Human hydatidosis in Chile. Seroprevalence and estimate of the number of infected people

Chile is located in the southwestern border of South America. The country is 4,329 km long and 96-342 wide. From north to south it is divided into five marked different biogeographical zones: deserts, steppes, bushes, forests (cattle raising) and austral (sheep raising). Population (June 1999) 15,017,760 (14.6% rural). Human hydatidosis is endemic in Chile. According to Ministry of Health information about 320 cases are registered each year. In order to find out the likely prevalence of human hydatidosis in Chile, a series of serosurveys was carried out in 1988-1997 throughout the total country. By using the indirect hemagglutination reaction and ELISA for hydatidosis (tests with good sensibility and specificity) 60,790 unselected apparently healthy persons: 41,399 from urban areas (16,428 blood donors, 13,894 delivering mothers and 11,077 middle grade schoolchildren) and 19,361 from rural areas--from randomly selected family groupings--were studied. A total individuals 82 (136/100,000) resulted positive: 36 (87/100,000) urban and 46 (241/100,000) rural, being the prevalence higher in rural areas, particularly in the southern austral zone (mean 1068/100,00). These figures agree with those observed in clinical epidemiological studies. In conformity with the present results, in the whole country 17,002 individuals should have hydatidosis: 10,318 urban and 6,784 rural. All these possible infected people, not necessarily should present pathology in the future, as it has been observed in autopsies from unselected individuals, performed at the Medico-Legal Service in Santiago, in whom 71.3% of diagnosed hydatosis with hydatid cysts in many different locations, was an autopsy finding.     

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.     

Accuracy of clinical diagnosis in a Canadian teaching hospital.

Two hundred autopsies were investigated to determine the correlation between the clinical and pathological diagnoses in three categories--major underlying disease, cause of death and significant incidental pulmonary findings. There was concurrence in diagnosis of the major underlying disease in 76% of cases, with 12% of disagreements being considered minor and 12% major. In only three cases might different management have affected the outcome had the correct diagnosis of the major underlying disease been made during life. There was concurrence of the diagnosis of the cause of death (which was often different from the underlying disease) in 64% of cases, and in 10% of cases the outcome might have been different had the clinical diagnosis been accurate. The clinical opinion that lung disease was the cause of death was confirmed at autopsy in 54% of cases, and 45% of the pulmonary causes of death as determined at autopsy had been recognized clinically. Major incidental pulmonary findings diagnosed clinically were confirmed in 76% of cases, and major pulmonary findings diagnosed at autopsy had been recognized clinically in 83%. The major sources of these discrepancies were pulmonary embolism and pneumonia. If autopsies are to play a role in patient management, clinicians will have to be made aware of discrepancies between clinical and autopsy diagnosis. The real test of efficacy would be modification of patient management for the good.     

Hydatidosis in the province of La Pampa, Argentina, 1998

Echinococcus granulosus is the agent that causes the classical hydatidosis or cystic echinococcosis. The most spread cycle in South America is the sheep-dog cycle, and offers favorable conditions for the development of the parasite. As the province of La Pampa shows an endemic presence with notification of cases and infected dogs, the present work has the aim of contributing to the study of the distribution and prevalence of the disease in the district of Maracó, La Pampa, Argentina. Dogs of 36 farms that had ovines, were dosed with arecoline hydrobromide at a dose of 3.5 mg/kg. Dogs from 27 (75%) farms resulted positive to Tenia sp. and 3 (8.3%) to E. granulosus. Blood samples were taken to all the people living in all the inquired farm and were processed by the ELISA test for hydatidosis. A retrospective survey on cases of human hydatidosis attended in the Hospital of General Pico, head if the sanitary region, and in two private clinics was performed. Analysis of clinical records indicated 11 cases operated during the period 1996/1997 (annual incidence rate of 6.8 per 100,000 inhabitants). It is of public health interest to fulfill epidemiologic investigations in other districts of the Province of La Pampa with the aim of delimitating the endemic distribution within the province and also organizing surveillance systems on human hydatidosis.     

