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Cystic hydatid disease is a zoonosis caused by Echinococcus granulosus. It may affect any organ and tissue in the body, in particular the liver and Lung. Musculoskeletal or soft tissue hydatidosis accounts for about 0,5%-5% of all echinococcal infections in endemic areas and is almost secondary to the hepatic or pulmonary disease (Karaman et al., 2011; Dirican et al., 2008; Kouskos et al., 2007). Case Presentation. We report an unusual case of primary subcutaneous hydatidosis in the left supraclavicular region of the neck. A 53-year-old female patient was admitted with three-month history of pain and gradually growing mass located in the left supraclavicular region. Physical examination revealed a moderately hard, painful, and erythematous mass. The blood cell count was normal. Computed tomography demonstrated, a multilocular cystic lesion with thin borders and thin wall. The mass is binocular and extends to the scapula. CT showed no involvement of the lung. From these signs, the patient was diagnosed as having abscess (bacterial infection or tuberculosis). The diagnosis of Echinococcus granulosus infection was made per operatively after visualization of the cyst wall and the daughter cysts. Following irrigation of cystic cavity with hypertonic saline solution, the cyst wall was excised along with a portion of surrounding tissue. Histopathological examination of the specimen confirmed the hydatid origin. Hemagglutination tests for Echinococcus and ELISA were negative. Ultrasound of the abdomen was normal. The patient received albendazole (400 mg/day) for 8 weeks postoperatively. No sign of recurrence could be detected by physical examination and imaging (CT) at 4-month followup. Conclusion. The case illustrates that echinococcal disease should be considered in the differential diagnosis of every cystic mass in every anatomic location, especially when it occurs in endemic areas. [ABSTRACT FROM AUTHOR]

Introduction. Hydatid disease is a disease caused by the cestode Echinococcus. Echinococcus granulosus is the most common Echinococcus species affecting human. It may affect any organ and tissue in the body, most in the liver and lung. Disease is endemic in some regions of the world, and is common in Iran. Primary hydatid cyst of the axillary region is an unusual and rare localization of hydatid disease. So far, only sixteen cases have been published in the all medical literature. Case Report. Herein, we present a 33-year-old woman because of a mass in the axillary region of four months duration. Axillary ultrasonography showed a thick wall cystic lesion. No abnormality was found in mammographic examination of either breast, or in abdominal ultrasonography and chest X-ray. The mass was excised for pathological examination that showed a typical laminated membrane of hydatid cyst. Postoperative IgG- ELISA serology in this case was negative. Based on pathology an axillary hydatid cyst was diagnosed. Conclusion. Hydatid cyst should be considered in endemic areas in patients presenting with a soft tissue mass in the axillary region. [ABSTRACT FROM AUTHOR]

Summary Cystic echinococcosis (CE) caused by larval stage of Echinococcus granulosus, is an endemic zoonosis in Iran particularly in rural regions. The objective of this study was to determine the prevalence of CE among rural communities in Kerman using ultrasonography (US) and serology. Kerman Province, in southeastern Iran, is the largest province, with 2.9 million inhabitants. A sample of 1140 individuals (200 males and 940 females) was selected by randomized cluster sampling in 2006-2008. After acquiring informed consent for each participant a questionnaire was filled, complete abdominal US in supine position was carried out and 5 ml blood was collected for ELISA test. Two hydatid cases (0.2%) were detected by ultrasound. Serological results showed 7.3% seropositivity, and females (8.3%) were significantly more positive than males (2.1%). There were significant difference between CE seropositivity and sex, age and occupation. Residents of desert regions (Shahdad, Andouhjerd and Golbaf) were 2.5 times more likely to be seropositive than mountainous regions with better socioeconomic status (OR = 2.5; 95% CI = 1.09-5.95). Dog ownership does not appear to be a significant risk factor for CE in the region. Only about 10% of households own dogs, usually only one dog. However, the stray dog population of Kerman province is estimated at 145 000-480 000 (3.5-11.5 times the owned dog population). Infection in humans and animals would appear to come mostly from infected stray dogs. Management of stray dog population could make major progress in control of hydatid disease. In addition, proper washing of vegetables decreased probability of infection by 53% (OR = 0.47; 95% CI = 0.26-0.84). The serological study showed that many people, especially women, had been exposed to Echinococcus eggs and had seroconverted but were not infected. [ABSTRACT FROM AUTHOR]

Background: Gossypiboma is a term used to describe a retained surgical swab in the body after a surgical procedure. Gossypiboma is a rare surgical complication, but can cause significant morbidity and mortality. It may be a diagnostic dilemma with associated medico-legal implications, and is usually discovered during the first few days after surgery; however, it may remain undetected for many years.Methods: We present a gossypiboma case immigrating to small intestine, as well as a literature review of studies published in the English language on intraluminal migration of gossypiboma, accessed through PubMed and Google Scholar databases.Results: Case of a 51-year-old man who was admitted due to vomiting, abdominal distension, and pain. He had a history of abdominal trauma 8 years previously, and surgery had been performed at another hospital. The physical examination revealed muscular guarding and rebound tenderness in the right lower quadrant. A splenic hydatid cyst and ileal calcified mass were suspected based on results of abdominal computed tomography. Therefore, a laparotomy was performed. Segmental ileal resection, end-to-end anastomosis, and splenectomy were performed. The final diagnosis was gossypiboma in both the spleen and ileum. We performed a systemic review of the English-language literature between 2000 and 2010 in PubMed and Google Scholar, and we found 45 cases of transmural migration of surgical sponges following abdominal surgery. Three cases in which the gossypiboma was located in the spleen are also discussed.Conclusion: Gossypiboma should be considered as a differential diagnosis of any postoperative patient who presents with pain, infection, or a palpable mass. [ABSTRACT FROM AUTHOR]

