Human echinococcosis: a neglected disease

Circulating free DNA as a diagnostic marker for echinococcosis: a systematic review and meta-analysis

Introduction

Echinococcosis is a chronic zoonotic disease caused by tapeworms of the genus Echinococcus. The World Health Organization (WHO) has identified encapsulated disease as one of 17 neglected diseases to be controlled or eliminated by 2050. There is no accurate, early, non-invasive molecular diagnostic method to detect echinococcosis. The feasibility of circulating free DNA as a diagnostic method for echinococcosis has yielded inconclusive results in a number of published studies. However, there has been no systematic evaluation to date assessing the overall performance of these assays. We report here the first meta-analysis assessing the diagnostic accuracy of cfDNA in plasma, serum, and urine for echinococcosis.

Methods

We systematically searched PubMed, Embase, Cochrane Library, China National Knowledge Infrastructure (CNKI), and WeiPu databases up to 17 January 2024, for relevant studies. All analyses were performed using RevMan 5.3, Meta-DiSc 1.4, Stata 17.0, and R 4.3.1 software. The sensitivity, specificity, and other accuracy indicators of circulating free DNA for the diagnosis of echinococcosis were summarized. Subgroup analyses and meta-regression were performed to identify sources of heterogeneity.

Results

A total of 7 studies included 218 patients with echinococcosis and 214 controls (156 healthy controls, 32 other disease controls (non-hydatid patients), and 26 non-study-targeted echinococcosis controls were included). Summary estimates of the diagnostic accuracy of cfDNA in the diagnosis of echinococcosis were as follows: sensitivity (SEN) of 0.51 (95% CI: 0.45-0.56); specificity (SPE) of 0.99 (95% CI: 0.97-0.99); positive likelihood ratio (PLR) of 11.82 (95% CI: 6.74-20.74); negative likelihood ratio (NLR) of 0.57 (95% CI: 0.41-0.80); diagnostic ratio (DOR) of 36.63 (95% CI: 13.75-97.59); and area under the curve (AUC) value of 0.98 (95% CI: 0.96-1.00).

Conclusion

Existing evidence indicates that the combined specificity of circulating cfDNA for echinococcosis is high. However, the combined sensitivity performance is unsatisfactory due to significant inter-study heterogeneity. To strengthen the validity and accuracy of our findings, further large-scale prospective studies are required.Systematic review registrationThe systematic review was registered in the International Prospective Register of Systematic Reviews PROSPERO [CRD42023454158]. https://www.crd.york.ac.uk/PROSPERO/.

Scolicidal and apoptotic effects of phyto- and chemically synthesized silver/boehmite nanocomposites on Echinococcus granulosus protoscoleces

Cystic hydatid disease (CHD) is a zoonotic disease caused by the larval stage of Echinococcus granulosus (E. granulosus). This study aimed to synthesize silver nanoparticles (Ag NPs), silver boehmite nanocomposite (Ag/Bhm NC), and silver boehmite nanocomposite modified with chitosan (Ag/Bhm/Chit NC) using Rosmarinus officinalis (R. officinalis) extract and chemical method, and to evaluate their scolicidal and apoptotic effects on protoscoleces (PSCs) in vitro. The nanomaterials (NMs) were characterized by XRD, FTIR, FESEM, EDS, DLS, PDI, and zeta potential (ZP). The NMs were tested against PSCs at different concentrations (0.2-1.6 mg/mL) and exposure times (10-60 min). The size of Ag NPs, phytosynthesized Ag/Bhm NC, Ag/Bhm/Chit NC, and chemically synthesized Ag/Bhm NC were 25.55, 43, 72.3, and 60.8 nm, respectively. Ag NPs and phytosynthesized Ag/Bhm NC showed the highest scolicidal effect, with 65.34 % and 51.60 % mortality rate at 1.6 mg/mL and 60 min, respectively. Caspase-3 mRNA expression was higher in PSCs treated with Ag NPs and Ag/Bhm NC than in control groups (P < 0.05). Phytosynthesized Ag/Bhm NC had stronger scolicidal and apoptotic effect than chemically synthesized Ag/Bhm NC. Ag/Bhm/Chit NC had a weaker scolicidal effect but higher gene expression than Ag/Bhm NC. In conclusion, this study demonstrates the potential of phytosynthesized Ag NPs and Ag/Bhm NC as effective scolicidal and apoptotic agents against PSCs of hydatid cysts, which may be useful for the treatment of this disease.

Multiple cystic echinococcosis in abdominal and pelvic cavity treated by surgery with a 4-year follow-up: a case report

We report a case of a male patient who presented with multiple abdominal and pelvic echinococcosis. The patient had been diagnosed with hepatic echinococcosis for 7 years and developed intermittent distension and discomfort in the upper abdomen after an accidental fall. In recent years, the patient's abdominal distention increased gradually. Computed tomography revealed multiple hydatid cysts in the liver, spleen, abdominal cavity, and pelvic cavity. Abdominal organs were severely compressed, such that he could not eat normally except for a liquid diet. The patient underwent radical surgical resection based on the multi-disciplinary treatment (MDT) and the operation lasted 10 h, nearly 100 hydatid cysts were excised, about 18 liters of cyst fluid and cyst contents were removed, and the patient lost 20 kg of weight after surgery. The operation was successful, but there were still some postoperative complications such as hypovolemic shock, postoperative ascites, postoperative bile leakage. Treatment measures for the patient were anti-infection, antishock, clamping the abdominal drainage tube, and negative pressure abdominal puncture drainage. At follow up the patient's quality of life had been significantly improved with 15 kg weight gain compared to before.

Prevalence of cystic echinococcosis among livestock in pastoral and agro-pastoral areas in Uganda

Cystic echinococcosis (CE) remains a significant challenge in Uganda with precise status largely undocumented in most communities. To determine CE prevalence, post-mortem examination was done on 14 937 livestock (5873 goats, 1377 sheep, 3726 zebu cattle and 3054 Ankole cattle) slaughtered in abattoirs in the districts of Moroto in Karamoja region, Kumi in Teso region and Nakasongola and Luwero in Buganda region. The overall CE prevalence was 21.9% in sheep, 15.2% in zebu cattle, 5.5% in goats and 2.1% in Ankole cattle. Moroto district had a higher prevalence of CE than other districts with 31.3% in zebu cattle, sheep 28%, goats 29.1% and (0%) in Ankole cattle. On organ locations, the lungs were the most affected in all livestock in all the study areas. Considering cyst fertility, 33.9, 1.7 and 6.4% of Ankole cattle, sheep and zebu cattle respectively had fertile cysts in the liver while 4.5% of goats and 4% Ankole cattle had fertile cysts in the lungs. In conclusion, CE is widespread and occurs among cattle, sheep and goats in pastoral and agro-pastoral areas in Uganda. Therefore, there is an urgent need to create awareness among the communities on role of livestock in CE epidemiology and transmission.

Expression of Matrix Metalloproteinases in Human Cystic Echinococcosis

BACKGROUND

Cystic echinococcosis (CE) is a zoonotic disease caused by the Echinococcus granulosus senso lato (E. granulosus s.l.) larval stages. Parasitederived products have been shown to regulate host matrix metalloproteinases (MMPs), contributing to CE pathogenesis and progressive liver fibrosis in intermediate hosts. The current study aimed to investigate the potential role of MMP1, 7, 8, and 13 in E. granulosus s.l-induced liver fibrosis.

METHODS

Thirty CE patients with active, transitional, or inactive hydatid cysts were enrolled in this study to determine the inductive effects of E. granulosus on the expression of MMP-1, MMP-7, MMP-8, and MMP-13 in healthy liver tissue and fibrotic liver tissue using qRT-PCR.

RESULTS

According to the WHO-IWGE classification, patients with functional cysts (CE1 and CE2) had the highest percentage (46.6%). MMP-1, MMP-7, MMP-8, and MMP-13 expression levels were significantly higher in fibrotic liver than in normal liver tissue. MMP-13 and MMP-1 had the highest and lowest expression levels among MMPs. Compared to the normal group, the fold change for MMP-13 in the fibrotic group was greater than 12 and had the highest AUC value (AUC= 0.8283).

CONCLUSION

Our findings suggest that E. granulosus-derived products might be involved in regulating host MMPs. Thus, MMPs may be considered potential biomarkers for predicting CE prognosis. Because of the non-normal distribution of our patients' CE types, further research, particularly on circulation MMPs, is needed to confirm the potential role of MMPs in CE pathogenesis and to follow up on CE patients.

