[Expression of neutrophil extracellular traps and phagocytic functions among patients with hepatic alveolar echinococcosis]

OBJECTIVE

To investigate the expression of neutrophil extracellular traps (NETs) and phagocytic function in the peripheral blood of patients with hepatic alveolar echinococcosis (HAE), and to examine their correlations with clinical inflamma tory indicators and liver functions.

METHODS

A total of 50 patients with HAE admitted to Department of Hepatobiliary and Pancreatic Surgery, The Affiliated Hospital of Qinghai University from August 2022 to June 2023 were enrolled, while 50 age- and gender-matched healthy individuals from the Centre for Healthy Examinations of the hospital during the same period served as controls. The levels of NETs markers neutrophil myeloperoxidase (MPO) and neutrophil elastase (NE) were measured using enzyme-linked immunosorbent assay (ELISA). Peripheral blood neutrophils were isolated using density gradient centrifugation, stimulated in vitro using phorbol 12-myristate 13 acetate (PMA), and the levels of MPO and citrullination histone H3 (CitH3) released by neutrophils were quantified using flow cytometry. The phagocytic functions of neutrophils were examined using flow cytometry. In addition, the correlations of MPO and NE levels with clinical inflammatory indicators and liver biochemical indicators were examined using Spearman correlation analysis among HAE patients.

RESULTS

The peripheral blood plasma MPO［(417.15 ± 76.08) ng/mL vs. (255.70 ± 80.84) ng/mL; t = 10.28, P < 0.05］, NE［(23.16 ± 6.75) ng/mL vs. (11.92 ± 3.17) ng/mL; t = 10.65, P < 0.05］and CitH3 levels［(33.93 ± 18.93) ng/mL vs. (19.52 ± 13.89) ng/mL; t = 4.34, P < 0.05］were all significantly higher among HAE patients than among healthy controls, and a lower phagocytosis rate of neutrophils was detected among HAE patients than among healthy controls［(70.85 ± 7.32)% vs. (94.04 ± 3.90)%; t = 20.18, P < 0.05］, and the ability to produce NETs by neutrophils was higher among HAE patients than among healthy controls following in vitro PMA stimulation. Pearson correlation analysis showed that the phagocytosis rate of neutrophils correlated negatively with platelet-to-lymphocyte ratio (PLR), neutrophil-to-lymphocyte ratio (NLR), interleukin-6 (IL-6) level and C-reactive protein (CRP) level (rs = -0.515 to -0.392, all P values < 0.05), and the MPO and NE levels positively correlated with inflammatory markers NLR, PLR, CRP and IL-6 (rs = 0.333 to 0.445, all P values < 0.05) and clinical liver biochemical indicators aspartic transaminase, alanine aminotransferase, direct bilirubin and total bilirubin among HAE patients (rs = 0.290 to 0.628, all P values < 0.001).

CONCLUSIONS

Excessive formation of NETs is found among HAE patients, which affects the phagocytic ability of neutrophils and results in elevated levels of inflammatory indicators. NETs markers may be promising novel biomarkers for early diagnosis, monitoring, and severity assessment of liver disease.

Whole-Body 18 F-FDG PET/CT Patlak Parametric Imaging of Hepatic Alveolar Echinococcosis

ABSTRACT

We present dynamic 18 F-FDG PET/CT acquisition in a 52-year-old old woman with histologically proven hepatic alveolar echinococcosis (AE). Metabolic rate of FDG images generated with traditional and relative Patlak analysis show the AE manifestation in the liver significantly better the static SUV images. Dynamic PET may thus have the potential to increase sensitivity in the assessment of hepatic AE manifestations. Such parametric images may offer complementary qualitative information and quantification superior to SUV images.

Zoonotic Transmission of Hepatic Hydatid Cyst from Domestic Dogs: A Case Report from an Urban-Marginal Area in Ecuador

BACKGROUND Hepatic hydatidosis, or echinococcosis, is a zoonosis with worldwide prevalence and is potentially lethal in humans. This report presents a case of hydatidosis in a 40-year-old woman that was associated with a zoonotic transmission of Echinococcus granulosus from domestic dogs in an urban-marginal area of the city of Guayaquil, Ecuador. This report shows how early diagnosis and awareness favored the correct treatment of the disease. CASE REPORT A 40-year-old woman from the aforementioned sector presented the following symptoms: malaise, pain in the upper right hypochondrium, palpable mass, jaundice, and fever. Next, the patient's fecal samples were analyzed by direct coproparasitic methods, flotation, and sedimentation with centrifugation using saline solution, whereby the presence of Entamoeba histolytica eggs was determined. Likewise, she underwent an ultrasound, in which hepatic hydatid cysts were observed. Subsequently, the cysts were treated and surgically removed, and parasitic forms of E. granulosus were identified. Later, coproparasitic analysis of her 2 domestic dogs for coproantigen ELISA were performed, by which the presence of this cestode was also identified and confirmed. CONCLUSIONS Hydatidosis is a zoonosis that can affect the population, especially in endemic areas of developed and underdeveloped countries. In this case, hepatic hydatidosis was identified in a 40-year-old woman. Additionally, the presence of E. granulosus eggs was determined in the fecal matter of her dogs, which indicated that the patient's relatives and other people around them were exposed to this zoonosis.

