Hidatidosis mesentérica y hepática en la costa caribe colombiana. Reporte de caso / Mesenteric and hepatic hydatid disease on the Colombian Caribbean coast. Case report

Introducción. La hidatidosis o equinococosis es una zoonosis parasitaria que se adquiere al ingerir huevos de cestodos del género Echinococcus. El diagnóstico clínico raramente se hace en sitios no endémicos. La mayoría de los pacientes se encuentran asintomáticos y los hallazgos incidentales en los estudios de imágenes o en procedimientos quirúrgicos permiten la sospecha diagnóstica. Caso clínico. Paciente masculino de 70 años, residente en área rural del municipio de Puerto Libertador, departamento de Córdoba, Colombia, quien consultó por masa abdominal en epigastrio y mesogastrio, parcialmente móvil e indolora. Resultados. En cirugía se identificaron lesiones quísticas mesentérica y hepática. Después de la cirugía y mediante estudios de inmunohistoquímica, se confirmó el diagnóstico de quiste hidatídico. El paciente tuvo una evolución satisfactoria. Conclusión. La hidatidosis quística mesentérica y hepática sintomática es una enfermedad rara en sitios no endémicos, donde la cirugía constituye un pilar fundamental en el diagnóstico y tratamiento, sumado al manejo médico farmacológico.

Introduction. Hydatidosis or echinococcosis is a parasitic zoonosis that is acquired by ingesting eggs of cestodes of the genus Echinococcus. Clinical diagnosis is rarely made in non-endemic sites. Most patients are asymptomatic and incidental findings on imaging studies or surgical procedures allow for diagnostic suspicion. Clinical case. A 70-year-old male patient, resident in a rural area of the municipality of Puerto Libertador, department of Córdoba, Colombia, who consulted for an abdominal mass in the epigastrium and mesogastrium, partially mobile and painless. Results. In surgery, mesenteric and hepatic cystic lesions were identified. After surgery and through immunohistochemistry studies, the diagnosis of hydatid cyst was confirmed. The patient had a satisfactory evolution. Conclusion. Symptomatic mesenteric and hepatic cystic hydatidosis is a rare disease in non-endemic sites, where surgery constitutes a fundamental pillar in the diagnosis and treatment in addition to pharmacological medical management.

Estrategias de control de la Equinococosis quística en el Uruguay / Strategies for the control of cystic echinococcosis in Uruguay / Estratégias de controle da equinococose cística no Uruguai

La equinococosis quística es una zoonosis de origen parasitario con distribución cosmopolita. En nuestro país continúa siendo una enfermedad endémica, afectando principalmente pequeños centros poblados y áreas rurales pobres relacionadas a la producción ovina. Los planes de control requieren de un abordaje holístico, con la participación de diferentes instituciones, profesionales y en especial de la comunidad. La cooperación regional busca monitorizar el avance de la enfermedad y centrar las medidas de acción sobre cuatro ejes, definidos según los puntos de intervención más comunes para la quiebra del ciclo de transmisión y la consecuente reducción en incidencia y prevalencia de la enfermedad. La presente revisión utilizó literatura obtenida en diferentes bases de datos, bibliotecas virtuales y sitios web regionales y locales con el objetivo describir las principales estrategias de control, vigilancia y prevención aplicadas actualmente en nuestro país.

Cystic echinococcosis is a zoonosis of parasitic origin with cosmopolitan distribution. In our country it continues to be an endemic disease, affecting mainly small population centers and poor rural areas related to sheep production. Control plans require a holistic approach, with the participation of different institutions, professionals and especially the community. Regional cooperation seeks to monitor the progress of the disease and focus action measures on four axes, defined according to the most common points of intervention to break the transmission cycle and consequently reduce the incidence and prevalence of the disease. This review used literature obtained from different databases, virtual libraries and regional and local websites with the aim of describing the main control, surveillance and prevention strategies currently applied in our country.

A equinococose cística é uma zoonose de origem parasitária com distribuição cosmopolita. Em nosso país, continua a ser uma doença endêmica, afetando principalmente pequenos centros populacionais e áreas rurais pobres relacionadas à produção de ovinos. Os planos de controle exigem uma abordagem holística, com a participação de diferentes instituições, profissionais e, principalmente, da comunidade. A cooperação regional busca monitorar o progresso da doença e concentrar as medidas de ação em quatro eixos, definidos de acordo com os pontos de intervenção mais comuns para interromper o ciclo de transmissão e, consequentemente, reduzir a incidência e a prevalência da doença. Esta revisão utilizou a literatura obtida em diferentes bases de dados, bibliotecas virtuais e sites regionais e locais com o objetivo de descrever as principais estratégias de controle, vigilância e prevenção aplicadas atualmente em nosso país.

