Epidemiology and clinical features of cystic hydatidosis in Western Sicily: A ten-year review

Hydatid cyst at unusual locations: Report of three cases

INTRODUCTION

Hydatidosis is an anthropozoonosis due to the development in humans of the larval form of Echinococcus granulosus and is endemic in many countries of the Mediterranean region such as Morocco.

CASES PRESENTATION

We report three cases of hydatid cyst at unusual locations such as the peritoneum, and the retroperitoneum.

DISCUSSION

Hydatid disease usually involves the liver (75 %), the lungs (15.4 %), and the spleen (5.1 %). Almost any anatomic location can be the host site of the parasitic cysts.

CONCLUSION

Multiple locations of hydatid cyst often pose a problem of differential diagnosis. Surgery is the mainstay of treatment.

Hydatid Cyst in the Thigh: An Unusual Extra-hepatic Site

Echinococcus granulosus, a cystic parasite, is the cause of hydatid illnesses. The liver and lungs are the most commonly affected organs. In this study, we report a rare instance of a hydatid cyst of the thigh. A 42-year-old male had been experiencing swelling on his left thigh that gradually increased in size. Upon examination, a firm, non-tender swelling measuring 12 x 8 x 8 cm at the lateral aspect of the left thigh was present. The diagnosis of a hydatid cyst in the thigh was confirmed by magnetic resonance imaging (MRI). The patient underwent surgical intervention and had an uneventful recovery post-operatively. The treatment for a hydatid cyst in the thigh, a rare parasitic condition that presents as a painless swelling and is typically diagnosed through MRI, involves en bloc resection. Therefore, surgeons must consider hydatidosis as a potential diagnosis when evaluating swelling in the thigh.

Primary Hydatidosis of the Thigh Involving the Vastus Lateralis Muscle: A Case Report

Hydatidosis is a parasitic disease caused by the larval stage of Echinococcal tapeworm that is endemic in many regions of the world. The subtle and nonspecific nature of the clinical signs frequently results in a delay in diagnosis. Ultrasonography (USG) is the first modality of choice for the diagnosis followed by magnetic resonance imaging (MRI). The detection of a ruptured membrane, observed as low-signal intensity on all pulse sequences, strongly suggests the diagnosis. We report a rare case of a 39-year-old male who presented with fever, pain, and swelling in the right thigh. On further investigations, he was diagnosed to have primary hydatidosis of the thigh involving the vastus lateralis muscle and subcutaneous tissue. The patient underwent en bloc surgical excision of the mass and histopathology confirmed the diagnosis of intramuscular hydatidosis. Understanding the diverse imaging manifestations of primary intramuscular hydatidosis is imperative for accurate preoperative diagnosis, thereby averting potentially fatal outcomes. Timely intervention is paramount as it mitigates both localized and systemic complications that may arise due to cyst maturation. This underscores the criticality of early therapeutic measures to enhance patient outcomes and diminish associated morbidities.

Prevalence of cystic echinococcosis in relatives of patients undergoing surgery for hepatic cystic echinococcosis in an endemic region

BACKGROUND

Cystic echinococcosis (CE) is an endemic disease in southern Chile. The aim of this study was to ascertain the prevalence of CE among relatives of patients who underwent surgical intervention for this disease in Cautín, a province of southern Chile.

METHODOLOGY/PRINCIPAL FINDINGS

Cross-sectional study. Relatives of patients who underwent surgery for hepatic echinococcosis (HE), who lived at the same address, during the period 2000-2020 were studied. A total of 288 relatives of 322 patients who underwent surgery for HE participated in a CE screening. All these relatives were interviewed and underwent abdominal ultrasonography, chest X-ray and immunodiagnostic studies (relatives who had been diagnosed with or had undergone surgery for CE were excluded). Descriptive statistics were applied. Prevalence calculation, odds ratio (OR), and their respective 95% confidence intervals (95% CI) were determined. Abdominal or thoracic CE was verified in 42 relatives of subjects operated on for HE (mean age 41±8 years; 73.8% women; 38.1% of cases had two or more cysts), all of them new and asymptomatic cases. CE was detected in the lungs, liver, peritoneum, and spleen in 16.7%; 71.4%; 7.1%; and 4.8%, respectively. The overall prevalence of EQ during the studied time period was 14,6% (17.9% and 12.3% in relatives of first and second degree respectively (OR:1.56; CI 95%: 0.81; 3.01).

