Echinococcus Infestation Research Articles

Echinococcus Infestation of the Central Nervous System as the Primary and Solitary Manifestation of the Disease: Case Report and Literature Review

Introduction: Hydatid disease of the central nervous system, especially when there is no involvement of other organs, is a rare occurrence and it accounts for 2–3% of all the hydatid cyst cases that are recorded worldwide. Echinococcus is considered as an endemic disease, mainly encountered in sheep and cattle-raising regions, with a large proportion of patients living in Mediterranean countries, as well as Turkey and Syria. Pediatric neurosurgeons in nonendemic countries are facing a differential diagnostic challenge when a patient with hydatid cyst of the central nervous system is admitted to their department, mainly due to lack of awareness. Materials and Methods: We report the case of an eleven years old patient, coming from a village, who was admitted to our hospital due to progressive hemiparesis, hemianopsia, headache and episodes of vomiting. A thorough laboratory and neuroimaging investigation was performed, which revealed the presence of a hydatid cyst at the right fronto-parietal region. An en-block total resection was performed and the patient neurological signs and symptoms were immediately relieved. Conclusions: The clinical features related to hydatid cyst involving the central nervous system are largely nonspecific. Nevertheless, MRI has proved to be a very important diagnostic tool, significantly enhancing the diagnostic aid of neuroimaging and supporting our pre-operative diagnostic accuracy. Laboratory investigation with immunological tests may be indicative, but negative results should be interpreted with caution. En block removal of the cyst without interruption of its wall and avoidance of any spillage of content is our ultimate therapeutic goal. Infection with Echinococcus granulosus should be included in the differential diagnosis for non-specific neurologic symptoms such as progressive headache, especially in pediatric patients who are coming from regions which are considered as endemic for such parasitic diseases. In addition, the adjuvant therapy with albendazole is strongly indicated. The majority of misdiagnoses or delayed diagnoses may have resulted from confusing clinical features and atypical radiographic findings.

Sciatica and femoral head osteonecrosis complicating a gluteal hydatid cyst: A case report.

Introduction and importanceHydatid disease is an endemic echinococcal infestation in Tunisia.Only 4% of hydatid cysts are located in the muscle. The gluteal localization is a very rare entity.The present case illustrates a gluteal hydatid cyst resulting in sciatica and osteonecrosis of the femoral head, an exceptional entity.Case presentationA 49-year-old man of urban origin, with free medical history, presented to our outpatient clinic with left sciatica and mechanical hip pain, that have been ongoing for 2 years.Pelvic radiograph showed femoral head osteonecrosis and lytic lesions of the ischium.MRI scan identified an extra-articular vesicular cyst in the left gluteal region involving the gluteus maximus. It suggested the diagnosis of musculo-skeletal echinococcosis.The patient underwent surgery and intraoperative findings showed a gluteal vesicular cyst with direct compression of the sciatic nerve, it also revealed femoral head necrosis. The cyst was drained and the pericyst excised. Total hip arthroplasty was postponed and the patient received a course of anthelmintic chemotherapy.Clinical discussionMuscular involvement of hydatid cysts is rare and seen only in 4% of cases. Neurological complications from sciatic nerve compression can present as sciatica, with a principal differential diagnosis of nerve root compression. Aseptic femoral head osteonecrosis, an exceptional complication of an extra-articular gluteal hydatid cyst, can result from three mechanisms: a direct mechanical compression, an ischemic process due to vessel obstruction or a cellular process mediated by osteoclasts.Treatment is based on surgical excision combined with anthelmintic chemotherapy, the latter reduces the number of live cysts and the risk of recurrence.ConclusionAlthough gluteal cysts are extremely rare with different clinical symptoms, surgery associated with anthelmintic treatment has a good functional outcome.