Autopsy analyses in acute exacerbation of idiopathic pulmonary fibrosis

Background

Acute exacerbation of idiopathic pulmonary fibrosis (AE-IPF) is associated with high mortality. However, few studies have so far reviewed analyses of autopsy findings in patients with AE-IPF.

Methods

We retrospectively reviewed 52 consecutive patients with AE-IPF who underwent autopsies at five university hospitals and one municipal hospital between 1999 and 2013. The following variables were abstracted from the medical records: demographic and clinical data, autopsy findings and complications during the clinical course until death.

Results

The median age at autopsy was 71 years (range 47–86 years), and the subjects included 38 (73.1%) males. High-dose corticosteroid therapy was initiated in 45 (86.5%) patients after AE-IPF. The underling fibrotic lesion was classified as having the usual interstitial pneumonia (UIP) pattern in all cases. Furthermore, 41 (78.8%) patients had diffuse alveolar damage (DAD), 15 (28.8%) exhibited pulmonary hemorrhage, nine (17.3%) developed pulmonary thromboembolism and six (11.5%) were diagnosed with lung carcinoma. In addition, six (11.5%) patients developed pneumothorax prior to death and 26 (53.1%) developed diabetes that required insulin treatment after the administration of high-dose corticosteroid therapy. In addition, 15 (28.8%) patients presented with bronchopneumonia during their clinical course and/or until death, including fungal (seven, 13.5%), cytomegalovirus (six, 11.5%) and bacterial (five, 9.6%) infections.

Conclusions

The pathological findings in patients with AE-IPF represent not only DAD, but also a variety of pathological conditions. Therefore, making a diagnosis of AE-IPF is often difficult, and the use of cautious diagnostic approaches is required for appropriate treatment.     

Validation of qualitative test for phosphine gas in human tissues

Phosphine has been known to science since the birth of modern chemistry. WHO reports that the technical product usually has a foul odour, like "fishy" or "garlicky" because of the presence of substituted phosphines and diphosphine (P2H4). Many medico-legal autopsy cases have been reported positive for aluminium phosphide even though there was neither any suspicion of consuming aluminium phosphide nor any clinical findings, postmortem findings or circumstantial evidences. The present study was carried out to validate the qualitative test, presently applied in many laboratories for testing phosphine. It was observed that 65% of human tissues in saturated solution of common salt show positivity for phosphine gas on the first day of autopsy.     

Correlation of clinical and anatomical findings in childhood meningitis]

Clinical and anatomical findings of 76 prophylactically not irradiated children with acute leukaemia were compared. In the group of 17 children (22%) with clinically manifest symptoms of CNS involvement in the course of the illness leukaemic infiltrates were identified in the CNS at the autopsy and during histopathological examinations even in 70% in spite of clinical healing and normalization of the cerebrospinal fluid finding. In children who had either no clinical symptoms of CNS leukaemia (42 children) or only terminal symptoms in the last 24 hours of their life (17 children) leukaemic infiltrations were found in 25.4% of the cases. Non-myeloid types showed 44.5% of histopathological changes, myeloid types 22.7%. Clinical main symptoms and anatomical findings were correlated to the corresponding groups of patients and typical illustrations were added.     

An abattoir-based study of hydatidosis in the dromedary (Camelus dromedarius) in Mashhad, Iran

A 6-year retrospective study based on abattoir records was carried out to determine the prevalence of hydatidosis in dromedaries in Khorasan province in north-eastern Iran. Between 20 March 2004 and 19 March 2010, 25,255 dromedaries were slaughtered in the study area and the livers of 2791 (11.1%) and the lungs of 3289 dromedaries (13.2%) were discarded due to hydatidosis. The annual prevalence of liver condemnations due to hydatidosis decreased from 24.1% in 2004-2005 to 13.3% in 2009, and finally to 6.8% in 2010. The corresponding features for lung condemnation due to hydatidosis were relatively higher than liver, declining from 28.7% in 2004-2005 to 14.9% in 2009, and finally to 7.1% in 2010. Liver and lung condemnations due to hydatidosis were significantly higher in the spring. This could be attributed to various factors such as sources of slaughtered animals, changes in management practice and ecological factors. The present survey provides baseline data for the future monitoring of this potentially important parasitic disease in the region.     

