1,721,058 research outputs found
Long term sonographic follow-up of inactive echinococcal cysts of the liver.
No full textExperience with expactant management of patients with inactive CE of the liver is reporte
Treatment of a large peritoneal echinococcal cyst with percutaneous drainage and albendazole
No full textA case of giant echinococcal cyst of the pelvus treated with percutaneous aspiration is described
The intermediate host immune response in cystic echinococcosis
No full textCystic echinococcosis (CE) is a chronic, complex and neglected zoonotic infection. In most cases, CE cysts and the intermediate host co-habit for a long time in the absence of symptoms and elicit very little inflammation. However, the immune interplay between the parasite and the host is complex, encompassing effective parasite-killing immune mechanisms implemented by the host, which in turn is modulated by the parasite. The immune response to the parasite has been exploited for the diagnosis of the disease and for the development of an effective vaccine to use in the natural intermediate host, but the mechanisms of parasite killing and immunomodulation are still unknown. Here, we reviewed the immune effector mechanisms and the strategies of immune evasion in the intermediate hos
Tests de diagnostic rapide pour le sérodiagnostic de l’échinococcose kystique humaine
No full textCystic echinococcosis (CE) is a parasitic zoonosis especially affecting resource-poor populations in livestock raising areas. Imaging, in particular ultrasound (US), is crucial for the diagnosis, staging, and clinical management of abdominal CE in humans. Serology is a valuable complement to imaging, especially when ultrasound features of CE are absent or unclear. In rural endemic areas, where expertise in US is scant, and conventional serology techniques are unavailable due to lack of laboratory equipment, rapid diagnostic tests (RDTs) may be very useful. Several reports have described the performance of commercial and experimental RDTs in the diagnosis of CE, including a recent study by our group that compared the diagnostic performances of three commercial RDTs for the diagnosis of hepatic CE. To put RDTs for CE in context, we reviewed the available literature in English on this topic. Overall, RDTs appear to be useful in resourcepoor settings where they may replace conventional serodiagnostic tests. However, like other serodiagnostic tests, RDTs lack standardization and show unsatisfactory sensitivity and specificity. An important issue that needs to be addressed is that studies on the diagnostic performance of RDTs fail to take into account the variables known to influence results such as anatomical location and cyst stage
Large multicystic spinal lesion in a young African migrant: a problem of differential diagnosis
No full textWe describe a rare case of large, fully cystic spinal schwannoma in a young adult from The Gambia. The initial clinical suspicion was spinal cystic echinococcosis. He came to our attention reporting progressive walking impairment and neurological symptoms in the lower limbs. An expansive lesion extending from L2 to S1 was shown by imaging (ie, CT scan and MRI). Differential diagnoses included aneurysmal bone cyst and spinal tuberculosis and abscess; the initial suggested diagnosis of spinal cystic echinococcosis was discarded based on contrast enhancement results. The final diagnosis of cystic schwannoma was obtained by histopathology of the excised mass. Cystic spinal lesions are rare and their differential diagnosis is challenging. Awareness of autochthonous and tropical infectious diseases is important, especially in countries experiencing consistent migration flow; however, it must be kept in mind that migrants may also present with 'non-tropical' pathologies
Confirmed Autochthonous Case of Human Alveolar Echinococcosis, Italy, 2023
No full textIn September 2023, a patient in Italy who had never traveled abroad was referred for testing for suspected hepatic cystic echinococcosis. Lesions were incompatible with cystic echinococcosis; instead, autochthonous alveolar echinococcosis was confirmed. Alveolar echinococcosis can be fatal, and awareness must be raised of the infection's expanding distribution
Expert reliability for the World Health Organization standardized ultrasound classification of cystic echinococcosis
