RESUMO

BACKGROUND: Cystic echinococcosis (CE) is a chronic disease considered a neglected one. Cystic echinococcosis is endemic in Uruguay and the region. Surgery, using various technical approaches, has the potential to safely remove the cyst(s) and lead to a complete cure in a high number of patients with simple forms of CE. However, surgery may be impractical in patients with multiple cysts in several organs, high surgical risk, or in patients with previous multiple surgeries. In these cases, the pharmacological treatment with the benzimidazolic drug Albendazole (ABZ) alone or combined with Praziquantel (PZQ), has been promising as the best choice to achieve improvement or cure. METHODS: In this study, we analyze the results obtained on the anti-parasitic treatment of 43 patients diagnosed with CE between the years 2003 and 2020. Patients were treated before and/or after surgery with ABZ or the combination ABZ/PZQ. The standardize protocol of the anti-parasitic drug treatment before surgery was 7 days, 15 days or 1 month depending on the urgency and availability of the surgical procedure. All cases that involved confirmed locations on lungs underwent immediate surgery with minimal pre-treatment when possible. After surgery, the standardize protocol of anti-parasitic drug treatment consisted of six cycles of 30 days each and resting intervals of 15 days in between. ABZ was used in all cases, administered orally, twice daily, at a total dosage of 15 mg/kg/day, with food high in fat content for improved absorption. The follow up was carried out according to WHO-IWGE guidelines for 5 years. RESULTS: Of the 43 patients fourteen were ≤ 15 years of age and had a differentiated pre-surgical treatment. From the ≥ 16 years of age, 36 completed the treatments and the 5 years follow up. Four patients changed geographical locations, without a forwarding contact, after the post-surgery treatment. No patient died during the study. Of the 36 patients that completed the study, 32 were treated only with ABZ; 93.75% achieved treatment success as determined by improvement or cure, and 6.25% treatment failure determined by no change or worsening. The last four patients received the ABZ/PZQ combination therapy and achieved 100% treatment success. CONCLUSION: The pharmacological treatment resulted in a good option not only as palliative but also as potentially curative. The main relevance of its use was in cases with previous multiple surgeries or surgeries with potential life-threatening complications due to the number and location of cysts and concurrent comorbidities. A follow-up of at least 5 years would be recommended to assure remission and control of the transmission. More randomized trials are needed to provide clear clinical evidence of different pharmacological treatments for CE.

Assuntos

Albendazol , Anti-Helmínticos , Equinococose , Praziquantel , Humanos , Albendazol/uso terapêutico , Albendazol/administração & dosagem , Praziquantel/uso terapêutico , Praziquantel/administração & dosagem , Equinococose/tratamento farmacológico , Equinococose/cirurgia , Masculino , Feminino , Uruguai , Adulto , Pessoa de Meia-Idade , Seguimentos , Anti-Helmínticos/uso terapêutico , Anti-Helmínticos/administração & dosagem , Adulto Jovem , Resultado do Tratamento , Adolescente , Idoso , Quimioterapia Combinada

RESUMO

Cystic echinococcosis is caused by the tissue-dwelling larva (hydatid) of Echinococcus granulosus sensu lato. A salient feature is that this larva is protected by the acellular laminated layer (LL). As the parasite grows, the LL sheds abundant particles that can accumulate in the parasite's vicinity. The potential of LL particles to induce inflammation in vivo has not been specifically analysed. It is not known how each of its two major components, namely highly glycosylated mucins and calcium inositol hexakisphosphate (InsP6) deposits, impacts inflammation induced by the LL as a whole. In this work, we show that LL particles injected intraperitoneally cause infiltration of eosinophils, neutrophils and monocytes/macrophages as well as the disappearance of resident (large peritoneal) macrophages. Strikingly, the absence of calcium InsP6 enhanced the recruitment of all the inflammatory cell types analysed. In contrast, oxidation of the mucin carbohydrates caused decreased recruitment of neutrophils. The carbohydrate-oxidised particles caused cell influx nonetheless, which may be explained by possible receptor-independent effects of LL particles on innate immune cells, as suggested by previous works from our group. In summary, LL particles can induce acute inflammatory cell recruitment partly dependent on its mucin glycans, and this recruitment is attenuated by the calcium InsP6 component.