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.

Hidatidosis pancreática en una niña de 5 años / Pancreatic echinococcosis in a 5-year-old girl

La hidatidosis pancreática representa el 0,2-0,6 % de los casos, siendo la población pediátrica la de mayor riesgo. Las lesiones suelen localizarse en cabeza del páncreas (50-58 %); la localización en cuerpo y cola del páncreas se encuentra en el 24-34 % y el 19 %, respectivamente. Dada la posibilidad de complicaciones, suele realizarse tratamiento quirúrgico. Se sugiriere indicar albendazol antes y después del acto quirúrgico por los riesgos de ruptura y diseminación de los protoescólices. Se presenta el caso de una niña de 5 años de edad con dolor abdominal progresivo y lesión quística en páncreas compatible con hidatidosis en la ultrasonografía. En la tomografía computada se observa compresión de la vía biliar. La hemoaglutinación indirecta fue negativa. Presentó elevación de la bilirrubina total, con franco predominio de bilirrubina directa, y aumento de enzimas hepáticas. Se realizó laparotomía exploradora, colecistectomía y destechamiento del quiste. Evolucionó favorablemente, continuó con albendazol durante 3 meses luego de la cirugía.

Pancreatic echinococcosis accounts for 0.2­0.6% of cases, with the pediatric population being at a higher risk. Most commonly, pancreatic lesions occur in the head of the pancreas (50­58%); and in the body and tail in 24­34% and 19% of cases, respectively. Given the potential complications, surgery is usually performed. Albendazole is recommended before and after the surgery due to the risks for rupture and dissemination of protoscolices. Here we describe the case of a 5-year-old girl with progressive abdominal pain and cystic lesion in the pancreas compatible with echinococcosis in the ultrasound. The computed tomography showed bile duct compression. Indirect hemagglutination was negative. She had elevated total bilirubin, with a clear predominance of direct bilirubin, and high liver enzymes. Exploratory laparotomy, cholecystectomy, and unroofing of the cyst were performed. The patient had a favorable course and continued with albendazole for 3 months after the surgery.

Hidatidosis pulmonar: Reporte de casos y preludio endémico de la equinococosis quística humana en Paraguay / Pulmonary hydatidosis: Case report and endemic prelude to human cystic echinococcosis in Paraguay

El Paraguay integra la Iniciativa Sudamericana para el Control y Vigilancia de Equinococosis Quística. Con el fin de optimizar los informes epidemiológicos sobre hidatidosis, presentamostres casos clínicos vistos en centros nacionales y realizamos una revisión de la literatura local sobre el tópico. Desde 1969 hasta la fecha se describen 70casos de equinococosis quística. Se requieren estudios epidemiológicos sistemáticos para evaluar el grado de penetración, la distribución geográfica y las características de transmisión de esta enfermedad en nuestro país.Palabras clave: equinococosis;equinococosispulmonar; equinococosis hepática; equinococcus granulosus; zoonosis.

Paraguay is a member of the South American Initiative for the Control and Surveillance of Cystic Echinococcosis. In order to optimize the epidemiological reports on hydatidosis, we present three clinical cases seen in national centers and we carry out a review of the local literature on the topic. From 1969 to date, 70cases of cystic echinococcosis have been described. Systematic epidemiological studies are required to assess the degree of penetration, geographic distribution, and transmission characteristics of this disease in our country.Key words:echinococcosis;echinococcosispulmonar;echinococcosishepatic;echinococcus granulosus; zoonoses.

Immunology of a unique biological structure: the Echinococcus laminated layer

The larval stages of the cestode parasites belonging to the genus Echinococcus grow within internal organs of humans and a range of animal species. The resulting diseases, collectively termed echinococcoses, include major neglected tropical diseases of humans and livestock. Echinococcus larvae are outwardly protected by the laminated layer (LL), an acellular structure that is unique to this genus. The LL is based on a fibrillar meshwork made up of mucins, which are decorated by galactose-rich O-glycans. In addition, in the species cluster termed E. granulosus sensu lato, the LL features nano-deposits of the calcium salt of myo-inositol hexakisphosphate (Insp6). The main purpose of our article is to update the immunobiology of the LL. Major recent advances in this area are (i) the demonstration of LL "debris" at the infection site and draining lymph nodes, (ii) the characterization of the decoy activity of calcium Insp6 with respect to complement, (iii) the evidence that the LL mucin carbohydrates interact specifically with a lectin receptor expressed in Kupffer cells (Clec4F), and (iv) the characterization of what appear to be receptor-independent effects of LL particles on dendritic cells and macrophages. Much information is missing on the immunology of this intriguing structure: we discuss gaps in knowledge and propose possible avenues for research.

