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Ntombela P, Linda Z, Hlapolosa T, Jingo M. The unsolved problem of musculoskeletal hydatid disease: two case reports. J Med Case Rep 2023; 17:531. [PMID: 38148487 PMCID: PMC10752011 DOI: 10.1186/s13256-023-04275-4] [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: 07/27/2023] [Accepted: 11/20/2023] [Indexed: 12/28/2023] Open
Abstract
BACKGROUND Hydatidosis is a parasitic infection caused by Echinococcus granulosus and humans are usually an accidental intermediate host. Involvement of the musculoskeletal system is reported to occur in 0.5% to 4% of the cases. CASE PRESENTATION We present our experience with two cases of musculoskeletal hydatidosis in black African patients that required orthopaedic surgical intervention. A 51-year-old black African female presented with right hip hydatid disease and a 37-year-old black African female presented with the disease affecting the left shoulder. Both patients presented with joint pain and reduced range of motion. The patient with involvement of the shoulder had a background history of human immunodeficiency virus, this was not present with the other patient. Diagnostic work-up confirmed peri-articular hydatid disease and both patients were surgically managed with arthroplasty. Post-operative complications encountered include hardware loosening from bone lysis and hardware failure. DISCUSSION The medical literature describes a limited number of cases of peri-articular musculoskeletal hydatid disease. Patients are often subjected to many investigations, prolonged treatment periods and multiple surgeries. Concurrent use of medical and surgical treatment is advocated however, the choice of surgery is individualised. CONCLUSION Hydatid disease must always feature in the differential diagnosis of multiple lytic bone lesions and radical surgical intervention may be required from the outset.
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Affiliation(s)
- Philani Ntombela
- Department of Orthopaedics, University of the Witwatersrand, 7 York Road Park-Town, Johannesburg, South Africa.
- Orthopaedic Oncology and Infections Unit, Charlotte Maxeke Johannesburg Academic Hospital, University of the Witwatersrand, 7 York Road, Park-Town, Johannesburg, 2193, South Africa.
| | - Zweli Linda
- Department of Orthopaedics, University of the Witwatersrand, 7 York Road Park-Town, Johannesburg, South Africa
- Orthopaedic Oncology and Infections Unit, Charlotte Maxeke Johannesburg Academic Hospital, University of the Witwatersrand, 7 York Road, Park-Town, Johannesburg, 2193, South Africa
| | - Tiego Hlapolosa
- Department of Orthopaedics, University of the Witwatersrand, 7 York Road Park-Town, Johannesburg, South Africa
| | - Maxwell Jingo
- Department of Orthopaedics, University of the Witwatersrand, 7 York Road Park-Town, Johannesburg, South Africa
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2
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Monge-Maillo B, Lopez-Velez R. Cystic echinococcosis of the bone. Curr Opin Infect Dis 2023; 36:341-347. [PMID: 37593962 DOI: 10.1097/qco.0000000000000951] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 08/19/2023]
Abstract
PURPOSE OF REVIEW Cystic echinococcosis (CE) has a wide world distribution causing important morbidity. Osseous involvement is present in less than 4% of the CE cases. Its diagnosis and therapeutic management is full of challenges and low grade of evidence. RECENT FINDINGS The study summarizes literature evidence on the management of osseous CE with particular emphasis on new data regarding diagnosis and treatment. SUMMARY Clinical presentation of osseous CE depends on the skeletal area affected. Diagnosis is mostly based on radiological findings and serology. Recent advances with qPCR on osseous tissue samples seem to be a good option for diagnosis confirmation. Complete resection of the cystic lesion is the only curative option, but it is usually not possible performing palliative surgery and prolonged albendazole intake in most cases. Radiotherapy could be an option, but experience to date is only based on clinical cases.
