Hydatid cyst in the gluteal muscle - an unusual location

Echinococcus sp. is an intestinal parasite of canids and felids, that can infect humans after contaminated ingestion. Through the portal circulation, the eggs can metastasize to the liver, lungs and, more infrequently, other organs. We present a hydatid cyst located on the gluteus muscles, a very unusual location.

The unsolved problem of musculoskeletal hydatid disease: two case reports

BACKGROUND

Hydatidosis is a parasitic infection caused by Echinococcus granulosus and humans are usually an accidental intermediate host. Involvement of the musculoskeletal system is reported to occur in 0.5% to 4% of the cases.

CASE PRESENTATION

We present our experience with two cases of musculoskeletal hydatidosis in black African patients that required orthopaedic surgical intervention. A 51-year-old black African female presented with right hip hydatid disease and a 37-year-old black African female presented with the disease affecting the left shoulder. Both patients presented with joint pain and reduced range of motion. The patient with involvement of the shoulder had a background history of human immunodeficiency virus, this was not present with the other patient. Diagnostic work-up confirmed peri-articular hydatid disease and both patients were surgically managed with arthroplasty. Post-operative complications encountered include hardware loosening from bone lysis and hardware failure.

DISCUSSION

The medical literature describes a limited number of cases of peri-articular musculoskeletal hydatid disease. Patients are often subjected to many investigations, prolonged treatment periods and multiple surgeries. Concurrent use of medical and surgical treatment is advocated however, the choice of surgery is individualised.

CONCLUSION

Hydatid disease must always feature in the differential diagnosis of multiple lytic bone lesions and radical surgical intervention may be required from the outset.

Society for Cardiovascular Magnetic Resonance 2022 Cases of SCMR case series

"Cases of SCMR" is a case series on the SCMR website (https://www.scmr.org) for the purpose of education. The cases reflect the clinical presentation, and the use of cardiovascular magnetic resonance (CMR) in the diagnosis and management of cardiovascular disease. The 2022 digital collection of cases are presented in this manuscript.

Magnetic resonance imaging and next-generation sequencing for the diagnosis of cystic echinococcosis in the intradural spine: a case report

BACKGROUND

Cystic echinococcosis (CE) is a parasitic zoonotic disease caused by the larval stage of Echinococcus granulosus. The liver and lungs are the most common sites for infection. Infection of the intradural spine is rare.

CASE PRESENTATION

A 45-year-old woman of Han ethnicity presented with a chronic history of recurrent lumbar pain. Magnetic resonance imaging of the lumbar spine revealed the classical characteristic of multiple cystic lesions of variable sizes, manifesting a "bunch of grapes" appearance, localized within the spinal canal at the L4-L5 vertebral level. In the meanwhile, metagenomic next-generation sequencing identified Echinococcosis granulosa. The patient underwent surgery to remove the cyst entirely and subsequently took albendazole 400 mg orally twice daily for 6 months.

CONCLUSION

Spinal CE should be suspected in patients with multiple spinal cystic lesions and zoonotic exposure. metagenomic next-generation sequencing serves as a robust diagnostic tool for atypical pathogens, particularly when conventional tests are inconclusive. Prompt and aggressive treatment for spinal cystic echinococcosis is imperative, and further research is warranted for improved diagnostic and therapeutic strategies.

Rupture of a liver hydatid cyst into the right portal vein leading to right portal vein thrombosis: a case report and literature review

Hydatid disease (HD) is a worldwide parasitic disease. HD is endemic in many sheep- and cattle-raising areas, with a high prevalence of 5% to 10% in the Mediterranean region. Fistulation of liver hydatid cysts (LHC) in the bile ducts is the most common complication, followed by rupture of cysts in the peritoneal and thoracic cavities. Vascular complications are a rare complication of HD. We describe the case of a 70-year-old woman who was admitted with the chief complaint of pain in the abdominal right upper quadrant for 6 months. Abdominal computed tomography revealed a large LHC in the right liver that had ruptured into the right portal vein branch, with venous thrombosis. Intraoperatively, the right portal vein was opened longitudinally, and the hydatid contents were evacuated. Right hepatectomy was performed to completely excise the LHC. The penetration of a cyst into an adjoining vessel is very rare, and portal vein invasion by HD is extremely rare, with only 10 cases published in the literature, to the best of our knowledge.

Gallbladder Hydatid Disease Complicated with Multiple Hepatobiliopancreatic Fistulae: A Case Report

Gallbladder is a rare localization for hydatid disease. Complications are even rarer and precise diagnosis is quite difficult even with radiological assistance. We report a rare case of 41-yr-old male patient presenting with the rupture of a gallbladder hydatid cyst with multiple fistulae to intra and extrahepatic bile ducts and pancreas, at Kocaeli State Hospital, Turkey in 2021. The patient had abdominal pain and abdominal CT scan reported a bizarre "contrast enhanced cholangiography" sign - radiopaque contrast substance in gallbladder, intra and extrahepatic bile ducts and pancreatic ducts, with concomitant acute cholecystitis. Surgery was performed and intraoperatively gallbladder hydatid cyst with multiple fistulae was noted. Cholecystectomy with total cyst excision was performed. Endoscopic retrograde cholangio pancreatography (ERCP) was utilized to irrigate and eradicate the parasite in the fistulae tracts localized near pancreas and intra/extrahepatic ducts. Postoperative period was uneventful, antiparasitic treatment was started, and in the yearly follow-up patient had no recurrence. Multidisciplinary and minimal invasive management is crucial in such bizarre, complicated cases.

Hydatid cyst in the parotid gland, a rare localization of the disease: A case report

INTRODUCTION AND IMPORTANCE

Hydatid cysts are often found in the liver or lungs. As for the parotid localization, it remains exceptional even in endemic areas and presents as a tumor of the parotid thus representing a challenge to the practitioner.

