Echinococcus in a U.S. Marine after deployment to Afghanistan

Isolated pulmonary hydatid cyst

Echinococcosis is primarily a disease of developing nations with poor medical infrastructure, where cohabitation with domesticated animals is common. These conditions, in conjunction with the inherent chronicity of the disease, lead to low rates of diagnosis and high morbidity. Robust surveillance is not readily available in communities with the highest disease burden.WHO classifications assist in diagnostic and treatment endeavours especially in countries where this disease is not commonly encountered. However, the understanding of the pathophysiology of echinococcosis and optimal treatment are still lacking in certain patient populations.We present the case of a female from Central Asia with an isolated pulmonary hydatid cyst. She was diagnosed several months after she had an uncomplicated pregnancy and gave birth to a healthy baby girl. Due to a delay in surgical intervention, our patient received a prolonged course of treatment which resulted in a significant reduction in the size of the cyst. Given her improvement, we questioned the current guidelines set by the WHO regarding surgical resection of pulmonary hydatid cysts, compared with an extended course with albendazole in patients with an unusual and protracted course of the disease. Furthermore, we discuss the possible role of pregnancy in exacerbating symptoms of underlying pulmonary hydatid disease.

Food-borne zoonotic echinococcosis: A review with special focus on epidemiology

Echinococcosis is a neglected, WHO-listed cyclozoonotic parasitic disease that is caused by a number of species belonging to the genus Echinococcus. This disease is widespread across the globe, resulting in heavy economic losses for farmers and cystic disease in aberrant human hosts. This review paper briefly discussed taxonomy, a brief history, the magnitude of economic losses, host spectrum and life cycle, risk factors, and clinical manifestations. Furthermore, the copro- and sero-ELISA-based prevalence of echinococcosis on different continents was summarized. Finally, the authors analyzed the frequency and use of molecular epidemiology in the taxonomy of Echinococcus species based on molecular markers. This review will serve as a quick reference to Echinococcus.

Helminth infections in the US military: from strongyloidiasis to schistosomiasis

BACKGROUND

Helminth infections caused by parasitic worms, including nematodes (roundworms), cestodes (tapeworms) and trematodes (flukes), can cause chronic symptoms and serious clinical outcomes if left untreated. The US military frequently conducts activities in helminth-endemic regions, particularly Africa, the Middle East and Southeast Asia. However, the military does not currently screen for these infections, and to date, no comprehensive surveillance studies have been completed to assess the frequency of helminth diagnoses in the military personnel and their families.

METHODS

To determine the burden of helminth infections in the US Military Health System (MHS), we conducted a retrospective analysis of International Classification of Diseases (ICD)-9/10 diagnosis codes from all medical encounters in the MHS Data Repository (MDR) from fiscal years (FY) 2012 to 2018. Chart reviews were conducted to assign ICD diagnoses as incorrect, suspected, probable or confirmed based on the laboratory results and symptoms.

RESULTS

Abstraction of MHS data revealed over 50 000 helminth diagnoses between FY 2012 and FY 2018. Of these, 38 445 of diagnoses were amongst unique subjects. After chart review, we found there were 34 425 validated helminth infections diagnosed amongst the unique subjects of US military personnel, retirees and dependents. Nearly 4000 of these cases represented infections other than enterobiasis. There were 351 validated strongyloidiasis diagnoses, 317 schistosomiasis diagnoses and 191 diagnoses of cysticercosis during the study period. Incidence of intestinal nematode infection diagnoses showed an upward trend, whilst the incidence of cestode infection diagnoses decreased.

CONCLUSIONS

The results of this study demonstrate that helminth infections capable of causing severe morbidity are often diagnosed in the US military. As helminth infections are often asymptomatic or go undiagnosed, the true burden of helminth infections in US military personnel and dependents may be higher than observed here. Prospective studies of US military personnel deployed to helminth-endemic areas may be indicated to determine if post-deployment screening and/or empirical treatment are warranted.

Primary left ovarian hydatid cyst presenting as an abdominal mass - Case report

Introduction

Hydatid disease, which is most often caused by Echinococcus granulosus, can occur in virtually all parts of the body. The disease most frequently occurs in the liver followed by the lungs, muscles, and bones respectively. Primary ovarian hydatid cyst is a rare case.

Case presentation

A 28-year-old woman presented to the emergency department with vague abdominal discomfort of 8-month duration which was located to the left side of lower abdomen and pelvis associated with episodes of low-grade fever. Her past medical and surgical histories were unremarkable with no surgical operation. She had 3 vaginal deliveries and did not smoke.

