Predictive Factors for Fertility of Daughter Cysts in Hepatic Cystic Echinococcosis and Insights into the Origin of Daughter Cysts

Introduction: The cycle of Echinococcus granulosus and its developmental potential has always been a subject of debate. While the origin of protoscoleces was well defined, the origin of daughter cysts (DC) was still a contentious topic, and several hypotheses have been proposed. The aim of this work was to study the fertility of DC and its predictive factors in order to determine its origin. Patients and Methods: This was a prospective pilot study including hepatic echinococcal cysts containing DC operated in the Department of General and Visceral Surgery of Habib Bourguiba University Hospital, Sfax, during a 22-month period. A parasitological study of the DC including the determination of their fertility was done. Results: A total of 248 DC collected from 27 multi-vesicular cysts from 21 patients were included in our study. The fertility rate of the DC was 64.5%. Free hooks were present in 130 DC (52.4%) and in only 11(12%) of infertile DC. In a multi-variable analysis, only World Health Organization-Informal Working Groups on Echinococcosis classification type CE2, bilious cyst fluid, number of DC per cyst, cyst size, and DC diameter were factors associated with DC fertility (p < 0.05). Out of 88 infertile DC, 77 (87.5%) were devoid of any hooks. Conclusion: Our findings suggest that most of the analyzed DC were fertile, with fertility associated with factors such as cyst size, DC size, CE2 type, and number of DC/cysts. The absence of hooks in infertile DC questions prevailing theories of their origin.

Molecular diagnosis of echinococcosis in patients based on frozen paraffin tissue samples and fixed formalin and hydatid cysts isolated from livestock in a slaughterhouse

Background

Various genotypes of Echinococcus granulosus have been studied in high-disease-risk areas and identified as causative agents of cystic echinococcosis (CE). This study was performed to examine and identify the molecular hydatid cyst in the dissected human specimens in paraffin tissue, and the dissected animal cyst was characterized using the DNA polymerase chain reaction-restriction fragment length polymorphism (PCR-RFLP) of internal transcribed spacer 1 (ITS1).

Materials and Methods

To determine the molecular properties of E. granulosus, 20 hydatid cyst samples (including 6 sheep samples, 9 camel samples, and 10 human paraffin samples) were collected from Zahedan and Zabol cities. After DNA extraction, molecular PCR was performed, and RFLP was evaluated. In this study, the Taq1 endonuclease cleavage enzyme was used.

Results

The patterns of DNA bands found in the isolates from human CE and animal bladder cysts were the same, as indicated by the results of ribosomal DNA-ITS1 amplification from E. granulosus. Two nested primer pairs were used. The rough size of the enhanced ITS1 piece was 444 and 391 base pairs (bp), individually. After cutting the PCR product with the Taq1 enzyme, the patterns of the fragments revealed that the samples had two identical RFLP patterns. The aftereffects of this study showed that the parasite genotypes confined to sheep, camels, and people had hereditary changes.

Conclusion

The transcendent type of E. granulosus sensu lato in the area is E. granulosus sensu stricto, which featured the meaning of the sheep/canine cycle in human transmission. Albeit the band profile in the camel is now and again like the sheep strain, RLFP can be recognized utilizing the PCR strategy, and two differentiating band profiles using the chemical were found in this review.

Molecular and immunological diagnosis of cystic echinococcosis from different hosts in the Gaza strip, Palestine

The aim of the present study was to determine the molecular characteristics of Echinococcus granulosus sensu lato from faecal samples of dogs and the hydatid cyst from liver of bovine, camel, cattle, and sheep and the immunodiagnosis of Hydatid cyst in human sera samples from the Gaza Strip, in Palestine. A total of 38 faecal samples were collected near farms and local markets where stray dogs were grouping there. Post-slaughtering, the livers of the bovine, camel, cattle, and sheep were examined for cysts. Where 30 suspected hydatid cysts were collected, the number and size of cysts in each liver were recorded. For serology, 23 sera specimens were collected from farmers within the Gaza Strip. According to hospital records in Gaza, 12 patients had attended three different hospitals and had tested positive for hydatid cyst/cystic echinococcosis by CT scans and histopathology. ELISA results from the 23 human patients showed that 3/23 (13%) tested positive for hydatid disease. Of the 30 bovine and cattle harboring cysts, 14/30 (46.6%) were positive for hydatid cyst/cystic echinococcosis of which 23 (76.7%) were males and 7 (23.3%) were females. The present study shows that 6/38 (15.7%) were positive for E. granulosus sensu lato from faecal analysis in dogs. Subsequent sequencing of both dogs and cattle confirmed infection by the G1 strain. The cattle/dog strain (G1) of E.granulosus sensu lato suggests that this infection is cosmopolitan in its distribution. It is concluded that the detection of hydatid cyst/cystic echinococcosis in the examined hosts either human or animals should be considered among physicians and a large sample size is recommended in future research.

Clinical characteristics and antibodies against Echinococcus granulosus recombinant antigen P29 in patients with cystic echinococcosis in China

Objectives

Cystic echinococcosis (CE) is a neglected parasitic zoonotic disease caused by the larval stage of the tapeworm Echinococcus granulosus (E. granulosus). This study aimed to understand the clinical characteristics of human CE in Ningxia Hui Autonomous Region (NHAR) located in northwest China and to investigate the antibody profiles against the recombinant E. granulosus antigen P29 (rEg.P29) in plasma of CE patients.

