Genotyping and phylogenetic analysis of unusually located hydatid cysts isolated from humans in north-east Iran

Discordance Therapeutic Protocol of Cystic Echinococcosis With WHO Guideline: A Descriptive Study Based on Liver Ultra-Sonographic Data in North Khorasan Province, Northeastern of Iran

BACKGROUND

Cystic echinococcosis (CE), a helminth-associated zoonosis caused by Echinococcus granulosus, poses a significant public health problem, particularly in pastoral-rearing regions. The lack of uniform guidelines led to variations in CE management. Based on ultrasound data, the World Health Organization Informal Working Group on Echinococcosis (WHO-IWGE) classification system categorizes cysts into active, transitional, and inactive groups. This study assesses whether the therapeutic approach from liver human operation cases in North Khorasan province aligns with the WHO-IWGE reference based on ultrasound data.

METHODS

The research is based on ultrasound data from liver CE human operation cases collected between 2018 and 2022. This retrospective study investigates the therapeutic protocol for (CE) in North Khorasan Province, Iran, comparing it with the WHO-IWGE guidelines. We collect data from previously registered patients' medical information from our studied area's main CE surgical hospital. Moreover, as the first hospitalized survey in Iran, this study reveals insights into patient demographics, cyst stage prevalence, and treatment modalities.

RESULTS

Notably, more than half of the patients were treated for CE1 stage cysts, and CE4 cases, which generally do not require surgery, underwent open surgery. The results suggest a need for adherence to the "watch-and-wait" approach in specific cases. All patients underwent successful surgeries, but we do not have access to follow-up data from patients after discharge.

CONCLUSIONS

This descriptive study contributes to understanding the implementation of WHO guidelines in a regional context, shedding light on the challenges and variations in CE management. It seems, retraining courses for surgeons are required to update their knowledge of standard CE diagnostic and treatment methods.

Primary cerebral cystic echinococcosis in a child from Roman countryside: Source attribution and scoping review of cases from the literature

BACKGROUND

Human cystic echinococcosis (CE) is a zoonotic parasitic infection caused by the larval stage of the species belonging to the Echinococcus granulosus sensu lato (s.l.) complex. Parasitic cysts causing human CE are mainly localized in the liver and in the lungs. In a smaller number of cases, larvae may establish in any organ or tissue, including the central nervous system (CNS). Cerebral CE (CCE) is rare but poses serious clinical challenges.

METHODS

This study presents a case of CCE in a child living in the countryside near Rome (Italy), along with a comparative molecular analysis of the isolated cyst specimens from the patient and sheep of local farms. We also systematically searched the literature to summarize the most relevant epidemiological and clinical aspects of this uncommon localization.

FINDINGS

The comparative molecular analysis confirmed that the infection was caused by E. granulosus sensu stricto (s.s.) (G3 genotype), and most likely acquired in the family farm. The literature search identified 2,238 cases of CCE. In 80.51% of cases, brain was the only localization and single CCE cysts were present in 84.07% of cases. Mean patients' age was 20 years and 70.46% were children. Cyst rupture was reported in 12.96% and recurrence of CCE after treatment in 9.61% of cases. Permanent disability was reported in 7.86% of cases, while death occurred in 6.21%. In case series reporting all CE localization, CCE represented 1.5% of all CE cases. In the few reports that identified at molecular level the CCE cyst, E. granulosus s.s. was found in 40% and E. canadensis in 60% of cases.

CONCLUSIONS

We report a rare case of CCE and evidenced the probable local origin of infection. The proportions of CE cases with uncommon localizations and with high impact on patients' lives have been globally neglected and should be included in the computation of the global burden of CE.

Three cases of brain hydatidosis in North Khorasan, Iran

Cystic hydatidosis is a serious public health problem in Iran. Although cysts can develop in almost all organs and the brain cysts are very rare. Here, we present 3 confirmed cases of brain hydatidosis and the patients who underwent successful surgery. Pathological examinations demonstrated the presence of cystic hydatidosis.

Sequence analysis, intra-genotyping variation, and phylogenetic study of nad1 gene in Echinococcus granulosus sensu lato genotypes from intermediate hosts in southwestern Iran

Cystic echinococcosis (CE) is caused by the larval stage of Echinococcus granulosus sensu lato (s. l.). The disease is cosmopolitan, and Iran is a highly endemic area for CE. This parasite exhibits high genetic diversity, which can be related to its life cycle, transmission, and pathogenesis. This study was aimed at determining the phylogenetic relationship and intra-genotyping variation of E. granulosus s.l. in a vast area in the southwest of Iran (SWI). Eighty hydatid cyst isolates of intermediate hosts (i.e., cattle, sheep, goat, buffalo, camel, and human) were collected. The sequence analysis of the nad1 gene exhibited the three genotypes of G1 (n = 70, 87.5%), G3 (n = 8, 10%), and G6/G7 (n = 2, 2.5%). Also, 16, 2, and 1 unique haplotypes were identified for the G1, G3, and G6/G7 genotypes, respectively. According to the phylogenetic tree topology, the nad1 gene similarities were found for some G1 isolates in some vast areas, and the G1 genotype showed a heterogeneous population worldwide. The only SWI G6/G7 haplotype was at a distant position in E. canadensis clade, indicating the notable difference of this haplotype from other isolates from Iran and other countries. The presence of the G6/G7 genotype in the SWI may be due to the transmission of the genotype from other regions or the role of camel/wild boar or other possible hosts in the expansion of this genotype in SWI. The results of the present study can be used in CE control programs, molecular epidemiology, and phylogenetic studies in Iran and other countries for future goals.

