1
|
Ludz C, Stirnimann G, Semela D, Mertens J, Kremer AE, Filipowicz Sinnreich M, Sokollik C, Bernsmeier C, Bresson-Hadni S, McLin V, Rock N, Braegger C, Posovszky C, Müller P, Cremer M, De Gottardi A, Galante A, Furlano R, Righini-Grunder F, Becker B, Böhm S, Heyland K, Nydegger A, Limoni C, Vergani D, Mieli-Vergani G, Di Bartolomeo C, Cerny A, Terziroli Beretta-Piccoli B. Epidemiology, clinical features and management of autoimmune hepatitis in Switzerland: a retrospective and prospective cohort study. Swiss Med Wkly 2023; 153:40102. [PMID: 37769636 DOI: 10.57187/smw.2023.40102] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/03/2023] Open
Abstract
BACKGROUND AND AIMS The Swiss Autoimmune Hepatitis Cohort Study is a nationwide registry, initiated in 2017, that collects retrospective and prospective clinical data and biological samples from patients of all ages with autoimmune hepatitis treated at Swiss hepatology centres. Here, we report the analysis of the first 5 years of registry data. RESULTS A total of 291 patients with autoimmune hepatitis have been enrolled, 30 of whom were diagnosed before 18 years of age and composed the paediatric cohort. Paediatric cohort: median age at diagnosis 12.5 years (range 1-17, interquartile range (IQR) 8-15), 16 (53%) girls, 6 (32%) with type 2 autoimmune hepatitis, 8 (27%) with autoimmune sclerosing cholangitis, 1 with primary biliary cholangitis variant syndrome, 4 (15%) with inflammatory bowel disease and 10 (41%) with advanced liver fibrosis at diagnosis. Adult cohort: median age at diagnosis 54 years (range 42-64, IQR 18-81), 185 (71%) women, 51 (20%) with primary biliary cholangitis variant syndrome, 22 (8%) with primary sclerosing cholangitis variant syndrome, 9 (4%) with inflammatory bowel disease and 66 (32%) with advanced liver fibrosis at diagnosis. The median follow-up time for the entire cohort was 5.2 years (IQR 3-9.3 years). Treatment in children: 29 (97%) children were initially treated with corticosteroids, 28 of whom received combination treatment with azathioprine. Budesonide was used in four children, all in combination with azathioprine. Mycophenolate mofetil was used in five children, all of whom had previously received corticosteroids and thiopurine. Treatment in adults (data available for 228 patients): 219 (96%) were treated with corticosteroids, mostly in combination with azathioprine. Predniso(lo)ne was the corticosteroid used in three-quarters of patients; the other patients received budesonide. A total of 78 (33%) patients received mycophenolate mofetil, 62 of whom had previously been treated with azathioprine. Complete biochemical response was achieved in 13 of 19 (68%) children and 137 of 182 (75%) adults with available follow-up data. All children were alive at the last follow-up, and none had undergone liver transplantation. Five (2%) adults underwent liver transplantation, two of whom had a fulminant presentation. Four (2%) adults with autoimmune hepatitis died (two from liver-associated causes). CONCLUSION Patients with autoimmune hepatitis in Switzerland had clinical features similar to those in other cohorts. The proportion of patients diagnosed with primary biliary cholangitis variant syndrome was higher than expected. Autoimmune hepatitis was managed according to guidelines, except for the use of budesonide in a small proportion of paediatric patients. The outcomes were excellent, but the findings must be confirmed over a longer follow-up period.
Collapse
Affiliation(s)
- Christine Ludz
- Facoltà di Scienze Biomediche, Università della Svizzera Italiana, Lugano, Switzerland
| | - Guido Stirnimann
- Universitätsklinik für Viszerale Chirurgie und Medizin, Inselspital Bern, Bern, Switzerland
| | - David Semela
- Klinik für Gastroenterologie und Hepatologie, Kantonsspital St. Gallen, St. Gallen, Switzerland
| | | | - Andreas E Kremer
- Klinik für Gastroenterologie und Hepatologie, Universitätsspital Zürich, Zürich, Switzerland
| | - Magdalena Filipowicz Sinnreich
- Clinic for Gastroenterology and Hepatology, Medizinische Universitätsklinik, Kantonsspital Baselland, Liestal, Switzerland
| | - Christiane Sokollik
- Departement Pädiatrische Gastroenterologie, Hepatologie und Ernährung, Kinderklinik Inselspital Bern, Bern Switzerland
| | - Christine Bernsmeier
- Gastroenterologie/Hepatologie, Universitäres Bauchzentrum Basel Clarunis, Basel, Switzerland
| | - Solange Bresson-Hadni
- Service de Gastroentérologie and Hépatologie, Hôpitaux Universitaires de Genève, Geneva, Switzerland
| | - Valérie McLin
- Département de l'Enfant et de l'Adolescent, Centre Suisse des Maladies du Foie de l'Enfant, Hôpitaux Universitaires de Genève, Geneva, Switzerland
| | - Nathalie Rock
- Département de l'Enfant et de l'Adolescent, Centre Suisse des Maladies du Foie de l'Enfant, Hôpitaux Universitaires de Genève, Geneva, Switzerland
| | - Christian Braegger
- Division of Pediatric Gastroenterology and Nutrition, University Children's Hospital Zurich, Zurich, Switzerland
| | - Carsten Posovszky
- Nutrition Research Unit, University Children's Hospital Zurich, Zurich, Switzerland
| | - Pascal Müller
- Departement pädiatrische Gastroenterologie und Hepatologie, Ostschweizer Kinderspital, St. Gallen, Switzerland
| | - Matthias Cremer
- Departement für Kinder- und Jugendmedizin, Kantonsspital Graubünden, Chur, Switzerland
| | - Andrea De Gottardi
- Servizio di Gastroenterologia, Ente Ospedaliero Cantonale Ospedale Regionale di Lugano, Lugano, Switzerland
| | - Antonio Galante
- Servizio di Gastroenterologia, Ente Ospedaliero Cantonale Ospedale Regionale di Lugano, Lugano, Switzerland
| | - Raoul Furlano
- University Children's Hospital Basel, Paediatric Gastroenterology and Nutrition, Basel, Switzerland
| | - Franziska Righini-Grunder
- Departement pädiatrische Gastroenterologie, Luzerner Kantonsspital/Kinderspital, Lucerne, Switzerland
| | - Björn Becker
- Departement Innere Medizin, Klinik für Gastroenterologie und Hepatologie, Kantonsspital Winterthur, Winterthur, Switzerland
| | - Stephan Böhm
- Departement Gastroenterologie und Hepatologie, Klinik Innere Medizin, Spital Bülach, Bülach, Switzerland
| | - Klaas Heyland
- Departement Kindergastroenterologie, Kantonsspital Winterthur, Winterthur, Switzerland
| | - Andreas Nydegger
- Département femme-mère-enfant, Centre hospitalier universitaire Vaudois, Lausanne, Switzerland
| | - Costanzo Limoni
- University of Applied Sciences and Arts of Southern Switzerland, Lugano, Switzerland
| | - Diego Vergani
- MowatLabs, Faculty of Life Sciences and Medicine, King's College London, King's College Hospital, London, UK
| | - Giorgina Mieli-Vergani
- MowatLabs, Faculty of Life Sciences and Medicine, King's College London, King's College Hospital, London, UK
| | | | | | - Benedetta Terziroli Beretta-Piccoli
- Facoltà di Scienze Biomediche, Università della Svizzera Italiana, Lugano, Switzerland
- MowatLabs, Faculty of Life Sciences and Medicine, King's College London, King's College Hospital, London, UK
- Epatocentro Ticino, Lugano, Switzerland
| |
Collapse
|
2
|
Bohard L, Lallemand S, Borne R, Courquet S, Bresson-Hadni S, Richou C, Millon L, Bellanger AP, Knapp J. Complete mitochondrial exploration of Echinococcus multilocularis from French alveolar echinococcosis patients. Int J Parasitol 2023:S0020-7519(23)00076-0. [PMID: 37148987 DOI: 10.1016/j.ijpara.2023.03.006] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/27/2022] [Revised: 03/14/2023] [Accepted: 03/20/2023] [Indexed: 05/08/2023]
Abstract
Alveolar echinococcosis (AE) is a parasitosis that is expanding worldwide, including in Europe. The development of genotypic markers is essential to follow its spatiotemporal evolution. Sequencing of the commonly used mitochondrial genes cob, cox1, and nad2 shows low discriminatory power, and analysis of the microsatellite marker EmsB does not allow nucleotide sequence analysis. We aimed to develop a new method for the genotyping of Echinococcus multilocularis based on whole mitochondrial genome (mitogenome) sequencing, to determine the genetic diversity among 30 human visceral samples from French patients, and compare this method with those currently in use. Sequencing of the whole mitochondrial genome was carried out after amplification by PCR, using one uniplex and two multiplex reactions to cover the 13,738 bp of the mitogenome, combined with Illumina technology. Thirty complete mitogenome sequences were obtained from AE lesions. One showed strong identity with Asian genotypes (99.98% identity) in a patient who had travelled to China. The other 29 mitogenomes could be differentiated into 13 haplotypes, showing higher haplotype and nucleotide diversity than when using the cob, cox1, and nad2 gene sequences alone. The mitochondrial genotyping data and EmsB profiles did not overlap, probably because one method uses the mitochondrial genome and the other the nuclear genome. The pairwise fixation index (Fst) value between individuals living inside and those living outside the endemic area was high (Fst = 0.222, P = 0.002). This is consistent with the hypothesis of an expansion from historical endemic areas to peripheral regions.
Collapse
Affiliation(s)
- Louis Bohard
- Department of Infectious Disease, University Hospital of Besançon, 3 boulevard A. Fleming, 25030 Besançon, France
| | - Séverine Lallemand
- UMR CNRS 6249 Chrono-environnement Laboratory, University of Franche-Comté, 16 Route de Gray, 25030 Besançon, France
| | - Romain Borne
- UMR CNRS 6249 Chrono-environnement Laboratory, University of Franche-Comté, 16 Route de Gray, 25030 Besançon, France
| | - Sandra Courquet
- UMR CNRS 6249 Chrono-environnement Laboratory, University of Franche-Comté, 16 Route de Gray, 25030 Besançon, France; Department of Parasitology-Mycology, Reference National Center for Echinococcosis, University Hospital of Besançon, 3 boulevard A. Fleming, 25030 Besançon, France
| | - Solange Bresson-Hadni
- UMR CNRS 6249 Chrono-environnement Laboratory, University of Franche-Comté, 16 Route de Gray, 25030 Besançon, France; Department of Parasitology-Mycology, Reference National Center for Echinococcosis, University Hospital of Besançon, 3 boulevard A. Fleming, 25030 Besançon, France
| | - Carine Richou
- Department of Hepatology, University Hospital of Besançon, 3 boulevard A. Fleming, Besançon France
| | - Laurence Millon
- UMR CNRS 6249 Chrono-environnement Laboratory, University of Franche-Comté, 16 Route de Gray, 25030 Besançon, France; Department of Parasitology-Mycology, Reference National Center for Echinococcosis, University Hospital of Besançon, 3 boulevard A. Fleming, 25030 Besançon, France
| | - Anne-Pauline Bellanger
- UMR CNRS 6249 Chrono-environnement Laboratory, University of Franche-Comté, 16 Route de Gray, 25030 Besançon, France; Department of Parasitology-Mycology, Reference National Center for Echinococcosis, University Hospital of Besançon, 3 boulevard A. Fleming, 25030 Besançon, France
| | - Jenny Knapp
- UMR CNRS 6249 Chrono-environnement Laboratory, University of Franche-Comté, 16 Route de Gray, 25030 Besançon, France; Department of Parasitology-Mycology, Reference National Center for Echinococcosis, University Hospital of Besançon, 3 boulevard A. Fleming, 25030 Besançon, France.
| |
Collapse
|
3
|
Marquis B, Demonmerot F, Richou C, Thiéfin G, Millon L, Wallon M, Vuitton DA, Grall-Jezequel A, Grenouillet F, Epaulard O, Gervais P, Manuel O, Bresson-Hadni S. Alveolar echinococcosis in solid organ transplant recipients: a case series from two national cohorts. Parasite 2023; 30:9. [PMID: 37010450 PMCID: PMC10069401 DOI: 10.1051/parasite/2023008] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/20/2022] [Accepted: 02/12/2023] [Indexed: 04/04/2023] Open
Abstract
Alveolar echinococcosis (AE) is a severe parasitic infection caused by the ingestion of Echinococcus multilocularis eggs. While higher incidence and faster evolution have been reported in immunosuppressed patients, no studies have been performed specifically on AE in transplant patients. We searched for all de novo AE cases diagnosed between January 2008 and August 2018 in solid organ transplant (SOT) recipients included in the Swiss Transplant Cohort Study and the FrancEchino Registry. Eight cases were identified (kidney = 5, lung = 2, heart = 1, liver = 0), half of which were asymptomatic at diagnosis. AE diagnosis was difficult due to the low sensitivity (60%) of the standard screening serology (Em2+) and the frequently atypical radiological presentations. Conversely, Echinococcus Western blot retained good diagnostic performances and was positive in all eight cases. Five patients underwent surgery, but complete resection could only be achieved in one case. Moreover, two patients died of peri-operative complications. Albendazole was initiated in seven patients and was well tolerated. Overall, AE regressed in one, stabilized in three, and progressed in one case, and had an overall mortality of 37.5% (3/8 patients). Our data suggest that AE has a higher mortality and a faster clinical course in SOT recipients; they also suggest that the parasitic disease might be due to the reactivation of latent microscopic liver lesions through immune suppression. Western blot serology should be preferred in this population. Finally, surgery should be considered with caution, because of its low success rate and high mortality, and conservative treatment with albendazole is well tolerated.
