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Tulahong A, Zhu DL, Liu C, Jiang TM, Zhang RQ, Tuergan T, Aji T, Shao YM. Simultaneous combined surgery for hepatic-renal double organ alveolar or cystic echinococcosis: A retrospective study. World J Gastrointest Surg 2025; 17:105007. [DOI: 10.4240/wjgs.v17.i6.105007] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/12/2025] [Revised: 03/19/2025] [Accepted: 03/20/2025] [Indexed: 05/30/2025] Open
Abstract
BACKGROUND Alveolar and cystic echinococcoses are lethal zoonotic diseases caused by Echinococcus multilocularis and Echinococcus granulosus infections, leading to alveolar echinococcosis (AE) or cystic echinococcosis (CE), respectively. No study has hitherto reported effective treatment approaches for AE or CE with concurrent hepatorenal involvement.
AIM To investigate the feasibility and efficacy of simultaneous combined surgery (SCS) as a comprehensive treatment approach for patients with hepatorenal echinococcosis.
METHODS Clinical datasets of hepatorenal AE (n = 10) and CE (n = 11) patients were retrospectively collected and systematically analyzed. The SCS approach was introduced, and surgical outcomes, complications, and prognoses were documented in detail.
RESULTS The SCS approach incorporated hybridized techniques, including partial hepatectomy, partial or total nephrectomy, ex vivo liver resection and autotransplantation, and total or subtotal cystectomy with endocystectomy. Radical SCS was achieved in 100% of AE patients and 63.6% of CE patients. All surgeries were completed without intraoperative complications. The short-term complication rate was 28.6% (Clavien-Dindo classification: AE-1 IIIb, 3 IIIa; CE-2 II), while the long-term complication rate was 4.8% (Clavien-Dindo classification: AE-1 IIIb). Patients were followed up for a median of 37 months (AE: 6-81 months; CE: 34-123 months), with no reported deaths or disease relapses.
CONCLUSION CS appears to be a feasible and effective treatment method for patients with hepatorenal involvement of AE or CE. It fulfills the management criteria for advanced AE or CE cases, aiming to maximize patient benefits.
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Affiliation(s)
- Alimu Tulahong
- Department of Hepatobiliary and Echinococcosis Surgery, The First Affiliated Hospital of Xinjiang Medical University, Urumqi 830054, Xinjiang Uygur Autonomous Region, China
| | - Da-Long Zhu
- Department of Hepatobiliary and Echinococcosis Surgery, The First Affiliated Hospital of Xinjiang Medical University, Urumqi 830054, Xinjiang Uygur Autonomous Region, China
| | - Chang Liu
- Department of Hepatobiliary and Echinococcosis Surgery, The First Affiliated Hospital of Xinjiang Medical University, Urumqi 830054, Xinjiang Uygur Autonomous Region, China
| | - Tie-Min Jiang
- Department of Hepatobiliary and Echinococcosis Surgery, The First Affiliated Hospital of Xinjiang Medical University, Urumqi 830054, Xinjiang Uygur Autonomous Region, China
| | - Rui-Qing Zhang
- Department of Hepatobiliary and Echinococcosis Surgery, The First Affiliated Hospital of Xinjiang Medical University, Urumqi 830054, Xinjiang Uygur Autonomous Region, China
| | - Talaiti Tuergan
- Department of Hepatobiliary and Echinococcosis Surgery, The First Affiliated Hospital of Xinjiang Medical University, Urumqi 830054, Xinjiang Uygur Autonomous Region, China
| | - Tuerganaili Aji
- Department of Hepatobiliary and Echinococcosis Surgery, The First Affiliated Hospital of Xinjiang Medical University, Urumqi 830054, Xinjiang Uygur Autonomous Region, China
| | - Ying-Mei Shao
- Department of Hepatobiliary and Echinococcosis Surgery, The First Affiliated Hospital of Xinjiang Medical University, Urumqi 830054, Xinjiang Uygur Autonomous Region, China
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Deibel A, Kindler Y, Mita R, Ghafoor S, Meyer zu Schwabedissen C, Brunner-Geissmann B, Schweiger A, Grimm F, Reinehr M, Weber A, Reiner CS, Kremer AE, Petrowsky H, Clavien PA, Deplazes P, von Felten S, Müllhaupt B. Comprehensive Survival Analysis of Alveolar Echinococcosis Patients, University Hospital Zurich, Zurich, Switzerland, 1973-2022. Emerg Infect Dis 2025; 31:906-916. [PMID: 40305427 PMCID: PMC12044251 DOI: 10.3201/eid3105.241608] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/02/2025] Open
Abstract
Alveolar echinococcosis (AE) is a zoonotic disease of increasing concern worldwide. Before benzimidazole drug therapy, 10-year death rates were 90% without surgical resection. In unresectable patients, long-term benzimidazole therapy is highly effective in stabilizing the disease course. We performed a retrospective study of 334 AE patients treated at the University Hospital Zurich, Zurich, Switzerland, during 1973-2022. Annual diagnoses increased over time, and more cases were detected by chance at earlier stages. Ninety patients died, mostly from causes unrelated to AE. Relative survival of AE patients compared with the population of Switzerland demonstrated a steady decrease 5 years after diagnosis. Patient age at diagnosis was the primary variable associated with overall survival. In a propensity-score matched survival analysis, early curative surgery was associated with overall improvement but not AE-specific survival. We conclude that survival of patients with AE is limited by non-AE causes and that early curative surgery does not improve AE-specific survival.
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Affiliation(s)
| | | | - Rubens Mita
- University Hospital Zurich, Zurich, Switzerland (A. Deibel, Y. Kindler, S. Ghafoor, C. Meyer zu Schwabedissen, B. Brunner-Geissmann, M. Reinehr, A. Weber, C.S. Reiner, A.E. Kremer, H. Petrowsky, P.-A. Clavien, B. Müllhaupt); University of Zurich, Zurich (R. Mita, F. Grimm, P. Deplazes, S. von Felten); Cantonal Hospital Zug, Zug, Switzerland (A. Schweiger)
| | - Soleen Ghafoor
- University Hospital Zurich, Zurich, Switzerland (A. Deibel, Y. Kindler, S. Ghafoor, C. Meyer zu Schwabedissen, B. Brunner-Geissmann, M. Reinehr, A. Weber, C.S. Reiner, A.E. Kremer, H. Petrowsky, P.-A. Clavien, B. Müllhaupt); University of Zurich, Zurich (R. Mita, F. Grimm, P. Deplazes, S. von Felten); Cantonal Hospital Zug, Zug, Switzerland (A. Schweiger)
| | - Cordula Meyer zu Schwabedissen
- University Hospital Zurich, Zurich, Switzerland (A. Deibel, Y. Kindler, S. Ghafoor, C. Meyer zu Schwabedissen, B. Brunner-Geissmann, M. Reinehr, A. Weber, C.S. Reiner, A.E. Kremer, H. Petrowsky, P.-A. Clavien, B. Müllhaupt); University of Zurich, Zurich (R. Mita, F. Grimm, P. Deplazes, S. von Felten); Cantonal Hospital Zug, Zug, Switzerland (A. Schweiger)
| | - Barbara Brunner-Geissmann
- University Hospital Zurich, Zurich, Switzerland (A. Deibel, Y. Kindler, S. Ghafoor, C. Meyer zu Schwabedissen, B. Brunner-Geissmann, M. Reinehr, A. Weber, C.S. Reiner, A.E. Kremer, H. Petrowsky, P.-A. Clavien, B. Müllhaupt); University of Zurich, Zurich (R. Mita, F. Grimm, P. Deplazes, S. von Felten); Cantonal Hospital Zug, Zug, Switzerland (A. Schweiger)
| | - Alexander Schweiger
- University Hospital Zurich, Zurich, Switzerland (A. Deibel, Y. Kindler, S. Ghafoor, C. Meyer zu Schwabedissen, B. Brunner-Geissmann, M. Reinehr, A. Weber, C.S. Reiner, A.E. Kremer, H. Petrowsky, P.-A. Clavien, B. Müllhaupt); University of Zurich, Zurich (R. Mita, F. Grimm, P. Deplazes, S. von Felten); Cantonal Hospital Zug, Zug, Switzerland (A. Schweiger)
| | - Felix Grimm
- University Hospital Zurich, Zurich, Switzerland (A. Deibel, Y. Kindler, S. Ghafoor, C. Meyer zu Schwabedissen, B. Brunner-Geissmann, M. Reinehr, A. Weber, C.S. Reiner, A.E. Kremer, H. Petrowsky, P.-A. Clavien, B. Müllhaupt); University of Zurich, Zurich (R. Mita, F. Grimm, P. Deplazes, S. von Felten); Cantonal Hospital Zug, Zug, Switzerland (A. Schweiger)
| | - Michael Reinehr
- University Hospital Zurich, Zurich, Switzerland (A. Deibel, Y. Kindler, S. Ghafoor, C. Meyer zu Schwabedissen, B. Brunner-Geissmann, M. Reinehr, A. Weber, C.S. Reiner, A.E. Kremer, H. Petrowsky, P.-A. Clavien, B. Müllhaupt); University of Zurich, Zurich (R. Mita, F. Grimm, P. Deplazes, S. von Felten); Cantonal Hospital Zug, Zug, Switzerland (A. Schweiger)
| | - Achim Weber
- University Hospital Zurich, Zurich, Switzerland (A. Deibel, Y. Kindler, S. Ghafoor, C. Meyer zu Schwabedissen, B. Brunner-Geissmann, M. Reinehr, A. Weber, C.S. Reiner, A.E. Kremer, H. Petrowsky, P.-A. Clavien, B. Müllhaupt); University of Zurich, Zurich (R. Mita, F. Grimm, P. Deplazes, S. von Felten); Cantonal Hospital Zug, Zug, Switzerland (A. Schweiger)
| | - Cäcilia S. Reiner
- University Hospital Zurich, Zurich, Switzerland (A. Deibel, Y. Kindler, S. Ghafoor, C. Meyer zu Schwabedissen, B. Brunner-Geissmann, M. Reinehr, A. Weber, C.S. Reiner, A.E. Kremer, H. Petrowsky, P.-A. Clavien, B. Müllhaupt); University of Zurich, Zurich (R. Mita, F. Grimm, P. Deplazes, S. von Felten); Cantonal Hospital Zug, Zug, Switzerland (A. Schweiger)
| | - Andreas E. Kremer
- University Hospital Zurich, Zurich, Switzerland (A. Deibel, Y. Kindler, S. Ghafoor, C. Meyer zu Schwabedissen, B. Brunner-Geissmann, M. Reinehr, A. Weber, C.S. Reiner, A.E. Kremer, H. Petrowsky, P.-A. Clavien, B. Müllhaupt); University of Zurich, Zurich (R. Mita, F. Grimm, P. Deplazes, S. von Felten); Cantonal Hospital Zug, Zug, Switzerland (A. Schweiger)
| | - Henrik Petrowsky
- University Hospital Zurich, Zurich, Switzerland (A. Deibel, Y. Kindler, S. Ghafoor, C. Meyer zu Schwabedissen, B. Brunner-Geissmann, M. Reinehr, A. Weber, C.S. Reiner, A.E. Kremer, H. Petrowsky, P.-A. Clavien, B. Müllhaupt); University of Zurich, Zurich (R. Mita, F. Grimm, P. Deplazes, S. von Felten); Cantonal Hospital Zug, Zug, Switzerland (A. Schweiger)
| | - Pierre-Alain Clavien
- University Hospital Zurich, Zurich, Switzerland (A. Deibel, Y. Kindler, S. Ghafoor, C. Meyer zu Schwabedissen, B. Brunner-Geissmann, M. Reinehr, A. Weber, C.S. Reiner, A.E. Kremer, H. Petrowsky, P.-A. Clavien, B. Müllhaupt); University of Zurich, Zurich (R. Mita, F. Grimm, P. Deplazes, S. von Felten); Cantonal Hospital Zug, Zug, Switzerland (A. Schweiger)
| | - Peter Deplazes
- University Hospital Zurich, Zurich, Switzerland (A. Deibel, Y. Kindler, S. Ghafoor, C. Meyer zu Schwabedissen, B. Brunner-Geissmann, M. Reinehr, A. Weber, C.S. Reiner, A.E. Kremer, H. Petrowsky, P.-A. Clavien, B. Müllhaupt); University of Zurich, Zurich (R. Mita, F. Grimm, P. Deplazes, S. von Felten); Cantonal Hospital Zug, Zug, Switzerland (A. Schweiger)
| | - Stefanie von Felten
- University Hospital Zurich, Zurich, Switzerland (A. Deibel, Y. Kindler, S. Ghafoor, C. Meyer zu Schwabedissen, B. Brunner-Geissmann, M. Reinehr, A. Weber, C.S. Reiner, A.E. Kremer, H. Petrowsky, P.-A. Clavien, B. Müllhaupt); University of Zurich, Zurich (R. Mita, F. Grimm, P. Deplazes, S. von Felten); Cantonal Hospital Zug, Zug, Switzerland (A. Schweiger)
| | - Beat Müllhaupt
- University Hospital Zurich, Zurich, Switzerland (A. Deibel, Y. Kindler, S. Ghafoor, C. Meyer zu Schwabedissen, B. Brunner-Geissmann, M. Reinehr, A. Weber, C.S. Reiner, A.E. Kremer, H. Petrowsky, P.-A. Clavien, B. Müllhaupt); University of Zurich, Zurich (R. Mita, F. Grimm, P. Deplazes, S. von Felten); Cantonal Hospital Zug, Zug, Switzerland (A. Schweiger)
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Polańska-Płachta M, Czerwińska M, Ostrowska M, Stefaniak J, Polański JA. Alveolar Echinococcosis: Is Non-Radical Liver Resection a Game Changer in the Current Treatment Approach to Patients with Advanced Alveolar Echinococcosis Disease? Single Center Experience of Poland. Acta Parasitol 2025; 70:100. [PMID: 40299105 DOI: 10.1007/s11686-025-01040-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/09/2025] [Accepted: 04/15/2025] [Indexed: 04/30/2025]
Abstract
BACKGROUND Alveolar echinococcosis is parasitic disease caused by Echinococcus multilocularis and spread endemically in the northern hemisphere. Although alveolar echinococcosis is considered a rare disease, with approximately 18,000 new cases diagnosed annually, it continues to present significant diagnostic and therapeutic challenges. Alveolar echinococcosis affects the liver through slow, asymptomatic infiltration over many years. At the time of diagnosis, approximately 70% of cases are not eligible for radical lesion resection. The aim of the study was to evaluate whether non-radical surgery increases patients' survival rates. METHODS We conducted a prospective analysis on patients diagnosed with alveolar echinococcosis in years 1995-2017 who underwent liver resection. Age, gender, mass of lesion, extensive nature of the operation (radical vs. conservative) and surgical procedures were collected. Mortality was analyzed. RESULTS Mean resected lesions' weight was statistically higher in non-radically resected group 1396,00 g (SD ± 845,39) compared with radically resected group 549,43 g (SD ± 364,27), p = 0,004. The type of surgical treatment did not significantly affect patient survival. CONCLUSION The complete lesion resection (in combination with albendazole) is only a curative therapy, if feasible. In advance stages when radical resection is not feasible, the reductive or debulking surgery should be done for symptoms' alleviation and quality of life improvement.
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Affiliation(s)
- Małgorzata Polańska-Płachta
- Second Department of General, Vascular and Oncological Surgery, Medical University of Warsaw, Warsaw, Poland.
| | - Magdalena Czerwińska
- Second Department of General, Vascular and Oncological Surgery, Medical University of Warsaw, Warsaw, Poland
| | - Małgorzata Ostrowska
- Second Department of General, Vascular and Oncological Surgery, Medical University of Warsaw, Warsaw, Poland
| | - Jerzy Stefaniak
- Department and Clinic of Tropical and Parasitic Diseases, University of Medical Sciences, Poznan, Poland
| | - Jerzy A Polański
- Second Department of General, Vascular and Oncological Surgery, Medical University of Warsaw, Warsaw, Poland
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Ollagnon M, Bresson-Hadni S, Spahr L, Rubbia-Brandt L, Toso C, Chappuis F. Alveolar echinococcosis in the canton of Geneva between 2010 and 2021: a descriptive analysis. Swiss Med Wkly 2025; 155:3863. [PMID: 39977361 DOI: 10.57187/s.3863] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/22/2025] Open
Abstract
BACKGROUND Alveolar echinococcosis is a rare but potentially severe parasitic disease caused by the larval stage of Echinococcus multilocularis, endemic in many countries in the northern hemisphere, including Switzerland. While the liver is most commonly affected, other organs can also be involved either by contiguity or haematogenous spread. To date, there is no epidemiological or clinical data on alveolar echinococcosis in the canton of Geneva. OBJECTIVES To describe the demographic, epidemiological, clinical and therapeutic characteristics of alveolar echinococcosis in the canton of Geneva between 2010 and 2021. METHODS An investigation was conducted among physicians from Geneva University Hospitals (HUG) and the private sector likely to encounter patients diagnosed with alveolar echinococcosis between 2010 and 2021. All patients being treated in the canton of Geneva were included. After obtaining their consent, an epidemiological questionnaire was completed by patients, and a clinical questionnaire by their referring physicians. Demographic, epidemiological and clinical data were entered into REDCap, then extracted and analysed. RESULTS Of a total of 27 patients diagnosed with alveolar echinococcosis, 25 were included in the study; one patient did not provide his consent and one patient could not be contacted. The annual incidence of alveolar echinococcosis in the canton of Geneva was calculated at 0.24 cases per 100,000 inhabitants based on the subset (n = 14) domiciled in Geneva. The vast majority of patients (n = 24; 96%) were followed at HUG. The median age of patients was 55 years (range: 17-79) with a slight predominance of women (56%). Reported risk factors for alveolar echinococcosis included owning a vegetable garden (70.8%), often unfenced, practicing composting (69.6%), and owning a dog (58.3%) or a cat (58.3%). Four patients (16%) had an immunosuppressive condition. Only 52% of patients were symptomatic at the time of diagnosis. The liver was affected in most cases (n = 24; 96%), but one patient had a primary splenic location. Surgical resection for curative purposes was performed in 13 patients (52%). All patients received parasitostatic treatment with albendazole, discontinued in 5 patients (20%) due to drug-induced hepatitis. Three patients died (12%), of which two directly related to alveolar echinococcosis. CONCLUSION Alveolar echinococcosis, a rare but severe disease, is endemic in the canton of Geneva. The establishment of mandatory reporting of this disease in Switzerland would allow monitoring of its epidemiological evolution. Primary and secondary prevention measures, currently non-existent, could potentially lower the incidence and severity of the disease.