Diagnosis of echinococcosis by detecting circulating cell-free DNA and miRNA

INTRODUCTION

Diagnosis of echinococcosis is difficult and usually performed based on clinical findings, imaging, and serological test. However, all of them have limitations, especially in follow-up approaches.

AREAS COVERED

Detection of cell-free DNA (cfDNA) and micro-RNA (miRNA) is currently a hot topic for diagnosis of echinococcosis diseases. For detecting cell-free DNA in echinococcosis patient's samples such as sera, some techniques are based on next-generation sequencing (NGS), DNA-deep sequencing, some are based on PCR-based methods, and a few works related to the detection of miRNA for the diagnosis of human echinococcosis.

EXPERT OPINION

In the detection of cell-free DNA in echinococcosis patient' samples, NGS and DNA-deep sequencing have shown high level of sensitivity, but are not suitable for routine clinical examination as they are expensive and inaccessible in the majority of endemic areas. However, PCR-based methods have shown a sensitivity of about 20-25%. To improve the sensitivity of these tests, improving the DNA extraction method, designing appropriate primers for detecting short-length fragments of circulating DNA, using a higher volume of a serum sample, and application of more sensitive PCR methods are recommended. In the field of miRNA detection, further works are recommended.

Sero-Epidemiological Study of Human Hydatidosis in Semnan and Sorkheh, Semnan Province, Iran

BACKGROUND

To determine the seroprevalence of human cystic echinococcosis/hydatidosis which is one of the most important zoonotic diseases by ELISA using native antigen B in Semnan and Sorkheh, Semnan province, Iran, where no significant information about human infection exists.

METHODS

Overall, 957 human serum samples were randomly prepared from Semnan, Sorkheh, and its 13 surrounding villages in different seasons from 2017 to 2018. Antigen B was prepared from native hydatid cyst fluid of domestic sheep. All serum samples were evaluated by ELISA while the suspected cases were rechecked. The cut-off was calculated as the X ¯ ±2SD.

RESULTS

Overall, 48(5%) out of 957 (422 males and 535 females) were positive for hydatidosis. The seropositivity based on sex showed 20(2.1%) out of 422 in males and 28(2.9%) out of 535 in females. The distribution of seropositive samples based on residence area showed 41 (4.3) out of 882 in urban and 7 (0.7) out of 75 in rural areas. The highest seroprevalence cases was among housewives (2.1%) followed by employers (1.5%). Based on education, source of drinking water, and age groups the highest seropositivity was observed in high school and less, in the plumping water consumers, and 50 to 59 yr old age group, respectively. There was a significant difference between seropositivity with occupation, literacy, and age group (P<0.05). Semnan with 4% seropositivity had the highest prevalence followed by Sorkheh, county.

CONCLUSION

High prevalence of the disease in this area emphasizes the importance of increasing people's awareness about hydatidosis.

Determination of macrophage types by immunohistochemical methods in the local immune response to liver hydatid cysts in sheep

Cystic echinococcosis is a zoonotic parasitic disease caused by Echinococcus granulosus. The main hosts in the life cycle of this parasite are dogs and other carnivores; The intermediate hosts are human, sheep, goat, cattle, pig, buffalo, horse and camel. The parasite damages the tissue by forming lesions in the form of fluid-filled cysts in the liver. These lesions are bounded by a layer of local inflammatory cells formed by the host. In the layer formed by this inflammatory response, there are lymphocytes, neutrophils and eosinophil leukocytes, including macrophages. Samples taken from sheep with hydatid cysts in their livers were followed for pathological analysis, and then histopathological and immunohistochemical examinations were performed. After histopathological examinations, the types of macrophages involved in the local immune response against cysts in the liver were determined by immunohistochemical methods using anti-INOS and anti-IL-10 antibodies. INOS and IL-10 immunopositivity were detected in all samples. Statistically, no significant difference was observed between these immunopositivity. This showed that both macrophage types are involved in the local immune response to hydatid cyst, and that Th1 and Th2 immune response stimulation continues together. It was concluded that in future studies that will be planned and experimentally, it will be possible to reveal more clearly how these macrophage types take part in the local immune response.

Seroprevalence of Cystic Echinococcosis in Yaks and Sheep During 2017 on the Qinghai–Tibet Plateau, China

Cystic echinococcosis (CE) is a livestock disease caused by a parasite known as Echinococcus granulosus. It is one of the primary cause for illness and poverty especially for herders on the Qinghai–Tibet plateau, China. Meanwhile, the Qinghai–Tibet plateau has been a key area for echinococcosis control in China. Here in current study, we determined the seroprevalence of E. granulosus in ruminants on this region. A total of 2,730 serum samples (1,638 samples from yaks and 1,092 samples from sheep) were collected on the plateau during the period of 2017. The samples were assayed for E. granulosus antibodies by commercial enzyme-linked immunosorbent assay kits. Our results exhibited a prevalence percentage of 52.2% in Tibetan yaks and 38.2% in Tibetan sheep. Moreover, there was more chance of being infected with E. granulosus infection in old animals due to more exposure to contaminated sources of infection. However, no significant difference was observed. Furthermore, we observed that the rainfall and presence of several lakes has increased the risk of CE infection in yaks and sheep in the Qinghai, Qinglong, and Baingoin areas. Hence, with this investigation, it was possible to determine the frequency and distribution of CE in yaks and Tibetan sheep on the Qinghai-Tibet plateau, that laying the groundwork for its prevention and management.

Stray Dogs and Public Health: Population Estimation in Punjab, India

The overpopulation of stray dogs is a serious public health and animal welfare concern in India. Neglected zoonotic diseases such as rabies and echinococcosis are transmitted at the stray–dog human interface, particularly in low to middle-income countries. The current study was designed to estimate the stray dog populations in Punjab to enhance the implementation of animal birth and disease (for example, rabies vaccination) control programs. This is the first systematic estimation of the stray dog population using a recommended method (mark–re-sight) in Punjab, India. The study was conducted from August 2016 to November 2017 in selected villages or wards in Punjab. For the rural areas, 22 sub-districts in each district were randomly selected, then one village from each of the 22 selected sub-districts was selected (by convenience sampling). For urban areas, 3 towns (less than 100,000 human population) and 2 large cities (more than or equal to 100,000 human population) were randomly selected, followed by convenience selection of two wards from each of the 5 selected towns/cities. To estimate the dog population size, we used a modified mark–re-sight procedure and analysed counts using two methods; the Lincoln–Petersen formula with Chapman’s correction, and an application of Good–Turing theory (SuperDuplicates method; estimated per km2 and per 1000 adult humans and were compared between localities (villages vs. towns), dog sex (male vs. female) and age group (young vs. adult) using linear mixed models with district as a random effect. The predicted mean (95% CI) count of the dogs per village or ward were extrapolated to estimate the number of stray dogs in Punjab based on (a) the number of villages and wards in the state; (b) the adult human population of the state and (c) the built-up area of the state. Median stray dog populations per village and per ward using the Lincoln–Petersen formula with Chapman’s correction were estimated to be 33 and 65 dogs, respectively. Higher estimates of 61 per village and 112 per ward are reported using the SuperDuplicates method. The number of males was significantly higher than the number of females and the number of adult dogs was about three times the number of young dogs. Based on different methods, estimates of the mean stray dog population in the state of Punjab ranged from 519,000 to 1,569,000. The current study revealed that there are a substantial number of stray dogs and a high number reside in rural (versus urban) areas in Punjab. The estimated stray dog numbers pose a potential public health hazard in Punjab. This impact requires assessment. The estimated stray dog numbers will help develop a dog population and rabies control program in which information about the logistics required as well as costs of implementing such programmes in Punjab can be incorporated.

Hepatitis E, Schistosomiasis and Echinococcosis-Prevalence in a Cohort of Pregnant Migrants in Germany and Their Influence on Fetal Growth Restriction

Background: Infections, as well as adverse birth outcomes, may be more frequent in migrant women. Schistosomiasis, echinococcosis, and hepatitis E virus (HEV) seropositivity are associated with the adverse pregnancy outcomes of fetal growth restriction and premature delivery. Methods: A cohort study of 82 pregnant women with a history of migration and corresponding delivery of newborns in Germany was conducted. Results: Overall, 9% of sera tested positive for anti-HEV IgG. None of the patients tested positive for anti-HEV IgM, schistosomiasis, or echinococcus serology. Birth weights were below the 10th percentile for gestational age in 8.5% of the neonates. No association between HEV serology and fetal growth restriction (FGR) frequency was found. Conclusions: In comparison to German baseline data, no increased risk for HEV exposure or serological signs of exposure against schistosomiasis or echinococcosis could be observed in pregnant migrants. An influence of the anti-HEV serology status on fetal growth restriction could not be found.