Collapse
Affiliation(s)
- Bastian Marquis
- Infectious Diseases Unit, Department of Medicine, University Hospital and University of Lausanne, CH-1011, Lausanne, Switzerland
| | - Florent Demonmerot
- Parasitology-Mycology Laboratory, French National Reference Center for Echinococcosis, University Hospital of Besançon and Franche-Comté University, F-25030, Besançon, France - UMR 6249 CNRS-Franche-Comté University « Chrono-Environnement », F-25030, Besançon, France
| | - Carine Richou
- Liver Diseases Unit, French National Reference Center for Echinococcosis, University Hospital of Besançon and Franche-Comté University, F-25030, Besançon, France
| | - Gérard Thiéfin
- Hepato-Gastroenterology Department, Reims Champagne Ardennes University and University Hospital of Reims, F-5192, Reims, France
| | - Laurence Millon
- Parasitology-Mycology Laboratory, French National Reference Center for Echinococcosis, University Hospital of Besançon and Franche-Comté University, F-25030, Besançon, France - UMR 6249 CNRS-Franche-Comté University « Chrono-Environnement », F-25030, Besançon, France
| | - Martine Wallon
- Parasitology-Mycology Laboratory, University Hospital of Lyon, F-69317, Lyon, France
| | - Dominique Angèle Vuitton
- French National Reference Center for Echinococcosis and Franche-Comté University, F-25030, Besançon, France
| | - Anne Grall-Jezequel
- Nephrology Service, Brest University Hospital Centre, F-29609, Brest, France
| | - Frédéric Grenouillet
- UMR 6249 CNRS-Franche-Comté University « Chrono-Environnement », F-25030, Besançon, France - Fungi and Parasite Serology Unit, French National Reference Center for Echinococcosis, University Hospital of Besançon and Franche-Comté University, F-25030, Besançon, France
| | - Olivier Epaulard
- Infectious Disease Service, University Hospital of Grenoble, F-38700, Grenoble, France
| | - Philippe Gervais
- Institut Universitaire de Cardiologie et de Pneumologie de Québec, Laval University, Quebec City, QC, G1V 4G5, Canada
| | - Oriol Manuel
- Infectious Diseases Unit and Transplantation Center, University Hospital and University of Lausanne, CH-1011, Lausanne, Switzerland
| | - Solange Bresson-Hadni
- Parasitology-Mycology Laboratory, French National Reference Center for Echinococcosis, University Hospital of Besançon and Franche-Comté University, F-25030, Besançon, France - UMR 6249 CNRS-Franche-Comté University « Chrono-Environnement », F-25030, Besançon, France - Visceral Surgery/Liver Transplant Unit, French National Reference Center for Echinococcosis, University Hospital of Besançon and Franche-Comté University, F-25030, Besançon, France
| |
Collapse
|
4
|
Autier B, Gottstein B, Millon L, Ramharter M, Gruener B, Bresson-Hadni S, Dion S, Robert-Gangneux F. Alveolar echinococcosis in immunocompromised hosts. Clin Microbiol Infect 2022; 29:593-599. [PMID: 36528295 DOI: 10.1016/j.cmi.2022.12.010] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/12/2022] [Revised: 12/02/2022] [Accepted: 12/06/2022] [Indexed: 12/23/2022]
Abstract
BACKGROUND Alveolar echinococcosis (AE) results of an infection with the larval stage of Echinococcus multilocularis. It has been increasingly described in individuals with impaired immune responsiveness. OBJECTIVES This narrative review aims at describing the presentation of AE according to the type of immune impairment, based on retrospective cohorts and case reports. Implications for patient management and future research are proposed accordingly. SOURCES Targeted search was conducted in PubMed using ((alveolar echinococcosis) OR (multilocularis)) AND ((immunosuppressive) OR (immunodeficiency) OR (AIDS) OR (solid organ transplant) OR (autoimmunity) OR (immune deficiency)). Only publications in English were considered. CONTENT Seventeen publications were found, including 13 reports of 55 AE in immunocompromised patients (AE/IS) and 4 retrospective studies of 755 AE immunocompetent patients and 115 AE/IS (13%). The cohorts included 9 (1%) solid organ transplantation (SOT) recipients, 2 (0.2%) HIV patients, 41 (4.7%) with chronic inflammatory/autoimmune diseases (I/AID) and 72 (8.3%) with malignancies. SOT, I/AID and malignancies, but not HIV infection, were significantly associated with AE (odds ratios of 10.8, 1.6, 5.9, and 1.3, respectively). Compared to AE immunocompetent patients, AE/IS was associated with earlier diagnosis (PNM stages I-II: 49/85 (58%) vs. 137/348 (39%), p < 0.001), high rate of atypical imaging (24/50 (48%) vs. 106/375 (28%), p < 0.01), and low sensitivity of serology (19/77 (25%) vs. 265/329 (81%), p < 0.001). Unusually extensive or disseminated infections were described in SOT and I/AID patients. IMPLICATIONS Patients who live in endemic areas should benefit from serology before onset of a long-term immunosuppressive therapy, even if the cost-benefit ratio has to be evaluated. Physicians should explain AE to immunocompromised patients and think about AE when finding a liver lesion. Further research should address gaps in knowledge of AE/IS. Especially, extensive and accurate records of AE cases have to be collected by multinational registries.
Collapse
Affiliation(s)
- Brice Autier
- Univ Rennes, CHU Rennes, Inserm, EHESP, Irset (Institut de recherche en santé, environnement et travail), UMR_S 1085, Rennes, France.
| | - Bruno Gottstein
- Institute of Infectious Diseases, Faculty of Medicine, University of Bern, CH-3012, Bern, Switzerland
| | - Laurence Millon
- Department of Parasitology-Mycology, National Reference Centre for Echinococcoses, University Hospital of Besançon, France; UMR CNRS 6249 Laboratoire Chrono-environnement, Université Bourgogne-Franche-Comté, Besançon, France; European Study Group of Clinical Parasitology, ESCMID, Basel, Switzerland
| | - Michael Ramharter
- European Study Group of Clinical Parasitology, ESCMID, Basel, Switzerland; Center for Tropical Medicine, Bernhard Nocht Institute for Tropical Medicine & I Dept. of Medicine University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Beate Gruener
- Division of Infectious Diseases, Department of Internal Medicine III, University Hospital of Ulm, Ulm, Germany
| | - Solange Bresson-Hadni
- Department of Parasitology-Mycology, National Reference Centre for Echinococcoses, University Hospital of Besançon, France; Division of Tropical and Humanitarian Medicine and Gastroenterology and Hepatology Unit, Faculty of Medicine, University Hospitals of Geneva, Switzerland
| | - Sarah Dion
- Univ Rennes, Inserm, EHESP, Irset (Institut de recherche en santé, environnement et travail) - UMR_S 1085, Rennes, France
| | - Florence Robert-Gangneux
- Univ Rennes, CHU Rennes, Inserm, EHESP, Irset (Institut de recherche en santé, environnement et travail), UMR_S 1085, Rennes, France; European Study Group of Clinical Parasitology, ESCMID, Basel, Switzerland
| |
Collapse
|
5
|
Calame P, Weck M, Busse-Cote A, Brumpt E, Richou C, Turco C, Doussot A, Bresson-Hadni S, Delabrousse E. Role of the radiologist in the diagnosis and management of the two forms of hepatic echinococcosis. Insights Imaging 2022; 13:68. [PMID: 35394226 PMCID: PMC8994011 DOI: 10.1186/s13244-022-01190-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/18/2021] [Accepted: 02/15/2022] [Indexed: 11/10/2022] Open
Abstract
Echinococcosis is a parasitic disease caused by two zoonotic tapeworms (cestodes) of the Echinocococcus genus. It can be classified as either alveolar or cystic echinococcosis. Although the two forms differ significantly in terms of imaging findings, they share similarities in terms of management and treatment. In parallel to medical treatment with albendazole (ABZ), and surgery, historically used in these diseases, various imaging-guided interventional procedures have recently emerged (drainage, stenting, or Puncture, aspiration, injection, and reaspiration (PAIR)). These options open up a new range of therapeutic options. As in oncology, multidisciplinary consultation meetings now play a major role in adapted management and patient care in hepatic echinococcosis. Consequently, diagnostic imaging and interventional expertise have brought radiologists to the fore as important members of these multidisciplinary team. The radiologist will need to evaluate parasite activity in both forms of the disease, to guide the choice of the appropriate therapy from among medical treatment, interventional radiology procedures and/or surgical treatment. Knowledge of the specific complications of the two forms of echinococcosis will also help radiologists to discuss the appropriate treatment and management. The aim of this review is to describe the core knowledge that what a radiologist should possess to actively participate in multidisciplinary meetings about hepatic echinococcosis. We discuss the role of imaging, from diagnosis to treatment, in alveolar (AE) and cystic echinococcosis (CE), respectively.
Collapse
Affiliation(s)
- Paul Calame
- Department of Radiology, University of Bourgogne Franche-Comté, University Hospital Besançon, 3 Boulevard Fleming, 25030, Besançon, France. .,EA 4662 Nanomedicine Lab, Imagery and Therapeutics, University of Bourgogne Franche-Comté, Besançon, France.
| | - Mathieu Weck
- Department of Radiology, University of Bourgogne Franche-Comté, University Hospital Besançon, 3 Boulevard Fleming, 25030, Besançon, France
| | - Andreas Busse-Cote
- Department of Radiology, University of Bourgogne Franche-Comté, University Hospital Besançon, 3 Boulevard Fleming, 25030, Besançon, France
| | - Eleonore Brumpt
- Department of Radiology, University of Bourgogne Franche-Comté, University Hospital Besançon, 3 Boulevard Fleming, 25030, Besançon, France
| | - Carine Richou
- Department of Hepatology, University of Bourgogne Franche-Comté, University Hospital Besançon, 25030, Besançon, France
| | - Celia Turco
- Department of Digestive Surgery, University of Bourgogne Franche-Comté, University Hospital Besançon, 25030, Besançon, France
| | - Alexandre Doussot
- Department of Digestive Surgery, University of Bourgogne Franche-Comté, University Hospital Besançon, 25030, Besançon, France
| | - Solange Bresson-Hadni
- Laboratoire de Parasitologie-Mycologie, University Hospital Besançon, 25030, Besançon, France.,Centre National de Référence Echinococcoses, University Hospital Besançon, 25030, Besançon, France
| | - Eric Delabrousse
- Department of Radiology, University of Bourgogne Franche-Comté, University Hospital Besançon, 3 Boulevard Fleming, 25030, Besançon, France.,EA 4662 Nanomedicine Lab, Imagery and Therapeutics, University of Bourgogne Franche-Comté, Besançon, France
| |
Collapse
|
6
|
Knapp J, Lallemand S, Monnien F, Felix S, Valmary-Degano S, Courquet S, Demonmerot F, Heyd B, Turco C, Doussot A, Bourgeois L, Bresson-Hadni S, Richou C, Millon L. Molecular diagnosis of alveolar echinococcosis in patients based on frozen and formalin-fixed paraffin-embedded tissue samples. Parasite 2022; 29:4. [PMID: 35113014 PMCID: PMC8812296 DOI: 10.1051/parasite/2022004] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/16/2021] [Accepted: 01/14/2022] [Indexed: 11/14/2022] Open
Abstract
Confirmed diagnosis of alveolar echinococcosis (AE) is based on pathological criteria and molecular evidence. This parasite-borne disease, caused by the cestode Echinococcus multilocularis, sparingly involves humans as a dead-end host. In humans, the parasite mainly colonizes the liver but can colonize any organ and cause atypical forms, often difficult to characterize clinically. Moreover, molecular methods may be suitable to make the diagnosis of AE in cases of atypical forms, extra-hepatic localizations, or immunosuppressed patients. The aim of this study was to determine the most relevant published PCR techniques, for diagnosis of AE in patients and adopt the best strategy for molecular diagnosis depending on the nature of the tested sample. In this study, we evaluated nine end-point PCR assays and one real-time PCR assay (qPCR), targeting mitochondrial genes, using a total of 89 frozen or formalin-fixed paraffin-embedded (FFPE) samples from either 48 AE or 9 cystic echinococcosis patients. Targeted fragment-genes ranged from 84 to 529 bp. Six PCR assays were able to amplify the DNA of 100% of the frozen AE-samples and for one PCR, 69.8% of the FFPE AE-samples. The 16S rrnL PCR (84 bp) was positive in PCR for 77% of the AE samples and in qPCR for 86.5%. The sensitivity of the PCR assays was higher for fresh samples and FFPE samples stored for less than 5 years. The qPCR assay further increased sensitivity for the tested samples, confirming the need for the development of an Echinococcus spp. qPCR to improve the molecular diagnosis of echinococcoses.
