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Ren Q, Dong Y, Huang Y, Xiao J, Ma Y, Liu Y, Sun H, Dai Y, Shi C, Wang S. Nrf2 induces angiogenesis in spinal cystic echinococcosis by activating autophagy via regulating oxidative stress. Biochem Pharmacol 2024; 226:116337. [PMID: 38844265 DOI: 10.1016/j.bcp.2024.116337] [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: 01/31/2024] [Revised: 05/31/2024] [Accepted: 06/03/2024] [Indexed: 06/10/2024]
Abstract
Spinal cystic echinococcosis (CE) is a rare but malignant zoonosis that can cause disability or even death in more than half of patients. Due to the complex pathological features, it is not curable by conventional drugs and surgery, so new therapeutic targets urgently need to be discovered. In this study, we clarify the occurrence of the phenomenon of spinal encapsulation angiogenesis and explore its underlying molecular mechanisms. A co-culture system was established by protoscoleces (PSCs) with human umbilical vein endothelial cells (HUVECs) which showed a high expression level of Nrf2. A short hairpin RNA (shRNA) and Sulforaphane (SFN) affecting the expression of Nrf2 were used to treat HUVECs. The results showed that Nrf2 could promote the tube formation of HUVECs. Nrf2 also exerts a protective effect against HUVECs, which is achieved by promoting NQO1 expression to stabilize ROS levels. Furthermore, autophagy activation significantly promotes angiogenesis in the spinal echinococcosis model (SEM) as a result of Nrf2 regulation of oxidative stress. These results suggest that the ROS/Nrf2/autophagy axis can induce angiogenesis and may be a potential target for the treatment of spinal cystic echinococcosis.
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Affiliation(s)
- Qian Ren
- Laboratory for Bone Cystic Echinococcosis Research, Orthopaedic Centre, The First Affiliated Hospital of Shihezi University, Shihezi City Xinjiang Uygur Autonomous Region, 832000, China
| | - Yimin Dong
- Department of Orthopedics, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan 430101, China
| | - Yiping Huang
- Laboratory for Bone Cystic Echinococcosis Research, Orthopaedic Centre, The First Affiliated Hospital of Shihezi University, Shihezi City Xinjiang Uygur Autonomous Region, 832000, China
| | - Jun Xiao
- Laboratory for Bone Cystic Echinococcosis Research, Orthopaedic Centre, The First Affiliated Hospital of Shihezi University, Shihezi City Xinjiang Uygur Autonomous Region, 832000, China
| | - Yibo Ma
- Laboratory for Bone Cystic Echinococcosis Research, Orthopaedic Centre, The First Affiliated Hospital of Shihezi University, Shihezi City Xinjiang Uygur Autonomous Region, 832000, China
| | - Yaqing Liu
- Laboratory for Bone Cystic Echinococcosis Research, Orthopaedic Centre, The First Affiliated Hospital of Shihezi University, Shihezi City Xinjiang Uygur Autonomous Region, 832000, China
| | - Haohao Sun
- Laboratory for Bone Cystic Echinococcosis Research, Orthopaedic Centre, The First Affiliated Hospital of Shihezi University, Shihezi City Xinjiang Uygur Autonomous Region, 832000, China
| | - Yi Dai
- Laboratory for Bone Cystic Echinococcosis Research, Orthopaedic Centre, The First Affiliated Hospital of Shihezi University, Shihezi City Xinjiang Uygur Autonomous Region, 832000, China
| | - Chenhui Shi
- Laboratory for Bone Cystic Echinococcosis Research, Orthopaedic Centre, The First Affiliated Hospital of Shihezi University, Shihezi City Xinjiang Uygur Autonomous Region, 832000, China.
| | - Sibo Wang
- Department of Spine Surgery, Xi'an Jiao Tong University Affiliated HongHui Hospital, Xi'an 710054, China.
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Marinescu R, Cretu CM, Ciumeica S, Dan Constantin L. Surgical Management of Cystic Pelvic Hydatid Bone Disease Using Additively Manufactured Customized Implants for Salvage Reconstruction: A Report of Two Cases. Cureus 2024; 16:e63559. [PMID: 39087194 PMCID: PMC11289703 DOI: 10.7759/cureus.63559] [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] [Accepted: 06/30/2024] [Indexed: 08/02/2024] Open
Abstract
The diagnosis and treatment of pelvic bone hydatidosis (BH) present substantial challenges for orthopedic surgeons, requiring collaboration with parasitologists, radiologists, pathologists, and engineers. Surgical treatment selection depends on factors such as the extent of bone loss, soft tissue management, previously applied therapies, and local colonization status. This report details the advanced management of two young patients diagnosed late with severe cystic pelvic BH, an atypical presentation due to their geographic origin and age. Following extensive diagnostic assessments, including serology and 3D imaging, the patients underwent a two-step surgical intervention. The initial surgery involved extensive debridement and the placement of a poly-methyl-methacrylate spacer, followed by a second procedure utilizing a custom-made, tri-flanged implant for definitive pelvic reconstruction. The custom implant, designed via an electron beam melting process, successfully restored hip functionality and anatomy, as evidenced by improvements in functional scores and post-operative imaging. Short-term monitoring confirmed the integration of the implant and the absence of infection recurrence, demonstrating the approach's effectiveness. These cases highlight the potential of using additive manufacturing (AM) to create patient-specific implants for managing complex hip cases and emphasize the necessity for early detection and a multidisciplinary approach in treatment planning.