Comparison of the multi-epitope recombinant antigen DIPOL and hydatid fluid for the diagnosis of patients with cystic echinococcosis

The use of serological tests containing multiple immunodominant antigens rather than single antigens have the potential to improve the diagnostic performance in Cystic Echinococcoses (CE) as a complement tool to clear the inconclusive imaging data. Here, we comparatively evaluated the diagnostic value of Hydatid Fluid (HF) and the recently described recombinant multi-epitope antigen DIPOL in IgG-ELISA in a clinically defined cohort of CE patients. The serum samples from 149 CE patients were collected just before surgical or Percutaneous- Aspiration- Injection- Reaspiration (PAIR) procedures. Additionally, serum samples of patients with other parasitic infections (n=49) and healthy individuals (n=21) were also included in the study as controls. To investigate the association between the genotype of the parasite and DIPOL, cyst materials from 20 CE patients were sequenced. In terms of overall sensitivity, HF was higher than DIPOL (82.55%,78.52%, respectively). However, while the sensitivity of HF was higher than DIPOL in patients with active and transitional cysts (83.3%, 75.4%, respectively), sensitivity of DIPOL in inactive cysts was higher compared to HF (95.6%, 78.3%, respectively). The sensitivity of DIPOL depending on cyst stage was statistically significant (P= 0.041). In terms of specificity, DIPOL was found to be better than HF (97.71%, 91.43%, respectively). By genotyping, the majority of 20 patients showed G1 genotype (80%). All patients harboring G3 and G1/G3 cyst genotypes were positive with both antigens, while 87.5% of patients with G1 genotype were seropositive with HF and 75% with DIPOL. The overall sensitivity and high specificity of DIPOL suggest that this recombinant protein containing immunodominant epitopes is a potential substitute for the HF by serological tests for the diagnosis of CE.

Reaching the Challenging Diagnosis of Complicated Liver Hydatid Disease: A Single Institution’s Experience from an Endemic Area

Background and Objectives: Hydatid disease (HD) remains a significant public health issue causing morbidity and mortality in many Mediterranean countries. Material and Methods: The present cohort study included 50 consecutive patients with liver hydatid disease who underwent surgery in a tertiary University Hospital. A total of 18 patients (36%) had a case of complicated HD, including simple communication of the cyst with the biliary tree (6 cases), rupture of the cyst into the biliary tree (6 cases), presence of a bronco-biliary fistula (2 cases), rupture of the cyst in the peritoneal cavity (2 cases), and rupture of the cyst and formation of a hepatic abscess (2 cases). Endoscopic retrograde cholangiopancreatography (ERCP) was pre-operatively performed on six patients. Results: The main clinical symptom presented was right upper quadrant pain in 16 patients (88%), which was associated with high fever (>39 °C) in 14 patients (78%). C-reactive protein (CRP) was the primary indicator of a complicated HD (p = 0.003); however, it was only elevated in 67% of cases. CRP was a more sensitive indicator of a rupture in the biliary tree cyst (p = 0.02). Computer tomography (CT) detected more cases (44%) of a complicated HD than ultrasonography (US) (25%); however, the difference was not statistically significant. Conclusions: For prevention and control of HD, a high suspicion of the disease leading to early referral to specialized centers, mainly in endemic areas, is required. Prior to surgical or percutaneous intervention, a combination of imaging and laboratory findings are essential in diagnosing a complicated case and avoiding unnecessary interventions.

Scolicidal and Apoptotic Activities of 5-hydroxy-1, 4-naphthoquinone as a Potent Agent against Echinococcus granulosus Protoscoleces

Cystic hydatid disease (CHD) is a zoonotic disease with different clinical stages caused by the larval stage of the cestode Echinococcus granulosus. It is important to highlight as a public health problem in various regions of the world. In the current study, the efficacy and apoptotic activity of the liposomal system containing juglone (5-hydroxy-1,4-naphthoquinone) were assessed against protoscoleces (PSCs) in vitro. To this aim, firstly, liposomal vesicles were prepared by the thin-film method. Their physico-chemical features were assessed using Zeta-Sizer and Scanning Electron Microscope (SEM). Subsequently, various concentrations (50, 100, 200, 400, and 800 μg/mL) of juglone nanoliposomes at different exposure times (15, 30, 60, and 120 min) were used against PSCs. Results showed that juglone nanoliposomes at all tested concentrations induced scolicidal effect, however, 800 μg/mL and 400 μg/mL of juglone nanoliposomes could reach 100% mortality in 60 and 120 min, respectively. Additionally, we found that caspase-3 mRNA expression was higher in PSCs treated with juglone nanoliposomes compared to control groups (p < 0.001). Therefore, juglone nanoliposomes are suggested to have a more potent apoptotic effect on PSCs. Generally, optimized doses of juglone nanoliposomes could display significant scolicidal effects. Moreover, further in vivo studies are required to evaluate the efficacy of this nanoliposome.

Echinococcus granulosus cyst fluid suppresses inflammatory responses by inhibiting TRAF6 signalling in macrophages

Echinococcus granulosus sensu lato has complex defence mechanisms that protect it from the anti-parasitic immune response for long periods. Echinococcus granulosus cyst fluid (EgCF) is involved in the immune escape. Nevertheless, whether and how EgCF modulates the inflammatory response in macrophages remains poorly understood. Here, real-time polymerase chain reaction and enzyme-linked immunosorbent assay revealed that EgCF could markedly attenuate the lipopolysaccharide (LPS)-induced production of pro-inflammatory factors including tumour necrosis factor-α, interleukin (IL)-12 and IL-6 but increase the expression of IL-10 at mRNA and protein levels in mouse peritoneal macrophages and RAW 264.7 cells. Mechanically, western blotting and immunofluorescence assay showed that EgCF abolished the activation of nuclear factor (NF)-κB p65, p38 mitogen-activated protein kinase (MAPK) and ERK1/2 signalling pathways by LPS stimulation in mouse macrophages. EgCF's anti-inflammatory role was at least partly contributed by promoting proteasomal degradation of the critical adaptor TRAF6. Moreover, the EgCF-promoted anti-inflammatory response and TRAF6 proteasomal degradation were conserved in human THP-1 macrophages. These findings collectively reveal a novel mechanism by which EgCF suppresses inflammatory responses by inhibiting TRAF6 and the downstream activation of NF-κB and MAPK signalling in both human and mouse macrophages, providing new insights into the molecular mechanisms underlying the E. granulosus-induced immune evasion.

Rodent-Related Zoonotic Pathogens at the Human-Animal-Environment Interface in Qatar: A Systematic Review and Meta-Analysis

Rodents are one of the most diversified terrestrial mammals, and they perform several beneficial activities in nature. These animals are also important as carriers of many pathogens with public health importance. The current systematic review was conducted to formulate a true depiction of rodent-related zoonoses in Qatar. Following systematic searches on PubMed, Scopus, Science Direct, and Web of Science and a screening process, a total of 94 published articles were selected and studied. The studied articles reported 23 rodent-related zoonotic pathogens that include nine bacterial, eleven parasitic, and three viral pathogens, from which the frequently reported pathogens were Mycobacterium tuberculosis (32 reports), Escherichia coli (23), and Salmonella spp. (16). The possible pathway of entry of the rodent-borne pathogens can be the land port, seaports, and airport of Qatar through carrier humans and animals, contaminated food, and agricultural products. The pathogens can be conserved internally by rodents, pets, and livestock; by agricultural production systems; and by food marketing chains. The overall estimated pooled prevalence of the pathogens among the human population was 4.27% (95%CI: 4.03–4.51%; p < 0.001) with significant heterogeneity (I² = 99.50%). The top three highest prevalent pathogens were M.tuberculosis (30.90%; 22.75–39.04%; p < 0.001; I² = 99.70%) followed by Toxoplasma gondii (21.93%; 6.23–37.61%; p < 0.001; I² = 99.30%) and hepatitis E virus (18.29%; 11.72–24.86%; p < 0.001; I² = 96.70%). However, there is a knowledge gap about the listed pathogens regarding the occurrence, transmission pathways, and rodent role in transmission dynamics at the human–animal–environment interface in Qatar. Further studies are required to explore the role of rodents in spreading zoonotic pathogens through the One Health framework, consisting of zoologists, ecologists, microbiologists, entomologists, veterinarians, and public health experts in this country.

