Diagnosis and treatment experience of atypical hepatic cystic echinococcosis type 1 at a tertiary center in China

BACKGROUND Some hydatid cysts of cystic echinococcosis type 1(CE1)lack well-defined cyst walls or distinctive endocysts,making them difficult to differentiate from simple hepatic cysts.AIM To investigate the diagnostic methods for atypical hepatic CE1 and the clinical efficacy of laparoscopic surgeries.METHODS The clinical data of 93 patients who had a history of visiting endemic areas of CE and were diagnosed with cystic liver lesions for the first time at the People's Hospital of Xinjiang Uygur Autonomous Region(China)from January 2018 to September 2023 were retrospectively analyzed.Clinical diagnoses were made based on findings from serum immunoglobulin tests for echinococcosis,routine abdominal ultrasound,high-frequency ultrasound,abdominal computed tomography(CT)scan,and laparoscopy.Subsequent to the treatments,these patients underwent reexaminations at the outpatient clinic until October 2023.The evaluations included the diagnostic precision of diverse examinations,the efficacy of surgical approaches,and the incidence of CE recurrence.RESULTS All 93 patients were diagnosed with simple hepatic cysts by conventional abdominal ultrasound and abdominal CT scan.Among them,16 patients were preoperatively diagnosed with atypical CE1,and 77 were diagnosed with simple hepatic cysts by high-frequency ultrasound.All the 16 patients preoperatively diagnosed with atypical CE1 underwent laparoscopy,of whom 14 patients were intraoperatively confirmed to have CE1,which was consistent with the postoperative pathological diagnosis,one patient was diagnosed with a mesothelial cyst of the liver,and the other was diagnosed with a hepatic cyst combined with local infection.Among the 77 patients who were preoperatively diagnosed with simple hepatic cysts,4 received aspiration sclerotherapy of hepatic cysts,and 19 received laparoscopic fenestration.These patients were intraoperatively diagnosed with simple hepatic cysts.During the followup period,none of the 14 patients with CE1 experienced recurrence or implantation of hydatid scolices.One of the 77 patients was finally confirmed to have CE complicated with implantation to the right intercostal space.CONCLUSION Abdominal high-frequency ultrasound can detect CE1 hydatid cysts.The laparoscopic technique serves as a more effective diagnostic and therapeutic tool for CE.

Coexistence of liver abscess, hepatic cystic echinococcosis and hepatocellular carcinoma: A case report

BACKGROUND Human cystic echinococcosis(CE)is a life-threatening zoonosis caused by the Echinococcus granulosus(sensu lato).Hepatocellular carcinoma(HCC)is a leading cause of cancer-related mortality in the world.The coexistence of CE and HCC is exceedingly rare,and only several well-documented cases have been reported.In addition to this coexistence,there is no report of the coexistence of CE,HCC,and liver abscess to date.Herein,we aimed to report a case of coexistence of liver abscess,hepatic CE,and HCC.CASE SUMMARY A 65-year-old herdsman presented to the department of interventional therapy with jaundice,right upper abdominal distension and pain for 10 d.Laboratory test showed that he had positive results for HBsAg,HBeAb,HBcAb,and echino-coccosis IgG antibody.The test also showed an increased level of alpha fetopro-tein of 3400 ng/mL.An abdominal computed tomography(CT)scan revealed an uneven enhanced lesion of the liver at the arterial phase with enhancement and was located S4/8 segment of the liver.In addition,CT scan also revealed a mass in the S6 segment of the liver with a thick calcified wall and according to current guideline and medical images,the diagnoses of hepatic CE(CE4 subtype)and HCC were established.Initially,transarterial chemoembolization was performed for HCC.In the follow-up,liver abscess occurred in addition to CE and HCC;thus,percutaneous liver puncture drainage was performed.In the next follow-up,CE and HCC were stable.The liver abscess was completely resolved,and the patient was discharged with no evidence of recurrence.CONCLUSION This is the first reported case on the coexistence of liver abscess,hepatic CE,and HCC.Individualized treatment and multidisciplinary discussions should be performed in this setting.Therefore,treatment and diagnosis should be based on the characteristics of liver abscess,hepatic CE,and HCC,and in future clinical work,it is necessary to be aware of the possibility of this complex composition of liver diseases.