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Affiliation(s)
- Rodica Marinescu
- Orthopedic Surgery, Carol Davila University of Medicine and Pharmacy, Bucharest, ROU
| | | | - Stefan Ciumeica
- Orthopedic Surgery, Carol Davila University of Medicine and Pharmacy, Bucharest, ROU
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Richter J, Lindner AK, Geisel D, Fleckenstein FN, Torsello GF, Millet Pascual-Leone B, Ivanov O, Zöllner C, Wilde ACB, Equihua Martinez G. Percutaneous drainage and combined praziquantel-albendazole therapy: a novel approach for the treatment of simple echinococcal liver cysts. ZEITSCHRIFT FUR GASTROENTEROLOGIE 2024; 62:500-507. [PMID: 37729942 DOI: 10.1055/a-2084-3735] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 09/22/2023]
Abstract
Cystic echinococcosis (CE) is a worldwide helminthic zoonosis causing serious disease in humans. The WHO Informal Working Group on Echinococcosis recommends a stage-specific treatment approach of hepatic CE that facilitates the decision on what therapy option is most appropriate. Percutaneous aspiration, instillation of a scolicide, e.g., ethanol or hypertonic saline, and subsequent re-aspiration (PAIR) have been advocated for treating medium-size unilocular WHO-stage CE1 cysts. PAIR can pose a risk of toxic cholangitis because of spillage of ethanol in the case of a cysto-biliary fistula or of life-threatening hypernatriaemia when hypertonic saline is used. The purpose of our study is to develop an alternative, safe, minimally invasive method to treat CE1 cysts, avoiding the use of toxic topic scolicides.We opt for percutaneous drainage (PD) in four patients: the intrahepatic drainage catheter is placed under CT-fluoroscopy, intracystic fluid is aspirated, and the viability of intracystic echinococcal protoscolices is assessed microscopically. Oral praziquantel (PZQ) is added to albendazole (ABZ) instead of using topical scolicidals.Protoscolices degenerate within 5 to 10 days after PZQ co-medication at a cumulative dosage of 250 to 335 mg/kg, and the cysts collapse. The cysts degenerate, and no sign of spillage nor relapse is observed in the follow-up time of up to 24 months post-intervention.In conclusion, PD combined with oral PZQ under ABZ coverage is preferable to PAIR in patients with unilocular echinococcal cysts.
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Affiliation(s)
- Joachim Richter
- Institute of International Health, Charité Universitätsmedizin Berlin, Berlin, Germany
| | - Andreas K Lindner
- Institute of International Health, Charité Universitätsmedizin Berlin, Berlin, Germany
| | - Dominik Geisel
- Department of Radiology, Charité Universitätsmedizin Berlin, Berlin, Germany
| | | | | | | | - Olga Ivanov
- Institute of International Health, Charité Universitätsmedizin Berlin, Berlin, Germany
| | - Caroline Zöllner
- Department of Gastroenterology and Hepatology, Charité Universitätsmedizin Berlin, Berlin, Germany
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Weber TF, Mokry T, Stojkovic M. Echinococcoses - A Primer for Radiologists. ROFO-FORTSCHR RONTG 2023; 195:1106-1121. [PMID: 37467780 DOI: 10.1055/a-2114-1980] [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: 07/21/2023]
Abstract
BACKGROUND Cystic (CE) and alveolar (AE) echinococcoses are zoonotic parasitoses that may pose diagnostic problems due to their relative rarity in Middle Europe. METHODS Based on a recent literature search and the observation of casuistics from a national echinococcosis treatment center, epidemiological, radiological, and therapeutic fundamentals are presented and important differences between AE and CE are discussed. RESULTS AND CONCLUSION AE and CE must be regarded as completely different diseases, which differ from each other in every significant aspect. This applies not only to the epidemiological background of the patients but also to the biology of the diseases and their respective imaging features. KEY POINTS · AE and CE are very distinct from one another and must be considered separately.. · AE is endemic in Middle Europe and is known as malignant parasitosis due to its destructive growth form.. · CE is primarily seen in Middle Europe in individuals with migration background and has a rather benign character.. CITATION FORMAT · Weber TF, Mokry T, Stojkovic M. Die Echinokokkosen - Einblicke aus Sicht der Radiologie. Fortschr Röntgenstr 2023; 195: 1106 - 1121.
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Affiliation(s)
- Tim Frederik Weber
- Diagnostic and Interventional Radiology, University Hospital Heidelberg, Germany
| | - Theresa Mokry
- Diagnostic and Interventional Radiology, University Hospital Heidelberg, Germany
- Radiology, German Cancer Research Center, Heidelberg, Germany
| | - Marija Stojkovic
- Tropical Medicine, Department of Infectiology, University Hospital Heidelberg, Germany
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Sun H, Wang S, Tan W, Li Y, Ren Q, Liu Y, Huang Y, Shi C, Li J. Echinococcus granulosus promotes bone resorption by increasing osteoclasts differentiation. Acta Trop 2023; 248:107027. [PMID: 37722448 DOI: 10.1016/j.actatropica.2023.107027] [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: 07/31/2023] [Revised: 09/14/2023] [Accepted: 09/15/2023] [Indexed: 09/20/2023]
Abstract
Osseous cystic echinococcosis (CE) is a rare disease caused by Echinococcus granulosus, which is characterized by high morbidity, disability, and mortality. However, it is severely neglected due to its mainly regional epidemic. The development of osseous CE is usually accompanied by severe bone erosion and destruction at the site of infection; however, there is a gap in research on the mechanism of this phenomenon. The current treatment for this disease is single-sided, ineffective, and has a high rate of disability and recurrence. Our study investigated the mechanism of bone destruction caused by osseous CE and provided a theoretical basis for basic research and innovative ideas for treating clinical disease. A co-culture system of osteoclast progenitor cells and protoscoleces (PSCs) was established to test the effects of PSCs on osteoclast differentiation. We also created two disease models of spinal and femoral CE, with the highest incidence of osseous CE. We verified the effect of E. granulosus on osteoclasts at the infection site in vivo. The stimulatory effect of E. granulosus on osteoclast formation was confirmed by in vivo and in vitro experiments. This study elucidates the elementary mechanism of bone destruction in osseous CE and fills a gap in the field of basic osseous CE research, which is conducive to treating the disease.
