Echinococcosis of the spine

Spinal Echinococcosis in a Japanese Woman Living in Tokyo: Diagnostic Challenges in Non-endemic Areas and Public Health Implications

Echinococcosis, caused by Echinococcus spp., often affects the lungs and liver, and spinal involvement is rare. Echinococcus multilocularis is prevalent in Japan, particularly in Hokkaido. We herein report a rare case of spinal echinococcosis in a 31-year-old woman who was diagnosed in Tokyo. Spinal echinococcosis is uncommon and often leads to misdiagnoses. The patient likely contracted the disease via contaminated fresh produce transported from an endemic region. This study emphasizes the diagnostic challenges of spinal echinococcosis in non-endemic regions and highlights the public health concerns related to the spread of infections in non-endemic areas.

A ten-year evaluation of central nervous system cystic echinococcosis in a highly endemic area of Iran: Molecular epidemiology and clinicopathological characteristics

Cystic echinococcosis can involve various organs in humans with the brain and spine being particularly vulnerable. This research aimed to study clinicopathological features and molecular analysis of the central nervous system (CNS) echinococcosis cases in a central hospital for hydatid cyst surgery in northeastern Iran. CNS echinococcosis cases from surgically managed human CE cases at Ghaem hospital in northeastern Iran were analyzed from 2012 to 2022. Demographic and clinicopathological data were collected for CNS echinococcosis cases and formalin-fixed paraffin-embedded (FFPE) blocks were used for molecular analysis. The total prevalence of CNS echinococcosis cases was 1. 8 %. Most of the CE cases were reported in women (64. 7 %) and from rural areas (58. 8 %). The highest number of cases (41. 2 %) were aged ≤18 years, with majority being ranchers (47. 1 %). Thirteen cases (76.5 %) were found to have cysts in their brain, particularly in the supratentorial site. Headache was the most commonly reported sign in cases (9/13, 69.2 %). Infiltration of eosinophils, polymorphic inflammatory cells, and giant cells, gliosis, and foreign body granulomatous reaction, along with mild infiltration of mononuclear cells showing degeneration and necrotic foci in the brain infections. Spine infections included bone cartilage, ligaments, and hydatid cyst wall fragments. PCR analysis conducted on 17 samples revealed the presence of 13 isolates of E. granulosus sensu lato. Among these, 11 were classified within the E. granulosus sensu stricto (G1 and/or G3) complex, while 2 isolates were identified as belonging to the E. canadensis G6/G7. Cerebrospinal infection is a significant aspect of CE cases in northcentral Iran, with a higher prevalence among women and in rural areas. Children were the most affected age group, with the E. granulosus s.s. genotypes being the most common.

Current knowledge of vertebral osteomyelitis: a review

PURPOSE

As life expectancy increases worldwide, the elderly population in every country is growing in both the size and proportion. This review aims to provide a comprehensive overview of the microbiology, clinical presentation, diagnostic strategies, and therapeutic approaches to vertebral osteomyelitis, summarizing the latest evidence to guide effective treatment.

METHODS

A comprehensive literature search was conducted using the Medline and Embase databases to identify relevant studies on vertebral osteomyelitis. The search included the following keywords: "vertebral osteomyelitis," "spinal infection," "discitis," "spondylitis," " spondylodiscitis," and "spinal epidural abscess." Both retrospective and prospective studies, case series, and reviews were considered.

RESULTS

This condition is commonly caused by bacteria such as Staphylococcus aureus or gram-negative bacilli, but can also be caused by other pathogens like fungi and parasites. The onset of vertebral osteomyelitis is insidious, with low specificity in clinical manifestations, often making early diagnosis difficult. Delayed or inadequate treatment may lead to sepsis, permanent neurological damage, or even death. Treatment strategies emphasize the importance of identifying the causative pathogen to guide effective antimicrobial therapy. Current consensus does not advocate for empirical antibiotic treatment unless patients exhibit signs of neurological impairment or severe sepsis. Severe cases involving neurological paralysis, spinal instability, or sepsis may require surgical intervention.

