Diagnosis and Surgical Treatment of Renal Hydatid Disease: a Retrospective Analysis of 30 Cases

Echinococcosis (CE) is an infection which is caused by the larval stage of a tapeworm and is endemic in stockbreeding regions of developing countries. The kidney is the most commonly affected organ in the urinary tract. However, reports on renal hydatid disease are limited in the literature, and usually there are no specific clinical characteristics and promising operative methods. The purpose of this study is to assess the most appropriate surgical technique for the patient with urinary tract CE. We retrospectively analyzed thirty patients with renal hydatid cysts who received different surgical treatments in the urology department of the First Affiliated Hospital of Xinjiang Medical University from February 1985 to April 2010. Twenty patients were males and ten were females. The diagnostic accuracy was 74%, 87.5%, and 66.6% respectively by using of ultrasound, CT, and laboratory tests. Thirty patients were followed up for 1–15 years after surgery. One patient experienced a recurrence of renal CE. The ultrasound, CT, and immunological tests are an important means of diagnosis. The surgical treatment principle of renal hydatid should be based on residual renal function, hydatid cyst size, number, location, and surgical techniques to determine the surgical plan to retain the renal function.     

Experience in northern Nigeria with countercurrent immunoelectrophoresis, double diffusion and indirect haemagglutination tests for diagnosis of hydatid cyst in camels

Sera from 36 slaughtered camels with proven hydatid disease, from 46 camels found to be free of hydatidosis at post-mortem meat inspection, and from 26 animals with confirmed caprine heartwater, bovine trypanosomiasis and cysticercosis were examined. The indirect haemagglutination was found to be the most sensitive but least specific of the three tests. Ouchterlony's double diffusion (DD) test was specific and fairly sensitive. Although the countercurrent immunoelectrophoresis was as specific as DD, it was the least sensitive of the three serological tests. All three serological tests were always positive in camels with hydatid cyst infection affecting both the liver and the lung. A combination of indirect haemagglutination and Ouchterlony's double diffusion test could be useful for diagnosing hydatidosis in camels and probably other animals.     

Echinococcosis (Hydatid Disease): Review and Report of a Case of Secondary Echinococcosis

Echinococcosis is a disease caused by the larval form of Echinococcus granulosus. The adult worm lives parasitically in the intestine of the definitive host, the dog, wolf and other wild carnivores. The ova, which are passed in the feces, are ingested by grazing animals. The intestinal juices free the ovum from its cuticle and, having entered a capillary, it is carried by the blood stream to the liver or lung, where it develops into a hydatid cyst. Man becomes infected by ingesting contaminated vegetables or drinking contaminated water.In a mature hydatid cyst there may be thousands of scolices and each one of these, if released from the hydatid cyst, may form a new cyst if it is planted in a suitable environment. Hydatid cysts are most commonly found in the liver and the lung, but may occur in other organs.A hepatic cyst may rupture into the peritoneal cavity and produce a hydatidoperitoneum. A pulmonary cyst frequently ruptures into a bronchus and is thus evacuated.The disease is of world-wide distribution. In Canada most of the cases of this disease have occurred among Indians and Eskimos. It is now known that a sylvatic cycle has been established in North America and that it serves as a source of infection of the dog and man.The patient reported herein had spontaneous rupture of a hepatic hydatid cyst, with subsequent development of secondary peritoneal echinococcosis. Repeated laparotomies had to be performed to relieve pressure on or obstruction of various organs. The patient made an uneventful recovery and is again usefully employed. No effective medical treatment for this disease is available.     

Epidemiology of human hydatidosis in the IX Region of la Araucania, Chile 1991-1998

In the region of la Araucania, located in the south of Chile (37 degrees 24'-39 degrees 34' South lat.), the economy is based in cattle raising and agriculture. The cases of human hydatidosis, mortality and notification registered in la Araucania 1991-1998 are reviewed. The rate for hydatid disease is 38.5 per 100,000 population. Liver (47.1%) and lung (40.7%) were the most affected viscera. Days in hospital, 11-20 the 56.1%. Disease in female is 51.1%. The mortality rate is 0.8 per 100,000, the most frequently affected county is Imperial. The age group 15-44 years is the most affected. The notification rate is 8.74 per 100,000 population. The rate for hydatid disease is higher than the rate of notification, then necessarily there exist a subnotification. We think that it is necessary to investigate the serological prevalence of hydatidosis in the population of the IX Region Araucania.     

A review of allergic respiratory disease in laboratory animal workers.