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Affiliation(s)
- Haohao Sun
- Medical College of Shihezi University, Shihezi, Xinjiang 832000, China
| | - Sibo Wang
- Xi'an Honghui Hospital, Xi'an, Shanxi 710000, China
| | - Wenbo Tan
- Medical College of Shihezi University, Shihezi, Xinjiang 832000, China
| | - Ye Li
- The Second Xiangya Hospital of Central South University, Changsha, Hunan 410000, China
| | - Qian Ren
- Medical College of Shihezi University, Shihezi, Xinjiang 832000, China
| | - Yaqing Liu
- Medical College of Shihezi University, Shihezi, Xinjiang 832000, China
| | - Yiping Huang
- Medical College of Shihezi University, Shihezi, Xinjiang 832000, China
| | - Chenhui Shi
- Orthopaedic Center of the First Affiliated Hospital of Shihezi University, Shihezi, Xinjiang 832000, China.
| | - Jing Li
- Orthopaedic Center of the First Affiliated Hospital of Shihezi University, Shihezi, Xinjiang 832000, China.
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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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Siles-Lucas M, Uchiumi L, Tamarozzi F. 'No cyst, no echinococcosis': a scoping review update on the diagnosis of cystic echinococcosis after the issue of the WHO-IWGE Expert Consensus and current perspectives. Curr Opin Infect Dis 2023; 36:333-340. [PMID: 37466103 PMCID: PMC10487401 DOI: 10.1097/qco.0000000000000941] [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: 07/20/2023]
Abstract
PURPOSE OF REVIEW In 2010, the WHO-Informal Working Group on Echinococcosis (IWGE) published an Expert Consensus on the diagnosis and treatment of echinococcal infections. We provide an update on the diagnosis of cystic echinococcosis through a scoping review of the literature published after the release of the WHO-IWGE document. RECENT FINDINGS Ultrasound accurately and reliably depicts the pathognomonic signs of cystic echinococcosis (CE) stages compared with other imaging techniques. Among these, T2-wighted MRI is to be preferred to computed tomography, which has poor performance for the etiological diagnosis of CE. A negative serology cannot exclude the diagnosis of CE, while a positive serology, applied after the visualization of a CE-compatible lesion, may confirm a CE diagnosis. Serology alone must not be used to define 'CE' nor as 'screening' tool for infection. Other imaging and laboratory techniques did not show clinically applicable performances. SUMMARY In the absence of a focal lesion compatible with a CE cyst, no diagnosis of CE should be attempted. There is urgent need to achieve univocal CE case definitions and consensus diagnostic algorithm, as well as standardization of diagnostic methods and issue of a Target Product Profile of CE diagnostics, as advocated by the WHO in the 2021-2030 roadmap for neglected tropical diseases (NTDs).
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Affiliation(s)
- Mar Siles-Lucas
- Laboratory of Helminth Parasites of Zoonotic Importance (ATENEA), Institute of Natural Resources and Agrobiology of Salamanca (IRNASA-CSIC), Salamanca, Spain
| | - Leonardo Uchiumi
- Ramon Carrillo Hospital, Bariloche, Río Negro Province, Argentina
| | - Francesca Tamarozzi
- Department of Infectious-Tropical Diseases and Microbiology, WHO Collaborating Centre on Strongyloidiasis and other Neglected Tropical Diseases, IRCCS Sacro Cuore Don Calabria Hospital, Negrar di Valpolicella, Verona, Italy
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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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Buscemi C, Randazzo C, Buscemi P, Caldarella R, Lombardo M, Buscemi S. Very Prolonged Treatment with Albendazole of a Case of Disseminated Abdominal Cystic Echinococcosis. Trop Med Infect Dis 2023; 8:449. [PMID: 37755910 PMCID: PMC10534633 DOI: 10.3390/tropicalmed8090449] [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: 08/29/2023] [Revised: 09/10/2023] [Accepted: 09/13/2023] [Indexed: 09/28/2023] Open
Abstract
Cystic echinococcosis is a zoonosis caused by the ingestion of food or water contaminated by Echinococcus eggs. E. granulosus is the most common causative agent of cystic echinococcosis that still has a relevant incidence in Italy, especially on the islands of Sicily and Sardinia. We report the case of a 64-year-old man with disseminated abdominal cystic echinococcosis (liver, spleen, peritoneum). The patient was asymptomatic and non-eligible for surgical treatment. Treatment with albendazole 400 mg/twice daily was started in 2012 for 15 cycles (each cycle consisted of three 28-day treatments at 14-day intervals) over 10 years for a total of 1260 days of treatment. Serum anti-Echinococcus antibody titers and imaging (echography, TC) were evaluated to monitor the evolution of the disease. Imaging techniques documented the regression of all cyst lesions, but it was less evident for the peritoneal localizations that still are in follow-up. In this case, the prolonged treatment with albendazole was effective, safe and free of side effects. Until today, the patient displays a good clinical condition.