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Affiliation(s)
- Manon Ollagnon
- Faculty of Medicine, University of Geneva, Geneva, Switzerland
| | - Solange Bresson-Hadni
- Division of Tropical and Humanitarian Medicine, University Hospitals of Geneva, Geneva, Switzerland
- Division of Gastroenterology and Hepatology, University Hospitals of Geneva, Geneva, Switzerland
| | - Laurent Spahr
- Faculty of Medicine, University of Geneva, Geneva, Switzerland
- Division of Gastroenterology and Hepatology, University Hospitals of Geneva, Geneva, Switzerland
| | - Laura Rubbia-Brandt
- Faculty of Medicine, University of Geneva, Geneva, Switzerland
- Division of Clinical Pathology, University Hospitals of Geneva, Geneva, Switzerland
| | - Christian Toso
- Faculty of Medicine, University of Geneva, Geneva, Switzerland
- Division of Visceral Surgery, University Hospitals of Geneva, Geneva, Switzerland
| | - François Chappuis
- Faculty of Medicine, University of Geneva, Geneva, Switzerland
- Division of Tropical and Humanitarian Medicine, University Hospitals of Geneva, Geneva, Switzerland
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Plum PE, Ausselet N, Kidd F, Noirhomme S, Garrino MG, Dili A, Hayette MP, Detry O, Leonard P, Motet C, Hites M, Bourgeois M, Montesinos I, Delaere B. EchiNam: multicenter retrospective study on the experience, challenges, and pitfalls in the diagnosis and treatment of alveolar echinococcosis in Belgium. Eur J Clin Microbiol Infect Dis 2025; 44:263-275. [PMID: 39585582 PMCID: PMC11754326 DOI: 10.1007/s10096-024-04996-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/27/2024] [Accepted: 11/17/2024] [Indexed: 11/26/2024]
Abstract
OBJECTIVES The aim of this retrospective study was to collect epidemiological, clinical, laboratory, imaging, management, and follow-up data on cases of alveolar echinococcosis (AE) diagnosed and/or followed up within the Namur Hospital Network (NHN) in order to gather information on the challenges, pitfalls, and overall experience in the diagnosis and treatment of AE. METHODS EchiNam was a multicenter retrospective study. Patients diagnosed and/or treated for probable or confirmed AE in the NHN between 2002 and 2023 were included in the study. Patient selection was based on diagnosis codes, laboratory results, and albendazole (ABZ) dispensing. RESULTS A total of 22 AE cases were retrieved, of which four were classified as probable and 18 as confirmed cases. Nine patients were either asymptomatic or had symptoms attributed to another disease. Clinical examination yielded pathologic findings in 10 patients. The median duration from the first AE-suggestive laboratory abnormalities to diagnosis was 176 days, and the median duration from the first AE-related imaging abnormalities to diagnosis was 133 days. Overall, 12 patients underwent surgical resection, with only four achieving complete lesion resection. Nine patients experienced ABZ-related adverse effects, with temporary ABZ discontinuation in five. CONCLUSION Due to various factors such as a long incubation period and a lack of awareness among Belgian physicians, AE is often diagnosed at advanced disease stages. Treatment then becomes more complex or even suboptimal, resulting in prolonged therapy, higher risk of adverse effects, significantly impaired quality of life, poor prognosis, and higher mortality rates. Measures should be taken to achieve early diagnosis in endemic areas.
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Affiliation(s)
- Pierre-Emmanuel Plum
- Department of Infectious Diseases, CHU UCL Namur (Site Godinne), Université catholique de Louvain, Avenue Dr Gaston Thérasse 1, Yvoir, 5530, Belgium.
| | - Nathalie Ausselet
- Department of Infectious Diseases, CHU UCL Namur (Site Godinne), Université catholique de Louvain, Avenue Dr Gaston Thérasse 1, Yvoir, 5530, Belgium
| | - François Kidd
- Department of Infectious Diseases, CHU UCL Namur (Site Namur), Université catholique de Louvain, Namur, Belgium
| | - Séverine Noirhomme
- Department of Infectious Diseases, Centre Hospitalier Régional de Namur (Site Namur), Namur, Belgium
| | - Maria-Grazia Garrino
- Department of Clinical Microbiology, Centre Hospitalier Régional de Namur (Site Namur), Namur, Belgium
| | - Alexandra Dili
- HPB Surgery Unit, CHU UCL Namur (Site Godinne), Université catholique de Louvain, Yvoir, Belgium
| | - Marie-Pierre Hayette
- National Reference Laboratory for Echinococcosis, Department of Clinical Microbiology, University Hospital of Liège (CHU Liège), Liège, Belgium
| | - Olivier Detry
- Department of Abdominal Surgery and Transplantation, University Hospital of Liège (CHU Liège), Liège, Belgium
| | - Philippe Leonard
- Department of Infectious Diseases, University Hospital of Liège (CHU Liège), Liège, Belgium
| | - Christian Motet
- Clinic of Infectious Diseases, Hôpital Universitaire de Bruxelles (H.U.B), Université Libre de Bruxelles, Brussels, Belgium
| | - Maya Hites
- Clinic of Infectious Diseases, Hôpital Universitaire de Bruxelles (H.U.B), Université Libre de Bruxelles, Brussels, Belgium
| | - Marc Bourgeois
- Department of Infectious Diseases, CHU UCL Namur (Site Godinne), Université catholique de Louvain, Avenue Dr Gaston Thérasse 1, Yvoir, 5530, Belgium
| | - Isabel Montesinos
- Department of Clinical Microbiology, CHU UCL Namur (Site Godinne), Université catholique de Louvain, Yvoir, Belgium
| | - Bénédicte Delaere
- Department of Infectious Diseases, CHU UCL Namur (Site Godinne), Université catholique de Louvain, Avenue Dr Gaston Thérasse 1, Yvoir, 5530, Belgium
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Aydin S, Irgul B, Memis KB, Kızılgoz V, Kantarci M. Characteristics of the imaging diagnosis of alveolar echinococcosis. World J Gastrointest Surg 2024; 16:2748-2754. [PMID: 39351560 PMCID: PMC11438814 DOI: 10.4240/wjgs.v16.i9.2748] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/28/2024] [Revised: 06/06/2024] [Accepted: 06/24/2024] [Indexed: 09/18/2024] Open
Abstract
Alveolar echinococcosis (AE) primarily manifests in the liver and exhibits characteristics resembling those of slow-growing malignant tumours. Untreated Echinococcus multilocularis infection can be lethal. By infiltrating the vascular systems, biliary tracts, and the hilum of the liver, it might lead to various problems. Due to its ability to infiltrate neighbouring tissues or metastasize to distant organs, AE can often be mistaken for malignancies. We present a concise overview of the epidemiological and pathophysiological characteristics of AE, as well as the clinical manifestations of the disease. This article primarily examines the imaging characteristics of AE using various imaging techniques such as ultrasonography, computed tomography (CT), magnetic resonance imaging, diffusion-weighted imaging, and virtual non-enhanced dual-energy CT. We additionally examined the contribution of radiography in the diagnosis, treatment, and monitoring of the condition.
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Affiliation(s)
- Sonay Aydin
- Department of Radiology, Erzincan Binali Yıldırım University, Faculty of Medicine, Erzincan 24100, Türkiye
| | - Baris Irgul
- Department of Radiology, Erzincan Binali Yıldırım University, Faculty of Medicine, Erzincan 24100, Türkiye
| | - Kemal Bugra Memis
- Department of Radiology, Erzincan Binali Yıldırım University, Faculty of Medicine, Erzincan 24100, Türkiye
| | - Volkan Kızılgoz
- Department of Radiology, Erzincan Binali Yıldırım University, Faculty of Medicine, Erzincan 24100, Türkiye
| | - Mecit Kantarci
- Department of Radiology, Erzurum Ataturk University, Erzurum 25000, Türkiye
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Lallemand S, Oyhenart J, Valot B, Borne R, Bohard L, Umhang G, Karamon J, Konyaev S, Rönnberg C, Gottstein B, Weil-Verhoeven D, Richou C, Bresson-Hadni S, Millon L, Bellanger AP, Knapp J. Challenging the phylogenetic relationships among Echinococcus multilocularis isolates from main endemic areas. Int J Parasitol 2024; 54:569-582. [PMID: 38815855 DOI: 10.1016/j.ijpara.2024.05.004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/16/2024] [Revised: 04/05/2024] [Accepted: 05/23/2024] [Indexed: 06/01/2024]
Abstract
Alveolar echinococcosis (AE) is a rare but severe disease that affects more than 18,000 people worldwide per year. The complete sequencing of the mitochondrial genome of Echinococcus multilocularis has made it possible to study the genetic diversity of the parasite and its spatial and temporal evolution. We amplified the whole mitochondrial genome by PCR, using one uniplex and two multiplex reactions to cover the 13,738 bp of the mitogenome, and then sequenced the amplicons with Illumina technology. In total, 113 samples from Europe, Asia, the Arctic and North America were analyzed. Three major haplogroups were found: HG1, which clustered samples from Alaska (including Saint-Lawrence Island), Yakutia (Russia) and Svalbard; HG2, with samples from Asia, North America and Europe; and HG3, subdivided into three micro-haplogroups. HG3a included samples from North America and Europe, whereas HG3b and HG3c only include samples from Europe. In France, HG3a included samples from patients more recently diagnosed in a region outside the historical endemic area. A fourth putative haplogroup, HG4, was represented by only one isolate from Olkhon Island (Russia). The increased discriminatory power of the complete sequencing of the E. multilocularis mitogenome has made it possible to highlight four distinct geographical clusters, one being divided into three micro-haplogroups in France.
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Affiliation(s)
- Séverine Lallemand
- UMR CNRS 6249 Chrono-Environnement, University of Franche-Comté, 16 Route de Gray, 25030 Besançon cedex, France
| | - Jorge Oyhenart
- Instituto de Ciencias de la Tierra y Ambientales de La Pampa, Consejo Nacional de Investigaciones Científicas y Técnicas - Facultad de Ciencias Naturales Universidad Nacional de La Pampa, La Pampa, Argentina
| | - Benoit Valot
- UMR CNRS 6249 Chrono-Environnement, University of Franche-Comté, 16 Route de Gray, 25030 Besançon cedex, France
| | - Romain Borne
- UMR CNRS 6249 Chrono-Environnement, University of Franche-Comté, 16 Route de Gray, 25030 Besançon cedex, France
| | - Louis Bohard
- Department of Infectiology, University Hospital of Besançon, 25030 Besançon, France
| | - Gérald Umhang
- INTERFAS Unit, National Reference Laboratory for Echinococcus spp., Rabies and Wildlife Laboratory, ANSES, Malzéville, France
| | - Jacek Karamon
- Department of Parasitology and Invasive Diseases, National Veterinary Research Institute, Puławy, Poland
| | - Sergey Konyaev
- Institute of Systematics and Ecology of Animals, SB RAS, Novosibirsk, Russia
| | - Caroline Rönnberg
- Public Health Agency of Sweden, Department of Microbiology, Unit for Parasitology, Solna, Sweden
| | - Bruno Gottstein
- Institute of Infectious Diseases, Faculty of Medicine, University of Bern, CH-3012 Bern, Switzerland
| | - Delphine Weil-Verhoeven
- Department of Hepatology and Intensive Cares, University Hospital of Besançon, 25030 Besançon, France
| | - Carine Richou
- Department of Hepatology and Intensive Cares, University Hospital of Besançon, 25030 Besançon, France
| | - Solange Bresson-Hadni
- UMR CNRS 6249 Chrono-Environnement, University of Franche-Comté, 16 Route de Gray, 25030 Besançon cedex, France; Department of Parasitology-Mycology, Reference National Centre for Echinococcoses, University Hospital of Besançon, 25030 Besançon, France
| | - Laurence Millon
- UMR CNRS 6249 Chrono-Environnement, University of Franche-Comté, 16 Route de Gray, 25030 Besançon cedex, France; Department of Parasitology-Mycology, Reference National Centre for Echinococcoses, University Hospital of Besançon, 25030 Besançon, France
| | - Anne-Pauline Bellanger
- UMR CNRS 6249 Chrono-Environnement, University of Franche-Comté, 16 Route de Gray, 25030 Besançon cedex, France; Department of Parasitology-Mycology, Reference National Centre for Echinococcoses, University Hospital of Besançon, 25030 Besançon, France
| | - Jenny Knapp
- UMR CNRS 6249 Chrono-Environnement, University of Franche-Comté, 16 Route de Gray, 25030 Besançon cedex, France; Department of Parasitology-Mycology, Reference National Centre for Echinococcoses, University Hospital of Besançon, 25030 Besançon, France.
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8
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Tsukanov VV, Vasyutin AV, Tonkikh JL. Parasites of the liver: A global problem? World J Gastroenterol 2024; 30:3554-3559. [PMID: 39193571 PMCID: PMC11346153 DOI: 10.3748/wjg.v30.i30.3554] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/27/2024] [Revised: 07/12/2024] [Accepted: 07/24/2024] [Indexed: 08/08/2024] Open
Abstract
Parasitic liver diseases can be caused by trematodes, cestodes, nematodes, and protozoa. This pathology is significant because millions of people in different parts of the world have liver parasites, which can manifest themselves in the development of inflammation, liver cysts, cholecystitis, cholelithiasis, pancreatitis and liver cirrhosis that are often threatening their lives. The International Agency for Research on Cancer considers three species of trematodes, Schistosoma haematobium, Opisthorchis viverrini and Clonorchis sinensis, to be carcinogens. Complex modern examination methods, in some cases including extensive screening of large populations, are required for diagnosing liver parasites. Treatment of parasitic liver diseases is differentiated and can involve a combination of surgical and therapeutic measures. There is no doubt that the clinical and epidemiological scale allows one to regard parasitic liver diseases as a global healthcare problem.
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Affiliation(s)
- Vladislav V Tsukanov
- Clinical Department of the Digestive System Pathology of Adults and Children, Federal Research Center “Krasnoyarsk Science Center” of the Siberian Branch of the Russian Academy of Sciences, Scientific Research Institute of Medical Problems of the North, Krasnoyarsk 660022, Russia
| | - Alexander V Vasyutin
- Clinical Department of the Digestive System Pathology of Adults and Children, Federal Research Center “Krasnoyarsk Science Center” of the Siberian Branch of the Russian Academy of Sciences, Scientific Research Institute of Medical Problems of the North, Krasnoyarsk 660022, Russia
| | - Julia L Tonkikh
- Clinical Department of the Digestive System Pathology of Adults and Children, Federal Research Center “Krasnoyarsk Science Center” of the Siberian Branch of the Russian Academy of Sciences, Scientific Research Institute of Medical Problems of the North, Krasnoyarsk 660022, Russia
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9
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Feiz-Haddad MH, Moradkhani MA. Molecular phylodiagnosis of Echinococcus multilocularis and Echinococcus granulosus among canids in Guilan province, northern Iran. Comp Immunol Microbiol Infect Dis 2024; 111:102210. [PMID: 38936204 DOI: 10.1016/j.cimid.2024.102210] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/27/2024] [Revised: 06/02/2024] [Accepted: 06/13/2024] [Indexed: 06/29/2024]
Abstract
Canine-transmitted worms and an uncontrolled deworming program of stray dogs have caused that accurate diagnosis of zoonotic parasites received notable attention in endemic regions. This study aimed to assess the presence of E. multilocularis and E. granulosus infections in canids from Guilan province, northern Iran. A total of 272 fecal samples from carnivores were collected across 24 different regions in Guilan province between 2023 and 2024. All fecal specimens were observed following concentration and flotation techniques. DNAs of taeniid eggs were extracted, amplified, and sequenced targeting of specific mitochondrial Cox1 gene for E. granulosus and NAD 1 gene for E. multilocularis. On the base of molecular and phylogenetic analysis 1.47 % (in jackal) and 25 % (in dogs and jackal) of samples were positive for E. multilocularis and E. granulosus sensu strico G1 genotype, respectively. Molecular technique was found to be more sensitive in detecting infection in comparison with conventional techniques. Sequence analysis of Cox1 indicated a high genetic diversity (Haplotype diversity; 0.933; Number of haplotypes, h: 7) in E. granulosus G1. Current findings show that canids particularly jackals play potential role of definitive host in maintenance and transmission dynamic of E. multilocularis and E. granulosus in northern Iran. The presence of these infections is of particular concern in Guilan province due to the high influx of tourists, increasing the risk of transmission to humans. Therefore, the implementation of preventive programs is warranted to apply hygienic practices and adjusting deworming programs for the canids and at-risk individuals in the region.