CASE PRESENTATION

A 54-year-old male farmer presented with a swelling in the left parotid gland region evolving over the past 2 years. Physical examination revealed a non-tender and mobile swelling in the left parotid region, the overlying skin was normal. Magnetic resonance imaging showed a cystic lesion of the left parotid gland. Fine-needle aspiration cytology (FNAC) yielded a clear fluid with a few benign epithelial cell. A superficial parotidectomy was performed. Histopathological examination confirmed the presence of a hydatid cyst in the parotid gland.

CLINICAL DISCUSSION

Parotid hydatid cyst is exceptional. However, it can be suspected in the context of an isolated parotid cystic mass in an endemic area, even in the absence of any other associated location.

CONCLUSION

Hydatid cysts of the parotid gland have a polymorphic and a specific symptomatology and require surgical removal.

Primary intramuscular and intermuscular Echinococcal disease of the iliopsoas and sartorius muscles: A case report

Hydatid disease is a parasitic infection caused by the Echinococcus tapeworm. Classically, Echinococcal lesions are slowly growing cystic masses with daughter cysts. The most common sites of disease are the liver in 75% of cases and lungs in 15% of cases. This report covers a case of a patient from Southeast Europe with primary extrahepatic hydatid disease in and along the left iliopsoas and sartorius muscles. Retroperitoneal and soft tissue Echinococcus infection without liver involvement is extremely rare and creates a diagnostic challenge for clinicians and radiologists, especially in nonendemic areas.

Hydatid pulmonary embolism underlying cardiac hydatid cysts - A case report

Cystic hydatidosis is an endemic parasitic disease with usual localization in liver and lungs. Rarely it localizes in uncommon sites, the right ventricle being an exceptional localization. We present an extremely rare case of a young man with hydatid pulmonary embolism complicating right-ventricle hydatid cysts. Echocardiography, CT pulmonary angiogram and MR-angiography were performed for the diagnostic evaluation. Our patient did not undergo surgery. He was discharged on a regimen of albendazole, and is still being followed-up. Hydatid disease rarely presents with pulmonary embolism. It has uncharacteristic clinical features, requiring particular diagnosis and therapy.

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.

Isolated greater omentum solid mass, a rare manifestation of hydatid disease; A Case Report and Review of Literature

Background

Echinococcus granulosus causes hydatid disease, which is found in various countries of the world, including Iran. The liver and lungs are prevalent involved structures in hydatid disease. One of the least common sites in hydatid disease seems to be the omentum. Seven cases of mesenteric, diaphragmatic, omental, pelvic, and retroperitoneal hydatid cysts have been reported in Iran within last 20 years. The appearance of hydatid disease as a primary mass in the greater omentum without hepatic involvement is very rare and no similar case was introduced in Iran in our searches.

Case Presentation

Our patient was a 33-year-old woman who underwent a diagnostic laparoscopy due to abdominal pain and an abdominal mass. During laparoscopy, there was a solid mass with a size of about 10 × 5 cm in the greater omentum that was resected. The histopathological examination of the mass showed the hydatid disease.

Conclusion

The hydatid cyst can appear anywhere on the body, and no part of the body is guarded. Since these uncommon locations often cause nonspecific symptoms, the hydatid cyst should be included in the differential diagnosing of omental cysts, particularly in endemic countries like Iran.

A giant isolated primary splenic hydatidosis: A case report

Introduction

and importance: Hydatid cyst disease is caused by Echinococcus tapeworm and is one of the major health problems in endemic regions like Nepal. The cases of splenic hydatidosis are quite rare and giant isolated primary splenic hydatidosis is even rarer. The patients present with vague symptoms or no symptoms at all. Here we report a case of isolated splenic hydatid cyst. So, we should think the differential diagnosis of splenic hydatidosis in any abdominal case of endemic regions.

Case presentation

A 27-year-old female presented with left-side abdominal pain for the past 7 months without any particular attraction. Abdominal ultrasound showed a well-defined cystic mass on the upper pole with low-level internal floating debris. Contrast Enhanced CT scan showed well defined cystic lesion measuring about 10.8 × 9.6 × 8.5 cm in the upper pole of the spleen with an exophytic component and minimal homogenous wall enhancement. Laparoscopic Splenectomy was done and albendazole for 3 weeks was prescribed after all the patient was completely normal.

Clinical discussion

In this case, the optimal treatment of giant isolated splenic hydatidosis was splenectomy and prescription of albendazole.

Conclusion

We believe in any abdominal case of the endemic region, the hydatid cyst of the spleen should be taken as one of the differential diagnoses and should be managed appropriately before the complication arises.

Surgical management of cardiac cystic echinococcosis in a paediatric patient: a case report

Cystic echinococcosis, a zoonotic parasitic disease, is endemic to many countries worldwide. This slowly progressing disease is seen rarely in the paediatric age group. In terms of cyst localization, cardiac involvement is infrequent. We report the case of a successful surgical and medical management of a paediatric hydatid disease patient with involvement of the heart.

Aspergilloma in a hydatid cavity

Fungal colonization by aspergillus usually occurs in pre-existing lung cavities mostly due to post-tubercular sequelae. Colonization of a hydatid cavity is very rare. We hereby report this unusual co-infection in a 55 years old diabetic male patient who was diagnosed pre-operatively and was managed with surgery, anti-fungal agents, and anthelminthics. The possibility of this co-infection should make clinicians more vigilant in managing hydatid cysts in diabetics and immunocompromised, as they may have concomitant fungal infestation of the hydatid cavity.

Hydatid Disease in Children from Diagnosis to Treatment: A 10-year Single Center Experience

OBJECTIVE

Hydatid disease caused by Echinococcus granulosus is a parasitic zoonosis and is endemic in Turkey. Clinical manifestations vary and are related to the anatomical location. In this report, we shared the diagnosis, treatment and follow-up of hydatid disease in children with a 10-year experience.

METHODS

A total of fifty-seven children diagnosed with hydatid disease were analyzed retrospectively from hospital records. Diagnosis was based on clinical, serological and radiological findings. Treatment response was evaluated with clinical, radiological and serological findings.