Methods

A total of 37 human CE patients, along with 37 healthy donors enrolled in this study and demographic and clinical data were analyzed, including age, gender, laboratory data, symptoms, and cysts description. Plasma levels of cytokines, total IgG, and total IgE were determined by sandwich ELISA kits. Specific antibodies against rEg.P29 and hydatid cyst fluid (HCF) were assessed by indirect ELISA.

Results

The results revealed that females have a higher percentage of CE patients than males. The incidence of CE reached a peak in the 41–50 years-old group. The liver was the most frequent location, accounting for 91.9%. Based on the CT images, cysts of 34 patients who had liver involvement, were classified as 1 (2.9%) CE1, 12 (35.3%) CE2, 5 (14.7%) CE3a, 1 (2.9%) CE3b, and 15 (44.2%) CE5. Twenty-nine (78.4%) patients had a single cyst and 8 (21.6%) had at least two cysts. The most frequently reported symptom was upper abdominal pain. The plasma level of IL-6 and total IgE were significantly increased in CE patients compared with healthy donors. Additionally, IgG response to rEg.P29 in CE patients was significantly higher than in healthy donors, and the dominant IgG subclass was IgG4. Further analysis of different patient groups revealed that rEg.P29-specific IgG and IgG4 were only elevated in CE patients with CE2 type cysts.

Conclusions

This study systematically investigated the clinical characteristics of patients with CE and may provide a reference basis for the diagnosis and treatment of CE in NHAR. Furthermore, tests of specific IgG and IgG4 against rEg.P29 can be used as an assisted method for imaging techniques to identify cystic activity and determine the best therapeutic approach for CE.

Autoimmunity in human CE: Correlative with the fertility status of the CE cyst

Cystic echinococcosis is speculated to exert several immune-evasion strategies involving autoimmune-phenomena. We evaluated the hypothesizes that the prevalence of autoantibodies increases in the sera of CE patients that may evidence the association between the parasite and autoimmune diseases. Sera from 63 subjects at distinct types of CE cyst fertility were investigated for antinuclear antibodies (ANA), and anti-CCP antibodies. Plasma levels and cellular production of IL-17A cytokine were specifically defined as being assumed to prime for autoimmunity. Healthy-controls were age and gender-matched to test sera. ANA expressions inside the surgically removed metacestode and adventitial layer were also assayed. Out of 63 patients, 35 % had fertile highly viable cysts (group-1), 41 % had fertile low viable cysts (group-2) and 24 % had non-fertile cysts (group-3). A four-fold increase in ANA sera-levels was detected in group-1 compared with their controls (p-value 0.001) while anti-CCP levels were of insignificant differences. In group-2 and group-3, no significant differences were detected between ANA and anti-CCP sera-levels in CE patients and their controls. IL-17A sera-levels in group-1 and group- 2 were significantly higher than their healthy-controls while being of insignificant differences in group-3, p-value= 0.300. No association was detected between sera-levels of IL-17A and ANA as well as anti-CCP antibodies. Interestingly, relative IL-17A cellular expression associated positive ANA deposition in the parasite cells and adventitial layer. Collectively, based on the parasite fertility, IL-17A and ANA seemed to be involved in the host immune defenses against CE. There is no association between CE and anti-CCP antibodies.

Acute pancreatitis as an uncommon complication of hydatid cyst of the liver: A case report and systematic literature review

Hydatid disease is a major health problem worldwide. The liver is the most frequent location of hydatid disease. Acute pancreatitis secondary to liver hydatid cyst ruptured in the biliary tract is scarce and fewly described in literature. The management of this pancreatic complication of liver hydatid disease is challenging and includes a combination of surgical and endoscopic approaches. We report herein a rare case of hydatid cyst of the liver with cysto-biliary communication revealed by acute pancreatitis. A systematic literature review of similar cases reported was provided to compare surgical and endoscopic techniques. A thirty-year-old woman was referred to our emergency unit for acute pancreatitis. The CT-scan findings revealed a liver hydatid cyst ruptured in the biliary tract and daughter vesicles within were found, responsible for C-grade acute pancreatitis. We decided then to perform an emergency surgery through a bisoucostal incision. We performed a cholecystectomy and a peroperative cholangiogram that showed the communication between the cyst and left biliary tracts and the presence of daughter vesicle within the common bile duct. We conducted an exploration of the common bile duct with extraction of vesicle daughters. We left behind a T-tube in the common bile duct and we sutured the cysto-biliary fistula. Drainage was left in the remnant cavity after unroofing the cyst. Postoperative course was uneventful. Six months follow-up showed no recurrence. Cysto-biliary communication of liver hydatid disease revealed by acute pancreatitis is uncommon. We chose to perform emergency open surgery. However, through a systematic literature review, we noticed that endoscopic treatment is an efficient therapeutic and diagnostic tool to delay a morbid surgery of the liver and the common bile duct.

Cystic echinococcosis in the Eastern Mediterranean region: Neglected and prevailing!

