Simultaneous alveolar and cystic echinococcosis of the liver

Alveolar echinococcosis (AE) and cystic echinococcosis (CE), caused by infection with the larval stages of Echinococcus multilocularis and E. granulosus, respectively, are of major clinical importance. Reports of infection with AE or CE are very common, but instances of simultaneous or dual infection are rare. We report on four cases with mixed AE/CE infections in the liver, diagnosed using retrospective surgical records and active community surveys in southern Ningxia Hui Autonomous Region (NHAR), PR China, a recognized hyperendemic area for echinococcosis.     

Community surveys and risk factor analysis of human alveolar and cystic echinococcosis in Ningxia Hui Autonomous Region, China

OBJECTIVE: To determine the true community prevalence of human cystic (CE) and alveolar (AE) echinococcosis (hydatid disease) in a highly endemic region in Ningxia Hui, China, by detecting asymptomatic cases. METHODS: Using hospital records and "AE-risk" landscape patterns we selected study communities predicted to be at risk of human echinococcosis in Guyuan, Longde and Xiji counties. We conducted community surveys of 4773 individuals from 26 villages in 2002 and 2003 using questionnaire analysis, ultrasound examination and serology. FINDINGS: Ultrasound and serology showed a range of prevalences for AE (0-8.1%; mean 2%) and CE (0-7.4%; mean 1.6%), with the highest prevalence in Xiji (2% for CE, 2.5% for AE). There were significant differences in the prevalence of CE, AE and total echinococcosis between the three counties and villages (with multiple degrees of freedom). While hospital records showed 96% of echinococcosis cases attributable to CE, our survey showed a higher prevalence of human AE (56%) compared to CE (44%). Questionnaire analysis revealed that key risk factors for infection were age and dog ownership for both CE and AE, and Hui ethnicity and being female for AE. Drinking well-water decreased the risk for both AE and CE. CONCLUSION: Echinococcosis continues to be a severe public health problem in this part of China because of unhygienic practices/habits and poor knowledge among the communities regarding this disease.     

Echinococcosis in Tibetan populations, western Sichuan Province, China

We screened 3,199 people from Shiqu County, Sichuan Province, China, for abdominal echinococcosis (hydatid disease) by portable ultrasound combined with specific serodiagnostic tests. Both cystic echinococcosis (CE) (Echinococcus granulosus infection) and alveolar echinococcosis (AE) (E. multilocularis) were co-endemic in this area at the highest village prevalence values recorded anywhere in the world: 12.9% were infected with one or the other form (6.8% CE and 6.2% AE). Prevalences of both CE and AE were significantly higher in female than male patients and increased with the age of the person screened. Pastoral herdsmen were at highest risk for infection (prevalence 19.0%). Prevalence of CE varied in 5 townships from 0% to 12.1%, whereas AE prevalence ranged from 0% to 14.3%. Risk factors associated with both infections included the number of owned dogs, frequency of contact with dogs, and sources of drinking water.     

Human cystic echinococcosis in two Mongolian communities in Hobukesar (China) and Bulgan (Mongolia)

In order to investigate the prevalence of human cystic echinococcosis (CE) in traditional Mongolian communities in western Mongolia and Xinjiang (northwest China), studies were carried out between 1995 and 2000, on two ethnically identical populations in Hobukesar (China) and Bulgan (Mongolia). The prevalence of human hepatic CE in the two communities was significantly different. In Hobukesar, human CE prevalence by ultrasound was 2.7% (49/1844), while in Bulgan it was 0.2% (4/1609) (P<0.001). Dog surveys showed that coproantigen-positive rates or dog necropsy positives were similar in both communities (35.0% in Hobukesar and 35.7% in Bulgan). Comparing possible risk factors, there appeared to be some significant differences between the two communities, which might contribute to the observed difference in CE prevalence. These included: the proportion of herdsman or farmers recorded; the proportions of dog ownership and livestock ownership; and the proportion of families practising home slaughter. The presence of a Russian dog-dosing programme up to the mid-1980s may explain the lower prevalence of human CE in the Bulgan population; no similar programme operated in the China-administered Hobukesar community.     

Guidelines for treatment of cystic and alveolar echinococcosis in humans. WHO Informal Working Group on Echinococcosis.

