Biliary fistula after treatment for hydatid disease of the liver:When to intervene

AIM:To determine the outcome of patients with biliary fistula(BF)after treatment for hydatid disease of the liver. METHODS:Between January 2000 and December 2010,out of 301 patients with a diagnosis of hydatid cyst of the liver,282 patients who underwent treatment [either surgery or puncture,aspiration,injection and reaspiration(PAIR)procedure]were analysed.Patients were grouped according to the presence or absence of postoperative biliary fistula(PBF)(PBF vs no-PBF groups,respectively).Preoperative clinical,radiological and laboratory characteristics,operative characteristics including type of surgery,peroperative detection of BF,postoperative drain output,morbidity,mortality and length of hospital stays of patients were compared amongst groups.Multivariate analysis was performed to detect factors predictive of PBF.Receiver operative characteristics(ROC)curve analysis were used to determine ideal cutoff values for those variables found to be significant.A comparison was also made between patients whose fistula closed spontaneously(CS)and those with intervention in order to find predictive fac-tors associated with spontaneous closure. RESULTS:Among 282 patients[median(range)age, 23(16-78)years;77.0%male];210(74.5%)were treated with conservative surgery,33(11.7%)radical surgery and 39(13.8%)underwent percutaneous drainage with PAIR procedure A PBF developed in 46(16.3%) patients,all within 5 d after operation.The maximum cyst diameter and preoperative alkaline phosphatase levels(U/L)were significantly higher in the PBF group than in the no-PBF group[10.5±3.7 U/L vs 8.4±3.5 U/L(P<0.001)and 40.0±235.1 U/Lvs 190.0±167.3 U/L(P=0.02),respectively].Hospitalization time was also significantly longer in the PBF group than in the no-PBF group[37.4±18.0 d vs 22.4±17.9 d(P< 0.001)].A preoperative high alanine aminotransferase level(>40 U/L)and a peroperative attempt for fistula closure were significant predictors of PBF development (P=0.02,95%CI:-0.03-0.5 and P=0.001,95%CI:0.1-0.4),respectively.Comparison of     

Praziquantel: Neglected drug? Ineffective treatment? Or therapeutic choice in cystic hydatid disease?

The role of praziquantel in hydatid disease has not been well defined. This review evaluates the evidence on the use of praziquantel in treatment of cystic hydatid disease from in vitro and in vivo animal studies, human clinical studies and case reports. Praziquantel may prevent the vesicular evolution of protoscoleces and inhibit the formation of secondary cysts. It may also contribute to the loss of viability of small cysts before cyst differentiation and development of the fibrous adventitial layer. There is some evidence to support a role for the use of praziquantel in combination with albendazole in pre- and post-intervention chemotherapy for hydatid disease. Combined therapy may reduce the risk of disease recurrence and intraperitoneal seeding of infection that develops via cyst rupture and spillage occurring spontaneously or during surgery or percutaneous procedures. At present, there is insufficient published evidence to support a clear recommendation for the use of praziquantel in prolonged chemotherapy for established hydatid disease for which surgery is not indicated or in severe disseminated disease and further work is necessary. Randomised controlled studies to determine the efficacy and optimum duration of praziquantel treatment in combination with albendazole are required so that treatment recommendations for its use can finally be clarified.     

Right ventricular hydatid cyst ruptured to pericardium

Cardiac hydatidosis is rare presentation of body hydatidosis. Incidence of cardiac involvements range from 5% to 5% of patients with hydatid disease. Most common site of hydatid cyst in heart is interventricular septum and left ventricular free wall. Right ventricular free wall involvement by cyst that ruptured to pericardial cavity is very rare presentation of hydatid cyst. Cardiac involvement may have serious consequences such as rupture to blood steam or pericardial cavity. Both the disease and its surgical treatment carry a high complication rate, including rupture leading to cardiac tamponade, anaphylaxis and also death. In the present report, a 43-year-old man with constrictive pericarditis secondary to a pericardial hydatid cyst is described.     