Objective: Hydatid disease is still an important health hazard in the world. This disease is a parasitic infestation which is endemic in many sheep and cattle raising areas such as in Iran. The aim of this study was to evaluate the clinical appearance, diagnosis, and treatment of liver hydatid cyst in children. Methods: This retrospective study evaluated 100 patients who were referred to Mofid Children's Hospital with liver hydatid cyst from March 1996 to March 2010. Medical records of 1 to 14 year old patients who had definitive liver hydatid cyst were included and analysis of variables such as age, gender, symptoms, diagnostic investigation, operative technique, hospital stay, mortality, morbidity and outcome of treatment were evaluated. Findings: The patients consisted of 54 boys (54%) and 46 (46%) girls with an age range of 1-14 years (mean 11.8±4.6). The incidence rate increased by age. The patients had totally 110 cysts, right pulmonary lobe 81 (73%) cysts and left side had 29 (27%). Abdominal mass was the most common (50%) symptom. Abdominal sonography gave correct diagnosis in 94 (94%) patients. Conservative surgical treatment was carried out in 98 children. Two patients were treated medically as the cysts were small and calcified. The most common complication was wound infection in 3 cases. Mean length of hospitalization was 9 days. In 100% of our patients the type of parasite was Echinoccocus granulosus. The morbidity rate was 12% (prolonging external catheter drainage in 12 patients). There was only one (1%) mortality and 2 (2%) recurrences. Conclusion: Due to the less invasive and high accuracy of liver sonography in diagnosis of hydatid cyst, we recommend it as the method of choice for the diagnosis in endemic regions. Surgery is the method of choice for treatment. [ABSTRACT FROM AUTHOR]

Rupture of a hydatid cyst into the biliary tract, also known as cystobiliary communication, is the most common complication of hepatic hydatid cyst. This may lead to obstructive jaundice, pancreatitis, cholangitis, and sepsis with high mortality. Imaging plays an important role in the preoperative diagnosis of this condition which facilitates its management. We studied six patients with rupture of hepatic hydatid cyst into a large bile duct in whom multidetector-row CT (MDCT) suggested the diagnosis. The imaging findings included a single hepatic cyst less than 10 cm in diameter in all the cases; interruption of the cyst wall adjacent to a bile duct signifying cyst-bile duct communication was seen in five patients. The common bile duct was dilated in all the patients, with linear membranes in four and diffuse irregular high dense intrabiliary material observed within the common bile duct in two of them. Intrahepatic ducts were dilated in all the six cases and two patients showed linear dense contents within distended gallbladder. Subcapsular and intrathoracic rupture was associated in one patient each. MDCT demonstration of hydatid cyst in the liver together with a dilated common bile duct and distended gallbladder containing high density hydatid material suggest rupture of the cyst into biliary tree. MDCT enhances demonstration of the dilated common bile duct with hydatid material inside. The diagnosis is reinforced by the demonstration of the cystobiliary communication itself. [ABSTRACT FROM AUTHOR]

Abstract: Hepatic alveolar echinococcosis (HAE) is a parasitic infection with an infiltrative growth pattern that has the appearance of a hepatic malignant tumor. Ultrasound (US) has been used for screening of HAE in epidemic areas. However, it has been very difficult to evaluate the clear boundary and microvessel perfusion of the lesions. The aim of this study was to demonstrate the characteristic imaging and clinical significance of HAE lesions by contrast-enhanced ultrasonography (CEUS). Seventeen patients with 19 HAE lesions were examined in sequence with US, color Doppler flow imaging (CDFI) and then CEUS before any treatment. All the data were compared before surgery. Examined by fundamental US, 47.4% of HAE lesions showed irregular hyperechoic substantive areas and 52.6% appeared as having a mixed echotype with irregular anechoic areas in the central portion of the lesions. The CDFI method indicated no blood flow signals inside any of the 19 lesions. By CEUS, all 19 lesions displayed circular rim enhancement in the peripheral segments and absent enhancement within the central areas of the lesions (a “black hole” effect). As a result, the lesions’ margins were clear, irregular and distinct. In general, the sizes of all the HAE lesions observed by CEUS were larger than those obtained by fundamental US. Therefore, CEUS is a simple imaging method and can be a helpful tool for more accurate sizing of HAE lesions and their surrounding invasion range and the proper cut-off margin when radical hepatectomy is needed. [Copyright &y& Elsevier]

Anti- Echinococcus serum immunoglobulin (Ig)E was assessed by the ImmunoCAP system and compared with anti- Echinococcus serum IgG assessed by enzyme-linked immunosorbent assay (ELISA) and Western blot. The ImmunoCAP system revealed very high specificity (one false positive of 110 healthy individuals), low cross-reactivity (one false positive of 58 patients with other diseases) and decreased sensitivity (73·55%). Receiver operating characteristic analysis displayed a beneficial diagnostic value with high accuracy. Comparison of the ImmunoCAP system with ELISA and Western blot showed significantly higher specificity and significantly lower cross-reactivity compared with the ELISA. Examination of sera from 155 patients with cystic echinococcosis (CE) showed varying levels of anti- Echinococcus IgE (range, 0·01-118·33 kUA/L). However, most samples had moderately elevated IgE levels. Analysis of serum-specific IgE revealed significantly higher sensitivity of the ImmunoCAP system and significantly higher antibody levels in hepatic CE compared with pulmonary CE. [ABSTRACT FROM AUTHOR]

Abstract: A modified Segmental Sedimentation and Counting Technique (SSCT) to examine the presence of Echinococcus multilocularis helminths in segments of fox (Vulpes vulpes) intestine is described and compared to the “gold standard”, SCT. Out of the 358 intestines collected, 117 were E. multilocularis positive. Using SSCT methods we compare the sensitivity of individual or pairs of segments to establish a tradeoff between saving time and the reliability of the diagnosis, especially in areas with low infection intensities. The results show that the analysis of segment S4 associated with segment S1 or S2 give 98.3% sensitivity, with specificity close to 100%. Based on our results and the time saved, we recommend using SSCT for routine examination of fox intestines for large epidemiological studies, particularly where the endemic prevalence of E. multilocularis is low or unknown. [Copyright &y& Elsevier]