RESULTS

The male/female ratio of 57 cases was 2.4:1 and the mean age was 113.6±45.9 months. The most common presenting complaint was abdominal pain (42.1%). While 22 (38.6%) of the cases had eosinophilia; indirect hemagglutination test positivity was detected in 27 cases (47.4%). Multiple organ involvement was present in 18 cases (31.6%). In patients with multiple organ involvement, the possibility of cysts being located in the abdomen was higher (p=0.005). Of the 50 cases (87.7%), 45 (78.9%) were operated with open surgery and 5 (8.8%) with percutaneous aspiration-injection-reaspiration method for treatment. There were 52 (91.2%) patients who were given albendazole in conservative treatment and the mean duration of treatment was 15.5±17.2 months. There were 10 cases (17.5%) who developed cyst rupture and the symptom duration was shorter than the cases without cyst rupture (p=0.017). Cyst rupture was more common in cases with dyspnea and fluid discharge from the mouth called rock water (p=0.001, p=0.005, respectively). Recurrence was observed in five cases (8.8%) during follow-up.

CONCLUSION

In areas where the disease is endemic, despite prevention and control programs consisting of personal habits and health education, active transmission of hydatid disease is seen in children and continues to be an important public health problem. Hydatid disease should definitely be considered in the presence of suspicious radiological and clinical findings in endemic areas. Controlled clinical studies are required for diagnosis and treatment procedures.

Impoverishment Effect of Hydatid Disease and Precision Medical Assistance Pattern of Government: Evidence from Yushu in China

Hydatid disease is one of the 17 neglected tropical diseases recognized by WHO and causes a huge global disease burden. Hydatid disease poses a great threat to local medical poverty alleviation. In efforts to break the vicious circle of poverty, Hydatid disease has been widely concerned and discussed. In the practice of poverty alleviation in China, medical poverty alleviation is regarded as the double goal of getting rid of poverty and promoting the construction of a healthy China. On the basis of on-the-spot investigation in Yushu Prefecture, this paper conducts a follow up study on the poverty-causing effect of Hydatid disease and the precision medical assistance pattern of government using a field investigation method. The results show that Hydatid disease led to the increase of poverty in the population in Yushu Prefecture, precision medical assistance played an obvious role in treating Hydatid disease and poverty alleviation, the health service in the study area continues to improve and the medical backbone team further expanded. The main conclusion is that the three-level diagnosis and treatment framework can effectively reduce local poverty and improve people's living environment.

A Rare Case Report of Primary Hydatid Disease of the Scapula - an Unforeseen Diagnosis!

Introduction

Hydatid disease of the bone is a parasitic infestation in the form of cystic echinococcosis by a tapeworm echinococcus granulosus. Its manifestation in the bone is relatively low and has the ability to mimic other skeletal pathologies.

Case Report

We came across a 30-year-old male farmer with complaints of sero-purulent discharge from a sinus tract wound in the axilla for the past 3 years. He had been previously evaluated elsewhere with blood investigations, pus culture/sensitivity tests, MRI, and CT scans. Blood reports and culture/sensitivity tests were inconclusive and imaging tests were suggestive of a sinus tract originating from the right scapula. He was incorrectly diagnosed as a case of Tuberculosis of the Scapula and started on anti-tubercular medications for 9 months which was ineffective. To confirm the diagnosis, a biopsy was taken from the scapular lesion through a posterior approach. Histological tests revealed a cystic lesion composed of trilaminar membrane consisting of dead and degenerating scolices consistent with "Hydatid Cyst of Bone."

Conclusion

Hydatid disease of the bone has an inconsistent clinical picture which makes diagnosing this rare disease even more difficult. A high suspicion for hydatid infestation in bone pathologies could help in diagnosing the disease at the earliest.

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.

Primary retroperitoneal hydatid cyst with intraperitoneal rupture: a case report

Background

Hydatid disease is endemic in Mediterranean countries and most commonly occurs in the liver followed by the lung. A primary localization in the retroperitoneum is extremely rare.

Case presentation

We report the case of a 29-year-old Tunisian patient presenting with progressive left flank pain and skin urticaria. On abdominal ultrasonography and computed tomography scan, a ruptured retroperitoneal hydatid cyst was diagnosed, which was confirmed by positive hydatid serology. The treatment consisted of resection of protruding dome. The evolution was favorable. No local recurrence was detected during postoperative follow-up.

Conclusions

Primary retroperitoneal hydatid cyst is extremely rare and has uncommon presentation, but we should learn the keys to its diagnosis. In endemic regions, high suspicion for this disease is justified regardless of localization.

Non-spinal Hydatid Disease of Bone: A Series of Nine Cases

BACKGROUND

Extra-spinal osseous hydatid disease is reported in a small number of case series. In the present study, we report our experience with extra-spinal hydatid disease of the bone in a series of nine patients.

METHODS

In this retrospective study, the patients who were diagnosed with an extra-spinal osseous hydatid disease were included. All patients were treated surgically. Preoperative anthelmintic drugs were employed for the cysts that were diagnosed before the operation. Postoperative chemotherapy was performed for all patients.

RESULTS

The study population included nine patients, including seven males and two females, with a mean age of 45.2±7.9 years and an average follow-up of 4.1±2.7 years. Non-specific pain was the most common symptom at presentation. Pelvic bones were the most frequent site of involvement. Serologic tests were false negative in seven patients. The disease was diagnosed preoperatively in five patients, and all of them were located in flat bones. The cysts were treated by radical excision in four patients, extended curettage in four patients, and amputation in one patient. The recurrence of the lesion was recorded in two patients who were treated by intralesional curettage. One case of suppuration was the only postoperative complication of this series.

CONCLUSION

Osseous hydatid disease is a serious disease with challenging diagnosis, difficult treatment, and significant morbidity. Preoperative diagnosis is generally easier in flat bones. Radical resection is the optimal treatment of this disease, while non-radical resection is associated with a higher risk of recurrence.