Epidemiological Studies on Cystic Echinococcosis in China─A Review

In the four decades from 1951 to 1990, the six provinces or autonomous regions (Xinjiang, Gansu, Qinghai, Ningxia, Xizang and Nei Monggol) reported a total of 26 065surgical cases of hydatid disease, most of which were reported in the recent decade. About one third of the patients was children and adolescents under 15 years old. So far, cystic hydatid infections of local origin have been confirmed in 22 provinces, autonomous regions and municipalities in the whole nation. Findings of X-ray examination and real-time B-mode ultrasonography in agricultural and pastoral areas of Xinjiang, Gansu, Qinghai,Ningxia and Xizang showed that the morbidity rate of hydatidosis in human population varied between 0.5% and 4.5%. The main animal intermediate host in all these regions is sheep, the morbidity of which varied between 3.3% and 90%. The infection rate of adult Echinococcus granulosus in dogs varied between 7% and 71%. The high-risk period for humans contracting hydatid disease is the pre-school age. Direct contact of children with dogs and ingestion of water, vegetables and foods contaminated by worm eggs are the chief mode of transmission for human hydatidosis. The common practices of home slaughter and of feeding dogs on offal containing hydatid cysts facilitate the life cycIe of the parasite.On the basis of hydatid control efforts for several years, the Ministry of Public Health promulgated officially the '1992-1995 National Programme for Hydatid Disease Control'in April, 1992, and pilot studies in which the control of hydatidosis is composed of extensive health education, sanitation of slaughtering and management and deworming of dogs are being established.Cystic echinococcosis has wide distribution in China and is a major public health problem in hyperendemic areas, poses a great threat against people's health and influences the development of livestock husbandry. This problem has received great attention from the medical and veterinary departments. In the rencent decade great efforts have been made in the epidemiology, parasitology and clinical treatment of echinococcosis, resulting in a better understanding of the disease and procedures effective in bringing about control of the disease

Radical resection of hepatic polycystic echinococcosis complicated with hepatocellular carcinoma: A case report

BACKGROUND Hepatic cystic echinococcosis(CE)is an infectious zoonotic parasitic disease,and the insidious onset and slow progression of hepatic CE usually contributes to delayed diagnosis and treatment.Hepatocellular carcinoma(HCC)is the fourth most common malignant tumor.Co-existence of CE and HCC is fairly rare in clinical settings and the association between the two is still not well recognized.We report a case of hepatic CE complicated with HCC which are radically resected and raise some questions worth thinking about.CASE SUMMARY A 70-year-old man presented with upper abdominal pain.On admission,laboratory data showed that,except for hepatitis B surface antigen positivity,other indicators were normal,including alpha-fetoprotein.Computed tomography of the abdomen revealed a huge polycystic lesion in left liver lobe,without reinforcement after enhanced scanning and sized about 16.9 cm×12.2 cm,which was considered a type II hydatid cyst.Multiple small solid lesions were also found adjacent to it,and thus it was highly suspected as a malignant tumor.After a multidisciplinary team discussion,the diagnosis of co-occurrence of hepatic CE and HCC was made.According to Romic classification,the case belongs to type IIb,and radical left hemi-hepatectomy was performed.Postoperative pathological examination revealed CE co-existence with welldifferentiated HCC,consistent with the preoperative diagnosis.CONCLUSION With the combination of hepatitis B and obvious extrusion by large hydatid,the HCC risk of a patient might be higher.

