Echinococcosis Research Articles

Genetic Characteristics of Echinococcus granulosus from Fixed Paraffin-Embedded Tissue Samples in Human Isolates Based on the High-Resolution Melting Point Analysis in Sabzevar, Northeast Iran.

There are ten genotypes of Echinococcus granulosus with different intermediate and final hosts affecting the parasite's life cycle and its transmission to humans. Therefore, this study was conducted to determine the genotype of isolated hydatid cysts using the simple and fast high-resolution melting point analysis (HRM) method. The paraffin tissue samples of patients who underwent surgery were obtained from the pathology sample bank of Vasei and Emdad Hospitals in Sabzevar, Iran during 2010-2020. The DNA content of the samples was extracted after collecting and determining the characteristics using the DNA extraction kit. PCR was performed on the samples and the presence of the hydatid cyst genome was confirmed using the special Master Kit. Mix PCR of Solis Biodyne Company and Real-Time device (Bio-Rad) were used, and the genetic identity of hydatid cysts were determined. Out of 33 paraffin samples, 21 samples contained hydatid cyst DNA, two of which were from the brain and 19 from the liver tissues; 12 samples did not contain hydatid cyst DNAs. All liver samples were from sheep species (G1), and the brain samples were from buffalo species (G3). Therefore, 9.53% of the Echinococcus species collected were buffalo (G3), and 90.47% were sheep (G1) strain. Based on previous patterns, HRM methods can be used for easy and quick identification of Echinococcus strains. The G1 strain was the dominant strain causing hydatid cyst in different human organs, including the liver and brain.

Evaluation of Th1/Th2/Th17 Balance in Pulmonary Cystic Echinococcosis Patients.

Cystic echinococcosis (CE) is a neglected tropical disease prevalent worldwide, particularly in rural areas. Previous studies evaluated immune responses in patients with hepatic CE, however none had assessed Th1, Th2 and Th17 levels simultaneously in pulmonary CE patients. This study aimed to fill this gap in literature by using flow cytometry analysis. Peripheral blood mononuclear cells (PBMCs) were isolated from blood samples collected from healthy control (HC) volunteers and patients with active pulmonary CE cysts. The PBMCs were analysed to evaluate Th1, Th2, and Th17 cell levels within the CD3 + CD4 + T-cell population, using antibodies against interferon (IFN)-γ, interleukin (IL)-4, and IL-17, respectively. Our analysis revealed elevated Th2 levels in CE patients, while Th1 and Th17 cell counts showed no significant difference between HC volunteers and patients with pulmonary CE. The results indicate an imbalanced Th1/Th2/Th17 cell regulation in the pathogenesis of pulmonary CE. Future studies are recommended to compare immune responses between pulmonary and hepatic CE to confirm these findings and evaluate any potential difference in the immunopathology associated with the two clinical forms of CE.

Critical Roles of IL-40 and IL-41 in the Determination of the Severity of Hydatid Cyst Infection in Iraqi Patients

Background: Hydatid cystic disease is a serious public health concern worldwide, and the link between the intermediate host (human) and parasite is important to the disease's etiology and severity. Objective: Determine the levels of IL-40 and IL-41 in the serum of Iraqi patients infected with hydatid disease, as well as their function in disease severity. Methods: The quantified ELISA was used to assess the levels of IL-40 and IL-41 in serum from 35 persons in Baghdad, Iraq, who had been diagnosed with hydatid cysts and were undergoing surgery to remove them. In addition, control samples from forty healthy individuals were taken for comparison purposes. Results: The patients' ages ranged from 8 to 63. Females had higher infection rates than males. Rural areas have a higher rate of infection than urban areas. The lungs and liver were the most severely injured. The majority of lung infections resulted in coughs and chest discomfort, whereas liver damage resulted in stomach pain as well as substantial changes in hematological parameters (white blood cells, hemoglobin, and erythrocyte sedimentation rate), liver enzyme, and C-reactive protein in patients compared to controls. Patients had lower IL-40 levels than the control group, but significantly higher IL-41 levels (p<0.05) than healthy controls. Conclusions: Patients with hydatid cysts showed higher serum levels of IL-41 and lower levels of IL-40, which may correlate with disease severity and act as biomarkers for chronic hydatid cyst infection.

