Complications Associated with Initial Clinical Presentation of Cystic Echinococcosis: A 20-year Cohort Analysis

Seroprevalence of human cystic echinococcosis in individuals occupationally exposed to Canidae in Central Iran: A case-control study

Echinococcus granulosus is a widespread zoonotic tapeworm that causes human cystic echinococcosis. Human CE, transmitted via dogs or Canidae feces, poses a public health challenge and exemplifies the One Health Theory. This survey was conducted to determine the seroprevalence of CE in individuals occupationally exposed (IOE) to dogs, livestock wool, and contaminated soil due to egg shedding from dogs/Canidae in industrial slaughterhouses and livestock fields, compared to a healthy control group in Isfahan province, central Iran. In a case-control study, 401 sera from IOE, including slaughterhouse workers, animal husbandry unit workers, wool industry workers, farm workers, livestock farmers, butchers, and veterinarians in the case group, were matched with 401 archived samples from the general population. All 802 samples were tested for echinococcosis IgG using ELISA. Out of 802 sera, 7 (0.9 %) tested positive for Echinococcus IgG. The seroprevalence in the IOE and control groups was 1.2 % (5/401) and 0.5 % (2/401), respectively. Although there was a 2.5-fold estimated risk of CE in IOE compared to the control group, this was not statistically significant. Based on the current study's findings, the overall seroprevalence of CE in the Isfahan area is similar to that of other regions in Iran.

Cystic Echinococcosis in Hospitalized Children and Adults from Western Romania: 2007-2022

Cystic echinococcosis (CE) is a serious health problem in many countries worldwide, including in Romania, because of the high infection rates in both humans and animals. We retrospectively assessed the demographic and epidemiological features of CE in children and adults hospitalized in Western Romania between 2007-2022. Analyzed data were collected from the hospitals' medical records. This research involved 426 subjects (3-90 years): 60 (14.1%) children and 366 (85.9%) adults. A decreasing trend in the number of cases was noted during the analyzed period (p = 0.004). Multiple-organ involvement was reported in 16.7% of the children and in 6.3% of the adults (p = 0.005). The liver was the most commonly affected organ. The rate of lung involvement was higher in children (25%) than in adults (13.1%) (p = 0.02). Most of the patients had one hospital presentation (74.9%). Multiple hospitalizations were reported in 40% of the children and 22.7% of the adults (p = 0.004). CE is a severe zoonotic disease that impacts individuals of all ages. Despite the decline in cases, CE remains a public-health problem in Western Romania. Health programs that target risk factors and control measures should be implemented to stop the parasite's spread and maintain the trend toward reduced numbers of CE cases.

Pulmonary manifestations and clinical management of echinococcosis in a low-endemic region of Mexico: a 15-year retrospective cohort study at a tertiary hospital

BACKGROUND

Cystic echinococcosis has a low incidence even in endemic countries. It is a chronic and complex zoonosis that in many cases presents delay in diagnosis; it typically affects the liver in up to 90% of the cases, being disseminated pulmonary disease the most common in young subjects, while the rate of cases located only in the pulmonary parenchyma is low. In Mexico it is considered a disease of low endemicity.

MATERIAL AND METHODS

We retrospectively collected data from patients with suspected echinococcosis infection from the hospital discharge database.

RESULTS

Of the 70 patients in the database, 59 had a clinical history (84.3%), of whom 11 had a histopathological diagnosis of cystic echinococcosis and were included in this study, 67.6% were female, with a median age of 32 years (IQR 17-53.5). A total of 45.6% had some comorbidity, the most frequent being type II diabetes mellitus (80%); only 54.6% had lived in a rural area as a risk factor, while only 27.2% had exposure to canines. All cases were symptomatic, with a mean symptom duration of 49 days. A total of 81.8% had exclusive pulmonary disease, while the rest had simultaneous lung and liver involvement. No case presented spontaneous rupture. All cases received anthelmintic treatment and, in 9 cases, surgical resection of the pulmonary parenchyma. The only postsurgical complication was a chylothorax with adequate resolution. The median follow-up in months was 8.3 (IQR 3.7 to 10.7 months), and almost two-thirds of the cases presented dyspnea grade 2-3 (mMRC) as sequelae.

CONCLUSION

Of all the patients studied with pulmonary echinococcosis, only two presented with hepatic-pulmonary hydatid disease, and spontaneous cyst rupture was not reported. About half had exposure to cattle as a risk factor, while no specific risk factor was identified in the rest of the subjects.

