Echinococcosis in children and adolescents in Bulgaria: a comparative study

Between 1971 and 1995, 5874 patients underwent surgery in Bulgaria because of cystic echinococcosis caused by Echinococcus granulosus. Of these 5874, 10.6% were children aged < 15 years and 5.25% adolescents aged 15-19 years, giving annual incidences of 1.25 and 2.03/100,000 inhabitants, respectively. Although the annual incidence of surgery for echinococcosis among adults (3.12/100,000) was higher than the combined value for children and adolescents (1.48/100,000), the data indicate that most human infections with E. granulosus occur during childhood and adolescence. In evaluating the epidemiology of echinococcosis or the effectiveness of a control programme, therefore, reductions or increases in the incidence of clinical disease among children and adolescents indicate an improving or worsening situation, respectively. The incidence of surgical treatment for echinococcosis was higher in males than females in all but the youngest subjects (< 5 years) and adults (> 19 years). It was also higher in rural populations than in urban populations, particularly among children and adolescents. Whereas cysts were found more frequently in the lungs of children and adolescents than their livers (51.8% v. 38.3% of the patients), most cysts found in the adults were hepatic (73.5% of patients) and relatively few were in the lungs (14.4% of patients).     

Hepatic echinococcosis: clinical and therapeutic aspects

Echinococcosis or hydatid disease (HD) is a zoonosis caused by the larval stages of taeniid cestodes belonging to the genus Echinococcus. Hepatic echinococcosis is a life-threatening disease, mainly differentiated into alveolar and cystic forms, associated with Echinoccus multilocularis (E. multilocularis) and Echinococcus granulosus (E. granulosus) infection, respectively. Cystic echinococcosis (CE) has a worldwide distribution, while hepatic alveolar echinococcosis (AE) is endemic in the Northern hemisphere, including North America and several Asian and European countries, like France, Germany and Austria. E. granulosus young cysts are spherical, unilocular vesicles, consisting of an internal germinal layer and an outer acellular layer. Cyst expansion is associated with a host immune reaction and the subsequent development of a fibrous layer, called the pericyst; old cysts typically present internal septations and daughter cysts. E. multilocularis has a tumor-like, infiltrative behavior, which is responsible for tissue destruction and finally for liver failure. The liver is the main site of HD involvement, for both alveolar and cystic hydatidosis. HD is usually asymptomatic for a long period of time, because cyst growth is commonly slow; the most frequent symptoms are fatigue and abdominal pain. Patients may also present jaundice, hepatomegaly or anaphylaxis, due to cyst leakage or rupture. HD diagnosis is usually accomplished with the combined use of ultrasonography and immunodiagnosis; furthermore, the improvement of surgical techniques, the introduction of minimally invasive treatments [such as puncture, aspiration, injection, re-aspiration (PAIR)] and more effective drugs (such as benzoimidazoles) have deeply changed life expectancy and quality of life of patients with HD. The aim of this article is to provide an up-to-date review of biological, diagnostic, clinical and therapeutic aspects of hepatic echinococcosis.     

苦参碱联合阿苯达唑治疗小鼠继发性棘球蚴病效果观察

目的 评价中药苦参碱单独及联合阿苯达唑使用治疗小鼠继发性棘球蚴病的效果.方法 将感染棘球蚴的昆明小鼠分为4组:苦参碱组、阿苯达唑组、联合用药组、对照组,每组10只.在对小鼠进行药物治疗90 d后,检测各组小鼠棘球蚴湿重、抑囊率,并利用光镜、电镜对棘球蚴组织进行形态结构和超微结构观察.结果 苦参碱组、阿苯达唑组、联合用药组、对照组棘球蚴湿重分别为(0.32±0.12)、(0.31±0.10)、(0.05±0.03)、(1.16±0.43)g,苦参碱组及联合用药组对小鼠棘球蚴的抑囊率分别达到72.4%和95.7%,显示联合用药组明显优于苦参碱组(P<0.05).上述4组包囊组织Ⅲ级病理损伤率分别为40.9%(9/22)、43.5%(10/23)、91.3%(21/23)、9.5%(2/21).与对照组比较,其他3组包囊组织Ⅲ级病理损伤率明显增高(P均<0.01),且联合用药组最为明显.结论 苦参碱对小鼠棘球蚴的增长有明显的抑制作用,尤其联合阿苯达唑使用治疗效果较好,说明两种药物具有协同治疗作用.     

