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The basic problems of culturing Echinococcus granulosus (sheep strain) in vitro, from the protoscolex to the sexually mature adult, are reviewed. Suitable procedures for the transport, storage and sterile dissection of hydatid material are described. Protoscoleces for culture are freed from brood capsules by treatment with pepsin, washed repeatedly in saline, and evaginated in a solution of sodium taurocholate. Evaginated protoscoleces are cultured in a diphasic medium comprising approximately 80% Parker 858 (with additional glucose, K+ and yeast extract) plus 20% foetal calf serum over a solid base of bovine or calf serum coagulated at 76°C. Static bottle cultures or a continuous circulating system with a gas phase of 5 % CO2+10% O2 in N2 are used. Foetal calf serum proved to be the most unreliable component of the culture medium, different batches varying greatly in both growth stimulating properties and in toxicity. Variations in the properties of other components (e.g. bile salts) were also noted. Detailed descriptions are given of the various stages of development of strobilated worms, especially those prior to segmentation. Identification of these stages is essential if early assessment of the growth properties is to be made. In the most successful cultures, the rate of development lagged only a few days behind that in the dog. In the majority of cultures, however, maturation required 30–50 per cent longer than in the dog. In worms developing to sexual maturity in vitro, the uterus of gravid proglottids was filled with ova; the latter failed to give rise to embryonated eggs. The receptaculum seminis of cultured worms was empty of sperm (in contrast to dog worms) indicating that impregnation had not taken place. Attempts to induce impregnation and subsequent fertilization have so far proved unsuccessful. The development of non-infective (i.e. eggless) worms, nevertheless, has an advantage from the safety point of view.

Serum IgE concentration is measured, according to the Rowe modification of the Mancini technique, in non-atopic patients suffering from various helminthic or protozoal infections. Our results indicate that the IgE level is often raised in parasitosis with prominent tissue phases and remains normal with helminths whose life is restricted to the lumen of the digestive tract. In addition, our observations show that, with helminthic or protozoal infestations, the serum IgE level tends to increase significantly and rapidly following a specific treatment of the parasitosis. Afterwards, the serum IgE level decreases slowly and may return to the normal in a few months. Thus, repetitive evaluations of serum IgE concentrations, before and after therapy, appear to be of a diagnostic value in the cases where a vague clinical picture is suggesting an helminthic parasitosis.

An antibody, named anti-Lu 11, has been found that reacts with a high-frequency red-cell antigen related to the Lutheran blood group. The reacting antigen is absent from red cells that are Lu(a-b-) and is weakly active on the red cells of newborn infants.

A new method is presented for the isolation of purified Echinococcus granulosus antigens from sheep hydatid fluid. Echinococcus granulosus antigens were separated from the host's serum contaminants by absorbing sheep serum proteins with specific immunoabsorbents. No net sensitivity gain was obtained by using these purified antigens rather than crude sheep hydatid fluid in hemagglutination and immunoelectrophoretic tests. The presence of two major antigens (≥ 400,000 and 150,000 MW) was confirmed, the larger component being clearly the most immunoreactive. Evidence of a third slightly antigenic fraction of low molecular weight is presented. The effectiveness of labeled major Echinococcus granulosus antigens in radioimmunoprecipitation test is reported.

Roentgen analysis of 50 cases of hydatid disease of the lungs is presented.The hydatid cysts of the lungs were commonly solitary, well circumscribed, polycyclic, unruptured, at the lung bases, and at the posterior segments.They exhibited different rates of growth in the same patient with a maximum growth of 7 cm. in 7 months. The presence of 2 or more large well circumscribed masses were found to be virtually pathognomonic of simple hydatid cysts. Characteristics of multiple small cysts are presented.The roentgen manifestations of rupturing and ruptured hydatid cysts included the classical roentgen signs; i.e., the crescent sign, the double arch sign, and the water lily sign. The "membrane" sign on bronchography and tomography and the "daughter cyst" sign are described and illustrated.Included also are cases showing: empty pericyst; pericyst effusion; hydatid lung abscess; pleural reaction; pleural effusion; and empyema. Accompanying types of pneumonitis included the peri-pericyst allergic and bacterial p...

Host IgG was revealed in the concentric lines of the laminated membranes of mouse, human, gerbil, and sheep hydatid cysts by the indirect fluorescent antibody test on cryostat and paraffin embedded sections. The penetration of these immunoglobulins into the laminated membrane was demonstrated by transplantation studies. Peroxidase (MW 40,000) and fluorescein-labeled rabbit IgG (MW 150,000) were also shown to reach the germinal membrane by in vitro studies. The results are discussed in terms of their immunological and pharmacological implications, present knowledge on the penetration of macromolecules into hydatid cysts and the structure of the laminated membrane.