Epidemiology of bacteraemia in Hamad general hospital, Qatar: a one year hospital-based study

We conducted a one-year observational study from July 2007 to June 2008 to describe the epidemiology of bacteraemia at Hamad general hospital. During this period, a total of 452 episodes of bacteraemia occurred, which corresponds to a rate of 19/1000 hospital admissions. Most patients 58.8% (266/452) had community acquired bacteraemia, and primary bacteraemia accounted for 62.2% (281/452) of the cases. The most common source of bacteraemia was intravenous catheterization in 19.2% (87/452) but no source was identified in 42.9% (194/452) of the episodes. Gram-negative organisms were isolated in 63.1% (285/452) episodes with Escherichia coli being the most frequent 21.5% (97/452). Multidrug resistance was observed in 33.3% (7/21) of all Pseudomonas aeruginosa isolates, 50% (6/12) of Acinetobacter isolates and 28.6% (6/21) of Enterobacter isolates, whereas all ESBL producing Klebsiella spp. and E. coli were multiresistant. The percentages of oxacillin resistant coagulase negative Staphylococci isolates and methicillin-resistant Staphylococcus aureus isolates were 81.8% (27/33) and 13.2% (7/53) respectively. In hospital mortality was 22.5% (102/452), and inadequate treatment and septic shock were found to be independent predictors of mortality. Therefore, bloodstream infection surveillance is crucial to produce meaningful guidelines for prevention (e.g., catheter-related) and empirical treatment of bacteraemia in Qatar.     

Spontaneous rupture of a hepatic hydatid cyst into the peritoneum causing only mild abdominal pain： A case report

Hydatid disease is an endemic disease in certain areas of the world. It is located mostly in the liver. Spontaneous rupture of the hydatid cyst into the peritoneum is a rare condition, which is accompanied by serious morbidity and mortality generally. We present herein a case with a spontaneous rupture of a hepatic hidatid disease into the peritoneum without any serious symptoms. A 15-year- old boy was admitted to the emergency room with a mild abdominal pain lasting for a day. Physical examination revealed only mild abdominal tenderness. There was no history of trauma or complaints related to hydatid diseases. Ultrasonography showed a large amount of free fluid and a cystic lesion with irregular borders in the liver. He was operated on. Postoperative albendazol therapy was given for 2 mo. No recurrence or secondary hydatidosis was seen on CT investigation in the 3^th, 6^th and 12^th mo following surgery.     

Pericyst: The outermost layer of hydatid cyst

Hydatid disease,caused by the parasite Echinococcus granulosus,mostly affects the liver and the lungs with hydatid cysts which consist of three layers:(1)the outer pericyst;(2)the middle laminated membrane;and(3)the inner germinal layer.Pericyst,as the outermost layer of the hydatid cyst,is made by host cells encasing the hydatid cyst.An extremely close interaction exists between this host tissue and the parasite,and any degenerative changes of the pericyst would result in hydatid cyst degeneration or rupture.The pericyst plays an undeniably important role in the development and survival of the hydatid cyst.     

Endocardial hydatid cyst: a rare presentation of echinococcal infection

A previously well 45-year-old male presented with 20 days ofbeing generally unwell with a fever and dyspnoea on exertion.Transthoracic echocardiography was done and revealed a roundcystic structure (3x3 cm) attached to the tricuspid valve. Multiplesmall calcified particles (daughter cysts) were also seen inthe cyst which was most consistent with the diagnosis of Hydatidcyst. The serology for Echinococcus granulosus antibody waspositive and confirmed the diagnosis. The patient was sent forcardiac surgery and hydatid cyst which was endocardial in location,and adherent to the tricuspid valve leaflets was the intraoperativefinding. The patient improved and was discharged on long-termchemotherapy. The most common cite of cardiac involvement isthe myocardium followed by the pericardium, whereas endocardialinvolvement is extremely rare. In the present study, we demonstrateda very rare case of endocardial hydatid cyst with attachmentto the tricuspid valve.     