Cystic echinococcosis (CE) is distributed worldwide, extending from China to the Middle East and from Mediterranean countries to the sub-Saharan Africa and South America. According to WHO, one million people around the world are suffering from CE with an estimated burden of 183,573 DALYs. The annual monetary burden of the disease due to treatment costs and CE-related livestock losses has been estimated at US$ 3 billion. CE is endemic in all countries within the WHO Eastern Mediterranean Regional Office (EMRO). The region, which includes most of the Middle East and North Africa, is one of the most ancient foci of the domestic cycle of CE and is recognized as one of the major hotspots of CE. There are 22 countries in the EMRO, where about 688 million people are living at risk of CE. In many EMRO countries, little is known about CE epidemiology and transmission. WHO included echinococcosis in a list of 17 neglected tropical diseases (NTDs) and 12 neglected zoonotic diseases (NZDs). Accordingly, different regional offices of WHO organized several initiatives for CE control and prevention. WHO's Western Pacific regional office considered echinococcosis as one of the region's major health topics, and several preventive measures have been implemented in the American region with the support of Pan American Health Organization (PAHO) in Argentina, Peru, Uruguay, and Chile. Although CE is endemic in all 22 EMRO countries, surprisingly, CE is absent from the health topics list of diseases and conditions in this region. Therefore, CE clearly requires further attention in the WHO EMRO agenda, and the need for elaboration of specific measures for CE control is becoming apparent in EMRO countries, where substantial collaborations among the member states and WHO EMRO is of paramount importance. Major topics of collaborative activities include training programs and health communication on different aspects of CE control, analysis of CE burden, national and international surveillance and disease registry systems, technical support to promote epidemiological studies for collecting baseline data, cost-benefit analysis of control interventions, and intersectoral cooperation among the agriculture, veterinary, medical, and health sectors.

Surgically confirmed cases of cystic echinococcosis from Baluchistan Province, Pakistan for the years 2011-2018

INTRODUCTION

Cystic echinococcosis (CE) is a parasitic zoonotic disease caused by the larval stage of Echinococcus granulosus tapeworms. It has a worldwide geographic distribution and can threaten the livestock industry and human health in endemic areas, including Pakistan. CE prevalence is high in Pakistan due to lack of local knowledge about disease transmission and a lack of control measures. The Pakistan province of Baluchistan shares a border with Iran and Afghanistan and is largely agricultural. However, little is known about E. granulosus transmission in this region.

METHODS

Information on surgically confirmed cases of CE in Baluchistan Province was obtained through evaluation of paraffin fixed cyst samples and patient records obtained from three local hospitals for the years 2011-2018.

RESULTS

A total of 22 paraffin fixed samples were collected during the study period. The majority of cysts were obtained from the liver (9/22; 40.9%), with anatomical location not available for two of the cysts. Demographic information was available for 18 cases. Females made up 61.1% (11/18) of the cases. The largest numbers of cases were found in the 31-40 years age group (5/18; 22.7%).

DISCUSSION

This study shows that Echinococcus spp. parasites are circulating in the study area. In order to control the disease, a comprehensive regional surveillance and control program is needed.

Retrospective Study of Cystic Echinococcosis (CE) Based on Hospital Record from Five Major Metropolitan Cities of Pakistan

BACKGROUND

Human cystic echinococcosis (CE) is an important zoonotic parasitic disease. It is one of the NTDs having strong roots in Pakistan. There are limited studies on the prevalence of CE in Pakistan.

METHOD

A retrospective study was conducted to determine the geographical distribution of human CE in Punjab (Lahore, Multan, and Faisalabad) and Sindh (Karachi and Hyderabad) provinces of Pakistan. Clinical records of infected patients from nine major hospitals were retrieved from 2008 to 2018.

RESULTS

A total of 188 surgically confirmed cases were included from selected hospitals during the study period, which showed the annual frequency of 18.8 cases/year. The number of reported cases was higher in Sindh province (67.55%) compared to Punjab (32.45%). Total number of CE cases/city was higher in Karachi (47.34%) compared to Hyderabad city (20.21%), while in Punjab province, this frequency was higher in Lahore (25%) followed by Multan (5.32%) and Faisalabad (2.13%). Out of total 188 patients, 73 (38.83%) were males and 115 (61.7%) were females. In surveyed hospitals, high burden of infection was reported in young adults (21-30 years; 29.79%) followed by 21.81% and 17.02% in 31-40 and 41-50 age groups, respectively. Data retrieved from the hospital record of diagnosed cases of CE showed liver (36.17%, n = 68) as the most affected organ followed by lungs (26.06%, n = 49). In this survey, some unusual sites of cyst formation were also observed.

CONCLUSION

Current study is a step forward towards filling the gap of knowledge for prevalence and regional distribution of hydatidosis in Pakistan reporting the CE cases in humans for the first time in Multan and Faisalabad.

Knowledge, Attitudes, and Practices of 50 Patients with Surgically Treated Cystic Echinococcosis from Basrah Province, Iraq

Cystic echinococcosis (CE) is recognised worldwide as a neglected disease of public health concern, particularly in low- and middle-income countries. The objectives of this study were to describe, using a questionnaire survey, the characteristics, attitudes, knowledge, and practices of patients with CE from Basrah Province, Iraq. We interviewed 50 patients, 31 female and 19 male, of whom, 74% originated from rural areas. Approximately half (48%) of the participants reported slaughtering livestock at home for their families’ consumption; 78% indicated the presence of a large number of stray dogs roaming freely about their village; 86% reported that they never boiled water prior to drinking it; and 26% reported not washing vegetables prior to eating them. Although a large proportion of the participants (72%) had heard of hydatid disease prior to becoming ill, over half (57%) were not aware how the disease was transmitted from animals to humans. This study highlighted a gap in health education efforts regarding CE in Southern Iraq, with a lack of counselling of patients on how to prevent reinfection. An intensive control programme should be implemented and founded on health education to reduce CE disease in Basrah.