Lethal in vitro effects of optimized chitosan nanoparticles against protoscoleces of Echinococcus granulosus

Cystic Echinococcosis (CE) is a parasitic infection caused by the larval stage of Echinococcus granulosus. Exploring safe and effective scolicidal agents for the surgery is an urgent need for the successful treatment of CE. This study aimed to determine scolicidal activity of the synthesized chitosan nanoparticles. Physicochemical properties of synthesized nanoparticles were determined by using DLS, FTIR, and SEM. Different concentrations of chitosan nanoparticles from 125 to 1000 μg/ml were examined at different incubation times (10, 60, 120, and 180 min). Scolicidal and cytotoxic activity of chitosan nanoparticles were confirmed by eosin exclusion and hemolysis activity tests. FTIR spectra, zeta potential (+42 ± 2.08) and PDI (0.388 ± 0.034) value revealed that the chitosan nanoparticles were synthesized. Significant differences among the scolicidal effects of chitosan nanoparticles were observed in comparison to the control treatments and highest scolicidal activity was observed at 1000 μg/ml after 180 min exposure time. Hemolytic activity was not significant at all concentrations of chitosan nanoparticles. Our findings support the hypothesis that Chitosan nanoparticles have the potential to be a safe and efficient scolicidal agent candidate at very low concentrations and in a wide range of exposure time. Further in vivo studies are recommended to evaluate chitosan nanoparticle efficacy before clinical application.

Percutaneous Drainage in Hepatic Hydatidosis-The PAIR Technique: Concept, Technique, and Results

Over decades, surgery has been the only accepted mode of treatment for liver hydatid cysts. It had been a surgical dogma for a long that hydatid disease is an absolute contraindication for needle puncture/aspiration as it can cause anaphylaxis, death, and dissemination. We envisaged prospectively perform percutaneous drainage as a primary form of treatment for hepatic hydatidosis. Through extensive and very careful experimentation, we proved that aspiration of hydatid cysts can be performed safely and is the ideal way to manage a subset of patients with hydatid cysts in the liver. The patient and cyst characteristics good and not good for percutaneous drainage were carefully selected. The procedure of percutaneous drainage of hepatic hydatid cysts involves four sequential steps as defined in the alphabets of the title PAIR, denoting puncture (P), Aspiration (A), Instillation (I), and Reaspiration (R). During and postprocedure, we enforced strict monitoring given the anticipated anaphylaxis. The first PAIR procedure was performed in June 1988. The results of percutaneous drainage of 21 cysts in 12 patients were reported in 1991. Next, a prospective study was done to show that concomitant Albendazole therapy is recommended as an adjuvant to percutaneous drainage for hepatic hydatidosis. In a seminal prospective study comparing percutaneous drainage and surgery, we showed that percutaneous drainage is as good as surgery in the management of uncomplicated hydatid cysts with fewer complications and shorter hospital stays. Lastly, long-term follow-up results of percutaneous drainage on a large cohort of patients with hepatic hydatid cysts were reported, with excellent results and no evidence of local, peritoneal or systemic dissemination. Based on these data percutaneous drainage, the so-called PAIR technique has established itself as a novel therapeutic advance in hepatic hydatid disease.

Prevalence and bacterial isolation from hydatid cysts in dromedary camels (Camelus dromedarius) slaughtered at Sharkia abattoirs, Egypt

Cystic echinococcosis (CE) is a severe neglected zoonotic parasitic disease caused by the larval stage of the dog tapeworm, Echinococcus granulosus. The objectives of this study were to determine the prevalence of hydatid cysts in dromedary camels (Camelus dromedarius) at Sharkia province, Egypt and investigate the occurrence of bacteria in hydatid fluid. A total of 6416 dromedary camels slaughtered in five abattoirs in Sharkia province, Egypt during the period from January and December 2018 were investigated for the presence of hydatid cysts. Furthermore, the bacterial species in 10 hydatid fluid isolated from lungs and livers was identified. The current findings revealed that the prevalence of hydatid cysts was 3.7%. Among those, the infection rate in lungs was 78.2%, which was significantly higher than hepatic infections (21.8%). The prevalence of hydatid cysts was the highest in winter (7.4%) and the lowest in spring (1.5%). The most common bacterial species found inside hydatid fluid collected from lungs were Salmonella spp., Staphylococcus spp., Enterococci and Pseudomonas spp. Meanwhile, Staphylococcus spp. were isolated from hepatic hydatid fluid. In conclusion, hydatid cysts infection is prevalent in dromedary camels in Sharkia province, Egypt as well as various aerobic and anaerobic bacterial species were isolated from hydatid fluid from camel lungs and livers.

Transcriptomic Analysis of the Early Strobilar Development of Echinococcus granulosus

Echinococcus granulosus has a complex life cycle involving two mammalian hosts. The transition from one host to another is accompanied by changes in gene expression, and the transcriptional events that underlie this transition have not yet been fully characterized. In this study, RNA-seq was used to compare the transcription profiles of samples from E. granulosus protoscoleces induced in vitro to strobilar development at three time points. We identified 818 differentially expressed genes, which were divided into eight expression clusters formed over the entire 24 h period. An enrichment of gene transcripts with molecular functions of signal transduction, enzymes, and protein modifications was observed upon induction and developmental progression. This transcriptomic study provides insights for understanding the complex life cycle of E. granulosus and contributes for searching for the key genes correlating with the strobilar development, which can be used to identify potential candidates for the development of anthelmintic drugs.

Comprehensive characterization of plasma cell-free Echinococcus spp. DNA in echinococcosis patients using ultra-high-throughput sequencing

Background

Echinococcosis is a life-threatening parasitic disease caused by Echinococcus spp. tapeworms with over one million people affected globally at any time. The Echinococcus spp. tapeworms in the human body release DNA to the circulatory system, which can be a biomarker for echinococcosis. Cell-free DNA (cfDNA) is widely used in medical research and has been applied in various clinical settings. As for echinococcosis, several PCR-based tests had been trialed to detect cell-free Echinococcus spp. DNA in plasma or serum, but the sensitivity was about 20% to 25%. Low sensitivity of PCR-based methods might be related to our limited understanding of the features of cell-free Echinococcus spp. DNA in plasma, including its concentration, fragment pattern and release source. In this study, we applied ultra-high-throughput sequencing to comprehensively investigate the characteristics of cell-free Echinococcus spp. DNA in plasma of echinococcosis patients.

Methodology/Principal findings

We collected plasma samples from 23 echinococcosis patients. Total plasma cfDNA was extracted and sequenced with a high-throughput sequencing platform. An average of 282 million read pairs were obtained for each plasma sample. Sequencing data were analyzed with bioinformatics workflow combined with Echinococcus spp. sequence database. After identification of cell-free Echinococcus spp. reads, we found that the cell-free Echinococcus spp. reads accounted for 1.8e-5 to 4.0e-9 of the total clean reads. Comparing fragment length distribution of cfDNA between Echinococcus spp. and humans showed that cell-free Echinococcus spp. DNA of cystic echinococcosis (CE) had a broad length range, while that of alveolar echinococcosis (AE) had an obvious peak at about 135 bp. We found that most of the cell-free Echinococcus spp. DNA reads were from the nuclear genome with an even distribution, which might indicate a random release pattern of cell-free Echinococcus spp. DNA.

Conclusions/Significance

With ultra-high-throughput sequencing technology, we analyzed the concentration, fragment length, release source, and other characteristics of cell-free Echinococcus spp. DNA in the plasma of echinococcosis patients. A better understanding of the characteristics of cell-free Echinococcus spp. DNA in plasma may facilitate their future application as a biomarker for diagnosis.