Summarized in this article are recent experiences in the treatment of human cystic echinococcosis (CE) and alveolar echinococcosis (AE) of the liver caused by the metacestode stages of Echinococcus granulosus and E. multilocularis, respectively. For CE, surgery remains the first choice for treatment with the potential to remove totally the parasite and completely cure the patient. However, chemotherapy with benzimidazole compounds (albendazole or mebendazole) and the recently developed PAIR procedure (puncture-aspiration-injection-re-aspiration) with concomitant chemotherapy offer further options for treatment of CE cases. Chemotherapy is not yet satisfactory: cure can be expected in about 30% of patients and improvement in 30-50%, after 12 months'' follow-up. AE is generally a severe disease, with over 90% mortality in untreated patients. Radical surgery is recommended in all operable cases but has to be followed by chemotherapy for at least 2 years. Inoperable cases and patients who have undergone nonradical resection or liver transplantation require continuous chemotherapy for many years. Long-term chemotherapy may significantly prolong survival, even for inoperable patients with severe AE. Liver transplantation may be indicated as a life-saving measure for patients with severe liver dysfunction, but is associated with a relatively high risk of proliferation of intraoperatively undetected parasite remnants. Details of indications, contraindications, treatment schedules and other aspects are discussed.     

Resurgence of hydatid disease (echinococcosis) in communities in northern Israel

Hydatid disease (echinococcosis), formerly endemic in the area of Israel, has occurred only sporadically in the past 40 years, mostly in immigrants. An unusual spatial and temporal cluster of surgically confirmed infections in northern Israel led to a review of echinococcosis hospital records. This revealed a resurgence of the disease in some rural and semirural Arab and Druze communities. Between 1960 and 1989, 224 cases of hydatid disease were surgically confirmed in residents of these communities. During this period, as the Arab-Druze population doubled, the mean annual surgical incidence of new cases per 100,000 rose 5-fold from 1.4 to 7.1. In Yirka, a Druze community of 7500 persons, from which no cases were known before 1970 and in which 52 cases were surgically confirmed thereafter, the mean annual surgical incidence for 1980-1989 rose to 53/100,000, to become one of the highly endemic areas of the world. The probable explanation of the outbreak is that, since 1967 with the opening of the border, importation of infected sheep has occurred from the hydatid-endemic West Bank region to individual homes in the communities in northern Israel. The sheep are raised to maturity in pens before home slaughtering; the offal, available to dogs, resulted in canine and then human infections.     

Classification, follow-up and recurrence of hepatic cystic echinococcosis using ultrasound images

Ultrasound image and morphological structure of hepatic cystic echinococcosis (CE) were analysed in 277 human cases (385 hepatic hydatid cysts). These included 65 CE cases from community surveys carried out between 1995 and 2000 in 3 countries (China, Mongolia and Jordan) and 212 cases from a clinical hospital survey from Xinjiang, China. A new simplified WHO ultrasound classification for human CE was assessed, and considered useful. It is proposed that type, size and number in particular need to be included in the ultrasound classification of hepatic CE. For comparative purposes 6 categories of type were classified in the study as Type 0 to Type 5 (T0-T5): T0, univesicular without pathognomonic signs; T1, univesicular with pathognomonic signs; T2, cysts with sagging or floating laminated membrane; T3, cysts containing daughter cysts; T4, solid mass or mixed cysts; and T5, cysts with partial or full calcifications. This differs from the WHO classification wherein Type T3 cysts (daughter cysts present) are considered a pathological stage to occur in general prior to the sagging or floating membrane (T2) stage. Recurrent hydatid cysts in the liver were also studied based on morphological structures observed directly from surgical intervention. Case follow-up over 1-5 years since endocystectomy in the community surveys indicated 10% (2/10) recurrence of cysts in the residual surgical cavity. Recurrent CE included 2 (2/4) cases after percutaneous treatment.     

