Echinococcus Alveolaris Research Articles

Hepatic Hydatid cyst in children: An experience from East of Turkey

İntoduction: Hydatid cyst is a parasitic disease caused by the infection of Echinococcus granulosus and rarely Echinococcus alveolaris eggs, which are endemic in our country. Current treatment options for liver hydatid cysts; They can be listed as medical treatment, surgical treatment, percutaneous drainage and clinical follow-up only. In this study, the effectiveness of the WHO-IWGE protocol in terms of diagnosis and treatment strategies in our pediatric cases of liver hydatid cyst in a health institution in eastern Turkey was evaluated in the light of the literature. Material Method: Pediatric patients between the ages of 0-16 who were diagnosed with KcKH and followed up and treated were evaluated retrospectively. In pre-operative evaluation, lung radiography, abdominal ultrasonography, serological tests, hemogram and liver function tests were routinely performed. Results: 250 child patients between the ages of 0 and 16, whose data were fully available, were included in the study. 118 of the cases were girls and 132 were boys. The average age was 11.2 years. Most of the KcKH patients were admitted to the hospital for another reason and the cyst was detected incidentally. Of the 65 patients requiring surgery, 17 were patients who initially underwent primary intervention with PAIR. Patients who underwent PAIR were observed for one night and discharged in an average of 18 hours. Patients with free drainage were discharged in 2-4 days. The average length of stay for patients who underwent open surgery was found to be 9 days. In conclusion; The Gharbi classification updated by WHO is effective and reliable in determining the KcKH treatment strategy. In cases who are receiving chemotherapy and an intervention decision is made, a final USG is performed just before the procedure; It can provide both a change in treatment management and more patients benefiting from medical treatment.

Hepatic mass caused by Fasciola hepatica: A case report

IntroductionFascioliasis is a zoonotic infestation which presents with a wide spectrum of clinical pictures. However, it may often be overlooked, especially in the acute phase, because of uncertain symptoms. Fasciola hepatica can have an initial presentation similar to malignant liver mass or complex hepatic cyst. Here, we report a case of a hepatic mass caused by fasciola hepatica.Case presentationA 48-year-old woman came with chief complaints of epigastric and right hypochondrial discomfort associated with nausea and vomiting. Ultrasonography (USG) showed a heterochronic lesion in the segment VIII of the liver with few cystic lesions. CECT abdomen and pelvic gave impression of ill-defined irregular hypodense lesions in the right lobe of the liver with progressive enhancing peripheral and central cystic areas suggestive parasitic liver infestation likely echinococcus alveolaris. Right hepatectomy was done and the patient was discharged without any complications.DiscussionFascioliasis is uncommon in developed countries but more commonly seen in developing countries. The identification of fasciola hepatica eggs in the stool is a standard method for the diagnosis of fascioliasis. Fascioliasis may cause a wide variety of clinical signs ranging from asymptomatic infection to severe liver cirrhosis. Surgery for complex hydatid cysts of the liver is potentially burdened by serious complications. Technique of choice for surgical management remains inconclusive.ConclusionFasciola hepatica infection can mimic a malignant liver mass or a complex hepatic cyst because of its uncertain presentation. The disease can be prevented with public education and environmental precautions.

Hepatic Cysts: Reappraisal of the Classification, Terminology, Differential Diagnosis, and Clinicopathologic Characteristics in 258 Cases.

