Figure - available from: Therapeutic Advances in Infectious Disease
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Representation of the liver hydatid cyst layers, which includes the outer acellular layer of the cyst (laminated layer), the inner nucleated layer of the cyst (germinal layer) and a granulomatous layer produced by the hosts’ immune system to wall off the cystic infection (adventitial layer). The protoscolex, the future head of the adult worm, is seen here budding from the germinal layer, and the daughter cyst is seen here floating within the main cyst. The hydatid sand is a sonographic finding representing a combination of cystic fluid and protoscolices. (Original – Adobe Photoshop).
Source publication
Liver cystic echinococcosis (CE), known as hydatid disease, is caused by the tapeworm Echinococcus granulosus sensu lato. Humans are accidental hosts in this zoonotic disease process, and hepatic infection accounts for over two-thirds of all cases. Since signs and symptoms are mainly non-specific, especially in early disease, clinicians should have...
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Background:
Human cystic echinococcosis (CE) is a zoonotic parasitic infection caused by the larval stage of the species belonging to the Echinococcus granulosus sensu lato (s.l.) complex. Parasitic cysts causing human CE are mainly localized in the liver and in the lungs. In a smaller number of cases, larvae may establish in any organ or tissue,...
Introduction and Aim: Cystic echinococcosis (CE) is a severe, widespread parasitic sickness that continues to be a significant health concern in many countries. The goal of the study was to find out how well ozonized saline solution (O3SS) cleans hydatid cysts to improve the results of neurosurgical treatment for patients with cerebral CE and to ma...
Cystic echinococcosis (CE) is a parasitic infestation caused by the Echinococcus Granulasus tapeworm. Although adults are the most affected, children also suffer from this disease. The lungs are the most common sites of infection in children, but other sites are also affected. Orbital cystic echinococcosis is rare in children, even in endemic areas...
Citations
... The mature worm exists in the small intestine of carnivores, and the eggs are released via the animal's feces and contaminate water and food. Food materials contaminated with Echinococcus eggs are swallowed by intermediate hosts, including herbivores, and the eggs enter the human body directly (contact with infected animals) or indirectly (eating contaminated food or water) and the larvae spread through the human body hematologically and via the lymphatic route (5,6). ...
... It is endemic in South America, China, Turkey, India, Australia, and Middle and Eastern European countries, with prevalence rates of up to 10% in endemic populations. [1][2][3][4][5][6] In Africa, the reported prevalence of CE is as low as 1.7%, a figure that grossly underestimates the disease burden. [7] Similarly, there is a paucity of epidemiological data for South Africa (SA). ...
... [9][10][11] Humans, who serve as accidental hosts ( Fig. 1), become infected through the inadvertent ingestion of soil, water or food that has been contaminated by the excrement of an afflicted dog. [1,6,12] Soil-deposited echinococcus eggs can remain viable for a duration of 1 year. [13] Once the parasite is consumed, it migrates from the intestine through the portal venous system to the liver and subsequently to the lungs. ...
... Although the most common sites of disease are the liver (70%) and lungs (20%), the disease may manifest in any organ. [1,3,6] Signs and symptoms are largely nonspecific, especially in the early stage of the disease; patients therefore often present late when the large cyst has some mechanical and compressive effects on organ function, or when rupture of a cyst causes acute hypersensitivity reactions. [1,3,6] Although hydatid cysts typically grow slowly, authors have reported accelerated cystic growth in patients with immunosuppressive states, which is relevant in our setting given the ongoing HIV and tuberculosis epidemics in sub-Saharan Africa. ...
... [15,22,[27][28][29] Some authors have reported that symptoms occur when the cyst is large (>10 cm) or when it occupies >70% of the liver volume. [1,2,6,29,30] However, in our study, 12 patients with cysts measuring between 7 and 9 cm also reported abdominal symptoms. ...
... These tests are typically performed when imaging findings are equivocal. [6,9,29,[34][35][36][37] A proportion of our patients had a negative result (21.4%) despite the findings on imaging being consistent with the diagnosis of liver CE. A seronegative result may occur due to the encapsulation of early cyst antigens by the endocyst, which prevents their detection by the immune system. ...
... This classification also provides further guidelines for managing the cyst based on its stage. [6,30,34,39] In our study, the majority of cysts were in the active stage, with just over half of all cases classified as CE1. This finding aligns with previous reports that CE1 is the stage most often observed on imaging. ...
Background. Cystic echinococcosis (CE) is a zoonotic disease with an Africa-wide prevalence of 1.7%. CE is caused by the tapeworm Echinococcus granulosus sensu lato, with the liver being the most commonly affected organ. In South Africa (SA), there is a paucity of data on liver CE demographics and management.
Objectives. To describe the demographics and clinical profile of patients with liver CE in a single tertiary hospital in Eastern Cape Province, SA.