Serologic longitudinal follow-up of surgically treated patients for hydatidosis]

Beginning with the register of human hydatidosis cases, kept by hydatidosis struggle programs of Rio Negro Province, was done the serologic longitudinal follow-up in patients operated on in the period 1980-1987, in the influence area of Ingeniero Jacobacci, Rio Negro, Argentina. The local Supervision Program obtained blood samples of 36 patients during 1990 (59% of them were operated on in the considered period), five patients died corresponding the remaining to persons to whom did not live in Ingeniero Jacobacci or to whom were not possible to evaluate. The blood samples were studied by DD5, confirming the disease immunologically in 18 cases (50%). In this work are evaluated possible causes of reinfection: surgery technic, individual susceptibility, immunological factors.     

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.     

Epidemiology of Echinococcus granulosus in Arbil province, northern Iraq, 1990-1998

During the period 1990-1998, 99 cases of human cystic hydatidosis (12.4 cases per year) were surgically treated at the two main hospitals in Arbil province, northern Iraq, and from this the human occurence for the province was estimated to be 2 per 100,000 inhabitants. In the same area, 1270 sheep, 550 goats and 320 cattle were examined at slaughter for hydatid cysts and prevalence rates were found to be 15.0%, 6.2% and 10.9%, respectively. A decreasing tendency in livestock prevalences was found towards the end of the study period. As in humans, most of the hydatid cysts in livestock were located in the liver. Fertility of sheep cysts, i.e. those containing protoscoleces, was found to be significantly higher (64%) than that of goats (35.7%) and cattle (29.8%). The percentage of fertile cysts containing viable protoscoleces varied between 63 and 82% in the livers and between 72 and 79% in the lungs of the different animal species. A total of 97 stray dogs were examined post-mortem in the years 1991, 1992 and 1998, and Echinococcus granulosus worms were found in the intestines of 48 dogs (49.5%). High worm burdens (> 1000) were observed in 37% of the dogs, medium worm burdens (200-1000) in 41%, and low worm burdens (< 200) in 22%. In 1998, the prevalence of canine echinococcosis (24.3%) was found to be significantly lower than in 1991 (70.4%) and 1992 (60.6%). The prevalence of human hydatidosis did not differ significantly over the years, but the study confirmed that hydatidosis is endemic in northern Iraq, and that housewives, labourers and farmers appear to be at the greatest risk of infection.     

西藏高原牧区肝包虫病患者CT表现分析

目的:探讨西藏高原牧区肝包虫病CT的特点,更好的指导临床诊断和治疗。方法:分析27例肝包虫病CT的特点和诊断,探讨其CT征象及价值。结果:共收集包虫病患者27例进行CT检查。单房性包虫囊肿25个,CT表现为囊性病变,囊内密度均匀,可见等密度的囊壁,囊比多均匀光滑,可有线状或环状钙化;有时合并内在性破裂,表现为内囊与外囊分离,或破碎的内囊漂浮在囊腔内。多房性包虫囊肿共2个,CT平扫可见多个子囊和程度不同的基质,囊壁可见钙化。结论:西藏高原牧区肝包虫病患者CT平扫有特定的影像特点,可以用来进行诊断     

Polyclonal carcinoembryonic antigen staining in the cytologic differential diagnosis of primary and metastatic hepatic malignancies.