Hidatidosis quística simulando una neoplasia hepática invasiva / Cystic hydatidosis simulating an invasive hepatic neoplasia

La hidatidosis/equinococosis quística es una infección zoonótica, endémica en muchos países de América del Sur, caracterizada por lesiones hepáticas que radiológicamente pueden simular neo-plasias malignas de aspecto quístico y que, dependiendo del tiempo de evolución y del grado de obstrucción de la vía biliar, pueden cursar con insuficiencia hepática, por lo cual es importante un diagnóstico oportuno. Presentamos el caso de un paciente masculino de 35 años, sin antecedentes patológicos de importancia, perteneciente a una comunidad indígena y residente de una zona rural de Colombia, quien presentó un cuadro clínico y pruebas de laboratorio sugestivos de obstrucción de la vía biliar, la cual fue confirmada con el hallazgo de una masa hepática quística infiltrante en los estudios imagenológicos, sospechándose inicialmente una etiología neoplásica maligna. El paciente finalmente falleció tras procedimiento quirúrgico, y su estudio histopatológico reveló una hidatidosis quística como diagnóstico definitivo.

Cystic echinococcosis/hydatidosis is a zoonotic infection, endemic in many South American coun-tries, characterized by liver lesions that radiologically can simulate malignant neoplasms with a cystic appearance, and depending on the time of progression and degree of obstruction of the bile duct, can present with liver failure, so a prompt diagnosis is important. We present the case of a 35-year-old male patient, with no significant pathological history, from an indigenous community and resident of a rural area in Colombia, who presented clinical symptoms and laboratory tests suggestive of bile duct obstruction, which was confirmed with the finding of an infiltrating cystic liver mass in imaging studies, initially suspecting a malignant neoplastic etiology. The patient developed a fulminant course after surgery, and the histopathological study revealed cystic hydatidosis as the definitive diagnosis.

Estudio morfocuantitativo de protoescólices y otras estructuras fundamentales de Echinococcus granulosus en hospederos humanos / Morphoquantitative study of protoscolices and other fundamental structures of Echinococcus granulosus in human hosts

La equinococosis quística (EQ) a pesar de ser una enfermedad endémica en diversos lugares del planeta, presenta pocos estudios morfológicos y cuantitativos de las estructuras fundamentales del Echinococcus granulosus en humanos, en especial de los protoescólices. El objetivo de este estudio fue analizar morfocuantitativamente protoescólices y otras estructuras fundamentales de E. granulosus obtenidos de hospederos humanos. Estudio de corte transversal. Se estudiaron 8 especímenes de EQ hepática humana, aplicando un muestreo no probabilístico por conveniencia. Se evaluó las capas quísticas, el líquido y la arenilla hidatídica. Las capas fueron fijadas en formaldehido tamponado a 10 % y procesadas para su inclusión en paraplast. Se realizaron cortes de 5 µm de grosor y fueron teñidas con H-E para su análisis con microscopía óptica. El líquido y arenilla fueron centrifugados y al sedimento obtenido se le realizó análisis directo para determinar las medidas morfométricas de los protoescólices y de los ganchos grandes y pequeños. Se utilizó estadística descriptiva. De los 8 quistes estudiados, 6 eran quistes univesicular, uno multivesicular y un quiste abscedado, cuyas capas laminada y germinativa se encontraban bien definidas. Las vesículas prolígeras presentaban forma redondeada con protoescólices en su interior. Los protoescólices invaginados presentaron un largo y ancho promedio de 140,8 ± 34,3 µm y 106,2 ± 29,5 µm, respectivamente; y los desarrollados un largo de 237,2 ± 53,0 µm y ancho de 128,7 ± 32,0 µm. Los ganchos rostelares presentaron contornos suaves distribuidos en dos filas regulares. El promedio del largo total de los ganchos grandes y pequeños fue 20,1 ± 2,7 µm; el promedio del ancho total fue 7,4 ± 1,2 µm. En conclusión, las características morfocuantitativas de los ganchos de E. granulosus en humanos, son distintos a otras especies hospederas intermediarias y de otros Echinococcus spp. Es posible que el abandono del estado de resistencia de los protoescólices invaginado hasta su desarrollo genere implicancias epidemiológicas de interés.