Cystic echinococcosis and other helminth infections of wild boar in northeastern and northwestern regions of Tunisia

This study identified helminth species of wild boar (Sus scrofa) originating from northeastern and northwestern regions of Tunisia using 297 lungs, 297 livers, 264 intestinal tracts, 120 samples of muscle tissue (tongue, masseter, diaphragm, inter-costal) and 232 faecal samples derived from a total of 591 animals. Host gender was registered for the lung and liver wild boar group, which included 163 males and 134 females. All animals, excluding those used to retrieve muscular samples, were classified into three age classes, <2 (n = 212), 2-3 (n = 208) and ⩾4 years old (n = 141). Helminth fauna of the examined wild boar included 14 parasite species: one trematode (adult, Brachylaemus suis), three cestodes (metacestodes of Echinococcus granulosus, Taenia hydatigena cysticercus, adult, Hymenolepis diminuta), nine nematodes (adults of Metastrongylus apri, Metastrongylus pudendotectus, Ascarops strongylina, Globocephalus urosubulatus, Physocephalus sexalatus, Gnathostoma hispidum, Gongylonema pulchrum and eggs of Strongyloides ransoni and Capillaria spp.) and one acanthocephalan (adult, Macracanthorhynchus hirudinaceus). Trichinella larvae were not recovered from any of the 30 wild boar examined. Results showed a 73.5% global prevalence of infection with visceral helminths, 67.3% of which were lung and hepatic infections and 80.3% of helminths were recovered from the gastrointestinal tract. The most prevalent parasite was M. hirudinaceus (61.7%) while the highest intensity of infection was observed for Metastrongylus spp. The most prevalent cestode was E. granulosus (18.9%). This is the first detailed study on helminth infections of wild boar from a North African country.

Genotyping of human Echinococcus granulosus cyst in Morocco

Echinococcus granulosus is the etiological agent of cystic echinococcosis (CE), also commonly called hydatidosis. This is a zoonotic infection endemic worldwide, including the Mediterranean basin and Morocco. The genetic variability of Echinococcus granulosus is known to influence development of parasitic cysts in different intermediate hosts, and therefore the epidemiology of infection. Molecular studies have identified nine genotypes of Echinococcus granulosus, eight of them affect humans, grouped today in four distinct species. In Morocco, molecular studies on CE cysts from animals showed the presence, for the large majority of cases, of the G1 genotype (« sheep strain » or Echinococcus granulosus sensu stricto), which is also the cause of the majority of human infections worldwide, and to a lesser extent of the other genotypes (G2 and G3) within Echinococcus granulosus sensu stricto complex. However, so far no genotyping of echinococcal cysts in Morocco has been carried out. We collected CE cysts material from 15 patients diagnosed with abdominal CE in the Meknès-Tafilalt region, Middle Atlas of Morocco, and an endemic area and genotyped by multiplex PCR. The only five cysts from which it was possible to successfully amplify the DNA were all belonging to the G1-G3 genotype, in line with the epidemiology of CE in animals in the same area. Our results add new information, on the human side, to the epidemiological picture of CE in the region, which are important in the context of any control plan for the infection.

New insights of the local immune response against both fertile and infertile hydatid cysts

BACKGROUND

Cystic echinococcosis is caused by the metacestode of the zoonotic flatworm Echinococcus granulosus. Within the viscera of the intermediate host, the metacestode grows as a unilocular cyst known as hydatid cyst. This cyst is comprised of two layers of parasite origin: germinal and laminated layers, and one of host origin: the adventitial layer, that encapsulates the parasite. This adventitial layer is composed of collagen fibers, epithelioid cells, eosinophils and lymphocytes. To establish itself inside the host, the germinal layer produces the laminated layer, and to continue its life cycle, generates protoscoleces. Some cysts are unable to produce protoscoleces, and are defined as infertile cysts. The molecular mechanisms involved in cyst fertility are not clear, however, the host immune response could play a crucial role.

METHODOLOGY/PRINCIPAL FINDINGS

We collected hydatid cysts from both liver and lungs of slaughtered cattle, and histological sections of fertile, infertile and small hydatid cysts were stained with haematoxylin-eosin. A common feature observed in infertile cysts was the disorganization of the laminated layer by the infiltration of host immune cells. These infiltrating cells eventually destroy parts of laminated layer. Immunohistochemical analysis of both parasite and host antigens, identify these cells as cattle macrophages and are present inside the cysts associated to germinal layer.

CONCLUSIONS/SIGNIFICANCE

This is the first report that indicates to cell from immune system present in adventitial layer of infertile bovine hydatid cysts could disrupt the laminated layer, infiltrating and probably causing the infertility of cyst.

