Imported hepatopulmonary echinococcosis: first report of Echinococcus granulosus sensu stricto (G1) in Bolivia

Abstract Hepatopulmonary hydatidosis in young children is a rare and atypical presentation of Echinococcus granulosus infection. We report the first case of cystic echinococcosis caused by a microvariant of E. granulosus sensu stricto. Chemotherapy and systemic corticoids were administered before curative surgery was performed. Recurrence was not observed for more than 24 months of follow-up.

Quince años de experiencia clínica con hidatidosis / Clinical presentation of hydatid disease during 15 years: a case series from Santiago, Chile

Introduction: Hydatidosis is a neglected parasitic disease that is endemic in Chile. We present the clinical experience of a single center in Santiago from 1996 to 2010. Methods: Cases were identified using hospital's database. Clinical and pathological features, treatment and outcomes were retrospectively analyzed. Results: In total, 23 patients were identified requiring 30 surgical interventions. Median age was 40 years old (range 5 to 73), and 76.5% visited or resided in regions of known endemicity in Chile. Abdominal cysts were predominant (78.3%), and most patients were symptomatic (73.9%). Elimination of cyst material by cough was reported in 42.9% of patients with symptomatic thoracic cysts. Eosinophilia was present in 41.2% of patients, and 57.1% had positive serology for hydatidosis. Aill patients underwent surgical treatment, in 60.9% in combination with albendazole treatment. While the majority of liver cysts (88.9%) were treated by complete cyst resection, lung cysts (83.3%) were predominantly treated by cyst resection plus capitonnage. Pathological examination revealed fertile cysts in 24%. Postsurgical morbidity was frequent (37.9%), and 13.3% of the series required readmission for this cause. Near 25% of patients remained in hospital > 14 days, a feature associated with fever during admission (p < 0.05). No recurrence was reported in the fraction of patients that were followed-up for 2 years or more. Conclusions: Our analysis of 23 cases demonstrates that patients were mainly adults suffering from abdominal cysts. Most patients were successfully treated by surgery with or without antiparasitic drugs but complications leading to prolonged hospital stays and readmissions were not infrequent.

Introducción: La hidatidosis es una enfermedad endémica en Chile. Se presenta la experiencia clínica de un hospital en Santiago, desde 1996 al 2010. Métodos: Los casos fueron identificados usando las bases de datos institucionales y se analizaron las características clínicas y patológicas, el tratamiento y la evolución en forma retrospectiva. Resultados: Se identificaron 23 pacientes intervenidos en 30 oportunidades. La mediana de edad fue de 40 años (rango 5 a 73) y 76,5% visitó o residía en zonas endémicas en Chile. Los quistes abdominales fueron predominantes (78,3%) y la mayor parte de los pacientes eran sintomáticos (73,9%). Un 42,9% de aquellos con quistes sintomáticos torácicos reportó eliminación de vesículas con la tos. Un 41,2% presentó eosinofilia y 57,1% tuvo serología positiva para hidatidosis. Todos los pacientes fueron tratados quirúrgicamente, en 60,9% en combinación con albendazol. La mayoría de los quistes hepáticos fueron tratados con cirugía radical (88,9%) y los pulmonares predominantemente con quistostomía y capitonaje (83,3%). Un 24% de los quistes eran fértiles. La morbilidad post-quirúrgica fue frecuente (37,9%) y 13,3% de la serie requirió reingresos por esta causa. Cerca de 25% de los pacientes estuvo hospitalizado por más de 14 días, un fenómeno asociado con la presencia de fiebre por complicación séptica al ingreso (p < 0,05). No se registraron recurrencias en la fracción de pacientes seguidos por más de dos años. Conclusiones: La hidatidosis afecta principalmente a adultos en su cavidad abdominal. Aunque los pacientes fueron tratados exitosamente con cirugía, las complicaciones, estadías prolongadas y reingresos por esta causa no fueron infrecuentes.

