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Hydatid disease caused byA total of fifty-seven children diagnosed with hydatid disease were analyzed retrospectively from hospital records. Diagnosis was based on clinical, serological and radiological findings. Treatment response was evaluated with clinical, radiological and serological findings.The male/female ratio of 57 cases was 2.4:1 and the mean age was 113.6±45.9 months. The most common presenting complaint was abdominal pain (42.1%). While 22 (38.6%) of the cases had eosinophilia; indirect hemagglutination test positivity was detected in 27 cases (47.4%). Multiple organ involvement was present in 18 cases (31.6%). In patients with multiple organ involvement, the possibility of cysts being located in the abdomen was higher (p=0.005). Of the 50 cases (87.7%), 45 (78.9%) were operated with open surgery and 5 (8.8%) with percutaneous aspiration-injection-reaspiration method for treatment. There were 52 (91.2%) patients who were given albendazole in conservative treatment and the mean duration of treatment was 15.5±17.2 months. There were 10 cases (17.5%) who developed cyst rupture and the symptom duration was shorter than the cases without cyst rupture (p=0.017). Cyst rupture was more common in cases with dyspnea and fluid discharge from the mouth called rock water (p=0.001, p=0.005, respectively). Recurrence was observed in five cases (8.8%) during follow-up.In areas where the disease is endemic, despite prevention and control programs consisting of personal habits and health education, active transmission of hydatid disease is seen in children and continues to be an important public health problem. Hydatid disease should definitely be considered in the presence of suspicious radiological and clinical findings in endemic areas. Controlled clinical studies are required for diagnosis and treatment procedures.Hidatik hastalığı,Hidatik hastalığı tanılı 57 çocuk olgu, hastane kayıtlarından geriye dönük olarak incelendi. Tanı, klinik, serolojik ve radyolojik bulgulara dayandırıldı. Tedavi yanıtı klinik, radyolojik ve serolojik bulgularla değerlendirildi.Toplam 57 olgunun erkek/kız oranı 2.4:1 ve yaş ortalamaları 113,6±45,9 ay idi. En sık görülen başvuru yakınması karın ağrısıydı (%42,1). Olguların 22’sinin (%38,6) eozinofilisi mevcutken; indirekt hemaglütinasyon test pozitifliği 27 olguda (%47,4) saptandı. Olguların 18’inde (%31,6) çoklu organ tutulumu vardı. Çoklu organ tutulumu olanlarda, kistlerin batın yerleşimli olma olasılığı daha yüksek bulundu (p=0,005). Tedavi amacıyla cerrahi girişim uygulanan 50 olgudan (%87,7), 45’inin (%78,9) açık cerrahi, 5’inin (%8,8) perkütan aspirasyon, enjeksiyon ve reaspirasyon yöntemi ile opere olduğu saptandı. Konservatif tedavide Albendazol verilen 52 (%91,2) olgu mevcuttu ve tedavi süreleri ortalama 15,5±17,2 aydı. Kist rüptürü gelişen 10 olgu (%17,5) mevcuttu ve semptom süreleri, kist rüptürü gelişmeyen olgulara göre daha kısaydı (p=0,017). Dispne görülen ve ağızdan kaya suyu gelen olgularda kist rüptürü olma olasılığı daha yüksek bulundu (sırasıyla p=0,001, p=0,005). İzlemde beş olguda (%8,8) nüks geliştiği görüldü.Hastalığın endemik olduğu bölgelerde kişisel alışkanlık ve sağlık eğitiminden oluşan önleme ve kontrol programlarına rağmen, hidatik hastalığının aktif geçişi çocuklarda görülmekte ve önemli bir halk sağlığı sorunu olmaya devam etmektedir. Endemik bölgelerde şü pheli radyolojik ve klinik bulgular varlığında hidatik hastalığı mutlaka akla getirilmelidir. Tanı ve tedavi prosedürleri oluşması adına, kontrollü klinik çalışmalara ihtiyaç duyulmaktadır.

Cystic echinococcosis (CE) is a common zoonotic infection in all provinces of Iran, especially in areas where people live on agriculture and animal husbandry. The current cross-sectional population-based study is aimed at determining the seroprevalence of CE in Kavar County, Fars province, southern Iran. Blood samples were collected from 1500 individuals (749 males and 751 females). Anti-hydatid cyst antibodies were detected, using a recombinant B8/1 antigen of Echinococcus graunlosus in an ELISA system. Multivariate logistic regression analysis was used to find out the independent risk factor for CE seropositivity. Anti-hydatid cyst antibodies were detected in the sera of 131 out of 1500 participants, corresponding to a seroprevalence rate of 8.73%. With a statistically significant difference ( p < 0.05 ), the seroprevalence of hydatid cyst in males and females was 5% and 7%, respectively. Differences in the seropositivity of hydatid cysts were also statistically significant by occupation ( p < 0.05 ). The seroprevalence of hydatid cyst was significantly higher in the age group of 35-45 years than in other age groups ( p < 0.05 ). Multivariate logistic regression showed that only age was associated with seropositivity to CE ( OR = 2.23 , 95% CI: 1.33-3.72). Moreover, there was a statistically significant association between seropositivity to hydatid cysts and underlying diseases such as hypertension ( p = 0.049 ) and fatty liver ( p = 0.048 ). The findings of this study indicate that the seroprevalence rate of CE is relatively high in the Fars province, southern Iran, and this high rate of infection is mainly linked to people’s jobs and lifestyles.

Background Alveolar hydatid disease caused by the tapeworm Echinococcus multilocularis is a parasitic disease present in the northern hemisphere. Echinococcus multilocularis is a parasite of canid and felid carnivores as defnitive hosts, and small mammals, particularly rodents as intermediate hosts. Other animal species and humans can be aberrant intermediate hosts for this parasite. It is known that besides acting as defnitive hosts, domestic dogs can rarely become infected with the larval form of E. multilocularis and develop alveolar echinococcosis; however, a role of wild canids as aberrant intermediate hosts has not been documented until now. To the best of our knowledge the present paper provides the frst description of alveolar hydatid disease in a golden jackal (Canis aureus). Case Presentation Necropsy of the yearling female animal found a large, round, tumor-like mass, 20 cm in diameter, with a rough, multilobulated surface in the abdominal cavity, connected to the liver and omentum. On the cut surface this tumorlike lesion was multicystic, with a number of locular cavities flled with a clear yellowish to orange watery fuid and a large area of necrosis in the central part of the mass. Histopathology revealed multiple cystic spaces separated by fbrous sheaths and infammatory cells—lymphocytes, plasma cells, neutrophil and eosinophil granulocytes. The cysts contained either pale, hyaline, eosinophilic laminar and occasionally amorphous, acellular, PAS-positive structures, or metacestodes with invaginated protoscolices. In several cysts round calcifed bodies (calcareous corpuscles) were noted. Microscopic examination showed everted and inverted protoscolices which were attached to fragments of the brood capsule or free in hydatid fuid. By comparing consensus nucleotide sequence of 457 bp obtained by PCR reaction with sequences deposited in NCBI GenBank it is determined that it was 100% identical with E. multilocularis sequences under accession numbers MH259778.1, MH259776.1, AB668376.1, EU704124.1 and AB018440.2. Conclusions The present paper provides a proof that the golden jackal, besides being a defnitive host, can also serve as the aberrant intermediate host for E. multilocularis.

The peritoneum is a unique serosal membrane, which can be the site of primary tumors and, more commonly, secondary pathologic processes. Peritoneal carcinomatosis is the most common malignant condition to affect the peritoneal cavity, and the radiologist plays an important role in making the diagnosis and assessing the extent of disease, especially in sites that may hinder surgery. In this review, we address the role of the radiologist in the setting of peritoneal pathology, focusing on peritoneal carcinomatosis as this is the predominant malignant process, followed by revising typical imaging findings that can guide the differential diagnosis. We review the most frequent primary and secondary peritoneal tumor and tumor-like lesions, proposing a systemic approach based on clinical history and morphological appearance, namely distinguishing predominantly cystic from solid lesions, both solitary and multiple.

Hydatid disease is an endemic zoonotic disease caused by the cestode Echinococcus multilocularis and Echinococcus granulosus. Intra-ventricular hydatid cysts are extremely rare. Even more rarely, and to the best of our knowledge, only three cases of third ventricle involvement have been reported. Herein, we present the fourth case of an intraventricular hydatid cyst in a pediatric patient located in the third ventricle. It is about a 7-year-old girl, of a rural origin, admitted for intracranial hypertension, deterioration of the general status, and weakness on the right side of her body. A cerebral magnetic resonance imaging (MRI) showed the presence of a rounded cystic formation in the third ventricle. The patient was operated through a transfrontal transventricular approach, and the cyst was removed. Postoperative course was uneventful. Hydatid disease should be considered part of the differential diagnosis for cystic lesions of the central nervous system, especially in endemic regions. Total removal of the cysts without rupture is a challenge, but best treatment remains an active nationwide prevention.