Evolving Pattern of Human Cystic Echinococcosis: A Cross-Sectional Study

Introduction Cystic echinococcosis (CE) poses a considerable public health challenge in many countries. Due to the absence of comprehensive CE surveillance and management guidelines and varying demographic and geographical factors across countries, examining the disease's epidemiology and clinical manifestations within specific regions is essential. The current study aims to investigate CE trends, clinical features, and patient complaints in an endemic area of Iraq. Methods This retrospective cross-sectional study was conducted at Smart Health Tower in Sulaymaniyah, Iraq, from May 2020 to May 2024. It involved patients diagnosed and treated for CE. Data was collected using detailed case forms covering patient demographics, cyst location, presentation, medical and surgical history, and recurrence. Results The study involved 605 CE patients with nearly equal gender distribution and a mean age of 40.1 ± 18.6 years. Most patients, 217(35.9%), were aged 31-50 and lived in urban areas 505(83.5%). The majority, 382(63.1%), were asymptomatic, with liver cysts being the most common 361(59.7%). Single cysts were more prevalent in 513(84.8%) cases, with surgery performed in 222(36.7%) of cases, and recurrence was rare 8(1.3%). Conclusion This study highlights a significant burden of CE in urban areas, where asymptomatic cases often lead to delayed diagnosis. The high prevalence of liver and lung cysts underscores the necessity for targeted public health strategies and enhanced control measures for free-roaming dogs.

Environmental contamination with feces of free-roaming dogs and the risk of transmission of Echinococcus and Taenia species in urban regions of southeastern Iran

BackgroundDogs are the most important definitive hosts of zoonotic taeniid helminths worldwide. Different Echinococcus and Taenia species of domestic and wild carnivores pose a potential risk to human population. High populations of free-roaming dogs (FRDs) in urban areas of Iran and widespread contamination of the environment with dog feces is a potential source of infecting people living in the urban regions with cystic echinococcosis (CE). Our knowledge on the risk of CE transmission in the urban settings in the endemic regions is limited. The present study surveyed the species and genotypes of E. granulosus sensu lato and other taeniids by examining feces of free-roaming dogs in the urban areas in the city of Kerman, southeastern Iran.MethodsThe city was divided into 100 consecutive blocks of which 25 blocks were randomly selected. Fecal samples of FRDs were counted, mapped and fresh samples were collected. Then Zinc chloride flotation, and sequential sieving was performed, and the samples were examined under an inverted microscope. Single individual taeniid eggs were isolated, partial nad1 gene was amplified and sequenced to identify species and genotypes.ResultsIn total 5607 fecal samples of dogs were mapped and 83 fresh samples were collected. Taeniid eggs were detected in nine fecal samples (10.8%) from seven out of the 25 city blocks (28.0%). Echinococcus eggs were found in four samples (4.8%) from three city blocks, two samples containing E. granulosus sensu stricto (2.4%), two samples containing E. canadensis G6/7 (2.4%). In addition, three samples contained eggs of Taenia hydatigena (3.6%), and one sample of Taenia serialis (1.2%).ConclusionsThis study documented the potential risk of CE transmission to humans resulting from the feces of dogs roaming freely in urban areas.Graphical

Synthesis of Silver Nanoparticles Using Haplophyllum robustum Bge. Extract: Antibacterial, Antifungal, and Scolicidal activity against Echinococcus granulosus Protoscolices