Summary Five cases of atypical hydatid cyst of the kidney are present. Four cases simulated kidney tumours and 1 an infectious lesion, but were misdiagnosed on account of the absence of the typical signs and finding of hydatid disease. With the increase in world travel hydatid disease should be included in the differential diagnosis of all other kidney masses, especially when they are atypical.

Summary Of 62 patients with cerebral hydatid cysts, 22 (35%) had epilepsy, 10 children and 12 adults. The most frequent type of fit was sensorimotor focal seizures. Postoperative seizures were confined to the immediate postoperative period or appeared with relapses (six patients) or as delayed epilepsy in patients with (four) or without (four) epileptic manifestations before operation. The main pathogenic factors were subcortical location of the parasite and slowly progressing compression that produced marked destruction and ischemia. RESUME Sur 62 patients ayant un kyste hydatique cerebral, 22 (35%) presentaient une epilepsie: 10 enfants et 12 adultes. Les crises les plus frequentes etaient des crises focales, sensorimotrices. En periode post-operatoire, les crises epileptiques apparais-saient immediatement, ou plusieurs mois apres dans les rechutes (six patients) ou plus tardivement chez des patients presentant (quatre)ou non (quatre) des crises avant 1'intervention. Les facteurs pathogeniques plus importants consistaient dans la localisation subcorticale du parasite et dans les phenomenes de compression lente et progressive aboutissant a d'importantes lesions de nature ischemique. ZUSAMMEnfassung Von 62 Patienten mit cerebralen Hydantiden hatten 22 (35%) Epilepsie, davon 10 Kinder und 12 Erwachsene. Die haufigste Anfallsform waren sensomotorische fokale Anfalle. Postoperative Anfalle waren beschrankt auf die unmittelbare postoperative Periode oder traten auf mit Ruckschlagen (sechs Patienten) oder als verzogerte Epilepsie bei Patienten mit (4) oder ohne (4) Manifestation von Epilepsie vor der Operation. Die wesentlichen pathogenetischen Ursachen waren subcorticale Lokalisation des Parasiten und langsam anwachsender Druck der deutliche Destruktion und Ischamie verursachte. RESUMEN Entre 62 enfermos con quistes hidatidicos cerebrales, 22 (35%)tenian epilepsyia, de los cuales 10 eran ninos y 12 adultos. La manifestacion clinica mas frecuente fueron los ataques focales sensorial-motores. Los ataques post-operatorios se limitaron al periodo post-operatorio inmediato apareciendo remisiones en 6 enfermos. La forma de epilepsyia tardia se presento en 4 enfermos con manifesta-ciones epilepticas previas a la operacion y en otros 4 sin epilepsia previa. Los factores patogenicos mas importantes fueron la localization subcortical del parasito y la compresion progresiva produciendo marcada destruction e isquemia.

The clinical presentation, pathology, and appropriate surgical management of cysts of the liver were analyzed in a review of 150 cases of hepatic cystic disease encountered surgically at the Mayo Clinic from Jan. 1, 1954, through Dec. 31, 1971. The incidence of this disease was 17 per 10,000 abdominal explorations. The series included 82 solitary cysts, of which 15 produced symptoms; 49 multiple cysts, of which 7 were symptomatic; 13 hydatid cysts, of which 12 were symptomatic; 3 traumatic cysts, of which 2 were symptomatic; and 3 inflammatory cysts, of which 1 was symptomatic. Symptoms, when present, comprised (in order of frequency) the presence of an abdominal mass, abdominal pain, and hepatomegaly. Congenital and hydatid cysts were located most often in the right lobe of the liver. The smallest cysts were the multiple cysts (average diameter, 4.3 cm) and the largest were the hydatid cysts (average diameter, 10.5 cm). Histologically, the lining of the congenital cysts most often was of cuboidal epithelium. The treatment of congenital cysts included simple biopsy, aspiration, and excision. In cases of hydatid cysts, preliminary sterilization was found to be essential prior to aspiration. Hydatid cysts may be excised or opened, evacuated, and the cavity obliterated. In certain cases hepatic resection may be warranted in order to remove all of the hydatid disease.

During the last 35 years 114 children were treated in the Royal Children's Hospital for hydatid disease. The disease is commoner in boys and is more common in the lung than in the liver. The incidence of the infestation at the Royal Children's Hospital has fallen, and a comparison is made with its incidence in the rest of Australia. The presenting symptoms are described, and the treatment of cysts in various sites is discussed.

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.