Study of Infection of Echinococcus granulosus in Yak in Spring and Its Potential Role in Transmission of Cystic Echinococcosis in Rangtang County of Sichuan,China

Dear Editor, Cystic echinococcosis （CE）, caused by Echinococcus granulosus in larval stage, is considered as one of the most dangerous parasitic zoonosis in the world. The obligate 2-host parasitic cycle of Echinococcus granulosus is predominantly synanthropic. Dogs are the usual definitive hosts, and lots of mammalian species can be intermediate hosts, including domestic livestock and human[I2]. In the Tibetan plateau, China, the population is mainly Tibetans primarily engaged in livestock husbandry and CE is therefore a health problem for both people and animal in Tibetan communities. The reported infection rate of Echinococcus gronulosus in slaughtered yak in slaughterhouses is usually very high, being about 50% or higher as reported, and the liver and lungs are the main affected organs[34].

Clinical and molecular features of human cystic echinococcosis in Tehran,Iran,2011-2019

Objective:To evaluate the clinical and molecular features of human cystic echinococcosis in Tehran,Iran.Methods:In this cross-sectional study,all human cystic echinococcosis patients admitted to Tehran’s hospitals from 2011 to 2019 were enrolled,and demographic characteristics,clinical findings,and laboratory data were collected.Formalinfixed,paraffin-embedded and fresh tissue samples of 175 cystic echinococcosis patients were evaluated for molecular characterization.The samples’isolated DNA was used to amplify cytochrome c oxidaseⅠand NADH dehydrogenase subunitⅠgenes.Also,the morphological features of fresh samples were examined.Results:In total,175 patients with a mean age of 45(9-98)years were admitted to Tehran’s hospitals diagnosed with cystic echinococcosis.Moreover,the highest(26.9%)and the lowest(2.9%)prevalence of cystic echinococcosis cases were in the 16-30 and 1-15 years range,respectively.Male/female ratio was 0.96(49.1%vs.50.9%).The liver was affected in 92 patients(52.6%),and two or more organs were infected in 7 patients(4.0%).The cysts’diameter varied from 1 to 25 cm,and 96.0%of the patients had a single hydatid cyst.All patients underwent radical surgery and the PAIR technique was applied for all cases.No significant difference was observed between the protoscolex hooks of pulmonary and hepatic cysts.G1-G3 had the highest percentage(99.4%)over other identified G6 genotypes(0.6%).Conclusions:The sheep-dog cycle plays an important role in transmitting the human cystic echinococcosis infection in Tehran.

Multiple recurrent cystic echinococcosis with abdominal aortic involvement: A case report

BACKGROUND Recurrent cystic echinococcosis(CE)with vital organ involvement is a challenge for clinicians.Herein,we report a case of aortic involvement in recurrent retroperitoneal CE lesions following primary splenic CE resection.CASE SUMMARY A 60-year-old male was admitted due to progressive abdominal pain and poor appetite.He was diagnosed with multiple recurrent CE with abdominal aortic involvement according to preoperative evaluation.During surgical resection,major aortic bleeding accidentally occurred while dissecting the cyst,which was firmly attached to the abdominal aortic wall.Hemostasis attempts were conducted to deal with this emergency situation and maintain circulation.Postinterventional recovery was uneventful,and 2-year follow-up showed no sign of recurrence or any other complications.CONCLUSION Radical resection of recurrent complicated CE with aortic involvement should be carefully planned and performed to prevent possible severe adverse complications,thereby improving the postoperative outcome.

Identification of a gene engineering antibody against cystic echinococcosis in liver

OBJECTIVE: To identify a gene engineering antibody against cystic echinococcosis in liver. METHODS: A single chain of variable fragment of human antibodies (ScFvs) was selected from the library by using affinity selection technique with the recombinant antigen on solid surface. The positive clones were demonstrated by ELISA and their DNA sequences were also determined. RESULTS: The DNA sequence data showed that the antibody gene is composed of 768bp. In addition, a specific combination capacity with recombinant Echinococcus granulosus antigen B (r-EgB) was demonstrated by ELISA. CONCLUSION: The obtained gene engineering antibody against r-EgB may have potential implications in immunological treatment and drug targeting delivery.