Methods. A 4-year (2019 - 2022) retrospective clinical record review study was conducted on patients presenting with liver CE to the Department of Surgery at Frere Hospital. The demographics, clinical characteristics and management of patients with liver CE are reported.
Results. A total of 56 patients diagnosed with and managed for liver CE were included in the study. The mean age of the patients was 37.5 years. Abdominal pain (n=39; 69.6%) was the most common presenting symptom, and a palpable abdominal mass (n=36; 64.3%) was the predominant presenting sign. Most patients had disease confined to the liver (n=35; 62.5%). The right lobe of the liver was most
commonly affected (n=38; 67.9%), and most patients had a single liver cyst on imaging (n=32; 57.1%). The majority of the patients (n=36; 64.3%) were managed with surgical partial cystectomy, with a perioperative bile leak being the most common complication.
Conclusion. In our setting, liver CE contributes to a significant local burden of the disease. The disease often has a nonspecific clinical presentation, necessitating imaging for the diagnosis. We observed good short- erm outcomes in patients managed with combined partial cystectomy and medical therapy, although there is a risk of perioperative bile leak.
... In addition, cystic growth has been reported to be one centimeter in diameter for the first six months, after which it is closely related to host immunity and surrounding tissue resistance, and liver cysts have been reported to grow more slowly than lung cysts. [9,10] In 1986, Romig et al. [11] followed 44 hydatid cysts in 36 patients for up to 18 months using ultrasound for liver hydatid cysts. During the observation period, 66% of the cysts grew, while 34% remained stable, collapsed, or disappeared. ...
Background: This study aims to investigate whether the concept of doubling time in hydatid cysts differs according to different parameters such as age, sex, and whether the cyst is located in the lung or liver. Background: This study aims to investigate whether the concept of doubling time in hydatid cysts differs according to different parameters such as age, sex, and whether the cyst is located in the lung or liver.
Methods: Between January 2012 and August 2023, a total of 138 hydatid cysts were retrospectively analyzed. There were 55 pulmonary (32 males, 23 females; mean age: 25.6±23.8 years; range, 2 to 77 years) and 83 hepatic hydatid cyst patients (32 males, 51 females; mean age: 31.1±22.8 years; range, 3 to 75 years).
Results: The mean doubling times for pulmonary and hepatic hydatid cysts were 73.4±41.8 and 172.6±108.8 days, respectively (p<0.001). When children (≤18 years old) and adult cases were compared for pulmonary hydatid cysts, the mean doubling times were 61.1±17.6 and 87.1±55.3 days, respectively (p=0.119), and for hepatic hydatid cysts, 110.6±48.4 and 215.6±118.3 days, respectively (p<0.001). While comparing male and female cases, the mean doubling time for pulmonary hydatid cysts was 77.6±32.2 and 67.6±52.6 days, respectively (p=0.018), while for hepatic hydatid cysts, it was 192.0±111.7 and 160.4±106.2 days, respectively (p=0.250).
Conclusion: The doubling time seems to be approximately 10 weeks in the lung and approximately 25 weeks in the liver. Hydatid cysts grow faster in children than adults in both the lungs and liver.
... Additionally, liver cysts were more frequently isolated than lung cysts (66.7%, p = 0.01), which is consistent with previous research. This pattern can be attributed to various factors, including the anatomical features of the liver, its rich blood supply, the route of infection, and the immune response [31][32][33][34][35]. These findings underscore the significance of understanding the demographic and clinical features of CE patients, particularly in terms of gender distribution, age ranges, and the prevalence of cysts in specific anatomical locations. ...
Background
The diagnostic tool for identifying cystic echinococcosis (CE) patients at an early stage is currently lacking. However, circulatory cell-free DNA (cfDNA) has shown potential as a biomarker for parasitic infections and could be used for diagnosing CE.
Research Design and methods
The plasma and urine samples were collected from 39 patients with confirmed CE through imaging and histopathological techniques. All plasma samples were tested for anti-echinococcal antibodies using a commercial ELISA test. Total plasma and urine cfDNA were extracted and an in-house PCR assay was developed to detect E. granulosus specific cfDNA in the samples of CE patients.
Results
Out of the 39 patients, 30 tested positive for E. granulosus using serology, with a sensitivity of 76.9%. Moreover, the detection rates for the cfDNA were 79.5% in plasma samples and 58.97% in urine samples using the 80 bp COX1 gene. The plasma-based PCR and serology test showed the highest agreement (Kappa = 0.53).
Conclusions
Plasma-based PCR has been found to be a reliable diagnostic tool for identifying CE patients at different cyst stages. It offers validity, speed, and sufficient sensitivity, making it an alternative to serology in diagnosing CE in endemic areas.