Abstract: We show that a conventionally purified glycoprotein component of Echinococcus multilocularis protoscolex, designated as Emgp-89, may be useful as a serodiagnostic antigen for detecting E. multilocularis infection in dogs domesticated in endemic areas. Emgp-89 was obtained from the parasite material by a simple procedure using Con A-agarose and subsequent gel filtration chromatography. The purified fraction showed a molecular weight of >4000kDa upon gel filtration and reacted with a series of lectins that specifically bind to mannose, galactose, N-acetylglucosamine, and N-acetylgalactosamine. Subsequently, serodiagnostic performance of Emgp-89 was evaluated through enzyme-linked immunosorbent assays (ELISAs) by using sera from normal, domestic dogs and dogs infected with other helminths. Emgp-89 positively reacted with all 16 serum samples from E. multilocularis-infected dogs, thus showing that this antigen is highly sensitive. On the other hand, the specificity of Emgp-89-based ELISA, determined using 41 serum samples from dogs infected with other helminths, was relatively low (83%). As an attempt to improve the specificity of Emgp-89-based ELISA, we pretreated Emgp-89 with proteinase K or sodium periodate, expecting that these treatments would enable discrimination of true positives from false positives. The ELISA value increased after treatment with sodium periodate in most false-positive samples, whereas significant decreases were observed in sera from all dogs infected with E. multilocularis. Further evaluation of this antigen should be performed using sera from dogs infected with closely-related parasites, including taeniid cestodes, which are expected to prove that this serodiagnostic system is sufficiently specific for clinical and field applications. [Copyright &y& Elsevier]

Echinococcosis is a zoonotic infection caused by adult or larval (metacestode) stages of cestodes belonging to the genus Echinococcus. The purpose of this study was to evaluate the antigenic ability of hydatid cyst fluid antigen for the diagnosis of hydatidosis in cattle using enzyme-linked immunosorbent assay (ELISA) and indirect haemagglutination test (IHA). The source of the antigens for the serological tests was fertile crude cyst fluids collected from naturally infected sheep at the Addis Ababa abattoir. A total of 502 sera were collected from 329 uninfected cattle and 173 hydatid-infected cattle which were confirmed by post-mortem examination. Most cysts were sterile and multiple organ infection predominated. Of 173 infected cattle, 166 (96.0%; confidence interval (CI) 91.8–98.4) were positive using ELISA while 7 (4.0%) were negative. Of 329 sera from uninfected cattle, 274 (83.3%; CI 78.8–87.2) were found to be negative and the remaining 55 (16.7%) were positive by ELISA. Of 173 infected cattle, 151 (87.3%; CI 81.4–91.9) were positive and 22 (12.7%) were negative by IHA. Of 329 negative sera tested using IHA, 266 (80.9%; CI 76.2–85.0) were negative and the remaining 63 (19.1%) were positive. The false positive and negative values of ELISA were 4.0 and 16.7%, respectively, and the corresponding values of IHA were 12.7 and 19.1%. The sensitivity and diagnostic efficiency of IHA were 87.2 and 83.6%, respectively. Crude hydatid cyst fluid antigen seems to have reasonable antigenic properties and hence could be employed for epidemiological surveillance of cattle hydatidosis. [ABSTRACT FROM AUTHOR]

Background: The aim of this study was to assess the performance of Antigen B (AgB) isolated from different Echinococcus granulosus intermediate hosts and from different cyst locations for immunodiagnosis of human cystic echinococcosis (CE). Methods: Hydatid cyst fluids were collected from lung and liver cysts of sheep, liver cysts of goats, lung cysts of camels and cattle, and liver cysts of human. AgB was purified from each of these hydatid cysts fluids. Serum samples obtained from 47 pathologically confirmed cases of CE along with 30 sera samples from non-CE patients and 40 sera from healthy individuals were tested by ELISA using AgB prepared from different hosts or cyst locations. Results: The highest sensitivity (97.8%) for diagnosis of CE was seen with AgB prepared from human liver cysts. This maximal sensitivity was followed by AgB isolated from those of sheep liver and lung cysts. The least sensitivity was found with AgB prepared from bovine lung cysts. The highest specificities (97.1%) were observed with AgB isolated from human liver cysts followed by those of sheep and goat liver cysts while the lowest specificity was seen with AgB isolated from bovine lung cysts. In view of the specificities and sensitivities of the different AgB, the best validity was found for AgB prepared from human liver cysts while the least validity was found with AgB prepared from bovine lung cysts. Conclusion: For any AgB-based tests, obtaining of the antigen from one of these sources will significantly increase the diagnostic sensitivity and specificity of the assay. [ABSTRACT FROM AUTHOR]

Background: Hydatid disease is rare in the United States. Rarely the hydatid cyst can become infected with mycotic organisms, such as Aspergillus. We describe a young male who presents with clinical features of suppurative lung abscess whose workup diagnosed hydatid cyst complicated by Aspergillus co-infection. Case presentation: A 27-year-old Peruvian male was hospitalized because of fever, chills, and productive cough of three months' duration. Clinical features were consistent with a suppurative lung abscess. Significant findings included leukocytosis with eosinophilia and a chest x-ray showing a large lingular lobe thick-walled cavity with a wavy irregular fluid level. The patient ultimately underwent surgical resection of the lingular lobe. Examination of the surgical specimen revealed the cavity to be a hydatid cyst. Histologic examination of the cyst wall showed intense inflammation and several septate hyphae of Aspergillus species. The patient recovered fully and has remained in good health. Conclusion: A thick-walled cavity and a wavy meniscus constitute unusual features for an ordinary pyogenic lung abscess and suggests other possibilities. Endogenous cases of hydatid disease are uncommon in the United States, with the majority of cases occurring in immigrants. There are few published case reports describing incidental findings of Aspergillus in a hydatid cyst. The rare occurrence of such a condition can lead to a delay in diagnosis and treatment. [ABSTRACT FROM AUTHOR]