A huge cardiac hydatid cyst: An unusual cause of chest pain revealing multivisceral hydatidosis in a young woman

Hydatid disease remains endemic in some parts of the world. Cardiac hydatidosis with multivisceral involvement is uncommon but potentially fatal. We report the case of a 36-year-old Tunisian woman admitted with chest pain and T-wave inversion in the inferior leads on her electrocardiogram. Transthoracic echocardiography revealed a large hydatid cyst in the epicardium throughout the left ventricle. Thoraco-abdominal computerized tomography (CT) scan showed several hydatid cysts in the left lung, the liver, and in both breasts.After one week of albendazole treatment, surgical excision of the cardiac cyst on cardiopulmonary bypass was carried out as well as excision of the pulmonary and breast cysts. The postoperative course was uneventful and albendazole treatment was continued for six months. Though hydatid cardiac involvement is very rare, it should be considered in the differential diagnosis of atypical chest pain in young patients, especially those living in regions where hydatid disease is endemic.     

Unusual site of recurrent musculoskeletal hydatid cyst： Case report and brief review of the literature

INTRODUCTION Echinococcosis is a zoonotic infection caused by tapeworms of the genus Echinococcus which inhabits in the small intestine of carnivores. The adult worms produce eggs that are released with the feces and spread in various ways, such as throug…     

Unexplainable development of a hydatid cyst

Echinococcosis is a cyclozoonosis characterized by cystic lesions usually situated inside or outside the liver. We discuss the case of a 77-year-old woman with a recurrent hydatidosis with a cyst arising from the liver, growing through the lateral right abdomen wall, and reaching the subcutaneous tissue of the lumbar region. In the literature, rare subcutaneous or muscular Iocalizations of hydatid cysts are described, however, there is no mention of a cyst growing over the abdominal wall muscles, shaped like an hourglass, partially in the liver and partially in the subcutaneous tissue, as in our case. We have not found any pathogenetic explanation for this growth pattern which is not typical of the biological behaviour of a hydatid cyst.     

Polyarthritis associated with hydatid disease (Echinococcosis) of the liver

Summary A 36-year-old male developed asymmetric polyarthritis during the course of hydatid disease of the liver. Excision of the hydatid cyst was accompanied by full remission of the arthritis without recurrence during the 7-year follow-up period. This sequence of clinical events suggests an eventual cause and effect relationship. A reactive immune mechanism, triggered by a parasite located at a distant site, appears to be responsible for this type of arthritis.     

宜昌市首例包虫病患者的诊断与发现

回顾分析宜昌市首例包虫病病例的诊断过程。患者外科囊肿切除术摘除20 cm×15 cm×12 cm巨大囊肿,内容物为大量白色膜状物,囊肿摘除物检获大量棘球绦虫的幼虫,病原学诊断为囊型包虫病。国家疾控中心有关专家对患者进行了感染来源的追溯调查,认为该例患者至少在10年前与携带棘球绦虫虫卵的狗的皮毛密切接触而被传染。传播链的形成可能与当地引进外来种羊、种牛、宠物狗和当地居民有普遍饲养家犬习惯有关,属本地感染病例。该病例为湖北宜昌市首例包虫病病例。     

Interventricular septal hydatid cyst: Transesophageal echocardiography as a therapeutic tool during bypass

Cystic echinococcosis (hydatid disease) arising from infestation with a larval or adult form of the Echinococcus granulosus tapeworm is endemic in certain states of India, but affecting interventricular septum (IVS) solitarily is a scarce phenomenon. We present a rare case of transesophageal echocardiography guided management of IVS hydatid cyst even during cardiopulmonary bypass, which presented with a rather unusual complaint of repeated syncope.     