Echinococcosis is one of the most neglected tropical diseases caused by the metacestodes of Echinococcus spp. tapeworms, which affect both humans and livestock. Plasma cell-free DNA (cfDNA) consists of nucleic acid fragments found extracellularly and may contain DNA released from the parasites. Research shows that a variety of parasites can be detected from plasma cfDNA. Cell-free Echinococcus spp. DNA in plasma or serum had been tested with PCR-based methods, but these PCR methods had low sensitivity ranged from 20% to 25%. Low sensitivity may be due to our limited understanding of cell-free Echinococcus spp. DNA in plasma. Here, we take advantage of high-throughput sequencing to get a comprehensive characterization of cell-free Echinococcus spp. DNA. Our results showed that with high-throughput sequencing we could detect cell-free Echinococcus spp. DNA in all samples, though at a very low level. Based on the sequencing data, we found that cell-free Echinococcus spp. DNA in plasma had a different fragment length distribution to cell-free human DNA, and fragment length distribution of cell-free Echinococcus spp. DNA is also different between cystic echinococcosis (CE) and alveolar echinococcosis (AE). The sequencing data can also help trace the release source of cell-free Echinococcus spp. DNA from the genome. According to the mapping results of cell-free Echinococcus spp. DNA reads, we found that most of them were from the nuclear genome rather than the mitochondrial genome, and their release position showed an even distribution on the genome. These characteristics of cell-free Echinococcus spp. DNA in echinococcosis patients’ plasma could facilitate their future application in research or clinical settings.

An integrated surgical training program for hepatic cystic echinococcosis in Xinjiang of China

Background

Human cystic echinococcosis (CE) is one of the commonest zoonoses, and it is endemic in many parts of the world including China. Complications and recurrences after the surgical treatment of hepatic CE (HCE) incur a large personal, healthcare, and societal burden. There has been some progress in HCE prevention, diagnosis, and treatment, but there is no “one size fits all” approach, and surgery still remains the cornerstone of treatment for some cyst stages and locations or in areas with little knowledge or access to other treatment modalities. In 2009 we designed and implemented a program to improve surgical outcomes from HCE in Xinjiang province, China.

Methodology/Principal findings

A multimodal HCE training program was implemented in eleven primary hospitals in Xinjiang province, China, which provided education and training on HCE clinical knowledge and practice, the application of diagnostic and treatment options, and optimal surgery. The management of HCE cases was analyzed before and after program implementation. Contrast enhanced CT use, application of scoloicidal agents, removal of necrotic cyst wall remnants, appropriate perioperative drug use, and the use of optimal surgical approach increased after program implementation. Further, postoperative recurrences and residual cavity complications creased from 7.4% to 1.3% and 15.2% to 9.0% after program implementation, respectively.

Conclusions/Significance

Tis integrated surgical training program is useful for improving outcomes of patients with HCE and can be used in institutions in other endemic areas.

Hepatic cystic echinococcosis (HCE) is an endemic and neglected global disease. Many deprived areas in China still lack the knowledge and expertise to successfully treat HCE surgically, which results in high postoperative complication and recurrence rates that further decrease postoperative quality of life. In this study, we aimed to transfer our extensive experience in the development and implementation of effective surgery for HCE to eleven hospitals in the Echinococcus granulosus endemic province of Xinjiang to improve the surgical treatment of HCE. Our results indicate that our training program effectively reduces recurrence and complication rates and will be of use in other endemic areas.

The current prevalence and diversity of cystic echinococcosis in slaughtered animals in Egypt

Cystic echinococcosis is a potential zoonotic helminthic disease affect a broad spectrum of mammals including humans worldwide. The economic impact of the disease interestingly requires updated gathering information on the prevalence in slaughtered animals. Accordingly, in the current study, 573 camels, 4300 sheep, and 1235 pigs were surveyed in four Egyptian municipal abattoirs. Among those, 62 (10.82%) camels, 33 (0.77%) sheep and 3 (0.24%) pigs had cystic echinococcosis in lungs, livers and spleen. The diversity of cysts revealed that positive-cystic echinococcosis animals from all species were detected in El-Basatin abattoir. In El-Monieb abattoir, sheep only were infected. In El-Waraa and Beni-Suef abattoirs, cysts were seen in camels only. Infected animals included both sexes. In camels, lungs were the most affected organs, while in sheep, livers were the most abundant. In pigs, hydatid cysts were detected only in lungs. Moreover, camel cysts were mostly large-sized (diameter > 10 cm) with smaller cysts are also recorded. In sheep, small-, moderately- and large-sized cysts were equally present. Cysts in pigs were large-sized. Camels showed a higher percentage of fertile cysts (46.77%; 29/62) followed by sheep (21.21%; 7/33). Calcified/degenerated cysts were less in camels (38.71%; 24/62) than in sheep (75.76%). Non-viable cysts were the less frequent in both species (14.52% in camels and 3.03% in sheep). All cysts recovered from pigs were fertile. In Egypt, governmental agencies and veterinary authorities are asked to potentially eradicate stray dogs (the main definitive host) and towards the proper hygienic disposal of infected offal in abattoirs to minimize the prevalence of cystic echinococcosis.

Variabilities of hydatidosis in domestic animals slaughtered at Cairo and Giza abattoirs, Egypt

Aim

The effect of some variables on hydatidosis in animals slaughtered at Cairo and Giza abattoirs was investigated and the influence on serum biochemical parameters, antioxidant enzymes, and histopathological lesions caused by these parasites as a consequence was estimated.

Materials and Methods

The effect of some variables on hydatidosis in 397 sheep, 401 cattle, 435 buffaloes, and 341 camels slaughtered at Cairo and Giza abattoirs was investigated, and the influence on serum biochemical parameters, antioxidant activity and histopathological lesions caused by these parasites as a consequence was estimated.

Results

The results revealed that 39 sheep (9.8%), 74 cattle (18.4%), 95 buffaloes (21.8%), and 79 camels (23.25%) were infected. Concerning age variations, 165 young and 232 adult sheep, 215 young and 186 adult cattle, 194 young and 241 adult buffaloes, and 112 young and 229 adult camels were examined. The prevalence of hydatidosis was higher in adult sheep, cattle, and camel; 32 (13.8%), 49 (26.3%), and 56 (24.5%) than the younger ones 7 (4.2%), 25 (11.6%), and 23 (20.5%), respectively. Two hundred and eighty-eight sheep, 171 cattle were examined during winter. However, 109 sheep, 230 cattle were examined during summer. Hydatidosis infection in sheep and cattle was higher in winter 26 (9.01%) and 47 (27.5%) than in summer 13 (11.9%) and 27 (11.7%), respectively. Out of 133 sheep and 128 camels slaughtered in El-Basatin abattoirs, 36 (15.3) and 38 (29.7%) showed higher prevalence than that from El-Warak and El-Moneib abattoirs. Comparing with the non-infected groups, alkaline phosphatase activity decreased in hydatid-infected animals, while cholesterol and liver enzymes activities increased. Total lipid and triglyceride levels decreased in infected camels. Glutathione peroxidase, superoxide dismutase, and catalase decreased in hydatid-infected animals.

Conclusion

The disturbance in the biochemical parameters, liver enzymes, and the antioxidant activities was consistent with the pathological findings that indicated the risk of hydatidosis infection. Finally, this study clarified the variabilities of hydatidosis in Cairo and Giza abattoirs as a starting point for future studies in different regions in Egypt.

The pattern of cystic echinococcosis in children in an endemic area in Morocco

Cystic echinococcosis is a parasitic infection of major public health concern. The infection is generally acquired during childhood and the disease incubation period can last many years. The occurrence and characteristics of the disease in children were not well studied. The present study aimed to explore the pattern and features of cystic echinococcosis in children in rural and urban environments in Morocco. A total of 338 children diagnosed and treated for cystic echinococcosis were investigated. The trend of the infection, risk and exposure factors and the distribution of the anatomic locations of cysts were studied. A non-uniform decrease in proportions of infected children was found. Children from rural environs had significantly higher infection rates than children from urban environs (p < 0.001). Males were significantly more infected than females. Children aged 7-11 years were the most affected. For cysts locations, single organ involvement was found in 94.4% of the children versus 5.6% with multi-organ localization. Despite control program, active transmission of echinococcosis still occurred in children and remains a major public health problem. The infection in younger population may have some features that need to be considered in the prevention and control programs in endemic areas.