Case of Botryoid Rhabdomyosarcoma Mimicking Biliary Hydatid Disease

Hepatobiliary rhabdomyosarcoma (RMS) is a soft tissue malignant musculoskeletal tumor of the biliary tract. It is rare tumor, mostly seen in children and mimics common benign biliary condition. Here, we present a case of 1 year 9 months child of biliary RMS who presented with obstructive jaundice and diagnosed after biopsy. This case highlights the unusual childhood malignancy of bile duct RMS in obstructive jaundice with atypical imaging findings.

Recommendations for the ethical guidelines for publication of scientific studies: The responsibilities of editors, reviewers and the authors

OBJECTIVE

We aimed to evaluate the role of anesthesiologist in the management of hydatid disease from the perspective of the editors, reviewers and the authors.

METHODS

We searched the PubMed/Medline database using the following keywords: (hydatid* OR echinococc*) AND (disease OR cyst) AND (anesthesiology). We have evaluated the authors, their institutions and department, and the aim of the studies. We also evaluated the studies published by anesthesiologists in terms of content.

RESULTS

The literature search showed 6344 articles published between February 2010 to 2021. Sixty-three had at least one anesthesiologist in the author list. Anesthesiologists were leading authors in 35 studies; and in 19 of them, all the authors were anesthesiologist. Sixteen (84.2%) of these articles defined the outcomes of surgical therapy and there was no information regarding anesthesia technique.

CONCLUSION

The results of our study emphasize an important controversy regarding jurisdiction of different departments in terms of scientific research ethics. We believe that different disciplines can work together to evaluate a scientific problem and can publish a study in collaboration. But collaboration is very important and violating the subject of another field without collaboration is a deontological problem.

Genome-wide transcriptome analysis of the early developmental stages of Echinococcus granulosus protoscoleces reveals extensive alternative splicing events in the spliceosome pathway

BACKGROUND

The complex life cycle of Echinococcus granulosus involves numerous environmental conditions within different intermediate and definitive hosts. This requires adaptation at different levels of transcript regulation. Alternative splicing (AS) and the related cellular functions as one of the major fields of post-genomics has been poorly studied in tapeworms. In the present study, we investigated AS events and their potential biological effects in E. granulosus.

METHODS

Whole transcriptome sequencing data of four groups of protoscoleces were prepared for RNA-seq library construction. Fresh protoscoleces were either used as non-induced controls (NT group) or incubated for 15 min with pepsin (PEP group) and cultivated in a biphasic medium for 12 and 24 h (12 and 24 h groups). The frequency and different types of AS events were identified using rMATS software. Functional annotations and gene ontology of differential AS (DAS) genes were performed using Blast2GO software. AS events were experimentally validated by PCR on the protoscolex cDNAs using specific primers for each gene.

RESULTS

At least one AS event was found in 38.1% of the genes (3904 out of 10,245) in the protoscoleces during early strobilar development. The genes were associated primarily with cellular and metabolic processes and binding and catalytic activity. KEGG pathway analysis of DAS events revealed a number of genes belonging to different components of the spliceosome complex. These genes tended to belong to common SR proteins, U1-related factors, U2-related factors, complex A-specific factors and other splicing-related proteins.

CONCLUSIONS

The high number of AS events in the transcriptome regulatory mechanisms indicates the essential rapid molecular processes required by the parasite for adaptation in different environments.

Hydatid disease as a rare cause of neck swelling: Two cases report

INTRODUCTION

Despite the fact that hydatid disease is endemic in some countries, its cervical location remains very rare.

PRESENTATION OF CASE

We report two cases of primary cervical hydatid disease in two children from rural areas. The imaging was not specific, since the location is rare; the diagnosis was only confirmed after surgery.

DISCUSSION

Hydatid cyst is a rare pathology. Thus clinical presentation, radiological examinations, fine needle aspiration and serology can be useful to suspect the diagnosis.

CONCLUSION

Hydatid disease should be considered when dealing with slow-growing renitent neck swelling in endemic countries.

A Challenging Case of Refractory Biliary Leak in a Patient With Hydatid Liver Disease

Hydatid liver disease (HLD) is the most common form of hydatid disease, and it is caused by a zoonotic infection with a tape worm. It is endemic mostly in sheep-farming countries and rare in the United States. Liver involvement is usually asymptomatic, but symptoms develop upon growth of the cyst leading to many complications, most common of which is intra-biliary rupture, and less likely biliary obstruction. Diagnosis is clinical, serologic and radiologic. Therapeutic approaches to HLD include surgery, anthelminthic medications and medico-surgical procedures. Here we present a case of HLD that presented in advanced stage leading to grave consequences, complicated course and difficult therapeutic options. Given the rarity of hydatid disease in Northern America, physicians have to keep high index of suspicion especially in a patient with history of travel to endemic areas, as early diagnosis and treatment is important to avoid high morbidity and mortality.

Seroprevalence of Hydatid Disease Among Migrant Workers in Malaysia

Hydatid disease is not endemic in Malaysia; however, its migrant workers originate from neighboring countries where the disease is prevalent. Thus, this study was aimed at investigating the seroprevalence of hydatid disease among the workers. A total of 479 migrant workers were screened for hydatid disease. The sociodemographic information was collected, and serum samples were tested with a rapid dipstick test for hydatid disease called Hyd Rapid™. The present study showed that 13.6% of the migrant workers were found to be seropositive for hydatid disease. The highest seroprevalence was seen among Indian workers (29.41%), followed by Myanmarese (21.43%), Bangladeshis (14.92%), Nepalese (10.68%), and Indonesian (10.66%). This is the first study that highlights the likely presence of hydatid disease among the migrant workers in Malaysia, which may be of interest to the health authorities.

