Liver hydatid disease: Morphological changes of protoscoleces after albendazole therapy

Disseminated hydatidosis an unusual presentation: a case report

Hydatidosis, also known as cystic echinococcosis, is a widespread zoonosis, caused by a tapeworm of the genus Echinococcus. It presents a significant public health concern, particularly in endemic areas. The occurrence of disseminated hydatid disease is uncommon, even in regions where it is endemic, with an incidence ranging from 1-8%. The definitive diagnosis relies on a parasitological method. In this work, we present an unusual case of disseminated hydatid disease that was diagnosed in the central parasitology-mycology laboratory of 'The Ibn Sina University Hospital'. This is a 21-year-old patient residing in a rural area, who presented with heaviness-type pain in the right hypochondrium, accompanied with nausea and vomiting. During the examination, the patient mentioned the contact with dogs. Abdominal radiography (ultrasound and CT) revealed findings suggestive of multiple hydatid cysts located in the liver and peritoneum. This suspicion was confirmed by positive hydatid serology. After 9 months of treatment with albendazole, the patient underwent surgery for excision of the cysts shown on the x-ray, as well as other cysts incidentally discovered intraoperatively at the pelvic and rectal levels. All of the extracted specimens were sent to the parasitology laboratory. The direct examination, along with the viability test, revealed the presence of hooks and scolex of non-viable Echinococcus granulosus. Disseminated hydatidosis is a rare but serious presentation, and the positive diagnosis relies on several epidemiological, clinical, radiological and parasitological arguments. Medical and surgical treatments play a crucial role in determining the patient's prognosis.

[Hydatidosis of psoas muscle revealed by vascular axis compression in lower limb: About one case at the Ibn Sina University hospital, Rabat, Morocco]

Introduction

Hydatidosis is a zoonosis caused by Echinococcus granulosus. It's a real public health problem in Morocco. Muscle localization is unusual, even in endemic countries. We report a rarely described case of a hydatid cyst of the psoas muscle diagnosed in our laboratory.

Case report

The patient was a 32-year-old male, living in a rural area. He reported a contact with dogs. He was admitted in vascular surgery department for left hypochondrium pain, with heaviness of the left lower limb and appearance of varicose veins. Clinical examination has found a huge painful and hard mass of the left flank arriving to the hypogastrium with varicose veins of the left leg. An injected CT scan of the pelvic region showed a 189 x 137 mm cystic mass of the left psoas muscle reflowing left iliac vessels. This suggested hydatid cyst. No other localization was found. Hydatid serology was positive with an ELISA test and an indirect hemagglutination test. The patient underwent surgery to remove the mass. Several white vesicles of a few centimeters were found in the cyst and were sent to the parasitology laboratory. Microscopic examination has confirmed the presence of viable Echinococcus granulosus. The patient received albendazole 400 mg twice daily for only a month and was not seen for follow-up. One year after surgery, he showed the same symptoms of abdominal pain and heaviness. Recurrence of hydatid cysts in the same localization was diagnosed with ultrasound showing two hydatid cysts type 3 according to Gharbi classification.

Discussion

Diagnosis of all hydatidosis localizations is based on epidemiological, clinical, and radiological data and confirmed by serology and parasitological examination of the surgical specimen. Surgery is then a diagnostic and therapeutic tool that cannot be bypassed since it allows the definitive elimination of the parasite and eviction of recurrence if it's well done. Conservative methods are related to recurrent cysts.

Conclusion

Muscle hydatidosis is extremely rare but should not be forgotten when radiological and epidemiological data suggest it. It's a benign infection but can be severe and deadly if not appropriately treated.

Abdominal effusion revealing an exophytic hydatid cyst of the liver has developed under mesocolic

The hydatid cyst of the liver is a parasitic disease due to the development of echinococcosis granulosus. It is common in livestock regions in developing countries but is gaining interest in the West due to migratory flows. If it remains a benign and asymptomatic affection for a long time, its natural evolution is often enamelled of complication which can put at the risk of vital prognosis. Diagnosis and staging are based on morphological examinations, including ultrasound and CT scan. The hydatid serology retains a place especially for the detection of recurrence after hydatid cyst of the liver surgery. In addition to surgery considered up to as the radical treatment of choice, other techniques have appeared in the therapeutic arsenal in combination with oral treatment with albendazol for uncomplicated cases thus reducing the morbidity of surgery. We report a case of giant hydatid cyst associated with exophytic liver development under mesocolic associated with a peritoneal hydatidosis.

Research Note. One minute, intraoperative assessment of the viability of hydatid cysts using a simple reagent strip test

The aim of the current work was to evaluate the possibility of using a rapid and simple reagent strip test to investigate the viability of hydatid cysts intraoperatively, via testing certain biochemical parameters. Thirty eight HCF samples were processed and examined by different methods for determining the viability status. Using the reagent strip test in the current study, the highest significant level of glucose was detected in HCF samples with the highest viability % at pH 7.5 and the lowest significant level of glucose was detected in HCF samples with the lowest viability % at pH 8.5, indicating a likely correlation between glucose concentration and the viability of PSs. On the contrary, protein was not detected in HCF containing viable PSs and was found to be higher in HCF containing non-viable PSs, denoting the possible degenerative processes in such PSs. Haemoglobin was found in trace amounts in all of our samples. In addition, the strip test detected bacterial contamination in 8 samples and biliary leakage in 7 samples. Our results suggest that the simple reagent strip test can assist in providing fast, uncomplicated primary data regarding the viability status of the hydatid cysts. Thus, it may aid the surgeons to make informed decisions for further management and appropriate follow up to minimise the risk of post-operative recurrence.

Albendazole for the treatment of human echinococcosis: a review of comparative clinical trials

BACKGROUND

Albendazole has been used in various ways in the treatment of cystic echinococcosis (CE).

METHODS

We reviewed the available evidence regarding the role of albendazole for the treatment of patients with CE. The available comparative clinical trials (randomized or not) that examined the use of albendazole in CE were identified from the PubMed and the ISI Web of Science databases. Relevant data from the trials were extracted and evaluated.

RESULTS

Thirteen studies were included in the review. Albendazole is superior to placebo for inoperable, symptomatic patients (1 study). In addition, in 4 trials that tested albendazole as a preoperative adjuvant therapy, the drug resulted in degeneration of hydatid cysts at the time of surgery in a considerable proportion of patients. Furthermore, combined therapy with albendazole and PAIR (Puncture, Aspiration, Injection of scolicidal agent, and Re-aspiration) technique was found more effective than albendazole or PAIR treatment alone, in a randomized controlled trial examining this issue. Finally, although existing evidence shows some superiority for albendazole compared to mebendazole, there is no definite proof about this.

CONCLUSIONS

Although the available comparative trials provide considerable evidence for the role of albendazole in patients with CE, there are some important clinical questions that remained unanswered by the studies. One of them is whether the combination of albendazole with praziquantel is superior to albendazole alone when both effectiveness and drug toxicity are taken into account. Also, further studies should also compare the combination of albendazole/PAIR with albendazole/surgery focusing on both short and long term outcomes.