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Affiliation(s)
- Mohammad Hossein Feiz-Haddad
- Infectious and Tropical Diseases Research Center, Health Research Institute, Ahvaz Jundishapur University of Medical Sciences, Ahvaz, Islamic Republic of Iran; Department of Parasitology, School of Medicine, Ahvaz Jundishapur University of Medical Sciences, Ahvaz, Islamic Republic of Iran
| | - Mohammad-Ali Moradkhani
- Student Research Committee, Ahvaz Jundishapur University of Medical Sciences, Ahvaz, Islamic Republic of Iran; Department of Parasitology, School of Medicine, Ahvaz Jundishapur University of Medical Sciences, Ahvaz, Islamic Republic of Iran.
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10
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Lavallée-Bourget ÈM, Fernandez-Prada C, Massé A, Turgeon P, Arsenault J. Prevalence and geographic distribution of Echinococcus genus in wild canids in southern Québec, Canada. PLoS One 2024; 19:e0306600. [PMID: 39008475 PMCID: PMC11249250 DOI: 10.1371/journal.pone.0306600] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/15/2023] [Accepted: 06/20/2024] [Indexed: 07/17/2024] Open
Abstract
Echinococcus spp. is an emerging zoonotic parasite of high concern. In Canada, an increase in the number of human and animal cases diagnosed has been reported, but information regarding the parasite's distribution in wildlife reservoir remains limited. A cross-sectional study was conducted to estimate the prevalence of wild canids infected with Echinococcus spp. and Echinococcus multilocularis in areas surrounding populated zones in Québec (Canada); to investigate the presence of areas at higher risk of infection; to evaluate potential risk factors of the infection; and as a secondary objective, to compare coproscopy and RT-PCR diagnostic tests for Taenia spp. and Echinococcus identification. From October 2020 to March 2021, fecal samples were collected from 423 coyotes (Canis latrans) and 284 red foxes (Vulpes vulpes) trapped in 12 administrative regions. Real-time PCR for molecular detection of genus Echinococcus spp. and species-specific Echinococcus multilocularis were performed. A total of 38 positive cases of Echinococcus spp., of which 25 were identified as E. multilocularis, were detected. Two high-risk areas of infection were identified. The prevalence of Echinococcus spp. was 22.7% (95% CI 11.5-37.8%) in the Montérégie centered high-risk area, 26.5% (95% CI 12.9-44.4%) in the Bas-St-Laurent high-risk area, and 3.0% (95%CI 1.8-4.7%) outside those areas. For E. multilocularis, a prevalence of 20.5% (95% CI 9.8-35.3%) was estimated in the high-risk area centered in Montérégie compared to 2.4% (95% CI 1.4-3.9%) outside. Logistic regression did not show any association of infection status with species, sex, or geolocation of capture (p > 0.05). This study shows the circulation of Echinococcus in a wildlife cycle in 9/12 administrative regions of Québec.
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Affiliation(s)
- Ève-Marie Lavallée-Bourget
- Department of Pathology and Microbiology, Faculty of Veterinary Medicine, Université de Montréal, Saint-Hyacinthe, Québec, Canada
- Epidemiology of Zoonoses and Public Health Research Unit (GREZOSP), Faculty of Veterinary Medicine, Université de Montréal, Saint-Hyacinthe, Québec, Canada
| | - Christopher Fernandez-Prada
- Department of Pathology and Microbiology, Faculty of Veterinary Medicine, Université de Montréal, Saint-Hyacinthe, Québec, Canada
- Epidemiology of Zoonoses and Public Health Research Unit (GREZOSP), Faculty of Veterinary Medicine, Université de Montréal, Saint-Hyacinthe, Québec, Canada
| | - Ariane Massé
- Epidemiology of Zoonoses and Public Health Research Unit (GREZOSP), Faculty of Veterinary Medicine, Université de Montréal, Saint-Hyacinthe, Québec, Canada
- Ministère de l'Environnement, de la Lutte Contre les Changements Climatiques, de la Faune et des Parcs, Québec, Québec, Canada
| | - Patricia Turgeon
- Department of Pathology and Microbiology, Faculty of Veterinary Medicine, Université de Montréal, Saint-Hyacinthe, Québec, Canada
- Epidemiology of Zoonoses and Public Health Research Unit (GREZOSP), Faculty of Veterinary Medicine, Université de Montréal, Saint-Hyacinthe, Québec, Canada
- Public Health Agency of Canada, Saint-Hyacinthe, Québec, Canada
| | - Julie Arsenault
- Department of Pathology and Microbiology, Faculty of Veterinary Medicine, Université de Montréal, Saint-Hyacinthe, Québec, Canada
- Epidemiology of Zoonoses and Public Health Research Unit (GREZOSP), Faculty of Veterinary Medicine, Université de Montréal, Saint-Hyacinthe, Québec, Canada
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11
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Lv X, Ai J, Mo X, Ding H, Litchev S, Lu E, Weng Y, He Q, Gongsang Q, Yang S, Ma X, Li J, Pang H, Lu S, Kong Q. Rapid Discriminative Identification of the Two Predominant Echinococcus Species from Canine Fecal Samples in the Tibetan Region of China by Loop-Mediated Isothermal Amplification-Lateral Flow Dipstick Assay. Trop Med Infect Dis 2024; 9:136. [PMID: 38922048 PMCID: PMC11209407 DOI: 10.3390/tropicalmed9060136] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/10/2024] [Revised: 06/12/2024] [Accepted: 06/13/2024] [Indexed: 06/27/2024] Open
Abstract
Echinococcosis poses a significant concern in the fields of public health and veterinary care as it can be transmitted between animals and humans. The primary endemic subtypes are cystic echinococcosis (CE) and alveolar echinococcosis (AE), which result from infestation by Echinococcus granulosus and Echinococcus multilocularis, respectively. A prominent epidemic of echinococcosis greatly affects the Tibet Autonomous Region (TAR) in China. A new technique called the loop-mediated isothermal amplification-lateral flow dipstick (LAMP-LFD) test is introduced in this research to differentiate between E. granulosus and E. multilocularis using their repetitive genetic sequences. The test is characterized by its portable nature, simple operation, quick result production, high sensitivity, and low susceptibility to aerosol contamination. The LAMP-LFD method demonstrated an exceptional minimal detection limit, reaching levels as low as approximately 1 fg/μL (femtogram per microliter) of genomic DNA. The assay's specificity was assessed, and no cross-reactivity was seen. A total of 982 dog fecal samples were collected from 54 counties in the TAR region between July 2021 and June 2022. The established method underwent validation using a commercially available ELISA kit. The agreement rate between the LAMP-LFD and ELISA methods was 97.25%, with a sensitivity of 96.05% and a specificity of 97.35%. The assay described in this study improves specificity by using a double-labeled probe, and it reduces the risk of false-positive results caused by aerosol contamination through the use of a sealed device. This makes it a suitable choice for quickly and accurately identifying the two main types of Echinococcus in field settings.
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Affiliation(s)
- Xinyue Lv
- Key Laboratory of Bio-Tech Vaccine of Zhejiang Province, Engineering Research Center of Novel Vaccine of Zhejiang Province, School of Basic Medicine and Forensics, Hangzhou Medical College, Hangzhou 310013, China; (X.L.)
| | - Jiajia Ai
- Tibet Center for Disease Control and Prevention, NHC Key Laboratory of Echinococcosis Prevention and Control, Lhasa 850000, China; (J.A.)
| | - Xiaojin Mo
- Tibet Center for Disease Control and Prevention, NHC Key Laboratory of Echinococcosis Prevention and Control, Lhasa 850000, China; (J.A.)
- National Institute of Parasitic Diseases, Chinese Center for Disease Control and Prevention, Chinese Center for Tropical Diseases Research, National Key Laboratory of Intelligent Tracking and Forecasting for Infectious Diseases, Key Laboratory on Parasite and Vector Biology, Ministry of Health, Shanghai 200025, China
| | - Haojie Ding
- Key Laboratory of Bio-Tech Vaccine of Zhejiang Province, Engineering Research Center of Novel Vaccine of Zhejiang Province, School of Basic Medicine and Forensics, Hangzhou Medical College, Hangzhou 310013, China; (X.L.)
| | - Sofia Litchev
- Department of Chemistry & Biochemistry, University of California, Los Angeles, CA 90095, USA
| | - Entung Lu
- Santa Monica College, Los Angeles, CA 90405, USA
| | - Youhong Weng
- Key Laboratory of Bio-Tech Vaccine of Zhejiang Province, Engineering Research Center of Novel Vaccine of Zhejiang Province, School of Basic Medicine and Forensics, Hangzhou Medical College, Hangzhou 310013, China; (X.L.)
| | - Qing He
- Key Laboratory of Bio-Tech Vaccine of Zhejiang Province, Engineering Research Center of Novel Vaccine of Zhejiang Province, School of Basic Medicine and Forensics, Hangzhou Medical College, Hangzhou 310013, China; (X.L.)
| | - Quzhen Gongsang
- Tibet Center for Disease Control and Prevention, NHC Key Laboratory of Echinococcosis Prevention and Control, Lhasa 850000, China; (J.A.)
| | - Shijie Yang
- National Institute of Parasitic Diseases, Chinese Center for Disease Control and Prevention, Chinese Center for Tropical Diseases Research, National Key Laboratory of Intelligent Tracking and Forecasting for Infectious Diseases, Key Laboratory on Parasite and Vector Biology, Ministry of Health, Shanghai 200025, China
| | - Xiumin Ma
- State Key Laboratory of Pathogenesis, Prevention and Treatment of High Incidence Diseases in Central Asia, Clinical Laboratory Center, Tumor Hospital Affiliated to Xinjiang Medical University, Urumqi 830000, China
| | - Jingzhong Li
- Tibet Center for Disease Control and Prevention, NHC Key Laboratory of Echinococcosis Prevention and Control, Lhasa 850000, China; (J.A.)
| | - Huasheng Pang
- Tibet Center for Disease Control and Prevention, NHC Key Laboratory of Echinococcosis Prevention and Control, Lhasa 850000, China; (J.A.)
| | - Shaohong Lu
- Key Laboratory of Bio-Tech Vaccine of Zhejiang Province, Engineering Research Center of Novel Vaccine of Zhejiang Province, School of Basic Medicine and Forensics, Hangzhou Medical College, Hangzhou 310013, China; (X.L.)
| | - Qingming Kong
- Key Laboratory of Bio-Tech Vaccine of Zhejiang Province, Engineering Research Center of Novel Vaccine of Zhejiang Province, School of Basic Medicine and Forensics, Hangzhou Medical College, Hangzhou 310013, China; (X.L.)
- Key Laboratory of Biomarkers and In Vitro Diagnosis Translation of Zhejiang Province, School of Laboratory Medicine and Bioengineering, Hangzhou Medical College, Hangzhou 310013, China
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12
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Müller S, Ghafoor S, Meyer Zu Schwabedissen C, Grimm F, Murray FR, Husmann L, Stanek N, Deplazes P, Schlag C, Kremer AE, Gubler C, Reiner CS, Semela D, Müllhaupt B, Deibel A. Management of biliary obstruction in patients with newly diagnosed alveolar echinococcosis: a Swiss retrospective cohort study. Swiss Med Wkly 2023; 153:40116. [PMID: 37956136 DOI: 10.57187/smw.2023.40116] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2023] Open
Abstract
BACKGROUND AND STUDY AIMS Alveolar echinococcosis, an orphan zoonosis affecting the liver, is of increasing concern worldwide. Most symptomatic cases present at an advanced and inoperable stage, sometimes with biliary obstruction prompting biliary tract interventions. These are, however, associated with a high risk of infectious complications. The aim of this retrospective study was to compare the effectiveness and safety of conservative and interventional treatment approaches in patients with newly diagnosed alveolar echinococcosis and biliary obstruction. PATIENTS AND METHODS Alveolar echinococcosis patients treated at two referral centres in Switzerland, presenting with hyperbilirubinaemia (total bilirubin >1.5 Upper Limit of Normal) at diagnosis were included, unless another underlying aetiology, i.e. common bile duct stones or decompensated cirrhosis, was identified. Patients were divided into two groups, according to whether they initially received a biliary tract intervention. The primary endpoint was normalisation of bilirubin levels within a 6-month period. Secondary endpoints included, among others, the occurrence of early and late biliary complications, the need for biliary tract interventions during follow-up and overall duration of hospital stays for treatment initiation and for biliary complications. RESULTS 28 patients were included in this study, of whom 17 received benzimidazole therapy alone and 11 additionally received a biliary tract intervention. Baseline characteristics did not differ between groups. All but one patient in each group achieved the primary endpoint (p=0.747). Biliary tract intervention was associated with faster laboratory improvement (t1/2 1.3 vs 3.0 weeks), but also with more frequent early biliary complications (7/11 vs 1/17, p=0.002) and longer initial hospital stay (18 days vs 7 days, p=0.007). CONCLUSION Biliary obstruction in patients with newly diagnosed alveolar echinococcosis can be treated effectively with benzimidazole therapy alone. Biliary tract intervention, on the other hand, is associated with a high complication rate and should probably be reserved for patients with insufficient response to benzimidazole therapy.
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Affiliation(s)
- Sandra Müller
- Department of Gastroenterology and Hepatology, University Hospital Zurich, Zurich, Switzerland
- Department of Gastroenterology and Hepatology, Cantonal Hospital St. Gallen, St. Gallen, Switzerland
| | - Soleen Ghafoor
- Institute of Diagnostic and Interventional Radiology, University Hospital Zurich, Zurich, Switzerland
| | | | - Felix Grimm
- Institute of Parasitology, University Zurich, Zurich, Switzerland
| | - Fritz Ruprecht Murray
- Department of Gastroenterology and Hepatalogy, Stadtspital Zurich, Zurich, Switzerland
| | - Lars Husmann
- Department of Nuclear Medicine, University Hospital Zurich, Zurich, Switzerland
| | - Nadine Stanek
- Department of Gastroenterology and Hepatology, Luzerner Kantonsspital, Luzern, Switzerland
| | - Peter Deplazes
- Institute of Parasitology, University Zurich, Zurich, Switzerland
| | - Christoph Schlag
- Department of Gastroenterology and Hepatology, University Hospital Zurich, Zurich, Switzerland
| | - Andreas E Kremer
- Department of Gastroenterology and Hepatology, University Hospital Zurich, Zurich, Switzerland
- Swiss HPB (Hepato-Pancreato-Biliary) Center, University Hospital Zurich, Zurich, Switzerland
| | - Christoph Gubler
- Department of Gastroenterology and Hepatalogy, Stadtspital Zurich, Zurich, Switzerland
| | - Cäcilia S Reiner
- Institute of Diagnostic and Interventional Radiology, University Hospital Zurich, Zurich, Switzerland
| | - David Semela
- Department of Gastroenterology and Hepatology, Cantonal Hospital St. Gallen, St. Gallen, Switzerland
| | - Beat Müllhaupt
- Department of Gastroenterology and Hepatology, University Hospital Zurich, Zurich, Switzerland
- Swiss HPB (Hepato-Pancreato-Biliary) Center, University Hospital Zurich, Zurich, Switzerland
| | - Ansgar Deibel
- Department of Gastroenterology and Hepatology, University Hospital Zurich, Zurich, Switzerland
- Swiss HPB (Hepato-Pancreato-Biliary) Center, University Hospital Zurich, Zurich, Switzerland
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13
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Peters L, Jiang W, Eberhardt N, Hagemann JB, Grüner B, Tappe D. 18FDG-PET/CT-Scans and Biomarker Levels Predicting Clinical Outcome in Patients with Alveolar Echinococcosis-A Single-Center Cohort Study with 179 Patients. Pathogens 2023; 12:1041. [PMID: 37624001 PMCID: PMC10457873 DOI: 10.3390/pathogens12081041] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/25/2023] [Revised: 07/24/2023] [Accepted: 08/08/2023] [Indexed: 08/26/2023] Open
Abstract
Background: Alveolar echinococcosis (AE) is a severe larval tapeworm infection with a variable clinical course of the disease. Reliable imaging techniques and biomarkers are needed to predict the course of the disease. Methods: 179 AE patients that received PET/CT scans between 2008 and 2012 were retrospectively included. From stored blood samples taken on the day of the scan, levels of IgE, parasite-specific serology, amyloid A, C-reactive protein, soluble interleukin 2 receptor, cytokeratin fragments, eosinophilic cell count, and eosinophil cationic protein were measured. Additionally, the current clinical outcome (cured, stable, or progressive disease) after a median duration of 8 years after baseline examination was assessed. Ultimately, an ordinal logistic regression was conducted to evaluate which imaging parameters and biomarkers independently influence the clinical outcome. Results: In general, patients in need of medical treatment or with progressive disease, advanced PNM stages, and positive PET/CT scans exhibited higher levels of the respective biomarkers. However, only the parasite-specific serological markers and total IgE levels differed significantly between clinical groups, WHO PNM stages, and the results of the PET/CT scan. In the multivariate analysis, PET/CT results were a strong predictor of the clinical outcome (OR 8.908, 95%CI 3.019-26.285; p < 0.001), and age at baseline was a moderate predictor (OR 1.031, 95%CI 1.003-1.060; p = 0.029). Conclusions: The PET/CT scan is, preferably in combination with parasite-specific serology and IgE levels, a valuable tool in the clinical management of AE and is able to predict the course of the disease.