Pulmonary echinococcosis.

Echinococcosis or hydatid disease is caused by larvae of the tapeworm Echinococcus. Four species are recognised and the vast majority of infestations in humans are caused by E. granulosus. E. granulosus causes cystic echinococcosis, which has a worldwide distribution. Humans are exposed less frequently to E. multilocularis, which causes alveolar echinococcosis. E. vogeli and E. oligarthrus are rare species and cause polycystic echinococcosis. In cystic echinococcosis, humans are an accidental host and are usually infected by handling an infected dog. The liver and lungs are the most frequently involved organs. Pulmonary disease appears to be more common in younger individuals. Although most patients are asymptomatic, some may occasionally expectorate the contents of the cyst or develop symptoms related to compression of the surrounding structures. Other symptoms of hydatid disease can result from the release of antigenic material and secondary immunological reactions that develop from cyst rupture. The cysts are characteristically seen as solitary or multiple circumscribed or oval masses on imaging. Detection of antibody directed against specific echinococcal antigens is found in only approximately half of patients with pulmonary cysts. Surgical excision of the cyst is the treatment of choice whenever feasible.     

Clinical value of Echinococcus granulosus--specific immunoglobulin G antibody avidity in liver cystic echinococcosis

Role of E. granulosus-specific IgG antibody avidity in evaluation of a natural history of the parasite cysts in the liver, duration of infection and immunogenic cysts activity was studied. Thirty-one patients with liver cysts suspected of echinococcosis were examined; E. granulosus infection was finally confirmed by a fine needle aspiration biopsy or surgery in 29 cases (93.5%) and two non-parasitic simple cysts in the liver were diagnosed. E. granulosus-specific IgG antibody was found in 21 patients (67.7%). High IgG avidity values were observed in 14 patients with liver cysts in a degeneration stage confirmed by imaging techniques. Low IgG avidity values were mostly detected in children with hypoechogenic echinococcal cysts being in a recent stage of infection. Determination of anti-E. granulosus immunoglobulin G antibody avidity is a very usefull diagnostic tool for a determination of parasitic cysts activity and their developmental age.     

复杂性肝棘球蚴病外科治疗策略研究进展

肝棘球蚴病是一种由棘球属绦虫幼虫所致的人畜共患性疾病。我国主要致病绦虫类型为细粒棘球绦虫和多房棘球绦虫,分别引起细粒棘球蚴病和多房棘球蚴病。目前,棘球蚴病治疗已经取得重大进展,但对于部分就诊时已出现一种或多种并发症以及病灶侵及肝门、重要血管及胆管的复杂性棘球蚴病病例的治疗仍存在一定困难。本文根据近年来文献报道,结合临床经验,对复杂性肝棘球蚴病的外科治疗策略进行综述。［关键词］     

人肝细粒棘球蚴病致病的研究进展

人肝细粒棘球蚴病是棘球蚴绦虫引起的一种人兽共患寄生虫病,也称肝包虫病,细粒棘球蚴的致病机制主要是对器官挤压,其次是细粒棘球蚴分泌的毒素对人体的毒性反应.目前,肝包虫病主要通过手术进行根治治疗.随着微创手术及精准手术标准的引用,腹腔镜手术治疗肝包虫病得到了长足的发展,本文将从腹腔镜肝包虫病适应症的选择、腹腔镜手术治疗肝包...     