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Affiliation(s)
- Begoña Monge-Maillo
- National Reference Unit for Tropical Diseases. Infectious Diseases Department, Ramón y Cajal University Hospital. IRICYS. CIBERINFEC. Madrid, Spain
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3
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Luan H, Liu K, Tian Q, Chen Y, Peng C, Sun X, Song X. Palliative Treatment for the Management of Advanced Pelvic Hydatid Bone Disease. Am J Trop Med Hyg 2023; 109:645-649. [PMID: 37524327 PMCID: PMC10484271 DOI: 10.4269/ajtmh.23-0267] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/05/2023] [Accepted: 06/22/2023] [Indexed: 08/02/2023] Open
Abstract
Hydatid bone disease is a zoonotic parasitic infection that is caused primarily by the tapeworm Echinococcus granulosus, and it continues to be a major public health concern in pastoral regions. The reconstruction of limb function after limb salvage surgery remains a challenge for clinicians. The purpose of this study was to determine the clinical efficacy of palliative treatment of the management of advanced pelvic hydatid bone disease. From March 2005 to December 2018, medical records and images of patients with advanced pelvic hydatid bone disease treated with surgery combined with antiparasitic chemotherapy were evaluated retrospectively. The Enneking classification was applied to determine the location of the lesion, and the Musculoskeletal Tumor Society score system was used for outcome evaluation. Fifteen patients who met the criteria were included in this study, with a mean follow-up of 4.40 ± 1.76 years. All patients received treatment with surgery combined with antiparasitic chemotherapy. The mean number of surgical interventions per patient for pelvic cystic echinococcosis was 5.3 (range, 2-9 interventions per patient). Recurrence of pelvic hydatid bone disease occurred in 5 patients and was managed successfully through repeated debridement procedures. Palliative treatment with limb salvage surgery was an effective and practical approach to the management of advanced pelvic hydatid bone disease. Standard antiparasitic chemotherapy, which included albendazole at a dose of 10 mg/kg/day administered in two daily doses for 3 to 6 months, was also considered an essential part of the overall treatment strategy.
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Affiliation(s)
- Haopeng Luan
- Department of Spine Surgery, The Six Affiliated Hospital of Xinjiang Medical University, Urumqi, Xinjiang, China
| | - Kai Liu
- Department of Trauma and Microreconstructive Surgery, The First Affiliated Hospital of Xinjiang Medical University, Urumqi, Xinjiang, China
| | - Qi Tian
- Department of Bone Tumor Surgery, The First Affiliated Hospital of Xinjiang Medical University, Urumqi, Xinjiang, China
| | - Yuanxin Chen
- Uygur Medical College, Xinjiang Medical University, Urumqi, Xinjiang, China
| | - Cong Peng
- Department of Spine Surgery, The Six Affiliated Hospital of Xinjiang Medical University, Urumqi, Xinjiang, China
| | - Xiaoyue Sun
- Department of Rehabilitation Medicine, Shenzhen People’s Hospital, Shenzhen, Guangdong, China
| | - Xinghua Song
- Department of Spine Surgery, The Six Affiliated Hospital of Xinjiang Medical University, Urumqi, Xinjiang, China
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Zali A, Shahmohammadi M, Biazar BH, Masoumi N, Samieefar N, Akhlaghdoust M. Spinal hydatid cyst initially diagnosed as spinal tumor: A case report and review of the literature. Clin Case Rep 2023; 11:e7244. [PMID: 37143458 PMCID: PMC10151595 DOI: 10.1002/ccr3.7244] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/17/2022] [Revised: 03/26/2023] [Accepted: 04/10/2023] [Indexed: 05/06/2023] Open
Abstract
The spinal hydatid cyst is a benign pathology but has considerable morbidity. It should be considered as a differential diagnosis in patients having signs and symptoms of spinal compression, particularly in endemic areas.
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Affiliation(s)
- Alireza Zali
- Functional Neurosurgery Research Center, Shohada Tajrish Neurosurgical Comprehensive Center of ExcellenceShahid Beheshti University of Medical SciencesTehranIran
- USERN Office, Functional Neurosurgery Research CenterShahid Beheshti University of Medical SciencesTehranIran
| | - Mohammadreza Shahmohammadi
- Functional Neurosurgery Research Center, Shohada Tajrish Neurosurgical Comprehensive Center of ExcellenceShahid Beheshti University of Medical SciencesTehranIran
| | - Bijan Herfedoust Biazar
- Functional Neurosurgery Research Center, Shohada Tajrish Neurosurgical Comprehensive Center of ExcellenceShahid Beheshti University of Medical SciencesTehranIran
| | - Niloofar Masoumi
- Student Research Committee, School of PharmacyShahid Beheshti University of Medical SciencesTehranIran
- USERN OfficeShahid Beheshti University of Medical SciencesTehranIran
- Network of Interdisciplinarity in Neonates and Infants (NINI)Universal Scientific Education and Research Network (USERN)TehranIran
| | - Noosha Samieefar
- USERN OfficeShahid Beheshti University of Medical SciencesTehranIran
- Network of Interdisciplinarity in Neonates and Infants (NINI)Universal Scientific Education and Research Network (USERN)TehranIran
- School of MedicineShahid Beheshti University of Medical SciencesTehranIran
| | - Meisam Akhlaghdoust
- Functional Neurosurgery Research Center, Shohada Tajrish Neurosurgical Comprehensive Center of ExcellenceShahid Beheshti University of Medical SciencesTehranIran
- USERN Office, Functional Neurosurgery Research CenterShahid Beheshti University of Medical SciencesTehranIran
- Network of Interdisciplinarity in Neonates and Infants (NINI)Universal Scientific Education and Research Network (USERN)TehranIran
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5
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Odishelashvili GD, Pakhnov DV, Kostenko NV, Nozdrin VM, Odishelashvili LG. [Rare complication of echinococcosis in clinical practice]. Khirurgiia (Mosk) 2023:72-76. [PMID: 36800872 DOI: 10.17116/hirurgia202303172] [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] [Indexed: 06/18/2023]
Abstract
The authors report retroperitoneal echinococcosis with destruction of the bodies and left transverse processes of L4-5 vertebrae, recurrence and pathological fracture of L4-5 vertebrae with secondary spinal stenosis and left-sided monoparesis. Retroperitoneal echinococcectomy, pericystectomy, decompressive laminectomy L5 and foraminotomy L5-S1 on the left were performed. Therapy with albendazole was prescribed in postoperative period.