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Affiliation(s)
- Lynn Peters
- Department of Internal Medicine III, Division of Infectious Diseases, Ulm University Hospital, 89081 Ulm, Germany; (L.P.); (W.J.)
| | - Wanjie Jiang
- Department of Internal Medicine III, Division of Infectious Diseases, Ulm University Hospital, 89081 Ulm, Germany; (L.P.); (W.J.)
| | - Nina Eberhardt
- Department of Nuclear Medicine, Ulm University Hospital, 89081 Ulm, Germany;
| | | | - Beate Grüner
- Department of Internal Medicine III, Division of Infectious Diseases, Ulm University Hospital, 89081 Ulm, Germany; (L.P.); (W.J.)
| | - Dennis Tappe
- Bernhard Nocht Institute for Tropical Medicine, 20359 Hamburg, Germany
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14
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Alvi MA, Ali RMA, Khan S, Saqib M, Qamar W, Li L, Fu BQ, Yan HB, Jia WZ. Past and Present of Diagnosis of Echinococcosis: A Review (1999-2021). Acta Trop 2023; 243:106925. [PMID: 37080264 DOI: 10.1016/j.actatropica.2023.106925] [Citation(s) in RCA: 12] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/18/2023] [Revised: 03/17/2023] [Accepted: 04/08/2023] [Indexed: 04/22/2023]
Abstract
The larval forms of taeniid cestodes belonging to the genus Echinococcus are the source of the zoonotic infection known as echinococcosis. Alveolar and cystic echinococcosis are caused by Echinococcus multilocularis and Echinococcus granulosus (s. s) respectively. It is endemic in several regions of the world. In this systematic review, we describe diagnosis, and the species (human, canids, livestock, and small rodents) affected by cystic (CE) and alveolar echinococcosis (AE). From 1999 to 2021, we searched the online directory through PubMed, SCOPUS, Web of Science, and google scholar. Among the 37,700 records found in the online databases, 187 publications met our eligibility requirements. The majority of investigations employed a range of diagnostic methods, such as ELISA, imaging, copro-PCR, necropsy or arecoline hydrobromide purgation, morphological cestode confirmation, and fecal sieving/flotation to detect and confirm Echinococcus infection. ELISA was the most commonly used method followed by PCR, and imaging. The research team retrieved data describing the incidence or assessment of the diagnostic test for E. multilocularis in humans (N = 99), canids (N = 63), small ruminants (N = 13), large ruminants (N= 3), camel (N= 2), pigs (N=2) and small mammals (N= 5). This study was conducted to explore the diagnostic tools applied to detect echinococcosis in humans as well as animals in prevalent countries, and to report the characteristic of new diagnostic tests for disease surveillance. This systematic review revealed that ELISA (alone or in combination) was the most common method used for disease diagnosis and diagnostic efficacy and prevalence rate increased when recombinant antigens were used. It is highly recommended to use combination protcols such as serological with molecular and imaging technique to diagnose disease. Our study identified scarcity of data of reporting echinococcosis in humans/ animals in low-income or developing countries particularly central Asian countries. Study reports in small rodents indicate their role in disease dissemination but real situation in these host is not refected due to limited number of studies. Even though echinococcosis affects both public health and the domestic animal sector, therefore, it is important to devise new and strengthe implementation of the existing monitoring, judging, and control measures in this estimate.
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Affiliation(s)
- Mughees Aizaz Alvi
- State Key Laboratory of Veterinary Etiological Biology, College of Veterinary Medicine, Lanzhou University, National Para-reference Laboratory for Animal Echinococcosis, Lanzhou Veterinary Research Institute, Chinese Academy of Agricultural Sciences, Lanzhou, China; Department of Clinical Medicine and Surgery, University of Agriculture, Faisalabad, Pakistan
| | - Rana Muhammad Athar Ali
- Department of Clinical Medicine and Surgery, University of Agriculture, Faisalabad, Pakistan
| | - Sadiq Khan
- Department of Clinical Medicine and Surgery, University of Agriculture, Faisalabad, Pakistan
| | - Muhammad Saqib
- Department of Clinical Medicine and Surgery, University of Agriculture, Faisalabad, Pakistan
| | - Warda Qamar
- Department of Parasitology, University of Agriculture, Faisalabad, Pakistan
| | - Li Li
- State Key Laboratory of Veterinary Etiological Biology, College of Veterinary Medicine, Lanzhou University, National Para-reference Laboratory for Animal Echinococcosis, Lanzhou Veterinary Research Institute, Chinese Academy of Agricultural Sciences, Lanzhou, China
| | - Bao-Quan Fu
- State Key Laboratory of Veterinary Etiological Biology, College of Veterinary Medicine, Lanzhou University, National Para-reference Laboratory for Animal Echinococcosis, Lanzhou Veterinary Research Institute, Chinese Academy of Agricultural Sciences, Lanzhou, China
| | - Hong-Bin Yan
- State Key Laboratory of Veterinary Etiological Biology, College of Veterinary Medicine, Lanzhou University, National Para-reference Laboratory for Animal Echinococcosis, Lanzhou Veterinary Research Institute, Chinese Academy of Agricultural Sciences, Lanzhou, China.
| | - Wan-Zhong Jia
- State Key Laboratory of Veterinary Etiological Biology, College of Veterinary Medicine, Lanzhou University, National Para-reference Laboratory for Animal Echinococcosis, Lanzhou Veterinary Research Institute, Chinese Academy of Agricultural Sciences, Lanzhou, China; Jiangsu Co-innovation Center for Prevention and Control of Important Animal Infectious Diseases and Zoonoses, Yangzhou, China.
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15
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Eren S, Aydın S, Kantarci M, Kızılgöz V, Levent A, Şenbil DC, Akhan O. Percutaneous management in hepatic alveolar echinococcosis: A sum of single center experiences and a brief overview of the literature. World J Gastrointest Surg 2023; 15:398-407. [PMID: 37032805 PMCID: PMC10080597 DOI: 10.4240/wjgs.v15.i3.398] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/24/2022] [Revised: 12/18/2022] [Accepted: 02/14/2023] [Indexed: 03/27/2023] Open
Abstract
BACKGROUND Hepatic alveolar echinococcosis (HAE) is a serious zoonotic infection that affects humans. It may have a tumor-like appearance at times. Percutaneous treatment of HAE patients is extremely relaxing for them. HAE is a significant human zoonotic infection caused by the fox tapeworm Echinococcus Multilocularis larvae. It possesses the characteristics of an invasive tumor-like lesion due to its infiltrative growth pattern and protracted incubation period. The disease is endemic over central Europe, Asia, and North America. AIM To characterize HAE patients who were treated percutaneously, their outcomes, and the major technical features of percutaneous treatment in HAE. METHODS Patients who were treated with percutaneous cyst drainage and/or percutaneous biliary drainage were included in the study. Uncorrected abnormal coagulation values and solid or non-infected HAE with minor necrotic change were excluded. RESULTS Thirty-two patients underwent percutaneous cyst drainage, two patients underwent percutaneous biliary drainage, and four patients underwent percutaneous biliary drainage alone. Interventional radiology is utilized to drain echinococcal necrosis and abscesses within/without the liver, as well as diseased and clogged bile ducts. CONCLUSION Percutaneous drainage of cyst contents and/or biliary channels using a minimally invasive technique is a very beneficial. Percutaneous cyst drainage with albendazole therapy improves quality of life in patients who are unable to undergo surgery, even when the mass resolves with long-term treatment.
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Affiliation(s)
- Suat Eren
- Department of Radiology, Faculty of Medicine, Atatürk University, Erzurum 25100, Turkey
| | - Sonay Aydın
- Department of Radiology, Faculty of Medicine, Erzincan Binali Yıldırım University, Erzincan 24100, Turkey
| | - Mecit Kantarci
- Department of Radiology, Faculty of Medicine, Erzincan Binali Yıldırım University, Erzincan 24100, Turkey
| | - Volkan Kızılgöz
- Department of Radiology, Faculty of Medicine, Erzincan Binali Yıldırım University, Erzincan 24100, Turkey
| | - Akın Levent
- Department of Radiology, Faculty of Medicine, Erzincan Binali Yıldırım University, Erzincan 24100, Turkey
| | - Düzgün Can Şenbil
- Department of Radiology, Faculty of Medicine, Erzincan Binali Yıldırım University, Erzincan 24100, Turkey
| | - Okan Akhan
- Department of Radiology, Hacettepe University, Ankara 06090, Turkey
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Yimingjiang M, Aini A, Tuergan T, Zhang W. Differential Gene Expression Profiling in Alveolar Echinococcosis Identifies Potential Biomarkers Associated With Angiogenesis. Open Forum Infect Dis 2023; 10:ofad031. [PMID: 36817746 PMCID: PMC9927572 DOI: 10.1093/ofid/ofad031] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/05/2022] [Accepted: 01/26/2023] [Indexed: 02/04/2023] Open
Abstract
Background Alveolar echinococcosis (AE) is a worldwide zoonosis caused by Echinococcus multilocularis. Alveolar echinococcosis is a severe chronic parasitic disease that exhibits a tumor-like growth, with the potential for invasion and distant metastasis; however, the molecular mechanism underlying this condition remains unclear. Methods Transcriptome analyses were performed to detect differentially expressed genes (DEGs) in samples from patients with AE with invasion and distant metastasis. The results were further verified by immunohistochemistry. Results A total of 1796 DEGs were identified, including 1742 upregulated and 54 downregulated DEGs. A subsequent functional analysis showed that the significant DEGs were involved in the angiogenesis process. Immunohistochemical analysis confirmed the reliability of the transcriptomic data. Conclusions These results suggest that angiogenesis is a possible mechanism underlying the tumor-like biological behavior observed during E multilocularis infection. Genes related to this process may play important roles in AE invasion and distant metastasis.
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Affiliation(s)
- Maiweilidan Yimingjiang
- Department of Pathology, The First Affiliated Hospital of Xinjiang Medical University, Xinjiang, China
| | - Abudusalamu Aini
- Hepatopancreatobiliary Center, Beijing Tsinghua Changgung Hospital, School of Clinical Medicine, Tsinghua University, Beijing, China
| | - Talaiti Tuergan
- Department of Hepatic Hydatid and Hepatobiliary Surgery, Digestive and Vascular Surgery Center, The First Affiliated Hospital of Xinjiang Medical University, Xinjiang, China
| | - Wei Zhang
- Correspondence: Dr. Wei Zhang, Department of Pathology, The First Affiliated Hospital of Xinjiang Medical University, 137 Liyushan Southern Road, Urumqi, Xinjiang 830054, China ( )
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17
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Joos N, Schmidberger J, Schlingeloff P, Kratzer W. [Diagnostic delaying factors in hepatic alveolar echinococcosis]. Dtsch Med Wochenschr 2023; 148:e37-e43. [PMID: 36690025 PMCID: PMC10060057 DOI: 10.1055/a-1996-3603] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/25/2023]
Abstract
PURPOSE The purpose of this study was to analyze the diagnostic workflow of patients with alveolar echinococcosis (AE) and to identify possible diagnosis-delaying factors. METHODS The number and type of diagnostic procedures of patients diagnosed with alveolar echinococcosis were investigated. The disease history was recorded on the basis of questionnaires, the available findings, and data supplements from the hospital information system (SAP). Statistical analyses were performed using SAS version 9.4 and Microsoft Excel version 16.43. The study population of the cross-sectional study included n = 109 patients with confirmed alveolar echinococcosis. RESULTS The definitive diagnosis of alveolar echinococcosis of the liver was made at 26.5 ± 65.0 (mean ± standard deviation) months (min - max: 0 - 344, median = 3). The majority of patients were diagnosed because of incidental imaging findings of the liver (n = 74/109 (67.9%)). A total of n = 56/74 (75.7%) of all incidental findings were diagnosed in an outpatient setting, while n = 15/74 (20.3%) of cases were diagnosed during inpatient hospitalization. On average, 1.1 ± 1.2 (0-11, median = 1) ionizing imaging modalities were used for each patient. Contrast-enhanced sonography was received by 0.3 ± 0.5 (0-2, median = 0) patients. Almost all patients (n = 104/109 (95.4%) had at least one suspected hepatic or extrahepatic malignancy at some time. Exclusion of suspected malignancy occurred at a mean of 4.1 ± 16.5 months (0 -133.8, median = 1). CONCLUSIONS The diagnostic clarification process of AE patients is lengthy and stressful. The psychological burden of a questionable malignant diagnosis is considerable. Early use of contrast-enhanced sonography and, if necessary, puncture of unclear hepatic masses helps to shorten the difficult diagnostic process.
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Affiliation(s)
- Natalie Joos
- Zentraler Ultraschall, Klinik für Innere Medizin I, Universitätsklinikum Ulm
| | - Julian Schmidberger
- Zentraler Ultraschall, Klinik für Innere Medizin I, Universitätsklinikum Ulm
| | | | - Wolfgang Kratzer
- Zentraler Ultraschall, Klinik für Innere Medizin I, Universitätsklinikum Ulm
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18
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Jamill N, Ahmed H, Afzal MS, Simsek S, Ali A, Arshad M, Yu C, Cao J. Assessment of risk, landscape epidemiology and management strategies to combat alveolar echinococcosis in the rural communities of Hunza, Pakistan. Front Public Health 2022; 10:1015475. [PMID: 36478720 PMCID: PMC9720312 DOI: 10.3389/fpubh.2022.1015475] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/09/2022] [Accepted: 10/31/2022] [Indexed: 11/22/2022] Open
Abstract
BACKGROUND Human alveolar echinococcosis (AE) is a neglected zoonotic disease. Prevalence of AE in humans is reported in Pakistan as a result of poor economic and sanitary conditions, close proximity to wildlife and limited knowledge of AE. Studies on the prevalence and transmission of AE have been limited, especially for rural Pakistan. The study objectives were to identify knowledge, attitudes and practices relating to AE, to determine awareness of the disease, and to identify knowledge about possible risk factors of infections involving the landscape epidemiological attributes of rural villages in Hunza, one of the districts of Gilgit-Baltistan, a region of Pakistan that borders China. METHODS A community-based cross-sectional study was conducted among the general population of Hunza to establish the level of awareness, knowledge, attitudes, practices, landscape epidemiology, and disease management and control relating to AE in rural areas of Hunza. Data were collected by questionnaire. RESULTS A total of 387 questionnaires was received. Statistical analysis showed that the population's knowledge about the disease was poor. The attitudes and practices of the participants indicated that their risk of infection was low. Knowledge of landscape epidemiology of the disease was poor but knowledge about AE disease management was good. The attitudes of residents toward disease treatment and control strategies were positive, although the overall knowledge of participants about prevention of infection was poor. CONCLUSION Knowledge of AE is poor among the residents of Hunza, Pakistan. Our study demands continued and strengthened awareness of the changes to lifestyle and practices associated with AE, not only in the study locality but throughout other areas of Pakistan.
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Affiliation(s)
- Naila Jamill
- Department of Biosciences, COMSATS University Islamabad, Islamabad, Pakistan
| | - Haroon Ahmed
- Department of Biosciences, COMSATS University Islamabad, Islamabad, Pakistan
| | - Muhammad Sohail Afzal
- Department of Life Sciences, School of Science, University of Management and Technology, Lahore, Pakistan
| | - Sami Simsek
- Department of Parasitology, Faculty of Veterinary Medicine, Firat University, Elazig, Turkey
| | - Abid Ali
- Department of Zoology, Abdul Wali Khan University Mardan, Mardan, Pakistan
| | - Muhammad Arshad
- Department of Life Sciences, School of Science, University of Management and Technology, Lahore, Pakistan
| | - Chenghang Yu
- National Institute of Parasitic Diseases, Chinese Center for Disease Control and Prevention (Chinese Center for Tropical Diseases Research), Shanghai, China
- Key Laboratory of Parasite and Vector Biology, National Health Commission of the People's Republic of China, Shanghai, China
- WHO Collaborating Center for Tropical Diseases, Shanghai, China
| | - Jianping Cao
- National Institute of Parasitic Diseases, Chinese Center for Disease Control and Prevention (Chinese Center for Tropical Diseases Research), Shanghai, China
- Key Laboratory of Parasite and Vector Biology, National Health Commission of the People's Republic of China, Shanghai, China
- WHO Collaborating Center for Tropical Diseases, Shanghai, China
- The School of Global Health, Chinese Center for Tropical Diseases Research, Shanghai Jiao Tong University School of Medicine, Shanghai, China
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19
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Qu J, Xu H, Lv X. Disseminated alveolar echinococcosis in a patient diagnosed by metagenomic next-generation sequencing: A case report. Front Public Health 2022; 10:972619. [PMID: 36091563 PMCID: PMC9454002 DOI: 10.3389/fpubh.2022.972619] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/18/2022] [Accepted: 07/29/2022] [Indexed: 01/25/2023] Open
Abstract
Background Alveolar echinococcosis (AE) is a parasitic zoonosis with high mortality and disability rates. Diverse clinical manifestations and mimicking of differential diagnoses such as tuberculosis and malignancy pose a diagnostic dilemma. With the rapid development of molecular diagnostic techniques in recent years, metagenomic next-generation sequencing (mNGS) has become an attractive approach for the etiological diagnosis of infectious diseases. Case presentation we report a case of 51-year-old Chinese Tibetan male presented with 3-year low-back pain and 4-month discomfort in the right upper quadrant of the abdomen. He had been in good health. He was diagnosed with tuberculosis and was given anti-tuberculosis treatment a month prior to the visit, but the symptoms were not relieved. Abdominal computerized tomography (CT) revealed a hypodense lesion with uneven enhancement in the liver, and two ring-enhancing cystic lesions in the right abdominal wall. Lumbar spine enhanced MRI showed lesions of mixed density with uneven enhancement in the L1 vertebra and paraspinal tissue. The pathological results of the liver biopsy revealed parasitic infection and possibly echinococcosis. The metagenomic next-generation sequencing (mNGS) of the puncture fluid of abdominal cysts using Illumina X10 sequencer revealed 585 sequence reads matching Echinococcus multilocularis. Disseminated AE was diagnosed. Albendazole (400 mg, twice daily) was used, and the patient was in stable condition during follow-up. Conclusions mNGS may be a useful tool for the diagnosis of AE. The case would help clinicians to improve their diagnostic skills.