Parasites in Sewage: Legal Requirements and Diagnostic Tools

Despite the vast amount of water on Earth, only a small percent is suitable for consumption, and these resources are diminishing. Moreover, water resources are unevenly distributed, leading to significant disparities in access to drinking water between countries and populations. Increasing consumption and the expanding human population necessitate the development of novel wastewater treatment technologies and the use of water treatment byproducts in other areas, such as fertilisers. However, water treatment sludge often cannot be used to enhance crop production due to the presence of parasite eggs, particularly from roundworms (Ascaridae family), which are resistant to environmental factors and can pose a threat for several years. Legislation prohibits the use of sludge containing parasite eggs as fertiliser. In some cases, water may not contain parasite eggs but larvae, which require different detection methods. Additionally, the presence of eggs does not necessarily indicate danger since they may lose infectivity due to prolonged storage or exposure to chemical compounds in the sewage. This paper reviews European Union regulations on wastewater treatment, the selected parasitic diseases related to the presence of parasites in wastewater, the spectrum of detection methods, and highlights differences in viability and invasiveness, which is intended to draw attention to the need to determine both biological properties of parasites.

A Comprehensive Analysis of Echinococcus granulosus Infections in Children and Adolescents: Results of a 7-Year Retrospective Study and Literature Review

Cystic echinococcosis (CE) is a neglected tropical parasitic disease linked with significant social and economic burdens worldwide. The scientific community has minimal information on echinococcosis in Romanian people, and hospital medical records are the only sources that may be used to investigate its status. A 7-year retrospective clinical study on pediatric patients with CE from Southeast Romania was performed, and 39 children and adolescents were included, aged 2-15 years old. They were hospitalized with cystic echinococcosis in the Pediatric Department and Pediatric Surgery Department of Constanta County Clinical Emergency Hospital "St. Apostle Andrew" between 1 January 2017 and 1 October 2024. Twenty-nine (74.36%) pediatric patients came from rural zones, and 10 (25.64%) had urban residences. In total, 28 children (71.79%) had contact with four different animals (dogs, goats, pigs, and sheep); only four were from urban zones, and they had contact only with dogs. Data regarding the length of hospital stay, cyst location, and complications were collected and analyzed. According to the medical files, the diagnosis was established using imaging techniques and serological tests for CE. IgE and IgG reported appreciable variations in correlation with all parameters, and significant differences (p < 0.05) were recorded. IgE levels considerably increased in cases of no animal contact, pulmonary involvement, complications, surgical treatment, and multiple hospitalizations. Moderate IgE values were recorded in cases of urban residences, pig and sheep contact, and hepatic involvement. The IgG concentration considerably increased with sheep contact and moderately increased in cases of rural zones, hepatic involvement, complications, and surgical treatment. The results show that incidental discovery, symptoms, complications, multiple dissemination, pulmonary involvement, and dog and pig contact increase the hospitalization time. Extensive data analysis supports our results. Our findings highlight the complexity of managing E. granulosus infections in children and evidence the importance of a multidisciplinary approach, combining early diagnostic tools, tailored medical therapy, and careful surgical intervention when necessary.

Complications and management of patients with liver hydatid cyst: A single center experience

Background and Aim

Hydatid cysts are caused by Echinococcus larvae and are prevalent in endemic areas worldwide. We analyzed post-procedure complications and outcomes of patients with liver hydatid cysts.

Materials and Methods

We included patients who were managed either by surgery or percutaneous drainage (PAIR) for hydatid liver cysts at Harran University Faculty of Medicine Hospital between January 2017 and February 2021. We recorded age, sex, segmental location, size, number, Gharbi classification, treatment modality, length of hospital stays, and complications.

Results

We included a total of 209 patients who were managed by hydatid liver cysts. Among them, 74 post-procedural complications were developed in a total of 69 (33%) patients. Biliary fistula was the most prevalent complication (n=38,18.2%). Hospitalization duration was a median of 5 days (2-36) and was 5 days (2-36) in patients who underwent surgery and 3 days (range:2-7) in patients managed by PAIR. Patients with cyst diameter ≥9.5 cm were predicted to have an increased risk of complications with 70% sensitivity and 60% specificity. More patients experienced any difficulties in patients who were managed by PAIR than those who underwent surgery (65.4% vs 28.4%, p<0.001).

Conclusion

Our study showed that both surgery and PAIR are safe and effective management strategies for patients with liver cyst hydatid. PAIR was associated with more complications but a shorter duration of hospitalization.