There is increased recognition of hypersensitivity lung disease among workers with laboratory animals as an occupational disease. Symptoms of asthma in 44 of 78 workers with laboratory animal dander allergy reflected the serious consequences of this occupational ailment. Affected employee profiles induced family history of atopy; immediate (Type I) allergic reaction; symptoms of rhinitis, asthma, and cough; hypersensitivity to one or more species, most often rats, mice, and rabbits. Diagnosis depends on history and physical, radiologic, and laboratory examinations, including skin tests with relevant antigens. Control and treatment depend on environmental change (reemployment or reduction of antigen contact); mechanical devices (masks and filters); chemotherapy (bronchodilators, steroids), prophylaxis and immunotherapy (hyposensitization). Standardization of medico-legal criteria covering occupational asthma is needed.     

The current status of immunotherapy for cervical cancer

BackgroundImmunotherapy has been proven effective in several tumours, hence diverse immune checkpoint inhibitors are currently licensed for the treatment of melanoma, kidney cancer, lung cancer and most recently, tumours with microsatellite instability. There is much enthusiasm for investigating this approach in gynaecological cancers and the possibility that immunotherapy might become part of the therapeutic landscape for gynaecological malignancies.Cervical cancer is the fourth most frequent cancer in women worldwide and represents 7.9% of all female cancers with a higher burden of the disease and mortality in low- and middle-income countries. Cervical cancer is largely a preventable disease, since the introduction of screening tests, the recognition of the human papillomavirus (HPV) as an etiological agent, and the subsequent development of primary prophylaxis against high risk HPV subtypes. Treatment for relapsed/advanced disease has improved over the last 5 years, since the introduction of antiangiogenic therapy. However, despite advances, the median overall survival for advanced cervical cancer is 16.8 months and the 5-year overall survival for all stages is 68%. There is a need to improve outcomes and immunotherapy could offer this possibility. Clinical trials aim to understand the best timing for immunotherapy, either in the adjuvant setting or recurrent disease and whether immunotherapy, alone or in combination with other agents, improves outcomes.     

多房棘球绦虫在我国自然动物宿主的发现及其形态学研究

本文报告在我国宁夏固原地区野生动物首次发现多房棘球蚴痫的病原自然感染。当地红狐自然感染多房棘球绦虫成虫27.27％,感染强度1,840—4,050条;达乌尔黄鼠citellus dauricus自然感染多房棘球蚴0.2％。成虫孕节人工感染小白鼠后163—424天,在其肝脏内可检到发育含有大量成熟原头节的多房棘球蚴。成虫期与幼虫期的形态特征有详细的描述并同国外代表性地区的报告列表比较。对我国西北地区人体多房棘球蚴病作综合报道。     

Medical treatment of pulmonary hydatid disease: for which child?

There have been many encouraging studies on medical treatment of pulmonary hydatid disease due to Echinococcus granulosus infection. Our aims were to demonstrate the safety and efficacy of medical treatment in pulmonary hydatid disease and to describe a pediatric population who would benefit from medical treatment, especially in respect to the diameter of the hydatid cyst. All patients were treated with mebendazole or albendazole. Treatment outcome was defined as cure, improvement or failure. Among 82 patients, 34.1% were cured, 34.1% improved and 31.8% failed. When 102 cysts were individually evaluated, 36.31% were cured, 32.4% improved and 31.3% failed. The cure and the failure rates were statistically insignificant in cysts treated with mebendazole and albendazole; however statistically significantly more cysts were improved with albendazole. The results were statistically insignificant between continuous and cyclic albendazole treatment. The mean size of successfully treated cysts was 5.3+/-3.4 cm, but "failed" for cyst with a mean size of 7.3+/-4.3 cm. There was a positive, weak and statistically significant correlation between the cyst size and treatment results. The major complication was infection. We suggest that selected pediatric patients with uncomplicated pulmonary hydatid cysts sized less than 5 cm should have a trial of medical treatment with a very close follow up.     

Prevalence of Echinococcosis in Reindeer (Rangifer Tarandus) in Sweden

In Sweden echinococcosis is uncommon in domestic animals. In reindeer in the most northern part of the country echinococcosis was found. Of 1453 pairs of lungs, 23 pairs (1.6 %) were infected with hydatid cysts. These were of two types: typical well-developed hydatid cysts, which were found in nine of the 23 infected lungs, and collapsed hydatid cysts, which were found in 13 of the lungs. In only one lung pair both types of cysts were seen.     