Echinococcosis is a disease prevalent both in man and animals with no effective therapeutic measures established against it so far, except for surgical removal of the cyst in humans. Attempts have been made to compare the properties of certain enzymes present in the parasite with those of the corresponding host in the hope of discovering inhibitors that would inhibit the parasite enzyme(s) selectively. In the present report certain properties of phosphoglucose isomerase of the ovine liver cyst fluid have been compared with those of the healthy ovine liver. The enzymes from both sources purified by the same procedure exhibited the following properties: (1) identical pH optimum (8.5), (2) no detectable inhibition in the presence of phosphate ion up to 4.1 mM, (3) marked differences in the K m value, 8.7 mM and 10.7 mM for the parasite and host enzymes respectively, and (4) higher thermostability of the parasite enzyme as compared with the host enzyme.

Summary Three cases of primary neoplasm of the liver are presented. The first patient, with a tumour mass in the right lobe, showed a small area of calcification within the tumour. The second patient, with a tumour in the left lobe showed radiological features simulating enlargement of the spleen. A third patient, whose tumour was discovered at post-mortem is presented briefly. Evaluation of the pattern of liver calcification in the diagnosis of hepatoma is stressed and the role of Alpha-fetoprotein estimation is also discussed.

Summary A glycoprotein with blood group P 1 specificity isolated from sheep hydatid cyst fluid was subjected to partial acid hydrolysis. The hydrolysis products were separated by preparative paper chromatography. One oligosaccharide with strong P 1 serological activity was characterised as a trisaccharide composed of galactose and glucosamine in the molar ratio of 2:1. Reduction with sodium borohydride gave galactose and glucosaminitol. Methylation analysis and degradation with specific α - and β - galactosidases showed the structure of the P 1 determinant to be D-galactosyl-α(l→4)-D-galactosyl-β(l→4)-N-acetyl-D-glucosamine.

A study of the records of 82 California hospitals, including 64.8% of hospital beds in the Central Valley and practically all of the state's referral beds, disclosed 69 cases of hydatid disease, 61 of them from the decade 1960–69. Among the 13 California-born patients, three new cases were found that were autochthonous to this state. Two modes of infection may be recognized among these patients. One involves principally native Californians plus immigrants from the Basque country of Spain and France and is associated with the sheep industry in the Central Valley of California. The second involves the more cosmopolitan urban populations of this state. The former mode includes infections acquired in California, while the latter represents mainly foreign-born patients from a number of countries in which infection with Echinococcus granulosus is endemic.

Hydatid disease is endemic in India. From 1952 through 1965 45 patients with intrathoracic hydatid disease have been operated at this hospital. No case of mediastinal hydatid cyst was seen. There were three cases who had hepatic or subdiaphragmatic hydatid disease which ruptured into the pleura. Twelve of the cases had multiple cysts. The clinical and radiologic features are described and illustrated. Bronchoscopy and endotracheal suction should not be done in patients who have unruptured hydatid cysts. The treatment of choice for all intrathoracic hydatid cysts is surgical removal. The technique in all simple cysts and in many complicated cysts is enucleation, closing the pericyst layer with lung suture as in other segmental resections. Occasionally segmentectomy or lobectomy is required if there has been chronic spillage and infection. The mortality rate was 2 per cent. Long term morbidity occurred in the patients who had empyema or abdominothoracic disease caused by ruptured cysts. One case developed broncho-pleurocutaneous fistula. One case later had lobectomy for bronchiectasis. All other cases had excellent results with quick recovery and without recurrence.

Summary In a series of 106 cows both the intradermal and complement fixation tests for hydatid disease were done to compare their relative values. These tests were checked by examination of the organs after slaughtering. Of 44 cows in which hydatid cysts were found, 38 or 86.3 per cent had a positive skin test, and 26 or 59 per cent had a positive complement fixation test. There were eleven false positive skin tests and ten false positive complement fixation tests. The rest of the series agreed with the findings in the organs. One of the two tests was positive in all of the cows in which hydatid cysts were found.

Summary. A surgical, pathological and parasitologics curiosity in the shape of a case of hydatid disease of the liver showing lesions of the alveolar type is described, illustrated and discussed. This is the first case of its kind recorded in New Zealand and is comparable to the case unique in Australia reported by Professor H. R. Dew in this journal of September, 1931. Reference is made with bibliographic excerpts to the few cases of the alveolaris type that have arisen in countries other than its peculiarly selected endemic home, the Bavaro-Tyrolean district. Some attention is given to the age-long controversy “dualists versus unicists”, regarding the vexed question as to whether the alveolaris lesion is due to a specific Taenia alveolaris or to a mere modification or mutation of the ordinary Taenia echinococcus

A case of solitary Echinococcus cyst of the lung was presented. The diagnosis can be suspected from the clinical history which should include animal contact. The presented patient had been in an endemic area; however, cases can occur in individuals who have never left the United States. This patient had a solitary pulmonary mass. The mass grew in size under observation with a pleural effusion which cleared spontaneously. The laboratory work-up was completely negative including lack of eosinophilia and a negative Casoni and complement fixation test. The semilunar air shadow within the mass suggested the preoperative diagnosis of Echinococcus cyst of the lung. If the diagnosis is considered, it is possible that it may be established preoperatively with increasing frequency.

