Intervención educativa en una enfermedad desatendida: hidatidosis/ equinococosis quística en escolares del norte de Chile

Introducción: La hidatidosis es una zoonosis cuyo control más eficiente y eficaz es la promoción en salud, especialmente en la población infante-juvenil. Objetivo: Medir el impacto de un programa de intervención educativa sobre hidatidosis en escolares del norte de Chile. Método: Estudio intervencional educativo con fases pre y post test en 3.145 estudiantes de educación preescolar, primaria y secundaria de tres comunas. Se definieron dimensiones, unidades educativas y sistemas de evaluación incorporados en las bases curriculares. Se calculó el puntaje de logro de respuestas correctas utilizando la prueba t. Se estimó el tamaño del efecto mediante d de Cohen y análisis de varianza mixto. Resultados: Se encontraron diferencias estadísticamente significativas en la muestra total y en las variables género, comuna, procedencia rural-urbana y nivel de educación. Los puntajes post intervención fueron mayores y con tamaños de efecto grandes a excepción de los primeros niveles de educación. Se hallaron puntajes mayores post test y efectos de interacción con diferencias significativas en rural-urbano y en comuna anteriormente intervenida. La dimensión mejor evaluada fue "medidas de autocuidado" y la más baja "tenencia responsable de perros". Conclusiones: El programa educativo fue efectivo al ser dirigido a grupos etarios, mediante métodos pedagógicos en las bases curriculares de los establecimientos educacionales.

Background: Hydatidosis is a zoonosis whose most efficient and effective control is health promotion, especially in children and youth. Aim: To measure the impact of an educational intervention program on hydatidosis in schoolchildren in northern Chile. Method: Educational interventional study was performed with pre-post test phases in 3,145 students of preschool, primary and secondary education from three districts. Dimensions, educational units and evaluation systems were defined and incorporated into the curricular bases. The correct answer achievement score was calculated using the T-test. Effect size was estimated using Cohen's d and mixed analysis of variance. Results: Statistically significant differences were found in the total sample and in variables such as gender, district, rural-urban origin and level of education. Post-intervention scores were higher than pre-intervention and with large effect sizes, except for the first levels of education. Higher post-test scores and interaction effects were found with significant differences in rural-urban and in a previously intervened district. The best evaluated dimension was "self-care measures" and the lowest was "responsibly keeping dogs". Conclusions: The educational program was effective when directed to age groups, through pedagogical methods in the curricular bases of educational facilities.

Vigilancia serológica de la zoonosis parasitaria en 13 regiones de la sierra del Perú: Periodo 2016-2019 / Serological surveillance of parasitic zoonoses in 13 highlands regions of Peru: Period 2016-2019

RESUMEN Objetivos. Determinar la seropositividad a anticuerpos anti-IgG por infección de Echinococcus granulosus, Fasciola hepatica y cisticerco de Taenia solium y describir las características de los infectados en 13 regiones de la sierra peruana entre 2016 y 2019. Materiales y métodos. Estudio observacional transversal, que analizó 7811 fichas epidemiológicas de la vigilancia basada en laboratorio de las zoonosis parasitarias del periodo 2016-2019. El diagnóstico se realizó mediante la detección de anticuerpos tipo IgG anti E. granulosus, F. hepatica y cisticerco de T. solium utilizando antígenos nativos mediante el ensayo inmunoabsorbente ligado a enzimas (ELISA) e Inmunoblot. La diferencia en la frecuencia de casos de estas zoonosis según características identificadas se realizó mediante la prueba chi-cuadrado de Pearson y prueba exacta de Fisher. Resultados. Se determinó una seropositividad de 7,9% para fascioliasis, 4,9% para equinococosis quística, y 2,3% para cisticerco de T. solium. Estas frecuencias fueron mayores en Cerro de Pasco para equinococosis quística (24,5%), en Ayacucho para cisticerco de T. solium (4,5%) y en Puno para fascioliasis (40,6%). Entre las características sociodemográficas, se encontró una diferencia estadísticamente significativa en la frecuencia de casos para todas las zoonosis según grupo etario, ocupación, y región de residencia. Además, se encontró diferencia con el consumo de verduras en emolientes, y entre las características clínico-epidemiológicas con tener antecedentes familiares de las zoonosis parasitarias. Conclusiones. A partir de las 7811 muestras evaluadas, se encontró que estas zoonosis parasitarias están distribuidas en 13 regiones de la sierra del Perú, ocasionando un problema de salud importante, con frecuencias que varían según diversas características.