SUMMARY: Although cystic echinococcosis (CE) is an endemic disease in several parts of the world, few morphological and quantitative studies of the fundamental structures of Echinococcus granulosus in humans, especially protoscolices. The aim of this study was to perform a morphoquantitative analysis of protoescolex and other fundamental structures of E. granulosus from human hosts. Cross- sectional study. Eight human hepatic EQ specimens were studied, applying non-probabilistic convenience sampling. Cystic layers, fluid and hydatid grit were evaluated. The layers were fixed in 10% buffered formaldehyde and processed for embedding in paraplast. Slices of 5 µm thickness were made and stained with H-E for light microscopic analysis. The liquid and grit were centrifuged and the sediment obtained was analyzed directly to determine the morphometric measurements of the protoscolices and the large and small hooks. Descriptive statistics were used. Of the 8 cysts studied, 6 were univesicular cysts, one multivesicular and one abscessed cyst, whose lamellar and germinative layers were well defined. The proligerous vesicles had a rounded shape with protoscolices inside. The invaginated protoscolices had an average length and width of 140.8 ± 34.3 µm and 106.2 ± 29.5 µm, respectively; and the developed ones had a length of 237.2 ± 53.0 µm and width of 128.7 ± 32.0 µm. The rostellar hooks presented smooth contours distributed in two regular rows. The average total length of the large and small hooks was 20.1 ± 2.7 µm; the average total width was 7.4 ± 1.2 µm. In conclusion, the morphoquantitative characteristics of E. granulosus hooks in humans are distinct from other intermediate host species and from other Echinococcus spp. It is possible that the abandonment of the resistance state of the invaginated protoscolices until their development generates epidemiological implications of interest.

Compresión medular por quiste hidático de partes blandas: reporte de un caso / Compression of the bone marrow caused by hydatid cyst of the soft tissues: a case report from Sociedad Médica Universal / Compressão da medula espinhal devido a cisto hidático de partes moles: relato de um caso

El quiste hidatídico en Uruguay continúa siendo un problema de salud pública. A pesar de los esfuerzos realizados en prevención primaria y secundaria, es una patología con alta incidencia. La hidatidosis de partes blandas es infrecuente. Su incidencia se estima en 0,5% a 5,3%. El objetivo de esta publicación es presentar un caso clínico de un paciente portador de una compresión medular, producto de una hidatidosis muscular lumbar complicada, hecho extremadamente infrecuente. Los sitios más frecuentes de infestación por equinococosis hidatídica son hígado (75%), pulmones (15%) cerebro (2-4%) tracto genitourinario (2%-3%). La afectación espinal ocurre en menos del 1%. Los síntomas de compresión no son habituales, pero es una de las posibles complicaciones, hecho que motiva la publicación del caso clínico.

Summary: Hydatid cyst continues to be a public health problem in Uruguay despite efforts made in primary and secondary prevention, and in fact, its incidence is high. Hydatid cyst of the soft tissues is rather unusual. Estimated incidence ranges between 0.5 and 5.3%. The study aims to present the clinical case of a patient carrier of bone marrow compression caused by a complicated lumbar hydatid cyst, something significantly rare. Liver (75%), lungs (15%), brain (2-4%), genitourinary tract (2-3%) are the most frequent sites where hydatid cyst is found. Spinal cord compromise occurs in less than 1%. Compression symptoms are not frequent, although it is one of the potential complications, what resulted in the clinical case being published.

O cisto hidático continua sendo um problema em nível de saúde pública no Uruguai, mesmo com os esforços realizados na prevenção primária e secundária, sendo uma patologia com alta incidência. A hidatidose dos tecidos moles é rara; sua incidência é estimada em 0,5% a 5,3%. O objetivo desta publicação é apresentar o caso clínico de um paciente com compressão medular, produto de uma complicada doença hidática muscular lombar, evento extremamente raro. Os locais mais frequentes de infestação por equinococose hidática são fígado (75%), pulmões (15%), cérebro (2-4%) e trato geniturinário (2-3%). O envolvimento da coluna ocorre em menos de 1% dos casos. Os sintomas de compressão não são comuns, mas é uma das possíveis complicações e motivo da publicação deste caso clínico.