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Affiliation(s)
| | - D V Pakhnov
- Astrakhan State Medical University, Astrakhan, Russia
| | - N V Kostenko
- Astrakhan State Medical University, Astrakhan, Russia
| | - V M Nozdrin
- Aleksandro-Mariinsky Regional Clinical Hospital, Astrakhan, Russia
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6
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Sun Y, Yan C, Tian D, Zhang C, Zhang Q. Imaging Manifestations and Misdiagnosis Analysis of Six Cases of Bone Hydatid Disease. THE KOREAN JOURNAL OF PARASITOLOGY 2022; 60:413-417. [PMID: 36588418 PMCID: PMC9806501 DOI: 10.3347/kjp.2022.60.6.413] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 08/25/2022] [Accepted: 11/14/2022] [Indexed: 12/29/2022]
Abstract
We retrospectively evaluated the clinical and imaging features of 6 patients with bone hydatid disease confirmed by surgery and pathological examination. Among the 6 patients, 2 were infected with Echinococcosis granulosus metacestode and 4 were infected with E. multilocularis metacestode. The 2 cases with cystic echinococcosis were diagnosed by computed tomographic (CT) examination, and other 4 cases were diagnosed by magnetic resonance (MR) imaging. On the initial evaluation, 1 case each was misdiagnosed as a giant cell tumor or neurogenic tumor, and 2 were misdiagnosed as tuberculosis. The imaging manifestations of bone hydatid disease are complex, but most common findings include expansive osteolytic bone destruction, which may be associated with sclerosing edges or dead bone formation, localized soft tissue masses, and vertebral lesions with wedge-shaped changes and spinal stenosis. Combining imaging findings with the patient's epidemiological history and immunological examinations is of great help in improving the diagnosis and differential diagnosis of bone hydatid disease.
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Affiliation(s)
- Yanqiu Sun
- Department of Radiology, Qinghai Provincial People’s Hospital, Xining, Qinghai,
China
| | - Chunlong Yan
- Department of Radiology, Jining No.1 People’s Hospital, Jining, Shandong,
China,Graduate school of Soochow University, Suzhou, Jiangsu,
China
| | - Dengfeng Tian
- Department of Radiology, Qinghai Provincial People’s Hospital, Xining, Qinghai,
China
| | - Chenhong Zhang
- Department of Radiology, Qinghai Provincial People’s Hospital, Xining, Qinghai,
China
| | - Qiang Zhang
- Department of Radiology, Qinghai Provincial People’s Hospital, Xining, Qinghai,
China,Corresponding author ()
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7
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Ferra Murcia S, Cabezas Fernández MT, Fernández Fuertes E, Collado Romacho AR. Dorsolumbalgia y colecciones paravertebrales con afectación ósea de etiología inesperada. Enferm Infecc Microbiol Clin 2022. [DOI: 10.1016/j.eimc.2021.09.007] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
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8
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Ferra Murcia S, Cabezas Fernández MT, Fernández Fuertes E, Collado Romacho AR. Back pain and paravertebral collections with bone involvement of unexpected etiology. ENFERMEDADES INFECCIOSAS Y MICROBIOLOGIA CLINICA (ENGLISH ED.) 2022; 40:396-398. [PMID: 35537996 DOI: 10.1016/j.eimce.2022.04.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/01/2021] [Revised: 09/11/2021] [Accepted: 09/14/2021] [Indexed: 06/14/2023]
Affiliation(s)
- Sergio Ferra Murcia
- Unidad de Enfermedades Infecciosas, Servicio Medicina Interna, Hospital Universitario Torrecárdenas, Almería, Spain.
