'No cyst, no echinococcosis': a scoping review update on the diagnosis of cystic echinococcosis after the issue of the WHO-IWGE Expert Consensus and current perspectives

CT imaging features and diagnostic algorithm for hepatic cystic echinococcosis

To systematically analyze CT imaging features of hepatic cystic echinococcosis (CE), explore radiological-pathological correlations, and develop a diagnostic algorithm for accurate disease classification. This retrospective study included 48 pathologically confirmed cases of hepatic CE from two medical centers. CT imaging features were analyzed by two experienced radiologists, evaluating lesion characteristics including location, morphology, wall features, and calcification patterns. Imaging findings were correlated with pathological results. A diagnostic algorithm was developed and validated, with inter-observer agreement assessed using Fleiss kappa coefficient. Seven distinct CT imaging patterns were identified, corresponding to different pathological stages: unilocular cystic (25.0%), multivesicular (8.3%), collapsed inner wall (10.4%), partially solidified (10.4%), solidified (16.7%), and calcified (25.0%) types, with complicated cases (4.2%) showing additional features. The proposed diagnostic algorithm achieved 94.0% accuracy (451/480 classifications) in validation testing by ten junior radiologists, with excellent inter-observer agreement (quadratic-weighted Fleiss kappa coefficient = 0.740 [95% CI 0.577-0.902], Gwet's AC2 coefficient = 0.768). Primary diagnostic challenges involved differentiating between CE2 and CE3b lesions, and between CE3b and CE4 lesions. This study explores the correlation between CT imaging patterns and pathological stages of hepatic CE, proposing a validated diagnostic algorithm. The findings provide valuable insights for CE classification, particularly in regions where the disease is emerging or underrecognized.

Targeted Theranostic Nanoprobes Assisted In Vivo NIR-II Fluorescence Imaging-Guided Surgery Therapy for Alveolar Echinococcosis

Alveolar echinococcosis (AE) is a serious parasitic infectious disease that is highly invasive and destructive to the liver and has a high mortality rate. However, currently, there is no effective targeted imaging and treatment method for the precise detection and therapy of AE. We proposed a new two-step targeting strategy (TSTS) for AE based on poly(lactic-co-glycolic acid) (PLGA). We designed and constructed a novel type of ICG@PLGA@Lips nanoprobe with integrated imaging and treatment properties. First, we used the characteristics of PLGA gluconeogenic raw material to target the liver during blood circulation. Then, we utilized the characteristics of PLGA specifically penetrating the AE shell to achieve specific identification of AE in the liver. Under 808 nm laser excitation, ICG@PLGA@Lips effectively achieved accurate imaging of AE based on near-infrared II (NIR-II, 900-1700 nm) fluorescence imaging methods and achieved AE treatment through PDT effects. PLGA improved the optical properties of ICG, while liposomes further improved the biocompatibility of the nanoprobe. As ICG@PLGA@Lips showed strong NIR-II fluorescence emission and good biocompatibility, ICG@PLGA@Lips showed advantages in the specific fluorescence navigation of AE surgical resection lesions. Thus, with the assistance of ICG@PLGA@Lips, we achieved precise targeted and real-time NIR-II fluorescence imaging of AE for the first time. We successfully obtained in vivo NIR-II fluorescence imaging-guided photodynamic/surgical therapy of AE. This TSTS-based AE imaging and treatment exploration provided a new strategy for accurate imaging and treatment of early AE, which is expected to significantly improve the prognosis of patients.

Echinococcus granulosus sensu lato control measures: a specific focus on vaccines for both definitive and intermediate hosts

Echinococcosis, a neglected zoonotic disease caused by Echinococcus tapeworms, presents significant public health challenges worldwide. Cystic and alveolar echinococcosis has substantial health and economic impacts, necessitating effective prevention and control strategies. The present review provides a framework to expand our knowledge regarding key components of echinococcosis prevention and control, including phases, options, targets and available tools as well as current gaps and challenges in the field. Furthermore, we discuss the progress made in developing vaccines for the intermediate and definitive hosts and review the limitations and obstacles in vaccine development for definitive hosts. Abundant information is available on various aspects of the Echinococcus vaccine in sheep. Livestock vaccination effectively reduces Echinococcus transmission to sheep, offering a feasible control measure in intermediate hosts. However, vaccine development for the definitive host, i.e. dogs, exhibits significant challenges. Information gaps regarding the immune-mediated protective responses in dogs, repeatability of results, factors influencing the immune response, reinfection resistance, potential age-related decreases in worm burden and factors associated with the antifecundity effect are key challenges that should be addressed in canine vaccine development, and research collaboration, innovative technologies, and a deeper understanding of transmission dynamics are crucial. Multisectoral coordination under the One Health framework, with long-term political commitment and national and international cooperation, is critical for effective control in endemic areas.

