Hidatidose policística no norte do Brasil: abordagem parasitológica e histopatológica de pacas e casos humanos / Polycystic hydatid in northern Brazil: parasitological and histopathological approach from human and pacas cases

A hidatidose policística é uma zoonose causada pelo cestóide Echinococcus vogeli, amplamente distribuído no norte do Brasil. Os hospedeiros definitivos são Speothos venaticus (cachorro-vinagre) e Canis familiaris (cães domésticos), enquanto Agouti paca (paca) é hospedeiro intermediário. Tanto as pacas quanto o homem (hospedeiro acidental) desenvolvem a forma larvar (metacestóide), principalmente na superfície e no interior do fígado. Esta tese tem como objetivo geral estudar as características parasitológicas e histopatológicas de metacestóides de E. vogeli, originários de pacas e humanos da região norte do Brasil, visto o conhecimento insuficiente ou mesmo o seu desconhecimento. Os fígados e mesentérios foram obtidos de oito pacientes com hidatidose policística durante ato cirúrgico na Fundação Hospital Estadual do Acre. Pacas foram capturadas no Município de Bujari, Floresta Estadual do Antimary, Acre. Durante a necropsia das pacas, foram observadas lesões macroscópicas (massas esbranquiçadas ou amareladas, semelhantes a bolhas na superfície dos fígados). Para a análise parasitológica foram aplicadas as microscopias de luz, contraste interferencial de Normaski (DIC) e varredura laser confocal. A análise morfométrica foi realizada com o auxílio do Programa Image Pro Plus Media Cybernetics. Os órgãos de pacas e humanos foram submetidos à análise histopatológica. Os pequenos e grandes ganchos rostelares apresentaram polimorfismo morfológico, enquanto a organização dos protoescólices acompanhou o padrão descrito para Echinococcus sp. Todas as pacas apresentavam cistos hepáticos, porém em apenas duas encontramos líquido hidático, comprovados pela presença dos ganchos e protoescólices. A análise histopatológica dos tecidos hepáticos das pacas confirmou a hidatidose policística e evidenciou, pela presença de agrupamentos de ovos, a coinfecção com Calodium hepaticum. As características morfológicas dos ganchos rostelares dos casos humanos não diferiram...

Polycystic hydatidosis is a zoonotic disease caused by the cestode Echinococcus vogeli, largely distributed in northern Brazil. The definitive hosts are Speothos venaticus (bush dogs) and Canis familiaris (domestic dogs), while Agouti paca (paca) is the intermediate host. Both the pacas and man (accidental host) develop the larval form (metacestodes), mainly on the surface and inside the liver. This thesis aims to study histopathological and parasitological characteristics of metacestodes of E. vogeli, from pacas and humans of the north region of Brazil, seen the insufficient knowledge or lack of it. The mesentery and livers were recovered from eight patients with polycystic hydatidosis during surgery in the Acre State Hospital Foundation. Pacas were captured in the municipality of Bujari, Antimary State Forest, Acre. During the pacas necropsy, macroscopic lesions were observed (whitish or yellowish masses, similar to blisters on the surface of the liver). Identification analyses were applied to light microscopy, interferential contrast microscopy of Normaski (DIC) and confocal laser scanning microscopy. Morphometric analysis was performed by Image Pro Plus Media Cybernetics program. The pacas and human organs were subjected to histopathological analysis. The small and large rostellar hooks presented morphological polymorphism while protoscoleces organisation accompanied the pattern described in Echinococcus sp. All pacas presented liver cysts, however in only two found proven by the presence of hydatid fluid, hooks and protoscoleces. Histopathological analysis of pacas’ hepatic tissues confirmed polycystic hydatidosis and evidenced by the presence of eggs clusters the Calodium hepaticum coinfection. The morphological characteristics of human cases rostellar hooks did not differ from described to the pacas; however, the hooks were greater than the mesenteric ones. Already in relation to protoscoleces, the mesenteric ones were larger than the liver...