CONCLUSION/SIGNIFICANCE

There is a high prevalence of CE in relatives of patients undergoing surgery by this disease in the province of Cautín, Chile.

Multiple Hydatid Cysts in Rare Locations Treated with Albendazole: A Case Report

Hydatid cyst is a common disease between humans and animals. Foods that are contaminated with eggs of echinococcal species are the cause of hydatid disease. Although this parasite affects different organs, the liver and lungs are very susceptible but the cardiac hydatid disease is very rare. We report the case of a 33-year-old man admitted because of chest pain. Echocardiography had shown suspected round cyst in the myocardium. More diagnostic managements had demonstrated cystic lesion in the liver, spleen and lungs. There were also multiple cystic lesions in both lungs. He refused surgery and was taken to medical therapy. Myocardial involvement by hydatid cysts occurs very rarely. The main treatment approach for cardiac hydatid disease in patients should be surgery. The alternative treatment was done to those who refused surgical removal, adjuvant therapy such as albendazole for at least 1-6 months. Because myocardial involvement by hydatid cysts is uncommon, we decided to report this rare case.

Clinical characteristics and antibodies against Echinococcus granulosus recombinant antigen P29 in patients with cystic echinococcosis in China

Objectives

Cystic echinococcosis (CE) is a neglected parasitic zoonotic disease caused by the larval stage of the tapeworm Echinococcus granulosus (E. granulosus). This study aimed to understand the clinical characteristics of human CE in Ningxia Hui Autonomous Region (NHAR) located in northwest China and to investigate the antibody profiles against the recombinant E. granulosus antigen P29 (rEg.P29) in plasma of CE patients.

Methods

A total of 37 human CE patients, along with 37 healthy donors enrolled in this study and demographic and clinical data were analyzed, including age, gender, laboratory data, symptoms, and cysts description. Plasma levels of cytokines, total IgG, and total IgE were determined by sandwich ELISA kits. Specific antibodies against rEg.P29 and hydatid cyst fluid (HCF) were assessed by indirect ELISA.

Results

The results revealed that females have a higher percentage of CE patients than males. The incidence of CE reached a peak in the 41–50 years-old group. The liver was the most frequent location, accounting for 91.9%. Based on the CT images, cysts of 34 patients who had liver involvement, were classified as 1 (2.9%) CE1, 12 (35.3%) CE2, 5 (14.7%) CE3a, 1 (2.9%) CE3b, and 15 (44.2%) CE5. Twenty-nine (78.4%) patients had a single cyst and 8 (21.6%) had at least two cysts. The most frequently reported symptom was upper abdominal pain. The plasma level of IL-6 and total IgE were significantly increased in CE patients compared with healthy donors. Additionally, IgG response to rEg.P29 in CE patients was significantly higher than in healthy donors, and the dominant IgG subclass was IgG4. Further analysis of different patient groups revealed that rEg.P29-specific IgG and IgG4 were only elevated in CE patients with CE2 type cysts.

Conclusions

This study systematically investigated the clinical characteristics of patients with CE and may provide a reference basis for the diagnosis and treatment of CE in NHAR. Furthermore, tests of specific IgG and IgG4 against rEg.P29 can be used as an assisted method for imaging techniques to identify cystic activity and determine the best therapeutic approach for CE.