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9
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Akhan O, Yildiz O, Unal E, Yildiz AE, Ciftci TT, Akinci D. Case Report: Imaging-Guided Percutaneous Catheterization and Microwave Ablation of a Bone Hydatid Cyst with Soft-Tissue Component. Am J Trop Med Hyg 2022; 107:tpmd220066. [PMID: 35895346 PMCID: PMC9490662 DOI: 10.4269/ajtmh.22-0066] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/22/2022] [Accepted: 03/22/2022] [Indexed: 11/07/2022] Open
Abstract
Cystic echinococcosis (CE) of the bone is a rare disease compared with CE of the viscera, and the most involved bony structures are the spine and the pelvis. Both the diagnosis and the treatment of bone CE are challenging for several reasons. The combination of surgery and antimicrobial therapy is the most common approach, the results are far from adequate. Luckily, percutaneous treatment has appeared on the horizon for bone lesions as a more practical option with fewer drawbacks in light of current reports. This article deals with the successful result of ablation-assisted percutaneous treatment of a bone CE lesion and a soft tissue CE lesion treated by modified catheterization technique in a male patient with left hip pain that was unresponsive to previous surgery for CE.
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Affiliation(s)
- Okan Akhan
- Department of Radiology, Hacettepe University School of Medicine, Ankara, Turkey
| | - Oguzhan Yildiz
- Department of Radiology, Hacettepe University School of Medicine, Ankara, Turkey
| | - Emre Unal
- Department of Radiology, Hacettepe University School of Medicine, Ankara, Turkey
| | - Adalet Elcin Yildiz
- Department of Radiology, Hacettepe University School of Medicine, Ankara, Turkey
| | - Turkmen Turan Ciftci
- Department of Radiology, Hacettepe University School of Medicine, Ankara, Turkey
| | - Devrim Akinci
- Department of Radiology, Hacettepe University School of Medicine, Ankara, Turkey
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10
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Antibiotic Cement Utilization for the Prophylaxis and Treatment of Infections in Spine Surgery: Basic Science Principles and Rationale for Clinical Use. J Clin Med 2022; 11:jcm11123481. [PMID: 35743551 PMCID: PMC9224689 DOI: 10.3390/jcm11123481] [Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/22/2022] [Revised: 06/11/2022] [Accepted: 06/14/2022] [Indexed: 01/27/2023] Open
Abstract
Antibiotic bone cement (ABC) is an effective tool for the prophylaxis and treatment of osteomyelitis due to the controlled, sustained release of local antibiotics. ABC has been proven to be effective in the orthopedic fields of arthroplasty and extremity trauma, but the adoption of ABC in spine surgery is limited. The characteristics of ABC make it an optimal solution for treating vertebral osteomyelitis (VO), a serious complication following spine surgery, typically caused by bacterial and sometimes fungal and parasitic pathogens. VO can be devastating, as infection can result in pathogenic biofilms on instrumentation that is dangerous to remove. New techniques, such as kyphoplasty and novel vertebroplasty methods, could amplify the potential of ABC in spine surgery. However, caution should be exercised when using ABC as there is some evidence of toxicity to patients and surgeons, antibiotic allergies, bone cement structural impairment, and possible development of antibiotic resistance. The purpose of this article is to describe the basic science of antibiotic cement utilization and review its usage in spine surgery.
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11
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Ellatif M, Pressney I, Lindsay D, O'Donnell P. Test yourself answer to question: atraumatic fracture of an abnormal humerus. Skeletal Radiol 2022; 51:889-890. [PMID: 34655315 DOI: 10.1007/s00256-021-03941-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/06/2021] [Revised: 10/05/2021] [Accepted: 10/08/2021] [Indexed: 02/02/2023]
Affiliation(s)
- Mostafa Ellatif
- Department of Radiology, Royal National Orthopaedic Hospital, Stanmore, UK.
| | - Ian Pressney
- Department of Radiology, Royal National Orthopaedic Hospital, Stanmore, UK
| | - Daniel Lindsay
- Department of Histopathology, Royal National Orthopaedic Hospital, Stanmore, UK
| | - Paul O'Donnell
- Department of Radiology, Royal National Orthopaedic Hospital, Stanmore, UK
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12
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Zhang T, Ma LH, Liu H, Li SK. Incurable and refractory spinal cystic echinococcosis: A case report. World J Clin Cases 2021; 9:10337-10344. [PMID: 34904108 PMCID: PMC8638056 DOI: 10.12998/wjcc.v9.i33.10337] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/08/2021] [Revised: 08/27/2021] [Accepted: 09/23/2021] [Indexed: 02/06/2023] Open
Abstract
BACKGROUND Although the incidence and cure rate of spinal hydatidosis are low, the recurrence rate of spinal hydatidosis is high, and the prognosis of spinal hydatidosis is poor. Therefore, we report a typical case of refractory spinal hydatidosis to increase spine surgeons’ awareness of the disease and reduce misdiagnosis and recurrence.
