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Calu V, Enciu O, Toma EA, Pârvuleţu R, Pîrîianu DC, Miron A. Complicated Liver Cystic Echinococcosis-A Comprehensive Literature Review and a Tale of Two Extreme Cases. Tomography 2024; 10:922-934. [PMID: 38921947 PMCID: PMC11209078 DOI: 10.3390/tomography10060070] [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: 04/26/2024] [Revised: 06/02/2024] [Accepted: 06/07/2024] [Indexed: 06/27/2024] Open
Abstract
Cystic echinococcosis is a zoonotic parasitic disease that affects the liver in more than 70% of cases, and there is still an underestimated incidence in endemic areas. With a peculiar clinical presentation that ranges from paucisymptomatic illness to severe and possibly fatal complications, quality imaging and serological studies are required for diagnosis. The mainstay of treatment to date is surgery combined with antiparasitic agents. The surgical armamentarium consists of open and laparoscopic procedures for selected cases with growing confidence in parenchyma-sparing interventions. Endoscopic retrograde cholangiopancreatography (ERCP) is extremely useful for the diagnosis and treatment of biliary fistulas. Recent relevant studies in the literature are reviewed, and two complex cases are presented. The first patient underwent open surgery to treat 11 liver cysts, and during the follow-up, a right pulmonary cyst was diagnosed that was treated by minimally invasive surgery. The second case is represented by the peritoneal rupture of a giant liver cyst in a young woman who underwent laparoscopic surgery. Both patients developed biliary fistulas that were managed by ERCP. Both patients exhibited a non-specific clinical presentation and underwent several surgical procedures combined with antiparasitic agents, highlighting the necessity of customized treatment in order to decrease complications and successfully cure the disease.
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Affiliation(s)
- Valentin Calu
- Elias University Emergency Hospital, 011461 Bucharest, Romania; (V.C.); (E.-A.T.); (R.P.); (A.M.)
- Department of Surgery, Carol Davila University of Medicine and Pharmacy, 020021 Bucharest, Romania
| | - Octavian Enciu
- Elias University Emergency Hospital, 011461 Bucharest, Romania; (V.C.); (E.-A.T.); (R.P.); (A.M.)
- Department of Surgery, Carol Davila University of Medicine and Pharmacy, 020021 Bucharest, Romania
| | - Elena-Adelina Toma
- Elias University Emergency Hospital, 011461 Bucharest, Romania; (V.C.); (E.-A.T.); (R.P.); (A.M.)
- Department of Surgery, Carol Davila University of Medicine and Pharmacy, 020021 Bucharest, Romania
| | - Radu Pârvuleţu
- Elias University Emergency Hospital, 011461 Bucharest, Romania; (V.C.); (E.-A.T.); (R.P.); (A.M.)
| | - Dumitru Cătălin Pîrîianu
- Elias University Emergency Hospital, 011461 Bucharest, Romania; (V.C.); (E.-A.T.); (R.P.); (A.M.)
- Department of Surgery, Carol Davila University of Medicine and Pharmacy, 020021 Bucharest, Romania
| | - Adrian Miron
- Elias University Emergency Hospital, 011461 Bucharest, Romania; (V.C.); (E.-A.T.); (R.P.); (A.M.)
- Department of Surgery, Carol Davila University of Medicine and Pharmacy, 020021 Bucharest, Romania
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Mattwich C, Huber K, Bretzel G, Suerbaum S, Wieser A, Dichtl K. Head-to-Head Comparison of Nine Assays for the Detection of Anti- Echinococcus Antibodies: A Retrospective Evaluation. Ann Lab Med 2024; 44:155-163. [PMID: 37880992 PMCID: PMC10628756 DOI: 10.3343/alm.2023.0212] [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: 05/19/2023] [Revised: 07/25/2023] [Accepted: 09/12/2023] [Indexed: 10/27/2023] Open
Abstract
Background Echinococcosis is a neglected tropical disease that is severely underdiagnosed in resource-limited settings. In developed countries, diagnosing echinococcosis is challenging, and reliable serological assays are urgently needed. In the Central European Alps, EM is more common than EG; however, data on the diagnostic performance of assays for EM cases are scarce. We evaluated the suitability of nine antibody assays for routine diagnostics. Methods Nine commercially available serological assays for detecting anti-Echinococcus antibodies were compared head-to-head using samples collected from 50 patients with echinococcosis and 50 age- and sex-matched control subjects. The assays are Anti-Echinococcus ELISA (IgG) (Euroimmun), Echinococcus IgG ELISA (DRG), Echinococcus IgG ELISA (IBL International), Echinococcus Western Blot IgG (LDBIO Diagnostics), EUROLINE WB (Euroimmun), Hydatidosis ELISA IgG (VirCell), Hydatidosis VIRCLIA IgG Monotest (VirCell), Ridascreen Echinococcus IgG (R-Biopharm), and Virapid Hydatidosis (VirCell). The cases were ranked according to the WHO-Informal Working Group on Echinococcosis (WHO-IWGE) criteria as confirmed, probable, or possible. Results The performance of the assays varied greatly, with overall sensitivities ranging between 50% and 88% and specificities between 62% and 100%. We observed a trend toward better performance with cases classified as "confirmed" using the WHO-IWGE criteria. Combined analysis with sequential screening and confirmatory testing resulted in a maximum sensitivity of 84% and specificity of 100%. Differentiation between EG and EM infections is clinically relevant but was found to be unreliable. Conclusions Echinococcus serological assays are highly variable in terms of sensitivity and specificity. Knowledge of the pre-test probability in the patient cohort is required to choose a suitable assay. A combined approach with screening and confirmatory assays may be the best diagnostic strategy in many situations.