青藏高原地区泡型包虫病患者住院费用影响因素分析

目的 分析泡型包虫病（alveolar echinococcosis,AE）患者住院费用变化趋势及其主要影响因素,为AE的综合防治及控制住院费用提供参考依据。方法 收集2004年4月~2016年1月青海省两家三甲医院收治的肝AE患者的临床及住院费用相关资料,并采用多因素Logistic回归法分析住院费用的影响因素。结果 收集AE患者300例,其中男性132例（44.0%）,女性168例（56.0%）,平均年龄为（38.87±13.62）岁。藏族病例为225例（75.0%）,住院天数中位数为15（1~102） d,总住院费用的中位数为14 115.25（361.20~187 670.60）元,其中西药费占36.0%、诊断费占20.0%、耗材费占19.0%、治疗费占13.0%。多因素Logistic回归分析发现:住院天数、手术与否、付费方式及有无合并疾病是影响住院费用的主要因素,差异均具有统计学意义（均有P<0.05）。结论 近年来,AE住院费用呈逐年上升趋势,合并其他诊断、治疗方式及付费方式均是患者住院费用的影响因素,因此选择合适的治疗方式、制定合理的单病种管理措施等可能是控制住院费用的必要措施。     

Human alveolar echinococcosis after fox population increase, Switzerland

We analyzed databases spanning 50 years, which included retrospective alveolar echinococcosis (AE) case finding studies and databases of the 3 major centers for treatment of AE in Switzerland. A total of 494 cases were recorded. Annual incidence of AE per 100,000 population increased from 0.12-0.15 during 1956-1992 and a mean of 0.10 during 1993-2000 to a mean of 0.26 during 2001-2005. Because the clinical stage of the disease did not change between observation periods, this increase cannot be explained by improved diagnosis. Swiss hunting statistics suggested that the fox population increased 4-fold from 1980 through 1995 and has persisted at these higher levels. Because the period between infection and development of clinical disease is long, the increase in the fox population and high Echinococcus multilocularis prevalence rates in foxes in rural and urban areas may have resulted in an emerging epidemic of AE 10-15 years later.     

Brain metastasis of alveolar echinococcosis in a hyperendemic focus of Echinococcus multilocularis infection

An unusual female case, with alveolar echinococcosis (AE) disseminated from the primary hepatic lesion to the brain by metastasis formation, was retrospectively identified during a community survey in Ningxia Hui Autonomous Region, northwest China in 2003. Among possible metastases of hepatic AE, locations to the brain are rare and usually fatal; and they have especially been assigned to concomitant immune suppression. An enhancing role of pregnancy, which may be suspected in this case, the favourable outcome after surgery and chemotherapy, and also a mental disability in a child following long-term intrauterine exposure to mebendazole, make the report particularly unique.     

Immunodiagnostic differentiation of alveolar and cystic echinococcosis using ELISA test with 18-kDa antigen extracted from Echinococcus protoscoleces

Immunoblotting analysis was carried out using crude extracts of Echinococccus multilocularis and E. granulosus. A total of 214 serum samples were examined for the detection of antibody responses against 18-kDa polypeptides (Eg18 and Em18). Of 44 sera from patients with alveolar echinococcosis (AE) 91% were positive against both Eg18 and Em18, compared with 10% and 13%, respectively, of 70 cystic echinococcosis (CE) samples and 13% and 17% of 29 cysticercosis samples. A relatively purified 18-kDa antigen was extracted from E. granulosus protoscoleces and an 18-kDa-ELISA test which is simple, fast and highly sensitive and specific has been established. A comparative ELISA analysis, using the purified 18-kDa antigen and pooled AE and CE serum, indicated that there are significant differences in antibody levels between AE and CE sera. The maximum ratio for the evaluation of AE to CE was 2.26. The 18-kDa-ELISA was positive for 91% (40/44) and 11% (8/70) of AE and CE sera, respectively, and there was no cross-reactivity with cysticercosis sera or healthy controls. The overall diagnostic values of 18-kDa-ELISA for AE sera were sensitivity 91%, specificity 94%, positive predictive value 83% and negative predictive value 97%. We conclude that (i) the 18-kDa antigenic component may not be species specific but (ii) levels of antibody to the 18-kDa antigen are significantly different between AE and CE sera. Therefore, the 18-kDa antigen can be a reliable serological marker for differentiation of AE from CE.     

