A rare case of the simultaneous location of Echinococcus multilocularis in the liver and the head of the pancreas: case report analysis and review of literature

Presentation and management of pancreatic hydatid cyst: A comprehensive systematic review of the literature with meta-data

INTRODUCTION

Hydatid cysts are among many cysts that can develop in the pancreas. Both the size and location of these cysts significantly influence clinical presentation and surgical approach required for management. This study aims to review the literature concerning pancreatic hydatic cysts, their presentations, and management strategies.

METHODS

A comprehensive search was conducted across CINAHL, Pubmed/Medline, Cochrane Library, Web of Science, and EMBASE Databases to identify English-language studies published up to January 2nd, 2024.

RESULTS

The mean age of the patients was 35.4 ± 17.4years, with females comprising 92 (59.0 %) of the cohort. Abdominal pain was the most common complaint, reported by 92 (59.0 %) patients. Serological testing for the echinococcal antigen demonstrated highest sensitivity at 67.0 %, whereas computed tomography exhibited a sensitivity of 34.1 %, and ultrasonography showed a sensitivity of 27.7 %. Among surgical interventions, laparotomy was the most frequently performed approach, utilized in 42(26.9 %) of the cases.

CONCLUSION

Although pancreatic hydatid cysts are rare and can be challenging to diagnose, their prognosis is generally favorable when appropriate therapeutic measures are employed. Surgical intervention, often combined with Albendazole, remains the mainstay of treatment.

Risk Factors and the Character of Clinical Course of the Echinococcus multilocularis Infection in Patients in Poland

Alveolar echinococcosis (AE) is a chronic zoonotic disease caused by the larval form of Echinococcus multilocularis. In humans, it may become a serious chronic infection of the liver which resembles a slow malignant process leading to death when untreated. The aim of the study was an assessment of the risk factors of the E. multilocularis infections and the description of AE clinical course in the group of 36 patients with confirmed AE, hospitalized at the Department and Clinic of Tropical and Parasitic Diseases, Poznan University of Medical Sciences between 2013 and 2022. Among the study participants, most patients cultivated land, bred livestock, worked in the forest, or were employed in animal shelters. The E. multilocularis infection was diagnosed based on imaging and immunoassay techniques within 6 months in the majority of patients hospitalized in the Department. All patients hospitalized in the Department initiated anti-parasitic therapy at the moment of the diagnosis. Pharmacological treatment combined with surgery was applied in most of the study participants, who were presented with more advanced stages of infection. We conclude the following: 1. For humans in the risk group, regular abdominal imaging examinations and the detection of specific antibodies against E. multilocularis are recommended. 2. Regular screening tests in the hyperendemic areas of AE would increase the early detection of the disease and to improve the clinical prognosis in this extremely life-threatening parasitic disease.

Genetic characterization of human echinococcosis in Southern Punjab, Pakistan

Introduction

Echinococcosis is a neglected tropical zoonotic infection that affects both the human and livestock populations. In Pakistan, the infection is long-standing, but data on its molecular epidemiology and genotypic characterization in the southern Punjab region are limited. The aim of the current study was the molecular characterization of human echinococcosis in southern Punjab, Pakistan.

Methods

Echinococcal cysts were obtained from a total of 28 surgically treated patients. Patients' demographic characteristics were also recorded. The cyst samples were subjected to further processing to isolate DNA in order to probe the Nad1 and Cyt-b genes, followed by DNA sequencing and phylogenetic analysis for genotypic identification.

Results

The majority of the echinococcal cysts were from male patients (60.7%). The liver was the most commonly infected organ (60.71%), followed by the lungs (25%), spleen (7.14%), and the mesentery (7.14%). Molecular and genotypic identification through sequencing and phylogenetic tree analysis showed that most of the cysts (24/28, 85.7%) were caused by the species Echinococcus granulosus sensu stricto (E. granulosus s.s.) (G1 and G3), followed by Echinococcus multilocularis (E. multilocularis) and Echinococcus canadensis (E. canadensis) (G6/G7) (3/28, 10.8%, and 1/28, 3.5%, respectively).

Conclusion

The current study concluded that the majority of human infections were caused by E. granulosus s.s., followed by the E. multilocularis and E. canadensis species (G6/G7). Genotypic characterization among both human and livestock populations is needed to explore the genetic diversity of echinococcosis.

An overview of the genetic diversity of Echinococcus granulosus sensu lato in Turkey

Echinococcus granulosus is a parasite that lives as a host in animals and humans, causes great economic damage and poses a serious threat to health. Morphological differences and intermediate host preference are used to distinguish the species of this parasite. Ten genotypes and lion strains of Echinococcus granulosus have been identified in molecular studies to date. It contributes to the fact that the effects of cystic echinococcosis detected in humans and the disease process caused by different genotypes can be handled differently. In genetic diversity analysis, species were classified as Echinococcus granulosus sensu stricto, Echinococcus equinus, Echinococcus ortleppi, Echinococcus canadensis and Echinococcus felidis genotypes. Echinococcus granulosus sensu stricto is the most common cause of human cystic echinococcosis worldwide and in Turkey. In this review, the distribution and epidemiology of Echinococcus granulosus genotypes detected in humans and animals in Turkey are discussed.