ABSTRACT Objectives. To determine seropositivity to anti-IgG antibodies against Echinococcus granulosus, Fasciola hepatica and Taenia solium cysticercus infection and to describe the characteristics of the infected patients in 13 regions of the Peruvian highlands between 2016 and 2019. Materials and methods. Cross-sectional, observational study, in which we analyzed 7811 epidemiological records of laboratory-based surveillance of parasitic zoonoses from 2016 to 2019. Diagnosis was established by detecting IgG type anti-E. granulosus, F. hepatica and T. solium cysticercus antibodies using native antigens by enzyme-linked immunosorbent assay (ELISA) and Immunoblot. We evaluated the difference in the frequency of the cases according to identified characteristics using Pearson's chi-square test and Fisher's exact test. Results. Seropositivity was 7.9% for fascioliasis, 4.9% for cystic echinococcosis, and 2.3% for T. solium cysticercus. These rates were higher in Cerro de Pasco for cystic echinococcosis (24.5%), in Ayacucho for T. solium cysticercus (4.5%) and in Puno for fascioliasis (40.6%). Regarding the sociodemographic characteristics, we found a statistically significant difference in the frequency of cases for all zoonoses according to age group, occupation, and region of residence. We also found a difference with the consumption of vegetables in emollients, and between clinical-epidemiological characteristics and having a family history of parasitic zoonoses. Conclusions. From the 7811 samples, we found that these parasitic zoonoses are distributed in 13 regions of the Peruvian highlands, and represent a major health problem, with frequencies that change according to different characteristics.

Morphology of Echinococcus granulosus protoscolex / Morfología de los Protoescolex de echinococcus granulosus

SUMMARY: Echinococcus granulosus (E. granulosus), is a tapeworm that spreads between intermediate and definitive hosts through the ingestion of fecal matter contaminated with the parasite's eggs. The life cycle consists of differentiation from eggs to oncospheres to embryos, which eventually form cysts in organs like the liver, lungs and others. Within these cysts are protoscolices, an intermediate stage of the parasite which develop into adult tapeworms once they infect their definitive hosts. When these hydatid cysts form in humans, it is known as Cystic Echinococcosis (CE). This disease is treated through surgical excision of the cysts and or chemotherapy with benzimidazole compounds. Understanding the morphology of the intermediate developmental stage of E. granulosus, protoscolex stage, can allow researchers to identify defining structural changes and protein functions that could be used to develop treatment modalities for CE. Unique characteristics in the tegumental surface during the protoescolex stage and proteins associated with cyst fertility have all been identified in previous research studies and bring researchers closer to understanding the underlying mechanisms of E. granulosus development, and consequently, means to disrupt it to achieve better control of the disease.

El Echinococcus granulosus (E. granulosus), es un cestodo que se propaga entre huéspedes intermedios y definitivos a través de la ingestión de materia fecal contaminada con los huevos del parásito. El ciclo de vida consiste en la diferenciación de huevos a oncosferas y embriones, que finalmente forman quistes en órganos como el hígado, los pulmones y otros. Dentro de estos quistes hay protoescólices, una etapa intermedia del parásito que se convierte en su forma adulta (tenia), una vez que infectan a sus huéspedes definitivos. Cuando estos quistes hidatídicos se desarrollan en seres humanos, se les conoce como equinococosis quística (EC). Esta enfermedad se trata mediante la extirpación quirúrgica de los quistes o la quimioterapia con compuestos benzimidazólicos. La comprensión de la morfología de la etapa de desarrollo intermedia del E. granulosus y la etapa de protosclex, puede permitir a los investigadores identificar cambios estructurales definidos y funciones de proteínas que podrían usarse para desarrollar modalidades de tratamiento para la CE. Las características únicas en la superficie tegumentaria durante la etapa de protoescolex y las proteínas asociadas con la fertilidad del quiste se han identificado en estudios de investigación anteriores y acercan a los investigadores a la comprensión de los mecanismos subyacentes del desarrollo del E. granulosus y, en consecuencia, los medios para interrumpirlo para lograr un mejor control de la enfermedad.