Incurable and refractory spinal cystic echinococcosis: A case report

BACKGROUND Although the incidence and cure rate of spinal hydatidosis are low,the recurrence rate of spinal hydatidosis is high,and the prognosis of spinal hydatidosis is poor.Therefore,we report a typical case of refractory spinal hydatidosis to increase spine surgeons’awareness of the disease and reduce misdiagnosis and recurrence.CASE SUMMARY A 48-year-old man presented with back pain,significant weight loss,and paralysis of both lower limbs.The patient was misdiagnosed with spinal tuberculosis in an outside hospital.However,spinal magnetic resonance imaging(MRI)showed hyperintense cystic components on T2-weighted images and hypointensity on T1-weighted images.A lobulated,multiocular,honeycombappearance,septated cystic mass protruding intraspinally and compressing the spinal cord at segments T8–T9 was present.Paravertebral polycystic lobular lesions presented as a“bunch of grapes”.The ELISA test result for Echinococcus granulosus was positive.Then,a diagnosis of spinal hydatidosis and lung hydatid disease was made,and the patient underwent left transthoracic approach lobectomy,paravertebral lesion debridement,and subtotal vertebrectomy with vertebral body replacement of segments T8 and T9 by a mesh cage.The patient also underwent albendazole chemotherapy before and after surgery.One year after stopping the drug therapy,the patient developed recurrent T5 vertebral lesions and underwent a second subtotal vertebrectomy surgery.The patient is currently in good condition and is receiving long-term medication and follow-up.CONCLUSION The MRI feature of a“bunch of grapes”is a typical imaging indication of spinal hydatidosis.Subtotal vertebrectomy is a risk factor for postoperative recurrence.Total spondylectomy makes it possible to cure spinal hydatidosis,but antiparasitic drug therapy is also an important supplementary therapy to multimodal therapy.It is preferable for patients with spinal hydatidosis to receive life-long antiparasitic medication therapy and follow-up.

Effects of 1-(2-chlorine)-phenyl-9-butyl-β-carboline(DH-330)on Cystic Echinococcosis in Mice in vivo

[Objectives]The paper was to evaluate the in vivo treatment efficacy of harmine derivative 1-(2-chloro)phenyl-9-butyl-β-carboline(DH-330)on mice cystic echinococcosis(CE).[Methods]Kunming mice were injected intraperitoneally into the protoscoleces and infected with secondary infection for 8 months to prepare CE model.The successfully modeled mice were randomly divided into 6 groups according to their body weight:model group,control-1,-2 groups and experimental-L,-M,-H groups,with 10 mice in each group.The model group was given distilled water and control-1,-2 groups were given 50 mg/kg albendazole and harmine,respectively.The experimental-L,-M,-H groups were given 25,50 and 100 mg/kg DH-330.After 8 weeks of intragastric administration,the mice were dissected and vesicles were taken,and the differences of cyst weight were compared.The ultrastructure changes of cysts were observed by transmission electron microscope(TEM).The histopathology of cysts and liver were observed by hematoxylin-eosin(HE)staining method.[Results]The cyst weight of model group,control-1,-2 groups and experimental-L,-M,-H groups were(34.38±4.32),(11.38±2.37),(15.89±1.31),(16.22±2.30),(11.69±2.95)and(9.78±1.14)g,respectively.Compared between drugs group and model group,the difference was significant(all P<0.05);compared between experimental-H group and harmine group,the difference was significant(P<0.05).Except for the model group and experimental-L group,all other groups can damage the hydatid nuclei,which lead to cell lysis and nucleoli disappear.Experimental groups can improve inflammatory cells infiltration in liver and vesicle.[Conclusions]DH-330 can reduce the cysts weight of CE mice,inhibit the growth of hydatid,and improve the inflammation of the liver and vesicles,showing a good resistance against Echinococcus granulosus,or may become an effective new drug against hydatid disease.

