Cases reported "Echinococcosis, Hepatic"

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1/7. Cystic echinococcosis in a Jordanian patient: albendazole in a short-term immigrant.

    With an ever increasing number of international travelers, physicians should be aware of the diseases that have rarely been encountered in their home countries. Cystic echinococcosis (CE) caused by echinococcus granulosus is seldom seen in japan despite frequent occurrence of the other type of echinococcosis, alveolar echinococcosis (AE) caused by E. multilocularis, in its northern parts. However, CE is prevalent in many parts of the world including the United Kingdom, Mediterranean basin, middle east, south america, and australia, and is supposed to be resurgent in several parts of the world. The disease is acquired by the oral ingestion of the eggs of E. granulosus passed into the feces of several definitive host animals carrying tapeworms, mostly dogs. These definitive hosts are infected by cannibalizing intermediate host animals including sheep and cattle whose livers and/or lungs are affected by cystic lesions that contain protoscoleces. In endemic areas the diagnosis of CE is not considered to be complicated; typical morphological features composed of cysts as revealed by ultrasonography and/or computerized tomography (CT) scan. The diagnosis is also aided by serological methods detecting serum antibodies. However, imaging procedures show a variety of features that could often lead to misdiagnosis as other diseases. Moreover, serological assays are sometimes difficult to interpret because of their incomplete sensitivities and specificities. Hence, a comprehensive understanding of a spectrum of imaging features and the application of serological methods with better sensitivities and specificities are indispensable. The mainstay of treatment of the disease is still surgical removal of cysts that has the potential to lead to a complete cure. Recently, the less invasive method PAIR (Puncture of cysts percutaneously, Aspiration of fluid, Introduction of protoscolicidal agent, and Reaspiration) was introduced with considerable success, and could be a promising alternative to surgery. Lastly, medical treatment with oral mebendazole or albendazole, especially the latter, can be beneficial not only as a adjunctive to surgery or PAIR, but as a sole treatment in cases in which invasive methods are not indicated. Here we report a Jordanian patient with CE whose diagnosis was substantiated by a novel immunoblot assay and who showed a rapid improvement during albendazole therapy.
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2/7. Hydatid cyst of the uterus.

    BACKGROUND: Hydatidosis is a common zoonosis that affects a large number of humans and animals, especially in poorly developed countries. The infesting parasite has four forms named Echinococcus granulosis, E. multilocularis, E. vogeli and E. oligarthrus (very rare in humans). The most frequently involved organs are liver followed by the lung. The involvement of the genital tract is rare and the occurrence in the uterus is an extreme rarity. We report a case of hydatid cyst in the uterus. CASE: A 70-year-old female with a history of hydatid cysts of the liver, was admitted to hospital after complaining of low abdominal pains. On physical and gynecological examinations, no pathological finding was detected. However, the uterus was significantly large for a postmenopausal patient. Transvaginal sonography (TS) revealed a cystic mass in the uterus with a size of 7 x 6 cm. After further examinations a subtotal hysterectomy was performed. Microscopic examination showed scolices of Echinococcus granulosis. CONCLUSION: Hydatid cysts in the genital tract are rare and the occurrence in the uterus is an extreme rarity. Differentiation between hydatid cyst and malignant disease of the related organ is difficult. To avoid misdiagnosis, a careful examination of pelvic masses should be carried out in endemic areas for detection of hydatid cysts.
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3/7. Glimpses of a hidden burden: hydatid disease in eighteenth-century scotland.

    "Hydatids" or watery cysts have been observed in animals and humans since ancient times, giving rise to frequent speculation as to their nature and origin. This essay focuses on an extremely rare clinical case managed at the Edinburgh Infirmary in 1785 by James Gregory, professor of the theory of medicine. Following the death of the patient, an autopsy disclosed lesions characteristic of a condition eventually labeled "echinococcosis of the liver," today one of the most common parasitic diseases in sheep raising regions of the world. The essay reviews the obscure nature of this endemic disease in Gregory's time, and the difficulties confronting scientists and clinicians keen to unravel its secrets.
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4/7. albendazole therapy in alveolar hydatid disease: a report of favorable results in two patients after short-term therapy.

    albendazole was administered preoperatively to two patients with active alveolar hydatid disease for 58 and 84 days. Vesicles of larval echinococcus multilocularis obtained from surgical tissues were inoculated into red-backed voles for in vivo testing viability. No proliferation of the larval cestode had occurred when the animals were dissected three months post-inoculation. These findings suggest that short-term therapy with albendazole was effective in killing the larval cestode in these two cases. albendazole was found to be hepatotoxic but resulting transaminase abnormalities have been reversible. Close monitoring of liver function and hematology is essential in patients under albendazole therapy.
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5/7. mebendazole treatment of echinococcus granulosus infection. Report of a case.

    A patient with an echinococcus granulosus cyst of the liver was treated with mebendazole for 94 days before operation. The serum levels of mebendazole varied from 39.4-274 ng/ml. After operation, cyst materials were inoculated into mice which developed hydatid cysts 10 months later. intestinal absorption of mebendazole is poor and variable, and determination of serum concentrations is necessary during treatment. No apparently successful cases of drug treatment of E. granulosus infection have been verified by animal inoculation of cyst material; therefore, surgery must still be considered the treatment of choice. It is recommended that mebendazole be given prophylactically to prevent spread of the disease at operation.
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6/7. Issues in clinical parasitology: the management of hydatid cyst.

    Echinococcal or hydatid cyst is not commonly seen in the united states; however, two cases were seen within a 6-month period at a southern teaching hospital, and it is endemic in many areas of the world. The causative organism, echinococcus granulosus, is a tapeworm of dogs; the normal intermediate hosts are hoofed animals. When man becomes infected enlarging cysts in the liver, lung, nervous system, or peritoneum may cause considerable morbidity. While surgery traditionally has been the treatment of choice, in the past few years the usage of high doses of mebendazole has been suggested as a possible alternative. This review describes two cases and the recent literature regarding the use of mebendazole as therapy for hydatid disease.
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7/7. Alveolar hydatid disease in minnesota. First human case acquired in the contiguous united states.

    A 56-year-old woman from southwestern minnesota underwent an extended left hepatic lobectomy to remove a large multinodular mass with a necrotic central cavity. The clinical, serological, and pathological findings led to the diagnosis of alveolar hydatid disease, and specific identification of echinococcus multilocularis was achieved by growing mature larvas in voles inoculated intraperitoneally with tissue from the hepatic lesions. The patient probably acquired her infection some years previously from pet cats or dogs that had become infected by ingesting infected rodents. In north america E multilocularis is enzootic in the northern tundra zone of alaska and canada. Since 1964 the cestode has been recognized with increasing frequency in several north-central states, including minnesota. The parasite may extend its range farther south, since suitable animal hosts occur throughout the united states.
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