Cystic echinococcosis misdiagnosed as hepatic cyst: a case report / 中国血吸虫病防治杂志

This case report presents the diagnosis and treatment of a case of cystic echinococcosis misdiagnosed as hepatic cyst. The case had anaphylactic shock caused by extravasation of cyst fluid during extraction of hepatic cyst and suffered from postoperative recurrence of echinococcosis. This case report may provide insights into diagnosis and treatment of cystic echinococcosis among healthcare workers in non-endemic areas.

Diagnosis and treatment of 15 cases with hepatic cystic echinococcosis / 中华传染病杂志

Objective:To provide reference for clinical diagnosis and treatment of hepatic cystic echinococcosis by analyzing the clinical characteristics of these patients.Methods:Clinical data of 15 patients with hepatic cystic echinococcosis hospitalized in the Second Hospital of Lanzhou University from April 22, 2019 to March 5, 2022 were collected. The general data, clinical manifestations, abdominal imaging results, treatment and outcome of the included patients were retrospectively analyzed.Results:The age of 15 patients with hepatic cystic echinococcosis ranged from 39 to 78 years, with a median age of 51 years. Among the 15 patients, 12 were farmers, two were freelance workers, and one was unknown. Eleven patients presented with abdominal pain and fatigue, one patient presented with obstructive jaundice, and three patients whom were found by physical examination did not complain of obvious discomfort. Echinococcoid cysts were located at the right lobe of the liver in eight patients, at the left lobe of the liver in five patients, and with multiple lesions in the left and right lobes of the liver in two patients. Two patients received conservative therapy. All the 13 patients who received surgical treatment recovered without complications, such as biliary fistula and subphrenic infection. The clinical symptoms including abdominal pain and fatigue were relieved significantly after surgery. The hospital stay were four to 23 days. All patients were administrated with albendazole (400 mg once daily).Conclusions:Hepatic cystic echinococcosis is more common in the right lobe of the liver, with atypical clinical symptoms. Preoperative imaging diagnosis and postoperative pathological examination are necessary for diagnosis. Surgery is the most effective treatment at present, and albendazole should be taken regularly in all patients.

Exosomes and cystic echinococcosis: systematic review / Exosomas y equinococosis quística: revisión sistemática

SUMMARY: Exosomes are small and single-membrane secreted organelles, up to 200 nm in diameter that have the same topology as the cell, but are enriched in proteins, nucleic acids, lipids, and glycoconjugates. It can be found in any type of body fluids such as plasma, urine, saliva, sperm, bile, etc. On the other hand, cystic Echinococcosis (CE) has been studied from different points of view, among others, from genomics and proteomics, and the presence of CE exosomes in humans and other intermediate hosts has been reported in very few articles. The aim of this review was to report the evidence available regarding exosomes and CE. Systematic review. Data sources: Trip Database, SciELO, WoS, MEDLINE, EMBASE and SCOPUS. Eligibility criteria: Studies related to CEin any type of host and state of the parasite, without language restriction, published between 1966-2021. Variables: Year of publication, geographical origin, species isolated, location of exosomes. Forty-two studies were initially identified. After scrutinizing titles and abstracts, checking duplications and in-depth analysis of the studies selected, 12 articles including human, bovine, sheep, dog samples were also included. All were case reports or case series. The highest proportion of articles was published between 2019 and 2021 (58.3 %). Publications were predominantly from China (58.3 %). Evidence about exosomes and CE is scarce and reduced range of articles and cases.

RESUMEN: Los exosomas son orgánulos pequeños y secretados por una sola membrana, de hasta 200 nm de diámetro que tienen la misma topología que la célula, pero están enriquecidos en proteínas, ácidos nucleicos, lípidos y glicoconjugados. Se puede encontrar en cualquier tipo de fluidos corporales como plasma, orina, saliva, esperma, bilis, etc. Por otro lado, la equinococosis quística (CE) ha sido estudiada desde diferentes puntos de vista, entre otros, desde la genómica y proteómica, y la presencia de exosomas de CE en humanos y otros huéspedes intermediarios se ha informado en muy pocos artículos. El objetivo de esta revisión fue informar la evidencia disponible con respecto a los exosomas y la CE. Revisión sistemática. Fuentes de datos: Trip Database, SciELO, WoS, MEDLINE, EMBASE y SCOPUS. Criterios de elegibilidad: Estudios relacionados con la EC en cualquier tipo de hospedador y estado del parásito, sin restricción de idioma, publicados entre 1966-2021. Variables: año de publicación, origen geográfico, especie aislada, ubicación de exosomas. Se identificaron inicialmente 42 estudios. Después de examinar los títulos y resúmenes, verificar las duplicaciones y analizar en profundidad los estudios seleccionados, se incluyeron 12 artículos que incluían muestras de humanos, bovinos, ovinos y caninos. Todos fueron informes de casos o series de casos. La mayor proporción de artículos se publicó entre 2019 y 2021 (58,3 %). Las publicaciones fueron predominantemente de China (58,3 %). La evidencia sobre exosomas y CE es escasa y la gama de artículos y casos es reducida.