Role of endoscopic retrograde cholangiopancreatography in the management of hepatic hydatid disease

Most cases of hepatic hydatid disease exhibit uncomplicated clinical course and management. However, the diagnosis and management of complicated hepatic hydatid disease is a special issue. One of the most common and serious complications of hepatic hydatid disease is the rupture of the cyst into intrahepatic bile ducts. The clinical appearance of intrabiliary rupture can range from asymptomatic to jaundice, cholecystitis, cholangitis, liver abscess, pancreatitis and septicemia. Current treatments for major ruptures can result in high morbidity and mortality rates. Furthermore, ruptures that cannot be diagnosed preoperatively can induce complications such as biliary fistulae, biloma, cavitary infection and obstructive jaundice. In the past, these complications were diagnosed and treated by surgical methods. Currently, complications in both the pre- and postoperative periods are diagnosed and treated by non-invasive or minimally invasive methods. In clinical practice, endoscopic retrograde cholangiopancreatography (ERCP) is indicated for patients with preoperative frank intrabiliary rupture in which hydatid elements are clearly seen in the bile ducts, or for biliary adverse events after surgery, including persistent biliary fistulae and jaundice. However, controversy concerning routine preoperative ERCP and prophylactic endoscopic sphincterotomy in patients suspected of having minor cystobiliary communications still remains. In this article, the role of ERCP in the diagnosis and management of hepatic hydatid disease during the pre- and postoperative periods is reviewed.     

青海省玉树县包虫病流行病学调查报告

目的调查了解玉树县人群包虫病流行分布状况。调查对象与方法调查对象为玉树县结古镇辖区2岁以上居民;主要调查方法为血清免疫学和B超诊断。结果本次共检801人,检出感染者33人,平均感染率为4.11％;检出棘球蚴病患者对例和泡球蚴病患者4例,患病率分别为2.62％和0.50％。高年龄组感染患病水平高于低年龄组,女性高于男性,牧民和农民高于其他职业人群。结论玉树县是一个有棘球蚴病和泡球蚴病并存的混合流行区,疫情十分严重。家犬管理不善和无主犬数量巨大是导致该地区包虫病高流行的主要原因,控制包虫病的工作重点应放在彻底消灭无主犬和加强家犬驱虫管理方面。     

Therapeutic endoscopic retrograde cholangiopancreatography and related modalities have many roles in hepatobiliary hydatid disease

The authors report their experience about 8 cases of intrabiliary rupture of hepatobiliary hydatid disease, and add an algorithm for treatment. To our opinion, the use of diagnostic and therapeutic endoscopic retrograde cholangiopancreatography (ERCP) in the management of hepatobiliary hydatid disease was not stated properly in their proposed algorithm. According to the algorithm, the use of ERCP and related modalities was only stated in the case of postoperative biliary fistulae. We think that postoperative persistant fistula is not a sole indication, there are many indications for ERCP and related techniques namely sphincterotomy, extraction, nasobiliary drainage and stenting, in the treatment algorithm before or after surgery.     

Epidemiology and clinical features of cystic hydatidosis in Western Sicily:A ten-year review

AIM:To assess retrospectively the epidemiological and clinical aspects of cystic echinococcosis(CE)and to evaluate follow-up and response to treatment in patients affected by CE.METHODS:From January 2000 to December 2010,all patients affected by CE at the Infectious Diseases Units of the University of Catania and of Basilotta Hospital in Nicosia-Enna,were enrolled as participants in the study.Epidemiological,clinical and laboratory data were collected for each patient.Diagnosis of CE was performed using clinical imaging and laboratory parameters.Response to treatment was categorized as follows:"cure"as the disappearance or complete calcification of cyst/s;"improvement"as a reduction in the diameter and/or number of existing cysts;and"impairment"as an increase in the diameter and/or number of existing cyst/s and the onset of relapses(i.e.,the onset of new cyst/s and an increase in the diameter of previously existing cyst/s and/or complications.Immunoglobulin E(IgE)titers and eosinophil percentages were evaluated at diagnosis,at six months after the initiation of treatment and again in the case of relapse.Hyper-eosinophilia was defined as an eosinophil percentage of≥6%.RESULTS:Thirty-two patients were diagnosed with CE in our Unit during the research period,with a malefemale ratio of 2:1.At the time of diagnosis,40%of patients presented a single CE cyst.Sixty percent showed multi-organ involvement.The liver-lung localization ratio was 2:1.Patients below the age of 50 at diagnosis were more likely to have multiple cysts(73.7%vs 35.5%,P<0.05).Regarding treatment,30 patients were treated medically and 16 surgically.Fourteen patients were treated both medically and surgically.Relapses were seen to be less frequent in patients treated with albendazole before and after surgery.Complete cure or an improvement was achieved in 23 patients.Impairment was observed in one patient.Two patients showed no improvement.Relapses were more frequent in those patients treated before 2005.At diagnosis,71%of patients were positive     