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Affiliation(s)
- Carola Buscemi
- Unit of Internal Medicine, V. Cervello Hospital, I-90100 Palermo, Italy
- Dipartimento di Promozione della Salute, Materno-Infantile, Medicina Interna e Specialistica di Eccellenza (PROMISE), University of Palermo, I-90100 Palermo, Italy
| | - Cristiana Randazzo
- Dipartimento di Promozione della Salute, Materno-Infantile, Medicina Interna e Specialistica di Eccellenza (PROMISE), University of Palermo, I-90100 Palermo, Italy
- Unit of Clinical Nutrition, AOU Policlinico "P. Giaccone", I-90100 Palermo, Italy
| | - Paolo Buscemi
- Postgraduate School in Radiology, University of Palermo, I-90100 Palermo, Italy
| | - Rosalia Caldarella
- Dipartimento di Promozione della Salute, Materno-Infantile, Medicina Interna e Specialistica di Eccellenza (PROMISE), University of Palermo, I-90100 Palermo, Italy
- Unit of Laboratory Medicine, AOU Policlinico "P. Giaccone", I-90100 Palermo, Italy
| | - Martina Lombardo
- Dipartimento di Promozione della Salute, Materno-Infantile, Medicina Interna e Specialistica di Eccellenza (PROMISE), University of Palermo, I-90100 Palermo, Italy
- Unit of Clinical Nutrition, AOU Policlinico "P. Giaccone", I-90100 Palermo, Italy
| | - Silvio Buscemi
- Dipartimento di Promozione della Salute, Materno-Infantile, Medicina Interna e Specialistica di Eccellenza (PROMISE), University of Palermo, I-90100 Palermo, Italy
- Unit of Clinical Nutrition, AOU Policlinico "P. Giaccone", I-90100 Palermo, Italy
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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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Yang L, Tuxunjiang P, Liu W, Guo H. Vertebral and pelvic echinococcosis in northwestern China. INTERNATIONAL ORTHOPAEDICS 2023; 47:1153-1162. [PMID: 36826481 PMCID: PMC10079730 DOI: 10.1007/s00264-023-05731-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/19/2023] [Accepted: 02/07/2023] [Indexed: 02/25/2023]
Abstract
PURPOSE Echinococcosis remains a major economic and severe public health problem in endemic areas. Bone echinococcosis is rare, and the vertebra and pelvis are the most common sites of echinococcosis involving the skeletal. Because of the clinical severe symptoms and high recurrence rate, it brings excellent trouble to patients. METHODS This study retrospectively analyzed the clinical manifestations, laboratory tests, radiological findings, and treatment of 44 patients with vertebral and pelvic echinococcosis during a period of 16 years (2005-2020). RESULTS The mean age was 43 years (25 males, 19 females; 19-68 years). The most common symptom was pain, followed by numbness, weakness, activity limitation, and progressive paraparesis. Enzyme-linked immunosorbent assay test (ELISA) results were positive in 18 cases (75%). There are 24 cases of hydatid infection of the spine, 14 hydatid infection of the pelvis, and six hydatid infection of both vertebra and pelvis. The site of infection was 13 (29.5%) thoracic, five (11.4%) lumbar, four (9.1%) lumbosacral, seven (15.9%) sacral, 19 (43.2%) ilium, seven (15.9%) hip, six (13.6%) ischium, five (11.4%) pubis, and two (4.5%) femur, respectively. The imaging findings were cystic dilatancy, septal, and irregular bone destruction. MRI has a special value in showing the relationship between the surrounding tissues and organs of cystic bone echinococcosis. All patients were followed up for at least one year. The mean follow-up time was 3.6 years. CONCLUSIONS Even in epidemic areas, the incidence of bone echinococcosis is relatively rare. However, when encountering the vertebral and pelvic destruction, consider bone echinococcosis's possibility, especially for the herdsmen in endemic regions.
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Affiliation(s)
- Laihong Yang
- Medical Imaging Center, Xinjiang Medical University Affiliated First Hospital, Urumqi, 830054, People's Republic of China
| | - Pahati Tuxunjiang
- Medical Imaging Center, Xinjiang Medical University Affiliated First Hospital, Urumqi, 830054, People's Republic of China
| | - Wenya Liu
- Medical Imaging Center, Xinjiang Medical University Affiliated First Hospital, Urumqi, 830054, People's Republic of China
| | - Hui Guo
- Medical Imaging Center, Xinjiang Medical University Affiliated First Hospital, Urumqi, 830054, People's Republic of China. .,State Key Laboratory of Pathogenesis, Prevention and Treatment of High Incidence Diseases in Central Asia, Xinjiang Medical University, Urumqi, People's Republic of China.
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García-Alvarez F, Estella R, Albareda J. Non-vertebral hydatidosis in bone: Difficulties in management. Jt Dis Relat Surg 2023; 34:58-62. [PMID: 36700264 PMCID: PMC9903126 DOI: 10.52312/jdrs.2023.825] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/20/2022] [Accepted: 09/13/2022] [Indexed: 01/19/2023] Open
Abstract
OBJECTIVES This study presents our experience in surgical treatment of extravertebral bone hydatidosis and aims to investigate the utility of specific immunoglobulin E (IgE) in diagnosis and prognosis of the disease. PATIENTS AND METHODS Between January 1990 and December 2019, a total of 10 patients (6 males, 4 females; mean age: 47.2±14.7 years; range, 27 to 71 years) with non-vertebral bone hydatidosis surgically treated in our hospital were retrospectively included. Curettage or wide resection was performed in all cases, followed by medical antihelminthic therapy. Specific IgE p2 was studied in seven patients during and at final follow-up. RESULTS At the time of diagnosis, secondary infection of the cyst was observed as the initial symptom in two patients mimicking an abscess and, in both cases, more surgeries were required without final healing. In two cases, over five specific IgE presented a false negative at the time of diagnosis and it was not correlated with clinical evolution in three cases over seven. In six cases, diagnosis was obtained before surgery. In treatment, pelvic disease had the worst prognosis (none healed) and bacterial overinfection was a common complication after surgery. At the final follow-up, only two femoral cases (20%) were free of disease. Other four cases (three in iliac bone, one in proximal femur) needed several surgeries without healing. The other four patients showed no progression or refused a new surgical treatment. CONCLUSION Location, bone defect, when it is possible to perform a radical surgery, and associated bacterial overinfection after surgery make cystic hydatidosis in bone an infection very difficult to treat definitively in humans. Negative specific IgE does not exclude bone hydatidosis.
