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Echinococcus multilocularis larvae, predominantly located in the liver, cause a tumor-like parasitic disease, alveolar echinococcosis (AE), that is characterized by increased infiltration of various immune cells, including macrophages, around the lesion that produces an “immunosuppressive” microenvironment, favoring its persistent infection. However, the role of hepatic macrophages in the host defense against E. multilocularis infection remains poorly defined. Using human liver tissues from patients with AE and a hepatic experimental mouse model of E. multilocularis, we investigated the phenotype and function of hepatic macrophages during the parasite infection. In the present study, we found that a large number of CD68+ macrophages accumulated around the metacestode lesion in the liver of human AE samples and that both S100A9+ proinflammatory (M1 phenotype) and CD163+ anti-inflammatory (M2 phenotype) macrophages were significantly higher in close liver tissue (CLT) than in distant liver tissue (DLT), whereas M2 macrophages represent the dominant macrophage population. Furthermore, E. multilocularis-infected mice exhibited a massive increase in macrophage (F4/80+) infiltration in the liver as early as day 5, and the infiltrated macrophages were mainly monocyte-derived macrophages (CD11bhi F4/80int MoMFs) that preferentially differentiated into the M1 phenotype (iNOS+) at the early stage of E. multilocularis infection and then polarized to anti-inflammatory macrophages of the M2 phenotype (CD206+) at the chronic stage of infection. We further showed that elimination of macrophages by treatment of mice with clodronate-liposomes before E. multilocularis infection impaired worm expulsion and was accompanied by a reduction in liver fibrosis, yielding a high parasite burden. These results suggest that hepatic macrophages may play a dual role in the establishment and development of E. multilocularis metacestodes in which early larvae clearance is promoted by M1 macrophages while persistent metacestode infection is favored by M2 macrophages.

Alveolar echinococcosis located in the adrenal gland can be considered a rare and aggressive infestation that radiologically and macroscopically mimics a malignant neoplasm. Its pathogenesis is poorly understood. This paper describes its clinical and radiological aspects and discusses its proper management.The records of two patients with adrenal gland alveolar echinococcosis who were diagnosed and treated in our center in 2009 were evaluated.Neither patient showed any signs of recurrence following radical surgical treatment and postoperative oral anthelmintic therapy.Radical surgery can be a feasible, effective management option that results in a good prospective outcome.

To explore and compare the clinical effect and safety of liposomal albendazole (L-ABZ) and tablet-albendazole (T-ABZ) in the treatment of cystic echinococcosis (CE1, CE2, and CE3).A total of 269 cases treated with cystic echinococcosis (CE) in Xinjiang Medical University the First Affiliated Hospital from 1998 to 2008 were reviewed. 51 cases were excluded and 218 cases were enrolled in this research by retrospective case-control method. Among 110 cases were treated with L-ABZ and 108 cases were treated with T-ABZ for short-term (3 months) and long-term courses (6 months) respectively. The effects and safety of the two medicines were compared by analyzing the clinical symptoms, imaging check and serologic test results.In short-term effect evaluation, the total effective rates and curative rates of L-ABZ group and T-ABZ group were 77.9% and 49.1% vs 28.4% and 13.9%, respectively. The effects of L-ABZ group was better than that of T-ABZ group, with remarkable difference in total effective rates and curative rates (x2 value was 19.581, 6.877, respectively, P is less than 0.05). In long-term effect evaluation, the total effective rates and curative rates of L-ABZ and T-ABZ group were 81.7% and 49.0% vs 47.6% and 20.6%, respectively. There was significant difference between L-ABZ group and T-ABZ group in total effective rates and curative rates (x2 value was 20.977, 15.049, respectively, P is less than 0.05). In T-ABZ group the short-term curative rates were 50.0% (15/30), 8.8% (8/91) and 33.3% (7/21) respectively in CE1, CE2, and CE3, the short-term total effective rates were 56.7% (17/30), 35.2% (32/91) and 61.9% (13/21) respectively in CE1, CE2, and CE3. The long-term curative rates were 58.3% (7/12), 28.6% (12/42) and 70.0% (7/10) respectively in CE1, CE2 and CE3, the long-term total effective rates were 75.0% (9/12), 69.0% (29/42) and 100.0% (10/10) respectively in CE1, CE2, and CE3. When compared with CE2, differences existed in CE1 (x2 = 24.887, 4.329; P is less than 0.05) and CE3 groups (x2 = 8.860, 5.076; P is less than 0.05) in terms of short-term effects. In L-ABZ group, the short-term curative rates were 47.4% (18/38), 12.2% (12/98) and 61.5% (8/13) respectively in CE1, CE2 and CE3, the short-term total effective rates were 92.1% (35/38), 65.3% (64/98) and 92.3% (12/13) respectively in CE1, CE2 and CE3, the long-term curative rates were 79.3% (23/29), 35.9% (23/64) and 50.0% (3/6) respectively in CE1, CE2 and CE3, the long-term total effective rates were 96.6% (28/29), 84.4% (54/64) and 100% (6/6) respectively in CE1, CE2 and CE3. When compared with CE2, there were significant differences in CE1 (x2 = 19.648, 9.930; P is less than 0.05) and CE3 groups (x2 = 18.880, 3.876; P is less than 0.05) in terms of short-term effect. In L-ABZ and T-ABZ groups, the drug-related adverse effects were 11.1% (12/108) and 12.7% (14/110) respectively without significant difference (x2 = 0.155, P is more than 0.05).L-ABZ and T-ABZ were both effective anti-echinococcosis drugs without dominant side-effects. The clinical effect of L-ABZ was better than that of T-ABZ.