CASE SUMMARY A 48-year-old man presented with back pain, significant weight loss, and paralysis of both lower limbs. The patient was misdiagnosed with spinal tuberculosis in an outside hospital. However, spinal magnetic resonance imaging (MRI) showed hyperintense cystic components on T2-weighted images and hypointensity on T1-weighted images. A lobulated, multiocular, honeycomb-appearance, septated cystic mass protruding intraspinally and compressing the spinal cord at segments T8–T9 was present. Paravertebral polycystic lobular lesions presented as a “bunch of grapes”. The ELISA test result for Echinococcus granulosus was positive. Then, a diagnosis of spinal hydatidosis and lung hydatid disease was made, and the patient underwent left transthoracic approach lobectomy, paravertebral lesion debridement, and subtotal vertebrectomy with vertebral body replacement of segments T8 and T9 by a mesh cage. The patient also underwent albendazole chemotherapy before and after surgery. One year after stopping the drug therapy, the patient developed recurrent T5 vertebral lesions and underwent a second subtotal vertebrectomy surgery. The patient is currently in good condition and is receiving long-term medication and follow-up.
CONCLUSION The MRI feature of a “bunch of grapes” is a typical imaging indication of spinal hydatidosis. Subtotal vertebrectomy is a risk factor for postoperative recurrence. Total spondylectomy makes it possible to cure spinal hydatidosis, but antiparasitic drug therapy is also an important supplementary therapy to multimodal therapy. It is preferable for patients with spinal hydatidosis to receive life-long antiparasitic medication therapy and follow-up.
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Affiliation(s)
- Tao Zhang
- Department of Spine Surgery, the 940th Hospital of Joint Logistics Support Force of Chinese PLA, Lanzhou 730050, Gansu Province, China
| | - Li-Hua Ma
- the First Hospital of Lanzhou University, Lanzhou 730050, Gansu Province, China
| | - Hua Liu
- Department of Spine Surgery, the 940th Hospital of Joint Logistics Support Force of Chinese PLA, Lanzhou 730050, Gansu Province, China
| | - Song-Kai Li
- Department of Spine Surgery, the 940th Hospital of Joint Logistics Support Force of Chinese PLA, Lanzhou 730050, Gansu Province, China
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Luan H, Liu K, Deng Q, Sheng W, Maimaiti M, Guo H, Li H. Multiple debridement of cavity lesions combined with antiparasitic chemotherapy in the treatment of mid or advanced spinal echinococcosis: a retrospective study of 33 patients. Int J Infect Dis 2021; 114:261-267. [PMID: 34775114 DOI: 10.1016/j.ijid.2021.11.014] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/15/2021] [Revised: 10/02/2021] [Accepted: 11/06/2021] [Indexed: 11/25/2022] Open
Abstract
OBJECTIVE The purpose of this study was to evaluate and document the complications and outcomes (bone and functional) of multiple debridement of cavity lesions combined with antiparasitic chemotherapy in the treatment of mid or advanced spinal echinococcosis. METHODS From January 2007 to February 2019, the medical records and imaging of all patients with mid or advanced spinal echinococcosis, who were treated by multiple debridement of cavity lesions, were evaluated retrospectively. The Braithwaite and Less classification system of spinal echinococcosis and the Frankel classification system were used to evaluate the results, both preoperatively and postoperatively. RESULTS Between January 2007 and February 2019, 33 patients met the criteria and were included in this study, with a mean postoperative follow-up time of 4.9 (1-10) years. They included 18 males (54.5%) and 15 females (45.4%), with a mean age of 41.5 years (range 23-70 years). A satisfactory recovery of lower-limb motor function was found in 32 patients, while 24 patients (72.7%) presented with recurrence of spinal echinococcosis. CONCLUSIONS Multiple debridement and spinal cord decompression, combined with antiparasitic chemotherapy after surgery, are effective methods for delaying or preventing disease progression or recurrence. A recurrence of infection is common in most cases. CT and MRI are the preferred methods for diagnosing this disease.
