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1.
PLoS Negl Trop Dis ; 18(5): e0012183, 2024 May.
Artigo em Inglês | MEDLINE | ID: mdl-38814859

RESUMO

Human cystic echinococcosis (CE) is a parasitic infection caused by the larval stage of the tapeworm Echinococcus granulosus sensu lato, primarily affecting the liver and lungs. Although the heart is affected in only 0.02-2% of all CE cases, a considerable number of cases have been, and continue to be, published. However, due to the rare occurrence of cardiac CE and the resulting lack of clinical trials, knowledge about various aspects of the disease remains limited. To obtain a clearer picture of anatomical, clinical, diagnostic as well as therapeutic aspects of cardiac CE, we systematically reviewed the literature published between 1965 and 2022. The anatomical pattern of the affected cardiac structures follows the extension of the supplying capillary bed. The majority of patients (82.7%) are symptomatic and present with prolonged non-specific symptoms such as dyspnoea, chest pain and palpitations. Acute complications generally derive from cyst rupture, occur in 18.3% of cases and manifest as embolism, pericardial tamponade, or anaphylactic reaction in 83.2%, 17.8% and 10.9% of these cases, respectively. As for CE cysts localized in other organs, the diagnosis of cardiac CE is made by imaging. Serology plays a minor role due to its limited sensitivity. Unlike abdominal CE cysts, cardiac CE cysts are usually resected independent of their stage (active/inactive), because their presence impairs cardiac performance and carries the risk of long-term sequelae. More than 80% of patients are treated with a single surgical intervention. We found a disease-related case fatality rate of 11.1%. Since local recurrence was reported up to 108 months and secondary CE up to 72 months after surgery, patients should be followed up for a minimum of 10 years.


Assuntos
Equinococose , Humanos , Equinococose/diagnóstico , Equinococose/cirurgia , Animais , Cardiopatias/parasitologia , Cardiopatias/cirurgia , Echinococcus granulosus , Coração/parasitologia
3.
PLoS Negl Trop Dis ; 7(9): e2450, 2013.
Artigo em Inglês | MEDLINE | ID: mdl-24086783

RESUMO

Bone involvement in human cystic echinococcosis (CE) is rare, but affects the spine in approximately 50% of cases. Despite significant advances in diagnostic imaging techniques as well as surgical and medical treatment of spinal CE, our basic understanding of the parasite's predilection for the spine remains incomplete. To fill this gap, we systematically reviewed the published literature of the last five decades to summarize and analyze the currently existing data on epidemiological and anatomical aspects of spinal CE.


Assuntos
Equinococose/epidemiologia , Equinococose/patologia , Doenças da Coluna Vertebral/epidemiologia , Doenças da Coluna Vertebral/patologia , Adolescente , Adulto , Idoso , Criança , Pré-Escolar , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Doenças da Coluna Vertebral/parasitologia , Adulto Jovem
4.
PLoS Negl Trop Dis ; 7(9): e2458, 2013.
Artigo em Inglês | MEDLINE | ID: mdl-24069501

RESUMO

Bone involvement in human cystic echinococcosis (CE) is rare, but affects the spine in approximately 50% of cases. Despite significant advances in diagnostic imaging techniques, surgical treatment and introduction of pharmacological therapy, spinal echinococcosis remains associated with a high degree of morbidity, disability and mortality. We systematically reviewed the published literature of the last five decades to update and summarize the currently existing data on treatment, follow-up and outcome of spinal CE.


Assuntos
Anti-Helmínticos/uso terapêutico , Equinococose/tratamento farmacológico , Equinococose/cirurgia , Doenças da Coluna Vertebral/tratamento farmacológico , Doenças da Coluna Vertebral/cirurgia , Procedimentos Cirúrgicos Operatórios/métodos , Equinococose/diagnóstico , Humanos , Doenças da Coluna Vertebral/diagnóstico , Resultado do Tratamento
5.
Infection ; 41(2): 409-14, 2013 Apr.
Artigo em Inglês | MEDLINE | ID: mdl-23001543

RESUMO

PURPOSE: Extrapulmonary tuberculosis (EPTB) is frequently seen in human immunodeficiency virus (HIV)-infected individuals in Sub-Saharan Africa and recent work has shown point-of-care (POC) ultrasound to be a diagnostic aid in the resource-limited, highly endemic setting. Its role in industrialized countries, however, has rarely been studied. With international migration, EPTB is increasingly seen in European hospitals. This study reports ultrasound findings and discusses the diagnostic relevance of EPTB in an industrialized country setting. METHODS: In this retrospective study, we describe a cohort of 27 patients with a predominantly immigrant background diagnosed with HIV and EPTB in Northern Italy and evaluate the role of ultrasound in their clinical management. All inpatient files of HIV-positive individuals admitted to our hospital with culture-proven diagnosis of EPTB were reviewed, along with chest X-rays and ultrasound studies. The outcome and results of long-term follow-up were extracted. RESULTS: A total of 243 HIV-positive inpatients were identified between January 2005 and November 2011. Twenty-seven of the patients [11.1 %, 95 % confidence interval (CI) 7.4-15.7] were diagnosed with EPTB. Ultrasound showed a typical pattern of enlarged abdominal lymph nodes and focal lesions in the spleen and liver in 22 patients (81.5 %, 95 % CI 7.4-15.7) and, thus, helped to raise the suspicion of mycobacterial infection. CONCLUSION: As disseminated mycobacterial infections in HIV-positive patients can be treated effectively if diagnosed early, and typical sonographic findings are seen in the majority of these patients, we suggest that POC ultrasound should be integrated in diagnostic and screening algorithms for EPTB in developed countries.