Hidatidosis poliquística tropical por Echinococcus vogeli / Polycystic tropical echinococcosis due to Echinococcus vogeli

Antecedentes. Hace 30 años se reconoció que las tumoraciones poliquísticas en 13 pacientes autóctonos de países tropicales sudamericanos eran producidos por una nueva especie de parásitos, el Echinococcus vogeli. Ahora se conocen 200 casos en 12 países (desde Panamá hasta Brasil y Perú). Lugar. Cali, Colombia; Nueva Orleans y Seattle, USA. Diseño. Estudio experimental y retrospectivo. Objetivo. Se presenta esta enfermedad a países con zonas tropicales donde la enfermedad aún es desconocida. Métodos. Se estudiaron 78 pacientes. El curso fue crónico, de quistes abdominales, algunos dolorosos, hepáticos, con o sin cirrosis biliar, asociados a lesiones torácicas y mesentéricas. El 85% se localizó en el hígado y el 14% en el pulmón. El diagnóstico se basó en el examen físico, la radiología, la procedencia rural, el conocimiento de la paca, en la convivencia con perros y en la serológica. Conclusiones. El tratamiento se basa en la cirugía y el albendazol. La equinococosis poliquística tropical por el Echinococcus vogeli representa un problema médico severo en América del Sur, con mortalidad del 29%. Los casos diagnosticados representan una pequeña proporción de las infecciones humanas.

Background. Thirty year ago it was recognized experimentally that polycystic tumors in 13 autochthonous patients from south American countries were produced by a new species: Echinococcus vogeli. As of march 2007, 200 cases were known from 12 countries (from Panamá, Colombia and Venezuela to Brasil and Perú). Places. Cali, Colombia; New Orleans and Seattle, USA. Design. Experimental and retrospective studies. Objective. This disease is presented to the countries with tropical areas, where the illness is steel unknown. Methods. 78 patients were studied. They had cysts, sometime painful, connected with the liver, with or without biliar cirrhosis, associated with pulmonary and mesenteric lesions. 85% in the liver, 14% in the lung. The diagnosis was based in palpation, radiological imaging, rural origin, knowledge of the paca, history of closed contact with dogs and positive serology for echinococcosis. Conclusions. The combination of surgery and albendazol was the most efficient treatment. The tropical polycystic echinococcosis is a severe medical problem in South America with a 29% mortality. The number of diagnosed cases probably only represent a small proportion of the human infections.

Observation of hydatid cyst infection in kordestan province [West of Iran] using epidemiological and seroepidemiological criteria

Echinococcosis is the major helminthic parasitic infection in Iran. The health hazard and economic loss in man and livestock is significant. In this study 3 major topics as the prevalence of hydatid cyst in human population, in livestock and echinococcosis in stray dogs, were studied. Total of 1114 serum samples in different age groups in Sanandaj and Divandareh area of Kurdestan province in west of Iran were examined by indirect immunoflurecent test [IFA]. In Sanandaj area 3.3% and in Divandareh 9.5% of serum samples were positive for hydatidosis. In livestock using abattoir inspection the rate of infection was 51.9% and 28.02% for sheep and cattle, respectively. Nine stray dogs [44%] autopsied in Sanandaj were positive for Echinococcosis

Quiste hidatídico pulmonar roto en un escolar de Calama / Ruptured hydatid cyst in a schoolchild from Calama

La hidatidosis es una zoonosis cuya frecuencia en Chile varía según el área geográfica. El desierto de Atacama tiene características que hacen raro el desarrollo de esta patología, que a la vez, se presenta con características particulares en la infancia. Reportamos la evolución clínica de una escolar de Calama, de 6 años de edad, que presentó compromiso del estado general, fiebre, y anorexia de 5 días de evolución, a lo que se agregó tos persistente con episodios asficticos y vómica de material blanco grisáceo, hemoptoico y filante, sin mal olor, asociado a dolor punzante en hemitórax derecho y dificultad respiratoria progresiva. La radiografía de torax y TAC pulmonar muestran imagen compatible con quiste hidatídico basal derecho y la serología ELISA para hidatidosis resultó (+). Se trató con albendazol por 17 días y se realizó quistectomía con capitonaje, sin complicaciones posteriores. Comentamos la forma de presentación, los factores de riesgo y el tratamiento de la patología, basados en una revisión de la literatura y la experiencia nacional.