CONCLUSION

Vertebral osteomyelitis requires prompt diagnosis and treatment for a good prognosis. Delayed diagnosis and treatment can lead to permanent neurological deficits or death. Identifying the causative organism is crucial for guiding appropriate antimicrobial therapy. In addition to conservative and surgical treatments, local drug delivery systems offer new approaches to managing spinal osteomyelitis.

Hydatid disease: imaging, treatment, and beyond

Hydatidosis is an endemic parasitic disease that can occur in almost any part of the body. It presents in two different forms according to the type of tapeworm: Echinococcus granulosus (hydatid disease [HD]) and Echinococcus multilocularis (alveolar HD). Radiological imaging can reveal the type of cyst, disease activity and progression, and complications, with features depending on the HD stage, the organ involved, and complications. Radiological imaging is also used to plan treatment strategies and evaluate patients at follow-up. Here, we review the morphologies of different HD presentations and their radiological features, the diagnostic findings that suggest possible HD in rare sites, and the potential complications of HD. We also discuss the role of radiology in hydatidosis diagnosis and treatment.

Osteoarticular hydatid disease: Epidemiological features, diagnosis and treatment

Osteoarticular hydatid disease is a very rare disease. Its diagnosis is challenging and often late because of the nonspecific clinical and radiological features. Through this study, we aim to describe the epidemiological, clinical and radiological features of a series of patients diagnosed with osteoarticular hydatid disease. Ten patients were included. The average age was 40,5 years [25-75]. The onset of symptoms was progressive in all cases with a mean diagnosis delay of 11 months [1-48]. Most frequent locations were spinal (n=7), pelvic (n=3) and costal (n=3). Hydatid serology was positive in seven screened patients. Seven patients underwent surgery and all of them received albendazole postoperatively with an average of 8 monthly courses. Total remission was reported in only one patient. There was no significant difference in the clinical outcome based on the number of albendazole courses. The diagnosis of osteoarticular hydatid disease is often challenging because of its progressive onset and nonspecific clinical signs. Epidemiological setting, immunological screening and imaging features contribute to an earlier diagnosis. Its management requires both surgery and long-term antiparasitic treatment.

Spinal Echinococcosis With Paralysis Successfully Treated With Posterior Stabilization and Antiparasitic Drugs

Case:

A 42-year-old woman presented with lateral chest and back pain. She was referred to our hospital after magnetic resonance imaging revealed a thoracic spine lesion. The initial examination revealed no obvious neurological deficits. A biopsy was performed, and enzyme-linked immunosorbent assay and western blotting confirmed Echinococcus infection. Paralysis and paresthesia developed, and stabilization and albendazole treatment were initiated. Postoperatively, the paralysis improved, and 2 years later, there was no lesion progression or symptom recurrence.

Conclusions:

Lesion resection is ideal for spinal echinococcosis; however, when resection is difficult, posterior stabilization and antiparasitic drugs may be effective.

Case report: a rare case of intradural and pleural wall cystic echinococcosis

BACKGROUND

Cystic echinococcosis (CE) is prevalent in livestock farming regions around the world. However, it remains relatively rare compared to other infectious diseases. CE typically affects the liver, lungs, brain, and kidneys. Spinal and pleural wall involvement is exceedingly rare. We report a unique case of intradural and pleural wall CE in a young male, successfully treated with surgery and postoperative medication.

CASE PRESENTATION

A 19-year-old Tibetan male from the Qinghai-Tibet Plateau was diagnosed with intradural and pleural wall CE through imaging, serology, and surgical pathology. According to the Dew/Braithwaite & Lees (BL) classification, his condition was an exceptionally rare form of spinal echinococcosis, compounded by an even rarer pleural wall involvement. Prompt surgical intervention and postoperative medication resulted in significant improvement in spinal cord compression symptoms.

CONCLUSIONS

This case highlights the diagnostic and therapeutic challenges of rare CE locations. MRI proved superior to CT in diagnosing bony cystic echinococcosis. Early surgical intervention combined with medication facilitates spinal cord function recovery, providing valuable insights for managing similar cases.