Does hydatid disease have protective effects against lung cancer?

We hypothesized that solid tumors rarely occur in patients with hydatid disease. We obtained the serum of 14 patients diagnosed with hydatid disease, the serum of 10 patients who did not have a history of hydatid disease, and the hydatid cyst fluid from six patients. These sera and fluid samples were added at different concentrations to NCI-H209/An1 human lung small cell carcinoma cells and L929 mouse fibroblasts as a control group. Sera of patients with hydatid diseases had cytotoxic effects on NCI-H209/An1 cells, but they did not have cytotoxic effects on fibroblast cells. Sera from healthy subjects did not have a cytotoxic effect on the tumor cell line or control fibroblasts. Cyst fluid, also, did not have toxic effects on the NCI-H209/An1 cell line, but was toxic to fibroblasts up to a 1:32 dilution. Sera from patients with hydatid disease had cytotoxic effects on human small cell lung cancer cells in vitro.     

Epidemiological and histomorphic studies in sheep infected with hydatid cyst in Taif area

Hydatidosis is a zoonotic disease caused by Echinococcus granulosus larvae, which affects sheep worldwide, especially in rural communities. This study aims to determine the prevalence and structure of hydatid cyst in sheep. A total number of 1,198 sheep in different age groups G1 (<1 year), G2 (1–2 years) and G3 (>2 years) were slaughtered at Taif abattoirs, then examined for the presence of hydatid cysts in lung, liver, and mesentery. Prevalence of hydatid cyst infection in imported sheep (13.0%) was higher than of local sheep (10.2%). Particularly, as per gender, prevalence of imported females (71.9%) was higher than those of local females (28.1%), while that of imported males (66.3%) was higher than those of local males (33.7%). Large sizes of hydatid cysts and fertility recorded in G3 were higher in both local and imported sheep than those of G1 and G2. Morphometric analysis of pathological lesions in liver of all infected sheep showed a significant increase compared to non-infected healthy sheep (have no lesions) (P < 0.001). In addition, for all infected sheep, histochemical investigation with Masson’s trichrome stain showed collagen fibers inside the hydatid cyst capsules and in pericystic region. The collagen fibers content and the cellular laminated membranes took the green color, while immunohistochemical evaluation detected a positive reaction for CD3.     

A Giant Hydatid Cyst in the Interventricular Septum with Papillary Muscle Involvement

We present here a 44-year-old male patient with hydatid disease who was referred to our hospital due to dyspnea and chest pain for the last 2 month before admission. Using echocardiography and contrast-enhanced computed tomography the heart hydatid was diagnosed. However, hydatid disease of the interventricular septum is rare; particularly, the involvement of mitral apparatus with mitral regurgitation (MR) is an exceptionally rare presentation. Early diagnosis and an integrated treatment strategy are crucial. Surgical excision was performed and the patient had an uneventful recovery and follow-up at 3 months.     

Echinococcus granulosus: In vitro effectiveness of warm water on protoscolices

Hydatid disease is one of the most important helminthic diseases worldwide. Hydatid cysts may be found anywhere in the body. The most effective treatment of hydatid cyst is surgical operation. Spillage of live protoscolices during the operation is the major cause of recurrence. Instillation of scolicidal agent into hydatid cyst is the most commonly employed measure to prevent this complication. To date, many scolicidal agents have been used for inactivation of the hydatid cyst content, however, most common scolicidal agents may cause unacceptable side-effects, limiting their use. In this study the scolicidal effect of warm water (45, 50, 55, and 60 °C) at different exposure times (1, 2, 3, 4, 5, 6, 8, 10, 12, and 15 min) is investigated. Protoscolices were collected aseptically from sheep livers containing hydatid cyst. Viability of protoscolices was determined by 0.1% eosin staining. Even though the highest scolicidal activity of warm water at 45 °C was 40.4% at the end of 15 min, the best scolicidal effect (100%) of warm water at 50, 55, and 60 °C was obtained after 5, 2, and 1 min, respectively. The results of this in vitro study showed that warm water at 50–60 °C can be regarded as an effective scolicidal agent. Warm water is commonly available, easily prepared, and inexpensive. In vivo scolicidal activity of warm water and also the possible side effects need further investigation.     