Hydatid Cyst or Echinococcosis: A Comprehensive Review of Transmission, Clinical Manifestations, Diagnosis, and Multidisciplinary Treatment

Echinococcosis, a parasitic infection caused by Echinococcus tapeworms, can cause various symptoms depending on the location and size of the cysts. This article explores the complexities of echinococcosis, including its transmission cycle, clinical manifestations, diagnosis, and treatment approaches. The review highlights the challenges associated with diagnosing the different echinococcosis types, including cystic echinococcosis, alveolar echinococcosis, and polycystic echinococcosis. Each form of the disease necessitates a unique diagnostic approach that often combines serological tests, imaging techniques, and histological analysis. The article explores treatment options for each type of echinococcosis, including surgical resection, medication, and minimally invasive procedures such as puncture-aspiration-injection-reaspiration (PAIR). The article acknowledges current treatment methods' limitations and emphasises the need for further research into improved diagnostics, drug targets, and preventative measures. This review aims to provide a comprehensive overview of echinococcosis, encompassing its transmission, clinical presentation, diagnosis, and treatment modalities. By outlining the complexities of the disease and highlighting areas for future research, the article hopes to contribute to improved disease management and control. Key findings of the review include the identification of significant diagnostic challenges in differentiating between cystic, alveolar, and polycystic echinococcosis, the varying efficacy of treatment modalities such as surgical resection and PAIR, and the urgent need for further research into enhanced diagnostic methods, novel drug targets, and effective preventative strategies.

Navigating Complexities: Successful Pericystectomy in a South Asian Female With Hepatic and Peritoneal Hydatid Disease

Hydatid cyst disease, caused by the larval stage of Echinococcus granulosus, is a parasitic infection endemic in many regions, including South Asia. We present a case of a 36-year-old South Asian female with concurrent liver and peritoneal hydatid cysts, emphasizing the diagnostic challenges and management complexities associated with this condition. The patient presented with abdominal pain, nausea, and decreased appetite, and imaging studies revealed characteristic cystic lesions in the liver and peritoneum. Initial medical management with albendazole was followed by surgical excision due to inadequate response to therapy. Postoperative care included prophylactic albendazole to prevent recurrence. This case highlights the importance of a multidisciplinary approach involving medical therapy and surgical intervention tailored to the individual patient's needs and disease presentation.

Evaluation of the Local and Peripheral Immune Responses in Patients with Cystic Echinococcosis

BACKGROUND

Cystic echinococcosis (CE) cysts may persist for decades because of immune modulation mechanisms. Here, we characterize the cysts and the blood immune responses in patients with CE.

METHODS

We enrolled 61 patients with CE and 19 control subjects. We received tissue samples from seven patients with CE and a control subject requiring liver cystectomy. The immunohistochemistry evaluation of the immune cell subtypes and cytokines in the pericysts and surrounding liver and the antigen B (AgB)-specific response analysis of whole blood were performed.

RESULTS

In CE, the pericyst and the surrounding liver parenchyma showed aggregates of CD3+ T lymphocytes, mainly CD4+. B lymphocyte aggregates were present in the liver tissue. Monocytes/granulocytes were rarely observed. Th2 cytokine expression was scarce, whereas IFN-γ expression was present in the CE tissues. The control subject did not show an inflammatory infiltrate. The IL-4-specific response to AgB was increased in the patients with CE compared to the control, and this result was confirmed in a larger cohort (p = 0.003), whereas the IFN-γ-response was similar between the two groups (p = 0.5570).

CONCLUSION

In patients with CE, CD4+ lymphocytes infiltrate the pericyst and the surrounding liver tissue with a low IL-4/IL-13 expression level and a moderate IFN-γ expression level; moreover, an IL-4 parasite-specific response is detected in the periphery. These results support adventitia involvement in CE immunopathogenesis.

