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Cystic echinococcosis in a child infected with HIV

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Echinococcosis is a parasitic disease caused by the tapeworm Echinococcus granulosus. Echinococcus infection is possible at any age, including childhood. Most of the cases are recognized accidentally. HIV infection in children is rarely diagnosed in Poland. A currently 16-year-old girl was diagnosed with HIV vertical infection at the age of 13. Antiretroviral therapy was started after 6 months of observation. Routine ultrasound examination of her abdomen revealed a cystic lesion in the liver. The IgG ELISA test for E. granulosus infection was negative. However, she was treated with albendazole due to clinical suspicion of echinococcosis. After anti-parasitic treatment, an abdominal ultrasonography (US) and computed tomography (CT) scans were performed and revealed progression of the lesion (one year of observation). As an additional imaging study, biliary tract scintigraphy was done. Localization of the cyst allowed its surgical removal. The surgery was performed under pharmacological protection with albendazole. Histopathology examination confirmed the diagnosis of echinococcosis.Currently, the clinical condition of the patient is good, antiretroviral treatment is effective and repeated abdominal ultrasound is unremarkable. E. granulosus infection in children is rare and may be accompanied by other diseases and infections. Diagnosis is difficult and it is often based on the clinical picture without serological confirmation. Surgical treatment should be supplemented with pharmacological treatment.
Cystic echinococcosis is a zoonotic disease with a cosmopolital distribution. It is caused by the larval stages (metacestodes) of the parasite Echinococcus granulosus which infects different animal species. In this report, we present a case of E. granulosus infection in a mule and molecular characterization of the cyst. For this purpose parasite material was collected from the liver of a necropsied mule. DNA was isolated and PCR amplification of mitochondrial 12S rRNA as well as partial sequencing of mitochondrial cytochrome c oxidase subunit 1 (mt-CO1) genes were performed. Six unilocular cysts, filled with clear fluid were found in the liver and spleen. All cysts were found to be fertile. The 12S rRNA-PCR did not yield any band while mt-CO1-PCR yielded a 446 bp sized amplification product. Sequence corresponding to mt-CO1 gene was identical to a sequence reported for E. equinus (formerly G4) (Genbank accession number: KC953029). This is the first record of E. equinus as a cause of cystic echinococcosis in a mule in Turkey.
Human cystic echinococcosis (CE), caused by Echinococcus granulosus, is one of the most important and widespread parasitic zoonoses. As one of the problems that can be encountered after treating CE patients is the risk of postsurgical relapses or treatment failure, a long-term clinical and serological follow-up is required to evaluate the success and failure of therapy. Therefore, the aim of the present study was to identify the best diagnostic and prognostic ELISA markers in patients with CE. The cohort comprised 50 patients with symptomatic CE treated with antihelminthic drugs and surgery, who were followed up clinically and radiologically for a mean of 6 years (range 4–8 years). The results clearly indicate that the hydatid specific antibodies of IgE, IgG1 and IgG4 are the most important antibodies for the serological diagnosis of cystic echinococcosis during the active stage of the disease. None of the serum samples from healthy controls gave a non-specific reaction with IgE, IgG1 or IgG4, and a considerably reduced cross-reaction was observed with these antibodies. During post-operative follow-up, the IgM, IgE, IgG1, IgG2 and IgG4 antibody response provided the best correlate of disease activity. The detection of total IgG and IgG3 subclass antibody response for the assessment of post-treatment disease activity among CE patients was insensitive. All patients responded to treatment except 2 women (32 and 36 years old), in whom multiple cysts (12 and 7 cysts) were detected in the liver and lung two years after the first operation. Hence, it can be concluded that the CE-specific antibodies of IgE, IgG1 and IgG4 are the best immunological markers for diagnosis and prognosis of CE patients.
Cystic echinococcosis (CE), caused by the parasite Echinococcus granulosus, is a prominent disease in Lebanon. The objectives of this study were to determine HLA allele-CE association in patients, and relate its presence to high anti-Echinococcus antibody titers and the presence of circulating immune complexes (CIC). Thirty patients and 20 controls were included. HLA profiles were determined by DNA-SSP typing. Relative risk and P-values were determined for each allele using Statcalc (EpiInfo, Version 6). Linkage disequilibrium was determined for associated alleles using SPSS 12.0 for Windows. Antibody titers were determined by indirect hemagglutination (IHA) and CIC by polyethylene glycol (PEG) precipitation. HLA-B*14 and HLA-DRB1*01 appeared to associate with protection against CE (P1 = P2 = 0.007 and P1 = P2 = 0.0007, respectively). However, it appeared that linkage disequilibrium did not exist between these 2 alleles (P = 0.250). HLA-B*35 was found to associate with susceptibility to disease (RR = 1.70, P = 0.02). Twenty five patients had anti-Echinococcus antibodies and 9 patients had CICs. However, there did not appear to be a correlation between the presence of HLA-B*35 and high antibody titers, or the presence of CICs. In conclusion, 2 HLA alleles that associate with resistance and 1 that associates with susceptibility to E. granulosus infection have been identified. The joint pain reported by some of the patients might be attributed to CIC deposits.
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