Unique sequelae of portal vein thrombosis in a pediatric patient with cystic echinococcosis: A case report

This case report presents a rare complication of hepatic cystic echinococcosis in a 12-year-old Latino male, residing in a nonendemic region, who developed long-term sequelae of portal vein thrombosis accompanied by the emergence of a hyper-vascular sigmoid colon mass. Portal vein involvement in hepatic cystic echinococcosis is exceedingly uncommon, with limited documented cases. The presentation of the patient included intermittent hematochezia, abdominal pain, and fatigue. Imaging revealed liver cysts and chronic portal vein thrombosis with cavernous transformation, resulting in portal hypertension. Notably, the patient also exhibited mesenteric venous thrombosis, further complicating the clinical picture. The diagnosis was confirmed through echinococcus serology testing. Treatment involved a six month course of Albendazole, puncture-aspiration-injection-reaspiration procedure, splenectomy, and splenorenal shunt to alleviate portal hypertension. This case underscores the significance of considering portal hypertension secondary to hepatic cystic echinococcosis, even in nonendemic regions, particularly in pediatric patients with unique clinical presentations.

Bacterial Infection of an Alveolar Echinococcus Cyst from C. perfringens Septicemia: A Case Report and Review of the Literature

Background and Objectives: Alveolar echinococcosis (AE) is a highly variable disease able to present as structurally diverse cysts in different organs based on the host's immunological state as well as the time between diagnosis and the primary infection. Bacterial superinfections, especially with anaerobic pathogens from the Clostridiaceae genus, can further alter the radiological findings due to pneumobilia, newly formed abscess formations, and inflammatory changes. Materials and Methods: We present a case of a 71-year-old Caucasian male admitted to our intensive care unit with septic shock, pneumobilia, and a complex cyst of the liver with calcification, as shown by an initial CT. Because of the septic shock, the patient was started on broad-band antibiotics. Clostridiaceae infection was considered an important differential diagnosis due to the presence of pneumobilia observed in the initial CT, without a history of previous endoscopy. Furthermore, serology for echinococcus was positive, and blood cultures showed growth of C. perfringens. Therefore, the patient was additionally treated with albendazole. After recovery, further staging was conducted, showing complete remission of the cyst and a left-over lesion classified as Alveolar Echinococcosis Ulm Classification (AEUC) V. In summary, the patient had a pre-existing, controlled AE infection that became superinfected with C. perfringens, likely attributable to the anaerobic necrotic tissue, leading to septicemia. Results: The anaerobic tissue within the AE cyst provided an ideal medium for C. perfringens to replicate, leading to cyst infection, which subsequently caused septic shock and pneumobilia. The initial findings from CT and MRI were confounded by the superinfection, demonstrating the diagnostic challenges of AE, especially when presenting with complications. Conclusions: Diagnosing AE remains a demanding task, even with the excellent tools available through serology, coupled with CT, FDG-PET-CT, and MRI. Notably, older superinfected cysts can pose difficulties when integrated into the appropriate diagnostic context. Prompt diagnosis is critical for the accurate treatment of echinococcosis and its complications, such as bacterial superinfections. From a clinical perspective, septicemia from Clostridiaceae and infections with C. perfringens-pathogens capable of inducing pneumobilia-should be regarded as significant differential diagnoses for pneumobilia in the absence of a recent history of endoscopy.

Cystic Echinococcosis in Hospitalized Adult Patients from Western Romania: 2007-2022

Cystic echinococcosis (CE) is a neglected parasitic disease caused by the tapeworm Echinococcus granulosus. The aim of this study was to assess the epidemiological features of human cystic echinococcosis in patients from Western Romania. We retrospectively investigated the medical records of patients hospitalized with CE between 1 January 2007 and 1 September 2022. A total of 366 patients (range 18-90 years) were recorded. The number of hospitalized individuals was higher in patients aged 50-59 years (83/366, 22.7%), in females (194/366, 53%), and in residents of rural areas (225/366, 61.5%). The liver was the most common localization of the cysts (302/366, 82.5%). Ninety-eight patients (26.8%) presented complications, including biliary fistula, allergies, and infection of the cyst. Patients with complications had a longer mean hospital stay (15.7 ± 8.3 days) compared to patients without complications (11.5 ± 7.3 days) (p < 0.001). The results of this study revealed that patients diagnosed with CE required hospitalization and extended medical care, indicating that this zoonotic disease remains a significant public health problem in Western Romania. Public health authorities should enhance CE surveillance by implementing control programs and mandatory notification of new cases.