Collapse
Affiliation(s)
- Jenny Knapp
- Department of Parasitology-Mycology, National Reference Centre for Echinococcoses, University Hospital of Besançon, 25030 Besançon, France - UMR CNRS 6249 Laboratoire Chrono-environnement, Université Bourgogne-Franche-Comté, 16 Route de Gray, 25030 Besançon, France
| | - Séverine Lallemand
- Department of Parasitology-Mycology, National Reference Centre for Echinococcoses, University Hospital of Besançon, 25030 Besançon, France
| | - Franck Monnien
- Department of Pathology, University Hospital of Besançon, 25030 Besançon, France
| | - Sophie Felix
- Department of Pathology, University Hospital of Besançon, 25030 Besançon, France
| | - Séverine Valmary-Degano
- Department of Pathology, University Hospital of Besançon, 25030 Besançon, France - Department of Pathology, University Hospital of Grenoble-Alps, 38043 Grenoble, France
| | - Sandra Courquet
- Department of Parasitology-Mycology, National Reference Centre for Echinococcoses, University Hospital of Besançon, 25030 Besançon, France - UMR CNRS 6249 Laboratoire Chrono-environnement, Université Bourgogne-Franche-Comté, 16 Route de Gray, 25030 Besançon, France
| | - Florent Demonmerot
- Department of Parasitology-Mycology, National Reference Centre for Echinococcoses, University Hospital of Besançon, 25030 Besançon, France
| | - Bruno Heyd
- Visceral, Digestive and Cancer Surgery, Hepatic Transplantation Unit, University Hospital of Besançon, 25030 Besançon, France
| | - Celia Turco
- Department of Digestive Surgery, Hepato-Biliary-Pancreatic and Liver Transplantation, AP-HP Pitié-Salpêtrière Hospital - Charles-Foix, 75651 Paris, France
| | - Alexandre Doussot
- Visceral, Digestive and Cancer Surgery, Hepatic Transplantation Unit, University Hospital of Besançon, 25030 Besançon, France
| | - Lucie Bourgeois
- Department of Pathology, University Hospital of Besançon, 25030 Besançon, France
| | - Solange Bresson-Hadni
- Department of Parasitology-Mycology, National Reference Centre for Echinococcoses, University Hospital of Besançon, 25030 Besançon, France - UMR CNRS 6249 Laboratoire Chrono-environnement, Université Bourgogne-Franche-Comté, 16 Route de Gray, 25030 Besançon, France
| | - Carine Richou
- Department of Hepatology, University Hospital of Besançon, 25030 Besançon, France
| | - Laurence Millon
- Department of Parasitology-Mycology, National Reference Centre for Echinococcoses, University Hospital of Besançon, 25030 Besançon, France - UMR CNRS 6249 Laboratoire Chrono-environnement, Université Bourgogne-Franche-Comté, 16 Route de Gray, 25030 Besançon, France
| |
Collapse
|
7
|
Bastid C, Terraz S, Toso C, Chappuis F, Spahr L, Bresson-Hadni S. [Update on cystic echinococcosis of the liver]. Rev Med Suisse 2021; 17:1466-1473. [PMID: 34468098] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/13/2023]
Abstract
Hepatic cystic echinococcosis (HCE), is a cosmopolitan parasitic zoonosis. Autochtonous HCE cases are rare and the majority of cases are imported from endemic areas. It induces the development in the liver of Echinococcus granulosus larvae. Extrahepatic localizations are also possible. Cyst development is slow with an often-late diagnosis. In Switzerland, HCE discovery is usually fortuitous, during an abdominal radiological examination. More rarely, an acute clinical picture reveals a complication that can be severe or even fatal. The diagnosis is based on ultrasound findings that allows cyst characterization according to the WHO classification. This guides the therapeutic choice: simple monitoring, albendazole therapy, percutaneous procedures or surgery.
Collapse
Affiliation(s)
- Caroline Bastid
- Services de gastroentérologie et hépatologie, HUG, 1211 Genève 14
| | | | | | | | - Laurent Spahr
- Services de gastroentérologie et hépatologie, HUG, 1211 Genève 14
| | - Solange Bresson-Hadni
- Services de gastroentérologie et hépatologie, HUG, 1211 Genève 14
- Service de médecine tropicale et humanitaire, HUG, 1211 Genève 14
- Centre national de référence échinococcoses, Laboratoire de parasitologie, CHU, 25030 Besançon
| |
Collapse
|
8
|
Abstract
Hepatic alveolar echinococcosis (HAE) is a rare but severe zoonosis caused by the pseudotumoral intrahepatic development of the larval stage of the tapeworm Echinococcus multilocularis. HAE is present only in the Northern Hemisphere, predominantly in China. Currently, there is a significant resurgence of cases in historically endemic areas associated with emergence of HAE in countries not previously concerned. Today, in European countries, HAE is often discovered by chance; however, clinicians should be made aware of opportunistic infections that progressively emerged recently as a result of therapeutic or pathological immunosuppression. Ultrasonography is the key first-line diagnostic procedure, with specific serology providing confirmation in 95% of the cases. Albendazole, only parasitostatic, is the mainstay for treatment. Surgical resection, if feasible, is the gold standard for treatment, and more patients are currently eligible for this option because of an earlier diagnosis. The prognosis has considerably improved but remains poor in countries where access to care is less favorable.
Collapse
Affiliation(s)
- Solange Bresson-Hadni
- Gastroenterology and Hepatology, Faculty of Medicine, University Hospitals of Geneva, Switzerland.,Division of Tropical and Humanitarian Medicine, Faculty of Medicine, University Hospitals of Geneva, Faculty of Medicine, Switzerland.,Laboratory of Parasitology-Mycology, National Reference Center for Echinococcosis, University Hospital of Besançon, Besançon, France
| | - Laurent Spahr
- Gastroenterology and Hepatology, Faculty of Medicine, University Hospitals of Geneva, Switzerland
| | - François Chappuis
- Division of Tropical and Humanitarian Medicine, Faculty of Medicine, University Hospitals of Geneva, Faculty of Medicine, Switzerland
| |
Collapse
|
9
|
Bellanger AP, Wang J, Gbaguidi-Haore H, Barrera C, Bresson-Hadni S, Zlobec I, Lachenmayer A, Richou C, Turco C, Gottstein B, Millon L, Beldi G. Investigating new serological and tissue markers for the follow-up of patients operated for alveolar echinococcosis. Parasite Immunol 2021; 43:e12827. [PMID: 33655559 DOI: 10.1111/pim.12827] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/09/2020] [Revised: 02/11/2021] [Accepted: 02/26/2021] [Indexed: 01/17/2023]
Abstract
AIMS Alveolar echinococcosis (AE) is characterized by a chronically progressing hepatic injury caused by Echinococcus multilocularis. Surgery presently remains the best curative option. Currently, biological predictive features derived from the resected specimens are not suitable to assess surgery efficacy. The present study was designed to investigate whether a selection of markers measured on the resected specimens exhibits predictive features related to parasite viability, or to a total elimination of the parasite, in addition to serological markers. METHODS AND RESULTS In a collaboration between two centres, one in France (Besançon), and one in Switzerland (Bern), samples from 40 AE patients were analysed by microarray and serology techniques, individually. Paired serum samples before and after surgery were obtained for 26 patients. In the sera, a significant decrease in PD-L1 levels was observed after surgery, in addition to anti-Em18 levels. In the liver tissue, low levels of Cluster of Differentiation (CD)-3 were correlated with the absence of serum anti-Em18 after surgery. CONCLUSION This study showed PD-L1 is promising as a potential serological marker and further confirmed the performance of anti-Em18 serology. Further studies on a larger cohort are needed to confirm the utility of performing systematically microarray on resected liver tissue.
Collapse
Affiliation(s)
- Anne-Pauline Bellanger
- Parasitology Mycology Department, University Hospital Jean Minjoz, Besancon, France.,Chrono-Environment UMR/CNRS 6249, University of Bourgogne Franche-Comté, Besançon, France.,National Reference Center for Echinococcosis, University Hospital of Besancon, Besançon, France
| | - Junhua Wang
- Faculty of Medicine, Institute for Infectious Diseases, University of Bern, Bern, Switzerland
| | | | - Coralie Barrera
- Chrono-Environment UMR/CNRS 6249, University of Bourgogne Franche-Comté, Besançon, France.,National Reference Center for Echinococcosis, University Hospital of Besancon, Besançon, France
| | - Solange Bresson-Hadni
- Parasitology Mycology Department, University Hospital Jean Minjoz, Besancon, France.,National Reference Center for Echinococcosis, University Hospital of Besancon, Besançon, France
| | - Inti Zlobec
- Institute of Pathology, University of Bern, Bern, Switzerland
| | - Anja Lachenmayer
- Visceral Surgery Department, Inselspital, University Hospital of Bern, Bern, Switzerland
| | - Carine Richou
- National Reference Center for Echinococcosis, University Hospital of Besancon, Besançon, France.,Hepatology Department, University Hospital Jean Minjoz, Besancon, France
| | - Celia Turco
- Digestive Surgical Oncology Department, Liver transplantation Unit, University Hospital Jean Minjoz, Besancon, France
| | - Bruno Gottstein
- Faculty of Medicine, Institute for Infectious Diseases, University of Bern, Bern, Switzerland
| | - Laurence Millon
- Parasitology Mycology Department, University Hospital Jean Minjoz, Besancon, France.,Chrono-Environment UMR/CNRS 6249, University of Bourgogne Franche-Comté, Besançon, France.,National Reference Center for Echinococcosis, University Hospital of Besancon, Besançon, France
| | - Guido Beldi
- Visceral Surgery Department, Inselspital, University Hospital of Bern, Bern, Switzerland
| |
Collapse
|
10
|
Bresson-Hadni S, Montange D, Richou C, Brumpt E, Fillion A, Bartholomot B, Blagosklonov O, Delabrousse E, Grenouillet F, Vuitton DA, Millon L. Tobacco, cannabis, and liquorice: Hidden players altering albendazole metabolism in patients with hepatic alveolar echinococcosis. J Hepatol 2021; 74:471-473. [PMID: 33309328 DOI: 10.1016/j.jhep.2020.10.032] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/05/2020] [Revised: 10/30/2020] [Accepted: 10/30/2020] [Indexed: 01/17/2023]
Affiliation(s)
- Solange Bresson-Hadni
- Laboratoire de Parasitologie-Mycologie, Centre Hospitalier Régional Universitaire de Besançon, Besançon, France; Centre National de Référence Echinococcoses, Centre Hospitalier Régional Universitaire de Besançon, Besançon, France; UMR 6249, Chronoenvironnement, Université de Franche-Comté, 25030 Besançon, France; Services d'Hepato-Gastroenterologie et; de Médecine Tropicale et Humanitaire, Hôpitaux Universitaires de Genève, Suisse.
| | - Damien Montange
- Laboratoire de Parasitologie-Mycologie, Centre Hospitalier Régional Universitaire de Besançon, Besançon, France; Laboratoire de Pharmacologie Clinique, Centre Hospitalier Régional Universitaire de Besançon, Besançon, France
| | - Carine Richou
- Laboratoire de Parasitologie-Mycologie, Centre Hospitalier Régional Universitaire de Besançon, Besançon, France; Service d'Hépatologie, Centre Hospitalier Régional Universitaire de Besançon, Besançon, France
| | - Eléonore Brumpt
- Laboratoire de Parasitologie-Mycologie, Centre Hospitalier Régional Universitaire de Besançon, Besançon, France; Service de Radiologie Viscérale, Centre Hospitalier Régional Universitaire de Besançon, Besançon, France
| | - Aurélie Fillion
- Service de Maladies Infectieuses, Centre Hospitalier Chalon sur Saône, France
| | | | - Oleg Blagosklonov
- Laboratoire de Parasitologie-Mycologie, Centre Hospitalier Régional Universitaire de Besançon, Besançon, France; Service de Médecine Nucléaire, Centre Hospitalier Régional Universitaire de Besançon, Besançon, France
| | - Eric Delabrousse
- Laboratoire de Parasitologie-Mycologie, Centre Hospitalier Régional Universitaire de Besançon, Besançon, France; Service de Radiologie Viscérale, Centre Hospitalier Régional Universitaire de Besançon, Besançon, France
| | - Frédéric Grenouillet
- Laboratoire de Parasitologie-Mycologie, Centre Hospitalier Régional Universitaire de Besançon, Besançon, France; UMR 6249, Chronoenvironnement, Université de Franche-Comté, 25030 Besançon, France; Sérologie Infectieuse, Centre Hospitalier Régional Universitaire de Besançon, Besançon, France
| | - Dominique-Angèle Vuitton
- Centre National de Référence Echinococcoses, Centre Hospitalier Régional Universitaire de Besançon, Besançon, France
| | - Laurence Millon
- Laboratoire de Parasitologie-Mycologie, Centre Hospitalier Régional Universitaire de Besançon, Besançon, France; Centre National de Référence Echinococcoses, Centre Hospitalier Régional Universitaire de Besançon, Besançon, France; UMR 6249, Chronoenvironnement, Université de Franche-Comté, 25030 Besançon, France
| |
Collapse
|
11
|
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] [What about the content of this article? (0)] [Affiliation(s)] [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.
Collapse
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
| |
Collapse
|
12
|
Vuitton DA, Mantion G, Million L, Bresson-Hadni S. [Échinococcose alvéolaire]. Rev Prat 2020; 70:754-764. [PMID: 33739723] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/12/2023]
Abstract
Alveolar echinococcosi. Alveolar echinococcosis is a parasitic anthropo-zoonosis which looks like a slow-growing liver cancer. The lesions progressively obstruct hepatic vessels and bile ducts and invade neighboring organs, and it may metastasize to the lung and the brain and possibly all distant organs. Since the 1990s earlier diagnosis by imaging, advances in surgical and less invasive interventions, and prolonged anti-parasitic treatment using albendazole, have totally transformed the prognosis of the disease. However, in Europe, the endemic area has considerably increased, the number of alveolar echinococcosis cases has more than doubled in the previously identified endemic regions, and the disease may now be considered to be an 'opportunistic infection', especially diagnosed in those patients treated with immunosuppressive drugs and biologic agents. Alveolar echinococcosis is currently more and more often diagnosed incidentally, at an early stage of development, and not in the usual 'at risk' regions and populations. This makes differential diagnosis and care management more challenging.
Collapse
Affiliation(s)
| | | | | | - Solange Bresson-Hadni
- Centre national de référence pour les échinococcoses, CHU de Besançon, Besançon, France
| |
Collapse
|
13
|
Knapp J, Gottstein B, Bretagne S, Bart JM, Umhang G, Richou C, Bresson-Hadni S, Millon L. Genotyping Echinococcus multilocularis in Human Alveolar Echinococcosis Patients: An EmsB Microsatellite Analysis. Pathogens 2020; 9:pathogens9040282. [PMID: 32295095 PMCID: PMC7238142 DOI: 10.3390/pathogens9040282] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/09/2020] [Revised: 04/06/2020] [Accepted: 04/08/2020] [Indexed: 12/19/2022] Open
Abstract
For clinical epidemiology specialists, connecting the genetic diversity of Echinococcusmultilocularis to sources of infection or particular sites has become somewhat of a holy grail. It is very difficult to trace the infection history of alveolar echinococcosis (AE) patients as there may be an incubation period of five to 15 years before reliable diagnosis. Moreover, the variability of parasitic manifestations in human patients raises the possibility of genetically different isolates of E. multilocularis having different levels of pathogenicity. Thus, the exposure of human patients to different strains or genotypes circulating in geographically different environments may lead to different disease outcomes. Molecular tools, such as the microsatellite marker EmsB, were required to investigate these aspects. This genetic marker was previously tested on a collection of 1211 European field samples predominantly of animal origin, referenced on a publicly available database. In this study, we investigated a panel of 66 metacestode samples (between 1981 and 2019) recovered surgically from 63 patients diagnosed with alveolar echinococcosis originating from four European countries (France, Switzerland, Germany, Belgium). In this study, we identified nine EmsB profiles, five of which were found in patients located in the same areas of France and Switzerland. One profile was detected on both sides of the French-Swiss border, whereas most patients from non-endemic regions clustered together in another profile. EmsB profiles appeared to remain stable over time because similar profiles were detected in patients who underwent surgery recently and patients who underwent surgery some time ago. This study sheds light on possible pathways of contamination in humans, including proximity contamination in some cases, and the dominant contamination profiles in Europe, particularly for extrahepatic lesions.
