Modified endocystectomy versus pericystectomy in echinococcus granulosus liver cysts: a randomized controlled study and the role of specific anti-hydatid iGG4 in detection of early recurrence

The evidence based data of hydatid liver disease indicate that the level of evidence was too low to help decide between radical or conservative surgeries [level IV evidence, grade C recommendation]. So, there is a need for accurately designed randomized trials with precise goals to compare pericystes-tomy versus a specific modified endocystectomy technique for the treatment of hepatic hydatid cysts 8 cm or less in diameter in Egyptian patients, regarding the operative time, intra-opera-tive blood loss, complications and long term recurrence and to test the role of anti-hydatid IgG4 in diagnosis and detection of early recurrence. 60Patients with 131 liver cysts of E. granu-losus fulfilling the study criteria were randomly divided to two groups. G1: 32 patients with 69custs treated by modified endo-cystectomy and GII: 28 patients with 62cysts treated by closed total pericystectomy. GIa included 40cysts >5cm in diameter [mean 6.86, SD +/- 0.809] and GIb29cysts5cm in diame-ter [mean 7.01 SD +/- 0.79] and GIIb25cysts >/-cm in diameter [mean 4.04 SD +/- 0.93]. Preoperative evaluation inclyded histo-ry taking, clinical examination, blood tests, specific anti-hydat-id IgG4, abdominal sonography and CT scan. The operative time for dealing with each cyst was in minutes. Operative blood loss and need for blood trancfusion were estimated for each patient. Specific anti-hydatid IgG4 by ELISA was used to diagnose and to detect early rasurrence. Patients were followed up clinically and by ultrasonography every 3 months and for anti-hydatid IgG4 every 6 months for 24-90 months. The mean maximum operative time was in GIIa followed by GIa, GIb, then GIIb. The operative time was significantly lower in GIIb than Ib and in GIa than IIa. Seven patients [GII] had blood transfusion. The intraoperative bleeding in GI was <500ml/patient, and 18patients [GII] each bled >500ml. No intra-peritoneal seedling during the follow up. Five of 55patients [9%] were serologically suspected of relapse or incomplete cure. One [GII] showed early recurrence at 3 months. High IgG4 antibodies were detected in patients which decreased gradually after surgery and normal after 18 months post-operation.

detection of Giardia lamblia coproantigen as a sensitive immunodiagnostic method for human giardiasis

This study was designed to develop a sandwich ELISA for detection of G. Iambiia antigens in stool and sera of giardiasis patients as a better diagnostic alternative to routine parasitological methods. Anti-G. Iamblia antibodies were produced by immunization of rabbit with G. lamblia antigen obtained from cultured trophozoites. Raised antibodies were then employed in sandwich ELISA for detection of G. lamblia antigen in collected sera and stool samples. In this study sera and stool samples from 80 G. lamblia infected patients, 71 patients infected with other parasites [Entamoeba histolytica, Schistosoma mansoni and Fasciola hepatica] and 30 uninfected individuals were tested by sandwich-ELISA for detection of G. lamblia antigen. The sensitivity of coproantigen assay reached 98.8% for detection of Giardia antigens in stool and 87.5% for detection of Giardia antigen in sera of giardiasis patients. The specificity of the assay was 94.1% for stool samples and 91% for sera of negative controls and patients harboring other parasites collectively. A positive correlation between age of patients and the antigen levels in both sera and stool samples of G. lamblia infected patients was observed. The sensitivity of antigen detection assay was directly related to the intensity of infection. The positivity rate for detection of coproantigen in stool was compared to the number of cysts in stool. Patients passing < 8 cysts showed false negativity in stool samples [one patient] compared to 100% positivity in patients passing > 50 cysts of stool [79 patients]. Moreover, a positive correlation was found between coproantigen level in stool and number of cysts in stool of G. lamblia infected patients [r=0.887, p< 0.001]. In conclusion, our data demonstrated that the employment of rabbit anti-G. lamblia IgG antibodies in sandwich ELISA for the detection of G. lamblia coproantigen in stool provided a sensitive and specific tool for immunodiagnosis of G. lamblia infection

Effect of varying the pharmaceutical formulation on the biochemical a vailability and immunological behaviour of schistosomicidal drug, Oxamniquine

Oxamniquine [OXQ] is one of schistosomicide specific for Schistosoma mansoni [S. mansoni] infection. The aim of this work was to encapsulate OXQ into a liposome. These liposomal formulations in order to exhibit long term prophylactic effect against S. mansoni. It was found that OXQ exhibited marked chemoprophylaxis effect when encapsulated in negatively charged liposomes. Pharmacokinetically, OXQ liposomes are perfectly targeted to the liver whereby they release oxamniquine in minute amounts over extended periods in the proximate of schistosomules, maturing in liver sinusoids. All animal groups were injected with either free oxamniquine, OXQ free liposomes or OXQ liposomes encapsulated, one, two or three months before infection by S. mansoni cercariae and were sacrificed 6 weeks post infection. It was found that OXQ liposomes had moderate normalization effect on liver enzymes, alanine aminotransferase, aspartate aminotransferase, alkaline phosphatase and gamma glutamyl transferase in serum. Oxamniquine liposomes normalized A/G ratio and decreased the liver granuloma diameters. Infection increased the IgE and IgGl level, treatment with OXQ liposomes increased the level of IgG1 when given one or two months before infection, while free OXQ reduced IgG1 when given one month before infection and no significant change when given two months before infection. Treatment with different formulations to S. mansoni infected mice produced a significant decrease in IgE level after one and two months protection, while in normal animals there was an increase in IgG1 level after one month and no significant change after two months protection. So, it was concluded that OXQ in liposomal formulations is more efficient and safe than free drug in the protection against S. mansoni infection

Tegumental alteration and immunological changes in murine schistosomiasis mansoni after treatment with artemesia extract

The present work was designed to evaluate the effect of an Egyptian strain of artemesia; namely, Artemesia inculta as a schistosomicidal agent. After infection of mice with 100 cercariae, they were divided according to the duration of infection into group I [22 days] and group II [49 days]; each group was further subdivided into infected control and treated subgroups. Mice in the treated groups received artemesinin in a dose of 800 mg/kg intragastrically 7, 14 and 21 days post infection. The artemesinin extract was found to be more effective in reducing the number of female more than male worms in both hepatic and portomesenteric systems. No obvious changes could be detected on the tegument of both male and female worms in the treated adult group compared with the infected control. These results demonstrated the role of artemether in eliciting a high level of anti- SWAP total IgG and its subclass IgGI that may have a role together with artemether in eliminating schistosomes and share in the damage process on the tegument of juvenile stages but not adult stages