Effect and mechanism of reactive oxygen species-mediated NOD-like receptor family pyrin domain-containing 3 inflammasome activation in hepatic alveolar echinococcosis

BACKGROUND

The NOD-like receptor family pyrin domain-containing 3 (NLRP3) inflammasome is a significant component of the innate immune system that plays a vital role in the development of various parasitic diseases. However, its role in hepatic alveolar echinococcosis (HAE) remains unclear.

AIM

To investigate the NLRP3 inflammasome and its mechanism of activation in HAE.

METHODS

We assessed the expression of NLRP3, caspase-1, interleukin (IL)-1β, and IL-18 in the marginal zone and corresponding normal liver of 60 patients with HAE. A rat model of HAE was employed to investigate the role of the NLRP3 inflammasome in the marginal zone of HAE. Transwell experiments were conducted to investigate the effect of Echinococcus multilocularis (E. multilocularis) in stimulating Kupffer cells and hepatocytes. Furthermore, immunohistochemistry, Western blotting, and enzyme-linked immunosorbent assay were used to evaluate NLRP3, caspase-1, IL-1β, and IL-18 expression; flow cytometry was used to detect apoptosis and reactive oxygen species (ROS).

RESULTS

NLRP3 inflammasome activation was significantly associated with ROS. Inhibition of ROS production decreased NLRP3-caspase-1-IL-1β pathway activation and mitigated hepatocyte damage and inflammation.

CONCLUSION

E. multilocularis induces hepatocyte damage and inflammation by activating the ROS-mediated NLRP3-caspase-1-IL-1β pathway in Kupffer cells, indicating that ROS may serve as a potential target for the treatment of HAE.

The hepato-cardiac disorders in Tibetan residents with hepatic echinococcosis: A case-control echocardiography study

BACKGROUND

Clinical guidelines indicate that chronic highland exposure could induce pulmonary hypertension; chronic hepatic disease may affect cardiac structure and functions. However, the simultaneous impact of hepatic echinococcosis (HE) and chronic highland exposure on cardiac structure and function in Tibetan residents are under-investigated.

METHODS

One hundred and twenty patients with HE, 23 healthy high-altitude migrants with a mean residence time of 7.15 ± 1.12 years, and 46 healthy Tibetan permanent residents were enrolled in this study. All participants received comprehensive transthoracic echocardiography.

RESULTS

High-altitude migrants have a relatively lower pulmonary artery flow velocity (PV) and a slightly higher pulmonary artery mean pressure (PAMP) than the Tibetan permanent residents. Patients with HE presented relatively smaller dimensions of the main pulmonary artery and branches and a bigger right atrium and right ventricular cavity size than the two control groups. PV, PAMP and numbers of detectable tricuspid regurgitation jet velocity (TRJV), right ventricular fractional area change (RV_FAC), tricuspid annular plane systolic excursion (TAPSE), the ratio of tricuspid inflow velocities at early diastole to tricuspid annular early diastolic excursion velocity (RV_E/e') and right ventricular myocardial performance index (RV_MPI) were increased in patients with HE compared to the two control groups. Similarly, decreased LVEF and Impaired left ventricular diastolic function were identified in patients with HE compared to the two control groups.

CONCLUSIONS

Patients with HE presented with impaired biventricular contractile performance and diastolic dysfunction.

Prevalence and Economic Significance of Hidatidosis in Cattle Slaughtered at an Abattoir in Konya, Turkey

OBJECTIVE

This study was conducted to determine the period prevalence of hydatid cysts isolated from the livers of cattle slaughtered at a slaughterhouse in Konya.

METHODS

For this purpose, 49,545 cattle were slaughtered and examined for the presence of hydatid cysts in the liver. The study was conducted between June 01, 2018, and May 31, 2019.

