Atypical polycystic echinococcosis without liver involvement in Brazilian patients

Abstract

Echinococcus vogeli is known to occur in the neotropics, causing polycystic echinococcosis (PE) in humans. The liver and lungs are the most commonly affected organs. In this paper, we report six cases of human PE in the mesenteries without primary liver involvement. All patients, four males and two females (median age 34 years; range 20-48 years), lived in a forested area (Acre, Brazil). Physical examination revealed abdominal masses. The patients were evaluated by abdominal CT scan, exploratory laparotomy and serology by immunoblot assay. CT scans revealed multiple and cystic lesions with calcified edges in the mesenteric segments. During exploratory laparotomy, polycystic lesions were excised from omentum, mesentery, pancreas and inferior vena cava. Positive serology identified 21 and 31 kDa subunits. We recommend that PE should be investigated in patients from tropical forests in northern Brazil exhibiting abdominal masses with no clearly defined diagnosis.

Historical Aspects of Echinococcosis

“…By Mar. 2007, in 12 Latin American countries, 172 human cases of neotropical echinococcosis had been recorded (D'Alessandro and Rausch 2008), and at least eight further cases were reported thereafter (Siqueira et al, 2007(Siqueira et al, , 2010Knapp et al, 2009b). Most of the cases were caused by E. vogeli (for details see reviews by D'Alessandro and Rausch, 2008).…”

Morphometric characteristics of the metacestode Echinococcus vogeli Rausch & Bernstein, 1972 in human infections from the northern region of Brazil

“…Zoonotic larval cestode infections were recently classified among the neglected tropical diseases (Budke et al , 2009; WHO, 2012). While human echinococcosis caused by E. granulosus is a serious life-threatening disease worldwide, polycystic echinococcosis (PE) caused by E. vogeli is an emergent zoonosis of great public health significance in the humid and tropical rainforests of South and Central America (D'Alessandro & Rausch, 2008; Siqueira et al , 2010). Furthermore, the number of diagnosed cases of human PE may represent only the tip of the iceberg (D'Alessandro & Rausch, 2008).…”

“…Echincoccus vogeli is considered to be the most pathogenic species, responsible for a total of 179 reported human cases in the past four decades (Knapp et al , 2009; Siqueira et al , 2010; Zegarra et al , 2010). Echinococcus vogeli is transmitted between canines, such as bush dogs ( Speothos venaticus ) and domestic dogs ( Canis familiaris ), that harbour the adult tapeworm, and rodents, such as the Agouti paca , that harbour E. vogeli during the larval cestode stage (D'Alessandro & Rausch, 2008).…”

Histopathological findings of an uncommon co-infection: Echinococcus vogeli, HIV, hepatitis C virus, and hepatitis B virus

“…1 In the last four decades, a total of 178 cases have been reported, in which the liver and mesentery were most often affected. 2 Hepatitis C virus (HCV) and hepatitis B virus (HBV) have become increasingly common among people living with HIV worldwide, and they strongly increase the risk of liver injury in this population. 3 Relatively little is known about how a concomitant parasitic co-infection may impact host tissues, especially if they share the same target organ.…”