Collapse
Affiliation(s)
- Jenny Knapp
- UMR CNRS 6249 Laboratoire Chrono-environnement, Université Franche-Comté, 16 Route de Gray, 25030 Besançon, France; (S.B.-H.); (L.M.)
- Department of Parasitology-Mycology, National Reference Centre for Echinococcoses, University Hospital of Besançon, 25030 Besançon, France
- Correspondence: ; Tel.: +33-370-632-106
| | - Bruno Gottstein
- Institute for Infectious Diseases, Faculty of Medicine, University of Berne, 3001 Berne, Switzerland;
| | - Stéphane Bretagne
- Parasitology-Mycology Laboratory, Lariboisière-Saint Louis-Fernand Widal Hospital, Assistance Publique-Hôpitaux de Paris (AP-HP), Université de Paris, 75475 Paris, France;
| | - Jean-Mathieu Bart
- UMR INTERTRYP, IRD/CIRAD, University of Montpellier, 34398 Montpellier, France;
| | - Gérald Umhang
- ANSES, Nancy Laboratory for Rabies and Wildlife, Wildlife Surveillance and Eco-Epidemiology Unit, Technopôle Agricole et Vétérinaire, B.P. 40009, 54220 Malzéville, France;
| | - Carine Richou
- Department of Hepatology, University Hospital of Besançon, 25000 Besançon, France;
| | - Solange Bresson-Hadni
- UMR CNRS 6249 Laboratoire Chrono-environnement, Université Franche-Comté, 16 Route de Gray, 25030 Besançon, France; (S.B.-H.); (L.M.)
- Department of Parasitology-Mycology, National Reference Centre for Echinococcoses, University Hospital of Besançon, 25030 Besançon, France
| | - Laurence Millon
- UMR CNRS 6249 Laboratoire Chrono-environnement, Université Franche-Comté, 16 Route de Gray, 25030 Besançon, France; (S.B.-H.); (L.M.)
- Department of Parasitology-Mycology, National Reference Centre for Echinococcoses, University Hospital of Besançon, 25030 Besançon, France
| |
Collapse
|
14
|
Beldi G, Vuitton D, Lachenmayer A, Heyd B, Dufour JF, Richou C, Candinas D, Bresson-Hadni S. Is ex vivo liver resection and autotransplantation a valid alternative treatment for end-stage hepatic alveolar echinococcosis in Europe? J Hepatol 2019; 70:1030-1031. [PMID: 30718093 DOI: 10.1016/j.jhep.2018.12.011] [Citation(s) in RCA: 17] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/04/2018] [Accepted: 12/12/2018] [Indexed: 12/15/2022]
Affiliation(s)
- Guido Beldi
- Department of Visceral Surgery and Medicine, Visceral Surgery, Inselspital University Hospital Bern and University Bern, Bern, Switzerland.
| | - Dominique Vuitton
- WHO-Collaborating Centre for Prevention and Treatment of Human Echinococcosis, University Bourgogne Franche-Comté, 25030 Besançon, France
| | - Anja Lachenmayer
- Department of Visceral Surgery and Medicine, Visceral Surgery, Inselspital University Hospital Bern and University Bern, Bern, Switzerland
| | - Bruno Heyd
- National Reference Centre for Echinococcosis and WHO-Collaborating Centre for Prevention and Treatment of Human Echinococcosis, Visceral Surgery Department, Besançon University Hospital and University Bourgogne Franche-Comté, 25030 Besançon, France
| | - Jean-François Dufour
- Department of Visceral Surgery and Medicine, Hepatology, Inselspital University Hospital Bern and University Bern, Bern, Switzerland
| | - Carine Richou
- National Reference Centre for Echinococcosis and WHO-Collaborating Centre for Prevention and Treatment of Human Echinococcosis, Hepatology Department, Besançon University Hospital and University Bourgogne Franche-Comté, 25030 Besançon, France
| | - Daniel Candinas
- Department of Visceral Surgery and Medicine, Visceral Surgery, Inselspital University Hospital Bern and University Bern, Bern, Switzerland
| | - Solange Bresson-Hadni
- National Reference Centre for Echinococcosis and WHO-Collaborating Centre for Prevention and Treatment of Human Echinococcosis, Parasitology-Mycology Laboratory and Visceral Surgery Department, Besançon University Hospital and University Bourgogne Franche-Comté, 25030 Besançon, France
| |
Collapse
|
15
|
Beaussant-Cohen S, Richou C, Lenoir M, Grenouillet F, Bresson-Hadni S, Delabrousse E. MR imaging features of peritoneal alveolar echinococcosis. Diagn Interv Imaging 2018; 99:511-512. [DOI: 10.1016/j.diii.2018.02.009] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/22/2018] [Revised: 02/19/2018] [Accepted: 02/27/2018] [Indexed: 10/17/2022]
|
16
|
Baraquin A, Hervouet E, Richou C, Flori P, Peixoto P, Azizi A, Delabrousse E, Blagosklonov O, Umhang G, Bresson-Hadni S, Valot B, Grenouillet F, Felix S, Heyd B, Mantion G, Di Martino V, Montange D, Vanlemmens C, Vuitton DA, Weil-Verhoeven D, Chavanet P, Dalle F, Gohier S, Minello A, Piroth L, Dumortier J, Mabrut JY, Wallon M, Frentiu E, Machouart M, Watelet J, Chemla C, Feron T, Heurge-Berlot A, Sommacale D, Thiefin G, Abou-Bacar A, Brunet J, Candolfi E, Hansmann Y, Lefebvre N. Circulating cell-free DNA in patients with alveolar echinococcosis. Mol Biochem Parasitol 2018; 222:14-20. [DOI: 10.1016/j.molbiopara.2018.04.004] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/28/2018] [Revised: 04/10/2018] [Accepted: 04/16/2018] [Indexed: 12/15/2022]
|
17
|
Valot B, Rognon B, Prenel A, Baraquin A, Knapp J, Anelli M, Richou C, Bresson-Hadni S, Grenouillet F, Wang J, Vuitton DA, Gottstein B, Millon L. Screening of antigenic vesicular fluid proteins of Echinococcus multilocularis as potential viability biomarkers to monitor drug response in alveolar echinococcosis patients. Proteomics Clin Appl 2017; 11. [PMID: 28697272 DOI: 10.1002/prca.201700010] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/27/2017] [Revised: 06/29/2017] [Accepted: 07/07/2017] [Indexed: 12/21/2022]
Abstract
PURPOSE The only drugs available to treat alveolar echinococcosis (AE) are mostly parasitostatic and in many cases prescribed for life. Decision criteria for discontinuation rely on the absence of parasitic viability. The aim of the present study is to search for candidate proteins that may exhibit good potential as biomarkers for viability. EXPERIMENTAL DESIGN Sixteen serum samples (five healthy controls, 11 patients with AE), are used. AE-patients are classified into three groups "Cured" (n = 2), "ABZ-responders" (n = 4) and "ABZ-nonresponders" (n = 5). Immunoreactive proteins from vesicular fluid (VF) are identified and quantified by LC-MS/MS analysis after immunoprecipitation (IP) using all 16 serum samples. RESULTS Shotgun analysis of VF lead to the identification of 107 E. multilocularis proteins. Comparative proteomics reveal nine proteins more abundant in IP eluates from ABZ-nonresponder patients (cathepsin b, prosaposin a preprotein, actin modulator protein, fucosidase alpha L1 tissue, gluthatione-S-tranferase, beta galactosidase, elongation factor 2, H17g protein tegumental antigen, and NiemannPick C2 protein). CONCLUSIONS AND CLINICAL RELEVANCE Detection of antibodies against these proteins by ELISA could be helpful to monitor the course of alveolar echinococcosis under albendazole (ABZ) treatment.
Collapse
Affiliation(s)
- Benoît Valot
- UMR/CNRS 6249 Chrono-Environnement, University of Franche-Comté, Besançon, France
| | - Bénédicte Rognon
- UMR/CNRS 6249 Chrono-Environnement, University of Franche-Comté, Besançon, France.,Parasitology-Mycology Department, University Hospital of Besançon, Besançon, France
| | - Anais Prenel
- UMR/CNRS 6249 Chrono-Environnement, University of Franche-Comté, Besançon, France
| | - Alice Baraquin
- UMR/CNRS 6249 Chrono-Environnement, University of Franche-Comté, Besançon, France
| | - Jenny Knapp
- UMR/CNRS 6249 Chrono-Environnement, University of Franche-Comté, Besançon, France.,Parasitology-Mycology Department, University Hospital of Besançon, Besançon, France
| | - Mathilde Anelli
- UMR/CNRS 6249 Chrono-Environnement, University of Franche-Comté, Besançon, France
| | - Carine Richou
- WHO Collaborating Centre for Prevention and Treatment of Echinococcosis, and French National Reference Centre for Alveolar Echinococcosis, University Hospital of Besançon, Besançon, France.,Hepatology Department, University Hospital of Besançon, Besançon, France
| | - Solange Bresson-Hadni
- Parasitology-Mycology Department, University Hospital of Besançon, Besançon, France.,WHO Collaborating Centre for Prevention and Treatment of Echinococcosis, and French National Reference Centre for Alveolar Echinococcosis, University Hospital of Besançon, Besançon, France
| | - Frederic Grenouillet
- UMR/CNRS 6249 Chrono-Environnement, University of Franche-Comté, Besançon, France.,Parasitology-Mycology Department, University Hospital of Besançon, Besançon, France
| | - Junhua Wang
- Vetsuisse Faculty, Institute of Parasitology, University of Berne, Berne, Switzerland
| | - Dominique Angèle Vuitton
- WHO Collaborating Centre for Prevention and Treatment of Echinococcosis, and French National Reference Centre for Alveolar Echinococcosis, University Hospital of Besançon, Besançon, France
| | - Bruno Gottstein
- Vetsuisse Faculty, Institute of Parasitology, University of Berne, Berne, Switzerland
| | - Laurence Millon
- UMR/CNRS 6249 Chrono-Environnement, University of Franche-Comté, Besançon, France.,Parasitology-Mycology Department, University Hospital of Besançon, Besançon, France
| |
Collapse
|
18
|
Ambregna S, Koch S, Sulz MC, Grüner B, Öztürk S, Chevaux JB, Sulima M, de Gottardi A, Napoléon B, Abergel A, Bichard P, Boytchev I, Deprez P, Dumortier J, Frossard JL, Kull E, Meny B, Moradpour D, Prat F, Vanbiervliet G, Thevenot T, Vuitton DA, Bresson-Hadni S, Vuitton L. A European survey of perendoscopic treatment of biliary complications in patients with alveolar echinococcosis. Expert Rev Anti Infect Ther 2016; 15:79-88. [PMID: 27788612 DOI: 10.1080/14787210.2017.1252260] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
Abstract
BACKGROUND Biliary complications represent a turning point in the course of Alveolar Echinococcosis (AE). We conducted a European survey to collect data on the current usage and results of perendoscopic interventions (PEIs) for their treatment. METHODS Patient's characteristics and follow-up until January 31st, 2015 were recorded using an online questionnaire. RESULTS From 18 centers 129 PEIs were analyzed in 38 patients; 139 plastic stents were inserted during 85 PEIs; median time between stent placements was significantly longer when 3 stents or more were placed. Initial symptoms disappeared in 95% and long-term bile duct patency was obtained in 73% of cases. Cholangitis was a more frequent complication of the PEIs (10%) than in other indications; intensive lavage of the bile ducts may prevent this complication. CONCLUSION European centers use perendoscopic biliary drainage as an efficient and safe alternative to surgery to treat AE biliary complications. Insertion of multiple plastic stents delays stent occlusion and leads to effective and prolonged bile duct patency.