Evaluation of Usefulness of Three Serological Tests Using Native Crude Antigen in Diagnosis of Hepatic Cystic Echinococcosis Patients

Objective: To evaluate three different serological tests [Indirect Hemaglutination (IHA), Enzyme Linked Immunosorbent Assay (ELISA) and Western Blotting (WB)] using native crude antigen for diagnosis of hepatic cystic echinococcosis (HCE) patients. Materials and Methods: Sheep hydatid fluid (HF) was collected from fertile cysts obtained from a slaughterhouse and used as an antigen. Forty patients who were attended the Dr. Ersin Arslan Training and Research Hospital in Gaziantep, Turkey, were investigated. Serum samples were obtained from surgically confirmed CE patients. Healthy Turkish people and 16 patients with other helminthic infections were included as a control group. Results: Of the 40 analyzed patients, 10 (25%) were men and 30 (75%) were female. The average age was 46.97 years (s.d.;18.95). The majority of the patients had a single cystic lesion situated in one lobe of the liver (usually in the right lobe) (55%), 32.5% of patients had two cystic lesions and 12.5% of patients had multiple cyst formations with various numbers. In all cases, ultrasound (US) examinations were positive and the size of cysts was between 2.1 - 12.7 cm. Twenty-three patients of the total 40 patients were classified according to the WHO classification system based on US findings. According to the results of WB analysis, molecular weights of 8 kDa (80%), 12 kDa (80%), 22 - 24 kDa (97.5%), 26 kDa (97.5%), 34 kDa (100%), 36 - 38 kDa (90%), 45 - 50 - 55 kDa (97.5%), and 60 - 75 kDa (97.5%) bands were identified. But 34, 50, and 55 kDa bands were also found in other helminthic diseases. Conclusion: The specificity and sensitivity of three serological tests (IHA, ELISA and WB) using crude antigen were compared by diagnosing hepatic cystic echinococcosis patients. IHA and ELISA showed high sensitivity but low specificity. Western blotting showed low sensitivity but high specificity.

In vivo therapeutic effects of albendazole in combination with IFN-on cystic echinococcosis in mice

Objective:This study was aimed to evaluate the in vivo therapeutic effects of the combination of ABZ with interferon(IFN)-αon cystic echinococcosis(CE)in mice.Methods:After 5-month secondary infection with protoscolices,Balb/c mice were randomly divided into four groups:ABZtreated group,IFN-α-treated group,ABZ+IFN-αgroup and untreated control group.Drugs in different treated groups were respectively administered for 2 months.Blood was respectively taken from caudal veins in mice at treatment time points of 0 d,7 d,14 d,28 d,36 d,48 d and 60 d,in order to detect the changes in the level of antibodies in the serum.Mice were then sacrificed after the end of treatment,and related indicators were detected to evaluate the therapeutic effects.Results:In comparison with untreated control group(p<.01)and ABZ-treated group(p<.05),ABZ+IFN-αgroup showed a more significant decrease in the number of cysts,cyst size and cyst weight.After transmission electron microscopy(TEM)of the cysts in different treated groups,it was found that,there was an obvious change in cyst ultrastructure in ABZ+IFN-αgroup.ELISA experimental results showed that,in ABZ+IFN-αgroup,there was a significant decrease in IL-10 in serums and splenocytes(p<.01);In comparison with untreated control group,ABZ+IFN-αgroup showed a more significant decrease in the levels of IgE,IgG and its subtypes(p<.01).Conclusions:In this study,the combination of ABZ with IFN-αwas proved to be an effective CE treatment option.

Coinfection with hepatic cystic and alveolar echinococcosis with abdominal wall abscess and sinus tract formation:A case report

BACKGROUND Hepatic cystic and alveolar echinococcosis coinfections,particularly with concurrent abscesses and sinus tract formation,are extremely rare.This article presents a case of a patient diagnosed with this unique presentation,discussing the typical imaging manifestations of both echinococcosis types and detailing the diagnosis and surgical treatment experience thereof.CASE SUMMARY A 39-year-old Tibetan woman presented with concurrent hepatic cystic and alveolar echinococcosis,accompanied by abdominal wall abscesses and sinus tract formation.Initial conventional imaging examinations suggested only hepatic cystic echinococcosis,but intraoperative and postoperative pathological examination revealed the coinfection.Following radical resection of the lesions,the patient’s condition improved,and she was discharged soon thereafter.Subsequent outpatient follow-ups confirmed no recurrence of the hydatid lesion and normal surgical wound healing.Though mixed hepatic cystic and alveolar echinococcosis with abdominal wall abscesses and sinus tract formations are rare,the general treatment approach remains consistent with that of simpler infections of alveolar echinococcosis.CONCLUSION Lesions involving the abdominal wall and sinus tract formation,may require radical resection.Long-term prognosis includes albendazole and follow-up examinations.