Conquering new battlegrounds: Successful management of isolated giant retrovesical hydatid cyst with robotic assistance

Hydatid disease (HD) is an accidental human parasitic infestation by cestodes and is most commonly caused by Echinococcus granulosus. Liver happens to be the most common site of involvement, although involvement of other organ symptoms is not uncommon. Involvement of the retrovesical pouch by hydatidosis is generally secondary in nature with an incidence of 0.1%–0.5% only. Primary retrovesical hydatid cyst (RVHC) is extremely rare with only few cases in existing literature. RVHC can present with a wide gamut of symptoms ranging from asymptomatic to obstructive uropathy. A 38-year-old male presented to us with complaints of lower urinary tract symptoms (LUTS) and was found to have an isolated primary retrovesical hydatid cyst on evaluation. The RVHC had compressed the right ureter leading to a grossly hydronephrotic non-functional right kidney. The patient was started on albendazole therapy and underwent robot assisted right nephroureterectomy and partial pericystectomy for the RVHC. The postoperative period was uneventful with resolution of symptoms. This report highlights the various clinical presentations of RVHC as well as the minimal invasive management of this rare entity.

MicroRNA profile of the strobilated worms of Echinococcus granulosus derived from in vivo and in vitro systems by using high-throughput approach

MicroRNAs are critical gene regulators at the post-transcriptional level and play essential roles in numerous developmental processes in metazoan parasites including the causative agent of cystic echinococcosis, Echinococcus granulosus. The molecular basis of different patterns of E. granulosus development in the canine definitive host and in in vitro culture systems is poorly understood. In the present study, miRNA transcriptomes of the strobilated worms derived from experimental infection in the definitive host were compared with those from diphasic culture system after 60-day protoscoleces cultivation. Total RNA was extracted from in vivo- and in vitro-derived strobilated worms. Small RNA libraries were constructed, and deep sequencing was performed. Subsequently, differential miRNA expressions and target predictions were obtained, and pathway analysis was performed by gene ontology and KEGG. Seven miRNAs were differentially expressed between the in vivo- and in vitro-derived worms. In addition, we reported 13 novel miRNA candidates and 42 conserved miRNAs. Four out of five top miRNAs with the highest read counts were shared between the in vivo and in vitro-derived worms, i.e., egr-miR-10a-5p, egr-let-7-5p, egr-bantam-3p, and egr-miR-71-5p. Target prediction of the differential miRNAs between the two systems showed significant differences in the membrane-enclosed lumen, membrane part, and an intrinsic component of the membrane. Findings of KEGG analysis indicated that differentially expressed miRNAs were involved in hippo, MAPK, and WNT signaling pathways. The study demonstrated a significant difference in miRNA transcriptomes and related signaling pathways between the two systems, suggesting the importance of host-parasite interplay in the fate of protoscoleces development in in vivo and in vitro systems.

Acquired right-sided diaphragmatic hernia in a patient with retroperitoneal hydatidosis: a case report and review of the literature

Background

Diaphragmatic hernia is primarily congenital in origin and has potentially devastating pulmonary complications. Acquired diaphragmatic hernia as a complication of hydatid disease remains a rare clinical entity. Retroperitoneal hydatidosis, in particular is an exceptionally rare cause behind a similar presentation. This paper aims to present the first case of acquired diaphragmatic hernia likely caused by eroding retroperitoneal hydatid cysts and provide a succinct literature review regarding the causative association between hydatid disease and diaphragmatic defects.

Case presentation

A 71-year-old Saudi man, with a history of hydatid disease involving several areas including the retroperitoneum, presented with multiple episodes of shortness of breath and abdominal pain of 10 months’ duration. Computed tomography scans of the chest and abdomen demonstrated the presence of a large diaphragmatic defect, with herniation of bowel loops into the chest cavity. Initially, the patient underwent a diagnostic laparoscopy which was then converted to a posterolateral thoracotomy to repair the defect.

Conclusions

The ability of hydatid disease to involve several body organs makes diagnosis and management of resultant complications a challenge in some cases, like ours. Knowledge about a reported rare complication could enable early detection and management to avoid serious complications, including abdominal viscera incarceration and strangulation.

Surgical management of hydatid cyst of the interventricular septum

Cardiac hydatidosis constitutes about 0.5-2% of all hydatid diseases. The interventricular septum is involved in 4% of cardiac hydatidosis cases. We demonstrate the surgical management of a large (76 x 66 mm) septal hydatid cyst in a 20-year-old man. The hydatid cyst was approached through a right ventriculotomy under cardiopulmonary bypass. The germinative membrane was removed in toto. The cavity was then obliterated to prevent recurrence of the cyst. The patient had an uneventful postoperative recovery. Histopathological examination confirmed the diagnosis of hydatid cyst. The patient remains asymptomatic with echocardiographic and magnetic resonance imaging evidence of freedom from disease at the 3-month follow-up.

Primary hydatid disease of chest wall mimicking chest wall mass-case report

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Hydatid disease can affect chest wall like many other organs.

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Primary hydatid disease of chest wall can present as a chest wall mass.

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Treatment of chest wall hydatid disease is surgery.

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Anti-parasite drugs and scolicidal agents can also be used.

Introduction

Hydatid cyst is a parasitic disease caused by echinococcus granoulosis. It is endemic in Mediterranean areas, south America, north Africa and Australia. The disease is most common in the liver and then in lung, the chest wall involvement by hydatid disease is a very rare condition.

Presentation of case

We present a case of chest wall mass in a 65-years old man, who intra operatively diagnosed as primary hydatid cyst. Cystectomy done and patient followed up for 2 months.

Discussion

The diagnosis of echinococcus infection mainly depends on the clinical history of the patient, serologic tests, and diagnostic radiological findings. Operative procedures for chest wall hydatid disease are cystectomy, cystotomy, evacuation, and chest wall resection.

Conclusion

Chest wall hydatid disease should be considered in the differential diagnosis of chest wall masses even in a patient who has not been operated for hydatid disease.

An arcane case report of primary intramuscular hydatid cyst of thigh

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Intramuscular hydatidosis is an extremely rare manifestation of hydatid disease which is endemic in India.

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Patient presented with a large swelling over the left thigh and was diagnosed in a timely manner using a multimodal approach.