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Affiliation(s)
- Carolina Mattwich
- Max von Pettenkofer-Institut für Hygiene und Medizinische Mikrobiologie, Medizinische Fakultät, LMU München, Munich, Germany
| | - Kristina Huber
- Division of Infectious Diseases and Tropical Medicine, University Hospital Ludwig-Maximilian University Munich, Munich, Germany
| | - Gisela Bretzel
- Division of Infectious Diseases and Tropical Medicine, University Hospital Ludwig-Maximilian University Munich, Munich, Germany
| | - Sebastian Suerbaum
- Max von Pettenkofer-Institut für Hygiene und Medizinische Mikrobiologie, Medizinische Fakultät, LMU München, Munich, Germany
| | - Andreas Wieser
- Max von Pettenkofer-Institut für Hygiene und Medizinische Mikrobiologie, Medizinische Fakultät, LMU München, Munich, Germany
- Division of Infectious Diseases and Tropical Medicine, University Hospital Ludwig-Maximilian University Munich, Munich, Germany
- German Centre for Infection Research (DZIF), Munich, Germany
- Fraunhofer Institute for Translational Medicine and Pharmacology ITMP, Immunology, Infection and Pandemic Research, Munich, Germany
| | - Karl Dichtl
- Max von Pettenkofer-Institut für Hygiene und Medizinische Mikrobiologie, Medizinische Fakultät, LMU München, Munich, Germany
- Diagnostic and Research Institute of Hygiene, Microbiology and Environmental Medicine, Medical University of Graz, Graz, Austria
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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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Tbini M, Lahiani R, Guelmami H, Jaafoura H, Riahi I, Bensalah M. Hydatid disease as a rare cause of neck swelling: Two cases report. Int J Surg Case Rep 2021; 87:106486. [PMID: 34628334 PMCID: PMC8515386 DOI: 10.1016/j.ijscr.2021.106486] [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: 09/08/2021] [Revised: 09/29/2021] [Accepted: 10/03/2021] [Indexed: 12/01/2022] Open
Abstract
INTRODUCTION Despite the fact that hydatid disease is endemic in some countries, its cervical location remains very rare. PRESENTATION OF CASE We report two cases of primary cervical hydatid disease in two children from rural areas. The imaging was not specific, since the location is rare; the diagnosis was only confirmed after surgery. DISCUSSION Hydatid cyst is a rare pathology. Thus clinical presentation, radiological examinations, fine needle aspiration and serology can be useful to suspect the diagnosis. CONCLUSION Hydatid disease should be considered when dealing with slow-growing renitent neck swelling in endemic countries.
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Affiliation(s)
- Makram Tbini
- Head and Neck Surgery Department, Charles Nicolle Hospital, Tunis, Tunisia.
| | - Rim Lahiani
- Head and Neck Surgery Department, Charles Nicolle Hospital, Tunis, Tunisia
| | - Houda Guelmami
- Head and Neck Surgery Department, Charles Nicolle Hospital, Tunis, Tunisia
| | - Habib Jaafoura
- Head and Neck Surgery Department, Charles Nicolle Hospital, Tunis, Tunisia
| | - Ines Riahi
- Head and Neck Surgery Department, Charles Nicolle Hospital, Tunis, Tunisia
| | - Mamia Bensalah
- Head and Neck Surgery Department, Charles Nicolle Hospital, Tunis, Tunisia
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Tamarozzi F, Longoni SS, Vola A, Degani M, Tais S, Rizzi E, Prato M, Scarso S, Silva R, Brunetti E, Bisoffi Z, Perandin F. Evaluation of Nine Commercial Serological Tests for the Diagnosis of Human Hepatic Cyst Echinococcosis and the Differential Diagnosis with Other Focal Liver Lesions: A Diagnostic Accuracy Study. Diagnostics (Basel) 2021; 11:diagnostics11020167. [PMID: 33503986 PMCID: PMC7911993 DOI: 10.3390/diagnostics11020167] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/05/2021] [Revised: 01/19/2021] [Accepted: 01/21/2021] [Indexed: 12/19/2022] Open
Abstract
The differential diagnosis of hepatic cystic echinococcosis (CE) may be challenging. When imaging is insufficient, serology can be applied, but no consensus diagnostic algorithm exists. We evaluated the performances of nine serological tests commercialized in Europe for the diagnosis of “echinococcosis”. We performed a diagnostic accuracy study using a panel of sera from patients with hepatic CE (n = 45 “liquid” content stages, n = 25 “solid” content stages) and non-CE focal liver lesions (n = 54 with “liquid” content, n = 11 with “solid” content). The diagnosis and staging of CE were based on ultrasound (gold standard). Nine commercial seroassays (5 ELISA, 2 WB, 1 Chemiluminescence Immunoassay [CLIA] and 1 Immunochromatographic test [ICT]) were the index tests. Sensitivity (Se) ranged from 43 to 94% and from 31 to 87%, and specificity (Sp) from 68 to 100% and from 94 to 100%, when borderline results were considered positive or negative, respectively. Three seroassays (2 ELISA, 1 WB) were excluded from further analyses due to poor performances. When tests were combined, Sp was 98–100%. The best results were obtained using the WB-LDBIO alone (Se 83%) or as a third test after two non-WB tests (Se 67–86%). A validated WB or two non-WB tests, read with stringent criteria (borderline = negative and considered positive only if concordant positive), possibly confirmed by the WB, appear sensible approaches.