Nrf2 induces angiogenesis in spinal cystic echinococcosis by activating autophagy via regulating oxidative stress

Spinal cystic echinococcosis (CE) is a rare but malignant zoonosis that can cause disability or even death in more than half of patients. Due to the complex pathological features, it is not curable by conventional drugs and surgery, so new therapeutic targets urgently need to be discovered. In this study, we clarify the occurrence of the phenomenon of spinal encapsulation angiogenesis and explore its underlying molecular mechanisms. A co-culture system was established by protoscoleces (PSCs) with human umbilical vein endothelial cells (HUVECs) which showed a high expression level of Nrf2. A short hairpin RNA (shRNA) and Sulforaphane (SFN) affecting the expression of Nrf2 were used to treat HUVECs. The results showed that Nrf2 could promote the tube formation of HUVECs. Nrf2 also exerts a protective effect against HUVECs, which is achieved by promoting NQO1 expression to stabilize ROS levels. Furthermore, autophagy activation significantly promotes angiogenesis in the spinal echinococcosis model (SEM) as a result of Nrf2 regulation of oxidative stress. These results suggest that the ROS/Nrf2/autophagy axis can induce angiogenesis and may be a potential target for the treatment of spinal cystic echinococcosis.

Use of Biomaterials in 3D Printing as a Solution to Microbial Infections in Arthroplasty and Osseous Reconstruction

The incidence of microbial infections in orthopedic prosthetic surgeries is a perennial problem that increases morbidity and mortality, representing one of the major complications of such medical interventions. The emergence of novel technologies, especially 3D printing, represents a promising avenue of development for reducing the risk of such eventualities. There are already a host of biomaterials, suitable for 3D printing, that are being tested for antimicrobial properties when they are coated with bioactive compounds, such as antibiotics, or combined with hydrogels with antimicrobial and antioxidant properties, such as chitosan and metal nanoparticles, among others. The materials discussed in the context of this paper comprise beta-tricalcium phosphate (β-TCP), biphasic calcium phosphate (BCP), hydroxyapatite, lithium disilicate glass, polyetheretherketone (PEEK), poly(propylene fumarate) (PPF), poly(trimethylene carbonate) (PTMC), and zirconia. While the recent research results are promising, further development is required to address the increasing antibiotic resistance exhibited by several common pathogens, the potential for fungal infections, and the potential toxicity of some metal nanoparticles. Other solutions, like the incorporation of phytochemicals, should also be explored. Incorporating artificial intelligence (AI) in the development of certain orthopedic implants and the potential use of AI against bacterial infections might represent viable solutions to these problems. Finally, there are some legal considerations associated with the use of biomaterials and the widespread use of 3D printing, which must be taken into account.

Echinococcus granulosus promotes bone resorption by increasing osteoclasts differentiation

Osseous cystic echinococcosis (CE) is a rare disease caused by Echinococcus granulosus, which is characterized by high morbidity, disability, and mortality. However, it is severely neglected due to its mainly regional epidemic. The development of osseous CE is usually accompanied by severe bone erosion and destruction at the site of infection; however, there is a gap in research on the mechanism of this phenomenon. The current treatment for this disease is single-sided, ineffective, and has a high rate of disability and recurrence. Our study investigated the mechanism of bone destruction caused by osseous CE and provided a theoretical basis for basic research and innovative ideas for treating clinical disease. A co-culture system of osteoclast progenitor cells and protoscoleces (PSCs) was established to test the effects of PSCs on osteoclast differentiation. We also created two disease models of spinal and femoral CE, with the highest incidence of osseous CE. We verified the effect of E. granulosus on osteoclasts at the infection site in vivo. The stimulatory effect of E. granulosus on osteoclast formation was confirmed by in vivo and in vitro experiments. This study elucidates the elementary mechanism of bone destruction in osseous CE and fills a gap in the field of basic osseous CE research, which is conducive to treating the disease.