A retrospective study of hydatid cysts in patients undergoing liver and lung surgery in Tehran, Iran

Hydatid cyst, caused by larval stages of Echinococcus granulosus, is a zoonotic parasitic disease with public health importance. The disease is cosmopolitan and endemic in Iran. We conducted a retrospective study of the records of Milad Hospital, Tehran, Iran to establish the proportion of lung and liver surgical procedures that were performed for removal of hydatid cyst and to investigate the demography of the population undergoing lung and liver hydatid cyst surgery in this hospital. A retrospective cross-sectional study was conducted of records of 682 patients who underwent liver (n = 404) or lung (n = 278) surgery from April 2009 to March 2013. In 404 liver surgeries, 111 (27.5%) diagnoses of hydatid cyst were verified. Liver hydatid infection demonstrated a significant age-related difference (p < 0.05). Cysts were found in 64 of 217 females (29.5%) and 47 of 187 males (25.1%). While in both sexes, more cysts were found in liver, the liver/lung ratio in females was significantly higher than in males (p < 0.001). Hydatid cyst was verified in 59 (21.2%) of 278 lung surgeries: 27 of 105 females (25.7%) and 32 of 173 males (18.5%). There was a significant relationship between sex and organ site (p < 0.001) with the proportion of hydatid cysts in males occurring in lung higher than seen in females. In the five investigated years, approximately 25% of liver and lung surgeries conducted at Milad Hospital were related to hydatidosis. Increasing public awareness of principles of avoiding infection could reduce the risk of nearly a quarter of liver and lung surgeries and costs associated with the treatment of hydatid cysts.

Retrospective Study of Cystic Echinococcosis in a Recent Cohort of a Referral Center for Liver Surgery

BACKGROUND

Cystic echinococcosis (CE) is a zoonosis endemic in Spain caused by the larval stage of the cestode Echinococcus granulosus and is one of the 18 neglected tropical diseases recognized by the WHO. The aim of this study was to describe the epidemiological and clinical data of CE in a surgical referral hospital.

METHODS

A retrospective descriptive study of all adults' patients diagnosed with CE and followed at Vall d'Hebron University Hospital in Barcelona, Spain, between 2000 and 2015.

RESULTS

We found 151 cases, 78 (51.7%) women, and median age at diagnosis was 68 (range, 15-92) years. Diagnosis was a radiological finding in 97 (64.2%) and the most frequent location was the liver [135 (89.4%) patients]. Nearly 80% of the cysts were calcified and serology was positive in 48 (51.6%). The WHO-IWGE classification was only available in 70 of the 104 (67.3%) cases of liver cysts that had an ultrasound. First therapeutic plan was "watch and wait" followed by surgery. International recommendations were not always followed, particularly in CE4 and CE5 stages, and 20% needed a change of treatment because of progression or recurrence. Patients treated surgically were younger, more symptomatic, and had larger and less calcified cysts in multiple sites. Serology was not useful for CE diagnosis and neither serology nor calcification of the cyst helped to predict viability.

CONCLUSIONS

The formation of multidisciplinary teams in reference hospitals could help to improve CE diagnosis, its management, and follow-up, since international recommendations are not usually followed.

Gross and histopathological alterations associated with cystic echinococcosis in small ruminants

Hydatidosis, an important parasitic zoonoses is a major public health as well as economic concern throughout the world. A total of 2100, sheep (2052) and goats (48), slaughtered or spontaneously dead, from various areas of Kashmir valley were screened for the presence of hydatidosis. Out of 2100 cases, 85 were positive for hydatidosis. The frequently infected organs were lungs and liver. The liver was observed to be the most frequently infected organ with relative prevalence of 61.17% followed by lungs (38.82%). The pulmonary cysts were more fertile (55%) compared to hepatic cysts (45%). Histopathologicallly, the cyst wall consisted of the inner germinal, middle lamellated/laminated, and outer fibrous layer. Inflammatory reaction around the cyst was variable and was characterized by an inner zone of loosely arranged fibroblasts infiltrated with mononuclear cells, followed by densely arranged fibroblasts along with mononuclear cells; and an outer layer of fibrous connective tissue. Fibroplasia and calcification were noted at places. In liver besides the cellular reaction against the expanding cyst, hepatocellular degeneration and cirrhosis were observed, the severity of which was inversely related to the distance from the cyst. The structural details of the protoscolices were clearly discernable.

Superinfection of a Dead Hepatic Echinococcal Cyst with a Cutaneous Fistulization

Cystic echinococcosis (CE), also known as "hydatid disease" (HD), is a zoonotic infection caused by the larval stage of Echinococcus granulosus, which infects humans as intermediate hosts through the orofecal route. Carried by the intestinal venous blood, the embryos released by the eggs of the tapeworms can reach every organ, especially the liver, turning into a hydatid cyst. Usually asymptomatic, the cysts can be incidentally detected through radiological examinations performed for other reasons. We show an unusual case of superinfection of a hydatid cyst with typical radiological features of inactivity (WHO-type CE5) with an even rarer skin fistulization passing through a subcutaneous-abdominal abscess involving the right iliac muscle.

Molecular and Morphological Characterizations of Echinococcus granulosus from Human and Animal Isolates in Kashan, Markazi Province, Iran

BACKGROUND

One of the most important zoonotic helminths in the world is known as Echinococcus granulosus. Different strains of the E. granulosus have been described based on morphological and molecular characterizations, however, there is limited information regarding the characteristics of the phenotypes and genotypes of E. granulosus in Iran.

METHODS

The present study was prepared to evaluate the phenotypic and genotypic diversity of E. granulosus isolates collected from human, goat, sheep, and cattle based on 19 standard morphometric parameters and mitochondrial and nuclear genes (CO1, ND1, and ITS1) in Kashan, Markazi Province, Iran during 2013-2014.

RESULTS

The biometric analysis for the 19 characters revealed that the 19 morphometric values of cattle isolates were exceptionally higher than human, goat, and sheep isolates (P<0.05). Molecular analysis confirms the morphological findings. Phylogenic analysis of the CO1, NAD1 and ITS1 genes for all isolates, independent of the host, revealed that the common sheep strain (G1) is traveling among livestock in Kashan and the strains are highly adapted to goats, cattle, sheep, and humans.

CONCLUSION

Both morphological and molecular results of this study indicated that the only genotype G1 of E. granulosus travels between humans and other intermediate hosts of this parasite in the area study.

Differential Expression of Hox and Notch Genes in Larval and Adult Stages of Echinococcus granulosus

This investigation aimed to evaluate the differential expression of HoxB7 and notch genes in different developmental stages of Echinococcus granulosus sensu stricto. The expression of HoxB7 gene was observed at all developmental stages. Nevertheless, significant fold differences in the expression level was documented in the juvenile worm with 3 or more proglottids, the germinal layer from infected sheep, and the adult worm from an experimentally infected dog. The notch gene was expressed at all developmental stages of E. granulosus; however, the fold difference was significantly increased at the microcysts in monophasic culture medium and the germinal layer of infected sheep in comparison with other stages. The findings demonstrated that the 2 aforementioned genes evaluated in the present study were differentially expressed at different developmental stages of the parasite and may contribute to some important biological processes of E. granulosus.

Evolutionary characterization of Ty3/gypsy-like LTR retrotransposons in the parasitic cestode Echinococcus granulosus

Cyclophyllidean cestodes including Echinococcus granulosus have a smaller genome and show characteristics such as loss of the gut, a segmented body plan, and accelerated growth rate in hosts compared with other tissue-invading helminths. In an effort to address the molecular mechanism relevant to genome shrinkage, the evolutionary status of long-terminal-repeat (LTR) retrotransposons, which are known as the most potent genomic modulators, was investigated in the E. granulosus draft genome. A majority of the E. granulosus LTR retrotransposons were classified into a novel characteristic clade, named Saci-2, of the Ty3/gypsy family, while the remaining elements belonged to the CsRn1 clade of identical family. Their nucleotide sequences were heavily corrupted by frequent base substitutions and segmental losses. The ceased mobile activity of the major retrotransposons and the following intrinsic DNA loss in their inactive progenies might have contributed to decrease in genome size. Apart from the degenerate copies, a gag gene originating from a CsRn1-like element exhibited substantial evidences suggesting its domestication including a preserved coding profile and transcriptional activity, the presence of syntenic orthologues in cestodes, and selective pressure acting on the gene. To my knowledge, the endogenized gag gene is reported for the first time in invertebrates, though its biological function remains elusive.