Rupture of liver hydatid cysts into the peritoneal cavity a challenge in endemic regions

To evaluate the clinical presentation and early and long-term outcomes of patients treated surgically for intraperitoneal ruptured liver hydatid cysts. The medical records of 21 patients with rupture of hydatid cysts were evaluated retrospectively between January 2000 and April 2009 at Izmir Ataturk Training and Research Hospital, Izmir, Turkey, as were the records of 368 patients with hydatid cysts. Age, gender, symptoms, laboratory findings, diagnostic procedures, surgical treatment modalities, in-hospital stay, morbidity, mortality and recurrence were evaluated. Sixteen of these patients [76.2%] were women. The mean age was 43.8 years. Cysts were single in 16 cases [76.2%]. In 14 cases [66.7%] cysts were localized only in the right lobe. There was also a cyst in the spleen in 4 patients [19%]. Simple falls or direct abdominal minor trauma was responsible in 8 patients [38.1%], and pedestrian mishaps in 4 [19%]. Nine [42.8%] patients experienced spontaneous rupture. External drainage was performed in 12 [57.1%] patients and omentoplasty in 9 patients [42.8%] to manage the cyst cavity. A total of 11 morbidities developed in 9 patients [42.8%]. There was no postoperative mortality. The mean hospital stay was 11.3 +/- 7.4 days, and mean follow-up was 63.1 +/- 31.3 months. The recurrence rate was 23.8%. The morbidity and recurrence rates of surgical interventions for ruptured hydatid cysts are high. This pathology, although rare, should be included in the differential diagnosis of an acute abdomen in endemic areas

Uso de Albendazol como tratamiento de la equinococcosis: toma de decisiones basadas en la validez interna y externa de un estudio concerniente / Internal and external validity of a clinical trial reporting the use of albendazole for the treatment of hydatidosis

Introducción: El tratamiento de la Equinoccocosis es quirúrgico. El estudio de Keshmiri plantea el uso de albendazol como alternativa. El objetivo de este estudio es determinar validez interna y externa del estudio de Keshmiri. Material y método: Se aplicaron 4 instrumentos que valoran diferentes ámbitos metodológicos al estudio de Keshmiri. Se realizó lectura crítica; se analizó calidad metodológica, validez interna y externa con 3 instrumentos: MINCIR, CONSORT y SIGN. Estos, fueron aplicados por 7 investigadores con formación en epidemiología clínica. Resultados: La guía de lectura permitió verificar carencia de objetivo específico, asignación aleatoria y enmascaramiento mal definido. Los pacientes no fueron considerados hasta el final del estudio (hubo pérdida de 22,7 por ciento de pacientes en la rama del fármaco y de 42,8 por ciento de pacientes en la rama placebo). La escala MINCIR permitió identificar un ensayo clínico, con enmascaramiento, secuencia de aleatorización no clara, sin cálculo del tamaño de la muestra y objetivos vagos. CONSORT permitió comprobar carencia de hipótesis de trabajo y objetivos específicos; no identificación de variable primaria y tamaño de muestra, ambigüedades del proceso de aleatorización, enmascaramiento poco claro, ausencia de ajuste estadístico y omisión de análisis de subgrupos. SIGN permitió objetivar los mismos problemas antes descritos. Conclusión: Los instrumentos aplicados, pusieron en evidencia falencias metodológicas que objetan la validez interna y externa del estudio. La adopción de este protocolo debe observarse con precaución.

Background: Classic treatment of echinococcosis is surgery. The study of Keshmiri raises the use of albendazole as an alternative. Aim: To determine internal and external validity of the Keshmiri study. Material and methods: Four instruments that assess methodological quality, were applied to the manuscript. A critical reading was done and the internal and external validity of the methodological quality was analyzed with three scales: Methodology and Research in Surgery (MINCIR), Consolidated Standards of Reporting Trials (CONSORT) and Scottish Intercollegiate Guidelines Network (SIGN). Guides and scales were applied by 7 researchers with training in clinical epidemiology. Results: The Keshmiri study has not a specific objective. The method used for random assignment is not described and not all patients were assessed at the end of the study due to a loss form follow up of 23 percent of patients in drug branch and 43 percent in the placebo branch. MINCIR scale identified a blinded randomized clinical trial, with an unclear randomized sequence, without sample size estimation and vague objectives. CONSORT proved the lack of working hypothesis and specific objectives as well as an absence of identification of the primary variable, absence of sample size calculation, ambiguities in the randomization process, absence of statistical adjustment and the omission of a subgroup analysis. SIGN verified the same methodological errors. Conclusions: The applied instruments found methodological deficiencies that jeopardize the internal and external validity of the study.