We are presenting the case of a 26-year-old female patient who presented with a large swelling in the left thigh anteromedially. She was preoperatively diagnosed as a case of intramuscular hydatid cyst radiologically, and then cyst was removed and pathology proved the diagnosis. This case illustrates that echinococcal disease should be considered in the differential diagnosis of every cystic mass in any anatomic location, especially when they occur in areas where the disease is endemic. [ABSTRACT FROM AUTHOR]

Hydatid cyst is a parasitic disease caused by the tapeworm Echinococcus granulosus. This disease is a rare finding in the head and neck region, and its presentation varies according to the area involved. We report the case of a 25-year-old woman who presented with bilateral neck swelling, which was found on histopathologic examination to be caused by a hydatid cyst. The patient underwent surgical drainage of the cyst and a modified radical mastoidectomy, followed by a 3-month course of treatment with albendazole. However, she experienced a recurrence in the left neck region 1 year later. At that time, reexploration of the left mastoid cavity was performed, with debridement of diseased occipital bone and foramen magnum. Intraoperatively, we used a novel method of saline irrigation with 3% hypertonic saline, previously not tested on exposed nerves, in an attempt to prevent further recurrence. Four years after the second surgery, no disease recurrence was found, and no neurologic sequelae were noted. We conclude that hypertonic saline irrigation can be considered as an option for preventing recurrence in cases that are difficult to clear surgically, especially around cranial nerves, although more studies are needed to document the safety of this approach. [ABSTRACT FROM AUTHOR]

Abstract: The earlier recommendations of the WHO-Informal Working Group on Echinococcosis (WHO-IWGE) for the treatment of human echinococcosis have had considerable impact in different settings worldwide, but the last major revision was published more than 10 years ago. Advances in classification and treatment of echinococcosis prompted experts from different continents to review the current literature, discuss recent achievements and provide a consensus on diagnosis, treatment and follow-up. Among the recognized species, two are of medical importance –Echinococcus granulosus and Echinococcus multilocularis – causing cystic echinococcosis (CE) and alveolar echinococcosis (AE), respectively. For CE, consensus has been obtained on an image-based, stage-specific approach, which is helpful for choosing one of the following options: (1) percutaneous treatment, (2) surgery, (3) anti-infective drug treatment or (4) watch and wait. Clinical decision-making depends also on setting-specific aspects. The usage of an imaging-based classification system is highly recommended. For AE, early diagnosis and radical (tumour-like) surgery followed by anti-infective prophylaxis with albendazole remains one of the key elements. However, most patients with AE are diagnosed at a later stage, when radical surgery (distance of larval to liver tissue of >2cm) cannot be achieved. The backbone of AE treatment remains the continuous medical treatment with albendazole, and if necessary, individualized interventional measures. With this approach, the prognosis can be improved for the majority of patients with AE. The consensus of experts under the aegis of the WHO-IWGE will help promote studies that provide missing evidence to be included in the next update. [Copyright &y& Elsevier]

Objective: To study epidemiologic and clinical features of pelvic hydatid disease and discuss its management.Method: A retrospective analysis of 11 cases of pelvic hydatid disease managed over 7 years and 8 months at the Maternity and Neonatalogy Unit, Tunisian Medical Center La Rabta, Tunis, Tunisia. All cases were identified from histopathologic reports.Results: The 11 affected patients had a mean age of 41.6years (range, 22-79 years), 6 had a history of surgery for hydatid disease, 8 presented for chronic pelvic pain, and 1 was admitted for acute surgical abdomen. On physical examination, 6 had a pelvic mass. An ultrasound examination suggested the diagnosis preoperatively in 6. All were treated surgically. Primary laparoscopy was performed in 5 patients. Unroofing (or partial cystectomy) was performed in 6 patients and complete cystectomy in 4. The postoperative course was uneventful in all cases. Recurrence occurred only in 1 patient, 6 months after initial surgery.Conclusion: Pelvic hydatid disease is rare and its diagnosis often difficult preoperatively. The treatment mainstay is surgery. The laparoscopic approach seems to be safe and effective, and may increasingly replace laparotomy. [ABSTRACT FROM AUTHOR]

Abstract  In serodiagnosis of cystic echinococcosis (CE) by Echinococcus granulosus infection, antigen B (AgB) has been utilized worldwide. However, it is known that about 40% of sera with alveolar echinococcosis (AE) by Echinococcus multilocularis infection recognize AgB. Furthermore, cross-reaction against AgB was also reported in sera from polycystic echinococcosis (PE) patients with Echinococcus vogeli infection. These findings indicate that AgB is widely common to the genus Echinococcus. On the other hand, AgB has several subunits, which are composed of the smallest 8-kDa subunit. In this study, reactivities of patient sera with three kinds of Echinococcus infections (CE, PE, and AE) were compared simultaneously under the same condition against three subunits of AgB (8, 16, and 24 kDa). Many articles have referred the fundamental 8-kDa subunit as a diagnostic antigen for CE. However, the reactivity for the 8-kDa subunit of the CE patient was not so high (47.7%) in this study. Furthermore, there are many cases in which serum of patients with PE or AE also recognizes this subunit (66.7% in PE; 45.9% in AE). AgB is effective for the detection of the genus Echinococcus infections, but it does not have high species specificity. Therefore, we need to pay attention to cross-reaction in serodiagnosis of CE in areas where plural species coexist. [ABSTRACT FROM AUTHOR]

