Proteomic analysis of plasma exosomes from Cystic Echinococcosis patients provides in vivo support for distinct immune response profiles in active vs inactive infection and suggests potential biomarkers.

The reference diagnostic method of human abdominal Cystic Echinococcosis (CE) is imaging, particularly ultrasound, supported by serology when imaging is inconclusive. However, current diagnostic tools are neither optimal nor widely available. The availability of a test detecting circulating biomarkers would considerably improve CE diagnosis and cyst staging (active vs inactive), as well as treatments and follow-up of patients. Exosomes are extracellular vesicles involved in intercellular communication, including immune system responses, and are a recognized source of biomarkers. With the aim of identifying potential biomarkers, plasma pools from patients infected by active or inactive CE, as well as from control subjects, were processed to isolate exosomes for proteomic label-free quantitative analysis. Results were statistically processed and subjected to bioinformatics analysis to define distinct features associated with parasite viability. First, a few parasite proteins were identified that were specifically associated with either active or inactive CE, which represent potential biomarkers to be validated in further studies. Second, numerous identified proteins of human origin were common to active and inactive CE, confirming an overlap of several immune response pathways. However, a subset of human proteins specific to either active or inactive CE, and central in the respective protein-protein interaction networks, were identified. These include the Src family kinases Src and Lyn, and the immune-suppressive cytokine TGF-ß in active CE, and Cdc42 in inactive CE. The Src and Lyn Kinases were confirmed as potential markers of active CE in totally independent plasma pools. In addition, insights were obtained on immune response profiles: largely consistent with previous evidence, our observations hint to a Th1/Th2/regulatory immune environment in patients with active CE and a Th1/inflammatory environment with a component of the wound healing response in the presence of inactive CE. Of note, our results were obtained for the first time from the analysis of samples obtained in vivo from a well-characterized, large cohort of human subjects.

A primary hydatid cyst in the abdominal wall -- case report.

INTRODUCTION: A solitary primary hydatid cyst in the abdominal wall is an exceptional entity, even in countries where the Echinococcus infection has a high rate, being considered an endemic disease. CASE PRESENTATION: We report a case of a 70-year-old Caucasian man who presented to our clinic with a slow-growing painless parietal mass in the abdominal wall, right flank area. The diagnosis of cystic mass was established at the ultrasound exam. There were no findings that could describe a hydatic cyst. The punction at the surgical intervention revealed a "clear, stone liquid like"; due to the high risk of major injury of the abdominal wall, we performed partial resection of the outer cystic wall, proligerous membrane removal and drainage. The patient had an uneventful post-operative recovery. The histopathology confirmed the suspected diagnosis. CONCLUSION: Hydatid cyst should be considered in the differential diagnosis of every abdominal intraparietal cystic mass, especially in regions where the disease is endemic. The best treatment is the total excision of the cyst preserving an intact wall (complete cystectomy). Otherwise, removing the proligerous membrane with partial pericyst's resection (partial pericystectomy) and drainage should be considered.

Albendazole associated to surgery or minimally invasive procedures for hydatid disease--how much and how long.

Cystic echinococcosis is parasitic disease due to the larval stage of the metacestode Echinococcus granulosus in the liver (80%), lungs, kidneys, spleen, myocardium etc. Humans are accidental intermediate hosts. Diagnosis is based on laboratory and imaging studies. Treatment is multimodal, surgical and medical. Risks for dangerous complications and relapses are quite common. Adequate follow-up is needed. Albendazole has a central role in the medical therapy of the disease.