Background: Human cystic echinococcosis (CE), most commonly caused by echinococcosis granulosis, is the most common presentation of hydatid disease of the liver and is considered endemic in the Mid...

This study aimed to evaluate the value of perfusion-weighted magnetic resonance imaging (MR-PWI) in assessing cerebral alveolar echinococcosis (CAE) biological activity.Totally, 15 cases of CAE patients who underwent surgery were enrolled. The MR-PWI perfusion parameters were measured and compared.The MR-PWI perfusion parameters cerebral blood flow (CBF), cerebral blood volume (CBV), and mean transit time were different among different areas. Their values were in the descending order of lesion marginal areacontralateral normal brain arealesion center area. However, time-to-peak value was in the ascending order of lesion marginal areacontralateral normal brain arealesion center area. Spearman correlation analysis showed that CBF and CBV at the edge of the lesion were significantly positively correlated with microvessel density. Moreover, CBF and CBV at the edge of the lesion were also significantly positively correlated with maximum standardized uptake value.Perfusion-weighted magnetic resonance imaging can be used to dynamically reflect the neovascularization of CAE lesions and may have a good application prospect in evaluating the biological activity of CAE.

Background Cystic echinococcosis (CE), caused by the larval stage of the complex Echinococcus granulosus sensu lato (s.l.), is a zoonotic parasitic disease with a high social burden in China. E. ortleppi is a species (formerly genotype 5 of E. granulosus s.l.) with unique epidemic areas (tropical areas), transmission patterns (mainly cattle origin), and pathological characteristics (large and small hook lengths) compared to other species that cause CE. A 19-year-old female patient in an area with no history of echinococcosis in Guizhou Province, China, was diagnosed with E. ortleppi infection in 2019. This study is to understand the source of this human E.ortleppi infection. Methods We performed computer tomography (CT) scans, surgical operation, morphological sectioning, molecular diagnosis, phylogenetic analyses, and epidemiological investigation in Anshun City, Guizhou Province, China in 2019. Results The patient presented with intermittent distension and pain in the upper abdomen without other abnormal symptoms. Routine blood examination results were normal. However, abdominal CT revealed a fertile cyst with a diameter of approximately 8 cm, uniform density, and a clear boundary, but without an evident cyst wall in the right lobe of the liver. The cyst was fertile, and phylogenetic analyses revealed that the isolates represented a new E. ortleppi genus haplotype. A result of 10‒14 years incubation period with indigenous infection was considered available for the case through the epidemiological survey. Conclusions CE due to E. ortleppi infection can be confused with other diseases causing liver cysts, resulting in misdiagnosis. A transmission chain of E. ortleppi may exist or existed in the past in the previously considered non-endemic areas of echinococcosis in southwestern China. Graphic abstract

BACKGROUND When Echinococcus multilocularis infects humans as a false intermediate host, alveolar echinococcosis (AE) usually manifests primarily intrahepatically and is initially asymptomatic. If the disease remains undiagnosed and untreated, progressive growth occurs, reminiscent of malignant tumours. The only curative therapy is complete resection, which is limited to localised stages, and palliative drug therapy is used otherwise. Consequently, early diagnosis and reliable detection of AE lesions are important. For this reason, abdominal ultrasonography, as the most common primary imaging for AE, relies on classification systems. AIM To investigate how hepatic AE lesion sonomorphology changes over time in the Echinococcosis Multilocularis Ulm Classification (EMUC)-ultrasound (US) classification. METHODS Based on data from Germany’s national echinococcosis database, we evaluated clinical and US imaging data for 59 patients according to the AE case definition in our preliminary retrospective longitudinal study. There had to be at least two liver sonographies ≥ 6 mo apart, ≥ 1 hepatic AE lesion, and complete documentation in all US examinations. The minimum interval between two separately evaluated US examinations was 4 wk. The AE reference lesion was the largest hepatic AE lesion at the time of the first US examination. To classify the sonomorphologic pattern, we used EMUC-US. In addition to classifying the findings of the original US examiner, all reference lesions at each examination time point were assigned EMUC-US patterns in a blinded fashion by two investigators experienced in US diagnosis. Statistical analysis was performed using SAS version 9.4 (SAS Institute Inc., Cary, NC, United Stated). P values < 0.05 were considered statistically significant. RESULTS The preliminary study included 59 patients, 38 (64.5%) women and 21 (35.6%) men. The mean age at initial diagnosis was 59.9 ± 16.9 years. At the time of initial ultrasonography, a hailstorm pattern was present in 42.4% (25/59) of cases, a hemangioma-like pattern in 16.9% (10/59), a pseudocystic pattern in 15.3% (9/59), and a metastasis-like pattern in 25.4% (15/59). For the hailstorm pattern, the average lesion size was 67.4 ± 26.3 mm. The average lesion size was 113.7 ± 40.8 mm with the pseudocystic pattern and 83.5 ± 27.3 mm with the hemangioma-like pattern. An average lesion size of 21.7 ± 11.0 mm was determined for the metastasis-like pattern. Although the sonomorphologic pattern remained unchanged in 84.7% (50/59) of AE reference lesions, 15.3% (9/59) showed a change over time. A change in pattern was seen exclusively for AE lesions initially classified as hemangioma-like or pseudocystic. A total of 70% (7/10) of AE lesions initially classified as hemangioma-like showed a relevant change in pattern over time, and 85.7% (6/7) of these were secondarily classified as having a hailstorm pattern, with the remainder (1/7; 14.3%) classified as having a pseudocystic pattern. A total of 22.2% (2/9) of AE lesions initially classified as pseudocystic showed a relevant change in pattern over time and were classified as having a hailstorm pattern. For AE lesions initially classified as having a hailstorm or metastatic pattern, no pattern change was evident. All patients with pattern change were on continuous drug therapy with albendazole. CONCLUSION The sonomorphology of hepatic AE lesions may change over time. The hemangioma-like and pseudocystic patterns are affected.

This study was conducted to determine the period prevalence of hydatid cysts isolated from the livers of cattle slaughtered at a slaughterhouse in Konya.For this purpose, 49,545 cattle were slaughtered and examined for the presence of hydatid cysts in the liver. The study was conducted between June 01, 2018, and May 31, 2019.The highest prevalence of hydatid cysts was observed in autumn 10.83% followed by spring 4.41%, winter 2.90%, and summer 2.66%, with an overall prevalence of 3.93%. Considering the month wise prevalence of hydatid cyst, the highest infection rate was detected in September (7.87%), June (7.16%) and August (7.14%), while the lowest prevalence was observed in February (2.72%) and January (2.83%). In gender-wise investigation, highest prevalence was observed in females (24.65%) during the summer and 18.45% inthe spring. In male animals, the infection rate was very low compared with females. However, the highest prevalence in males was observed throughout the year in autumn (2.36%) and the lowest prevalence in winter (1.68%). The highest prevalence was found among female cattle in heifers in winter (6.52%) and cows in summer (27.52%).The overall economic losses of 56,434 USD were estimated due to discarded hydatid cyst-infected livers during the study period. This study enlightens the prevalence and economic significance of hydatidosis in Konya.Araştırma Konya’da bir mezbahada kesilen sığırların karaciğerinden izole edilen kist hidatiklerinin mevsimsel prevalansını belirlemek amacıyla yapılmıştır.Toplam 49,545 kesilmiş sığır, karaciğerde kist hidatik varlığı yönünden incelendi. Çalışma 1 Haziran 2018 ile 31 Mayıs 2019 tarihleri arasında gerçekleştirildi.En yüksek kist hidatik prevalansı sonbaharda (%10,83) gözlendi. Bunu ilkbahar (%4,41), kış (%2,90) ve yaz (%2,66) mevsimi izledi. Genel prevalans ise %3,93 idi. Ay bazında kist hidatik prevalansına bakıldığında en yüksek enfeksiyon oranı Eylül (%7,87), Haziran (%7,16) ve Ağustos (%7,14) aylarında tespit edilirken, en düşük prevalans Şubat (%2,72) ve Ocak (%2,83) aylarında görüldü. Cinsiyet açısından bakıldığında en yüksek prevalans dişi hayvanlarda yaz mevsiminde (%24,65) ve ilkbahar mevsiminde (%18,45) rastlandı. Erkek hayvanlarda enfeksiyon oranı dişilere göre çok düşüktü. Ancak yıl boyunca erkeklerde en yüksek prevalans sonbaharda (%2,36) ve en düşük prevalans kışta (%1,68) gözlendi. Dişi sığırlar arasında düvelerde kış döneminde (%6,52) olan en yüksek prevelans, ineklerde yaz aylarında (%27,52) olarak tespit edilmiştir.Çalışma süresi boyunca kist hidatik ile enfekte karaciğerlerin imhası nedeniyle toplam 56,434 USD’lik ekonomik kayıp tahmin edilmiştir. Çalışma, Konya’da hidatidozun yaygınlığı ve ekonomik önemi hakkında fikir vermektedir.