Pulmonary hydatid disease: a four-year experience in an urban black hospital

Intrathoracic hydatid disease is rarely seen in black patients hospitalized in the Johannesburg area. Eleven patients with pulmonary hydatid disease were treated during 4 years at a major referral center for black patients. The clinical features and management of these patients are described.     

Serodiagnosis of human hydatidosis with an ELISA developed based on antigens derived from sheep hydatid cysts and comparison with a commercial human ELISA kit

ObjectiveTo explore the serodiagnosis of hydatid cyst in human using different antigens of sheep (hydatid fluid, Somatic and Excretory/secretory antigens of protoscolex) by ELISA and compares this result with commercial human ELISA kit.MethodsOne hundred blood samples from patients with history of severe abdominal pain and eosinophilia were obtained. Ten serum samples were obtained from surgically and pathologically confirmed cystic echinococcosis patients from Mashhad university hospital as positive control and 5 serum samples from infant under one year old as negative control. Blood samples were centrifuged at 3 000μg at 20 °C for 15 min and sera were stored at ?20 °C. First, these samples were tested for the presence of antibody by commercial human ELISA. Then, ELISA was developed on microplates coated with hydatid fluid, Somatic and Excretory/secretory antigens of protoscolex of sheep.ResultsThe results of this study as analyzed by Kappa test showed that, hydatid fluid antigen could be used as a precise source of detection in indirect ELISA test.ConclusionsHydatid fluid in comparison with Excretory-secretory and somatic antigens showed more compatibility agreement in kappa test which can be used for further studies in development of any ELISA test for diagnosis of human hydatidosis.     

Peritoneal tuberculosis in Qatar: a five-year hospital-based study from 2005 to 2009

There is limited information about peritoneal tuberculosis in Qatar. This retrospective study aimed to review our experience with peritoneal tuberculosis in patients admitted to Hamad general hospital over a period of 5 years, from 2005 to 2009, with emphasis on presentation, investigation, diagnosis and therapeutic outcome. Fifty-four patients with peritoneal tuberculosis identified during the study period were included. The mean age of them was 31.85 years and 96.3% (52/54) of them were non-Qataris with male predominance. The main symptoms and signs at the time of presentation were abdominal pain and ascites respectively. Underlying diseases were described in 24% (13/54) and history of contact with tuberculous cases was present in 31.5% (17/54) of patients. Tuberculin test was positive in 66.7% (36/54). The ascitic fluid smear showed acid fast bacilli in 2% (1/53), and culture was positive in 39.6% (21/53) of cases. Laparoscopically obtained peritoneal biopsy showed caseating granulomas in 93% (40/43) and mycobacteria were identified by acid fast staining and culture in 58.5% (24/41) and 98% (40/41) of the tested specimens respectively. Most of the patients (84%; 37/44) who had completed their therapy in Qatar improved with antituberculosis therapy, and only one patient died. In conclusion, the clinical features and the imaging findings of the disease were non-specific. A high index of suspicion is essential for early diagnosis. Culture of ascitic fluid delayed the diagnosis in clinically suspected cases, whereas laparoscopically guided peritoneal biopsy provided rapid and correct diagnosis. A Six-month course with antituberculous therapy was effective and improved the outcome.