Disappearance of recurrent intra-abdominal extrahepatic hydatid cyst following oral albendazole administration

A 44-year old male patient with a past medical history of a complete surgical excision of pelvic hydatid cyst two years previously presented with constant pelvic floor pain and plasma IgG anti-echinococcal antibody titres of 14.27 U/mL. Based on that and the imaging findings of abdominal ultrasound (US), Computed Tomography (CT) and Magnetic Resonance (MR) the diagnosis of a recurrent retrorectal pelvic hydatid cyst was made. Three courses of oral albendazole treatment were administered and sixteen weeks later, the patient was admitted for a planned elective operation. At that time, a new CT scan revealed disappearance of the cyst, while the serological tests showed a decrease in the IgG anti-echinococcal antibody titres to 0. 71 U/mL. Four different species of the Echinococcus tapeworm can produce infection in humans. E granulosus and E multilocularis are the most common, causing cystic and alveolar echinococcosis respectively, while E vogeli and E oligarthrus, have only rarely been associated with human infection. Although surgical resection remains the treatment of choice for hydatid disease, the present case could suggest that especially in cases of recurrent intraabdominal extrahepatic hydatid cyst, treatment with albendazole may lead to disappearance of the recurrent cyst therefore, should constitute a first line therapeutic option prior to any planned reoperation.

Surgery of liver hydatidosis with and without albendazole

Hepatic hydatidosis still remains a serious problem in general surgery. Recurrence and/or secondary hydatidosis rates are up to 25% in the cases treated with surgery alone. Albendazole is the most commonly used drug in the dual treatment of echinococcosis. To evaluate the effect of albendazole using the intraoperative and perioperative periods as dual therapy on recurrence of echinococcosis. Eighty-eight patients with hydatid disease who were operated upon for hepatic hydatid cysts between 1[st] of March 1998 and 31[st] of July 2006, in the Surgical Department of Erbil Teaching Hospital in Erbil City, Iraq, are included in this study. The patients were divided into two groups. The first group was treated with albendazole peri- and intra-operatively with surgery while the second [comparison] group was treated surgically alone and without albendazole. Peri-operative albendazole treatment was given in a dose of 12-15 mg/kg/day in four divided doses. The treatment was started 2-28 days before the surgery when the diagnosis was established and was continued for one month. Thirty six per cent of scoleces were viable in the treated group, while 80% of scolices were viable in the second [comparison] group [P < 0.005]. In the second [comparison] group there were four patients with sterile cysts and 15 patients with fertile and viable cysts but with no daughter cysts. In the treated patients there were only 3 [9%] with recurrent cysts that developed in the previous surgical field, compared with the second [comparison] group, where there were 13 patients [24%] who developed recurrent cysts. Dual albendazole treatment is effective in the prevention of recurrences and/or secondary hydatidosis

Collaborative control initiatives targeting zoonotic agents of alveolar echinococcosis in the northern hemisphere

Alveolar echinococcosis is one of the most important lethal zoonotic helminth infections in the northern hemisphere. Currently, the threat to public health is increasing, as evidenced by the rising prevalence rate of alveolar echinococcosis, as well as the invasion of urban areas by infected wild foxes. This threat is further increased due to the involvement of pet dogs, and probably cats, as emerging sources of infection. These increased threats to public health also have associated economic risks; therefore, there is a need for effective and sustainable methods of control. In this paper, initiatives to control alveolar echinococcosis by targeting its definitive hosts through anthelmintic baiting campaigns initiated by local residents who used local resources for bait production, distribution and collection of fecal samples for diagnosis are described. Further, when such distribution programs are coupled with the use of GIS-based maps, the optimum distribution of bait was obtained. These programs have also included the use of intravital diagnostic analyses of infection rates, which have been overseen by the Forum on Environment and Animals (FEA), and also allowed a nationwide monitoring of echinococcosis in difinitive hosts. In addition, a government initiative requiring mandatory reporting of echinococcosis in dogs to health authorities was recently initiated in Japan. Overall, the results of this study have shown that use of collaborative control initiatives targeting zoonotic agents of alveolar echinococcosis can be an effective method for reducing the threat of lethal echinococcosis in the northern hemisphere.