Comparison of ex vivo harvested and in vitro cultured materials from Echinococcus granulosus by measuring expression levels of five genes putatively involved in the development and maturation of adult worms

Parts of the natural life cycle of Echinococcus granulosus can be retraced in vitro such as the development of protoscoleces into semiadult worms with three or more proglottids, or the redifferentiation of in vitro cultured protoscoleces into metacestode-like cystic structures. Most in vitro generated samples share—at the microscopical level—high similarities with those naturally grown, but developmental differences have also been documented, such as missing egg production in in vitro grown adults or unusual bladder/vesicle formation in protoscoleces cultured into the metacestode direction. The aim of the present study was to explore how far different in vitro generated stage-specific materials/structures match the natural situation on the transcriptome level, based on testing five exemplarily chosen different genes: the frizzled receptor eg-fz4 (posterior marker), the FGF receptor-like factor eg-fgfrl (anterior association), the cell differentiation protein eg-rcd1 (part of the CCR4-NOT complex, a key regulator of eukaryotic gene expression), the rapidly accelerated fibrosarcoma serin/threonin kinase eg-braf (part of the MAPK pathway involved, e.g., in EGF signaling) and the co-smad eg-smadD (downstream factor of TGFβ/BMP2/activin signaling). These genes—tested via qPCR—were selected such as to allow a discussion on their potential role in the development of E. granulosus into the adult stage. Thus, testing took place with three ex vivo isolated samples, namely (i) egg-containing adult worms, (ii) invaginated protoscoleces, and (iii) protoscolex-free germinal layer tissue. Respective data were compared (a) with in vitro generated metacestode-like microcysts developed from protoscolices, and (b) different development stages of protoscoleces in vitro cultured toward adult maturation. As a finding, only eg-smadD and partially eg-fz4 showed high expression similarities between ex vivo harvested and in vitro cultured E. granulosus, thus suggesting a putative role in adult maturation. Conclusively, the fact of using “only” five genes did not allow answering the question if ex vivo and in vitro materials are similar on the transcriptome level. Another experimental restriction arises from different growth conditions of the in vitro cultured materials, and comparing these to the ex vivo harvested ones. Future experiments may solve the problems by using fully standardized E. granulosus sample collection and fully standardized culture conditions.

Treatment of Hepatic Cystic Echinococcosis in Patients from the Southeastern Rhodope Region of Bulgaria in 2004-2013: Comparison of Current Practices with Expert Recommendations

Cystic echinococcosis (CE) is a clinically complex chronic parasitic disease, management options for which include surgery, percutaneous treatments, and treatment with albendazole (ABZ) for active cysts, and the "Watch-and-Wait" approach for uncomplicated, inactive cysts. We examined, retrospectively, the clinical management of 334 patients with hepatic CE from the southeastern Rhodope region of Bulgaria between 2004 and 2013. Cysts were reclassified according to the World Health Organization Informal Working Group on Echinococcosis (WHO-IWGE) on the basis of ultrasound reports and images. The majority (62.3%) of uncomplicated cysts were CE1, 66% of which were treated surgically. Of all interventions, 5% were performed on inactive uncomplicated CE4-CE5 cysts. About half (47.6%) of these cysts were therefore treated inappropriately, exposing patients to unnecessary treatment-related risks and the health system to unnecessary costs. No management change was observed after the publication of the WHO-IWGE Expert Consensus recommendations in 2010. In Bulgaria, ABZ is still used in interrupted cycles as this is reimbursed, and peri-interventional chemoprophylaxis was not administered in the majority of surgical patients. Efforts are needed to introduce the WHO-IWGE classification and management recommendations and to encourage reception of state-of-the-art practices by public health regulatory bodies to improve patient quality of care and optimization of health resources.

Comparative Evaluation of Liposomal Albendazole and Tablet-Albendazole Against Hepatic Cystic Echinococcosis: A Non-Randomized Clinical Trial

In this study, we aimed to compare the clinical efficacy of liposomal albendazole (L-ABZ) and tablet-albendazole (T-ABZ) for the treatment of human hepatic cystic echinococcosis (CE). Sixty patients with single cyst (CE1) or daughter cyst (CE2) were included in this study and were nonrandomly divided into the L-ABZ group (n = 30, 10  mg/kg per day, p.o., b.i.d.) and T-ABZ group (n = 30, 12-20 mg/kg per day, p.o., b.i.d.), respectively. The treatment duration lasted for 6 months, during which dynamic follow-up was carried out to evaluate the clinical efficacy through calculating the total effective rates (TERs). Measurement data and numerous data were analyzed by the chi-square test. Two-sided tests were performed for all the statistical tests. In our study, 2 patients were lost in the follow-up in the L-ABZ group. One patient was lost in the follow-up in the T-ABZ group, and 1 patient was withdrawal from the study due to receiving surgery. Significant difference was identified in the 3-month TERs of L-ABZ group and T-ABZ group (33.3% vs 76.7%, P < 0.05). Also, remarkable difference was noted in the 6-month TERs in the L-ABZ group and T-ABZ group (66.7% vs 93.3%, P = 0.01). No statistical difference was noticed in the incidence rate of adverse reactions in both groups (P > 0.05). Based on our study, both T-ABZ and L-ABZ are effective for treating human CE. The TER in the L-ABZ group is superior to that of T-ABZ.

In vitro protoscolicidal effects of various concentrations of Ziziphora tenuior L. extract at different exposure times

OBJECTIVE

Hydatidosis is one of the most important zoonotic diseases and surgery is still the main treatment for this problem. One of the side effects of hydatid cyst surgery is recurrence, thus, searching and assessment of some new agents such as medicinal plant extracts are very important. In the present study, the scolicidal effect of ethanolic extract of Ziziphora tenuior (Z. tenuior) was investigated.

MATERIALS AND METHODS

Protoscolices were aseptically collected from sheep livers containing hydatid cyst and used in the experiments. Z. tenuior extract was used at concentration of 3-100 mg/ml for 10-60 min. Viability of protoscolices was determined by 0.1% eosin staining.

RESULTS

Based on our results, Z. tenuior extract at concentration of 10 mg/ml killed all protoscolices after 20 min. However, this medicinal plant at concentration of 25 mg/ml destroyed all protoscolices in a shorter exposure time (10 min). Therefore, the scolicidal activity of the extract at 10 and 25 mg/ml concentrations was considerably effective in lower concentrations and shorter exposure times.

CONCLUSION

The findings of this study showed that the ethanolic extract of Z. tenuior produces high scolicidal activity; it may be used as an appropriate and effective scolicidal agent in hydatidosis surgery. This is the first report on the protoscolicidal activity of Z. tenuior.

Evaluation of a New Immunochromatographic Test Using Recombinant Antigen B8/1 for Diagnosis of Cystic Echinococcosis

Diagnosis of cystic echinococcosis (CE) is based on the identification of the cyst(s) by imaging, using immunodiagnostic tests mainly as complementary tools in clinical settings. Among the antigens used for immunodiagnosis, previous studies described a good performance of the recombinant antigen B8/1 (rAgB) in an enzyme-linked immunosorbent assay (ELISA) format; however, in remote parts of areas where the disease is endemic, the implementation of an ELISA is difficult, so a more simple, rapid, and reliable method such as the immunochromatographic test (ICT) is required. In this study, using a set of 50 serum samples from patients with surgically confirmed CE, we compared the performance of an ICT and that of an ELISA using the rAgB. The overall sensitivities of ICT and ELISA were not statistically different (78% versus 72%; P = 0.36). The overall agreement between both tests was moderate (κ = 0.41; P < 0.01). Concordance between ICT and ELISA was substantial or almost perfect for patients with liver involvement (κ = 0.65; P < 0.001) and patients with more than one hydatid cyst (κ = 0.82; P < 0.001), respectively. Moreover, specificity analysis using a total of 88 serum samples from healthy individuals (n = 20) and patients (n = 68) with other parasitic infections revealed that ICT had a specificity of 89.8%. ICT and ELISA had similar performance for the detection of specific antibodies to E. granulosus, and ICT had a high specificity, opening the possibility of using ICT as a screening tool in rural settings.

Open Conservative Surgical Management of Cystic Echinococcosis in a Tertiary Care Hospital, Nepal

BACKGROUND

Cystic echinococcosis (CE) or hydatid disease caused by E. granulosus in Nepal is amenable to surgical treatment.

AIM

Aim of the study is to evaluate the efficacy of surgical treatment of CE, by open partial pericystectomy with albendazole as adjuvant.