Hidatidosis cardíaca múltiple: reporte de un caso clínico / Multiple cardiac hydatidosis: clinical case report

El compromiso cardíaco de la enfermedad hidatídica es poco frecuente y representa el 0,5 al 2 porciento de todos los quistes hidatídicos en el hombre. En general estos pacientes son llevados a cirugía como una forma de prevenir la ruptura espontánea considerada como la complicación más temida y a menudo mortal. Presentamos el caso de un varón de 33 años de edad admitido en el Hospital San Borja Arriarán con diagnóstico de hidatidosis cardíaca múltiple.

Primary ovarian hydatid disease in the Kingdom of Saudi Arabia

Human hydatid disease is caused by Echinococcus granulosus. Its distribution is world wide and it affects mainly the liver, but other organs could be involved. Primary involvement of pelvic organs is very rare. This is a case report of primary ovarian hydatid disease in a postmenopausal woman, diagnosed postoperatively. Surgical excision was adequate. Ultrasonography, particularly high frequency trans-vaginal, computed tomography scan and, more recently, magnetic resonance imaging are more frequently used in the diagnosis of Echinococcus cyst. They appear more reliable than many of the old tests of varying sensitivities. Whereas, there are anecdotal reports of obstetric and gynecological manifestations of echinococcosis from some Middle Eastern and North African countries, this is the first of such report from the Kingdom of Saudi Arabia. It is unclear why there is a lack of information about this condition among Saudi women, even though socio-cultural attitude to female involvement in sheep farming and animal husbandry is similar to that in other Arabic and Islamic countries. We endorse the recommendation that every gynecologist, radiologist and histopathologist should maintain a high index of suspicion for hydatid cyst, whenever a septate cystic pelvic mass is found

Estudio de viabilidad de escólices de quistes hidatídicos hepáticos humanos / Viability study of scolices of human hydatid liver cysts

El adecuado control de la hidatidosis en general, requiere conocer algunos aspectos relacionados con la supervivencia de los agentes infectantes, especialmente de los escólices. El objetivo de este trabajo, es evaluar la viabilidad de los escólices de quistes hidatídicos humanos de localización hepática. Estudiar la asociación entre las características clínicas al momento de la cirugía y el porcentaje de viabilidad de los escólices. Los criterios de viabilidad utilizados fueron: forma ovoide, invaginados, ganchos rostrales y corpúsculos calcáreos intactos, movimientos vibratorios presentes y ausencia de tinción con colorantes vitales. Los criterios para certificar mortalidad de los escólices fueron dos o más de los siguientes hechos: inmovilidad, alteración de los ganchos rostrales y de los corpúsculos calcáreos, rotura de membrana y pérdida de la forma ovoide y fácil tinción con el colorante vital (azul de tripan al 1,5 por ciento). Se estudiaron de esta forma 16 quistes, con un diámetro promedio de 16,2 cm. Siete lesiones (44 por ciento) de tipo univesicular, 5 (31 por ciento) multivesiculares y 4 (25 por ciento) quistes abscedados. En 7 oportunidades (44 por ciento), se evidenció comunicación a la vía biliar; y se constató viabilidad en 9 de los 16 quistes (56 por ciento). Las muestras con mayor porcentaje de escólices viables fueron los quistes multivesiculares, principalmente a expensas de las vesículas hijas. Se constató que los quistes multivesiculares eran viables en el 100 por ciento de los casos, a diferencia de los univesiculares con un 57 pir ciento y los abscedados con 0 por ciento (p= 0,01)