Cardiac cystic echinococcosis-A systematic review and analysis of the literature

Human cystic echinococcosis (CE) is a parasitic infection caused by the larval stage of the tapeworm Echinococcus granulosus sensu lato, primarily affecting the liver and lungs. Although the heart is affected in only 0.02-2% of all CE cases, a considerable number of cases have been, and continue to be, published. However, due to the rare occurrence of cardiac CE and the resulting lack of clinical trials, knowledge about various aspects of the disease remains limited. To obtain a clearer picture of anatomical, clinical, diagnostic as well as therapeutic aspects of cardiac CE, we systematically reviewed the literature published between 1965 and 2022. The anatomical pattern of the affected cardiac structures follows the extension of the supplying capillary bed. The majority of patients (82.7%) are symptomatic and present with prolonged non-specific symptoms such as dyspnoea, chest pain and palpitations. Acute complications generally derive from cyst rupture, occur in 18.3% of cases and manifest as embolism, pericardial tamponade, or anaphylactic reaction in 83.2%, 17.8% and 10.9% of these cases, respectively. As for CE cysts localized in other organs, the diagnosis of cardiac CE is made by imaging. Serology plays a minor role due to its limited sensitivity. Unlike abdominal CE cysts, cardiac CE cysts are usually resected independent of their stage (active/inactive), because their presence impairs cardiac performance and carries the risk of long-term sequelae. More than 80% of patients are treated with a single surgical intervention. We found a disease-related case fatality rate of 11.1%. Since local recurrence was reported up to 108 months and secondary CE up to 72 months after surgery, patients should be followed up for a minimum of 10 years.

Ultrasound diagnosis of cystic echinococcosis: updates and implications for clinical management

The diagnosis of cystic echinococcosis (CE) is based on imaging. Detection of a focal lesion with morphological characteristics of Echinococcus granulosus sensu lato metacestode is the starting point for the diagnostic workup. In organs explorable with ultrasound (US), this is the method of choice for both aetiological diagnosis of CE and staging of the CE cyst. Staging in terms of lesion morphology is also needed when serology is added to the diagnostic workflow when imaging alone is inconclusive. Finally, staging guides the clinical management of uncomplicated CE, especially in the liver. This commentary provides an overview of the most up-to-date evidence backing the above-mentioned role of US in the diagnosis and clinical management of CE. Finally, we outline future perspectives for the improvement of CE diagnosis.

Performance of Echinococcosis Serology is Associated with Disease Endemicity, Hydatid Cyst Location, Eosinophilia, Imaging Finding, and Treatment

BACKGROUND

We aimed to assess echinococcosis serology performance for diagnosing cystic echinococcosis (CE) in children living in CE-endemic vs. non-endemic populations, and in different clinical settings.

METHODS

A retrospective cohort study, assessing children with ELISA test for echinococcosis, 2005-2021. Sensitivity, specificity, positive and negative predictive values (PPV and NPV) were calculated comparing CE-endemic vs. non-endemic populations, cases with/without eosinophilia, and cases with/without CE-suggestive imaging findings. Additionally, we examined the association between serology titers/levels (values) and clinical characteristics.

RESULTS

Of 273 cases, 66 (24%) were confirmed as CE. Overall, 97% of CE were in Bedouin children, and the pre-test probability was 28% vs. 9% (p < 0.001) in CE-endemic vs. non-endemic population, respectively. Sensitivity was higher in hepatic than extra-hepatic CE (74% vs. 47%). Overall specificity was 86%. PPVs were higher in CE-endemic population compared to non-endemic (66% vs. 22%), while NPVs were higher in non-endemic population (100% vs. 87%). Eosinophilia was associated with lower specificity (73% vs. 94%) and PPV (47% vs. 78%). Typical imaging was associated with higher specificity (94% vs. 82%) and PPV (91% vs. 11%), while NPVs were lower in typical imaging cases (77% vs. 98%). Higher titer levels (above median) were associated with typical imaging (76% vs. 49%), higher PPV (79% vs. 43%), albendazole treatment (100% vs. 56%), surgery (60% vs. 19%), and new imaging finding (75% vs. 0%).

CONCLUSIONS

Echinococcosis serology performance was impacted by disease endemicity, and by various clinical characteristics. These findings may assist physicians in the interpretation of echinococcosis serology results.

Cystic Echinococcosis in the Early 2020s: A Review

Cystic echinococcosis (CE) is a zoonosis caused by metacestodes, the larval stage of Echinococcus granulosus. Although the World Health Organization (WHO) has defined CE as a neglected disease, it is the second most important foodborne parasitic disease, and it remains an important public health issue, considering its zonal endemicity and potential morbidity. The control and prevention of CE is a relevant WHO target, especially from a One Health perspective, as the disease affects not only animals and humans but also the food chain. Since not all countries have a CE surveillance strategy or reporting system and specific management guidelines, recent epidemiological data are relatively scarce, and research concerning the specific geographical distribution of the disease is ongoing. To add new information to the subject, we have analyzed and collected data from national guidelines and several medical databases. Out of the 751 research articles that were originally identified, only 52 were included in the investigation after applying specific inclusion and exclusion criteria. Notable international projects that have provided significant contributions and had a positive impact are presented. The available data were correlated with WHO recommendations on the subject, thus showcasing the measures taken and those that are still needed to properly control the disease's spread.