Multiple recurrences of vertebral hydatidosis: a case report

We present a case of an Italian man with a particularly prolonged history of hydatid disease (more than 20 years, with six recurrences) involving both osseus (costal and vertebral) and visceral (pulmonary) sites. The main clinical problems involved in the diagnosis and management of vertebral manifestations of hydatidosis are discussed in the light of the latest clinical research.     

Epidemiologic surveillance of hydatidosis in the Patagonian region, Argentina: 1983-1988

The results of a control program of hydatid disease in five jurisdictions of the Patagonian Region in Argentina are presented. The information is glossed in rates of infection in man (95 x 100,000 in 1988 and 15 x 100,000 in 1983), dogs (21.6% in 1983 and 3.1% in 1988) and sheep (16.6% in 1983 and 2.6% in 1988). Factors that condition the endemic situation of hydatidosis in the region are discussed.     

Hydatidosis in Sardinia. Co-involved parameters and hypothesis for a control campaign

Although hydatidosis provokes in man and livestock losses of economic significance, there has been no comprehensive study on this disease. This article is an account of Sardinia as an important area of echinococcosis-hydatidosis. The incidence and distribution of infection in the intermediate and definitive hosts are reviewed and the current status of hydatid disease is evaluated. The review is divided into main sections: (a) geographical and environmental data; (b) domestic intermediate hosts; (c) definitive host; (d) human infections. An average of 85% of the sheep are infected and about 75% of cysts are fertile, 13% of the dogs are parasitized and mainly live as strays, up to 39% of the shepherd's dogs were found to harbour the mature worm of Echinococcus granulosus. Hospital data indicate that even nowadays about 200 people are operated every year with an incidence of 11.1/100.000 inhabitants. The socio-cultural factors (seminomadism, slaughtering practice, etc.) involved in the dissemination, the economic implication of this disease, the benefits due to an eradication, the feasibility of a campaign and the organizational structure aimed at eradicating echinococcosis/hydatidosis in this area, are discussed.     

肝包虫病的诊断现状及进展

肝包虫病是畜牧地区常见的寄生虫病,是一种人畜共患病,非牧地区偶尔也可以见到,可以通过与狗等动物密切接触直接感染,还可以通过呼吸道吸入虫卵或经消化道误食含有虫卵感染的食物或水源等方式感染使人患病,并且可以寄生于人体内各个部位,但以肝脏最为多见,严重危害人体健康和畜牧业的发展。加强肝包虫病的诊断是防控本疾病的重要措施之一,在不能排除肝包虫病的情况下,应结合病史、化验室检查、B超、CT等影像学检查、免疫学检查进行综合分析,给出明确诊断,以防止误诊、漏诊。近年来随着分子生物学以及病原学等技术的发展,为包虫病的诊断提供更多的方法和信息,本文将从肝包虫病的病史及临床表现、影像学检查、免疫学检查、分子生物学检查及病原学检查等方面对其诊断现状及进展做一综述。     

Two cases of primary splenic hydatid cyst in Greece

Cystic disease of the spleen is an uncommon entity in general population. Most cases result from parasitic infection by Echinococcus granulosus, a form called splenic hydatid disease (SHD), with a reported frequency of 0.5-6.0% within abdominal hydatidosis. On the contrary, an isolated splenic involvement of hydatid disease is very uncommon even in endemic regions. Two cases of primary SHD managed with open and laparoscopic radical surgery in our department are reported herein. Primary SHD is a rare entity with non-specific symptoms underlying clinical suspicion by the physician for prompt diagnosis. Surgical treatment is the mainstay therapy, while laparoscopic approach when feasible is safe, offering the advantages of laparoscopic surgery.     

In vivo IL-12 and IL-8 production in hydatic patients and their possible diffusion in hydatid cysts

Cystic echinococcosis (CE) is caused by infection with the larval stage of the cestode Echinococcus granulosus. It is one of the world's major zoonotic infections. Variability and severity of clinical expression of this parasitosis are associated with duration and intensity of infection. They are also related to the variety of human immunological responses to the hydatic antigens. The aim of this work is to study the inflammatory response associated with human hydatidosis by evaluating the possible roles of the proinflammatory cytokines in hydatic patients. We investigated the patterns of IL-12 and IL-8 in serum from Algerian hydatic patients. Serum IL-12 and IL-8 levels are significantly higher in patients with hydatidosis than in control subjects. Furthermore, cytokines secretion correlates with disease statues (cystic localizations and clinical stage). These data indicate that infection with E. granulosus is associated with high levels of circulating IL-12 and IL-8. Moreover, our data, to our knowledge, constitute the first report of IL-12 and IL-8 diffusion into the hydatid cyst. Our results underline the permeability of the cyst wall to the soluble immune system of the host. The relationship between cyst fertility and cytokine infiltration indicates a strong host-parasite interaction. All these findings have important implications for the diagnosis of hydatidosis in humans.     