Paciente con quistes pulmonares y diagnóstico de coinfección con tuberculosis e hidatidosis: reporte de un caso pediátrico / Patient with pulmonary cysts and diagnosis of co-infection with tuberculosis and hydatidosis. Pediatric cases report

Existen numerosas entidades en la población pediátrica que pueden presentarse en forma de quistes o como lesiones de similares características. De estas patologías, las infecciosas son las más frecuentes. Se presenta el caso de una paciente oriunda de Bolivia con migración reciente a la Argentina que presentó una coinfección con tuberculosis e hidatidosis pulmonar. Ambas infecciones se pueden presentar con signos y síntomas similares y, aunque la asociación citada es poco frecuente en la bibliografía, ciertos mecanismos inmunitarios podrían intervenir en la coinfección de parásitos helmintos y micobacterias. Ambas patologías son infecciones prevalentes en nuestra región y deben ser tenidas en cuenta entre los diagnósticos diferenciales ante pacientes con imágenes quísticas o cavitarias pulmonares.

Numerous entities in the pediatric population can present in the form of cysts or as lesions with similar characteristics. Of the pathologies that can cause these images in children, infectious diseases are the most frequent. We present the case of a native of Bolivia with recent immigration to Argentina who presented a pulmonary co-infection with tuberculosis and hydatidosis. Both infections can present with similar signs and symptoms and although this association is rarely reported in the literature, certain immunological mechanisms could intervene in the causal association of co-infection between helminth parasites and mycobacteria. Both pathologies are very prevalent infections in our region and should be taken into account among the differential diagnoses in patients with cystic or cavitary pulmonary diseases.

Hidatidosis esplénica gigante primaria en una gestante: reporte de caso / Primary giant splenic hydatid disease in a pregnant woman: case report

La hidatidosis es considerada en la actualidad como un problema de salud pública en el Perú. Es una infección parasitaria trasmitida por la ingesta de huevos de Echinococcus granulosus y los órganos más comprometidos son el hígado y los pulmones, siendo rara la afectación del bazo. Presentamos el caso de una gestante joven con dolor abdominal y sensación de masa en hipocondrio izquierdo. El estudio ecográfico reveló imagen quística multitabicada en hemiabdomen izquierdo, con feto viable. Se le realizó cesárea, seguido de laparotomía exploratoria y se halló una tumoración gigante de bazo que, según el estudio anatomopatológico corresponde a una hidatidosis esplénica multiquística. Asimismo, como complicación fetal ocurrió restricción del crecimiento intrauterino. La paciente evolucionó favorablemente sin recurrencia de focos hidatídicos, mientras que el neonato mostró un patrón de crecimiento adecuado.

Hydatidosis is currently considered a public health problem in Peru. It is a parasitic infection transmitted by the ingestion of eggs of Echinococcus granulosus. The most involved organs are the liver and lungs, with spleen involvement being rare. We present the case of a young pregnant woman with abdominal pain and a sensation of mass in the left hypochondrium. The ultrasound study revealed a multiloculated cystic image in the left hemiabdomen, and a viable fetus. She underwent cesarean section, followed by exploratory laparotomy, which revealed a giant spleen tumor that, according to the anatomopathological study, corresponded to multicystic splenic hydatid disease. Likewise, intrauterine growth restriction was found as a fetal complication. The patient progressed favorably without recurrence of hydatid foci and the neonate had an adequate growth pattern.

Mortalidad por parasitosis endémicas e importadas en Chile. 1997-2020 / Mortality due to endemic and imported parasitoses in Chile. 1997-2020

INTRODUCCIÓN: Las parasitosis son un problema de salud pública mundial por su alta prevalencia en países en vías de desarrollo, su persistencia en países desarrollados debido principalmente por la migración de personas, y por su morbi-mortalidad asociada. OBJETIVO: Determinar las defunciones causadas por parasitosis endémicas e importadas en Chile, según región, sexo, grupo etario, procedencia urbana/rural y nivel educacional, y estimar tasas de mortalidad. MÉTODO: Estudio de base poblacional y serie de tiempo de mortalidad (1997 a 2020). Los análisis estadísticos fueron realizados mediante programas Excel y R Studio, cálculo de χ2, valor p < 0,05. RESULTADOS: 2.413 muertes fueron causadas por parásitos, 65,1% por protozoos, 33% por helmintos y 1,9% por artrópodos. La tasa promedio de mortalidad nacional fue de 0,6 por cada 100 mil habitantes. Las principales causas de fallecimiento fueron: enfermedad de Chagas (63,6%), hidatidosis (24,3%) y cisticercosis (8,1%). La mayoría de los fallecidos pertenecía a la Región de Coquimbo. La edad promedio de defunción fue de 74, 62 y 67 años para muertes por protozoos, helmintos y artrópodos, respectivamente. Las defunciones ocurrieron mayormente en hombres. La mayoría provenía de zona urbana y poseían un nivel educacional bajo. CONCLUSIONES: La enfermedad de Chagas es la principal causa de muerte por parasitosis en Chile.