RESULTS

The highest prevalence of hydatid cysts was observed in autumn 10.83% followed by spring 4.41%, winter 2.90%, and summer 2.66%, with an overall prevalence of 3.93%. Considering the month wise prevalence of hydatid cyst, the highest infection rate was detected in September (7.87%), June (7.16%) and August (7.14%), while the lowest prevalence was observed in February (2.72%) and January (2.83%). In gender-wise investigation, highest prevalence was observed in females (24.65%) during the summer and 18.45% inthe spring. In male animals, the infection rate was very low compared with females. However, the highest prevalence in males was observed throughout the year in autumn (2.36%) and the lowest prevalence in winter (1.68%). The highest prevalence was found among female cattle in heifers in winter (6.52%) and cows in summer (27.52%).

CONCLUSION

The overall economic losses of 56,434 USD were estimated due to discarded hydatid cyst-infected livers during the study period. This study enlightens the prevalence and economic significance of hydatidosis in Konya.

Histological Changes and Ghrelin, P-Selectin, and Leptin Parameter in Patients with Hepatic Hydatidosis in Iraq

Humans and animals are affected by hydatid cyst disease as a worldwide zoonotic disease, which is caused by the metacestode stage of Echinococcus spp. This study was performed to evaluate the histological change of liver and blood concentrations of biomarkers, such as ghrelin, p-selectin, and leptin, in humans infected with hydatid cyst. A total of 30 surgical specimens of liver and blood of infected humans and 30 healthy individuals as a control group were evaluated. Liver tissue sections in cases infected with hydatid cyst and control group, histological abnormalities in the liver, including fibrosis, increased inflammatory cells, dystrophic areas, and necrosis were compared in this study. In addition, serum leptin levels were significantly lower in patients with hydatid cyst disease QUOTE <0.05) than in the control group (P-value<0.05), whereas p-selectin and ghrelin levels significantly decreased in patients (P-value<0.05). The results of this research can be effective in improving and promoting the treatment programs of hydatidosis.

[Échinococcose alvéolaire]

Alveolar echinococcosi. Alveolar echinococcosis is a parasitic anthropo-zoonosis which looks like a slow-growing liver cancer. The lesions progressively obstruct hepatic vessels and bile ducts and invade neighboring organs, and it may metastasize to the lung and the brain and possibly all distant organs. Since the 1990s earlier diagnosis by imaging, advances in surgical and less invasive interventions, and prolonged anti-parasitic treatment using albendazole, have totally transformed the prognosis of the disease. However, in Europe, the endemic area has considerably increased, the number of alveolar echinococcosis cases has more than doubled in the previously identified endemic regions, and the disease may now be considered to be an 'opportunistic infection', especially diagnosed in those patients treated with immunosuppressive drugs and biologic agents. Alveolar echinococcosis is currently more and more often diagnosed incidentally, at an early stage of development, and not in the usual 'at risk' regions and populations. This makes differential diagnosis and care management more challenging.

Ventricular Tachycardia and the Cystic Heart: A Case Report

BACKGROUND

Hydatid cysts are caused by Echinococcus granulosus infection, and hydatidosis is recognized as a re-emerging zoonotic disease globally. While the liver is the most commonly affected organ, other organs can also be affected, including the heart. Because of the low sensitivity and specificity of serologic diagnostic tests, ultrasound and echocardiography are increasingly used to make the diagnosis of cardiac hydatid cyst.

CASE REPORT

We report the case of a cardiac hydatid cyst, detected by point-of-care ultrasound (POCUS), in a 79-year-old woman who presented with shortness of breath and was in ventricular tachycardia. The diagnosis was further confirmed with a computed tomography scan. Although cases of alveolar and liver hydatid cysts are seen, this is the first case of a cardiac hydatid cyst in Bhutan. WHY SHOULD AN EMERGENCY PHYSICIAN BE AWARE OF THIS?: This case illustrates the importance of POCUS in reaching a diagnosis, particularly in resource-poor areas where other sophisticated diagnostic tools are not easily available. A cardiac hydatid cyst must be in the differential for structural causes of dysrhythmias. This is especially so because treatment of unstable dysrhythmias in the acute setting of an emergency department has to be modified from the usual algorithm in the presence of a cardiac hydatid cyst, due to the potentially fatal risk of cyst rupture and anaphylaxis.

[Echinococcus multilocularis infection - six cases during two years in Sweden]

Alveolar echinococcosis (AE) caused by the fox tapeworm Echinococcus multilocularis is a zoonosis presenting with focal liver lesions and has a poor prognosis without treatment. The disease is common in Central and Eastern Europe but has been highly unusual in Sweden. A suspicion of AE usually arises through radiology and the diagnosis may be confirmed by histology and/or serological antibody detection. AE is treated with radical surgery in combination with anti-helminthic drug therapy. During the last two years six cases of AE have been diagnosed in Sweden. In no case was AE suspected clinically before biopsy. A heightened awareness of AE is needed among Swedish physicians, including radiologists, surgeons and pathologists.