MATERIALS AND METHODS

Material of this prospective study were the consecutive series of 33 patients operated for CE, over a period of 8 years, at a single centre. Clinical examination, ultrasonography (USG) and computed tomography (CT) were used for establishing diagnosis. Patients were prescribed perioperative albendazole. Povidone iodine 10% (betadine)was used as contact scolicidal agent during operation. Cysts were evacuated from livers, lungs, retroperitoneum by partial pericystectomy. CE of mesentery was completely excised. Descriptive statistics was obtained using EPI- info windows version soft ware.

RESULTS

A total of 33 patients were operated for CE; 24 were females and 9 males. Age ranged from 4 years to 80 years. Organs/ site involved were: liver - 24, lungs - 4, combined liver and lungs - 2, retroperitoneum - 2 and mesentery - 1. Complication - bile leak for 2 weeks in an operated CE of liver. There was no mortality. Hospital stay (in days) was - mean 14 (range 7to21). Follow up for 3 years (average 2years) showed no recurrence.

CONCLUSION

Evacuation of CE by partial pericystectomy is an effective, safe and simple procedure, and gives excellent cure rate with perioperative albendazole therapy.

Molecular characterization of Echinococcus granulosus sensu lato from farm animals in Egypt

Little is known on the diversity and public health significance of Echinococcus species in livestock in Egypt. In this study, 37 individual hydatid cysts were collected from dromedary camels (n=28), sheep (n=7) and buffalos (n=2). DNA was extracted from protoscoleces/germinal layer of individual cysts and amplified by PCR targeting nuclear (actin II) and mitochondrial (COX1 and NAD1) genes. Direct sequencing of amplicons indicated the presence of Echinococcus canadenesis (G6 genotype) in 26 of 28 camel cysts, 3 of 7 sheep cysts and the 2 buffalo derived cysts. In contrast, Echinococcus granulosus sensu stricto (G1 genotype) was detected in one cyst from a camel and 4 of 7 cysts from sheep, whereas Echinococcus ortleppi (G5 genotype) was detected in one cyst from a camel. This is the first identification of E. ortleppi in Egypt.

Cystic echinococcosis is an occupational disease?

Cystic echinococcosis (CE) is considered as an occupational infection and among different careers greengroceries have a close contact with raw vegetables which can transmit eggs of Echinococcus granulosus. Therefore, the objective of this survey was to determine the seroprevalence of CE among greengroceries using ELISA test in Mazandaran and Gilan Provinces, northern Iran. Overall, 160 serum samples (60 male and 100 female) were collected from greengroceries in Mazandaran and Gilan Provinces, 2012. Sera were surveyed employing ELISA assay for diagnosis of CE. In addition, before sampling, a questionnaire was filled out for each subject. Seropositivity was 2.4 % (four cases) and females 1.8 % (three cases) were more positive compared to males 0.8 % (one case). Age group of 40-60 years encompassed the highest rate of positivity (1.8 %) and the least rate was in 20-40 years old age group (0 %). Besides, 1.8 % of seropositive subjects were dog owner, unaware of the disease and lives in rural areas. In conclusion, seroprevalence of cystic hydatid disease among greengroceries is relatively high in Mazandaran and Gilan Provinces. More continuous serological researches and preventive measures should be taken into consideration owing to the significance of the disease.

Clinical outcome and immune follow-up of different surgical approaches for human cyst hydatid disease in liver

A new surgical approach (subadventitial cystectomy) has been developed for liver hydatid disease. We retrospectively compared clinical outcomes and immune status 24 months after a subadventitial cystectomy with traditional surgical approaches. Patients with liver hydatid cysts were treated with a subadventitial cystectomy (N = 11), pericystectomy (N = 16), partial pericystectomy (N = 18), or hepatic resection (N = 12). By the end of the follow-up period, the subadventitial cystectomy group had the fewest post-operative complications and shortest hospital stays. Two recurrences occurred: one recurrence after partial pericystectomy and one recurrence after pericystectomy. The total immunoglobulin E (IgE) level decreased significantly in the subadventitial cystectomy group. The post-surgery IgG level was lower in the subadventitial cystectomy than the pericystectomy and partial pericystectomy groups. In conclusion, subadventitial cystectomy completely removes the parasite, causing lower complication rates and lower immune reactions.

Echinococcus of the liver treated with laparoscopic subadventitial pericystectomy

PURPOSE

Because of the new radical procedure, subadventitial pericystectomy, has succeed in treatment for the liver hydatid cysts. The aim of this report is to describe the technical details of our laparoscopic method and report the initial results.

METHODS

Six patients were considered for laparoscopic subadventitial pericystectomy treatment from March 2009 and May 2011.

RESULTS

A laparoscopic surgical technique was used in all cases. The total subadventitial pericystectomy was successfully performed in 2 patients (33.3%) and subtotal subadventitial pericystectomy was performed in 4 patients (66.7%). The mean operating time was 158.3 minutes (range, 90 to 270 min). Complications were observed in 2 patients postoperatively. Postoperatively the mean length of hospital stay was 6.3 days (range, 4 to 10 d). No recurrence was found after laparoscopic surgery in all the patients. The mean follow-up was 15.6 months (range, 6 to 25 mo).

CONCLUSIONS

Laparoscopy subadventitial pericystectomy is effective and reliable in selected patients. It can be a useful alternative for treating hepatic hydatid disease.

Infection status of hydatid cysts in humans and sheep in Uzbekistan

Uzbekistan is endemic of cystic echinococcosis (CE). In order to estimate endemicity of CE, we collected data from emergency surgery due to CE in 2002-2010 and also investigated the prevalence of hydatid cysts in the liver and lungs of sheep at an abattoir in Uzbekistan from July 2009 to June 2010. In 14 emergency hospitals, 8,014 patients received surgical removal or drainage of CE during 2002-2010, and 2,966 patients were found in 2010. A total of 22,959 sheep were grossly examined of their liver and lungs, and 479 (2.1%) and 340 (1.5%) of them were positive for the cyst in the liver and lungs, respectively. Echinococcus granulosus is actively transmitted both to humans and sheep, and CE is a zoonotic disease of public health priority in Uzbekistan.

An imported case of cystic echinococcosis in the liver

A 25-year-old Uzbek male presented with right upper abdominal pain for 20 days. On radiologic studies, a huge cystic mass was noticed in the right liver which was suspected as parasitic. The patient received right hepatic segmentectomy (segment 7), and the surgically resected mass was confirmed as cystic echinococcosis (CE), measuring 10.5 cm in its diameter. The inner surface of the cyst was bile-stained. The patient was discharged on the 8th hospital day, and was rechecked 6 months after the surgical intervention without any evidence of recurrence. The present report describes findings of an imported case of CE which represented ultrasound images of the 'ball of wool'.

Serological diagnosis of lung cystic hydatid disease using the synthetic p176 peptide

Cystic hydatid disease (CHD) is a worldwide zoonosis caused by the larval stage of the dog tapeworm Echinococcus granulosus. Diagnosis is based on imagenological tools (abdominal ultrasound, chest X-rays, or computed tomography [CT] scan). Serological antibody-detecting assays, using diverse native antigens, have been used as a supportive diagnostic tool, but their sensitivities and specificities differ greatly. The use of synthetic peptides as antigens should provide more reliability and allow better assessment and comparison of test formats and case series. The synthetic peptide p176, corresponding to the N-terminal extreme of the subunit of antigen B (AgB8/1), has shown promising performances for diagnosis of CHD. We evaluated the performance of the synthetic peptide p176 for the diagnosis of pulmonary hydatid disease in an enzyme-linked immunosorbent assay (ELISA) format. Sixty-one serum samples from patients with a diagnosis of pulmonary hydatidosis confirmed by surgery and 128 from healthy volunteers were tested. The overall sensitivity and specificity of the p176 ELISA for lung CHD were 78.69% and 96.88%, respectively. On bivariate analysis, positive serum antibody reactions were associated with the presence of complications and with the number of cysts (single/multiple). Only the presence of persistent complications significantly associated with seropositivity on multivariate logistic regression analysis (odds ratio [OR], 9.58; 95% confidence interval [CI], 2.15 to 42.6; P = 0.003). The p176 ELISA performs well for the diagnosis of lung CHD and adds an easily reproducible diagnostic assay to the existing diagnostic tools.