小鼠肝细粒棘球蚴和多房棘球蚴病不同时期病灶周围组织纤维化对比

目的 本实验通过研究对比不同时间两种肝棘球蚴病灶周围组织纤维化情况,进一步了解肝棘球蚴病的病理生理发展过程,为肝棘球蚴病的诊治提供参考。方法 建立动物模型,使用HE,Masson染色以及COL1,COL3、α-SMA、TGF-β1免疫组化染色对比观察两种肝棘球蚴病在不同时间纤维化情况的不同。结果 随着时间的变化肝细粒棘球蚴病灶周围纤维化由弥漫到聚集,可形成连续致密的纤维外膜;肝多房棘球蚴病灶周围组织纤维化始终为弥漫性,无法形成连续质密的纤维外膜。细粒棘球蚴组病灶周围COL1(r=-0.768,P<0.05)、COL3(r=-0.781,P<0.05)、α-SMA(r=-0.867,P<0.05)、TGF-β1(r=-0.854,P<0.05)的表达强度与时间呈负相关,多房棘球蚴组病灶周围COL1(r=-0.349,P>0.05)、COL3(r=-0.037,P>0.05)、α-SMA(r=-0.107,P>0.05)、TGF-β1(r=-0.148,P>0.05)的表达强度与时间无相关性。 无相关性同时观察到两种包虫周围细胞外基质胶原含量不同,细粒棘球蚴组I、III型胶原比高于多房棘球蚴组(Z=-3.23,P<0.05)。结论 相较于多房棘球蚴,细粒棘球蚴病灶周围可产生连续致密的纤维外囊。细粒棘球蚴在外囊形成后纤维化进程减弱或停止,多房棘球蚴在整个病程中均有活跃的纤维化反应。细粒棘球蚴相较于多房棘球蚴外囊的I/III型胶原比值较高。     

肝包虫病与肝囊肿CT表现比较*

目的 探讨使用256排CT检查在鉴别肝包虫病与肝囊肿方面的临床价值。方法 2017年4月～2020年11月我院诊治的肝囊肿患者77例和肝包虫病患者34例接受256排CT增强扫描检查,采用ELISA法检测血清抗囊液抗原抗体(EgCF)、抗头节抗原抗体(EgP)、抗囊液半纯化抗原抗体(EgB)和抗泡球蚴抗体(Em2)。结果 本组肝包虫病患者术前血液嗜酸性粒细胞计数为(0.3±0.1)×10⁹/L,显著高于肝囊肿患者【(0.1±0.1)×10⁹/L,P＜0.05】;肝包虫病患者血清抗EgCF抗体和抗EgB抗体阳性率分别为85.3%和61.8%,均显著高于肝囊肿患者【分别为31.2%和0.0%,P＜0.05】;增强CT扫描,肝包虫病患者肝内存在类圆形、圆形或分叶状囊性灶,囊壁钙化;在入组的111例患者中,CT检查将3例(2.7%)肝包虫病误诊为肝囊肿,1例(1.0%)肝包虫病被误诊为肝转移癌,2例(1.8%)肝囊肿被误诊为肝包虫病。结论 CT检查能很好地显示肝包虫病囊性病灶的影像学特征,对鉴别肝包虫病与肝囊肿有帮助,为临床治疗提供可靠的影像学依据。     

Cloning and expression of a cDNA encoding an elongation factor 1β/δ protein from Echinococcus granulosus with immunogenic activity

A cDNA clone (Eg EF-1beta/delta) of Echinococcus granulosus has been isolated by an expression library screened with immunoglobulin (Ig)E of sera from patients with cystic echinococcosis (CE). The Eg EF-1beta/delta was identified on the basis of sequence homology to the subunits beta or delta of the elongation factor-1. The amino acid sequence deduced from this open reading frame is 244 residues long with a predicted molecular mass of 31 kDa. In Southern blot under high stringent condition, Eg EF-1beta/delta hybridized to genomic DNA of E.granulosus at two bands of 4 and 2.5 Kb. In immunoblotting analysis, the Eg EF-1beta/delta protein shows immunological reactivity with sera from CE patients: 51.7% of sera contained IgE, 41.7% IgG and 18.3% IgG4 specific to the recombinant protein. We identify the Eg EF-1beta/delta by immunoblotting with specific monoclonal antibody both in protoscoleces and in sheep hydatid fluid. The higher percentage of humoral immune response against Eg EF-1beta/delta observed in CE patients with calcified cysts than in patients with active cysts indicates the possible release of the protein in the hydatid fluid after protoscoleces degeneration suggesting the possible use of this antigen in the immunosurveillance of CE. Overall, these findings seem to assign to Eg EF-1beta/delta a key role in the allergic disorders and in the complex host-parasite relationship in CE.     