Neglected Zoonoses and the Missing Opportunities for One Health Education: The Case of Cystic Echinococcosis among Surgically Operated Patients in Basrah, Southern Iraq

Cystic echinococcosis (CE) is recognized as a neglected disease of public health significance throughout the world, particularly in low and middle-income countries. The objectives of this study were to describe the characteristics, attitudes, knowledge, and practices of some Basrah province residents diagnosed with CE. Using a questionnaire survey, we interviewed 50 surgically operated cases of CE from Basrah, south Iraq. The cases comprised of 31 females and 19 males, of which 74% originated from rural areas. The questionnaire contained 30 questions and focused on gathering the demographic characteristics of the patients and capturing their overall knowledge, attitudes, and practices toward CE. Approximately half of the participants reported slaughtering livestock at home for their families’ consumption, 78% indicated the presence of a large number of stray dogs roaming freely about their village, 86% reported that they never boiled water before drinking it, and 26% reported not washing vegetables before eating them. Although a large proportion of the participants (72%) had heard of hydatid disease before becoming sick, over half (57%) were not aware of how the disease can be transmitted from animals to humans. This study highlights a gap in One Health education efforts regarding CE in southern Iraq, with a lack of counselling of patients on how to prevent reinfection. An intensive One Health education program should be implemented in Basrah to reduce CE at the human–animal interface. Lack of awareness on zoonoses among medical professionals, who are supposed to disseminate advice on preventative measures to their patients, is a challenge to the public health system.

A retrospective study of human cystic echinococcosis in Basrah province, Iraq

Human cystic echinococcosis (CE) is a parasitic zoonosis with serious clinical burden and constitutes a challenge to public health in endemic areas worldwide. We performed a retrospective study to investigate the occurrence of CE in patients at six hospitals in Basrah province, Iraq. In the current study setting, data retrieval and validation of the quality of hospital records was very challenging considering the difficult situation Iraq is unfortunately facing. Hospitalization records were reviewed from January 2005 to December 2015. A total of 748 cases of human with CE were diagnosed and operated in Basrah hospitals, equivalent to an annual clinical incidence of approximately 4.5 cases per 100 000 people. Hospital records show that, cystic echinococcosis affected more females (61.2%) than males (38.8%). Descriptive review of recorded CE cases in the surveyed hospitals revealed that more cases were reported in the age group of 21-30 years than in the other age groups. Based on the reviewed recorded clinical reports, cysts were mainly found in the liver (46.3%) and lungs (28.1%) of the patients. Hospital reports demonstrate that females had more hepatic cysts (63.9%) than males (36.1%). This study found that CE continues to pose a threat to public health in Basrah, and there is a need for more epidemiological investigations of CE in humans in order to determine risk factors and the economic impact of the disease in this province of Iraq.

Global Distribution of Alveolar and Cystic Echinococcosis

Alveolar echinococcosis (AE) and cystic echinococcosis (CE) are severe helminthic zoonoses. Echinococcus multilocularis (causative agent of AE) is widely distributed in the northern hemisphere where it is typically maintained in a wild animal cycle including canids as definitive hosts and rodents as intermediate hosts. The species Echinococcus granulosus, Echinococcus ortleppi, Echinococcus canadensis and Echinococcus intermedius are the causative agents of CE with a worldwide distribution and a highly variable human disease burden in the different endemic areas depending upon human behavioural risk factors, the diversity and ecology of animal host assemblages and the genetic diversity within Echinococcus species which differ in their zoonotic potential and pathogenicity. Both AE and CE are regarded as neglected zoonoses, with a higher overall burden of disease for CE due to its global distribution and high regional prevalence, but a higher pathogenicity and case fatality rate for AE, especially in Asia. Over the past two decades, numerous studies have addressed the epidemiology and distribution of these Echinococcus species worldwide, resulting in better-defined boundaries of the endemic areas. This chapter presents the global distribution of Echinococcus species and human AE and CE in maps and summarizes the global data on host assemblages, transmission, prevalence in animal definitive hosts, incidence in people and molecular epidemiology.

Diagnostic value of semi-purified antigens of hydatid cyst fluid in human cystic echinococcosis

Cystic Echinococcosis (CE) is an infection caused by the larval stage of Echinococcus granulosus. The diagnosis of this disease has been problematic. Serological tests detecting antibodies against E. granulosus are the most popular and mainly use the crude Hydatid Cyst Fluid (HCF) or its components, Ag 5 and B. However, the diagnostic value of these tests is limited by the problems of specificity and/or sensitivity. The use of purified HCF antigens could be more helpful in the serodiagnosis of CE compared to the whole HCF. In the present study, we have evaluated the diagnostic value of semi-purified antigens using ELISA tests. Our results have shown that the 53 KDa antigen gave the best specificity (97.5%) and sensitivity (80%). We have also used Western Blot technique to analyze the serological profile against HCF. The results have confirmed that the most immunogenic component of HCF is the Ag 5.

Characterization of the inflammatory cell infiltrate and expression of costimulatory molecules in chronic echinococcus granulosus infection of the human liver

Background

The local immune responses to chronic echinococcal infections in various organs are largely unknown. Since the liver is the most frequently involved organ in such infections in human we aimed to characterize the inflammatory as well as immune cell infiltrate around hydatid cysts in the liver and compared to common inflammatory processes of the liver.

Method

Surgical samples from the liver of 21 cystic echinococcosis (CE) patients were studied and the distribution of different types of inflammatory and immune cells were determined by immunohistochemistry. Furthermore, expression levels of costimulatory CTLA4, CD28, CD80 and CD86 molecules were measured at RNA level by PCR. Liver biopsy samples from patients with steatohepatitis (SH, n = 11) and chronic hepatitis (CH, n = 11) were used as non-inflammatory and chronic inflammatory controls, respectively. The composition and density of the inflammatory and immune cell infiltrates have been compared by using morphometry.