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Affiliation(s)
- Junyan Qu
- Center of Infectious Disease, West China Hospital of Sichuan University, Chengdu, China
| | - Huan Xu
- Pathology Department, West China Hospital, Sichuan University, Chengdu, China
| | - Xiaoju Lv
- Center of Infectious Disease, West China Hospital of Sichuan University, Chengdu, China,*Correspondence: Xiaoju Lv
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20
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Maimaitinijiati Y, AJi T, Jiang TM, Ran B, Shao YM, Zhang RQ, Guo Q, Wang ML, Wen H. Approaches to reconstruction of inferior vena cava by ex vivo liver resection and autotransplantation in 114 patients with hepatic alveolar echinococcosis. World J Gastroenterol 2022; 28:4351-4362. [PMID: 36159005 PMCID: PMC9453774 DOI: 10.3748/wjg.v28.i31.4351] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/11/2022] [Revised: 06/10/2022] [Accepted: 07/25/2022] [Indexed: 02/06/2023] Open
Abstract
BACKGROUND Hepatic alveolar echinococcosis (AE) is most commonly found in retrohepatic inferior vena cava (RHIVC). Ex vivo liver resection and autotransplantation (ELRA) can better realize the radical resection of end-stage hepatic AE with severely compromised hepatocaval confluences, and reconstruction of the affected vessels. Currently, there is a scarcity of information regarding RHIVC reconstruction in ELRA.
AIM To propose reasonable RHICV reconstruction strategies for ex vivo liver resection and autotransplantation.
METHODS We retrospectively summarized the clinical data of 114 patients diagnosed with hepatic AE who treated by ELRA in our department. A total of 114 patients were divided into three groups according to the different reconstruction methods of RHIVC: Group A with original RHIVC being repaired and reconstructed (n = 64), group B with RHIVC being replaced (n = 43), and group C with RHIVC being resected without reconstruction (n = 7). The clinical data of patients, including the operation time, anhepatic phase, intraoperative blood loss, complications and postoperative hospital stay, were analyzed and the patients were routinely followed up. The normally distributed continuous variables were expressed as means ± SD, whereas the abnormally distributed ones were expressed as median and analyzed by analysis of variance. Survival curve was plotted by the Kaplan-Meier method.
RESULTS All patients were routinely followed up for a median duration of 52 (range, 12-125) mo. The 30 d mortality rate was 7.0% (8/114) and 7 patients died within 90 d. Among all subjects, the inferior vena cava (IVC)-related complication rates were 17.5% (11/63) in group A and 16.3% (7/43) in group B. IVC stenosis was found in 12 patients (10.5%), whereas thrombus was formed in 6 patients (5.3%). Twenty-two patients had grade III or higher complications, with the complication rates being 17.2%, 16.3%, and 57.1% in the three groups. The average postoperative hospital stay in the three groups was 32.3 ± 19.8, 26.7 ± 18.2, and 51.3 ± 29.4 d (P = 0.03), respectively.
CONCLUSION ELRA can be considered a safe and feasible option for end-stage hepatic AE patients with RHIVC infiltration. The RHIVC reconstruction methods should be selected appropriately depending on the defect degree of AE lesions in IVC lumen. The RHIVC resection without any reconstruction method should be considered with caution.
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Affiliation(s)
- Yusufukadier Maimaitinijiati
- State Key Laboratory on Pathogenesis, Prevention and Treatment of High Incidence Diseases in Central Asia, The First Clinical College, Xinjiang Medical University, Urumqi 830011, Xinjiang Uygur Autonomous Region, China
- Department of Hepatobiliary Surgery, The First Affiliated Hospital of Xinjiang Medical University, Urumqi 830011, Xinjiang Uygur Autonomous Region, China
| | - Tuerganaili AJi
- Department of Hepatobiliary Surgery, The First Affiliated Hospital of Xinjiang Medical University, Urumqi 830011, Xinjiang Uygur Autonomous Region, China
| | - Tie-Min Jiang
- State Key Laboratory on Pathogenesis, Prevention and Treatment of High Incidence Diseases in Central Asia, The First Clinical College, Xinjiang Medical University, Urumqi 830011, Xinjiang Uygur Autonomous Region, China
- Department of Hepatobiliary Surgery, The First Affiliated Hospital of Xinjiang Medical University, Urumqi 830011, Xinjiang Uygur Autonomous Region, China
| | - Bo Ran
- Department of Hepatobiliary Surgery, The First Affiliated Hospital of Xinjiang Medical University, Urumqi 830011, Xinjiang Uygur Autonomous Region, China
| | - Ying-Mei Shao
- Department of Hepatobiliary Surgery, The First Affiliated Hospital of Xinjiang Medical University, Urumqi 830011, Xinjiang Uygur Autonomous Region, China
- Xinjiang Organ Transplant Institution, The First Affiliated Hospital of Xinjiang Medical University, Urumqi 830011, Xinjiang Uygur Autonomous Region, China
| | - Rui-Qing Zhang
- Department of Hepatobiliary Surgery, The First Affiliated Hospital of Xinjiang Medical University, Urumqi 830011, Xinjiang Uygur Autonomous Region, China
| | - Qiang Guo
- Department of Hepatobiliary Surgery, The First Affiliated Hospital of Xinjiang Medical University, Urumqi 830011, Xinjiang Uygur Autonomous Region, China
| | - Mao-Lin Wang
- Department of Hepatobiliary Surgery, The First Affiliated Hospital of Xinjiang Medical University, Urumqi 830011, Xinjiang Uygur Autonomous Region, China
| | - Hao Wen
- State Key Laboratory on Pathogenesis, Prevention and Treatment of High Incidence Diseases in Central Asia, The First Clinical College, Xinjiang Medical University, Urumqi 830011, Xinjiang Uygur Autonomous Region, China
- Xinjiang Organ Transplant Institution, The First Affiliated Hospital of Xinjiang Medical University, Urumqi 830011, Xinjiang Uygur Autonomous Region, China
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Peters L, Burkert S, Hagemann JB, Albes R, Klemptner J, Birkle J, Schwaibold E, Siefermann S, Grüner B. Initial Risk Assessment in Patients with Alveolar Echinococcosis—Results from a Retrospective Cohort Study. Pathogens 2022; 11:pathogens11050557. [PMID: 35631078 PMCID: PMC9144025 DOI: 10.3390/pathogens11050557] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/31/2022] [Revised: 04/15/2022] [Accepted: 04/22/2022] [Indexed: 11/30/2022] Open
Abstract
Background: Alveolar echinococcosis (AE) is a potentially lethal parasitosis with a broad spectrum of disease dynamics in affected patients. To guide clinical management, we assessed initial prognostic factors for both progressive and controlled AE based on initial staging. Methods: A retrospective cohort study was conducted, examining 279 patients assigned to different clinical groups: cured, stable with and without the need for benzimidazole treatment, and progressive disease. Univariate analysis compared demographic and clinical variables. Significant variables were subsequently entered into two separate logistic regression models for progressive and controlled disease. Results: Based on the multivariate analysis, a large AE lesion (OR = 1.02 per millimetre in size; 95%CI 1.004–1.029), PNM staging (OR = 2.86; 95%CI 1.384–5.911) and especially the involvement of neighbouring organs (OR = 3.70; 95%CI 1.173–11.653) remained significant risk factors for progressive disease. A negative Em2+ IgG (OR = 0.25; 95%CI 0.072–0.835) and a small AE lesion (OR = 0.97; 95%CI 0.949–0.996) were significant protective factors. Conclusions: Patients with large lesions and advanced stages should be monitored closely and most likely require long-term treatment with benzimidazoles if curative resection is not feasible. Patients with small lesions and negative Em2+ IgG seem able to control the disease to a certain extent and a less strict treatment regimen might suffice.
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Affiliation(s)
- Lynn Peters
- Department of Internal Medicine III, Division of Infectious Diseases, Ulm University Hospital, 89081 Ulm, Germany; (S.B.); (R.A.); (J.K.); (J.B.); (E.S.); (S.S.); (B.G.)
- Correspondence:
| | - Sanne Burkert
- Department of Internal Medicine III, Division of Infectious Diseases, Ulm University Hospital, 89081 Ulm, Germany; (S.B.); (R.A.); (J.K.); (J.B.); (E.S.); (S.S.); (B.G.)
| | | | - Rasmus Albes
- Department of Internal Medicine III, Division of Infectious Diseases, Ulm University Hospital, 89081 Ulm, Germany; (S.B.); (R.A.); (J.K.); (J.B.); (E.S.); (S.S.); (B.G.)
| | - Jonas Klemptner
- Department of Internal Medicine III, Division of Infectious Diseases, Ulm University Hospital, 89081 Ulm, Germany; (S.B.); (R.A.); (J.K.); (J.B.); (E.S.); (S.S.); (B.G.)
| | - Jessica Birkle
- Department of Internal Medicine III, Division of Infectious Diseases, Ulm University Hospital, 89081 Ulm, Germany; (S.B.); (R.A.); (J.K.); (J.B.); (E.S.); (S.S.); (B.G.)
| | - Elias Schwaibold
- Department of Internal Medicine III, Division of Infectious Diseases, Ulm University Hospital, 89081 Ulm, Germany; (S.B.); (R.A.); (J.K.); (J.B.); (E.S.); (S.S.); (B.G.)
| | - Sofia Siefermann
- Department of Internal Medicine III, Division of Infectious Diseases, Ulm University Hospital, 89081 Ulm, Germany; (S.B.); (R.A.); (J.K.); (J.B.); (E.S.); (S.S.); (B.G.)
| | - Beate Grüner
- Department of Internal Medicine III, Division of Infectious Diseases, Ulm University Hospital, 89081 Ulm, Germany; (S.B.); (R.A.); (J.K.); (J.B.); (E.S.); (S.S.); (B.G.)
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22
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Kim JG, Han X, Kong Y. Echinococcus granulosus Protoscolex DM9 Protein Shows High Potential for Serodiagnosis of Alveolar Echinococcosis. THE KOREAN JOURNAL OF PARASITOLOGY 2022; 60:25-34. [PMID: 35247951 PMCID: PMC8898642 DOI: 10.3347/kjp.2022.60.1.25] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 02/02/2022] [Accepted: 02/10/2022] [Indexed: 11/23/2022]
Abstract
Alveolar echinococcosis (AE) caused by infection with E. multilocularis metacestode, represents one of the most fatal helminthic diseases. AE is principally manifested with infiltrative, proliferating hepatic mass, resembling primary hepatocellular carcinoma. Sometimes metastatic lesions are found in nearby or remote tissue. AE diagnosis largely depends on imaging studies, but atypical findings of imaging features frequently require differential diagnosis from other hepatic lesions. Serological tests may provide further evidence, while obtaining reliable AE materials is not easy. In this study, alternative antigens, specific to AE were identified by analyzing E. granulosus protoscolex proteins. An immunoblot analysis of E. granulosus protoscolex showed that a group of low-molecular-weight proteins in the range from 14 kDa to 16 kDa exhibited a sensitive and specific immune response to AE patient sera. Partial purification and proteomic analysis indicated that this protein group contained myosin, tubulin polymerization promoting protein, fatty-acid binding protein, uncharacterized DM9, heat shock protein 90 cochaperone tebp P-23, and antigen S. When the serological applicability of recombinant forms of these proteins was assessed using enzyme-linked immunosorbent assay, DM9 protein (rEgDM9) showed 90.1% sensitivity (73/81 sera tested) and 94.5% specificity (172/181 sera tested), respectively. rEgDM9 showed weak cross-reactions with patient sera from the transitional and chronic stages of cystic echinococcosis (3 to 5 stages). rEgDM9 would serve as a useful alternative antigen for serodiagnosis of both early- and advanced-stage AE cases.
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Affiliation(s)
- Jeong-Geun Kim
- Department of Molecular Parasitology, Samsung Medical Center, Sungkyunkwan University School of Medicine, Suwon 16419,
Korea
| | - Xiumin Han
- Clinical Research Institute of Hydatid Disease, Qinghai Provincial People’s Hospital, Xining 810007,
China
| | - Yoon Kong
- Department of Molecular Parasitology, Samsung Medical Center, Sungkyunkwan University School of Medicine, Suwon 16419,
Korea
- Corresponding author ()
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Knapp J, Lallemand S, Monnien F, Felix S, Valmary-Degano S, Courquet S, Demonmerot F, Heyd B, Turco C, Doussot A, Bourgeois L, Bresson-Hadni S, Richou C, Millon L. Molecular diagnosis of alveolar echinococcosis in patients based on frozen and formalin-fixed paraffin-embedded tissue samples. Parasite 2022; 29:4. [PMID: 35113014 PMCID: PMC8812296 DOI: 10.1051/parasite/2022004] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/16/2021] [Accepted: 01/14/2022] [Indexed: 11/14/2022] Open
Abstract
Confirmed diagnosis of alveolar echinococcosis (AE) is based on pathological criteria and molecular evidence. This parasite-borne disease, caused by the cestode Echinococcus multilocularis, sparingly involves humans as a dead-end host. In humans, the parasite mainly colonizes the liver but can colonize any organ and cause atypical forms, often difficult to characterize clinically. Moreover, molecular methods may be suitable to make the diagnosis of AE in cases of atypical forms, extra-hepatic localizations, or immunosuppressed patients. The aim of this study was to determine the most relevant published PCR techniques, for diagnosis of AE in patients and adopt the best strategy for molecular diagnosis depending on the nature of the tested sample. In this study, we evaluated nine end-point PCR assays and one real-time PCR assay (qPCR), targeting mitochondrial genes, using a total of 89 frozen or formalin-fixed paraffin-embedded (FFPE) samples from either 48 AE or 9 cystic echinococcosis patients. Targeted fragment-genes ranged from 84 to 529 bp. Six PCR assays were able to amplify the DNA of 100% of the frozen AE-samples and for one PCR, 69.8% of the FFPE AE-samples. The 16S rrnL PCR (84 bp) was positive in PCR for 77% of the AE samples and in qPCR for 86.5%. The sensitivity of the PCR assays was higher for fresh samples and FFPE samples stored for less than 5 years. The qPCR assay further increased sensitivity for the tested samples, confirming the need for the development of an Echinococcus spp. qPCR to improve the molecular diagnosis of echinococcoses.