Evaluation of a structured treatment discontinuation in patients with inoperable alveolar echinococcosis on long-term benzimidazole therapy: A retrospective cohort study

Objectives

Alveolar echinococcosis (AE) is an orphan zoonosis of increasing concern in endemic areas, including Europe. It frequently presents in an advanced, inoperable stage, that requires life-long parasitostatic benzimidazole therapy. In some patients, long-term therapy leads to negative anti-Em18 antibody ELISA and PET. It is disputed, whether these patients are truly cured and treatment can be safely discontinued. Our aim was to retrospectively assess long-term outcome of 34 patients with inoperable AE who participated in a previous study to determine feasibility of benzimidazole treatment cessation.

Methods

Retrospective analysis of medical charts was undertaken in all 34 AE patients who participated in our previous study. Of particular interest were AE recurrence or other reasons for re-treatment in patients who stopped benzimidazole therapy and whether baseline clinical and laboratory parameters help identify of patients that might qualifiy for treatment cessation. Additionally, volumetric measurement of AE lesions on contrast-enhanced cross-sectional imaging was performed at baseline and last follow-up in order to quantify treatment response.

Results

12 of 34 patients stopped benzimidazole therapy for a median of 131 months. 11 of these patients showed stable or regressive AE lesions as determined by volumetric measurement. One patient developed progressive lesions with persistently negative anti-Em18 antibody ELISA but slight FDG-uptake in repeated PET imaging. At baseline, patients who met criteria for treatment cessation demonstrated higher lymphocyte count and lower total IgE.

Conclusion

Treatment cessation is feasible in inoperable AE patients, who demonstrate negative anti-Em18 antibody ELISA and PET on follow-up. Close monitoring including sectional imaging is strongly advised.

Evaluation of inflammatory parameters in patients with hepatic hydatid disease

BACKGROUND

To the best of our knowledge, the association of inflammatory parameters with hepatic hydatid disease (HD) has not been investigated in a single study. We aimed to evaluate the potential value of inflammatory indices in this disorder.

METHODS

The retrospective study including 114 patients was performed from January 2016 to November 2019. Clinical characteristics and laboratory data for all participants were collected and analysed. The levels of inflammatory parameters were compared in the patient and control group, the predictive value of these inflammatory parameters was assessed by the logistic regression analysis and receiver operating characteristic curve, and differences between pre- and post-surgical operations were compared by pair tests.

RESULTS

Significantly higher levels of platelet distribution width (PDW), eosinophil percentage (EOS %), neutrophil to lymphocyte ratio (NLR), gamma-glutamyl transpeptidase to platelet ratio (GPR) and alkaline phosphatase to platelet ratio (APPR) and lower levels of platelet (PLT) and prognostic nutritional index (PNI) were observed in patients than in controls. Multivariate analyses showed that hydatid could induce the abnormal levels of these parameters, of which APPR and PNI had more obvious changes as compared to other parameters. The levels of PDW and APPR significantly decreased after surgical treatment.

CONCLUSIONS

Inflammatory parameters closely associated with the hepatic HD could be used in the evaluation of treatment as assistant indexes.KEY MESSAGEHydatid disease (HD) seriously endangers public health and economic development.Inflammatory parameters that are readily available and acceptable in routine clinical practice could be closely associated with HD.Inflammatory parameters could be used in the evaluation of disease development by combing with histological and radiological results in future studies.

Isolated renal hydatid disease: varied presentations, treatments, dilemmas, and the way ahead: case report series

Background

Hydatid disease is an infectious disease that affects several organs. Isolated renal involvement is very rare. The treatment for renal hydatid cyst ranges from minimally invasive percutaneous aspiration techniques to laparoscopic and open techniques. We describe five cases of isolated renal hydatidosis with varied presentations who were treated successfully by various methods.