Results

CD3+ T cells predominated the inflammatory infiltrate in all pathological processes, while in CE samples CD20+ B cells, in CH samples CD68+ macrophages were also frequent. Both myeloperoxidase (MPO) + leukocytes and CD68+ macrophages were found to be significantly decreased in CE as compared to either SH or CH samples. Concerning T cell subtypes, only CD8+ T cells were found to be significantly decreased in SH samples. CD1a + dendritic cells were almost completely missing from CE biopsies unlike in any other sample types. There were no differences detected in the mRNA expression of costimulatory molecules except decreased expression of CD28 in CE samples.

Conclusion

In the hydatid lesions of the liver of chronic echinococcal infections T cell-mediated immunity seems to be impaired as compared to other types of chronic inflammatory processes, suggesting an immunosuppressive role for Echinococcus granulosus, which deserve further attentions.

Knowledge, attitudes and practices with regard to the presence, transmission, impact, and control of cystic echinococcosis in Sidi Kacem Province, Morocco

BACKGROUND

This study is a component of a large research project on five major neglected zoonotic diseases (NZDs) including cystic echinococcosis and was undertaken in the Province of Sidi Kacem over a period of four years (April 2009-March 2013).

METHODS

Questionnaires were administered at community level in a total of 27 communes and visits were made to all of the 10 abattoirs situated in the Province, to collect qualitative data on determinants of transmission for disease in humans and animals. More specifically, community knowledge, attitudes and practices related to cystic echinococcosis were assessed, as well as the extent to which local customs and behaviours may promote transmission. Abattoir infrastructure and practices, and their role in perpetuating disease transmission were also critically evaluated.

RESULTS

The results show that only 50 % of people have heard of the disease, and of those, only 21 % are aware of the dog's role in disease transmission. Sixty-seven per cent of respondents stated that dogs are fed ruminant organs deemed unfit for human consumption. Owned dogs have access to the family home, including the kitchen, in 39 % of households. The extent of this close proximity between humans and animals is even more pertinent when one considers that dogs are omnipresent in the community, with an average of 1.8 dogs owned per household. The unrestricted access of dogs to abattoirs is a huge issue, which further promotes disease transmission.

CONCLUSION

This study would suggest that the high prevalence of cystic echinococcosis in humans and animals in Morocco is largely due to three factors: 1) abundance of dogs 2) engagement in risky behaviour of the local population and 3) poor abattoir infrastructure and practices. This has serious implications in terms of the socio-economic impact of the disease, especially for rural poor communities.

Human cystic echinococcosis in Heilongjiang Province, China: a retrospective study

Background

Cystic echinococcosis (CE) is one of emerging zoonotic parasitic diseases throughout the world, having significant medical and economic importance in developing countries. The western and northwestern China is considered as CE endemic areas. In northeastern China’s Heilongjiang Province, the increasing number of sporadic human CE cases has attracted more and more attention. The aims of the present study were to understand the clinical characteristics of human CE in the investigated area and to compare the coincidence rates of CT, ultrasound and serological test against the histopathology results among CE patients.

Methods

Hospital data of 183 human CE cases in the period from January 2004 to July 2013 were collected from the two largest hospitals in Heilongjiang Province. Clinical data were analyzed, including age, gender, occupation and living residence of CE patients and localization, size and number of CE cysts as well as the diagnosis methods of CE before operation.

Results

The results revealed that the incidence of CE reached a peak in the age group of 41–50 years. Among the 183 CE patients, the females were observed to have a higher percentage of CE patients (60.66%, 111/183) than males (39.34%, 72/183). The majority of CE patients were farmers, followed by workers, employees, public servants, students and so on. CE cysts were most commonly found in the livers, with a 30 cm cyst in diameter being detected. CT showed the highest coincidence rate (96.64%) for hepatic CE among the three common diagnosis methods (CT, ultrasound imagine and serological test) compared against the histopathology results.

Conclusions

This is the first retrospective analysis of human CE cases in Heilongjiang Province in recent ten years. Clinical characteristics of human CE were described here. CT appeared to be the most effective diagnosis method for hepatic CE.

Histopathological changes associated with E. granulosus echinococcosis in food producing animals in Punjab (India)

Cystic echinococcosis due to Echinococcus granulosus is a serious public health and economic concern in India. The disease is endemic in most of the food producing animals such as cattle, buffalo, sheep, goat and pigs in the country. In this study, tissues comprising of pieces of liver and lungs were collected in 10 % formal buffered saline. The formalin fixed tissues (liver and lungs) from 10 cattle, buffalo, sheep, goat and pigs each were selected and further processed by acetone benzene method for histopathological examinations. The cysts were surrounded by outer fibrous layer over the inner germinal layer and filled with clear hydatid fluid. Echinococcal protoscolices were also noticed in some of the sections. Histologically, slight hemorrhage, leucocyte infiltration and mild hepatocellular degeneration in the liver were noticed. The adjacent hepatic paraenchyma showed atrophy, variable degeneration and infiltration. The parenchyma adjacent to cysts was markedly congested and showed multiple small haemorrhagic areas. In lungs, there was proliferation of fibrous connective tissue and infiltration of mononuclear cells.