ECHINOCOCCOSIS AND CYSTICERCOSIS OF SHEEP AND GOATS IN THE FARMS OF THE SOUTH OF UKRAINE

The article provides data on the spread of echinococcosis and cysticercosis of sheep and goats in the farms of the South of Ukraine.
 The aim of the study was to monitor echinococcosis and cysticercosis of small cattle in farms in the southern and northern regions of Odessa region.
 The research was carried out at the slaughter points of the Odessa region. In order to identify larval cestodoses, carcasses and organs from 322 sheep and 84 goats were examined. In the south of the Odessa region at slaughter points with. Tatarbunary of the Tatarbunar district and Olefirenko LLC of the Liman district, 217 sheep and 45 goats were examined. 105 sheep and 39 goats were examined at the slaughter points of cattle in the Kodimsky district and LLC "Segros" in the Shiryaevsky district of the northern part of the Odessa region.
 For the period from 2016 to 2020, four causative agents of larvaceous cestodoses were registered, which include: echinococcosis, cysticercosis ovis (phinosis), tenuikolny and coenurosis (whirligig). Echinococcus infestation of sheep in the southern regions of the Odessa region was in the range from 10.1 % to 14.7 %, and in goats - 10.7-11.1 %, while in the northern regions the infection of sheep was 7.4-8.9 %, and goats - 6.5-7.9 %. The incidence of Cysticercus tenuicollis sheep in the southern regions ranged from 13.8% to 15.7 %, while in the northern regions - from 18.5% to 22.3 %, which is 29.6 % more. In 95 % of sheep, Cysticercus tenuicollis was found on the omentum, in 3 % on the omentum and liver, and in 2 % an only on the liver with an intensity of 3 to 16 cysts per animal. In goats, all cysts were exclusively on the omentum.

Study of Intra Abdominal Hydatid Cyst

Background: Hydatid disease (cystic echinococcosis) is a zoonotic infection caused by larval form of tapeworm Echinococcus Granulosus. Echinococcus infestation has been known for many centuries. Most common sites for cysts are lung and hepatic hydatidosis. They have a diverse clinical spectrum from being asymptomatic to symptoms arising due to involvement of surrounding structures or dissemination or secondary infection. Disease is endemic in Mediterranean basin, Central Asia, Africa and South America. In India, Andhra Pradesh and Tamilnadu predominate with incidence of hydatid disease. Hydatid disease is common in Saurashtra region due to cattle rearing and farming as occupation. It is commonly seen in the lower socioecomic strata due to poor personal hygiene and sanitation. In India the highest prevalence is reported in Andra Pradesh, Tamil Nadu and Jammu Kashmir. Hydatid disease is a zoonotic disease caused by echinococcus granulosus (larval stage). echinococcus granulosus and echinococcus multiformis are the two main species causing hydatid disease. Animals are the Definitive host and intermediate hosts. Humans are accidental intermediate hosts. The aim of this study was to determine the sociodemographic characteristics, presentation patterns, type of surgical management and outcome of patient operated on for intra abdominal hydatid cyst. Materials and Methods: All the patients suffering from hydatid disease who were admitted in our hospital from May 2019 to June 2020 were included in this study. All the patients underwent thorough clinical examination with detailed history and investigation as per protocol. All patients were followed for 3 months. Inclusion Criteria: Documented intraabdominal hydatid disease. Conclusion: Hydatid disease is common in Saurashtra and Kutch regions of Gujarat & other states of India. Patients mostly present at the age group of 20-40 years. Sex distribution is equal. Occupation like agriculturist, residing in rural areas and low socioecomomic status are considered to be risk factor for hydatid disease. Most commonly involved organ was liver followed by peritoneal involvement followed by spleen. Most common lobe involved was right lobe. Gharbi type 2 cysts are common. Most common treatment modality is surgical with medical management only reserved for small cysts. Decompression of cyst with deroofing and omentoplasty/ capitonnage was the commonest procedure adopted to deal with hydatid disease.