Hydatidosis is an endemic parasitosis in Tunisia that affect mostly the liver and the lung. Brain involvment is rare.To focus on diagnostic, therapeutic and evolutive characteristics of cerebral hydatidosis.We report all cases of cerebral hydatidosis seen in the infectious diseases and neurosurgery departments between January 2013 and June 2020.Six cases of intracranial hydatid cyst were reported. The male to female ratio was 3:3. Age ranged from 3 to 60 years with a median age of 20,5 years. All patients lived in rural areas. The clinical symptomatology was progressive in 4 cases. It was dominated by headache (all cases). Brain imaging confirmed the diagnosis in all cases. The hydatid cyst was solitary and supratentorial in 3 cases. All the patients were operated. Albendazole was prescribed immediately after surgery, for 6 months in 5 cases and for 3 years in the case of disseminated hydatidosis. The outcome was favorable without recurrence in all patients with an average follow-up of 3,5 ± 0,5 years.Hydatid cyst of the brain is characterized by the severity of the neurological signs, the mandatory use of surgery because of life threatening and the excellent outcomes.

Cystic echinococcosis (CE) is a parasitic zoonosis caused by the larval stage of Echinococcus granulosus sensu lato with medical importance and economic effect. This study was carried out in Sulaimani province, Kurdistan Region, Iraq from October 2020 to November 2021. The study focused on the prevalence of cystic echinococcosis in slaughtered animals. The total prevalence was 8% (1324/16524), with a high rate in sheep (5.3%) and low rates in goats and cattle (1.9% and 0.76%, respectively). With respect to abattoirs involved in the study, the highest prevalence was detected in Kalar abattoir (16.8%) and the lowest in Sulaimani abattoir (4.4%). Among the infected animals, sheep in Kalar abattoir recorded the highest prevalence, while cattle in Sulaimani abattoir recorded the lowest prevalence (11.7% and 0.4%, respectively). Males of sheep, cattle, and female goats showed higher prevalence (66.7%, 76.2%, and 58.6%, respectively). Regarding organ involvements, males of cattle and sheep showed high liver involvement (81.25% and 72.2%, respectively), while females of goat showed the highest liver involvement (76%). Females of cattle and sheep showed high lung involvement (46.7% and 28.5%, respectively), but the males of goats showed the highest lung involvement (53.8%).

BACKGROUND: Hydatid disease usually affects the liver, but can also extend to other locations, such as the bones. In these cases, complete resection of the bone is considered the only curative approach. However, this is rarely feasible, and patients are left with benzimidazoles as their only option. In this context, there is an evident need for alternative treatments that can improve results. We present the case of a patient with a treatment-refractory hydatid cyst of the bone, who successfully underwent radiotherapy (RT). CASE SUMMARY: A 64-year-old woman was diagnosed with a hydatid cyst of the bone in the sacroiliac joint that caused her sciatalgia and paresthesia. She underwent treatment with albendazole and surgery, and was treated with further doses of albendazole after relapsing six months later. After 2 years, she required a new resection, achieving a stable disease for 2 more years. At this point, she began to suffer from more intense pain (visual analogue scale 6/10). Given that further surgery was no longer feasible, she underwent radiotherapy (54 Gy in 27 fractions). No treatment-related toxicity was observed. At 1 month after radiotherapy, the pain had completely disappeared; 9 months later, the patient remains asymptomatic. The titer of anti-Echinococcus-granulosus antibodies and the absolute volume of eosinophils decreased after treatment with radiotherapy. The cyst remains radiologically stable. CONCLUSION: Although further studies are needed, radiotherapy seems to be effective for hydatid cysts that are refractory to other treatments.

We observed liver failure with a presumed etiology of echinococcosis in an 89-year-old woman. Our patient had been born and then resided on Rebun Island until she was 12 years old. At 46 years old, she had been referred to our hospital due to right abdominal pain. Ultrasound had revealed multilocular cysts in the right lobe of the liver. At 84 years old, the hepatic cyst occupied nearly the entire liver with ring-shaped calcification along the cyst wall. The patient was diagnosed with decompensated cirrhosis and hepatic hydatid disease based on typical imaging and the long-term natural clinical course.

Hydatid cyst (HC) is a parasitic disease that is endemic particularly to the sheep-breeding regions of the world, our country included. Given their propensity to materialize most commonly in the liver, our study evaluates the value of ultrasound elastography in the differential diagnosis of simple cyst and type I HCs of the liver.The study involved a total of 73 cysts (22 simple cysts, 51 type I HCs) that were removed using the puncture aspiration injection reaspiration technique between 2016 and 2018. All measurements were made using a Siemens ACUSON S2000 (Siemens Healthcare, Erlangen, Germany) device with a 4-MHZ 4C1 convex probe, an acoustic radiation force impulse elastography procedure, and a Virtual Touch IQ option. The difference between the mean shearwave elastography (SWE) values of both groups was analyzed with an independent t test.Of the 70 patients involved in the study, 29 were female and 41 were male, with a mean ± SD age of 38.85 ± 17.62 years (range, 5-82 years). Upon the examination of the 22 simple cysts and the 51 HCs, the mean ± SD SWE values were found to be 2.6 ± 0.96 (0.96-4.25) and 2.8 ± 1.69 (0.66-4.84), respectively. No statistically significant difference was identified between the SWE values of type I HCs and simple cysts (P > 0.005).Although HCs and simple cysts had similar radiological appearances, and a relative difference was noted in the differentiation of the elastographic measurements, this difference was not statistically significant. Accordingly, more comprehensive and various studies are needed.

Several strategies exist to prevent and control echinococcosis, a global parasitic disease. However, most treatments are ineffective and adverse effects are common. Therefore, we aimed to screen protoscolex antigen molecules of Echinococcus granulosus to identify a diagnostic biomarker for hydatid disease. Published E. granulosus transcriptome sequencing data were analyzed to screen for antigen molecules that are highly expressed in protoscoleces but not in oncospheres. The membrane protein EG-06283 (annotated as Frizzled-4) was selected from 16 antigens, and its gene fragment was subjected to codon optimization and synthesis. rEG-06283 expression was induced in the pET-24a/EG-06283/BL21 strain; subsequently, the protein was purified and subcutaneously injected into ICR mice at weeks 0, 2, 4, and 6. Blood sampling occurred periodically to quantify serum immunoglobulin G (IgG) levels via enzyme-linked immunosorbent assays (ELISA). Immunogenicity was determined by western blot assays using sera from normal mice and mice with secondary hydatid infections. The antigen’s immune reactivity and diagnostic value were validated using sera of patients with hydatid disease. ELISA results confirmed that the antigen molecule induced specific IgG production in mice, resulting in significantly higher levels than those in the adjuvant and control groups (P

Objective. Alveolar echinococcosis (AE) is a zoonosis caused by the larval stage of the metacestode Echinococcosis multilocularis with a tumor-like behavior in the targeted organ, especially in the liver. Surgery with albendazole is first-line modality for AE. Drug discontinuation is usually based upon the parasitic viability shown by the positron emission tomography (PET) scan. However, as a demanding and expensive method, it is not widely practiced in majority of the endemic regions. Further understanding on the cytokine and chemokine response profiles in AE patients may provide an interesting insight for potential markers in viability assessment. Methods. Mice were inoculated with Echinococcus multilocularis intrahepatically to develop the hepatic AE murine model. Oral albendazole administration was then applied for three months after the first inoculation, and peripheral and regional immune cells including type 1 T helper cells (Th), Th2, Th17, regulatory T (Treg) cells, related cytokines, and chemokines were examined. Results. The hepatic AE lesion was confirmed by ultrasound examination resulting in a successful rate of 70%. Among the 17 cytokines and chemokines detected, plasma levels of IL-23 were significantly higher in E. multilocularis-infected mice when compared to the control group; furthermore, more obvious increasing levels were found after albendazole treatment ( p < 0.05 ). All chemokine levels other than eotaxin and MCP-3 were slightly higher in E. multilocularis-infected mice compared to the control group ( p > 0.05 ). Eotaxin levels were significantly decreased in mice with E. multilocularis infection followed by albendazole treatment ( p < 0.05 ). Both IL-17A and IL-23 expressions in hepatic AE lesions were significantly higher and related with disease activity. Conclusion. Albendazole administration influenced the balance of immune response and promotes the secretion of proinflammatory factors which is beneficial to parasite clearance. IL-23 seems to be associated with the successful albendazole treatment in mice with E. multilocularis infection; such a change could be translated into clinical application in the near future.