Hepatic cystic echinococcosis complicated with tuberculous empyema misdiagnosed as hepatic and pulmonary cystic echinococcosis: one case report / 中国血吸虫病防治杂志

Hepatic cystic echinococcosis is a chronic parasitic disease caused by the infection with the larvae of Echinococcus granulosus in human or animal liver tissues. As a chronic active infectious disease, tuberculous empyema mainly invades the pleural space and then causes visceral and parietal pleura thickening. It is rare to present comorbidity for hepatic cystic echinococcosis and tuberculous empyema. This case report presents a case of hepatic cystic echinococcosis complicated with tuberculous empyema misdiagnosed as hepatic and pulmonary cystic echinococcosis, aiming to improve clinicians’ ability to distinguish this disorder.

Preparation and characterization of a recombinant poly-epitopic vaccine EgG1Y162-2 (4) against cystic echinococcosis based on the linker GSGGSG / 中国血吸虫病防治杂志

Objective To perform prokaryotic expression and preliminary characterization of the recombinant poly-epitope vaccine EgG1Y162-2 (4) against cystic echinococcosis. Methods The recombinant poly-epitope vaccine EgG1Y162-2 (4) against Echinococcus granulosus based on the linker GSGGSG was subjected to structural three-dimensional (3D) modeling using immunoinformatics to analyze the structural changes and evaluate the antigenicity of the vaccine. The pET30a-EgG1Y162-2 (4) recombinant plasmid was generated using double digestion with EcoR I and Sal I, and then transformed into competent cells. Following protein induction with isopropyl-β-D-thiogalactoside (IPTG), the prokaryotic expression proteins were characterized using Western blotting, and the antigenicity of the recombinant protein was analyzed using sera from cystic echinococcosis patients and health volunteers. Results The four EgG1Y162-2 proteins coupled by the 3D structure of the recombinant vaccine EgG1Y162-2 (4) presented independent and effective expression and good antigenicity. The highest protein expression was detected in the supernatant following induction of the recombinant plasmid pET30a-EgG1Y162-2 (4) by 0.2 mmol/L IPTG at 37 °C for 4 h, and a pure protein component was seen following elution with 60 mmol/L imidazole. Western blotting analysis of the recombinant multiepitope protein HIS-EgG1Y162-2 (4) showed a band at approximately 39 kDa, and this band was recognized by sera from cystic echinococcosis patients. Conclusion A recombinant poly-epitope vaccine EgG1Y162-2 (4) against cystic echinococcosis has been successfully constructed, which provides a preliminary basis for researches on recombinant multi-epitope vaccine against cystic echinococcosis.

Preliminary study on differentially expressed proteins in a mouse model of secondary cystic echinococcosis based on data independent acquisition proteomics / 中国血吸虫病防治杂志

