Cystic Echinococcosis/Hydatid Cyst Coinfection with HIV: A Report from Shiraz, Iran

Abstract

HIV coinfected with other parasitic diseases may cause a serious problem for the patients. A few case reports describing echinococcosis with human immunodeficiency virus (HIV) infection have been reported in the world; however, it has not been reported in Iran, so far. Here, the first case of liver hydatid cyst coinfected with HIV in Iran is reported. The patient is a 46-year-old female HIV-positive based on the laboratory report. Her clinical symptoms included abdominal pain, abdominal enlargement, and anorexia. Ultrasound showed three large hepatic hydatid cysts with hundreds of daughter cysts. Ultrasonography of the cyst revealed it as a CE2 stage according to the WHO classification. The patient went under complete anesthesia followed by complete cyst removal by surgery. Observation of the hydatid cyst fluid using eosin 0.1% revealed more than 70% viable protoscoleces. Histopathology examination, polymerase chain reaction (PCR), and viable protoscoleces confirmed the diagnosis of echinococcosis. The IgG ELISA test with native AgB for E. granulosus infection was also positive. mtDNA amplification using PCR and sequencing showed the cyst as E. granulosus sensu stricto genotype. Our observations show that huge, large, and high-pressure cysts with hundreds of daughter cysts are difficult to be completely removed, and drug treatment has not been able to reduce their size. Therefore, in HIV coinfection with hydatid cyst, surgery is preferable to other treatments.

Equinococosis quística peritoneal diseminada en paciente con infección por VIH: reporte de caso

“…The most frequent symptom is abdominal pain 8 , which is almost always associated with complications due to the size of the cyst. In our case, the multicystic mass compressed multiple organs (stomach, intestines, ureters and bladder) due to its size; it also led to the appearance of symptoms such as anorexia, nausea and vomiting, similar to previous reports 8 - 12 . The patient presented stress incontinence and lower limb edema, which are considered to be rare symptoms.…”

“…The immunity mechanisms involved in the defense against echinococcosis are characterized by the activation of Th2 cells and a Th1 subset, which leads to the expression of immunoglobulin isotypes (IgG4 and IgE) and eosinophilia 19 . In our case, transient eosinophilia was found after surgery, which could have been due to the rupture of some cysts during surgical removal 12 , considering that the hystopathological study reported the presence of viable cysts.…”

“…On the contrary, our case showed an abrupt increase in the size of the cyst with increasingly worsening disease progression, due to gastric, intestinal and ureteral compression, concordant with a decrease in CD4+ T cells (55 cells/uL) during treatment with albendazole. These findings can be explained by the suppression of these cells by the parasitic infection 20 , which predisposes the uncontrolled proliferation of proto-scolices, accelerated growth and the formation of multiple cysts in HIV-positive patients with altered immunity 12 , and in this case, in a stage of acquired immunodeficiency syndrome (AIDS).…”

HIV and Mediterranean Zoonoses: A Review of the Literature

“…The vast majority of cases reported in the literature concerning infection of CE in PLWH confirms this data [ 117 , 118 , 119 , 120 , 121 , 122 , 123 ]: most of them had a full recovery after treatment. There are two cases of AE in seropositive patients [ 124 , 125 ], and a case of Echinococcus vogeli , causing polycystic echinococcosis [ 126 ].…”

Prevalence of Cystic Echinococcosis Genotypes in Iranian Animals: A Systematic Review and Meta-Analysis

“…Cystic echinococcosis (CE) is a common parasitic infection of humans and animals caused by the larva of 9pt?>Echinococcus granulosus sensu lato and cystic echinococcosis is a widespread zoonotic disease of global concern This disease has been reported in humans from all parts of Iran [1][2][3], and Cystic echinococcosis is considered an endemic chronic disease that is seen in many countries of the world [4]. Eurasia, Africa, Australia, and South America, obscenity is prevalent.…”