[Thoracic hydatic cysts. An important differential diagnosis to tuberculosis among immigrants]

Hydatid cysts, caused by Echinococcus granulosis, most commonly occur in the liver as a space-occupying lesion; the second most common are lung cysts, whereas rupture into the pleural space occurs very rarely. A case of intra-thoracic hydatid cysts with invasion of the pleural space and rupture into the thoracic muscle is described in a young immigrant from Morocco to Europe (Denmark). Hydatid cyst is an important differential diagnosis from tuberculosis in immigrants from areas with endemic echinococcosis and tuberculosis, such as North Africa and the Middle East.

Epidemiology of alveolar echinococcosis in Xinjiang Uygur autonomous region, China: a preliminary analysis

The Xinjiang Uygur autonomous region (XUAR) in north-western China is known to be endemic for Echinococcosis multilocularis, the causative agent of human alveolar echinococcosis (HAE). Despite regular reports of HAE cases in their region, very little is known about the local epidemiology of the disease or the transmission of E. multilocularis. The epidemiology of HAE in Xinjiang has now been investigated by the analysis of data collected from the medical records of 157 clinical cases who had attended the four main hospitals in the region. These data indicate that the disease is relatively common in the Altai, western Junggar, and Tianshan mountain ranges, whereas the Tarim and Junggar basins are likely to be of low endemicity. The prevalence of the disease in the Kunlun mountains is not clear. Semi-nomadic groups, especially those of Kazakh or Mongol origin, have a higher risk of infection than other ethnic groups. Prevalence of the disease in humans appears to be correlated with aspects of the local climate, such as annual precipitation and temperature. Red foxes, Microtinae, Ochotona spp. and Marmota spp. may be important hosts of E. multilocularis in the XUAR, sustaining the transmission cycles of the parasite.

[The solitary echinococcal cyst--a rare cause of a round pulmonary focus]

HISTORY AND ADMISSION FINDINGS

A 29-year-old man from Kazakhstan presented with right-sided chest pain, cough, whitish sputum and a temperature up to 38.5 degrees C. He had been working in an animal farm for the previous two years.

INVESTIGATIONS

Laboratory tests showed increased inflammatory parameters (WBC 15.9 gpt/l with an increased proportion of band and segmented granulocytes, C-reactive protein (242.3 mg/dl). Chest radiogram showed an infiltration and effusion in the right base judged to be due to pneumonia. In addition there was a round homogeneous mass, 2.5 cm in diameter, at the lateral thoracic wall in the 8th lower lobe segment. Computed tomography (CT) of the lung and mediastinum confirmed these findings. Bronchoscopy, echocardiography, upper abdominal sonography and CT of the skull revealed no other space-occupying lesion.

DIAGNOSIS, TREATMENT AND COURSE

The right-sided pneumonia was successfully treated, at first with ceftriaxone (i.v.), later with ofloxacin (by mouth). An echinococcal cyst was considered especially because of the patient's profession in Kazakhstan in the differential diagnosis of the right-sided round mass and confirmed by an indirect haemagglutination test giving an antibody titre of 1:1024. In response a thoracotomy was performed and the mass, histologically an echinococcal cyst (E. granulosa), resected. There were no other cysts. There was no explanation for the right-sided pneumonia.

CONCLUSIONS

Even though Echinococcosis is rare in Central Europe, it should be included in the differential diagnosis of a round pulmonary mass. A detailed history, especially with regard to occupation and country of origin, is essential. Serological tests for specific Echinococcus antibodies, together with usual imaging procedures, will usually and quickly provide the diagnosis.

