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Clinical management of cystic echinococcosis (CE) has evolved over decades without adequate evaluation of important features such as efficacy, effectiveness, rate of adverse reactions, relapse rate, and cost. CE occurs in health care environments as different as Europe/North America and resource-poor countries of the South and the East. This create...
Contexts in source publication
Context 1
... classifications are most frequently used: the Gharbi and the WHO Informal Working Group on Echinococcosis (IWGE) classification (Table 1). As shown in Table 1, the WHO classification is almost the same as Gharbi's, with Gharbi type II corresponding to CE3a and vice versa. ...
Context 2
... classifications are most frequently used: the Gharbi and the WHO Informal Working Group on Echinococcosis (IWGE) classification (Table 1). As shown in Table 1, the WHO classification is almost the same as Gharbi's, with Gharbi type II corresponding to CE3a and vice versa. How- ever, there are two important additions in the WHO classifi- cation: the predominantly solid cyst with daughter cysts, which was not explicitly included in Gharbi's classification, has been found a place in the CE3 slot, and the types are now grouped according to their biological activity (Table 1; far right column). ...
Context 3
... shown in Table 1, the WHO classification is almost the same as Gharbi's, with Gharbi type II corresponding to CE3a and vice versa. How- ever, there are two important additions in the WHO classifi- cation: the predominantly solid cyst with daughter cysts, which was not explicitly included in Gharbi's classification, has been found a place in the CE3 slot, and the types are now grouped according to their biological activity (Table 1; far right column). This has important consequences for treatment decisions, as we will detail in the paper. ...
Citations
... Although several classifications emerged thereafter, their adoption was limited. In 1994, due to the introduction of new potential treatments of CE including albendazole and percutaneous treatment, the World Health Organization -Informal Working Group on Echinococcosis (WHO-IWGE) started to develop an internationally standardized ultrasound classification, to establish universal application replacing the diverse range of classifications previously used and to guide the clinical decision making in treating the CE patient [7,[10][11][12]. The four treatment modalities that are specified in WHO-IWGE are: medical (albdendazole alone), percutaneous treatment such as Puncture, Aspiration, Injection, Re-aspiration (PAIR), surgical treatment for active cyst stage CE1 to CE3b and 'watch & wait' for inactive cyst stages CE4 and CE5 [13][14][15][16]. ...
... This is reflected in our health professionals' survey, where parasitological, histological, and serological laboratory facilities all scored below 2. The remoteness and diagnostic challenge are an inherent aspect of the disease that is difficult to change [17,35]. In contrast, clinical management and surveillance systems can indeed be improved just with better communication and governance [7,12,27]. In our survey, CE reporting to the NDR system in Mongolia got the second lowest average score, while such reporting should be mandatory for most infectious and zoonotic diseases. ...
... In 2017, the Ministry of Health mandated CE reporting in the NDR, which eventually failed to yield results due to the absence of clear guidance on communication between clinicians and epidemiologists [34]. This experience underlines the importance of the communication and dialogue between and within the sectors for handling such complex diseases as CE [7]. ...
Cystic echinococcosis (CE), caused by the larval stage of Echinococcus granulosus, is significantly underreported in Mongolia due to geographical remoteness, lack of early diagnostics, and poor clinical management. This study aimed to provide a more accurate estimate of CE in Mongolia by comparing data of surgical (reported) and diagnosed (unreported) cases, and assessing the challenges faced by rural doctors in disease management and surveillance. We collected data on surgical cases hospitalized between 2006-2016 and newly diagnosed CE cases in 2016 from eight provinces. Using a quasi-Poisson regression model of the collected data, we used extrapolation to estimate the number of diagnosed cases for the entire country. Additionally, fourty health professionals from all 21 provinces rated local clinical management for CE through a questionnaire. Results reveal that surgical cases (2.2 per year) represent only one-eighth of diagnosed cases (15.9 per year). The laboratory facilities, disease reporting, and cyst classification usage scored below 2. These results highlight the significant underreporting of CE in Mongolia and urges human and animal health experts, along with policymakers, to invest into combating CE, particularly in remote provincial areas. It also emphasizes the need for standard clinical management involving cyst classification according to WHO-IWGE, seamless integration of CE reporting and monitoring mechanisms, which can significantly contribute to the national and global burden estimation of CE.
... Common protoscolicidal agents include silver nitrate (AgNO3), hypertonic saline, and hydrogen peroxide. However, recent studies have revealed that these synthetic drugs are not without side effects, such as liver fibrosis, cirrhosis, and cholangitis (9,10). ...