... E. granulosus is endemic in India and in the Middle East, with an incidence of up to 50 per 100,000 person-years and an estimated prevalence of 10% of the population in endemic areas. 1,2 Hydatid cysts are typically asymptomatic and last for a very long time; in most cases, they are unintentionally found during routine imaging after going unnoticed for 10-15 years. However, some patients may experience symptoms, such as nausea, vomiting, stomach pain, and jaundice. ...
Key Clinical Message
Hydatid cysts, primarily found in the liver (70%), are caused by parasitic infections and can lead to severe complications such as cyst rupture. This case report describes a unique instance of a hydatid liver cyst occupying the right lobe with a communicating part with the biliary tree that ruptured showing a concurrent superinfection.
Abstract
Hydatid cysts are a clinical pathology resulting from parasitic infections. They may occur in different organs of the body. However, these are mostly found in the liver (70%). This can cause significant complications including cyst rupture. Several case reports have described various hydatid cyst ruptures; however, only a few have reported an intra‐biliary hydatid cyst rupture. A 24‐year‐old male patient presented with right upper quadrant pain, jaundice, dark urine, and pale stool. Imaging studies, including Magnetic resonance cholangiopancreatography (MRCP) and computed tomography (CT), revealed a beavertail liver, cystobiliary communication and intrahepatic biliary tree‐ruptured hydatid cysts. The cyst was in the right liver lobe, which is the most common site for hydatid cysts. Surgical intervention involving laparoscopic de‐roofing and cyst removal resulted in a smooth recovery without complications. Several case reports have described various hydatid cyst ruptures; however, only a few have reported originally placed intra‐biliary hydatid cyst ruptures. This case report describes a unique instance of a hydatid liver cyst occupying the right lobe with a communicating part with the biliary tree that ruptured showing a concurrent superinfection.
... To achieve a unified management of this condition, an algorithm has been developed that establishes a therapeutic sequence based on the imaging classification of the hydatid cyst and its dimensions (Figure 1). Modified Catheterisation Technique (MoCAT), or surgery represents the most optimal option in terms of cyst inactivation and low recurrence [10][11][12][13]. When comparing albendazole with mebendazole, albendazole shows better results, and its combination with praziquantel is the most efficient drug therapy [9]. ...
Hydatid cyst disease is a parasitic ailment with an endemic nature, predominantly affecting geographical areas with a tradition in animal husbandry. The most common localization of hydatid disease is in the liver (60%), followed by the lungs, with other organ localizations comprising less than 10%. The surgical approach to this condition can be carried out through open surgery or laparoscopy. The coexistence of hepatic and intraperitoneal hydatidosis often leads to the preference for open surgery. We performed a literature review aiming to retrieve data regarding demographic characteristics, clinical features, preoperative management, and surgical approach concerning these unusual localizations of hydatid disease. It was observed that the mesenteric localization frequently presented with acute abdominal pain (p = 0.038) and that the open approach was preferred in 85.71% of cases. Furthermore, an interdependence was identified between the localization of the cysts and the type of surgical approach (p = 0.001), with mesenteric localizations being approached through laparotomy and excision (p = 0.037), while omental localizations, due to the easier approach, benefited from laparoscopy with excision in 14.29% of cases. Overall, the laparoscopic approach was less frequently used, but its utilization resulted in a lower number of complications and faster recovery. Additionally, we present a rare case of hepatic and intra-abdominal hydatidosis, resolved exclusively through a laparoscopic approach, including a review of the literature for these uncommon localizations of hydatid disease. A 45-year-old patient diagnosed with multiple hydatid cysts, both hepatic and intraperitoneal, underwent surgical intervention with exploratory laparoscopy. Laparoscopic excision of peritoneal, epiploic, mesenteric cysts, and round ligament, along with laparoscopic inactivation, evacuation, and pericystectomy of hepatic hydatid cysts, was performed. The patient’s recovery was uneventful, and she was reevaluated at 3 and 9 months without signs of recurrence. The association of hepatic hydatid cysts with multiple intra-abdominal localizations is not commonly encountered. The treatment of choice is surgical and is predominantly conducted through open surgery. The presented case is unique due to the exclusive laparoscopic approach in the management of mixed hepatic and intra-abdominal hydatidosis.
... However, the main point of mentioned reports and other similar studies were obtained to be similar to Shambesh et al. (1997) .Therefore, until now achieving highly great sensitivity and specificity simultaneously by antigen B using ELISA or any other hydatid cyst antigen has been impossible, and one of the main challenges and efforts such as these studies is to achieve this aim (29). ...
Background:
Hydatidosis, a chronic zoonotic disease, has a distribution worldwide and is caused by the larval stage of the Echinococcus helminth. The Dot-ELISA test can diagnose hydatidosis quickly and accurately. Additionally, unlike other hydatid disease tests now used, this quick and affordable enzyme immunoassay is very serum-conservative and antigen-conservative, needing just nanogram levels of parasite antigen.