Progress of research on the diagnosis and treatment of bone cystic echinococcosis

Bone cystic echinococcosis (CE) is one of the most complex and dangerous of all echinococcoses. The lack of typical imaging features and clinical manifestations makes diagnosis and treatment of this disease difficult. X-ray and computed tomography (CT) images of bone CE are similar to those of bone cysts, giant-cell bone tumors, and bone metastases, but magnetic resonance imaging (MRI) shows good diagnostic value due to excellent soft-tissue imaging features. Serological tests cannot be used as a definitive diagnostic method for bone CE due to cross-reactivity, which can lead to false-positive or false-negative results. The development of novel antigens can open new frontiers in the diagnosis of the disease. Currently, views conflict on how to diagnose and treat bone CE. Both surgical and pharmacological treatments can be used, but determining which is appropriate is difficult due to the different sites and clinical manifestations of bone CE. Radical resection is not indicated for large-bone injuries, and Pharmacotherapy becomes important. This article reviews the progress of research into the pathogenesis and clinical manifestations of, and diagnostic strategies and treatment options for, bone CE. We aimed to provide a reference for clinical diagnosis and -treatment options.

Cystic echinococcosis of the bone

PURPOSE OF REVIEW

Cystic echinococcosis (CE) has a wide world distribution causing important morbidity. Osseous involvement is present in less than 4% of the CE cases. Its diagnosis and therapeutic management is full of challenges and low grade of evidence.

RECENT FINDINGS

The study summarizes literature evidence on the management of osseous CE with particular emphasis on new data regarding diagnosis and treatment.

SUMMARY

Clinical presentation of osseous CE depends on the skeletal area affected. Diagnosis is mostly based on radiological findings and serology. Recent advances with qPCR on osseous tissue samples seem to be a good option for diagnosis confirmation. Complete resection of the cystic lesion is the only curative option, but it is usually not possible performing palliative surgery and prolonged albendazole intake in most cases. Radiotherapy could be an option, but experience to date is only based on clinical cases.

Troublemaking Lesions: Spinal Tumor Mimics

There are various mass-like lesions that can mimic true neoplasms in the spine, including inflammatory, infectious, vascular, congenital, and degenerative etiologies. While some lesions have distinctive imaging features that suggest a correct diagnosis, others have overlapping characteristics that do not allow their differentiation based solely on their imaging findings. For entities with nonspecific imaging features, knowledge of the clinical and laboratory information is critical to provide an accurate diagnosis.

Posterior Mediastinal Hydatid Cyst with Spine and Chest Wall Involvement

Hydatid cyst, which is caused by Echinococcus larvae, is a worldwide zoonotic disease which can affect virtually any organ in the body. Although the liver and lungs are the most commonly affected, it can occur in other parts of the body. Mediastinal hydatid cysts are incredibly rare, but imaging is crucial to diagnose and determine the extent of involvement and complications. In this article, we present a case of posterior Mediastinal hydatid cyst with adjacent chest wall and spinal involvement, diagnosed through chest CT and histopathology.

Non-resectable pulmonary alveolar echinococcosis with multi-stage vertebral location

Alveolar echinococcosis (also known as Hydatid cyst or Hydatydosis) is a zoonosis with a high degree of disability and morbidity. Bone echinococcosis is a rare presentation. Authors are always defending a personalized approach taking account of the particularities of the cyst location. Recognition of this syndrome is crucial because advances in medical and surgical management strategies have controlled and relieved symptoms in numerous cases. We report, hereby, a case of a patient with a thoracic spine alveolar echinococcosis of an unusual extension. We discussed the outcome of the treatment after fifteen years of follow-up.