Pathological changes in dogs with echinococcal infestation in the Tyumen region

Dogs are the definitive hosts of Echinococcus, so not only do they carry a dangerous infestation for farm animals and humans, but they are also exposed to the substantial toxic effects of helminths themselves. The present work aims to find out the pathological impact of Echinococcus on the intestinal microflora and some blood parameters in the organism of affected dogs under the conditions of the Tyumen region. The authors studied the pathological effect of the sexually mature parasites on the host organism in 8 mongrel dogs. The contents were inoculated on special nutrient media, followed by cell counting as part of the bacteriological analysis of fresh animal faeces. Bacteria were identified by microscopy of isolated cultures, examining morphological features and Gram staining. Blood was taken from dogs from the femoral vein in the morning before feeding for general and biochemical analysis. It was found that the digestive tract of the dogs infected with Echinococcus decreased in bifidoand lactobacilli by a factor of 2 (P<0.001) compared with those of intact individuals. Escherichia increased by 1.6 times, Staphylococcus was augmented by 4.1, and Clostridium increased by 8.3 (P<0.001), leading to intestinal dysbacteriosis, digestive disorders, and secondary toxicosis animals. General blood analysis showed a 30.2% reduction in erythrocytes, 26.7% in platelets and 32.4% in haemoglobin. This reduction is the result of the action of toxins in the body of the patients. In the leukoformula, changes are manifested by a slight increase in the proportion of granulocytes (by 6.6%) due to eosinophils (P<0.01) and a decrease in agranulocytes (by 20.0%). Biochemical blood analyses of dogs with echinococcosis showed a 17.7% reduction in total protein and a 3-fold decrease in cholesterol. A 2-fold increase in creatinine and urea, a 3.2fold increase in bilirubin, a 2.6-fold increase in ALT and AST, and a 2-fold increase in alkaline phosphatase indicate inhibition of liver and kidney function.

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.

Hydatid cyst of the neck. A case report and literature review

Echinococcosis or hydatid disease is a zoonotic infection caused by Echinococcus granulosus. It has been recognized by humans for centuries, as it was described by Hippocrates more than two thousand years as a “fluid-filled liver”, and the famous Arabian physician Al-Rahzes described it, but it took till the 17th century when Francesco Redi illustrated that the hydatid cysts of echinococcosis were of animal origin. Hydatid disease is endemic in the Middle East, India, Africa, South America, New Zealand, Australia, Turkey and Southern Europe keeping in mind that it can occur also in non-endemic countries because of the upsurge of emigration and trade. The primary hosts are dogs. Intermediate hosts are sheep, cattle, horses and occasionally man.Hydatid cyst develops most frequently in the liver (65%), the lungs (25%), and the remaining 10% occurs in muscle, spleen, bones, kidneys, brain, eye, heart, and pancreas. Multiorgan involvement is seen in 20–30% of the cases with involvement of the liver in all cases. Occurrence of hydatid cyst is extremely rare in the head and neck region even in geographical areas where echinococcal infestation is frequent. Only a few cases of hydatid cyst located in head and neck have been reported in the literature.We will present our experience in treating a case of hydatid cyst located in the neck area, which is considered one of the few cases published due to the relative rarity of the disease in the fore mentioned anatomical location.

20-23-Submental hydatid cyst in 16 year-old girl (Case report)

Hydatid cyst in the head and neck region is a very rare even where the echinococcus infestation is endemic. The diagnosis is quit challenging. We report the case of a 16-old-female patient presenting with a hydatid cyst in the submental region. The diagnosis of hydatid cyst is made mainly with the help of imagining methods and review of the patient’s history. The diagnostic use of fine-needle aspiration biopsy generally has not been advised because of the potential to precipitate acute anaphylaxis or to spread a daughter cyst. Treatment is surgical albendazole therapy is suggested especially when there is perioperative contamination risk.