Benign liver lesions 2022: Guideline for clinical practice of Associazione Italiana Studio del Fegato (AISF), Società Italiana di Radiologia Medica e Interventistica (SIRM), Società Italiana di Chirurgia (SIC), Società Italiana di Ultrasonologia in Medicina e Biologia (SIUMB), Associazione Italiana di Chirurgia Epatobilio-Pancreatica (AICEP), Società Italiana Trapianti d'Organo (SITO), Società Italiana di Anatomia Patologica e Citologia Diagnostica (SIAPEC-IAP) - Part I - Cystic lesions

Benign liver lesions are increasingly diagnosed in daily clinical practice due to the growing use of imaging techniques for the study of the abdomen in patients who have non-specific symptoms and do not have an increased risk of hepatic malignancy. They include simple or parasitic cysts and solid benign tumors which differ widely in terms of prevalence, clinical relevance, symptoms and natural history and often lead to significant clinical problems relating to diagnosis and clinical management. Following the need to have updated guidelines on the management of benign focal liver lesions, the Scientific Societies mainly involved in their management have promoted the drafting of a new dedicated document. This document was drawn up according to the present Italian rules and methodologies necessary to produce clinical, diagnostic, and therapeutic guidelines based on evidence. Here we present the first part of the guideline, concerning the characterization of focal hepatic lesions detected by ultrasound, and the diagnosis and clinical management of simple and parasitic hepatic cysts, and of polycystic liver disease.

The role of helminths in the development of non-communicable diseases

Non-communicable diseases (NCDs) like cardiovascular disease, chronic respiratory diseases, cancers, diabetes, and neuropsychiatric diseases cause significant global morbidity and mortality which disproportionately affect those living in low resource regions including low- and middle-income countries (LMICs). In order to reduce NCD morbidity and mortality in LMIC it is imperative to understand risk factors associated with the development of NCDs. Certain infections are known risk factors for many NCDs. Several parasitic helminth infections, which occur most commonly in LMICs, have been identified as potential drivers of NCDs in parasite-endemic regions. Though understudied, the impact of helminth infections on the development of NCDs is likely related to helminth-specific factors, including species, developmental stage and disease burden. Mechanical and chemical damage induced by the helminth in combination with pathologic host immune responses contribute to the long-term inflammation that increases risk for NCD development. Robust studies from animal models and human clinical trials are needed to understand the immunologic mechanisms of helminth-induced NCDs. Understanding the complex connection between helminths and NCDs will aid in targeted public health programs to reduce helminth-induced NCDs and reduce the high rates of morbidity that affects millions of people living in parasite-endemic, LMICs globally.

Role of the radiologist in the diagnosis and management of the two forms of hepatic echinococcosis

Echinococcosis is a parasitic disease caused by two zoonotic tapeworms (cestodes) of the Echinocococcus genus. It can be classified as either alveolar or cystic echinococcosis. Although the two forms differ significantly in terms of imaging findings, they share similarities in terms of management and treatment. In parallel to medical treatment with albendazole (ABZ), and surgery, historically used in these diseases, various imaging-guided interventional procedures have recently emerged (drainage, stenting, or Puncture, aspiration, injection, and reaspiration (PAIR)). These options open up a new range of therapeutic options. As in oncology, multidisciplinary consultation meetings now play a major role in adapted management and patient care in hepatic echinococcosis. Consequently, diagnostic imaging and interventional expertise have brought radiologists to the fore as important members of these multidisciplinary team. The radiologist will need to evaluate parasite activity in both forms of the disease, to guide the choice of the appropriate therapy from among medical treatment, interventional radiology procedures and/or surgical treatment. Knowledge of the specific complications of the two forms of echinococcosis will also help radiologists to discuss the appropriate treatment and management. The aim of this review is to describe the core knowledge that what a radiologist should possess to actively participate in multidisciplinary meetings about hepatic echinococcosis. We discuss the role of imaging, from diagnosis to treatment, in alveolar (AE) and cystic echinococcosis (CE), respectively.

Antiprotozoal and anthelmintic activity of zinc oxide nanoparticles

Nanomaterials represent a wide alternative for the treatment of several diseases that affect both human and animal health. The use of these materials mainly involves trying to solve the problem of resistance that pathogenic organisms acquire to conventional drugs. A well-studied example that represents a potential component for biomedical applications is the use of zinc oxide (ZnO) nanoparticles (NPs). Its antimicrobial function is related, especially the ability to generate/induce ROS that affects the homeostasis of the pathogen in question. Protozoa and helminths that harm human health and the economic performance of animals have already been exposed to this type of nanoparticle. Thus, through this review, our goal is to discuss the state-of-the-art effect of ZnO NPs on these parasites.