Primary cardiac hydatid cyst seen in the right ventricle is an infrequent appearance of disease. An immediate and precise identification of cystic lesion is critical, especially if a surgery is planned. In this context, the multimodality imaging can give precious knowledge on both the lesion and its relation to other cardiac and extracardiac structures and thereby can guide the surgery. [ABSTRACT FROM AUTHOR]

Giant hydatid cyst in spleen is rare in the pediatric age group. We came across two cases of giant splenic hydatid cysts in pediatric age group, out of which, one case had pulmonary, liver and splenic hydatid cyst which was managed with single stage approach. As a single stage approach is a novel method with less morbidity, it should be adopted as a preferred method for the management of pulmonary and abdominal hydatidosis. Hydatid cyst is described as a slow growing cyst in literature, but the presentation of giant size hydatid cyst in our 7 and 12 year old child is difficult to explain by this concept of slow growth. [ABSTRACT FROM AUTHOR]

This case illustrates one of the largest reported hydatid cyst of the interventricular septum that almost obliterated both ventricular cavities. Diagnosis of hydatid cyst was confirmed on echocardiography, cardiac MRI, CT chest, and postoperative histopathology. [ABSTRACT FROM AUTHOR]

Background: Ovarian mucinous cystadenomas (MCAs) are very rare in adolescent females. These lesions can be misdiagnosed as hydatid cysts in endemic regions when seen on imaging. The cysts may wander after autoamputation and then can be diagnosed only with histology testing. Case: A 14-year-old adolescent female had a cyst that was wandering in her peritoneal cavity. This lesion appeared to be a hydatid cyst on imaging. The patient underwent a laparotomy with complete excision of the cyst. Results: Histopathology testing of the cyst revealed that it was a MCA of the ovary. The patient was discharged, as she was well, on the 8th postoperative day. Conclusions: Ovarian MCAs are very rare in adolescent females, with only 19 cases reported in previous literature. This type of lesion may mimic a hydatid cyst on imaging studies. Even if both ovaries may appear to be normal and are seen separately from the lesion, it is important to remember that, as a result of torsion, an ovarian mass may autoamputate and continue to grow by obtaining a blood supply from mesenteric vessels. (J GYNECOL SURG 32:64) [ABSTRACT FROM AUTHOR]

Although the most common cause of obstructive jaundice is viral infections, there are some rare disorders which can cause this picture. We present a 15-year-old girl, admitted with an obstructive jaundice. Her laboratory tests including viral infections were normal. The diagnosis of hydatid cyst was performed with both ultrasonography and indirect hemagglutination assay. The patient was operated on and hydatid cyst was seen to be ruptured into the choledochus. In conclusion, nonviral causes of hepatitis are less common, but must be considered in the differential diagnosis. An important complication of hydatid disease is rupture to biliary tree. This situation may cause obstructive jaundice. [ABSTRACT FROM AUTHOR]

Abstract: Echinococcus multilocularis is an important parasite that causes human alveolar echinococcosis. Identification and characterization of the proteins encoded by E. multilocularis metacestode might help to understand the complexity of the parasites and their interactions with the host, and to identify new candidates for immunodiagnosis and vaccine development. Here we present a proteomic analysis of E. multilocularis protoscolex (PSC) proteins. The proteins were resolved by 2-DE (pH range 3.5–10), followed by MALDI-TOF MS analysis. Fourteen known Echinococcus proteins were identified, including cytoskeletal proteins, heat shock proteins, metabolic enzymes, 14-3-3 protein, antigen P-29 and calreticulin. To construct a systematic reference map of the immunogenic proteins from E. multilocularis PSC, immunoblot analysis of PSC 2-DE maps was performed. Over 50 proteins spots were detected on immunoblots as antigens and 15 of them were defined. The results showed that cytoskeletal proteins and heat shock proteins were immunodominant antigens in alveolar echinococcosis. [Copyright &y& Elsevier]

Abstract: Alveolar echinococcosis (AE) is a rare but potentially serious zoonosis for which an early diagnosis is of primary importance. We report the first observation of AE in a cardiac transplant patient infected by hepatitis C virus. He first presented with a single asymptomatic hepatic nodule. The liver biopsy showed an epithelioid granuloma with necrosis. We review the clinical features, diagnosis and outcome of this disease in immunocompromised hosts. In immunocompromised patients living in areas endemic for Echinococcus multilocularis, AE should be included in the differential diagnosis of tumor like lesions of the liver. [Copyright &y& Elsevier]

Background. Echinococcosis is a zoonotic disease that occurs mainly in endemic areas. Recurrent hydatid cyst (RHC) and its diagnosis present insidious problems for surgeons. The aim of this study was to evaluate the diagnosis and surgical management of RHC in Turkey, where the disease is endemic. Methods. We conducted a comprehensive study of 146 patients with abdominal hydatid cysts that were managed surgically between 1997 and 2007. Among those patients, RHC arose in 14 (9.5%) of cases. Results. The female to male patient-ratio was 6 to 8 and median age was 47.4 years. Patients' symptoms included abdominal pain, nausea, fever, and jaundice. Cysts reoccurred in patients sporadically between 4 months and 22 years. Abdominal US, CT, and MRI were utilized for the diagnosis in 14 (100%), 11 (78.5%), and 2 (14.2%) patients respectively, demonstrating the RHC of the liver and concomitant cysts (splenic region, mesentery of the colon and perivesical) in all cases, respectively. The recurrent cysts (with a mean diameter of 12 cm) were removed using partial pericystectomy, introflexion, and total cystectomy surgical techniques. Postoperative morbidity occurred in 14% of patients. Conclusions. Especially in endemic countries like Turkey, RHC should be included in the differential diagnosis of cystic masses in abdominal organs that were previously treated for hydatid cysts. Surgery still remains the treatment of choice for RHC with early management and proper perioperative evaluation contributing to a high cure rate. [ABSTRACT FROM AUTHOR]