Stroke-Associating Acute Limb Ischemia Due to the Rupture of a Hydatid Cyst

(1) Background: Hydatidosis, or human cystic echinococcosis, is a zoonotic disease. Endemic in some areas, recently it has an increasing incidence in wider regions, determined by population migration. Clinical features depend on the localization and level of infection: asymptomatic or with signs related to hypersensitivity, organic functional deficiencies, expanding mass effects, cyst infection and sudden death. In rare cases, the rupture of a hydatid cyst causes emboli formation by the residual laminated membrane. (2) Methods: We performed an extensive literature review, starting from the case of a 25-year-old patient presenting with neurologic symptoms relevant for acute stroke, associating right upper limb ischemia. (3) Results: Imaging investigations revealed the source of the emboli as the rupture of a hydatid cyst, the patient presenting multiple pericardial and mediastinal localizations. Cerebral imaging confirmed an acute left occipital ischemic lesion, with complete recovery of the neurological deficit after therapy, while surgery for acute brachial artery ischemia had a favorable postoperative evolution. Specific anthelmintic therapy was initiated. An extensive literature review using available databases revealed the scarcity of data on embolism as a consequence of cyst rupture, highlighting the significant risk of clinicians overlooking this possible etiology. (4) Conclusions: An associated allergic reaction should raise the hypothesis of a hydatid cyst rupture as a cause of any level acute ischemic lesion.

Hydatid disease of the brain and spine

Hydatid disease of the central nervous system is relatively rare and comprises about 2-3% of all the hydatid cyst cases reported in the world. Spinal hydatid disease is an even rarer entity. It is endemic in sheep and cattle-raising regions, seen mainly in Mediterranean countries including Turkey and Syria. Pediatric neurosurgeons in non-endemic countries face a challenge when they encounter children with hydatid cysts of the central nervous system, mostly due to lack of awareness and the ensuing diagnostic dilemmas. It is also a significant socioeconomic problem in developing countries, due to improper hygiene and lack of dedicated veterinary practice. The clinical features are largely nonspecific and very according to location and severity of disease. However, with the advent of advances in MR imaging, the diagnostic accuracy of hydatic disease involving the brain and spine has increased. Intact removal of the cyst/s, without causing any spillage, and appropriate antihelminthic therapy is the goal and key to cure and prevention of recurrence. In this manuscript, the current literature on hydatid cyst of the brain and spine is reviewed to better understand the epidemiology, pathophysiology, diagnostic accuracy, and advances in therapeutic options. A heightened clinical suspicion, awareness of MR imaging features, improved surgical strategies, and options for prevention are discussed.

Extensive hydatid cysts involving the lumbosacral vertebrae and pelvis

•A patient with typical hydatid cysts involving both lumbosacral vertebrae and pelvis is presented in this paper.•Conservative treatment with antiparasitic medication may improve symptoms.•Surgical treatment followed by antiparasitic chemotherapy may reduce the relapse rate of bone hydatid cysts.

Coding and Noncoding RNA Expression Profiles of Spleen CD4+ T Lymphocytes in Mice with Echinococcosis

Cystic echinococcosis (CE) is a severe and neglected zoonotic disease that poses health and socioeconomic hazards. So far, the prevention and treatment of CE are far from meeting people's ideal expectations. Therefore, to gain insight into the prevention and diagnosis of CE, we explored the changes in RNA molecules and the biological processes and pathways involved in these RNA molecules as E. granulosus infects the host. Interferon (IFN)-γ, interleukin (IL)-2, IL-4, IL-6, IL-10, IL-17A, and tumor necrosis factor (TNF)-α levels in peripheral blood serum of E. granulosus infected and uninfected female BALB/c mice were measured using the cytometric bead array mouse Th1/Th2/Th17 cytokine kit. mRNA, microRNA (miRNA), long noncoding RNA (lncRNA), and circular RNA (circRNA) profiles of spleen CD4+ T cells from the two groups of mice were analyzed using high-throughput sequencing and bioinformatics. The levels of IFN-γ, IL-2, IL-4, IL-6, IL-10, IL-17A, and TNF-α were significantly higher in the serum of the CE mice than in control mice (P < 0.01). In total, 1,758 known mRNAs, 37 miRNAs, 175 lncRNAs, and 22 circRNAs were differentially expressed between infected and uninfected mice (|fold change| ≥ 0.585, P < 0.05). These differentially expressed molecules are involved in chromosome composition, DNA/RNA metabolism, and gene expression in cell composition, biological function, and cell function. Moreover, closely related to the JAK/STAT signaling pathways, mitogen-activated protein kinase signaling pathways, P53 signaling pathways, PI3K/AKT signaling pathways, cell cycle, and metabolic pathways. E. granulosus infection significantly increased the levels of IFN-γ, IL-2, IL-4, IL-6, IL-10, IL-17A, and TNF-α in mouse peripheral blood of mice and significantly changed expression levels of various coding and noncoding RNAs. Further study of these trends and pathways may help clarify the pathogenesis of CE and provide new insights into the prevention and treatment of this disease.