Objective To identify the differentially expressed proteins in different liver tissues in the mouse model of cystic echinococcosis (CE), so as to provide insights into the research and development of therapeutic drugs targeting CE. Methods Female Kunming mice at ages of 6 to 8 weeks were randomly assigned into the CE group and the control group. Mice in the CE group were intraperitoneally infected with 2 000 Echinococcus multilocularis protoscoleces, while mice in the control group were injected with the same volume of physiological saline. All mice in both groups were sacrificed after breeding for 350 d, and the lesions (the lesion group) and peri-lesion specimens (the peri-lesion group) were sampled from the liver of mice in the CE group and the normal liver specimens (the normal group) were sampled from mice in the control group for data independent acquisition (DIA) proteomics analysis, and the differentially expressed proteins were subjected to Gene Ontology (GO) term enrichment analysis and Kyoto Encyclopedia of Genes and Genomes (KEGG) pathway enrichment analysis. Results A total of 26 differentially expressed proteins were identified between the lesion group and the normal group and between the peri-lesion group and the normal group, including 8 up-regulated proteins and 18 down-regulated proteins. GO term enrichment analysis showed that these differentially expressed proteins were predominantly enriched in endoplasmic reticulum membrane (biological components), oxidoreductase activity (molecular function) and oxoacid metabolic process and monocarboxylic acid metabolic process (biological processes). KEGG pathway enrichment analysis revealed that the differentially expressed protein Acyl-CoA oxidase 1 (Acox1), which contributed to primary bile acid biosynthesis during the fatty acid oxidation, was involved in peroxisome signaling pathway, and the differentially expressed protein fatty acid binding protein 1 (Fabp1), which contributed to fatty acid transport, was involved in the peroxisome proliferator-activated receptor (PPAR) signaling pathway. Conclusion Differentially expressed proteins are identified in the liver specimens between mouse models of CE and normal mice, and some differentially expressed proteins may serve as potential drug targets for CE.

Manejo quirúrgico de la hidatidosis hepática en esta última década: ¿qué hemos aprendido? / Surgical management of liver hydatidosis in the last decade: what have we learned?

Resumen El manejo clínico de la hidatidosis hepática es complejo y se basa fundamentalmente en tres pilares: quirúrgico, percutáneo y farmacológico; los cuales en ocasiones pueden ser complementarios. La terapia debe definirse en función de las características, ubicación y tipo de quiste; a lo cual debe sumarse la experiencia del equipo médico, recursos disponibles y la adherencia de los pacientes al monitoreo a largo plazo. La cirugía es el tratamiento más utilizado, las técnicas percutáneas posiblemente puedan reemplazar a la cirugía en casos específicos. Sin embargo, a pesar de los avances en las técnicas quirúrgicas, en el uso de la quimioterapia y otros tratamientos, el manejo de hidatidosis hepática sigue siendo un problema importante, debido principalmente a la falta de consenso sobre qué procedimiento a utilizar es mejor. El objetivo de esta presentación es dar a conocer el amplio abanico de terapias existentes en el actual manejo de la hidatidosis hepática, así como indicar algunas sugerencias en la utilización de cada una de ellas.

The clinical management of hepatic hydatidosis is complex and is fundamentally based on three pillars: surgical, percutaneous and pharmacological; which can sometimes be complementary. Therapy should be defined based on the characteristics, location and type of cyst; to which must be added the experience of the medical team, available resources and the adherence of patients to long-term monitoring. Surgery is the most used treatment, percutaneous techniques can possibly replace surgery in specific cases. However, despite advances in surgical techniques, in the use of chemotherapy and other treatments, the management of liver hydatidosis continues to be a major problem; mainly due to the lack of consensus on which procedure to use is better. The objective of this presentation is to present the wide range of existing therapies in the current management of hepatic hydatidosis and some suggestions in the use of each one of them.

Equinococosis: actualización en terminologías utilizadas desde la biología a la terapéutica / Echinococcosis: update on terminologies used from biology to therapeutics

RESUMEN: El diagnóstico y tratamiento de las equinococosis requiere de la participación de especialistas multidisciplinarios,por lo que, estandarizar la terminología utilizada es fundamental. Para armonizar la terminología sobre bases científicas y lingüísticas sólidas, la Asociación Mundial de Equinococosis generó un proceso de consenso formal. Los principales logros de este proceso fueron: realizar una actualización de la nomenclatura actual de Echinococcus spp.; generar un acuerdo sobre nombres de enfermedades causadas por Echinococcus spp.: equinococosis quística (EQ), equinococosis alveolar (EA) y equinococosis neotropical (NE), y la exclusión de los demás nombres; ejecutar un acuerdo sobre el uso restringido del adjetivo "hidatido" para referirse al quiste y al líquido debido a E. granulosus sensu lato; y un acuerdo sobre una descripción estandarizada de las intervenciones quirúrgicas para EQ, de acuerdo con el marco de "Acceso, Apertura, Resección e Integridad del quiste" (AARI). Además, se enumeraron 95 términos "aprobados" y 60 "rechazados". Las recomendaciones proporcionadas serán aplicables a publicaciones científicas y comunicación con profesionales. El objetivo de este manuscrito fue generar un documento de estudio referente al uso de terminología actualizada en echinococcosis desde la biología a la terapéutica.