Collapse
Affiliation(s)
- Sylvain Ambregna
- a WHO Collaborating Centre for the Prevention and Treatment of Human Echinococcosis; Centre National de Référence pour l'Echinococcose alvéolaire; & Department of Gastroenterology, Digestive Endoscopy and Nutrition , University of Franche-Comté and University Hospital , Besançon , France
| | - Stéphane Koch
- a WHO Collaborating Centre for the Prevention and Treatment of Human Echinococcosis; Centre National de Référence pour l'Echinococcose alvéolaire; & Department of Gastroenterology, Digestive Endoscopy and Nutrition , University of Franche-Comté and University Hospital , Besançon , France
| | - Michael C Sulz
- b Division of Gastroenterology and Hepatology , Kantonsspital , St. Gall , Switzerland
| | | | | | | | - Małgorzata Sulima
- e Institute of Maritime and Tropical Medicine in Gdynia , Medical University of Gdynia , Poland
| | | | - Bertrand Napoléon
- g Gastroenterology department, Mermoz Private Hospital , Générale de Santé , Lyon , France
| | - Armand Abergel
- h Gastroenterology and Hepatology department , University Hospital , Clermont-Ferrand , France
| | - Philippe Bichard
- i Gastroenterology and Hepatology department , University Hospital , Grenoble , France
| | - Isabelle Boytchev
- j Gastroenterology department , Kremlin-Bicêtre University Hospital , Paris , France
| | - Pierre Deprez
- k Gastroenterology department , Saint-Luc University Hospital , Brussels , Belgium
| | - Jerome Dumortier
- l Department of digestive diseases , Edouard Herriot University Hospital , Lyon , France
| | - Jean-Louis Frossard
- m Hepato-Pancreato-Biliary Centre , University Hospital , Geneva , Switzerland
| | - Eric Kull
- n Gastroenterology and Hepatology department , Regional Hospital , Metz , France
| | - Bernard Meny
- o Gastroenterology unit , Clinique Drevon , Dijon , France
| | - Darius Moradpour
- p Gastroenterology and Hepatology department , University Hospital , Lausanne , Switzerland
| | - Fréderic Prat
- q Gastroenterology department , Cochin University Hospital , Paris , France
| | | | - Thierry Thevenot
- a WHO Collaborating Centre for the Prevention and Treatment of Human Echinococcosis; Centre National de Référence pour l'Echinococcose alvéolaire; & Department of Gastroenterology, Digestive Endoscopy and Nutrition , University of Franche-Comté and University Hospital , Besançon , France
| | - Dominique Angèle Vuitton
- a WHO Collaborating Centre for the Prevention and Treatment of Human Echinococcosis; Centre National de Référence pour l'Echinococcose alvéolaire; & Department of Gastroenterology, Digestive Endoscopy and Nutrition , University of Franche-Comté and University Hospital , Besançon , France
| | - Solange Bresson-Hadni
- a WHO Collaborating Centre for the Prevention and Treatment of Human Echinococcosis; Centre National de Référence pour l'Echinococcose alvéolaire; & Department of Gastroenterology, Digestive Endoscopy and Nutrition , University of Franche-Comté and University Hospital , Besançon , France
| | - Lucine Vuitton
- a WHO Collaborating Centre for the Prevention and Treatment of Human Echinococcosis; Centre National de Référence pour l'Echinococcose alvéolaire; & Department of Gastroenterology, Digestive Endoscopy and Nutrition , University of Franche-Comté and University Hospital , Besançon , France
| |
Collapse
|
19
|
Vuitton DA, Azizi A, Richou C, Vuitton L, Blagosklonov O, Delabrousse E, Mantion GA, Bresson-Hadni S. Current interventional strategy for the treatment of hepatic alveolar echinococcosis. Expert Rev Anti Infect Ther 2016; 14:1179-1194. [DOI: 10.1080/14787210.2016.1240030] [Citation(s) in RCA: 37] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/28/2022]
|
20
|
Faucher J, Descotes-Genon C, Hoen B, Godard J, Kantelip B, Grenouillet F, Brientini M, Richou C, Bresson-Hadni S, Chirouze C. IPF-02 - Premier cas de guérison d’une échinococcose alvéolaire vertébrale. Med Mal Infect 2016. [DOI: 10.1016/s0399-077x(16)30421-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
|
21
|
Bourgeois B, Marguet P, Gbaguidi-Haore H, Knapp J, Said-Ali Z, Demonmerot F, Bresson-Hadni S, Millon L, Bellanger AP. Alveolar echinococcosis: how knowledgeable are primary care physicians and pharmacists in the Franche-Comté region of France? Acta Parasitol 2015; 60:682-90. [PMID: 26408591 DOI: 10.1515/ap-2015-0097] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/09/2015] [Accepted: 05/25/2015] [Indexed: 11/15/2022]
Abstract
BACKGROUND Alveolar echinococcosis (AE) is a parasitic disease resulting from the intrahepatic growth of Echinococcus multilocularis larva. This zoonotic helminthic disease is rare but, if left untreated or treated too late, can be severe or even fatal. In France, endemic areas containing infected foxes have become larger, spreading towards western regions of the country and leading to an increased risk of environmental contamination. An observational survey was undertaken in 2014 to assess the level of knowledge of AE among primary care physicians (PCPs) and pharmacists in the Franche-Comté region. METHODS Standardized questionnaires were sent to a random sample of 183 PCPs and 236 pharmacists practicing in the Franche-Comté region (eastern France), requesting their voluntary and anonymous participation. The questionnaires collected socio-demographic details, self-evaluation and asked multiple choice questions (MCQs) about epidemiology, prevention, diagnosis and management of AE. RESULTS The crude response rate was 37.5% of the PCPs and pharmacists questioned. Responses to MCQs showed that most of the participating PCPs and pharmacists had acceptable basic knowledge of AE, especially concerning epidemiology and prevention of the disease. However, a serious lack of knowledge was observed concerning the management of AE. CONCLUSION PCPs are often the first health professionals to suspect latent AE, which is still a rural disease in France. Both PCPs and pharmacists play an important role in informing and referring patients potentially exposed to AE. This study shows that although AE is rare, PCPs and pharmacists of the Franche-Comté region have a satisfactory level of knowledge of AE.
Collapse
|
22
|
Vuitton D, Demonmerot F, Knapp J, Richou C, Grenouillet F, Chauchet A, Vuitton L, Bresson-Hadni S, Millon L. Clinical epidemiology of human AE in Europe. Vet Parasitol 2015; 213:110-20. [DOI: 10.1016/j.vetpar.2015.07.036] [Citation(s) in RCA: 48] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
|
23
|
Piarroux M, Gaudart J, Bresson-Hadni S, Bardonnet K, Faucher B, Grenouillet F, Knapp J, Dumortier J, Watelet J, Gerard A, Beytout J, Abergel A, Wallon M, Vuitton DA, Piarroux R, the FrancEchino network C. Landscape and climatic characteristics associated with human alveolar echinococcosis in France, 1982 to 2007. Euro Surveill 2015; 20. [DOI: 10.2807/1560-7917.es2015.20.18.21118] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
Binary file ES_Abstracts_Final_ECDC.txt matches
Collapse
Affiliation(s)
- M Piarroux
- Aix-Marseille University, INSERM-IRD-AMU UMR 912, Marseille, France
| | - J Gaudart
- Aix-Marseille University, INSERM-IRD-AMU UMR 912, Marseille, France
| | - S Bresson-Hadni
- Franche-Comté University, CNRS UMR 6249, Besançon, France
- WHO Collaborating Centre for Prevention and Treatment of Human Echinococcosis, University Hospital Jean Minjoz, Department of digestive surgery, Besançon, France
| | - K Bardonnet
- WHO Collaborating Centre for Prevention and Treatment of Human Echinococcosis, University Hospital Jean Minjoz, Department of digestive surgery, Besançon, France
- University Hospital Jean Minjoz, Department of biochemistry, Besançon, France
| | - B Faucher
- Aix-Marseille University, UMR MD 3, Marseille, France
| | - F Grenouillet
- Centre National de Référence Echinococcose alvéolaire, Department of parasitology, CHRU Jean Minjoz Besançon, France
| | - J Knapp
- Centre National de Référence Echinococcose alvéolaire, Department of parasitology, CHRU Jean Minjoz Besançon, France
- WHO Collaborating Centre for Prevention and Treatment of Human Echinococcosis, University Hospital Jean Minjoz, Department of digestive surgery, Besançon, France
| | - J Dumortier
- University Hospital Edouard Herriot, Department of hepatogastroenterology, Hospices civils de Lyon, Lyon, France
| | - J Watelet
- University Hospital Brabois, Department of hepatogastroenterology, Nancy, France
| | - A Gerard
- University Hospital Brabois, Department of intensive care, Nancy, France
| | - J Beytout
- University Hospital G Montpied, Department of tropical medicine and infectious diseases, Clermont-Ferrand, France
| | - A Abergel
- University Hospital Estaing, Department of hepatogastroenterology, Clermont-Ferrand, France
| | - M Wallon
- University Hospital de la Croix Rousse, Institute of parasitology and medical mycology, Hospices civils de Lyon, Lyon, France
| | - D A Vuitton
- WHO Collaborating Centre for Prevention and Treatment of Human Echinococcosis, University Hospital Jean Minjoz, Department of digestive surgery, Besançon, France
- Franche-Comté University, CNRS UMR 6249, Besançon, France
| | - R Piarroux
- Aix-Marseille University, UMR MD 3, Marseille, France
| | | |
Collapse
|
24
|
Charbonnier A, Knapp J, Demonmerot F, Bresson-Hadni S, Raoul F, Grenouillet F, Millon L, Vuitton DA, Damy S. A new data management system for the French National Registry of human alveolar echinococcosis cases. ACTA ACUST UNITED AC 2014; 21:69. [PMID: 25526544 PMCID: PMC4271653 DOI: 10.1051/parasite/2014075] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/29/2014] [Accepted: 12/12/2014] [Indexed: 01/18/2023]
Abstract
Alveolar echinococcosis (AE) is an endemic zoonosis in France due to the cestode Echinococcus multilocularis. The French National Reference Centre for Alveolar Echinococcosis (CNR-EA), connected to the FrancEchino network, is responsible for recording all AE cases diagnosed in France. Administrative, epidemiological and medical information on the French AE cases may currently be considered exhaustive only on the diagnosis time. To constitute a reference data set, an information system (IS) was developed thanks to a relational database management system (MySQL language). The current data set will evolve towards a dynamic surveillance system, including follow-up data (e.g. imaging, serology) and will be connected to environmental and parasitological data relative to E. multilocularis to better understand the pathogen transmission pathway. A particularly important goal is the possible interoperability of the IS with similar European and other databases abroad; this new IS could play a supporting role in the creation of new AE registries.
Collapse
Affiliation(s)
- Amandine Charbonnier
- Laboratoire Chrono-Environnement, UMR/CNRS 6249 University of Franche-Comté, 25000 Besançon, France - OSU THETA Franche-Comté Bourgogne, 25000 Besançon, France
| | - Jenny Knapp
- Laboratoire Chrono-Environnement, UMR/CNRS 6249 University of Franche-Comté, 25000 Besançon, France - National Reference Centre of Alveolar Echinococcosis - FrancEchino Network - WHO Collaborating Centre for Prevention and Treatment of Human Alveolar Echinococcosis, University Hospital Centre of Besançon, 25000 Besançon, France
| | - Florent Demonmerot
- Laboratoire Chrono-Environnement, UMR/CNRS 6249 University of Franche-Comté, 25000 Besançon, France - National Reference Centre of Alveolar Echinococcosis - FrancEchino Network - WHO Collaborating Centre for Prevention and Treatment of Human Alveolar Echinococcosis, University Hospital Centre of Besançon, 25000 Besançon, France
| | - Solange Bresson-Hadni
- Laboratoire Chrono-Environnement, UMR/CNRS 6249 University of Franche-Comté, 25000 Besançon, France - National Reference Centre of Alveolar Echinococcosis - FrancEchino Network - WHO Collaborating Centre for Prevention and Treatment of Human Alveolar Echinococcosis, University Hospital Centre of Besançon, 25000 Besançon, France
| | - Francis Raoul
- Laboratoire Chrono-Environnement, UMR/CNRS 6249 University of Franche-Comté, 25000 Besançon, France - National Reference Centre of Alveolar Echinococcosis - FrancEchino Network - WHO Collaborating Centre for Prevention and Treatment of Human Alveolar Echinococcosis, University Hospital Centre of Besançon, 25000 Besançon, France
| | - Frédéric Grenouillet
- Laboratoire Chrono-Environnement, UMR/CNRS 6249 University of Franche-Comté, 25000 Besançon, France - National Reference Centre of Alveolar Echinococcosis - FrancEchino Network - WHO Collaborating Centre for Prevention and Treatment of Human Alveolar Echinococcosis, University Hospital Centre of Besançon, 25000 Besançon, France
| | - Laurence Millon
- Laboratoire Chrono-Environnement, UMR/CNRS 6249 University of Franche-Comté, 25000 Besançon, France - National Reference Centre of Alveolar Echinococcosis - FrancEchino Network - WHO Collaborating Centre for Prevention and Treatment of Human Alveolar Echinococcosis, University Hospital Centre of Besançon, 25000 Besançon, France
| | - Dominique Angèle Vuitton
- Laboratoire Chrono-Environnement, UMR/CNRS 6249 University of Franche-Comté, 25000 Besançon, France - National Reference Centre of Alveolar Echinococcosis - FrancEchino Network - WHO Collaborating Centre for Prevention and Treatment of Human Alveolar Echinococcosis, University Hospital Centre of Besançon, 25000 Besançon, France
| | - Sylvie Damy
- Laboratoire Chrono-Environnement, UMR/CNRS 6249 University of Franche-Comté, 25000 Besançon, France
| |
Collapse
|
25
|
Knapp J, Sako Y, Grenouillet F, Bresson-Hadni S, Richou C, Gbaguidi-Haore H, Ito A, Millon L. Comparison of the serological tests ICT and ELISA for the diagnosis of alveolar echinococcosis in France. ACTA ACUST UNITED AC 2014; 21:34. [PMID: 25058754 PMCID: PMC4111071 DOI: 10.1051/parasite/2014037] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/18/2013] [Accepted: 07/04/2014] [Indexed: 01/31/2023]
Abstract
Serological diagnosis of alveolar echinococcosis (AE) is a key element for efficient patient treatment management. A rapid immunochromatography test kit (ICT) using the recombinant Em18 antigen (rEm18) was recently developed. The aim of our study was to assess this test on a panel of sera from French patients with alveolar echinococcosis and control patients. In a blind test, a total of 112 serum samples were tested including samples of AE (n = 30), cystic echinococcosis [CE] (n = 15), and polycystic echinococcosis [PE] (n = 1). For the comparison, 66 sera from patients with hepatocarcinoma, fascioliasis, toxocariasis, Caroli’s disease, or autoimmune chronic active hepatitis were used. The diagnostic test sets we used were the rEm18-ICT and two validated ELISAs with rEm18 and Em2-Em18 antigens, respectively. For the ICT, 27/30 sera from AE patients, 4/15 sera from CE patients and the PE patient serum were positive. One serum from the control panel (toxocariasis) was positive for the ICT. The rEm18-ICT sensitivity (90.0%) and specificity (92.7%) for detection of Em18-specific antibodies confirmed it as a relevant tool for AE diagnosis. The rEm18-ELISA had a sensitivity of 86.7% and specificity of 91.5%, and the Em2-Em18-ELISA had a sensitivity of 96.7% and specificity of 87.8%. However, when AE patient sera are recorded as weak in intensity with the ICT, we recommend a double reading and use of a reference sample if the ICT is used for patient follow-up.