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Affiliation(s)
- Haopeng Luan
- Department of Spine Surgery, The First Affiliated Hospital of Xinjiang Medical University, Urumqi, Xinjiang, 830054, China
| | - Kai Liu
- Department of Trauma and Microreconstructive Surgery, The First Affiliated Hospital of Xinjiang Medical University, Urumqi, Xinjiang, 830054, China
| | - Qiang Deng
- Department of Spine Surgery, The First Affiliated Hospital of Xinjiang Medical University, Urumqi, Xinjiang, 830054, China.
| | - Weibin Sheng
- Department of Spine Surgery, The First Affiliated Hospital of Xinjiang Medical University, Urumqi, Xinjiang, 830054, China
| | - Maierdan Maimaiti
- Department of Spine Surgery, The First Affiliated Hospital of Xinjiang Medical University, Urumqi, Xinjiang, 830054, China
| | - Hailong Guo
- Department of Spine Surgery, The First Affiliated Hospital of Xinjiang Medical University, Urumqi, Xinjiang, 830054, China
| | - Huaqiang Li
- Department of Spine Surgery, The First Affiliated Hospital of Xinjiang Medical University, Urumqi, Xinjiang, 830054, China
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14
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Lal DN, Roza GDL, Damron TA. Total Femoral Replacement for Complicated Echinococcus Infection: Sixteen-Year Follow-up. JBJS Case Connect 2021; 11:01709767-202112000-00047. [PMID: 34762606 DOI: 10.2106/jbjs.cc.21.00408] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022]
Abstract
CASE Osseous hydatidosis caused by Echinococcus is rare, especially in long bones. To the best of our knowledge, this is the third femoral hydatidosis case with successful osseous eradication through total femoral resection and total femoral megaprosthesis. Unlike the previous 2 cases, we uniquely illustrate recurrent soft-tissue hydatidosis episodes requiring additional hydatid resections for local control with no evidence of disease at final 16-year follow-up, the longest follow-up period of the 3 reported cases. CONCLUSION Despite radical bone resection for osseous hydatidosis eradication, additional complex surgical interventions may be needed to locally control soft-tissue disease.
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Affiliation(s)
- Divakar N Lal
- Department of Orthopedic Surgery, Upstate Medical University, Syracuse, New York
| | | | - Timothy A Damron
- Department of Orthopedic Surgery, Upstate Medical University, Syracuse, New York
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Cystic Echinococcosis of the Ilium Treated with Curettage and Microwave Thermoablation Followed by Bone Cement Installation: A Novel Treatment Technique for a Rare Disease. Case Rep Orthop 2021; 2021:5533183. [PMID: 34258091 PMCID: PMC8249124 DOI: 10.1155/2021/5533183] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/09/2021] [Revised: 06/05/2021] [Accepted: 06/09/2021] [Indexed: 11/17/2022] Open
Abstract
Bone cystic echinococcosis (CE) is a rare condition requiring a high level of suspicion during primary diagnosis. Wide excision of the lesion is the gold standard of treatment, posing however extreme challenges in certain parts of the skeleton, since it may well be accompanied by increased morbidity. We report the case of a 35-year-old Caucasian female with iliac bone CE, referred to our department (a regional referral center for the treatment of patients with musculoskeletal tumors). The patient reported gradually increasing dull pain at the right iliac fossa and antalgic gait, with an onset of approximately 5 years before her referral. Bone CE diagnosis was established based on physical examination, imaging studies, and two subsequent CT-guided core needle biopsies, performed within a period of 3 months, of which the second was diagnostic. Following a musculoskeletal tumor multidisciplinary meeting, it was decided that the optional treatment was the surgical removal of the cyst. Aiming to minimize the morbidity accompanying a wide resection of the lesion, we performed extended curettage of the lesion through a typical iliac spine approach, followed by microwave ablation of the walls of the remaining bone cavity. The remaining iliac defect was treated with the installation of polymethyl methacrylate bone cement. The patient reported immediate remission of symptoms postoperatively and was able to return to everyday activities two weeks postoperatively. She began oral treatment with albendazole on the 7th postoperative day. She remained symptom-free for a period of 25 months, until she developed a seroma at the gluteal area, which was treated with simple drainage. On her latest follow-up six months later, she remained symptom-free and was able to perform all her previous activities. Microwave ablation may serve as a useful adjuvant modality when treating patients with bone CE, in order to prevent relapse of the disease.
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16
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Computed tomography and magnetic resonance imaging of hydatid disease: A pictorial review of uncommon imaging presentations. Heliyon 2021; 7:e07086. [PMID: 34095581 PMCID: PMC8166760 DOI: 10.1016/j.heliyon.2021.e07086] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/29/2020] [Revised: 01/14/2021] [Accepted: 05/13/2021] [Indexed: 01/23/2023] Open
Abstract
Hydatid disease (HD), also known as echinococcal disease or echinococcosis, is a worldwide zoonosis with a wide geographic distribution. It can be found in almost all parts of the body and usually remains silent for a long period of time. Clinical history can be varied based on the location, size, host immune response, and complications. The most common imaging modalities used for diagnosis and further evaluations of HD are ultrasound, computed tomography (CT), and magnetic resonance imaging (MRI). Although conventional radiography may be the first used tool, rarely can lead to a definite judgment. Clinical indications and cyst location may alter the choice of imaging. MRI and CT would be useful when the involved area is inaccessible for ultrasound or surgical treatment is required. CT is particularly valuable for osseous organ involvements and the presence of calcifications in the cyst and also demonstrates the size, number, and local complications. MRI can differentiate HD from neoplasms in cases with an unusual appearance on imaging. Moreover, it is preferable in biliary or neural involvements. Besides, more detailed images of MRI and CT could help to resolve the diagnostic uncertainty. Imaging is the main stem for HD diagnosis. Brain, orbit, muscle, bone, and vascular structures are less commonly involved areas. Familiarity with typical clinical presentation, CT scan and MR imaging findings of HD in this sites facilitate the radiologic diagnosis and guiding appropriate treatment.