Infección por Echinococcus granulosus (quiste hidatídico) Reporte de un caso / Echinococcus granulosus infection (hydatid cyst)

Se reportó la infección larvaria por Echinococcus granulosus (quiste hidatídico) en una niña de 10 años procedente de Ucrania. Las manifestaciones clínicas fueron ligeras pues solo se quejaban de dolor abdominal frecuentemente. El diagnóstico se realizó por ultrasonido y la detección inmunoenzimática de anticuerpos contra Echinococcus (ELISA) con títulos de 1/800. Se le puso tratamiento con varios ciclos de albendazol y tuvo una evolución favorable con reducción del tamaño del quiste

Quiste hidatídico de la lengua / Hydatid cyst of the tongue

La lengua es una rara localización de la hidatidosis. Se reporta el caso de una paciente de 3 años con enfermedad hidatídica de la lengua demostrada histológicamente. El quiste de la lengua fue extirpado quirúrgicamente. La paciente tenía además hidatidosis hepática y pulmonar que fueron tratadas exitosamente con Albendazol

Tratamiento percutáneo mediante alcoholización del quiste hidatídico hepático / Liver hydatid cysts: percutaneous treatment with alcohol

Propósito: presentar nuestra experiencia y resultados de largo plazo en el tratamiento percutáneo con alcoholización de los quistes hidatídicos hepáticos, mediante el empleo de una técnica y protocolo diferentes a los utilizados convencionalmente. Material y métodos: se trataron 19 quistes hidatídicos hepáticos en 15 pacientes, 9 mujeres y 6 hombres con un rango de edades entre 24 y 65 años (edad media 42 años). Se incluyeron en éste trabajo pacientes con quistes tipo I y II de la clasificación de Gharbi. Todos los tratamientos se realizaron bajo guía tomográfica. Quistes menores a 5 cm de diámetro (7 en total) fueron tratados mediante punción, aspiración, inyección y respiración (ésta en la última sesión) en un total de 3 procedimientos-punciones por quiste en días consecutivos. Quistes de más de 5 cm (12 en total) fueron tratados mediante cateterización. Luego de la primera punción o colocación de catéter se realizaron quistografías bajo control radioscópico para descartar comunicaciones con la vía biliar, estructuras vasculares y/o fuga pericatéter. Se inyectó alcohol absoluto (95 por ciento) en distintas proporciones dependiendo de que fuese el 1er, 2do o 3er día de tratamiento. Todos los procedimientos se realizaron bajo internación (4 días para las punciones y 5-6 para los drenajes). Los pacientes recibieron tratamiento clínico con albendazol (10-12 mg/kg/día) durante 21 días previos al tratamiento y 15 días después de finalizado el mismo. Resultados: la mortalidad del procedimiento, la diseminación abdominal y el sangrado sobre el tracto de abordaje fue nulo. Las complicaciones fueron: sobreinfección de la cavidad quística en un paciente (5,3 por ciento) (drenada por vía percutánea) y aparición de febrícula en las primeras 24 hs. en 3 pacientes (20 por ciento). El seguimiento a más de un año no mostró recurrencia de la enfermedad. Conclusiones: el tratamiento percutáneo mediante alcoholización del quiste hidatídico de hígado es, en nuestra experiencia un procedimiento de alta efectividad que brinda la posibilidad de curación al paciente

Quiste hidatídico en el niño: experiencia del Servicio de Cirugía Hospital Roberto del Río 1996-1999 / Hidatid cyst in the child: experience of surgery service at the Hospital Roberto del Río 1996-1999

Hidatidosis es una enfermedad endémica en diversas partes del mundo. Entre marzo de 1996 y diciembre 1999 en el Hospital Roberto del Río fueron sometidos a cirugía por hidatidosis de distintas ubicaciones anatómicas 26 niños, 12 niñas y 14 niños, 22 eran de regiones del norte del país y 4 eran de Santiago (de estos últimos 2 habían vivido en áreas rurales). La hidatidosis fue pulmonar en 18 niños, uno de los cuales también tenía ubicación del parásito en hígado. Hidatidosis hepática se observó en 9 niños, ino de los cuales tenía también ubicación renal. El tiempo transcurrido entre la primera consulta y la cirugía varió de 2 a 103 días (mediana 13 días). Los procedimientos quirúrgicos fueron cistectomía, evacuación, drenaje y obliteración de la cavidad residual mediante capitonaje o marsupialización. Solamente 3 pacientes recibieron albendazol antes de la cirugía y 8 después de la intervención. No hubo fallecidos. 12 niños presentaron complicaciones post operatorias

Laparoscopic management of hydatid cyst of liver.