Analysis of some variables in patients with hydatidosis surgically treated at the Regional Hospital of Valdivia, Chile, 1976-1986

A survey of surgically treated cases of hydatidosis in the province of Valdivia, Chile, was done. Data were provided by the Regional Hospital of Valdivia, and a period of eleven years was covered (1976-1986). Disease, treatment and related data from each patient were consigned. For the analysis, the information was grouped according to: sex, age, cyst location, condition of the cyst, concomitance with another pathology, condition at time of discharge, hospitalization period and number of repeat hospitalizations. In the period studied, 197 cases of hydatidosis were surgically treated. The sex distribution was 53.3% for males and 46.7 for females; the age group 10-19 years was the most affected by the disease (19.3%). The most frequent locations of hydatid cysts were the liver (58.9%) and lungs (36.5%); the 38.6% of the patients showed complicated cysts, mainly with bacterial infections (11.7%); also, 20% of the cases presented a concomitant liver-related pathology. After the operation, 153 (77.7%) clinically recovered and 27 (13.7%) non-recovered patients left the hospital and 7 (3.5%) cases died while hospitalized. The average hospitalization period was 29 days. During 1976-1986, 24 patients were rehospitalized.     

The serodiagnosis of human hydatid disease: 1. The routine use of latex-agglutination and complement-fixation in diagnosis

The combined use of complement fixation (CF) and latex agglutination (LA) tests is reported on sera from 6328 patients with suspected hydatid disease; 191 were confirmed positive at operation ('known positives'). Results by LA are related to CF titres. Both tests were negative in 90% of specimens. Nine patients were subsequently found infected of whom 3 became positive in tests after operation. Of sera positive in both tests, 75% were from 'known positives'. The remainder were almost certainly from infected patients. Half the patients whose sera were LA positive/CF less than or equal to 1/4 were follow-up 'known positives' in whom CF titres had waned; 2 were early infections. Only 3% of the cases with an LA negative/CF titre of greater than or equal to 1/16 were 'known positives' and 6% where the CF titre was 1/8. The remaining CF results in the group were false positives and accounted for 1.2% of all sera tested. Findings show that a CF titre greater than or equal to 1/8 with positive LA indicates past or present infection; a negative CF test with positive LA usually indicates past infection; rarely, infection is present when a CF titre is greater than or equal to 1/8 and LA is negative. A rising CF titre and positive LA indicates current infection; reliable prognosis following treatment is given by CF.     

Incidentally discovered adrenal tumors: a lesson from observation of 1,444 patients

This study was aimed at summarizing our experience in the management of 1,444 patients with incidentally found adrenal tumors observed at a single endocrinological centre. Hormonal determinations were performed in all patients at the beginning of the observation period to detect subclinical adrenal hyperfunction. The imaging phenotype on CT and MRI was analyzed for defining the malignant potential of the tumors. Based on the results of these examinations we diagnosed among our cohort probably benign masses in 87%, malignant tumors in 10% (adrenal carcinoma - 9%), and metastases in 3%. Subclinical hyperfunction was diagnosed in 8%; the most frequent was the pre-Cushing's syndrome. A subgroup of 480 patients (33%) was submitted to surgery because of oncological or endocrinological indications. The patients not qualified for surgery were carefully controlled by imaging and hormonal examinations. Malignancy is the most serious risk in the group of patients with incidentally discovered adrenal tumors.     

Solitary subcutaneous hydatid cyst: Review of the literature and report of a new case in the deltoid region

BackgroundSolitary subcutaneous hydatid cyst is not frequent and the only symptom is generally a silent growing mass. Total excision remains the mainstay of treatment. Aim of the study was to present a case surgically treated and perform a statistical analysis reviewing previous published works in order to define a correct approach to diagnosis and treatment.Methods264 documents from Medline database were considered for primary subcutaneous hydatid cyst cases. Data concerning geographic region, gender, age, job, location, evolving time, history and physical, mobility, diameter, laboratory, imaging, locularity (uni- or multilocular cyst), fine-needle aspiration, preoperative diagnosis, neoadjuvant chemotherapy, treatment, spillage, adjuvant therapy, follow-up and recurrences were ordered in a database and analysed performing t-test, Fisher's test and Pearson's test.Results23 cases, included ours, resulted suitable for our study. Lower extremities were involved in most cases (60.9%) and the thigh represented the most common site (34.8%), whereas upper extremities were the rarest location (8.7%). Patients with head and neck located cysts were younger than those with upper extremities cysts (P = 0.037). Patients who underwent multiple imaging approach received a significantly correct first diagnosis (P = 0.001) and ultrasonography, unlike other techniques, appeared to be essential (P = 0.013).Case reportA 68-year-old man who lived and worked in his farm in Sicily (Italy) presented with a 30-year-growing mass in the deltoid region measuring 10 cm. Ultrasonography and magnetic resonance imaging strongly suggested hydatid cyst. Therefore the cyst was excised and pathology confirmed the diagnosis.ConclusionSolitary subcutaneous hydatid cyst must always be considered in the differential diagnosis of silent growing mass in soft tissues. History and physical associated with ultrasound and magnetic resonance imaging are sufficient to achieve a correct preoperative diagnosis.     