Discussion

Hydatid disease is commonly caused by Echinococcus granulosus. The parasite can colonize virtually in every organ or in several organs at one time in the body. Pelvic hydatid cyst most often presents with vague abdominal pain. The diagnosis of the disease is not straightforward most of the time and requires investigations. The gold standard surgical treatment for ovarian hydatid cyst is cystectomy.

Conclusion

Ovarian hydatid cyst should always be considered in the differential diagnosis of pelvic masses, especially in endemic areas. Surgical treatment in the form of radical cystectomy is the treatment of choice and it is necessary to take all precautions not to spill hydatid fluid and daughter cysts inside the abdomen. Anthelmintics adjuvant chemotherapy postoperatively may decrease the recurrence rate of the disease.

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Hydatid disease can affect ovaries, like many other organs.

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Primary hydatid disease of ovary can be misdiagnosed due to its rarity.

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Treatment of primary ovary hydatid disease is surgery.

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Anti-parasite agents can also be used, post operatively.

Primary hydatid disease of chest wall mimicking chest wall mass-case report

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Hydatid disease can affect chest wall like many other organs.

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Primary hydatid disease of chest wall can present as a chest wall mass.

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Treatment of chest wall hydatid disease is surgery.

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Anti-parasite drugs and scolicidal agents can also be used.

Introduction

Hydatid cyst is a parasitic disease caused by echinococcus granoulosis. It is endemic in Mediterranean areas, south America, north Africa and Australia. The disease is most common in the liver and then in lung, the chest wall involvement by hydatid disease is a very rare condition.

Presentation of case

We present a case of chest wall mass in a 65-years old man, who intra operatively diagnosed as primary hydatid cyst. Cystectomy done and patient followed up for 2 months.

Discussion

The diagnosis of echinococcus infection mainly depends on the clinical history of the patient, serologic tests, and diagnostic radiological findings. Operative procedures for chest wall hydatid disease are cystectomy, cystotomy, evacuation, and chest wall resection.

Conclusion

Chest wall hydatid disease should be considered in the differential diagnosis of chest wall masses even in a patient who has not been operated for hydatid disease.

Global Distribution of Alveolar and Cystic Echinococcosis

Alveolar echinococcosis (AE) and cystic echinococcosis (CE) are severe helminthic zoonoses. Echinococcus multilocularis (causative agent of AE) is widely distributed in the northern hemisphere where it is typically maintained in a wild animal cycle including canids as definitive hosts and rodents as intermediate hosts. The species Echinococcus granulosus, Echinococcus ortleppi, Echinococcus canadensis and Echinococcus intermedius are the causative agents of CE with a worldwide distribution and a highly variable human disease burden in the different endemic areas depending upon human behavioural risk factors, the diversity and ecology of animal host assemblages and the genetic diversity within Echinococcus species which differ in their zoonotic potential and pathogenicity. Both AE and CE are regarded as neglected zoonoses, with a higher overall burden of disease for CE due to its global distribution and high regional prevalence, but a higher pathogenicity and case fatality rate for AE, especially in Asia. Over the past two decades, numerous studies have addressed the epidemiology and distribution of these Echinococcus species worldwide, resulting in better-defined boundaries of the endemic areas. This chapter presents the global distribution of Echinococcus species and human AE and CE in maps and summarizes the global data on host assemblages, transmission, prevalence in animal definitive hosts, incidence in people and molecular epidemiology.

Epidemiology and control of echinococcosis in central Asia, with particular reference to the People's Republic of China

At least 270 million people (58% of the total population) are at risk of cystic echinococcosis (CE) in Central Asia including areas of Mongolia, Kazakhstan, Kyrgyzstan, Tajikistan, Turkmenistan, Uzbekistan, Afghanistan, Iran, Pakistan and western China. The annual surgical incidence rate in Uzbekistan and Tadjikistan has been estimated to be as high as 25-27 cases/100,000 with the highest prevalence reaching 10% (range from 0.8 to 11.9%) in some Tibetan communities in western China. Echinococcus transmission in the region is largely associated with social factors including limited community knowledge of echinococcosis, small-scale household animal production, home killing of livestock, and the feeding of dogs with uncooked offal. Alveolar echinococcosis (AE) is also endemic in Central Asia and is recognized as a major problem in some Tibetan communities with up to 6% of villagers infected in some villages. In western China, 5-30% of the population are seropositive against E. granulosus antigens, indicating that a large number of individuals have been exposed to the parasite. Although echinococcosis control programs have been initiated in some countries in Central Asia, control efforts are generally fragmented and uncoordinated. Monthly deworming of dogs with praziquantel (PZQ), as a key measure to control the Echinococcus parasites, has been used in western China. However, the approach has proven difficult in local semi-nomadic communities. Additional control measures including health education, domestic livestock animal treatment/vaccination and dog vaccination are needed in CE-endemic areas to accelerate progress.