Case presentation

The presenting symptoms included flank pain (n = 5), mass abdomen (n = 2), and hydaturia (n = 1). In 4 patients, the diagnosis of a hydatid cyst was known preoperatively, but one patient with a preoperative diagnosis of a simple cyst was found to harbor hydatidosis intra-operatively. Eosinophilia as a marker for the active disease was present in 60% (3/5), while echinococcal serology was positive in only 25% (1/4). Two cases were approached laparoscopically, while three required an open approach. Two patients were treated with nephrectomy due to the high bulk of the disease, while the other three underwent renal preserving cyst excision.

Conclusions

The presence of eosinophilia in the preoperative workup may indicate an infective/active hydatid disease. Echinococcal serology is representative of past hydatid infection but cannot reveal about current disease status. Cysts with varied attenuations and residence in an endemic region may support a renal hydatid cyst diagnosis. A holistic approach including clinical history, laboratory parameters, and imaging is needed for diagnosis. Surgical treatment requires cyst excision, along with precautions to prevent spilling. Nephrectomy may be preferred in cases with minimal residual function.

An arcane case report of primary intramuscular hydatid cyst of thigh

•

Intramuscular hydatidosis is an extremely rare manifestation of hydatid disease which is endemic in India.

•

Patient presented with a large swelling over the left thigh and was diagnosed in a timely manner using a multimodal approach.

•

The rare location of the disease is confounding and required thorough and meticulous evaluation.

•

Upon surgical exploration, the presence of multiple cysts and daughter cysts proved to be challenging but complete pericystectomy was achieved.

Introduction

Hydatid diseases are a cystic parasitic infestation caused by Echinococci which are endemic to parts of India and commonly occur in agricultural workers. Primary intramuscular hydatidosis is a rare manifestation of hydatid disease.

Presentation of case

Our case report describes a rare case of primary intramuscular hydatidosis in an agricultural worker with no involvement of any other viscera. This was diagnosed with clinical evaluation, radiological modalities and managed surgically.

Discussion

Hydatid disease is endemic in parts of India. Primary intramuscular hydatidosis is uncommon because the lactic acid in the muscle and muscle contractility hinders the development of cysts making it improbable diagnosis on first presentation. Hydatid cyst demonstrates a wide variety of imaging features, which can vary according to growth stage, associated complications and affected tissue. The treatment of choice is complete surgical excision of the cyst along with thorough irrigation of the surrounding soft tissues combined with the use of systemic antiparasitic drugs after surgery.

Conclusion

In a patient of an agricultural background of cattle rearing living in an endemic region and presenting with a swelling in the musculoskeletal system, a suspicion of hydatidosis should always be kept in the clinicians mind, so that it can be diagnosed using a multimodal approach and managed properly in a timely manner.

Evidence of Low Prevalence of Cystic Echinococcosis in the Catanzaro Province, Calabria Region, Italy

Cystic echinococcosis (CE) is one of the neglected tropical diseases recognized by the WHO. Echinococcus granulosus sensu lato affects more than 1 million people worldwide and is responsible for high costs in the healthcare system. A clear knowledge of the prevalence of CE and its clinical characteristics could have an important impact on the approach to its diagnosis and to the public health planning of treatment and control interventions. We performed a prevalence study in four municipalities of Catanzaro Province, South Italy. This area is considered to be at high risk of CE because of ovine breeding. We screened by abdominal ultrasound 2,426 volunteers, four of whom had abdominal CE. Given the need for prevention and control programs for CE in endemic areas of Italy, a detailed mapping of prevalence of CE, to complement data obtained through hospital discharge records, appears imperative.

Unusual localizations of hydatid cysts: a rare case report from Syria

Hydatid disease (HD) is an infection with the metacestode stage of the tapeworm Echinococcus. It is commonly seen in South America, The Middle East, Eastern Mediterranean, Africa and China. Hydatid cysts usually affect the liver followed by the lungs. Involvement in other organs has been reported. However, in the majority of the cases, cysts are localized in one organ or one region. We report a rare case of a 36-year-old woman who presented to the hospital in Syria with long-standing history of non-specific abdominal pain. Computerized tomography showed several hydatid cysts in the liver, spleen, left lung, mediastinum (adjacent to the aortic arch), both breasts and above the right gluteal muscles.