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Sioutis S, Reppas L, Bekos A, Soulioti E, Saranteas T, Koulalis D, Sapkas G, Mavrogenis AF. Echinococcosis of the spine. EFORT Open Rev 2021; 6:288-296. [PMID: 34040806 PMCID: PMC8142696 DOI: 10.1302/2058-5241.6.200130] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/04/2022] Open
Abstract
Echinococcosis or hydatid disease affecting the spine is an uncommon manifestation of Echinococcus granulosus infection of the spine.More commonly found in endemic areas, it causes significant morbidity and mortality as it grows slowly and produces symptoms mainly by compressing the spinal cord.As diagnostic methods are non-specific, diagnosis and management are usually delayed until the disease is advanced, thereby therapy is usually unlikely.Treatment is usually surgical, aiming at cyst excision, spinal cord decompression and spinal stabilization.This article summarizes the clinical findings of echinococcosis of the spine, discusses the specific laboratory and diagnostic findings, lists the current treatment options, and reviews the patients' outcomes.The aim is to prompt clinicians to be aware of the possibility of echinococcosis as a possible diagnosis in endemic areas. Cite this article: EFORT Open Rev 2021;6:288-296. DOI: 10.1302/2058-5241.6.200130.
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Affiliation(s)
- Spyridon Sioutis
- First Department of Orthopaedics, National and Kapodistrian University of Athens, School of Medicine, Athens, Greece
| | - Lampros Reppas
- First Department of Orthopaedics, National and Kapodistrian University of Athens, School of Medicine, Athens, Greece
| | - Achilles Bekos
- First Department of Orthopaedics, National and Kapodistrian University of Athens, School of Medicine, Athens, Greece
| | - Eleftheria Soulioti
- Second Department of Anaesthesiology, National and Kapodistrian University of Athens, School of Medicine, Athens, Greece
| | - Theodosis Saranteas
- Second Department of Anaesthesiology, National and Kapodistrian University of Athens, School of Medicine, Athens, Greece
| | - Dimitrios Koulalis
- First Department of Orthopaedics, National and Kapodistrian University of Athens, School of Medicine, Athens, Greece
| | - Georgios Sapkas
- First Department of Orthopaedics, National and Kapodistrian University of Athens, School of Medicine, Athens, Greece
| | - Andreas F. Mavrogenis
- First Department of Orthopaedics, National and Kapodistrian University of Athens, School of Medicine, Athens, Greece
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Govindasamy A, Bhattarai PR, John J. Lytic parasitic: a case of bone destructing echinococcosis. Ther Adv Infect Dis 2021; 8:20499361211047664. [PMID: 34616554 PMCID: PMC8488500 DOI: 10.1177/20499361211047664] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/29/2021] [Accepted: 09/03/2021] [Indexed: 01/10/2023] Open
Abstract
Pelvic hydatid bone disease is a rare and debilitating condition. Patients often present with symptoms and signs when the disease process is advanced and curative resection is not possible. We present a case of destructive bone hydatid disease affecting the left iliac bone. A 45-year-old woman presented initially 5 years ago with a left pelvic mass to the gynaecology department. Computed tomography (CT) scan done at that time showed a large pelvic, left iliac fossa cystic mass with the destruction of the left iliac bone. Extension of the cystic mass transversed the iliac bone into the posterior soft tissue. Percutaneous biopsy taken showed hydatid cystic disease. The patient was planned for surgery and, however, was lost to follow-up. Four years later, she presented with a history of worsening left pelvic pain with an enlarging, left pelvic mass, and another mass in the posterior gluteal area. In addition, CT imaging showed extensive left iliac bone destruction with posterior soft tissue extension to the gluteus muscle. A multidisciplinary team concluded that complete excision would not result in cure. Thus, complete iliac wing bone reconstruction was not an option in this patient. Instead, palliative measures were deemed in the patient's best interest to control disease progression and relieve painful pressure-related symptoms from the hydatid cystic mass. The patient received preoperative albendazole and underwent an extraperitoneal debulking of the soft tissue hydatid infiltration and debridement of bony fragments from left iliac bone destruction. Postoperatively, the patient did well, and her main complaint of pain related to the cystic mass pressure had improved significantly.