The literature on liver cysts is highly conflicting, mostly owing to definitional variations. Two hundred and fifty-eight ≥1cm cysts evaluated pathologically using updated criteria were classifiable as: I. Ductal plate malformation related (63%); that is, cystic bile duct hamartoma or not otherwise specified-type benign biliary cyst (35 with polycystic liver disease). These were female predominant (F/M=2.4), large (10cm), often multifocal with degenerative/inflammatory changes and frequently misclassified as "hepatobiliary cystadenoma." II. Neoplastic (13%); 27 (10.5%) had ovarian-type stroma (OTS) and qualified as mucinous cystic neoplasm (MCN) per World Health Organization (WHO). These were female, solitary, mean age 52, mean size 11cm, and 2 were associated with carcinoma (1 in situ and 1 microinvasive). There were 3 intraductal papillary neoplasms, 1 intraductal oncocytic papillary neoplasm, 1 cystic cholangiocarcinoma, and 2 cystic metastasis. III. Infectious/inflammatory (12%). These included 23 hydatid cysts (including 2 Echinococcus alveolaris both misdiagnosed preoperatively as cancer), nonspecific inflammatory cysts (abscesses, inflammatory cysts: 3.4%). IV. Congenital (7%). Mostly small (<3cm); choledochal cyst (5%), foregut cyst (2%). V. Miscellaneous (4%). In conclusion, hepatic cysts occur predominantly in women (3/1), are mostly (90%) non-neoplastic, and seldom (<2%) malignant. Cystic bile duct hamartomas and their relative not otherwise specified-type benign biliary cysts are frequently multifocal and often misdiagnosed as "cystadenoma/carcinoma." Defined by OTS, MCNs (the true "hepatobiliary cystadenoma/carcinoma") are solitary, constitute only 10.5% of hepatic cysts, and have a significantly different profile than the impression in the literature in that essentially all are perimenopausal females, and rarely associated with carcinoma (7%). Since MCNs can only be diagnosed by demonstration of OTS through complete microscopic examination, it is advisable to avoid the term "cystadenoma/cystadenocarcinoma" solely based on radiologic examination, and the following simplified terminology would be preferable in preoperative evaluation to avoid conflicts with the final pathologic diagnosis: (1) noncomplex (favor benign), (2) complex (in 3 subsets, as favor benign, cannot rule out malignancy, or favor malignancy), (3) malignant features.

An extremely rare localization of Echinococcus alveolaris; pancreas

Background: Echinococcus alveolaris causes a zoonotic infestation and behaves like a malignant tumor. Here, we present a case of pancreatic echinococcus alveolaris. Methods: A 29-year old young woman was admitted to the clinic with abdominal pain, distention and nausea. Bilirubin level was slightly high. Abdominal sonography and contrast enhanced abdominal computed tomography revealed a pancreatic head mass 6 cm in diameter, compressing portal vein, arteria hepatica propria and vena cava inferior. Fine needle aspiration biopsy using endosonography was performed but the biopsy was not diagnostic. Pancreaticoduodenectomy was planned. Frozen section biopsy was performed during the surgery. The results were consistent with E. alveolaris infestation. Pancreaticoduodenectomy was performed. Postoperative period was uneventful, and the patient was discharged on postoperative 8th day. Results: Echinococcus alveolaris can be seen in liver, lung, brain. There is only one cese report of isolated pancreatic infestation due to E. alveolaris. The infestations by E. alveolaris resemble neoplastic diseases but show comparatively slower progression. The disease mimics a slow-growing tumour. For the diagnosis, serological procedures, ultrasonography, CT and MRI scans are helpful. Conclusion: Alveolar echinococcus infestation is not so common compared to E. granulosus. The most common localization is the liver. It can be concomittantly seen in any other organ with liver. Isolated pancreatic infestation is extremely rare.

An extremely rare localization of Echinococcus Alveolaris; pancreas

Background: Echinococcus alveolaris causes a zoonotic infestation and behaves like a malignant tumor. Here, we present a case of pancreatic echinococcus alveolaris. Methods: A 29-year old young woman was admitted to the clinic with abdominal pain, distention and nausea. Bilirubin level was slightly high. Abdominal sonography and contrast enhanced abdominal computed tomography revealed a pancreatic head mass 6 cm in diameter, compressing portal vein, arteria hepatica propria and vena cava inferior. Fine needle aspiration biopsy using endosonography was performed but the biopsy was not diagnostic. Pancreaticoduodenectomy was planned. Frozen section biopsy was performed during the surgery. The results were consistent with E. alveolaris infestation. Pancreaticoduodenectomy was performed. Postoperative period was uneventful, and the patient was discharged on postoperative 8th day. Results: Echinococcus alveolaris can be seen in liver, lung, brain. There is only one cese report of isolated pancreatic infestation due to E. alveolaris. The infestations by E. alveolaris resemble neoplastic diseases but show comparatively slower progression. The disease mimics a slow-growing tumour. For the diagnosis, serological procedures, ultrasonography, CT and MRI scans are helpful. Conclusion: Alveolar echinococcus infestation is not so common compared to E. granulosus. The most common localization is the liver. It can be concomittantly seen in any other organ with liver. Isolated pancreatic infestation is extremely rare.