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Affiliation(s)
- Jenny Knapp
- Department of Parasitology-Mycology, National Reference Centre for Echinococcoses, University Hospital of Besançon, 25030 Besançon, France - UMR CNRS 6249 Laboratoire Chrono-environnement, Université Bourgogne-Franche-Comté, 16 Route de Gray, 25030 Besançon, France
| | - Séverine Lallemand
- Department of Parasitology-Mycology, National Reference Centre for Echinococcoses, University Hospital of Besançon, 25030 Besançon, France
| | - Franck Monnien
- Department of Pathology, University Hospital of Besançon, 25030 Besançon, France
| | - Sophie Felix
- Department of Pathology, University Hospital of Besançon, 25030 Besançon, France
| | - Séverine Valmary-Degano
- Department of Pathology, University Hospital of Besançon, 25030 Besançon, France - Department of Pathology, University Hospital of Grenoble-Alps, 38043 Grenoble, France
| | - Sandra Courquet
- Department of Parasitology-Mycology, National Reference Centre for Echinococcoses, University Hospital of Besançon, 25030 Besançon, France - UMR CNRS 6249 Laboratoire Chrono-environnement, Université Bourgogne-Franche-Comté, 16 Route de Gray, 25030 Besançon, France
| | - Florent Demonmerot
- Department of Parasitology-Mycology, National Reference Centre for Echinococcoses, University Hospital of Besançon, 25030 Besançon, France
| | - Bruno Heyd
- Visceral, Digestive and Cancer Surgery, Hepatic Transplantation Unit, University Hospital of Besançon, 25030 Besançon, France
| | - Celia Turco
- Department of Digestive Surgery, Hepato-Biliary-Pancreatic and Liver Transplantation, AP-HP Pitié-Salpêtrière Hospital - Charles-Foix, 75651 Paris, France
| | - Alexandre Doussot
- Visceral, Digestive and Cancer Surgery, Hepatic Transplantation Unit, University Hospital of Besançon, 25030 Besançon, France
| | - Lucie Bourgeois
- Department of Pathology, University Hospital of Besançon, 25030 Besançon, France
| | - Solange Bresson-Hadni
- Department of Parasitology-Mycology, National Reference Centre for Echinococcoses, University Hospital of Besançon, 25030 Besançon, France - UMR CNRS 6249 Laboratoire Chrono-environnement, Université Bourgogne-Franche-Comté, 16 Route de Gray, 25030 Besançon, France
| | - Carine Richou
- Department of Hepatology, University Hospital of Besançon, 25030 Besançon, France
| | - Laurence Millon
- Department of Parasitology-Mycology, National Reference Centre for Echinococcoses, University Hospital of Besançon, 25030 Besançon, France - UMR CNRS 6249 Laboratoire Chrono-environnement, Université Bourgogne-Franche-Comté, 16 Route de Gray, 25030 Besançon, France
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Tamarozzi F, Manciulli T, Brunetti E, Vuitton DA. Echinococcosis. HELMINTH INFECTIONS AND THEIR IMPACT ON GLOBAL PUBLIC HEALTH 2022:257-312. [DOI: 10.1007/978-3-031-00303-5_8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/03/2025]
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Saeidi S, Aliakbarian M, Di Martino M. Long-term experience with debulking surgery in extensive hepatic alveolar echinococcosis: A case series and literature review. ASIAN PAC J TROP MED 2022. [DOI: 10.4103/1995-7645.354423] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
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The Significance of Perfusion-Weighted Magnetic Resonance Imaging in Evaluating the Pathological Biological Activity of Cerebral Alveolar Echinococcosis. J Comput Assist Tomogr 2021; 46:131-139. [DOI: 10.1097/rct.0000000000001253] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
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Maca against Echinococcosis?-A Reverse Approach from Patient to In Vitro Testing. Pathogens 2021; 10:pathogens10101335. [PMID: 34684284 PMCID: PMC8537204 DOI: 10.3390/pathogens10101335] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/03/2021] [Revised: 10/07/2021] [Accepted: 10/14/2021] [Indexed: 02/06/2023] Open
Abstract
Drug-based treatment of alveolar echinococcosis (AE) with benzimidazoles is in most cases non-curative, thus has to be taken lifelong. Here, we report on a 56-year-old male AE patient who received standard benzimidazole treatment and biliary plastic stents, and additionally self-medicated himself with the Peruvian plant extract Maca (Lepidium meyenii). After 42 months, viable parasite tissue had disappeared. Based on this striking observation, the anti-echinococcal activity of Maca was investigated in vitro and in mice experimentally infected with Echinococcus multilocularis metacestodes. Albendazole (ABZ)-treated mice and mice treated with an ABZ+Maca combination exhibited a significantly reduced parasite burden compared to untreated or Maca-treated mice. As shown by a newly established UHPLC-MS/MS-based measurement of ABZ-metabolites, the presence of Maca during the treatment did not alter ABZ plasma levels. In vitro assays corroborated these findings, as exposure to Maca had no notable effect on E. multilocularis metacestodes, and in cultures of germinal layer cells, possibly unspecific, cytotoxic effects of Maca were observed. However, in the combined treatments, Maca inhibited the activity of ABZ in vitro. While Maca had no direct anti-parasitic activity, it induced in vitro proliferation of murine spleen cells, suggesting that immunomodulatory properties could have contributed to the curative effect seen in the patient.
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Brumpt É, Liu W, Graeter T, Calame P, Rong S, Jiang Y, Li W, Bao H, Delabrousse É. Kodama-XUUB: an informative classification for alveolar echinococcosis hepatic lesions on magnetic resonance imaging. Parasite 2021; 28:66. [PMID: 34569927 PMCID: PMC8475500 DOI: 10.1051/parasite/2021062] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/20/2021] [Accepted: 08/31/2021] [Indexed: 12/30/2022] Open
Abstract
Objective: To propose a modification of the Kodama classification to classify type III lesions of alveolar echinococcosis (AE) that do not have microcysts. Materials and Methods: 200 magnetic resonance imaging (MRI) images of AE liver lesions from four endemic regions of the world were classified according to Kodama, distinguishing within type III those with microcysts from those without. Each center included 50 MRIs of patients with unoperated AA liver lesions. The first 50 cases were classified by a first reader in the presence of four second-line readers from each region. Then each second-line reader classified his or her 50 cases. Results: In all centers, type III lesions were predominant: 58% of the total lesions and 23% of them were without microcysts. The average age of the patients was 47 years. In China, the patients were on average younger and the lesions larger. German patients had more lesions within the liver. Type I and II lesions, synonymous with earlier diagnosis, were more common in Europe. Conclusion: The Kodama classification needed to be modified because of the existence of a significant proportion of unclassifiable lesions. This is especially true since the presence of microcysts is an informative element of parasite activity. Therefore, this study proposes a Kodama-XUUB classification with type IIIa lesions having microcysts and type IIIb lesions not having microcysts.
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Affiliation(s)
- Éléonore Brumpt
- University Bourgogne Franche-Comté (UFC) and Besançon University Hospital, WHO Collaborating Centre on Prevention and Treatment of Human Echinococcosis/National French Reference Centre for Echinococcosis, UMR 6249 CNRS-UFC Chrono-environment, 25030 Besançon, France - Department of Anatomy, University of Franche-Comté, 25000 Besançon, France - Nanomedicine Laboratory, INSERM EA 4662, University of Franche-Comté, 25000 Besançon, France
| | - Wenya Liu
- Xinjiang Medical University, First Affiliated Hospital, WHO Collaborating Centre on Prevention and Care Management of Echinococcosis, 830000 Urumqi, Xinjiang Uyghur Autonomous Region, PR China
| | - Tilmann Graeter
- Ulm University Hospital, Department of Diagnostic and Interventional Radiology, Albert-Einstein-Allee 23, 89081 Ulm, Germany
| | - Paul Calame
- University Bourgogne Franche-Comté (UFC) and Besançon University Hospital, WHO Collaborating Centre on Prevention and Treatment of Human Echinococcosis/National French Reference Centre for Echinococcosis, UMR 6249 CNRS-UFC Chrono-environment, 25030 Besançon, France - Nanomedicine Laboratory, INSERM EA 4662, University of Franche-Comté, 25000 Besançon, France
| | - Shi Rong
- Ulm University Hospital, Department of Diagnostic and Interventional Radiology, Albert-Einstein-Allee 23, 89081 Ulm, Germany
| | - Yi Jiang
- Xinjiang Medical University, First Affiliated Hospital, WHO Collaborating Centre on Prevention and Care Management of Echinococcosis, 830000 Urumqi, Xinjiang Uyghur Autonomous Region, PR China
| | - Weixia Li
- Qinghai University, Qinghai University First Affiliated Hospital, 810001 Xining, Qinghai Province, PR China
| | - Haihua Bao
- Qinghai University, Qinghai University First Affiliated Hospital, 810001 Xining, Qinghai Province, PR China
| | - Éric Delabrousse
- University Bourgogne Franche-Comté (UFC) and Besançon University Hospital, WHO Collaborating Centre on Prevention and Treatment of Human Echinococcosis/National French Reference Centre for Echinococcosis, UMR 6249 CNRS-UFC Chrono-environment, 25030 Besançon, France - Nanomedicine Laboratory, INSERM EA 4662, University of Franche-Comté, 25000 Besançon, France
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Clinical tolerance and efficacy of anti-parasitic treatment with albendazole in patients with alveolar echinococcosis: long-term follow-up observation in 117 patients. Parasitol Res 2021; 120:3603-3610. [PMID: 34432154 DOI: 10.1007/s00436-021-07297-3] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/29/2021] [Accepted: 08/17/2021] [Indexed: 12/27/2022]
Abstract
Alveolar echinococcosis is the most severe worm disease primarily detected in the liver. This study aimed to determine the clinical tolerance and efficacy of albendazole in patients with alveolar echinococcosis, depending on the volume of previous surgical treatment or its absence and the duration of anti-parasitic therapy. We retrospectively (over the last 15 years) analyzed the data of 117 patients, who were divided into 4 groups according to curability: R0 (radical resection), R1+2 (incomplete resection), Nr (unresectable), and Rr (recurrence). All of them received albendazole from 3 months to 11 years, depending on the volume of resection. We evaluated patients' tolerability of albendazole according to the level of hepatic transaminases and blood cell count. The effectiveness of anti-parasitic treatment was evaluated by imaging studies and the absence of serum antibodies. There was no direct relationship between the frequency of adverse reactions and the duration of taking albendazole (r - 0.20229). Adverse reactions were significantly more often observed in unresectable patients (p < 0.01), which is most likely associated with the general serious condition of the patients and with individual drug intolerance. The effectiveness of the anti-parasitic treatment was manifested in the inhibition of tumor development in 88% of patients in group R1+2 and 60% in group Nr. Follow-up of group R0 patients from 3 to 14 years did not reveal new lesions of the liver and other organs. The chance of a complete cure depends on the early detection of a parasitic tumor and can reach 50%.
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Abstract
Hepatic alveolar echinococcosis (HAE) is a rare but severe zoonosis caused by the pseudotumoral intrahepatic development of the larval stage of the tapeworm Echinococcus multilocularis. HAE is present only in the Northern Hemisphere, predominantly in China. Currently, there is a significant resurgence of cases in historically endemic areas associated with emergence of HAE in countries not previously concerned. Today, in European countries, HAE is often discovered by chance; however, clinicians should be made aware of opportunistic infections that progressively emerged recently as a result of therapeutic or pathological immunosuppression. Ultrasonography is the key first-line diagnostic procedure, with specific serology providing confirmation in 95% of the cases. Albendazole, only parasitostatic, is the mainstay for treatment. Surgical resection, if feasible, is the gold standard for treatment, and more patients are currently eligible for this option because of an earlier diagnosis. The prognosis has considerably improved but remains poor in countries where access to care is less favorable.
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Affiliation(s)
- Solange Bresson-Hadni
- Gastroenterology and Hepatology, Faculty of Medicine, University Hospitals of Geneva, Switzerland.,Division of Tropical and Humanitarian Medicine, Faculty of Medicine, University Hospitals of Geneva, Faculty of Medicine, Switzerland.,Laboratory of Parasitology-Mycology, National Reference Center for Echinococcosis, University Hospital of Besançon, Besançon, France
| | - Laurent Spahr
- Gastroenterology and Hepatology, Faculty of Medicine, University Hospitals of Geneva, Switzerland
| | - François Chappuis
- Division of Tropical and Humanitarian Medicine, Faculty of Medicine, University Hospitals of Geneva, Faculty of Medicine, Switzerland
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Peters L, Burkert S, Grüner B. Parasites of the liver - epidemiology, diagnosis and clinical management in the European context. J Hepatol 2021; 75:202-218. [PMID: 33636243 DOI: 10.1016/j.jhep.2021.02.015] [Citation(s) in RCA: 35] [Impact Index Per Article: 8.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/17/2020] [Revised: 01/22/2021] [Accepted: 02/03/2021] [Indexed: 12/13/2022]
Abstract
Parasites in the liver cause significant global morbidity and mortality, as they can lead to recurrent cholangitis, cirrhosis, liver failure and cancer. Due to climate change and globalisation, their incidence is increasing, especially in Europe. The correct diagnosis of a hepatic parasite is often delayed because clinicians are unfamiliar with respective entities. Therefore, in this review, we aim to provide clinicians with a comprehensive clinical picture of hepatic parasites and to bring these neglected parasitic liver diseases to the wider attention of hepatology stakeholders in Europe and around the world.
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Affiliation(s)
- Lynn Peters
- University Hospital of Ulm, Department of Internal Medicine III, Division of Infectious Diseases, Albert-Einstein-Allee 23, 89081 Ulm, Germany
| | - Sanne Burkert
- University Hospital of Ulm, Department of Internal Medicine III, Division of Infectious Diseases, Albert-Einstein-Allee 23, 89081 Ulm, Germany
| | - Beate Grüner
- University Hospital of Ulm, Department of Internal Medicine III, Division of Infectious Diseases, Albert-Einstein-Allee 23, 89081 Ulm, Germany.
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Takenaka Y, Kogiso T, Ogasawara Y, Koroku M, Yatsuji S, Taniai M, Nakamura S, Tokushige K. Long-term Follow-up of a Patient with Portal Hypertension and Hepatic Failure Due to Hepatic Hydatid Disease. Intern Med 2021; 60:1855-1861. [PMID: 33518572 PMCID: PMC8263174 DOI: 10.2169/internalmedicine.6397-20] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/29/2020] [Accepted: 12/06/2020] [Indexed: 12/19/2022] Open
Abstract
We observed liver failure with a presumed etiology of echinococcosis in an 89-year-old woman. Our patient had been born and then resided on Rebun Island until she was 12 years old. At 46 years old, she had been referred to our hospital due to right abdominal pain. Ultrasound had revealed multilocular cysts in the right lobe of the liver. At 84 years old, the hepatic cyst occupied nearly the entire liver with ring-shaped calcification along the cyst wall. The patient was diagnosed with decompensated cirrhosis and hepatic hydatid disease based on typical imaging and the long-term natural clinical course.
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Affiliation(s)
- Yuki Takenaka
- Institute of Gastroenterology, Department of Internal Medicine, Tokyo Women's Medical University, Japan
| | - Tomomi Kogiso
- Institute of Gastroenterology, Department of Internal Medicine, Tokyo Women's Medical University, Japan
| | - Yuri Ogasawara
- Institute of Gastroenterology, Department of Internal Medicine, Tokyo Women's Medical University, Japan
| | - Miki Koroku
- Institute of Gastroenterology, Department of Internal Medicine, Tokyo Women's Medical University, Japan
| | - Sho Yatsuji
- Institute of Gastroenterology, Department of Internal Medicine, Tokyo Women's Medical University, Japan
| | - Makiko Taniai
- Institute of Gastroenterology, Department of Internal Medicine, Tokyo Women's Medical University, Japan
| | - Shinichi Nakamura
- Institute of Gastroenterology, Department of Internal Medicine, Tokyo Women's Medical University, Japan
| | - Katsutoshi Tokushige
- Institute of Gastroenterology, Department of Internal Medicine, Tokyo Women's Medical University, Japan
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Alveolar Echinococcosis of the Liver with a Rare Infiltration of the Adrenal Gland. Helminthologia 2021; 58:100-105. [PMID: 33664623 PMCID: PMC7912238 DOI: 10.2478/helm-2021-0002] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/08/2019] [Accepted: 12/01/2020] [Indexed: 12/28/2022] Open
Abstract
Human alveolar echinococcosis (AE) is a silently-progressing disorder that has become a threat in many countries. Since 2000, when the first case was recorded, the number of human AE patients in Slovakia is on continuous raise. The article presents a rare case of alveolar echinococcosis with infiltration in the adrenal gland and discusses the problems associated with differential diagnosis of the disease. In 2016, abdominal ultrasound performed due abdominal pain complaint showed the presence of cystic lesions in the right liver lobe of 54-year old female patient. During surgery, another lesion in the right adrenal gland was found, and neoplastic processes or echinococcosis were considered in the differential diagnosis. Due to unclear correlation between radiology, serology and histopathology results and endemic situation in Slovakia, molecular examination was recommended. Subsequently E. multilocularis was confirmed as etiological agent of infection. Alveolar echinococcosis is considered as a rare disease, with very few patients referred to clinicians or hospitals that sometimes have almost none existing experience with the diagnosis and treatment of the disease. Therefore, the establishment of networks or reference centres specialized on management of the disease would be suitable way to provide the patients with the best care and improve the disease diagnosis, treatment and prognosis.
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Emerging human alveolar echinococcosis in Hungary (2003-2018): a retrospective case series analysis from a multi-centre study. BMC Infect Dis 2021; 21:168. [PMID: 33568075 PMCID: PMC7877032 DOI: 10.1186/s12879-021-05859-5] [Citation(s) in RCA: 18] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/01/2020] [Accepted: 01/31/2021] [Indexed: 02/06/2023] Open
Abstract
Background Human alveolar echinococcosis (AE) caused by Echinococcus multilocularis is an underreported, often misdiagnosed and mistreated parasitic disease mainly due to its low incidence. The aim of this study was to describe the epidemiological and clinical characteristics of human AE patients in Hungary for the first time. Method Between 2003 and 2018, epidemiological and clinical data of suspected AE patients were collected retrospectively from health database management systems. Results This case series included a total of 16 AE patients. The mean age of patients was 53 years (range: 24–78 years). The sex ratio was 1:1. Four patients (25%) revealed no recurrence after radical surgery and adjuvant albendazole (ABZ) therapy. For five patients (31.3%) with unresectable lesions, a stabilization of lesions with ABZ treatment was achieved. In seven patients (43.8%), progression of AE was documented. The mean diagnostic delay was 33 months (range: 1–122 months). Three AE related deaths (fatality rate 18.8%) were recorded. Conclusions AE is an emerging infectious disease in Hungary with a high fatality rate since based on our results, almost every fifth AE patient died in the study period. Differential diagnosis and appropriate surgical and medical therapy for AE is an urging challenge for clinicians in Hungary, as well as in some other European countries where E. multilocularis is prevalent.