Background: Silver nanoparticles (AgNPs) biosynthesized via the deployment of plant extractives have garnered much attention, especially due to their antimicrobial properties. Herein, the green synthesis of silver nanoparticles has been accomplished using the aqueous extract of Haplophyllum robustum, which includes a study of its antibacterial, antifungal, and scolicidal activity. Methods: The preparative process was followed by characterization using UV-Vis spectroscopy, and the ensuing spherical AgNPs of average size 7-25 nm were identified by Dynamic Light Scattering (DLS), X-Ray Diffraction (XRD), Fourier Transform Infrared Spectroscopy (FTIR), Scanning Electron Microscopy (SEM), and Transmission Electron Microscopy (TEM). The antibacterial, antifungal, and scolicidal activities of AgNPs were assessed by deploying disc diffusion and microdilution methods against four standard bacteria and four typical Candida species and liver hydatid cyst protoscoleces, where they exhibited good biological activity. Results: The results showed that the greener synthesis of silver nanoparticles using the aqueous extract of renewable and abundant H. robustum plant is a simple, inexpensive, and safer alternative that does not use any toxic or harmful substances. Conclusion: Thus, with minimal or no side effects, this approach to AgNPs bodes well for their appliances as antibacterial, antifungal, and scolicidal agents.

MicroRNA-145 enhances lung cancer cell progression after exposure to lyophilized fertile hydatid cyst fluid of Echinococcus granulosus sensu stricto

There is increasing evidence that the secretory/excretory antigens of the larval stage of Echinococcus granulosus can induce both anticancer and oncogenic effects between parasite-derived metabolites and various cancer cells. The dual role of miR-145 as either a tumor suppressor or oncogene has already been reported in cancer. However, the mechanism by which miR-145 induces apoptosis in lung cancer cells treated with hydatid cyst fluid (HCF) remains unclear. The fertile HCF was obtained from sheep, purified and lyophilized. H1299 human lung cancer cells were then cultured into two groups: HCF-treated H1299 lung cancer cells and untreated H1299 cancer cells as control cells. Cell viability was assessed using MTT assay to evaluate the effects of HCF on the H1299 cells. Caspase-3 activity was assessed by fluorometric assay. In addition, mRNA expression levels of VGEF, vimentin, caspase-3, miRNA-145, Bax and Bcl-2 genes were quantified by real-time PCR. A scratch test was also performed to assess the effects of HCF on cell migration. The MTT assay revealed that the growth of H1299 cells increased when treated with 60 μg/mL of fertile HCF for 24 h. The fold change of caspase-3, miRNA-145, Bax/Bcl-2 ratio and caspase-3 activity was lower in HCF-treated H1299 cells compared to the control cell. The fold change in VGEF and vimentin gene expression was higher in the HCF-treated H1299 cells than in the control cell. The scratch test results showed that H1299 cell mobility increased 24 and 48 h after exposure to HCF. Our results suggest that the downregulation of miR-145 in HCF-treated H1299 cells may play a role as a possible oncogenic regulator of lung cancer growth. To confirm this assumption, further studies are required to evaluate the microRNA profile and effective oncogenes in vivo.

A scoping review on control strategies for Echinococcus granulosus sensu lato.

Cystic echinococcosis (CE) is a widespread neglected zoonotic disease caused by Echinococcus granulosus sensu lato (EG) with a global burden of control in the billions of dollars. E. granulosus' life cycle involves definitive, intermediate, and humans as dead-end hosts. Echinococcosis control programs use strategies that focus on any of these hosts. We aimed to provide a comprehensive and up-to-date overview of the EG control interventions worldwide. We conducted a scoping review by mapping all studies on interventions for EG control following the Arksey and O'Malley Framework. We screened identified articles, and charted and coded selected papers. We classified the data based on target host, type of study, and control mechanism. We described the efficacy or safety outcomes, and the associated barriers/facilitators for the intervention. Critical appraisal was conducted. From 7,853 screened studies, we analyzed 45: seven centered on human interventions, 21 on animals, and 17 on both. Studies on humans focused on educational strategies and human CE monitoring. The studies on animals were field trials and most were based on Praziquantel (PZQ) for dogs. Studies focused on both animals and humans had, in general, more participants, lasted longer, and covered larger geographical areas. Overall, the quality of studies was moderate to low. Available evidence suggests that long-term interventions aimed at both animals and humans can achieve significant reduction in EG transmission, particularly when PZQ treatment for dogs is included. Higher quality evidence, standardization of methodologies, and better reporting on post-intervention outcomes are necessary for drawing stronger conclusions. Further evidence is needed to assess the sustainability and scalability of control measures. Nonetheless, an integrative One Health approach is essential for overcoming the multiple challenges associated with sustaining long-term control efforts for Echinococcosis.