CEREBRAL HYDATID LESIONS

Echinococcus alveolaris and granulosus are more dangerous helminthiases, remaining serious medical and social problem so far. Brain alveococcosis and echinococcosis are naturofocal parasitic diseases of central nervous system caused by larval stages of helminths Echinococcus multilocularis and Echinococcus granulosus. Diagnosing of parasitic cyst of brain represents great difficulties. The aim of the research is to study the characteristics of course of cerebral alveococcosis and echinococcosis and improve their diagnosis. Medical histories have been analyzed for 14 years (from 2000 to 2014) of 53 patients with cerebral alveococcosis and echinococcosis between 2 and 58, among them 43 people have been operated in the departments of neurosurgery, National Hospital, the others 10 patients - at other clinics of the country. The diagnosis of all patients have been verified intraoperatively and pathomorphologically. It is found that the parasitic (alveococcus and echinococcus) lesion of brain is frequently found in rural population (92%). Young and able-bodied people suffer from brain alveococcosis between 21 and 40 - 66,7%, and brain alveococcosis is not found in children between 2 and 10. Brain echinococcosis is frequently found in children between 2 and 10 - 21,1%, and in young people between 11 and 30 - in 54,9% cases. An initial focus of alveococcus has been found in the liver of 80% of patients, and brain metastases has been found among them in 53,3% of patients, and both lungs and brain metastases have been found in 26,7% of patients. Primary alveococcal lesion of brain has been found in 20% of patients. Primary echinococcal lesion of brain has been found in 29% of patients, and primary echinococcal lesion of liver - in 65,8% of patients. The MRI is highly informative for diagnosing brain alveococcosis and echinococcosis, and, correspondingly, for effective treatment.

Portal hypertension and cholestasis due to Echinococcus alveolaris: a case report

Alveolar ecchinococcosis (AE) is a rare but potentially life-threatening serious parasitic disease. The parasit may involve liver and, most importantly, expand vessels and biliary tract. We present here a case of esophageal variceal bleeding due to portal hypertension and cholestasis secondary to AE. We present the case of a 30-year-old female patient who was admitted to emergency service with hematemesis, melena and icter. Upper gastrointestinal endoscopy revealed gastroesophageal varices and portal gastropathy. Contrasted computerized tomography examination showed a solid calcific lesion (cross dimension 6x11 and 5x9 cm.) of biliary tracts causing dilatation. An USG guided biopsy from the mass was performed and histological examination revealed AE. We also review here the literature on portal hypertension and cholestasis due to Echinococcus alveolaris. AE is rare a disease and may cause severe complications. Endoscopic and percutaneous drainage for biliary obstruction caused by hepatic AE has a palliative effect even in the late stages. Liver transplantation was recommended but this operation was not performed for living donor shortage. Liver transplantation should be considered in the management of advanced liver alveolar echinococcosis.

Living donor liver transplantation for Echinococcus Alveolaris: single-center experience.

Echinococcus alveolaris (EA) causes a hepatic zoonotic infection and behaves like a malignant tumor during invasion. Liver transplantation (LT) is the only curative treatment option for this unresectable disease. Here, we share our experience with living donor liver transplantation (LDLT) due to EA from the time between March 2002 and November 2014 at the Liver Transplantation Institute of İnönü University. Ten patients (mean age, 38.6 years) undergoing LDLT because of unresectable EA were evaluated preoperatively, and the operative and follow-up data were analyzed retrospectively. The mean time interval between diagnosis and LT was 27 months. The mean operation time and mean intraoperative blood requirement were 613 minutes and 4 units of packed red blood cells, respectively. Diaphragmatic resections were performed in 3 patients, and vena cava replacement was performed in 2 patients because of difficulties in removing the extended disease. The local recurrence and distant metastasis rates were 10% and 20%, respectively. The mean survival time was 19.5 months (range, 0-54 months), and the mortality rate was 30%. Unresectable hepatic alveolar echinococcosis is a rare indication for LT and presents some technical difficulties during surgery because diaphragmatic resection, vascular reconstruction, or multiple blood transfusions may be needed. LDLT can be performed successfully in patients with this rare infectious disease, with careful follow-up for potential recurrence and metastasis and administration of low-dose immunosuppressive agents.