Collapse
Affiliation(s)
- Jenny Knapp
- Laboratory of Chrono-environnement, UMR/CNRS 6249, Faculty of Medicine and Pharmacy, Besançon, France - WHO Collaborating Centre for prevention and treatment of human echinococcosis, Besançon, France
| | - Yasuhito Sako
- Department of Parasitology, Asahikawa Medical University, Asahikawa, Hokkaido, Japan
| | - Frédéric Grenouillet
- Laboratory of Chrono-environnement, UMR/CNRS 6249, Faculty of Medicine and Pharmacy, Besançon, France - WHO Collaborating Centre for prevention and treatment of human echinococcosis, Besançon, France - Laboratory of Parasitology-Mycology, University Hospital of Besançon, France
| | - Solange Bresson-Hadni
- WHO Collaborating Centre for prevention and treatment of human echinococcosis, Besançon, France - Department of Hepatology, University Hospital of Besançon, France
| | - Carine Richou
- WHO Collaborating Centre for prevention and treatment of human echinococcosis, Besançon, France - Department of Hepatology, University Hospital of Besançon, France
| | - Houssein Gbaguidi-Haore
- Laboratory of Chrono-environnement, UMR/CNRS 6249, Faculty of Medicine and Pharmacy, Besançon, France - Laboratory of Hospital Hygiene, University Hospital of Besançon, France
| | - Akira Ito
- Department of Parasitology, Asahikawa Medical University, Asahikawa, Hokkaido, Japan
| | - Laurence Millon
- Laboratory of Chrono-environnement, UMR/CNRS 6249, Faculty of Medicine and Pharmacy, Besançon, France - WHO Collaborating Centre for prevention and treatment of human echinococcosis, Besançon, France - Laboratory of Parasitology-Mycology, University Hospital of Besançon, France
| |
Collapse
|
26
|
Chauchet A, Grenouillet F, Knapp J, Richou C, Delabrousse E, Dentan C, Millon L, Di Martino V, Contreras R, Deconinck E, Blagosklonov O, Vuitton DA, Bresson-Hadni S, Virginie V, Karine B, Brigitte B, Isabelle BC, Oleg B, Solange BH, Pascale BM, Sylvie C, Remy C, Eric D, Vincent DM, Philippe E, Sophie F, Patrick G, Frédéric G, Bruno H, Séverine VD, Jenny K, Stéphane K, Georges M, Laurence M, Francis R, Carine R, Claire V, Angèle VD, Lucine V, Patricia P, Claire G, Armand A, Jean B, Monique C, François BJ, Bernadette C, Patrick H, Anne M, Odile F, Christian L, Jérôme D, Olivier G, Christian P, Meja R, Martine W, Martine P, Eric C, Marc J, Jean-Jacques R, Daniel S, Alain G, Lorraine L, Marie M, Jérôme W, Olivier F, Didier S, Cathy C, Francois DJ, Bruno G, Monique D, Ahmed AB, Maxime A, Yves H, Nicolas L, Véronique L, Blandine AL. Increased Incidence and Characteristics of Alveolar Echinococcosis in Patients With Immunosuppression-Associated Conditions. Clin Infect Dis 2014; 59:1095-104. [DOI: 10.1093/cid/ciu520] [Citation(s) in RCA: 85] [Impact Index Per Article: 8.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/11/2023] Open
|
27
|
|
28
|
Piarroux M, Piarroux R, Knapp J, Bardonnet K, Dumortier J, Watelet J, Gerard A, Beytout J, Abergel A, Bresson-Hadni S, Gaudart J. Populations at risk for alveolar echinococcosis, France. Emerg Infect Dis 2013; 19:721-8. [PMID: 23647623 PMCID: PMC3647496 DOI: 10.3201/eid1905.120867] [Citation(s) in RCA: 55] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/17/2023] Open
Abstract
During 1982–2007, alveolar echinococcosis (AE) was diagnosed in 407 patients in France, a country previously known to register half of all European patients. To better define high-risk groups in France, we conducted a national registry-based study to identify areas where persons were at risk and spatial clusters of cases. We interviewed 180 AE patients about their way of life and compared responses to those of 517 controls. We found that almost all AE patients lived in 22 départements in eastern and central France (relative risk 78.63, 95% CI 52.84–117.02). Classification and regression tree analysis showed that the main risk factor was living in AE-endemic areas. There, most at-risk populations lived in rural settings (odds ratio [OR] 66.67, 95% CI 6.21–464.51 for farmers and OR 6.98, 95% CI 2.88–18.25 for other persons) or gardened in nonrural settings (OR 4.30, 95% CI 1.82–10.91). These findings can help sensitization campaigns focus on specific groups.
Collapse
|
29
|
Bertrand C, Marcandetti M, Vuitton D, Millon L, Grenouillet F, Bresson-Hadni S, Leconte des Floris M, Morel P. Échinococcose alvéolaire : évaluation du risque de contamination post-transfusionnelle. Transfus Clin Biol 2013. [DOI: 10.1016/j.tracli.2013.03.063] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
|
30
|
Caoduro C, Porot C, Vuitton DA, Bresson-Hadni S, Grenouillet F, Richou C, Boulahdour H, Blagosklonov O. The Role of Delayed 18F-FDG PET Imaging in the Follow-up of Patients with Alveolar Echinococcosis. J Nucl Med 2013; 54:358-63. [DOI: 10.2967/jnumed.112.109942] [Citation(s) in RCA: 66] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022] Open
|
31
|
Bardonnet K, Vuitton DA, Grenouillet F, Mantion GA, Delabrousse E, Blagosklonov O, Miguet JP, Bresson-Hadni S. 30-yr course and favorable outcome of alveolar echinococcosis despite multiple metastatic organ involvement in a non-immune suppressed patient. Ann Clin Microbiol Antimicrob 2013; 12:1. [PMID: 23281596 PMCID: PMC3564901 DOI: 10.1186/1476-0711-12-1] [Citation(s) in RCA: 27] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/31/2012] [Accepted: 12/21/2012] [Indexed: 01/08/2023] Open
Abstract
We report the 30-yr history of a well-documented human case of alveolar echinococcosis, with a lung lesion at presentation followed by the discovery of a liver lesion, both removed by surgery. Subsequently, within the 13 years following diagnosis, metastases were disclosed in eye, brain and skull, as well as additional lung lesions. This patient had no immune suppression, and did not have the genetic background known to predispose to severe alveolar echinococcosis; it may thus be hypothesized that iterative multi-organ involvement was mostly due to the poor adherence to benzimidazole treatment for the first decade after diagnosis. Conversely, after a new alveolar echinococcosis recurrence was found in the right lung in 1994, the patient accepted to take albendazole continuously at the right dosage. After serology became negative and a fluoro-deoxy-glucose-Positron Emission Tomography performed in 2005 showed a total regression of the lesions in all organs, albendazole treatment could be definitively withdrawn. In 2011, the fluoro-deoxy-glucose-Positron Emission Tomography showed a total absence of parasitic metabolic activity and the patient had no clinical symptoms related to alveolar echinococcosis. The history of this patient suggests that multi-organ involvement and alveolar echinococcosis recurrence over time may occur in non-immune suppressed patients despite an apparently “radical” surgery. Metastatic dissemination might be favored by a poor adherence to chemotherapy. Combined surgery and continuous administration of albendazole at high dosage may allow alveolar echinococcosis patients to survive more than 30 years after diagnosis despite multi-organ involvement.
Collapse
Affiliation(s)
- Karine Bardonnet
- WHO Collaborating Centre for Prevention and Treatment of Human Echinococcosis, University Hospital, University of Franche-Comté, Besançon 25030, France.
| | | | | | | | | | | | | | | |
Collapse
|
32
|
Piarroux M, Piarroux R, Giorgi R, Knapp J, Bardonnet K, Sudre B, Watelet J, Dumortier J, Gérard A, Beytout J, Abergel A, Mantion G, Vuitton DA, Bresson-Hadni S. Clinical features and evolution of alveolar echinococcosis in France from 1982 to 2007: results of a survey in 387 patients. J Hepatol 2011; 55:1025-33. [PMID: 21354448 DOI: 10.1016/j.jhep.2011.02.018] [Citation(s) in RCA: 99] [Impact Index Per Article: 7.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/11/2010] [Revised: 02/04/2011] [Accepted: 02/10/2011] [Indexed: 01/02/2023]
Abstract
BACKGROUND & AIMS Alveolar echinococcosis (AE) is a rare disease in humans, caused by the larval stage of the fox tapeworm Echinococcus multilocularis. METHODS We present here 387 detailed AE cases diagnosed in France from 1982 to 2007 actively identified by a retrospective survey performed in 1997-1998 and prospectively thereafter. RESULTS Male:female ratio was 1.03 and mean age 57.8 years at time of diagnosis. Among the 362 complete files (including 347 non dead-out and 15 dead-out lesions), 73% of the patients were symptomatic at first admittance. Among them, 83% presented with clinical patterns evocative either of a digestive or a hepatic disorder. Other symptomatic patients presented with erratic clinical pictures, generally due to metastasis or extra-hepatic location of the parasite. Except for a few patients with particularly severe AE who died shortly after the diagnosis, most patients were treated using benzimidazoles. Their mortality tends to merge with that of the general French population, matched by sex, age, and calendar year. This study also highlights an unexpectedly high frequency of blood-tied family cases (13% of patients submitted to a specific questionnaire). CONCLUSIONS Even though the broad set of clinical features provoked by E. multilocularis makes AE a potential diagnostic trap for many physicians, our study revealed an improvement of its prognosis. However, as shown by our findings about the frequency of family cases, there is still a need for studies aimed at better describing this uncommon parasitic disease.
Collapse
Affiliation(s)
- Martine Piarroux
- TheMA, UMR CNRS 6049, Université de Franche-Comté, 25030 Besançon, France
| | | | | | | | | | | | | | | | | | | | | | | | | | | |
Collapse
|
33
|
Vuitton DA, Wang Q, Zhou HX, Raoul F, Knapp J, Bresson-Hadni S, Wen H, Giraudoux P. A historical view of alveolar echinococcosis, 160 years after the discovery of the first case in humans: part 1. What have we learnt on the distribution of the disease and on its parasitic agent? Chin Med J (Engl) 2011; 124:2943-2953. [PMID: 22040507] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/31/2023] Open
Abstract
Since the first 2 cases observed in southern Germany and the correct identification of a parasite at the origin of the disease by the famous scientist Rudolf Virchow in 1855, the borders of the endemic area of alveolar echinococcosis (AE) have never stopped to expand. The parasite was successively recognized in Switzerland, then in Russia, Austria and France which were long considered as the only endemic areas for the disease. Cases were disclosed in Turkey in 1939; then much attention was paid to Alaska and to Hokkaido, in Japan. The situation totally changed in 1991 after the recognition of the Chinese endemic areas by the international community of scientists. The world map was completed in the beginning of the 21st century by the identification of AE in most of the countries of central/eastern Europe and Baltic States, and by the recognition of cases in central Asia. Up to now, the disease has however never been reported in the South hemisphere and in the United Kingdom. In the mid-1950s, demonstration by Rausch and Schiller in Alaska, and by Vogel in Germany, of the distinction between 2 parasite species responsible respectively for cystic echinococcosis (“hydatid disease”) and AE put an end to the long-lasting debate between the "dualists", who believed in that theory which eventually proved to be true, and the "unicists", who believed in a single species responsible for both diseases. At the end of the 20th century, molecular biology fully confirmed the "dualist" theory while adding several new species to the initially described E. granulosus; within the past decade, it also confirmed that little variation existed within Echinococcus (E.) multilocularis species, and that AE-looking infection in some intermediate animal hosts on the Tibetan plateau was indeed due to a new species, distinct from E. multilocularis, named E. shiquicus. Since the 1970s, the unique ecological interactions between the landscape, the hosts, and E. multilocularis have progressively been delineated. The important role of the rodent/lagomorph reservoir size for the maintenance of the parasite cycle has been recognized within the last 2 decades of the 20th century. And the discovery of a close relationship between high densities of small mammals and particularities in land use by agriculture/forestry has stressed the responsibility of political/economic decisions on the contamination pressure. Urbanization of foxes in Europe and Japan and the major role of dogs in China represent the new deals at the beginning of the 21st century regarding definitive hosts and prevention measures.
Collapse
Affiliation(s)
- Dominique Angèle Vuitton
- WHO Collaborating Center for Prevention and Treatment of Human Echinococcosis, University Hospital and University of Franche-Comté, 25030 Besançon, France.
| | | | | | | | | | | | | | | |
Collapse
|
34
|
Bresson-Hadni S, Blagosklonov O, Knapp J, Grenouillet F, Sako Y, Delabrousse E, Brientini MP, Richou C, Minello A, Antonino AT, Gillet M, Ito A, Mantion GA, Vuitton DA. Should possible recurrence of disease contraindicate liver transplantation in patients with end-stage alveolar echinococcosis? A 20-year follow-up study. Liver Transpl 2011; 17:855-65. [PMID: 21455928 DOI: 10.1002/lt.22299] [Citation(s) in RCA: 74] [Impact Index Per Article: 5.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/24/2022]
Abstract
Liver transplantation (LT) is currently contraindicated in patients with residual or metastatic alveolar echinococcosis (AE) lesions. We evaluated the long-term course of such patients who underwent LT and were subsequently treated with benzimidazoles. Clinical, imaging, serological, and therapeutic data were collected from 5 patients with residual/recurrent AE lesions who survived for more than 15 years. Since 2004, [(18) F]-2-fluoro-2-deoxyglucose (FDG)-positron emission tomography (PET) images were available, and the levels of serum antibodies (Abs) against Echinococcus multilocularis-recombinant antigens were evaluated. Median survival time after LT was 21 years. These patients were from a prospective cohort of 23 patients with AE who underwent LT: 5 of 8 patients with residual/recurrent AE and 4 of 9 patients without residual/recurrent AE were alive in September 2009. High doses of immunosuppressive drugs, the late introduction of therapy with benzimidazoles, its withdrawal due to side effects, and nonadherence to this therapy adversely affected the prognosis. Anti-Em2(plus) and anti-rEm18 Ab levels and standard FDG-PET enabled the efficacy of therapy on the growth of EA lesions to be assessed. However, meaningful variations in Ab levels were observed below diagnostic cutoff values; and in monitoring AE lesions, images of FDG uptake taken 3 hours after its injection were more sensitive than images obtained 1 hour after its injection. In conclusion, benzimidazoles can control residual/recurrent AE lesions after LT. Using anti-rEm18 or anti-Em2(plus) Ab levels and the delayed acquisition of FDG-PET images can improve the functional assessment of disease activity. The potential recurrence of disease, especially in patients with residual or metastatic AE lesions, should not be regarded as a contraindication to LT when AE is considered to be lethal in the short term.