BACKGROUND: Parasites are a public health problem due to their high prevalence in developing countries, their persistence in developed countries mainly due to the migration of people, and their associated morbidity and mortality. AIM: To determine the deaths in Chile caused by endemic and imported parasites; according to region, sex, age group, urban-rural origin and educational level, and mortality rates. METHOD: Population-based study, times series of mortality (1997 to 2020). Statistical analysis was performed using Excel and R Studio programs, calculation of χ2, p value < 0.05. RESULTS: 2,413 deaths occurred due to parasites, 65.1% by protozoa, 33% by helminths and 1.9% by arthropods. The average national mortality rate was 0.6 per 100.000 inhabitants. The main causes of death were Chagas disease (63.6%), hydatidosis (24.3%) and cysticercosis (8.1%). Most of the deceased belonged to the Coquimbo Region. The mean age of death was 74, 62 and 67 years old for deaths from protozoa, helminths and arthropods, respectively. Deaths occurred mostly in men. Most came from urban areas and had a low educational level. CONCLUSIONS: Chagas disease is the main cause of death from parasites in Chile.

Disseminated Abdominal Echinococcosis: Case Report / Equinococosis abdominal diseminada: reporte de caso

Abstract We describe a case of disseminated abdominal hydatid disease in a 21-year-old man who presented with clinical symptoms of persistent abdominal pain after abscess drainage post-appendectomy. The images showed multiple cystic lesions in the peritoneum, liver, and spleen. Due to pain exacerbation, the patient was taken to laparotomy. Multiple cystic lesions scattered throughout the abdominal cavity were observed, which were diagnosed by histopathology as multiple cystic lesions due to peritoneal and abdominal echinococcosis.

Resumen Se realiza la descripción de un caso de hidatidosis abdominal diseminada de un hombre de 21 años, quien consultó por cuadro clínico de dolor abdominal persistente después de un drenaje de absceso luego de una apendicetomía. Las imágenes mostraron múltiples lesiones quísticas en peritoneo, hígado y bazo. Por exacerbación del dolor, el paciente se lleva a laparotomía, donde se evidenciaron múltiples lesiones quísticas diseminadas en toda la cavidad abdominal, que se diagnosticaron a la histopatología como lesiones quísticas múltiples por equinococosis peritoneal y abdominal.

Características clínicas y epidemiológicas de equinococosis quística en niños de un centro terciario en Perú / Clinical and epidemiological characteristics of cystic echinococcosis in children from a tertiary center in Peru

RESUMEN La equinococosis quística (EQ) en niños es un problema de salud pública. Para describir las características clínicas y epidemiológicas de la EQ se revisaron los registros de 55 niños con diagnóstico confirmado de EQ admitidos entre 2017 y 2019 en un centro quirúrgico referencial del Perú. Se analizaron los datos demográficos, las manifestaciones clínicas y el tratamiento. El 61,8% (34/55) de los niños fue de sexo masculino. La edad promedio fue de 9,25 años (DE: 2,79); un 16,4% tuvo diagnóstico previo de EQ, y un 50,9% tuvo contacto con perros. La mediana de tiempo de enfermedad fue de dos meses. El 65,5% tuvo afectación hepática, el 56,4% pulmonar y el 21,8% hepática y pulmonar. Los síntomas más frecuentes fueron dolor abdominal (80,6%) y tos (80,6%). El tratamiento quirúrgico se realizó en el 87,5% de los casos con EQ hepática y en el 100% de los casos con EQ pulmonar y EQ hepática y pulmonar. Se prescribió albendazol en el 100% de casos hepáticos, en el 73,7% de casos pulmonares y en el 75% de ambas afectaciones. No se reporta mortalidad.

ABSTRACT Cystic echinococcosis (CE) in children is a public health problem. To describe the clinical and epidemiological profile of CE, we reviewed the records of 55 children admitted to our institution with a confirmed diagnosis of CE between 2017-2019, analyzing demographic data, clinical manifestations, and treatment. Of the population, 61.8% (34/55) were male. The mean age was 9.25 years (SD: 2.79); 16.4% had previous CE diagnosis, and 50.9% had contact with dogs. The median time of illness was 2 months. Of the patients, 65.5% had hepatic involvement, 56.4% had pulmonary involvement, and 21.8% had both hepatic and pulmonary involvement. The most frequent symptoms were abdominal pain (80.6%) and cough (80.6%). Surgical treatment was performed in 87.5% of patients with hepatic CE, in 100% of those with pulmonary CE and in 100% of those with hepatic and pulmonary CE. Albendazole was prescribed in 100% of hepatic cases, in 73.7% of pulmonary cases, and in 75% of those with both conditions. Mortality was not reported.