Efficacy of radiotherapy for the treatment of cystic echinococcosis in naturally infected sheep

Background:Radiotherapy is commonly used to treat cancers.To date,there has been no study focusing on the effects of radiotherapy on hydatid disease in large animals.In this study,we aim to investigate the efficiency and safety of radiotherapy for treating hydatid disease caused by Echinococcus granulosus in naturally infected sheep.Methods:Ultrasound was used to screen naturally infected sheep in an echinococcosis endemic area in Xinjiang,China.A computer tomography(CT)scan confirmed the presence of hydatid cysts.Twenty sheep naturally infected with E.granulosus in the liver and/or lungs were randomly assigned into four groups receiving no irradiation,or X-ray irradiation of low(30 Gy),medium(45 Gy),and high dose(60 Gy),respectively.After three months of radiotherapy,a CT scan was performed to measure the changes in the cysts.The hepatic parasite cysts and host tissues were collected for histology and gene expression analysis.Results:In the animals subject to irradiation,no significant differences were observed in their appetite,daily activities,and weight before and after radiotherapy.Severe calcification was noticed in the cysts subject to a high dose of radiation compared with the groups subject to low and medium doses.Hematoxylin and eosin staining showed that irradiation contributed to the damage of the cyst structure and nucleus in the germinal layers.Quantitative PCR demonstrated that expression of TPX and HSP70 significantly decreased in a dose-dependent manner(P<0.05).The expression of the EPC1 decreased in the medium-and high-dose groups compared with the low-dose group(P<0.05).Meanwhile,the expression of radiation-related apoptosis genes caspase-3 and Gadd45 decreased with an increase in the irradiation dose.Conclusions:Radiotherapy is an option with satisfactory efficiency and safety for treating cystic echinococcosis in sheep with partial response or stable disease at month 3.In future,inhibition of cystic activity using radiotherapy may serve as a new regimen for treating hydatid disease.

Knowledge, attitudes and practices with regard to the presence, transmission, impact, and control of cystic echinococcosis in Sidi Kacem Province, Morocco

Background:This study is a component of a large research project on five major neglected zoonotic diseases(NZDs)including cystic echinococcosis and was undertaken in the Province of Sidi Kacem over a period of four years(April 2009-March 2013).Methods:Questionnaires were administered at community level in a total of 27 communes and visits were made to all of the 10 abattoirs situated in the Province,to collect qualitative data on determinants of transmission for disease in humans and animals.More specifically,community knowledge,attitudes and practices related to cystic echinococcosis were assessed,as well as the extent to which local customs and behaviours may promote transmission.Abattoir infrastructure and practices,and their role in perpetuating disease transmission were also critically evaluated.Results:The results show that only 50%of people have heard of the disease,and of those,only 21%are aware of the dog’s role in disease transmission.Sixty-seven per cent of respondents stated that dogs are fed ruminant organs deemed unfit for human consumption.Owned dogs have access to the family home,including the kitchen,in 39%of households.The extent of this close proximity between humans and animals is even more pertinent when one considers that dogs are omnipresent in the community,with an average of 1.8 dogs owned per household.The unrestricted access of dogs to abattoirs is a huge issue,which further promotes disease transmission.Conclusion:This study would suggest that the high prevalence of cystic echinococcosis in humans and animals in Morocco is largely due to three factors:1)abundance of dogs 2)engagement in risky behaviour of the local population and 3)poor abattoir infrastructure and practices.This has serious implications in terms of the socio-economic impact of the disease,especially for rural poor communities.