Paraspinal hydatid cyst with unusual presentation: a case report

Hydatid disease is a zoonotic infection most commonly caused by Echinococcus granulosis. Primary hydatid cysts of the skeletal muscles are extremely rare. In this paper, we present a case in which a patient had a hydatid cyst in the paraspinal muscle. A 19 years old female patient presented with a painless swelling over the left side on the back for the last two months. On local examination, a solitary, firm, non tender well defined, non movable, oval swelling was present over the left paraspinal region from T12 -L3. Provisional diagnosis of hydatid cyst was made on ultrasonography. Magnetic Resonance imaging revealed a well defined ovoid lesion measuring 4.3 × 4.54 × 2.3cm within the left erector spinae muscle. Operative intervention was planned and preoperative albendazole therapy (15 mg/kg/day) was given for two weeks. Hydatid disease is caused by the larval form of Echinococcus granulosus, It is most frequently located in the liver (75%) and lungs (15%). Musculo-skeletal involvement is secondary and uncommon. Spinal and paraspinal involvement is rare, with an incidence of less than 1%. Investigations for diagnosis include Ultrasonography, Computed tomography, Magnetic Resonance Imaging and Serologic tests. Surgical removal is the most effective treatment of hydatid cyst. Therapy with nontoxic scolocidal agents or combination chemotherapy with mebendazole is of therapeutic value. Albendazole is suggested to be given post operatively. Primary paraspinal echinococcosis must be considered in the preoperative differential diagnosis of the atypical presentation of paraspinal lesions in countries where Echinococcus infestation is endemic. Early diagnosis and radical surgery combined with antihelminthic therapy of sufficient duration are mandatory for the treatment of this disease.

Hydatid Cyst Of Pericardium And Its Surgical ExcIIn Guided By Trans-Esophageal E chocardiography

Introduction: Cardiac involvement in Echinococcus infestation is rare, ranging from 0.5 to 2% 1,2,3 . Left ventricle is most commonly involved but involvement of the right ventricle, left atrium, right atrium and inter atrial septum have also been reported. Discussion: Cystic Hydatid disease is cause by the small tape worm Taenia echinococcus or Echinococcus granulous whish spends part of its parasitic life cycle in dogs and sheep.

A solitary primary subcutaneous hydatid cyst in the abdominal wall of a 70-year-old woman: a case report

IntroductionA solitary primary hydatid cyst in the subcutaneous abdominal wall is an exceptional entity, even in countries where the Echinococcus infestation is endemic.Case presentationWe report a case of a 70-year-old Caucasian woman who presented to our hospital with a subcutaneous mass in the para-umbilical area with a non-specific clinical presentation. The diagnosis of subcutaneous hydatid cyst was suspected on the basis of radiological findings. A complete surgical resection of the mass was performed and the patient had an uneventful post-operative recovery. The histopathology confirmed the suspected diagnosis.ConclusionHydatid cyst should be considered in the differential diagnosis of every subcutaneous cystic mass, especially in regions where the disease is endemic. The best treatment is the total excision of the cyst with an intact wall.

Unusual Location of Primary Hydatid Cyst: Soft Tissue Mass in the Parapharyngeal Region

Hydatid cyst is a cyclozoonotic infection caused by the cestode Echinococcus granulosus. Hydatid cyst in the head and neck region is very rare, even in countries where echinococcus infestation is endemic. We report the case of a 17-year-old male patient presenting with a hydatid cyst in the parapharyngeal and neck region. There was no pulmonary or hepatic involvement. The definitive therapy comprised excision of the cystic mass and postoperative medical treatment.

Disseminated hydatid disease

Echinococcus infestation is endemic in certain parts of the world. Extrahepatic dissemination of the disease is rare. Successful management of these patients and possible routes for abdominopelvic dissemination of the disease are discussed.

Primary hydatid cyst of the neck

Hydatid cyst in the head and neck is very rare even in countries where echinococcus infestation is endemic. We report the case of a 33-year-old female patient presenting with a hydatid cyst in the lateral cervical region. The diagnosis of hydatid cyst is made mainly with the help of imaging methods and review of the patient's history. Serologic tests can also be useful. The diagnostic use of fine-needle aspiration biopsy generally has not been advised because of the potential to precipitate acute anaphylaxis or to spread daughter cysts. Treatment is surgical. Postoperative albendazole therapy is suggested especially when there is preoperative contamination risk.

