Parasites of the liver – epidemiology, diagnosis and clinical management in the European context

Peters, Lynn; Burkert, Sanne; Grüner, Beate

doi:10.1016/j.jhep.2021.02.015

Cited by 42 publications

(32 citation statements)

References 135 publications

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“…Diagnosis and classification of AE was performed using positive imaging, serology and histology and AE-case-definition according to criteria, which were established by the WHO Informal Working Group on Echinococcosis [ 28 ] as well as PNM–staging system (P = parasitic mass in the liver, N = involvement of neighbouring organs, and M = metastasis) [ 1 – 3 , 29 ], and most patients were re-examined regularly during follow-ups.…”

Section: Methodsmentioning

confidence: 99%

“…The application of imaging techniques for AE staging is essential. Ultrasound (US) and computed tomography (CT) were used to confirm alveolar echinococcosis [ 1 ], and magnetic resonance imaging (MRI) can provide a more differentiated diagnosis, to identify blood vessel structures before surgery [ 3 , 30 ]. Positron emission tomography (PET) or combined PET-CT was used to shows areas of high metabolic activity, which may indicate inflammatory reactions and possible activity of the parasite [ 31 ].…”

Section: Methodsmentioning

confidence: 99%

“…Alveolar echinococcosis (AE) is a severe disease caused by the cestode Echinococcus multilocularis , the fox tapeworm. The disease is most prominent in northwest China but also occurs in central Europe [ 1 ]. AE morbidity and treatment costs are high, with a lethal course if left untreated [ 2 – 5 ].…”

Section: Introductionmentioning

confidence: 99%

“…multilocularis larvae appear to have developed effective immune evasion mechanisms which facilitate an asymptomatic incubation and an extended host and parasite coexistence. The larvae may persist for decades exerting a progressive tissue invasive tumour-like growth [ 1 , 2 , 15 ], but few AE patients may present with a healing course of the disease. This diversity suggested immunological mechanisms which may control the course of AE.…”

Section: Introductionmentioning

confidence: 99%

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Echinococcus multilocularis specific antibody, systemic cytokine, and chemokine levels, as well as antigen-specific cellular responses in patients with progressive, stable, and cured alveolar echinococcosis: A 10-year follow-up

et al. 2022

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Background The infestation with Echinococcus multilocularis larvae may persist in humans for up to decades without evident clinical symptoms. Longitudinal investigations are needed to understand the dynamic immunological processes in alveolar echinococcosis (AE) patients associated with an active and progressive, a stable or a regressive course of disease. Methodology/Principal findings This study evaluated the E. multilocularis specific antibody responses, systemic cytokine, and chemokine serum levels over a 10-year follow-up period, as well as cellular responsiveness in AE patients. Our results demonstrate a rapid decrease in antibodies against E. multilocularis specific antigen Em2+. Especially in cured patients, these antibodies remained negative, making them a significant predictor for cured AE. E. multilocularis specific IgG4, and indirect hemagglutination IHA decreased later in time, after around 5 years. While total IgE did not show significant dynamics over the course of disease, E. multilocularis specific IgE decreased after one to two years, and increasing levels were a significant predictor of progressive disease. There was no significant change in systemic IL-8, IL-9, CCL18 or CCL20 serum levels over time. Univariate analysis across groups indicated lower IL-8 levels in cured patients; however, this result could not be confirmed by multivariate analysis. Levels of CCL17 decreased during treatment, especially in cured patients, and thus might serve as a predictive or risk factor for progressive disease. Levels of IL-10 and CCL13 decreased during disease, especially after five and ten years of intervention. The E. multilocularis antigen (EmAg) inducible cellular productions of MCP1(CCL13), TARC(CCL17) and PARC(CCL18) were lowest in patients with cured AE and infection-free controls, while the EmAg inducible cellular production of IFN-γ increased after cure. Significant positive cytokine and chemokine correlations were observed in AE patients for IL-9, IL-10, CCL13(MCP-4), CCL17(TARC) and CCL20(LARC)(for all p<0.001). E. multilocularis specific IgG4 response correlated positively with TARC (p<0.001). Both markers enhanced over time in progressive disease and decreased after cure. The levels of IL-8, IL-10, MCP4 and LARC enhanced with AE regression. Conclusions/Significance Repeated biomarker surveys are advisable to evaluate progression or regression of disease during longitudinal follow-up and such analyses can support imaging techniques and improve staging of AE patients.