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.

Spatial analysis of echinococcosis in pastoral area of Qinghai province, 2019 / 中华流行病学杂志

Objective: To understand the spatial characteristics of echinococcosis and associated factors in the pastoral area of Qinghai province, and provide evidence for the effective prevention and control of echinococcosis. Methods: The number of echinococcosis cases in the pastoral areas of Qinghai in 2019 was collected to perform spatial epidemiological analysis. The thematic map of the distribution of echinococcosis cases was generated with software ArcGIS 10.8 for visual analysis and spatial autocorrelation analysis. The spatial autocorrelation and spatial scanning analysis were performed to estimate the clustering of echinococcosis with software SaTScan 9.5. Software GeoDa 1.14 and ArcGIS 10.8 were used to establish spatial lag model and geographical weighted regression model to analyze the related factors of echinococcosis epidemic. Results: In 2019, the echinococcosis surveillance covered 64 741 people in the pastoral area of Qinghai, and 829 echinococcosis cases were found, with a prevalence rate of 1.28%. The distribution of the cases had spatial correlation (Moran's I=0.41, P<0.001). The most possible clustering areas indicated by spatial scanning analysis included Banma, Jiuzhi, Dari and Gande counties of Guoluo Tibetan Autonomous Prefecture (LLR=460.77, RR=9.20, P<0.001). The prevalence of echinococcosis in the pastoral areas was positively associated with the total annual precipitation (β=0.13, P=0.036), and negatively associated with population density (β=-1.36, P=0.019) and doctors/nurse ratio (β=-25.60, P=0.026). Conclusions: The distribution of echinococcosis cases in the pastoral areas of Qinghai in 2019 had spatial correlation, and the prevalence was affected by total annual precipitation, population density, and doctors/nurse ratio.

Analysis of the equity of health human resource allocation for echinococcosis control based on Gini index / 中国血吸虫病防治杂志

OBJECTIVE@#To analyze the current status and evaluate the equity of health human resource allocation for echinococcosis control in Ganzi Tibetan Autonomous Prefecture, Sichuan Province, so as to provide the empirical evidence for optimizing the health human resource allocation for echinococcosis control.@*METHODS@#A questionnaire survey was performed to collect the numbers of health human sources for echinococcosis control, including health workers, healthcare professionals, certified/assistant physicians and registered nurses, per 1 000 permanent residents, per 1 000 m2, per 1 000 residents screened using Bmode ultrasonography and per 1 000 echinococcosis patients in two highly endemic counties and three lowly endemic counties in Ganzi Tibetan Autonomous Prefecture, Sichuan Province from 2016 to 2019. The equity of health human resource allocation for echinococcosis control was evaluated by permanent residents and geographical areas using Lorenz curve and Gini index in Ganzi Tibetan Autonomous Prefecture from 2016 to 2019.@*RESULTS@#The numbers of health workers, healthcare professionals, certified/assistant physicians and registered nurses per 1 000 permanent residents, per 1 000 permanent residents, per 1 000 m2, per 1 000 residents screened using B-mode ultrasonography and per 1 000 echinococcosis patients were 0.99-, 1.06-, 1.78- and 1.88-fold; 3.38-, 3.67-, 6.00- and 6.00-fold; 1.64-, 1.74-, 3.22- and 3.18-fold; and 64.92-, 70.39-, 139.34- and 117.44-fold more in lowly endemic counties than in highly endemic countries in Ganzi Tibetan Autonomous Prefecture, Sichuan Province, 2019. The Gini indexes of health human resource allocation for echinococcosis control were 0.371 to 0.397 by permanent residents and 0.477 to 0.591 by geographical areas in Ganzi Tibetan Autonomous Prefecture from 2016 to 2019, and the Gini indexes (0.469 to 0.730) for allocation of certified/assistant physicians and registered nurses were both higher than those of health workers and healthcare professionals (0.302 to 0.451) by both permanent residents and geographical areas.@*CONCLUSIONS@#The health human resource allocation for echinococcosis control showed general equity by permanent residents and poor equity by geographical areas in Ganzi Tibetan Autonomous Prefecture, Sichuan Province from 2016 to 2019.