Echinococcus alveolaris and cysticus of the liver]

From 1964-1976 34 patients were treated for Echinococcus of the liver at the Mainz University department of surgery. There were 25 cases of E. cysticus and 9 cases of E. alveolaris. Decisive for the diagnosis are Casoni's intracutaneous test, scout film of the abdomen, liver scan and arteriography. In all cases a surgical therapy is indicated. A central localization of the parasite cysts makes problems to the surgical management. In these cases we prefere the cystectomy. All other echinococcal cysts were removed totally, either by pericystectomy or hepatic lobectomy. Such a radicality is the exception in E. alveolaris. Twice we performed right hepatic lobectomy. In the other cases operative treatment was carried out to confirm diagnosis and ensure bile passage by a hepato-enterostomy. However, palliative bile draining procedures may prolong survival time to more than 10 years.     

Short report: endemic focus of cystic echinococcosis in a coastal city of Peru

No evidence of Echinococcus granulosus infection has been described in the coastal region of Peru, with the exception of the capital city of Lima. Anecdotal evidence suggests the existence of a focus of echinococcosis in the coastal city of Chincha, located south of Lima. We conducted a preliminary epidemiologic study in Chincha, which included an ultrasound, chest radiography, and serologic survey of abattoir workers, a review of medical records from local hospitals, and examination of the intestines of stray dogs to determine the presence of canine echinococcosis. Among 25 abattoir workers examined for the presence of cystic echinococcosis, we found three (12%) subjects with echinococcal cysts. A review of medical records showed a surgical incidence of 32/100,000 for the period 1996-1998. Three of 48 dogs (6.25%) were found to be infected with E. granulosus tapeworms. This study demonstrates the existence of an undocumented endemic focus of E. granulosus previously unknown in the coastal region of Peru.     

Short report: Inadequacy of yaks as hosts for the sheep dog strain of Echinococcus granulosus or for E. Multilocularis

Hydatid disease (echinococcosis) has a two-host cycle involving the domestic dog and grazing animals. Humans are also infected by the dog. Both unilocular (Echinococcus granulosus in yaks, sheep, and goats) and multilocular (alveolar) (E. multilocularis in hares and rodents) hydatids are common in western Sichuan in the People's Republic of China. Humans and dogs are equally infected with both species. Many yaks (Bos grunniens) were found with multilocular cysts that visually were deemed to be E. multilocularis. However, a histologic and molecular study showed that they were actually E. granulosus. No infective cysts were found in 125 necropsied yaks. We conclude that the yak is an inadequate and dead-end host for the sheep dog (G1) strain of Echinococcus granulosus and also for E. multilocularis.     

The specific features of development of Echinococcus granulosus metacestode (exogenous blastogenesis) in man

The paper describes a case of abnormal development of a parasitic cyst by the type characteristic of alveolar echinococcosis (exogenous blastogenesis) detected in a female patient operated on for echinococcus. The fact that the exogenous blastogenesis has been found allows the mechanism of a postoperative recurrence of human echinococcosis to be explained from basically new standpoints. A parasitological analysis of the punctates of cystic masses and cysts themselves, taken from patients operated on for cystic echinococcosis has revealed one of the signs of malignant exogenous proliferation of elements of a parasytic metacestode, namely, the development of acephalocysts from the germinative cells of the pedicle of protoscoleces. The capacity of cystic echinococcosis metacestodes for exogenous blastogenesis by the type of human alveolar echinococcosis is an early unknown species-specific feature of E. granulosus.     