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Section: Methodsmentioning

confidence: 99%

Section: Methodsmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

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Echinococcus multilocularis specific antibody, systemic cytokine, and chemokine levels, as well as antigen-specific cellular responses in patients with progressive, stable, and cured alveolar echinococcosis: A 10-year follow-up

et al. 2022

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“…Patients are frequently misdiagnosed as benign or malignant tumors or falsely identified as cystic echinococcosis (CE) and subsequently treated suboptimally [12]. Therefore, several recent studies have tried to put the disease back into the clinician's focus [13][14][15].…”

Section: Introductionmentioning

confidence: 99%

Alveolar Echinococcosis—A Challenging Task for the Hepatobiliary Surgeon

Strohaeker

Sulyok²,

Koenigsrainer

et al. 2021

Pathogens

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(1) Background: Alveolar echinococcosis (AE) is an ultimately fatal disease, whose only curative treatment is surgery. Due to its late presentation extended liver resections are often necessary. The true benefit of extensive surgery has yet to be established; (2) Methods: We present a single center experience of 33 cases of Echinococcus multilocularis that have been treated at a high-volume hepatobiliary surgery center between 2004 and 2021. (3) Results: Of the 33 patients 24 patients underwent major liver resection (73%). In addition to the liver resection patients frequently underwent complex extrahepatic procedures such as lymphadenectomy (n = 21, 61%), vascular resections and reconstructions (n = 9, 27%) or resections and reconstruction of the extrahepatic bile duct (n = 11, 33%). Seven patients suffered from ≥ grade III complications (21%). Complete resection was achieved in 17 patients. Fourteen patients had R1 resections and two had macroscopic parasitic remnant (R2). Progressive disease was reported in three patients (The two R2 patients and one R1 resected patient). At a median follow-up of 54 months no mortality has occurred in our cohort; (4) Conclusions: Liver resection remains the gold standard for AE. Even in extensive disease the combination of complex resection and perioperative benzimidazoles can achieve favorable long-term outcomes.

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Statins associate with lower risk of biliary tract cancers: A systematic review and meta‐analysis

et al. 2022

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Background Biliary tract cancers (BTCs), encompassing cholangiocarcinoma (CCA), gallbladder (GBC), and ampulla of Vater cancers (AVC), are common hepatobiliary cancer after hepatocellular carcinoma with a high mortality rate. As there is no effective chemopreventive agent to prevent BTCs, this study aimed to explore the role of statins on the risk of BTCs. Methods PubMed, Embase, and Cochrane Library from inception until 24 April 2020 were searched according to the Meta‐Analyses of Observational Studies in Epidemiology (MOOSE) guidelines. The adjusted risk ratios (aRRs) of BTCs and individual cancer were pooled using a random‐effects model. Results Eight observational studies (3 cohort and 5 case–control studies) were included with 10,485,231 patients. The median age was 68.0 years (IQR: 67.0–71.5) and 48.3% were male. Statins were associated with a lower risk of all BTCs (aRR: 0.67; 95% CI: 0.51–0.87). The pooled aRR for CCA was 0.60 (95% CI: 0.38–0.94) and GBC was 0.78 (95% CI: 0.68–0.90). There was only one study on AVC with aRR of 0.96 (95% CI: 0.66–1.41). The pooled aRR for lipophilic and hydrophilic statins was 0.78 (95% CI: 0.69–0.88) and 0.70 (95% CI: 0.61–0.80), respectively. The effects were attenuated in studies that adjusted for aspirin and/or non‐steroidal anti‐inflammatory drugs (aRR: 0.80, 95% CI: 0.72–0.89) and metformin (aRR: 0.80, 95% CI: 0.72–0.90). Conclusions Statins, both lipophilic and hydrophobic, were associated with a lower risk of BTCs, particularly CCA and GBC.

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Parasites of the liver – epidemiology, diagnosis and clinical management in the European context

Cited by 42 publications

References 135 publications

Echinococcus multilocularis specific antibody, systemic cytokine, and chemokine levels, as well as antigen-specific cellular responses in patients with progressive, stable, and cured alveolar echinococcosis: A 10-year follow-up

Echinococcus multilocularis specific antibody, systemic cytokine, and chemokine levels, as well as antigen-specific cellular responses in patients with progressive, stable, and cured alveolar echinococcosis: A 10-year follow-up

Alveolar Echinococcosis—A Challenging Task for the Hepatobiliary Surgeon

Statins associate with lower risk of biliary tract cancers: A systematic review and meta‐analysis

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