Human alveolar echinococcosis (AE) is a zoonotic cestode infection which is usually fatal in the absence of treatment. Treatment involves major surgery or indefinite antiparasitic therapy. The incidence is rising in Europe and Asia, with an increased risk observed in immunocompromised individuals. Previously, AE acquisition in North America was extremely rare, except for one remote Alaskan Island. Recent studies have demonstrated a new European-like strain of Echinococcus multilocularis (Em) in wildlife and in human AE in western Canada. We report the experience of all AE patients diagnosed in Alberta. Each was diagnosed by histopathology, serology, and PCR-confirmed by a reference laboratory. Seventeen cases of human AE, aged 19–78 years, nine females, were diagnosed between 2013 and 2020: all definitely or probably acquired in Alberta. Six lived in urban areas, and 14 had kept dogs. In eight, the lesions were found incidentally on abdominal imaging performed for other indications. Six were immunocompromised to varying degrees. Six were first diagnosed at surgery. All have been recommended benzimidazole therapy. One died of surgical complications. Clinicians should be aware of this diagnostic possibility in patients presenting with focal nonmalignant hepatic mass lesions. Greater urbanization of coyotes, the predominant definitive host of Em in Alberta, and growing numbers of immune suppressed individuals in the human population may lead to increasing recognition of AE in North America.

Background. Alveolar echinococcus (AE) is a severe health problem in endemic areas. In recent years, the incidence of this disease in China has been increasing. The study was designed to illustrate the multi-slice computed tomography (MSCT) and magnetic resonance imaging (MRI) features of extrahepatic AE.Methods. A cohort of 33 patients who suffered from extrahepatic AE was enrolled consecutively from January 2012 to December 2017. The MSCT and MRI features of extrahepatic AE were recorded and analyzed by experienced radiologists. The MSCT and MRI agreements for detecting imaging features of extrahepatic AE were calculated using kappa statistics.Results. All cases secondary to hepatic AE, except two primary extrahepatic AE, were found in this study. Locations of extrahepatic AE included 19 (57.6%) lung, 10 (30.3%) adrenal gland, 9 (27.3%) brain, 5 (15.2%) peritoneal cavity, 5 (15.2%) spleen, 4 (12.1%) diaphragm, 3 (9.1%) kidney, 3 (9.1%) retroperitoneal, and 2 (6.1%) vertebra; Involvement of 1 (3.0%) heart, 1 (3.0%) mediastinum, 1 (3.0%) muscle, and 1 (3.0%) pancreas was rare. AE of the lung usually appeared as irregular and scattered nodules with small vacuoles or cavities inside and peripheral distribution. Multiple cerebral nodules with calcification and surrounding edema were the most common features seen in brain AE. Adrenal gland AE presented as plaques containing different sizes of hypodense areas and different amounts of calcification. Injection of contrast medium showed no enhancement of lesions except in the brain. Very good agreements were seen between MSCT and MR for detecting number (κ=0.841, p=0.000), border (κ=0.911, p=0.000) and size (κ=0.864, p=0.000) of extrahepatic AE.Conclusions. MSCT and MRI are reliable imaging methods for the diagnosis of extrahepatic AE. When one AE patient is clinically confirmed, MSCT scan from the head to pelvis should be performed to exclude other organs AE.

BackgroundEchinococcosis (E) is a zoonotic parasitic disease caused by the larval morphology of echinococcosis tapeworms. Among the recognized species, two are of medical importance—E. granulosus and E. multilocularis—causing cystic echinococcosis (CE) and alveolar echinococcosis (AE) in humans, respectively. Diagnosis of AE is based on clinical manifestation and epidemiological data, imaging techniques, histopathology and/or nucleic acid detection, and serology. At present, WHO guidelines suggest that benzimidazoles (BMZ) are mandatory in all AE patients, temporarily after complete resection of the lesions and for life in all other AE cases. Interventional procedures should be preferred to palliative surgery whenever possible, and radical surgery is the first choice in all cases suitable for total resection of the lesion. However, some research centers have proposed that local ablation (LA) including radiofrequency ablation (RFA) and microwave ablation (MWA) is no less effective than radical surgery or better than simple medication in the early stage hepatic AE (WHO-IWGE PNM classification of AE: P1N0M0). This study attempted to compare the real efficacy of the above treatment methods, so as to find the best treatment for this kind of patient.MethodsThe data of patients with hepatic AE who underwent laparoscopic hepatectomy (LH), RFA, and MWA in Qinghai Provincial People's Hospital from January 2015 to January 2021 were collected. At the same time, the cases treated with Albendazole (ABZ) were collected together with the institution for disease control and prevention. According to the treatment methods, the above cases were divided into LH group, RFA group, MWA group, and medication group. The basic data and postoperative recovery indices of the four groups were compared, respectively.ResultsA total of 199 patients with hepatic AE were enrolled in this study, including 90 males and 109 females. The youngest was 5 years old and the oldest was 66 years old, with an average of 33.41±14.64 years old. 20.6% of the patients had hepatitis B (41/ 199). A total of 45 patients underwent ultrasound-guided RFA, 47 patients underwent ultrasound-guided MWA, 51 patients were treated with ABZ, and 56 patients underwent LH. There were no significant differences in baseline characteristics among the four groups (p > 0.05). The RFA group and MWA group were more advantageous than the LH group regarding operation time and incidence of postoperative complications (p < 0.05). But recurrence rate of the lesion in the LH group was significantly lower than the RFA group, MWA group, and medication group. However, there was no significant difference in recurrence-free survival time among the four groups (p >0.05).ConclusionLH has a significant effect in the treatment of early-stage hepatic AE, especially in terms of recurrence which is significantly better than LA and medication alone. Follow-up and adherence to ABZ therapy are essential if conservative treatment is to achieve better outcomes.

Cystic echinococcosis (CE) is prevalent, especially in animals in Turkey and stands as a significant zoonose. In this study, we aimed to retrospectively evaluate the indirect hemagglutination (IHA) tests results performed on samples of CE suspected patients in microbiology laboratory of our hospital.One thousand six hundred-seven files of patients admitted to hospital between January 2013 and December 2020 were examined for the presence of anti-A total of 1.607 file records; 644 (40.1%) males and 963 (59.9%) females, aged between 1-96 years (average 45.26±19.91) were examined. It was found that 244 (15.18%) of the patients were positive, 78 (4.86%) were determined at an intermediary value and 1.285 (79.96%) were negative. According to the IHA method a titer of 1/320 and above were evaluated as positive. Compared to anti-Based on the data, it is suggested that while interpreting the patient's serum antibody titers, patient's clinical and radiological findings should also be taken into account. If possible, it should be used along with another serological method like ELISA to assist CE patient's diagnosis and treatment.Kistik ekinokkozis (KE), ülkemizde özellikle hayvanlarda çok yaygın olması nedeniyle, hem insan sağlığı hem de hayvancılık yönünden önemli bir zoonozdur. Bu çalışmada hastanemizin mikrobiyoloji laboratuvarına KE şü phesiyle gönderilen hasta serumlarında çalışılan indirekt hemaglütinasyon (IHA) test sonuçlarının geriye dönük olarak değerlendirilmesi amaçlanmıştır.Ocak 2013-Aralık 2020 tarihleri arasında 1,607 hastada anti-Yaşları 1-96 arasında (yaş ortalaması 45,26±19,91) değişen toplam 1,607 hastanın 244’ü (%15,18) pozitif, 78’i (%4,86) ara değer ve 1,285’i (%79,96) negatif saptanmış olup; 963’ü (%59,9) kadın, 644’ü (%40,1) erkekti. IHA testine göre 1/320 ve üzeri sonuçlar pozitif olarak değerlendirilmiştir. Yüz altmış dört olgunun radyolojik verileri ile anti-Hastaların serolojik sonuçları yorumlanırken, titre değerinin yanı sıra hastanın klinik ve radyolojik bulgularının da değerlendirmeye dahil edilmesi, mümkünse ELISA gibi diğer bir serolojik yöntem ile birlikte kullanılmasıyla, KE hastalarının tanı ve tedavisine destek sağlanabileceği değerlendirilmektedir.