Case Report: A case of a multivisceral echinococcosis with atypical localization

Hydatidosis is a pathology that is still common. Hydatid cysts commonly involves the liver and lung. Cases of multi visceral echinococcosis with atypical localization are rare. We, herein, report the case of a 53-year-old Maghrebi farmer with multiple organ hydatidosis including 13 hydatid cysts involving the lungs, the liver, the left heart ventricle, the left kidney, the abdomen cavity, the muscles (psoas, adductors), and the subcutaneous gluteal area. The majority of these cysts were already treated surgically, and some of them were due to be removed.

Isolated Hydatid Cyst: A Misleading Diagnosis

Cystic hydatid disease is an endemic disease caused by the larval form of Echinococcus granulosis. It is especially evident in the liver, lungs, and kidney. Testicular hydatidosis is extremely rare. A case of a hydatid cyst of the testis is reported that was misdiagnosed clinically as a testicular hydrocele. Echinococcosis should be considered in the differential diagnosis of testicular masses especially in endemic countries. Treatment is mainly surgical and, with proper diagnosis and treatment, the prognosis is good.

Confounding giant right atrial mass

BackgroundPrimary cardiac tumors are uncommon, with approximately 70–80% classified as benign. Myxomas constitute roughly half of all benign cardiac tumors, while cardiac hydatid cysts are exceptionally rare. Shortness of breath is a prominent symptom associated with these conditions. Echocardiography serves as the primary diagnostic tool, enabling early detection. The preferred course of action involves the surgical excision of the mass.Case presentationOur first case, a 51-year-old female presented to the cardiology outpatient clinic with complaints of shortness of breath and palpitations persisting for 3 months. Physical examination and tests were within normal limits. Echocardiography revealed a right atrial myxoma measuring 65 * 35 mm. Despite not affecting valve and ventricular functions, the mass was surgically resected. Our second case, a 55-year-old male admitted to the cardiology clinic with recurrent fever, shortness of breath, and chest pain. Physical examination and tests were normal. Echocardiography revealed an echogenic mass with a septate appearance adhering to the free wall of the right atrium. The patient, diagnosed with a hydatid cyst, underwent surgical resection.ConclusionsWe came across two different cases of RA masses which happened to be myxoma and hydatid cysts, and we managed accordingly. The right atrial myxomas typically present with nonspecific shortness of breath unless they cause valve obstruction. In cases where clinical findings suggest infection in the right atrial masses, it is essential to consider hydatid cyst as a potential diagnosis alongside the initial consideration of vegetation.

Predictive Factors of Pulmonary Hydatid Complications in Children

BackgroundPulmonary echinococcosis in children has frequent and severe complications. The aim of our study was to determine predictive factors of pre and postoperative complications of pediatric pulmonary hydatid cyst. MethodsWe conducted a retrospective descriptive and analytic study conducted from January 2010 to December 2018. The study population was divided into two groups to determine predictive factors of pre- and post-operative complications of pediatric pulmonary echinococcosis. Data were analyzed by IBM SPSS 21.0. A p-value of 0.05 was accepted as significant. ResultsThe study included 106 boys and 94 girls with a median age of 8 years. One hundred and thirty-eight patients (69%) had complicated pulmonary hydatid cyst preoperatively. Univariate analysis identified 12 predictive factors of pre-operative complications: rural origin (p = 0.0001), hydatid contact (p < 0.001), long period between the onset of symptoms and the first medical consultation (p = 0.0001), the autumn and the winter (cold seasons) (p = 0.0001), chest pain (p = 0.0001), hemoptysis (p = 0.023), fever (p = 0.0001), right side (p = 0.01), apical and para hilar location (p = 0.01), superior lobe (p = 0.05), superior right lobe (p = 0.0001), cyst size>5 cm (p = 0.02), positive hydatid serology (p < 0.0001). It identified 2 predictive factors of post-operative complications: giant cyst (p = 0.009) and not performing a capitonnage (p = 0.016). Multivariate analysis showed 4 independent pre-operative predictive factors of complications: rural area (p < 0.0001), fever (p = 0.006), right side (p = 0.02) and positive hydatid serology (p < 0.001). It identified 2 postoperative independent predictive factors of complications: not performing. capitonnage (p = 0.029) and solitary hydatid pulmonary cyst (p = 0.02). ConclusionPulmonary hydatid cyst management in children needs a thorough appreciation of independent predictive factors of pre and postoperative complications in order to reduce their morbidity.

