medigraphic.com
Órgano Oficial de la Asociación Mexicana de Hepatología

2013, Number 4

<< Back Next >>

Ann Hepatol 2013; 12 (4)

Unexpected discovery of massive liver echinococcosis. A clinical, morphological, and functional diagnosis

Bonfrate L, Giuliante F, Palasciano G, LaMont JT, Portincasa P

Language: English
References: 40
Page: 466-473
PDF size: 399.48 Kb.


ABSTRACT

We report a case of symptomatic massive liver echinococcosis due to Echinococcus granulosus, unexpectedly found in a 34 year old woman living in Apulia, Italy. Based on size (max diameter 18 cm), clinical presentation, geographical area, and natural history of echinococcosis, we estimate that the initial infection should have occurred 9-20 yrs before. Presenting symptoms were those of typical mass effect with RUQ pain, pruritus, malaise, and recent weight loss. Abdominal ultrasound diagnosis of probable echinococcal cyst was subsequentely confirmed by positive serology and further detailed by radiological imaging. The cyst was massively occupying subdiaphragmatic liver segments and extending to the omentum and the stomach. The characteristics of the lesion were compatible with the WHO 2003 classification type CE2l, indicating a large active fertile cyst with daughter cysts. The cyst was successfully treated with medical therapy followed by surgery. The prevalence, diagnostic workup, management, and costs of echinococcosis are discussed in this case presentation.


REFERENCES

  1. Nunnari G, Pinzone MR, Gruttadauria S, Celesia BM, Madeddu G, Malaguarnera G, Pavone P, et al. Hepatic echinococcosis: clinical and therapeutic aspects. World J Gastroenterol 2012; 18: 1448-58.

  2. Geographic distribution and prevalence [computer program]. 2001.

  3. Jenkins DJ, Romig T, Thompson RC. Emergence/re-emergence of Echinococcus spp.—a global update. Int J Parasitol 2005; 35: 1205-19.

  4. McManus DP, Thompson RC. Molecular epidemiology of cystic echinococcosis. Parasitology 2003; 127(Suppl.): S37- S51.

  5. Thompson RC, McManus DP. Towards a taxonomic revision of the genus Echinococcus. Trends Parasitol 2002; 18: 452-7.

  6. Zhang W, Li J, McManus DP. Concepts in immunology and diagnosis of hydatid disease. Clin Microbiol Rev 2003; 16: 18-36.

  7. Archer GT, Robson JE, Thompson AR. Eosinophilia and mast cell hyperplasia induced by parasite phospholipid. Pathology 1977; 9: 137-53.

  8. Vuitton DA. Echinococcosis and allergy. Clin Rev Allergy Immunol 2004; 26: 93-104.

  9. Atli M, Kama NA, Yuksek YN, Doganay M, Gozalan U, Kologlu M, Daglar G. Intrabiliary rupture of a hepatic hydatid cyst: associated clinical factors and proper management. Arch Surg 2001; 136: 1249-55.

  10. Kammerer WS, Schantz PM. Echinococcal disease. Infect Dis Clin North Am 1993; 7: 605-18.

  11. Brunetti E, Kern P, Vuitton DA. Expert consensus for the diagnosis and treatment of cystic and alveolar echinococcosis in humans. Acta Trop 2010; 114: 1-16.

  12. Portincasa P, Grattagliano I, Lauterburg BH, Palmieri VO, Palasciano G, Stellaard F. Liver breath tests non-invasively predict higher stages of non-alcoholic steatohepatitis. Clin Sci (Lond) 2006; 111: 135-43.

  13. Grattagliano I, Lauterburg BH, Palasciano G, Portincasa P. (13)C-breath tests for clinical investigation of liver mitochondrial function. Eur J Clin Invest 2010.

  14. Dakkak A. Echinococcosis/hydatidosis: a severe threat in Mediterranean countries. Vet Parasitol 2010; 174: 2-11.

  15. Grosso G, Gruttadauria S, Biondi A, Marventano S, Mistretta A. Worldwide epidemiology of liver hydatidosis including the Mediterranean area. World J Gastroenterol 2012; 18: 1425-37.

  16. Gabriele F, Bortoletti G, Conchedda M, Palmas C, Ecca AR. Human cystic hydatidosis in Italy: a public health emergency? Past to present. Parassitologia 2004; 46: 39-43.

  17. Wang Y, Zhang X, Bartholomot B, Liu B, Luo J, Li T, Wen X, et al. Classification, follow-up and recurrence of hepatic cystic echinococcosis using ultrasound images. Trans R Soc Trop Med Hyg 2003; 97: 203-11.