Collapse
Affiliation(s)
- Solange Bresson-Hadni
- World Health Organization Collaborating Centre for Prevention and Treatment of Human Echinococcosis, University Hospital and University of Franche-Comté, Besançon, France
| | | | | | | | | | | | | | | | | | | | | | | | | | | |
Collapse
|
35
|
Vuitton DA, Bresson-Hadni S, Giraudoux P, Bartholomot B, Laplante JJ, Delabrousse E, Blagosklonov O, Mantion G. Échinococcose alvéolaire : d’une maladie rurale incurable à une infection urbaine sous contrôle ? Presse Med 2010; 39:216-30. [DOI: 10.1016/j.lpm.2008.10.028] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/17/2008] [Revised: 10/13/2008] [Accepted: 10/23/2008] [Indexed: 11/25/2022] Open
|
36
|
Crouzet J, Grenouillet F, Delabrousse E, Blagosklonov O, Thevenot T, Di Martino V, Piarroux R, Mantion GA, Bresson-Hadni S. Personalized management of patients with inoperable alveolar echinococcosis undergoing treatment with albendazole: usefulness of positron-emission-tomography combined with serological and computed tomography follow-up. Clin Microbiol Infect 2009; 16:788-91. [PMID: 19912267 DOI: 10.1111/j.1469-0691.2009.02924.x] [Citation(s) in RCA: 37] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/15/2022]
Abstract
The present study aimed to identify a sub-group of inoperable alveolar echinococcosis (AE) patients undergoing long-term treatment with benzimidazole (BZM) who presented with an evolution suggestive of a parasitocidal effect. An evolution compatible with parasite death was observed in five patients.
Collapse
Affiliation(s)
- J Crouzet
- WHO Collaborating Center for Prevention and Treatment of Human Echinococcosis, University Hospital, Besançon, France
| | | | | | | | | | | | | | | | | |
Collapse
|
37
|
De Gottardi A, Thévenot T, Spahr L, Morard I, Bresson-Hadni S, Torres F, Giostra E, Hadengue A. Risk of complications after abdominal paracentesis in cirrhotic patients: a prospective study. Clin Gastroenterol Hepatol 2009; 7:906-9. [PMID: 19447197 DOI: 10.1016/j.cgh.2009.05.004] [Citation(s) in RCA: 154] [Impact Index Per Article: 10.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/19/2009] [Revised: 04/27/2009] [Accepted: 05/04/2009] [Indexed: 02/07/2023]
Abstract
BACKGROUND & AIMS Complications and technical problems of paracentesis in cirrhotic patients are infrequent. However, the severity and the incidence of these events and their risk factors have not been assessed prospectively. METHODS Cirrhotic patients (n = 171) undergoing paracentesis were included. Of the 515 paracenteses, 8.8% were diagnostic, and 91.2% were therapeutic. Technical features, demographic data, and adverse events during a period of 72 hours after the procedure were examined. RESULTS Major complications occurred in 1.6% of procedures and included 5 bleedings and 3 infections, resulting in death in 2 cases. Major complications were associated with therapeutic but not diagnostic procedures and tended to be more prevalent in patients with low platelet count (<50 10(9)/L), Child-Pugh stage C, and in alcoholic cirrhosis patients. Technical problems occurred in 5.6%. The most frequent complication was a leak of ascites at the puncture site (5.0%), and in 89.5% there were no complications. CONCLUSIONS The safety of paracentesis in cirrhotic patients might be decreased if risk factors, which depend on the characteristics of the patient and of the procedure itself, are present.
Collapse
Affiliation(s)
- Andrea De Gottardi
- Division of Gastroenterology and Hepatology, University Hospital of Geneva, Geneva, Switzerland.
| | | | | | | | | | | | | | | |
Collapse
|
38
|
Bresson-Hadni S, Delabrousse E, Grenouillet F, Mantion G, Vuitton DA. [Alveolar echinococcosis: how to confirm the diagnosis?]. Bull Acad Natl Med 2008; 192:1141-1150. [PMID: 19235478] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 05/27/2023]
Abstract
Ultrasonography is the first-step exam for the diagnosis of alveolar echinococcosis. Liver involvement commonly appears as an ill-defined infiltration of the liver parenchyma. Lesions are heterogeneous and in most cases hyperechoic, related to fibro-parasitic tissue associated to scattered calcifications. Hypoechoic foci can also be observed, related to necrosis. In 25 % of the cases, ultrasonography discovers atypical aspects that must be known by radiologists working in endemic region for alveolar echinococcosis. Specific serological tests, particularly ELISA and western blot, usually confirm the diagnosis. Therefore, per-cutaneous punction is exceptionally needed to assess the diagnosis. Other imaging techniques are very useful to complete the diagnosis step and to specify vascular and biliary extension, a crucial information for the therapeutic choice. Computed tomography may show small additional parasitic foci, non visualized by ultrasonography. It allows an accurate examination of the lesions particularly in case of very calcified images that could have made ultrasonographic analysis more difficult. Magnetic resonance imaging may be useful for diagnosis showing on T2 weighted images, in cases of fertile lesions, numerous clustered small cysts. Moreover, it is an excellent technique to analyse vascular involvement, particularly for vena cava and hepatic veins, and to diagnose involvement of adjacent organs. Coupled to cholangio-MR, it allows a precise examination of the biliary tree invasion, particularly in the hilum area.
Collapse
Affiliation(s)
- Solange Bresson-Hadni
- Centre Collaborateur OMS pour la Prévention et le Traitement des Echinococcoses humaines, C.H.U Jean Minjoz et Université de Franche-Comt6-25030 Besançon
| | | | | | | | | |
Collapse
|
39
|
Vuitton DA, Mantion G, Bartholomot B, Giraudoux P, Bresson-Hadni S. [Parasite-host relationships and treatment]. Bull Acad Natl Med 2008; 192:1103-1117. [PMID: 19235475] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 05/27/2023]
Abstract
Alveolar echinococcosis (AE) is a parasitic disease caused by intrahepatic growth of the larval stage of the cestode Echinococcus multilocularis. The main definitive host in Europe is the fox. The adult worms live in the fox intestine and their oncospheres are disseminated by faeces. Wolves, dogs and cats may also serve as definitive hosts. Small rodents--especially voles in Europe and small lagomorphs in Asia--are the natural intermediate hosts. The tumour-like larva is composed of multiple vesicles which produce protoscoleces, the fertile stage of the E. multilocularis metacestode. Carnivores are infected by preying on infected rodents. Like rodents, humans are intermediate hosts and are infected either by eating uncooked vegetables and berries contaminated by faeces of infected carnivores, or by touching such animals. Humans are naturally resistant to metacestode development. Genetic characteristics are involved in susceptibility/resistance to E. multilocularis metacestodes. In humans and other intermediate animal hosts, immune suppression enhances parasite growth, which is normally controlled by cytotoxic mechanisms and delayed-type hypersensitivity. Tolerance of E. multilocularis is due in part to parasite characteristics (especially carbohydrate antigens of the laminated layer) and in part to the "anti-inflammatory/tolerogenic" cytokines IL-10 and TGF-beta. Treatment with interferon-a restores a cytokine balance favorable to the host and might be a new therapeutic option for AE patients. Vaccination is a scientifically sound but economically and politically Utopian means of preventing the disease. Prevention thus relies on simple lifestyle measures: cooking potentially contaminated food, regular treatment of domestic animals with praziquantel, and precautions when touching potentially infected definitive hosts (foxes and dogs).
Collapse
Affiliation(s)
- Dominique-Angèle Vuitton
- Centre Collaborateur OMS pour la Prévention et le Traitement des Echinococcoses humaines, Université de Franche-Comté et C.H.U. Jean Minjoz-25030 Besancon
| | | | | | | | | |
Collapse
|
40
|
Mantion G, Bresson-Hadni S, Vuitton DA, Wen H, Chapuis Y, Gillet M. [Treatment of alveolar echinococcosis: a multidisciplinary task]. Bull Acad Natl Med 2008; 192:1151-1158. [PMID: 19235479] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 05/27/2023]
Abstract
Alveolar echinococcosis is characterized by a long asymptomatic period but, without treatment, up to 80% of patients may die within ten years of diagnosis. Owing to a lack of fast-acting and fully effective chemotherapy, partial radical hepatic resection is the only chance of cure. One-third of patients are now treated in this way, and complex vascular and biliary reconstruction procedures are sometimes necessary. Liver transplantation may also be indicated for highly selected patients (about 5%) with life-threatening complications after failure of other treatments. Interventional radiology and endoscopy can be used to drain liver abscesses and/or infected and obstructed bile ducts, either as palliative procedures or as a bridge to radical resection. Parasitostatic benzimidazole therapy, especially based on continuous albendazole administration, is mandatory for at least two years after radical resection, and for life in inoperable patients.
Collapse
Affiliation(s)
- Georges Mantion
- Centre Collaborateur OMS pour la prévention et le traitement des échinococcoses humaines, CHU Besançon
| | | | | | | | | | | |
Collapse
|
41
|
Giraudoux P, Raoul F, Boue F, Combes B, Piarroux R, Bresson-Hadni S, Vuitton DA. [Geography of alveolar echinococcosis]. Bull Acad Natl Med 2008; 192:1119-1130. [PMID: 19235476] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 05/27/2023]
Abstract
Alveolar echinococcosis is restricted geographically to the colder areas of the northern hemisphere. In France, the highest prevalence is observed in Franche-Comtd. The yearly incidence of AE in endemic areas is generally low (0.02-0.18 per 100,000 inhabitants) but it can exceed 1 per 100,000 locally. E. multilocularis transmission has intensified in traditionally in foxes endemic areas during the last twenty years, and the parasite has extended its range to new areas and countries of Europe. The increasing proximity of fox populations to urban areas may lead to a new epidemiological pattern. Control measures are only applicable at the local scale, and are essentially based on for deworming.
Collapse
Affiliation(s)
- Patrick Giraudoux
- Centre Collaborateur OMS pour la Prevention et le Traitement des Echinococcoses humaines, Centre hospitalier universitaire et Université de Franche-Comté, 1 place Leclerc 25030 Besançon Cedex.
| | | | | | | | | | | | | |
Collapse
|
42
|
Bresson-Hadni S, Miguet JP, Mantion G, Giraudoux P, Vuitton DA. [Alveolar echinococcosis: a disease comparable to a slow growing cancer]. Bull Acad Natl Med 2008; 192:1131-1139. [PMID: 19235477] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 05/27/2023]
Abstract
Alveolar echinococcosis, a parasitic disease due to the larval stage of the cestode Echinococcus multilocularis, is initially located in the liver in 97% of cases. Progression is very slow and the disease remains silent for many years. The developing larva behaves like a slow-growing liver tumor that gradually invades the liver parenchyma, vessels and bile ducts. Marked granulomatosis around the larva, and the subsequent strong reactive fibrosis, contribute to the severity of the disease. Gradual extension to adjacent organs and distant metastases due to haematogenous spread can also occur. Purely extrahepatic alveolar echinococcosis is rare, but physicians in endemic areas should be aware of this possibility. Diagnostic methods have dramatically improved over the past twenty years. The clinical presentation used to be similar to that of liver cancer, with slowly progressivejaundice (due to involvement of the hilum), huge, hard and irregular hepatomegaly, and a chronic Budd-Chiari syndrome due to hepatic vein involvement. Currently, with extensive use of abdominal ultrasonography, alveolar echinococcosis is commonly diagnosed when still asymptomatic. Alveolar echinococcosis may also be revealed by a complication, such as cholangitis due to communication between the parasite mass and the lumen of a bile duct or to pigment stones accumulating above a parasitic biliary stenosis; liver abscess related to centro-parasitic necrosis; or hematemesis due to esophagal varices in case of portal vein involvement. Metastases, especially in the lungs, reveal the disease in 5% of cases.
Collapse
Affiliation(s)
- Solange Bresson-Hadni
- Centre Collaborateur OMS pour la Prevention et le Traitement des Echinococcoses humaines, CHU Jean Minjoz et Université de Franche-Comté-25030 Besançon
| | | | | | | | | |
Collapse
|
43
|
Thevenot T, Denis J, Jouannaud V, Monnet E, Renou C, Labadie H, Abdelli N, Nguyen-Khac E, Dumouchel P, Bresson-Hadni S, Chousterman M, DI Martino V, Cadranel JF. Coeliac disease in chronic hepatitis C: a French multicentre prospective study. Aliment Pharmacol Ther 2007; 26:1209-16. [PMID: 17944735 DOI: 10.1111/j.1365-2036.2007.03499.x] [Citation(s) in RCA: 14] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/16/2022]
Abstract
BACKGROUND A prevalence of 1.2% of coeliac disease (CD) in patients with chronic hepatitis C was recently reported, suggesting a possible epidemiological link between these two diseases. However, other studies have not found this relationship. AIM To conduct a French multicentre prospective study to assess the prevalence of CD in hepatitis C virus (HCV)-infected patients. METHODS Between June 2003 and November 2005, 624 consecutive HCV-positive out-patients were tested for antiendomysial IgA antibodies (AEA), antigliadin IgA and IgG antibodies (AGA). Patients with positive AEA or IgA AGA and positive IgG AGA in a context of a high suspicion of CD were asked to undergo gastroscopy with duodenal biopsies. RESULTS Isolated IgA AEA, IgA AGA and IgG AGA were 0.16%, 5.7% and 4.4%, respectively. Gastroscopy was required for 39 patients, 31 were performed (eight refusals), but only 25 duodenal biopsies were performed as six patients had cirrhosis. CD was never detected. CONCLUSIONS The prevalence of CD in HCV-positive patients was 0% (95% confidence interval: 0-0.59%), but there is a low prevalence of CD in the whole French population.