For patients with end-stage hepatic alveolar echinococcosis (AE), in vivo resection of the involved parts of the liver is usually very difficult, therefore, allogenic liver transplantation is indicated. However, we hypothesize that for selected patents, ex vivo liver resection for thorough elimination of the involved tissues and liver autotransplantation may offer a chance for clinical cure.We presented a 24-year-old women with a giant hepatic AE lesion who was treated with hepatectomy, ex vivo resection of the involved tissue and hepatic autotransplantation. The patient had moderate jaundice and advanced hepatic AE lesion which involved segments I, IV, V, VI, VII, VIII and retrohepatic inferior vena cava. The lateral segments (II and III) of the left liver remained normal with over 1000 ml in its volume. No extrahepatic metastases (such as to the lung or brain) could be found. As the first step of treatment, X-ray guided percutaneous transhepatic cholangiodrainage (PTCD) was performed twice for bile drainage in segment III and II separately until her serum total bilirubin decreased gradually from 236 to 88 µmol/L. Total liver resection was then performed, followed by extended right hepatic trisegmentectomy and the entire retrohepatic vena cava was surgically removed en bloc while her hemodynamics parameters were stable. Neither veino-veinous bypass nor temporary intracorporeal cavo-caval or porto-caval shunt was used during the 5.7-hour anhepatic phase. The remained AE-free lateral segments of the left liver were re-implanted in situ. The left hepatic vein was directly anastomosed end-to-end to the suprahepatic inferior vena cava due to the lack of the retrohepatic inferior vena cava with AE total infiltration. Because compensatory retroperitoneal porto-caval collateral circulation developed, we enclosed remained infrahepatic inferior vena cava at renal vein level without any haemodynamics problems.During a 60-day following-up after operation, the patient had a good recovery except for a mildly elevated serum total bilirubin.As a radical approach, ex vivo liver resection and liver autotransplantation in a case has shown a optimal potential for treatment of the end-stage hepatic AE. Strict compliance with its indications, evaluation of vessels of patients pre-operatively, and precise surgical techniques are the keys to improve the prognosis of patients.

To explore the approach of operation plus chemotherapy in the treatment and diagnosis of human complicated alveolar echinococcosis (AE) in multi-organs (liver, lung and brain).The clinical data for 17 cases of alveolar echinococcosis were reviewed by a follow-up of 1 - 7 years between 2000 and 2009 at our hospital.Among 17 cases, 8 cases achieved an excellent effect after taking liposomal albendazole, 3 cases received radical hepatectomy and 1 case pneumonectomy with a better effect, 1 case of palliative liver transplantation had lung metastasis and stayed on a long-term therapy of liposomal albendazole. Another case of liver transplantation received a long-term postoperative chemotherapy. And the metastases of lung and brain were found. Three operative cases suffered serious complications in liver and brain and received a long-term chemotherapy. One of them died of serious brain complications after a 6-month follow-up. And one advanced AE patient died at home due to a refusal of any further treatment. Since more than two organs are involved by AE lesion of alveolar echinococcosis, it was rather difficult to diagnose and cure AE radically by complicated surgery. Thus the life quality and long-term survival of patients were seriously endangered.Based on surgical approaches for serious complications and a comprehensive medical therapy, the multi-organ AE patients may have a prolonged survival and an improved clinical outcome.