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The rare location of the disease is confounding and required thorough and meticulous evaluation.

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Upon surgical exploration, the presence of multiple cysts and daughter cysts proved to be challenging but complete pericystectomy was achieved.

Introduction

Hydatid diseases are a cystic parasitic infestation caused by Echinococci which are endemic to parts of India and commonly occur in agricultural workers. Primary intramuscular hydatidosis is a rare manifestation of hydatid disease.

Presentation of case

Our case report describes a rare case of primary intramuscular hydatidosis in an agricultural worker with no involvement of any other viscera. This was diagnosed with clinical evaluation, radiological modalities and managed surgically.

Discussion

Hydatid disease is endemic in parts of India. Primary intramuscular hydatidosis is uncommon because the lactic acid in the muscle and muscle contractility hinders the development of cysts making it improbable diagnosis on first presentation. Hydatid cyst demonstrates a wide variety of imaging features, which can vary according to growth stage, associated complications and affected tissue. The treatment of choice is complete surgical excision of the cyst along with thorough irrigation of the surrounding soft tissues combined with the use of systemic antiparasitic drugs after surgery.

Conclusion

In a patient of an agricultural background of cattle rearing living in an endemic region and presenting with a swelling in the musculoskeletal system, a suspicion of hydatidosis should always be kept in the clinicians mind, so that it can be diagnosed using a multimodal approach and managed properly in a timely manner.

Liver graft harbouring hydatid disease: how far can we extend our donor pool?

As the current demand for liver transplantation exceeds our donor pool, the donor search is shifted towards the extended donor criteria. The livers harbouring hydatid disease are a controversial source of grafts. We report the use of a liver graft harbouring hydatid disease in urgent liver transplantation in a patient with autoimmune hepatitis. Corroborated with previous experiences, we show that the liver grafts harbouring hydatid cysts provide a rare but valuable source of organs.

Image in Hydatid Disease of the Central Nervous System

Hydatid disease most frequently occurs in the liver. This article presents a case of spinal cord compression caused by vertebral hydatidosis with typical imaging characteristics and pathologic findings, which is rarely involved in the hydatidosis. The patient was successfully treated with surgical excision combined with antiparasitic therapy.

Comparative Analysis of miRNA Expressions in Different Developmental Stages of Echinococcus granulosus in Mono-Phasic and Di-Phasic Culture Systems

BACKGROUND

The dog tapeworm, Echinococcus granulosus, is a zoonotic parasite affecting humans and livestock across the globe. Basic research on the molecular biology and genetics of E. granulosus improves our understanding of the biology and potential drug targets in various developmental stages of E. granulosus in both definitive and intermediate hosts. There has been increasing interest in the identification of microRNAs in parasitic organisms. The purpose of the current study was to compare the activity of a selected profile of miRNAs in different developmental stages of E. granulosus.

METHODS

Different developmental stages of the parasite were obtained from ex vivo as well as in vitro cultured E. granulosus. MicroRNAs were extracted from the ex vivo germinal layer and invaginated protoscoleces as well as the in vitro generated microcysts, evaginated protoscoleces, and strobilated worms. The expression of the selected miRNAs was evaluated by RT-qPCR for each stage.

RESULTS

Four out of five miRNAs were present and active in different developmental stages of E. granulosus. A significant over-expression of miR-61 was observed in the germinal layer and during the protoscolex transformation into the microcysts, however, miR-10 was more expressed in the mature strobilated forms than in the other stages. Let-7 and miR-3489 showed a high expression in the germinal layer.

CONCLUSION

Differential expression of four miRNAs among different in vitro and ex vivo developmental stages of E. granulosus was documented in the present study. Further experimental investigations are required to elucidate the probable role of the miRNAs in bi-directional differentiation of protoscoleces either into the strobilated worm or to a secondary hydatid cyst and the potential of these miRNAs as drug targets.

Management of a primary retroperitoneal hydatid cyst ruptured in the abdominal wall: A case report

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Hydatid disease is endemic in North Africa countries such as Tunisia.

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Retroperitoneal location is scarce.

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Parietal complications are rarely described even in endemic geographic locations.

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Management of parietal complications of hydatid cysts is not consensual.

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Surgical drainage remains the gold standard.

Introduction

Hydatid disease is a global zoonosis. Any organ of the human body can be involved. Single or multiple locations are reported. However, retroperitoneal hydatid cysts are uncommon. Furthermore, parietal complications are rarely reported in literature. Therefore, the management of hydatid cysts ruptured in the abdominal wall remains challenging.

Presentation of case

In this case report, we aim to describe our experience in treating a primary retroperitoneal hydatid cyst with rupture into abdominal wall in an 87-year-old woman who presented with a 15-centimeter mass of the right flank. Hydatid serology test was positive. An abdominal CT scan showed a 20-centimeter cystic mass of retroperitoneum extended to the abdominal wall with several septa within and enhanced thick wall. The patient underwent a surgical elective drainage with perioperative antiparasitic chemotherapy. Follow-up showed no recurrence.

Discussion

Primary retroperitoneal hydatid cyst with parietal complications is scarce and barely described in literature. We performed a review of the recent relevant literature that deals with this subject. None of the hydatid cysts reported in 55 cases was located in retroperitoneum. The top seven countries of origin are located in Mediterranean region except for India. Imaging is compulsory for the diagnosis along with patient’s history, physical examination and hydatid serology. The treatment is surgical and must be must be covered by antiparasitic chemotherapy.

Conclusion

Primary retroperitoneal hydatid cyst extended to the abdominal wall remains a rare and challenging diagnosis that must be considered in endemic countries.

Gluteal muscles primary hydatid cyst after cortical bone destruction in the sacrum

Introduction

Hydatid disease is caused by infection of Echinococcus Granulosus. Usually Hydatid Cysts occur in the liver and lungs. Presenting hydatid cysts in bone without hepatic affectation is rare and occurs in 0.5–2% of cases. Hence, this rare case makes the diagnosis difficult for the clinicians and, as a result, misdiagnosis of sacral Echinococcosis is common.

