Cystic echinococcosis in Tunisia: analysis of hydatid cysts that have been surgically removed from patients

Abstract

Echinococcosis/hydatidosis caused by Echinococcus granulosus has a widespread distribution in the human population of Tunisia, particularly in the north-west and centre-west of the country. In a recent study, the morphological features, fertility and viability of hydatid cysts that had been excised from patients in Tunis were explored, and the E. granulosus strain or genotype involved in each case was identified from morphology of the protoscolex hooks and the results of molecular genotyping. The hepatic cysts investigated came from 41 patients [31 women and 10 men, with a mean (S.E.) age of 43.41 (14.25) years] who were treated for cystic echinococcosis, by surgery but rarely with chemotherapy, at the La Rabta Hospital in Tunis, in the 12 months ending in June 2008. Most (56%) of these patients originated from rural areas in endemic governorates. Of the 60 hepatic cysts that were studied, 38.3% were located in the right lobe of the liver and 35.0% each involved both hepatic lobes. Almost a third (31.7%) of the excised cysts were degenerating, with the rest considered viable and either multivesicular (38.3%) or univesicular (30.0%). Almost all (93.3%) of the cysts were categorized as fertile, with a mean protoscolex viability of 21.8%. Protoscolex viability was relatively high in the viable univesicular cysts with a visible cyst wall and in the multivesicular and multiseptate cysts with daughter cysts, and lowest in the cysts that appeared to be solid calcified masses. The observed variation in protoscolex viability with cyst type, in cysts excised from patients before any chemotherapy, supports the cyst classification recommended by the World Health Organization but could also be compatible with the imaging-based 'Gharbi' classification. The results of the molecular genotyping showed that all 23 cysts investigated (which came from 20 of the patients) were caused by E. granulosus of the G1 genotype (also known as the 'sheep' or 'sheep-dog' strain).

Knowledge, Attitudes, and Practices of 50 Patients with Surgically Treated Cystic Echinococcosis from Basrah Province, Iraq

“…Women may be more frequently exposed to the infection than men due to being involved with activities such as feeding dogs and preparing food for the family. A higher occurrence of CE in women has similarly been reported in other countries including Jordan, Tunisia, and Iran [19][20][21].…”

New insights of the local immune response against both fertile and infertile hydatid cysts

“…In the intermediate host, it is possible to find two different types of hydatid cysts: fertile hydatid cysts, in which PSC are attached to the germinal layer and free into the hydatid fluid. Fertile hydatid cyst PSC viability, that is, the percentage of live PSC, varies between 100% and 2,8% [13][14][15][16][17]. Contrarily, infertile hydatid cysts (also called sterile hydatid cysts [18][19][20][21][22][23]), have no PSC neither attached to the germinal layer nor floating free in the hydatid fluid, and thus are unable to continue with the parasite life cycle.…”

Histopathological changes associated with E. granulosus echinococcosis in food producing animals in Punjab (India)

“…Humans act as accidental intermediate hosts. Cystic echinococcosis (CE) is endemic in many countries across the world (Sakamoto et al 1987;Ghorui and Sahai 1989;Uysaler et al 1998;Yildiz and Tuncer 2005;Lahmar et al 2009). …”