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Affiliation(s)
- Felícito García-Alvarez
- Servicio de Cirugía Ortopédica y Traumatología, Hospital Clínico Universitario Lozano Blesa, 50.009 Zaragoza, Spain
| | - Rubén Estella
- Department of Orthopaedic Surgery and Traumatology, Hospital Clínico “Lozano Blesa”, Zaragoza, Spain
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Instituto de Investigación Sanitaria Aragón (IIS Aragón), Zaragoza, Spain
| | - Jorge Albareda
- Department of Orthopaedic Surgery and Traumatology, Hospital Clínico “Lozano Blesa”, Zaragoza, Spain
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Instituto de Investigación Sanitaria Aragón (IIS Aragón), Zaragoza, Spain
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Department of Surgery, University of Zaragoza, Zaragoza, Spain
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13
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Ziede-Rojas E, Ramírez-González E, Jans-Baez J. Pelvic retroperitoneal echinococcal cyst. A case report. CASE REPORTS 2022. [DOI: 10.15446/cr.v8n2.93080] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/01/2023] Open
Abstract
Introduction: Echinococcosis or hydatidosis is a parasitic zoonosis endemic in Chile that poses an important public health concern. It mainly affects the liver and lungs; however, it may involve diverse areas, with the isolated pelvic location being exceptional and difficult to manage.
Case presentation. A 41-year-old female consulted the emergency department of a hospital in Chile due to lumbosacral pain and was diagnosed with hydatidosis. The patient received surgical treatment and medication, but the disease recurred twice: the first time, a year after the first intervention, and the second time, two months after the second. Therefore, she required a multidisciplinary approach that included long-term antibiotic therapy and a radical approach to the lesion, achieving an adequate control of the disease.
Conclusion: Pelvic echinococcosis is difficult to diagnose due to its low frequency. This disease should be considered in the event of any cystic lesion in endemic areas. A multidisciplinary management reduces possible complications and recurrence.
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14
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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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15
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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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16
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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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17
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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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18
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Colpani A, Achilova O, D’Alessandro GL, Budke CM, Mariconti M, Muratov T, Vola A, Mamedov A, Giordani MT, Urukov X, De Silvestri A, Suvonkulov U, Brunetti E, Manciulli T. Trends in the Surgical Incidence of Cystic Echinococcosis in Uzbekistan from 2011 to 2018. Am J Trop Med Hyg 2022; 106:724-728. [PMID: 34902836 PMCID: PMC8832901 DOI: 10.4269/ajtmh.21-0261] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/02/2021] [Accepted: 04/25/2021] [Indexed: 02/03/2023] Open
Abstract
Cystic echinococcosis (CE) is a zoonosis with a cosmopolitan distribution caused by Echinococcus granulosus sensu lato tapeworms. Although Uzbekistan and other countries in Central Asia are considered endemic, estimates of disease burden are lacking. We present data regarding surgically managed cases of CE obtained from Uzbekistan's national disease surveillance registry. These data are from medical centers in Uzbekistan authorized to treat the disease and reported to the Uzbek Center for Sanitation and Epidemiology from the period 2011 to 2018. Information included patient age class (children 14 years or younger versus adults 15 years and older), but no data regarding cyst location. Incidence rates were calculated using data from the national population registry, and the Cuzick nonparametric test for trends was used to test for differences in the incidence over time at the country and regional levels. A total of 7,309 CE cases were reported. Of these, 857 (11.73%) involved pediatric patients. The mean incidence rates were 4.4 per 100,000 population in 2011 and 2.3 per 100,000 population in 2018 (P = 0.016). One region (Republic of Karalpakistan) showed a nonstatistically significant increase (P = 0.824). All other regions except three showed a statistically significant decrease. We present data showing a decrease in the overall incidence of surgically treated CE in Uzbekistan from 2011 to 2018. However, the presence of cases involving children suggests ongoing parasite transmission. The absence of clinical information (starting with cyst stage and localization) needs to be addressed to improve the national surveillance system. Field studies are also needed to further explore the epidemiology of CE in the country.