Presentation of case

The authors report on a 47-year male with primary sacral hydatidosis and 34 years of recurrence. He was admitted with compressive neurological symptoms like tingling pain, numbness, sciatica and foot drop. He has undergone 8 operations and has been treated with Albendazole. He has developed a Sacro-cutaneous fistula.

Discussion

When assessing sciatica, low back pain or lower limb weakness the pelvic cavity should be examined for hidden disease that might explain the neurological symptoms.

Conclusion

A missed diagnosis of osseous Hydatidosis could be devastating. Accordingly, the sacral Hydatid cyst must be included as a differential diagnosis for compressive neurological symptoms. In clinical practice, surgery remains the gold standard for treating osseous Hydatidosis.

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The symptoms of osseous echinococcosis are non-specific and widely variable.

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Sacral hydatid cyst it should be included in the differential diagnosis of any bone mass caused compressive neurological symptoms.

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Treatment of hydatid cyst is primarily surgical, demanding total removal without rupture.

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Posterior approach is preferred over anterior due to feasibility of the intervention and decrease of the recurrence rate.

[Horse tail syndrome revealing spinal-medullary hydatid disease]

Hydatid disease is an anthropozoonosis caused by the larval stages of the genus Echinoccus granulosus in humans. It mainly occurs in subjects living in the rural and livestock areas in the Mediterranean basin, South America, Near and Middle East. Spinal hydatid disease is rare but it is the most severe form of bone hydatid disease. It mostly affects the dorsal spine, increasing the risk of spinal injury; hence its severity. We here report the case of a 60-year-old female patient admitted with progressive bilateral, poorly systematized, paralyzing lumbar radiculopathy associated with urinary urgency. MRI showed lumbar spinal hydatid disease infiltrating the intra and extra-ductal structures and compressing the roots of the horse tail. The patient underwent surgery through a posterior approach with favorable outcome.

Multiple recurrent cystic echinococcosis with abdominal aortic involvement: A case report

BACKGROUND

Recurrent cystic echinococcosis (CE) with vital organ involvement is a challenge for clinicians. Herein, we report a case of aortic involvement in recurrent retroperitoneal CE lesions following primary splenic CE resection.

CASE SUMMARY

A 60-year-old male was admitted due to progressive abdominal pain and poor appetite. He was diagnosed with multiple recurrent CE with abdominal aortic involvement according to preoperative evaluation. During surgical resection, major aortic bleeding accidentally occurred while dissecting the cyst, which was firmly attached to the abdominal aortic wall. Hemostasis attempts were conducted to deal with this emergency situation and maintain circulation. Post-interventional recovery was uneventful, and 2-year follow-up showed no sign of recurrence or any other complications.

CONCLUSION

Radical resection of recurrent complicated CE with aortic involvement should be carefully planned and performed to prevent possible severe adverse complications, thereby improving the postoperative outcome.

Australian beef producers' knowledge and attitudes relating to hydatid disease are associated with their control practices

Despite available control strategies, hydatid disease in beef cattle has been shown to have a wider geographic range and higher prevalence than previously recognised in Australia. The aim of the current study was to determine whether producer knowledge and attitudes are associated with farm management practices that could influence transmission among domestic dogs, wildlife, livestock and humans. Between June and August 2019, a cross-sectional study was conducted among beef producers throughout Australia (N = 62). Producers were asked to complete an online survey to obtain information on their knowledge about hydatid disease, their attitudes towards the disease and their farm management practices that could affect transmission. Descriptive statistics were conducted to investigate potential predictors for practices that might influence transmission of the parasite. A Bayesian network (BN) model was then constructed to evaluate the interrelationships between variables. The results show that most respondents (87 %; 54/62) had heard of hydatid disease. However, only 61 % of respondents knew how hydatid disease is transmitted (38/62) and only half knew how to prevent transmission (52 %; 32/62). Of respondents that knew that hydatid disease could affect humans (44/62), many did not think their family was at risk (46 %, 20/44) because they dewormed their dogs and prevented their dogs' access to offal. However, most respondents who owned dogs did not deworm their dogs frequently enough to prevent patency of Echinococcus granulosus infection (86 %; 49/57). Almost all respondents (94 %; 58/62) said they would take action if they found out their cattle were infected. BN analysis revealed that implementation of practices that could reduce the risk of hydatid disease transmission were associated with producers' knowledge and attitudes. In the model, practices were most influenced by attitudes (percentage change in variance = 42 %). All respondents in the "hydatid prevention" practices group were in the "good" knowledge group and the "less concerned" attitudes group. In comparison, most of the respondents in the "standard husbandry" practices group were in the "poor" knowledge group and the "more concerned" attitudes group. In summary, the results indicate that greater knowledge of hydatid disease among beef producers is associated with practices that reduce hydatid risk and attitudes of less concern about hydatid impact on properties. Therefore, increasing producer knowledge is warranted to encourage adoption and improvement of hydatid prevention practices and would be well received by beef producers.

Study on the effect of an ion channel inhibitor "Fluralaner" on Echinococcus granulosus protoscolices and metacestode layers in vitro

Hydatid disease has a great impact on public health, causing high morbidity and mortality. Main lines of treatment include surgery, which mostly requires the installation of a scolicidal agent into hydatid cysts to prevent dissemination. Alternatively, medical treatment involves the use of benzimidazole drugs; however, the results are not satisfactory, and new drug compounds are urgently needed. Fluralaner is a potent inhibitor of GABA-gated chloride channels and L-glutamate-gated chloride channels (GluCls) providing immediate and persistent flea, tick and mite control in dogs after a single oral dose. Researches previously identified different genes encoding ion channels in Echinococcus granulosus, making ion channel inhibitors a promising target for treating hydatid disease. Thus, the present study aimed to evaluate the effect of fluralaner on protoscolices and metacestode layers. Parasite materials (Protoscolices, Metacestodes layers) were exposed to different concentrations of the drug ranging from "12.5-100 ug/ml" and examined for viability after 1, 6 and 24 h. Morphological and ultrastructural alterations were recorded by both light and electron microscopies. Immunohistochemical staining confirmed caspase-3 activation as an indicator of apoptosis- induced therapy. The treated protoscolices and metacestode layers showed loss of the viability, the formation of vacuoles and lipid droplets, separation of the germinal layer, and damage in the laminated layer; apoptosis was prominent after treatment. These findings revealed that fluralaner has a potent scolicidal activity and suggested its therapeutic potential against hydatid disease. Further evaluations for animals and human use in the treatment and prevention of hydatid disease are needed.