Hydatid cyst of the submandibular salivary gland in a child

The majority of hydatid cysts are seen in the liver and lungs. In countries where Echinococcus infestation is common, high index of suspicion is required for hydatosis and although it is a rare location, a hydatid cyst should be considered in the differential diagnosis of the cervical lesions in order to avoid any dangerous complication such as untreatable multiple hydatosis or a fatal anaphylactic reaction. Surgical removal without causing any spillage of its contents is the most effective treatment. To the best of our knowledge, only one submandibular gland hydatid cyst case in a child has been reported. A case of 9-year-old male with hydatid cyst of the submandibular salivary gland is presented. The literature was reviewed and characteristics of the disease were discussed.

Intraventricular Administration of rt-PA in Patients with Intraventricular Hemorrhage

Intraventricular hemorrhage (IVH) represents a clinicopathologic entity with a dismal prognosis. The associated mortality rate has been reported as high as 80%; the morbidity is also quite high. The use of various fibrinolytic agents (streptokinase, urokinase, and recombinant tissue-type plasminogen activator [rt-PA]) has been reported in a small number of clinical series with a very limited number of participants, yielding significant variability regarding inclusion criteria, treatment protocol, and outcome analysis. In our prospective study, we report our experience using rt-PA in 21 patients with IVH. Patients with IVH of aneurysmal or arteriovenous malformation origin were excluded. Intraventricular administration of rt-PA was initiated within 24 hours after the ictal event (dose, 3 mg every 24 hours) through a ventricular catheter. The patients' intracranial and cerebral perfusion pressures, cerebrospinal fluid (CSF) cell count, and head CT scans with emphasis to frontal horn dimension and inner cranium diameter at the same level ratio were collected and analyzed. Good outcome was observed in 47.5% of our patients, whereas 28.5% died and 24.0% survived with severe disability. The development of rt-PA-associated complications was as follows: new hemorrhage in 19%, infection in 14.3%, and CSF pleocytosis in 100% of patients. Permanent CSF shunt was required in 40%. The intermediate (3-month) follow up of our survivors showed no significant outcome changes compared with the immediate (1-month) follow up. Intraventricular administration of rt-PA appears to be beneficial in cases of IVH even though it is occasionally associated with serious complications. Further multi-institutional studies are required for validating this treatment modality and standardizing its parameters.

Primary Echinococcus Infestation of the Bone and Muscles

Hydatid diseases of the bone and muscles are rare, generally are incurable, and have a high level of recurrence. We attempted to ascertain whether the recurrence rate decreased in patients with hydatid disease infestation of the bone and skeletal muscle who were treated with current surgical techniques and antihelminthic chemotherapy, and whether the outcomes for bone infestation were different when compared with outcomes for muscular infestation. We retrospectively reviewed 15 patients with hydatid disease of the bone (eight patients) and muscle (seven patients). The average followup was 30 months (range, 6-69 months). Recurrence was observed in four patients with bone involvement. No patient with muscle involvement had a recurrence after excision. Hydatid disease of the bone often is recurrent and progressive despite using advanced diagnostic studies, improved surgical techniques, and newly developed antihelminthic drugs. The disease status also was not as good as for patients with bone lesions when compared with patients with muscular lesions.

Vertebral hydatid disease presenting as a parapharyngeal and neck mass: A case report

Echinococcus granulosus is a cestode causing disease in human beings. Both the vertebral column and cervicofacial region are uncommon sites for hydatid involve‐ment, even in countries of the Middle East, South America, Australia, and New Zealand, where Echinococcus infestation is high.1 It was stated that only 1 in 1000 cases will exhibit cervical spine infestation, if the spine is infected in 1% to 2% of hydatid cases.12

Hydatid disease of the interventricular septum causing pericardial effusion

Echinococcal infestation of the heart is uncommon. We report a case of a 35-year-old man with an hydatid cyst located in distal interventricular septum. Clinical presentation was chest pain and urticaria. Diagnosis was made by echocardiography and magnetic resonance imaging. Surgical resection was performed; the cyst was punctured and its content was drained, hypertonic glucose solution was instilled for sterilization, and it was removed. The patient did well and remains asymptomatic. Diagnosis and ultimate surgical treatment of this disease prevented potentially lethal complications such as cyst rupture with embolic phenomena and anaphylactic shock.