  18. Gharbi HA, Hassine W, Brauner MW, Dupuch K. Ultrasound examination of the hydatic liver. Radiology 1981; 139: 459-63.

  19. International classification of ultrasound images in cystic echinococcosis for application in clinical and field epidemiological settings. Acta Trop 2003; 85: 253-61.

  20. Hosch W, Junghanss T, Stojkovic M, Brunetti E, Heye T, Kauffmann GW, Hull WE. Metabolic viability assessment of cystic echinococcosis using high-field 1H MRS of cyst contents. NMR Biomed 2008; 21: 734-54.

  21. Zhang W, McManus DP. Recent advances in the immunology and diagnosis of echinococcosis. FEMS Immunol Med Microbiol 2006; 47: 24-41.

  22. Ito A. Serologic and molecular diagnosis of zoonotic larval cestode infections. Parasitol Int 2002; 51: 221-35.

  23. Liu D, Rickard MD, Lightowlers MW. Assessment of monoclonal antibodies to Echinococcus granulosus antigen 5 and antigen B for detection of human hydatid circulating antigens. Parasitology 1993; 106(Pt. 1): 75-81.

  24. Ortona E, Rigano R, Margutti P, Notargiacomo S, Ioppolo S, Vaccari S, Barca S, et al. Native and recombinant antigens in the immunodiagnosis of human cystic echinococcosis. Parasite Immunol 2000; 22: 553-9.

  25. Poretti D, Felleisen E, Grimm F, Pfister M, Teuscher F, Zuercher C, Reichen J, et al. Differential immunodiagnosis between cystic hydatid disease and other cross-reactive pathologies. Am J Trop Med Hyg 1999; 60: 193-8.

  26. Portincasa P, Grattagliano I, Palmieri VO, Palasciano G. Nonalcoholic steatohepatitis: recent advances from expe rimental models to clinical management. Clin Biochem 2005; 38: 203-17.

  27. Palmieri VO, Grattagliano I, Minerva F, Pollice S, Palasciano G, Portincasa P. Liver function as assessed by breath tests in patients with hepatocellular carcinoma. J Surg Res 2009; 157: 199-207.

  28. Grattagliano I, de Bari O, Bernardo TC, Oliveira PJ, Wang DQ, Portincasa P. Role of mitochondria in nonalcoholic fatty liver disease-from origin to propagation. Clin Biochem 2012.

  29. Junghanss T, da Silva AM, Horton J, Chiodini PL, Brunetti E. Clinical management of cystic echinococcosis: state of the art, problems, and perspectives. Am J Trop Med Hyg 2008; 79: 301-11.

  30. Saimot AG. Medical treatment of liver hydatidosis. World J Surg 2001; 25: 15-20.

  31. Buttenschoen K, Carli BD. Echinococcus granulosus infection: the challenge of surgical treatment. Langenbecks Arch Surg 2003; 388: 218-30.

  32. Filice C, Brunetti E. Use of PAIR in human cystic echinococcosis. Acta Trop 1997; 64: 95-107.

  33. da Silva AM. Human echinococcosis: a neglected disease. Gastroenterol Res Pract 2010; 2010.

  34. Brunetti E, Filice C. Radiofrequency thermal ablation of echinococcal liver cysts. Lancet 2001; 358: 1464.

  35. Falagas ME, Bliziotis IA. Albendazole for the treatment of human echinococcosis: a review of comparative clinical trials. Am J Med Sci 2007; 334: 171-9.

  36. Teggi A. An up-to-date on clinical management of human cystic echinococcosis. Parassitologia 2004; 46: 405-7.

  37. Matossian RM, Awar GN, Radwan H, Craig PS, Meshefedjian GA. Immune status during albendazole therapy for hydatidosis. Ann Trop Med Parasitol 1992; 86: 67-75.

  38. Gauci C, Heath D, Chow C, Lightowlers MW. Hydatid disease: vaccinology and development of the EG95 recombinant vaccine. Expert Rev Vaccines 2005; 4: 103-12.

  39. Zhang W, McManus DP. Vaccination of dogs against Echinococcus granulosus: a means to control hydatid disease? Trends Parasitol 2008; 24: 419-24.

  40. Petavy AF, Hormaeche C, Lahmar S, Ouhelli H, Chabalgoity A, Marchal T, Azzouz S, et al. An oral recombinant vaccine in dogs against Echinococcus granulosus, the causative agent of human hydatid disease: a pilot study. PLoS Negl Trop Dis 2008; 2: e125.




2020     |     www.medigraphic.com