The host–parasite interface is defined broadly as a region of intimate contact between host and parasite surfaces. The limitations of this definition are considered. The difficulties of studying the morphology, ultrastructure, and physiology of this region are discussed. Possible host–parasite interfaces appear to fall (theoretically) into one of the following categories: type 1: membrane-to-membrane; type 2A: cytoplasm-to-membrane; type 2B: membrane-to-cytoplasm; type 3: cytoplasm-to-cytoplasm. Phenomena associated with the interface region are various forms of membrane transport, pinocytosis, excretion, secretion, and membrane (= contact) digestion. The apparent role of the interface in differentiation in the protozoan Gregarina polymorpha and the cestode Echinococcus granulosus are discussed. The immunological significance of intimate contact between host and parasite and the various hypotheses to account for the (apparent) 'molecular mimicry' by the parasite, of host surface antigens, are briefly summarized.

Summary 1. A case of hydatid cyst of the brain, occurring in a Turkish Cypriot living in this country, is reported. 2. The difficulties of diagnosis, and in particular, the differentiation of the condition from a cerebellar tumour are described. 3. The importance of avoiding ventriculography is mentioned, and, if it be performed, of recognising the characteristic appearances of air around the cyst giving a crescent shaped appearance.

Summary Gel-diffusion analysis of sheep hydatid fluid (SHF) antigen and antisera prepared from hydatid fluid and various sheep serum fractions showed ten components: three were identified as major parasite antigens, four as host antigens and three were unidentified. Lines produced by SHF and diagnostic human sera were almost exclusively identified with the parasite components. Diffusion coefficients of the parasite antigens were calculated as 1.2, 2.3 and 3.5 × 10-7 cm2/sec by the Allison and Humphrey right angle method. Measurements of the host components were compatible with the serum gamma globulins and albumins with which they were identified.

1. The radiological features of skeletal hydatid disease are discussed. Osseous lesions occur in about 1 to 2 per cent of cases, bone being involved only after the embryos have passed the filters provided firstly by the liver and secondly by the lungs. At first, ill defined areas of translucency appear which are not diagnostic. In developed lesions, clear-cut destructive areas, with a surrounding sclerotic reaction, become visible. The cysts thin and expand the cortex and tend to spread throughout an affected bone. In advanced stages the cortex is ruptured, and exuberant hydatid cyst growth takes place in the adjacent soft tissue. Around this an ectocyst forms, which may later calcify, indicating death of the parasite. The progress of the disease is very slow. 2. Three cases of affection of the thoracic spine are described, and the differential diagnosis is considered, particularly from plasmacytoma and neurofibroma. Each case presented with cord pressure symptoms. Operative decompression relieved these totally in one case, incompletely in another, and not at all in the third and most advanced case. 3. With rapid and easy travel in the modern world hydatid disease is liable to be seen in areas where it is not endemic.

It is concluded that E. sibiricensis is the etiologic agent of alveolar hydatid disease in man. The cestode has a wide distribution in Eurasia, and St Lawrence Island apparently represents the north-easternmost extent of its range. The study of the cestode in Europe has been complicated by the co-existence of E. granulosus, which does not occur on St Lawrence Island. Microtine rodents, particularly Microtus spp. and Clethrionomys rutilus, are the natural intermediate hosts of this cestode, although other species of mammals, including man, are parasitized with varying degrees of success on the part of the larval cestode.

Male and female albino mice were inoculated peritoneally with live scolices of Echinococcus granulosus. A group from each sex was then treated weekly with the homologous sex hormone while another group, also from each sex, received the heterologous hormone. The rest of the animals served as controls. After 21 weeks, the mice were killed and the number and size of cysts found in their abdomens and chests were determined. It was evident that female mice harbored fewer and smaller cysts than the males. This was indicative that male hosts were more susceptible to infection with hydatid. Moreover, the course of the infection was modified by treatment with exogenous hormones. In fact, testosterone seemed to increase the susceptibility of animals of both sexes while estradiol tended to decrease susceptibility. The magnitude of these differences showed a statistically significant inhibition of infection in female mice and thus may account for the variable extent of infection in the groups of mice of mixed sexes. The relationship of gonadal hormones to host resistance in hydatidosis as well as to other helminthic infection, at large, is discussed.