In order to assess the utility of immunocytochemical staining of bile canaliculi with a polyclonal antiserum to carcinoembryonic antigen (pCEA) in the differentiation of primary hepatocellular carcinomas from metastatic malignancies, pCEA staining was performed on fine needle aspiration specimens from hepatic lesions in 60 patients. The original cytologic diagnoses were hepatocellular carcinoma in 22 patients, metastatic neoplasm or cholangiocarcinoma in 27 patients and benign hepatocytes in 11 cases. The cytologic diagnoses of malignancy were confirmed by surgical excision, autopsy or clinical investigations in 82% of the patients. Follow-up data, supported by pCEA staining, reversed the original cytologic diagnosis in three cases. Bile canalicular pCEA staining was identified in 18 of 22 cases of hepatocellular carcinoma and in all 11 benign hepatocellular aspirates. All 27 cases of metastatic malignancy or cholangiocarcinoma were negative for canalicular pCEA staining, although 11 cases exhibited cytoplasmic staining. Interpretation of pCEA staining was not affected by the intermingling of malignant cells and benign hepatocytes. Predictive values were 100% for a positive test and 87% for a negative test. These findings indicate that staining with pCEA antiserum is a useful adjunct in the differential cytologic diagnosis of malignant hepatic lesions.     

Clinicopathological study of involvement of granulocyte colony stimulating factor and granulocyte-macrophage colony stimulating factor in non-lymphohematopoietic malignant tumors accompanied by leukocytosis

Involvement of granulocyte colony stimulating factor (G-CSF) and granulocyte-macrophage colony stimulating factor (GM-CSF) in non-lymphohematopoietic malignant tumors accompanied by leukocytosis was clinicopathologically investigated. Among 1,778 autopsy cases in the last 20 years, 485 lesions of 439 cases with non-lymphohematopoietic malignant tumors accompanied by leukocytosis with a white blood cell count of 10,000/mm3 or greater during the course were immunohistologically examined for G-CSF and GM-CSF. Three (0.7%) and two cases (0.5%) were G-CSF- and GM-CSF-positive, respectively. GM-CSF mRNA was confirmed by using non-fixed cryopreserved tumor tissues in one case positive for GM-CSF. G-CSF-positive cases were large cell carcinoma of the lung, adenocarcinoma of the colon, and adenocarcinoma of the stomach, and GM-CSF-positive cases were spindle cell carcinoma of the lung and malignant thymoma. In the case with stomach carcinoma, the primary lesion showing moderately differentiated adenocarcinoma was negative, but the lung metastatic lesion showing less differentiated adenocarcinoma was G-CSF-positive. The survival period was six months or less in four out of five positive cases. The highest white blood cell count in five CSF-positive cases was markedly elevated: 29,400-103,500/mm3 (mean: 59,700/mm3). In four cases, excluding one case which may have been markedly affected by chemotherapy, the bone marrow showed hyperplasia, and the number of the granulocyte series cells significantly increased. There were three cases (0.7%) negative for both G-CSF and GM-CSF, although they showed marked leukocytosis (60,000/mm3 or higher) which were higher than the mean count of CSF-positive cases and was not observed in autopsy cases with non-tumorous diseases. Other stimulating factors may be involved in the development of leukocytosis in such cases.     

An abattoir-based study on the prevalence of hydatidosis in livestock in Mashhad, Iran

A 6-year (2004-2010) retrospective study was carried out to determine the prevalence of hydatidosis in livestock slaughtered in Mashhad abattoir, Mashhad, in north-eastern Iran and the capital of Khorasan province. Between 20 March 2004 and 19 March 2010, 5,131,485 animals (411,163 cattle; 4,547,618 sheep; 172,704 goats) were slaughtered in the study area and 388,399 (7.5%) livers and 1,139,529 (22.2%) lungs were discarded. Hydatidosis was responsible for 4% and 6.5% of total livers and lungs inspected, respectively. Of the cattle livers and lungs inspected over the survey period, 5.5% and 7.9% were condemned, respectively, because they held hydatid cysts. The corresponding values for livers and lungs of sheep (2%, 4%) and of goats (4.5%, 7.8%), respectively, were also condemned due to hydatidosis. Data showed a prominent seasonal pattern for hydatidosis. Liver condemnations due to hydatidosis were higher in winter and autumn for cattle and sheep, respectively, whereas lung condemnations were higher in summer for sheep and cattle. In goats, liver and lung condemnations were higher in winter. This could be attributed to various factors, such as sources of slaughtered animals, changes in management practice and ecological factors. The present survey provides baseline data for the future monitoring of this potentially important parasitic disease in the region.     

