Unusual Location of Hydatid Cysts: Report of Two Cases in the Heart and Hip Joint of Romanian Patients

Hydatid cyst is usually located in the liver and lungs, rare cases showing localization in other organs or tissues. In the unusual location, echinococcosis is an excluding diagnosis that is established only after microscopic evaluation. Our first case occurred in a 67-year-old female previously diagnosed with pulmonary tuberculosis and hospitalized with persistent pain in the hip joint. The clinical diagnosis was tuberculosis of the joint, but the presence of the specific acellular membrane indicated a hydatid cyst of the synovial membrane, without bone involvement. Fewer than 25 cases of joint hydatidosis have been reported in literature to date. In the second case, the intramural hydatid cyst was incidentally discovered at autopsy, in the left heart ventricle of a 52-year-old male hospitalized for a fatal brain hemorrhage, as a result of rupture of an anterior communicating artery aneurysm. The conclusion of our paper is that echinococcosis should be taken into account for the differential diagnosis of cystic lesions, independently from their location.

Hydatid disease of bone with adjacent joint involvement. A radiological follow-up of 12 years

Osseous lesions have been reported in only 1-2% of patients with hydatid disease. Joint involvement is usually due to secondary extension from the adjacent bone, although primary hydatid synovitis after haematogenous spread of the infection can be seen. We present a long-term radiological follow-up (12 yr) in a patient who developed hydatid disease of the left pelvic and femoral bones with cartilage destruction of the ipsilateral hip joint. After a Girdlestone arthroplasty, she received mebendazole (3 g/day) for 10 yr and albendazole (400 mg/day) for 2 yr with radiological impairment of the lesions. Complete surgical excision is the treatment of choice for osseous hydatid disease. Isolated medical therapy with mebendazole or albendazole is not adequate for controlling the process, but it can be added to surgery or, as in our case, used like isolated therapy when complete excision is not possible.

Synovial schistosomiasis of the hip

Schistosomiasis is a common parasitic infestation in Egypt. We describe the case of a 24-year-old Egyptian man who presented with the signs of acute septic arthritis of the hip and in whom biopsy subsequently revealed schistosome ova in the synovium.

Case report 629: Osseous hydatidosis

In summary, hydatidosis is a common infection that infrequently involves the skeleton. When this happens the prognosis is uncertain because of the possible extension of the disease and serious complications, (e.g., pathological fractures, visceral involvement, neurologic damage from vertebral involvement). For this reason, simple curettage is not sufficient for cure and no medical treatment can surely eradicate the disease. Hydatidosis, in our opinion, should be staged and surgically treated like a malignant tumor (e.g., with wide surgical margins). Medical treatment is useful in association with surgery and remains the only therapy for inoperable lesions. A case of echinococcosis of the hip joint in a 37-year-old man has been reported. In this case the clinicoradiographical features suggested pigmented villonodular synovitis. Proof was obtained on the basis of a frozen section on biopsy. The clinical and laboratory characteristics of hydatidosis were discussed, with emphasis on the medical and surgical treatment of the disorder.

Observations on Onchocerca volvulus in experimentally infected chimpanzees

The paper describes observations made on 32 chimpanzees experimentally infected with Onchocerca volvulus. The mean pre-patent intervals for the Cameroon forest and the Guatemalan strains of O. volvulus were 13-16 months and 12-15 months respectively. That for the Cameroon Sudan-savanna strain was much longer, i.e. 22-23 months. The numbers of microfilariae found in the skins of animals infected with the Cameroon Sudan-savanna strain were also much lower than in animals infected with the other two strains. Long-term observations on infected animals showed that microfilarial infections had virtually died out 6.5-9 years after the last inoculation with infective larvae. Those animals which were inoculated with infective larvae in the head or above the waist tended to show a higher proportion of microfilariae in the upper parts of the body, than did those inoculated with infective larvae below the waist. In animals which showed adult worm-bundles on only one side of the body, the concentration of microfilariae was usually greater on that side of the body. Worm-bundles in the chimpanzee varied in size from 8 x 5 x 2 mm to 4 x 3 x 2 cm. Out of 47 worm-bundles found, only two were subcutaneous. The remainder lay deep in the tissues, most commonly adjacent to the posterior surface of the capsule of the hip joint. No onchocerciasis eye lesions were seen in any of the infected animals.