Assuntos

Echinococcus granulosus , Ácido Fítico , Animais , Echinococcus granulosus/imunologia , Ácido Fítico/farmacologia , Ácido Fítico/metabolismo , Equinococose/imunologia , Equinococose/parasitologia , Inflamação , Neutrófilos/imunologia , Mucinas/metabolismo , Camundongos , Macrófagos/imunologia , Macrófagos/metabolismo , Eosinófilos/imunologia , Feminino , Larva/imunologia

RESUMO

Cystic echinococcosis control in South American countries requires a comprehensive integrative 'One Health' approach. While insular nations have seen successful in their elimination programmes, South American countries face persistent challenges in hostile environments, with Echinococcus granulosus s.l., posing a significant public health concern. Vaccination of intermediate hosts has demonstrated the efficacy of the EG95 vaccine in reducing transmission rates. For example, since 2009, Rio Negro Province in Argentina has added, with marked success, the EG95 vaccine to the control programme, supplementing dog deworming. The Aysen Region of Chile has also reported encouraging preliminary results in reducing cyst prevalence in vaccinated sheep after 3 years of vaccination. The challenges in aligning control strategies with socio-cultural factors, especially in indigenous communities, underlines the need for context-specific strategies. The Rio Negro programme demonstrated commendable compliance, underlining the importance of community engagement in achieving lasting success. The most promising strategies for effective echinococcosis control involved dog deworming and the routine vaccination of sheep and/or goats, underscoring the importance of sustained implementation until all grazing animals have been replaced. For lasting success, these interventions need to be combined with a robust surveillance system.

RESUMO

Scavenger receptors participate in a wide range of biological functions after binding to multiple non-self or altered self-ligands. Among them, CD5 and CD6 are lymphocyte scavenger receptors known to interact with different microbial-associated molecular patterns, and the administration of the recombinant soluble ectodomains of human CD5 (rshCD5) and/or CD6 (rshCD6) has shown therapeutic/prophylactic potential in experimental models of fungal, bacterial and echinococcal infections. The latter is a zoonosis caused by the larval stage of the cestode parasite Echinococcus granulosus sensu lato, which in humans can induce secondary cystic echinococcosis (CE) after the spillage of protoscoleces contained within fertile cysts, either spontaneously or during surgical removal of primary hydatid cysts. Herein, we have analysed the mechanisms behind the significant protection observed in the mouse model of secondary CE following prophylactic administration of rshCD5 or rshCD6. Our results show that both molecules exhibit intrinsic antiparasitic activities in vitro, as well as immunomodulatory functions during early secondary CE, mainly through Th1/Th17 cytokine bias and promotion of peritoneal polyreactive antibodies. These data support the relevance of the parasite components bound by rshCD5 and rshCD6, as well as the potential of their prophylactic administration as a useful strategy to reduce secondary CE in patients.

Assuntos

Anti-Infecciosos , Equinococose , Animais , Camundongos , Humanos , Antiparasitários , Zoonoses , Receptores Depuradores

RESUMO

Cystic echinococcosis (CE) is a zoonotic disease caused by the tapeworm Echinococcus granulosus sensu lato (s.l). In the intermediate host, this disease is characterized by the growth of cysts in viscera such as liver and lungs, inside of which the parasite develops to the next infective stage known as protoscoleces. There are records that the infected viscera affect the development and morphology of E. granulosus s.l. protoscolex in hosts such as buffalo or humans. However, the molecular mechanisms that drive these differences remains unknown. Weighted gene co-expression network analysis (WGCNA) using a set of RNAseq data obtained from E. granulosus sensu stricto (s.s.) protoscoleces found in liver and lung cysts reveals 34 modules in protoscoleces of liver origin, of which 12 have differential co-expression from protoscoleces of lung origin. Three of these twelve modules contain hub genes related to immune evasion: tegument antigen, tegumental protein, ubiquitin hydrolase isozyme L3, COP9 signalosome complex subunit 3, tetraspanin CD9 antigen, and the methyl-CpG-binding protein Mbd2. Also, two of the twelve modules contain only hypothetical proteins with unknown orthology, which means that there are a group of unknown function proteins co-expressed inside the protoscolex of liver CE cyst origin. This is the first evidence of gene expression differences in protoscoleces from CE cysts found in different viscera, with co-expression networks that are exclusive to protoscoleces from liver CE cyst samples. This should be considered in the control strategies of CE, as intermediate hosts can harbor CE cysts in liver, lungs, or both organs simultaneously.