Methods:
In the present cross-sectional study, crude and B antigens of hydatid cyst fluid were obtained to diagnose human hydatidosis using CIEP (Counter Immunoelectrophoresis), ELISA (Enzyme-linked Immuno Sorbent assay), and Dot- ELISA (Dot Enzyme linked Immuno Sorbent Assay) methods. Infected liver with a hydatid cyst was collected from Tehran's slaughterhouses to prepare cyst fluid in different stages. After extracting and purifying the Cyst fluid, it is centrifuged at 4ºc, then prepared to concentrate. The study also included sera from hydatidosis (n=60), samples of helminth parasites (n=55), fascioliasis (n=35), toxocariasis (n=20) and negative control (n=35) were tested by CIEP (Counter Immunoelectrophoresis), ELISA (Enzyme-linked Immune Sorbent assay), and Dot- ELISA (Dot Enzyme linked Immuno Sorbent Assay) methods. All statistical analyses were performed using Statistical Package for the Social Sciences (SPSS) for Windows release 25.0 (SPSS Inc., Chicago, IL, USA).
Results:
Crude antigen of hydatid cyst showed a specificity of 76.7%, a sensitivity of 93.3% using the ELISA method, and B antigen showed a specificity of 96.7% and sensitivity of 88.3% using the same method. The crude antigen of the hydatid cyst exhibited a specificity of 68.9% and a sensitivity of 86.7% using CIEP. The B antigen showed a specificity of 87.8% and sensitivity of 83.3% using the same method.The crude antigen of hydatid cyst having serum dilution at 1:800 exhibited a specificity of 83.3% and sensitivity of 100% using the Dot-ELISA method and B antigen having serum dilution at 1:800 serum showed a specificity of 100% and sensitivity of 98.3% using the same method. The results of this finding showed that B antigen has the maximum specificity to diagnose hydatid test using the Dot- ELISA method.
Conclusion:
Hydatid cysts present with varied symptomatology. History of exposure to infected animals may not be present. A high degree of clinical suspicion combined with meticulous history and clinical examination supported by laboratory investigations are required for its diagnosis. The Dot-ELISA system with native antigen B is a viable approach for the immunodiagnosis of human hydatidosis that is preferred to infection.
Cystic echinococcosis (CE) is a significant health problem in both human and veterinary medicine. It is caused by the tapeworm Echinococcus granulosus (E. granulosus). The objective of this study was to investigate molecular diversity of E. granulosus from the paraffin-embedded human (FFPE) tissue samples using sequencing of mitochondrial genes. Thirty-five FFPE tissue samples were collected from different regions of Guilan province, north of Iran. Demographic data were recorded using a questionnaire. Five sections (1 mm) of the tissue were prepared and deparaffined using xylene and ethanol methods. Molecular analysis was performed using the Nad1 and Cox1 genes using PCR and DNA sequencing. Totally, 25 cases (71.43%) were women and 10 cases (28.57%) were men. The most affected age group was 21–30 yr old. The most of cysts were isolated from the liver (n = 19; 54.29%) and others in the lung (n = 16; 45.71%). The Cox1 and Nad1 genes were successfully amplified in 16 (45.71%) and 12 (34.28%) DNA samples from FFPE tissue. Sequencing analysis revealed that all samples were E. granulosus sensu stricto complex (G1 and G3). In this study, E. granulosus sensu stricto complex G1 and G3 were identified in human hydatid cysts and showed the presence of sheep/dog cycle in human infection. This finding confirmed and completed previous studies on the geospatial distribution of E. granulosus sensu stricto complex G1 and G3 in the southern and coastal areas of the Caspian Sea region.
Cysts are abnormal fluid-filled sacs found in various human organs, including the liver. Liver cysts can be associated with known causes such as parasite infections and gene mutations, or simply aging. Among these causes, simple liver cysts are often found in elderly people. While they are generally benign, they may occasionally grow but rarely shrink with age, indicating their clear association with aging. However, the mechanism behind the formation of simple liver cysts has not been thoroughly investigated. Recently, we have generated transgenic mice that specifically overexpress fibroblast growth factor (FGF)18 in hepatocytes. These mice exhibit severe liver fibrosis without inflammation and spontaneously develop liver cysts that grow with age. Our findings suggest that simple liver cysts can be induced by fibrosis accompanied by sterile inflammation or injury, whereas fibrosis accompanied by severe inflammation or injury may lead to cirrhosis. We also discuss the detrimental effects of disease- and aging-associated fibrosis in various organs, such as the heart, lungs, and kidneys. Additionally, we provide a brief summary of the two currently approved anti-fibrotic drugs for idiopathic pulmonary fibrosis, nintedanib and pirfenidone, as well as their possibility of future expansion of application toward other fibrotic diseases.