Hidatidosis múltiple / Multiple hydatidosis

Patient of 25 years with jaundice, fever and pain in the upper right zone of the abdomen. The sonography and computer tomography reveled images compatible with cyst hydatide disease. IgG ELISA for hydatidosis was positive. In the operation a 15 cm hydatide cyst of the liver comunicated to the biliary tree and multiple peritoneal cyst were found. The patient scape at 36 days of hospitalization

Hidatidosis cervical: compromiso de tiroides y glándula submaxilar en dos casos / Neck located hydatid cysts: report of 2 cases

Neck located hydatid cysts are of rare occurrence. We report two patients with such condition. A 66 years old male with a slowly progressive painless 4 cm nodule located in the right thyroid. It did not concentrate 131I and a fine needle aspiration cytology was informed as an acute thyroiditis. A 5 years old boy presented with a 5 cm painless right submaxillary cyst. Ultrasound examination showed that it was unilocular, and fine needle aspiration biopsy disclosed unspecific findings. In both cases surgical findings and the pathological study showed hydatid cysts. Both patients had normal chest x ray and abdominal ultrasound examinations. They had an uneventful postoperative evolution. Echinococcosis must be considered in the differential diagnosis of cervical cysts in endemic area

Primary hydatidosis of the pancreas: short communication

Primary hydatid cyst of the pancreas is a rare condition. In a large series study the reported incidence was 0.25% [1]. We present the case of a 35-year-old patient who presented with a history of a vague upper abdominal pain, with nausea, vomiting and heartburn. Abdominal ultrasonography and CT scans revealed a cystic mass occupying the body and tail of the pancreas. Surgery was performed and yielded a tense hydatid cyst in the pancreas

Ultrastructural alterations in glomerulophathy associated with hydatidosis in sheep

En el presente trabajo se investigaron las alteraciones ultraestructurales en el glomérulo renal de ovejas con hidatidosis. Utilizando microscopía electrónica de transmisión, fueron examinadas muestras renales de 39 ovejas, 34 de ellas con hidatidosis y 5 sin la parasitosis. Adicionalmente, fue realizado un estudio bioquímico a través de dosaje sérico de creatinina, úrea, proteínas totales y albumina. Las alteraciones ultraestructurales identificadas fueron la presencia de depósitos densos mesangiales, subendoteliales e intramembranosos; proliferación de células mesangiales con áreas de esclerosis segmentaria e interposición de células mesangiales con formación de neo-membrana. Durante el estudio bioquímico se observó un aumento significativo de proteínas totales séricas en el grupo experimental en relación con el de control. El estudio demostró que la glomerulonefritis asociada a hidatidosis en ovinos puede ser clasificada en 4 categorías: lesiones mínimas, glomerulonefritis mesangial, glomerulonefritis segmentaria y focal, y glomerulonefritis membranoproliferativa, siendo predominantemente proliferativa y mesangial

Treatment and diagnostic procedures of renal hydatid disease

Renal hydatid disease is uncommon and accounts for 2-3% of all reported cases of hydatid disease. The treatment of choice is surgical. Medical therapy is not always satisfactory, and cure depends mostly on removal of all affected tissue. Cystectomy, nephrectomy, or cystectomy with pedicled omentoplasty, especially if the cyst communicates with the renal collecting system, are the treatments of choice. The use of a scoilicidal agent is mandatory during surgery. Mixed echogenecity on ultrasound and multivesicular cyst with mixed density on computed tomography [CT] are most helpful in establishing the diagnosis. We wish to report 10 cases of renal hydatid disease encountered and successfully treated by surgery at King Hussein Medical Center [KHMC]. None of the patients had liver or lung involvement

Cerebral hydatid cysts in Chilodon: Unusual imaging findings

Cerebral involvement accounts for approximately 1-4% of patients infected with Echinococcus granulosus. The imaging appearance of a cerebral hydatid cyst comprises usually a single spherical cavity with signal intensity identical to cerebrospinal fluid on CT and MR imaging. In this communication unusual aspects of cerebral hydatid cysts are reported in children. These included multiple cysts, extensive calcifications of the pericyst and parasitic membranes, pericystic edema, and contrast-enhancement on CT and on MR