Human Cystic Echinococcosis in the Nalut District of Western Libya: A Clinico-epidemiological Study

Human cystic echinococcosis (CE) is an endemic disease in the Mediterranean area that has not yet been fully documented in western Libya. The present study describes the clinico-epidemiologic profile of CE in western Libya’s Nalut district. From April 2008 to July 2011, 36 cases of CE were confirmed following surgical removal of cysts. The cysts were most frequently found in the liver (61.1%), followed by the lungs (19.4%), kidneys (11.1%), peritoneal cavity (11.1%), and spleen (5.6%). Among the 36 patients, 6 possessed plural cysts and 3 had cysts in 2 organs. Blood samples from this group were examined for the presence of serum anti-hydatid IgG antibodies, which revealed positivity in 25 patients (69.4%). An additional 300 blood samples were collected randomly from the inpatient and outpatient clinics at Nalut Hospital. Twenty-seven samples (9%) were found to be positive for the anti-hydatid IgG antibody among which the prevalence of infection tended to be higher in men (12%) than in women (6%). This study demonstrates that CE is a major parasitic infectious disease of public health significance in Libya, notably in the western part of the country, and that disease awareness needs to be raised nationwide.

[Parasitological study of 78 cases of human cystic echinococcosis collected between 2005 to 2012 in Mustapha hospital center of Algiers]

AIM

The aim of this work is to know the fertility rate of the metacestodes resulting from patients suffering from hydatidosis, the one of protoscoleces's viability and by comparing the results obtained with those found elsewhere. It reports, also, the epidemiological, clinical and diagnostically aspects of the studied patients.

MATERIALS AND METHODS

This study has carried on 78 hydatics samples resulting from 78 patients collected between 2005 and 2012 at the laboratory of parasitology of the Mustapha hospital center of Algiers. A questionnaire on the epidemiological context (contact with an animal-host of the cycle, place of residence, presence of family cases reached of hydatidosis and knowledge on the hydatic disease) concerned 69 patients. For each sample, a direct microscopic examination is made with or without vital staining. The presence of protoscoleces made qualified the fertile cyst. Those visualized moving or resistant to eosin at 0.2% are considered viables. Indirect diagnosis is based on the techniques: passive hemagglutination, electrophoresis, Elisa IgG Echinococcus granulosus and immunoblotting IgG "Echinococcus". Molecular analysis is based on PCR and sequencing the partials fragments of two mitochondrial genes with the primers COX1 and ND1.

RESULTS

The results obtained show that the surgical frequency of hydatidosis is significant at the young adult and at the child. The epidemiological context associated at the disease is the conjointly presence of a dog and herbivores. The fertility rate of human hydatid cysts is 88.4% and the ones of viability of the protoscoleces is 74.5%. In this series, the serology shows global positivity at 70%. The molecular characterization of five samples identify the species: E. granulosus ss.

CONCLUSION

Finally, the viability and fertility rates found here are raised. Sometimes viables protoscoleses are found after use of scolicidal solution. In front of these results, the parasitical treatment is more than necessary in order to minimize the risk of occurred of secondary echinococcosis or the relapses postoperatives.

Echinococcus granulosus sensu lato genotypes infecting humans--review of current knowledge

Genetic variability in the species group Echinococcus granulosus sensu lato is well recognised as affecting intermediate host susceptibility and other biological features of the parasites. Molecular methods have allowed discrimination of different genotypes (G1-10 and the 'lion strain'), some of which are now considered separate species. An accumulation of genotypic analyses undertaken on parasite isolates from human cases of cystic echinococcosis provides the basis upon which an assessment is made here of the relative contribution of the different genotypes to human disease. The allocation of samples to G-numbers becomes increasingly difficult, because much more variability than previously recognised exists in the genotypic clusters G1-3 (=E. granulosus sensu stricto) and G6-10 (Echinococcus canadensis). To accommodate the heterogeneous criteria used for genotyping in the literature, we restrict ourselves to differentiate between E. granulosus sensu stricto (G1-3), Echinococcus equinus (G4), Echinococcus ortleppi (G5) and E. canadensis (G6-7, G8, G10). The genotype G1 is responsible for the great majority of human cystic echinococcosis worldwide (88.44%), has the most cosmopolitan distribution and is often associated with transmission via sheep as intermediate hosts. The closely related genotypes G6 and G7 cause a significant number of human infections (11.07%). The genotype G6 was found to be responsible for 7.34% of infections worldwide. This strain is known from Africa and Asia, where it is transmitted mainly by camels (and goats), and South America, where it appears to be mainly transmitted by goats. The G7 genotype has been responsible for 3.73% of human cases of cystic echinococcosis in eastern European countries, where the parasite is transmitted by pigs. Some of the samples (11) could not be identified with a single specific genotype belonging to E. canadensis (G6/10). Rare cases of human cystic echinococcosis have been identified as having been caused by the G5, G8 and G10 genotypes. No cases of human infection with G4 have been described. Biological differences between the species and genotypes have potential to affect the transmission dynamics of the parasite, requiring modification of methods used in disease control initiatives. Recent investigations have revealed that the protective vaccine antigen (EG95), developed for the G1 genotype, is immunologically different in the G6 genotype. Further research will be required to determine whether the current EG95 vaccine would be effective against the G6 or G7 genotypes, or whether it will be necessary, and possible, to develop genotype-specific vaccines.