Association of IL-9 Cytokines with Hepatic Injury in Echinococcus granulosus Infection.

Cystic echinococcosis (CE) is a zoonotic disease caused by the parasite Echinococcus granulosus (E. granulosus), which can lead to the formation of liver lesions. Research indicates that E. granulosus releases both Toll-like receptor 2 (TLR2) and Interleukin-9 (IL-9), which can potentially impair the body's innate immune defenses and compromise the liver's ability to fight against diseases. To investigate the role of TLR2 and IL-9 in liver damage caused by E. granulosus infection, samples were initially collected from individuals diagnosed with CE. Subsequently, BALB/c mice were infected with E. granulosus at multiple time points (4 weeks, 12 weeks, 32 weeks) and the expression levels of these markers was then assessed at each of these phases. Furthermore, a BALB/c mouse model was generated and administered anti-IL-9 antibody via intraperitoneal injection. The subsequent analysis focused on the TLR2/MyD88/NF-κB signaling pathway and the expression of IL-9 in E. granulosus was examined. A co-culture experiment was conducted using mouse mononuclear macrophage cells (RAW264.7) and hepatic stellate cells (HSCs) in the presence of E. granulosus Protein (EgP). The findings indicated elevated levels of IL-9 and TLR2 in patients with CE, with the activation of the signaling pathway significantly increased as the duration of infection progressed. Administration of anti-IL-9 in mice reduced the activation of the TLR2/MyD88/NF-κB signaling pathway, exacerbating liver injury. Moreover, EgP stimulates the TLR2/MyD88/NF-κB signaling pathway, resulting in the synthesis of α-SMA and Collagen I. The data suggest that infection with E. granulosus may stimulate the production of IL-9 through the activation of the TLR2/MyD88/NF-κB signaling pathway, which is mediated by TLR2. This activation stimulates RAW264.7 and HSCs, exacerbating liver injury and fibrosis.

Identification and comparison of intestinal microbial diversity in patients at different stages of hepatic cystic echinococcosis

There is a significant focus on the role of the host microbiome in different outcomes of human parasitic diseases, including cystic echinococcosis (CE). This study was conducted to identify the intestinal microbiome of patients with CE at different stages of hydatid cyst compared to healthy individuals. Stool samples from CE patients as well as healthy individuals were collected. The samples were divided into three groups representing various stages of hepatic hydatid cyst: active (CE1 and CE2), transitional (CE3), and inactive (CE4 and CE5). One family member from each group was selected to serve as a control. The gut microbiome of patients with different stages of hydatid cysts was investigated using metagenomic next-generation amplicon sequencing of the V3–V4 region of the 16S rRNA gene. In this study, we identified 4862 Operational Taxonomic Units from three stages of hydatid cysts in CE patients and healthy individuals with a combined frequency of 2,955,291. The most abundant genera observed in all the subjects were Blautia, Agathobacter, Faecalibacterium, Bacteroides, Bifidobacterium, and Prevotella. The highest microbial frequency was related to inactive forms of CE, and the lowest frequency was observed in the group with active forms. However, the lowest OTU diversity was found in patients with inactive cysts compared with those with active and transitional cyst stages. The genus Agatobacter had the highest OTU frequency. Pseudomonas, Gemella, and Ligilactobacillus showed significant differences among the patients with different stages of hydatid cysts. Additionally, Anaerostipes and Candidatus showed significantly different reads in CE patients compared to healthy individuals. Our findings indicate that several bacterial genera can play a role in the fate of hydatid cysts in patients at different stages of the disease.