SUMMARY: The diagnosis and treatment of echinococcosis requires the participation of different multidisciplinary specialists Therefore, standardizing the terminology used is essential. To harmonize terminology on a sound scientific and linguistic basis, the World Echinococcosis Association generated a formal consensus process. The main achievements of this process were to update the current nomenclature of Echinococcus spp .; to generate an agreement on names of diseases caused by Echinococcus spp .: cystic echinococcosis (CE), alveolar echinococcosis (EA) and neotropical echinococcosis (NE), and the exclusion of other names; execute an agreement on the restricted use of the adjective "hydatid" to refer to the cyst and the fluid due to E. granulosus sensu lato; and an agreement on a standardized description of surgical interventions for CE, according to the framework of "Cyst Access, Opening, Resection and Integrity" (AARI). In addition, 95 "approved" and 60 "rejected" terms were listed. The recommendations provided will be applicable to scientific publications and communication with professionals. The aim of this manuscript was to generate a study document referring to echinococcosis from biology to therapy.

Hidatidosis esplénica: resultados de una serie de casos consecutiva intervenidos quirúrgicamente / Splenic hydatidosis: results of a series of consecutive cases undergoing surgery

INTRODUCCIÓN: La echinococcosis esplénica (EE), suele ser una enfermedad asintomática cuyo diagnóstico se plantea de forma incidental. OBJETIVO: Determinar morbilidad post-operatoria (MPO) y recurrencia en pacientes intervenidos quirúrgicamente por EE. Material y MÉTODO: Serie de casos con seguimiento, de pacientes con EE intervenidos de forma consecutiva, entre 2000 y 2018. Las variables resultado fueron MPO y recurrencia. Otras variables de interés fueron: diámetro y localización del quiste, tipo de cirugía, tiempo quirúrgico, estancia hospitalaria, y mortalidad. Los pacientes fueron seguidos de forma clínica y con imágenes por un mínimo de 18 meses. Se utilizó estadística descriptiva, con medidas de tendencia central y dispersión. RESULTADOS: Se intervinieron 26 pacientes (53,8% hombres), con una mediana de edad de 41,5 años. Las medianas del diámetro de los quistes, el tiempo quirúrgico y el tiempo de hospitalización fueron 14,5 cm; 65 minutos y 4,5 días, respectivamente. La MPO fue 11,5% (3 casos). No hubo mortalidad. Con una mediana de seguimiento de 94 meses, se verificó una recurrencia de 3,8%. CONCLUSIÓN: Los resultados verificados, en términos de MPO, mortalidad y recurrencia son apropiados en comparación a otras series publicadas.

BACKGROUND: Splenic echinococcosis (SE) is usually an asymptomatic disease whose diagnosis is made incidentally. Aim: To determine postoperative morbidity (POM) and recurrence in patients who underwent surgery for SE. METHODS: Case series with follow-up, of patients with SE operated on, consecutively, between 2000 and 2018. The outcome variables were POM and recurrence. Other variables of interest were diameter and location of the cyst, type of surgery, surgical time, hospital stay, and mortality. The patients were followed up clinically and with images for a minimum of 18 months. Descriptive statistics were used, with measures of central tendency and dispersion. RESULTS: Twenty-six patients (53.8% men), with a median age of 41.5 years, underwent surgery in this period. The medians of cysts diameter, surgical time and hospital stay were 14.5 cm, 65 min, and 4.5 days respectively. POM was 11.5% (3 cases). There was no mortality. With a median follow-up of 94 months, a recurrence of 3.8% was verified. CONCLUSION: Verified results, in terms of POM, mortality and recurrence are appropriate in comparison with those of series of similar size and follow-up.

Primary liver cancer complicated by hepatic cystic echinococcosis: a case report / 中国血吸虫病防治杂志

A primary liver cancer patient complicated by hepatic cystic echinococcosis was reported. The case was admitted to the hospital due to intermittent upper abdominal discomfort for more than half a month, and an auxiliary examination revealed primary liver cancer complicated by hepatic cystic echinococcosis. Then, hepatic artery infusion and chemoembolization was performed, and no treatment was given to cystic echinococcosis lesions. Following treatment, the patient had remarkable improvements in the liver functions.