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Affiliation(s)
- Agnese Colpani
- Department of Clinical, Surgical, Diagnostic and Pediatric Sciences, University of Pavia, Pavia, Italy
| | - Olesya Achilova
- Isaev Institute for Medical Parasitology, Samarkand, Uzbekistan
| | - Gian Luca D’Alessandro
- Department of Clinical, Surgical, Diagnostic and Pediatric Sciences, University of Pavia, Pavia, Italy
| | | | - Mara Mariconti
- Unit of Infectious Diseases and Immunology, IRCCS San Matteo Hospital Foundation, Pavia, Italy
| | - Timur Muratov
- Isaev Institute for Medical Parasitology, Samarkand, Uzbekistan
| | - Ambra Vola
- Unit of Infectious Diseases and Immunology, IRCCS San Matteo Hospital Foundation, Pavia, Italy
| | - Arzu Mamedov
- Department of Clinical, Surgical, Diagnostic and Pediatric Sciences, University of Pavia, Pavia, Italy
| | - Maria Teresa Giordani
- Unit of Microbiology and Virology, IRCCS San Matteo Hospital Foundation, Pavia, Italy
| | - Xusan Urukov
- Department of Infectious Diseases, San Bortolo Hospital, Vicenza, Italy
| | - Annalisa De Silvestri
- Center of Sanitation and Epidemiology, Well-Being Sanitary of Population, Payarik District Branch, Samarkand, Uzbekistan
| | | | - Enrico Brunetti
- Department of Clinical, Surgical, Diagnostic and Pediatric Sciences, University of Pavia, Pavia, Italy;,Unit of Infectious Diseases and Immunology, IRCCS San Matteo Hospital Foundation, Pavia, Italy
| | - Tommaso Manciulli
- Department of Clinical, Surgical, Diagnostic and Pediatric Sciences, University of Pavia, Pavia, Italy;,Unit of Infectious Diseases and Immunology, IRCCS San Matteo Hospital Foundation, Pavia, Italy;,Address correspondence to Dr. Tommaso Manciulli, University of Pavia, Viale Brambilla 53, 27100 Pavia. E-mail: tommaso.manciulli01@ ateneopv.it
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19
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Tas N, Tuncer K, Aydin Y. An unusual tumor mimicker in the iliac wing: A hydatid cyst. Rev Soc Bras Med Trop 2022; 55:e03442022. [PMID: 36197384 PMCID: PMC9536806 DOI: 10.1590/0037-8682-0344-2022] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/08/2022] [Accepted: 08/24/2022] [Indexed: 12/02/2022] Open
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20
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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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21
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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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22
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Richter J, Lindner AK, Geisel D, Torsello GF, Martinez GE, Isner C, Schürmann D, Pfäfflin F, Orhun A, Manciulli T, Brunetti E. Treatment of a giant hepatic echinococcal cyst with percutaneous drainage and in vivo assessment of the protoscolicidal effect of praziquantel. Clin J Gastroenterol 2021; 14:888-892. [PMID: 33851365 PMCID: PMC8154811 DOI: 10.1007/s12328-021-01397-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/27/2021] [Accepted: 03/19/2021] [Indexed: 11/26/2022]
Abstract
Therapy choices for cystic echinococcisis (CE) are stage-specific: surgical, minimally invasive, medical or observation without intervention. PAIR (percutaneous aspiration, instillation of a scolicide, and re-aspiration) has been considered the treatment of choice for uncomplicated echinococcal liver cysts. However, PAIR carries the risk of toxic cholangitis or hypernatremia and that the cyst frequently refills with bile after withdrawing the catheter. We treated a patient with a giant CE 1 liver cyst with puncture drainage (PD) under albendazole coverage. Drainage enabled us to monitor the morphology of protoscolices under praziquantel (PZQ) co-medication. Protoscolices degenerated within 5 days of PZQ 50 mg/kg/d. The cyst cavity solidified with no evidence of reactivation or secondary spread. Percutaneous treatments can replace surgery in a significant number or cases with hepatic CE. PD allows to assess microscopically the viability of protoscolices under co-medication with PZQ-albendazole and to avoid the instillation of topical scolicides.
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Affiliation(s)
- Joachim Richter
- Institute of Tropical Medicine and International Health, Charité University Medicine, Berlin, Corporate Member of Free University and Humboldt University, Augustenburgerplatz 1, 13353, Berlin, FR, Germany.
| | - Andreas Karl Lindner
- Institute of Tropical Medicine and International Health, Charité University Medicine, Berlin, Corporate Member of Free University and Humboldt University, Augustenburgerplatz 1, 13353, Berlin, FR, Germany
| | - Dominik Geisel
- Department of Radiology, Charité University Medicine, Berlin, Corporate Member of Free University and Humboldt University, Berlin, Germany
| | - Giovanni Federico Torsello
- Department of Radiology, Charité University Medicine, Berlin, Corporate Member of Free University and Humboldt University, Berlin, Germany
| | - Gabriela Equihua Martinez
- Institute of Tropical Medicine and International Health, Charité University Medicine, Berlin, Corporate Member of Free University and Humboldt University, Augustenburgerplatz 1, 13353, Berlin, FR, Germany
| | - Caroline Isner
- Department of Infectious Diseases and Pulmonary Medicine, Charité University Medicine, Berlin, Corporate Member of Free University and Humboldt University, Berlin, Germany
| | - Dirk Schürmann
- Department of Infectious Diseases and Pulmonary Medicine, Charité University Medicine, Berlin, Corporate Member of Free University and Humboldt University, Berlin, Germany
| | - Frieder Pfäfflin
- Department of Infectious Diseases and Pulmonary Medicine, Charité University Medicine, Berlin, Corporate Member of Free University and Humboldt University, Berlin, Germany
| | - Arzu Orhun
- Department of Plastical and Reconstructive Surgery, Charité University Medicine, Berlin, Corporate Member of Free University and Humboldt University, Berlin, Germany
| | - Tommaso Manciulli
- Department of Clinical, Surgical, Diagnostic and Pediatric Sciences, University Hospital of Pavia, Pavia, Italy
| | - Enrico Brunetti
- Department of Clinical, Surgical, Diagnostic and Pediatric Sciences, University Hospital of Pavia, Pavia, Italy
- Department of Tropical and Infectious Diseases, IRCCS Policlinico San Matteo Foundation Hospital, Pavia, Italy
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23
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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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24
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Tamarozzi F, Horton J, Muhtarov M, Ramharter M, Siles-Lucas M, Gruener B, Vuitton DA, Bresson-Hadni S, Manciulli T, Brunetti E. A case for adoption of continuous albendazole treatment regimen for human echinococcal infections. PLoS Negl Trop Dis 2020; 14:e0008566. [PMID: 32941434 PMCID: PMC7498015 DOI: 10.1371/journal.pntd.0008566] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/29/2022] Open