This current in vitro, ex vivo, and in vivo research aims to evaluate and analyze the linalool-zinc oxide nanocomposite (Lin-ZNP) for treating cystic echinococcosis. Lin-ZNP was synthesized using an ethanolic solution of polyvinyl alcohol. The protoscolicidal effects of Lin-ZNP were tested on hydatid cyst protoscoleces (PTS) in both in vitro and ex vivo by eosin exclusion test. The study also examined the impact on caspase-3 gene expression and the external structure of PTS. The in vivo effect was measured by examining hydatid cysts' quantity, dimensions, and weight in mice intraperitoneally infected with 0.5 mL of PTS solution containing 1,000 PTS. The antioxidant and inflammatory cytokine gene expression levels were examined using real-time PCR. Lin-ZNP significantly (P < 0.001) killed the PTS in both in vitro and ex vivo in a dose- and time-dependent manner. The treated PTS exhibited creases and protrusions as a result of bleb formation and upregulation in the gene expression of caspase-3. Upon treatment with Lin-ZNP, there was a significant (P < 0.001) reduction in the number, diameter, and weight of the hydatid cysts. Treatment with Lin-ZNP nanocomposite led to a significant increase in the expression of antioxidant genes and a notable decrease in oxidative stress markers, and the expression levels of IL-4 and IL-10. Lin-ZNP has the potential to act as a scolicidal agent and demonstrates promise in controlling hydatid cysts in a mouse model, attributed to its antioxidant and anti-inflammatory properties. However, additional studies in clinical trials are needed to confirm the use of Lin-ZNP for treating hydatidosis.
... CE presents a significant challenge in terms of treatment. While surgery was the only available treatment option for CE for a long time, it is no longer the primary or optimal treatment option in all cases [8]. Surgical treatment is preserved for complicated cysts (ruptured, perforated, compression on vital organs and vessels, secondary infection), large cysts containing daughter cysts, and superficial cysts [8,9]. ...
... While surgery was the only available treatment option for CE for a long time, it is no longer the primary or optimal treatment option in all cases [8]. Surgical treatment is preserved for complicated cysts (ruptured, perforated, compression on vital organs and vessels, secondary infection), large cysts containing daughter cysts, and superficial cysts [8,9]. Otherwise, alternative methods, such as the use of anthelmintic medications like albendazole (ABZ) and praziquantel or minimally invasive surgical procedures such as puncture (P), aspiration (A), instillation (I), and re-aspiration (R) PAIR method and also watch and wait, should be taken into account [8,10]. ...
... Surgical treatment is preserved for complicated cysts (ruptured, perforated, compression on vital organs and vessels, secondary infection), large cysts containing daughter cysts, and superficial cysts [8,9]. Otherwise, alternative methods, such as the use of anthelmintic medications like albendazole (ABZ) and praziquantel or minimally invasive surgical procedures such as puncture (P), aspiration (A), instillation (I), and re-aspiration (R) PAIR method and also watch and wait, should be taken into account [8,10]. ...
Background
This study aimed to determine the therapeutic efficacy of curcumin nanoemulsion (CUR-NE) in mice infected with Echinococcus granulosus sensu stricto protoscoleces.
Methods
Forty-two inbred BALB/c mice were divided into seven groups of six animals each. Six groups were inoculated intra-peritoneally with 1500 viable E. granulosus protoscoleces, followed for six months and used as infected groups. The infected groups were named as: CEI1 to CEI6 accordingly. The 7th group was not inoculated and was named cystic echinococcosis noninfected group (CENI7). CEI1 and CEI2 groups received 40 mg/kg/day and 20 mg/kg/day curcumin nanoemulsion (CUR-NE), respectively. CEI3 received nanoemulsion without curcumin (NE-no CUR), CEI4 received curcumin suspension (CUR-S) 40 mg/kg/day, CEI5 received albendazole 150 mg/kg/day and CEI6 received sterile phosphate-buffered saline (PBS). CENI7 group received CUR-NE 40 mg/kg/day. Drugs administration was started after six months post-inoculations of protoscoleces and continued for 60 days in all groups. The secondary CE cyst area was evaluated by computed tomography (CT) scan for each mouse before treatment and on the days 30 and 60 post-treatment. The CT scan measurement results were compared before and after treatment. After the euthanasia of the mice on the 60th day, the cyst area was also measured after autopsy and, the histopathological changes of the secondary cysts for each group were observed. The therapeutic efficacy of CUR-NE in infected groups was evaluated by two methods: CT scan and autopsied cyst measurements.