Cystic echinococcosis (CE) is a common zoonotic disease in the world, which is caused by the larval form ofStudy material; between January 2018 and December 2020, 498 blood samples were sent to the Parasitology Laboratory from patients with clinical pre-diagnosis of CE, who applied to Kafkas University Health Research and Application Hospital for three years. The obtained serum samples were analyzed by indirect hemagglutination method.Anti-Although the study data do not cover the entire Eastern Anatolia region of Turkey, it has been concluded that KE maintains its importance as a public health problem in the region.Kistik ekinokokkozis (KE),Çalışma materyalini Kafkas Üniversitesi Sağlık Araştırma ve Uygulama Hastanesi’ne Ocak 2018-Aralık 2020 tarihleri arasında müracaat eden KE klinik ön tanılı hastalardan alınarak Parazitoloji Laboratuvarı’na gönderilen 498 kan örneği oluşturmuştur. Elde edilen serum örnekleri indirekt hemaglütinasyon yöntemiyle incelenmiştir.Kist hidatik yönünden klinik ön tanılı 498 hastanın 74’ünde (%14,9) anti-Çalışma verileri Türkiye’nin Doğu Anadolu Bölgesi’nin tamamını kapsamasa da bölgede KE’nin halk sağlığı sorunu olarak önemini koruduğu kanaatine varılmıştır.

Cystic echinococcosis (CE) is a parasitic disease that has been known for years in helminth diseases and it is important as human and animal health problem in many parts of the world and in our country due to economic losses. In this study, it was aimed to retrospectively evaluate the distribution of anti-Commercial kit was used for indirect hemaglutination (IHA), indirect fluorescent antibody test (IFAT) and Western blot (WB) methods using sera from patient samples was applied according to the kit proposal. In addition, patient materials for CAM, CSF and blood for which polymerase chain reaction (PCR)/QPCR tests were requested were examined.Sera of the patients who were tested with at least one of the IHA, IFAT and WB methods or a combination of these methods, and 443 cases out of 2.283 cases were found to beAs a result of a six-year retrospective screening, 22% of the cases were found to be positive, and it was concluded that the prevalence of CE is high and the use of a single test may be insufficient in the diagnosis of CE, therefore, test combinations will increase the sensitivity and reliability in reaching the correct diagnosis.Kistik ekinokokkozis (KE), helmint hastalıkları içinde yıllardır bilinen, insan ve hayvan sağlığının yanı sıra sebep olduğu ekonomik kayıplar nedeniyle dünyanın birçok bölgesinde ve ülkemizde halk sağlığı problemi olarak önemini koruyan paraziter bir hastalıktır. Bu çalışmada Ocak 2013-Aralık 2018 tarihleri arasında parazitoloji laboratuvarına tetkik için başvuran ve ön tanısı KE olan hastaların anti-İndirekt hemaglütinasyon (IHA), indirekt flerosan antikor testi (IFAT) ve Western blot (WB) yöntemlerinde ticari kit önerisine göre test prosedürü hasta numunelerinden elde edilen serumlar kullanılarak uygulanmıştır. Ayrıca, polimeraz zincir reaksiyon (PZR)/QPZR testleri yapılması istenilen kist aspirasyon mayii, beyin omurilik sıvısı ve kan hasta materyalleri incelenmiştir.Serum örnekleri IHA, IFAT ve WB yöntemlerinin en az biri veya bu yöntemlerin kombinasyonları ile test edilerek, toplam 2283 olgudan 443 olgununAltı yıllık bir retrospektif tarama sonucunda olguların %22’sinin pozitif tespit edilerek KE yaygınlığının yüksek olduğu ve KE tanısında tek bir testin kullanımının yetersiz kalabileceği, bu nedenle test kombinasyonlarının doğru tanıya ulaşmada duyarlılığı ve güvenilirliği artıracağı kanaatine varılmıştır.

Hydatidosis; is a zoonotic disease caused by Echinococcus granulosus and characterized by infiltration of inflammatory cells. This study was investigated the hematological and histopathological changes in the hearts of rats injected with protoscoleces. Rats were injected with protoscoleces collected from either liver of sheep, goats, and cows (from the abattoir of Al-Muthanna province, south of Iraq) or isolated from infected humans from Al-Hussein Teaching Hospital. Sheep protoscoleces showed a significant increase of lymphocytes that refer to the induction of a high response of the immune system in rats. The numbers of WBC, RBCs, and platelets were generally increased in rats injected with protoscoleces isolated from sheep and goats. These changes could refer to the activation of defense mechanisms against the hydatid injected materials. However, the levels of MCV, MCH, MCHC, MPV and PDW were less than normal values. Heart sections of rats injected with protoscoleces isolated from humans showed clear histological changes. While TSP, TGP and TCP exhibited variant histopathological changes such as infiltration of inflammatory cells, pink glass appearance and congestion of arteries. Thus, these alterations can be considered as additional evidence of how the immune response reacts against the injected materials in the heart.

Objectives Cystic echinococcosis (CE) is a neglected parasitic zoonotic disease caused by the larval stage of the tapeworm Echinococcus granulosus (E. granulosus). This study aimed to understand the clinical characteristics of human CE in Ningxia Hui Autonomous Region (NHAR) located in northwest China and to investigate the antibody profiles against the recombinant E. granulosus antigen P29 (rEg.P29) in plasma of CE patients. Methods A total of 37 human CE patients, along with 37 healthy donors enrolled in this study and demographic and clinical data were analyzed, including age, gender, laboratory data, symptoms, and cysts description. Plasma levels of cytokines, total IgG, and total IgE were determined by sandwich ELISA kits. Specific antibodies against rEg.P29 and hydatid cyst fluid (HCF) were assessed by indirect ELISA. Results The results revealed that females have a higher percentage of CE patients than males. The incidence of CE reached a peak in the 41–50 years-old group. The liver was the most frequent location, accounting for 91.9%. Based on the CT images, cysts of 34 patients who had liver involvement, were classified as 1 (2.9%) CE1, 12 (35.3%) CE2, 5 (14.7%) CE3a, 1 (2.9%) CE3b, and 15 (44.2%) CE5. Twenty-nine (78.4%) patients had a single cyst and 8 (21.6%) had at least two cysts. The most frequently reported symptom was upper abdominal pain. The plasma level of IL-6 and total IgE were significantly increased in CE patients compared with healthy donors. Additionally, IgG response to rEg.P29 in CE patients was significantly higher than in healthy donors, and the dominant IgG subclass was IgG4. Further analysis of different patient groups revealed that rEg.P29-specific IgG and IgG4 were only elevated in CE patients with CE2 type cysts. Conclusions This study systematically investigated the clinical characteristics of patients with CE and may provide a reference basis for the diagnosis and treatment of CE in NHAR. Furthermore, tests of specific IgG and IgG4 against rEg.P29 can be used as an assisted method for imaging techniques to identify cystic activity and determine the best therapeutic approach for CE.

Echinococcus infections are rare in the United States but may present a growing public health threat. We present the case of an 8-year-old female patient from Southern California who was diagnosed with hepatic echinococcosis after the incidental discovery of large hepatic cysts.

Background Echinococcosis is a parasitic zoonotic disease that threatens human health and economic development. In China, 370 counties are endemic for echinococcosis. Qinghai-Tibet Plateau has the most patients and people at risk. Therefore, analyzing the societal factors related to susceptibility to the disease is critical for efficient prevention and control of echinococcosis. Methods The demographic characteristics and lifestyle of echinococcosis cases were clustered using K-means cluster analysis to determine the main factors of risk of echinococcosis. Results Middle-aged and young people as well as those with a low education level and herdsmen are at risk of contracting echinococcosis. Nomadism, domestic and feral dogs in the surrounding environment, and drinking heavily polluted natural surface water are the main behavioral risk factors. The cystic echinococcosis (CE) and alveolar echinococcosis (AE) cluster analysis focused on female, middle-aged, and young people, winter settlement and summer nomadism, and domestic and feral dogs in the surrounding environment. There were significant differences in lifestyle between Qinghai-Tibet Plateau cases and non-Qinghai-Tibet-Plateau cases. Conclusion According to the distribution of cases and CE and AE, this study identified the factors of risk of echinococcosis in the Qinghai-Tibet Plateau and non-Qinghai-Tibet Plateau. Adapted control techniques appropriate for the various epidemic areas should be established to serve as a reference for echinococcosis prevention. Graphical Abstract

Background Lymphangioma is a rare diagnosis in adult patients and typically presents in early infancy. These tumors are a result of malformation of the lymphatic vessels and usually involve the head, neck, and axilla. Case presentation We report the case of a 28-year-old African female who recently immigrated from East Africa and presented to our surgical breast clinic with a large and rapidly growing left axillary mass. Initial history and evaluation were concerning for hydatid cyst; however, on surgical excision, gross appearance was consistent with cystic lymphangioma. Diagnosis was confirmed on pathology review. Conclusions Although lymphangiomas are typically found in young children, adults may develop these tumors in response to unknown triggers. Surgical excision is the preferred treatment.