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

Hydatidosis, also known as hydatid cyst, is caused by the larval stages of the parasite Echinococcus granulosus. Its diagnostic relies mainly on clinical findings, epidemiology and imaging techniques supported by serological tests. Surgery is the commonest treatment; it is important to have a definitive diagnostic of hydatidosis before surgery, to avoid the spread of the cysts during the procedure. In this study, two immunoserologic tests for the diagnostic of hydatidosis are compared: Enzyme-linked Immunosorbent Assay (ELISA) for immunoglobulin G; and Fluoro-Enzyme Immunoassay (FEIA) for immunoglobulin E. The 55 patients included in this study are in a pre surgery stage, 31% have a calcified hydatic cyst, 54,5% a not calcified cyst and 14.5% have no hydatic cyst. Both tests had the same specificity (87.5%), the sensitivity of the ELISA IgG was lower (63.8%) then the FEIA IgE (76.6%). The correlation observed between of both tests was good (r = 0.726, p < 0.05). [ABSTRACT FROM AUTHOR]

We report herein a hydatid cyst of the right ventricle and its two- and three-dimensional echocardiographic appearance. [ABSTRACT FROM AUTHOR]

Diagnosis is a basic component of population studies on echinococcosis. Other than careful necropsy in animals, there is no perfect gold standard. In the definitive host, techniques for direct parasite identification include copro-antigen and copro-DNA detection. In intermediate hosts, necropsy is typically used. In humans, diagnostic imaging and serology are both widely employed. The use of multiple parallel testing or an additional confirmatory test (or tests) in a diagnostic strategy can overcome the lack of a perfect gold standard. This will yield valuable information at population and individual levels, providing the study is well designed and any shortcomings of the tests are incorporated into the analysis. Here, we discuss analytical approaches to population studies of echinococcosis. [Copyright &y& Elsevier]

The article presents a study that analyses the presence of Human alveolar echinococcosis (AE), zoonotic parasitic disease caused by larvae of Echinococcus multilocularis tapeworms, in Czech Republic from 2007-14. Topics include diagnosis of AE based on ultrasonography, confirmation of AE through histopathologic findings, and use of Mann-Whitney nonparametric test.

The hydatid cyst (HC) is endemic in Mediterranean region including Syria. The central nervous system is involved in 2-3% of cases. HC in cerebellum is very rare. We report a case that presented as an emergency for high intracranial pressure and deteriorating Glascow coma scale. Close monitoring and precise surgical management using Dowling's technique resulted in very good outcome with full recovery. We highlight the need for very careful surgical treatment because cyst rupture and secondary hydatidosis due to spillage of the cyst contents can dramatically worsen the outcome. HC should be taken into consideration in countries where hydatid infestation is endemic. [ABSTRACT FROM AUTHOR]

Hydatid cyst in the breast is very rare and unusual for its location. Reported incidence of hydatid cyst in the breast is 0.27% in the literature. Herein, we report a case of hydatid cyst of breast in a 65-year-old female who presented with painless, slowly growing lump in the breast mimicking breast neoplasm clinically. Radiological investigations such as ultrasonography and mammography may be helpful but not conclusive. Preoperative fine-needle aspiration cytology (FNAC) diagnosis was consistent with hydatid cyst of breast and was without any complications. Histopathological examination of lumpectomy specimen confirmed the diagnosis of hydatid cyst of breast. High suspicion of this entity should be there in the differential diagnosis in the evaluation of breast lump in endemic as well as in migrant population in nonendemic areas. [ABSTRACT FROM AUTHOR]

Hydatid disease results from infection with larval stage of Echinococcus granulosus tapeworm. Dogs and other canines are the definitive hosts; Human beings are common accidental intermediate hosts. Liver is the most common organ to be involved in this condition. Cardiac hydatid, seen in only 0.5 to 2% cases, is a rare entity because of myocardial contractility. Larvae reach the myocardium through coronary circulation. Among various locations of cardiac hydatid, due to its rich coronary arterial supply Left ventricle (LV) myocardium is the most common site of involvement followed by interventricular septum and right ventricle. Rare locations include pericardium, right atrium and left atrium. A 50-year-old woman presented with dyspnoea for 11 months, chest X-ray showed a well defined, homogenous left paracardiac mass, which is not separable from left heart border. Transthoracic echocardiography revealed a complex multicystic mass lesion abutting antero-lateral wall of left ventricle. Contrast enhanced computed tomography showed a well-circumscribed multicystic mass lesion with honeycomb appearance arising from myocardium of anterolateral wall of left ventricle. Indirect haemagglutination test for hydatid disease was positive. At surgery the cyst was seen to arise from LV myocardium. It was incised and grape like contents were evacuated. The cavity was irrigated with scolicidal solution. Thereafter, the cyst was marsupialised. Histopathological examination revealed grape like cyst contents consistent with the diagnosis of hydatid cyst. [ABSTRACT FROM AUTHOR]

Abstract Purpose  To investigate the incidence and define the importance of recurrent pulmonary hydatid cysts in developing countries. Methods  We analyzed the records of 312 patients with pulmonary hydatid cyst disease diagnosed in our center between 1999 and 2005. Results  A recurrent pulmonary hydatid cyst was diagnosed in 10 (3.2%) of the 312 patients [8 men and 2 women, mean age 36.9 (range 20–60) years]. The diagnosis was based on radiographic, clinical, or serological findings, established intraoperatively. The most frequent symptom of recurrent pulmonary hydatid cyst was hemoptysis (60%). The mean interval between diagnosis of the initial hydatid cyst and detection of recurrence was 8.75 (range 3–15) years. Bronchoscopy was performed in all patients, but proved diagnostic in only one. The localization of the initial and recurrent cysts differed in seven patients. A median follow-up period of 5 years revealed second recurrences in only two patients; manifesting as an intrapleural rupture of the cyst in one and as empyema in one. The recurrence was treated by resection in all patients; as cystectomy in eight patients, lobectomy in one patient, and pneumonectomy in one patient. Conclusion  Pulmonary hydatid cyst may recur in the same or a different location in the lung. Patients with a pleural lesion must be followed up regularly for any signs of recurrence. [ABSTRACT FROM AUTHOR]