Results
Septal calcification in three groups of infected mice (CEI1, CEI2, and CEI4) was revealed by CT scan. The therapeutic efficacy of CUR-NE 40 mg/kg/day (CEI1 group) was 24.6 ± 26.89% by CT scan measurement and 55.16 ± 32.37% by autopsied cysts measurements. The extensive destructive effects of CUR-NE 40 mg/kg/day (CEI1 group) on the wall layers of secondary CE cysts were confirmed by histopathology.
Conclusion
The current study demonstrated a significant therapeutic effect of CUR-NE (40 mg/kg/day) on secondary CE cysts in BALB/c mice. An apparent septal calcification of several cysts revealed by CT scan and the destructive effect on CE cysts observed in histopathology are two critical key factors that suggest curcumin nanoemulsion could be a potential treatment for cystic echinococcosis.
... Also, 1/39 (2.5%) of the CE patients were found to be negative in all three diagnostic tests. Our study showed among three diagnostic tests the highest sensitivity (79.5%) and specificity observed in antigen-based serological diagnostic methods, underdiagnosis remains a common issue [36][37][38][39]. ...
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.
... Albendazole is the accepted medical therapy for hydatidosis and has better efficacy and absorption than mebendazole. However, its value in the definitive treatment of the disease remains controversial [10]. ...
Hydatid disease in humans is caused by accidental ingestion of Echinococcus in its larval form. It mostly affects the liver and lungs, but rarely the mediastinum and other areas as well. The diagnosis is mostly confirmed intraoperatively in cases of mediastinal disease. The mainstay of treatment in such cases is surgery. This is a case report of a rare finding of hydatid disease in mediastinum along with the abdomen
and its surgical management.
... But, apart from such rare incidents, other applications may prove useful; a prominent case might be the surgical removal of cysts of Echinococcus granulosus from the spine [344]. However, the surgical removal of the cysts may sometimes present complications [345]; the removal might only be partial [346] or the resultant spillage may lead to secondary echinococcosis [347,348]. In such cases, prostheses associated with proper drugs, namely albendazole, mebendazole, and perhaps praziquantel [349], may be useful. ...
The incidence of microbial infections in orthopedic prosthetic surgeries is a perennial problem that increases morbidity and mortality, representing one of the major complications of such medical interventions. The emergence of novel technologies, especially 3D printing, represents a promising avenue of development for reducing the risk of such eventualities. There are already a host of biomaterials, suitable for 3D printing, that are being tested for antimicrobial properties when they are coated with bioactive compounds, such as antibiotics, or combined with hydrogels with antimicrobial and antioxidant properties, such as chitosan and metal nanoparticles, among others. The materials discussed in the context of this paper comprise beta-tricalcium phosphate (β-TCP), biphasic calcium phosphate (BCP), hydroxyapatite, lithium disilicate glass, polyetheretherketone (PEEK), poly(propylene fumarate) (PPF), poly(trimethylene carbonate) (PTMC), and zirconia. While the recent research results are promising, further development is required to address the increasing antibiotic resistance exhibited by several common pathogens, the potential for fungal infections, and the potential toxicity of some metal nanoparticles. Other solutions, like the incorporation of phytochemicals, should also be explored. Incorporating artificial intelligence (AI) in the development of certain orthopedic implants and the potential use of AI against bacterial infections might represent viable solutions to these problems. Finally, there are some legal considerations associated with the use of biomaterials and the widespread use of 3D printing, which must be taken into account.
... According to WHO-IWGE, CE cysts can be stadiated by imaging techniques as active: unilocular (CE1) or multi-vesicular with daughter vesicles (CE2), found to be viable; transitional (CE3), differentiated into active (CE3a) and active or inactive (CE3b); finally, the inactive group (CE4 and CE5) with increasing degrees of calcification that are nearly always found non-viable [14,16]. About 2% of inactive hydatid cysts can 'reactivate' by switching from an inactive (CE4 or CE5) to an active stage (CE2) [14,17]. ...
... The course of the treatment is relatively long, so the patient would soon have complications such as intestinal obstruction and jaundice. In addition, albendazole can often lead to nausea, hepatic injury, and irreversible neutropenia, so the patient must periodically have white blood cell count and liver function tests (5,11). (2) Percutaneous drainage of hydatid cyst fluid under the guidance of B ultrasound, assisted with albendazole. ...
