Case Of Alveolar Echinococcosis Research Articles

A Case of Alveolar Echinococcosis Treated with Monitoring of Serum Albendazole Concentration

A Case of Alveolar Echinococcosis Treated with Monitoring of Serum Albendazole Concentration

Pulmonary diffuse calcified multiple nodules in alveolar echinococcosis.

Alveolar echinococcosis is a potentially life-threatening parasitic disease primarily involving the liver caused by echinococcus multilocularis. Alveolar echinococcosis shows tumor-like growth that can lead to infiltration of neighboring organs. It is a slowly progressive disease and most commonly metastasizes to the lung. In this study, a 45-year-old female case of alveolar echinococcosis with bilateral pulmonary diffuse calcified multiple nodules metastases is presented.

A case of alveolar echinococcosis in the liver that ruptured into the pericardium treated by a combination of hepatectomy and albendazole

BackgroundAlveolar echinococcosis (AE) is a rare parasitic disease caused by the larva of Echinococcus multilocularis. It nearly always occurs in the liver, and cardiac involvement is extremely rare. Liver resection is the most effective intervention for AE because the only potentially curative treatment is removal of the lesion. Even when complete resection is not performed, long-term survival can be expected after surgical removal of most of the lesion with lifelong administration of albendazole (ABZ).Case presentationA 64-year-old man who lived in Hokkaido was referred to our hospital due to abnormalities in biliary enzymes. According to the findings from enhanced computed tomography and magnetic resource imaging of the abdomen, transthoracic echocardiography and serologic tests, he was diagnosed with hepatic AE with rupture into the pericardium. He underwent extended left hemi-hepatectomy with reconstruction of the inferior vena cava and opening of the pericardium with drainage as reduction surgery. Pathological examination revealed echinococcal infection in the pericardium as well as the liver. He started chemotherapy with 400 mg ABZ per Day 67 days after surgery. Although the surgical margin was positive in the pathological findings, he was alive 19 months later with no regrowth of the echinococcal lesion.ConclusionAE with cardiac involvement is extremely rare. Even if the complete removal of cardiac-involved AE is not possible, surgical debulking with lifelong ABZ treatment can successfully manage the disease.

Alveolar Echinococcosis of the Liver with a Rare Infiltration of the Adrenal Gland.

SummaryHuman alveolar echinococcosis (AE) is a silently-progressing disorder that has become a threat in many countries. Since 2000, when the first case was recorded, the number of human AE patients in Slovakia is on continuous raise. The article presents a rare case of alveolar echinococcosis with infiltration in the adrenal gland and discusses the problems associated with differential diagnosis of the disease. In 2016, abdominal ultrasound performed due abdominal pain complaint showed the presence of cystic lesions in the right liver lobe of 54-year old female patient. During surgery, another lesion in the right adrenal gland was found, and neoplastic processes or echinococcosis were considered in the differential diagnosis. Due to unclear correlation between radiology, serology and histopathology results and endemic situation in Slovakia, molecular examination was recommended. Subsequently E. multilocularis was confirmed as etiological agent of infection. Alveolar echinococcosis is considered as a rare disease, with very few patients referred to clinicians or hospitals that sometimes have almost none existing experience with the diagnosis and treatment of the disease. Therefore, the establishment of networks or reference centres specialized on management of the disease would be suitable way to provide the patients with the best care and improve the disease diagnosis, treatment and prognosis.

The first case of autochthonous Echinococcus multilocularis in human in the Republic of Kalmykia

Purpose: Two recognized species of Echinococcus, have special medical importance - E. granulosus and E. multilocularis - causing cystic echinococcosis (CE) and alveolar echinococcosis (AE) in humans. Due to the developed pasture livestock farming, the prevalence of the rural population in the territory of the Republic of Kalmykia, cases of CE are recorded annually. However, no cases of AE have been observed in this area. Purpose to describe the first case of AE in the territory of the south of Russua. Methods & Materials: Case of AE was described in 46-year-old patient, who contracted disease in non-endemic area. Results: In September 2016, a 46-year-old patient, a resident of the rural area of Kalmykia, applied to the surgical clinic of Rostov Medical University. The patient complained of the appearance of large tumor in the right side of the abdomen. With tomography, a lumpy tumor of the right lobe of the liver was found, 18 × 20 cm in size, with sharp uneven contours, and an inhomogeneous density. Condition of health in patient was relatively satisfactory. Markers of pathological changes in the blood tests were absent. The level of AlAt exceeded the normal values by 3 times. Patient was examined with an enzyme-linked immunosorbent assay (ELISA) and antibodies G against E. Granulosus were discovered (coefficient of positivity 1.5). A Western Blot IgG reaction detected antigen fractions 26–28 kDa specific for E. multilocularis. The tumor was removed in the surgical clinic of Rostov Medical University. The patient underwent liver resection. Alveolar echinococcosis was verified by histological examination of the tumor. The patient was under medical supervision in clinic of infectious and parasitic diseases of Rostov-on-Don Research Institute of Microbiology and Parasitology. The patient received chemotherapy with albendazole 800 mg per day per day in 2 doses with an interval of 12 hours continuous course during 9 months. The patient was examined in March 2018, signs of recurrence of alveococcosis were not revealed. Conclusion: The appearance of alveolar echinococcosis in areas where it was not previously recorded in human is also noted by some European scientists. Thus, it is necessary to improve the serological methods for diagnosis AE.