Living Donor Liver Transplantation With Vena Cava Replacement

ObjectivesThis study sought to evaluate the indications, techniques, and results of inferior vena cava (IVC) replacement at living donor liver transplantation (LDLT). Materials and MethodsWe performed 821 LDLTs and 11 (1.3%) patients required concomitant IVC replacement. We analyzed the indications, replacement materials, and outcomes. ResultsRight, left, and left lateral liver lobes were transplanted in 7, 2, and 2 patients, respectively. The indications for IVC replacement were thrombosis/fibrosis in 7 patients (Budd-Chiari 4, hereditary tyrosinemia 1, congenital hepatic fibrosis 1, cryptogenic 1), involvement with mass in 3 patients (Echinococcus alveolaris 2, hepatoblastoma 1) and iatrogenic narrowing at IVC in 1 patient. Cryopreserved grafts (aorta n = 5, IVC n = 4, iliac vein n = 1) or synthetic graft (n = 1) were used for replacements. In 1 patient, hepatic outflow obstruction developed at 39 days and was treated successfully by interventional radiology. There was only 1 hospital mortality (8.9%) that was unrelated to caval replacement (subarachnoid hemorrhage). Of the remaining patients, the caval grafts were patent after a mean 7.7 months of follow-up (range 1 to 17 months). ConclusionsAlthough rare, IVC replacement can be necessary at LDLT. Budd-Chiari and E. alveolaris are the main underlying diseases for replacement requirements. Caval replacement with cryopreserved vascular grafts can provide successful short-term and long-term patency.

Water-lily sign: A case report

Echinococcosis (or hydatid disease) is a zoonotic disease caused by the larval form of Echinococcus granulosus or Echinococcus alveolaris. It continues to be endemic in developing countries including India. Liver is the most common organ involved but the parasite can affect any organ in the body. A 45 year old lady who presented with abdominal pain was subjected to ultrasonography and MRI of the abdomen which showed the characteristic “water lily sign” of hydatid cyst. Patient underwent pericystectomy, and on followup screening ultrasound has remained free of disease recurrence.

EComment. Alveolar echinococcosis of the lung.

We read with great interest Karaman et al.'s rare case concerning lung infection with Echinococcus alveolaris [1]. We would like to highlight two points concerning the conservative treatment and imaging characteristics of alveolar echinococcosis (AE). AE is a severe disease, with a mortality of over 90% in untreated patients. Radical surgery combined with chemotherapy for up to 2 years after surgery is recommended. Inoperable cases or patients who have undergone liver transplantation require continuous chemotherapy for many years. Long-term chemotherapy may significantly prolong survival [2]. Benzimidazoles, albendazole and mebendazole are presently used as chemotherapeutic agents. Failures in drug treatment as well as the occurrence of side effects have been reported, leading to the discontinuation of treatment or to progressive diseases [3]. Intravenous amphotericin B (preferably as a lipid emulsion) may be used as rescue chemotherapy in patients resistant or intolerant to benzimidazoles. Pilot trials with interferon-gamma and nitazoxanide were unsuccessful. Interferon-alpha has yet to be tested in a pilot trial. With regard to diagnosis, ultrasonography, computed tomography (CT) and magnetic resonance (MR) with standard and diffusion-weighted sequences all provide useful information and serve complementary roles in detecting and characterizing echinococcal lesions. Cross-sectional imaging is crucial for differentiating echinococcosis from malignant processes. CT is most useful for depicting the peripheral calcifications surrounding established echinococcal cysts, and MR imaging is most helpful for identifying echinococcosis of the central nervous system [4]. Conflict of interest: none declared

Atypical localized hydatid cyst: case report

Summary Hydatid cyst is a parasitic disease caused frequently by Echinoccus granulosis and rarely by Echinococcus alveolaris which detected commonly in our country. Cystic lesions in involved organs are typical for the disease. Although found in all organs, the liver and lung are the most commonly affected organs. Hydatid cyst disease in the skeletal muscle is quite rare, as the lactic acid in muscles and increased blood flow hinders the de velopment of the parasite. Diagnosis is difficult due to lack of typical clinic. The diagnosis of hydatid cyst is mainly based on serological and radiological methods. Primary treatment of the disease is surgical removal of the cyst. In our case, we present a female patient diagnosed with hydatid cyst that was located in the left musculus vastus medialis.