Diagnostic value of a dot immunobinding assay for human pulmonary hydatidosis

The diagnosis of human hydatidosis is primarily made using radiological and serological methods. Radiological methods are generally of low specificity and serological methods lack sensitivity, especially for pulmonary disease. In this study the capabilities of a new rapid test, the hydatid antigen dot immunobinding assay (HADIA), which was developed for the diagnosis of pulmonary hydatidosis, were studied and compared with another immunodiagnostic method, indirect hemagglutination (IHA). The study subjects included 18 patients, 9 women, 9 men; range 7 to 63 years; mean 30 years, with surgically proven pulmonary hydatidosis, a control group comprised of 14 patients; viral respiratory infections (1), cirrhosis (2), connective tissue disease (2), taeniasis (3), and 6 healthy donors. We found that the HA-DIA test had a sensitivity of 67% and specificity of 100%, and that the IHA test had a sensitivity of 50% and specificity of 100%. We conclude that HA-DIA is a simple, rapid, low cost assay that does not require instrumentation and has a higher sensitivity than IHA for the diagnosis of pulmonary hydatidosis.     

Multi-organ hydatidosis with extensive involvement of the hemi-pelvis and ipsilateral femur

Bone involvement of hydatid disease is uncommon but when encountered, it presents few unique pathological features. The pattern of tissue involvement is largely different from that of visceral hydatid cyst. We describe the case of a 47 year-old man from northern India, a case of systemic hydatidosis including the liver and the right lung, presenting with an abscess like lesion in the left gluteal region with pathological fractures of the left femur. Radiographs and CT-scan images showed extensive invasion of the left hemi-pelvis and left proximal femur. Debridement of the honeycombed ilium yielded hydatid fluid, numerous small cysts and necrotic material. Multiple large devitalized and sequestrated bone pieces were recovered from the bone cavity of the affected ilium. A histopathological study of the bone sequestrums revealed the unique pattern of bone invasion by the characteristic laminated multi-layered cyst walls into areas of least resistance. Bone sequestration has not often been described or demonstrated elaborately in published studies of the past. The bone defects formed after debridement of the ilium and proximal femur were filled with bone cement along with augmentation of the femur using intra-medullary nail. The surgical technique adopted in our case although was not expected to be curative owing to the multi-system disease; it did result in significant functional improvement in the patient.     

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.     

Sequence homology between two immunodiagnostic fusion proteins from Echinococcus multilocularis.

Serological diagnosis of alveolar hydatid disease using crude parasite antigen is problematical with the result that several groups have addressed the question of specific serodiagnosis using defined native or recombinant antigens. Sequence data are available for two lambda gt 11 cDNA clones, designated EM4 and pEM10, which express E. multilocularis species-specific proteins in immunodiagnostic assays using human sera. Here, we have drawn attention to the extensive similarities between these antigens and have compared their characteristics since both may prove valuable in the future diagnosis of alveolar hydatidosis.     

Hydatid disease in acute leukemia: effect of anticancer treatment on echinococcosis

Echinococcosis, also known as hydatid disease or hydatidosis, is a zoonotic illness caused by the larval form of Echinococcus spp. It is highly prevalent in areas where the parasite is endemic such as the Mediterranean region. However, occurrence of echinococcosis and cancer together is rare. We treated and followed approximately 1200 patients with different hematologic neoplastic diseases between 1985 and 2003, and only one of these individuals had concomitant acute leukemia and liver hydatidosis. This report describes the case of a 19-year-old man who had both primary refractoriness of acute leukemia (AML-M4) and liver hydatidosis. Management is discussed. The patient had cystic echinococcosis (CE) of the liver that was classified as CE1 according to the system established by the World Health Organization's Informal Working Group on Echinococcosis. The patient underwent 3 months of treatment with agents that targeted the leukemia (daunorubicin, idarubicin, cytarabine, fludarabine) and its complications (amphotericin B, amphotericin B lipid complex, liposomal amphotericin B). Throughout this period, the size and the contents of the cyst did not change, Echinococcus titers remained unchanged, and the cyst classification remained CE1.     

Application of antigens from Taenia hydatigena cyst fluid for the immunodiagnosis of human hydatidosis

Fluid was collected from cysts of Taenia hydatigena in 60 adult sheep and fluid from each animal pooled separately. By double diffusion antigen 5 was demonstrated in all pools but one. The criteria are described for selection and standardization of these preparations for use as antigens for the immunodiagnosis of human hydatid disease. Sera from 50 persons harbouring hydatid cysts and from 50 patients with other disease conditions were examined by the arc-5 double-diffusion test, using two antigens prepared from Echinococcus granulosus and T. hydatigena cyst fluids, respectively. The results showed that a higher diagnostic sensitivity was obtained with the hydatid antigen. The significance of the findings is discussed in terms of their application to human immunodiagnosis in areas where hydatidosis, but not cysticercosis, is rare in livestock.     