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Affiliation(s)
- Francesca Tamarozzi
- Department of Infectious Tropical Diseases and Microbiology, IRCCS Sacro Cuore Don Calabria Hospital, 37024 Verona, Italy; (S.S.L.); (M.D.); (S.T.); (E.R.); (M.P.); (S.S.); (R.S.); (Z.B.); (F.P.)
- Correspondence: ; Tel.: +39-0456013226
| | - Silvia Stefania Longoni
- Department of Infectious Tropical Diseases and Microbiology, IRCCS Sacro Cuore Don Calabria Hospital, 37024 Verona, Italy; (S.S.L.); (M.D.); (S.T.); (E.R.); (M.P.); (S.S.); (R.S.); (Z.B.); (F.P.)
| | - Ambra Vola
- Department of Medical Sciences and Infectious Diseases, IRCCS San Matteo Hospital Foundation, 27100 Pavia, Italy; (A.V.); (E.B.)
| | - Monica Degani
- Department of Infectious Tropical Diseases and Microbiology, IRCCS Sacro Cuore Don Calabria Hospital, 37024 Verona, Italy; (S.S.L.); (M.D.); (S.T.); (E.R.); (M.P.); (S.S.); (R.S.); (Z.B.); (F.P.)
| | - Stefano Tais
- Department of Infectious Tropical Diseases and Microbiology, IRCCS Sacro Cuore Don Calabria Hospital, 37024 Verona, Italy; (S.S.L.); (M.D.); (S.T.); (E.R.); (M.P.); (S.S.); (R.S.); (Z.B.); (F.P.)
| | - Eleonora Rizzi
- Department of Infectious Tropical Diseases and Microbiology, IRCCS Sacro Cuore Don Calabria Hospital, 37024 Verona, Italy; (S.S.L.); (M.D.); (S.T.); (E.R.); (M.P.); (S.S.); (R.S.); (Z.B.); (F.P.)
| | - Marco Prato
- Department of Infectious Tropical Diseases and Microbiology, IRCCS Sacro Cuore Don Calabria Hospital, 37024 Verona, Italy; (S.S.L.); (M.D.); (S.T.); (E.R.); (M.P.); (S.S.); (R.S.); (Z.B.); (F.P.)
| | - Salvatore Scarso
- Department of Infectious Tropical Diseases and Microbiology, IRCCS Sacro Cuore Don Calabria Hospital, 37024 Verona, Italy; (S.S.L.); (M.D.); (S.T.); (E.R.); (M.P.); (S.S.); (R.S.); (Z.B.); (F.P.)
| | - Ronaldo Silva
- Department of Infectious Tropical Diseases and Microbiology, IRCCS Sacro Cuore Don Calabria Hospital, 37024 Verona, Italy; (S.S.L.); (M.D.); (S.T.); (E.R.); (M.P.); (S.S.); (R.S.); (Z.B.); (F.P.)
| | - Enrico Brunetti
- Department of Medical Sciences and Infectious Diseases, IRCCS San Matteo Hospital Foundation, 27100 Pavia, Italy; (A.V.); (E.B.)
- Department of Clinical, Surgical, Diagnostic and Pediatric Sciences, University of Pavia, 27100 Pavia, Italy
| | - Zeno Bisoffi
- Department of Infectious Tropical Diseases and Microbiology, IRCCS Sacro Cuore Don Calabria Hospital, 37024 Verona, Italy; (S.S.L.); (M.D.); (S.T.); (E.R.); (M.P.); (S.S.); (R.S.); (Z.B.); (F.P.)
- Department of Diagnostics and Public Health, University of Verona, 37129 Verona, Italy
| | - Francesca Perandin
- Department of Infectious Tropical Diseases and Microbiology, IRCCS Sacro Cuore Don Calabria Hospital, 37024 Verona, Italy; (S.S.L.); (M.D.); (S.T.); (E.R.); (M.P.); (S.S.); (R.S.); (Z.B.); (F.P.)
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