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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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Wang X, Huang J, Su L, Ma Q, Ma C, Xie Z. Complete excision of giant clavicular hydatid cyst: a case report. BMC Infect Dis 2023; 23:178. [PMID: 36949399 PMCID: PMC10035111 DOI: 10.1186/s12879-023-08149-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/02/2022] [Accepted: 03/10/2023] [Indexed: 03/24/2023] Open
Abstract
BACKGROUND Echinococcosis, also known as hydatid disease, is a zoonotic parasitic disease prevalent in pastoral areas, mainly involving the liver and lungs, and less frequently the bones and surrounding soft tissues. Diagnosis and treatment of bone hydatid disease is a challenge, and because of the insidious course of the disease, the lesions are often widely disseminated by the time patients seek medical attention. CASE PRESENTATION A 29-year-old woman presented with a painless mass that was gradually increasing in size in the cervical thorax. Imaging revealed an enlarged clavicle with multiple bone cortical defects and the existence of cysts in the soft tissues surrounding the clavicle, for which complete excision of the clavicle and the attached cysts was performed. There was no recurrence of the cyst within one year after the operation, and the patient felt well and had normal shoulder joint movement. CONCLUSIONS Bone hydatid may appear in bones throughout the body, and cysts that leak from the bone into the surrounding soft tissues may spread at a relatively rapid rate. Prompt surgical removal of the affected bone and surrounding cysts is necessary for treatment.
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Affiliation(s)
- Xin Wang
- Department of Orthopedics and Trauma, the First Affiliated Hospital of Xinjiang Medical University, Urumqi, Xinjiang, China.
- Key Laboratory of High Incidence Disease Research in Xingjiang (Xinjiang Medical University), Ministry of Education, Urumqi, Xinjiang, China.
- Xinjiang Clinical Research Center for Orthopedics, Xinjiang Medical University, Urumqi, Xinjiang, China.
| | - Jinyong Huang
- Department of Orthopedics and Trauma, the First Affiliated Hospital of Xinjiang Medical University, Urumqi, Xinjiang, China
| | - Liping Su
- Department of Pathologyathology, the First Affiliated Hospital of Xinjiang Medical University, Urumqi, Xinjiang, China
| | - Qian Ma
- Department of Pathologyathology, the First Affiliated Hospital of Xinjiang Medical University, Urumqi, Xinjiang, China
| | - Chao Ma
- Department of Orthopaedics, the Fourth Clinical Medical College of Xinjiang Medical University, Urumqi, Xinjiang, China
| | - Zengru Xie
- Department of Orthopedics and Trauma, the First Affiliated Hospital of Xinjiang Medical University, Urumqi, Xinjiang, China.
- Key Laboratory of High Incidence Disease Research in Xingjiang (Xinjiang Medical University), Ministry of Education, Urumqi, Xinjiang, China.
- Xinjiang Clinical Research Center for Orthopedics, 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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Verghese SC, George ST, Duraisamy P, Karthikeyan TM, Kumar SA, Arasu S. A Rare Case Report of Primary Hydatid Disease of the Scapula - an Unforeseen Diagnosis! J Orthop Case Rep 2022; 12:98-101. [PMID: 36687497 PMCID: PMC9831220 DOI: 10.13107/jocr.2022.v12.i08.2982] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/21/2022] [Revised: 05/27/2022] [Indexed: 11/07/2022] Open
Abstract
Introduction Hydatid disease of the bone is a parasitic infestation in the form of cystic echinococcosis by a tapeworm echinococcus granulosus. Its manifestation in the bone is relatively low and has the ability to mimic other skeletal pathologies. Case Report We came across a 30-year-old male farmer with complaints of sero-purulent discharge from a sinus tract wound in the axilla for the past 3 years. He had been previously evaluated elsewhere with blood investigations, pus culture/sensitivity tests, MRI, and CT scans. Blood reports and culture/sensitivity tests were inconclusive and imaging tests were suggestive of a sinus tract originating from the right scapula. He was incorrectly diagnosed as a case of Tuberculosis of the Scapula and started on anti-tubercular medications for 9 months which was ineffective. To confirm the diagnosis, a biopsy was taken from the scapular lesion through a posterior approach. Histological tests revealed a cystic lesion composed of trilaminar membrane consisting of dead and degenerating scolices consistent with "Hydatid Cyst of Bone." Conclusion Hydatid disease of the bone has an inconsistent clinical picture which makes diagnosing this rare disease even more difficult. A high suspicion for hydatid infestation in bone pathologies could help in diagnosing the disease at the earliest.