Assessment of prevalence of hydatidosis in slaughtered Sawakny sheep in Riyadh city,Saudi Arabia

Hydatidosis, or echincoccosis, is a serious medical and veterinary problem in many countries, particularly those with rural communities where there is a greater contact between dogs and domestic animals. Domestic livestock act as intermediate hosts which are the main reservoir for the disease in humans. It is therefore very important to estimate the prevalence of hydatid cysts in slaughtered animals since it can be transmitted to humans through dogs, which act as the final host for the disease. From this point of view, the present study was suggested to determine the prevalence of hydatidosis in Sawakny sheep slaughtered in Riyadh city, Saudi Arabia. During the course of the study 12,569 Sawakny sheep were inspected for hydatidosis infection. An overall prevalence of 1.06% was detected among the examined sheep, with the highest prevalence occurring in winter (1.38%) and lowest prevalence in summer (0.67%). Sheep aged 6–12 months had a higher rate of infection than older animals, and males were the predominant carriers of infection (97.7%) compared to females (2.3%). The liver was the most infected organ (79.1%), followed by the lungs (14.6%), while concurrent infections of both the liver and the lungs occurred in 6% of cases. The fertility and viability rates of hydatid cysts in the liver (70.1% and 85.1% respectively) were higher than that in any other organs. In conclusion, it is evident that fertile cysts in slaughtered sheep could have an important role in the continuation of hydatid cyst transmission to humans through dogs. Considerable effort should be devoted to controlling the transmission of cysts from abattoirs by the secure disposal of infected offal. In addition, plans are required for further epidemiological studies and control programs.     

Hydatid disease in China

Hydatid disease is one of the world's most geographically widespread zoonoses. It is present on all inhabited continents and occurs in tropical, subtropical, temperate, sub-arctic and arctic regions. The two countries with the greatest areas over which transmission occurs are almost certainly the Soviet Union and China. Until recently, however, very little information about hydatidosis in China was available outside the country(1). Since the 'open-door' policy over the past few years the great importance of hydatid disease in north and western China is gradually being realized.     

Pelvic Hydatidosis Mimicking a Malignant Multicystic Ovarian Tumor

Echinococcosis is a multisystem disease and has propensity to involve any organ, an unusual anatomical site, and can mimic any disease process. Primary peritoneal echinococcosis is known to occur secondary to hepatic involvement but occasional cases of primary peritoneal hydatid disease including pelvic involvement have also been reported. We report here 1 such case of primary pelvic hydatidosis mimicking a malignant multicystic ovarian tumor where there was no evidence of involvement of the liver or spleen. Our patient, a 27-year-old female, was detected to have a large right cystic adnexal mass on per vaginal examination which was confirmed by ultrasonography. Her biochemical parameters were normal and CA-125 levels, though mildly raised, were below the cut off point. She underwent surgery and on exploratory laparotomy, another cystic mass was found attached to the mesentery of the small gut. The resected cysts were processed histopathologically. On cut sections both large cysts revealed numerous daughter cysts. Microscopic examination of fluid from the cysts revealed free scolices with hooklets and the cyst wall had a typical laminated membrane with inner germinal layer containing degenerated protoplasmic mass. The diagnosis of pelvic hydatid disease was confirmed and patient was managed accordingly. Hydatid disease must be considered while making the differential diagnosis of pelvic cystic masses, especially in endemic areas.     

Serum Antigen and Antibody Detection in Echinococcosis: Application in Serodiagnosis of Human Hydatidosis

Diagnosis of hydatidosis is based on immunodiagnostic methods along with radiological and ultrasound examinations. The objectives of the present study were to develop a specific and simple antigen-based ELISA method for diagnosis of hydatidosis and compare it with antibody detection method. The subjects in this study included 89 patients in the following groups: surgically confirmed hydatidosis patients (35 cases), control with other parasitic diseases (29 cases), and healthy controls (25 cases). Hyperimmune serum was raised against hydatid cyst fluid in rabbits. Anti-hydatid cyst IgG was purified by affinity chromatography using protein A column and labeled with horseradish peroxidase. Collected sera were assessed for hydatid cyst antigens and antibody by ELISA. Circulating hydatid antigen was found in 9 out of 35 patients with surgically confirmed hydatidosis. A sensitivity of 25.7% and a specificity of 98.0% were calculated for the antigen detection assay. Antibody detection by indirect ELISA, using antigen B, showed that 94.2% of patients (33 cases) have anti-hydatid cyst antibodies in their serum while cross reaction was noted in a few of non-hydatidosis patients. A sensitivity of 94.2% and specificity of 81.6% were found for the antibody detection assay. Findings of this study indicated that antibody detection assay is a sensitive approach for diagnosis of hydatid cyst while antigen detection assay might be a useful approach for assessment of the efficacy of treatment especially after removal of the cyst.     