A Case Report of Liver and Pancreatic Echinococcal Cysts

A 54-year-old female patient with complaints of abdominal pain for 2 months was admitted to the General Surgery clinic of our tertiary care hospital. Abdominal ultrasound (US) and computed tomography revealed cholelithiasis, liver hydatid cyst, and hypodense multicystic mass lesion in the pancreatic body. In the endoscopic US performed, pancreatic hydatid cysts were considered as the pre-diagnosis. Cystotomy and external drainage were performed on the 8-cm cystic lesion in the pancreas head-class junction. Pancreatic hydatid cyst can be rarely seen isolated or can develop synchronously to liver hydatid cyst, and should be kept in mind in a differential diagnosis. If the perioperative diagnosis is confirmed and in case of the absence of a pancreatic ductal fistula, surgical morbidity and mortality can be reduced by applying cystotomy and external drainage procedures.

Albendazole reduces hepatic inflammation and endoplasmic reticulum-stress in a mouse model of chronic Echinococcus multilocularis infection

BACKGROUND

Echinococcus multilocularis causes alveolar echinococcosis (AE), a rising zoonotic disease in the northern hemisphere. Treatment of this fatal disease is limited to chemotherapy using benzimidazoles and surgical intervention, with frequent disease recurrence in cases without radical surgery. Elucidating the molecular mechanisms underlying E. multilocularis infections and host-parasite interactions ultimately aids developing novel therapeutic options. This study explored an involvement of unfolded protein response (UPR) and endoplasmic reticulum-stress (ERS) during E. multilocularis infection in mice.

METHODS

E. multilocularis- and mock-infected C57BL/6 mice were subdivided into vehicle, albendazole (ABZ) and anti-programmed death ligand 1 (αPD-L1) treated groups. To mimic a chronic infection, treatments of mice started six weeks post i.p. infection and continued for another eight weeks. Liver tissue was then collected to examine inflammatory cytokines and the expression of UPR- and ERS-related genes.

RESULTS

E. multilocularis infection led to an upregulation of UPR- and ERS-related proteins in the liver, including ATF6, CHOP, GRP78, ERp72, H6PD and calreticulin, whilst PERK and its target eIF2α were not affected, and IRE1α and ATF4 were downregulated. ABZ treatment in E. multilocularis infected mice reversed, or at least tended to reverse, these protein expression changes to levels seen in mock-infected mice. Furthermore, ABZ treatment reversed the elevated levels of interleukin (IL)-1β, IL-6, tumor necrosis factor (TNF)-α and interferon (IFN)-γ in the liver of infected mice. Similar to ABZ, αPD-L1 immune-treatment tended to reverse the increased CHOP and decreased ATF4 and IRE1α expression levels.

CONCLUSIONS AND SIGNIFICANCE

AE caused chronic inflammation, UPR activation and ERS in mice. The E. multilocularis-induced inflammation and consecutive ERS was ameliorated by ABZ and αPD-L1 treatment, indicating their effectiveness to inhibit parasite proliferation and downregulate its activity status. Neither ABZ nor αPD-L1 themselves affected UPR in control mice. Further research is needed to elucidate the link between inflammation, UPR and ERS, and if these pathways offer potential for improved therapies of patients with AE.

Alveolar Echinococcosis of the Parotid Gland-An Ultra Rare Location Reported from Western Europe

(1) Background: Alveolar echinococcosis (AE) is restricted to the northern hemisphere with high endemic regions in Central Europe, North and Central Asia as well as Western China. The larval stage of Echinococcus multilocularis (E. multilocularis) causes AE with tumor-like growth. Humans are accidental hosts. This report is on the first case of AE becoming clinically manifested in the parotic gland. (2) Case presentation: A 52-year-old male patient presented with progressive and painful swelling of the right parotid gland persisting for one year. We performed a partial parotidectomy. The histological examination and immunohistological staining revealed larval stage of E. multilocularis. (3) Conclusion: E. multilocularis is known to infect animals and humans coincidentally, and leads to AE. It is one of the most life-threatening zoonoses in Europe. It typically manifests in the liver (50–77%), with further spreading to other organs being a rare phenomenon. Echinococcosis should be considered in the differential diagnosis of lesions of the parotid gland in endemic areas, but AE has not been described so far in the parotid gland as the sole manifestation and, therefore, impedes the correct diagnosis. A complete resection should be the aim, however, preservation of the facial nerve and adjuvant albendazole therapy is mandatory.