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Li S, Chen J, He Y, Deng Y, Chen J, Fang W, Zeren Z, Liu Y, Abdulaziz ATA, Yan B, Zhou D. Clinical Features, Radiological Characteristics, and Outcomes of Patients With Intracranial Alveolar Echinococcosis: A Case Series From Tibetan Areas of Sichuan Province, China. Front Neurol 2021; 11:537565. [PMID: 33519658 PMCID: PMC7843382 DOI: 10.3389/fneur.2020.537565] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/24/2020] [Accepted: 12/21/2020] [Indexed: 02/05/2023] Open
Abstract
Objectives: Intracranial alveolar echinococcosis (IAE), a zoonotic disease, is a critical health problem in the Tibetan region. We aimed to describe the clinical and radiological characteristics and outcomes among patients with IAE. Methods: We screened patients diagnosed with IAE between March 2015 and May 2019 at the Ganzi Tibetan Autonomous Prefecture People's Hospital. Detailed demographics, clinical characteristics, neuroimaging features, and outcomes were recorded. Results: A total of 21 patients with an average age of 44.1 ± 12.7 years were included. Thirteen (61.9%) patients were male. The most common chief neurological complaint was headache (n = 17, 81.0%), followed by dizziness, seizure, visual disturbances, hemiparesis, disturbed consciousness, and dysphasia. All the patients had coexisting liver localizations. The typical neuroimaging features of IAE on cerebral magnetic resonance imaging scans showed obvious low-signal shadow with multiple small vesicles inside the lesions on T2-weighted images and FLAIR images. The pathological HE staining demonstrates vesicular lesions with several internal sacs. For hepatic alveolar echinococcosis (AE), the hepatic portal was invaded in six (28.6%) patients, and the portal vein (n = 5, 23.8%) was the mostly commonly involved vessel. As for treatment, 11 patients (52.4%) had poor compliance with albendazole. The duration of patients taken albendazole ranged from 2 months to 3 years. Cerebral AE surgery was performed in 11 patients, five of them underwent partial resection of AE lesions, and six patients received total resection. One patient with primary IAE underwent radical surgery. Ten patients (47.6%) died during the follow-up for a mean of 21.7 ± 11.9 (3–46) months. In total, 28.9% of the patients died within 5 years, and 71.6% died within 10 years. The median interval between the date of diagnosis as AE and death was 84 (19–144) months. Conclusion: Despite substantial advances in diagnostic and therapeutic methods, the treatment of IAE remains difficult and results in unsatisfactory outcomes. The major critical issue is surgical treatment of IAE although the disease is disseminated. Besides, lifelong albendazole would be indicated, but most patients had poor medication compliance. It is important to educate patients about the necessity of medical treatment.
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Affiliation(s)
- Sisi Li
- Department of Neurology, West China Hospital, Sichuan University, Chengdu, China
| | - Jiani Chen
- Department of Neurology, West China Hospital, Sichuan University, Chengdu, China
| | - Yongqiao He
- Department of Neurology, Ganzi Tibetan Autonomous Prefecture People's Hospital, Kangding, China
| | - Yongyi Deng
- Department of Neurology, Ganzi Tibetan Autonomous Prefecture People's Hospital, Kangding, China
| | - Jie Chen
- Department of Neurology, Ganzi Tibetan Autonomous Prefecture People's Hospital, Kangding, China
| | - Wenyu Fang
- Department of Neurology, Ganzi Tibetan Autonomous Prefecture People's Hospital, Kangding, China
| | - Zhamu Zeren
- Department of Neurology, Ganzi Tibetan Autonomous Prefecture People's Hospital, Kangding, China
| | - Yadong Liu
- Department of Neurology, West China Hospital, Sichuan University, Chengdu, China
| | | | - Bo Yan
- Department of Neurology, West China Hospital, Sichuan University, Chengdu, China
| | - Dong Zhou
- Department of Neurology, West China Hospital, Sichuan University, Chengdu, China
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Ahmad I, Ilyas M, Ashraf A, Rather AA, Gojwari TA. Prevalence of Hepatic Alveolar hydatid in a Nonendemic Region of North India in Hospital-based Population. JOURNAL OF DATTA MEGHE INSTITUTE OF MEDICAL SCIENCES UNIVERSITY 2021; 16:86-89. [DOI: 10.4103/jdmimsu.jdmimsu_86_19] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/05/2025]
Abstract
Objective:
The objective of this study was to calculate the prevalence of hepatic alveolar hydatid disease in hospital-based population in North India, a nonendemic region for alveolar hydatid disease.
Materials and Methods:
This study was conducted at a tertiary care center in North India between April 2017 and March 2019. Patients with suspected hepatic alveolar hydatid on ultrasonography were evaluated with further imaging studies based on classical radiological findings and then confirmed by histopathology.
Results:
Twenty-five cases of hepatic alveolar hydatid were diagnosed primarily based on the classical imaging/radiological findings with histopathology confirmation, with a 2-year period prevalence of 0.207 cases/1000 population. Majority of the cases were in the age group of 41–60 years, with a mean age of 53.04 years. Fifty-two percent of the cases were female. Majority of them were from hilly areas and working with livestock animals. Abdominal pain was the most common presenting symptom.
Conclusion:
Hepatic alveolar hydatid is considered as a rare disease in India; however, the increased number of cases been diagnosed in our study could be either due to increased diagnostic modalities or due to actual increase in the number of cases. Therefore, hepatic alveolar hydatid should be considered in the differentials of suspicious liver mass in nonendemic regions.
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The spectrum of multimodality imaging findings in hepatic alveolar echinococcosis and the potential role of diffusion-weighted imaging in its characterisation. Pol J Radiol 2020; 85:e613-e623. [PMID: 33376563 PMCID: PMC7757515 DOI: 10.5114/pjr.2020.101015] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/06/2020] [Accepted: 05/25/2020] [Indexed: 12/28/2022] Open
Abstract
Purpose To study the spectrum of imaging findings in hepatic alveolar echinococcosis (HAE) and to evaluate the potential role of diffusion-weighted imaging (DWI) in its characterisation. Material and methods Two radiologists with more than seven years of experience retrospectively studied ultrasonography, computed tomography (CT), and magnetic resonance imaging (MRI) findings in 23 histopathologically proven cases of HAE with emphasis on the appearance and extent of disease. DWI characteristics of lesions were noted, and their apparent diffusion values (ADC) were calculated. Results Ultrasonography features of HAE included heterogeneous, hyperechoic hepatic mass with or without calcification (n = 20), or heterogeneous mass with solid-cystic appearance (n = 2). CT revealed heterogeneous density infiltrative hepatic mass with no contrast enhancement in 19 patients or thick-walled cystic mass (n = 4). Following Kodama classification one type 1, six type 2, two type 3, eight type 4, and two type 5 lesions were identified on T2-weighted MRI. No enhancement was seen on post-contrast T1-weighted images. Mean ADC values were 1.74 ± 0.48 × 10-3 mm2/s (range: 1.39 × 10-3 mm2/s to 2.3 × 10-3 mm2/s). Conclusions HAE by virtue of its infiltrative growth pattern with a tendency to involve biliary, vascular, and extra hepatic structures can be easily misdiagnosed as malignant hepatic neoplasm. Knowledge of varied imaging appearances of HAE is essential to suspect the condition and to make an appropriate diagnosis. Diffusion-weighted imaging is a useful adjunct with relatively high diffusivity (high ADC values) suggesting diagnosis of alveolar hydatid.
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Zeng X, Yang X, Yang P, Luo H, Wang W, Yan L. Individualized biliary reconstruction techniques in autotransplantation for end-stage hepatic alveolar echinococcosis. HPB (Oxford) 2020; 22:578-587. [PMID: 31471064 DOI: 10.1016/j.hpb.2019.08.003] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/24/2019] [Revised: 06/02/2019] [Accepted: 08/06/2019] [Indexed: 02/08/2023]
Abstract
BACKGROUND Biliary reconstruction in ex vivo liver resection followed by autotransplantation (ERAT) for end-stage hepatic alveolar echinococcosis (HAE) remains the most challenging step, we present our experience with this complex procedure. METHODS A retrospective data analysis of 55 patients with end-stage HAE underwent ERAT, the biliary reconstruction techniques and short- and long-term outcomes were discussed. RESULTS All autografts were derived from the left lateral section after extensive ex vivo liver resection, multiple bile ducts were observed in 52 (94.5%) patients, and forty-four (80.0%) cases required ductoplasty. Biliary reconstruction was achieved with duct-to-duct anastomosis in 32 (58.2%) patients, Roux-en-Y hepaticojejunostomy (RYHJ) in 14 (25.5%) patients, and a combination of the two methods in 9 (16.4%) patients. Twenty (36.4%) patients had multiple anastomoses. Biliary leakage occurred in 8 (14.5%) patients postoperatively. Three (5.5%) patients died of liver failure, cerebral hemorrhage and intraabdominal bleeding. During a median of 31 months followed-up time, 3 (5.5%) patients developed anastomotic stricture, 1 of whom was treated by repeat RYHJ, while the others were managed with stenting. CONCLUSIONS With a well-designed plan and precise anastomosis, complex biliary reconstruction in ERAT can be performed with few biliary complications by a professional team.
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Affiliation(s)
- Xintao Zeng
- Department of Liver Surgery & Liver Transplantation Center, West China Hospital, Sichuan University, Chengdu, China; Department of Hepatobiliary Surgery, Mianyang Central Hospital, Sichuan, Mianyang, China
| | - Xianwei Yang
- Department of Liver Surgery & Liver Transplantation Center, West China Hospital, Sichuan University, Chengdu, China
| | - Pei Yang
- Department of Hepatobiliary Surgery, Mianyang Central Hospital, Sichuan, Mianyang, China
| | - Hua Luo
- Department of Hepatobiliary Surgery, Mianyang Central Hospital, Sichuan, Mianyang, China
| | - Wentao Wang
- Department of Liver Surgery & Liver Transplantation Center, West China Hospital, Sichuan University, Chengdu, China.
| | - Lunan Yan
- Department of Liver Surgery & Liver Transplantation Center, West China Hospital, Sichuan University, Chengdu, China
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Kamiyama T. Recent advances in surgical strategies for alveolar echinococcosis of the liver. Surg Today 2019; 50:1360-1367. [DOI: 10.1007/s00595-019-01922-6] [Citation(s) in RCA: 21] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/24/2019] [Accepted: 10/16/2019] [Indexed: 02/07/2023]
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Baumann S, Shi R, Liu W, Bao H, Schmidberger J, Kratzer W, Li W. Worldwide literature on epidemiology of human alveolar echinococcosis: a systematic review of research published in the twenty-first century. Infection 2019; 47:703-727. [PMID: 31147846 PMCID: PMC8505309 DOI: 10.1007/s15010-019-01325-2] [Citation(s) in RCA: 65] [Impact Index Per Article: 10.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/21/2019] [Accepted: 05/20/2019] [Indexed: 12/13/2022]
Abstract
PURPOSE Human alveolar echinococcosis (AE) is a potentially lethal zoonosis caused by the cestode Echinococcus multilocularis. The aim of this systematic review is to establish a comprehensive global AE literature overview taking into account the epidemiologically relevant AE research of the twenty-first century. METHODS We systematically searched the global literature published from 2001 through 2018 via MEDLINE, EMBASE, the Russian databases eLIBRARY.RU, CyberLeninka, the Chinese databases CNKI, VIP, Journals. RESEARCH ac.ir (Farsi language-based), Jordan E-Library (Arab language-based) and supplementary Google Scholar, in accordance with the PRISMA guidelines. QGIS software was used for the mapping of the affected countries. RESULTS We have listed 154 relevant publications in the final literature synopsis in consideration of our quality assessment. Including non-autochthonous cases, human AE was reported in 36 countries within the northern hemisphere from 2001 to 2018. The first publication of AE in Tajikistan, Pakistan, South Korea, Belgium, the Netherlands, Slovakia, Hungary, Lithuania, Latvia, Slovenia and Morocco occurred in this century; further first cases in Taiwan, Thailand, and Denmark were considered to be non-autochthonous by the authors. The highest total case numbers (n ≥ 100 in a single article) were reported in France, Germany, Switzerland, Poland, and Lithuania, including China and Kyrgyzstan with by far the highest prevalence figures. CONCLUSIONS Our paper emphasises the increasing spread of reported cases and the rise in its numbers in the literature of the twenty-first century, especially in western, northern and eastern Europe, as well as in central Asia. Epidemiological studies on human infections are lacking in many parts of the world.
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Affiliation(s)
- Sven Baumann
- Department of Internal Medicine I, Ulm University Hospital, Albert-Einstein-Allee 23, 89081, Ulm, Germany
| | - Rong Shi
- Department of Diagnostic and Interventional Radiology, Ulm University Hospital, Albert-Einstein-Allee 23, 89081, Ulm, Germany
| | - Wenya Liu
- Xinjiang Medical University, First Affiliated Hospital, WHO Collaborating Centre on Prevention and Care Management of Echinococcosis, Urumqi, 830000, Xinjiang Uyghur Autonomous Region, People's Republic of China
| | - Haihua Bao
- Qinghai University Affiliated Hospital, Qinghai University, Xining, 810001, Qinghai, People's Republic of China
| | - Julian Schmidberger
- Department of Internal Medicine I, Ulm University Hospital, Albert-Einstein-Allee 23, 89081, Ulm, Germany
| | - Wolfgang Kratzer
- Department of Internal Medicine I, Ulm University Hospital, Albert-Einstein-Allee 23, 89081, Ulm, Germany.
| | - Weixia Li
- Qinghai University Affiliated Hospital, Qinghai University, Xining, 810001, Qinghai, People's Republic of China
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Yang C, He J, Yang X, Wang W. Surgical approaches for definitive treatment of hepatic alveolar echinococcosis: results of a survey in 178 patients. Parasitology 2019; 146:1414-1420. [PMID: 31267889 DOI: 10.1017/s0031182019000891] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
Abstract
Hepatic alveolar echinococcosis (HAE) is a potentially fatal disease caused by the larval growth of Echinococcus multilocularis. We analysed the clinical data of 178 consecutive HAE patients treated with definitive radical surgery at our institution. According to the surgical approach: group A patients underwent direct radical hepatic resection; group B patients first underwent percutaneous puncture external drainage, followed by radical hepatic resection 2 months later; group C patients underwent a two-step hepatic resection; and group D patients underwent liver transplantation. The baseline characteristics, mortality, postoperative complications and recurrence rates were evaluated. Symptoms were present in 79.8% (142/178) patients. Bi-lobar lesion was found in 34 (19.1%, 34/178) patients, 47.2% (84/178) of whom had ⩾2 lesions each. There were no intraoperative deaths. The postoperative mortality was 2.29% in group A, 8.62% in group D and 0% in groups B and C. The main cause of death was a serious postoperative complication (Clavien-Dindo grades III-V). Patients were followed-up systematically for a median of 35.8 months (8-72) without recurrence. Active HAE should be treated by radical liver resection, and the complicated alveolar echinococcosis of the liver has been managed whenever possible using principles of radical liver resection by experienced hepatic surgeons.
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Affiliation(s)
- Chuang Yang
- Department of Liver Surgery & Liver Transplantation Center, West China Hospital, Sichuan University, Chengdu, P. R. China
- Department of Hepatobiliary & Pancreatic Surgery, The Third Hospital of Mianyang·Sichuan Mental Health Center, Mianyang, P. R. China
| | - Jingyu He
- Department of Hepatobiliary & Pancreatic Surgery, The Third Hospital of Mianyang·Sichuan Mental Health Center, Mianyang, P. R. China
| | - Xianwei Yang
- Department of Liver Surgery & Liver Transplantation Center, West China Hospital, Sichuan University, Chengdu, P. R. China
| | - Wentao Wang
- Department of Liver Surgery & Liver Transplantation Center, West China Hospital, Sichuan University, Chengdu, P. R. China
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Kuscher S, Kronberger IE, Loizides A, Plaikner M, Ninkovic M, Brunner A, Auer H, Gassner EM, Öfner D, Schneeberger S. Exploring the limits of hepatic surgery for alveolar echinococcosis—10-years’ experience in an endemic area of Austria. Eur Surg 2019; 51:189-196. [DOI: 10.1007/s10353-019-0596-7] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/09/2019] [Accepted: 04/15/2019] [Indexed: 12/28/2022]
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A new treatment strategy for end-stage hepatic alveolar echinococcosis: IVC resection without reconstruction. Sci Rep 2019; 9:9419. [PMID: 31263143 PMCID: PMC6602961 DOI: 10.1038/s41598-019-45968-5] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/12/2019] [Accepted: 06/18/2019] [Indexed: 12/28/2022] Open
Abstract
Patients with hepatic alveolar echinococcosis (HAE) infringing on the inferior vena cava (IVC) have a poor prognosis when radical resection cannot be performed because curative resection is limited by IVC reconstruction. There is little information concerning combined resection of the liver and the IVC. This study explored a novel treatment method for HAE infringing on the IVC and evaluated the safety and feasibility of combined resection of the liver and the IVC. A total of 13 patients were treated with liver resection combined with IVC resection for end-stage HAE between January 2016 and July 2018 at the Affiliated Hospital of Qinghai University. The demographic, clinical, and follow-up data were collected and analysed. The 13 patients underwent resection of the IVC without reconstruction. Of these, 3 exhibited oedema of both lower limbs and the scrotum (23.1%), 2 exhibited pneumothorax (15.4%), 1 exhibited bile leakage (7.7%), 1 exhibited bacteraemia (7.7%), and 1 developed abdominal haemorrhage that was stopped with conservative treatment (7.7%). There was 1 case of operation-related mortality because of upper gastrointestinal haemorrhage (7.7%), and no patients developed recurrence or had residual lesions. Liver resection combined with IVC resection is effective and feasible for patients with HAE infringing on the IVC.