European echinococcosis registry: human alveolar echinococcosis,Europe, 1982-2000

Surveillance for alveolar echinococcosis in central Europe was initiated in 1998. On a voluntary basis, 559 patients were reported to the registry. Most cases originated from rural communities in regions from eastern France to western Austria; single cases were reported far away from the disease-"endemic" zone throughout central Europe. Of 210 patients, 61.4% were involved in vocational or part-time farming, gardening, forestry, or hunting. Patients were diagnosed at a mean age of 52.5 years; 78% had symptoms. Alveolar echinococcosis primarily manifested as a liver disease. Of the 559 patients, 190 (34%) were already affected by spread of the parasitic larval tissue. Of 408 (73%) patients alive in 2000, 4.9% were cured. The increasing prevalence of Echinococcus multilocularis in foxes in rural and urban areas of central Europe and the occurrence of cases outside the alveolar echinococcosis-endemic regions suggest that this disease deserves increased attention.     

Sero-epidemiological survey for alveolar echinococcosis (by Em2-ELISA) of blood donors in an endemic area of Switzerland

Sera from 17,166 blood donors living in 10 cantons of northern Switzerland in an area endemic for Echinococcus multilocularis were investigated by serological survey for alveolar echinococcosis (AE). A highly species-specific antigen (Em2) and a commonly used E. granulosus hydatid fluid antigen (EgHF) were compared for their suitability in seroepidemiology. EgHF showed a degree of nonspecificity which did not allow direct detection of AE cases. Antibody reaction with Em2 resulted in the detection of 2 asymptomatic clinical cases of AE (seroprevalence 0.01%) within this population of blood donors. A further 4 persons were positive in Em2-ELISA. These 4 persons had negative imaging studies and will be followed serologically and clinically.     

7830例矽尘作业工人肺功能检查分析

为了解青海省矽尘作业工人肺部损伤情况，将“职业病与职业卫生信息监测系统”2017年矽尘作业工人肺功能检查结果导出并分析。7830例矽尘作业工人FVC%、FEV，%和FEV/FVC%异常检出率分别为22.6%、11.6%和2.8%；三项指标在地区分布、企业规模、经济类型、行业分布间差异有统计学意义（P<0.01）。应加强对矽尘作业工人的定期肺功能检查，早期发现肺部损伤，保护劳动者健康。     

新疆和布克赛尔蒙古自治县囊型包虫病危险因素分析

目的 分析新疆和布克赛尔蒙古自治县囊型包虫病流行相关的危险因素及探讨预防措施.方法 在和布克赛尔蒙古自治县采用随机抽样方法 ,进行人群囊型包虫病的流行病学调查,调查内容包括民族、年龄、性别、职业及生活习惯等,并对囊型包虫病相关的危险因素进行多因素logistic回归分析.结果人群包虫病患病率为3.8%,血清阳性率为12.4%,其中囊型包虫病患病率为3.7%,泡型包虫病患病率为0.16%.通过多因素logistic回归分析,发现年龄和家庭屠宰牲畜与囊型包虫病患病有关,OR值分别是7.6(2.481～23.579)、3.2(1.297～7.809).50～60岁年龄组患病率最高,OR值是<20岁年龄组的7.6倍;牧民患病率最高.结论 和布克赛尔蒙古自治县囊型包虫病呈持续高流行势态;年龄和有家庭屠宰牲畜行为与患囊型包虫病相关.     

新疆维吾尔自治区部分包虫病流行地区患者药物治疗现状调查

目的 调查新疆维吾尔自治区(新疆)部分包虫病流行地区患者药物治疗情况。方法 2013年4－6月通过问卷形式对新疆4个包虫病医疗点(新疆医科大学第一附属医院、布克塞尔蒙古自治县、额敏县和裕民县)进行包虫病规范化药物治疗现况调查,以WHO包虫病药物治疗建议作为规范化治疗标准。结果 共调查329例包虫病患者,其中行抗包虫药物治疗250例,规范化药物治疗占49.2%(162/329);未规范化药物治疗病例50.8%(167/329)。结论 新疆部分包虫病地区患者临床药物治疗亟待规范,其综合性防治应包括规范化诊断、手术、药物治疗以及随访的个体治疗     

Human hydatidosis in Dalmatia,Croatia.