Assuntos
Soropositividade para HIV/microbiologia , Tuberculose/diagnóstico por imagem , Adulto , Técnicas Bacteriológicas , Coinfecção/microbiologia , Coinfecção/virologia , Intervalos de Confiança , Emigrantes e Imigrantes , Feminino , Febre/microbiologia , Febre/patologia , Febre/virologia , Seguimentos , Soropositividade para HIV/epidemiologia , Humanos , Itália/epidemiologia , Estimativa de Kaplan-Meier , Fígado/patologia , Masculino , Pessoa de Meia-Idade , Estudos Retrospectivos , Baço/patologia , Tórax/diagnóstico por imagem , Tórax/microbiologia , Resultado do Tratamento , Tuberculose/epidemiologia , Ultrassonografia , Adulto Jovem
6.
Crit Ultrasound J ; 4(1): 21, 2012 Nov 21.
Artigo em Inglês | MEDLINE | ID: mdl-23171481

RESUMO

BACKGROUND: Ultrasound can rapidly identify abnormal signs, which in high prevalence settings, are highly suggestive of extra-pulmonary tuberculosis (EPTB). Unfortunately experienced sonographers are often scarce in these settings. METHODS: A protocol for focused assessment with sonography for HIV-associated tuberculosis (FASH) which can be used by physicians who are relatively inexperienced in ultrasound was developed. RESULTS: The technique as well as normal and pathological findings are described and the diagnostic and possible therapeutic reasoning explained. The protocol is intended for settings where the prevalence of HIV/TB co-infected patients is high. CONCLUSION: FASH is suitable for more rapid identification of EPTB even at the peripheral hospital level where other imaging modalities are scarce and most of the HIV and TB care will be delivered in the future.

7.
PLoS Negl Trop Dis ; 6(1): e1444, 2012 Jan.
Artigo em Inglês | MEDLINE | ID: mdl-22253935

RESUMO

UNLABELLED: Cystic echinococcosis (CE) is a chronic, complex and neglected disease caused by the larval stage of Echinococcus granulosus. The effects of this neglect have a stronger impact in remote rural areas whose inhabitants have no chances of being diagnosed and treated properly without leaving their jobs and travelling long distances, sometimes taking days to reach the closest referral center. BACKGROUND: In 1980 our group set up a control program in endemic regions with CE in rural sections of Rio Negro, Argentina. Since 1997, we have used abdominopelvic ultrasound (US) as a screening method of CE in school children and determined an algorithm of treatment. OBJECTIVES: To describe the training system of general practitioners in early diagnosis and treatment of CE and to evaluate the impact of the implementation of the field program. MATERIALS AND METHODS: In 2000, to overcome the shortage of radiologists in the area, we set up a short training course on Focused Assessment with Sonography for Echinococcosis (FASE) for general practitioners with no previous experience with US. After the course, the trainees were able to carry out autonomous ultrasound surveys under the supervision of the course faculty. From 2000 to 2008, trainees carried out 22,793 ultrasound scans in children from 6 to 14 years of age, and diagnosed 87 (0.4%) new cases of CE. Forty-nine (56.4%) were treated with albendazole, 29 (33.3%) were monitored expectantly and 9 (10.3%) were treated with surgery. DISCUSSION: The introduction of a FASE course for general practitioners allowed for the screening of CE in a large population of individuals in remote endemic areas with persistent levels of transmission, thus overcoming the barrier of the great distance from tertiary care facilities. The ability of local practitioners to screen for CE using US saved the local residents costly travel time and missed work and proved to be an efficacious and least expensive intervention tool for both the community and health care system.