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Han X, Kim JG, Wang H, Cai H, Ma X, Duong DH, Ahn CS, Kang I, Kong Y. Survey of echinococcoses in southeastern Qinghai Province, China, and serodiagnostic insights of recombinant Echinococcus granulosus antigen B isoforms. Parasit Vectors 2019; 12:323. [PMID: 31242932 PMCID: PMC6593596 DOI: 10.1186/s13071-019-3569-6] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/06/2018] [Accepted: 06/17/2019] [Indexed: 12/13/2022] Open
Abstract
Background Echinococcoses, caused by metacestodes of Echinococcus granulosus (cystic echinococcosis; CE) and E. multilocularis (alveolar echinococcosis; AE), represent major emerging parasitic diseases. These enzootic helminthiases invoke significant public health concerns and social burdens in endemic areas. The diseases are prevalent in the Qinghai-Tibetan Plateau, China, while community-based epidemiological studies have been scarcely reported. We surveyed echinococcosis patients in the southeastern Qinghai Province, China, to better understand the concurrent epidemiological situation in this area. Methods During July and August of 2013 and 2014, we screened echinococcosis patients at Yushu and Golog Prefectures, Qinghai Province, China, in a diagnostic campaign. A total of 2856 people (male:female ratio, 1:1.12; mean age, 34.6 years; age range, 6–88 years) were ultrasonographically examined for the presence of hepatic echinococcal cysts. We also collected serum samples from patients and analyzed antibody reactivity against recombinant forms of diverse E. granulosus antigen Bs (rEgAgB1-5) by enzyme-linked immunosorbent assay. Results We detected 134 patients whose imaging scans were compatible with CE (115 cases) and AE (20 patients). One patient might have been infected with both CE and AE. The overall incidence was 4.7% (CE, 4.0%; AE, 0.7%). A large proportion (67.5%) of CE patients was diagnosed at active and transitional CE1-CE3 stages in their late 30s. The AE cases were generally detected at advanced stage in patients at early 20s (60%). Analysis of the receiver operating characteristic curve and Youden’s index indicated that rEgAgB2 was the most promising biomarker, followed by rEgAgB3 and rEgAgB1. Overall, sensitivity and specificity of rEgAgB1-3 were 84.5–92.7% and 91.9–94.6%, respectively. rEgAgB4 and 5 showed low sensitivity with high cross-reactivity. Conclusions Our results strongly suggest that disability-adjusted life years related to echinococcoses in Qinghai-Tibetan areas might be more serious than previously considered. Control and prevention strategy against CE and AE are highly required in these areas. In addition to ultrasonography, serological tests might provide supportive data. However, serological data should be carefully interpreted for differential diagnosis, especially in areas where both CE and AE are co-endemic. Electronic supplementary material The online version of this article (10.1186/s13071-019-3569-6) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- Xiumin Han
- Qinghai Provincial People's Hospital, Xining, 810007, China.,Qinghai Province Institute for Endemic Diseases Prevention and Control, Qinghai Centers for Disease Prevention and Control, Xining, 811602, China
| | - Jeong-Geun Kim
- Department of Molecular Parasitology, Samsung Medical Center, Sungkyunkwan University School of Medicine, Suwon, 16419, Korea
| | - Hu Wang
- Qinghai Province Institute for Endemic Diseases Prevention and Control, Qinghai Centers for Disease Prevention and Control, Xining, 811602, China.,Endemic Disease Administration Office, Qinghai Province Health and Family Planning Commission, Xining, 811602, China
| | - Huixia Cai
- Qinghai Province Institute for Endemic Diseases Prevention and Control, Qinghai Centers for Disease Prevention and Control, Xining, 811602, China.,Department of Molecular Parasitology, Samsung Medical Center, Sungkyunkwan University School of Medicine, Suwon, 16419, Korea
| | - Xiao Ma
- Qinghai Province Institute for Endemic Diseases Prevention and Control, Qinghai Centers for Disease Prevention and Control, Xining, 811602, China
| | - Duc Hieu Duong
- Department of Molecular Parasitology, Samsung Medical Center, Sungkyunkwan University School of Medicine, Suwon, 16419, Korea
| | - Chun-Seob Ahn
- Department of Molecular Parasitology, Samsung Medical Center, Sungkyunkwan University School of Medicine, Suwon, 16419, Korea
| | - Insug Kang
- Department of Molecular Biology and Biochemistry, Kyung Hee University College of Medicine, Seoul, 02447, Korea
| | - Yoon Kong
- Department of Molecular Parasitology, Samsung Medical Center, Sungkyunkwan University School of Medicine, Suwon, 16419, Korea.
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Lin C, Chen Z, Zhang L, Wei Z, Cheng KK, Liu Y, Shen G, Fan H, Dong J. Deciphering the metabolic perturbation in hepatic alveolar echinococcosis: a 1H NMR-based metabolomics study. Parasit Vectors 2019; 12:300. [PMID: 31196218 PMCID: PMC6567409 DOI: 10.1186/s13071-019-3554-0] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/23/2019] [Accepted: 06/05/2019] [Indexed: 12/12/2022] Open
Abstract
BACKGROUND Hepatic alveolar echinococcosis (HAE) is caused by the growth of Echinococcus multilocularis larvae in the liver. It is a chronic and potentially lethal parasitic disease. Early stage diagnosis for this disease is currently not available due to its long asymptomatic incubation period. In this study, a proton nuclear magnetic resonance (1H NMR)-based metabolomics approach was applied in conjunction with multivariate statistical analysis to investigate the altered metabolic profiles in blood serum and urine samples obtained from HAE patients. The aim of the study was to identify the metabolic signatures associated with HAE. RESULTS A total of 21 distinct metabolic differences between HAE patients and healthy individuals were identified, and they are associated with perturbations in amino acid metabolism, energy metabolism, glyoxylate and dicarboxylate metabolism. Furthermore, the present results showed that the Fischer ratio, which is the molar ratio of branched-chain amino acids to aromatic amino acids, was significantly lower (P < 0.001) in the blood serum obtained from the HAE patients than it was in the healthy patient group. CONCLUSIONS The altered Fischer ratio, together with perturbations in metabolic pathways identified in the present study, may provide new insights into the mechanistic understanding of HAE pathogenesis and potential therapeutic interventions.
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Affiliation(s)
- Caigui Lin
- Department of Electronic Science, Fujian Provincial Key Laboratory for Plasma and Magnetic Resonance, Xiamen University, Xiamen, 361005 China
| | - Zhong Chen
- Department of Electronic Science, Fujian Provincial Key Laboratory for Plasma and Magnetic Resonance, Xiamen University, Xiamen, 361005 China
| | - Lingqiang Zhang
- Department of Hepatopancreatobiliary Surgery, Affiliated Hospital of Qinghai University, Xining, 810001 China
- Qinghai Province Key Laboratory of Hydatid Disease Research, Xining, 810001 China
| | - Zhiliang Wei
- Department of Electronic Science, Fujian Provincial Key Laboratory for Plasma and Magnetic Resonance, Xiamen University, Xiamen, 361005 China
- Department of Radiology, Johns Hopkins University, Baltimore, MA 21205 USA
| | - Kian-Kai Cheng
- Innovation Centre in Agritechnology, Universiti Teknologi Malaysia, 84600 Muar, Johor Malaysia
| | - Yueyue Liu
- Department of Electronic Science, Fujian Provincial Key Laboratory for Plasma and Magnetic Resonance, Xiamen University, Xiamen, 361005 China
| | - Guiping Shen
- Department of Electronic Science, Fujian Provincial Key Laboratory for Plasma and Magnetic Resonance, Xiamen University, Xiamen, 361005 China
| | - Haining Fan
- Department of Hepatopancreatobiliary Surgery, Affiliated Hospital of Qinghai University, Xining, 810001 China
- Qinghai Province Key Laboratory of Hydatid Disease Research, Xining, 810001 China
| | - Jiyang Dong
- Department of Electronic Science, Fujian Provincial Key Laboratory for Plasma and Magnetic Resonance, Xiamen University, Xiamen, 361005 China
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Ailixire SA, Sai Charan Goud K, Hari Krishna K, Wenya L. A new classification of hepatic alveolar echinococcosis (HAE) calcification and biological activity using CT and PET-CT. ACTA ACUST UNITED AC 2019. [DOI: 10.1016/j.jrid.2019.06.002] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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Yang X, Kang Y, Qiao Y, Li W, Cao J, Li H, Bao H. Magnetic resonance imaging evaluation of characteristics of vascular invasion in intermediate and advanced hepatic alveolar echinococcosis. Exp Ther Med 2019; 17:4197-4204. [PMID: 31007751 PMCID: PMC6468930 DOI: 10.3892/etm.2019.7460] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/25/2018] [Accepted: 11/14/2018] [Indexed: 12/17/2022] Open
Abstract
The objective of the present study was to provide a basis for the personalized treatment of intermediate and advanced hepatic alveolar echinococcosis (HAE) by elucidating the characteristics of vascular invasion and lesion growth. A total of 160 patients with intermediate and advanced HAE who were subjected to plain as well as contrast-enhanced 3.0-T magnetic resonance imaging prior to surgery were analyzed. Pathological and intra-operative observations of the subjects were also considered. The size and location of HAE lesions, vascular invasion characteristics and growth patterns were assessed. A total of 78 patients (48.75%) had lesions involving the S5-8 segment/partial right liver lobe, 21 (13.13%) had involvement in the S2-4 segment/partial left liver lobe and 61 (38.13%) had lesions that transcended the left and right liver lobes. Pathological examination revealed that the vascular invasion rates of the hepatic portal veins, intrahepatic veins (left, central and right vein, and inferior vena cava) and hepatic arteries were 51.88, 43.28 and 26.87%, respectively. Liver hilum invasion was observed in 128 patients (80.00%), 71 of which (44.38%) presented with invasion of the primary porta hepatis, 11 (6.88%) with invasion of the secondary porta hepatis and 46 (28.75%) with invasion of the primary as well as the secondary porta hepatis. In conclusion, the growth pattern of intermediate and advanced HAE is determined by the site, blood supply and activity of the lesion. The current study demonstrated that lesions tend to invade the intrahepatic venous system and porta hepatis, and to target veins rather than arteries.
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Affiliation(s)
- Xiaofei Yang
- Imaging Center of Affiliated Hospital of Qinghai University, Xining, Qinghai 810001, P.R. China
| | - Yingli Kang
- Imaging Center of Affiliated Hospital of Qinghai University, Xining, Qinghai 810001, P.R. China
| | - Yijie Qiao
- Department of Radiation Oncology, Medical College of Qinghai University, Xining, Qinghai 810001, P.R. China
| | - Weixia Li
- Imaging Center of Affiliated Hospital of Qinghai University, Xining, Qinghai 810001, P.R. China
| | - Jiayuan Cao
- Imaging Center of Affiliated Hospital of Qinghai University, Xining, Qinghai 810001, P.R. China
| | - Hailong Li
- Imaging Center of Affiliated Hospital of Qinghai University, Xining, Qinghai 810001, P.R. China
| | - Haihua Bao
- Imaging Center of Affiliated Hospital of Qinghai University, Xining, Qinghai 810001, P.R. China
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Wen H, Vuitton L, Tuxun T, Li J, Vuitton DA, Zhang W, McManus DP. Echinococcosis: Advances in the 21st Century. Clin Microbiol Rev 2019; 32:e00075-18. [PMID: 30760475 PMCID: PMC6431127 DOI: 10.1128/cmr.00075-18] [Citation(s) in RCA: 618] [Impact Index Per Article: 103.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022] Open
Abstract
Echinococcosis is a zoonosis caused by cestodes of the genus Echinococcus (family Taeniidae). This serious and near-cosmopolitan disease continues to be a significant public health issue, with western China being the area of highest endemicity for both the cystic (CE) and alveolar (AE) forms of echinococcosis. Considerable advances have been made in the 21st century on the genetics, genomics, and molecular epidemiology of the causative parasites, on diagnostic tools, and on treatment techniques and control strategies, including the development and deployment of vaccines. In terms of surgery, new procedures have superseded traditional techniques, and total cystectomy in CE, ex vivo resection with autotransplantation in AE, and percutaneous and perendoscopic procedures in both diseases have improved treatment efficacy and the quality of life of patients. In this review, we summarize recent progress on the biology, epidemiology, diagnosis, management, control, and prevention of CE and AE. Currently there is no alternative drug to albendazole to treat echinococcosis, and new compounds are required urgently. Recently acquired genomic and proteomic information can provide a platform for improving diagnosis and for finding new drug and vaccine targets, with direct impact in the future on the control of echinococcosis, which continues to be a global challenge.
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Affiliation(s)
- Hao Wen
- State Key Laboratory of Pathogenesis, Prevention and Treatment of High Incidence Diseases in Central Asia and WHO Collaborating Centre for Prevention and Care Management of Echinococcosis, Urumqi, China
| | - Lucine Vuitton
- WHO Collaborating Centre for Prevention and Treatment of Human Echinococcosis and French National Centre for Echinococcosis, University Bourgogne Franche-Comte and University Hospital, Besançon, France
| | - Tuerhongjiang Tuxun
- Department of Liver and Laparoscopic Surgery, Digestive and Vascular Surgery Center, The First Affiliated Hospital of Xinjiang Medical University, Urumqi, China
| | - Jun Li
- State Key Laboratory of Pathogenesis, Prevention and Treatment of High Incidence Diseases in Central Asia and WHO Collaborating Centre for Prevention and Care Management of Echinococcosis, Urumqi, China
- Clinical Medical Research Institute, The First Affiliated Hospital of Xinjiang Medical University, Urumqi, China
| | - Dominique A Vuitton
- WHO Collaborating Centre for Prevention and Treatment of Human Echinococcosis and French National Centre for Echinococcosis, University Bourgogne Franche-Comte and University Hospital, Besançon, France
| | - Wenbao Zhang
- State Key Laboratory of Pathogenesis, Prevention and Treatment of High Incidence Diseases in Central Asia and WHO Collaborating Centre for Prevention and Care Management of Echinococcosis, Urumqi, China
- Clinical Medical Research Institute, The First Affiliated Hospital of Xinjiang Medical University, Urumqi, China
| | - Donald P McManus
- Molecular Parasitology Laboratory, Infectious Diseases Division, QIMR Berghofer Medical Research Institute, Brisbane, Queensland, Australia
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Caglar YS, Ozgural O, Zaimoglu M, Kilinc C, Eroglu U, Dogan I, Kahilogullari G. Spinal Hydatid Cyst Disease : Challenging Surgery - an Institutional Experience. J Korean Neurosurg Soc 2019; 62:209-216. [PMID: 30840976 PMCID: PMC6411577 DOI: 10.3340/jkns.2017.0245] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/09/2017] [Accepted: 04/25/2018] [Indexed: 12/27/2022] Open
Abstract
Objective Hydatid cyst disease is caused by the parasite Echinococcus granulosus. It is rarely seen in the vertebral system, occurring at a rate of 0.2–1%. The aim of this study is to present 12 spinal hydatid cyst cases, and propose a new type of drainage of the cyst.
Methods Twelve cases of spinal hydatid cysts, surgical operations, multiple operations, chronic recurrences, and spinal hydatic cyst excision methods are discussed in the context of the literature. Patients are operated between 2005 and 2016. All the patients are kept under routine follow up. Patient demographic data and clinicopathologic characteristics are examined.
Results Six male and six female patients with a median age of 38.6 at the time of surgery were included in the study. Spinal cyst hydatid infection sites were one odontoid, one cervical, five thoracic, two lumbar, and three sacral. In all cases, surgery was performed, with the aim of total excision of the cyst, decompression of the spinal cord, and if necessary, stabilization of the spinal column. Mean follow up was 61.3 months (10–156). All the patients were prescribed Albendazole. Three patients had secondary hydatid cyst infection (one lung and two hepatic).
Conclusion The two-way drainage catheter placed inside a cyst provides post-operative chlorhexidine washing inside the cavity. Although a spinal hydatid cyst is a benign pathology and seen rarely, it is extremely difficult to achieve a real cure for patients with this disease. Treatment modalities should be aggressive and include total excision of cyst without rupture, decompression of spinal cord, flushing of the area with scolicidal drugs, and ensuring spinal stabilization. After the operation the patients should be kept under routine follow up. Radiological and clinical examinations are useful in spotting a recurrence.
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Affiliation(s)
- Yusuf Sukru Caglar
- Department of Neurosurgery, Ankara University School of Medicine, Ankara, Turkey
| | - Onur Ozgural
- Department of Neurosurgery, Ankara University School of Medicine, Ankara, Turkey
| | - Murat Zaimoglu
- Department of Neurosurgery, Ankara University School of Medicine, Ankara, Turkey
| | - Cemil Kilinc
- Department of Neurosurgery, Ankara University School of Medicine, Ankara, Turkey
| | - Umit Eroglu
- Department of Neurosurgery, Ankara University School of Medicine, Ankara, Turkey
| | - Ihsan Dogan
- Department of Neurosurgery, Ankara University School of Medicine, Ankara, Turkey
| | - Gokmen Kahilogullari
- Department of Neurosurgery, Ankara University School of Medicine, Ankara, Turkey
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50
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[What comes on its own, goes on its own? : Case report of an infiltrating liver tumor growing over 16 years]. Chirurg 2019; 90:318-320. [PMID: 30725145 DOI: 10.1007/s00104-019-0800-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
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