Antigenic differences between the EG95-related proteins from Echinococcus granulosus G1 and G6 genotypes: implications for vaccination

Cystic echinococcosis caused by Echinococcus granulosus remains an important and neglected issue in public health. The study of the likely efficacy of the currently available EG95 vaccine against other genotypes of the parasite is important to improve the vaccine as a potential tool to be used in control programmes. The recombinant vaccine EG95-1G1 was developed based on the G1 genotype of E. granulosus. Characterization of the eg95 gene family in the G6 genotype by genomic DNA cloning previously produced the first unequivocal information about the composition of the gene family in a different genotype. The information was used in this study to predict and express two EG95-related proteins from the G6 genotype as recombinants, for assessment of their capacity to bind antibodies raised in sheep vaccinated with the EG95-1G1 vaccine. The proteins (EG95-1G6 and EG95-5G6) from the G6 genotype of E. granulosus were unable to bind all the antibodies raised by sheep vaccinated with EG95-1G1. Differences in the amino acid sequence of EG95-related proteins from G6 and likely the differences in the encoded FnIII domain may be responsible for changes in the conformation of these epitopes.

[Epidemiological profile of 290 cases of human cystic echinococcosis diagnosed in the Mustapha University Hospital (Algiers) from 2006 to 2011]

THE AIM OF THE STUDY

This study reports a series of 290 cases of hydatidosis confirmed by the surgery and/or the imagery with a positive immuno-diagnosis collected between 1st January 2006 and 31 March 2011 at parasitology-mycology laboratory of hospital university center of Mustapha of Algiers. Our aim is to specify, through the listed cases, the epidemiological aspects of this affection and compared with those obtained in two previous Algerian epidemiological investigations carried out, between 1963-1964 and 1966-1975.

PATIENTS AND METHODS

It is a retrospective (2006-2008) and prospective (2008-2011) study. The parasitological diagnosis was carried out by the direct macroscopic and/or microscopic identification of the parasite and indirect diagnosis based on four techniques: passive hemagglutination, Elisa IgG "Echinococcus granulosus", Western Blot IgG "Echinococcus" and electrophoresis.

RESULTS

The study shows that this affection is still prerogative of the young adult. It bring out also in this study that the child of school age (ten years), in particular the boy, pays a heavy tribute. At the child, the preferential pulmonary seat of the hydatic disease is not devoid of risk. At adult, this parasitic disease mainly affect the active woman.

CONCLUSION

Generally, the epidemiological and clinical characteristics join the endemic countries data and confirmed the row of our country among them. The transmission seems as strong as in the past, in spite of a much better social educational level.

Extra-hepatic intra-abdominal hydatid cyst: which characteristic, compared to the hepatic location?

Hydatid cysts are mostly located in the liver, followed by the lung. Primary and isolated extrahepatic intra-abdominal hydatid cysts (PIEHC) are rare and only a few sporadic series have been reported. This article aims to study the epidemiological, diagnostic difficulties and therapeutic principles of PIEHC. More over, it aims to make comparison between PIEHC and the liver location of the cyst concerning all these data. We report a retrospective study from January 1995 to September 2010 concerning 34 patients who underwent surgical removal of a PIEHC. The mean age was 46 years. Abdominal pain was the main symptom, and was found in 27 patients (79.4 %). Physical examination revealed an abdominal mass in 19 patients (55.9 %). In 6 patients (17.6 %) the PIEHC was incidental. Abdominal ultrasound and abdominal CT scan helped to highlight all cystic masses. The diagnosis was established preoperatively in 28 patients (84.8 %). Five patients (14.7 %) were operated with a diagnosis other than PIEHC. The diagnosis was made intraoperatively in one case (2.9 %). A laparotomy in 24 cases (70 %) was the surgical approach often used. Majority of the patients, 25 cases (73.5 %), received a conservative procedure. Only 3 patients (8.8 %) had recurrences and were reoperated. The diagnosis of PIEHC is often facilitated by means of modern imaging, however, serious diagnostic problem were found with a pancreatic location of the cyst. Complete surgical excision, when possible without major sacrifice, seems to be the best therapeutic option to reduce the risk of recurrence.

Cystic echinococcosis in slaughtered domestic ruminants from Tunisia

A total of 10,818 domestic ruminants (3913 cattle, 2722 sheep, 3779 goats, 404 dromedaries) slaughtered in various abattoirs in Tunisia between 2003 and 2010 were examined for the presence of Echinococcus granulosus hydatid cysts. The prevalence of cystic echinococcosis (CE) was 16.42% in sheep, 8.56% in cattle, 5.94% in dromedaries and 2.88% in goats. CE prevalence increased with age according to an asymptotic model and there was evidence of variation in infection pressure depending on the region of Tunisia where the animals were slaughtered. Cattle appeared to have the highest infection pressure of the species examined. The mean intensity of hepatic cysts was higher than that of pulmonary cysts in all species. The highest mean intensity of infection with E. granulosus larvae was observed in cattle (18.14) followed by sheep (9.58), goats (2.31) and dromedaries (2.12). The abundance of infection increased in a linear fashion with age in all animal species. Cyst abundance varied with species of animal and district of Tunisia. Cysts from dromedaries were more fertile (44.44%) than those from sheep (30.25%), goats (30.32%) and cattle (0.95%). The viability of the protoscoleces from fertile cysts from cattle (78.45%) was higher than those from sheep (70.71%) and camels (69.57%). The lowest protoscolex viability was recorded for hydatid cysts from goats (20.21%). This epidemiological study confirms the importance of CE in all domestic ruminant species, particularly in sheep, throughout Tunisia and emphasizes the need to interrupt parasite transmission by preventive integrated approaches in a CE control programme.