Study on mechanisms of Th17/Treg imbalance in patients with cystic echinococcosis based on miRNA expression profiles / 中国血吸虫病防治杂志

OBJECTIVE@#To investigate the serum microRNA (miRNA) expression and examine the impact of miRNA expression profiles on T helper type 17 (Th17)/regulatory T cells (Treg) imbalance among patients with cystic echinococcosis, so as to provide insights into the illustration of the mechanisms underlying chronic Echinococcus granulosus infections, and long-term pathogenesis.@*METHODS@#Total RNA was extracted from the sera of cystic echinococcosis patients and healthy controls, and subjected to high-throughput sequencing with the Illumina sequencing platform. Known miRNAs were annotated and new miRNAs were predicted using the miRBase database and the miRDeep2 tool, and differentially expressed miRNAs were identified. The target genes of differentially expressed miRNAs were predicted using the software miRanda and TargetScan, and the intersection was selected for Gene Ontology (GO) enrichment analysis and Kyoto Encyclopedia of Genes and Genomes (KEGG) pathway analysis. Among the differentially expressed miRNAs with the 20 highest fold changes, miRNAs that targeted genes relating to key transcription factors RORC and FOXP3 that determine the production of Th17 and Treg cells or their important regulatory pathways (PI3K-Akt and mTOR pathways) were matched.@*RESULTS@#A total of 53 differentially expressed miRNAs were screened in sera of cystic echinococcosis patients and healthy controls, including 47 up-regulated miRNAs and 6 down-regulated miRNAs. GO enrichment analysis showed that these differentially expressed miRNA were involved DNA transcription and translation, cell components, cell morphology, neurodevelopment and metabolic decomposition, and KEGG pathway analysis showed that the differentially expressed miRNA were mainly involved in MAPK, PI3K-Akt and mTOR signaling pathways. Among the differentially expressed miRNAs with the 20 highest fold changes, there were 3 miRNAs that had a potential for target regulation of RORC, and 15 miRNAs that had a potential to target the PI3K-Akt and mTOR signaling pathways.@*CONCLUSIONS@#Significant changes are found in serum miRNA expression profiles among patients with E. granulosus infections, and differentially expressed miRNAs may lead to Th17/Treg imbalance through targeting the key transcription factors of Th17/Treg or PI3K-Akt and mTOR pathways, which facilitates the long-term parasitism of E. granulosus in hosts and causes a chronic disease.

A case of echinococcosis in Hunan Province / 中南大学学报(医学版)

Echinococcosis is mainly prevalent in the agricultural and pastoral areas in the northwest of China, but it is relatively rare in Hunan Province. Here, we reported the clinical data of a case of echinococcosis in Hunan Province. The patient was an 11-year-old male, who sought treatment at the Second Xiangya Hospital of Central South University due to abdominal mass. According to the symptoms, signs, and laboratory examinations, he was initially diagnosed as "intra-abdominal mass" and "spleen cyst". Subsequently, he underwent abdominal massive occupying resection and splenectomy. Postoperative pathological examination revealed the cuticle and germinal layer of hydatid and protoscolex, which was consistent with characteristics of echinococcosis. In addition, the serological examination showed that the specific anti-hydatid IgG antibody was positive. Combined with the patient's condition, he was given praziquantel treatment. After a month of follow-up, the patient was asymptomatic.

Quiste hidatídico cervical primario / Primary cervical hydatid cyst

RESUMEN La hidatidosis cervical es una enfermedad poco frecuente aun en áreas endémicas. Suele presentarse como una lesión quística indolora de lenta evolución. Se presenta un caso clínico de una paciente femenina de 19 años con una lesión quística en el compartimento cervical central, inicialmente interpretada como un quiste tirogloso. El diagnóstico debe ser sospechado ante epidemiología compatible, el método de imágenes de elección es la ecografía. En localizaciones extrahepáticas los métodos serológicos tienen baja sensibilidad. El tratamiento de elección es la cirugía, realizando tratamiento perioperatorio con albendazol. Debe manipularse el quiste con cuidado para evitar su rotura y el derrame de contenido líquido, por riesgo de reacción anafiláctica, recurrencia e hidatidosis múltiple. En pacientes con alto riesgo quirúrgico puede optarse por realizar tratamiento médico con albendazol.

ABSTRACT Cervical echinococcosis is a rare disease, even in endemic areas. The lesions usually present as painless slow-growing cystic lesion. We report the case of a 19-year-old female patient with a cystic lesion in the central cervical region that was initially interpreted as a thyroglossal duct cyst. The diagnosis should be suspected when the epidemiology is consistent, and ultrasound is the imaging method of choice. The sensitivity of serologic tests is low in extrahepatic locations. Surgery is the treatment of choice and the administration of albendalzole before surgery is indicated. The cyst must be handled with care to avoid rupture and leakage of cyst contents, which can cause anaphylaxis, recurrence and multiple echinococcosis. In patients with high surgical risk, medical treatment alone may be the option.