Demonstration that a case of human alveolar echinococcosis in Minnesota in 1977 was caused by the N2 strain.

Alveolar echinococcosis is the most serious helminthic zoonosis of the northern hemisphere affecting humans. The causative agent, Echinococcus multilocularis, occurs in geographically distinct strains that can be distinguished based on sequence variations of mitochondrial genes and nuclear microsatellite targets. This report finds that the human case of Alveolar echinococcosis occurring in Minnesota in 1977 was caused by the N2 haplotype described previously; the N2 haplotype is distinct from European and Asian isolates of the parasite and is restricted to the central region of North America.

Extrahepatic Primary Adrenal Alveolar Echinococcosis: A Review

Primary echinococcosis, and especially primary alveolar echinococcosis (AE) is rare among adrenal lesions. We report a case of primary AE in a 28-year-old male with low backache and occasional upper limb pain lasting for six months, and review the pertinent but sparse literature on this disorder. Evaluation of the patient revealed an abdominal mass as right adrenal AE. The adrenal gland is a rare extrahepatic site of occurrence of echinococcosis, and particularly of AE. Patients with adrenal echinococcosis usually have nonspecific clinical symptoms. Imaging examinations revealed clearly the features of AE and its surrounding pathology. Alveolar echinococcosis was seen as an inhomogeneous pseudotumor with irregular boundaries, an irregular central pseudocystic appearance, and infiltration into surrounding structures. On contrast-enhanced computed tomography, the periphery of the mass in AE may be enhanced and multicentric vesicles may be seen. Magnetic resonance imaging may show the multivesicular morphology of lesions. The definitive diagnosis of AE should be confirmed by pathologic or serologic examination. Radical surgical resection of the removable parasitic lesion, followed by anti-infective therapy with benzimidazoles, is the primary method for treating AE. Although primary adrenal AE is rare, it should be included in the differential diagnosis of adrenal masses, especially in regions where AE is endemic.

30-yr course and favorable outcome of alveolar echinococcosis despite multiple metastatic organ involvement in a non-immune suppressed patient

We report the 30-yr history of a well-documented human case of alveolar echinococcosis, with a lung lesion at presentation followed by the discovery of a liver lesion, both removed by surgery. Subsequently, within the 13 years following diagnosis, metastases were disclosed in eye, brain and skull, as well as additional lung lesions. This patient had no immune suppression, and did not have the genetic background known to predispose to severe alveolar echinococcosis; it may thus be hypothesized that iterative multi-organ involvement was mostly due to the poor adherence to benzimidazole treatment for the first decade after diagnosis. Conversely, after a new alveolar echinococcosis recurrence was found in the right lung in 1994, the patient accepted to take albendazole continuously at the right dosage. After serology became negative and a fluoro-deoxy-glucose-Positron Emission Tomography performed in 2005 showed a total regression of the lesions in all organs, albendazole treatment could be definitively withdrawn. In 2011, the fluoro-deoxy-glucose-Positron Emission Tomography showed a total absence of parasitic metabolic activity and the patient had no clinical symptoms related to alveolar echinococcosis.The history of this patient suggests that multi-organ involvement and alveolar echinococcosis recurrence over time may occur in non-immune suppressed patients despite an apparently “radical” surgery. Metastatic dissemination might be favored by a poor adherence to chemotherapy. Combined surgery and continuous administration of albendazole at high dosage may allow alveolar echinococcosis patients to survive more than 30 years after diagnosis despite multi-organ involvement.

Hepatic alveolar echinococcosis: a diagnostic challenge

We report a case of alveolar echinococcosis involving the liver in a 61-year-old male. Alveolar echinococcosis is a rare chronic and progressive disease, which can involve mostly liver and in rare cases lung and brain. It is caused by Echinococcus multilocularis. In this report we describe the imaging findings of hepatic involvement of alveolar echinococcosis by ultrasonography, computed tomography and magnetic resonance imaging.