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Affiliation(s)
- Sumant Chacko Verghese
- Department of Orthopaedics, KMCH Institute of Health Sciences and Research, Coimbatore, Tamil Nadu, India,Address of Correspondence: Dr. Sumant Chacko Verghese, Department of Orthopaedics, KMCH Institute of Health Sciences and Research, Coimbatore, Tamil Nadu, India. E-mail:
| | - Sandeep T George
- Department of Orthopaedics, KMCH Institute of Health Sciences and Research, Coimbatore, Tamil Nadu, India
| | - Praveen Duraisamy
- Department of Orthopaedics, KMCH Institute of Health Sciences and Research, Coimbatore, Tamil Nadu, India
| | - T M Karthikeyan
- Department of Pathology, KMCH Institute of Health Sciences and Research, Coimbatore, Tamil Nadu, India
| | - S Arun Kumar
- Department of Radiodiagnosis, KMCH Institute of Health Sciences and Research, Coimbatore, Tamil Nadu, India
| | - Sabari Arasu
- Department of Radiodiagnosis, KMCH Institute of Health Sciences and Research, Coimbatore, Tamil Nadu, India
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Chen YW, Aikebaier AIERKEN, Zhao Y. Evaluation of imaging features of pelvic echinococcosis based on multimodal images. J Orthop Surg Res 2020; 15:493. [PMID: 33106164 PMCID: PMC7590711 DOI: 10.1186/s13018-020-01912-2] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/16/2020] [Accepted: 08/24/2020] [Indexed: 11/21/2022] Open
Abstract
Background Hydatid disease (HD) is a zoonotic parasitic disease caused by the larvae of Echinococcus, It is mainly prevalent in pastoral areas. Bone echinococcosis is rare, accounting for 0.5 to 4.0% of all echinococcosis. It is likely to miss the diagnosis and misdiagnose due to non-specific early symptoms and the clinical manifestations and imaging features. The clinical data of 15 patients with pelvic cystic echinococcosis were analyzed retrospectively, and the X-ray, CT, and MRI imaging features of the disease were discussed, which are reported below. Methods All 15 patients underwent CT scan evaluation. A total of 8 patients underwent coronal, sagittal, and three-dimensional reconstruction with 3-mm-slice thickness, and 4 patients underwent X-ray plain film examination. Five cases underwent MRI scan. Eight cases underwent MRI or CT enhanced scan. Results X-ray plain film is characterized by continuous cystic bone destruction, irregular low-density shadow when invading soft tissue, and sometimes calcification which can be seen on the wall or inside the cyst. The involved sacroiliac joint or hip joint may narrow or disappear. The involvement of pelvic cystic echinococcosis is relatively wide, and 80% of patients with pelvic cysts in this group had multiple lesions in the same period. Cystic expansive bone destruction was the most common. Pelvic CT revealed a lobulated hypodense lesion of varying size with internal septae, causing cortical thinning and destruction. Most of them had no periosteal reaction. The iliopsoas muscle is most easily invaded. Single cystic echinococcosis of pelvis showed intermediate or low signal intensity on T1-weighted images and hyperintensity on T2-weighted images in the involved bone and surrounding soft tissue on MRI, and the cyst wall showed linear low signal in T1WI, T2WI, and STIR sequences. The polycystic type is characterized by multiple cysts of varying signal intensity (daughter cysts) within a larger cyst is the typical MRI finding, forming “small vesicles” high signal daughter cysts. Osteosclerosis or calcification showed low signal in T1WI and T2WI. Conclusions The results of this study suggest that the lesions of pelvic cystic echinococcosis are mostly cystic expansive and osteolytic bone destruction, which is easy to invade the surrounding soft tissue, often accompanied with calcification; among them, multiple cystic lesions are characteristic.
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Affiliation(s)
- Yu-Wei Chen
- Department of Imaging Center, First Affiliated Hospital of Xinjiang Medical University, 137 Liyushan Road, Urumqi, Xinjiang, 830054, China
| | - A I E R K E N Aikebaier
- Department of Imaging Center, First Affiliated Hospital of Xinjiang Medical University, 137 Liyushan Road, Urumqi, Xinjiang, 830054, China
| | - Yuan Zhao
- Department of Imaging Center, First Affiliated Hospital of Xinjiang Medical University, 137 Liyushan Road, Urumqi, Xinjiang, 830054, China.
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Abstract
Hydatid disease is one of the most complicated and devastating conditions caused by Echinococcus granulosus. This globally distributed disease continues to be an important public health concern in many low- and middle-income countries. The liver and the lungs are the most frequently involved sites, but virtually any organ system can be affected. Osseous hydatidosis is relatively less common, but it is extremely debilitating and difficult to manage due to frequent recurrences. Patients often demonstrate a delayed clinical presentation as bone involvement is predominantly a silent and slowly progressive disease with a long latent period. Radiological investigations play an important role in the diagnosis. Although standard therapeutic guidelines are not available, the treatment of choice is a combination of chemotherapy and surgery. Clinicians should perform a lifelong follow-up for early detection of potential recurrence and sequels. This paper aims to highlight hydatid disease of the pelvic bone as an important differential diagnosis of tubercular hip arthritis, especially in areas with high echinococcosis prevalence.
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Affiliation(s)
- Faisal Inayat
- Internal Medicine, Allama Iqbal Medical College, Lahore, PAK
| | - Raza E Rana
- Orthopaedics, King Edward Medical University, Lahore, PAK
| | - Shoaib Azam
- Orthopaedics, King Edward Medical University, Lahore, PAK
| | - Rizwan Ahmad
- Internal Medicine, Lahore General Hospital, Lahore, PAK
| | - Soban Ahmad
- Emergency Medicine, Hamad Medical Corporation, Doha, QAT
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