Complications Associated with Initial Clinical Presentation of Cystic Echinococcosis: A 20-year Cohort Analysis

Cystic echinococcosis (CE) is a chronic, complex, and overlooked zoonotic disease caused by Echinococcus granulosus. In humans, it may result in a wide spectrum of clinical manifestations depending on the type of complications, ranging from asymptomatic infection to fatal disease. The primary complications and risk factors associated with CE are not well defined. We performed a retrospective, observational study of inpatients diagnosed with CE from January 1998 to December 2017 in the public health-care system of western Spain. Five hundred and six cases were analyzed. More than half of the patients (302 [59.7%]) were asymptomatic, and the diagnoses were made incidentally. A total of 204 (40.3%) patients had complications associated with CE; 97 (47.5%) were mechanical, 62 (30.4%) were infectious, 15 (7.3%) were immunoallergic, and 30 (14.7%) involved a combination of complications. Mortality was higher in patients with mechanical complications (9.4%) than in patients with infectious complications (5.6%) and in patients with allergic complications (0%) (odds ratio = 19.7, 95% CI, 4.3-89.1, P < 0.001). In summary, CE frequently results in complications, especially in the liver in younger patients and, regardless of other variables, such as size or stage of cyst. Mechanical problems and superinfection are the most frequent complications. CE is an obligatory diagnosis in patients with urticarial or anaphylactoid reactions of unknown cause 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.

Demographic aspects of human hydatidosis in Iranian general population based on serology: A systematic review and meta-analysis

AIM

Human cystic echinococcosis (CE), caused by the larval stage of Echinococcus granulosus cestodes, is a globally distributed chronic disease that is an important socioeconomic and public health problem in humans and livestock in developing countries, including Iran. The aim of this study was to determine the overall seroprevalence of hydatid infection in the general population of Iran.

MATERIALS AND METHODS

This systematic review began by searching electronic databases in English (PubMed, Science Direct, Scopus, and Google Scholar) and Persian (Magiran, Scientific Information Database, Iran Medex, and Iran Doc).

RESULTS

Our search resulted in a total of 40 reports published from 1995 to 2015. Of 49,460 individuals surveyed, 3090 cases of hydatidosis were reported. Community-based studies showed that the seroprevalence of CE in the Iranian general population was 6.0% (95% confidence interval: 5.0-7.0%). The age group with the highest CE seroprevalence was 20-40 years, and the lowest one was in the under 20 year's group. The seroprevalence of hydatidosis in males was significantly higher than that in females. In addition, the intended rate was significantly higher in rural regions than in urban areas.

CONCLUSION

Management program for developing more efficient diagnostic tests should be established. Further, cost-effective preventive approaches, including relevant research, should be considered. Finally, hydatid cyst control programs that are important for interrupting the transmission of human CE should be improved.

Surgically managed human cystic echinococcosis in north-eastern Iran: a single center's experience from 2001 to 2008

Cystic echinococcosis (CE) is a zoonotic parasitic disease caused by the tapeworm Echinococcus granulosus. Although CE has a large geographic distribution, data are lacking on the frequency of infection and epidemiology of CE in many endemic areas of the world, including the Middle East. Demographic and clinical information on surgically managed human CE cases were evaluated from a referral hospital in north-eastern Iran for the years 2001-2008. Of the 400 CE cases, 218 (54.5%) were male. The median age of patients was 35 years (range 2-83 years). The lungs (41.0%) and liver (37.7%) were the most commonly infected organs. However, 12.7% of patients had multiple organ involvement. The majority of cases (54.3%) were diagnosed using ultrasound, with only 12.0% diagnosed with the help of serology. Total white blood cell count was elevated in 26.8% (107/400) of patients, neutrophil count was elevated in 24.0% (96/400) of patients, and eosinophil count was elevated in 13.3% (53/400) of patients. Lymphocyte count was the only complete blood count (CBC) value that differed based on organ location (P = 0.001). Despite some successes in the control of CE, the number of surgical CE cases in north-eastern Iran remains high. Although not diagnostic alone, CBC values allow for clinicians to obtain a more complete clinical picture of CE before, during, and after treatment. While serology has its place, the use of diagnostic imaging continues to be the most commonly used tool for the diagnosis of CE cases.