A young woman from an Echinococcus-endemic area with progressive abdominal distension: a case report

Background

Cystic echinococcosis is a zoonotic infection caused by Echinococcus granulosus. This case report shows the difficulty in differential diagnosis in a patient with highly suspected hydatid disease.

Case presentation

A 29-year-old Chinese woman presented with progressive abdominal distension. Imaging results revealed a large multicystic tumor with typical features of hydatid disease. There was no clear relationship between the cystic tumor and the liver, which led to the assumption of primary extrahepatic cystic echinococcosis. After albendazole therapy was initiated, a laparotomy was performed and a huge ovarian cystadenoma was diagnosed.

Conclusions

This case highlights the possible challenges of differential diagnosis in patients with suspicion of hydatid cysts.

Contribution to the echinococcosis control programme in China by NIPD-CTDR

As a zoonotic parasitosis caused by the parasitism of Echinococcus larvae, echinococcosis imposes serious disease and economic burdens on human beings and society, and is thus a global public health issue. Its complex life history, wide distribution, the combined influence of various epidemic factors, coupled with the unique natural environment, customs, and religious beliefs in endemic areas, pose a huge challenge to the national echinococcosis control programme in China. Accurate early detection and confirmation of diagnosis of echinococcosis, the use of effective drugs, real-time surveillance of the infection status of populations and various hosts, controlling the source of infection, and blocking the route of transmission are of enormous significance for control. In this paper, the work by NIPD-CTDR on the prevention and control of echinococcosis in China is reviewed, with a view to providing reference for the further promotion of the national echinococcosis control programme.

Primary hydatic cyst of the fallopian tube

•Hydatid disease is an endemic infection in the Mediterranean region, and Tunisia is one of the most affected countries.

•The involvement of the female genital tract is uncommon, and the occurrence in the fallopian tube is extremely rare.

•In reproductive organs, the involvement is always secondary. Primary involvement of the fallopian tube is rarely reported.

Hydatid disease is endemic in Tunisia. The involvement of the female genital tract is uncommon, and the occurrence in the fallopian tube is exceptional. We present a case of a 42-year-old woman who had complained of a 4-month history of lower abdominal pain. The abdominal ultrasonography and CT scan showed a multiloculated cystic lesion in the left adnexa. The exploratory laparotomy found a cystic mass developing in the left fallopian tube. Left salpingectomy was performed. The pathological examination confirmed the diagnosis of hydatid cyst disease. No recurrence was detected at the 2-year follow-up. Tubal hydatid cyst is an extremely rare condition that should be considered in the differential diagnosis of any cystic lesion in patients from endemic areas.

Massive pulmonary embolism due to hydatid cysts: A rare postoperative complication of liver echinococcosis

Pulmonary embolism due to hydatid cysts is a very rare pathology. A 55-year-old male was transferred to our hospital due to respiratory failure, as a result of left pulmonary artery obstruction by cystic lesions. His medical history included multiple operations for abdominal echinococcosis. He was urgently operated for the extraction of the proximal hydatid cysts with the use of cardiopulmonary bypass with an excellent outcome and six months later through a right thoracotomy for the distal right pulmonary artery, the cysts were extracted. Meanwhile, he followed additional medication treatment with albendazole, preoperatively as well as postoperatively. Today, 5 years later, he has no evidence of hydatidosis recurrence.

Biological and morphological consequences of dsRNA-induced suppression of tetraspanin mRNA in developmental stages of Echinococcus granulosus

BACKGROUND

Cystic echinococcosis, caused by the cestode Echinococcus granulosus, is a neglected tropical disease with remarkable morbidity in humans and a problem of worldwide economic importance in livestock industry. Understanding the molecular basis of the parasite growth and development is essential for the disease diagnosis, management and control. The tetraspanin (TSP) family of proteins are transmembrane proteins with a role in many physiological processes of eukaryotic organisms. TSPs present in the tegumental surface of platyhelminths play pivotal roles in host-parasite interaction. However, little is known about the role of TSPs in growth and development in the Platyhelminthes. To understand the role of TSP1 in the growth and development of E. granulosus we investigated the effect of EgTSP1-specific long dsRNA in different in vitro stages of the parasite.

METHODS

Different stages of E. granulosus, protoscoleces and strobilated worms, were cultivated In vitro in di-phasic media. Using long dsRNA and two delivery methods, i.e. electroporation and electro-soaking, EgTSP1 silencing was performed with an EgTSP1-specific dsRNA. The TSP1 expression profile was assessed as well as the biological and ultrastructural properties of the parasites.

RESULTS

After three days of dsRNA treatment, EgTSP1 expression was significantly reduced in both stages of E. granulosus as compared to irrelevant/unrelated dsRNA and untreated controls. Silencing expression of EgTSP1 in different stages of E. granulosus resulted in reduced viability and body contractions, inhibition of protoscoleces evagination and distinctive tegumental changes. Ultrastructural morphology of the strobilated worms treated with EgTSP1-specific dsRNA was indicative of the microtriches impairments and vacuolated tegument compared to the control helminths.

CONCLUSIONS

Results of the present study suggest that EgTSP1 plays important structural roles in tegument configuration in E. granulosus. EgTSP1 is proved to be a potential target for the development of vaccines and RNAi-based drugs.