Cystic echinococcosis of the waist and hip: a case report / 中国血吸虫病防治杂志

A patient with cystic echinococcosis was presented with primary lesions in the waist and hip. The case was misdiagnosed as subcutaneous abscess at initial diagnosis, and then definitively diagnosed as echinococcosis by means of imaging examinations and anti-Echinococcus antibody test. This case was reported with aims to improve the awareness of cystic echinococcosis among clinical physicians to avoid and reduce the misdiagnosis and missing diagnosis.

Hydatid cyst in the cervical spinal cord complicated by potentially life-threatening difficult airway: a case report / Cisto hidático na medula cervical complicada por via aérea difícil com potencial risco de vida: relato de caso

Abstract Hydatid cyst in the cervical region is an extremely rare condition that can create challenges for anesthesiologists. Timely recognition of difficult airway and preparing the management plan is crucial to avoid life-threatening complications such as hypoxic brain damage. We describe a case of difficult airway management in a patient with massive cervical hydatid cyst. We used a low-dose ketamine-propofol sedation and lidocaine spray for local oropharyngeal anesthesia. Muscular relaxants were not used, and spontaneous breathing was maintained during intubation. Recognition, assessment, and perioperative planning are essential for difficult airway management in patients with cervical hydatid cyst.

Resumo O cisto hidático na região cervical é uma condição extremamente rara que pode criar desafios para os anestesiologistas. O reconhecimento oportuno das vias aéreas difíceis e a preparação do plano de manejo são cruciais para evitar complicações com risco de vida, como danos cerebrais hipóxicos. Descrevemos um caso de difícil controle das vias aéreas em um paciente com cisto hidático cervical maciço. Utilizamos sedação com cetamina-propofol em baixa dose e spray de lidocaína para anestesia local orofaríngea. Relaxantes musculares não foram utilizados e a respiração espontânea foi mantida durante a intubação. O reconhecimento, a avaliação e o planejamento perioperatório são essenciais para o manejo difícil das vias aéreas em pacientes com cisto hidático cervical.

Pulmonary hydatid cyst in children

Hydatidosis is a zoonotic parasitic disease with global existence caused by tapeworm of family Taeniidae and genus Echinococcus. It is transmitted by feco oral route or direct contact with dogs. A 7-year-old female was admitted with cough, fever, chest pain and history of contact with dog. Chest radiography showed round to oval mass with air fluid level while ultrasonography of thorax was suggestive of a large cystic lesion in right mid zone with dense moving echo and multiple hyper echoic foci with connected artifacts without calcification. Computerized tomography showed large cystic lesion containing fluid with air within it in right mid zone. Initially cystic aspiration followed by pericystectomy was done. Health education, hand washing practices, creating awareness and protection of intermediate host by vaccine will help to control the disease.

Antihydatic and immunomodulatory effects of Algerian propolis ethanolic extract: In vitro and in vivo study

Objective: To evaluate the in vitro and in vivo effect of the Algerian propolis ethanolic extract (EEP) against Echinococcus granulosus (E. granulosus) infection. Methods: In vitro scolicidal activity of EEP was investigated on the protoscolices of hydatid cyst. This in vitro study was conducted by using an in vivo assay. BALB/c mice were inoculated with E. granulosus and treated with propolis for three months. Hydatid cysts development was assessed. Nitric oxide (NO), tumor necrosis factor alpha (TNF-α) production and inducible NO synthase, NF-κB, and TNF-α spleen expression were estimated by Griess method and immunofluorescence respectively. Results: Our study revealed that EEP has a high scolicidal activity against E. granulosus. Oral administration of EEP decreased TNF-α, NF-κB and inducible NO synthase expression in the spleen tissues in the CE+EEP group, in comparison with the CE group. Concomitantly, EEP treatment caused an important systemic decrease in NO and TNF-α levels. These findings are associated with the reduction of CE development. Conclusions: This is the first report demonstrating with interest the antihydatic and immunomodulatory effects of the Algerian EEP, suggesting its therapeutic potential for the hydatid disease treatment.