Clinical Profile and Outcome of Surgery of Patients with Hydatid Cysts at the National Referral Hospital, Bhutan: An Observational Study

Background Hydatid disease a zoonosis caused by tapeworms (cestodes) of genus Echinococcus. Humans acquire this infection by ingestion of eggs of Echinococcus from infected dogs, sheep, goat, cattle or pigs. Hydatid cyst causes significant morbidity, mortality and socioeconomic loss. Objective The objective of this study was to describe the clinical profile and short-term outcome of surgical treatment of hydatidosis at Bhutan's largest hospital. Method This was a descriptive study conducted among patients ≥ 18 years at the National Referral Hospital, Thimphu, Bhutan from 01 January to 31 December 2017. Data on pre-surgery treatment, type and outcome of surgery and histopathology were collected. Data was entered analysed in EpiData. All variables are presented using descriptive statistics. Ethics approval was obtained from the Research Ethics Board of Health, Ministry of Health, Bhutan. Result There were 38 patients who underwent surgeries. The mean age of the sample was 36 (±17) years; cases were reported from almost all districts in the country. The most common symptoms at presentation was abdominal pain (27, 71.4%), nausea (21, 55.3%), abdominal distension (16, 41.1%). The median duration of symptoms was 6.0 months (IQR 3.0, 12.0). Liver was involved in 36 patients (94.7%). All underwent de-roofing and drainage through laparotomy (35; 92.1%), laparoscopy (2, 5.3%) or throracotomy (1, 2.6%). Histopathologic confirmation was obtained in 28 patients (73.7%). Twenty-three patients (60.5%) suffered from minor post-operative complications. Conclusion Patients with hydatid cyst present with abdominal pain, nausea abdominal distension. They suffer with symptoms for long periods till surgical treatment. The majority had favourable outcomes of surgery.

[Changes of Toll-like Receptor mRNA and Related Cytokines in Patients with Hepatic Alveolar Echinococcosis]

OBJECTIVE

To investigate the expression of Toll-like receptor 2（TLR2） and TLR4 mRNA in peripheral blood mononuclear cells （PBMC） and in the liver of patients with hepatic alveolar echinococcosis (HAE), and their correlations with related cytokines in plasma.

METHODS

Twenty-eight HAE patients hospitalized in the First Affiliated Hospital of Xinjiang Medical University during January 2012 and June 2015 and 28 healthy volunteers as a control were enrolled in this study. Plasma levels of interferon-γ （IFN-γ）, interleukin-5 （IL-5）, IL-23, and IL-10 were measured by ELISA. qRT-PCR was performed to detect TLR2 and TLR4 mRNA levels in PBMCs and hepatic tissues. The percentage of peripheral blood eosinophil （Eo%） was determined by a hematology analyzer. The correlations of TLR2 and TLR4 mRNA levels in PBMCs with levels of related cytokines and Eo% were analyzed with the Spearman Correlation method.

RESULTS

ELISA results showed that the plasma levels of IFN-γ, IL-5, IL-23, and IL-10 in the HAE group were （301.100±47.290）, （43.420±11.380）, （86.580±31.990） and （8.766±7.568） pg/ml respectively, which were higher than those in the control［（301.100±67.790）, （40.970±6.310）, （46.770±15.490） and （6.272±10.360） pg/ml］ with a statistical significance for IL-23 （P<0.01）. Results of qRT-PCR showed that the expression level of TLR2 in the HAE group （0.100±0.084） was significantly higher than that in the control （0.055±0.040） （P<0.05）, while the expression level of TLR4 in the HAE group （0.004±0.003） was comparable to that in the control（0.003±0.002）（P>0.05）. The expression of TLR2 and TLR4 mRNA in HAE lesions in the HAE group（29.680±25.650 and 21.340±16.640, respectively） were both significantly higher than that in para-lesion regions（2.308±4.140 and 5.541±9.233） and that in tissues of the control （1.112±1.431 and 1.100±1.734）（P<0.01）. There was also a significant difference in Eo% between the HAE（0.448±0.240） and the control（0.110±0.100） groups. Spearman correlation coefficients revealed a positive correlation of TLR2 mRNA in PBMCs with plasma IL-23 level and peripheral blood Eo% in HAE subjects（r=0.368, r=0.382, respectively）.

CONCLUSION

There are increases in TLR2 and TLR4 mNRA expression in PBMCs and in HAE lesions in HAE patients. The TLR2 mNRA expression in PBMCs positively correlates with plasma IL-23 level and peripheral Eo%.