Lung metastasis caused by an infection with Echinococcus alveolaris

Echinococcus alveolaris (E. alveolaris) (multi-localaris) is a parasitic agent that commonly affects the liver and poses as a solid mass. In contrast to Echnicoccus granulosus, E. alveolaris tends to invade adjacent structures rather than displace and compress them. Haematogenous dissemination to other organs such as the lungs, brain, or bone is rare. In this case, we report on a 34-year old woman with a history of liver segmentectomy due to E. alveolaris infestation and the disease disseminated to the lungs. Computed tomography and magnetic resonance imaging showed multiple opacities and mixed signal intensities in the lungs, mimicking metastatic disease. The biopsy proved that the lesions were a result of metastasis of E. alveolaris.

Changes of interleukin-17 and interleukin-6 in BALB/C mice infected with Echinococcus multilocularis

Objective To observe the dynamic expression of interleukin (IL)-17 and IL-6 and pathological features of the BALB/C mice livers infected with Echinococcus multilocularis (Em).Methods BALB/C mice were infected by intraperitoneal injection of a metacestode suspension (experimental mice) or the physiological saline ( control mice ),and the mouse liver samples and the serum were collected.The samples of mouse livers were subjected to Hematoxylin and Eosin (HE) staining.The dynamic changes in liver IL-17 and IL-6 expression in BALB/C mice infected with Em were analyzed immuno-histochemically.IL-17 was also determined by enzyme linked immunosorbent assay (ELISA).Results At different time points during the course of Em infection,pathological changes were observed in the liver of experimental groups,including inflammatory cell invasion,Kuffer cell proliferation,steatosis,necrosis,the formation of cyst wall,etc.In the experimental groups,the expression of IL-17 was positive at the 3rd month post-infection.There was significant difference in IL-17 between experimental group and control group at the 3rd,4th,6th and 10th month time points (P ＜ 0.05 ).The content of IL-17 was increased since 2nd month.The serum IL-17 contents at the 2nd,3rd,4th,10th groups were significantly higher than in the control group (P ＜ 0.05 ).Conclusion The IL-17 and IL-6 expression in the liver of BALB/C mice infected with Em was increased and kept in a high level during the Em infection,and may result in the immune evasion and host immunopathogenesis injury. Key words: Echinococcus alveolaris; Infection; IL-17; IL-6

Proliferative Peritonitis With Larval and Cystic Parasitic Stages in a Dog

A six year old Labrador mix dog, born in Spain, was imported to Germany in young age. After a period of vague abdominal pain and negative laboratory results, the dog was referred to a local veterinary clinic for laparotomy, where the tentative diagnosis of echinococcus alveolaris was made and the dog was euthanized. At necropsy, many cystic structures and a massive proliferative peritonitis were visible. Furthermore a few solid larval cestodal stages were found in the peritoneal and chest cavity. Histological the cysts contained a small eosinophillic tegument, a cell poor stroma, basophilic somatic nuclei and a variable amount of amorphous bodies. The solid cestodes exhibited a quite similar composition with neither scolices nor any head structures. Histological features of the parasitic stages resembled cysts and asexual stages of Sparganum proliferum. Distinctions to other larval cestode infestations in body cavities were discussed.