Purpose Alveolar echinococcosis (AE) is caused by the larval stage of Echinococcus multilocularis. Chemotherapy for AE involves albendazole (ABZ), which has shown insufficient efficacy. More effective chemotherapy for AE is needed. Previously, we have demonstrated that atovaquone (ATV), an anti-malarial, inhibits mitochondrial complex III of E. multilocularis and restricts the development of larval cysts in in vivo experiments. Therefore, in this study, we evaluated the efficacy of ABZ and ATV combination therapy on E. multilocularis in culture and in vivo experiments. Methods Protoscoleces were treated with 50 µM ABZ and/or ATV in the medium; the duration of parasite elimination was determined under aerobic and anaerobic culture. In the in vivo experiment, the effects of ABZ and ATV combination treatment in BALB/c mice infected orally with eggs from the feces of an adult-stage E. multilocularis-infected dog were compared with those of standard oral ABZ therapy. Results In the culture assay, the duration of elimination associated with ABZ and ATV combination treatment was 1 day shorter than that associated with ATV alone under aerobic conditions. Protoscolex viability progressively reduced owing to the combination treatment under anaerobic conditions; however, either drug used singly did not exhibit antiparasitic effects under hypoxia. Furthermore, compared with ABZ alone, the combination treatment significantly reduced the growth of the primary cyst in the liver of mice infected orally with parasite eggs. Conclusion ATV enhanced the effect of ABZ in the treatment of AE in mice.

OBJECTIVE: To identify risk factors to pre-surgical complications in patients with cystic echinococcosis (CE) in endemic areas of Peru. MATERIALS AND METHODS: Study of cases (n=43) and controls (n=127) not paired was designed, with a case-control ratio of 1:3 based on a secondary source. The case was defined as the patient with CE who presented with pre-surgical complications related or not with the disease and the control without pre-surgical complication. The response variable was preoperative complication and the exposition ones were age, gender, degree of instruction, occupation, number, size (diameter in centimeters) and location of the cyst. To identify the risk factors, a bivariate logistic regression analysis was performed to obtain the crude odds ratios (cOR) and then the variables with significant association were adjusted by a multivariate logistic regression analysis using the Stata® version 14 software, obtaining theadjusted odds ratios (aOR). RESULTS: Fifty eight point eight percent (24/43) of the cases were women and the median age was 35 years and 59.1% (75/127) of the controls correspond to the female gender and the median age was 27 years. The multivariate logistic regression analysis found that being over 56 years old has an aOR 2.91 (95% confidence interval [CI]: 1.007-8.433) and having ≥3 cysts has an aOR 4.26 (95% CI: 1.62-11.22) for present pre-surgical complications in patients with CE. CONCLUSION: It was identified that being over 56 years old and having ≥3 cysts are risk factors for presenting pre-surgical complications in CE Objetivo: Identificar los factores asociados a complicaciones prequirúrgicas en pacientes con equinococosis quística (EC) en áreas endémicas del Perú. Materiales y métodos: Se diseñó un estudio de casos (n = 43) y controles (n = 127), sin emparejamiento, de fuente secundaria con una relación de caso-control de 1:3. Se definió como «caso» al paciente con EC que presentó complicaciones prequirúrgicas relacionadas o no con la enfermedad y el control sin complicación prequirúrgica. La variable respuesta fue complicación prequirúrgica y las de exposición fueron edad, género, grado de instrucción, ocupación, número de quistes, tamaño (diámetro en centímetros) y localización del quiste. Para identificar los factores de riesgo, primero se calcularon los odds ratio crudos (ORc) mediante regresión logística; luego las variables que mostraron asociación significativa se ajustaron mediante análisis multivariado de regresión logística utilizando Stata® versión 14, y se obtuvieron los odds ratio ajustados (ORa). Resultados: El 55,8% (24/43) de los casos fueron mujeres y la mediana de edad fue 35 años. Entre los controles, el 59,1% (75/127) fueron mujeres y la mediana de edad fue 27 años. En el análisis de regresión logística multivariado, se encontró que tener más de 56 años tiene un ORa de 2,91 (intervalo de confianza [IC] 95%: 1,01-8,43) y tener ≥3 quistes tiene un ORa de 4,26 (IC 95%: 1,62-11,22) para presentar complicaciones prequirúrgicas en pacientes con EQ. Conclusión: Los factores asociados para presentar complicaciones prequirúrgicas en EQ fueron el tener más de 56 años y el tener ≥3 quistes

Cystic echinococcosis (CE) may be encountered in almost every site of the body, but bone involvement is relatively rare. The vertebral column and pelvis are the most affected areas. The combined medical and surgical approach is the main treatment option in current literature. Although percutaneous treatment of CE cysts located in the liver, spleen, kidney, and soft tissues has become a serious alternative to surgery, there is no bone CE cyst treated percutaneously in the literature. This case report aims to point out that percutaneous treatment can be an effective treatment choice and alternative to surgery.

To identify risk factors to pre-surgical complications in patients with cystic echinococcosis (CE) in endemic areas of Peru.Study of cases (n=43) and controls (n=127) not paired was designed, with a case-control ratio of 1:3 based on a secondary source. The case was defined as the patient with CE who presented with pre-surgical complications related or not with the disease and the control without pre-surgical complication. The response variable was preoperative complication and the exposition ones were age, gender, degree of instruction, occupation, number, size (diameter in centimeters) and location of the cyst. To identify the risk factors, a bivariate logistic regression analysis was performed to obtain the crude odds ratios (cOR) and then the variables with significant association were adjusted by a multivariate logistic regression analysis using the Stata® version 14 software, obtaining theadjusted odds ratios (aOR).Fifty eight point eight percent (24/43) of the cases were women and the median age was 35 years and 59.1% (75/127) of the controls correspond to the female gender and the median age was 27 years. The multivariate logistic regression analysis found that being over 56 years old has an aOR 2.91 (95% confidence interval [CI]: 1.007-8.433) and having ≥3 cysts has an aOR 4.26 (95% CI: 1.62-11.22) for present pre-surgical complications in patients with CE.It was identified that being over 56 years old and having ≥3 cysts are risk factors for presenting pre-surgical complications in CE.Identificar los factores asociados a complicaciones prequirúrgicas en pacientes con equinococosis quística (EC) en áreas endémicas del Perú.Se diseñó un estudio de casos (n = 43) y controles (n = 127), sin emparejamiento, de fuente secundaria con una relación de caso-control de 1:3. Se definió como «caso» al paciente con EC que presentó complicaciones prequirúrgicas relacionadas o no con la enfermedad y el control sin complicación prequirúrgica. La variable respuesta fue complicación prequirúrgica y las de exposición fueron edad, género, grado de instrucción, ocupación, número de quistes, tamaño (diámetro en centímetros) y localización del quiste. Para identificar los factores de riesgo, primero se calcularon los odds ratio crudos (ORc) mediante regresión logística; luego las variables que mostraron asociación significativa se ajustaron mediante análisis multivariado de regresión logística utilizando Stata® versión 14, y se obtuvieron los odds ratio ajustados (ORa).El 55,8% (24/43) de los casos fueron mujeres y la mediana de edad fue 35 años. Entre los controles, el 59,1% (75/127) fueron mujeres y la mediana de edad fue 27 años. En el análisis de regresión logística multivariado, se encontró que tener más de 56 años tiene un ORa de 2,91 (intervalo de confianza [IC] 95%: 1,01-8,43) y tener ≥3 quistes tiene un ORa de 4,26 (IC 95%: 1,62-11,22) para presentar complicaciones prequirúrgicas en pacientes con EQ.Los factores asociados para presentar complicaciones prequirúrgicas en EQ fueron el tener más de 56 años y el tener ≥3 quistes.