[Research progress on the relationship between osteopontin and hepatic echinococcosis]

Osteopontin is a negatively charged, hydrophilic secreted phosphorylated glycoprotein. It is synthesized and secreted by a variety of cells, and is found in various tissues and cells. The protein is similar in structure to matrix proteins, has the characteristics of cytokines in function and involved in a series of pathological processes. Recent studies confirmed that osteopontin is highly expressed in liver hydatid cyst and may play an important role in cyst formation.

[Treatment of hepatic and intra-abdominal hydatidosis with mebendazole: prospective comparison of the cyclic and the continuous regimen]

AIM

To communicate the results of two different schedules (cyclic and continuous) of mebendazole therapy for hepatic and intraabdominal hydatid disease.

DESIGN

Prospective and randomized.

PATIENTS

26 cases of abdominal hydatid disease.

RESULTS

No significant differences were registered between both groups.

CONCLUSION

Cyclic mebendazole therapy does not improve the results of continuous treatment in abdominal hydatid disease.

Pediatric liver cysts and abscesses

Cystic liver lesions in children pose diagnostic and therapeutic dilemmas. When discovered during evaluation of abdominal distension, the likely cause is benign hepatic cyst. Surgical intervention aimed at resection is highly curative. Echinococcal disease, usually distinguishable from nonparasitic cystic disease, is rare in children in the United States. Therapy is aimed at sterilization and complete excision of hydatid tissue. Cystic liver lesions in septic children represent liver abscesses, pyogenic or amebic, which are frequently fatal if not diagnosed early and treated appropriately. Ultrasonography and computed tomography have simplified the diagnosis and treatment of these diseases, but a high index of suspicion is required because the signs and symptoms of liver abscess in children are nonspecific.

Cerebral alveolar hydatid cyst--case report

A rare case of cerebral alveolar hydatid disease in a 41-year-old female is presented. The larval mass was subtotally removed and the presence of alveolar hydatid cysts established histologically. Postoperatively, slight mental disturbance persisted but paresis did not develop.

Clinical echinococcosis

In 221 patients (0.48% of hospital admissions) with hydatid disease (122 female and 99 males), 81% had single and 19% multiple organs involved. Lungs, liver and spleen as single sites of echinococcosis together represented 83.24% of cases and the liver alone represented 95.24% of instances with multiple organ involvement. One hundred seventy-nine single and 74 multiple cysts (ratio of 2.42/1) represented a total of 363 cysts (1.64 cysts/patient). The incidence of intact cysts was 51.52% and 48.48% had ruptured. Ruptures numbered highest in the lungs (73.44%) and greater in multiple (79.66%) than in single cysts (68.12%). In the liver, 27.14% of single and 54.55% of multiple cysts (40.44% of all liver cysts) had ruptured. Cysts varied in size from 0.8 to 35 cm diameter. Single cysts averaged significantly higher (14.16 cm) and multiple ones lower (5.71 cm) as did intact (6.75 cm) versus reptured cysts (4.33 cm). Except for 10 silent and 15 symptomatic cysts treated medically, all the rest were treated surgically by removal of the endocyst or resection of both endo and exocysts including 205 first, 31 second and 5 third procedures (1.75% of all major operations). Complications occurred in 28.57%. Surgical mortality (3.57%) was markedly lower than with conservative treatment (60%) and significantly less than that of the whole group (14.48%).

[The scope and limitations of cavography in tumour diagnosis (author's transl)]

Fourteen cavograms showing abnormal findings were selected from a total of 500 examinations; in these the diagnosis had been confirmed surgically, histologically, at autopsy or by the clinical course. The aim of selecting this material was to determine retrospectively the accuracy to cavography in localising retroperitoneal masses, to determine their extent, whether it is possible to diagnose the type of tumour and whether the presence of thrombi can be regarded as a sign of invasion of the cava by malignant tumour. The abnormal cavograms were evaluated with respect to certain radiological signs and the diagnostic value of individual signs was calculated statistically. It was found that the only fairly reliable sign of tumour thrombus consists of an ill-defined impression with breaks in the continuity of the vascular margin. All other radiological signs examined were found to be non-specific.

Primary pulmonary involvement in rodents infected with Echinococcus multilocularis

Pulmonary cysts developed in four gerbils and one cotton rat infected orally with Alaskan strain Echinococcus multilocularis eggs. In three cases, liver and lung cysts were similar. Two rodents, however, showed typical fertile pulmonary cysts while the liver foci were small and sterile or necrotic. For these reasons, the lung infections were considered to be primary in origin.