Risk factors of human cystic echinococcosis in Shiqu County Sichuan Province: a case-control study / 中国血吸虫病防治杂志

Objective To identify the main risk factors of human cystic echinococcosis in Shiqu County, Sichuan Province, so as to provide the reference for the formulation of echinococcosis control strategies in Shiqu County. Methods During the period from November 2015 through June 2017, the patients with cystic echinococcosis (case group) and healthy controls (control group) were randomly sampled from Shiqu County as the study subjects. A questionnaire survey was conducted to capture the study subjects’age, gender, ethnicity, occupation, religion, lifestyle, education level, number of household dogs, bovine and sheep, and density of dog feces in the courtyard. The major risk factors of human cystic echinococcosis were identified using a logistic regression model. Results Univariate logistic regression analysis showed 7 risk factors with statistical significance between the case and control groups, and age, lifestyle, number of household bovine, number of household sheep, number of house-hold dogs, and the density of dog feces in the courtyard were included in the multivariate logistic regression model (OR = 1.026, 4.792, 1.067, 1.022, 1.709 and 1.095, respectively). Conclusion High age, pastoral nomadic lifestyle, high number of house-hold bovine, high number of household sheep, high number of household dogs and high density of dog feces in the courtyard are strongly associated with the riks of human cystic echinococcosis in Shiqu County.

Surgical treatment strategy for complex hepatic echinococcosis: a review / 中国血吸虫病防治杂志

The hepatic echinococcosis is an anthropozoonosis and caused by the larva of Echinococcus. The main pathogenic type of Echinococcus in China is E. granulosus and E. multilocularis, which cause cystic echinococcosis and alveolar echinococcosis respectively. At present, the treatment of hepatic echinococcosis has made great progress, but there are still some difficulties in the treatment of complex echinococcosis, especially of the cases existing one or more complications, and the focus of infection encroaching the hepatic portal, important vessels and bile vessel. This paper based on the literature reports and clinical experiences in recent years, puts forward the surgical treatment strategy for complex hepatic echinococcosis.

Imaging analysis of 79 cases of hepatic echinococcosis / 中国血吸虫病防治杂志

Objective To analyze the imaging manifestations of 79 cases of hepatic echinococcosis retrospectively, so as to provide evidences for improving the diagnosis and differential diagnosis of the disease. Methods Seventy-nine patients with hepatic echinococcosis who underwent imaging examinations and pathologic confirmation in Qinghai Provincial People’s Hospital from 2014 to 2017 were chosen as the investigation objects, and the data of their medical records and imaging manifestations were collected and analyzed. Results Among the 79 cases of hepatic echinococcosis, 57 were suffered from cystic echinococcosis (CE) and 22 were suffered from alveolar echinococcosis (AE) . Among the patients with CE, those in single cystic type, multiple cysts type, internal capsule collapse type, solid type, and calcification type were 21, 16, 9, 4 cases and 7 cases respectively. The imaging signs of 62 cases were common. The image of the single cystic type was characterized by intrahepatic cystic water-like lesions, the cystic wall was thin and uniform without any enhancement. The multiple cysts were characterized by "cyst in the cyst", "rose petals", and "spoke wheel". The collapse and separation of the internal capsule was manifested as "drift belt sign" and "double ring sign", the calcification of the cyst wall was curved and eggshell-shaped, the contents of the cyst were cotton-shaped or the whole lesion was calcific. The image of the patients with AE was manifested as a solid mass in the liver, the density and signal were heterogeneous, the edge was irregular and not obviously enhanced, the "small vesicles" scattered in the lesion were often accompanied by calcification, and the whole lesion showed a map appearance. The other 17 cases of hepatic echinococcosis showed complex and rare imaging features. The capsules of 6 cases of CE contained fat, the images presented single or multiple fat density nodules in the hepatic hydatid cyst, and CT value was –28 to –84 HU; in 4 cases of echinococcosis, the lesions were broken into the bile duct, the density of adjacent bile duct was increased, with bile duct wall thickening and peripheral biliary dilatation. For the 4 cases of echinococcosis combined with primary liver cancer, the imaging manifestations of the hepatic cysts presented solid-mass enhancement, with "fast forward and fast out" performance. For the image of the 3 cases of CE with infection, the cystic wall was thickening and enhanced obviously, of these, 2 cases had gaseous shadows in the cyst, 1 patient’s cyst was complicated with infection and it invaded the abdominal wall. Conclusion The imaging manifestations of hepatic echinococcosis are varied and complicated, which need careful analysis for differential diagnosis.