西藏高原牧区肝包虫病患者CT表现分析

目的：探讨西藏高原牧区肝包虫病CT的特点,更好的指导临床诊断和治疗。方法：分析27例肝包虫病CT的特点和诊断,探讨其CT征象及价值。结果：共收集包虫病患者27例进行CT检查。单房性包虫囊肿25个,CT表现为囊性病变,囊内密度均匀,可见等密度的囊壁,囊比多均匀光滑,可有线状或环状钙化;有时合并内在性破裂,表现为内囊与外囊分离,或破碎的内囊漂浮在囊腔内。多房性包虫囊肿共2个,CT平扫可见多个子囊和程度不同的基质,囊壁可见钙化。结论：西藏高原牧区肝包虫病患者CT平扫有特定的影像特点,可以用来进行诊断。     

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.     

Conventional respiratory cytology versus fine needle aspiration cytology in the diagnosis of lung cancer

The results of 184 fine needle aspiration (FNA) cytologic examinations were compared with the findings of "conventional" respiratory cytology (on sputums, bronchial brushings and bronchial washings) and histology (on biopsy and autopsy samples) and with the medical records. Positive cytologic results were obtained in 6 (10%) of 60 sputums, 17 (21%) of 80 brushings, 16 (19%) of 84 washings and 82 (44%) of 184 aspirates. These positive results were confirmed by biopsy for 6 of 6 sputums, 16 of 17 brushings and 15 of 16 washings. Among the 82 patients with a positive FNA cytology, malignancy was confirmed by lung biopsy in 39 and by autopsy in 2; the cytologic diagnosis was supported by clinical and radiographic findings in all but 1 of the remaining 41 patients. Using transbronchial lung biopsy, autopsy and medical records as final standards, the positive predictive values were 100% for sputum, 94.1% for brushings, 93.0% for washings and 98.6% for FNA samples. The high positive predictive values of FNA and the other cytologic procedures indicate that these diagnostic modalities provide simple, rapid and reliable methods for the diagnosis of lung cancer.     

Microbiology in sudden infant death syndrome (SIDS) and other childhood deaths

The usefulness of post-mortem microbiology in the assessment of sudden unexpected deaths in infants and children has been debated by many pathologists. In our centre, microbiological investigations have been part of the post-mortem protocol for investigation of sudden deaths in infants and children for the past 12 years. The objective of this study was to review the microbiological findings for infants and children examined by our unit during the past 4 years in relation to gross and histological findings of the autopsy and the medical and social histories of the children. We reviewed 57 consecutive sudden deaths in infants and children examined by our Referral Centre between November 1994 and October 1998. These 57 sudden deaths were aged from 1 day to 4 years and 9 months including 40 cases of sudden infant death syndrome (SIDS) and 17 non-SIDS deaths. Results of the microbiological investigations of tissues and body fluids were assessed during the case review with reference to histological shock signs, severe gastric aspiration, and signs of acute thymic involution. Bacteria alone or in association with viruses were identified in 45/57 (79%) cases including 34/40 (85%) SIDS. The most frequent bacterial isolate was Escherichia coli (27), and the virus identified most frequently was enterovirus (8). C-reactive protein was increased in 10 out of the 42 cases tested including 8/32 (25%) SIDS. Significant gastric content aspiration was found in 17/57 (29.8%) including 13/40 (32.5%) SIDS. Histological signs of shock were present in 33/55 (60%) cases including 22/39 SIDS (56.4%). The microbiological findings were positive for 27/33 (81.8%). We conclude that post-mortem microbiology is essential in sudden death investigation. The conclusion that a death is unexplained if no microbiology was done is not valid, even if in some cases it may be difficult to know precisely in what way the pathogen contributed to the death.