A Conservative Management of Spontaneously Ruptured Liver Hydatid Cyst

Hydatid disease is a zoonotic disease caused mainly by the cestode (tapeworm) Echinococcus granulosus, also known as hydatidosis. It is endemic mainly in areas where dog/horse breeding and sheep farming are common, such as Australia, New Zealand and the Mediterranean region. A rare, yet serious, complication of hydatid cyst of the liver is rupture, which could be spontaneous due to increased intra-cystic pressure or following a traumatic injury of the abdomen. Rupture into the peritoneal cavity may result in an anaphylactic reaction, usually treated by means of emergency surgical intervention. Herein, we present a case of a 55-year-old male patient, known to have liver hydatid cystic disease 3 years ago, who presented to other hospital with acute abdominal pain, tachycardia and hypotension. A computed tomography (CT) scan of the abdomen revealed ruptured liver hydatid cyst into the peritoneal cavity, with free intra-abdominal fluid and dissemination into the mesentery. The patient was treated successfully by conservative means including nil per os (NPO), intravenous fluids, noradrenaline and anthelminthic treatment by albendazole. Two months later the patient underwent laparoscopic resection of the mesenteric as well as the hepatic cyst. The presentation, diagnosis, course of treatment and follow-up are discussed in this report. Reviewing the current English literature reveals that this is the first case to report a successful initial conservative management of spontaneous intraperitoneal rupture of liver hydatid cyst.

Portal hypertension as a result of the incomplete surgically treated advanced alveolar echinococcosis: a case description

Background

Infection of Echinococcus multilocularis causes in humans the alveolar echinococcosis. Although the infection has world-wide distribution it is rarely detected. Diagnosis of alveococcosis is difficult because of not typical clinical picture and irregular results of radiological examinations suggesting neoplasmatic process which begins in the liver tissue or in the biliary tracts. The parasitic growth is slow, so the illness is quite often established in late invasion period. Treatment of long-lasting and late diagnosed infection is difficult and requires cooperation of parasitologists together with surgeons to avoid life-threatening organ dysfunction.

Case presentation

We describe a young male patient, diagnosed, according to the radiological, immunological and histological examination results, infection of Echinococcus multilocularis, who was treated with not radical resection of pathologic mass together with persistent albendazole intake. The right hepatectomy was performed. In addition, visible cysts were removed from the left lobe of the liver in nonanatomical resection and suspicious calcified lesions in hepatoduodenal ligament were also removed. After the operation portal hypertension, with splenomegaly and symptoms of the liver cirrhosis occurred (thrombocytopenia, collateral venous circulation, first degree varices oesophagii). The portal hypertension probably could be a result of incomplete surgery due to extended parasitic infection and liver anathomical changes due to performed procedures, because the portal hypertension and it’s further complications had not been observed before the operation.

Conclusions

Echinococcus multilocularis should be taken under consideration in differential diagnosis of irregular lesions within the liver. Lon-lasting invasion could be responsible for the irreversible secondary liver changes such as cirrhosis and portal hypertension. The surgery treatment (treatment of choice) is difficult and it’s results depends on the invasion period the patient is operated on. After the surgery the patient requires careful follow – up, to detect early complications.

Evaluation of the Clinical, Laboratory, and Radiological Findings and Treatment of 19 Cases of Pancreatic Echinococcosis

Background

Hydatid disease is a severe health problem in endemic areas. In recent years, the incidence of this disease in China has been increasing. As the imaging characteristics of pancreatic echinococcosis (PE) are similar to those of cystic diseases, such as cysts, tuberculosis, and tumors, PE is often misdiagnosed and mistreated.

Methods

The clinical manifestations, laboratory tests, radiological findings, and treatment of 19 patients with PE between January 2006 and December 2018 in 2 hospitals were retrospectively analyzed.

Results

The mean age of the patients was 38 years, and the ratio of women to men was 2. All patients came from rural areas. Clinical manifestations included cholestatic jaundice, mass, nausea, pain, and swelling. Hemagglutination inhibition test results were positive for all patients. Enzyme-linked immunosorbent assay test results were positive in 17 cases (89.5%). Foci in the pancreas were head in 52.6%, body in 26.3%, body and tail in 15.8%, tail in 5.3%. The size of lesions’ diameter ranged from 1 to 12 cm (mean, 6.5 cm). The imaging features of PE included the presence of (a) daughter cysts on abdominal computed tomography (CT) and/or magnetic resonance imaging (MRI); (b) internal cyst wall dissection and ribbon sign on abdominal CT and/or MRI; (c) typical eggshell cyst wall calcification on abdominal CT.

Conclusions

For patients with cystic lesions on CT and/or MRI combined with epidemiological history and positive echinococcosis serology, doctors can correctly diagnose PE earlier. Surgical treatment combined with drugs can reduce the mortality of PE, leading to a better prognosis.