Immunological parameters associated with susceptibility or resistance to alveolar hydatid disease in Yupiks/Inupiats

Alveolar hydatid disease (AHD) is a serious and often fatal disease with a relatively high prevalence among the Alaska native Yupik/Inupiat population. In a few patients, however, a spontaneous cure of the disease has been shown by demonstrating the presence of dead metacestode lesions. The present study shows a comparative analysis of the humoral (antibody activity to two different antigens: Em2-antigen and recombinant II/3-10-antigen) immune response and a respective immunogenetic background (HLA-DR typing) in (i) "susceptible" patients who had a still active intrahepatic metacestode and (ii) "resistant" patients who were shown to be spontaneously cured by presenting dead and calcified lesions. Control groups included relatives who were genetically closely related and less related cohabitants of the same villages. Antibody levels in the Em2- and the II/3-10-ELISA were high for patients who had still active lesions and low (Em2-ELISA) or negative (II/3-10-ELISA) for cured patients with dead lesions. Comparative HLA-DR analyses between infected and non-infected Yupiks/Inupiats revealed a slight tendency for susceptibility markers respective to the HLA-DRB1*0901 and HLA-DRB1*1601,02 genes.

Giant hydatid lung cysts in the Canadian northwest: outcome of conservative treatment in three children

Hydatid lung disease due to Echinococcus granulosus in the Canadian northwest and Alaska is often asymptomatic and usually benign. We reviewed the course and outcome of three children with giant hydatid lung cyst seen over a 2-year period. All were North American Indian children aged 9 to 12 years who presented with cough, fever, and chest pain. One had a rash. There was a history of exposure to domestic dogs who had been fed moose entrails in each case. Chest x-rays showed solitary lung cysts with air-fluid levels, from 6 cm to 12 cm in diameter. Aspiration of each cyst demonstrated Echinococcus hooklets and protoscolices. Serology was unhelpful, being negative in two cases. Transient pneumonitis and pneumothorax were seen as complications of needle aspiration. Two cysts gradually resolved over the following 6 months. One child returned after 9 months with a lung abscess due to superimposed infection of the cyst remnant with Haemophilus influenzae, and eventually required lobectomy. The existence of an endemic benign variant of E granulosus in Canada is not widely known, and it is important to distinguish it from the more aggressive pastoral form of the disease seen in immigrants from sheep-rearing countries. The native Canadian disease usually resolves spontaneously, does not cause anaphylaxis, and does not implant daughter cysts if spilled. Surgical treatment should be avoided except for complications such as secondary bacterial infection.

[Pulmonary echinococcosis, hepatic opisthorchiasis and generalized trichinelliasis combined with pregnancy]

A case is reported of a spontaneous abortion (25 weeks of gestation) in a Nenets woman resulting in thrombohemorrhagic syndrome and profuse uterine bleeding. The abortion is attributed to drastic allergization by three parasites: Echinococcus granulosus, Opisthorchis felineus, Trichinella spiralis.

[The characteristics of the clinical course of hydatid pulmonary echinococcosis in the native inhabitants of Chukotka]

23 patients with pulmonary hydatid disease were observed in Chukotka. The patients observed were divided into 2 groups (14 and 9 patients) matched for sex, age, invasion intensity and topography. The patients of the first group were operated after they had been diagnosed, and the patients of the second group were observed without operation. In the both groups, the symptoms of invasion were low expressive, its course was torpid, the complications were rare and the dissemination was not recorded. Two patients observed without operation recovered after the break of the cyst into the bronchus and its evacuation. Relapses of invasion after operation were not recorded in any case. The causes of the good clinical course of pulmonary hydatid disease in the aborigines of Chukotka and the necessity of revising the treatment course are discussed.

[The distribution of ABO system blood groups in patients with unilocular echinococcosis]

The distribution of the AB0 blood groups was investigated in 624 patients with echinococcosis operated on and in 579 persons whose sera were subjected to IHAT with echinococcosis diagnosticum. Higher disease incidence was recorded in patients with the A (II) blood, especially in males, as compared to the controls. Simultaneous involvement of the liver, lungs and other organs was more common in them. Rh-positive patients predominated both in the A (II) and control groups. Blood group distribution with regard to IHAT findings failed to reveal any regular features.