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Meng Y, Ren Q, Xiao J, Sun H, Huang Y, Liu Y, Wang S, Wang S. Progress of research on the diagnosis and treatment of bone cystic echinococcosis. Front Microbiol 2023; 14:1273870. [PMID: 37920269 PMCID: PMC10618348 DOI: 10.3389/fmicb.2023.1273870] [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: 08/07/2023] [Accepted: 09/27/2023] [Indexed: 11/04/2023] Open
Abstract
Bone cystic echinococcosis (CE) is one of the most complex and dangerous of all echinococcoses. The lack of typical imaging features and clinical manifestations makes diagnosis and treatment of this disease difficult. X-ray and computed tomography (CT) images of bone CE are similar to those of bone cysts, giant-cell bone tumors, and bone metastases, but magnetic resonance imaging (MRI) shows good diagnostic value due to excellent soft-tissue imaging features. Serological tests cannot be used as a definitive diagnostic method for bone CE due to cross-reactivity, which can lead to false-positive or false-negative results. The development of novel antigens can open new frontiers in the diagnosis of the disease. Currently, views conflict on how to diagnose and treat bone CE. Both surgical and pharmacological treatments can be used, but determining which is appropriate is difficult due to the different sites and clinical manifestations of bone CE. Radical resection is not indicated for large-bone injuries, and Pharmacotherapy becomes important. This article reviews the progress of research into the pathogenesis and clinical manifestations of, and diagnostic strategies and treatment options for, bone CE. We aimed to provide a reference for clinical diagnosis and -treatment options.
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Affiliation(s)
- Yibin Meng
- Department of Spine Surgery, Xi’an Jiaotong University Affiliated HongHui Hospital, Xi’an, China
| | - Qian Ren
- Laboratory of Translational Medicine, School of Medicine, Shihezi University, Shihezi, China
| | - Jun Xiao
- Laboratory of Translational Medicine, School of Medicine, Shihezi University, Shihezi, China
| | - Haohao Sun
- Laboratory of Translational Medicine, School of Medicine, Shihezi University, Shihezi, China
| | - Yiping Huang
- Laboratory of Translational Medicine, School of Medicine, Shihezi University, Shihezi, China
| | - Yaqing Liu
- Laboratory of Translational Medicine, School of Medicine, Shihezi University, Shihezi, China
| | - Shan Wang
- Laboratory of Translational Medicine, School of Medicine, Shihezi University, Shihezi, China
| | - Sibo Wang
- Department of Spine Surgery, Xi’an Jiaotong University Affiliated HongHui Hospital, Xi’an, China
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Ahmad A, Ghani T, Hanifi AN, Faez SA, Baset Z, Malakzai HA. Recurrent spinal hydatidosis causing Gibbus deformity: Report of a rare case. IDCases 2023; 34:e01912. [PMID: 37886696 PMCID: PMC10597852 DOI: 10.1016/j.idcr.2023.e01912] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/29/2023] [Revised: 10/11/2023] [Accepted: 10/12/2023] [Indexed: 10/28/2023] Open
Abstract
Hydatid disease is caused by the larvae of the parasite Echinococcus granulosus and, less commonly, Echinococcus multilocularis in the endemic regions. A hydatid cyst of Echinococcus granulosus commonly develops in the liver and lungs of the affected individual and rarely occurs in the brain, bones, and heart. The spinal hydatidosis comprises 50% of the cases affecting the bones, which usually leads to severe morbidities. We present a case of a 52-year-old Afghan woman presented to the hospital with Gibbus deformity, complaining of lower back pain and flaccid paraplegia for one year. Findings of Magnetic Resonance Imaging of the lumbosacral spine were suggestive of a hydatid cyst involving the vertebrae with extension to the paravertebral soft tissue, leading to acute kyphosis, severe canal stenosis, and cord compression. Treatment included complete cyst removal. The diagnosis was confirmed by gross and microscopic evaluation of the cyst contents. The patient was discharged after significant pain relief and deformity correction. Vertebral hydatidosis is notorious for its recurrence despite vigorous surgical and medical treatment. The hydatid cyst grows rapidly and can cause irreversible damage to the spinal cord in neglected cases. Currently, the best treatment approach is complete surgical removal of the cyst, irrigation with a scolicidal agent, and postoperative follow-up with a long-term course of albendazole. Spinal hydatidosis is a rare, severe disease with significant morbidity. Despite significant scientific advances in understanding of disease pathogenesis, the parasite's predilection for the spine and the influence of host-specific factors on anatomical manifestations remain a mystery.
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Affiliation(s)
- Abdullah Ahmad
- Prof. Dr. Siawash Surgical Orthopaedic Hospital, Kabul, Afghanistan
| | - Torgot Ghani
- Wazir Mohammad Akbarkhan Hospital, Kabul, Afghanistan
| | - Ahmed Nasir Hanifi
- Human Medical Laboratories (HML) and Research Center, Kabul, Afghanistan
| | | | - Zekrullah Baset
- Human Medical Laboratories (HML) and Research Center, Kabul, Afghanistan
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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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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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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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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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