No full textAbstractCystic echinococcosis (CE), a parasitic zoonosis, results in cyst formation in the viscera. Cyst morphology depends on developmental stage. In 2003, the World Health Organization (WHO) published a standardized ultrasound (US) classification for CE, for use among experts as a standard of comparison. This study examined the reliability of this classification. Eleven international CE and US experts completed an assessment of eight WHO classification images and 88 test images representing cyst stages. Inter- and intraobserver reliability and observer performance were assessed using Fleiss' and Cohen's kappa. Interobserver reliability was moderate for WHO images (κ = 0.600, P < 0.0001) and substantial for test images (κ = 0.644, P < 0.0001), with substantial to almost perfect interobserver reliability for stages with pathognomonic signs (CE1, CE2, and CE3) for WHO (0.618 < κ < 0.904) and test images (0.642 < κ < 0.768). Comparisons of expert performances against the majority classification for each image were significant for WHO (0.413 < κ < 1.000, P < 0.005) and test images (0.718 < κ < 0.905, P < 0.0001); and intraobserver reliability was significant for WHO (0.520 < κ < 1.000, P < 0.005) and test images (0.690 < κ < 0.896, P < 0.0001). Findings demonstrate moderate to substantial interobserver and substantial to almost perfect intraobserver reliability for the WHO classification, with substantial to almost perfect interobserver reliability for pathognomonic stages. This confirms experts' abilities to reliably identify WHO-defined pathognomonic signs of CE, demonstrating that the WHO classification provides a reproducible way of staging CE
Laboratory Parameters after Treatment for Loa loa and Mansonella perstans: The Experience of a Single Referral Center for Tropical Diseases in a Non-Endemic Area
No full textInfections due to Loa loa and Mansonella perstans are common yet elusive neglected filariases. Parasitological cure after treatment is very difficult to assess, as adult parasites are not accessible. Therefore, outside transmission areas, patients require a long follow-up period to ascertain the therapeutic outcome, which is impractical for non-sedentary populations such as migrants. We studied the change over time of microfilaremia, eosinophil counts, and antifilarial antibodies tested with a commercial ELISA test (Bordier Affinity Products, Crissier, Switzerland), in a retrospective cohort of patients with confirmed L. loa and M. perstans infections, to evaluate the role of serology in clinical practice. After treatment, all 22 eligible patients diagnosed in our center between 2015 and 2017 reached amicrofilaremia, with microfilarial counts decreasing sharply within 2 months. Paralleling eosinophil counts, antibodies decreased in all patients, 36% of whom reached sero-reversion or near-sero-reversion in < 20 months. These findings suggest that positive serology is not just residual from a past infection, and may be used for diagnosis even when microfilaremia is negative or cannot be performed. Interestingly, antibodies and eosinophil counts increased following some, but not all, re-treatment courses. If the rise in these parameters reflects death of macrofilariae, caution is required in interpreting high eosinophil counts and antibody titers shortly after treatment, as these may reflect no need for further treatment. To optimize patients' management, it is now pivotal to ascertain the interval between treatment and macrofilarial death and therefore whether re-treatments are required for complete clearance of parasites
Long-term Sonographic Follow-up of inactive echinococcal cysts located to the liver.
No full textThe sonographic classification of echinococcal cysts proposed by the WHO Informal Working Group on Echinococcosis (WHO-IWGE) allows the distinction between active, transitional and inactive cysts, thus facilitating selection of treatment modalities. For uncomplicated, inactive cysts (CE4, CE5), recent expert opinion recommends they should be left untreated and monitored, but no data exists on the safety and effectiveness of this approach. To fill this gap, we report our experience with long-term sonographic monitoring of inactive cysts.
Records of patients who presented at our clinic and were diagnosed with inactive echinococcal cysts of the liver were searched. Inclusion criteria were:
• presence of cysts exclusively in inactive stage at the time of diagnosis;
• follow-up with abdominal ultrasound performed every 6 or 12 months;
• minimal length of follow up of 24 months.
For each patient, demographic details, characteristics of the cyst within the liver and complications and sonographic changes if they occurred during follow-up were obtained.
From March 1994 to May 2011, 94 patients with exclusively inactive liver cysts were seen in our clinic with 41 meeting all inclusion criteria. 16 patients were male and 25 were female (mean age at time of diagnosis: 48 years, range: 14-86 years). They harbored a total of 55 cysts (of which 33 were CE4 type and 22 were CE5 type). The average cyst diameter was 52 mm.
27 patients had 1 cyst each, 14 patients had 2 cysts each. 42 cysts were located in the right lobe, 4 in the left lobe and 9 in the fourth segment.
The mean follow-up period was 78 months (range: 24-453 months) and in 40 patients (97.6%) the cysts remained in the inactive stage (reactivation occurred only in 1 patient).
Our observations indicate that a proportion of cysts become completely inactive without any treatment and cysts that reached this stage are likely to remain inactive over time. Our data suggest that “Watch and Wait” may be a viable management option for uncomplicated inactive liver cysts
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