细粒棘球蚴囊液蛋白组分分析

目的 利用鸟枪法分析细粒棘球蚴(Echinococcus granulosus)囊液蛋白(hydatid cyst fluid protein,HCFP)组分,寻找其中具有潜在调控免疫失调性疾病功能的活性组分.方法 无菌收集细粒棘球蚴病患者肝囊肿中的细粒棘球蚴囊液,采用鸟枪法进行液相色谱-串联质谱鉴定,采用MaxQua...     

Augmented bioavailability and cysticidal activity of albendazole reformulated in soybean emulsion in mice infected with Echinococcus granulosus or Echinococcus multilocularis

The anthelminthic drug, albendazole (Abz), was reformulated in a soybean oil emulsion and evaluated as a therapeutic agent for the treatment of Echinococcus granulosus and Echinococcus multilocularis in mice. Abz emulsified with 30% soybean oil (AbzE-30) resulted in higher circulating plasma concentrations of the major bioactive Abz metabolite, Abz sulfoxide (AbzSOX), after oral administration, compared with an Abz suspension. The soybean oil-emulsified Abz compound was also noted to penetrate into the hydatid cyst wall and produced higher hydatid cyst concentrations of AbzSOX. The emulsion was superior to Abz suspension in reducing the size of hydatid cysts caused by E. granulosus protoscolices collected from naturally infected sheep in Urumchi, Xinjiang Uygar Autonomous Region. In contrast, the reformulated compound's ability to reduce E. multilocularis cyst masses was only marginally superior to Abz suspension. AbzE-30 exhibited increased bioavailability and bioactivity in the treatment of murine Echinococcus hydatid cyst infections. The compound has the potential for improving therapeutic outcomes for human echinococcosis.     

阿苯达唑脂质体生发层单抗复合物治疗小鼠细粒棘球蚴病效果观察

目的　评价阿苯达唑免疫脂质体 (IL - Alb)治疗小鼠细粒棘球蚴病的效果。　方法　每只小鼠感染约 10 0 0个细粒棘球绦虫原头蚴 ,80天后随机分为 5组 ,4个治疗组分别给予阿苯达唑 (Alb)、阿苯达唑脂质体 (L-Alb)、阿苯达唑亚砜脂质体 (L - Albso)及 IL - Alb,按原药 10 0 m g/ (kg.d)× 5 d ip,连续 3个疗程 ,另 1组为对照组。治疗效果按囊重抑制率、常规病理切片、超微结构及高效液相色谱法测定囊药含量 4个指标综合评价。　结果　L - Alb治疗组 ,囊重抑制率为 80 .3% ,囊药含量为 2 .18μg/ g,优于 Alb组囊重抑制率为 6 1.2 % ,囊药含量为 0 .76μg/ g;而 IL- Alb组的囊重抑制率为 91.45 % ,囊药含量为 5 .15 μg/ g。组织病理损伤以 IL- Alb组较重。　结论　免疫脂质体作为 Alb载体 ,可增加药物的靶特异性 ,提高 Alb治疗细粒棘球蚴的疗效。     