Dynamic modeling and optimal control of cystic echinococcosis

Background:Cystic echinococcosis is one of the most severe helminth zoonosis with a drastic impact on human health and livestock industry.Investigating optimal control strategy and assessing the crucial factors are essential for developing countermeasures to mitigate this disease.Methods:Two compartment models were formulated to study the dynamics of cystic echinococcosis transmission,to evaluate the effectiveness of various control measures,and to find the optimal control strategy.Sensitive analyses were conducted by obtaining PRCCs and contour plot was used to evaluate the effect of key parameters on the basic reproduction number.Based on forward-backward sweep method,numerical simulations were employed to investigate effects of key factors on the transmission of cystic echinococcosis and to obtain the optimal control strategy.Results:The food resources of stray dog and invalid sheep vaccination rate,which are always neglected,were significant to the transmission and control of cystic echinococcosis.Numerical simulations suggest that,the implementation of optimal control strategy can significantly reduce the infections.Improving the cost of health education and domestic dog deworming could not decrease human infections.Conclusions:Our study showed that only a long-term use of the optimal control measures can eliminate the disease.Meanwhile,during the intervention,sheep vaccination and stray dogs disposing should be emphasized ahead of domestic dogs deworming to minimize the control cost.Simultaneously reducing other wild intermediate hosts and strengthening the sheep vaccination as well as disposing the stray dogs would be most effective.

Community survey, treatment and long-term follow-up for human cystic echinococcosis in northwest China

Background Human cystic echinococcosis （CE） is a parasitic zoonosis of major public health importance throughout the world. CE is endemic throughout central Asia including northwestern China. In China, CE has been reported in 21 provinces, autonomous regions and municipalities, covering approximately 87% of China＇s territories. It is most common in the pastoral and semi-pastoral western provinces and regions. This study aimed to reveal the natural history, curative effect and possible re-infection risk factors of human CE through long termed follow-up of treated and untreated CE cases in Hobukesar, Xingjiang, China.Methods Follow-up studies on CE were performed twice in Hobukesar from August 2005 to October 2008, after an initial mass screening performed in 1995 and 1996. Ultrasound scan was the primary diagnostic method.Results Among 24 patients with confirmed CE, 22 were treated （surgery in 19 and chemotherapy in three）. Two recurrent cases and one re-infection case were subsequently found during follow-up. The CE type of one of the recurrent cases reverted from CE4 to CE3, as classified using World Health Organization （WHO） guidelines.Conclusions Ultrasound was required to differentiate primary, recurrent and re-infection cases during epidemiological investigation and follow-up of CE. Most patients did not change their habits, which may be one possible cause of reinfection. One recurrent case suggested that, despite initial suggestion from the WHO Informal Working Group on Echinococcosis, CE4-type cysts are not inactive.

Knowledge,attitudes and practices related to cystic echinococcosis endemicity in Pakistan

Background:Cystic echinococcosis(CE)is a human and animal health problem in many endemic areas worldwide.It is considered a neglected zoonotic disease caused by the larval form(hydatid cyst)of Echinococcus spp.tapeworm.There are limited studies on echinococcosis in Pakistan.Methods:A cross-sectional survey was conducted to find out recent knowledge,attitudes and practices on the occurrence of cystic echinococcosis in butchers and dog owners in both urban and rural areas of Rawalpindi/Islamabad regions,Pakistan.The quantitative data was collected in the form of questionnaires to investigate the knowledge and awareness of CE among community members and their routine practices that were behind the factors involved in hydatid cyst infection.The practices and infrastructure of abattoirs/butcher shops and their role in transmission of cystic echinococcosis were also evaluated in the present study.Results:The participants involved in the study were dog owners and people who kept animals.A total of 400 people were interviewed and 289 questionnaires were received.The results showed that only 4.1%of people have heard about the disease,and 58.1%were closely associated with dogs.Sixty-three percent of dogs in study area were consuming uncooked organs(e.g.liver,lung,etc.)of slaughtered animals,while 100%of dogs at butcher shops were consuming uncooked organs.Home slaughtering was common in 20.06%.Among butchers,32.3%had heard about zoonoses and 7.61%knew about CE.The statistical analysis showed that there was highly significant difference(P<0.05)among most of the practices that were associated with the prevalence of CE.Conclusions:It was concluded from the present study that,the knowledge and awareness of CE among people of Rawalpindi/Islamabad were low.Because of dogs and poor knowledge of CE among community members and butchers,the transmission of echinococcosis is facilitated.Therefore,there is urgent need to strengthen awareness and health education among people,as well as proper practices related to the CE not only in the study area,but also in other areas of Pakistan.

