Viability and fertility of human hepatic hydatid cysts.

INTRODUCTION: The adequate treatment for hydatidosis requires a knowledge of certain aspects related to the survival of infectious agents, especially protoscoleces. The aim of this study is to evaluate the viability of protoscoleces in human hepatic hydatid cysts in order to determine the prevalence of their fertility and to study the association with variables typical of the host and of the parasite. MATERIALS: A cross-sectional study was done in biological material (the fluid from human hepatic hydatid cysts). The viability criteria used were: ovoid form, invaginated scolices and intact calcareous corpuscles, the presence of vibrating movements, and the absence of "vital" staining. The cysts were grouped as univesicular cysts (UVC), multivesicular cysts (MVC) and abscessed cysts (LAHO). Fertility was defined as living protoscoleces in relation to the total number of protoscoleces. Descriptive statistics were for the calculation of the prevalence of fertility, analytical statistics for the comparison of groups, and a multivariate analysis for the examination of the association between cyst fertility and clinical variables. RESULTS: A total of 163 cysts with a median diameter of 15 cm were studied in this way. Of these lesions, 79 (48.5%) were UVC, 54 (33.1%) MVC, and 30 (18.4%) LAHO. On 99 occasions (60.7%), macroscopic communication was evident in the bile duct, and a prevalence of general fertility of 57.1% (94.4% for MVC, 53.2% for UVC, and 0% for LAHO, with a value of P<0.001). Association with location, type, and diameter of the cyst, and presence of biliary communications was verified by applying a bivariate analysis, and association between fertility and the variables of the type of the cyst and the existence of biliary communications was verified employing a multivariate analysis (P values of 0.004 and <0.001, respectively). CONCLUSIONS: The prevalence of fertility found was low. The main prevalence of fertility was observed in MVCs. Fertility is associated with the type of cyst and the presence of biliary communications.

In a diagnostic test study the validity of three serodiagnostic test was compared in patients with liver echinococcosis.

BACKGROUND AND OBJECTIVE: To determine the efficacy of immunoprecipitation (DD5), enzyme immunoanalysis (ELISA-IgG), and immunoelectrotransference or Western blot (WB) in patients with liver echinococcosis (LE) used separately, in parallel and in series. METHODS: Diagnostic test study. DD5, ELISA-IgG, and WB were applied in 75 patients with LE and 75 with cholelithiasis. Surgery was considered a reference standard. The sample size was calculated assuming a 99% confidence interval (99% CI), expected sensitivity (S) of 90% and a worst result of 80%; expected specificity (SP) of 95% and a worst result of 85%. S, SP, and predictive values (PPV and NPV) were calculated. RESULTS: The best S was verified with ELISA-IgG and WB (82.7%) and the best SP with DD5 (94.7%). DD5 presented a better PPV (92.9%) and WB a better NPV (83.5%). When applying the tests in parallel, the best S was obtained from the combination of DD5 and WB (82.7%); and the best SP, PPV and NPV with ELISA-IgG and WB (88.0%, 87.3%, and 83.5%, respectively). CONCLUSIONS: DD5 appears as the most specific test and as having greater PPV; ELISA-IgG and WB are more sensitive. The combined use of these tests does not improve diagnosis validity.

Preoperative albendazole and scolices viability in patients with hepatic echinococcosis.

To determine the plasmatic and intracystal concentrations of albendazole sulfoxide (AS) and correlate them with the viability of the scolices in patients surgically treated for hepatic hydatid cysts (HHC) that received albendazole preoperatively, as an indirect way of evaluating the scolicide efficacy of the drug. A non-consecutive series of patients with uncomplicated HHC, underwent operation at the Department of Surgery, Regional Hospital of Temuco, Chile, between 2001 and 2002. The patients were given 10 mg/kg/day of albendazole for 4 days prior to the surgery. Intraoperative samples of venous blood and hydatid fluid were taken, in which the plasmatic concentration (PIC) and intracystal concentration (ICC) of AS were measured by means of high-performance liquid chromatography. With the remaining hydatid fluid, the viability of the scolices was examined. The following variables were taken into consideration: diameter, type of cyst, number of cysts, and development of cyst-biliary communications. Descriptive statistics were used in the calculation of medians, averages, and standard deviations, and analytical statistics were used for the comparison of continuous variables applying the t-test and the Mann-Whitney U-test. A total of 26 patients with HHC, with a median age of 39.5 years (range: 16-80 years); 16 were women (61.5%). Nineteen patients presented only one cyst (73.1%), and the diametric median of the cysts was 14.5 cm (range: 7-30). Fourteen patients presented univesicular cysts (53.9%), and the remaining 12 had multivesicular cysts (46.1%). The average PIC of AS in the whole series was 1.88 +/- 0.5 microg/ml and the ICC was 0.26 +/- 0.2 microg/ml. The ICC in viable hydatid cysts was 0.25 microg/ml versus 0.28 microg/ml in non-viable cysts (p = 0.7556). The absence of association between intracystal levels of AS and the viability of the scolices allows one to posit indirectly that albendazole is ineffective as a scolicidal agent administered preoperatively for 4 days.

Uncommon locations of abdominal hydatid disease.

South Chile is an endemic zoonosis area of hydatid disease, where prevalence rates can be 30 to 40/100 000 habitants. Not only is surgery performed on a great number of liver and lung hydatid cysts every year, but also upon cysts found in uncommon abdominal locations such as spleen, peritoneum and kidney. Information on this subject is scarce. We reviewed PubMed index from 1975 to 2001 and found only five related articles, reporting more than 30 cases.

Hidatidosis abdominal de localización extrahepática: características clínica y evolución de una serie de casos / Abdominal extrahepatic echinococcosis: clinical characteristics and evolution

La hidatidosis es una zoonosis endémica en nuestro país, especialmente en la IX región de Chile, donde la alta prevalencia de la enfermedad permite observar hidatidosis en localizaciones poco habituales como bazo, páncreas y peritoneo. El objetivo de este trabajo es describir las características clínicas y evolución de una serie de pacientes con hidatidosis abdominal extra-hepática atendidos en nuestro Hospital. Se desarrollo un registro y análisis de datos: edad, sexo, procedencia, antecedentes quirúrgicos, estudios de laboratorio y de imágenes, hallazgos quirúrgicos y seguimiento. La serie de pacientes se conformó por 38 pacientes, 19 hombres y 19 mujeres, con un promedio de edad de 43,9 años (20 a 80 años). El 31,6 por ciento de los pacientes tenía antecedente de cirugía previa de quiste hidatídico. El laboratorio general fue inespecífico. En el 92,1 por ciento de los casos, la ecotomografía permitió constatar quistes de patrón ecolúcido. El diámetro promedio de las lesiones fue de 14,1 cm (5-30cm). Los órganos más frecuentemente comprometidos fueron peritoneo (60,5 por ciento) y bazo (26,3 por ciento). En el 50 por ciento de los pacientes el número de quiste fue de 5 ó más. En el 81,6 por ciento de los pacientes hubo coexistencia con quiste hidatídico hepático. El 42,1 por ciento de los pacientes recibió tratamiento médico postoperatorio con albedazol. Con un seguimiento promedio de 37 meses (1 a 86 meses). La morbilidad de la serie fue de 23,7 por ciento y se verificó una recidiva de 7,9 por ciento

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)