Purification and partial immunochemical characterization of a low molecular mass, diagnostic Echinococcus granulosus immunogen for sheep hydatidosis

Abstract A hydatid specific antigen of 8 kDa molecular mass was affinity-purified from crude hydatid cyst fluid. Some of the epitopes recognised by antibodies in the sera from sheep with hydatidosis were periodate-sensitive. The purified 8 kDa antigen was observed to be a thermo-stable glycoprotein in its immunochemical characteristics. By immunofluorescence on acetone-fixed protoscolices anti-8 kDa monospecific IgG antibodies indicated the existence of the 8 kDa molecule on the hooklets of protoscolices. The purified antigen was used in an enzyme-linked immunosorbent assay for the detection of specific antibodies in sera from sheep hydatidosis. Eighteen (90%) of 20 sera from sheep hydatidosis had antibodies to purified 8 kDa antigen while none of the sera from other parasitic infections or uninfected animals had any detectable levels of antibodies to 8 kDa antigen. Thus, the data on localization and recognition of hydatid specific 8 kDa molecule suggested that this may be one of the major molecules for specific immunodiagnosis and for modulating the hydatid disease process in infected hosts.     

Identification of immunodominant antigens by immunoelectrotransfer in hydatid fluid.

Identification and characterization of immunodominant antigens in hydatid fluid was performed by electrophoresis in polyacrylamide gels (SDS PAGE) followed by immunoelectrotransfer (Western Blot). The studies were performed in sera of 23 patients with surgically confirmed hydatid disease, 12 patients with clinical suspicion of the infection and positive serology according to conventional serology (double diffusion with detection of are 5 and ELISA test), 28 healthy subject and 23 patients with parasitic infections different from hydatidosis. The results showed 7 antigenic bands located between 8 and 120 kDa, two immunodominant bands (MW 8 and 12 kDa) were recognized by the sera of patients suffering from hydatid disease and those with positive serology. Two additional bands were detected by the sera of healthy subjects and by the samples of patients presenting cysticercosis. It is concluded that the antigens with molecular weights of 8 and 12 kDa. would be those of major diagnostic value, while those of 32 and 60 kDa are nonspecific.     

Release and survival of Echinococcus eggs in different environments in Turkana, and their possible impact on the incidence of hydatidosis in man and livestock

In Turkana, Kenya, a prevalence of hydatidosis of nearly 10% has been recorded among the pastoralists yet their livestock have a much lower prevalence of the disease. The present study investigated the release from dogs and subsequent survival of Echinococcus eggs in Turkana huts, water-holes and in the semi-arid environment. The results were compared with the survival of eggs of Taenia hydatigena and T. saginata. The study was repeated under the cooler and moister conditions found in Maasailand where livestock have a greater incidence of hydatid disease than in Turkana but where the incidence in man is ten times lower. The average number of Echinococcus eggs per proglottid is 823. Nine percent of these remain in proglottids 15 minutes after release from a dog and the released eggs lose their viability in less than two, 48 and 300 hours in the sun, huts and water in Turkana respectively: the major influencing factor being temperature. The greater survival of eggs in the houses, coupled with the fact that dogs congregate for most of the day in the small houses facilitating a close man:dog contact, provide ideal conditions for the transmission of the parasite to man. The hostile environmental conditions and lack of contact between dogs and livestock contributes to the lower infection rate in livestock. Conversely in Maasailand, Echinococcus eggs survive in the environment for longer than three weeks and in addition, dogs are used for herding. This partly explains the higher infection rate among Maasai livestock but the low human infection rate remains arcane and requires further study.(ABSTRACT TRUNCATED AT 250 WORDS)     

Treatment of hepatic hydatid disease with mebedazole: preliminary results in four cases.

Mebendazole was given to four patients with hepatic hydatid disease. In three patients hydatidosis had remained after surgery, and in the fourth it could not be treated surgically. Mebendazole was given orally in maximum doses of 400-600 mg three times a day during courses lasting 21 to 30 days. Ultrasonic echotomography showed a complete regression of the intrahepatic cysts after four to 13 months in all four cases. In three patients the course of treatment had to be repeated. Mebendazole also induced clinical improvement and a progressive lowering of the concentration of specific IgE of Echinococcus granulosus. During treatment circulating blood levels of specific immune complexes of antigen 5 were increased. These observations indicate that mebendazole has a lethal effect on E granulosus cysts in primary hydatid disease in man and that the efficacy of chemotherapy can be assessed with ultrasonography and by measuring changes in the concentration of specific IgE of E granulosus and circulating immune complexes.