细粒棘球绦虫磷酸甘油酸变位酶的表达、定位和诊断价值的初步评价

目的克隆、表达细粒棘球绦虫磷酸甘油酸变位酶(EgPGAM),分析其免疫反应性及其在原头节、包囊及成虫中的分布情况,对EgPGAM的诊断价值进行初步评价。方法提取细粒棘球蚴原头节RNA,逆转录为cDNA,PCR扩增EgPGAM基因,测序。通过多种生物信息学软件分析EgPGAM的理化性质、保守结构域、抗原表位和同源性等。利用Mega 5.0软件进行序列特征分析,采用邻接法构建系统进化树。将EgPGAM基因连接至pET32a表达载体,转入大肠埃希菌(E.coli)BL21(DE3)中进行诱导表达,镍柱纯化,十二烷基磺酸钠-聚丙烯酰胺凝胶电泳(SDS-PAGE)分析其表达情况并进行蛋白质免疫印迹(Western blotting)分析。免疫荧光定位分析EgPGAM在原头节、包囊及成虫中的分布。采用ELISA评价EgPGAM的诊断价值。结果EgPGAM长756 bp,共编码251个氨基酸,编码蛋白的相对分子质量(Mr)约28000,等电点为8.29,不含信号肽,无跨膜区。EgPGAM含有12个高保守的氨基酸位点、3个保守的催化活性位点、1个底物结合位点和7个B抗原表位。EgPGAM的氨基酸序列与多房棘球绦虫、猪带绦虫、华支睾吸虫、秀丽隐杆线虫、人和羊的PGAM序列相似性分别为99%、94%、78%、45%、57%和4%。SDS-PAGE分析结果显示,EgPGAM在E.coli BL21(DE3)中大量表达,主要以可溶形式存在;Western blotting分析结果显示,EgPGAM可与感染细粒棘球蚴的绵羊血清发生反应。免疫荧光定位显示,EgPGAM主要分布在原头节表皮层和顶突沟,包囊生发层和成虫薄壁组织。建立的间接ELISA敏感性为55.6%(15/27),特异性为86.4%(89/103)。结论EgPGAM广泛分布于细粒棘球蚴和细粒棘球绦虫中,具有较好免疫反应性,但敏感性较低,不适合作为细粒棘球蚴病的候选诊断抗原。     

Surgical treatment of pulmonary hydatid cysts in pediatric patients

Hydatid cyst is a zoonotic infection that is caused by Echinococcus granulosus and alveolaris, and that can result in endemics in rural regions. Infections caused by Echinococcus granulosus are more commonly seen in our country. In this retrospective study, we aimed at discussing the experience we have accumulated on pediatric pulmonary hydatid cyst cases over the last 6 years. Between 1995-2001, in the Department of Thoracic and Cardiovascular Surgery in Gaziantep University, 38 cases underwent 39 operations due to pulmonary and hepatic hydatid cysts. Of these, 24 were males and 14 were females, with an age range of 2-16 years. Operations were frequently performed via thoracotomy. Nineteen cysts were intact, and 26 were perforated. One case had sternotomy, another had sequential thoracotomy, and the rest of the cases underwent thoracotomy, which resulted in cystotomy-capitonnage. In the postoperative period, 2 patients had sustained air leakage, and 2 other cases developed skin infections. Average hospital stay was 5 days. After the operation, the patients received chemotherapy (albendazole 10 mg/kg/day) for 1.5 months. Early or late deaths or recurrences were not observed. We conclude that cystotomy-capitonnage is a successful treatment for pediatric pulmonary hydatid cysts, as it preserves the parenchyma. Chemotherapy in the postoperative period is beneficial in preventing the recurrences.     

细粒棘球蚴重组抗原B 8-kDa亚单位1对囊型包虫病的血清学诊断价值

目的通过基因工程技术获得细粒棘球蚴抗原B8-kDa亚单位1重组蛋白(rEgAgB8/1),探讨其对囊型包虫病(CE)的血清学诊断价值。方法将构建的rEgAgB8/1原核表达质粒(pET32b-rEgAgB8/1)转化至E.coli BL-21(DE3)中,用IPTG诱导表达,经亲和层析纯化获得高纯度rEgAgB8/1,以rEgAgB8/1为抗原,应用ELISA和Immuno blotting方法对31例手术确诊的囊型包虫病病人血清进行了回顾性检测与分析。结果ELISA和Immuno blotting方法检测CE病人血清阳性率均为90.3%(28/31),3例血清学检测阴性的CE病人均为初次诊断为CE及单纯性肝脏单发感染的病人;血清抗体水平随着病人棘球蚴囊数目增加而有所增加,棘球蚴囊的数目与血清抗体水平的比较用单因素方差分析有显著性差异(F=5.06,P=0.0142),1个囊与2个囊/3个囊组间血清抗体水平有显著差异,2个囊与3个囊组间差异无统计学意义。结论rEgAgB8/1重组蛋白抗原对囊型包虫病有较高的血清学诊断价值,多囊型包虫病人血清抗体水平高于单囊型包虫病人。