Hydatid disease is endemic in parts of India. Genitourinary involvement is rare. Laparoscopic management of such cases is uncommonly reported. We present our experience of laparoscopic management of two cases of retrovesical hydatid cyst treated by laparoscopic aspiration, instillation, and suction and two cases of renal hydatid cyst treated by partial nephrectomy and cystopericystectomy with preservation of renal parenchyma. [ABSTRACT FROM AUTHOR]

Early and non-invasive evaluation of hydatid infestation of brain and spine is of paramount importance, especially in endemic areas. We present a spectrum of imaging findings in neurohydatidosis with a brief review of literature. [ABSTRACT FROM AUTHOR]

The early recognition and treatment of hydatid disease of the heart is important as it can result in potentially lethal complications. We present the clinical and echocardiographic features of a 71 year old Afghanistani man who presented with left-sided chest pain. Transthoracic (TTE), transesophageal (TEE), and contrast echo demonstrated a calcified cystic structure within the distal anterior septum consistent with an echinococcal cyst, despite negative serologies. Treatment strategies for this patient are discussed. [ABSTRACT FROM AUTHOR]

Sheep erythrocytes were stabilised with glutaraldehyde tanned and fixed with formalin in the indirect hemagglutination test (IHA-GF) and sensitised with hydatid antigen for the diagnosis of human cystic echinococcosis (CE). The sensitivity of this method was compared to that prepared with fresh tanned cells (IHA-TA) in 278 sera from hydatid patients. The sensitivity of IHA-GF (87.8%) was higher than that of IHA-TA (85.6%), the difference being insignificant. Higher geometric mean titres were obtained by IHA-GF (1:13 300) than by IHA-TA (1:11 600). The use of two sorts of aldehydes proved to be a satisfactory method, showing high sensitivity, a very good specificity and some advantages. The sensitised cells retained their diagnostic effectiveness for at least 15–18 months when stored at 4 °C. The technique is inexpensive and rapid, allowing the testing of a large number of sera. The method reduces the variation of the results and improves the reproducibility of the test. When the minimal diagnostic titre—1:400 is used the specificity of IHA-GF might increase by 2.9% while the sensitivity might decline by only 1.4%. The IHA-GF demonstrated better immunodiagnostic characteristics than enzyme linked immunosorbent assay (ELISA) and Latex agglutination test (LAT). The IHA-GF should be considered as an useful method in the range of classical diagnosis for the serology of CE. The clinical diagnostic potential should be increased by a combination of at least two tests: IHA-GF and ELISA or LAT. [Copyright &y& Elsevier]

In Algeria, cystic echinococcosis (CE) is a serious economic and public health problem. The common sheep/dog cycle is usually considered as the major source of human contamination. But to date the main strain of Echinococcus granulosus involved in the human contamination and the role of other hosts are still unknown. This paper reports an original work performed in northern Algeria combining field observations and molecular analysis. In a first step, examination of 6237 carcasses in slaughterhouses showed high infection and fertility rates in cattle and dromedaries. Then, in a second step, we used a molecular biology approach to identify the E. granulosus strain(s) involved. Forty-six samples from various origins were collected. They were analysed using comparison of PCR-amplified DNA sequences with one genomic (BG 1/3) and two mitochondrial (COI and NDI) targets. Results show the presence of a “sheep” strain of E. granulosus in North Algeria circulating between cattle and ovines and infectious to humans, whereas in South Algeria, a “camel” strain and a “sheep” strain were found to circulate in camels and in sheep, respectively. This study also reports an ambiguous genotype which resembled the “sheep” strain genotype (Gl) on the basis of the partial COI gene sequence, whereas on the basis of the partial NDI gene sequence, it was similar either to the “sheep” strain (Gl) or to the “camel” strain (G6). Besides its basic interest, our study confirms the role of other hosts (mainly cattle) in leading to transmission to humans and suggests that control measures should not only target sheep. [Copyright &y& Elsevier]

Background. Although hydatid disease is common, individual series are usually not large as far as primary cardiac hydatid disease is concerned. We believe this study is the largest series of primary cardiac hydatid disease for which cross-sectional imaging is available. Methods. We reviewed the radiologic and medical records of 9 pathologically proven cases of primary cardiac hydatid disease. Echocardiography, computed tomography (CT), and magnetic resonance imaging (MRI) were used. In 5 patients, all three modalities were used, and in 4 only CT was available. Results. Three types of cardiac involvement (pericardial, left ventricular, and right atrial wall) were detected. The cysts showed daughter cyst formation, detached parasitic membrane, rupture, segmental calcification, and end-stage calcification. Conclusion. Echocardiography is useful in detecting the cystic nature. Computed tomography best shows the wall calcification. Magnetic resonance imaging depicts the exact anatomic location and nature of the internal and external structures and is the modality of posttreatment follow-up. [ABSTRACT FROM AUTHOR]