Intrathoracic Extrapulmonary Hydatid Disease: Radiologic Manifestations

Hydatidosis is a parasitic disease caused by the larvae of Echinococcus granulosus and rarely by Echinococcus alveolaris. It is endemic to South America, North Africa, Asia, Australia, and the Middle East [1,2]. The definitive hosts are foxes and, less commonly, dogs and cats. Humans are infected by direct contact with an infected animal or by ingestion of contaminated food or fluids. Echinococcal embryos migrate through the intestinal mucosa, and, in 60%e70% of cases, reach the liver via the portal system [1]. They can then enter the systemic circulation via the porta caval anastomoses and be carried by the bloodstream to any organ or tissue in the body. Alternatively, the eggs can be inhaled and cause primary lung disease [2]. Intrathoracic extrapulmonary hydatid disease is very rare but can occur in the pleural space, extrapleural region, pleural fissure, chest wall, mediastinum, pericardium, myocardium, and diaphragm [1]. In this pictorial essay, we present the clinical manifestations and imaging features of patients with hydatid cysts (HC) in the extrapulmonary sites of the thorax.

Diagnosis and differential diagnosis of benign liver tumors and tumor-like lesions

Benign liver tumors and tumor-like lesions cover a broad spectrum of differential diagnoses, varying from dysontogenetic cysts to pseudolesions. Focal nodular hyperplasia, adenoma and regenerating nodules play a major role in clinical practice. Based on imaging findings, these lesions can be classified as cystic or solid, solitary or multiple, and hyper- or hypovascular. Haemangioma, FNH, steroid-associated adenoma, cystadenoma and echinococcus cysts can be reliably diagnosed using imaging techniques. The same is true for pseudolesions, which are found in particular on dynamic computed tomography. Other entities such as adenoma in cirrhotic livers, angiomyolipoma, regenerating nodules or Echinococcus alveolaris cannot be safely diagnosed by imaging and require biopsy. Morphological and functional characteristics of the most common lesions in the different imaging modalities will be discussed. Where possible, a diagnostic strategy will be presented.

Portal Hypertension Due to Echinococcus Alveolaris: A Case Report

Infection of the liver with Echinococcus alveolaris (EA) contemplates with a fatal course though it is a rare condition. We present herein a patient with upper gastrointestinal bleeding due to portal hypertension caused by the involvement of the liver with EA.

Contrast-enhanced CT and MRI findings of atypical hepatic Echinococcus alveolaris infestation

Diagnosis of liver infestation by Echinococcus alveolaris (EA) is based on serological and radiological findings. In this report, we present a 15-year-old girl with atypical hepatic EA infestation showing central punctate calcifications and contrast enhancement on the portal and late phases of CT and MRI. CT showed a hypodense mass involving more than half of the liver with prominent central calcifications. MRI revealed hypointense signal of the infiltrative mass on both T1- and T2-weighted images. Contrast enhancement is a unique finding in hepatic EA infestation that may cause difficulties with diagnosis. MRI may provide invaluable information in the diagnosis of EA infestation of the liver, either by disclosing the infiltrative pattern of infestation without significant effect to vascular structures, or by the signal characteristics.

Surgical treatment of pulmonary hydatid cysts in pediatric patients.

Hydatid cyst is a zoonotic infection that is caused by Echinococcus granulosus and alveolaris, and that can result in endemics in rural regions. Infections caused by Echinococcus granulosus are more commonly seen in our country. In this retrospective study, we aimed at discussing the experience we have accumulated on pediatric pulmonary hydatid cyst cases over the last 6 years. Between 1995-2001, in the Department of Thoracic and Cardiovascular Surgery in Gaziantep University, 38 cases underwent 39 operations due to pulmonary and hepatic hydatid cysts. Of these, 24 were males and 14 were females, with an age range of 2-16 years. Operations were frequently performed via thoracotomy. Nineteen cysts were intact, and 26 were perforated. One case had sternotomy, another had sequential thoracotomy, and the rest of the cases underwent thoracotomy, which resulted in cystotomy-capitonnage. In the postoperative period, 2 patients had sustained air leakage, and 2 other cases developed skin infections. Average hospital stay was 5 days. After the operation, the patients received chemotherapy (albendazole 10 mg/kg/day) for 1.5 months. Early or late deaths or recurrences were not observed. We conclude that cystotomy-capitonnage is a successful treatment for pediatric pulmonary hydatid cysts, as it preserves the parenchyma. Chemotherapy in the postoperative period is beneficial in preventing the recurrences.