Hydatid Cyst of the Spine: A Rare Case Report

Hydatid cyst is a zoonotic disease that can affect multiple organs and is difficult to diagnose and treat. Spinal hydatid cyst (SHC) is a rare hydatid cyst involvement observed in 1% of all cases. It can induce various neurological symptoms depending on the region of the involvement. Paraplegia is one of the most prevalent neurological symptoms. In this case report, a 63-year-old male patient with bilateral lower extremity paraplegia was operated on by neurosurgery and diagnosed with SHC at the level of Th 11 vertebra in the pathological examination of surgically removed materials. Thus, we aimed to emphasize the significance of pathological and microbiological examination in the differential diagnosis of spinal disorders.

Tumor-mimicking musculoskeletal infectious lesions: Experience of a single referral center

Introduction/Objectives. Bone and soft tissue infections might mimic bone and soft tissue tumors. Therefore, differential diagnosis is important to prevent errors in treatment. This report aims to present the data of patients with indistinct clinical and radiological findings mimicking benign and malignant bone and soft tissue tumors, which were later diagnosed as inflammatory infections. Methods. A retrospective chart review of the clinical, microbiological, radiologic, and pathologic findings of patients presented with a presumed diagnosis of a possible malignant lesion was performed. Results. The study included 21 patients with a median age (IQR) of 37 (1 month ? 72 years) years, and 13 (61%) patients were men. In total, 16 (76%) patients were admitted to the hospital with complaints of pain. The diagnoses were hydatid cyst, tuberculous osteomyelitis, cat-scratch disease, chronic osteomyelitis, subacute osteomyelitis, and soft tissue abscess. All patients were treated depending on the diagnosis of the lesion. Conclusion. There are chances of misdiagnosis due to shared common characteristics of tumoral and infectious lesions which might be mildly increased inflammatory markers with deeply seated non-mobile soft tissue masses and aggressive periosteal reactions and/or bone destruction patterns. So, each pseudotumoral lesion due to possible infectious causes should be histopathologically examined and correlated with other clinical and laboratory data in order to achieve a final diagnosis

Multiple debridement of cavity lesions combined with antiparasitic chemotherapy in the treatment of mid or advanced spinal echinococcosis: a retrospective study of 33 patients

OBJECTIVE

The purpose of this study was to evaluate and document the complications and outcomes (bone and functional) of multiple debridement of cavity lesions combined with antiparasitic chemotherapy in the treatment of mid or advanced spinal echinococcosis.

METHODS

From January 2007 to February 2019, the medical records and imaging of all patients with mid or advanced spinal echinococcosis, who were treated by multiple debridement of cavity lesions, were evaluated retrospectively. The Braithwaite and Less classification system of spinal echinococcosis and the Frankel classification system were used to evaluate the results, both preoperatively and postoperatively.

RESULTS

Between January 2007 and February 2019, 33 patients met the criteria and were included in this study, with a mean postoperative follow-up time of 4.9 (1-10) years. They included 18 males (54.5%) and 15 females (45.4%), with a mean age of 41.5 years (range 23-70 years). A satisfactory recovery of lower-limb motor function was found in 32 patients, while 24 patients (72.7%) presented with recurrence of spinal echinococcosis.

CONCLUSIONS

Multiple debridement and spinal cord decompression, combined with antiparasitic chemotherapy after surgery, are effective methods for delaying or preventing disease progression or recurrence. A recurrence of infection is common in most cases. CT and MRI are the preferred methods for diagnosing this disease.