Assuntos
Equinococose/diagnóstico , Equinococose/terapia , Medicina Geral/métodos , Clínicos Gerais/educação , Ultrassonografia/métodos , Abdome/diagnóstico por imagem , Adolescente , Albendazol/administração & dosagem , Animais , Anti-Helmínticos/administração & dosagem , Argentina , Criança , Diagnóstico Precoce , Equinococose/parasitologia , Echinococcus granulosus/patogenicidade , Pesquisa sobre Serviços de Saúde , Humanos , Programas de Rastreamento/métodos , Pelve/diagnóstico por imagem , População Rural , Procedimentos Cirúrgicos Operatórios , Ultrassonografia/estatística & dados numéricos
8.
PLoS Negl Trop Dis ; 5(6): e1154, 2011 Jun.
Artigo em Inglês | MEDLINE | ID: mdl-21695106

RESUMO

Percutaneous treatment (PT) emerged in the mid-1980s as an alternative to surgery for selected cases of abdominal cystic echinococcosis (CE). Despite its efficacy and widespread use, the puncture of echinococcal cysts is still far from being universally accepted. One of the main reasons for this reluctance is the perceived risk of anaphylaxis linked to PTs. To quantify the risk of anaphylactic reactions and lethal anaphylaxis with PT, we systematically searched MEDLINE for publications on PT of CE and reviewed the PT-related complications. After including 124 publications published between 1980 and 2010, we collected a total number of 5943 PT procedures on 5517 hepatic and non-hepatic echinococcal cysts. Overall, two cases of lethal anaphylaxis and 99 reversible anaphylactic reactions were reported. Lethal anaphylaxis occurred in 0.03% of PT procedures, corresponding to 0.04% of treated cysts, while reversible allergic reactions complicated 1.7% of PTs, corresponding to 1.8% of treated echinococcal cysts. Analysis of the literature shows that lethal anaphylaxis related to percutaneous treatment of CE is an extremely rare event and is observed no more frequently than drug-related anaphylactic side effects.


Assuntos
Anafilaxia/induzido quimicamente , Anafilaxia/epidemiologia , Equinococose/terapia , Medição de Risco , Anafilaxia/psicologia , Equinococose/complicações , Humanos , Incidência
9.
Int J Infect Dis ; 14 Suppl 3: e108-12, 2010 Sep.
Artigo em Inglês | MEDLINE | ID: mdl-20363170

RESUMO

OBJECTIVE: To investigate the diagnostic value of abdominal ultrasound in HIV-positive inpatients in a rural African setting. METHODS: This was a prospective case series over 3 months of adult HIV-positive patients with symptoms suggestive of abdominal tuberculosis (TB). Diagnostic ultrasound was performed for all patients: sonographic criteria included abdominal lymph node enlargement (>1.5cm) and focal splenic lesions; ascites was a supportive finding. Further diagnostic studies, e.g., aspiration or biopsy were not routinely performed. TB treatment was initiated on the basis of clinical and sonographic features. The patients were contacted after 4 months to evaluate the clinical outcome. RESULTS: One hundred and eighty adult HIV-positive patients were screened; 30 (16.7%) showed sonographic signs of abdominal TB. The median CD4 count was 78 cells/mm(3). Presenting symptoms were weight loss (86.7%), abdominal pain (76.7%), and diarrhea (60%). Abdominal lymph node enlargement was the diagnostic finding in almost all cases (96.7%); hypoechoic lesions of the spleen were seen in 50% and ascites in 73.3%. Follow-up information was available for 25 patients: 24% had died and the remaining 76% reported symptomatic improvement and weight gain. CONCLUSIONS: Characteristic sonographic features of abdominal TB are common in HIV-infected inpatients in a rural African setting. Ultrasound should be introduced into clinical algorithms for the diagnosis of extrapulmonary TB.


Assuntos
Infecções por HIV/complicações , Tuberculose Gastrointestinal/complicações , Tuberculose Gastrointestinal/diagnóstico por imagem , Adulto , Ascite/diagnóstico por imagem , Feminino , Infecções por HIV/diagnóstico por imagem , Humanos , Doenças Linfáticas/diagnóstico por imagem , Masculino , Pessoa de Meia-Idade , Estudos Prospectivos , População Rural , África do Sul , Baço/diagnóstico por imagem , Tuberculose Gastrointestinal/diagnóstico , Ultrassonografia , Adulto Jovem
10.
Am J Trop Med Hyg ; 82(3): 512-5, 2010 Mar.
Artigo em Inglês | MEDLINE | ID: mdl-20207884

RESUMO

In Africa, human immunodeficiency virus (HIV)-associated extrapulmonary tuberculosis (TB) is common and poses diagnostic difficulties. Ultrasound is useful to find suggestive signs such as effusions or abdominal lymphadenopathy. Because trained radiologists are scarce in resource-poor settings, even this simple and relatively inexpensive diagnostic tool is frequently unavailable to patients in district hospitals in sub-Saharan Africa. We developed a focused protocol for assessment with sonography for HIV/TB and trained physicians in a rural district hospital in South Africa. In this pilot study, high levels of confidence in identifying specific signs were rapidly achieved and ultrasound was introduced into routine clinical practice.


Assuntos
Educação Médica/métodos , Infecções por HIV/complicações , Infecções por HIV/diagnóstico por imagem , Tuberculose Pulmonar/complicações , Tuberculose Pulmonar/diagnóstico por imagem , Currículo , Humanos , Projetos Piloto , Prevalência , África do Sul/epidemiologia , Ultrassonografia
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