Assuntos

Cistos , Equinococose , Echinococcus granulosus , Humanos , Animais , Echinococcus granulosus/genética , Evasão da Resposta Imune , Genótipo , Equinococose/genética , Equinococose/parasitologia

RESUMO

Echinococcosis is a parasitic disease caused by infection with tiny tapeworms of the genus Echinococcus. Echinococcosis is classified as either cystic echinococcosis or alveolar echinococcosis. The common form is a zoonosis from goats and sheep that tends to cause liver lesions. The larval stage of Echinococcus multilocularis causes alveolar echinococcosis/alveolar hydatid disease. It is a zoonosis with field mice and tundra voles as intermediate and wild carnivores like foxes and wolves as definitive hosts. This zoonosis is highly uncommon compared to the other form known as cystic echinococcosis but poses a great human threat if untreated. We report the case of a young man who was working in the Kashmir Valley, North India, and presented with jaundice and right upper quadrant abdominal pain. Computed tomography revealed a large solid-cystic intrahepatic lesion measuring 125x118x123 mm, suggestive of a malignant tumor with central necrosis. A liver biopsy showed necrosis with PAS-positive membranes morphologically consistent with echinococcosis. Alveolar echinococcosis can present as a solid-cystic mass in the liver and can simulate metastatic malignancy.

RESUMO

Introducción. La hidatidosis o equinococosis es una zoonosis parasitaria que se adquiere al ingerir huevos de cestodos del género Echinococcus. El diagnóstico clínico raramente se hace en sitios no endémicos. La mayoría de los pacientes se encuentran asintomáticos y los hallazgos incidentales en los estudios de imágenes o en procedimientos quirúrgicos permiten la sospecha diagnóstica. Caso clínico. Paciente masculino de 70 años, residente en área rural del municipio de Puerto Libertador, departamento de Córdoba, Colombia, quien consultó por masa abdominal en epigastrio y mesogastrio, parcialmente móvil e indolora. Resultados. En cirugía se identificaron lesiones quísticas mesentérica y hepática. Después de la cirugía y mediante estudios de inmunohistoquímica, se confirmó el diagnóstico de quiste hidatídico. El paciente tuvo una evolución satisfactoria. Conclusión. La hidatidosis quística mesentérica y hepática sintomática es una enfermedad rara en sitios no endémicos, donde la cirugía constituye un pilar fundamental en el diagnóstico y tratamiento, sumado al manejo médico farmacológico.

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Introduction. Hydatidosis or echinococcosis is a parasitic zoonosis that is acquired by ingesting eggs of cestodes of the genus Echinococcus. Clinical diagnosis is rarely made in non-endemic sites. Most patients are asymptomatic and incidental findings on imaging studies or surgical procedures allow for diagnostic suspicion. Clinical case. A 70-year-old male patient, resident in a rural area of the municipality of Puerto Libertador, department of Córdoba, Colombia, who consulted for an abdominal mass in the epigastrium and mesogastrium, partially mobile and painless. Results. In surgery, mesenteric and hepatic cystic lesions were identified. After surgery and through immunohistochemistry studies, the diagnosis of hydatid cyst was confirmed. The patient had a satisfactory evolution. Conclusion. Symptomatic mesenteric and hepatic cystic hydatidosis is a rare disease in non-endemic sites, where surgery constitutes a fundamental pillar in the diagnosis and treatment in addition to pharmacological medical management.