Laboratory Diagnosis of Echinococcus spp. in Human Patients and Infected Animals

Among the species composing the genus Echinococcus, four species are of human clinical interest. The most prevalent species are Echinococcus granulosus and Echinococcus multilocularis, followed by Echinococcus vogeli and Echinococcus oligarthrus. The first two species cause cystic echinococcosis (CE) and alveolar echinococcosis (AE) respectively. Both diseases have a complex clinical management, in which laboratory diagnosis could be an adjunctive to the imaging techniques. To date, several approaches have been described for the laboratory diagnosis and followup of CE and AE, including antibody, antigen and cytokine detection. All of these approaches are far from being optimal as adjunctive diagnosis particularly for CE, since they do not reach enough sensitivity and/or specificity. A combination of several methods (e.g., antibody and antigen detection) or of several (recombinant) antigens could improve the performance of the adjunctive laboratory methods, although the complexity of echinococcosis and heterogeneity of clinical cases make necessary a deep understanding of the host-parasite relationships and the parasite phenotype at different developmental stages to reach the best diagnostic tool and to make it accepted in clinical practice. Standardization approaches and a deep understanding of the performance of each of the available antigens in the diagnosis of echinococcosis for the different clinical pictures are also needed. The detection of the parasite in definitive hosts is also reviewed in this chapter. Finally, the different methods for the detection of parasite DNA in different analytes and matrices are also reviewed.

Retrospective study of human cystic echinococcosis over the past decade in France, using a nationwide hospital medical information database

No specific surveillance system of cystic echinococcosis infections in humans exists in France. The incidence and trends over time have not been documented since the last decade of the twentieth century. We performed the current analysis to assess human cystic echinococcosis epidemiology over a 10-year period in France (including the island of Corsica but excluding the overseas territories) using a nationwide hospital medical information database. A total number of 2629 patients were identified in this database between 2005 and 2014. The average annual incidence rate was 0.42 hospitalized cases/100,000 inhabitants. It was highest in the Island of Corsica (1.76 cases/100,000) and in the region Provence-Alpes-Côte d'Azur (0.85 cases/100,000). This retrospective analysis of hospital records provides a population-based estimate of cystic echinococcosis incidence and trends over a 10-year period at a national level. It indicates a significant decrease of the incidence between 2005 and 2014 at the national level and in the area that reported the highest incidence. It stresses the fact that in France, cystic echinococcosis is not re-emerging and that the incidence remains low in comparison with similar studies in other Mediterranean countries.

Eosinophilia in Infectious Diseases

In determining the etiology of eosinophilia, it is necessary to consider the type of patient, including previous travel and exposure history, comorbidities, and symptoms. In this review, we discuss the approach to the patient with eosinophilia from an infectious diseases perspective based on symptom complexes.