Recurrent Hepatic Alveolar Echinococcosis: Report of The First Case in Korea with Unproven Infection Route

Human alveolar echinococcosis (AE), a hepatic disorder that resembles liver cancer, is a highly aggressive and lethal zoonotic infection caused by the larval stage of the fox tapeworm, Echinococcus multilocularis. E. multilocularis is widely distributed in the northern hemisphere; the disease-endemic area stretches from north America through Europe to central and east Asia, including northern parts of Japan, but it has not been reported in Korea. Herein, we represent a first case of AE in Korea. A 41-year-old woman was found to have a large liver mass on routine medical examination. The excised mass showed multinodular, necrotic, and spongiform appearance with small irregular pseudocystic spaces. Microscopically, the mass was composed of chronic granulomatous inflammation with extensive coagulation necrosis and parasite-like structure, which was revealed as parasitic vesicles and laminated layer delineated by periodic acid-Schiff (PAS) stain. Clinical and histologic features were consistent with AE. After 8 years, a new liver mass and multiple metastatic pulmonary nodules were found and the recurred mass showed similar histologic features to the initial mass. She had never visited endemic areas of AE, and thus the exact infection route is unclear.

The first case of human alveolar echinococcosis in Hungary

Infection caused by Echinococcus multilocularis is a rare helminthiasis, human cases have not been diagnosed in Hungary until now. The endemic region is Central Europe; the occurrence of this infection has been reported from most of the neighbouring countries; however, E. multilocularis has been found in the red fox population in Hungary. Summarizing the recent knowledge concerning epidemiological, clinical patterns and therapeutic options, the authors describe the first Hungarian case of alveolar echinococcosis. In the presence of appropriate clinical findings, the possibility of this rare infection has to be considered in the differential diagnosis of infiltrative hepatic lesions.

A rare case of alveolar echinococcosis in a 14-year-old child

Abstract We report the case of a 14-year-old girl who suffered from headache, fatigue, caught and a fever with body temperature up to 40 °C for a week. The patient had abdominal enlargement and clinical examination showed the hepatomegaly +5 cm. In ELISA assays employing Em2+ antigen, high titres of specific IgG antibodies to Echinococcus multilocularis somatic antigens were found in the serum. Western blot analysis also indicated on presence of alveolar echinococcosis (AE). CT examination showed expansive foci in the right liver lobe and histological examinations of the biopsy after PAS staining confirmed the presence of alveolar echinococcosis. After 320 days of chemotherapy with albendazole, CT revealed progression of parasitic foci and new abscess lesions inside parasitic cysts were detected, with some parts being necrotic. The surgical removing of foci was performed as following — the laparotomic revision, the removal of the right liver lobe with dilatation, reconstruction of v. cavae cum prothesis PTFE in length 12 cm. Three months after the operation, the rest of the patient’s left liver lobe had grownup and compensated at least a part of the removed liver.

Alveolar echinococcosis localized in the liver, lung and brain

chinococcosis is a parasitic disease caused by the larval forms of echinococci. It has two main forms as the unilocular cystic form that is more commonly seen and caused by E. granulosus and the alveolar form that is rarely seen and caused by E. multilocularis. E. multilocularis usually contaminates from foxes and sometimes contaminates from domestic animals as dogs and cats to humans and usually affects the liver. Progression of alveolar echinococcosis is more severe and agressive. It can metastise to the lungs, brain and bones. We present a case of alveolar echinococcosis that was initially thought to be a lymphomatous infiltration but then determined to infect the liver, lung and brain in a patient with a large T-cell lymphoma.

A case of alveolar echinococcosis of the liver for which hepatectomy with hepatic artery and biliary resection was performed

A case of alveolar echinococcosis of the liver for which hepatectomy with hepatic artery and biliary resection was performed

A Mass in the Liver

We report a case of alveolar echinococcosis. To our knowledge this is the first report of human alveolar echinococcosis to be confirmed in the UK and if contracted in Afghanistan the first report for that country.

Echinococcus multilocularis in carnivores from the Klatovy district of the Czech Republic.

A unique human case of alveolar echinococcosis was described in 1979 from the Klatovy district of the Czech Republic. However, there were no previous epidemiological studies in this area focusing on detection of the source of infection--Echinococcus multilocularis adults producing eggs. During the period June 1997 to April 1999, 29 out of a total of 46 (63.3%) red foxes (Vulpes vulpes) in the Klatovy district and one of four foxes (25.0%) in the Pilsen South district were found to be infected with adult worms of E. multilocularis. No E. multilocularis adults were found in other animals from the Klatovy district (i.e. three specimens of Martes martes, two Martes foina, one Mustela erminea, two Meles meles and one Felis catus f. domestica). An examination of faecal samples from 55 dogs (Canis familiaris) from the Klatovy district resulted in the detection of E. multilocularis DNA in one (1.8%) sample. The present results support the possibility that human alveolar echinococcosis previously described in the Czech Republic had the character of an autochthonous infection. There are also indications of a potential risk of infection to humans.