Seroprevalence of Cystic Echinococcosis Using Recombinant Antigen B-ELISA in North Khorasan Province, Northeast of Iran

Background

Cystic echinococcosis (CE) is one of the most important helminthic parasitic diseases in Iran. The current study aimed to assess the seroprevalence of CE in North Khorasan Province, Northeast of Iran in 2018.

Methods

The study was carried out in seven cities of North Khorasan Province. Venous blood samples were collected from 932 individuals referring to health centers of those seven cities. A questionnaire was used to obtain the data regarding the subject's gender, age, residence and risk factors linked to the hydatid cyst. Sera samples were evaluated for anti-hydatid cyst antibodies in an ELISA system, using a recombinant B8/1 antigen of E. granulosus.

Results

Of the 932 recruited subjects, 496 (53.2%) were male and 436 (46.8%) were female. The range of participants' age was between 11 to 83 yr old and the mean age of the subjects was 35.4 (±12.7) years. Anti-hydatid cyst antibodies were detected in the sera of 37 out of 932 subjects, corresponding to a seroprevalence rate of 3.96%. From these, 20 (54.05%) were male and 17 (45.95%) were female. There were no associations between seropositivity to hydatid cyst and age, the gender of the participants, residential areas and having contact with dogs (P>0.05).

Conclusion

CE is relatively prevalent throughout the North Khorasan Province in the Northeast of Iran. Rate of CE infection in this Province is somewhat similar to the rate of infection in other parts of the country.

Giant Cerebral Hydatid Cyst: A Rare Case Report

The diagnosis of hydatid cyst should be considered in children with seizure in endemic regions.

Seroprevalence of Toxocara spp. in children (3-13 years old) in Zahedan, Southeast of Iran

Child Toxocariasis (CT) is one of the most important helminthic parasitic diseases in Iran. The current study was aimed to determine the seroprevalence of toxocariasis in children in Zahedan, southeast of Iran. In this cross-sectional study, serum samples of 373 children aged 3-13 years old referred to health centers in Zahedan were collected randomly with criteria based on the parameters that were used in earlier studies and examined for anti-Toxocara antibody using a commercial ELISA kit. Of the 373 recruited subjects, 206 (55.2%) were male and 167 (44.8%) were female. Most of the subjects (36.5%) were in the age group 3-4 years old. Anti-Toxocara antibodies were detected in the sera of five out of 373 individuals, corresponding to a seroprevalence rate of 1.3%. A significant correlation was found between the incidence of disease and eosinophilia, a history of contact with dogs or cats, as well as the consumption of raw vegetables and drinking of contaminated water. There was no significant correlation between prevalence and gender or age. The finding of this study revealed that the prevalent CT is relatively low in Zahedan region. The rate of CT infection in the southeast of Iran was lower than the rate in other parts of Iran.

Environmental, climatic and host population risk factors of human cystic echinococcosis in southwest of Iran

BACKGROUND

Cystic echinococcosis (CE), a worldwide zoonotic disease, is affected by various biological and environmental factors. We investigated dog/livestock populations, climatic and environmental factors influencing the distribution of human CE cases in Fars province, southwest Iran.

METHODS

We mapped the addresses of 266 hospitalised CE patients (2004-2014) and studied the effects of different temperature models, mean annual rainfall and humidity, number of frosty days, slope, latitude, land covers, close proximity to nomads travel routes, livestock and dog densities on the occurrence of CE using geographical information systems approach. Data were analyzed by logistic regression.

RESULTS

In the multivariate model predicting CE, living in an urban setting and densities of cattle and dogs were the most important CE predictors, sequentially. Dry (rained) farm, density of camel and sheep, close proximity to nomads travel routes, humidity, and slope also were considered as the determinants of CE distribution, when analyzed independently. Slope had a negative correlation with CE while temperature, frost days and latitude were not associated with CE.

CONCLUSIONS

In our study, an urban setting was the most important risk factor and likely due to a combination of the high density of key life cycle hosts, dogs and livestock, a large human susceptible population and the high number of abattoirs. Farmland and humidity were highly suggestive risk factors and these conditions support the increased survival of Echinococcus granulosus eggs in the soil. These findings support the development of strategies for control of disease. More research is needed test optimal interventions.

Uncommon Locations of Cystic Echinococcosis: A Report of 46 Cases from Southern Iran

Background

Most cases of hydatid cysts form in the liver and lung and other tissues are considered as unusual locations in hydatid cysts. The current study aimed to find out the rate and features of hydatid cysts in uncommon locations in Fars Province, Southern Iran, over a 15-year period.