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Affiliation(s)
- Avaan Govindasamy
- Division of General Surgery, Department of Surgery, Frere Hospital and Walter Sisulu University, East London 5200, South Africa
| | - Pushpa Raj Bhattarai
- Division of General Surgery, Department of Surgery, Frere Hospital and Walter Sisulu University, East London, South Africa
| | - Jeff John
- Division of Urology, Department of Surgery, Frere Hospital and Walter Sisulu University, East London, South Africa
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Outcomes of Radiotherapy for Osseous Echinococcosis of Meriones meridianus. BIOMED RESEARCH INTERNATIONAL 2020; 2020:6457419. [PMID: 32879885 PMCID: PMC7448241 DOI: 10.1155/2020/6457419] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 04/09/2020] [Revised: 06/25/2020] [Accepted: 06/26/2020] [Indexed: 12/28/2022]
Abstract
Background Osseous cyst echinococcosis (CE) is an infectious disease that causes disability and deformity in patients, yet there is still no satisfactory treatment. Focusing on the feasibility and prognosis of radiotherapy as an adjuvant or palliative treatment for osseous CE, this study investigated the outcome of Meriones meridianus with osseous CE after radiotherapy. Methods The study utilized a comparison control group design with three groups of gerbils, and 240 osseous CE gerbils were randomly divided into control, 40Gy/5times, and 50Gy/5times groups. Different doses of radiotherapy were given to the gerbils, and then, the effects of radiotherapy on gerbils and lesions were observed at 3 and 6 months after radiotherapy. Statistical analysis was done using χ2 test, unpaired t-test, and one-way ANOVA. Results Significant changes (P < 0.05) were achieved between the three groups in terms of seven parameters at 3 and 6 months, including the number of dead gerbils and lesion sites with ulceration and infection, number of dead scolices, protein content, Ca2+ concentration, the maximum diameter of lesion site, and wet weight of cysts. Except for the number of dead gerbils and lesion sites with ulceration and infection, all other parameters were observed a big difference between 3 months and 6 months in the 50Gy/5times group. Conclusion Radiotherapy at a dose of 50 Gy has inhibitory and therapeutic effects on osseous CE in gerbils, and radiotherapy could probably be a treatment option for persistent or recurrent osseous CE.
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Patino JM, Ramos Vertiz AJ. Hydatidosis of the complete humerus. Treated with radical resection and endoprosthesis. Case report. Int J Surg Case Rep 2019; 65:296-300. [PMID: 31759302 PMCID: PMC6880118 DOI: 10.1016/j.ijscr.2019.10.083] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/13/2019] [Revised: 10/27/2019] [Accepted: 10/29/2019] [Indexed: 11/08/2022] Open
Abstract
Hydatid bone disease is caused by the Echinococcus granulosus worm. Osseous involvement accounts for 0.5% to 4% of cases in humans. No reports of hydatid disease in the entire humerus have been found in the bibliography. There is no consensus as regards the medical treatment of hydatidosis in the humerus. The affections of the entire humerus and the recurrences present a challenge of treatment for the reconstruction and rescue of the limb. We report a case of salvatage limb with a total humerus endophrostesis with 2 years of follow up.
Introduction Hydatid bone disease is caused by the Echinococcus granulosus worm. The location of the disease in the humerus is infrequent. No reports of hydatid disease in the entire humerus have been found in the bibliography. We present one case of primary hydatid bone disease affecting the entire humerus, which was treated with radical resection and total endoprosthesis of the humerus. Case A 24-year-old patient presented with a diaphyseal humerus fracture. The x-rays and MRI showed an oblique fracture and heterogeneous osteolytic and multiloculated images along the entire humerus. The biopsy resulted in hydatid cysts. Oncological resection of the humerus and total replacement of the same with a non-conventional prosthesis designed for the patient was performed. Conclusion Total humerus hydatidosis is infrequent, and there is scarce information about its treatment. The local resection plus graft and osteosynthesis conserving the bone has shown complications and recurrences. For healing, a radical procedure is necessary. Although functional results may be limited.
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Affiliation(s)
- Juan Martin Patino
- Departamento de Ortopedia y Traumatologia, Servicio de cirugía de mano y miembro superior, Hospital Militar Central "Cosme Argerich", Buenos Aires, Argentina.
| | - Alejandro José Ramos Vertiz
- Departamento de Ortopedia y Traumatologia, Servicio de cirugía de mano y miembro superior, Hospital Militar Central "Cosme Argerich", Buenos Aires, Argentina
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