Abstract
Cystic (CE) and alveolar (AE) echinococcosis are chronic, neglected parasitic diseases burdened by high morbidity and, for AE, by high mortality, if left untreated. CE and AE have a widespread distribution, including Europe. Albendazole (ABZ), a broad-spectrum benzimidazole drug widely used to treat parasitic infections, is the drug of choice for the management of CE and AE, and is parasitostatic on echinococcal metacestodes. In Europe, ABZ is licensed for interrupted “cyclic” treatment, for a maximum of 3 cycles. However, better efficacy with no increased side effects has been shown when the drug is administered continuously and for longer periods. Current international recommendations, on the basis of clinical, pharmacological, and biological studies, recommend continuous administration of ABZ for months to years for the treatment of CE and AE, and this schedule has been widely in use for the past 20 years. However, in Europe this internationally recommended schedule, with the exception of France, is technically “off-label”, and, as such, requires an informed consent by the patient and, in some countries, even precludes the reimbursement of the drug cost. Adding to the very high cost of the drug, frequent “out-of-stock” situation, and packaging format impractical for long therapies, these conditions put patients with CE and AE regularly at risk of treatment discontinuation and disease progression. European regulations envisage variations to marketing authorization, but postauthorization studies should be carried out by the holder of the license of the drug, in the form of randomized controlled trials. While such studies do not seem feasible and would probably not be ethically justified for CE and AE, European regulations envisage other possibilities in particular situations, which apply to CE and AE, but there is limited interest to invest in this perspective. We urge a coordination between stakeholders to find effective and feasible ways to take action to revise the benzimidazole dosage regimens for CE and AE and to ensure a fair, regular, and easy access to the appropriate treatment to those suffering from these serious diseases.
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Affiliation(s)
- Francesca Tamarozzi
- Istituto di Ricovero e Cura a Carattere Scientifico (IRCCS) Sacro Cuore Don Calabria Hospital, Department of Infectious-Tropical Diseases and Microbiology, Negrar, Verona, Italy
- * E-mail:
| | | | - Marin Muhtarov
- Multi-Profile Hospital for Active Treatment “Kardzhali”, Gastroenterology Ward, Khardzhali, Bulgaria
| | - Michael Ramharter
- Department of Tropical Medicine, Bernhard Nocht Institute for Tropical Medicine, Department of Medicine, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Mar Siles-Lucas
- Instituto de Recursos Naturales y Agrobiología de Salamanca (IRNASA), Consejo Superior de Investigaciones Científicas (CSIC), Parasitology Group, Salamanca, Spain
| | - Beate Gruener
- Division of Infectious Diseases, Department of Internal Medicine III, University Hospital Ulm, Ulm, Germany
| | - Dominique A. Vuitton
- French National Reference Center for Echinococcosis, Besançon University Hospital, University Bourgogne Franche-Comté, Besançon, France
| | - Solange Bresson-Hadni
- French National Reference Center for Echinococcosis, Besançon University Hospital, University Bourgogne Franche-Comté, Besançon, France
- Hepato-Gastroenterology and Tropical Medicine Units, University Hospital, Geneva, Switzerland
| | - Tommaso Manciulli
- Istituto di Ricovero e Cura a Carattere Scientifico (IRCCS) San Matteo Hospital Fundation–Unit of Infectious and Tropical Diseases, Pavia, Italy
- Department of Clinical, Surgical, Diagnostic and Pediatric Sciences, University of Pavia, Pavia, Italy
| | - Enrico Brunetti
- Istituto di Ricovero e Cura a Carattere Scientifico (IRCCS) San Matteo Hospital Fundation–Unit of Infectious and Tropical Diseases, Pavia, Italy
- Department of Clinical, Surgical, Diagnostic and Pediatric Sciences, University of Pavia, Pavia, Italy
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25
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Schleenvoigt BT, Theis B, Wüst M, Forstner C, Pletz MW, Hagel S. Intermittent pain of the pelvis in a Syrian woman. PLoS Negl Trop Dis 2020; 14:e0008183. [PMID: 32555592 PMCID: PMC7302433 DOI: 10.1371/journal.pntd.0008183] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022] Open
Affiliation(s)
- Benjamin T. Schleenvoigt
- Institute for Infectious Diseases and Infection Control, Jena University Hospital, Jena, Germany
- * E-mail:
| | - Bernhard Theis
- Section Pathology of the Institute of Forensic Medicine, Jena University Hospital, Jena, Germany
| | - Michaela Wüst
- Department of Internal Medicine IV (Gastroenterology, Hepatology, and Infectious Diseases), Jena University Hospital, Jena, Germany
| | - Christina Forstner
- Institute for Infectious Diseases and Infection Control, Jena University Hospital, Jena, Germany
- Department of Medicine I, Division of Infectious Diseases and Tropical Medicine, Medical University of Vienna, Vienna, Austria
| | - Mathias W. Pletz
- Institute for Infectious Diseases and Infection Control, Jena University Hospital, Jena, Germany
| | - Stefan Hagel
- Institute for Infectious Diseases and Infection Control, Jena University Hospital, Jena, Germany
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26
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Mustapayeva A, Manciulli T, Zholdybay Z, Juskiewicz K, Zhakenova Z, Shapiyeva Z, Medetov Z, Vola A, Mariconti M, Brunetti E, Budke CM, Khalykova M, Duisenova A. Incidence Rates of Surgically Managed Cystic Echinococcosis in Kazakhstan, 2007-2016. Am J Trop Med Hyg 2020; 102:90-95. [PMID: 31802731 DOI: 10.4269/ajtmh.19-0572] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/19/2022] Open
Abstract
Cystic echinococcosis (CE) is a zoonotic disease caused by the larval stage of the cestode Echinococcus granulosus. The parasite typically infects dogs and ungulates, with humans acting as dead-end hosts. Information on the epidemiology of CE is lacking from Central Asia, including from Kazakhstan where CE cases are reported centrally. This study presents data from the Kazakhstan Scientific and Practical Center for Sanitary and Epidemiological Evaluation and Monitoring on CE patients treated surgically, with a diagnosis confirmed by pathology. Evaluation of data from 2007 to 2016 indicated that the CE incidence rate decreased during this time period in most areas of Kazakhstan (country-level incidence rate of 5.6 versus 4.7 cases/100,000 population in 2007 and 2016, respectively). Cystic echinococcosis had a higher incidence in southern Kazakhstan, with an incidence rate between 7.0 and 10.5 cases per 100,000 population, whereas northern regions had rates less than 4.0 cases per 100,000 population. Moreover, despite the overall decrease, CE incidence continues to increase in the south. Cystic echinococcosis surveillance is needed, particularly in the south, to help inform policymakers and orient disease control efforts.