Human echinococcosis remains a very serious public health problem worldwide, although a decline in incidence has been observed in some endemic areas during the last decades. However, in some non-endemic areas an increase in new cases and new foci of animal echinococcosis were registered during the same time. In Dalmatia, a well known endemic area of hydatidosis in the most Mediterranean part of Croatia, from the mid-1950s until present a decrease of incidence of over 70% has been registered. Age, sex and occupational category specific incidence as well as lethality rate have remained the same as before. Migrations from rural to urban regions seem to be the most important parameter in the changing epidemiology of human hydatidosis in Dalmatia.     

四川省棘球蚴病患病情况调查及评估

目的 了解四川省人群棘球蚴病患病情况.方法 采用分层随机系统抽样方法,对四川省棘球蚴病流行区的甘孜州和阿坝州31个县人群进行腹部B超检查结合血清抗棘球蚴抗体IgG检测的方法筛查棘球蚴病患者,统计患病率,推算患病人数.结果 四川省棘球蚴病标化患病率为1.06％,患者数约2万人,其中甘孜州棘球蚴病标化患病率1.55％,推算患者15335人,主要分布在石渠7720人,色达2755人,甘孜1760人,德格835人,白玉404人,炉霍333人,新龙305人和理塘265人;阿坝州棘球蚴病标化患病率0.48％,推算患者4112人,主要分布在若尔盖748人,马尔康595人,阿坝579人,金川497人,红原302人,松潘301人和壤塘294人.结论 四川省包虫病主要流行于甘孜州石渠等8县和阿坝州若尔盖等7县.防治重点和经费投入应主要集中在这15个县.     

影响农村晚期血吸虫病患者防治因素的访谈调查

目的　探索影响现阶段晚期血吸虫病防治 (血防 )的相关因素。方法　采用偶遇抽样和判断抽样的方法 ,在洞庭湖区抽取 6 1例晚期血吸虫病患者分别进行访谈调查。结果　影响晚期血吸虫病防治的因素为患者社会支持程度较高 (6 1/ 6 1) ,缺乏个人应对自己的健康负责任的观念 ,血防知识知晓率偏低 (2 8/ 6 1)、年龄偏大 (5 7.4 0岁± 10 .0 8岁 )、受教育程度低 (4.70年 )、家庭收入较低、社会缺乏有效的医疗保障系统和缺乏高效的“接近患者系统”。结论　防治晚期血吸虫病需要患者个人、卫生机构和社会的积极参与。加强对疫区居民的血吸虫病健康教育 ,强化其血防意识和对自己的健康负责任的观念 ,建立健全疫区医疗保障体系、农村公共卫生体系和重大疾病救治体系 ,提高农村卫生系统的反应能力和居民卫生服务的可及性。     

Field diagnosis of Echinococcus granulosus infection among intermediate and definitive hosts in an endemic focus of human cystic echinococcosis

Human, canine and ovine echinococcosis prevalence was determined in a highland community located in the central Peruvian Andes during 1997 and 1998. Human echinococcosis was determined using portable ultrasonography, chest X-ray examination, and an enzyme-linked immunoelectrotransfer blot (EITB) assay. Canine echinococcosis was determined using microscopy stool examinations and a coproantigen detection enzyme-immunoassay (EIA) for Echinococcus granulosus. Ovine echinococcosis was determined by an EITB assay for sheep echinococcosis and necropsy examination of viscera from domestic slaughtered animals. An abdominal ultrasound, a chest X-ray examination and an EITB for echinococcosis were performed on 214 subjects (45% of the village population). The frequency of presumptive liver/abdominal, lung and liver-lung hydatid cysts was 5.1% (11/214), 3.7% (8/214) and 0.5% (1/214), respectively. The overall prevalence of human cystic echinococcosis was 9.3% (20/214). The frequency of canine echinococcosis was 46% (23/50) and 32% (16/50) by the coproantigen EIA test and arecoline purging, respectively. The frequency of sheep echinococcosis was 65% (22/34) by the EITB and 38% (13/34) by necropsy. We demonstrated a high prevalence of human and animal echinococcosis in this Peruvian village. In remote areas where echinococcosis is endemic, both the coproantigen EIA and arecoline purging may be used for the study of canine echinococcosis; the EITB is useful in establishing the diagnosis of echinococcosis in sheep prior to necropsy.