Human and canine echinococcosis infection in informal, unlicensed abattoirs in Lima, Peru

Echinococcus granulosus infections are a major public health problem in livestock-raising regions around the world. The life cycle of this tapeworm is sustained between dogs (definitive host, canine echinococcosis), and herbivores (intermediary host, cystic hydatid disease). Humans may also develop cystic hydatid disease. Echinococcosis is endemic in rural areas of Peru; nevertheless, its presence or the extension of the problem in urban areas is basically unknown. Migration into Lima, an 8-million habitant's metropolis, creates peripheral areas where animals brought from endemic areas are slaughtered without veterinary supervision. We identified eight informal, unlicensed abattoirs in a peripheral district of Lima and performed a cross-sectional study in to assess the prevalence of canine echinococcosis, evaluated by coproELISA followed by PCR evaluation and arecoline purge. Eight of 22 dogs (36%) were positive to coproELISA, and four (18%) were confirmed to be infected with E. granulosus tapeworms either by PCR or direct observation (purge). Later evaluation of the human population living in these abattoirs using abdominal ultrasound, chest X-rays and serology, found 3 out of 32 (9.3%) subjects with echinococcal cysts in the liver (two viable, one calcified), one of whom had also lung involvement and a strongly positive antibody response. Autochthonous transmission of E. granulosus is present in Lima. Informal, unlicensed abattoirs may be sources of infection to neighbouring people in this urban environment.     

Focus: Zoonotic Disease: Retrospective Evaluation of Hydatid Cyst Cases During Pregnancy

Aim: Zoonotic parasite infections affect many pregnant people around the world. Hydatid cystic disease is also a zoonotic disease caused by Echinococcus sp. This study aims to present the maternal-fetal results and clinical treatment of pregnant women diagnosed with liver hydatid cyst (CH). This zoonotic disease is discussed again in the light of current literature. Materials and Methods: Pregnant women with hydatid cyst monitored in a tertiary health center between 2018 and 2020 were evaluated. Seven cases were included in this study. We retrospectively collected and analyzed clinical data, which did not interfere with medical treatment. Results: Albendazole was started as medical therapy in six patients, and percutaneous drainage was applied to one patient. Three of our six patients who started medical treatment had to undergo surgery due to maternal complications that developed despite medical treatment. Two of our patients were delivered with a cesarean section due to the obstetric indications. Discussion: Hydatid cysts are most commonly caused by Echinococcus granulosus infection and most common in the liver. The diagnosis of liver hydatid cysts is not difficult, but pregnant women’s treatment methods have some problems. Although both medical and surgical treatments are available, there is no consensus. We would also like to underscore that echinococcal disease of the liver should be kept in mind in the differential diagnosis of abdominal pain, jaundice, and/or fever, especially in endemic regions. We think that when we increase awareness about this disease, we can improve fetal and maternal outcomes by making an early diagnosis and management.     

An endemic area of sporotrichosis in Guatemala]

An endemic area of sporotrichosis is described in the Lake of Ayarza District, South Guatemala, where 53 patients have been observed within 3 years. In 45.3% of the cases, the infection appeared after handling fish. The disease was more frequently observed in man (83%) and in patients less than 30 years of age. The most frequent clinical type was the ascending lymphocutaneous sporotrichosis of the limbs. Some cases of ulcerative or verrucous lesions were seen. Almost all the patients cured rapidly either by potassium iodide (46 patients) or spontaneously, or after application of local heat (4 patients). Intradermal tests were performed in healthy population in the endemic area and, for comparison, in Guatemala City. Whole yeast cell antigens of Sporothrix schenckii and Ceratocystis stenoceras were used in these tests. Skin tests to both antigens were more frequently positive in the endemic area; the highest frequency was obtained with the antigen of C. stenoceras. A serological study was performed in 26 patients. The fluorescent antibody staining technique was more sensitive than yeast cell and latex particles agglutinations. C. stenoceras was isolated from bark of some trees, especially Eucalyptus, in the environment, but not S. schenckii.