only about one-third of patients experience complete remission or cure with such treatments, largely because of the low oral bioavailability of ABZ caused by its very low solubility. To improve the oral bioavailability of ABZ, a novel nanocrystalline (NC) formulation of ABZ was obtained by spray-drying ABZ with a triblock copolymer poly(ethylene oxide)-poly(propylene oxide)-poly(ethylene oxide) (Poloxamer 188), and its physical structure was confirmed by scanning electron microscopy (SEM), small-angle X-ray scattering (SAXS), wide-angle X-ray diffraction (WAXRD), and polarized optical microscopy (POM). The significantly reduced ABZ crystallite size coupled with prolonged ABZ supersaturation significantly improved the drug dissolution performance compared with that of the commercial ABZ oral product (Albenda), and the NC formulation showed an approximately 4.2-fold higher AUC than Albenda in a pharmacokinetic comparison in Beagle dogs as measured by the plasma concentration of albendazole sulfoxide, the active antiparasitic metabolite. Even more encouragingly, after 30 days of once-daily oral administration of the NC and Albenda formulations to SD rats with hepatic alveolar echinococcosis, the NC formulation demonstrated a cyst inhibition effect 3.7-fold greater than that of Albenda. We therefore conclude that the NC formulation could potentially be developed into an improved anti-AE drug therapy.
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Affiliation(s)
- Chunhui Hu
- School of Pharmaceutical Sciences, Collaborative Innovation Center for Diagnosis and Treatment of Infectious Diseases, and Key Laboratory of Bioorganic Phosphorus Chemistry & Chemical Biology (Ministry of Education), Tsinghua University, Beijing 100084, P. R. China
- Medical College, Qinghai University, Xining, Qinghai 810001, P. R. China
| | - Zhengsheng Liu
- School of Pharmaceutical Sciences, Collaborative Innovation Center for Diagnosis and Treatment of Infectious Diseases, and Key Laboratory of Bioorganic Phosphorus Chemistry & Chemical Biology (Ministry of Education), Tsinghua University, Beijing 100084, P. R. China
| | - Chengyu Liu
- School of Pharmaceutical Sciences, Collaborative Innovation Center for Diagnosis and Treatment of Infectious Diseases, and Key Laboratory of Bioorganic Phosphorus Chemistry & Chemical Biology (Ministry of Education), Tsinghua University, Beijing 100084, P. R. China
| | - Yaogang Zhang
- Qinghai Research Key Laboratory for Echinococcosis, Affiliated Hospital of Qinghai University, Xining, Qinghai 810001, P. R. China
| | - Haining Fan
- Department of Hepatopancreatobiliary Surgery, Affiliated Hospital of Qinghai University, Xining, Qinghai 810001, P. R. China
| | - Feng Qian
- School of Pharmaceutical Sciences, Collaborative Innovation Center for Diagnosis and Treatment of Infectious Diseases, and Key Laboratory of Bioorganic Phosphorus Chemistry & Chemical Biology (Ministry of Education), Tsinghua University, Beijing 100084, P. R. China
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28
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Outcomes of different surgical resection techniques for end-stage hepatic alveolar echinococcosis with inferior vena cava invasion. HPB (Oxford) 2019; 21:1219-1229. [PMID: 30782476 DOI: 10.1016/j.hpb.2018.10.023] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/31/2018] [Revised: 10/16/2018] [Accepted: 10/18/2018] [Indexed: 02/07/2023]
Abstract
BACKGROUND Hepatic alveolar echinococcosis (HAE) lesions with inferior vena cava (IVC) invasion require combined resection of the liver and IVC. The outcomes of different surgical treatments, including in situ, ante situm and ex vivo resection, remain unclear. METHODS A total of 71 consecutive HAE patients who underwent hepatectomy with retrohepatic IVC resection were included. The patients were divided into ex vivo liver resection and autotransplantation (ERAT) group (n = 45) and in vivo resection group (n = 26). These techniques were assessed for feasibility and short- and long-term outcomes. RESULTS There were no significant differences with respect to postoperative complications and mortality between the ERAT and in vivo resection groups. The causes of mortality were liver failure in 3 patients, hemorrhagic shock in 1 patient, intra-abdominal bleeding in 1 patient, and acute cerebral hemorrhage in 1 patient. During a median of 22 months followed-up time, 2 patients developed ascites because of venous outflow stenosis, and 1 patient developed biliary stenosis in the ERAT group. The distant metastasis, local recurrence, and mortality rates were 0%, 1.4%, and 8.5%, respectively. CONCLUSION Combined liver resection and reconstruction of the IVC can be safely performed in selected patients with in situ, ante situm, and ex vivo resection.
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