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Affiliation(s)
- Aigerim Mustapayeva
- Department of Visual Diagnostics, Asfendiyarov Kazakh National Medical University, Almaty, Kazakhstan
| | - Tommaso Manciulli
- Department of Clinical, Surgical, Diagnostic and Pediatric Sciences, University of Pavia, Pavia, Italy.,PhD School of Experimental Medicine, University of Pavia, Pavia, Italy
| | - Zhamilya Zholdybay
- Department of Visual Diagnostics, Asfendiyarov Kazakh National Medical University, Almaty, Kazakhstan
| | - Konrad Juskiewicz
- Department of Visual Diagnostics, Asfendiyarov Kazakh National Medical University, Almaty, Kazakhstan
| | - Zhanar Zhakenova
- Department of Visual Diagnostics, Asfendiyarov Kazakh National Medical University, Almaty, Kazakhstan
| | - Zhanna Shapiyeva
- Scientific and Practical Center for Sanitary and Epidemiological Expertise and Monitoring, Almaty, Kazakhstan
| | - Zhumagul Medetov
- Department for Quality Control and Safety of Goods and Services of the Turkestan Oblast, Turkestan
| | - Ambra Vola
- Department of Infectious Diseases, IRCCS San Matteo Hospital Foundation, Pavia, Italy
| | - Mara Mariconti
- Department of Infectious Diseases, IRCCS San Matteo Hospital Foundation, Pavia, Italy
| | - Enrico Brunetti
- Department of Infectious Diseases, IRCCS San Matteo Hospital Foundation, Pavia, Italy.,Department of Clinical, Surgical, Diagnostic and Pediatric Sciences, University of Pavia, Pavia, Italy
| | | | - Maira Khalykova
- Department for Quality Control and Safety of Goods and Services of the Turkestan Oblast, Turkestan
| | - Amangul Duisenova
- Department of Visual Diagnostics, Asfendiyarov Kazakh National Medical University, Almaty, Kazakhstan
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27
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Casulli A, Siles-Lucas M, Cretu CM, Vutova K, Akhan O, Vural G, Cortés Ruiz A, Brunetti E, Tamarozzi F. Achievements of the HERACLES Project on Cystic Echinococcosis. Trends Parasitol 2019; 36:1-4. [PMID: 31753546 DOI: 10.1016/j.pt.2019.10.009] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/04/2019] [Revised: 10/22/2019] [Accepted: 10/22/2019] [Indexed: 12/21/2022]
Abstract
The FP7 project 'Human Cystic Echinococcosis ReseArch in CentraL and Eastern Societies' (HERACLES), developed between 2013 and 2018 by nine partners in five countries, is one of the largest projects on cystic echinococcosis. Here we present the core HERACLES achievements, which should help to foster the translation of scientific investigations on health policies.
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Affiliation(s)
- Adriano Casulli
- WHO Collaborating Centre for the Epidemiology, Detection and Control of Cystic and Alveolar Echinococcosis (in Animals and Humans), Istituto Superiore di Sanità (ISS), Rome, Italy; European Union Reference Laboratory for Parasites, ISS, Rome, Italy.
| | - Mar Siles-Lucas
- Instituto de Recursos Naturales y Agrobiología de Salamanca, CSIC, Spain
| | - Carmen Michaela Cretu
- C. Davila University of Medicine and Pharmacy, Colentina Clinical Hospital, Bucharest, Romania
| | - Kamena Vutova
- Specialised Hospital of Infectious and Parasitic Diseases 'Prof. Ivan Kirov', Department of Infectious, Parasitic and Tropical Diseases, Medical University, Sofia, Bulgaria
| | - Okan Akhan
- Department of Radiology, Faculty of Medicine, Hacettepe University, Ankara, Turkey
| | - Gulay Vural
- Department of Parasitology, Faculty of Veterinary Science, Namik Kemal University, Tekirdag, Turkey
| | | | - Enrico Brunetti
- Department of Clinical Surgical Diagnostic and Pediatric Sciences, University of Pavia, Italy; Division of Tropical and Infectious Diseases, San Matteo Hospital Foundation, Pavia, Italy
| | - Francesca Tamarozzi
- WHO Collaborating Centre for the Epidemiology, Detection and Control of Cystic and Alveolar Echinococcosis (in Animals and Humans), Istituto Superiore di Sanità (ISS), Rome, Italy; European Union Reference Laboratory for Parasites, ISS, Rome, Italy
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