A molecular survey on cystic echinococcosis in Sinnar area, Blue Nile state （Sudan）

Background Cystic echinococcosis （CE） is a zoonosis caused by the cestodes of the Echinococcus species. Its life cycle involves dogs and other canids as definitive hosts for the intestinal tapeworm, as well as domestic and wild ungulates as intermediate hosts for the tissue-invading metacestode （larval） stage. The disease has a special impact on disadvantaged pastoralist communities and is listed now among the three top priority neglected tropical disease （NTD）. Therefore, CE is a neglected disease even in high endemicity regions. This study aimed at investigation of the prevalence of CE in different animals slaughtered for food consumption in Sinnar area, Blue Nile states in Sudan. Methods A survey of CE in livestock was conducted from April 2009 to March 2011 in Sinnar area, Blue Nile state in Sudan. Location, parasitological status and fertility conditions were determined. In addition, 120 hydatid cysts （30 from camels, 62 from cattle and 28 from sheep） were examined by polymerase chain reaction （PCR） and mitochondrial gene sequencing for the genetic allocation of Echinococcus strains or species Results The prevalence of CE was 29.7% （30/101） in camels, 2.7% （62/2310） in cattle and 0.6% （26/4378） in sheep. It was shown that infection rates increased with age in camels, cattle and sheep. In camels, 67% （20/30） of the infected animals were aged between 2-5 years whereas 58% （36/62） of the infected cattle were 〉5 years. In sheep, the prevalence rate was distributed equally between animals ranging 2-5 years and 〉5 years. Even though multiple cysts were found in some animals, the average number of cysts per animal was close to 1 in all examined species. Lungs were found to be the predilection sites for the parasite in both camels and cattle, while most of the cysts found in sheep were located in the liver. About 63.4% of cysts encountered in camels were considered as large （5-7 cm）, whereas those in cattle and sheep were medium （2-4 cm） and small （〈2 cm） respectively. The highest fertility rate was found in camel cysts with 85.4% （35/41） followed by cattle （50.0%, 32/64） and sheep （39.0%, 11/28）. All examined cysts belonged to Echinococcus canadensis G6, which was confirmed to be the overwhelmingly predominant species in that area. Conclusion The epidemiological situation in Sinnar area, Blue Nile state is characterized by intense transmission of Echinococcus canadensis G6, thereby closely resembling the situation in most other regions of Sudan.

Breaking-then-curing strategy for efficient cystic echinococcosis therapy

Cystic echinococcosis(CE)is one of the most harmful and life-threatening helminths.As the essential therapeutics,chemotherapy is always difficult to achieve desired anti-echinococcal effect due to the problems that the echinococcus granulosus cyst laminated layer makes the drug difficult to infiltrate and the poor solubility of drugs.In this study,we established a“breaking-then-curing”anti-echinococcal treatment strategy for efficient CE therapy.The photodynamic therapy(PDT)was used as a breaker to produce toxic reactive oxygen species(ROS)and damage the laminated layer of protoscolices(PSCs),leading to enhanced infiltration of albendazole sulfoxide nanoparticles(ABZSO NPs).Then,ABZSO NP was worked as curer for efficient anti-echinococcal treatment.As a result,the breaking-then-curing treatment strategy could generate more intracellular ROS in PSCs induced by plenty of ABZSO NPs,greatly increasing the mortality rate of PSCs in a shorter time than using ABZSO NPs alone,leading to the attenuation of laminated layer and finally disintegrating PSCs.We believe the“breaking-then-curing”strategy will suggest great potential in the treatment of CE and provide a new sight for anti-echinococcal treatment.