[Chronic Right Ventricular Failure Revealing a Large Compressive Hydatid Cyst at the Cardiology Department of the Aristide le Dantec Hospital (Dakar, Senegal)]

Hydatidosis, an anthropozoonosis caused by the development of the Echinococcus granulosus larva in human, is a parasitic infection that is endemic in many countries. Pericardial localization in the absence of other cardiac involvement is extremely rare. Its spontaneous evolution is serious because of the risk of rupture. We report the case of a 65-year-old patient, who received limb edema that had been going on for 4 months, and in whom the physical examination noted a 3/6 tricuspid regurgitation and a right heart failure syndrome. Transthoracic echocardiography revealed an intra-pericardial mass whose contents appeared fluid with hyperechogenic area. It measured 86x61 mm and significantly compressed the straight cavities. Thoracic computed tomography showed an appearance in favor of an aged intrapericardic hydatid cyst (GHARBI V) with mass effect on the right cavities. The hydatid serology was negative. The patient did not accept the surgical cure. She had been put on albendazole and diuretic treatment. Fatal outcome was reported after two-month follow-up.

[Left localization of biliobronchial fistula: Exceptional complication of hepatic hydatidosis]

INTRODUCTION

The biliobronchial fistula of hydatic origin is a rare complication and the left localization is exceptional.

OBSERVATION

We report the case of a 26-year-old patient from the rural area who was referred to us for treatment of biliptysis. The thoracic and abdominal computed tomography diagnosed a left biliobronchial fistula was. Management consisted of primary endoscopic sphincterotomy, followed by left exclusive thoracotomy surgery to treat pulmonary, hepatic and diaphragmatic repair. The evolution was favorable with disappearance of the biliptysie.

CONCLUSION

The diagnosis of left biliobronchial fistula requires a precise assessment not only by the imagery but also the bronchial fibroscopy allowing the acurate localisation of the lesion before any surgical enterprise.

[Cardiac compression of hydatid origin]

INTRODUCTION

Cardiac hydatid disease is uncommon and occurs in 0.5 to 2% of patients with hydatidosis. Isolated intrapericardial hydatid cystic disease is extremely rare.

OBSERVATION

We report the case of a young woman with cardiac compression due to multiple primary intrapericardial hydatid cysts. Since 1 year, she had gradual general health deterioration including dyspnoea, sweats and weight loss of 8kg. A widening of the mediastinum was observed on chest X-ray. The CT-scan, echocardiography and the dynamic IRM showed multiple mediastinal cysts with mass effect on the heart and main pulmonary artery. The size of the main pulmonary artery was reduced to 5 mm in diameter and the right upper pulmonary vein was nearly closed by posterior cysts. The right and left ventricular ejection fractions were estimated at about 34%. A complete resection of the cysts was performed by sternotomy. The surgical procedure was technically difficult because of major local inflammatory process. The postoperative outcome after an initial pulmonary embolism event was finally favourable.

CONCLUSION

Hydatidosis can lead to severe cardiac involvement. These rare forms of hydatid cystic disease must be known even in non endemic regions by surgeons because of increasing mobility of the world's population.

Swollen eyelid reveals multiple intracranial hydatid cysts associated with a palpebral cyst

We report a case of a hydatid cyst of the eyelid in a 12-year-old boy associated with cerebral involvement. The patient was initially treated by neurosurgeons for brain cysts. The course after an interval of two months was marked by regression of the palpebral cyst on albendazole.

[Intrapleural rupture of pulmonary hydatid cysts]

INTRODUCTION

Intrapleural rupture of pulmonary hydatid cyst (PHC) is a rare but dangerous complication. The purpose of this study was to report the characteristics of this form of thoracic hydatidosis and analyze the favoring factors.

MATERIALS AND METHODS

Between 1996 and 2011, 75 patients were operated in our department for PHC ruptured in the pleura (PHCP). The characteristics of this group were compared with those of a control group of 300 patients randomly selected from patients operated during the same period for PHC.

RESULTS

PHCP patients were younger than controls (23 years old vs. 27,56) (P=0.03) with male predominance (70% vs. 46%) (P=0.01). The PHCP were often located in the lower lobes (64% vs. 48%) (P=0.03). Anatomic resections were more used in control group (P=0.03) whereas decortication and pleurectomy were more frequently in PHCP (P=0.001).

CONCLUSION

Young age, male sex, and basal locations of PHC promote their rupture in the pleura. Surgical treatment of these cysts requires less anatomic resections but more decortication and pleurectomy.

Differential genomics output and susceptibility of Iranian patients with unilocular hydatidose

BACKGROUND

The objective of this study was to investigate HLA-DRB1*and DQB1* allelic polymorphisms in Iranian patients with hydatidose. This is the first survey dealing with the correlation between HLA-DRB1* and DQB1* alleles and cystic echinococcosis in Iranian patients.

METHODS

The study was carried out on 56 patients with confirmed cystic echinococcosis and 30 apparently healthy individuals living in Arak- Markazi Province by HLA-DRB1 and DQB1 typing through PCR-SSP method. The first step was to identify the patients and blood sampling. DNA was prepared from whole blood and PCR-SSP with 31 primer mixes for per sample was used. PCR reaction mixtures were loaded in agarose gels and bands were observed under UV illumination and gel document after electrophoresis. Analysis of results was carried out with specific softwares and frequency and interpretation tables for calculation of P-value in χ(2) test were provided via Fisher's exact test. Significant samples were analyzed by logistic regression and odds-ratios were calculated.

RESULTS

A statistically significant positive association was found between HLA-DQB1*03 and the resistance to cystic echinococcosis (P < 0.02) (odds-ratio = 2.87).

CONCLUSION

Immunogenetic susceptibility to unilocular hydatidose varies according to the HLA antigens in Arak, Markazi Province, and DQB1*03 molecules are associated with the level of immune response to parasite antigens.