Cystic echinococcosis in Southern Israel

The aim of this retrospective, population-based study was to characterize demographically and clinically cystic-echinococcosis (CE) in southern Israel, between 2005 and 2012. Newly-diagnosed (nd-CE) and past-diagnosed (pd-CE, diagnosed before the study) cases were defined. Two populations live in southern-Israel, receiving medical treatment at a single hospital: the Jewish and the Bedouin populations (resembling resource-rich and resource-poor populations, respectively). 126 CE cases were identified; 55 nd-CE and 71 pd-CE. Mean annual nd-CE incidence per 100,000 in the Bedouin and Jewish populations were 2.7 ± 1.2 and 0.4 ± 0.3, respectively (P<0.001). None of the Bedouin and 86.5% of the Jewish patients were born outside Israel. Liver and lung involvement were recorded in 85.7% and 15.1% of overall-CE, respectively. Abdominal pain, cough, fever, eosinophilia and asymptomatic disease were documented in 63.6%, 32.7%, 27.3%, 41.5% and 12.7% of nd-CE, respectively. Serology sensitivity for first test and any positive test were 67.3% and 83.3%, respectively. Computed tomography, ultrasonography and X-ray diagnosis were documented in 79.2%, 58.4% and 17.0% of overall-CE, respectively, with ultrasonography mainly used in liver-CE and X-ray in lung-CE. Treatment included surgery and albendazole in 50.0% and 55.3% of CE, respectively. We conclude that CE is endemic in southern-Israel among the Bedouin population, while disease is probably mainly imported in the Jewish population. Liver involvement and eosinophilia rates were high compared with those of other endemic regions, possibly due to differences in the timing of diagnosis. These findings may help developing treatment and prevention strategies.

Serological Diagnosis and Follow-Up of Human Cystic Echinococcosis: A New Hope for the Future?

Cystic echinococcosis (CE) is an important helminthic zoonotic disease caused by the Echinococcus granulosus complex. In humans, CE is a chronic disease driven by the growth of echinococcal cysts in different organs. Prognosis of this disease depends on multiple factors, including location, number, size, and stage of the cysts, making CE a disease of complex management. CE is usually asymptomatic for years and attracts limited attention from funding organizations and health authorities. For this reason, only experts' recommendations are available but no evidence-based conclusions have been drawn for CE clinical management. One of those pitfalls refers to the lack of evidence to support the use of serological tools for the diagnosis and follow-up of CE patients. In this respect, crude antigens are used to detect specific antibodies in patients, giving rise to false positive results. The advent of molecular techniques allowing the production of recombinant proteins has provided a number of candidate antigens that could overcome the problems associated with the use of crude parasite extracts in the serological assays. In this review, we present the last advances in this field, proposing the use of serology to support cyst stage-specific diagnosis and follow-up.

Human cystic echinococcosis in Heilongjiang Province, China: a retrospective study

Background

Cystic echinococcosis (CE) is one of emerging zoonotic parasitic diseases throughout the world, having significant medical and economic importance in developing countries. The western and northwestern China is considered as CE endemic areas. In northeastern China’s Heilongjiang Province, the increasing number of sporadic human CE cases has attracted more and more attention. The aims of the present study were to understand the clinical characteristics of human CE in the investigated area and to compare the coincidence rates of CT, ultrasound and serological test against the histopathology results among CE patients.

Methods

Hospital data of 183 human CE cases in the period from January 2004 to July 2013 were collected from the two largest hospitals in Heilongjiang Province. Clinical data were analyzed, including age, gender, occupation and living residence of CE patients and localization, size and number of CE cysts as well as the diagnosis methods of CE before operation.

Results

The results revealed that the incidence of CE reached a peak in the age group of 41–50 years. Among the 183 CE patients, the females were observed to have a higher percentage of CE patients (60.66%, 111/183) than males (39.34%, 72/183). The majority of CE patients were farmers, followed by workers, employees, public servants, students and so on. CE cysts were most commonly found in the livers, with a 30 cm cyst in diameter being detected. CT showed the highest coincidence rate (96.64%) for hepatic CE among the three common diagnosis methods (CT, ultrasound imagine and serological test) compared against the histopathology results.

Conclusions

This is the first retrospective analysis of human CE cases in Heilongjiang Province in recent ten years. Clinical characteristics of human CE were described here. CT appeared to be the most effective diagnosis method for hepatic CE.