Background Using effective scolicidal agents intraoperatively is essential to lessen the recurrence rate of hepatic echinococcosis. However, severe hypernatremia may occur after hypertonic saline (HS) has been applied as the scolicidal agent. The aim of this study is to report on pediatric patients with severe hypernatremia after hepatic echinococcus surgery. Methods Patients who presented to West China Hospital between January 2010 and February 2017 were retrospectively analyzed. Children under 16 years with echinococcosis treated by resection were included in the study. Results A total of 26 children were enrolled in this study, including 16 boys and 10 girls with a median age of 8 (2–16). 24 (92.3 %) cases were cystic echinococcosis (CE) and two (7.7 %) were alveolar echinococcosis (AE). According to Clavien-Dindo classification of surgical complications, the complication rate of all 26 patients was 19.2 %, among which three cases belonged to Grade I, one to Grade III b and 1 to Grade IV. Two children encountered severe hypernatremia (sodium: 155.3 mmol/L and 190.0mmol/L). Data showed classic clinical features of severe hypernatremia: profound and persistent bradycardia, hypotension and coma. After treatment, they recovered well without any neurologic sequelae. All patients were followed up regularly for a median time of 38 months (range 4–89 months); the overall disease-free survival was 100.0 %. Conclusions HS irrigation of intra-abdominal echinococcosis may cause acute hypernatremia and severe consequences. Diagnostic suspicion and early intervention are vital tools for avoiding morbidity and mortality.

Over one million people are living with cystic echinococcosis (CE) and alveolar echinococcosis (AE). For CE, long-term albendazole treatment is often needed, which requires regular follow-up. Follow-up is mainly through imaging which is insensitive to subtle changes and subjective to experience. We investigated the changes of Echinococcus granulosus (Eg) cell-free DNA (cfDNA) in plasma of CE patients before and after albendazole treatment to evaluate its potential as an objective marker for treatment follow-up. Plasma samples of nine CE patients were collected before and after treatment. We identified Eg cfDNA from every sample through high-throughput sequencing. Eg cfDNA concentration and fragment length increased significantly after the treatment period. Ultrasound examination before and after the treatment initiation reflected the drug effects to a certain extent, as the cyst size of four patients reduced. Our findings indicated that Eg cfDNA from plasma could be a potential marker in the monitoring of CE treatment.

Background Human alveolar echinococcosis (AE) caused by Echinococcus multilocularis is an underreported, often misdiagnosed and mistreated parasitic disease mainly due to its low incidence. The aim of this study was to describe the epidemiological and clinical characteristics of human AE patients in Hungary for the first time. Method Between 2003 and 2018, epidemiological and clinical data of suspected AE patients were collected retrospectively from health database management systems. Results This case series included a total of 16 AE patients. The mean age of patients was 53 years (range: 24–78 years). The sex ratio was 1:1. Four patients (25%) revealed no recurrence after radical surgery and adjuvant albendazole (ABZ) therapy. For five patients (31.3%) with unresectable lesions, a stabilization of lesions with ABZ treatment was achieved. In seven patients (43.8%), progression of AE was documented. The mean diagnostic delay was 33 months (range: 1–122 months). Three AE related deaths (fatality rate 18.8%) were recorded. Conclusions AE is an emerging infectious disease in Hungary with a high fatality rate since based on our results, almost every fifth AE patient died in the study period. Differential diagnosis and appropriate surgical and medical therapy for AE is an urging challenge for clinicians in Hungary, as well as in some other European countries where E. multilocularis is prevalent.

Objective To determine the clinical characteristics of patients with cystic echinococcosis and the diagnostic and therapeutic approaches used. Methods This is a multicentre, retrospective study. Patients from six centres who were diagnosed with hydatid cysts in the last five years were evaluated. Results The mean age was 45.4±17.4 years, and 54.7% were female. The most common complaints were abdominal pain, nausea and vomiting, and the most common physical examination finding was abdominal tenderness. Most patients were diagnosed within 2-6 months. Anaemia and eosinophilia were the most common laboratory findings. The liver was the most commonly involved organ (n=153, 90%). One hundred twenty-five (73.5%) patients underwent ultrasonography. The largest cyst was present in the liver at stage four, and its diameter was 160x170 mm. The rates of the negative, grey zone and positive results were 9.4%, 8.8% and 81.8%. Surgery was more common (n=72, 42.4%) than puncture, aspiration, injection, and re-aspiration treatments (n=14, 8.2%). Of the 47 patients who had a recurrence, 22 (46.8%) had a history of hydatid cyst treatment. Conclusion Hydatid disease, which is endemic in our country, is diagnosed at a late stage. In terms of disease diagnosis, serological tests may be misleading. It was not possible to compare the success rates according to the treatment choices because of the lack of randomisation of stages and sizes of the lesions.

Objective To differentially diagnose a calcified formation recovered from a 13th century AD grave from the Tuscan monastery of Badia Pozzeveri, Lucca, Italy. Materials A calcified formation from the thoraco-abdominal region of a skeleton buried in the monastery cemetery. Methods Cone Beam Computed Tomography, Scanning Electron Microscope and Energy Dispersive X-Ray Spectroscopy. Results A hollow, calcified ovoid formation was identified as typical of a hydatid cyst, permitting the diagnosis of cystic echinococcosis in a 35-45year-old female. Conclusions The study reveals the circulation of the parasite Echinococcus granulosus in the region of Lucca in late medieval Tuscany. Significance This finding is the fourth case of cystic echinococcosis from an archaeological context in Italy and provides insight into environmental conditions that appear to have affected members of a community, irrespective of social status. Limitations Caution and the application of multiple analyses must be exercised in the differential diagnosis to discriminate among calcified formations. Suggestions for further research Analysis of stable isotopes of the calcified formation, such as 15N and 13C, in order to compare them with isotopic values of the host individual and to further confirm the parasitic origin of the find.

Objective:Cystic echinococcosis (CE) is a zoonotic disease, which leads to morbidity and mortality worldwide. This study aimed to retrospectively evaluate the presence of anti-Echinococcus granulosus immunoglobulin G (IgG) antibodies, which were detected by indirect fluorescent antibody test in the samples that were transferred to the Microbiology Laboratory of University of Health Sciences Turkey, Diyarbakır Gazi Yaşargil Training and Research Hospital with the pre-diagnosis of CE. Moreover, gender differences with respect to positivity rates of anti-E. granulosus IgG antibodies were investigated.Methods:Anti-E. granulosus IgG antibodies, which were detected in the samples of cases with the pre-diagnosis of CE between January 2014 and December 2017, were retrospectively evaluated. Gender difference with respect to positivity rates was investigated by applying the chi-square test in cases with positive anti-E. granulosus IgG antibodies.Results:Out of the 829 serum samples, 222 (26.7%) were found to be positive for E. granulosus IgG antibodies, among which 40 (27.2%), 56 (25.5%), 51 (23.3%) and 75 (30.6%) were found to be positive in 2014, 2015, 2016 and 2017, respectively. No significant difference was found between genders amongst the cases with positive anti-E. granulosus IgG antibodies (p>0.05).Conclusion:Since CE is a major public health problem, evaluation of the presence of anti-E. granulosus IgG antibodies would be important to understand the positivity rate at the regional level.

Background Pulmonary alveolar echinococcosis (PAE) is a chronic disease caused by Echinococcus multilocularis with very low incidence in developed countries. Methods This single-center, retrospective study included 34 patients who were diagnosed with PAE between January 2001 and February 2019 (15 males, 19 females, mean age: 52.4 ± 15.8 years, age range: 28–78 years) in Ataturk University Medical School, Erzurum, Turkey. Results The liver was the primary involved organ in all cases. Pulmonary involvement was detected in 13.0% (34/261) of all cases with hepatic alveolar echinococcosis (AE), and three patients (8.8%) had both pulmonary metastasis and brain metastasis. The route of spread to the lungs based on radiological data was hematogeneous in 25 patients (73.5%), transdiaphragmatic in three patients (8.8%) and both hematogeneous and transdiaphragmatic in six patients (17.7%). AE showed bilateral involvement in 19 patients (55.9%), whereas only the right lung was involved in 12 patients (35.3%) and the left lung in three patients (8.8%). Of the patients, five underwent surgery due to PAE and 29 patients received medical therapy with albendazole. A total of three patients died during the follow-up period (2, 5 and 10 years after the diagnosis of PAE), while 31 patients continued with follow-up and treatment for a mean duration of 5.4 ± 3.8 years (1–14 years). Conclusions Patients with hepatic AE must, as a matter of course, be screened for possible lung involvement. Albendazole therapy may slow down disease progression in patients with widespread pulmonary involvement who are not eligible for surgery.

Cystic echinococcosis (CE) is one of the neglected tropical diseases recognized by the WHO. Echinococcus granulosus sensu lato affects more than 1 million people worldwide and is responsible for high costs in the healthcare system. A clear knowledge of the prevalence of CE and its clinical characteristics could have an important impact on the approach to its diagnosis and to the public health planning of treatment and control interventions. We performed a prevalence study in four municipalities of Catanzaro Province, South Italy. This area is considered to be at high risk of CE because of ovine breeding. We screened by abdominal ultrasound 2,426 volunteers, four of whom had abdominal CE. Given the need for prevention and control programs for CE in endemic areas of Italy, a detailed mapping of prevalence of CE, to complement data obtained through hospital discharge records, appears imperative.