A single 12.5 mg/kg dose of albendazole (Abz) in tablet form (AbzT) followed 2 weeks later by an equivalent dose of Abz emulsified in 30% soybean oil (AbzE) was administered orally 2 h after the first morning meal to 7 male adult patients with cystic echinococcosis caused by Echinococcus granulosus. Serum samples were taken 1, 3, 5, 7, 8, 9, 11, 14, 18, 24, 36, and 48 h post medication from each patient to measure the serum concentrations of albendazole sulfoxide (AbzSOX), the principal bioactive metabolite of Abz. AbzSOX concentrations were measured by reverse phase HPLC. The data were subjected to pharmacokinetic analysis to compare the relative bioavailability and bioequivalence of AbzT and AbzE. The results demonstrated that the mean peak concentrations (Cmax) for AbzT and AbzE were 1.06±0.38 mg/l and 1.71±0.47 mg/l, respectively; the area under the concentration–time curves (AUC) were 13.24±4.93mg·h/l and 21.01±7.54 mg·h/l, respectively. The relative bioavailability of AbzE was FFlu=1.59. Two one-sided tests procedure and (1−2α) 90% confidence interval methods were used to evaluate the bioequivalence of AbzE and AbzT. The results demonstrated that the bioavailability of AbzE was greater than AbzT. [Copyright &y& Elsevier]

Human cystic echinococcosis (CE) is a serious public health problem in West China. The Tibetan has a nature relation with these definitive and intermediate hosts in West China. Although Tibet is CE endemic, a few community studies have been reported. Eight hundred and eighty two Tibetans residing in the three rural communes of Tianzhu County, Gansu province of West China were investigated by serology and ultrasound scanning. 11.2% serum antibody positive rate in ELISA test was found out, and a 12.1% ultrasound rate of hepatic CE was found in the sero-positive population. Seropositivity rates varied for communes between 7.6 and 13.7%. Overall, females had a significantly greater risk of infection than males—ratio was about 2:1. The local behaviors were investigated and showed that family dog and grazing could not effect the infectious rates, but the number of sheep owned a family had a positive correlation with the infection rates. The infectious rate of hunting population was significantly higher than that of no-hunting population. The educated level of Tibetans in school had no effect on the infected rates. [Copyright &y& Elsevier]

We report two cases of primary cardiac hydatid cyst in which hydatid materials caused recurrent embolizations in pulmonary arteries and pulmonary parenchyma. Cardiac hydatid cysts may stay asymptomatic for a long time, until they reveal themselves being perforated into cardiac chambers and/or pulmonary artery or systemic circulation. The role of imaging techniques in diagnosis is discussed and the importance of dynamic enhanced CT, MR imaging, and enhanced MR angiography (MRA) is reported. Imaging findings were confirmed by surgery and pathology. Early diagnosis is essential because delayed treatment increases the morbidity and mortality rates. [ABSTRACT FROM AUTHOR]

In the past years, the diagnostic tools applied to identify alveolar (AE) and cystic echinococcosis (CE) in human patients have not only increased in number but also substantially improved in quality. The identification and characterization of species-specific parasite proteins/antigens allowed to generate subsequently recombinant or synthetic polypeptide antigens, as well as corresponding monoclonal antibodies. Some of these new tools have already demonstrated operating characteristics superior to conventional tests used for the immunodiagnosis of CE and AE, and thus may be suggested for routine laboratory application. Powerful molecular techniques, such as the polymerase chain reaction (PCR), have been developed and adapted to advance laboratory diagnosis of AE and CE. Detecting minute amounts of parasite DNA and mRNA, not only to identify but also to characterize the biological status of parasite material, thus becomes a complementary method to synergize immunodiagnostic techniques. This review focuses on recent developments of molecular tools, discussing their potential use as a primary or a supporting diagnostic element. We also outline some future developments to be undertaken in the field of molecular diagnosis, linked to clinical and laboratory problems. [ABSTRACT FROM AUTHOR]

We report a case of hydatid cyst of the pelvis in a 36-year-old woman presented with right adnexal cystic mass with similar cystic lesions in the liver. Laparatomy revealed a right paraovarian cystic mass densely adhered to the uterus, to the pelvic side wall, and to the right fallopian tube. Histopathological examination of the cyst wall showed the cuticular layer of the cyst. Cystic liver lesion was later proved to be hepatic hemangioma by magnetic resonance imaging. [ABSTRACT FROM AUTHOR]

Complete hydatidiform moles are now being diagnosed earlier in gestation, thus the clinical presentation and pathologic findings of complete molar pregnancy have changed. We studied the sonographic appearance of first trimester moles and the ability of ultrasound to detect them. We reviewed the sonographic interpretation and sonograms, when available, from all patients with first trimester complete moles diagnosed at our institution from January 1988 to March 1996. Of the 24 patients in our study, the mean gestational age at time of the sonogram was 8.7 ± 2.0 weeks (mean ± SD) with a range of 5.7–12.3 weeks. The initial sonographic interpretation was a complete mole in 17 (71%) cases, partial mole versus failed pregnancy in two (8%), and failed pregnancy in five (21%) cases. Of the 22 patients with sonograms available for review, interpretation on review of the images was a complete mole in 18 (82%) cases, partial mole versus failed pregnancy in one (5%), and failed pregnancy in three (14%) cases. The typical sonographic appearance of a first trimester complete mole was a complex, echogenic, intra-uterine mass containing many small cystic spaces. The majority of first trimester complete moles demonstrate a typical ultrasound appearance such that the diagnosis can be made with ultrasound in most cases. [ABSTRACT FROM AUTHOR]

The occurrence of polycystic echinococcosis (PE) caused by Echinococcus vogeli in Suriname is reviewed. Six of the eight known cases, including the first (which was incorrectly diagnosed as cystic hydatid disease caused by E. granulosus) in 1982, are described. The distribution in Suriname of the natural hosts of E. vogeli —the bush dog (Speothus venaticus) and the paca (Agouti paca)—is discussed. Characteristics of the four species recognized in the genus Echinococcus are compared, and all known cases of PE in 11 countries in the Neotropics are summarized. Finally, it is stressed, that, in Suriname, PE should be considered during the differential diagnosis of all subjects from rural areas who present with abdominal pain and palpable, intraperitoneal masses. [ABSTRACT FROM AUTHOR]