We report a case of a male patient who presented with multiple abdominal and pelvic echinococcosis. The patient had been diagnosed with hepatic echinococcosis for 7 years and developed intermittent distension and discomfort in the upper abdomen after an accidental fall. In recent years, the patient’s abdominal distention increased gradually. Computed tomography revealed multiple hydatid cysts in the liver, spleen, abdominal cavity, and pelvic cavity. Abdominal organs were severely compressed, such that he could not eat normally except for a liquid diet. The patient underwent radical surgical resection based on the multi-disciplinary treatment (MDT) and the operation lasted 10 h, nearly 100 hydatid cysts were excised, about 18 liters of cyst fluid and cyst contents were removed, and the patient lost 20 kg of weight after surgery. The operation was successful, but there were still some postoperative complications such as hypovolemic shock, postoperative ascites, postoperative bile leakage. Treatment measures for the patient were anti-infection, antishock, clamping the abdominal drainage tube, and negative pressure abdominal puncture drainage. At follow up the patient’s quality of life had been significantly improved with 15 kg weight gain compared to before.
... These data indicate a higher percentage of cases of CE (0.2%) compared to the official information for all country, but it In terms of liver CE, there are four main possible types of therapeutic behavior -surgery, percutaneous puncture treatment (PAIR mini-invasive technique and drainage procedures), chemotherapy and "watch and wait". "Stage-specific" imaging approach based on the WHO ultrasound classification of CE seems to be the best available tool for rational therapeutic choice nowadays [9][10]. During ultrasound screening, we found recurrences in 5.6% of patients with CE after previous treatment. ...
Introduction: Cystic echinococcosis (CE) is a chronic disease in humans, usually asymptomatic, but in some cases could be very severe with fatal outcomes. This parasitosis is a health and economic problem in many areas of the world. The actual spread among people with CE in endemic regions is not known. The purpose of prophylactic ultrasound examinations of people in some areas was to clarify the real prevalence of CE and to detect undiagnosed asymptomatic cases and recurrences. Materials and methods: An abdominal ultrasound survey in four endemic regions in Bulgaria with the highest rate of registered patients with CE in Bulgaria for the last five years was conducted. For every patient with CE an epidemiological and clinical history, abdominal ultrasound examination , blood tests and ELISA IgG test for CE were performed. Results: From all 8602 people examined, in seventeen persons (0.2%), liver hydatid cysts were found for the first time. Ssixty five (0.8%) reported a history of previous surgical treatment for CE, of which 54 (83.1%) had passed surgery because of liver CE and 11 (16.9%) had extrahepatic CE (pulmonary, cardiac, bone, spleen). In three (5.6%) patients , who were operated years before for liver CE, recurrences were discovered. In 11 (64.7%) patients devitalized CE 4 cysts were observed without any data for previous treatment. Three of the discovered patients with CE were treated with surgery, one with puncture-aspiration-injection-reaspiration, four only with Albendazole. The patients were successfully treated and followed for a period of five years. Conclusions: During the prophylactic ultrasound examinations , a higher percentage of people infected with liver cystic echinococcosis was found compared to the official information. It should be noted that these results are found in areas with the highest incidence of this disease in the country. US screenings give the opportunity for early detection, timely treatment of infected people and to prevent severe complications in patient with CE disease.
... Mebendazole and albendazole (ABZ) are the two anthelmintic drugs used for medical treatment, with the latter being acknowledged to have better performance and safety profile. Therapy with ABZ is recommended for uncomplicated abdominal HEC with a diameter <5 cm, disseminated infection and peri-interventional prophylaxis of secondary echinococcosis [5,6]. ABZ inhibits both microtubule assembly and the activity of helminthic fumarate reductase leading to cell death. ...
Cystic echinococcosis is a zoonosis caused by the ingestion of food or water contaminated by Echinococcus eggs. E. granulosus is the most common causative agent of cystic echinococcosis that still has a relevant incidence in Italy, especially on the islands of Sicily and Sardinia. We report the case of a 64-year-old man with disseminated abdominal cystic echinococcosis (liver, spleen, peritoneum). The patient was asymptomatic and non-eligible for surgical treatment. Treatment with albendazole 400 mg/twice daily was started in 2012 for 15 cycles (each cycle consisted of three 28-day treatments at 14-day intervals) over 10 years for a total of 1260 days of treatment. Serum anti-Echinococcus antibody titers and imaging (echography, TC) were evaluated to monitor the evolution of the disease. Imaging techniques documented the regression of all cyst lesions, but it was less evident for the peritoneal localizations that still are in follow-up. In this case, the prolonged treatment with albendazole was effective, safe and free of side effects. Until today, the patient displays a good clinical condition.