Methods

The hospital records of patients who underwent surgery for hydatid cysts in university-affiliated hospitals in Fars Province, Southern Iran, from 2004 to 2018, were retrospectively reviewed. For each patient, clinical and demographical data were recorded.

Results

During a 15-year period, a total of 501 patients were surgically treated for hydatid cysts, and out of these, 46 (9.2%) were presented with the unusual locations of hydatid disease. Males constituted 28 (60.9%) of these patients while 18 (39.1%) of the patients were females. The patients' age ranged from 5 to 80 years (mean = 40.49; SD = 20.37). The size of the cysts ranged from 2 to 20 cm (mean = 8.69, SD = 4.59). The most common unusual location for the hydatid cyst was the spleen with 30.4% of cases, followed by the pelvic cavity (15.2%). Out of 46 cases with unusual location of the hydatid cyst, 10 (21.7%) cases had lung, 22 (47.8%) cases had liver, and 5 (10.9%) cases had both liver and lung hydatid cysts, simultaneously with cysts in unusual locations.

Conclusion

In cystic echinococcosis- (CE) endemic areas, hydatid disease can affect any organ, from head to toe, in humans. The disease should be considered in the differential diagnosis of any cystic entities anywhere in the body.

Effects of geographical and climatic factors on cystic echinococcosis in south-western Iran

Cystic echinococcosis (CE) is caused by the larval form of Echinococcus granulosus that can cause serious health and economic problems in the endemic foci. CE is globally distributed in various climatic conditions from circumpolar to tropical latitudes. Iran is an important endemic area with a spectrum of weather conditions. The aim of this study was to determine the effects of geo-climatic factors on the distribution of livestock CE in south-western Iran (SWI) in 2016 to 2018. Data of livestock CE were retrieved from veterinary organizations of four provinces of SWI. The geo-climatic factors, including mean annual temperature (MAT), minimum MAT (MinMAT), maximum MAT (MaxMAT), mean annual rainfall (MAR), elevation, mean annual evaporation (MAE), sunny hours, wind speed, mean annual humidity (MAH), slope, frost days and land cover, were analysed using geographical information systems (GIS) approaches. The statistical analysis showed that MAR, frost days, elevation, slope and semi-condensed forest land cover were positively and MAE, MAT, MaxMAT, MinMAT and salt and salinity land cover were negatively correlated with CE occurrence. MAE was shown to be a predictive factor in the stepwise linear logistic regression model. In short, the current GIS-based study found that areas with lower evaporation were the main CE risk zones, though those with lower temperature and higher rainfall, altitude and slope, especially where covered with or in close proximity of semi-condensed forest, should be prioritized for consideration by health professionals and veterinarians for conducting control programmes in SWI.

Cytokine profile and nitric oxide levels in peritoneal macrophages of BALB/c mice exposed to the fucose-mannose ligand of Leishmania infantum combined with glycyrrhizin

Background

The fucose-mannose ligand (FML) of Leishmania infantum is a complex glycoprotein which does not elicit adequate immunogenicity in humans. In recent years, adjuvant compounds derived from plants have been used for improving the immunogenicity of vaccines. Glycyrrhizin (GL) is a natural triterpenoid saponin that has known immunomodulatory activities. In the present study, we investigated the effects of co-treatment with FML and GL on the production of cytokines and nitric oxide (NO) by macrophages, in vitro.

Methods

Lipopolysaccharide (LPS) stimulated murine peritoneal macrophages were treated with FML (5 μg/ml) of L. infantum and various concentrations of GL (1 μg/ml, 10 μg/ml and 20 μg/ml). After 48 h of treatment, cell culture supernatants were recovered and the levels of TNF-α, IL-10, IL-12p70 and IP-10 were measured by sandwich ELISA and NO concentration by Griess reaction.

Results

Our results indicate that the treatment of activated macrophages with FML plus GL leads to enhanced production of NO, TNF-α and IL-12p70, and reduction of IL-10 levels in comparison with FML treatment alone.

Conclusions

Therefore, we concluded that GL can improve the immunostimulatory effect of FML on macrophages and leads to their polarization towards an M1-like phenotype.

Status of human toxocariasis, a neglected parasitic zoonosis in Iran: a systematic review from past to current

Although human toxocariasis can lead to serious complications including neurological, ocular and visceral complications, there is a lack of comprehensive epidemiological information about the seroprevalence of Toxocara species in humans. In the present study, we analysed and reviewed the overall seroprevalence of human toxocariasis in Iran. The data collection was systematically undertaken on published articles using the PubMed, Google Scholar, ScienceDirect and Scopus databases. A total of 27 studies from the past two decades reporting seroprevalence of human toxocariasis met our eligibility criteria. The pooled proportion of Toxocara infection was estimated as 6.58% (95% confidence interval = 3.98-9.77). A wide variation between different studies was observed (Q statistic = 799.37, df = 26, P < 0.0001, and I² = 96.7%). The seroprevalence rate of toxocariasis in the Iranian population is relatively high; contamination of the environment by eggs from the host as well as from household dogs and cats should be blamed.