Collapse
Affiliation(s)
- T Thevenot
- Service d'Hépatologie et de Soins Intensifs Digestifs, Hôpital Universitaire Jean Minjoz, Besançon, France.
| | | | | | | | | | | | | | | | | | | | | | | | | |
Collapse
|
44
|
Bart JM, Piarroux M, Sako Y, Grenouillet F, Bresson-Hadni S, Piarroux R, Ito A. Comparison of several commercial serologic kits and Em18 serology for detection of human alveolar echinococcosis. Diagn Microbiol Infect Dis 2007; 59:93-5. [PMID: 17509798 DOI: 10.1016/j.diagmicrobio.2007.03.018] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/20/2006] [Revised: 03/20/2007] [Accepted: 03/22/2007] [Indexed: 11/26/2022]
Abstract
The aim of this study was to design the best serologic strategy for diagnosing human alveolar echinococcosis (AE) cases in medical laboratory routine procedures. By combining 2 screening techniques, indirect hemagglutination with Em(2plus)-ELISA and/or recEm18-ELISA, 46 of 47 AE cases were detected. The necessary confirmation of results is then obtained by using immunoblot (LDBIO-IB and/or recEm18-IB).
Collapse
Affiliation(s)
- Jean-Mathieu Bart
- Laboratoire de Parasitologie, Faculté de Sciences Médicales et Pharmaceutiques de Besançon, 2500 Besançon Université de Franche-Comté, France.
| | | | | | | | | | | | | |
Collapse
|
45
|
Spahr L, Bresson-Hadni S, Amann P, Kern I, Golaz O, Frossard JL, Hadengue A. Allopurinol, oxidative stress and intestinal permeability in patients with cirrhosis: an open-label pilot study. Liver Int 2007; 27:54-60. [PMID: 17241381 DOI: 10.1111/j.1478-3231.2006.01382.x] [Citation(s) in RCA: 35] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
Abstract
BACKGROUND Cirrhosis is associated with intestinal barrier failure, related in part to enterocytes oxidative damage via xanthine oxidase overactivity. Experimentally, allopurinol, a xanthine oxidase inhibitor, reduces enterocytes' damage and bacterial translocation. AIM To assess the short-term effects of allopurinol on intestinal permeability, oxidative stress and endotoxin-dependent cytokines in patients with cirrhosis. METHODS Nineteen patients with cirrhosis, in a stable condition (age: 56 years; Child A/B/C: 6/7/6; ascites: 12; alcoholic cirrhosis: 16/19; abstinence >2 weeks), were included. At baseline and day 10 of allopurinol 400 mg/day, intestinal permeability [lactulose/mannitol (Lac/Man) ratio test], oxidative stress (serum malondialdehyde), as well as TNF-soluble receptor-1, IL-6 and lipopolysaccharide-binding protein (which reflects exposition to endotoxin) were measured. RESULTS Malondialdehyde decreased significantly (-23%, P<0.05), whereas no effects were seen on intestinal permeability and the endotoxin-associated systemic inflammatory response. At baseline, portal pressure correlated to the Lac/Man ratio (r=0.55, P<0.02). At day 10, changes in malondialdehyde correlated to changes in the Lac/Man ratio (r=0.51, P<0.05). CONCLUSIONS A 10-day course of allopurinol in patients with cirrhosis is associated with a significant reduction in oxidative stress but no effect on intestinal permeability and inflammatory markers. Whether intestinal damage in cirrhosis can be accessible to antioxidant therapy requires further study.
Collapse
Affiliation(s)
- Laurent Spahr
- Gastroenterology and Hepatology, University Hospital, Geneva, Switzerland.
| | | | | | | | | | | | | |
Collapse
|
46
|
Decaens T, Roudot-Thoraval F, Bresson-Hadni S, Meyer C, Gugenheim J, Durand F, Bernard PH, Boillot O, Compagnon P, Calmus Y, Hardwigsen J, Ducerf C, Pageaux GP, Dharancy S, Chazouillères O, Cherqui D, Duvoux C. Role of immunosuppression and tumor differentiation in predicting recurrence after liver transplantation for hepatocellular carcinoma: A multicenter study of 412 patients. World J Gastroenterol 2006; 12:7319-25. [PMID: 17143948 PMCID: PMC4087490 DOI: 10.3748/wjg.v12.i45.7319] [Citation(s) in RCA: 53] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/06/2023] Open
Abstract
AIM: To assess pre-orthotopic liver transplantation (OLT) factors that could be evaluated pre-operatively or controlled post-operatively associated with hepatocellular carcinoma (HCC) recurrence and disease-free survival after liver transplantation (LT).
METHODS: Four hundred and twelve patients transplanted for HCC between 1988 and 1998 in 14 French centers, who survived the postoperative period were studied. Kaplan Meier estimates were calculated for 24 variables potentially associated with recurrence of HCC. Uni- and multivariate analyses were conducted to identify independent predictors of recurrence.
RESULTS: Overall 5-year disease-free survival was 57.1%. By univariate analysis, variables associated with disease-free survival were: presence of cirrhosis (P = 0.001), etiology of liver disease (P = 0.03), α fetoprotein level (< 200, 200 to 2000, or > 2000; P < 0.0001), γ-GT activity (N, N to 2N or > 2N; P = 0.02), the number of nodules (1, 2-3 or ≥ 4; P = 0.02), maximal diameter of the largest nodule (< 3 cm, 3 to 5 cm or > 5 cm; P < 0.0001), the sum of the diameter of the nodules (< 3 cm, 3 to 5 cm, 5 to 10 cm or >10 cm; P < 0.0001), bi-lobar location (P = 0.01), preoperative portal thrombosis (P < 0.0001), peri-operative treatment of the tumor (P = 0.002) and chemoembolization (P = 0.03), tumor differentiation (P = 0.01), initial type of calcineurin inhibitor (P = 0.003), the use of antilymphocyte antibodies (P = 0.02), rejection episodes (P = 0.003) and period of LT (P < 0.0001). By multivariate analysis, 6 variables were independently associated with HCC recurrence: maximal diameter of the largest nodule (P < 0.0001), time of LT (P < 0.0001), tumor differentiation (P < 0.0001), use of anti-lymphocyte antibody (ATG) or anti-CD3 antibody (OKT3) (P = 0.005), preoperative portal thrombosis (P = 0.06) and the number of nodules (P = 0.06).
CONCLUSION: This study identifies immunosuppression, through the use of ATG or OKT3, as a predictive factor of tumor recurrence, and confirms the prognostic value of tumor differentiation.
Collapse
Affiliation(s)
- Thomas Decaens
- Service d'Hépatologie et de Gastroentérologie, AP-HP, Hôpital Henri Mondor, Créteil, Unité INSERM 581, France.
| | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | |
Collapse
|
47
|
Thevenot T, Di Martino V, Lagrange A, Petrella T, Faucher JF, Fontan J, Terebus M, Miguet JP, Bresson-Hadni S. Granulomatous hepatitis and hemophagocytic syndrome after bacillus Calmette-Guerin bladder instillation. ACTA ACUST UNITED AC 2006; 30:480-2. [PMID: 16633319 DOI: 10.1016/s0399-8320(06)73208-0] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
Abstract
Intravesical instillations of bacillus Calmette-Guérin are frequently used for treating superficial bladder carcinoma which is considered a safe treatment. We describe an unusual complication with hemophagocytosis and granulomatous hepatitis. Prompt diagnosis and treatment with corticosteroids, anti-tuberculous agents and intravenous immunoglobulins led to a rapid recovery.
Collapse
Affiliation(s)
- Thierry Thevenot
- Service d'Hépatologie et de Soins Intensifs Digestifs, Centre Hospitalier Louis Pasteur, Dole.
| | | | | | | | | | | | | | | | | |
Collapse
|
48
|
Monnet E, Collin-Naudet E, Bresson-Hadni S, Minello A, Di Martino V, Carel D, Jooste V, Gagnaire A, Evrard P, Obert-Clerc B, Miguet JP, Hillon P. Place of residence and distance to medical care influence the diagnosis of hepatitis C: a population-based study. J Hepatol 2006; 44:499-506. [PMID: 16427717 DOI: 10.1016/j.jhep.2005.11.044] [Citation(s) in RCA: 25] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/19/2005] [Revised: 11/15/2005] [Accepted: 11/17/2005] [Indexed: 01/16/2023]
Abstract
BACKGROUND/AIMS In France, geographic access to medical care may affect the diagnosis of hepatitis C. The aims of this study were to compare the detection rates of hepatitis C in urban and rural areas after adjusting for distance to medical care, and evaluating the impact of the place of residence on patients' clinical characteristics. METHODS Between 1994 and 2001, 1938 newly detected cases were recorded in a French population of 1,005,817 inhabitants. Age and sex-adjusted detection rates for 10(5) inhabitants were estimated for urban and rural areas and for classes of distance to the nearest practitioner. RESULTS Detection rates were lower in rural than in urban areas [14.1, (95CI: 12.5-15.7) versus 24.7, (95CI: 23.5-26.0)] and decreased as the distance to the general practitioner increased [27.0, (95CI: 25.5-28.4) versus 13.7, (95CI: 12.1-15.3) for a cutoff value of 1.5 km]. In multivariate analyses, detection rates were only influenced by the distance to general practitioner. Hepatocellular carcinoma at diagnosis was more frequent among rural than among urban patients (adjusted OR = 2.28, 95CI: 0.97-5.39, P = 0.059). CONCLUSIONS A poorer geographic access to care explained the lower detection of hepatitis C in rural areas. Hepatocellular carcinoma was more frequent in rural patients. It may result from later detection and/or involvement of environmental factors on hepatocarcinogenesis.
Collapse
Affiliation(s)
- Elisabeth Monnet
- Hepatology and Intensive Care unit, Besançon University Hospital Center, 1 Boulevard Fleming, 25030 Besançon cedex, France.
| | | | | | | | | | | | | | | | | | | | | | | |
Collapse
|
49
|
Thevenot T, Di Martino V, Lunel-Fabiani F, Vanlemmens C, Becker MC, Bronowicki JP, Bresson-Hadni S, Miguet JP. Traitements complémentaires de l’hépatite chronique virale C. ACTA ACUST UNITED AC 2006; 30:197-214. [PMID: 16565651 DOI: 10.1016/s0399-8320(06)73154-2] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/24/2022]
Abstract
Pegylated interferon and ribavirin combination therapy represent the standard-of-care treatment for chronic hepatitis C, that allows to cure more than half of the patients. However, the success of this bitherapy is in balance with numerous side effects, especially hematologic and psychiatric. This review is focused on complementary treatments (erythropoietin, G-CSF, vitamin E, glutathion, ursodeoxycholic acid and antidepressants) likely to bring a benefit in maintaining adequate interferon and ribavirin dosages and in improving quality of life. This analysis has been performed by using the Medline(R) data base and with data from laboratories which commercialized these molecules. Erythropoietin, G-CSF and antidepressants are the best tools to optimize the bitherapy in its dose and its duration while privileging the quality of life of HCV-infected patients.
Collapse
Affiliation(s)
- Thierry Thevenot
- Service d'Hépatologie et de Soins Intensifs Digestifs, Service d'Hépatologie, Hôpital Universitaire Jean Minjoz, Besançon.
| | | | | | | | | | | | | | | |
Collapse
|
50
|
Bresson-Hadni S, Delabrousse E, Blagosklonov O, Bartholomot B, Koch S, Miguet JP, Mantion GA, Vuitton DA. Imaging aspects and non-surgical interventional treatment in human alveolar echinococcosis. Parasitol Int 2006; 55 Suppl:S267-72. [PMID: 16403670 DOI: 10.1016/j.parint.2005.11.053] [Citation(s) in RCA: 121] [Impact Index Per Article: 6.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/11/2022]
Abstract
Alveolar echinococcosis (AE) of the liver caused by the metacestode of the fox tapeworm Echinococcus multilocularis is characterized by a multivesicular structure surrounded by an extensive fibro-inflammatory host reaction. The lesions behave like a slow-growing liver cancer, without sharp limits between the parasitic tissue and the liver parenchyma. Invasion of biliary and vascular walls is another hallmark of this severe disease. Moreover, the poor vascularization of the parasitic mass often leads to necrosis in the central part of the lesion. This explains why liver abscess due to superimposed bacterial infection of the necrotic area may occur in this disease. Currently, a range of imaging techniques can be used at the different stages of management of AE. For diagnosis, ultrasonography remains the first line examination. For a more accurate disease evaluation, aiming to guide the surgical strategy, computerized tomography, Magnetic Resonance (MR) imaging, including cholangio-MR imaging are of importance, providing useful complementary information. More recently, Positive-Emission Tomography using [18F] fluoro-deoxyglucose has been developed for the follow-up of inoperable AE patients under long-term benzimidazoles therapy. This approach seems very promising to assess inflammatory activity and thereby to indirectly depict parasitic activity. Non-surgical interventional procedures, mainly percutaneous biliary and/or centro-parasitic abscesses drainages, are currently a major aspect in the care of incurable AE patients and have largely contributed to the improvement of survival in this situation during the past 20 years. They may also be used as a bridge before a curative surgical procedure in symptomatic patients presenting a life-threatening bacterial and/or fungal infection. It is also very useful in inoperable patients to overcome similar infectious episodes.
Collapse
|