We describe the laparoscopic excision of a hydatid cyst in the liver. During the procedure, done after treatment with the scolicidal agents praziquantel and albendazole, care was taken to prevent spillage of scolices during evacuation of contents and to excise the entire germinal epithelium. The patient had no immediate or short-term complications and is asymptomatic 3 months later.

Albendazol como tratamiento coadyuvante en la cirugía del quiste hidatídico hepatoabdominal / Albendazol as coadyuvant treatment in hepato-abdominal hydatidic cyst surgery

El objetivo de la presente investigación es la de presentar los resultados tras 13 años de uso del Albendazol en concomitancia a la cirugía, con el fin de disminuir la recidiva hidatídica. Con tal propósito, es que desde marzo de 1985 hemos utilizado el Albendazol en 43 pacientes, siendo 14 de ellos en forma preoperatoria (grupo A) y 29 postoperatoria (grupo B). Los ciclos de Albendazol fueron de 30 días, con descanso de 15. La dosis fue de 400 mg c/12 horas en el adulto y de 10 mg x kg x día en los niños. Los criterios de inclusión para el tratamiento pre y postquirúrgico fueron: a) hidatidosis hepática múltiple, en la cual no se practicó cirugía resectiva, b) hidatidosis hepatoabdominal, c) ruptura del quiste y d) recidiva hidatidica. Todos los pacientes del grupo A fueron intervenidos quirúrgicamente y los del grupo B se controlaron mediante ecotomografía. La recidiva global de la serie fue de 13,8 por ciento y el tiempo de aparición varió entre los 28 y 75 meses de practicada la intervención quirúrgica. El seguimiento promedio fue de 51,8 meses, teniendo el 76 por ciento más de 4 años de control. Se concluye que el uso del Albendazol en concomitancia con la cirugía disminuye la posibilidad de recidiva hidatídica

Metabolic acidosis induced by cetrimide-chlorhexidine solution in hydatid cyst surgery.

A patient with a large hydatid cyst of the left lobe of the liver developed metabolic acidosis following rather liberal use of cetrimide-chlorhexidine solution as a scolicidal agent. The progress and management of this complication are described in the patient is being reported.

Alopecia areata universalis following high dose mebendazole therapy for hydatid disease

Alopecia following mebendazole treatment, is considered to be rare and self-limited. We found this complication in 3 of a total of 57 patient during a 7 year period from 1989 to 1995. Their hair regrew, but its color and quality changed somewhat and remained so for at least one year in 2 patients. The third patient died earlier

Diagnostic et traitement des kystes hydatiques du foie a propos de 87 cas ooe're's entre 1980 et 1992

Human echinococcosis is still endemic in some areas of the world, including Mediterranean countries and Lebanon because there is no effective medical therapy, surgery remains the principal mode of treatment. A consecutive series of 87 patients operated on for liver hydatid disease between January 1980 and march 1992 in the division of general surgery at saint george's hospital Beirut, were analyzed. Patients with hydatic cysts in other sites than liver were excluded from the study. There were 39 men [45%] and 48 women [55%] aged 12 to 75 years [mean 43]. the right lobe of the liver was affected in 67 cases [77%] the left lobe in 18 cases [20.6%] and both lobes in 2 cases [2.4%]. clinical symptomatology consisted of abdominal pain, fever, jaundice, urticaria and an abdominal mass preoperative diagnosis was established using imaging studies: plain abdominal films, ultrasonography computed tomography and serologic tests. Cases were classified into 3 groups: G1[n=44,50.5%] had a partial resection of the cyst followed by an external drainage, G2 [n=15,17.2%] had a partial resection of the cyst with a filling of the residual cavity, G3[n=28,32.2%] made benefit of complete resection of the cyst [perikystectomy] with or without partial hepatectomy. In this retrospective study we compared the results of these different surgical techniques: postoperative complications and mortality hospital stay of patient. We noted the better postoperative cursus of the nondrained patient [G2 and G3]. three patients died during the postoperative period because of septic complications. Conclusions and general recommendations are proposed