Prevalence of hydatidosis in nomadic tribes of southern Iran

In order to assess the prevalence of Echinococcus granulosus [EO] infection [hydatidosis] in nomadic tribes of southern Iran, 1000 individuals from a total population of 112,519 were selected by randomized single blind cluster sampling method and studied from 1994-1995. The study included: [1] a physical examination by a gastroenterologist, [2] abdominal ultrasonography [US], and [3] detection of anti-EO-antibodies [EOA] by an enzyme-linked immunosorbent assay [ELISA] and counterimmunoelectrophoresis [CIE]. The statistically significant prevalences were: US: 1.8%, CIE: 6.8%, and ELISA, 13.7%. The rate of infection varied with age, sex, education, occupation, life style, geographical location of tribal subgroups and the frequency of contact with dogs and cattle. The power of agreement between a combination of each two methods were significant as determined by kappa statistics method. The results obtained indicated that a combination of ELISA and CIE was the most reliable method with a high sensitivity and specificity

Foco de hidatidosis humana en la provincia del Chaco (Argentina) / Human hydatidosis in the province of Chaco (Argentina)

En Argentina han sido descritas cinco áreas endémicas de hidatidosis, no estando la Provincia de Chaco incluida en ninguna de ellas. Habiéndose notificado un caso autóctono en esta región, se decidió realizar un estudio epidemiológico para reconocer si esta área es endémica a hidatidosis. Se estudiaron 52 personas (13 mujeres-39 varones) de entre 8 y 58 años de edad, elegidos al azar entre los residentes permanentes del pueblo de Samuhú. A todos se les confeccionó una ficha epidemiológica, y se tomó muestra de sangre. Para investigar anticuerpos anti E. granulosus se empleó la prueba de ELISA y los sueros que resultaron positivos se les practicó inmunoelectroforesis (IEF) empleando en ambos casos reactivos comerciales. Diez muestras (19,3 por ciento) resultaron positivas a ELISA y de éstas, 5 (9,6 por ciento) se confirmaron por IEF (2 mujeres y 3 varones). De acuerdo a los resultados obtenidos y a la información epidemiológica recogida, se puede concluir que en la provincia del Chaco existe una área geográfica endémica a hidatidosis

Hydatid disease [Echinococcus granulosus]: experience at Asir central hospital

In a six-year period, starting from the commissioning of Asir Central Hospital in 1408 H [1988]43 cases of hydatid cyst disease caused by echinococcus granulosus seen in Asir Central Hospital were studied. The pattern was not significantly different from other workers' experiences. There was equal sex distribution and the average age was 41.7 years. The clinical presentations depended essentially on the organs affected, and computed tomography usually confirmed the diagnosis. The serological test at times gave a false negative result. Most of the patients came from Abha in Asir region and the most commonly involved organ was the right lobe of the liver. All the patients had laparotomy, excision or incision and drainage of the cyst, depending on whether the cyst could be safely excised or only drained. The average hospital stay was II days. We believe that surgical intervention should be the first line of treatment especially when the cyst is large

Epidemiological characteristics of abdominal hydatidosis among adult surgery patients in the Al-Jahra district in Kuwait

Dogs are kept in the Al-Jahra area as part of a traditional lifestyle based on raising sheep. Dogs and sheep are reservoirs for Echinoccocus granulosus, a parasite causing hydatidosis in humans. Thirty- seven cases seen and/or treated at the Al-Jahra Hospital, Kuwait between 1991-96 were reviewed. The female/male ratio of these cases was 4:1 and the mean age was 43.7 years. In 27% of cases, silent cysts were discovered inadvertently, and did not receive any treatment. In most cases where surgery was performed, cysts were excised with or without drainage of the cavity, and only 7 cases developed post operative complications. On average, patients with a drain stayed in hospital for a relatively longer period and had a higher likelihood of complications than those without. The study indicated that excision of the cyst without drainage offered a better quality of recovery for patients. Better public health measures need to be taken in areas where livestock are kept near human habitations