Assuntos

Humanos , Zoonoses , Equinococose Hepática , Equinococose , Laparotomia , Mesentério

RESUMO

ABSTRACT Echinococcosis is a parasitic disease caused by infection with tiny tapeworms of the genus Echinococcus. Echinococcosis is classified as either cystic echinococcosis or alveolar echinococcosis. The common form is a zoonosis from goats and sheep that tends to cause liver lesions. The larval stage of Echinococcus multilocularis causes alveolar echinococcosis/alveolar hydatid disease. It is a zoonosis with field mice and tundra voles as intermediate and wild carnivores like foxes and wolves as definitive hosts. This zoonosis is highly uncommon compared to the other form known as cystic echinococcosis but poses a great human threat if untreated. We report the case of a young man who was working in the Kashmir Valley, North India, and presented with jaundice and right upper quadrant abdominal pain. Computed tomography revealed a large solid-cystic intrahepatic lesion measuring 125x118x123 mm, suggestive of a malignant tumor with central necrosis. A liver biopsy showed necrosis with PAS-positive membranes morphologically consistent with echinococcosis. Alveolar echinococcosis can present as a solid-cystic mass in the liver and can simulate metastatic malignancy.

RESUMO

Hydatid cyst is a parasitic infestation caused by Echinococcus larvae. Hydatid cyst of the ovary is a highly unusual presentation. Herein, we present a case of a young woman who complained of episodic lower abdominal pain. Ultrasound of the abdomen revealed a multi-cystic left adnexal mass measuring 86 mm x 67 mm. A possibility of ovarian cystic neoplasm was suggested. Unilateral salpingo-oophorectomy was performed. On histopathological examination, a cyst measuring 8.0 x 5.5 x 4.5 cm was found, replacing the entire ovary. The cyst cavity was filled with serous fluid and multiple pearly white membranous structures, giving a multiloculated appearance. Microscopic examination showed a cyst lined by a lamellar membrane containing protoscolices and hooklets. Hydatid disease is a zoonotic ailment caused by tapeworms (Echinococcus granulosus or, less commonly, Echinococcus multilocularis). The definitive hosts are carnivores. Humans are the accidental intermediate hosts. The hydatid cyst commonly affects the liver and the lungs. The primary hydatid cyst of the ovary is quite rare, with few case reports in the literature. In most cases, symptoms are vague, and the lesion is misdiagnosed as benign or malignant ovarian cystic neoplasm on clinical and radiological examination. Ovarian hydatid cyst is treated by surgery with ovarian cystectomy as the gold standard. The possibility of a hydatid cyst should be kept under differential diagnoses while evaluating the cystic diseases of the ovary.

RESUMO

In an attempt to find new anti-echinococcal drugs, resveratrol (Rsv) effectiveness against the larval stages of Echinococcus granulosus and E. multilocularis was evaluated. The in vitro effect of Rsv on parasites was assessed via optical and electron microscopy, RT-qPCR and immunohistochemistry. In vivo efficacy was evaluated in murine models of cystic (CE) and alveolar echinococcosis (AE). The impact of infection and drug treatment on the mouse bone marrow hematopoietic stem cell (HSC) population and its differentiation into dendritic cells (BMDCs) was investigated via flow cytometry and RT-qPCR. In vitro treatment with Rsv reduced E. granulosus metacestode and protoscolex viability in a concentration-dependent manner, caused ultrastructural damage, increased autophagy gene transcription, and raised Eg-Atg8 expression while suppressing Eg-TOR. However, the intraperitoneal administration of Rsv was not only ineffective, but also promoted parasite development in mice with CE and AE. In the early infection model of AE treated with Rsv, an expansion of HSCs was observed followed by their differentiation towards BMCDs. The latter showed an anti-inflammatory phenotype and reduced LPS-stimulated activation compared to control BMDCs. We suggest that Rsv ineffectiveness could have been caused by the low intracystic concentration achieved in vivo and the drug's hormetic effect, with opposite anti-parasitic and immunomodulatory responses in different doses.