Limei Wen,1– 3,* Guodong Lv,2,4,* Jun Zhao,1,3,* Shuai Lu,1,3 Yuehong Gong,1,3 Yafen Li,2 Haiya Zheng,2 Bei Chen,1,3 Huijing Gao,1,3 Chunyan Tian,2 Jianhua Wang1,3 1Pharmaceutical Department, The First Affiliated Hospital of Xinjiang Medical University, Urumqi 830054, People’s Republic of China; 2College of Pharmacy, Xinjiang Medical University, Urumqi 830054, People’s Republic of China; 3State Key Laboratory of Pathogenesis, Prevention, Treatment of Central Asian High Incidence Diseases, Urumqi 830054, People’s Republic of China; 4Clinical Medical Research Institute, The First Affiliated Hospital of Xinjiang Medical University, Urumqi 830054, People’s Republic of China*These authors contributed equally to this workCorrespondence: Jianhua WangPharmaceutical Department, The First Affiliated Hospital of Xinjiang Medical University, No. 137 Liyushan South Road, Urumqi 830054, People’s Republic of ChinaEmail jhw716@sohu.comBackground: In this study, we aim to investigate the efficiency of artesunate (AS) on Echinococcus granulosus protoscoleces and metacestodes.Methods: For the in vitro assay, the eosin dye exclusion test and transmission electron microscope (TEM) were utilized to evaluate the effects of AS against protoscoleces (PSCs) from Echinococcus granulosus. In addition, mortality, ultrastructure change, reactive oxygen species (ROS) content and DNA damage were measured in order to explore the anti-echinococcosis mechanism of AS. For the in vivo assay, CE-infected mice were divided into model group, albendazole (ABZ) group (200 mg/kg), low AS (AS-L) group (50 mg/kg), moderate AS (AS-M) group (100 mg/kg), and high AS (AS-H) group (200 mg/kg). Upon 6 weeks oral administration, wet weight of cysts and the ultrastructural changes of cystic wall were utilized to evaluate the effects of AS on metacestodes. In addition, the liver biochemical parameters, tumor necrosis factor-α (TNF-α), glutathione/glutathione oxidized (GSH/GSSG) ratio in serum, and H2O2, total superoxide dismutase (T-SOD) in cyst fluid were detected.Results: Both in vivo and in vitro experiments showed that AS showed anti-parasitic effects on CE. The AS could elevate the ROS level in the PSCs, which then resulted in obvious DNA damages. AS could significantly improve the liver biochemical parameters in infected mice compared with the model group (P < 0.05). Compared with the model group, AS-M and AS-H decrease the TNF-α content (P < 0.05); AS-H group significantly decrease in the serum GSH/GSSG ratio (P < 0.05). The content of H2O2 in hydatid fluid treated by AS showed significant decrease compared with the model group (P < 0.01), while the T-SOD level showed significant elevation compared with model group (P < 0.01).Conclusion: In this study, we confirmed that the effects of AS on Echinococcus granulosus protoscoleces and metacestodes may be related to the DNA damages induced by oxidative stress, which provided solid information for the research and development of drugs for cystic echinococcosis.Keywords: cystic echinococcosis, artesunate, Echinococcus granulosus, reactive oxygen species, DNA damage

Background Cardiac involvement is an uncommon presentation of hydatid disease. In this study, we aim to analyze the experience of surgical treatment of cardiac and great vessels echinococcosis in our cardiovascular and thoracic surgery department. Methods Through a 16-year period, from 2000 to 2015, 27 patients underwent surgery for cardiac and great vessels hydatid disease. The clinical, operative, and postoperative data were analyzed through this retrospective and descriptive study. Results Most of our patients came from a rural area. The most common symptom was chest pain. The diagnosis was mainly made by transthoracic echocardiography, which has shown the right ventricle as the most frequent location of the disease. All patients received surgical treatment under cardiopulmonary bypass, and only six surgeries were performed without cross-clamping the aorta. Inhospital mortality rate was 7.4%. Conclusions Cardiac hydatidosis is a rare but potentially serious condition whose treatment is mainly surgical even for asymptomatic patients owing to its possible fatal complications. The surgery outcomes are usually satisfactory. Follow-up examinations are highly recommended to detect recurrences.

Spinal cystic echinococcosis (CE) is a rare but devastating form of a neglected parasitic disease caused by the larval stage of the cestode Echinococcus granulosus. CE or hydatid disease most commonly affects the liver and lungs. Spinal CE occurs in less than 1% of all cases. Patients with cysts confined to the intradural space typically present with neurological impairment due to compression of the spinal cord. We report a case of a 32-year-old woman with unusual, extensive spinal intradural CE, located at the T2-L5 levels. She was treated with surgical removal of the cystic lesions by laminectomy and instrumentation. Long-term oral albendazole was recommended postoperatively. Her status was medically stable at 5-year follow-up, but lower limbs paralysis, urinary retention, and bowel dysfunction persisted.

Background: We aimed to determine the prevalence of Alveolar echinococcusis using ELISA in our region, to perform the specific differentiation of species by using the Western Blott method, to diagnose and treat this disease effectively in early periods, and to inform the patients about the results quickly. Methods: From the provinces of Erzurum, Kars, Ardahan, Iğdır, Ağrı and Erzincan in the Eastern Anatolia Region, Turkey in August-September 2017, blood samples were provided from 305 participants (volunteer patients and their relatives), including 151 females (49.50%), whose ages ranged between 6-85 yr and were diagnosed as Alveolar echinococcosis (AE) and operated in concerned clinics. Results: EIgG ELISA was determined as positive in 29 (9.5%) participants, including 17 (11.3%) females and 12 (7.8%) males. In addition, Em2-Em18 ELISA was also determined as positive in 15 (4.9%) participants, including 9 (6%) females and 6 (3.9%) males. Tweleve (3.94 %) of these findings were observed as positive in terms of both tests. Through the verification done by Anti-EWB IgG, Echinococcus multilocularis (EM) was identified in 7 (21.9%) of the female participants, E. granulosus (EG) in 1 (3.1%), and both parasites in 2 (6.2%). For male participants, EM was determined in 3 (9.3%) of them, EG in 1 (3.1%), and both parasites in 1 (3.1%). Conclusion: AE continues to threaten public health in the region. In families where AE is detected positive, the reason for disease is based on nutrition; thus, it will be proper to check up all family members in the terms of infection. © 2022 Akkas et al. Published by Tehran University of Medical Sciences. Bilimsel Araştırma Projeleri Birimi, İstanbul Teknik Üniversitesi, BAP: 2016-FBE-B09 This study was supported by the Igdir University Rectorate Scientific Studies Support Unit (BAP) Coordinator with Project No: 2016-FBE-B09. We would like to thank the Igdir University Rectorate for their contributions. This study was supported by the Igdir University Rectorate Scientific Studies Support Unit (BAP) Coordinator with Project No: 2016-FBE-B09. We would like to thank the Igdir University Rectorate for their contribu-tions.

To identify the differentially expressed proteins in different liver tissues in the mouse model of alveolar echinococcosis using high-resolution mass spectrometry with data independent acquisition (DIA), and to identify the key proteins contributing to the pathogenesis of alveolar echinococcosis.Protoscoleces were isolated fromA total of 1 020 differentially expressed proteins were identified between the lesion group and the normal group, including 671 up-regulated proteins and 349 down-regulated proteins, and 495 differentially expressed proteins were identified between the peri-lesion group and the normal group, including 327 up-regulated proteins and 168 down-regulated proteins. The Kyoto Encyclopedia of Genes and Genomes (KEGG) pathway enrichment analysis revealed that these differentially expressed proteins were involved in peroxisome, peroxisome proliferator-activated receptor (PPAR) and fatty acid degradation pathways, and the peroxisome and PPAR signaling pathways were found to correlate with liver injury. Several differentially expressed proteins that may contribute to the pathogenesis of alveolar echinococcosis were identified in these two pathways, including fatty acid binding protein 1 (Fabp1), Acyl-CoA synthetase long chain family member 1 (Acsl1), Acyl-CoA oxidase 1 (Acox1), Enoyl-CoA hydratase and 3-hydroxyacyl CoA dehydrogenase (Ehhadh) and Acetyl-Coenzyme A acyltransferase 1B (Acaa1b), which were down-regulated in mice in the experimental group.A large number of differentially expressed proteins are identified in the liver of the mouse model of alveolar echinococcosis, and Fabp1, Acsl1, Acox1, Ehhadh and Acaa1b may contribute to the pathogenesis of alveolar echinococcosis.