Echinococcus ortleppi infection in humans: An emerging zoonosis in Asia

Echinococcus ortleppi is the genotype G5 of Echinococcus granulosus sensu lato and is a zoonotic canine tapeworm of which larvae causes cystic diseases in domestic animals and also humans. While this species is highly endemic and widely spread in domestic animals, human infection is extremely rare and only sporadic, and thus, entire picture of human cystic echinococcosis due to infection with E. ortleppi is unclear. We have made an extensive literature review on the cases of E. ortleppi infection in humans and found a total of 19 cases from various places in the world with recent emergence in Asian countries.

Efficiency of Anatomical Hepatectomy in the Treatment of Hepatic Cystic Echinococcosis.

Introduction: Total cystectomy and hepatectomy are the main radical surgical procedures for hepatic cystic echinococcosis (CE). When CE lesions severely invade intrahepatic biliary ducts and vessels or single or multiple lesions occupy one hepatic lobe, performing total cystectomy is not indicated. This study aimed to analyze the clinical efficiency of anatomical hepatectomy in the treatment of patients with hepatic CE. Methods: Clinical data of 74 patients with hepatic CE who received anatomical hepatectomy were retrospectively analyzed from January 2005 to January 2022. The patients were classified into the intrahepatic biliary duct invasion group (group A), the intrahepatic vessel invasion group (group B), and the hepatic lobe occupation group (group C). Results: Among these 74 patients who received anatomical hepatectomy, right hepatectomy was performed in 20 cases (27.03%), left hepatectomy in 26 cases (35.13%), right posterior lobectomy in nine cases (12.16%), and left lateral sectionectomy in 19 cases (25.68%). Short-term post-operative complications occurred in seven cases (9.50%), including abdominal abscess in one case, pleural effusion in three cases, intestinal obstruction in one case, incision infection in one case, and ascites in one case. Long-term post-operative complications occurred in four cases (5.4%), including recurrences of CE in two cases and incisional hernias in another two cases. There were no statistical differences in the concentrations of total bilirubin, alanine aminotransferase, and aspartic transaminase before and after surgery between groups (p > 0.05). However, differences in operative time, short-term post-operative complications, average hospital stay, and number of open hepatectomy cases were statistically significant between groups (p < 0.05). The differences in cases receiving hepatic portal occlusion, intra-operative blood loss, and intra-operative blood transfusion were not statistically significant between groups (p > 0.05). Conclusions: Anatomical hepatectomy is an effective and feasible surgical procedure for patients with hepatic CE with severe invasion of intrahepatic biliary ducts and vessels or patients with huge lesions occupying one hepatic lobe, which effectively avoids residual cavity-related complications.

Primary Muscular Cystic Echinococcosis Disease: A Case Report and Review of the Literature

Primary Muscular Cystic Echinococcosis Disease: A Case Report and Review of the Literature

Adrenal pheochromocytoma masquerading as a hydatid cyst: A case report and review of literature

Adrenal pheochromocytoma masquerading as a hydatid cyst: A case report and review of literature

Investigating the Inhibitory Effects of Hydatid Cyst Fluid and its Antigens on Cancer Progression; A Review

Investigating the Inhibitory Effects of Hydatid Cyst Fluid and its Antigens on Cancer Progression; A Review

Osteoarticular hydatid disease: Epidemiological features, diagnosis and treatment

Osteoarticular hydatid disease is a very rare disease. Its diagnosis is challenging and often late because of the nonspecific clinical and radiological features. Through this study, we aim to describe the epidemiological, clinical and radiological features of a series of patients diagnosed with osteoarticular hydatid disease.Ten patients were included. The average age was 40,5 years [25-75]. The onset of symptoms was progressive in all cases with a mean diagnosis delay of 11 months [1-48]. Most frequent locations were spinal (n=7), pelvic (n=3) and costal (n=3). Hydatid serology was positive in seven screened patients. Seven patients underwent surgery and all of them received albendazole postoperatively with an average of 8 monthly courses. Total remission was reported in only one patient. There was no significant difference in the clinical outcome based on the number of albendazole courses.The diagnosis of osteoarticular hydatid disease is often challenging because of its progressive onset and nonspecific clinical signs. Epidemiological setting, immunological screening and imaging features contribute to an earlier diagnosis. Its management requires both surgery and long-term antiparasitic treatment.